Monday, May 27, 2013

Hit By My Own Car

Being a veterinarian means you wear a lot of hats, everyday.

Most of us vets are what we call "general practitioners."  A quaint little way of saying "jack of all trades, master of none."

Truth be told, I enjoy having a broad spectrum of basic knowledge. But every vet has their own particular strengths, weaknesses and areas of interest. I am lucky to work with 5 other veterinarians who all have their own honed skills and resume of experiences. We often work together collectively and will tackle the cases that require multiple brains with our multiple own perspectives and this ultimately always benefits our patients.

At Jarrettsville Vet I am the surgeon. It suits me just fine. I enjoy the tedious challenge, the never-the-same-problem twice individuality of every case, and the cosmetic aspect. I like to take the puzzle pieces and put them back neatly, and prettily in order, not losing site of function, of course.

Sometimes the surgeries are what we term "routine." A spay, neuter, or a small skin mass removal, these are the daily bread and butter. The surgeries we don't think much about, get too excited about, or fret over.

The once in a while trauma cases, those are the toughies.

Trauma, when I talk about this in veterinary medicine I separate them into two categories;

1. Motor vehicle meets pet. 


2. Mammal meets mammal. Whether it be BDLD, (our acronym for big dog vs little dog), or wildlife meets pet, or human being is abusive to pet.

Let's discuss category number one today.

Twenty years ago HBC (hit by car) was a more frequent, more likely to be fatal event. 

In my opinion a few things have happened to change the once grim statistics.

  • More people spay and neuter, and therefore, fewer pets wander.
  • More people use home containment devices (invisible fence, etc) to keep their pet within their own property.
  • Almost every municipality have shelters and actively pick up roaming pets.
  • Many people will stop and try to help a wandering or injured pet.
  • Veterinarians who specialize in surgery and can correct almost every broken bone in the body.
But here's the trauma that I do see happening now more often these days.

Household-induced trauma.Specifically, I see more and more pets being injured by automobiles that belong to the pets own family. These are tough cases on many levels. The family feels guilty, they feel terrible about inflicting pain and suffering on their own pet, and they have to be clear headed enough to be able to make decisions about their pets care.

If there is one wish I could make with today's blog it would be to be diligent and careful and not to assume that your pet understands that a moving car, or lawn mower, or piece of farm equipment, or anything that moves, or has moving parts, is a threat. No matter how slow or how fast it moves your pet is curious and unable to comprehend circumstances, I don't care if they have "been hit before, and you think they have learned their lesson." They haven't and they will be hurt again, or worse yet, maimed or killed.

This is the story of Mac. He was seen lying on the driveway as his family started the car and began to back out. They heard him yelp! and they stopped the car to find they they had run over his tail and ankle.

Abrasion wound to the inside of the ankle.
Mac was brought in immediately after his family injured him. He was examined, x-rays were taken and he was started on pain medications and antibiotics. Luckily nothing was broken. He had a few abrasions, some with open wounds, a moderate amount of soft tissue damage, which included bruising and a few small areas of bleeding. All of his wounds were cleaned and dressed and he was scheduled for surgery the next morning.

The end of the tail is filleted open and there is damage to the fibers that surround the tail vertebrae.
There was some concern that we would have to amputate the end of Mac's tail. We would have had to do this if the end of the tail was necrotic (not viable or dead tissue). Thankfully, Mac's tail tip was still pink and he had feeling when you pinched it.

I have had many discussions over the years about how best to treat tail tip problems. There is a condition in dogs that we call "happy tail." This happens when a dog wags their tail so much, and in close enough proximity to a hard wall, that they break the blood vessels in the end of their tail. Or they hit it hard enough and often enough to cause the skin on the end of the tail to open. It can be a very frustrating ordeal to treat. Try asking a happy dog to stop wagging? Or try affixing anything that can, or will, stay on to the end of a wagging tail..not easy tasks.

Every vet has had to deal with this problem, and just about every one of us has had to amputate a tail or two because we either can't get that tail to heal, or the client loses the ability to try any longer.

The first vet Mac saw on the day of his trauma thought that maybe his tail would need to be amputated. She had forewarned his parents. It has been my experience to always try to keep from amputating a tail because I know how hard it is to manage them long term. If you ever think that this is the easier option please have a long talk with your vet before cutting..any happy dog with happy tail will keep wagging and keep busting open those sutures. Not only do you have to think about dehiscence of a suture, you also have to try to figure out a way to keep it bandaged..

When Mac came in the next day we removed his bandages to see how things were progressing.

The first big clue that Mac needed surgery was the smell that removing the ankle bandage produced. The bouquet of a simmering infection is a definable as the pus that it emits. Sometimes you only smell infection and Mac smelled of infection. Oddly I didn't see a wound that made sense with the putrid pungent aroma I smelled.

I knew right then that Mac would need surgery to find the source of the smell.

Mac's wound was very small..About half an inch long, and there wasn't any signs of bleeding, or the ever easy to identify pus. To an untrained eye (and nose) the ankle wound was small and unimpressive. But when Mac was placed under anesthesia we were able to make a very large pocket of fluid, about 6 inches long with the surgical scrub. The pocket was infection and it lay not beneath the skin where the small wound was obvious, but rather below the layer of muscle that appeared to be wound free.

Half of the drain has been placed. The drain must enter and exit at an area outside of the pocket of infection, but be in communication with it.The drains function is to keep the infection from remaining walled off under the muscle and allow a tunnel for both draining and flushing of an antibiotic solution.

Under general anesthesia as we prep his wounds for surgery.

The drain in above and below the infection.
His tail looked jagged and swollen but it was healthy tissue and I thought that a few simple sutures to keep the edges opposed were the first step. The next was just to keep it clean, protected, and watch and wait to see if it would heal on its own.

After surgery. 
Mac's tail stayed bandaged for a week. We checked it daily for the first four days, and then the owners changed it at home for the remainder of the week. The tail healed quickly and looks like brand new.

The ankle was flushed twice daily with a chlorhexidine solution. It is important to remind clients that we are flushing around the drain and not through it. The drain is a flexible latex material that keeps an opening around the infection. We want to keep the entry and exit hole open so that the wound can drain, and so that you can flush a cleaner around the drain and into the infections pocket.

A few last notes on drains;

  • Drains need to be removed within 7 to 10 days or the latex starts to break down.
  • Be very diligent in keeping your pet away from the drain, and never cut it on your own. Every once in a while the ends get cut, or chewed off and I have to go back into that wound that we have worked so hard to get to heal and fish out a piece of shrunken latex..frustrating and annoying, for everyone.

If you have any questions, or any story to share please share them.

For any pet question you can find me, and many other helpful people with many other skills, at Pawbly

If you are a pet person please visit us at pawbly and share your skills, thoughts, and help other pets and their people. We are a place for all things pet, always free. Or visit us on facebook, Many thanks for reading.


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