Clinical warning signs: when to call the clinic and when to watch

Some presentations have a therapeutic window of minutes or a few hours. In these cases you do not phone to ask whether it is worth coming in: you phone while already on the way, so the clinic knows an emergency is arriving and can prepare what will be needed.

A second category is not dramatic at the moment you see it but deteriorates quickly if left alone. Here the phone call really is a phone call: you describe the picture and agree whether to come now or later the same day.

• Vomiting more than two or three times within a few hours, especially if the animal cannot keep water down, or if it is a puppy, a kitten or a senior, where dehydration develops fast.
• Diarrhoea with plenty of fresh red blood, or tarry black stool, indicating bleeding low and high in the digestive tract respectively.
• Complete refusal of food for more than twenty four hours in a dog and more than twelve to eighteen hours in a cat, since prolonged fasting in cats can trigger liver problems.
• Lameness with total inability to bear weight, or acute joint swelling, which can indicate a fracture, a dislocation or a septic process.
• A painful, half closed, reddened eye with heavy tearing, or a sudden change in pupil size: many ocular emergencies lose sight within a day.
• A distended abdomen painful on gentle palpation, with the animal adopting the praying position, chest down and hindquarters raised.
• Bleeding that does not stop after five minutes of pressure, or pinpoint haemorrhages appearing on gums and belly.

Cats deserve one extra rule: hiding. A cat that withdraws to an unusual place, stays motionless and does not respond to its usual cues is communicating pain or serious illness, even with no other sign present. It is one of the few behavioural signals in the species with high predictive value.

A third category calls for neither a dash to the clinic nor forgetting. These are the slow changes that owners notice, attribute to age and then set aside until they become serious. The right way to handle them is to write them down with dates, so that the next visit has a chronology instead of an approximate memory.

• Increased thirst and urine volume, which often precedes a diagnosis of kidney disease, diabetes or an endocrine disorder by months.
• Progressive weight loss with a preserved appetite, the classic picture of hyperthyroidism in the older cat and of some enteropathies in the dog.
• Less activity, fewer jumps, hesitation at stairs, difficulty stepping into the litter tray: this is usually joint pain, not laziness.
• Strong mouth odour, bleeding gums, chewing on one side only, dropping food from the mouth.
• A cough appearing at night or after exercise, and a sustained rise in resting respiratory rate.
• New skin or subcutaneous lumps: measure them and date the note, because growth rate is clinical information.
• Disorientation, night time vocalising and disrupted sleep patterns in an older animal.

Before phoning, four measurements give the conversation a concrete basis. They need no special equipment, and together they describe circulatory and respiratory status better than any adjective.

Hypothermia needs clarifying, because it is less intuitive than fever and often more serious. A low temperature in a dull animal is not a reassuring finding: it accompanies shock, internal bleeding and critical illness. An obstructed cat or a dog in shock can arrive at the clinic well below normal temperature, and in that case time matters as much as it would with a high fever.

The pulse can also be assessed at home with a little practice, by resting your fingers on the inner thigh where the femoral artery runs. What matters is less the absolute number, which varies widely with size and emotion, than the quality: a weak, thready pulse that is hard to find in a dull animal is a warning sign worth reporting.

Whoever answers the phone has to judge in seconds how urgent the case is and what to prepare. An ordered description shortens that time and sometimes changes the outcome, because it allows the room, the oxygen or intravenous access supplies to be ready before the animal even arrives.

1. 1

   Open with species, age, weight and the main problem

   One sentence: neutered male cat, six years old, 5 kg, going to the litter tray every ten minutes since last night without passing urine. That is the information that sets priority.

2. 2

   Say when it started and how it has changed

   The time of onset and the direction of travel matter more than a detailed description. Stable, worsening and improving are three different scenarios.

3. 3

   Give the parameters you measured

   Gum colour, capillary refill time, respiratory rate and temperature. Four numbers are worth more than ten adjectives.

4. 4

   List medications, known conditions and the last dose given

   Include over the counter products and supplements. If the animal has a known chronic condition, say so immediately: it changes the range of possibilities.

5. 5

   Report what it ate or could have swallowed

   Last meal, time, and anything unusual it could have reached: plants, human medicines, chocolate, household products, bait.

6. 6

   Ask what to do on the way

   In some cases there are useful actions before arrival, such as gradual cooling in heatstroke, keeping the animal dark and still after a seizure, or bringing the packaging of whatever was swallowed.

Emergencies happen at night, on holidays and while travelling, which is exactly when information is hardest to find. Preparing a few things in advance cuts the time lost at the worst possible moment.

• The number of your regular clinic and of the nearest out of hours emergency service, saved in your phone before you need them.
• Current body weight, because almost every emergency dose is calculated per kilogram.
• A list of current medications with dose and timing, and a copy of the latest test results.
• Microchip number and, where your country requires it, the pet registration details.
• An accessible carrier, not buried in the cellar, with a towel inside: in cats the capture phase is often what wastes the most time.
• A soft muzzle that fits your dog, to be used only if breathing is normal: acute pain makes even the calmest dog reactive.

One last element concerns cost. Many hard decisions in an emergency are not clinical but financial, and they get made under pressure. Knowing in advance what spending margin you have, and whether insurance cover exists with its limits and exclusions, lets you discuss the options clearly rather than in a panic.