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I guess we’re in the middle of winter. With the equinox behind us, however, I can’t help but feel we’ve “turned the corner”. Funny how watershed moments occur in many walks of life and veterinary medicine is no exception.
A few weeks ago, we had a rush of cases with breathing problems. Respiratory infections are common in man and animals. They are often caused by viruses, most of which are self-limiting and result in a full recovery. However, some viruses are more pathogenic than others. None of us needs to be reminded of the COVID crisis and the fact that Influenza A caused 15,000 excess human deaths last winter in the UK.
So, respiratory infections are not to be sniffed at (sorry but couldn’t resist)! They fall broadly into two categories; upper and lower. “Upper” means the nose, larynx and trachea (windpipe). When we humans get a “cold”, the annoying but not life-threatening symptoms are due to inflammation and hence swelling in the upper airways, including sinuses. We are all familiar with these. “Lower” means bronchi and the important bits, the small airways (bronchioles) and lungs. Inflammation down in the bronchi makes you cough (bronchitis). It is even more annoying but again, not usually life-threatening (unless asthma is involved, which is constriction of bronchioles starving the lungs of oxygen).
Go a bit lower and the problems really begin if inflammation of the delicate tissues of the lungs’ alveoli (air sacs) occurs, where oxygen is exchanged for carbon dioxide. Just a tiny increase in the fluid lining our alveoli results in a dramatic reduction in oxygen-carbon dioxide exchange. This is why pneumonia is life-threatening, all because of a few microns of inflammatory fluid that sends the pulse oximeter plunging towards the critical level of 80%.
I could spend lots of time here talking about upper respiratory infections in cats and dogs (cat ‘flu and kennel cough). I’m sure I’ve done all that before! Instead, here’s the story of three little puppies. They came in one afternoon in November, all about 7 weeks old, in varying degrees of respiratory distress. Believe me, there is nothing worse than a sick puppy! Well, there is of course, three sick puppies! The alarm bells rang and all our wonderful nurses dropped lunches (and everything else)! They grabbed oxygen masks, pulse oximeters and intra-venous cannulas and set to work. With two nurses per puppy, we were giving the best care we could.
Despite all efforts, two of the three were really struggling to breathe. Our vets’ WhatsApp was buzzing with advice and encouragement. Every medical treatment was considered and given, what more could be done? Well, only anaesthesia and artificial ventilation remained as the final option…but we don’t have two mechanical ventilators. So I was facing the choice given to many doctors during COVID…who gets the ventilator? This largely unacknowledged aspect of the COVID crisis has had long-term effects on the mental health of many in the NHS. And now I was approaching a similar decision. There were no smiles in the emergency treatment room that afternoon. With everyone working as a team, any decision I might have made would have been the result of a consensus among all the vets and nurses.
And then something happened; the two at-risk puppies started breathing a little easier. We reduced the oxygen supplementation and the pulse ox readings stabilised. One of the pups started chewing my finger and showed an interest in its surroundings, soon to be joined by his sister. We had literally “turned a corner”. An hour later, all three were on their way back home to complete their recovery. As you can imagine, there were smiles all round!
So what happened to make the puppies so ill in the first place and then recover so unexpectedly? The short answer is that we will never know. Their symptoms were not dissimilar to Acute Respiratory Distress Syndrome (ARDS), a well-documented and usually fatal condition in dogs. It is triggered by a range of possible causes; bacteria, viruses, smoke inhalation, near drowning and trauma. ARDS is characterised by extreme efforts to breathe, coughing, fever and cyanosis (blueing of mucous membranes). We didn’t get far identifying the underlying cause of these puppies’ illness as there was nothing in the history to suggest exposure to any of the risk factors. As for the recovery, oxygen supplementation was certainly a major factor. The steroids that we gave at an early stage were also possibly a big help.
The fact is, neonatal medicine is a fast roller-coaster and 20 minutes can be a long time for a very young patient. For these puppies at least, we managed to get them through the ups and downs. Eventually, they made it around that final corner to recovery.
