Sunday, May 17, 2015

2156. Third opinion. The stench of covered armpit wounds in a 16-year-old dog

Sunday May 17, 2015

The 16-year-old Maltese was afraid of me examining the wound, despite being given Tramadol painkiller tablets by Vet 2, 4 days ago. I was unwrapping the elastoplast and yellow wrap around self-adhering bandages covering the long left armpit wound. As I unrolled the bandage, the smell of rotting flesh permeated the consultation room.

"Vet 2 had given an antibiotic injection guaranteed to last 2 weeks," the young lady owner said. "So, he only prescribed the Tramadol, 1/2 tablet 2 times a day."
"Was Tramadol effective?" I asked.
"Yes," she confirmed that the dog was walking around when given the medication.

The dark greenish stained gauze under the bandage gave off an offensive odour of dead meat. I tried to control my breath. It is an odour of decomposed egg few Singaporeans will ever smell. It glued onto my fingers and needed several hand shampoos to get rid of the smell.

Vet 1 had prescribed some antibiotics and cleanser but this did not work. The dog's armpit got infected. So Vet 2 bandaged the leg from the wrist upward and adduct the armpit closer to the body with Elastoplast. The owner must return every 3 days to get the bandage changed. The owner sought me as the 3rd opinion.     

The dog was practically screaming when I slowly unwrapped the bandage. He had a high tolerance to pain and had taken half a tablet of a 50-mg Tramadol.

"There's no choice but to sedate him to clean up the bad smelly armpit wound," I told the owners. "When a wound is covered up, it becomes smelly as a different type of bacteria thrives and grow in the flesh. It is highly risky as he may die. I will give a very low dose."

I can understand that Vet 1 and Vet 2 do not want to take risk in anaesthesizing this old dog to stitch up the wound. It is a thankless option if the dog dies. Some owners just blame the vets when the dog dies, implying negligence and incompetence.

I gave Domitor and Ketamine at 10% of the normal dosage IV. The dog slept for less than 10 minutes and the armpit wound was flushed and irrigated. The dog was shampooed. I applied KMnO4 powder, injected antibiotics and inflammatory and the dog was sent home.


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