Tetanus anti-serum??

Re: Tetanus anti-serum??

mariette asselbergs — Thu, 21 Feb 2013 12:42:36 GMT

My sympathies also Julie.

I remember from vet school that GSDs are especially susceptible and have bad outcomes. They told us it was often related too change of teeth, so that firs with the age of your dog.

Mariette

Re: Tetanus anti-serum??

Julie Innes — Wed, 20 Feb 2013 16:40:30 GMT

Fraid this one died too :((. Oh well, at least this time I felt I did everything I could as quickly as I could. Maybe next time...

Re: Tetanus anti-serum??

Michael Woodhouse — Tue, 19 Feb 2013 21:10:14 GMT

Good luck, Julie. Keep us informed.

Re: Tetanus anti-serum??

Julie Innes — Tue, 19 Feb 2013 19:22:30 GMT

Well, having never seen one in my previous 18 years before that one, think I have another one on the go tonight!

This one is a racing greyhound, kennelled outdoors, reported as "collapsed" all day (but typically not presented until 6.55pm!!) couldn't work it out at first- disorientated, almost as if blind, jerky movements. fresh(ish) puncture wound to foot, with leg swollen to hock, popliteal LN huge. T40.4. Kept thinking I'd seen something like this before, but only twigged when I tried to exam its mouth and couldn't open it....

Typically, they have no money to spend, but have banged it full of anti-toxin (which I now have, although never expected to use it!!) , penicillin and some meloxicam. Praying this one might make it....

Re: Tetanus anti-serum??

Evelyn Barbour-Hill — Thu, 23 Aug 2012 15:58:03 GMT

[quote user="Julie Innes"]but I keep thinking what ifs- [/quote]

Don't be ridiculous , you did all you could. Antitoxin is not a magic infallible cure.

Re: Tetanus anti-serum??

Julie Innes — Thu, 23 Aug 2012 15:42:37 GMT

Thanks all- you are making me feel a bit better, but I keep thinking what ifs- what if I had twigged immediately on seeing the dog (although to be fair, the only symptoms then were his pricked ears and general slight disorientation) What if I had managed to get in touch with owner earlier, and got the anti-toxin earlier, what if i'd had the stuff in stock and not had to trail to another practice....AArgh! I know I could (and will!) drive myself mad over this one!!

As I said, thank you for all your help and sympathies- this website is a great resource to those of us who need to bounce things off others for peace of mind- one of the things I do miss now as a sole practitioner!

At least the owners , although devastated, seem happy that I did everything I could.

Re: Tetanus anti-serum??

Joyce Whitehead — Thu, 23 Aug 2012 14:05:12 GMT

Me too Julie, you did all you could, some are destined not to survive. Sympathies.

Re: Tetanus anti-serum??

Mark Hedberg — Thu, 23 Aug 2012 13:23:49 GMT

Well said. My sympathies as well.

Re: Tetanus anti-serum??

Mark Lowrie — Thu, 23 Aug 2012 13:16:21 GMT

Hi Julie,

Sorry I didn’t reply sooner and sorry for the sad outcome. It sounds like you did a fantastic job with everybody’s help here.

I would agree with Hannah’s post though that some of these dogs just do terribly despite what you do – and this sounds like one of those cases. You will see from individual experiences they can do really well or really badly. Feeding tubes are often required if they can’t open their mouths, and sometimes the problem is so bad they can respiratory arrest as it sounds like your dog did. I really don’t believe the outcome would have been different in this dog. I am not sure I can add too much to what others have already said but the rules I tend to follow are:

- Treat the wound = debride/clean any obvious wound

- Neutralise unbound toxin = give a one-off dose of tetanus anti-toxin (giving 0.1ml intradermally to check for reaction, if no reaction is seen after 30 mins then give the remainder intravenously)

- Kill the toxin producing bacteria = give metronidazole (I tend to avoid penicillin as there is a human study that suggests it is associated with higher mortality)

- Treat muscle rigidity/seizures = give benozdiazepines (chlorpromazine or ACP and consider diazepam/midazolam CRI)

- I also try and keep the environment as calm as possible, e.g. turn down lights, use cotton wool ear plugs for the patients etc.

You asked a question about how long it takes to see an improvement. Unfortunately the Tetanus toxin binds irreversibly to interneurons and so new interneurons need to form before a dog will improve. This is believed to take around 14 days. The main thing to try and achieve in these cases is to stop them getting worse – i.e. by treating wound, killing bacteria and neutralising unbound toxin.

In summary, I think you did everything you could and I don’t believe any other vet would have achieved a different outcome. Certainly worthy of a pat on the back despite the sad outcome. Well done!

Re: Tetanus anti-serum??

Hannah Wynne Richards — Thu, 23 Aug 2012 13:10:24 GMT

the downside of this job-my sympathy

Wynne

Re: Tetanus anti-serum??

Julie Innes — Thu, 23 Aug 2012 12:52:21 GMT

Sorry to say, he died at 6.45 this morning . Was up all night with him- the spasms were horrible, did give some diaz in the end just to try to calm him as his resp rate was through the roof, and he was getting hyperthermic with all the spasms- did all the cooling things, he seemed to settle a little, then at 5am had horrendous foul smelling D++ (which was a joy to clear up as he was lying in it too), became increasingly unresponsive, D++ again at 5.45am, but he had seemed to be settling a bit...huge spasm and resp arrest at 6.45.

Gutted

But I tell you something, if I ever see a case again, at least I will be better prepared, so appreciate all your help and comments. I bought the antitoxin and expensive or not, Im hanging onto it till it goes out of date. Also now equipped with all the other potentially helpful drugs too, so have surely now guaranteed I'll never see another one in my veterinary career. Really appreciate all your help last night folks, just sorry the outcome wasn't happy.

Re: Tetanus anti-serum??

Michael Woodhouse — Thu, 23 Aug 2012 09:10:55 GMT

Julie - how are things this morning? That sounds a fairly desperate message posted at 1.12AM with no one to reply.

If he's not febrile and lungs sound ok leave him quiet in a dimly lit room. If you think he might have aspirated beef up the abs.

I would avoid the diazepam if possible. Got any ACP?

Re: Tetanus anti-serum??

Julie Innes — Thu, 23 Aug 2012 01:12:12 GMT

Thanks again- I'll definitely try to get the chlorpromazide tomorrow- if he makes it that far . Really worried about him at the moment- his breathing is really laboured and he is whining/ panicking. Not sure if he is trying to get up or if it is the muscles spasming. THis is horrible. Thought maybe he needed the toilet and was distressed, so took him out, which seemed to calm him a little, but he didn't pass urine, just wanted to lie in the grass.

Really not sure what I can do about his breathing. His mm are pink, but he is getting distressed. I'm really wary of giving diazepam as he had a really bad reaction to it initially- what else can I do here? I'm trying to wipe up the drooling, as I'm not sure if he is swallowing it and it is making things worse. I think O2 therapy might freak him out further. I feel like he is getting worse now

Re: Tetanus anti-serum??

Michael Woodhouse — Thu, 23 Aug 2012 00:26:44 GMT

Julie - I have only ever given the TAT as a single dose. In this case (and if it is all you had) I wouldn't be worrying about the licence claim on the penicillin you have, the animal welfare usurps the cascade.

Chlorpromazine is cheap and available as an oral liquid

From the BNF: Oral solution, chlorpromazine hydrochloride 25 mg/5 mL, net price 150 mL = £2.00; 100 mg/5 mL, 150 mL = £4.65. Label: 2, 11

Do you have a local friendly pharmacy?

I wouldn't GA and I wouldn't worry about flushing the wound at this stage.I would say it was an unquantifiable risk from the GA.

Last dog I had we were toying with a feeding tube but began to be able to swallow sloppy food from a hight. Kept hydrated on IVFT.

Re: Tetanus anti-serum??

Julie Innes — Thu, 23 Aug 2012 00:13:23 GMT

Thanks all- will look into chlorpromazine tomorrow too! I did wonder earlier about giving him ACP, but chickened out. I've given him a tiny amount of oral diazepam, bit cautious because when he had it IV at OOH vet he went loopy, apparently!!

I've ordered penicillin for tomorrow- only had procaine penicillin, for some reason not licensed for dogs Crystapen also a good idea- I could also use it to flush out the wound, I guess, if I reach being brave enough to GA him and get a proper look in his mouth (where I suspect the primary wound is)

It's the puffing and panting that is worrying me, although his colour is good and he has managed to take half a tin of a-d when hand fed (he seems to be able to lap a little) I worry when he's puffing and panting, then, when he stops, I rush over and disturb him so he starts again

Meant to ask- from the data sheets it looks like you should only give the anti-tox once (because of increased risk of anaphylaxis, with it being horse-derived) Is this right? Anyone ever given it more than once??

If I never see this horrible condition for another 18 years, I will be happy!

Re: Tetanus anti-serum??

katie mountford — Wed, 22 Aug 2012 23:14:43 GMT

I've seen 1 case a colleage dealt with and it did ok in the end. I remember from somewhere that penicillin is the antibiotic to use, I think we used crystapen last time-can't remember why-maybe an equine vet will be along in a bit to tell me why! Hope the dog is doing ok

Re: Tetanus anti-serum??

Lorna McHardy — Wed, 22 Aug 2012 23:11:07 GMT

We had one many years ago (doberman) which eventually recovered after lengthy hospitalization; the main problem being that she couldn't eat or drink properly. We placed a percutaneous stomach tube which stayed in, I think, several weeks. She also needed some fairly intensive nursing during the time she couldn't get up or walk. Lovely dog, and recovered fully!

Re: Tetanus anti-serum??

Joyce Whitehead — Wed, 22 Aug 2012 22:02:18 GMT

I'm sure that the last one I had (about 20 years ago - eek!), we used diazepam in the initial stages to relax her. I know we used chlorpromazine IV as previously mentioned, as I remember once we got past the initial crisis she would come in with her owner twice daily for her IV "fix" of chlorpromazine. You could see the tension in her face go as we gave the drug, and she loved coming in!

I guess she associated us with feeling better and being able to eat etc easier. We gradually reduced the dose as she recovered.

Hope the little lad recovers - isn't it always the nice ones?

Re: Tetanus anti-serum??

Julie Innes — Wed, 22 Aug 2012 19:41:49 GMT

Thanks guys. Keep trying to post but for some reason computer not letting me!

Managed to track down some anti-toxin, and have given him that- any idea how long it takes to see any effect?? After a little while I thought his ears seemed slightly less tense, but he is still panting and drooling. He has had potentiated amox, metronidazole, fluids and the anti-tox. Don't have any robaxin, but will definitely look into that tomorrow, thanks for the tip!

Really kicking myself for missing the diagnosis yesterday. He had initially presented to our OOH service as a possible poisoning- disorientated and agitated. They gave him diazepam and it made him far worse- hyper-reactive and hugely agitated. After being kept quiet and monitored overnight, the owner reported he was a little better the next morning.

When I saw him, he was walking about, reasonably calm and took a biscuit. I did think there was something odd about his prehension of the biscuit, as if his mouth was sore, but the owner said that wasn't unusual for him (should have listened to that niggle..) Also niggled me that his ears were unusually pricked, but we were concentrating on potential toxic substances... I admitted him for bloods and observations- bloods pretty unremarkable- sl low HCT and platelets, slightly high phos, everything else ok. I fed him and he ate, but I still felt he ate slightly hesitantly. He wasn't keen to have his mouth examined, but after a slight struggle I got a quick look and saw a swollen red area under his tongue (which in retrospect I think may be the original wound- doh!) The owner had talked about him drinking water running off a field, and was convinced there must have been something toxic in it, so I originally thought the sore area in his mouth might be due to some irritant substance (kicks self again) We monitored him all day, and he did nothing unusual (besides his ears looking strange) so I sent him home last night to come back today. The ears kept niggling me, and after some brain-wracking/ reading, i realised it could be tetanus. Called the owner first thing, but he was at work. Saw the dog lunchtime and he was worse- stiffer gait, now drooling and jaw v. tense

He's home with me now (the dog, not the owner!!) and I really don't want to lose this little guy (4mth old GSD), so ALL suggestions/ info/ advice hugely appreciated. I hadn't considered tetanus at the outset- but I definitely will the next time

Re: Tetanus anti-serum??

Bob Russell — Wed, 22 Aug 2012 15:23:15 GMT

[quote user="Virginia Campbell"]

[quote user="Joyce Whitehead"]We used to use chlorpromazine I think for relaxation of the muscles[/quote]

Worth stomach tubing with crushed up robaxin for this purpose if dog can't swallow?

[/quote]

We have used robaxin crushed up and given as an enema in cats. Permethrin toxicity in these cases!

Re: Tetanus anti-serum??

Virginia Campbell — Wed, 22 Aug 2012 14:01:10 GMT

[quote user="Joyce Whitehead"]We used to use chlorpromazine I think for relaxation of the muscles[/quote]

Worth stomach tubing with crushed up robaxin for this purpose if dog can't swallow?

Re: Tetanus anti-serum??

Joyce Whitehead — Wed, 22 Aug 2012 13:55:34 GMT

If you want some antitoxin very quickly, try your local horse practice - they will likely have some, saves waiting for delivery! Good luck, I too have had a couple survive, but not seen one in years....

We used to use chlorpromazine I think for relaxation of the muscles, but not sure if you can even get that nowadays!

Re: Tetanus anti-serum??

Michael Woodhouse — Wed, 22 Aug 2012 11:16:20 GMT

[quote user="Hannah Wynne Richards"]the prognosis is rotten even with immediate treatment-really hopeless if left[/quote]

I would disagree with that (when talking about dogs). Not very common but have had a couple of cases and they both lived.

The cattle I have seen have all died. Not good for horses either.

Re: Tetanus anti-serum??

Hannah Wynne Richards — Wed, 22 Aug 2012 10:41:46 GMT

If you suspect tetanus start treatment straight away-the prognosis is rotten even with immediate treatment-really hopeless if left Other possible theory-any chance of strychnine exposure-don't expect an honest answer from owners on this one though

Wynne

Re: Tetanus anti-serum??

Julie Innes — Wed, 22 Aug 2012 09:31:24 GMT

cheers Michael!! Wow, tis expensive alright, but may need to look into it.