I think diagnostics was always what I loved most about veterinary medicine. While I am NOT a competitive person at all, and never have been, I found that I liked the challenge of arriving at a correct diagnosis. People often say that pediatricians and veterinarians have a lot in common in that their patients can’t talk to them or tell them how they are feeling or what they feel, or where it hurts. That’s true, and it makes diagnosing cases even more challenging.
To me, diagnosing cases was like putting together the pieces of a puzzle. Sometimes that puzzle was very easy and straightforward and other times it seemed like I was putting together a 1000 piece puzzle with multiple pieces missing. Yes, it could be frustrating. It was especially rewarding though to find all those pieces and arrive at a correct diagnosis. The veterinarian I went to work for was my mentor and I learned a lot from him about diagnostics over the years. As a young veterinarian just out of school, I remember something he told me that always stuck with me. He told me that if things aren’t adding up and the pieces of that puzzle just aren’t fitting together, start thinking cancer. I can’t tell you how helpful that was to me and how many times he ended up being right about that. But I digress as that has nothing to do with the case I’m about to tell you about. There’s not a doctor or a veterinarian around who hasn’t missed a diagnosis at some point in their career. After all, we’re human, and as the saying goes, we’re practitioners…. we practice throughout our entire careers. We’re not perfect, although many people think we should be, and hold us accountable when we aren’t.
I am often asked what my most interesting case or most unusual case was while in practice. I smile when this happens because when I was a child, I used to love to ask my uncle (who was also a veterinarian) that same question.
When I’m asked that question, my thoughts always go to a white American Pekin duck patient brought in as an emergency one night to our clinic.
The very excited client said she heard a commotion outdoors and heard the sound of a dog barking and growling and an obviously alarmed duck quacking and went outside just as a large dog chased this poor white Pekin duck underneath a deck. She ran after the two, somehow managed to run the dog off and away from the duck, and then picked the poor frightened duck up in her arms and brought him in to our clinic. The duck was in obvious distress and showing rapid breathing (tachypnea). It was lethargic. The feathers were ruffled in places and upon exam, I noticed severe bruising in the skin around the base of the feathers on several places on the duck’s back. Dark reddish purple ecchymotic bruising and hemorrhaging was present all over the duck’s body.
I thought the diagnosis was pretty straight forward. The duck had been attacked by the dog, was banged around and traumatized, hence the bruising and the shock-like symptoms. He had taken a good beating. I began shock treatment and admitted the duck for hospitalization and observation. We put the duck in a cage with a towel covering the door so as to let it calm down as it was extremely stressed. It stood in the cage and even drank some water. And then it settled down and closed it eyes. We checked on the duck every 10-15 minutes and found it resting.
About an hour after the duck’s arrival, I went down to check on the duck. I pulled back the towel from the cage and was hit by a sight I did not expect to see. The duck was lying there dead as a door nail on it’s side with it’s mouth open and a dead, obviously regurgitated, soggy, and quite large dark gray slimy mouse was lying next to the duck’s mouth. I stood there puzzled, literally shaking my head and doing a double take. I was so confused! My first literal thought was, “WHAT THE HELL???? WHERE DID THIS MOUSE COME FROM?” HOW DID THIS DUCK SWALLOW THIS LARGE MOUSE? WHAT IS GOING ON HERE?”
And then the missing pieces started coming in. The client confirmed there had been d-con rodenticide poisoning under the deck.
The mouse had eaten the d-con and was poisoned and the duck gobbled up the mouse, which then poisoned the duck. This is called secondary poisoning. Did you know ducks love to gobble up mice and eat them quite often? I didn’t! D-con contains warfarin or other anticoagulants that decrease Vitamin K levels interfering with blood clotting. The duck had internal hemorrhaging. When I picked his little deceased body up to remove him from the cage, blood came pouring from his nostrils. I don’t think I could have saved the duck with Vit K treatment. It usually takes 3-7 days for death to occur after a duck eats a poisoned mouse. The stress from the dog incident probably speeded up the process a little.
So a sad ending for a poor little duck and a poor little mouse. And a most unusual case that taught this young veterinarian that things are not always as they seem. I actually learned after I experienced this very strange case, that secondary d-con poisoning is actually very common in poultry and also birds of prey. In 2014/15, there were some Federal Restrictions placed on d-con and 12 of its products were banned.
I’ll never, ever forgot that case.