Saturday, February 28, 2009

Goodbye to Charlie

I am very saddened to report that Charlie has passed away. He went peacefully and after a long fight; he is in a better place. I commend the entire hospital staff who worked tirelessly to ensure that he had the best possible care and every chance to survive this tragic ordeal. There is often death in veterinary medicine, and while you never get used to it you do learn to accept it. However, in cases like this where a sweet patient has a horrible disease that does not respond to treatment, it just breaks my heart. Goodbye Charlie, we will see you at the Rainbow Bridge.

Friday, February 27, 2009

Charlie - Day 6

Charlie remains in critical condition today. Thursday morning we were hopeful as he ate well but by the afternoon his seizures had worsened from focal facial seizures to more generalized, full body seizures. He responded initially to Valium which is used as an anti-convulsant, but soon after the seizures returned. We have tried the remaining anti-convulsant medication available with no success. His seizures have been waxing and waning in severity. Overnight and this morning he has been able to get some rest which is promising. In addition to his neurologic signs he is also having difficulty oxygenating his blood due to the severe damage to his lungs. To help with this he is in an oxygen tent and has a direct supply of nasal oxygen via a tube in his nose. We were able to place a feeding tube this morning which will help support his nutrition needs. Other than Thursday morning he has not eaten since the fire. The plan remains the same, aggressive supportive care and time.

We understand that Charlie's owner has been discharged from the hospital today and is planning to visit. We hope that contact with his owner will help Charlie keep fighting.

Thursday, February 26, 2009

Charlie's Story

We have a heart-wrenching and very critical case in the hospital right now. Charlie is a one-year-old miniature pinscher that was caught in an apartment fire early Sunday morning. He and his owner awoke to a smoke-filled apartment after their stove exploded. Though it was difficult for her to breathe, Charlie’s owner saved her dog and herself by kicking out the air-conditioning window unit and jumping three stories to the ground--with Charlie in her arms.

DC Animal Control brought Charlie to Friendship for emergency care. When we first examined him, he was having difficulty breathing and could not open his eyes. Chest X-rays revealed severe damage from smoke inhalation. In addition, Charlie’s corneas were damaged by heat and exposure to smoke. We placed him in an oxygen tent and started aggressive supportive care.

Meanwhile, emergency medics rushed Charlie’s owner to a nearby human hospital, where she was placed in an induced coma so doctors could address her multiple pelvic fractures. Not surprisingly, her lungs severely damaged from smoke inhalation.

Here at Friendship, we are all in awe of how this heroic woman saved her dog. When we learned that she had recently been laid off from her job, and that she would not be able to afford Charlie’s extensive veterinary bills, we found a way to help: We turned to Friendship’s Brudder Sullivan Fund, which will now cover the cost for the majority of Charlie’s care.

Earlier this week, Charlie seemed to be improving: he was alert, responsive, and breathing more comfortably. On Wednesday morning, however, he took a drastic turn for the worse, developing blindness and seizures. These symptoms are consistent with Delayed Neurologic Sequela, a term used in human medicine for a condition that has been seen to occur 3 to 200 days after severe smoke inhalation. Human doctors do not know if it is caused by lack of oxygen to the brain, carbon monoxide or cyanide toxicity. Prognosis for recovery is 50/50.

We are doing our best but all we can do now is hope that Charlie will pull through this. He is receiving constant, 24-hour care from Friendship’s amazing technicians and his doctor - Hannah Minch - has been at his side constantly. As of Thursday morning he ate for the first time since the accident, which is promising. He is receiving medications to control his seizures as well as pain medication, antibiotics, fluid, and oxygen therapy. Charlie is a brave little dog in very serious condition. I will be posting daily updates on his progress, so please check the page often.


Please check back in Thursday afternoon for Charlie's full story and update, in the meantime you can see ABC's coverage at:

Tuesday, February 24, 2009

The Mysterious Indy

One Sunday afternoon this summer I was called in to perform an emergency surgery on Indy, a three-year-old Rhodesian Ridgeback. He had been vomiting, not eating and acting very lethargic for a few days. At presentation he was very painful in his abdomen and febrile; we were concerned with a foreign body that was lodged in his intestinal tract. Initial blood work and X-rays were what we call unremarkable, meaning that they didn’t show any obvious abnormalities. Still, despite aggressive supportive care for 24 hours Indy did not improve.

Indy’s owner elected to perform an abdominal exploratory surgery with the understanding that we might not find anything. Indy was prepped for surgery and I entered the abdomen. The first thing I noticed was that his liver had a laceration that I could not explain. (Given that he is a very deep-chested dog there was little chance that I caused the laceration when I cut into his abdomen.) I examined all of Indy’s abdominal organs and did not find any foreign material or abnormalities. When this occurs we take samples of everything and submit it to a pathologist for review.

Indy recovered well from surgery and went home a few days later. His owner called to report that though he had done well initially, once again Indy was not acting like himself. We managed his post-operative pain and treated the diarrhea that had developed with oral antibiotics. Still, Indy was not himself so his owner brought him in for a follow-up exam. During this visit, I saw that his back seemed sore and we decided to try another course of pain medication and rest. He continued to have soft stool despite treatment with antibiotics, so we prescribed an additional antibiotics as well as a de-worming medication. The biopsies that were submitted after his surgery were unremarkable and did not give us an answer as to what was going on with Indy.

In September, a little over a month after the surgery Indy came back in for a mass that developed on the side of his chest. At first a needle aspirate revealed a benign mass called a lipoma but over the next four months it developed into an abscess. We cultured the wound and started treatment with a broad spectrum antibiotic. During the months of November and December the wound responded slowly to antibiotics and warm compresses. But in the beginning of January it became very large again and developed a draining tract.

At this point we decided to perform surgery to remove the mass in case it might be cancerous. Dr. Begnoche performed the surgery and we were all very surprised with what she found. From the center of the abscess she removed a large toothpick, the kind that is usually seen holding a sandwich together!

Our best guess is that Indy ate the toothpick, presumably while it was still in the sandwich, and it migrated through his stomach, diaphragm, and chest wall, ending up trapped under his skin. This explains the odd laceration I found in his liver at surgery and why he never seemed quite right since his initial presentation in July.

I am happy to report that Indy is now doing great and has made a complete recovery. For me, this served as a reminder that owners know their pets best and if they feel something is off, it usually is. Indy’s owner was incredibly dedicated to the extensive nursing care he required at home for many months. Indy’s story is yet another example of the amazing things that can happen at Friendship with our talented, highly skilled doctors, a wonderful owner and a very brave dog.

Tuesday, February 17, 2009

Naughty Bailey!

On a Friday morning Bailey a four year old Bernese mountain dog (one of my favorite breeds) presented to me on emergency after collapsing on his morning walk. His owners report he had been lethargic the night before and didn’t want to eat dinner. While on the walk he became weak and collapsed, after resting for a few minutes he tried to get up again but collapsed a few yards later. His physical exam was fairly unremarkable with the exception of an extremely elevated heart rate. I was initially concerned the weakness was from anemia due to a bleeding tumor in his spleen or an immune-mediated disease that was attacking his read blood cells. We admitted Bailey for supportive care and initial diagnostics. Radiographs of his chest and abdomen were taken immediately and did not show any abnormalities. Now I just had to wait for the blood work which I would have back in an hour and monitor his clinical signs.

Bailey’s owners called when they arrived home to let us know that he had chewed up an albuterol asthma inhaler and could this be the cause? I called ASPCA poison control to speak with a veterinary toxicologist and confirm that all of his clinical signs could be explained by albuterol toxicity. This medication is used in asthmatic people and animals to dilate airways making it easier to breath. Signs of toxicity include increased heart rate, electrolyte abnormalities, high blood pressure, fever, vomiting and hyper-excitability.

We had to administer a medication to help slow down Bailey’s heart but since his heart had been beating so fast for almost 24 hours if we gave the medication too fast he could go into cardiac arrest and die. We carefully gave the medication and monitored his heart rate constantly, happily everything went as planned. Overnight he was kept on intravenous fluids to correct the electrolyte abnormalities that had occurred and his heart rate was monitored every hour. By the next morning he was eating again and ready to go home.

Bailey’s story is important in that at Friendship we often see cats and dogs get into medications, prescribed to them or their owners. Bailey was lucky in that his owners knew what he got into so we were able to treat quickly and aggressively, often this is not the case. Be sure to keep all medications closed in a drawer or cabinet. If your pet does get into something either call ASPCA Poison Control or bring them in on emergency immediately.

Thursday, February 5, 2009


Friendship is one of the few veterinary hospitals in the area qualified to offer an internship program for recent veterinary school graduates. It makes huge contributions to our patient care and to those fortunate veterinarians participating in the program. Internships are highly competitive. Only the most talented and motivated of new graduates seek advanced clinical training. Friendship accepts only about one out of every five applicants to its internship program. We are proud of our program and I consider myself lucky to have completed it.

Unlike medical doctors--who are required to do an internship plus a residency before beginning to practice--most veterinarians enter general practice immediately after graduation and begin practicing medicine. Alternatively, a new graduate can apply for a position in an elective, year-long program of post graduate clinical training, working side-by-side with senior veterinarians with years of experience. These programs are provided by veterinary colleges or busy, multi-doctor hospitals like Friendship.

For the fortunate graduates who are accepted, this is an exciting opportunity to obtain an enormous amount of clinical experience while also being mentored by more senior veterinarians. These programs are completely optional and very demanding. At Friendship, our interns work grueling hours and commit an entire year of their lives so that they can become even better doctors. Some go on to complete residencies in the specialty of their choice, while others, like myself, enter general practice.

From time to time, I have heard pet owners say, "I don't want an intern working on my pet." My response is: Our interns are the best of the new vet school graduates. Not only have they just spent four years learning the latest advances in veterinary medicine from specialists at their respective schools, but they benefit from the fulltime mentoring of Friendship’s highly experienced senior veterinarians.

So let’s give a hand to these doctors for their enthusiasm, dedication to veterinary medicine, willingness to learn from their colleagues, and their desire to be the best veterinarian they can be. To learn more about our current inters please visit the Friendship Hospital for Animals website.

Wednesday, February 4, 2009

Shelter Friends of the Week

Each week I will be posting stories about dogs and cats who are up for adoption in an effort to create awareness about all of the amazing animals that are living in shelters just waiting to meet you. If you are interested in one of our featured pets or any of the wonderful dogs and cats in need of a new home please contact Washington Humane Society (WHS) or Washington Animal Rescue League (WARL) directly.

Jake is a 1-year-old Australian Shepherd mix whose previous owner didn't have time to care for a high-maintenance breed like an Aussie. Jake is a friendly, intelligent dog who needs a home with someone who will provide him with plenty of daily exercise and a "job", such as obedience training or dog sports (like Agility, for example). He gets along with other dogs and may even be able to share his home with a confident cat. Jake is an excellent match for an active person or family who would like an intelligent dog eager to learn and work. He'll provide you with plenty of love and snuggles in return. Jake is a medium-sized dog, full grown at about 35 pounds. WHS

Pete (7050553) is an incredibly handsome 1 year old boy who was found wandering in the 7300 block of Georgia Ave. NW. A local woman found him on her way to work and didn't want him to freeze! Pete is a very friendly, loving little guy who loves to be petted and held once he gets to know you. He's at the age where playtime is still very important but so is snuggletime! WHS

Tuesday, February 3, 2009

Advanced Veterinary Dentistry and Oral Surgery

At Friendship we do routine dental cleaning, have advanced imaging with digital radiography and perform extractions if necessary. Sometimes more advanced techniques such as a root canal, complicated jaw fracture or aggressive surgical excision of oral cancer are required. For this we usually refer outside of the hospital to any of the veterinary dentistry specialists.

Unfortunately, I have personal experience with aggressive oral surgery, because my dog Westin was diagnosed with oral melanoma in April 2008. In my opinion, Dr. Mark Smith and Dr. Kendall Taney at the Center for Veterinary Dentistry and Oral Surgery are gods in the world of veterinary dentistry. Not only were they sympathetic and caring but the surgery they performed on Westin was amazing. The type of tumor she had required wide surgical margins to make sure all of the cells were removed and given the location there was not a lot of extra tissue in the mouth to work with. Performing cutting edge techniques, they excised the entire tumor while barely leaving a scar. I cannot thank them enough for helping me with Westin and, when necessary, I send my clients to them with the utmost confidence in their abilities.

Pictured above are the photos of Westin after surgery. You can barely see the incision on her muzzle. Amazing!