This week: Your dog's head makes a poor golf ball In previous articles, I have talked a little about Murphy's Law and how the veterinary profession is plagued by it. I had a prime example of this inescapable law just last week. It was a busy Saturday, the morning appointment chart was packed to the rafters with surgeries and in the afternoon we were double-booked till closing time. It was with a great sigh of relief that I heard the door close behind the last appointment as she was leaving. I went into a meditative relaxation mode, sat down on my moderately comfy swivel office chair with a nice hot cup of coffee and picked up a veterinary journal. Just as my blood pressure started to come down, there was an almighty crash outside in the appointment room and a very distraught cry for help. I spilled coffee on my lap and had to psych myself up again to work. My nurses helped bring a large German shepherd named 'Jane-mo' onto the examination table. The dog was in a comatose state but still breathing. The dog's two owners were speaking at the same time, and through all the stressed-out gibberish, I gathered the story behind the dog's state was an accident with a new set of golf clubs. It appeared that during a practice swing with a one-iron at home, the dog got in the way and the owner accidentally clubbed it on the head. The dog dropped to the ground instantly in the same coma-state as was presented to the clinic. On examination, there was a large contusion to the skull with a little bleeding that had already stopped. What was disconcerting was the crater-like skull fracture underneath the bruising. The dog was also very pale and clearly in shock with very low blood pressure. This led us to a medical conundrum, as we needed to increase blood pressure without increasing the pressure in the skull. The brain is tightly encased in the skull and unlike a pressure cooker with a pressure release valve, the pressure simply builds in the skull. The dog could well have died from the subsequent swelling. With such a mighty trauma to the head, there would have been severe swelling to the brain already - any more would have been deadly. We kept the head raised in relation to the body and carefully removed the dog's collar, as that could have increased pressure in the skull. We started the dog on a special intravenous fluid called Mannitol that has minimal affects on brain pressure but still increases central blood pressure, and we injected a powerful anti-inflammatory to bring the swelling down. The only good news I had for the couple was that the pupils still responded to light, albeit more slowly then normal. Once the dog was as stable as possible, I performed surgery. I had to carefully fish out all the bone fragments from the brain, as the skull was shattered like an egg shell by the golf-club impact. We staunched the bleeding and closed up the skin. What was remarkable was that the dog was comatose when we anaesthetised it, but after surgery it woke up like it had been a routine surgery. It wasn't until after midnight that I was able to leave work that day, leaving behind an intensive-care nurse to keep two eyes on Jane-mo. Jane-mo made a complete recovery with no discernable neurological after-effects. Two weeks later, Jane-mo came back to get her sutures out and the owner remarked on one side effect of the surgery - the dog used to be hyperactive and aggressive and was poorly toilet trained, but after the surgery Jane-mo was much more docile. She still had an intelligent gleam in her eyes, but she was much more mellowed out and seem happier. It would appear that removing a substantial part of Jane-mo's prefrontal cortex had unexpectedly curbed her aggressive tendencies, like with humans that suffer through a lobotomy that causes a major personality change. In humans, a lobotomy can cause retardation, as the cortex is responsible for thinking and decision-making. But with Jane-mo, it was hard to tell a difference, probably because she wasn't that bright to begin with. Dogs don't have a very substantial prefrontal lobe compared to humans. She was normal in most other respects and could remember old tricks she had learnt. She was also easier to toilet train for some reason, but I won't be recommending a lobotomy for inappropriate urination anytime soon. Head trauma is most commonly caused by car accidents and the so-called high-rise syndrome, where animals jump out of apartment windows. Animals also get crushed by doors, and I had one client whose cat's head was caught and traumatised by a mechanical reclining massage chair.