Dogterin'

Willie

We’ve had a bit of a medical whirlwind at the ranch since the beginning of the new year. As you may have read here, my Mom had her second hip replacement surgery on February 15. That’s gone very well, and she’s already discarded the walker and is getting around quite nicely. The crushing chronic pain of a destroyed hip joint is gone now. The surgeon is very pleased with her progress. What a difference a few weeks have made.

On the morning of Mom's pre-surgery appointment she noticed that Willie had a big lump on her neck.

Willie is a 12 year old miniature Dachshund. She’s a sweet little dog, for those values of sweet achievable by a miniature Dachshund, and she’s part of the family. The lump was very large, about the size of a golf ball, and right on the centerline of her neck, about where you would expect her Adam's apple to be. Mom was afraid it might be a goiter, or enlarged thyroid. I took a quick look and found that the lump was fluctuant and filled with fluid. Most likely it was an abscess.

Now an abscess is nature's way of dealing with an infection. The one Willie had was most likely caused by a sticker or some other tiny foreign object. The body does a number of things in response to the foreign object. It sends in white blood cells to attack the invading object and the bacteria which always comes along for the ride. It also begins to encapsulate the area around the object with a wall of tissue, which eventually forms the body of the abscess. As the cellular battle rages inside the abscess, pus forms and collects, making the abscess grow. Eventually the surface skin over the abscess begins to thin, and at a certain point it ruptures, allowing the pus (which usually contains the offending foreign object) to drain. Over the next few days the ruptured skin heals, the abscess wall is reabsorbed by the body, and the last of the bacteria are slaughtered.

In very many cases it's best to let nature take her course. In fact, if the dog is generally healthy and the dog's human is not OCD enough enough to wash, wax, groom, and completely examine their pet on a daily basis, the dog has most likely dealt with countless abscesses completely unknown to the owner..

Willie's abscess wasn’t tender and didn’t seem to be bothering her. She was perky and didn't have a fever or act sick. Most likely it would resolve on its own, and at that particular point, mucking about with it could have made things worse. We decided to keep an eye on it and headed off to keep mom's surgical appointment. Which we did.

When we returned home Willie's condition had changed. She was now acting droopy and sick. The lump was now nearly the size of a baseball. That's a very big lump on a little dog. She had a fever and was panting and seemed to be in some distress. So a couple of things. The size and location of the abscess coupled with the panting and distress made me think that it was pressing on the trachea and interfering with her breathing. That was the immediate, life-threatening concern. Also, the fever and her general malaise made me think that the bacteria might be winning the battle against her immune system. If that was the case it could kill her nearly as fast as a constricted airway.

A complicating factor was that it was after 6 p.m. on a Friday and our small town doesn't have a puppy emergency room. The airway constriction could potentially kill her before we could call the local vet and arrange to have her meet us at the clinic. I closely examined the abscess and weighed my options. It was pointing and clearly getting ready to open and drain on its own. The main question was whether it would do so before she suffocated. An ancillary concern was the mess it would make somewhere in the house. Not a life-or-death concern, but a factor nonetheless.

There was really nothing for it but to give nature an assist by opening and draining the abscess. Fortunately, I had the knowledge, skills, and tools to do so. During my navy career I'd treated many an abscess. And we all know the close connection between sailors and dogs (keep off the grass!). After leaving the navy I'd graduated to providing medical care to livestock, and I had all of the usual tools of the trade.

So Willie went into the deep sink (small dogs are so much easier to work on than cows) and I scrubbed the site with betadine. I snapped a #20 scalpel blade onto a knife handle and prepared to cut. The abscess was pointing at the perfect location, directly on the midline and at the lowest point. This was the place to stick the knife, for it would not only drain the abscess but would also allow it to drain completely.

I poised my knife and prepared to cut. Extensive practice on lab humans had developed in me a fine surgical muscle memory. A quick but careful stroke opened a 6-7 mm incision, through which the abscess spontaneously (and nearly explosively) drained.

This brought immediate relief to Willie and she went from being very sick to tail-waggingly joyful in an instant. I irrigated the wound with water and peroxide, dabbed away the excess moisture, and put her down on the floor. She immediately scampered to the back door and barked to be let outside. On Monday Dad took her to the vet where she got a "just in case" dose of antibiotic, which she didn't really need. All better!

Not even a scar.

She's nervous about being up high on a very slick surface.

Red

And then there was Red. Red is a three year old Border Collie. Her coloration is the red and white variation (thus her name) rather than the more usual black and white. She’s a crackerjack cow dog with amazing herding instinct and cow-smarts. She’s friendly and docile around people and is very nearly the perfect dog.

Nona and Red

Her fatal flaw is a bit of rambunctious aggressiveness when it comes to defending her territory against strange dogs. Two months ago a trio of strange dogs showed up, Red charged in, and in the resulting donnybrook she drove them off.

But she did not emerge unscathed. She wound up with three puncture wounds on her chest, and they became infected. A trip to the vet saw the wounds cleaned and irrigated and $250 worth of top shelf, long acting antibiotic injected.

All of this I got at second-hand. Red is my Dad's dog and I don't pay all that much attention to her. But I did notice, a couple of weeks later, that she was acting pretty droopy. One evening I scratched her ears and she rolled over for a good belly scratch. I didn't like what I saw. The three punctures were still present and they were all leaking pus. A bit of poking and prodding revealed the presence of an extensive abscess running from the top third of her sternum to about 2-3 cm below the xyphoid process. She also had a fever. She was pretty sick.

This was on a Friday, of course. We were pretty much on our own until the vet clinic opened on Monday. As sick as Red appeared to be I was pretty sure the bacteria were overwhelming her immune system. I wasn't any too sure she'd survive long enough to see the vet.

So. First things first. I had some injectable cow antibiotic, a third generation cephalosporin which would be effective against the most likely bacterial culprits. Now before you call katie couric and loretta lyncher, be advised that this particular antibiotic is also labeled for use in dogs. And be further advised that it was properly prescribed and dispensed by my vet to be used as labeled.

I calculated the dose and gave red a shot. The dose was 0.7 cc and could be repeated every 72 hours as needed.

Then I cleaned her wounds and copiously irrigated the abscess with a water/peroxide solution.

Rolling over for her treatment

It’s been a tough battle for Red. The antibiotic is working but the infection was extensive and the wound channel needed to heal from the inside. This required twice-daily cleaning and irrigation. After two weeks of this the vet switched the antibiotic to an oral amoxicillin.

None of this has been pleasant for Red but she's been very good about it. When I show up with the irrigating syringe she rolls over on her back and lets me get on with the job.

Getting better

As of this morning the wounds are still draining but most of the inflammation is gone and the wound channel has gone from about 60 cc volume to about 5 cc. It's healing from the inside, just as it needs to. She's not completely better, but she will be in another week or so.

Nature is master

Having won one fight with infection, and being on the verge of another victory, it would be easy to start thinking I'm pretty hotel sierra. That would be dangerous, for nature seems to abhor hubris even more than vacuum.

The wise course is to remain humble and keep in mind the fact that despite our scalpels and peroxide and antibiotics, nature is the one in charge. We can do some clever things to assist nature, but we cannot bend nature to our will. She'll often work with us, but she'll never submit.

Antibiotics

Here's a reasonably good overview of antibiotics, how they work, and what they're used for. As with most of today's lay articles about antibiotics, this one gets hysterical about antibiotic resistance. Sometime in the next few days I'll delve into antibiotic resistance and provide some factual and non-hysterical detail.