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Saturday, August 02, 2008

A truly technicolour yawn

"Brandon, these people are here with a puppy they think ate some lead pencils," Liz said as I was finishing up with another client.

"Oh, okay," I said. "I'll see them next, just a second."

Normally we are appointment-only, however for things that obviously cannot wait to be seen, such as potential toxin ingestions or other emergencies, we will of course clear the decks.

I'm still pretty new to New Zealand, but I couldn't remember the last time I used any lead-containing pencils in the States. Well, okay, I could remember using them way back in like second grade but we're talking the mid-1970's here. Lead had long since been banished from most commercial things like paints and petrol, and certainly things that little kids might handle such as pencils.

But I knew it would not be smart to assume (is it ever smart to assume?) that there is no possible way this puppy could have gotten hold of a pencil with lead in it. To wait until she showed symptoms would be foolish as lead certainly can be life-threatening in more than one way. Also, if given the opportunity to prevent further absorption of a toxin - and the timing does not always work out like this - then by all means you have to take it.

In most cases, this usually involves making your patient vomit.

Yes, normally I'm trying to stop my patients from vomiting any way I can, but in these cases it can help them out tremendously. Just as long as you can, you know, stop them from vomiting once they've gotten everything out they need to.

So I head out into the waiting area and there, surrounded by about eight girls ranging in age from five to, oh, fourteen, is an adult woman looking a little discombobulated. One of the girls is holding onto a little mixed-breed terrier with long spiky light brown and black hair. Somewhere under all that poofed-out hair was a dog, I assumed, so I asked them all to follow me into the exam room.

The ten of us now in the little exam room, all of the girls watched me intently as I took the puppy from the little girl who was carrying it. "Kaylee" was the pup's name, and sure enough under all of that fur was a pair of shiny black eyes and a smiling face. There were several suspicious pink smudges along the puppy's upper lip and jaw, and she gave a little wag of her tail as I picked her up.

The woman whose job it was to shepherd all of these girls and their sick puppy placed the chewed-up remnants of three coloured pencils on the exam table. They were all various shades of pink. "Here. That's what we found with her when we got home. Actually I'm not the owner; this girl's mother is still at work so they called me."

"Ah," I said. "Well that is just fine, you did good getting her in here quickly like you did." I knew the girl from whom I took the pup was the dog's owner, but as far as her relationship to the other girls I never knew for sure, or even if the woman there was the mother to any of the other girls.

It was no matter, and I asked them if they saw her actually chewing on the pencils. They said that they did, they caught her doing it soon after they got in from school that afternoon. I asked if there were any other things they saw her chewing or that looked as if they may have been chewed by her, and they said there weren't. Apparently most of the coloured pencils in the collection survived desolation in this puppy's jaws, but given enough time I'm sure she would have moved on from pink to some other tasty colour.

I examined the pencil fragments more closely, looking for anything emblazoned down the side that might indicate that these contained lead. There was nothing of the sort (it's never that easy), so I still didn't know for sure. Also, I remember most pencils used for writing used to contain lead but I was never sure of the coloured pencils. Did they ever contain lead? If they did, did they somehow escape the moratorium on lead in all 'normal' black pencils?

Kaylee seemed in perfectly good nick, aside from the pink smudges on her face giving her up as a pencil-chewer, but lead takes a while to work its damage. Among other things it causes the destruction of the body's red blood cells and also can have neurological effects, such as seizures. Not wanting to wait for any of these things as proof, I told my assembled crowd that it was now time to make Kaylee vomit.

There were a variety of reactions but mostly they seemed actually pretty keen to see this happen! One girl I remember held her ears as I said this, and I'm not exactly sure what she was expecting because vomiting isn't usually a deafening occurrence, but she seemed a little bit distressed. Nonetheless they all followed me to the courtyard, where I told them I'd return with Kaylee once I'd given her something to make her vomit.

There are several options for inducing vomiting in a dog or a cat (dunno about you human types, but too much alcohol has always worked for me). My favourite over the years for getting a dog to yak has been good old hydrogen peroxide. One or two tablespoons of this, combined with a brisk walk around the yard, has given me the most successful results. There is a drug called apomorphine that most other vets swear by, but it has let me down more often than I have found it to work.

With one of the nurses holding on to Kaylee, I gave the pup a couple of teaspoons of peroxide and she took it like a champ. It also helped to scrub away the pink smudges on her fur, which made her look as if she had tried to apply some lipstick during an earthquake.

We returned outside where the girls eagerly awaited some results and the nurse walked Kaylee in brisk little circles around the yard. Kaylee was having the time of her life, getting all this attention and exercise. After five minutes with no results, I decided to give the peroxide one last go. After that, I'd move on to the apomorphine or perhaps some washing soda, as I really did want to make her vomit since she'd just ingested these bits of pencil.

After too much longer, it'd be too late to try vomiting as a treatment and I'd have to make a decision about treating her with an expensive antidote. A heavy metal chelator, succimer is quite good at what it does, but at a couple hundred dollars a pop, it was an expensive insurance policy compared to the cheap wonders of hydrogen peroxide.

So Kaylee bravely downed ten more milliliters of hydrogen peroxide (bravely, hell - she had no choice!) and we returned to the outside. Within a minute of her touching the ground, she started to make those initial motions involved in upchucking. Her tiny belly contracting, her neck extending, she finally managed to disgorge a slimy pile of mucus, kibble... and pink smudges of chewed up pencil!

Several of the girls let out a collective "Yay!" and I was pleased to see that Kaylee finally vomited. She horked up about another seven or eight progressively smaller piles of pink-coloured goo until finally she stopped bringing anything up and then stopped retching altogether, all in the span of about ten minutes. Perfect!

Poison control didn't seem to be too worried about these coloured pencils containing any lead, unless they were several decades old. The woman had no clue but the little girl who owned Kaylee said they bought them this year, so I felt relieved that they were probably free of harmful toxins. Still, I educated the girl and her chaperon about signs of lead toxicity and to keep a close eye on Kaylee.

And to pick up all remaining pencils, coloured or otherwise! For that matter, to try and puppy-proof in general as best they could, for as any dog owners know, anything that's not bolted down (and even then ...) is fair game for a dog to chew on, doubly so for a puppy who's curious and teething.

After cleaning the slobber off of Kaylee's face and noting that the vomitus had served to re-colour her whiskers with a tinge of pink, we handed her back over to the girl and they all left happily.

The next day, the girl's mother stopped by to settle the account and let us all know that Kaylee was fine. The woman was quite happy we worked them in at a moment's notice, especially while she was away at work and unable to attend or pay straight away. I told her the pleasure was all ours and Kaylee was a very sweet puppy.

After all, it's not that often that you can make a little girl happy to see her puppy vomit! Except when it's pink and potentially toxic, I guess.


Blogger EvaKCAidan said...

Gotta love H202!! Absolutely love the remark about the puppy trying to apply lipstick during an earthquake!! ROFL! I have visions of little terriers with pink lips now!! heehee

Keep up the good work, Dr B!

7:58 AM  
Blogger Brooksie said...

Thanks Eva! Glad you found that story enjoyable. Cases like this make it all worthwhile :)

12:18 PM  
Anonymous Anonymous said...

Glad the puppy did well....don't see too many lead toxicity cases these days...which is a good thing. I removed an "open" large safety pin the other day from a dog's stomach...I figured that it would be good to avoid the peroxide in this dietary indiscretion case. Had a cat eat some legos this past weekend....which was a first. Glad things are going well. If you're ever in town, drop by the hospital. Opening day is September 8th.

6:33 PM  
Blogger Brooksie said...

Hi Robb, thanks for stopping by. Wow, a cat that ate some legos... that is a first! You'd expect that from a puppy, sure, but a cat wow. Yes sometimes unfortunately we just can't make them vomit, can we? But a gastrotomy is pretty straightforward, too, as it could always be worse. I look forward to visiting your new hospital one day, I'm sure you guys will do great. Good luck on your opening!

9:27 PM  
Blogger Sometimes Saintly Nick said...

Grand post, Brooksie. This is a splendid chapter for your forth-coming version of All Creatures Great and Small!

Alex and I are glad you were able to get the nassy pink pencil out of Kaylee.

You know, ten (even little kids) could never fit in one of my vet’s examining rooms! I hope your rooms are bigger than hers.

1:12 PM  
Blogger Alex the Blogging Kat said...

This comment has been removed by the author.

1:33 PM  
Blogger Alex the Blogging Kat said...

I iz happy u fixeded da lill woofie doggie, Docktor Brooksie. U iz a berry nice docktor. OK?

I iz sorry I haz to writez dis again cause I dunt spell 2 nice. OK?

1:36 PM  
Blogger Brooksie said...

Hey Nick, well they are pretty small rooms actually but we managed! And thanks to you, Alex, for stopping by! Very flattered you took the time out of your day to post here. Cheers for the compliment and no worries about having to post twice!

9:34 PM  

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