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Dudley’s Braveheart

03/09/2018

Dudley is a 4 year old dogue de Bordeaux, his owners were concerned as he was becoming increasingly lethargic, was off his food and losing weight. On examination at the surgery he was obviously a very unwell dog, his breathing was rapid and laboured and he had lost weight. He was admitted for further investigations.

Later that morning Dudley was given a sedative so scans and x-rays could be taken of his chest. Both of these confirmed Jonathan’s concern that there was fluid within his chest cavity. A chest drain was inserted and 4 litres of milky type fluid was removed from his chest cavity. On examination under the microscope the fluid was confirmed as being ‘chyle’ this is the fluid produced by your lymphatic system.

By the following day Dudley was much happier, the drain was removed and he was sent home for close monitoring. Unfortunately 5 days later Dudley came back with similar symptoms, a large catheter was inserted into his chest cavity and 5 litres of chyle were removed. Jonathan was now becoming concerned his thoracic duct was leaking, the thoracic duct is the vessels which collects and transport the lymphatic fluid from the front end of the body. Sometimes these can spontaneously resolve in the same way as they spontaneously occur, so he was sent home with antibiotics and careful monitoring.

For 3 weeks Dudley returned every 5 days to have the fluid in his chest drained, luckily he was a brilliant patient and we could do this conscious with just a little local anaesthetic. At his visit on the 18th October it was apparent the thoracic duct was not going to re-seal itself and a further 5 litres of fluid was removed, poor Dudley was starting to feel a little worse for wear now, barely eating and had lost over 4kg in body.

Jonathan had spoken to many different referral surgeons including a human cardiothoracic specialist, all of whom advised that surgery would be the next step. The surgery would be lengthy and complex with only a 50/50 chance of survival. Jonathan and the owners had the long discussion as to whether to try surgery or alternatively put him to sleep. The decision was made to give Dudley a chance and opt for surgery, his owners were made aware of the serious risks involved in the surgery, and that even if he survived the surgery he may still die in the recovery period. Given his age and determination so far surgery was booked for 3 days later……….

The morning of the surgery Dudley was admitted and his owners said their goodbyes should the worst happen. He was prepared for surgery, this included placing intravenous catheters and fluids, draining his chest of fluid to make internal visualisation better during surgery, and clipping the whole of the right side of his chest.  Due to the severity of the surgery a pre-op plan was drawn up and the people involved in the surgery were fully briefed on their roles. Due to the necessity to open his chest, Dudley required one person to ventilate him during the surgery, as once an incision is made into the chest the vacuum is lost and spontaneous respiration is impossible. A pain relief plan was drawn up and implicated including a constant infusion of ketamine. Dudley was ready for surgery…………..

Two incisions were made at the 9th and 4th intercostals space. Jonathan managed to visualise the thoracic duct deep down in Dudley’s chest. He put 2 ligating sutures in place one at each end and two surgical staples to close off the thoracic duct to stop the leak. During his research Jonathan had been advised that due to the irritant nature of the chylous fluid in the chest, a common complication was thickening of the pericardium (the sac surrounding the heart) and that it was advisable to remove a portion of this during surgery to allow the heart to expand and contract properly. This was the seriously risky part of the surgery, slowly and carefully Jonathan removed a small window of tissue from the pericardium around the heart.

Following 2 hours of surgery, during which Dudley was constantly ventilated by one nurse and monitored by another including heart rate, temperature, colour and oxygen saturation, Jonathan was finished. His ribs were sewn back together and a chest drain inserted to remove any post operative air or fluid. Now the wait to see if he would recover………………

30 minutes after surgery was completed Dudley was breathing by himself and his respiratory tube was removed and he was transferred from theatre back to his kennel. He was monitored continuously by a qualified registered veterinary nurse for the next 2 hours until he was fully conscious and standing. Now it was a case of wait and see how he responded to surgery…………

Overnight checks appeared good and with great anticipation the following morning I arrived for work and was greeted by a wagging tail and a hungry dog! Dudley devoured half a chicken and some scrambled eggs for breakfast along with his medications. The chest drain removed a small amount of fluid but overall things were looking good, his owners were informed he had survived the surgery but nobody wanted to get too excited due to the risk of post operative complications including infection, pneumonia and even heart failure.

Dudley remained hospitalised for a further 5 days receiving painkillers, antibiotics and meals little and often. Each day he grew a little less painful and little more hungry. That Saturday the day came to try removing the chest drain, we removed any residual fluid then removed the drain. The decision was made to allow him to go home. His owners were delighted, but warned there still may be complications and that the surgery might not actually work. When they arrived to collect Dudley he was so excited and happy to see them it made everything worthwhile and after making follow up appointments he left with all of us having crossed fingers hoping this would be a happy ending……………

Dudley returned several times for check-ups and he is doing fantastically, when he comes here he understandably looks a little concerned however his owners report that at home he is like the old Dudley, playful, barking at people and of course hungry!