On again, Off again

Saturday I saw a dog who had eaten a bunch of pillow stuffing the previous Sunday.  Throughout the week, his appetite and came and gone, as well as some intermittent vomiting.  But Friday night he refused to eat, then vomited a lot overnight.  So Saturday his concerned owners brought him to me.

I took some abdominal Xrays, and saw what I expected: a very full stomach, empty gassey intestines.  For the stomach to be full in a dog that had not eaten in 24 hours, I knew something was amiss.  I diagnosed a gastric obstruction - much better overall than an intestinal obstruction, but still, a surgical problem.  I told the staff to prepare for a surgery.

The owners asked me if it was still in the stomach, could it be removed endoscopically?  Clearly, this would be preferable to an open abdomen.  There would be fewer complications and a faster recovery. But we don't have an endoscope, so I called our referral surgical center.

"Yes!  We can do that procedure!  Are they coming soon?" was their first response.  Then I got a call back requesting the Xrays.  Since I can send them digitally, they soon called me again.  "You know, with something fibrous like stuffing, and with the way those Xrays look, I think we'll work on this patient for 3 hours, pulling little bits up, then send them to surgery anyway.  It will be much longer and more expensive than surgery alone."  The owners understood, and asked if instead we would do the surgery.  So we were back on.

I was excited about doing an exploratory gastrotomy, even if it was after close on a Saturday.  "Couldn't we just give this dog something to make it vomit up all the stuffing?" my technician asked.  "Silly Susan," I said, "He's been vomiting all week.  It's not coming up."

Our pre-anesthetic medication contains morphine, which makes a lot of patients vomit.  The dog urped up a little stuffing.  "Oh, well, I guess now we know we're doing the right thing with surgery," I said.  Then he HEAVED about 4 times, bringing up a stomach sized amount of disgusting polyfoam stuffing.

We took another Xray, and sure enough, empty stomach.  I called the owners.  "Wow, you are fast!" she said. "No seriously, did we forget to sign something?"  When I told her about the very productive vomiting, she was very happy.  I sent the dog to the after hours emergency clinic for some monitoring, but he went home that evening, free from stuffing AND surgery.