Monday, January 14, 2008

Survival instinct + sleep deprivation

I could see a man carrying a furry black dog into the clinic as I finished up my second to last appointment. "I just found her like this," I heard him say, "I've still got kids in the car..." Leah took the dog from him, and I met her in the back.

The poor dog was extremely painful, she wasn't moving anything except her eyes. She had a huge gaping laceration on her midline belly, from just below her ribs nearly to her pubic bone. I put on gloves and as gently as possible examined the wound. The gaping hole was huge, but it seemed to be just in the skin; I saw no holes going into her abdomen. The wound was full of leaves and dirt, and the dog looked pretty scruffy.

We started fluids immediately and gave her a big morphine shot. I went to talk to the owner. He had a boisterous 2 year old son, and a wheezy, stuffy 4 month old baby with him. He explained that the baby kept them up all night with the flu. When he'd gotten home late from his job as a chef, the baby was crying, and the dog snuck out without them noticing. They were up all night with the baby, but were relieved to see the dog come back in the morning. They left to take the baby to the pediatrician. In the afternoon, the dad realized the dog had been in the back yard all day. He went to check on her, and saw a small cut on her wrist. Then he was horrified to see the huge wound on her abdomen. He piled everyone into the car and drove to my hospital.

"I feel so bad. I didn't mean to ignore her! Do whatever you need to," he said. Hey, I know my powers of observation are not that great when I'm sleep deprived. I also know that animals are excellent at hiding illness and injury. I'm sure that's why she hunkered down in the leaves all day. I sent the dad and the kids home.

After my last appointment, we sedated the dog and used over 2 liters of saline flushing out the huge, dirty wound. I was shocked to find that in addition to the foot long laceration on her belly, the skin was pulled completely away from her body wall on the right side of her body. The skin was intact but not touching her trunk all the way up to her dorsal midline, from her shoulder to her hip. Bits of dried brown leaves were spread all along her trunk. Amazingly, there was still no compromise of the abdominal wall.

The other doctors and I discussed her injury. Initially I thought it was a dog or coyote bite-and-pull, but she had no puncture wounds like you would expect to see from a fight. Could be a hit-by-car, but there was no telltale road rash. We decided she must've gotten hung up on a fence. The laceration had a 3-corner tear type shape. She had gotten hung on a sharp point of the fence, then panicked and struggled, tearing the flesh off her body. The small clean cut on her wrist made sense, too.

The receptionists came back and told me the wife had stopped by on her way home from work. "You'd better go up there and talk to her," one said. "I think her daughter was just in a car accident." What? Can anything else go wrong for this poor person?

I talked with the woman and said, "I'm sorry you're having such a bad day." Actually, it was her niece and sister in a car accident. She did not have a daughter. The niece had to be cut out of the car, but was largely unhurt. I explained her dog's injuries to her. "Man, I thought the baby having the flu was bad; now all this! I didn't even know she snuck out last night, and I was so tired I didn't even check her this morning..." I assured her we understood how it happened. She said the dog likes to go explore in an area with a chain link fence, so the injuries fit with a fence hanging. I sent her home while I did surgery.

It took over an hour to tack the skin back down to the trunk from the back midline to the abdomen midline. I also placed a drain from the back down to her belly, because a big physiological space like that is going to naturally accumulate a lot of fluid. Also, it was so contaminated that the body needed a way to drain infection out.

I gave her lots of pain meds after surgery, but still my patient was moving nothing but her eyes. We carried her out on a stretcher and to the owner's car, to transfer to the emergency clinic for overnight care. "Thank you so much for staying late and taking care of her!" the owner said. It was 8:15 pm.

The next morning my patient came back, and I saw her standing for the first time. She had a sweet nature and was much more stoic than some of our other patients with very minor injuries we saw that day. She refused to eat until about 4pm, when she took three bites of AD from my hand (it's like liver pate for dogs). I sent her home with antibiotics, but warned the owner that she still might get an infection, and hoped that the skin would not be so devitalized that it might die and slough off. "Expect lots of drainage," I told them.

Four days later, she is still doing well, no sign of infection, still lots of drainage. Healing is happening!

In other news, I called the cops again on the leash-free dog walker today. And, new food post.


mr man said...

Besides being super-mama and incredi-vet, you might also pick up leash-lady as a moniker. Great story about the fence mauled dog. Watching Emma be sick was a testament to animals' will to survive and appear healthy, even when they are ill or very hurt. It's very rewarding to know such a wonderful human-being.

Emily said...

Wow. What an incredible survival story! I'm glad you were there to help her, and it's fascinating to read how you forensically determined the cause of the injury.

I agree with Mr. Man. It is rewarding to know such a wonderful person such as you.

peevish said...

Oh, that poor dog. I'm so glad you could help her. And how well I remember that zombie phase of parenting. I think I barely would have noticed if our house had caught fire.

Yea, Jenn!

paula said...

That poor dog is so lucky to have received attention from such a talented vet - amazing stuff Jenn XX

Laura said...

Poor dog. I can just picture how she must have looked, based upon your description. Reading the story brought back some very vivid memories of our poodle climbing the fence when we were kids. She never flayed her skin back like that, but did suffer a nasty puncture wound, from which her intestines extruded. She healed fine, though. We were lucky that time.