Tuesday, July 15, 2014

Pale Gums Are An Emergency: Bailey's Story

by  Krista Magnifico, DVM

I met Bailey on a Tuesday evening appointment. She was brought in by her owners who were in their mid-twenties and full of smiles. They told me that they had just returned from their 2 week honeymoon..


Bailey was a big (like 100 pounds) fluffy, (which makes you look even bigger) 2 year old spayed female white Husky. Bailey’s parents had left the care of her and their other dog with their parents while they were honeymooning in sunny Mexico.

Their parents had called them and reported that “Bailey wasn’t acting quite herself.” 

Apparently everyone wrote this off as her just not used to being in a different house and missing her parents.

Later their parents called them back to report that “Bailey’s gums were pale.” 

Now as soon as this came out of their mouths I wanted to scream!

This is like telling me that you noticed that your child had had passed out, had a seizure and stopped breathing. I was waiting to hear that their parents had recognized the immense severity of this clinical sign and IMMEDIATELY brought her to the emergency clinic, but this never came.

I let them continue to tell me about her, from the perspective of their parents. They went on to tell me that Bailey had seemed to wax-and-wane the whole time they were away.

She wasn’t playing, or eating as well, then she would be a little better the next day and worse a day later. 

They also said that after their parents noted her pale gums they watched the gums very closely, and reported her gums were pale pink, then pale, then white, then got pale again.

I was writing all of this down as fast as I could, because it kept me from talking, and I was afraid my gasps and looks of horror might cause us to loose track, and Damn, I couldn’t really believe what I was hearing. After they told me about what their parents had observed I asked them what they had observed. I think that they had been pretty wrapped up in wedding plans, honeymoon plans, and each other to be too observant with Bailey. It was all very understandable. (FYI they told me that the wedding and honeymoon were fabulous!)

Bailey’s parents had just gotten back the day before and they too had realized that she just wasn’t right.

I started my examination of her. One of the things we have to “train” ourselves to do is understand what a “normal” gum color looks like in all of the different breeds of dogs.

There are some breeds of dogs with very dark gums, it can be hard to tell the color pink when your background is black. And then the white dogs can have a red, pink, or pale gum. It is definitely a learned assessment.

I looked at Bailey and she had what we call a “muddy pale” color. 

I did not like this at all. The second I see such a bad color I stand on alert and dig hard. There is NO way a pale mucous membrane dog is getting out my door without a lot of talking about my fears for their dog. AND just in case you aren’t getting my “I am really afraid” vibe yet, I will say for the record..

Every single dog with pale gums needs to be at the emergency room right now!

Further, if you or your dog or anyone else, ever has a seizure you must go to the emergency room ASAP!  My dad actually came home one day and found their dog having a seizure, what did he do? He got back in his car, and drove to my mom’s work, to tell her. He left the dog at their house. He got a lecture from me later. Now I understand we don’t always respond correctly in the event of an emergency, that’s why I write this blog, and talk to my clients a lot.

Bailey’s physical exam also revealed an increased heart and respiratory rate, and a palpable mass in her belly.

I discussed my exam findings with the owners. I wanted to do some blood work and take an x-ray. They told me they had a budget. I thought to myself, this was not the case to have a budget on.

The x-ray revealed an enlarged spleen, which had been what I suspected when I felt the mass in her belly, but thankfully no blood in her abdomen.

I ran a PCV (packed cell volume to get a red blood cell count), because by this point it was after 7 pm and I couldn’t keep her in the hospital alone, and they told me they couldn’t afford the few thousand dollars a transfer to the ER would likely cost.

Her PCV was 30, it is supposed to be mid 40’s. 

I told them I would have the blood work back in the morning and I wanted her back at the hospital by 9 am and left here for the day. I suspected that she would need her spleen taken out then, (splenectomy). They said “ok” left with a brochure for Care Credit. Care Credit is a credit card for those who need to pay for a medical procedure.

The next morning Bailey was dropped off with a large amount of trepidation from her parents who had been warned she would probably be having a surgery today, and a Care credit limit of $1500. Which we were pretty sure would cover her needs.

Dr. C looked at Bailey and to my surprise did not feel an abdominal mass. She did however see Bailey urinate.

The urine was bright orange. 

This is a big CLUE! I called Baileys owners immediately and told them our newest findings.

We were now concerned that maybe she had Immune-Mediated Hemolytic Anemia (IMHA).

Which made a little more sense, because Bailey was so young and splenic tumors are much more common in older dogs.

I wanted to give Bailey an ultrasound but this was going to cost $200. They couldn’t afford this. So I tried to cut a corner. Dr. C and I tried to do an ultrasound on Bailey. Neither one of us has had enough practice to be proficient at ultrasounds. I was fairly certain that there wasn’t a mass in her belly, but we don’t have eyes trained well enough to distinguish the finer details of a trained ultrasonographer. Because there wasn’t a mass on palpation, and we couldn’t see it on the ultrasound.

We defaulted to the IMHA diagnosis.

We started her on a steroid, and sent her home. I wanted to see her in 3 days to re-check her PCV and immediately if anything worsened or changed. They came in 3 days later and then 3 days after that. Bailey’s PCV never changed. Neither did her demeanor. I wasn’t settled we were right. The next Monday, 6 days later I begged them to come back and let the very very well trained ultrasonographer take a look at her. I told them we wouldn’t charge them for this.

As soon as the ultrasound probe hit Baileys belly the ultrasonographer said. “Splenic torsion! You have to cut this dog now!” 

I very quickly called the owners and braced them for surgery, again. I told them that if we didn’t remove her spleen she would die.

Bailey’s surgery happened a few minutes later.

Thankfully there were 2 other vets in the building. For a bad splenic surgery you need a few more hands in the belly. I have done probably 20 splenectomies in the last few years.

When I looked in Bailey’s belly I couldn’t believe what I was seeing.

Her entire spleen looked like it had been tied in knots. I couldn’t even recognize the surrounding organs. My heart sank. I had to look up, close my eyes, and take a few deep breaths. How was I going to break the news that she had an inoperable, beyond the worst thing I have ever seen the abdomen, and that she was certainly going to die soon, and shouldn’t even be woken up from this surgery? I just sank.

I asked Dr. E to help out. I needed another set of hands and eyes, and I damn well needed to be sure before I made that phone call. Dr. E scrubbed in and helped me lift out the tangled mess. She couldn’t believe what she was seeing either. That belly looked so bleak.

We looked at each other and I just said. “Let’s just start taking out what we know we need to, and let’s see what’s left.” “Okay,” she replied.

3 hours later, we had what used to be a spleen out and some completely unrecognizable structures that I think were really angry lymph nodes? Maybe? Without being able to explain it the stomach and kidney which were right up to, but not incorporated with the mass, were fine.

I closed her up, said a little prayer, and crossed my fingers. I called her parents and told them how lucky this girl was. And, how after seeing what was in her belly, how I couldn’t believe that she could walk, eat, live, not be screaming in pain, and how lucky we were that we did that ultrasound and did her surgery today.

Bailey walked out of the clinic the next day.

She was actually wagging her tail, and eating. It took a week for her PCV to get back to normal. But I swear that dog is a miracle.

As a parting thought I told Bailey’s parents to RUN to the emergency room if she ever hints at not feeling well, because that girl can mask the most horrific illness. Talk about stoic, that’s an understatement!

***

Krista Magnifico, DVM owns a small animal hospital in northern Maryland, where she practices everyday. She wants to make quality veterinary care available to everyone, everywhere at any time; trying to save the world 1 wet nose @ a time.  Her blog is a diary of he day-to-day life & the animals and people she meets. 

Dr. Krista is also the founder of pawbly.com, free pet advice and assistance.

To contact her, you may leave a comment on her blog, email her or catch her on Twitter or Facebook.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo


Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

9 comments

  1. What a lucky girl.... I never leave my poochies with anyone pther than the boarding at the shelter I was a vol at..they know what to watch for they know what is maybe a dog just pining or a dog that needs vet treatment...and they will ring and hubby and I would be on the next flight home all holidays forgotten..so glad Bailey had an insistent vet! ..Fozziemum

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    1. Scary stuff. Leaving a dog with one's parents would seem like a good choice. I think it is, but it's important to educate them what things would consist the need to see a vet immediately or as soon as possible.

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  2. Thank you for sharing this story. I would not have had any idea. Jana, I count on your blog to educate me in areas that I wouldn't even think to look into. Thank you.

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    1. A lot of really scary stuff can hide behind relatively subtle symptoms. Particularly when your dog is not "a complainer".

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    2. Quite a good share, educational and full of knowledge. I liked it very much.
      Lot's of stuff that dog owners generally overlook. Thanks for sharing this.

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  3. My dog is not a complainer either. So when he seems to be feeling down, I know he's probably feeling a lot worse than he's showing. I guess that's how most dogs are.

    Thank you to this vet for not charging the owners for the ultrasound. I know many pet owners are on a budget and are limited on what they can do. Thank goodness Bailey turned out OK.

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    1. Yes, in general dogs are good at hiding pain and physical discomfort. It is so important to see the signs.

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  4. Thank god! What a lucky dog! I've wonder a bit what kind of food does this dog eat? Does the food contributed to the disease?

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    1. No, food isn't know to contribute to this.

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