Voss: Is this an emergency?

This past weekend, I picked up a shift at the ER in Basalt to help provide coverage. Staffing veterinary hospitals is always a challenge in the Roaring Fork Valley and I try to help when my schedule allows. It also gives me a chance to return to emergency medicine, which is where I first fell in love with this field.

A day in the ER is as unpredictable as mountain weather. Some shifts are calm and orderly with sick cats and dogs somehow spacing out their emergencies in neat 30 to 60 minute intervals. Other days, eight critical cases arrive at once, each needing immediate attention from the doctor and support staff just to stabilize. And unlike human medicine, our patients can’t tell us what hurts, so we rely heavily on physical exams, diagnostics and pattern recognition to make fast decisions. “Controlled chaos” is how I usually describe these shifts.

In the Roaring Fork Valley, life often moves at a slower pace than it does in larger cities, and sometimes our hospital days do too. But with limited options for after-hours and emergency care, there are also times when you are the only open facility for miles. On those days, the pace can be relentless. 

This week, I wanted to address one of the most common questions I hear from pet guardians: Is this an emergency?

It is an especially important question in mountain communities where access to emergency and speciality care can be limited. In addition to general practice services like preventative care, routine surgery and chronic disease management, many veterinarians in smaller towns also provide urgent care and emergency support during business hours. For vets like myself with a background in emergency medicine, that is a role we’re happy to fill. 

One challenge in emergency medicine is that we are often meeting patients for the first time during a crisis. In those moments, pet guardians may not know the names of medications, have recent lab results on hand or have access to medical records. That can make it much harder to step into the middle of a complicated medical history and make the best decisions quickly. This is one reason it can be ideal to see your regular veterinarian for urgent concerns when possible, assuming they have the equipment and experience to manage the case. Your family veterinarian already knows your pet, their medical history and what is normal for them.

Still, it is not always obvious what needs immediate care, what can wait until Monday and what warrants a drive to a larger city for specialty treatment. Over the next few weeks, I’ll walk through some of the most common emergencies I see to help answer the question: Is this an emergency? 

One of the most time-sensitive emergencies in dogs is bloat, or gastric dilatation-volvulus (GDV). This is when the stomach becomes gas dilated and then rotates on itself, eventually compressing major blood vessels and sending the patient into circulatory shock. GDV is a true surgical emergency. The stomach must be decompressed to relieve pressure, followed by emergency surgery to untwist it and secure it into proper position. Without urgent surgery, GDV is fatal.

Some dogs are at higher risk than others. Deep-chested breeds (Great Danes, German Shepherds, Standard Poodles, etc.) are more predisposed, although there are also environmental risk factors. Unfortunately, development of GDV can be unpredictable. 

The classic clinical sign is repeated attempts to vomit with little or nothing produced (i.e. unproductive retching). Dogs may also appear restless, panting, anxious or painful. As shock progresses, they become weak and collapse. 

Time is of critical importance. If the stomach remains twisted for too long, its blood supply is cut off and the tissue can begin to die. If surgery is delayed too long, sometimes the stomach can’t be salvaged. This progression can happen within hours of the first onset of clinical signs. 

If your dog is showing any signs of bloat (especially if they are a deep-chested breed), this is not a “wait and see” situation. They need to be evaluated immediately at a vet hospital with access to radiography and surgery, if needed. If you have a high risk breed, there is a surgical procedure called a gastropexy that your vet can perform as a preventative measure against bloat.

Next week, we’ll cover a few more clinical signs that should never be ignored: respiratory distress and pale gums. 

Dr. Kelly Voss is a veterinarian at Aspen Animal Hospital, where she practices small animal medicine and surgery. She has a background in emergency and critical care and is passionate about bringing high-quality veterinary care to the mountains. Have a question for the column? Email her at dr.kellyvoss@gmail.com.