Friday, March 29, 2013

1344. A Good Friday's miracle (Mar 29, 2013)

I don't believe in miracles. This 5-year-old male neutered  Jack Russell was rushed in by the father on March 27, 2013 panting and unable to stand since 12 hours ago.

His neck was skywards. His four limbs were extended as straight as a ramrod. Panting and panting non-stop. His rectal temperature skyrocketed to 41 deg C. This scene reminded me of a dog under domitor IV anaesthesia. All muscles stiffened. Or a dog with tetanus with all 4 limbs straight but in this case, the jaws were not locked.

Was there any hope? The father gave permission for blood sample and I took a urine sample to test. Evidence-based medicine should be used as the family will want to know what is the cause of these symptoms and should the dog die, much allegations of incompetence will be insinuated if the vet does not practise evidence-based medicine.

Recently one retiree dog owner did not want the blood test or X-rays although his female dog had been lethargic for 2 days and her abdomen was bloated. His dog had fever. He came towards closing hours and the dog was given a drip and therefore needed to be warded overnight. His daughter objected to the dog being hospitalised as "none of the family's sick dogs had ever been hospitalised over the years even by the vets of a well-known big practice."  In other words, no dogs need to be hospitalised. Just give an injection and medication and the dogs go home. I discharged the dog home the next day. He phoned again to ask what was wrong with his dog and what caused the abdominal bloat as his dog was sleepy again. I asked him to seek a second opinion from another vet.

For this dog, the blood and urine test showed a bacterial infection. The bacteria would have invaded the brain and meninges causing the stiffness. It was not a stroke as the father postulated. There was an explanation for the cause of this stiffness of limbs and neck.

I gave this dog intensive treatment to prevent dehydration, reduce the stiffness and medication. On the 2nd day, he still could not stand. He started crying non-stop all the morning and afternoon. He would drink when a bowl was held to him. He would not eat. Bloody stools stained the thermometer when I took his rectal temperature. His moaning was loud and neighbours wondered why there was dog abuse. I injected sedatives but his loud crying would recur soon as the IV drip diluted the sedative effect.

So I phoned the owner's father to let him know of the poor prognosis and asked him to visit the dog. In one  experience, I had not phoned the owner to view the sick dog and it died leading to scoldings from the owner. I did not expect it to die, but some owners are quick to vent their anger. In this case, I expected the dog to die and therefore contacted the owner urgently.

A dog crying continuously, in my experience, is a sign of intense pain affecting the brain. I had seen such cases in puppies infected with distemper virus encephalitis. The crying just goes on and on.

"Nothing can be done till my son come back from overseas," the father said that euthanasia would require the son's permission. He had visited the dog and attributed the crying to his visit. But the dog had been crying for three hours before his visit. Sedatives seem to have no effect. A half-dose domitor and ketamine lasted less than an hour. The IV drip was still on. Oral sedatives. Rectal sedatives. No effect. Feeding of water temporarily stopped the crying. He did not want to eat.

Finally I decided to give another type of IV sedative to let him sleep through the night. At 8 am on Good Friday, Day 3 of the hospitalisation, there was no more crying. The dog could lift his head and stand when placed on the ground. He lapped water from the bowl. My new assistant placed a bowl of canned food in front of him. "Feed him using the spoon," I said to this young man who is under training by me in dog nursing. The dog swallowed the food. I got a video of the dog outside the clinic, standing and walking a few steps, of sitting upright on his chest. Then I placed him back to rest.

The son and his wife and father came. "What is the cause of his problem?" the father asked again although I had told him. "It is a bacterial infection of the blood and brain," I said. "What type of bacteria?" he asked.  I said I had not got the bacteria cultured. Economics played a big part in the heartlander's veterinary practice and more tests meant higher veterinary bills. If my practice was situated in a prime area where money was no problem, I would have done MRI costing a $1,000 and other tests. The overall bill would add up to at least $3,000 or more. This would not be much appreciated by the heartlander client. 

The daughter-in-law  took out her card to pay the bill. The dog was alive, eating and drinking. I advised the son that the dog would do better when nursed at home. It would also cost less. The medication and management, if complied with, would lead to his recovery. There was no blood test to show that he has recovered from the bacterial infection. This ought to be done as the father asked whether the dog had recovered. As this is heartlander practice, the minimal costs would be appreciated.

If the dog could eat and drink and was able to stand and walk for a few seconds, there was progress and recovery. MRI would be excellent in such cases to aid diagnosis. In economics, the important thing is to deliver. And this was the miracle on this Good Friday, March 29, 2013. There are miracles one can't help but believe in.


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