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A Deadly Bout of Tetanus

Morgan, a six-year old Welsh spaniel, is back on her feet following a deadly bought of tetanus, thanks to the team at Pride Veterinary Centre in Derby. Tetanus is an often fatal and uncommon disease in dogs, and Morgan is the first case seen at Pride where a dog has gone from being so severely ill to making a full recovery. Following a month at Pride, which included round-the-clock treatment by eight different teams and two weeks in the Intensive Care Unit (ICU) – the longest any dog has spent in ICU at Pride and survived – miraculously she is now back to her normal, bouncy self.

Morgan’s owner noticed a small puncture wound on her left paw, which at first wasn’t causing any issues, but after three days Morgan stopped eating and wasn’t her herself. Following a referral by her local vet who suspected it could be tetanus, Morgan was brought into Scarsdale Vets’ state-of-the-art referral hospital Pride Veterinary Centre for further investigation.

Upon admission Morgan was examined by Veterinary Neurologist Juanjo Mínguez. As Morgan’s face and head muscles were becoming very tense, and she was stiff in all four limbs, he agreed it could be tetanus. She was not coughing, sneezing or showing any other clinical signs of tetanus, but she was clearly unwell. Juanjo started Morgan on a course of medication which included muscle relaxants, pain relief, sedatives and given the suspicion that it could be tetanus, antibiotics to fight the bacteria that causes the disease - Clostridium tetani. Morgan was then taken into theatre to have her paw wound thoroughly cleaned; the surgery team found no foreign bodies, so flushed it to prevent infection and stitched it up.

But when Morgan woke, she had deteriorated; she couldn’t eat, move and was just lying on the floor stiff, with all four limbs extended. Due to the intense muscle spasms she was now experiencing, her blood pressure and heart rate increased, and she was becoming hyperthermic – where the body’s heat-regulation system becomes overwhelmed, causing the body temperature to soar. Juanjo Mínguez, Veterinary Neurologist at Pride Veterinary Centre, explains: “At first Morgan only presented mild clinical signs of tetanus. Usually, we would expect to see the worst phase of the disease after around two weeks, but Morgan experienced this after only 4-5 days. Generalised tetanus is serious, but when the animal starts to present autonomic signs too (fluctuating heart rate, temperature, blood pressure, vomiting, diarrhoea etc.) then that really is the worst-case scenario, with the worst prognosis. Morgan was experiencing both within a very short amount of time, which made her case extremely serious – and even more impressive that she was able to fully recover.”

“Tetanus is caused by toxins binding to the muscle receptors which affects the nervous system, spinal cord and brain, resulting in constant seizures and muscle spasms, which is very painful. It can also affect the dog’s breathing and, in most cases, dogs with tetanus won’t survive or will sadly have to be euthanased. If a dog can survive the two-week period where the disease is at its worst - until the toxins eventually decay - a full recovery is possible, if the dog can be kept alive. Therefore, a multidisciplinary approach and very careful management of Morgan was required.” Pride’s neurology, internal medicine, ICU, surgery, anaesthesia, nursing, Vets at Night and physiotherapy teams all worked together to treat Morgan. Due to the severity of her case, ICU had to be isolated for Morgan, who spent two weeks there. Morgan was hypersensitive, so any stimulus provoked an explosion in her temperature, blood pressure, heart rate and caused painful spasms, so controlling her environment was essential. The lights were almost turned off and the sound controlled to maintain a very quiet environment, which included moving other dogs also in ICU onto a separate ward, which is some feat given there can be several other dogs in ICU!

Morgan was kept sedated by Pride’s anaesthesia team, to keep her as relaxed and pain free as possible, and she was cared for 24/7 by the nursing team. She had a urinary catheter in place to prevent urine burns or scalds to her skin and was drip fed liquid food via a catheter placed into her jugular, which ICU Veterinary Nurse Georgia Bollington inserted. For this, Georgina worked alongside Tiago Henriques, Resident in Veterinary Internal Medicine, who sourced the liquid food and put together Morgan’s feeding plan.

Georgia Bollington, ICU Veterinary Nurse explains: “Morgan was attached to a multi-parameter machine so we could constantly monitor her heart rate, oxygen saturation, blood pressure and temperature. This enabled us to adjust and change her medication and nursing interventions, to ensure that Morgan stayed as relaxed as possible. When she was too hot, we gently placed her on a cool mat, positioned a fan nearby and surrounded her with ice packs. We also would use lukewarm water to dampen her down too, which worked well for an hour or so, before she become too hot, so it was a constant battle between keeping Morgan from becoming too hot or too cold.”

“Morgan’s case was a big learning curve, as I’d never seen a tetanus case that severe. There was something about Morgan – the fire that both she and her owner had throughout her time at Pride, made everyone all the more determined to help her. It was emotional to see her finally recover – even when she managed to drink a bowl of water on her own, you wouldn’t believe it was the same dog that was once so poorly. It was brilliant how everyone came together to treat Morgan – we even had a WhatsApp group so staff could check how she was doing even when they weren’t working!”

Eventually, Morgan improved. She was very lucky not to suffer with any secondary problems such as gastro-intestinal issues or complications such as aspiration pneumonia – caused when a dog is recumbent and unable to deal with excess saliva, which can then be inhaled and end up on the chest, causing infection. Morgan first became conscious, with her medication reduced, three weeks after she first arrived at Pride. Veterinary Nurse Catherine Thaw, who also played a key role during Morgan’s time at Pride, worked alongside the physiotherapy team to draw up a physio plan, as Morgan’s joints were so stiff following the recurring spasms, seizures and weeks being bed-bound.

Juanjo concludes: “Everyone has experienced how uncomfortable cramp is, so imagine that feeling but all over your body, which is what poor Morgan was experiencing. Amazingly, she has made a full recovery. She still experiences some seizures when she wakes up, but this is a normal and her owner has reported these are becoming less frequent and less intense, and they will gradually stop. This was a special case because of the way everyone worked together – the anaesthesia team did a fantastic job constantly reviewing and controlling her medication, the nursing team were by her side day and night for weeks and the medicine team enabled her to eat. We cannot do our job, or get amazing results like this, without the wider team, which includes Morgan’s local vet who first suspected it could be tetanus. It was her quick referral combined with our multidisciplinary approach – and the perseverance of Morgan’s owner - that gave Morgan the best chance to recover.”

Morgan is now happily back at home with her owner, eating normally and is running around the local parks like nothing had ever happened! If your dog develops muscle stiffness, or any of the above clinical signs following an injury or wound, consult your vet immediately.