It was 7.30 p.m. and I was running a little late at work after a pretty full on day. I was feeling quite fatigued and when I realised I was on emergency call, I expressed myself aloud saying: ‘I hope not to receive a single afterhour’s call and if I do, it had better be a true emergency’. I knew the moment I uttered those words that I had shot myself in the foot.
Only five minutes later, the after hour’s phone rang. I immediately picked up the phone and the distressed caller said:
‘I have just picked up a stray dog that was struck by several cars, can I bring him in?’
Obviously that counts for a true emergency and so I instructed the caller to bring the injured dog straight in.
In the ten minutes that followed, I prepared the oxygen mask, pain relief, IV fluid set up and everything I pondered would be relevant. In my opinion, you can never be too well prepared for a true emergency!
I then heard a knock at the door and let in this bloke carrying a Staffordshire terrier that was copiously bleeding from his nose and mouth. The poor dog was in a serious state of shock.
In any emergency, I must establish a triage protocol and quickly determine and treat the injuries in a multistage process starting with the more pressing issues first.
As soon as the patient arrived, I detected he was suffering from major head trauma.
My strategy was to get this patient as stable as possible and so I started him on IV fluids at a very conservative rate as too much fluid can further exacerbate brain swelling! I also gave him pain relief and an IV shot of cortisone to reduce the amount of brain inflammation.
I also listened to his chest to make sure he didn’t develop any tension pneumothorax from the impact and I took x-rays to rule it out. Based on my examination and x-rays, I was pretty certain that his nasal bleeding was mostly secondary to a blow to the nose and not due to internal haemorrhage.
At that stage, I felt the patient was fairly stable and basically needed close monitoring to ensure sure he didn’t develop any post-head trauma complications like seizures, breathing issues and etc.
Amidst all the chaos of treating the patient, I had also managed to scan him for a microchip and thankfully detected one.
I then contacted Central Animal Records and gave them his microchip number so they could supply me with his full details. The bloke that had brought him in also informed me that he suspected the patient was owned by his relatives. He had placed a call to them earlier asking them if their dog was missing. Our combined efforts finally determined and confirmed the patient’s identity. His name was ‘Diesel’ and he was owned by one of our regular clients that happened to be related to the bloke that had picked him up!
I called his owners and gave them the run down on Diesel’s injuries and explained they were pretty serious and that he was in a very critical state. I explained that he required intensive supportive care and that we would not be able to assess the level of damage his brain had contracted until all the swelling had subsided.
We also discussed the tragic circumstances of ‘Diesel’s escape from the backyard followed by TWO CARS running over his head and body one after the other and take off straight after.
There was no point for me to dwell on the tragic circumstances of how my patient ended up on my surgery table. I simply had to
focus on getting him through his ordeal. ‘Diesel’ was starting to snap out of his shock state and attempted to get off the table and so I moved him into a well padded cage. I then observed him closely for another few hours. His nystagmus was still quite prominent so I started him on IV Mannitol. Mannitol is meant to help draw out fluid into the vessels and help reduce brain swelling. I also topped him up with pain medication and he finally seemed more comfortable. At midnight, I felt I had simply done everything I could within my capabilities and so I went home wishing I had a nearby accessible and affordable veterinary intensive care unit (ICU) that I could have sent ‘Diesel’ to. I just had to give Diesel’s body a chance to recuperate overnight.
The next morning, I woke up around 6ish a.m. and did an early check on ‘Diesel’. I was very pleased to see he was much more responsive and his nystagmus had decreased dramatically. However, when I took him out of his cage to conduct a full examination, I discovered he was quite unbalanced and kept falling towards his right side.
Balance issues could be related to his brain trauma but I thought it was worth taking more x-rays to rule in/out any musculoskeletal injuries.
At 9 a.m. sharp, our clinic doors were open and Diesel’s owners walked straight in. He didn’t seem to react much when they patted and spoke to him. You could tell his mentation was severely affected. The owners thought he looked much better than they had expected. I explained to them while he didn’t appear to have many obvious external injuries, he was suffering from serious internal injuries especially brain trauma.
We proceeded with our x-ray safari that started with his skull and ended with his hips and hind legs.
His skull x-ray appeared to be grossly normal. I hope you can appreciate how challenging skull x-rays can be to interpret with all the overlying structures.
We positioned him on his side to take a lateral pelvic view and it was normal. We were starting to think his brain injury was the cause of his balance issues. I got interrupted during the x-ray session as I had to duck out to do an emergency consult. Thankfully our head vet nurse Amy decided to be very vigilant and proceeded to take another view of ‘Diesel’s hip with him lying on his back The final x-ray taken showed us Diesel’s right hip was luxated from its normal coxofemoral position even though it appeared normal on the lateral view.
This illustrates the importance of taking several x-ray views to avoid missing out on an important diagnosis.
Below is the VD view of his pelvis which shows that his right hip is out of its coxofemoral joint.
My head was spinning with so many thoughts after the discovery of his hip luxation. Generally if you reduce a luxated hip within 6-12 hours after it has occurred, you can successfully correct the luxation. However, if you don’t pop the hip back within that short time frame, the patient is more likely to require surgical intervention to physically replace his in its correct position.
Given Diesel’s very delicate circumstances, I decided stabilising his brain issues was the number one priority. Hence putting him under anaesthetic to replace his hip was out of the question as it was going to exacerbate his head trauma injuries. Ultimately, it meant that I was reducing the good odds of successfully replacing his hip and that he may require a femoral head excision arthroplasty later on.
Later that afternoon, Diesel’s mom came in to visit him again and we discussed our x-ray findings and treatment plan with her. He seemed more responsive to her and he even ate some food. Unfortunately, Diesel vomited up all his food later that evening and was suffering from quite severe rumblings of his abdomen (borborymi) but he was still in fairly good spirits. I was pretty astounded with his determination as it felt like he was fighting an uphill battle;
every time we managed to get one of his health issues under control, a new one would surface.
The Easter long weekend was coming up and Diesel’s vet bill was already quite high. I explained to his owner that Diesel was going to require intensive care therapy for another week or so and informed her of the current bill and the further estimated expenses. Although financially it was quite burdensome, she was not going to give up on him and I was very ecstatic to hear that.
By day three in hospitalisation, Diesel’s nystagmus had completely resolved and he was much more alert. We decided it was worth putting him under the influence of heavy sedation + muscle relaxant to attempt to replace his right hip in its correct position. Fortunately, we were successful at popping his hip back into its normal position and then we applied an Ehmer sling to support it in that position.
This is a picture of him with his Ehmer sling
Poor Diesel was extremely sedated for the rest of the day and his brain issues seemed to resurface. It made me wonder if we should have held off on replacing his hip.
Easter break arrived and my colleague Liz was rostered on call and she did great work with monitoring Diesel’s progress and offered him lots of supportive care: fluids, gastric protectants, antibiotics and pain relief.
On his 6th day in hospitalisation, Diesel was finally able to keep some food down and seemed more much responsive.
He was sent home as his owner was keen on giving him all the nursing intensive care he required. She was well aware that if he wasn’t eating or keeping food down then he had to be brought back and we would be surgically putting a feeding tube down his oesophagus.
A few days after his discharge, he came back for his scheduled revisit and he hadn’t improved much. The owner was struggling to get him to eat much. The owner still wanted to keep trying at home as he was making tiny improvements in her opinion. Needless to say, we were all feeling very deflated by the news and mortified of what is in store for Diesel in the next few days.
Diesel was booked in with me a week later to check his Ehmer sling and to make sure that it was still intact.
When he arrived, I just could not believe my eyes.
He was running around on all four legs as his Ehmer sling had slipped down. He was so interactive and even made whiney staffy sounds when we put him in his cage. It was so good to have Diesel back to his old staffy self.
Check out his pictures… I mean who would believe that this dog was run over twice only two weeks ago:
I decided it was best to remove his sling as it was not serving its purpose followed by another hip x-ray which confirmed his hip was still in.
This is the x-ray confirming his hip was in its correct position so far. He was not as cooperative with us taking his x-ray this time around and that explains why he wasn’t more appropriately positioned :-)
I then called his owner to update her on my findings and to get her report on his progress. She informed me that he was eating and drinking well but still had very loose bowels. I recommended she start feeding him a cooked chicken and rice diet mixed with probiotics to see if that will help firm up his stools.
In that particular moment in time, we all felt reassured that Diesel was going to definitely pull through.
Even though Diesel had so many war wounds from his tragic accident (deafness, lots of scars, a painful hip and sensitive tummy), he was going to conquer each and every injury and make a full recovery!
I seriously believe ‘Diesel’s big staffy resilient skull prevented his brain from being crushed and his strong survival instinct did the rest. I look forward to monitoring his progress over the next few months.
It really gets you thinking that being big headed may be not be so bad in the canine world!