A Sunday in the life of an out-of-hours vet

.30am. Arrive in the parking lot of the PDSA in Dunkirk Road … it’s a lovely clear autumn morning. I wave hello/goodbye to the PDSA ACA who is just finishing his overnight shift. I tuck my dog Abe into his usual kennel – he’s got a fresh knuckle bone from my favourite butcher to keep him amused today. It’s a bit of a boring life for him when I’m working long shifts but he gets out whenever someone has a little break. I change into scrubs, say good morning to the night shift and boil the kettle for a cup of tea all round. 8am. My shift officially starts. We’ve got a one-hour overlap with me and the night vet who is due to go home at 9am. 8.15am. First client arrives … an elderly lady had rung at 6am because her dog has developed bloody diarrhoea. Dog has had diarrhoea for three days but now there’s blood in it. The owner had to round up friends for transport so has come in at 8am with a very very cute five-year-old Jack Russell Terrier who is bouncing around the exam room but actually doesn’t ming being examined and gives me doggy kisses! My secret trick with little dogs is to sit down and put them on my lap. Faecal sample brought in by owner is mustard-brown soft faeces with blobs of bloody mucus around it. Dog has been routinely wormed. Let’s call it colitis, switch to metronidazole. 8.55am. Time to take a hand-over from night vet, Steph Brien. Fortunately I helped to admit all of the current in-patients yesterday so I already know the background: (1) 10- month-old Dachshund who was transferred for post-op care after gastrotomy and two enterotomies for removal of assorted foreign bodies; (2) 11-year-old German Shepherd that was in a house fire on Friday afternoon and is battling smoke inhalation; (3) four-year-old MN cat who has severe subcutaneous oedema;(4) five-year-old Boxer who is on fluids for haemorrhagic gastroenteritis. Spent about half an hour checking the in-patients and treatment plans. 9.50am. Next consult – one-year-old Labrador cross-bred who developed acute diarrhoea at 3am. He’s very quiet, not his usual Labrador self. IV fluids, basic labs plus abdominal rads to rule out GI foreign body… all clear, so he gets to sleep in a kennel all day. 10.05am. House call request for euthanasia on a collapsed 13-year-old dog … turns out she is eligible for PDSA treatment so she will bring the dog here. 10.35am. Another house call request for a 16-year-old dog who is urinating blood. Discussed options with them, they will think about it and ring back. 11am. 17-year-old cat arrives, has developed acute vestibular signs this morning, cannot stand up. Is already on meds for cardiac and renal disease. It might do all right with some supportive care for a few days but owners request euthanasia. 11.30am. Owners of the inpatient cat with subcutaneous oedema have arrived for discussion. Our workup shows proteinuria, hypoalbuminaemia, normal liver enzymes. Top differentials are protein-losing nephropathy, pyelonephritis, renal neoplasia. None of them easy to fix. Owner is an elderly lady on a budget. She elects euthanasia and I ask for permission to perform a post-mortem. Permission granted. 11.45am. House call request people phoned back – yes they would like a house call. Fortunately we have a second vet who started at 11am so the clinic can be covered if I go. I’ll take Liz with me, one of our current “cutting edge” trainees. 12.15pm. All packed for the house call. It’s a sunny Sunday and a nice day for a drive up the M1, at least. Thank goodness for sat nav. The 16-year-old dog has haematuria and is a bit dehydrated. Bladder seems a bit thickened on palpation but no masses are obvious. Will start him on antibiotics and recommend they take the dog and a urine sample to their own vet soon. 2.30pm. Arrived back at the clinic from house call. One of our vets is trying to pass a urinary catheter on a male cat that had been catheterised two days ago at its regular vet and is again straining to urinate. It’s a weird one – the cat had pulled out its first urinary catheter and the penis is now pointing dorsally instead of ventrally (Figure 1). We can only get a catheter in 5cm, to the level of the pubic bone. Contrast radiography doesn’t show a urethral tear and the contrast material does pass through into the bladder. We suture the catheter in as far as it will go and perform cystocentesis on the cat. Offered the owners immediate referral but they declined. 4.30pm. Smoke inhalation dog has been off oxygen for the last four hours. Is eating, drinking, looking good. Blood gases are unchanged from four hours ago – yay! She has superficial burns along her back (Figure 2) but it’s time to send her home – well, to their temporary home. She will rest better with her family. Instructed the owners re coupage … they are dedicated owners and I am confident they’ll get it done. I show them the black soot that is inside the nasal oxygen catheter (Figure 3) to get it across to them how much material is inside of her lungs. 5.30pm. Telephone call from owner of a dog who ate a bunch of acorns yesterday and now has diarrhoea. At least, they think he ate some acorns. Must have been a Labrador, acorns don’t taste very good! 6pm. Shift is officially over. Steph’s back on deck and is taking the consultations. But I’ve still got three cases to write up and a post-mortem to do. Wrote up notes on the dachshund: he’s been on a morphine/lidocaine/ ketamine infusion and we’ve finally got him to a dose where he’s pain-free and alert. I’m still suspicious of peritonitis but can’t prove it yet. Post-mortem exam on the cat with subcutaneous oedema: liver was grossly enlarged and slightly pale. Kidneys were moderately enlarged and pale (Figure 4), with pale tissue infiltrating about 50% of the cortex (Figure 5). I need to do some cytology on the tissue samples but I’m betting on renal lymphoma. 9pm. Out the door finally … me and the dog home to bed. Nothing died today that shouldn’t have. That makes it a good day.