Emergency medicine in Cary, NC.

Urethral obstruction.

Urethral obstruction occurs most commonly in male cats but may occur in male or female dogs and cats of any age.
The most common signs/symptoms are straining to urinate with no urine or small drops of urine being produced. Other signs that may be seen include bloody urine, frequent urination, urinary accidents, vomiting and lethargy. Urinary obstruction may quickly become a life-threatening condition if not promptly diagnosed and treated.

Recommended diagnostics for urethral obstruction often include urinalysis, urine culture, radiographs (x-rays) and sometimes more advanced imaging like ultrasound and/or x-ray contrast studies of the urinary tract.

Treatment involves relieving the urethral obstruction, typically by placement of a urinary catheter, which typically requires sedation or anesthesia. Treatment also often involves giving medications to treat electrolyte abnormalities (if present) and IV fluids to provide hydration and bring down kidney values. Appropriate treatment also involves identifying and treating the underlying cause of the urethral obstruction (such as bladder stones).

Aftercare generally involves medications (such as antibiotics and medications to help relax muscles in the urethra) and sometimes diet changes. Generally, follow up with the primary care veterinarian for exam and recheck of urine will be recommended.

Acute collapse.

Acute collapse results from a sudden loss of strength causing your pet to either sit suddenly or completely fall over. Pets are often unable to get back up on their own after a collapsing episode. If your pet sits, lies down or falls over and cannot get back up, seek veterinary help immediately as this is considered a medical emergency requiring immediate attention.

Some pets will collapse due to a loss of consciousness. Some pets will recover quickly from an episode of collapse and continue on like nothing has happened, and others will not recover until medical help is sought. Acute collapse can happen for a number of reasons including abnormal heart beats (arrhythmias), cardiovascular problems, sudden internal hemorrhage, nervous system disorders, toxin exposure, breathing difficulties, limb weakness and heat stroke.

Treatment for acute collapse varies depending on the underlying cause. Clearing the airway of obstructions, medications to combat poisons, intravenous fluids, blood transfusions in case of internal or external bleeding and surgery are possible treatments for an episode of collapse.

Diagnostics can also vary based on the suspected cause of collapse. Common diagnostics include blood work and x-rays. In some cases, an EKG, ultrasound or more in-depth imaging such as an MRI or CT is warranted. Your pet may also be referred to a specialist such as a Cardiologist for further testing.

Your pet’s recovery varies widely depending on the underlying cause of the collapse. It is best to discuss this with your veterinarian to fully understand your pet’s situation.

Bite wounds.

The severity of bite wounds can be hard to assess by simply looking at their external appearance. The skin can sustain little damage while the deeper tissues are severely affected by crushing and loss of blood supply. Internal organs like the lung, intestines or liver can be perforated or lacerated. Bite wounds are most severe when a larger animal, or animals, have bitten or attacked a smaller animal.

We recommend pets with bite wounds be seen as soon as possible either by your primary veterinarian or at an emergency facility. Recommended diagnostics for bite wounds may include bloodwork, ultrasound examination and/or radiographs depending on the severity and location of the wound.

Treatment for wounds can be as simple as clipping and cleaning the affected area followed by oral medications for pain and infection. Bite wounds more commonly need to be aggressively cleaned, trimmed of dead or dying tissue and repaired to avoid serious complications. Aggressive care happens under heavy sedation or anesthesia and the patient typically needs a drain placed for a few days in the tissue surrounding the wound to help stop an abscess (or infection) from developing. Some severely traumatized patients require more invasive surgery with hospitalization and IV fluid therapy and medications.

Aftercare can include follow-up visits to monitor tissue healing and infection with most patients going home with oral antibiotics, pain medications and an Elizabethan collar.

Vomiting and diarrhea.

Vomiting and diarrhea are two of the most common and broad clinical signs of disease in veterinary medicine. The level of concern for these symptoms depends on several factors including what is in the vomit or feces, the size and age of the pet, the duration of symptoms, the pet’s medical history and any other accompanying symptoms.

If a pet has only vomited or had diarrhea once or twice and otherwise appears normal, they can be watched at home for further developments. Pets should be seen by a veterinarian if vomiting and diarrhea are persistent; vomitus or feces contain blood or foreign material; the pet’s behavior and attitude is abnormal; or if the pet has a known, underlying disease process.

Although there is a long list of possible causes for vomiting and diarrhea, common causes include dietary indiscretion, ingestion of foreign material, ingestion of toxins, gastrointestinal irritation, viral or bacterial gastrointestinal infection and pancreatitis or other metabolic diseases. Recognizing and treating problems early will help prevent dehydration (especially in smaller pets or those with marked symptoms) and ulceration or irritation of the stomach and esophagus.

Diagnosing the underlying cause of the vomiting and diarrhea with lab work and abdominal imaging is often necessary. Common supportive treatments for vomiting and diarrhea include IV fluids, anti-nausea medications, intestinal protectants and occasionally antibiotics. Treatment for specific disease processes will be added when an underlying cause can be found.

Traumatic injuries.

Traumatic injury refers to physical injuries of sudden onset and severity which require immediate medical attention. Common causes of traumatic injury in pets include being hit by a car, getting into a fight, being attacked by another animal and especially in the case of small dogs and kittens, being dropped or having an object dropped on them.

Diagnostics are performed to help determine the type of injuries caused by the trauma and the patient’s current state of stability. These can include radiographs, blood pressure monitoring, ECG (heart rhythm) monitoring, blood work and a quick ultrasound scan called a TFAST/AFAST.

Initial treatment for traumatic injury can include IV fluids to stabilize blood pressure, control of bleeding, analgesics, antibiotics and in the case of head trauma medications to control seizures or brain swelling.

Depending on the types of injuries sustained, further treatments are often needed after the patient is stabilized. Casts/splints are needed in the case of broken bones and surgical repair of open wounds is sometimes called for. Continued hospitalization and medications are often needed in cases of severe trauma, especially head trauma.

Toxin ingestion or exposure.

Toxin exposure involves a wide range of substances either eaten or absorbed by our pets. Various medication (veterinary and human), certain foods, illegal drugs, plants and chemicals can cause toxicity. We ask that you be as specific as possible when describing your pet’s behavior and let us know the amount and type of toxin ingested. Symptoms vary depending on the toxin and your description will help us identify potential risks and treatment. Bring any toxin packaging or information pamphlets with you when you bring your pet to the hospital.

You may contact the ASPCA Poison Control prior to coming in. Their database of toxins, clinical signs and treatment options is comprehensive, and trained toxicologists are on staff 24 hours a day. There is a $65 fee associated with the phone call, and the information provided by this service allows our staff to develop an appropriate treatment plan for your pet in a timely manner.

In many cases, a toxic ingestion is discovered before symptoms begin to show. A container, wrapper or some other evidence is noticed before abnormal behavior or illness begins. Symptoms vary and commonly include vomiting, diarrhea, bleeding, bruising, lethargy, depression, inappetence, uncoordination, stumbling and, in more extreme cases, collapse, seizures and respiratory distress. Recommended diagnostics include radiographs, blood testing, urinalysis and other tests specific to certain toxins.

While the clinical signs for different toxins vary, treatment is similar for most. We will often recommend making your pet vomit to remove the toxin if it was ingested to prevent absorption from the intestinal system into the bloodstream. We rarely recommend that you induce vomiting at home due to the risk of complications. A bath with mild dish soap is recommended for toxin exposure on the skin. Dawn is the preferred brand, but any dish soap will work.

Giving activated charcoal by mouth can be useful to absorb toxins in the intestinal tract, and IV fluids are often administered to help speed elimination of a toxin through the kidneys and liver. Gastrointestinal, liver and kidney protectants, as well as anti-nausea medications may be administered to prevent organ damage or help make the pet more comfortable. In the case of neurologic signs (tremors, seizures, uncoordination or inappropriate mental state), anticonvulsants, sedatives or muscle relaxants may be given.

The prognosis for toxin exposure is dependent on a number of factors, including the type of toxin, how it was absorbed, how quickly treatment was sought, how aggressively the pet is treated and the individual pet’s reaction. Some toxins, like sago palm, have a very poor prognosis regardless of how quickly and aggressively the animal is treated. Others, like chocolate, have a very good prognosis.

Because of the wide range of potential toxins that our pets can be exposed to and the large number of variables involved, each case must be considered individually. Following up with your primary care veterinarian to monitor any long-term effects of toxin exposure is typically an important key to success.


Seizures are one of the most frequently seen neurologic problems in dogs. A seizure is also known as a convulsion or fit and may have all or any combination of the following signs.

  • Loss of or altered consciousness
  • Muscular contractions
  • Involuntary urination, defecation or salivation
  • Behavioral changes including non-recognition of owner, aggression, pacing or walking in circles

The brain is an organ that is always active but is also held in check. The slightest imbalance in excitation may cause brain cells to activate spontaneously which can cause a cascade of events leading to the uncontrollable activation of large groups of cells. Outwardly, this activation of the brain results in the clinical signs of a seizure.

Seizures can be grouped into three categories:

  1. They can occur in pets for no particular reason, usually showing up between the ages of 1 – 5 years. We do not know why the seizures occur and all diagnostic testing is normal. This is referred to as “idiopathic epilepsy.”
  2. Seizures can occur secondary to a systemic illness such as liver disease, kidney disease or exposure to toxins. These patients are usually very sick and tend to be older than five, with the exception of toxin exposure which can show up at any age.
  3. Seizures may be a sign of primary brain disease. In these cases, the brain is damaged by a disease and seizures are a symptom of the underlying problem. Structural brain disease can be divided into progressive diseases such as a brain tumor or infection and static diseases like a stroke or a bleeding episode.

Seizures consist of three components or phases:

  1. The pre-ictal phase or aura is a period of altered behavior in which the pet may hide, appear nervous or seek out the owner. Your pet may be restless, nervous, whining, shaking or salivating. This may last a few seconds to a few hours.
  2. The ictal phase is the seizure itself and lasts from a few seconds to several minutes. During this period the muscles of the body may contract strongly. The pet usually falls on its side and seems paralyzed and unresponsive while shaking. Urination, defecation and salivation often occur. If it is not over within five minutes, the state is described as status epilepticus or prolonged seizure.
  3. During the post-ictal phase there is confusion, disorientation, salivation, pacing, restlessness and possibly temporary blindness. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase.

Determining the cause of a pet’s seizure.

When you suspect that your pet has had a seizure, we recommend that the animal be evaluated as soon as possible. We begin by taking a thorough history concentrating on possible exposure to toxic substances or history of head trauma. We also perform a physical and neurologic examination.

Diagnostic tests that may be recommended or discussed include a basic battery of blood tests to check the blood sugar level and rule out disorders of the liver, kidneys, heart and electrolytes. If cancer is a possibility, chest x-rays will be recommended to look for the presence of disease spread.

If these tests are normal and there is no exposure to poison or recent trauma, further testing, including an MRI or spinal fluid analysis, will be discussed to look for the presence of structural brain disease.

Preventing future seizures.

Treating the underlying problem is the goal to prevent further seizures if a metabolic cause for the problem has been identified. In the case of idiopathic epilepsy or structural brain disease, we generally prescribe anticonvulsant therapy if the patient is experiencing multiple seizures or if a single seizure was severe.

We often wait to put a patient on long term anticonvulsants if only one seizure has occurred or if seizures are very mild in nature. Since starting anticonvulsant therapy means that medication must be given every 8 to 24 hours for the rest of the pet’s life, we do not recommend starting these medications until the patient has multiple seizures in a day, is having frequent seizures or if the seizures are prolonged in length (5 minutes or greater).

The veterinarian will discuss different anticonvulsant options before starting therapy with the goals of reducing the frequency and severity of seizure activity while minimizing side effects of the medications.


The most common venomous species of North Carolina include:

  • Rattlesnakes
  • Copperheads
  • Cottonmouths (water moccasins)
  • Coral snakes

Copperhead bites are by far the most common poisonous snakebite we see in North Carolina.

Preventing snake bites.

  • Controlling your dog with a leash while outside may be your best preventative
  • Do not allow your pet to explore holes in the ground or dig under logs, flat rocks or planks
  • Stay on open paths where snakes are more visible
  • Off-trail hiking with an unleashed dog may stir up a snake and you may be as likely a victim as your dog
  • If your pet seems unusually curious about “something” hidden in the grass, investigate carefully

What are the signs of a venomous snakebite?

The clinical signs associated with a venomous snakebite vary based on the species of snake. Extensive and painful swelling that often spreads rapidly is typical. Bleeding or a bloody discharge at the site of the bite is common. The fang wounds may not be visible due to either the rapid swelling or the mouth size of small snakes.

The venom of rattlesnakes, water moccasins and copperheads contains toxic proteins which produce effects both at the bite and throughout the body. These effects may include local tissue and blood vessel damage, destruction of red blood cells, bleeding or clotting disorders and problems in the lungs, heart, kidneys or nervous system. A severe reaction can include shock, hypotension (low blood pressure) and severe pH imbalances.

How is a diagnosis of snakebite envenomization made?

Diagnosis is primarily made on medical history and clinical signs. If the type of snake is unknown, diagnosis and treatment will be directed at the clinical signs.

Should my pet be evaluated by a veterinarian?

Yes! A veterinarian should evaluate your pet as soon as possible. Snakebites are painful and your pet should be given pain medication. Bites are very prone to infection, so antibiotics are also a standard part of treatment. Diagnostic tests may also be warranted to determine if your pet is experiencing any systemic effects from the venom.

What is the treatment for snakebite envenomization?

Copperhead bites are usually treated with pain medications and fluid therapy to counter potential hypotension or shock. Wounds are clipped/cleaned and monitored for signs of tissue death. Antibiotics are given to prevent infection of the bite wound. Antivenom is rarely indicated, but in certain cases such as a bite to the tongue or eye it may be a useful part of therapy.

Rattlesnake and coral snake envenomization involves treatment for shock and administering appropriate antivenom. Rattlesnake envenomization is an immediately life-threatening situation and prompt medical assistance must be sought. Treatment to counter shock, low blood pressure, infection and respiratory distress is indicated in most cases.

The prognosis for snakebite depends on a host of factors:

  • The size and species of the snake
  • The location of the bite(s) and amount of venom injected – bites to the head and body tend to be more severe than to the legs. Swelling from bites around the muzzle and face can lead to breathing difficulties due to airway obstruction.
  • The age, size and health of the pet
  • Individual susceptibility to the venom

Emergency surgery.

There are times when a pet requires immediate surgical intervention to save their life. There are also times when timely surgery is indicated to ensure the best outcome for your pet and waiting until the morning or after the weekend poses risks.

Examples of emergency surgeries include gastric dilatation & volvulus (GDV), hemoabdomen (free blood in the abdominal cavity usually from a ruptured mass), pyometra (infection of the uterus in an unspayed female), C-section (surgery to safely deliver puppies or kittens that cannot be vaginally delivered), intestinal obstruction or perforation or a herniated intervertebral disc leading to paralysis.

When a pet presents with symptoms consistent with any of the above, they will be triaged straight to our ICU treatment area by a nurse. You will most likely be asked to fill an emergency consent form which will allow our veterinarians to perform basic diagnostics and treatment to help stabilize your pet.

Gastric dilatation volvulus.

This issue is also known as gastric torsion or bloat and is characterized by a stomach dilated with air and fluid which rotates or twists on itself. Common symptoms are a painful and distended abdomen, retching without producing any vomitus and abnormal behavior such pacing or inability to get comfortable. On presentation, we may request permission to perform a radiograph to diagnose or rule out this condition. At this point, your pet will be started on IV fluids and pain medication.

GDV is most common in large, deep-chested breeds such as Great Danes, German Shepherds and Standard poodles but can be seen in other breeds of dogs and even cats. GDV is an emergency condition and can be fatal if left untreated.

GDV is a condition that can be prevented with a prophylactic gastropexy during which a part of the stomach is attached to the inside of the abdominal wall. The procedure can be performed on your pet when under anesthesia for a spay or neuter. The procedure isn’t a guarantee that your pet will not bloat, but it does drastically decrease the chances.


The abdominal cavity is a space containing many different organs, such as the stomach, spleen, liver, intestines and bladder. A hemoabdomen is diagnosed when there is free blood in this cavity. The most common cause of blood in the abdomen is a ruptured tumor on the spleen or liver. Trauma or blood clotting deficiencies (as seen with some rat poisons) can also lead to a hemoabdomen. Common symptoms include pale gums, poor circulation leading to weakness and collapse and abnormally cool extremities. Other signs that pets may exhibit include, but are not limited to, increased respiratory rate or effort, pacing or a swollen abdomen.

Patients experiencing a hemoabdomen are generally in shock and require immediate treatment including an IV catheter and fluid therapy. They frequently require surgery to stop the bleeding and blood transfusions to replace the lost blood. Continued bleeding can lead to severe anemia (a low blood count) and eventual death if not treated.

Intervertebral disc disease.

Between each of the back bones, or vertebrae, is a cartilage disc that helps to cushion the vertebrae from the forces of walking and jumping. These discs are called intervertebral discs. They can become herniated or “slipped” and put pressure on the nerves of the spinal cord leading to pain and potentially paralysis. Patients with a slipped disc may have decreased activity levels, act stiff in their neck or back, possess a hunched posture, whine, not want to go up or down stairs or they may appear like they are walking with a drunken gait. They also can be completely normal one moment, then run off or jump off the bed, cry out suddenly and have limited mobility in the back limbs. Slow or sudden progression of signs are both considered emergencies.

A sudden onset in a patient that is completely unable to use their back legs is considered more critical, and these patients should be seen by a veterinarian immediately. A neurologic and orthopedic examination will be performed by the veterinarian and diagnostics, such as radiographs (x-rays), may also be performed. Pain medication will be given at the veterinarian’s discretion and more advanced imaging such as CT or MRI and surgery are indicated in severely affected patients.


Heatstroke is most often seen in dogs that may be predisposed to overheating because of breed-related respiratory issues (such as brachycephalic or “flat-nosed” breeds such as bulldogs and pugs), or dogs with underlying respiratory diseases such as laryngeal paralysis. Any dog or cat may be at risk of heatstroke if exposed to excessive temperatures or humidity. Even healthy young dogs may quickly become overheated if they are exercised during times of high heat or humidity or left in a car during the summer months.

Signs of heatstroke include weakness or collapse, respiratory difficulty, pale or blue mucous membranes, diarrhea (sometimes with blood) and vomiting. In dogs that may be suffering from heatstroke, it may be helpful to start treatment at home or in the car by wetting the pet down with cool (not ice cold) water and placing a fan on the pet. Emergency veterinary care should be sought immediately.

Diagnostics other than monitoring the patient’s temperature include bloodwork and sometimes radiographs (x-rays).

Treatment for heatstroke involves aggressive & intensive supportive care to help maintain hydration and organ function and to identify and treat any secondary complications. Even with aggressive treatment, the prognosis for severe heat stroke is guarded but animals may make a full recovery if diagnosed and treated quickly.

Aftercare may involve rechecking physical examinations and blood tests with your primary care veterinarian as well as treating any predisposing breathing problems. Dogs that have experienced heat stroke should avoid outdoor activity during times of excessive heat or humidity.

Dogs and cats should never be left in a car for any length of time during warmer months due to the risk of heatstroke.

End of life care.

Saying goodbye to a pet is one of the hardest decisions you can make. Realizing that you are doing what is best for your pet allows you to give them the gift of passing without pain and with tons of love.

When the time comes, you have the option to be present or not. You are welcome to have family members present and you can bring your pet’s favorite toy, blanket or snack and spend as much time with them as you want.

What to expect.

You will be escorted to a comfortable room with a sofa and chair. We will take your pet to the ICU area of the hospital for a catheter to be placed in their leg. We will bring your pet back to you and will give them a sedative so they get really sleepy and then we will inject the euthanasia solution. We will listen to their heart to make sure they have passed. Just as with a natural passing, occasionally a pet will make a sound or take a breath but for the most part, it is a very peaceful passing.

Please know that we completely understand how heart-breaking it is to say goodbye to a pet. We are happy to provide you with a clipping of fur and a clay paw print. We also offer cremation services (both private and communal), or we can prepare your pet for a home burial.