Tetanus

Ashley contracted tetanus. Tetanus in dogs is so rare that they are not immunized for it, but once contracted, it is often fatal without treatment. Luckly, in this modern era of antibiotics, antitoxins, and advanced medical care, if caught early enough, tetanus is survivable, and complete recovery is common. It is easy to forget that only sixty years ago, tetanus was a death sentence for most people or animals that contracted it.

Ashley's saga started four weeks ago, when she got up on Sunday with a noticable limp. She visited the vet on Monday, but they were unable to determine the cause of the limp, other than a soreness in her toe. She left with a prescription for a pain-killer/anti-inflammatory.

On Thursday she was no better, so she went back to vet, where X-rays of her paw showed no broken bones, and other than trimming her toenails to releive pressure on that foot, she went back home with a tentative diagnosis of a jammed or sprained toe.

By Saturday she was feeling ill, and by Sunday she wasn't eating at all. Monday night she again returned to the vet with lethargy and dehydration, having lost 10% of her weight. This time she stayed there, hospitalized for IV fluids, and so that the source of her ailment could be determined.

On Wednesday, a week and a half after she first started limping, her vets diagnoised tetanus. It was actually a very good call on their part, because tetanus is so rare in dogs that many vets never see a case, and the classic symptoms of rigidity are often the first, and only, indication of the disease. In Ashley's case, her vets diagnoised tetanus within a day of her presenting the symptoms.

Her treatment consisted of antibiotics to fight the tetanus bacteria, and antitoxin to counter the tetanus toxin produced by the bacteria. While the antitoxin helps neutralize toxin in the blood stream, it can do nothing about the toxin already bound to nerve receptors, where it produces the muscle rigidity that gives tetanus its name. Intensive support is all that can be done for muscle spasms that affect critical muscles. For Ashley, this support necessitated a feeding tube, since she was unable to take food or water by mouth. After five days of hospitalization, I would estimate that Ashley was stabilized well into Group II symptoms, and possibly starting Group III symptoms, as described on the Mar Vista Animal Medical Center description of tetanus symptoms:

Group I: The dog was able to walk but also demonstrated constricted pupils, risus sardonicus, erect ears, inability to open its jaws, sunken eyes, and/or sensitivity to light.

Group II: All of the above plus erect tail, sawhorse stance, difficulty swallowing, walking stiffly with difficulty.

Group III: All of the above plus muscle tremors or spasms, inability to walk, and seizures.

Group IV: All of the above plus any of the following: heart rate below 60 beats per minute, heart rate above 140 beats per minute, high blood pressure, low blood pressure or respiratory arrest.

At the end of her first week of hospitalization, her vets recommended amputation of the toe that led off this experience, on the basis of new X-rays that showed changes since the previous X-rays, indicative of a continuing infection. By this time Ashley was responding well to treatment, and while her prognosis was still "guarded", it seemed to me that as long as she wasn't getting worse, then she was going to get better.

Finally, that Friday, after ten days of hospitalization, almost three weeks after her initial visit for her toe, Ashley was discharged to home care, with eight different medications, an hour's worth of home care instructions, and the necessity for feeding her a dog food "smoothy" via tube about every six hours. Her feet were wrapped and taped to prevent pressure sores from the muscle contractions, which made it almost impossible for her to get traction.

(The diapers, by the way, were a bad idea, because they contributed to a type of vulvar infection that only cleared up after Ashley's vet cleaned her up and recommended against their use.)

The first week of care was pretty brutal, similar to one experiences with a new born, with interrupted sleep, and frequent cleanings and feedings. Thankfully, her human mother returned from spring break to assist with her care, which also contributed greatly to improving Ashley's attitude. Ashley's progress has been steady, as she has regained mobility in her facial muscles, was able to open her mouth, and began to walk again. Now, at the start of her fifth week, she is walking even better, and although she still has the "turtle walk", she is showing her old levels of enthusiasm and energy. Hopefully she will soon be able to resume eating by mouth.

(Ashley's change of outfit courtesy of the nursing staff at PCVH.)

I'd like to finish by thanking Ashley's many great doctors and the nurses and staff at Pet Care Veterinary Hospital in Santa Rosa, who most assuredly saved her life, among them Doctor Freya Kruger, Doctor Nicholas Davainis, and Doctor Benita von Dehn. I know there are many others I missed, and all I can say is our thanks and appreciation go out to you as well.