Tuesday, July 1, 2014

Patient of The Week: Tucker Weintraub

Tucker  Weintraub or “Why Bones are Bad”

He got into the garbage almost two weeks before we met him. It was not intentional (on his owner’s part, anyway).  The garbage bag was sitting next to the front door; closed and ready to be taken outside. Tucker, an extremely sweet, fluffy, grey yorkiepoo very quietly nosed his way into the bag and ate his delectable find, including the chicken bones that would cause him so much trouble.

He vomited right after his feast and over the next couple of days, his energy and appetite waned. He began trembling as if he was uncomfortable.  He was examined by his veterinarian (Dr. David Handel). He knew that something was not right but none of the examination findings nor lab tests gave him any clues as to the reason.  Two days later, Tucker was worse and went back to see Dr. Handel. This time, he had a fever and was dehydrated.  When Dr. Handel took x-rays of Tucker’s chest, he identified a small volume of fluid around the lungs. He immediately started antibiotic therapy and transferred him to VCA Veterinary Referral Associates because he knew that Tucker required further diagnostics and round the clock care.

At VRA, Dr. Prantil was able to collect a small sample of the fluid that was around his lungs and diagnosed a bacterial infection in his chest (pyothorax).  This is a very serious infection and most animals who have it are even more sick than Tucker was. These patients usually have so much fluid in the chest that they have trouble breathing and require tubes to be placed in their chests to allow drainage of the infection. Tucker was not following the “rules”.  There was not enough fluid in his chest to drain so we treated him with intravenous fluids and antibiotics. His fever resolved and he was feeling so well that he went home after three days in the hospital.  Our only concern was that he was not eating.  We all know that some dogs just don’t like to be in the hospital so, when we sent him home, it was with the caveat that if he did not start eating well, he would need to come back for a recheck.

And fortunately, the Weintraubs were very attuned to their little dog.  They really must have had a sixth sense about him because even though he finally started eating on the third day after leaving the hospital, they brought him back in for a recheck. The main problem I could see when I examined him was that his breathing was just a little labored. We took x-rays of his chest and saw that there was still a little bit of fluid around his lungs and now, there was a small abnormality visible in his lungs as well: a spot that was a smidge too grey in an area that should have been black.  So the treatment we were using was not working; Tucker seemed to be getting worse. Our next step was to go to surgery and explore the chest for the cause of the infection. And it was lucky we did.

During surgery, Dr. Snakard (surgeon) found that a small portion of the esophagus felt abnormal: very firm and irregular. Because of its location (way down in the chest beneath the constantly beating heart and the always moving lungs), she couldn’t really get a good look at it so we decided to look at it from another perspective.  Dr. Conway (internist) came in and “scoped” him.  Passing an endoscope down through Tucker’s mouth and into his esophagus, she was able to see that there was a piece of a chicken bone sitting right in the esophagus.  Actually, it was sitting both in and out of the esophagus because on its way down, the bone had torn right through the wall.  This was the source of the pyothorax and without fixing it, Tucker would never get better. One of the amazing things about this, and the main reason no one had been able to diagnose it sooner, was that the bone – a fairly large piece of bone - was too thin (only a millimeter or 2 in width) to show up on x-rays. Bones normally show up very well on x-rays.  Poor Tucker! No wonder his appetite had been poor! Dr. Snakard went to work. She removed the bone, repaired the esophagus and removed a piece of the lung that had been terribly infected because it was sitting against the esophageal wound.

Tucker recovered slowly from surgery and ten days later (almost 3 weeks after getting into the garbage), he left the hospital with his tail held high.

Having a bone lacerate the esophagus is bad enough but, unfortunately, it might not be the end of Tucker’s problems.  As the esophagus heals, there is a danger that it will scar down and stricture, resulting in a passage that is too narrow for food to pass.  If this happens, Tucker will have a lot of trouble holding food down and will have to undergo additional medical procedures to dilate the stricture. There is no preventative measure that we can take or medication that we can give; we just have to see what Tucker’s body does as it heals.  He is doing well now and I very much hope he stays that way!


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