Dean's Lunchtime Clinical Club - 19 September 2017 - Steve Martin
The second Clinical Club of the year took place in another packed VET115, with the session chaired by Dr Colm Reid. Dr Steve Martin gave a talk on ‘When Vaccine Reactions become Surgical…’ Steve highlighted that there was a mixed group in the audience in terms of programme, stage etc, and that the case he was going to discuss covers a lot of areas and is applicable to everyone; the case touches on first opinion and referrals, and a number of elements both Veterinary Medicine and Veterinary Nursing students will see at some stage in their career. It was an interesting case from the point of view of the decision making involved, which was very difficult, but Steve outlined that this aspect would also be informative for the group.
The case involved Lola, a three year old Yorkshire Terrier, whose owners were moving to Australia and so Lola had to be vaccinated against rabies. The dog was very unwell in the days after receiving the vaccine, and her owners brought her back to their vet who subsequently contacted the Small Animal Medicine (SAM) team in the UCDVH. When Lola was admitted to the UCDVH, she was collapsed, flat, anaemic and basically very unwell. She had suffered a profound response to the vaccine and the SAM team worked hard to stabilise Lola and keep her alive. In the days after admission, Lola developed a dry skin patch and then a crusty scab along her spine, which spread down her chest. The UCDVH Small Animal Surgery (SAS) team were asked to get involved as it spread to cover 25% of Lola's body; as she was medically stabilized, SAS now took over the case.
Steve highlighted the importance of having discussions with the owners throughout the patient's treatment and also ethical issues which needed to be considered in this case – particularly as Lola was facing a prolonged hospital stay, with no clear end point in her treatment; this was all part of the conversations the team had with Lola's owners. Both isolation and intensive wound management were key to this case. The temperament of the dog also played a part, as she became very amenable to her treatment over time. Having removed the large scab from Lola's body, and following on from intensive wound management, the SAS team then carried out two strip grafting procedures, both of which proved to be successful. Lola remained in isolation from 2 June to 21 July; this was hard for the dog and her owners, but a necessary part of the treatment. Lola was last seen by Steve on 8 August, and by this time, bridging of the strip grafts had occured. Since then, there have been a number of issues around Lola's micro-chip, which had been removed during her initial surgery, and also re-vaccination for rabies in preparation for her family's move to Australia in December; the re-vaccination issue is still outstanding. Steve highlighted that this was really a multi-factorial case, with the UCDVH Small Animal Medicine and Small Animal Surgical teams involved, and also industry, government vets and relevant authorities.
Lola has been back into the UCDVH since, and is happy and healthy and suffering no ill effects. She tolerated the treatment well from the start and so it was appropriate in her case, but might not have worked for other dogs. She had a period of intensive hospitalisation, which is difficult for any animal, and the welfare of the dog needed to be considered in this; her owners were also involved in her care when she was allowed home for a number of weekends, and having such committed owners was very helpful in this case. The case required regular updates to the owners and having frank and honest conversations with them over the course of Lola's treatment was very important.
The talk was followed by a range of interesting and pertinent questions around various aspects of the case, which rounded off a really fascinating and thought-provoking session.