D. E. Larsen, DVM
Carol backed through the clinic door and turned around in a frantic search for someone, anyone, to help her. Her usual short permed hair was hanging over her eyes. Her dark green coat hung lopsided from her shoulders, and there was a large smear of blood on the left side. There was blood dripping from the knuckle of her right hand.
She was holding her little toy chihuahua, Poncho, cradled in her arms. Poncho was an older chihuahua, black and tan in color. His main identifying feature was his tongue hanging out of the left side of his mouth. Like all chihuahuas, he was sure he was the toughest dog on the block.
Kari was the first one to reach Carol, and she carefully took Poncho from her hands. I was not far behind and took a quick look at Poncho’s wounds. His chest was torn open on the left side. I could see his lungs fighting to exchange some air in an open chest.
“Get him back on some oxygen,” I say as Kari starts toward the treatment table. “I will be there in a second.”
I turned my attention to Carol for a moment.
Carol is a long time client. She is a short, trim lady in her late sixties. She has always been more than generous with others in the community. Often paying the vet bills of her family members and friends.
“You know Poncho, he just ran up to those big dogs who were fighting in the neighbor’s yard,” Carol says with tears in her eyes now. “This big shepherd just picked him up by the chest, shook him a couple of times, and flung him into the street. It happened so fast, there was nothing I could do. I just gathered him up, and here we are. Thankfully, my son was home so he could drive.”
“This is a major wound, Carol. There is a possibility that Poncho may not survive.”
“I know that, but we have to try.”
“I don’t have time to provide you an estimate. It may be expensive.”
“That is fine, Doc. Please do what you can to save him. I don’t know what I will do if I lose him like this.”
“Carol, if you can, have a seat and wait a short time. I will get Poncho stabilized and assess the extent of his wounds. If we are just dealing with a chest wall injury, things will be a lot better than if we have some lung damage along with it.”
I stepped back where Kari was providing Poncho some positive pressure oxygen via a mask. I quickly placed an endotracheal tube and started the ventilator. Then we looked him over for other injuries.
With everything looking okay except for his left his chest wall, I carefully examined his lungs. The ventilator had them working fine. I moved the lung lobes around a little and could not see any injury to the lungs or the heart.
“With any kind of luck, we will be able to close up his chest with little problem. I don’t see any injury to his lungs,” I say to Carol. “We will need to keep him overnight, at least, because we will have a chest drain in place.”
“I will be back at about 4:30, and maybe I will be able to have you rethink the overnight thing,” Carol says. “I won’t be able to sleep without him at home. Maybe you can wrap up the chest drain, and I can have him back at the first thing in the morning.”
“Okay, you check at the end of the day. A lot depends on how well the chest wall repairs and on how painful Poncho is following surgery.”
We packed the wound with moist gauze sponges while we clipped and prepped the wounds. Then came the task of figuring out the best way to close this chest wall.
Three of Poncho’s ribs were broken away from the sternum. I was able to wire those back into place. Then it was a matter of closing the muscles and moving other soft tissues around to provide an air-tight closure of the chest wall.
With a chest tube in place and a careful block of the region’s nerves with local anesthesia, we recovered Poncho.
I had a continuous suction device on the chest tube, and Poncho acted fine when he woke up from anesthesia. He was a little guarded of the injury, but not obviously painful. The regional anesthesia was doing its job.
When Carol returned, there was no hint of her ruffled appearance from the morning. Her hair was fluffed as always, and she displayed a soft smile. Her coat was changed to a tweed. I would guess the green coat was already at the cleaners.
“There is mostly good news,” I said. “The chest wall repaired well, and Poncho is a little stiff but is otherwise doing well.”
“Is it going to be possible for me to take him home?”
“I have a suction device on his chest tube, and it is not showing much drainage. I think I can put a wrap on his chest and send him home. There is a little risk in that, but then, we don’t have 24-hour care available for him here.”
Poncho was dancing in the kennel and turning circles when he saw Carol. I had to catch him as he tried to jump to her when we opened the kennel door.
“We have bloodied one coat today, Poncho,” I said. “Let’s get you wrapped up for the evening before giving you to your owner.”
With a chest wrap in place, Poncho and Carol headed for the door. Poncho trying to lick Carol’s chin with a tongue that never seemed to track just right.
“We will see you the first thing in the morning, Doc. And I can’t thank you enough,” Carol said as she pushed through the door.
As promised, Carol and Poncho were the first ones through the door in the morning.
We removed the wrap and I was able to pull his chest tube.
“It looks like you dodged a bullet this time, Tiger,” I said to Poncho. “I would guess that it would do me no good to try to tell you that you are a little dog.”
“That is for sure,” Carol said. “He was barking at the neighbor dog when I loaded him into the car this morning. I don’t think he learned a thing.”
“It is the nature of the beast. I think all these little guys think they are the toughest dog on the block.”