Clinical Connections  –  Summer 2018

A dog with tetanus was hospitalised at RVC Small Animal Referrals, where he spent 22 days in the Intensive Care Unit (ICU).   

Paddy, an eight-year-old Labrador, was admitted in early March 2018, and was treated and cared for by a large team of veterinary surgeons and registered veterinary nurses during his time in hospital.

Initially Paddy's clinical signs were limited to risus sardonicus, mild to moderate muscle rigidity and stiff wide stance gait, but he soon progressed to being recumbent and unable to walk (Grade 3 tetanus).

He was very sensitive to noise and light and struggled with episodes of hyperthermia, ptyalism and agitation. As he had a history of left forelimb lameness, radiographs of the distal limb were taken which revealed osteomyelitis of the fifth digit. This injury was thought to be the likely point of entry of the Clostridium tetani bacteria.

Paddy was managed with antibiotic therapy, intravenous fluids, muscle relaxants and sedatives, and nutritional support via both an oesophagostomy tube and parenteral nutrition. Previous research from the RVC has shown that dogs with tetanus are at marked risk of weight loss due to their increased muscular activity and periods of decreased food supply, so this is something the team really focused on.

As well as managing Paddy’s nutrition, his intensive nursing care included daily physiotherapy sessions, urethral catheter care, maintenance of hygiene including oral care and provision of general attention and emotional support, as Paddy was a very social dog who experienced increasing tetany if stressed.

Once Paddy was ambulatory, with full control of his bladder and bowels, and able to maintain his own hydration and nutrition with oral intake, he was discharged. He still had a stiff gait and his owners were warned he could have intermittently spastic muscles for many weeks or months.

Paddy, who spent 22 days in the Intensive Care Unit at the RVC.

Karen Humm, co-head of the Emergency Referrals and Critical Care services said: “We were so pleased with Paddy’s recovery. We see approximately 1-2 dogs with tetanus a month, although a recent investigation by one of our ECC Residents, Daria Starybrat, has shown they present more commonly in the winter and spring seasons associated with colder weather. Tetanus cases involve a huge amount of work from the whole team and so we become very emotionally bonded to them. Their prognosis is actually good, even if they are severely affected, but it is not a quick recovery.”

Commenting on the care he received in the ICU, Eleanor Haskey, Head Emergency and Critical Care RVN, said “Paddy was a challenging but also a very rewarding case for the team as he required very intensive nursing care and being in ICU for so long meant most nurses spent time with him. ICU was plunged into darkness and voices were kept to a whisper in order to keep him settled. A turning point was being able to get him outside to the grass to stretch his legs and him taking his first mouthful of chicken.”

Since Paddy left the QMHA, he had to return as he unfortunately developed orchitis, thought likely due to a urinary tract infection due to his prolonged recumbency and urethral catheter. Luckily, he coped well with his castration and now appears to be well on the way to full recovery.

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