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Focus on Emergency Services

Metropolitan Emergency Service is available every day of the year – twenty-four hours a day, seven days a week. We triage every patient upon arrival in order to insure those with the most urgent need are taken care of swiftly and effectively.

"Sprockett's journey begins with Emergency Services..."

Sprockett began his journey with Metropolitan in November, 2009. He was referred to our Emergency Service after his owners found him collapsed in their yard with a large amount of vomit matted in his fur. They had rescued him 4 weeks prior from a Mississippi shelter where he had been brought in as a stray and was thought to be about 1 1/2 years of age. The rescue diagnosed him with heartworm disease and Sprocket was treated. Once in Pennsylvania with his new family he remained thin despite being provided a high protein diet and they felt he was uncharacteristically lethargic for such a young dog, particularly because he had been more active and alert before his food was changed.

When Sprockett arrived at Metropolitan he was clinically dehydrated, IV fluids were instituted and by the morning he had perked up significantly. At this time, the owners reported that they had scheduled vacation plans and requested that he remain with us for continued monitoring during their trip. About five days into Sprockett's stay at Metropolitan he began vomiting and suddenly became extremely lethargic and unrousable. His owners reported similar events happening at home, particularly around mealtimes. These episodes coupled with several bloodwork abnormalities and Sprockett's thin body condition caused suspicion that he may have a portosystemic shunt.

An abdominal ultrasound was performed by Dr. McLear (Radiology) which revealed a right divisional intrahepatic portosystemic shunt. Given the location of this vessel within the hepatic parenchyma, this type of shunt is not as easily amenable to surgical attenuation or ligation as extra-hepatic shuts are and is often associated with more significant intra and peri-operative concerns for the patient. Fortunately, Dr. Roland (Cardiology) is one of the specialists who is able to perform an interventional procedure using the placement of an intravenous stent for insertion of coils to induce gradual embolization of the aberrant vessel.

Dr. Roland discussed Sprocket's condition with his owners along with the progression of disease and limited long-term quality of life if left unaddressed. The decision was made to proceed with the treatment in hopes of achieving a resolution. Dr. DeBiasio (Internal Medicine) then designed a several week plan for out patient medical management to improve body conditioning for his coil embolization procedure. During this time a short anesthetic procedure allowed Dr. McLear to perform a contrast CT scan to better define the specific course taken by the shunt and to allow Dr. Roland to obtain specific measurements for appropriate coil size selection.

Sprockett arrived at Metropolitan on January 13th, 2010, after having gained 8 pounds with improved blood parameters and overall general health. He successfully underwent the procedure for intra-vascular placement of the shunt coils and recovered uneventfully. He is now back home with his adoptive family and is scheduled for reevaluation with Drs. DeBiasio and Roland in 3 months. At that time, an ultrasound will be performed to assess the reduction of shunt flow. If flow is shown to be successfully attenuated or completely eliminated, Sprockett has the potential to have a normal length and quality of life.

We are very excited to have the ability to offer intravenous coiling for the treatment of intrahepatic portosystemic shunts. Please contact us if you have suitable cases of this nature. Additionally, Dr. Roland is happy to discuss other interventional radiology procedures such as placement of coils for occlusion of patent ductus arteriosus (PDA) or placement of tracheal and urethral stents.

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