When a Case Goes Bad
One of the saddest cases I ever dealt with as a veterinarian involved a dog who had been hit by a car while his owners were out of town.
Initially, it appeared that the dog, let’s call him Jessie, had dodged the proverbial bullet. He walked into my clinic with his pet sitter, looking a little sore and shaken up but otherwise okay. I could not initially get in touch with his owners, but they had a long history of doing what was right for their animals and I knew they would want me to do everything I could for him.
I gave Jessie a physical exam and found nothing other than some soft tissue tenderness that I was sure would turn into significant bruising over time. I ran bloodwork, mostly so that I would have a baseline for comparison should his condition start to decline. Finally, I took chest and abdominal x-rays to rule out any bleeding that I couldn’t pick up on Jessie’s physical. When I finally was able to talk to his owners, I told them that everything looked good so far but that we had to keep a close eye on Jessie to make sure his condition didn’t take a turn for the worse over the next 24-48 hours.
I put Jessie in a comfy cage, ordered up some pain relief (Tramadol since it had the lowest possibility of adverse effects in this situation), and made plans for him to be checked frequently. All went well for the rest of the morning, but just as I was finishing up in an exam room, a technician flew through the door to tell me that Jessie was having a seizure.
Another technician had already pulled him out of the cage and onto a pad on the floor of the treatment area. He was having such severe convulsions that it was impossible to give him an intravenous anticonvulsant injection. Thankfully, diazepam can be given rectally. We did so and Jessie’s seizure ended after just a couple of minutes. The technicians quickly placed an intravenous catheter, started oxygen therapy, and repeated his bloodwork and x-rays. Other than some evidence of bruising to his lungs, nothing else had changed. As I was leaving a voicemail with an update on his owner’s cell phone, Jessie started having another seizure.
For the rest of the afternoon, we gave Jessie repeated doses of stronger and stronger anticonvulsants but his seizures kept returning. Eventually, he had one that we could not stop with any intravenous drug. I intubated him (put a breathing tube into his windpipe) and started him on inhalant anesthesia. His seizure quieted as I left a frantic message for his owners. Before they could call back, Jessie went into cardiac arrest. I was able get him back once with CPR, but just a few minutes later his heart stopped again and despite my best efforts, he died.
I will never know exactly what happened to Jessie (his owners declined a necropsy, the animal equivalent of an autopsy), but I suspect that he developed a thromboembolism (a blood clot that travels through the circulatory system). The clot probably originated in his bruised lungs and then lodged in a vessel in his brain where it prevented a portion of the organ from receiving the blood it needed to function. This led to his progressive seizures and eventually his death.
Why do I tell you this story? Simply because it’s a reminder that injuries that appear minor at first can turn serious or even deadly over a short period of time. Even though we weren’t able to save Jessie, his owners, pet sitter, and I can rest a little easier knowing that we did everything possible for him.
Dr. Jennifer Coates