Meet "Mara"

“Mara”

“Mara,” a 2-3 month old, female, intact Pit Bull presented to the Animal Emergency Room by the City of San Antonio’s Animal Care Services (ACS) for examination. She exhibited generalized skin disease, leaving her essentially no hair, and had one episode of diarrhea. No history was available on “Mara”; however, she was assumed to be a stray. Upon presentation to he AER, Denise developed an immediate attachment to her leading enrollment into a foster program.

On physical examination, other than the skin condition, “Mara” appeared to be healthy. Mara received a variety of tests, which concluded that she had Demodex canis (a mange mite), a generalized skin infection, and intestinal parasites.   Fortunately, all things that should respond well to a nursing care, proper nutrition, and a good home.

The opening treatment regimen included daily ivermectin administration, systemic antibiotics for secondary pyoderma, follicular flushing with daily ketoconazole/chlorhexidine shampoo baths for secondary bacterial dermatitis, diphenhydramine as needed for pruritis, topical therapy for control of otitis externa, and administration of parasiticides.

Mara’s clinical improvement was evident by one month into treatment with development of new healthy follicular hair growth on the face. Within two months of treatment, there was new hair growth covering 98% of her body.   To date, “Mara” has been adopted by Denise who continues to provide her with the happy, healthy home that she deserves.   

Meet Churchill

Presenting Complaint

On Sunday, September 13, 2009, “Churchill”, a 2 year old male intact Bulldog, was a presented to the AER with 2^nd           and 3^rd degree burns.   “Churchill” was surrendered to and presented by Animal Care Services (ACS) utilizing the                AER for after-hours emergency care.

History

Reports indicated that cologne was spilled on the patient and he was then ignited.  

Assessment

“Churchill” was presented in such great pain, he was too defensive to remove from the ACS vehicle and/or handle.   His injuries consisted of burns, reportedly caused by an accelerant

Diagnostics

Diagnostics were an important part of “Churchill’s” treatment and recovery used to evaluate both declines and progressions.   We repeatedly utilized hematology analysis, complete serum chemistry analysis, electrolyte analysis, blood gas analysis, and clotting profiles.

Treatment

Upon presentation to shift veterinarian Dr. Alicia Gonzalez, aggressive pain killers were administered for pain control and sedation.   Upon examination, “Churchill” had singed hair over 85% of his body with burns over 50% of his body, with 10-20% of the burns assessed as 3^rd degree.   Dr. Gonzalez proceeded to stabilize “Churchill” with pain control, NSAIDs, IV fluid therapy, prophylactic antibiotics, and aggressive wound care.   Frequent reassessment was necessary to reevaluate the severity of the dermal damage which would not become fully apparent for several days.   “Churchill” was also monitored for smoke inhalation, sepsis, pneumonia, anemia, hypo-albuminemia, DIC, and multi-organ failure

By day 2-3, “Churchill’s” blood work was showing multiple organ failure and pain control was increased to a constant rate of infusion (CRI).   Physically, “Churchill’s” condition was largely unchanged, and the patient’s guarded prognosis and treatment plan were discussed with the ACS veterinary staff, the acting guardian of the patient.   The owners were presented with a recommended treatment plan for intensive care, as well as the expenses for prolonged care, a list of potential complications, and or considerations for the general welfare of the patient, which included a guarded prognosis.   In a severely burned dog, these factors (in addition to the lack of a guarantee for survival) will often lead owners to humanely euthanize a pet rather than risk failure of treatment; however, thanks to an outpouring of community support and donations, a “shelter discount” from AER, and the caring of some key people involved in the case, the decision was made to pursue treatment.

By day 4, Churchill's condition continued to decline with the presence of bleeding issues and nutrition issues.   In addition, wound care was upgraded from topical application to twice daily sedation and deep skin scrubbing using a combination of Technical surgical scrub and Malaseb Shampoo.

    

Over the next 3 weeks, “Churchill” remained at AER for 24-hour intensive care, continuing to receive daily wound care (initially twice daily with sedation until the level of debridement was minimal as he was gradually transitioned to once daily without sedation) and general supportive care.   Early in his treatment, he developed acute renal failure and liver dysfunction, but it was caught early and managed aggressively to achieve resolution by the end of the third week.  

Day 9 of treatment marked several milestones in “Churchill’s” treatment.   The patient began eating on his own which eventually allowed the discontinuation of IV feeding.   In addition, day 9 marked the end of aggressive wound care that required general anesthesia and we began the gradual process of weaning him off the CRI pain medication administration.   His dermal wounds were healing appropriately, and  surgical resection was not needed.     

After 24 days of treatment, “Churchill” was ready to leave the intensive care environment; however, still in need of daily wound care and the management of multiple topical and oral medications.   Ultimately, he was fostered by two AER employees who had the expertise and skill to care for him while living in a home environment.          

At this point, “Churchill” resided under the foster care of Karen, an AER employee; however, a short time later Karen adopted Churchill.   Remarkably, the burns have healed with no excessive scarring or cheloid formation and “Churchill” continues to return to life as a  happy and healthy young dog with no apparent long-term effects.  





A thank you goes out to Karen as well for continuing to provide Churchill

with the loving home he deserves.

Zack

Zack was presented to the Animal Emergency Room on 10/12/10 with the complaint of loss of appetite, lethargy, and vomiting with the appearance of blood.   Upon examination and investigation, it was determined that Zack had a liver issue, anemia, and a bleeding issue.   Zack was hospitalized and treated aggressively with fluid therapy, a blood transfusion, and a variety of medications.   Zack is suspected to suffer from an autoimmune disease.  

This story has a happy ending.   After 4 days of treatment, Zack was discharged and continues to do well.   Follow Zack's future progress.

A Letter From the Owner

" I will never forget that day, 10-12-10.   Two days after the first birthday or our Miniature Schnauzer Zack.  He is a friendly, smart, and very loving doggie.   That day, 10-12-10, around 10pm he urinated a large amount of pure blood.   I have been a RN for 37 years and have never seen anyone loose that much blood in such a short period.   After that episode, I immediately took him to the Animal Emergency Room on Fredericksburg Rd.   The initial exam and lab studies showed high liver values and poor blood clotting.   He became weak and critically ill.   Over the next two days, he received a blood transfusion, started multiple medications, and received x-rays.   He slowly became more active, bleeding decreased, and he regained his appetite.   Today he is recovering on 4 medications.   The exact cause of illness is unknown.   It was not pancreatic related, the doctors suspect possible toxicity or auto immune disease.   I have to give a million thanks and best wishes to the wonderful vets and hospital personnel.   They were very interested and participated eagerly in the care of my Zack."