On my way in Friday, my phone rang. Morning phone calls are never good. “Doctor, where are you?”
“Seven minutes.” Steph doesn’t care where I am. She wants me there. I can tell. “What’s up?”
“Roxie is here, and she is in respiratory distress. We have her on oxygen, but she is not doing well.”
“Roxie, we just saw last week after the cat scratched her eye?”
“Yeah. She is not doing well. She is working really hard to breathe. They said she has been doing this since 2:00 a.m., but the ER said if she was pink, it is okay. I don’t think it is okay.”
“Get a rads and a temp, and I will be right there.” Because it is Roxie, I already know that she is an older terrier type dog with heart problems.
Roxie was looking a little better on oxygen in the few minutes that it took me to get to Guardian Animal. I checked her quickly and gave some injections and directed her to be put in the oxygen cage. The radiographs or x-rays were ready to be evaluated. There was a massive amount of fluid in Roxie’s lungs. Another injection to pull some of the fluid off and I go talk to the owners and show them the radiographs.
Acute Respiratory Distress Syndrome (ARDS) is a sudden respiratory failure due to fluid accumulation and severe inflammation in the lungs. It is life-threatening. Mortality rates in dogs are almost 100 percent. There is usually an underlying medical condition. This could be an injury with damaged alveoli (tiny air sacs in the lungs) which causes them to collapse. Fluid-filled alveoli cannot exchange oxygen and breathing is labored or impossible. It is a true emergency.
By the time I check Roxie, her gums are not blue because the oxygen has helped. In addition to the extreme difficulty breathing, there can be a cough, nasal discharge, and fever. Or not. ARDS is the hallmark of smoke or noxious gas inhalation of smoke, near drowning or thermal burns. But it can also happen with pneumonia, aspiration of gastric contents, lung trauma or other serious illness. I note that Roxie has a splint on her right front leg that I didn’t put there. She was at the ER two nights ago when she broke her leg. I don’t know if Roxie’s ARDS is caused by the trauma that caused the fracture, an anesthetic incident or a chordae tendinae (heart valve attachment cord) rupture. Right now, it doesn’t matter.
Acute respiratory distress syndrome is a medical emergency requiring immediate attention. It was nice to know Roxie and her history, but if you are at the ER, you need to provide a thorough history of your dog’s health and the onset of symptoms. Include any incidents that preceded this incident (trauma to any part of the body, or inhalation of gases, fumes, or solid matter can all cause ARDS). As a veterinarian, I am providing emergency treatment and trying to find and treat the underlying cause of this sudden lung failure. We quickly had lab work with blood tests, serum biochemical tests, and blood gas analysis. Blood gas analysis is not often used in routine veterinary medicine, but I was glad to have it for Roxie. Blood gas is one of the most important diagnostic methods used in veterinary practice for the diagnosis of ARDS.
Roxie has been being treated for a cardiac disease for quite a while. I suspect that she decompensated due to the stress of her fracture and anesthesia. After the initial oxygen, we added some additional cardiac meds. Roxie stayed in our oxygen cage on IV fluids for 72 hours. I stayed with her on a Sunday to see if we could wean her off oxygen. She responded well and went home four days after she came in with panicked owners.
Roxie is very lucky. We have done everything the same way and lost patients. Even after she is home, Roxie’s parents must be careful. If the underlying disease is still present, there may be another episode of respiratory distress. Even if Roxie just needed extra medication, she will need time, rest, and good nutrition to fully recover. They must have plenty of ventilation and not be over walked or exercised. There may be fibrosis (lung scarring), which means the lung tissue will be stiffer and have less oxygen capacity. Roxie’s parents are following all our recommendations and keeping Roxie’s activity minimal. None of us want to go through that again, but I am glad that we have an oxygen cage with temperature and humidity control for days of oxygen and a great staff that knows to start treatment as they call me and can do what I direct as I am on the way. All this so that we can send Roxie home.
I much prefer the call on Monday. “Hey, this is Doctor Wixsom. Roxie is doing great. I took her off oxygen Sunday afternoon and stayed with her several hours. Roxie can go home.”