A sticky situation

Who would have thought a fun game of catch could have such a traumatic outcome?  A play in the park with a ball or a stick is usually par for the course for many large active dogs, yet even something as simple as throwing a stick can land in a trip to the emergency room.

 We had a patient in a little while ago, Jasper, an Australian Cattle dog, who simply loves a game of stick chasing with his owners.  At least that was until the night he came in to see us with the end of a stick emerging from his mouth.  Dad had been throwing quite a long narrow stick and Jasper had managed to land end-on on the stick, basically impaling the stick down his throat.  The stick had been longer, but for comfort sake, Jasper had managed to chew the long end off so he could actually close his mouth.  The question was how much more stick was in his mouth/throat, and where had it lodged?  Had it damaged any important structures?

Jasper’s owner was keen to get his boy fixed, so Jasper was anaesthetised to have some x-rays performed to assess the path of the stick prior to carefully removing it.  Sticks and wood are not easily identified on radiographs as they tend to blend in with the surrounding tissues.  So I considered injecting some contrast solution (Iohexol -> a benign sterile agent) around the stick to see if we could see where it was.  The pictures worked well and we could see importantly that it had not penetrated the chest cavity, and did not appear to have caused interference with the oesophagus or trachea.

For those unfamiliar with radiographs of the neck, this may not mean a lot. The normal structures are the vertebral column and the endotracheal tube maintaining gaseous anaesthesia can been seen as the straight lines down the airway. The hazily outlined structure between is the stick!

The stick was carefully removed and we explored the wound with endoscopy.  Unfortunately, Jasper had managed to have this accident with a stick covered in bark, and there were thousands of tiny pieces of bark along the track the stick had made.  There was no way I would be able to remove them all so we attampted to provide a drainage solution.

We see this often with stick injuries where tiny pieces of bark remain in the tissues and cause ongoing problems, developing abscesses intermittently and sometimes requiring repeated investigations.  This material will track around the body via tissue planes and can be exceedingly difficult to locate and remove.  His owner was warned of potential complications with foreign material inside his neck as is commonly seen.

Jasper and the stick we removed from his mouth & neck

Jasper and the stick we removed from his mouth & neck

So not surprisingly, Jasper had a couple of repeated occurrences of draining neck wounds which failed to respond to antibiotics.  He was eventually referred back to our hospital to see our surgeon.  By this point there was a lot of scar tissue and several pockets of pus found.  The surgeons explored these pockets and hoped to remove the source of his infection.  He recovered well and hopefully will be out of trouble now.  These wounds can be very difficult to get on top of at times though and there is still a chance that small amounts of material remain behind.

Interestingly, the Australian Veterinary Association has recently released a report encouraging a ban on throwing sticks for dogs given the number and extent of injuries seen.  A veterinarian from the RSPCA has stated that stick injuries are seen at least once a month at emergency facilities, and I expect our figures would support this.  Many are small wounds to the back of the oral cavity, however they can be far more sinister.  One recent patient seen at the hospital developed severe and critical complications secondarily to a stick injury, and succumbed to those complications despite our best efforts.

Moral of the story, if it is small enough to enter the mouth, and sharp, it is probably too small to play with…  And there is more than one way to impale a dog on a stick, as one of our other vets tells the story of a patient who managed to stop his down hill run on a large branch which went through his chest and abdomen.  He survived fortunately and amazingly!  Maybe a good solid rubber stick is the way to the future of stick play.

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