It is surprising things go to plan as often as they do. One thing about animal medicine compared to human medicine is the difficulty presented by dealing with patients that have no concept of hygiene and self-control. Fortunately most health problems animals face are simple to treat and most animals are fairly co-operative, but the exceptions really require a good dose of ingenuity to overcome. One major hurdle for any vet is getting the owners to follow instructions. First is good communication of what the appropriate treatment is and how it is administered - and what to expect.
It sounds relatively simple, but the animal can often throw a spanner in the works. For example, some cats are simply impossible to give medicines to. Some will claw and bite the owners and in some cases the owners are not even able to catch the cat to administer treatment. Some cats respond badly to any oral medication with profuse salivation. Sometimes we can get around the problem with liquid medications, but sometimes this tactic makes it worse. Another oft-used method is tricking the cat with snacks, but some cats' sense of smell is too acute, or the cat is just too fussy or ill to be tricked. I am then left with very few treatment options: admit the cat to hospital, the owner brings the cat in for daily injections, or I have to think of a way to minimise frequency of treatment.
In some situations there are so many problems I am surprised when things turn out okay. I recently had a potentially nightmarish case that was so full of hazards that I prepared myself and the owner for the worst. It was a three-month-old poodle I had seen weeks earlier for its first check-up and vaccination. The owner was distraught and probably feeling a little guilty because her son had tripped over the dog and fallen on top of it. The dog was now lame in its right front leg. It was a very active and unco-operative puppy with a propensity to be aggressive and bite.
I put the puppy under anaesthetic and took some X-rays of its legs. They showed a fracture through the growth plate on the long bone. It was very close to the wrist joint, which made it very mobile - too mobile for it to heal without some sort of fixation. It was an active, growing dog, which meant it would be almost impossible to use a cast, as it would most likely slip off like a sock if too loose and cause pressure sores if it was too tight. So we decided to use pins to stabilise the fracture. Utmost care was taken during surgery to keep everything sterile because any infection of the fracture site would probably lead to surgical failure or even amputation. Even with the best surgical suite and sterilisation techniques, there is still a chance of infection.
The surgery was uneventful and the dog was sent home a couple of days later with a secure light splint and strict instructions for cage resting, to restrict its movements. Unfortunately the advice was not heeded. Seeing the dog was walking, even running on the splinted leg, the owner thought it wouldn't hurt to have the dog running around.
Even with a successful pinning, if the animal moves too much there is a chance the pin may break. In this case, the pin wiggled out of the bone hole and when the dog returned a couple of weeks later, the pin was poking through skin. We call this an open fracture, since there is an opening from the bone to the external body through which bacteria can enter and cause infection. I was also concerned that with one of the pins no longer in place, we had lost rigidity, which might cause the bone not to heal. So I had to supplement the pins with a cast - but with an open fracture it was going to be difficult to assess the wound without removing the cast. Also a large pressure sore developed on the elbow where it was rubbing against the splint. This would only get worse with a more rigid cast.
