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Black Knight syndrome

All vets are familiar with clients who, possibly because they have little experience of dealing with serious injuries or illnesses, have a tendency to exaggerate or misinterpret the seriousness of a situation. There are many times I have been called out to see a dog that is “pouring blood” only to find that it has but a small split in its pad, or similar, that is inconveniently leaving a smudge of blood each time it puts it foot down. Of course we have to take all such calls seriously as sometimes the concern is all too real.

Then there’s the cat owner whose pet has, “just come in with a massive wound on its face”, only for it to turn out to be a four-day old burst abscess that started as an innocuous puncture wound and was ignored as insignificant.

Being a terminally competitive sportsman whose motivation is to continue at all costs despite blood-soaked clothing, broken bones and torn ligaments (yes I’ve done all of those), I’m from the Monty Python’s Holy Grail Black Knight school of thought; that unless my head has been removed from my torso then ‘it’s only a flesh wound’. I am therefore very sceptical of these client exaggerations, as all vets are, when we obviously see far worse on a regular basis.

However, every now and again there comes a call from a client whose description is, despite its outrageous proportions, actually true, or who conversely is a master of understatement – i.e. is even more of a Black Knight than me. A couple of cases over the years serve to adequately illustrate these more unusual syndromes.

A call from a concerned member of the public advised us that a dog had been involved in a road traffic accident and that it was; “lying in a pool of blood with its back cut wide open”. The dog was apparently still recumbent in the road and the owner was with it, but was afraid to move it because she was worried she might cause it further injury. Despite my experience that so often these calls result in a patient with a small wound being tended by a group of concerned on-lookers or it had already recovered and made a bolt for home, the call was taken seriously and I duly set off on an emergency call out.

Arriving at the scene, there was the expected huddle surrounding the dog where it had apparently lain motionless in the gutter since the accident, covered in a blanket provided by a generous local householder. Upon removing the blanket, the dog’s reluctance to rise was obvious. The caller had not exaggerated as the “cut back” was revealed to be the dog virtually cleaved in two down the spine with almost surgical precision, its body split open as though someone had taken a band saw straight down the middle. It had plainly been killed instantly and, although it should have been evident to anyone with a modicum of common sense that the dog was lifeless, I could at least accept the assertion that moving it would theoretically have made it worse since lifting the body without holding both halves together would have resulted in the whole carcass splitting asunder.

I confess to the rather uncharitable thought that I suspected the true motivation for requesting a call-out was not because anyone thought there was any hope for the victim, but because the owner didn’t want to get their clothes or their own car dirty. Sadly this is also often my experience.

Case two involved a Yorkshire terrier bitch upon which I had performed a caesarean section. The owner had eschewed the advice to keep the anti-lick collar on but come back for a post-op check after twenty-four hours at which all seemed well. She phoned a couple of days later in the evening to advise me that she was concerned that the wound was weeping a little and had opened up slightly.

As it was out of hours, I was tempted by the lack of urgency in the owner’s voice to advise bringing the patient in the next morning, but decided that it would be best to see her just in case there was serious problem. The dog arrived with her owner clutching her in her arms wrapped in a tea towel. Upon examination of the wound, I discovered that far from being just “slightly open”, the stitches had all been removed and the whole incision had opened to its full depth while the abdominal contents were being held in place only by the towel.

The poor little dog was admitted immediately and a nurse summoned promptly. An emergency anaesthetic was administered and exploration of the wound revealed that not only had the bitch chewed out all her sutures, she had also interfered with her herniated abdominal organs. I had to perform an enterectomy to remove approximately six inches of small intestine, which had been gnawed completely through and replaced everything carefully back in, hoping that she had not damaged herself beyond the point of recovery.

The concern that this dog, which weighed little more than five kilograms, may miss so much of its gut was deepened when she vomited on recovery and brought up another equal length of her own intestine, which she had obviously eaten and swallowed whole. I don’t know how long the intestinal tract of Yorkshire terrier is but I would have thought that a foot would have been a significant loss. Thankfully however, she made a rapid and uneventful recovery and suffered no further complications. The legacy of this experience was that I now use much tougher sutures and make certain the advice to ensure an anti-lick collar is worn at all times until the wound is healed is taken on board fully by owners on discharge.

I also pondered on the nature of pain receptors in the organs that would allow this little dog to happily traumatise itself so disastrously, while others often appear to show resentment when one performs a simple examination. Maybe this reflects the said syndrome in animals – the Yorkie, like its owner, was a true Black Knight!