Dancer’s Dilemma

D. E. Larsen, DVM

Dancer was standing in the exam room when I entered. Unlike her usual demeanor, she barely acknowledged me. She was concentrating on her next breath.

Dancer is a walker hound. A fine confident hunter, she is one of Leon’s leading girls. For Dancer to be distressed, she must have a major problem.

“Do you want her on the table?” Leon asked.
“He looks like we should leave her on the floor for now,” I said. “How long has she been breathing like this?”

“I noticed she was slow yesterday,” Leon said. “She was the last one back to the truck, and usually, she is leading the pack. But this morning, she has just been standing the breathing pretty hard.”

I pat Dancer on her head. She had no response, and she didn’t move when I knelt beside her. I noticed that she was breathing with a lot of abdominal movement.

I put my stethoscope on the left side of her chest. I could hear breathing sounds, and her heart sounds were normal. When I moved to her right side, there were no sounds.

I listened closer. I could hear muffled heart sounds, but no breathing sounds. I thumped her chest on the right side. The normal chest should sound hollow. On Dancer, it was a dull thud.

“I think her chest is full of fluid, probably mostly on the right side,” I said.

“Same as Roxy?” Leon asked.

We had lost Roxy to a prothorax not long ago. Her chest was filled with fluid on both sides, and we lost her before getting too far along in the treatment. When I opened her chest, I found the cause quickly. That is unusual in a prothorax. Roxy had a porcupine quill sticking out of her right lung. She had probably inhaled it when she tangled with a porcupine some months before her death. It took some time, but it finally migrated to the outside of the lung, contaminating the pleural space and causing the pus-filled chest.

“Probably, but it sounds like just one side of the chest is involved,” I said. “Hopefully, we will have a favorable result this time.”

“What do we need to do?” Leon asked.

“We need to get an x-ray,” I said. “But I am going to drain a lot of this fluid first. That will make her comfortable. Then we will decide how to proceed. My thought is to open her chest with a small incision, flush out all the exudate, and place a chest drain. That way, we can reduce the scarring in her chest. If the left side is not involved, we will be lucky. The mediastinum, the structure which divides the chest, is usually not complete in the dog.”

We clipped the right side of Dancer’s chest and prepped it with Betadine Surgical Scrub. I rigged a sixty cc syringe on a three-way stopcock with a discharge tube to a one-liter bag. After using some lidocaine for local anesthesia, I inserted a fourteen-gauge needle into the chest and started aspirating a thick exudate.

It did not take long to fill the one-liter bag. We changed the bag and had nearly a half liter before I could feel the needle bumping into some lung tissue. I withdrew the needle and reserved the last bit of fluid for culture.

Dancer looked like that elephant just stood up off her chest. She wagged her tail for the first time as she took a deep breath.

Her x-ray showed that there was still a lot of fluid on the right side of the chest, even after I pulled a liter and a half of exudate out of her chest. The left side was clear.

“I think I should open this chest and flush all this exudate out,” I said. “That way, we can start with a clean chest, and the antibiotics will work better. Then I will place a chest tube, close the chest and hang on to her for a few days.”

“Do you think this is another quill?” Leon asked.

“I would doubt that, but was she in the fight with the porcupine?” I asked.

“No, she wasn’t involved with the porcupine,” Leon said. “But what else could it be?”

“It only takes a little puncture into her chest from the claw of one of those bobcats she runs,” I said.

“Yeah, there is plenty of opportunity for that to happen,” Leon said. “So I guess I just wait for your call.”

“I will keep you posted,” I said. “But I will keep her for at least three days. I will flush this chest daily through the chest tube. I want the drainage to be clear before pulling the tube.”

We hooked Dancer up to an IV and got some IV antibiotics started. Then we went to surgery. I opened her chest on the right side between ribs five and six. A lot of foul-smelling yellowish fluid was in the chest. I explored the chest wall and the lung lobes as best I could but found no apparent cause.

It took multiple saline flushes before the fluid suctioned out of the chest was clear. I placed a drain tube and secured it to a suction device. Before I closed the chest, I instilled a dose of antibiotics.

Dancer’s recovery was unremarkable. By closing time, she was up and around and looking for dinner. Her breathing was close to normal, and she felt much better than when she came through the door.

The first thing in the morning, I flushed a half liter of saline into Dancer’s chest. To encourage the fluid to do a little slouching about in her chest, I allowed her to follow me on my morning rounds.

Dancer showed genuine interest in the other patients in the clinic. I wasn’t sure how she would respond to the cats, but she seemed to understand that we were taking care of them. At the end of rounds, I lifted Dancer up on the treatment table and drew off the fluid I had infused earlier. It was almost clear.

“I think you are doing pretty well, Dancer,” I said. Dancer looked at me like she knew exactly what I said.

We repeated the procedure that evening. And by the next morning, Dancer jumped down from the treatment table after her infusion and waited for me to start my rounds. She rubbed noses with dogs through their kennel doors and stood on her hind legs with her front feet on the lower kennels to watch the cats.

When the fluid was clear on the third day, I pulled the drain tube and started to go call Leon. Dancer followed me to my office and sat at my feet while I called Leon.

“Things are looking pretty good with Dancer,” I told Leon on the phone. “She is eating well. The fluid coming out of her chest this morning is clear. She can go home. The only problem is she will miss taking care of all the other animals in the clinic.”

“That sounds great,” Leon said. “We will be right down to pick her up.”

Dancer went home on antibiotics and returned to normal. She lived a good life and had a couple of litters of pups.

Photo by Leon Olson of Sweet Home.