Your Pet's Best Friend

Christmas Decoration Hazards

"It's beginning to look a lot like Christmas, everywhere you go..."  Personally, I think getting started too early makes you sort of take it for granted by the time the blessed day arrives.  I'd rather have a frenzy of decorating about a week before, but I'm in the minority.  My house is getting decorated, and on the first day of December the staff had the clinic decked in boughs of holly, or some synthetic equivalent thereof.  I absolutely refuse to countenance this sort of thing before Thanksgiving (and Wal-Mart had Santa Claus rosy cheek-by-jowl with ghosts and goblins right after Halloween; like mayonnaise on pancakes, this is just wrong).  I can only hold the line for so long, though. 

The clinic Christmas tree has little red ornaments with our names and our pets' names.  Note that it hangs on the wall, out of reach of casual nibbling by pets (or kids, for that matter).  Most folks have decorations that are a little more accessible to their pets.  There is a ton of information on Christmas hazards, but I'll hit the high points. 

Poinsettias aren't so terribly poisonous, but they aren't good to eat, either -- lots of puking, at least, and maybe worse, so put them out of reach (say, at somebody else's home).  Any kind of string, garland, tinsel (even if not covered with tasty popcorn) can cause an intestinal blockage.  A real, live tree in the home is a temptation to climb (and fall), and is often considered a taste treat (more puking).  Don't put that preservative chemical in your tree water; it's almost as good a place to drink from as the toilet.

If your pet is blinking on and off because he's latched on to the electric light cord, step number one is (and I can't stress this enough) PULL THE PLUG! Do not grab the pet. PULL THE PLUG!  Otherwise you join the circuit and get electrocuted, too.  Pets who have received electric shocks need emergency attention.  They may look okay at first, but they can drown as their lungs fill with fluid shortly after the shock.

You have to eat a LOT of chocolate to get poisoned, but Christmas is when some of us have a lot of chocolate around (or should).  On the other hand, it takes very little of the artificial sweetener Xylitol to kill your pet, so don't drop the sugar-free gum or candy.  If you do, treat it as an emergency.  Of course, there are other bad things to eat around Christmas, too.  This guy doesn't look like he feels too good, and he doesn't.

He's got a bit of a sore throat after eating some glass.  I can't tell you how many times I've seen patients dying with parvovirus, and the owner asks "Do you think somebody fed him glass?"  And I reply, "Why would he eat glass?"  The answer is that he would eat glass to get in the holiday spirit, apparently.  Above, we have the intact ornament.  Below, the ornament that was mistaken for a tasty snack. Ouch.

As it turns out, the little pieces of glass (which ARE dense enough to show up on an X-ray) are all in the poop already.  If you look closely, you can see some bright white spots in the poop.  However, he's still not feeling too spiffy.  Once I accidentally swallowed a fish-bone.  It hurt for a long time.  I'm guessing that little pieces of broken glass are worse.  I'm not going to try it and see.  After all, with seven years of college and thirty years of practice, my guesses are "educated guesses" (and all my excuses are "doctor's excuses").

Cat-bite Abscesses

Cats have disagreements.  Diplomacy often fails to resolve these (if it's ever tried), resulting in physical altercations.  Most of this involves a lot of swatting with claws.  In fact, even a cat who has been de-clawed for years will usually instinctively slap you before he thinks to bite you (fortunately for my nose).  They do bite each other, though (and me, too... sigh).

When they do bite each other, you usually don't have the big tearing lacerations that dogs open up on one another.  Instead, you have small, but deep punctures.  It's sort of the cat equivalent of getting shivved with an ice-pick.  There's a little crushing, but not nearly so much as with a dog-bite. 

Now you've got these very small (one or two millimeters) wounds, looking like baby Dracula paid a visit.  They don't bleed that much, and the cat licks that off, and the fur covers up the scab.  You don't see the wound (or feel it either, probably).  Just think how long it takes to find Dracula's fang-marks on the naked skin of the beautiful girl's pretty white neck.  And the vampire-hunters are really looking for something (unlike the cat-owner, who really isn't).

So the cat looks pretty normal... at first.  BUT, since the wounds are about ten times as deep as they are wide, you can't wash them out, even if you did see them (which you didn't).  You can't push a string.  Fortunately, even though the wounds are contaminated with the evil germs from the attacking cat's mouth ("the germs that cause bad breath" and bad infections, too), the body's defenses usually take care of it.

When they don't, you may notice some tenderness, or pain, or swelling about three days after the wound.  The bacteria multiply, damaging tissue, and the body's defenses come to the battle.  The battle rages on, producing casualties: dead tissue, dead white blood cells, dead germs, leaking fluids... PUS, in short.  This accumulation is painful, just from the pressure of the swelling, not to mention the dying tissue.  This is an abscess, a pocket of pus.  If you don't get your cat to his veterinarian first, the damage may deprive the overlying skin of circulation, and the abscess may break open through the dying skin.  This is when you find some drainage.  For instance, this cat put his head in the owner's lap, and she said, "What is THAT?"

As nasty as this looks, it's actually as bad as it's going to get.  The overlying skin is all dead (Yes, I picked it off, primate that I am), and the pus has all drained away, and we just have some damaged tissue on the bottom.  A little pain medicine, some antibiotic therapy, and some hot-compresses, and this will be closing up in a week or so. 

It would have been better to catch this before it all got dead.  Earlier (with just a little swelling), we would have made a small hole (as opposed to this huge one), drained the pus, irrigated the cavity, and started the antibiotic therapy.  It gets better faster that way.

Crushing Injury Evolution

Here's Rex.  Despite her name, Rex is a girl.  She is a house-dog, except for the day she escaped and ran off for a couple of hours.  She came back with her left hind leg wounded.  The next day she came in to see me.

This wound is obviously infected.  It looks like there are several cuts.  It also looked to me like there might have been some crushing of the tissue involved, like maybe she got her leg hung up in a fence or something.  If it weren't all infected, you could sew this back together.  Of course, it IS all infected, so we started with antibiotics, pain meds and a nice bandage with tissue-friendly dressing and a secondary layer to soak up drainage.

Good thing we waited to sew it up, because we sure would have wasted a lot of time.  When tissue is crushed, it loses circulation.  It may look okay initially, but over the next three to five days, things can change drastically.  Sometimes we sew it together anyway (when it isn't as grossly contaminated as Rex's wound), but we have to be prepared to see all our hard work dry up and fall off a few days later.  Here is Rex's leg after everything that was crushed and going to die had gone ahead and died.  This is nine days after the initial injury and (after many bandage changes) we are down to healthy tissue, with a nice granulating bed in the middle.  Granulation tissue is half capillaries and half fibroblasts.  It's the body's "fill in the gap" tissue -- nature's spackling compound.

There's not much loose skin to play with here down low on the leg.  So, I'm pretty happy with the amount of reconstruction I was able to do on the leg.  We've got skin covering almost all of the area.  Of course, we'll have to wear a heavy padded bandage to protect this while it heals.

Here we are ten days after reconstruction with  just a 5mm raw spot.  I'm happy.  We took out the stitches and rebandaged "one last time".

 

Here we are seven days later with just a tiny little 2mm raw spot.

And here we are with hair, five and a half weeks after reconstruction.  It's all good.

Cuddles beats the odds.

This is the “after” picture.  I didn’t take “before” pictures.  Things were a little hectic at the time.

 

“The other dogs have attacked Cuddles, and I can’t tell whether she’s still alive or not.  I can’t see her breathing.”  It was before 7:00 AM, and Cuddles’ owner was as upset as you can be without being hysterical.  “Does she have a blink reflex?  Touch the corner of her eyelids.”  “She blinked a little.”  “She’s still there. Come on.”

Cuddles lives in Portageville, over 30 miles away.  When a conversation starts with “I can’t tell if she’s alive…” you can’t help but be a little pessimistic.  I got dressed, rushed to the office, set out the stuff to start I.V. fluids and oxygen and so forth, but I figured I’d be putting it all away.  The next exchange is usually something like, “I’m sorry, she’s already gone.”   Then it’s on to “She was a good wife and mother, everyone loved her.”

 

In this case, that would not have been strictly true, since five of the other toy poodles had ganged up on her like wolves, trying to kill her. (Number seven was beating on the door screaming “Mama!”).  This was not the first time the other dogs had tried to take her down.  The previous occasion had been bad, but not this bad.  Mom tried strenuously to always keep them separated if unsupervised, but… things happen.

 

SO, you can imagine my surprise (and her owner’s, for that matter), when Cuddles had revived somewhat on the trip.  She was in terrible shape, but she was holding her head up.  Ear ripped, neck ripped, leg ripped, and one leg… Well, have you ever watched one of those cooking shows where they take a pointy-looking mallet and beat a chicken breast until you can read through it?  Many, many bite punctures, and every bite is a crushing injury.

 

Some quick patching, and intensive care for a couple of days got her ready to go home.  The little curly wolves were as surprised as the rest of us.  She’s pretty much healed up now, but that tenderized thigh has got a few more weeks of recovery before those muscles regain strength.

Use "break-away" collars for cats.

The cat's basic nature differs considerably from that of the dog.  They are nocturnal hunters.  They climb trees.  They are very flexible -- if their whiskers can get through an opening, so can the rest of the cat.  A dog accepts restraint pretty well, but cats hate it.  Many cats simply refuse to wear a collar, struggling constantly while it is on. [So do some dogs, but not many.]

Because of a cat's propensity for investigating small places and climbing trees, collars may become hung up on something.  With a regular buckle like this, the cat will have great difficult getting disentangled.

The same is true for this type of "snap" ("seatbelt") buckle.  They look like plastic junk, but the company guarantees them not to break (with free replacement if they do).  They don't pop open on their own if properly closed.

You might have wondered why the cat looks a little angry in the first picture.  This is why.  She was missing for four days, returning home thin and a little dehydrated, and with her collar in her armpit.  Apparently it was a little tight, having been adjusted for her neck, not her neck and shoulder.

Here's a close-up of the wound.  It's too infected to close up today, but we've cleaned her up, and she is taking antibiotics and pain medication.  Cats are such great healers, it will probably be half closed by the time the infection is under control.

Here's the buckle on a "break-away" collar.  If the cat pulls hard enough, the buckle just pops open.  People complain about the cat losing its collar and having to buy more collars, but the collars are pretty inexpensive -- certainly cheaper than treating such a wound.  "He keeps coming home without his collar".  The key words in that phrase are "He keeps coming home".   Some cats that get hung up just don't come home.  Somewhere in a bush there is a little kitty skeleton hanging by that collar we didn't want to lose.  Wish I had a picture of that.

Head Trauma

This is Junior.  If he looks a little "out of it", then this is a really good picture.  Junior is a Bassett Hound, led astray by an old English Bulldog.  They both left the yard, but Junior got too far out into the street.  [What,no fence, you say?  Yeah, no fence.  "You pays your money and you takes your choice."...Charlie Allnutt ]

He managed to drag himself out of the street, but had trouble with his hind legs.  The folks rushed him to my office (at 9:00PM), and at first, things looked like he had a few scrapes on his face, but that his hindquarters were suffering.  By the time I got his rear end X-rayed, his pupils had become asymmetrical and poorly responsive - a cerebral concussion, with brain swelling on one side, is almost certainly the cause of that situation, particularly with a little road-rash on the head.  His hindquarter problem actually stemmed from his "headquarters".   

Here he is on I.V. fluids with his head elevated.  We used to fill these guys full of cortisone to reduce the brain swelling and give warm I.V. fluids to keep them from going into shock.  Turns out, the cortisone doesn't really help the brain swelling, and it may cause other problems, so that's a "no-no" now.  As for warm fluids, it turns out that you treat a bruised brain a lot like you treat a sprained ankle.  R-I-C-E = Rest, Ice, Compression and Elevation.  Instead of ice, you use cool I.V. fluids and try to lower the body temperature a little.  Sometimes you even go to the extent of filling the bladder with cool fluids to help lower the body temperature. Lower temps cause blood vessels to constrict, limiting leakage of fluids.  We elevate the head 30 degrees above the body so fluid doesn't want to pool just due to the force of gravity.  Rest is important, and some of these guys may require drugs to combat seizures.  The compression thing doesn't apply - no pressure wraps around the head [no tourniquets on the neck, either].  In fact, the skull will provide so much compression that the brain damage could be permanent if you don't reduce that swelling.  Keeping the blood glucose level up is important, as is plenty of oxygen.

Mannitol is an osmotic diuretic.  It's such a big molecule that it pulls fluid to it and out through the kidneys.   This does more to reduce brain swelling than anything else you can do.  You have to give the dose slowly, though, spreading it out over 20 to 30 minutes.  You can't imagine how fascinating it is to watch the little timer and give another 1.0cc every 30 seconds -- slightly better than watching paint dry. 

The mannitol is followed with another diuretic, and is repeated at six to eight hour intervals if necessary. 

Unfortunately, I was too swamped to get a picture when Junior went home today.  It took him a couple of days to remember who he was and how to eat, but he's doing pretty well now.

"Will he have brain damage, Doc?"  "With your dog, I'm not sure we'll be able to tell a difference."  And get a fence.

Dogs swallow needles.

Why do dogs swallow needles?  As Sir Edmund Hillary said about Everest, "...because it's there."  Oddly enough, if they actually get a needle or pin swallowed, more often than not, it just passes on through and comes out in the stool.  Under most (NOT ALL) circumstances, the intestinal tract recoils from those sharp points and the needle just eases on through.   This does not mean you should ignore an occurrence of needle eating.  The needle can certainly lodge in other places, can perforate the gut, and can do a great deal of damage as it travels through.  You should definitely consult your veterinarian if you know your pet has eaten a needle.

Oddly enough, the situation is usually worse if a thread is attached.  In fact, a wad of thread by itself can be a problem.  One end gets caught, the thread is now a "linear foreign body", and the intestine bunches up on it like the waistband of a pair of sweatpants.  The string then saws through the folds, causing multiple holes in the gut, which is VERY bad.  This is called a plicating (folding) foreign body.

That's why seeing this dog who had swallowed a needle had me more worried than usual.  The dog is saying, "Thread?  What thread?  I don't see a thread.  Do you see a thread?"  Like his owner, he's just worried about the needle.

This thread right here.  Now the owner knew he had grabbed up her quilting needle, because A. it wasn't where she left it, and B.  here is the thread she was using, hanging out of the dog's mouth.  Hey, why don't we just pull on it and get the needle out?  Reason #1:  If we break the thread, we've lost our handle that will help us find it.  Remember Theseus and Ariadne in the labyrinth?  (No?  Better google it, then.)    Reason #2: It might be really painful for the patient.

First we took a whole-body X-ray and found that the needle was in the head "somewhere".  That's why we anesthetized our curious friend to look for it.  Fortunately (for me) I could see the eye at the back of the palate (roof of the mouth).  It was also fortunate that I didn't pull on the thread much.  The needle point was directed straight up behind the eye (about an inch deep). Ouch!

We sent him home with a little pain medicine and antibiotics and he'll be fine.

A Crushing Injury

Warning: We have a happy ending, but there are some gross pictures.

Crushing injuries are among my least favorite. They not only do a lot of damage, but it is difficult to determine the extent of the damage when you first examine them. Sometimes tissue looks okay, but has had its circulation irreparably damaged. You work diligently to reconstruct the injury and three or four days later everything turns black and rots off. Since you can’t tell for sure whether something will survive, you salvage as much as you can and hope for the best.

This is Duke the Bloodhound. He’s only six months old and already weighs 62 pounds. I estimate that his adult weight will be close to 100 pounds, or about 25 pounds per paw. Actually, dogs tend to carry more weight on their front legs in motion, so maybe 30 pounds per front paw and 20 pounds per rear paw. That would make it bad to have only one front paw; it would have to carry quite a bit more weight than it is designed to.

Duke ran in front of his owner’s truck in the driveway. His owner slammed on the brakes to keep from running over him, but actually stopped the truck on top of his right front paw. Being between a ton-truck and an asphalt drive is very similar to being between a rock and a hard place. Plus, there was a little skidding in the process.

When Duke got free, he ran under some bushes, filling his mangled paw with dirt. This is what it looked like when I saw it soon afterwards.

This is what it looked like when I began to clean it (and yes, he is anesthetized by now).

This is how much I knew was crushed beyond repair and had to just trim off and chuck into the trash (I mean the biohazard container).

This is what it looked like after the initial reconstruction. All he has left is his little toe and the big metacarpal pad, but it looks pretty slick. I was hoping that big pad would survive. While the foot would be far from normal, if he had that much left, I felt it would be enough weight-bearing surface to give his good leg a rest. We are using a LOT of pain medication now, lots of antibiotics, lots of bandage material.

This is Callie. We don’t know what happened to her front toes, as she was adopted from a shelter. Maybe it was a de-claw gone wrong, but we really don’t know. She gets along fine, except for having to stop every now and then – she’ll sit up on her haunches, give those front paws a little shake and then continue about her business.

This is all she has for front feet, and she’s making it pretty fair (although on light duty, admittedly). Callie’s toe-less feet were the reason I opted to try and save some of Duke’s foot, instead of just amputating his leg.

So here we are with Duke again on day 6, when the dead tissue comes apart. It’s not looking so good. Now comes about 10 days of bandage changes and cleaning and removing dead tissue until we finally get down to nothing but live, healthy tissue.

We performed a second reconstruction, on day 15 after the injury. (sorry, lost the picture) Now we have more bandage changes for the next two weeks, plus a few more days of topical therapy in the hospital.

Here we have the almost finished product. Just a little raw spot in the middle, and it’s getting smaller every day. He walks on this foot, even runs on it some. It only took five weeks in the hospital, a gazillion bandage changes, and a whole lot more money than it would have cost to just amputate that leg. I think it’s going to be worth it, though, to have four feet for the rest of his life (even 3 and ¾ feet).

Hip Dislocations

So here we are with our hip joint back in place, taped up in a "sling", but still under anesthesia.  It usually takes a lot of force to dislocate that ball-and-socket joint, so it's unusual to have a big dog like this with her hip dislocated and no other major injuries.  If there's that much force, it usually breaks a few other things, too.  Calli here just has some road-rash and minor cuts to go with her injury.

We medical professionals call this a "coxo-femoral luxation".  "Dislocated hip" just doesn't sound scientific enough for us cool guys.  Most can be replaced without surgery (though some cannot).  Most of the time, the head of the femur (the "ball") is displaced in front and above the socket.  Then the muscles lock up in a spasm, so that even under anesthesia it is really hard to manipulate things back to their normal alignment.  You have to fatigue the muscles by pulling on them and manipulating the hip.   Bigger dogs have bigger muscles and are more difficult to manipulate. It took about 45 minutes for this one on Saturday night (which is unusually long).  I began to wonder whether my own muscles would turn into dishrags before Calli limbered up enough to pop back in place.   It reminded me of when I had my shoulder dislocated the first time -- a complete separation, they called it.  The next day my wrist hurt worse than my shoulder (I think they pulled on it pretty hard when they put things back in place).  It didn't hurt as badly as the shoulder did when it was displaced, though.

Sometimes it feels almost right, so you stop and take an X-ray.  It's still out, so back to the tug-of-war.  When you finally get it right, everything moves smoothly and the muscles relax.  You push hard while you manipulate the hip so that you mash the blood clots out of the socket and make room for the femoral head.  Then you tape things up.  Those muscles and ligaments are really stretched out, and they need time to tighten up and heal a little before the dog puts weight on the limb.

Most dogs return to normal activity in a couple of weeks.  That hip may get arthritis before the other one, but not for a few years (we hope).

Calli went home with her sling, instructions to rest (on a 10-months old Lab: good luck with that!) and pain meds, of course.  We'll be rechecking her soon.

Proptosed Eye = Eyeball out of socket

Warning: There is a gross "before" picture at the bottom of this post.

Some time ago, in my discussion of bug-eyed dogs, I touched on proptosis globus.  This means that the eyeball has been popped out of the socket.  Since the bug-eyed dog has a shallow socket and a big eyeball, it doesn't take much force to do the deed. A slap to the head, a rough grab of the neck scruff, a scary movie ... (I made up that last one.)   

This guy looks like he's more than half-way there, and it's just an average day for him (we fixed this guy later, by the way).  One good thing is that if you can catch it right away, these eyes can often be saved.

For an animal with a normal eyeball-socket relationship, it takes a much greater trauma, and is a rare injury.  If there's enough force to pop that eyeball out, the rest of the head will probably have a lot of other problems... like a skull fracture, and it's unlikely you could just pop it back in.  That's why I was really surprised to see this kitten with a proptosed eye with no other major injuries (the gross picture is at the bottom).  Apparently a big dog grabbed his head and squeezed. The eyeball was unsalvageable, so we just had to remove it so the little kid wouldn't be in pain (plus we gave pain medicine, of course).

So, here we are after surgery.  You have to remove the tear-producing glands, and the third eyelid (with its tear-producing gland) or the thing will open up later and ooze.  You trim off the edge of the eyelids and sew it all together, nice and neat.  Doesn't it look nice and neat?  It doesn't?  Well, it will when the hair grows back.  Fortunately, the socket doesn't sink in and need a glass eye.

Of course, you could always go pirate, but you really don't have to.

Here's what it looks like when the sutures come out.  The hair hasn't all grown back yet, but you can see that it looks pretty good already.   When it's soft and furry, she'll just look like she's giving you a sly wink.

Here are the gross pictures.