Thursday, January 14, 2010

Mystery and intrigue

Last Tuesday, an owner called and stated that her dog was having seizures, and she was bringing her in.

When the dog came in, the owner was cradling her in his arms, and the dog was trembling terribly. I rushed to get the Valium while my technician gathered information on the case.

The history: no seizures in the past, normal up until that night. Then the dog went outside to use the bathroom. The owners didn't accompany her to the yard, as it was raining. She was outside for a few minutes, came back inside, and started to "seizure."

The "seizuring" had contiued unabated since then. On presentation, the patient's temperature was 108 degrees. Valium did nothing to help control the "seizures." It was only after the first dose that I realized that my patient wasn't seizuring. She was having terrible, generalized muscle tremoring. The difference was obvious once I really looked at my patient. She was aware of us, attempting to look around, but she couldn't walk due to the tremoring.

I discussed with the owner that I strongly suspected a toxin of some sort. I grilled them about anything she could have gotten into ... moldy food being my biggest concern. The owners were adamant that they knew of nothing.

They went home and left the patient in my care. Over the course of the night, I couldn't get the tremoring under control. I resorted to general anesthesia with propofol (yes, the drug that killed MJ). Strongly suspecting toxin, I also pumped her stomach (gastric lavage) and then gave her activated charcoal. That's the black stuff in the drain. It coats the stomach and prevents further absorption of ingesta. What came out of the tube looked and smelled exactly like moldy food.

It was around that time that the owner called me back and confessed that her boyfriend had thrown a great deal of moldy food from their fridge into the backyard. Moldy chicken noodle soup, bread, and cheese. They also noted that when the dog came back in the house, it came from the side of the house where the moldy food had been thrown. The tremoring started 30 minutes later, consistent with mycotoxin ingestion. Mycotoxins are mold species that grow on food and can cause severe tremoring in dogs.

Unfortunately, this dog was severely affected, and the owners lacked the funds to treat for the required 2-4 days. She was euthanized later that day at her veterinarian's office.

This case offered an important lesson: what the owner perceives to be occurring and what is actually occurring are not necessarily the same thing. When the dog was presented, I heard what the owners said: seizure and treated accordingly. It was only after assessing my patient that I realized my error. I wish it had made a difference in the outcome for my patient, but sadly, it did not.


Nicki said...

I totally agree with what you observed, don't assume the owner knows what is going on. I can't tell you how many times someone calls about a "broken leg"-almost never is it broken. Too bad for the dog though, totally preventable=total shame.

Anonymous said...

As a side note, I think it is important to consider the feelings of owners re: posting pictures of patients being treated in hospital, especially patients who have been euthanized. Imagine how the owners of this dog would feel if they came across this blog and saw these pictures.