11/8/05 Mike gets his wish

Ever since Mike got here he kept saying that he really wanted to see an interesting case. Well, he got that interesting case and more!

Yesterday I was performing a spay on a Weimaraner and Mike was watching the anesthesia. As I opened up the abdomen, I felt small amount of air moving in and out of the incision. Normally I wouldn’t have made a big deal about this because the incision is small and if the patient is breathing deeply it can cause a little air movement through the incision. However, several weeks ago I had a very similar spay go very wrong when I felt air move across the incision. I was about half way through that spay when I noticed that the dog was moving her chest a large amount but barely moving any gas through the anesthesia bag and her tongue was turning a disturbing shade of purple. I took off my gloves and started to ventilate for her and she pinked right up. I finished the surgery as quickly as I could and immediately took an x-ray. What I saw did not make me happy. Instead of seeing air-filled lung in her chest, I saw a whole bunch of soft tissue. We got her back on the table, gave the person assisting me that day a quick lesson in ventilating for a patient, had someone else who knew how to put sterile gloves on get ready to be a human retractor, and I opened the dog back up from stem to stern (her entire abdomen was opened). It was then that I discovered an 8 cm tear in the right side of her diaphragm (the muscle that separates the abdomen from the chest and is used to breath). Her entire spleen, stomach, and part of the liver where up in the chest far away from their normal homes. I spent over an hour trying to suture the diaphragmatic hernia back together but towards the end she died on the table. The entire situation was upsetting but I had to call the owner and let her know. The owner was understandably upset but then shed some light on the situation; turns out that the dog had been hit by a car about a year ago but didn’t have any visibly broken bones so they never brought her to a clinic.

Back to the spay I was performing two days ago. I continued the surgery and related the previous story to Mike. We started to notice that again, for as hard as she seemed to be moving her chest she wasn’t moving an equal amount of air through the anesthesia bag. Based on that fact, air moving through the incision, and my recent past experience, I opened the incision further. Once I got my hand through the incision I was again not happy. This dog also had a large diaphragmatic hernia. Unbelievable!! This time, however, I had some good help. Between the two of us, Mike and I were able to get the hernia closed and complete the surgery in about 2 to 2.5 hours. Considering neither of us had successfully done this before I was happy but we where a long way from being finished. When we first took her temperature the thermometer just read “low.” After placing warm blankets on her and warming up her fluids about half an hour later the thermometer read 90 degrees Fahrenheit. That is LOW! The normal temp for a dog is somewhere between 100.5 and 102.5 so we were concerned about the current body temp. We continued the warm fluids and blankets and then we moved her outside onto the warm concrete and the setting sun. She was getting warm and started to shiver so we placed her into her cage. We were starving by this time so we went to dinner. When we got back we weren’t really sure what to expect and were elated to see Suede standing up in her cage wagging her little nub of a tail!!

Fortunately we did have some good antibiotics to give to her, Cefazolin and Amikacin (which Mike just brought down), but the only pain medication we have available is ketoprofen (which I just brought down). It would be the equivalent of me opening up your chest, messing around with your guts and lungs, and then only giving you a couple of aspirins for the pain. These Grenadian dogs continue to amaze me but I will be oh so happy when I go back to the States where I can give my patients narcotics for pain!

With the previous case that I saw, I was concerned about our normal procedure on surgery day. If we have a busy day of surgeries lined up, I don’t perform a physical exam on all the dogs. I kept beating myself up figuring that I would have found something on the exam of that dog with the diaphragmatic hernia and wouldn’t have performed the surgery. Other vets had told me that without knowing that the dog had a history of being hit by a car it wouldn’t necessarily be easy to pick up the problem on an exam. However, Mike had examined Suede the day before her spay and hadn’t found anything abnormal. That made me feel a little better about my first diaphragmatic hernia case.

I’m still concerned though…things have a way of coming around in three’s. So for as unusual as it is for someone to find a diaphragmatic hernia during a spay, I’m waiting for the third one to walk through the door! And this also reminds me that even though I spay dogs several times a week, there is no such thing as a routine surgery!!

Suede is doing well today.