Wednesday, November 6, 2013

1154. Why is the dog still vomiting 19 days after swallowing a chicken rib bone?

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Date:   08 November, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
A young Silkie vomited daily for 19 days 
Be Kind To Pets Veterinary Education Project 2010-0129. Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   08 November, 2013  
November 6, 2013 Today, I insisted that the owner had 4 X-rays taken of his dog. 4 X-rays are the minimum number to show whether his dog has chicken rib bones lodged inside his throat (2 X rays), chest - oesophagus (1 X ray), and abdomen - stomach or intestines (1 X-ray).
The owner protested: "Vet 2 had taken X-rays of the chest and abdomen on Oct 21 and had stated no chicken bones were presented!"
Vet 2 had also used ultrasound on October 28 and reported no chicken bones. I found out that Vet 2 had not taken X-rays of the throat and so had advised.  As the dog was still vomiting lots of white froth after drinking, the owner got him X-rayed this morning and was not keen on another 2 "unnecessary" X-rays since Vet 2 had done it with negative results.
From my experience, it is best to repeat the test since the dog had not recovered after 19 days. He swallowed chicken rib bones after scavenging the rubbish bin on Oct 18 and was sent to Vet 1 and was treated but still continued vomiting. Vet 2 did the X-rays and ultrasound and gave medication but the dog still vomited.
"He would want to bite us if we feed him medication," the father said today. "But this morning he was active and barked. For the past 19 days he was sleepy and his stomach was heaving. He kept vomiting and would not eat."   
The father had consulted me on Nov 2 but did not approve any X-rays. So I treated the dog with IV drips and sent him home on Nov 4. He continued to vomit on Nov 4 and 5 and so he had to be reviewed again. That meant X-rays, a minimum of 4.
Sometimes vets try to accommodate the owner's wishes to save medical expenses. In this case, if I had not insisted on the repeat of the chest and abdominal X-rays and just did the throat's X-rays, the outcome for this dog would be very bad as he really has a large chicken rib bone in the chest X-ray!

The throat X-rays may have bone fragments but his main problem was the big rib bone in his caudal gullet near his stomach. For 19 days, he could not retain his water and hence he would vomit a few times, retching and heaving to the distress of the family members daily for the past 19 days!
Now that the problem of the stuck rib inside the caudal oesophagus is evident, what is the treatment?

1.  "Any drug to dissolve the bone?" the father asked me.
"No," I said. I consulted a senior vet who told me that the gastric acid from the stomach would dissolve chicken bones after some time. This would not apply to pork rib bones though.
"It has been 19 days," I said.
2.  "The second approach is to pass a stomach tube to push the bone into the stomach," he advised. "However you may rupture the oesophagus although it is a tough muscular tube. You would need to do surgery then."
"The dog would be dead then," I said.
3. "The third method is to open up the chest and extract the bone from the gullet. There is little space to maneouvre and the surgical costs would be around $2,000."
4. "How about extracting the bone via the stomach using forceps to grasp it?" I asked him.

"I don't think you can do it."

So now, I have a diagnosis. My solution will be the least traumatic and cheapest. To use Method 4.  But the dog is in poor health. "No blood test as the dog had normal results from Vet 2," the owner disapproved my request. The blood test taken by Vet 2 was on Oct 30, 2013 and now it is Nov 6, 2013. I am giving him the IV drip for the next 2 days before surgery as there is no other option unless the bone "dissolves". This may be science fiction but there is a possibility.

At around 5 pm, I gave the dog 2 ml of Spasmogesic and Baytril. He was still panting and his abdominal movements were marked.

I video-taped his abdominal movements. He vomited canned food just eaten. When the owners and friends numbering 8 people came to visit him at 7 pm, he was barking furiously and jumping about wanting to go home. "His bone had gone down to his stomach," Dr Daniel remarked. I thought of taking another X-ray but the owner would have to pay for it and the X-ray was just taken this morning. So I did not insist. 
Chest & abdominal X-ray (original at left & photoshopped)
Chicken rib bone was seen in the caudal oesophagus 24 hours before surgery
Head & neck X-ray showed some small bone fragments?
Original X-ray Vet 2 reported no bones but the dog vomited daily. Blood tests were normal 
Nov 7, 2013
The dog was active and barking furiously at one time to get attention in the morning. In the afternoon, he was operated by Dr Daniel and I. A long tissue forceps was used to grasp the bone inside the caudal oesophagus but there was no solid bone. A stomach tube passed into the stomach without encountering obstacles at first. The tube was full of gastric froth and withdrawn. It was passed again.

There was some obstruction. It was withdrawn and passed into the stomach again. The bone was in small fragments. An examination of the small and large intestines, all inflamed, was undertaken. No large bones. The gastric incision of 1 cm was stitched. The chicken rib bone had disintegrated and was no longer intact as in the X-ray.
As at 9 pm, the dog had recovered from anaesthesia. He should live a normal life and must be kept away from scavenging the garbage bins for chicken bones. . 

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