A Veterinary Journal by Claire Poole
March
Chapter 3 - Page 7
Chapter 1
Chapter 2
Chapter 3
Sunday 15th & 16th March
Sunday 15th March
2 a.m. - Jude remains stable and accepts a drink of water.
7 a.m. - Stable but restless. I suspect she is in pain and top up her painkillers. There is some ‘clonking’ on examining the left side of her pelvis but I cannot feel anything conclusive. There are no sharp boney edges on rectal examination. The patient accepts 3 dessertspoons of recovery diet. This food is high in energy - for decades it was thought that ill or injured patients use up less calories while lying immobile. We now know that the body’s metabolic rate increases in those circumstances so a calory dense, easily digestible diet is important to aid recovery.During the day, Jude is checked every hour or so. She remains stable and at 2.30 p.m. polishes off a plateful of recovery diet.
4 p.m. - her owner visits. This provokes quite a response; she stands for the first time - and wags her tail. The situation is much improved on yesterday but I warn Cath that we are not out of the woods yet. The cardiac irregularities seem to be reducing but we must be cautious - like any other organ, heart muscle can be damaged in an accident, and this can be potentially fatal. Strict rest is vital. We will probably need x-rays to investigate Jude’s pelvis, but a general anaesthetic is rather risky just now.
The evening wears on, punctuated by regular trips to the surgery to monitor our patient. I am happy with her progress until the pre-bedtime check at midnight - Jude’s heart rate has accelerated and sounds irregular. Connecting her to the ECG monitor, I count 20 PVCs (premature ventricular complexes) per minute. This indicates heart muscle damage. Electrical impulses cause the heart to contract in an orderly manner; the impulses pass through the heart in waves causing first the auricles then the ventricles to contract. These ‘waves’ show up on the ECG as a characteristic form. In heart disease, there is often a change in the shape of the ECG wave which can tell which part of the heart is affected. In Jude’s case, the ventricles are contracting more frequently than the auricles - this sounds chaotic through the stethoscope. She does not appear distressed and her circulation is holding up but her breathing is rather rapid. I decide against giving any medication until we can seek an opinion from a veterinary cardiologist. I set the alarm for 3 a.m. just in case there is any deterioration.
Monday 16th March
7a.m. - an early start to check Jude and clean out her kennel. All our inpatients are bedded on veterinary fleece, an excellent material which allows fluids to drain onto the underlying newspaper leaving the patient warm and dry. It is quite a performance persuading her first to leave the kennel, and then to return after cleaning. Her heart is still irregular and fast but she seems cheerful and even gives a small tail wag before eating some breakfast. After morning surgery, Gillian and I return to carry out her ECG examination. The dog is connected by several leads to an ingenious device which broadcasts the ECG waves via the telephone lines to a heart expert. He will examine the trace and send recommendations for treatment. Jude is not the calmest of dogs but Gillian does a sterling job of restraining her while the examination is in progress. Later in the day, the results appear. As we suspected, the irregularities are due to cardiac contusion (bruising) which typically ‘ripens’ after 24 - 48 hours. He recommends a drug which we collect from the local chemist - it is a human drug, there being no licensed veterinary drug for this condition. As Jude is becoming increasingly difficult to handle, and her owner is very sensible, we decide to send her home with a collapsible kennel to ensure complete rest - as with Yoyo, the poodle with the dislocated hip, it is not possible to explain to animal patients the importance of staying still. Cath will keep in close touch with the surgery and I will check Jude in a few days.
How marvellous it is to have an empty surgery overnight. It is very satisfying to deal so closely with in-patients - but it is also very tiring, and it will be lovely to have an unbroken night’s sleep (phone permitting, of course).
Copyright Claire Poole 2005
