Interesting Cases

This is a compilation of some interesting cases I have seen since I arrived in Botswana.  I'm sure there will be more before I go but I thought I would go ahead and share these.  I hope you find them as interesting as I did!

Testicular avulsion

This dog presented for castration while we were on outreach in Nata. The owner wasn’t even worried about the huge testicle problem the dog had.  Didn’t even mention it. We just happened to see it.  After questioning the owner we found that the injury happened a month prior.  Poor dog!  There was no way to correct this problem so I guess it was a good thing he was getting castrated.  I ended up performing a scrotal ablation which basically means that instead of just removing the testicles and leaving the scrotum behind (like we normally do) I took off the entire scrotum and the testicles.  We call that making a “mangina” lol  The avulsed testicle was huge and the “normal” testicle was super tiny.  It was a bit crazy.  Tons of bleeding but in the end it looked great and I hope the dog continues to do well!

Prior to surgery

After surgery - "mangina"

The top is the affected testicle (avulsed) and the lower "lump " is the "normal" testicle

Paraphimosis/priapism

“Peter” (I named him that - I'm funny) presented for castration.  His owner did not mention anything to Nation (our driver) about the dog having an issue when he got picked up.  When we went to weigh him for surgery we noticed his penis just completely hanging out of the sheath (prepuce).  The penis was bulbous and swollen at the base and the dog could not retract it back into the sheath.  He had what we call priapism (basically a persistent erection). He was anesthetized for surgery but I didn’t castrate him.  I wanted to make sure he was able to urinate so I passed a urinary catheter.  It passed without much resistance and the urine was normal in appearance.  I checked his prostate and could not feel any abnormalities but I do have a short finger and he is a pretty good-sized dog so that or may not be diagnostic :)  I applied copious amounts of KY jelly to the penis to keep it from drying out and was finally able to work it back into the prepuce.  It would not stay in there so I placed a purse string suture in the tip of the prepuce to keep it closed.  I left only a small opening to allow him to urinate.  He was started on antibiotics, pain medication and NSAIDS.  I kept him at the clinic for a few days to see if the priapism would resolve. It definitely got better over the next couple of days so I finally did castrate him.  At castration I flushed the prepuce with dilute Betadine solution just in case some urine was collecting in there.  Today I will remove the purse string suture and he gets to go home!  Yay!  

I will miss him.  He is a really neat dog.  VERY scared of people.  It took me until yesterday (about a week) for him to allow me to pet him and give him some treats. He still cowers when I raise my hand up. I feel bad sending him home…….

Ouch!

Penis three days later

Peter & me just before he went home

Penile injury (tip)

This dog (I named him Richard, lol) presented for castration and treatment for a possible penile TVT (transmissible venereal tumor).  A good samaritan brought the dog in for her neighbor.  We do treat a lot of TVTs at this clinic.  The dog was anesthetized for surgery and after further inspection of the penis it was determined that he did not have a TVT. He had some type of traumatic injury to the tip of the penis, most likely from a dog fight since he was covered in puncture wounds on his hind legs.  I have no idea how long the penis had been like this.  It was a miracle he could still urinate.  I expressed the bladder manually to check that before proceeding with surgery.  I went ahead and castrated him and then went to work reconstructing the tip of the penis.  The tip was debrided and then sutured back into place taking care that it ended up pointing in the right direction :)   The tip was then saturated with 50% dextrose solution to help reduce swelling and it was placed back into the prepuce (sheath).  It was iced post operatively too to help with swelling.  He was kept overnight and in the morning he was doing great!  The tip was staying inside the prepuce and he was urinating normally.  I got one picture of the tip one day post-op.  Looking good! He was sent home to the owner with antibiotics and anti-inflammatory medications.

At presentation, before surgery

Immediately after surgery

One day post-op - healing nicely

Eyelid Injury

This particular dog presented for castration.  Owner mentioned nothing Nation about the injury below the left eye.  Do you see a theme here??  We noticed it when we attempted to weigh the dog for surgery.  Luckily the eyeball itself was not damaged. The lower eyelid however, had major damage.  I’m guessing it was from getting his head stuck in a fence or something when he was scrounging for food.  The wound appeared to be old as it’s edges were contracted. I debrided the wound edges to bring some blood supply to the area and sutured the eyelid back together the best I could taking care not to allow any of the sutures to come into contact with the cornea. That would be irritating and could cause a corneal ulcer.  I was happy with the finished product.  Unfortunately, there was a lot of swelling due to the chronic nature of the injury and that worries me a bit.  I don’t think I will get any follow up so I’m just going to keep believing that it healed wonderfully!

Before surgery

After surgery

Paracetamol toxicity 

A man called and said his cat Smokey (5 months old) had been limping so some of the neighbor children gave it a capsule of Paracetamol thinking that would help.  Within a matter of hours the cat turned blue and had trouble breathing.  At first I had no idea what the cat had actually ingested because I had never heard of Paracetamol.  After some investigating I realized it was acetaminophen (Tylenol) which is really bad. Cats do not have the proper enzymes to break down this compound.  What happens is the hemoglobin (compound on the red blood cells which carries oxygen around the body) is changed to methhemoglobin which cannot carry oxygen.  No oxygen = blue cat. Cats seem to be more susceptible to the hemoglobin changes and dogs are more apt to get liver failure however, either, and/or both, can happen.

We started intravenous fluids on the cat but unfortunately we did not have acetylcysteine on hand to give him.  Aceytlcysteine can help mitigate damage to the liver. I called the one vet clinic in town and every pharmacy in town but no one carries that drug. I was not optimitistc that the cat would survive but we gave him a chance with the fluids and other supportive care.  I took him to the cottage with me to monitor him.  He is the coolest cat!  Obviously well taken care of.  The guy that owns him loves him which is odd in this place because cats aren’t highly regarded.  He said he has no children so this is his child.  So cute :)  I didn’t think the cat looked like a Smokey so I called him Squiggy…..  

After two days of “Amber home care” he was ready to go back to his owner!  He somehow healed himself! Cats are amazing!  Of course he slept with me under my bug net and followed me around the house.  It was nice to have my "cat fix" while away from home. I gave the owner specific instructions to make sure that ,in the future, no one gives the cat ANY medications without calling us first!  

At presentation

One day later

In my bed behind the mosi net

Donkey

Someone called and said there was a dog laying on it’s side in front of their house.  They wanted to see if we could do something since it’s been there for a few days like that…..UGH.   Turns out it wasn't a dog.  It was a donkey.  Language barrier for sure!

It had a brand on the left side of his neck but no one could locate the owner. Like I said in previous blogs, all the animals roam free around town so there is no telling where the owner is. The brand has to be matched in the government branding system to find the owner. Of course they weren't open on a Sunday.  Chances are, even if we found the owner, they would say just to put it down.  Donkeys are not valued here.  You can buy one for about 50 pula (like $5 US) so no one is going to spend money on one. Just sad.

So, we got out there and found this donkey laying on the side of the road in the hot sun.  It’s summer here and it gets 90+ degrees in the afternoon.  He was laying with his left side down.  At the initial exam I didn’t notice any injuries only that he had tachycardia (rapid heart rate) and tachypnea (rapid breathing).  His gum color looked normal, he was not bloated and his gut sounds were good.  I placed a 14 gauge IV catheter in his jugular vein and ran him 3 liters of fluids as rapidly as possible.  I also gave him injections of Banamine (anti-inflammatory) and penicillin.  After about an hour his heart rate and respiratory rate normalized and we were able to get him into sternal recumbency.  He drank some water on his own which was encouraging.  A couple of local guys passed by (drunk but nonetheless helpful) and they assisted us in getting the donkey to a standing position and then we walked him about 20 feet over to the shade.  When he stood up I did notice some wounds on his left side, hip and both the left legs.  The antibrachium (forearm) was definitely swollen.  I suspect he was hit by a car.  I don’t know  if he had any internal injuries or not.  It’s on my list to get x-ray vision one of these days!  Once into the shade, he couldn't stand on his own and went right back down to a lateral position.  We made sure he was now laying right side down.  There was nothing else we could do so we had to leave him there.  

This morning Tana checked on him and he was still down. There is really nothing more that could be done so we had to call the state veterinarian to come and shoot him.  We can't do an injection of euthanasia solution like we do back in the States for three reasons.  One, they use everything here.  If something dies people want to either eat it themselves or feed it to another animal.  Two, it is a worry that another animal will come and feed on the dead carcass and ingest the euthanasia solution in the meat and then they will die (ie: wild dog, hyena, lion, cheetah).  And three, a bullet is cheaper than the euthanasia solution.  If done correctly, shooting can be very humane.  I couldn't do it so I'm glad I don't have to.

Administering fluids to the donkey

"If having a soul means being able to feel love and loyalty and gratitude, then animals are better off than a lot of humans" ~ James Herriot

Well, after a few hectic weeks here in Botswana with some interesting people and cases I am being given the trip of a lifetime.  Tana works for Wildnerness Safaris which books clients into different safari camps around the country.  These camps range from middle budget to super high-end luxury camps.  She has booked me into Abu Elephant Camp which is the most premier, luxury camp in all of Botswana!  It costs $2,700 per night. Yes, I said PER NIGHT!  I don't have pay a cent (other than tipping the guides).  There are only 6 rooms at this camp so I am feeling pretty special.  You have to got to check out their website.  I am so excited to interact with the Elephants and sleep with them under the stars! 

http://www.abucamp.com

The whole premise on which Abu Camp is based is that of elephant conservation.  As a guest of Abu Camp, you are invited to walk with and ride elephants, to get a glimpse of their world and learn about their lives. Abu Camp is 450,000 acres of private, unspoiled, pristine wilderness area in the Okavango Delta. As the largest inland delta on the planet, the Okavango and surrounding areas of northern Botswana hold more elephants than any other area in Africa.

I leave tomorrow and will be there over Christmas.  Merry Christmas to me!! The only way to get there is by bush plane (think rickety tiny little 7 seater plane) and that ,I am not looking forward to.  I will suck it up for the elephants I suppose!  I get back on the 27th.  I'm sure I will have a ton of photos and stories to tell :)  

Everyone have a very happy and safe holiday season.  I love you all!  Best wishes from Africa!