Veterinary Criticalist

February 2017 Patient of the Month

Pilot's Story

January 13 2016 is a day that I will never forget, that was the day my boy was diagnosed with Immune Mediated Hemolytic Anemia-IMHA. When your dog has IMHA, it means his immune system destroys its own red blood cells. Your dog’s body still produces red blood cells in the bone marrow to replace the destroyed cells, but, once they are released the immune system mistakenly recognizes them as something foreign. Pilot is a 3 year old Schipperke male who came into my life on October 19th 2013. I show dogs and I waited a very long time, years in fact, to get a dog as special as he is. He was the most confident dog I have ever seen and I knew he was going to be a top show dog, he loves everyone he meets and everyone who meets him loves him, a dream come true but that was not to be. He rose to the top in a very short time, finished his championship in record speed before his first birthday, on his way to becoming a grand champion. I had HUGE goals for him and he certainly was the dog to do it all. But I noticed that he was starting to fade just after his second birthday, he would what I call pass out with exertion lost interest in eating and developed bloody stool. I rushed him to Stack Vet Hospital to see what was wrong they took a blood sample and said they would get back to me with results the next day.

Well I got the call from Dr. Stack and he asked me if I could come up that day to review the results, I knew right then and there it was not good. I called my husband Spencer and we met at home to take our boy for results. I was told that Pilot had IMHA and it was a life threatening illness, a normal RBC is 45 and above, he was at 15.5. We were in total shock, I had never heard of this disease. They started him on Prednisone which is the first line of treatment. A follow up appointment was made for the following week for a RBC count. I went home to do my research on this illness. I contacted some of my show friends and no one really knew or had seen this before.

When we went for his follow up appointment it was snowing and blowing out. Pilots RBC count was now 7.5! Dr. Stack said to me Pilot needs a blood transfusion or he will die. I chose to take him to the Emergency Room at the Veterinary Medical Center (VMC) and the arrangements were made.

Well, the staff at VMC were just incredible! I was an emotional wreck thinking the worst and in shock myself. I was treated with such compassion and a better knowledge of what was wrong with my dog. I left knowing he was in good hands. They kept in contact with me throughout the night and his RBC count went up to 19. He was hospitalized for two days and transferred to the Critical Care Service. I was told how serious this was that some dogs do well but it is a long battle, our goal is to get Pilot into remission.

Pilot still has a long way to go and is going to need frequent visits with the Internal Medicine Service at the VMC. The Internal Medicine Service is the greatest “team” ever to care for him. My husband, Pilot and I would like to personally thank Dr. Heather White, Dr. Cortright, Kim (vet tech) and Toby (vet tech), and Tracie receptionist who just love my boy, hard not to since he is very special. I can honestly say my dog would not be here if it weren’t for the love and devotion they have for him and for the emotional support they have given my husband and I. As long as Pilot is willing to fight so are we!!!

Thanks so much to everyone who has been there for Pilot!!!

Spencer, Sandi and Pilot Lovelace…

Izzy's Story

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Izzy was referred to the Veterinary Medical Center of Central New York by her family veterinarian.  Izzy, a 3 year old otherwise healthy Yorkshire Terrier, had collapsed and was non-responsive by the time she arrived at her family veterinarian.   She was not breathing well, and her veterinarian quickly responded by placing a breathing tube and beginning assisted breathing with an ambu-bag.  Izzy’s heart rate was abnormally fast, and so IV fluids were also administered.  Because her family veterinarian knew Izzy needed specialty care, she was transferred to the Critical Care Service at the Veterinary Medical Center of CNY.  Izzy’s owners drove her here (an approximately 45 minute drive) with a tube in her airway.  Izzy was comatose and they were not sure that she would even survive the drive.

On arrival to the Veterinary Medical Center’s Critical Care Service, Izzy was immediately rushed to the ICU for evaluation and treatment.  She remained in a coma, with a fast heart rate and low blood pressure.  Her oxygen level was low, so she was given supplemental oxygen while a technician gave her breaths through an ambu-bag.  Tests were performed immediately while additional treatments were provided in order to improve Izzy’s condition.  An EKG showed a fast heart rate.  Blood pressure and oxygen levels were low.  Emergency blood work showed a low red blood cell level as well as a low protein level.  Izzy continued to receive IV fluids while her parameters were continuously monitored.  During this time a large swelling was noted on Izzy’s neck.  Further inspection of this swelling showed it was due to bleeding under the skin.  Izzy had also bled heavily from her IV catheter sites.  An ultrasound showed she was bleeding around her lungs, causing her lungs and airways to collapse.  This was deemed the cause of her difficulty breathing.

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Based on these findings she was immediately screened for anticoagulant rat poison toxicity, a toxin which causes life-threatening internal and external bleeding.  Her test results were highly suggestive of rat poison toxicity.  Izzy’s owners were informed of this and realized that there had been the potential for exposure to rat poison a few days prior to this incident.   Izzy immediately received treatment for this condition, which included a red blood cell transfusion, a plasma transfusion and Vitamin K injection.  She continued to be continuously monitored while a Critical Care specialist and a team of licensed veterinary technicians stood constantly by her side.  Over the next hour Izzy became responsive and able to breathe well on her own.  The breathing tube was removed, and her heart rate and blood pressure normalized.  Within 2 hours of treatment Izzy was up and going outside for walks!

Izzy remained hospitalized in the ICU for 48 hours to be closely monitored and receive supportive care.  During this time she made a steady recovery.   For the first 24 hours she remained in an oxygen cage to help support her breathing. Her heart rate, breathing rate, temperature, blood pressure and EKG were closely monitored.  Recheck blood work was performed to monitor her for internal bleeding.  She was eating and drinking well, and she was bright and alert (especially when her family came by for visits!).  Izzy was discharged 48 hours after presenting to the Veterinary Medical Center.  She was sent home with a 4 week course of treatment with Vitamin K.  A recheck evaluation performed 1 month later showed that Izzy made a complete recover and no further treatment was necessary.

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Recently the Veterinary Medical Center received these pictures of Izzy running through her yard, happy and healthy.  We are so grateful that Izzy has made a full recovery, and we wish her all the best!  Izzy is a very special patient of the CriticalCare Service, and she will never be forgotten!

So what made Izzy’s case so successful?  Not only did Izzy receive immediate care and treatment by her primary care veterinarian, but Izzy’s transfer to the Veterinary Medical Center (VMC) was an important step in her treatment.  At the VMC Izzy was directly cared for by board-certified specialists in Emergency and Critical Care.  The VMC is the only private hospital in central New York to have not only one, but two full-time Emergency and Critical Care Specialists, Dr. Maureen Luschini and Dr. Elise Craft.  Please refer to "What is Veterinary Critical Care"  or our website for more information.

Thanks to our Medical Director, Dr. Maureen Luschini, for summarizing Izzy's case for this post and some very special thanks to Izzy's family for allowing us to share her story!

What is Veterinary Critical Care?

The Veterinary Medical Center of CNY is the only private hospital in Central New York to have not only one, but two, full-time Emergency and Critical Care Specialists.

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The following information provided by the American College of Veterinary Emergency and Critical Care helps address many questions pet owners have about veterinary Emergency and Critical Care specialists (information obtained from http://acvecc.org/): What is a specialist in Veterinary Emergency and Critical Care? A specialist in emergency and critical care is a specially trained veterinarian who is dedicated to treating life-threatening conditions. Yes, they do have additional training! They must first be a graduate of a recognized veterinary school, then receive a minimum (or equivalent) of 3 additional years of intense training in emergency, surgery and critical care through completion of an American College of Veterinary Emergency and Critical Care (ACVECC)-approved training program. This intense program is referred to as a “residency” in emergency and critical care and focuses on the most up-to-date techniques for diagnosis and treatment of life-threatening disease processes in an emergency, and for the critical time while the animal is recovering. The emergency and critical care residency is supervised by mentors who have been through similar training programs and are themselves board-certified Diplomates of the American College of Veterinary Emergency and Critical Care (DACVECC).

Once the veterinarian has completed these years of specialty residency training, the individual must then pass a tough board -certification examination given by the ACVECC. Upon successful completion of the training and passing of the examination, the veterinarian is a Diplomate of the ACVECC, is termed a “specialist”, and is board-certified in veterinary emergency and critical care.

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How do I know if a veterinarian is a specialist in emergency and critical care? There are several ways for you to find an ACVECC Diplomate in your area. First, you may consult the ACVECC web site (http://acvecc.org/), where Diplomates are listed according to geographical location. Second, you may ask your veterinarian if the emergency practice in your area is led by a veterinarian that is an ACVECC Diplomate. Third, if your veterinarian refers your pet to a specialty practice for non-routine surgery, medical care or diagnostics, you can inquire whether there is an ICU with a life support team headed by a specialist in emergency and critical care, should your pet require intensive care and life support.

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How can I find a specialist in veterinary emergency and critical care for my pet? First, ask your veterinarian. Any pet that is seriously ill might benefit from this type of care. Animals that have sustained trauma or bite wounds are an obvious example, but a number of other problems are commonly treated. The following is a sampling of the type of patients that routinely benefit from care by an ACVECC Diplomate: • Trauma patients, including those hit by cars, bite, bullet, knife or burn injuries • Any animal that is having trouble breathing • Animals that need a blood transfusion • Any patient that is in shock (signs of shock can include weakness, pale mucous membranes in their mouth, cold extremities, and an abnormal heart rate) • Animals that are having trouble urinating, or are not producing urine • Dogs and cats that need specialized nutritional support because they are unwilling or unable to eat on their own • Animals in which an abnormal heart rhythm is causing problems • Animals with life-threatening neurologic disease such as coma or severe seizures that are not responding to medications • Patients that have had surgery and are not recovering well from anesthesia or are having trouble in the first few post-operative days