Veterinary offices everywhere are struggling to keep up with the demand of the needs of pets lately and some folks are having to wait a couple of weeks to months to get things addressed. This is causing excessive spill over into the Emergency Clinic world. Suddenly, a place that was designed for the super severe, complicated, or tragic cases that happen in the middle of the night are now clogged up with ear infections and dogs that have been limping for 2 hours. Then, they are getting horrible reviews and dragged through the mud on social media for owners having to wait 8 hours and having to pay hundreds of dollars more than they would at their regular vet (if they have one). People sometimes forget how much money it costs to keep a top tier facility like that open 24 hours a day and fully staffed to be able to drop everything and take your dog to surgery for a bleeding abdominal mass. They also forget that a non-emergency is going to continue to get bumped by the actual emergencies that may not live through the night. So, I decided to come up with a list of things that are absolutely not an emergency to save numerous angry owners from the long waits and heavy fees of going to a place that is currently doing CPR on a dying dog. Then, I will have a list of things that are absolute emergencies that some owners might wait a little too long to address which could lead to more money spent, but more importantly, a poorer outcome for your pet. Also, please read my previous post “5 ridiculously easy ways to avoid pet emergencies and BIG bills that your vet doesn’t want you to know… oh, wait.”
Things that often present as emergency, but are not.
- Ear infections. Yes, these can be painful and itchy, but save your trip to the ER. It can wait until regular business hours. Ear infections in dogs and (lesser) cats are not like infant/child ear infections in that they typically don’t cause fever and significant internal pain. The vast majority of ear infections in dogs and cats are external to the ear drum and therefore, not as serious. Most ear infections can be prevented with diligent observation of the dog’s ears every now and then – are they red? Do they smell bad? Is your dog shaking/scratching ears more often? Your vet has some amazing ear cleaners that can prevent the infections to begin with if your dog produces excessive ear wax. Most infections are caused by breed (Here’s looking at you, Cockers) and allergies. Dogs can be kept on allergy meds (talk to your vet for recommendations) to prevent the excessive wax production that the little buggers (bacteria and yeast) love to thrive on. Your dog suddenly have fire-red ears on a Saturday night and won’t stop digging/shaking? Give 1mg/lb benadryl (So, 50lb dog will get 50mg benadryl – DON’T Give children’s liquid if it has xylitol in it) every 8 hours and wait for Monday morning to call your vet.
- Limping. Ugh, so many. Unless you feel like the leg is broken ie. dangling, bent in unnatural way, bleeding, largely swollen, or dog screams if you touch the leg (30min after injury) it can probably wait until normal business hours or may even resolve by that time. Yes, occasionally we will get a broken leg, more often, a torn cruciate (ACL tear) – big dog playing hard, screams, holding back leg up – but more often than not, it’s a sprain or strain and will not show up on an x-ray and will get better with rest.
- Bleeding toe nail. There’s a saying in medicine “the farther from the heart, the more likely to live”. Your dog is MORE than likely not going to exsanguinate from a bleeding toenail. If your dog will let you, elevate the leg, apply pressure with your fingers to either side of the toe involved, apply cornstarch or flour (all purpose, cake, self rising, I don’t care) until you get the bleeding to stop. If he won’t let you, send him out in the yard and forget about him for an hour.
- Vomiting…. once. We see it all the time. Client rushes into the clinic on emergency for vomiting dog. We’re all geared up for the next train wreck foreign body surgery, blocking off appointments to make sure we have enough time, and when we get into the room, we find out the dog vomited once last night – but ate breakfast this morning. Or vomiting three times 10 days ago. Or had diarrhea once. Would you rush yourself to the ER if you had diarrhea last night, but felt fine today? Or if you vomited three times last week, but have been fine since? Now, if a patient has been vomiting several times in a day, absolutely it could be an emergency, especially if they can’t keep anything, including water, down.
- Any skin issues. When I was working shifts at the ER, we would get someone waiting 8 hours to be seen for skin issues and end up paying 10x the amount they would at their regular vet due to increased costs of running a 24/7 clinic. Flea prevention goes a REALLY long way in preventing these, but even then, likely it can wait until normal business hours. Hot, inflamed skin that pops up all of the sudden and is oozing and terribly itchy? Trim the hair away from it, clean it with mild soap (Dog oatmeal shampoo if you have it, baby shampoo if not), give 1mg/lb benadryl every 8 hours until you can get to your regular vet.
Things that ARE an emergency but people don’t always take seriously
- Eyes! Eyes are always an emergency. Even when they’re not, you should still treat them like one until proven otherwise. One eye squinty? Redness, swelling? Drainage with squinting? Bluish color or cloudiness to the eyes? Any wound involving eyelids? Take to the vet NOW. Could it be something simple like conjunctivitis? Sure! But it could also be an ulcer or scratch or hole in the cornea that causes your pet’s eye to rupture and have to have their eye removed. Lacerated eyelids need to be repaired ASAP to make sure they are aligned correctly without too much “shrinkage”. If the repaired lids do not line up pretty perfectly, it will lead to problems in the future – like increased risk of corneal ulcers. Sometimes animals get foreign bodies in their eye that need to be either flushed out, or the eye needs to be numbed and the vet will look behind the third eyelid for sticks, grass, bugs, etc that will continue to scratch the eye every time the animal blinks. Eyes will either heal up like nothing ever happened or can turn into a train wreck in just a matter of hours.
- A male cat (neutered or not) that is straining or vocalizing in the litterbox. Male cats, as you can imagine, have VERY tiny penises with even tinier urethras. Any amount of crystals can get caught in that very tiny urethra as it twists and turns around the pelvis to get to the end of the penis. Once the crystals get backed up to the point of blocking the flow of urine, the bladder starts to fill like a water balloon left on the spigot. Not only will this put extraordinary pressure on the kidneys, but if the bladder eventually pops, your kitty is pretty much done.
- Bloated dog that is not eating or is vomiting/retching or is really really sad looking. Especially deep chested dogs. You can even thump on the belly and if it sounds like an empty drum, it’s gas. Big belly, happy, wagging tail, jumping around? Likely just got into something and ate too much (food bloat) but still, take in for radiographs to just make sure. Gastric dilatation volvulus GDV is a condition where the stomach bloats with gas, then flips over, cutting off the blood supply to itself and the spleen. This means you have mere minutes to jump in the car and get to a facility capable of dealing with these. You will likely need to get to a 24 hour emergency clinic as the dog will need surgery, then intensive hospitalization care as the dog can literally just drop dead hours to days after the surgery due to toxins released when the stomach is righted and the effects of those toxins on the heart. It will be vital to have your dog at a facility that can constantly monitor electrolytes and the heart to prevent this. Most small clinics likely will not be able to handle this entire procedure correctly. Ask your regular veterinarian if they are capable of performing a GDV after hours before it ever happens so that you don’t have to waste time calling them only to have them tell you to get to the ER. Get your dog in the car, start driving, have someone call the ER to give them a heads up on the way. This way they will be set up and prepared to properly treat your dog in an expedited fashion.
- Vomiting and unable to keep anything down. Sure, dogs sometimes throw up and it’s no big deal. They go out, eat some grass, vomit, but later, will eat a whole bowl of food and never look back. But if the dog has vomited multiple times, seems lethargic, and/or anytime he eats or drinks anything, it comes back up – DO NOT wait to bring these in. These could be a multitude of issues, but all need to be taken care of ASAP. It could be a foreign body, intestinal blockage, intussusception, intestinal torsion, pancreatitis, etc. Some are surgical, some need intensive hospitalization, but one thing is for sure: the longer you wait, the much much worse it will be. Waiting could result in severe dehydration with multiple organ damage, intestines dying or rupturing, causing deadly infection of the abdomen and body, and a general rapid regression in the overall prognosis of your pet. Foreign body caught right away – simple incision into intestines, suture back up, go home that night. Foreign body after three days: possible inches to feet of intestines removed, infection, days in the hospital, possible death. You may expect to pay a bit more for an emergency visit, but the longer you wait, the more exponential the bill will increase.
- Intact female dog doing almost anything. Vomiting? Drinking and peeing a lot? Lethargic? Vaginal discharge? Swollen abdomen? Any or all of the above? Not currently in heat or knowingly pregnant? Intact female dog (and sometimes cat – but more rare) coming in sick for almost ANY reason is a pyometra until proven otherwise. I discussed this a little before on how to save big bucks on major vet bills (spay and neuter), but a pyometra is where the uterus gets an infection and because it’s just a huge sack of pus hanging out in your dog’s abdomen, it causes grave sickness and if it leaks or ruptures, likely death. It’s easy to diagnose and easy(ish) to treat. Notice your intact female sick and take her in right away, if she is diagnosed with a pyometra, they will take her straight to surgery, remove the entire sack of pus without leakage and she will be a new dog when she wakes up. Wait a few days or try to nurse her at home, she will quickly become septic (whole body infection) and require prolonged hospitalization and a much greater risk the sack of pus will leak or rupture during surgery (all that bacteria, inflammation, and stretching of the uterus makes it super weak and friable) and that will lead to an even poorer prognosis.
In the end, if you aren’t sure, try calling the ER and finding out how emergent your pet’s issue is.