Visiting Veterinarian : When a canine squabble leads to the ICU
Big Dog didn't mean to hurt his friend, Tiny Dog. The two have lived together amicably for years. But that special Christmas treat was sooooo yummy. Tiny got a bit too close... and Big instinctively snapped a warning. "Stay away from my delicious treasure!" was all he meant to say. But Big's mouth is so big. And Tiny is so, well, tiny.
"We need immediate attention," the owner phoned urgently that afternoon. "Big bit Tiny. It's bad. There's blood everywhere. We're on our way." As I awaited their arrival, I wondered if I should call my assistant back. It was December 24th, and I had closed early to give my staff a holiday head start.
Tiny might just have a torn ear. Ear wounds can bleed so much that inexperienced owners get scared, but they're not really serious. It would be a shame to drag Elise away from her family for that. On the other hand, these owners have dog-smarts. If they said it was bad, it probably was bad.
Veterinarians have a name for these encounters — BDLD. That's Big Dog, Little Dog. As I collected supplies, I thought of a Yorkie I had seen once after a large dog had grabbed her back and literally peeled half her body, as though trying to pull her skin off over her head like a turtleneck sweater. Maybe I should call my assistant....
When Tiny arrived, it was immediately clear this wasn't a torn ear. Wrapped in a bloody towel, the six-pound dog lay flat on his side, neck arched oddly, clearly in distress. "Oh no," I thought, "what if Big broke Tiny's neck?" Large dogs sometimes grab and shake smaller animals like rag dolls, breaking their backs. I examined Tiny's limbs. He had feeling and motion of all four legs. Good. His spinal cord was intact. No broken back.
Now, where was all that blood coming from? His short black coat made it hard to locate the source. Gingerly exploring his neck with my fingers, I flashed on the case of a beagle who had lived with another large dog that kept picking fights. The large dog had finally gone for the little hound's throat one day. There had been a lot of mangled skin and blood-caked fur when I had first tried to assess the extent of the damage. Finding jugular veins and carotid arteries intact, and the bleeding subsiding, I had commented tentatively, "I think we might be okay."
Then I heard a rhythmic, gurgling whistle coming from her neck. In. Out. In. Out. Pulling aside a dangling skin flap, I found that the attacking dog had completely torn out two inches of the beagle's windpipe. She was breathing through the severed end protruding from her neck.
I held Tiny's face in my hands. His eyes flicked rhythmically and rapidly side to side. Despite his odd position, his neck seemed essentially undamaged, but the top of his head was swollen and damp with blood. There was the source of the problem. Big had bitten Tiny's head, his big canine tooth puncturing the little dog's delicate skull, right into the brain. Based on the extensive external bleeding, we had to assume there was significant internal bleeding inside the skull, too.
"I need to place an intravenous catheter," I said, mentally kicking myself for not having called Elise in. Too late now. When the body is injured, it often responds by swelling. Get punched in the mouth, you get a fat lip. Sprain your ankle, it puffs up. Head trauma also leads to swelling, but because the brain is contained within the finite space of the inflexible skull, there is no room for tissue to expand. As it tries to swell, intracranial pressure increases, and more and more brain cells die. To minimize this, we give intravenous diuretics that reduce central nervous system swelling.
"If we can stabilize him, you should take him off Island to an emergency facility with 24-hour care," I sighed. "This could go either way." At any moment, Tiny could seizure, or go into respiratory or cardiac arrest. Brain injuries are such a mystery, and there is only a limited amount a country veterinarian such as myself can do diagnostically, prognostically, or even for treatment.
"They might do a CT scan or an MRI over there," I said, administering the diuretic as well as fluids for shock, injections for pain, and antibiotics to prevent infection. "But really, only time will tell."
Not long ago I had sent off a springer spaniel who had been hit in the head by a car. That dog had looked almost this bad, and had survived. But there was another springer I saw years back, also hit by a car, who had started out looking better than Tiny, but then deteriorated steadily hour by hour and eventually died. Tiny's owners called their family. We called the Steamship Authority, alerted the emergency clinic, and sent them off to the Cape.
Big Dog, Little Dog. The Yorkie with the peeled skin had survived, although it took months and multiple surgeries to repair the damage. The beagle's injuries had been too extensive and she was euthanized. Tiny spent Christmas eve in ICU. Miraculously, four days later, he was discharged. The neurologist says that Tiny "may continue to improve slowly or his progress may halt here. I have no way of knowing which will happen."
Tiny stopped in to visit me yesterday. So far, so good. He can walk, albeit a bit unsteadily. He still holds his head tilted to one side, but can make his way across a room. He can see. His owners think he has lost the hearing in one ear and sometimes has trouble getting oriented, but he is functional and not in pain. It's up to Mother Nature now. And Big Dog? He's sorry. He didn't mean to hurt his pal. But from now on, special treats get given in separate rooms.