Yesterday I had the pleasure of seeing some of my friends as my 8 o'clock appointment. We chatted about their cat, but also made plans and small talk. Finally they said, "Uh, don't you have to get back to work?" and I looked at my watch and said, "Yup, your appointment time is up." Moments later, a nurse popped his head in asking me to come to the treatment area, there was an emergency.
Nothing could have prepared me for what I saw - a small schauzer with what we term a degloving injury. Her entire forearm was stripped bare of skin from the mid-humerus down to the paw. Muscles, vessels, bone, even raw white nerves were exposed to the air. In addition, the tissues were quite traumatized and had obviously lost most of their blood supply. One of my nurses mistakenly called it a de-sleeving injury, and although not precisely the correct term, it did seem more accurate.
The poor dog was in shock, rigid on her side, not really responsive, definitely painful. We immediately administered fluids, pain meds, and antibiotics to stabilize her. I immediately knew amputation was in her near future.
First, however, we had to deal with the "drama." The injury had occured through a fence. You know the saying, good fences make good neighbors? This was a bad fence, with a gap underneath, through which the poor schnauzer's leg was pulled through by several dogs and mauled. The teenage daughter who was first upon the scene pulled the schnauzer away but sustained several bites from her own dog, who struck out blindly in pain and fear. The neighbors were the ones who brought the dog and the daughter to our clinic to receive medical care, but there was a lot of tension between the parties, which got worse once the mother arrived. Apparently, she had complained about the fence and the aggressive nature of the dogs to the home owners' association. Understandably, everyone was very upset. The neighbors offered to pay for the considerable estimate but did not want to admit fault. The owners wanted them to pay but did not want that to be the end of the resolution. DRAMA! Did I also mention I had volunteered to be acting manager this day since both the usual managers were out of town? Eventually, we convinced everyone that we needed to just focus on getting the schnauzer treated, the daughter also needed to go get medical attention. After everyone was a little more stable, they could figure out a long term solution to the problem. It wasn't our responsibility to find that solution; we needed to treat the dog.
As terrible as I felt about the dog's horrible ordeal and loss of her limb, I must admit I was pretty excited about the surgery. Its not something I get to do on a regular basis, plus I knew it would really help the patient to get this severely injured appendage, a source of all sorts of inflammatory mediators and pain, off of the animal. While the patient stabilized, I started clearing my schedule and getting the immediate patients seen.
That's when the fun doubled. I had a drop off appointment for a standard poodle that I had seen earlier in the week for vomiting. OK, prepare yourselves, this is gross - the owner knew the dog had eaten feminine hygeine products. Used ones. The previous day, the dog was eating and had a relaxed abdomen, stayed all day at my clinic and never vomited, so I sent it home. At 4 am, he vomited a tampon, so the owner brought him in. Now, on exam, he was extremely tender in his abdomen and looked miserable. Xrays revealed a huge wad in his stomach and a possible obstruction in his intestines.
"Do you really have an exploratory, too?" the staff all asked me. One of the nurses, who comes in mid-morning, came up to me and said, "Are you doing surgeries today? I volunteer to help!" She gets as excited about these things as I do.
I had planned to go and work out on my lunch hour. But now I was going to be "surgerizing", and I couldn't have been happier.
The amputation went really well. The shoulder was broken, and the scapula was all bruised. After removing the entire limb from the scapula down, the incision came together very nicely and the dog recovered well from anesthesia. We gave her injectable morphine, NSAIDs, and put a fentanyl patch on her for pain.
The exploratory was great. You never know what you're going to find when you open them up. Fortunately, all the foreign objects were in the stomach. It is much easier for the surgeon and the patient to open the stomach up than the small intestines. Unfortunately, I removed ELEVEN tampons and 1 panty liner. Yuck. They weren't bloody or anything, but they were hugely swollen with gastric juices.
I sent both patients to the emergency clinic for overnight care. On recheck this morning, the amputee schnauzer looked much better. She was sitting up and had a little spark of personality in her eye I had not seen the day before. Her pain level was much lower, too. I sent her home to continue nursing care in her own surroundings. The poodle was better, too, although he had vomited once postoperatively. After a few more hours of fluids and pepcid, I sent him home, too.
My boss had stopped in the clinic in the middle of the day between surgeries. When he heard everything that was going on, he said, "Man, I'm jealous!" I smiled, because I understood. Although its kinda sick, these are the exciting cases for us, the ones where you go in and do something dramatic to save a patient, and get to use all your technical skills. We go through all that training just so we can apply it to cases like these and really help animals. I never would have wished these calamities on these animals or their owners, but it is a privelege and a thrill to get to fix them.
(sorry, I have pictures on both cases but decided not to post them)
