Case of the Month – April 2013

Marmite is our Case of the Month for April.  You may remember her as our March 2012 Case of the Month!!!  She is sadly the first patient to appear twice in this spot. This time however she was incredibly lucky to survive after being hit by a car. Marmite is a petite girl, only weighing 13.8kg she struggles to keep weight on due to being so fit and really should know better than to pick fights with cars.  Unfortunately she was hit by a car travelling at speed; thankfully her owners were in hot pursuit at the time trying to call her back before she was hit.   From being hit by the car to arriving at the surgery it only took 20 minutes at the most which probably saved her life. On arrival at the surgery Marmite was in a bad way.  She had a large tear in the skin over her shoulder and signs of concussion with one pupil of her eyes larger than the other and she was clearly disorientated. There was blood coming from her mouth and she had broken several teeth.  More concerning was that she was showing signs of breathing difficulties, her respiration was shallow and laboured with a lot of effort via her abdominal muscles. She was very pale and was suffering from shock. In emergencies we are always concerned with vital signs: Airway, Breathing and Circulation.  Skin tears and broken teeth are not life threatening although they don’t look very nice.  Breathing difficulties are life threatening and if not treated correctly can prove fatal. Marmite was immediately given oxygen, pain relief and admitted straight away for stabilisation and further treatment.  Conscious chest x-rays revealed that she had torn a lung and was leaking blood and air into her chest cavity.  This is a life threatening problem, the ribs stop the chest from expanding beyond a certain point and as the air and blood leaking out has no escape the lungs then become squashed.  This is called a pneumothorax and as you can imagine without prompt treatment to release the pressure and allow the lungs to inflate can become fatal.   Marmite was treated for shock with intra-venous fluids and given high level pain relief to calm her and make her comfortable.  You can see the extent of her pneumothorax in the gallery photos below. An ultrasound showed no evidence of free fluid in her abdomen  and her bladder was intact.  But despite stabilising her shock her breathing was deteriorating. Despite the risks we had no choice but  to take Marmite to surgery. Under a general anaesthetic a chest drain was placed into her chest cavity and a whopping  600mls of free air and 156mls blood drained.  Marmite was also found to have considerable blunt force trauma to her abdomen, the internal bruising was horrific with her kidney having been pulled away from its normal attachment to her body wall.  Thankfully her spleen was intact but everything was very bruised. As you can imagine all this had to happen very quickly with Marmite being in such a fragile state.  Karen did a marvellous job with Marmite’s anaesthetic and Andrew and Louise both operated at the same time.  Amazing Marmite improved dramatically as soon as her lungs were able to inflate properly and she recovered from her anaesthetic well. The chest drain that you can see in the x-ray is a special sterile tube that is placed under the skin and left inside the chest cavity for several days in case the torn lung begins to leak again.  Thankfully with Marmite being so fit and healthy otherwise the tear healed well by itself – if not she might have needed to have the lung lobe removed. After her anaesthetic Marmite was still not out of the woods – the bruising left her at high risk of further compromising her breathing.  As you can imagine lung tissue is very delicate and when bruised swells up so air cannot pass through.  Further to this she had lost a lot of blood, not only in her chest but in the bruising too. Over the following days in intensive care Marmite’s bruising was profound with her abdomen a nasty shade of purple as the full extent of her trauma became apparent.  Amazingly she had not broken a single bone.  However for poor Marmite this was not the end of her ordeal because a few days into her recovery Marmite developed a severe episode of pancreatitis and liver inflammation which caused her to become severely unwell and jaundiced. It is suspected that the pancreatitis was secondary to the trauma she sustained in her accident, most likely due to the brusing.  Thankfully with further intensive treatment and nursing she once again showed amazing powers of recovery. We are thrilled to report though that despite all this Marmite has been a real trooper and has pulled through!  She is due her last blood test this Friday which should indicate complete recovery of her liver and pancreas and is already back to lead exercise.  Once she is fit enough she will need to have her broken teeth removed but considering the extent of her injuries it is a miracle she is still alive. Throughout everything Marmite has been incredibly brave and not once complained despite the fact she must have been very painful.  Let’s hope she stays out of trouble for as long as possible! After all her treatment she is still a waggy, happy dog when visiting the Barn, a brave patient indeed.