"Dollar" the dalmatian recovering from his surgery episode. All is well.

Shipboard wilderness surgery

Posted on Posted in Cruising, Surgery

Ten years ago, while we were living aboard our sailboat and spending the summer hurricane season holed up in Luperón harbor on the north coast of the Dominican Republic, I was called upon to help a dog belonging to a couple of fellow cruisers who were there with us. The hurricane season turned out to be one of the longest in history and we ended up staying there for eight months. Later I wrote this article intended for magazine publication, but I decided I didn’t have enough photos to accompany it, so it just got set aside. I thought my readers might find it interesting. Let me know what you think:

Dollar Gets a Nip and a Tuck – Shipboard Style

By David W. LaVigne, D.V.M.

BEYOND THE REACH OF TODAY’S HIGH-TECH VETERINARY FACILITIES , A DOG UNDERGOES SOME ‘MEATBALL SURGERY’ AND COMES THROUGH WITH FLYING COLORS

It’s 0830 and I’m arriving aboard ‘Sanctuary,’ a 56 foot Ted Brewer ketch anchored in Puerto Blanco, commonly known as Luperón harbor, in the Dominican Republic. ‘Sanctuary’ is anchored along with our boat, ‘Fidelis,’ and over a hundred other cruising boats spending hurricane season in the protection of one of the best hurricane holes to be found in the Caribbean basin.

A view of Luperon harbor from the south shoreline with all the anchored cruisers.
A view of Luperon harbor from the south shoreline with all the anchored cruisers. Above the ridge at the top of the photo you can see the Atlantic Ocean along the horizon.

Yesterday we checked over our patient and decided there was no point in putting off this surgery any longer. After a few visits ‘Dollar,’ the six year old Dalmatian dog belonging to Amanda and Caroline, has become much more receptive to my attention and is actually eager to see me today. No signs of nervousness and no more growling. That’s a good thing, since today he goes ‘under the knife.’

The island of Hispaniola. Haiti occupies the western end, the Dominican Republic the eastern end. You can see Luperon at the very top of the island.
The island of Hispaniola. Haiti occupies the western end, the Dominican Republic the eastern end. You can see Luperon at the very top of the island.

A physical examination a few days ago revealed a skin tumor low on Dollar’s chest, between the front legs. That alone, his owners can afford to just keep an eye on; however, he also has an aural hematoma, a squishy pocket of fluid on the surface of the ear, which they have since been monitoring, and the consensus is that, if anything, it is getting larger. Either of these problems by itself might warrant a ‘wait and watch’ approach, but the two together suggest that we should probably address this situation now, before either one progresses any further, especially in view of the fact that his owners will soon be leaving him under the care of a boat sitter and flying out for a month

I have already discussed the alternatives with Dollar’s keepers. They are not eager to entrust his care to an unknown doctor with limited facilities.

Ideally this sort of procedure, even though quite minor, should be done in a veterinary hospital with gas anesthesia, monitoring equipment, and an overnight hospitalization. Here in the Dominican Republic, gas anesthesia, let alone any type of sophisticated monitoring device, is almost unheard of at veterinary facilities, and the trip from rural Luperón to the nearest veterinary facilities in Puerto Plata or Santiago requires a long ride of over thirty-five miles, either by multiple gua-guas (the local mass transportation, where commonly upwards of fifteen to twenty passengers literally pile into a small minivan to get where they are going) or an expensive taxi ride.

I have explained to the ladies that frankly I cannot see much of an advantage to subjecting Dollar to that kind of trauma for what amounts to little or no increase in safety. In addition, if there are any complications following the surgery, not uncommon with an aural hematoma repair, his post-op care will fall under my hands here in the harbor. And, as is common among surgeons, if I have to do any aftercare I’d prefer to clean up my own mess rather than someone else’s. As a result, it was their preference to go ahead and do this here in the harbor aboard ‘Sanctuary.’

SIDEBAR:   An aural hematoma is essentially a large pocket of blood, which collects between the skin and the cartilage of the earflap. Usually it occurs as a result of self-induced trauma from scratching at the head, often triggered by an ear infection or fleas, or as a result of shaking the head and knocking the ear flap against a metal buckle or D-ring on the collar or against a hard object in the environment.

A cursory look at Dollar’s ears doesn’t reveal any infection, and I have found no evidence of fleas, so I am suspicious that he probably whapped the ear on a stanchion or any of a multitude of other solid shipboard objects. The excessive head shaking that has developed since the swelling arose is simply a result of the unusual sensation of the heavier ear flap, and each subsequent shake of the head disturbs the swelling, leading to more bleeding into the pocket and further enlargement. With repeated head shaking the swelling could literally become the size of a tennis ball. Eventually, striking that swollen mass against a hard or sharp surface could then rupture the oversized blood blister, creating a huge mess and an invitation to serious infection. Thus our decision to operate. While we are at it, we will also remove the small chest tumor.

Dollar the Dalmatian undergoing some minor surgery on the stern deck of ‘Sanctuary.’
The aural hematoma is repaired. This is the finished product, complete with pink sutures.
The aural hematoma is repaired. This is the finished product, complete with pink sutures.

 

 

 

 

 

 

 

 

 

 

 

On the stern deck of ‘Sanctuary,’ I administer intravenously a heavy dose of sedative and an immobilizing agent, which is essentially the same anesthetic protocol that would have been used by any of the local veterinarians, and Dollar drifts off into a deep sleep. I use a local anesthetic around the chest tumor, prepare the site for surgery, and we promptly dispense with that.

We then shave the earflap and prepare that site. A large S-shaped incision of the skin on the inner surface of the ear allows complete drainage of the fluid pocket, and I then place a number of sutures through the ear flap in an effort to close the space and prevent it from filling again. While I have Dollar immobilized, a closer examination of the ear canals confirms my previous impression that the ears look clean and healthy and that this was probably caused by an incidental smack on some piece of boat hardware. Finally, we place a wrap snugly around the head and put in place the Elizabethan collar that Amanda has already made on her sewing machine from a spare piece of vinyl glass that she had aboard.

The finished product complete with pink sutures.

I have previously explained to Amanda and Caroline that postoperative care and restriction of activity is the most important part of this surgery and is likely to make the difference between success and failure. I prefer to leave the sutures in an aural hematoma repair considerably longer than the usual seven to ten days allotted for most other surgeries; and I usually allow a good three to four weeks before proclaiming this particular surgery a success, as disruption of the healing process by excessive activity or by shaking of the head can easily occur. We will be sorely tested here, as Amanda and Caroline will be leaving in ten days and while they are away Dollar will be under the care of a resident harbor boat sitter who will be responsible for ensuring his well-being. I will also be checking in periodically.

Within a matter of two or three days after the surgery, it is evident that Dollar is behaving himself admirably – the model patient! He is tolerating his head wrap and his Elizabethan collar with commendable patience. Amanda and Caroline are following my instructions to the letter. Removal of the wrap reveals that the ear is healing nicely, and the prognosis for a cosmetically attractive result is improving. By the time his owners are ready to leave on their trip, we have removed the sutures from the tumor site on the chest, and Dollar has recovered to such an extent that I am actually willing to let them leave with a clear conscience – I go out on a limb and pronounce his ear surgery a complete success.

I strongly recommend to the boat-dog-sitter that, to assure everyone that any reinjury of the ear is not his fault, Dollar should continue to wear the protective collar until his owners return. If there should happen to be any relapse, let it be on their watch. He gets along great with Dollar and he enthusiastically agrees.

A week or so after Amanda and Caroline leave, I feel comfortable doing the final suture removal from the ear, and, with firm instructions to limit activity and watch for excessive head shaking for the next day or so, I renew my concern that the E-collar be worn. A couple of follow-up check-ups, and he’s hanging in there fine. The ear looks as good as any hematoma repair I have ever seen. By the time the ladies return from their trip, Dollar is a picture of cooperation, proudly wearing his E-collar, and with a completely healed, good-as-new earflap. Over the next few days, in order to acclimate to the new sensation of not wearing the protective collar, it is removed for increasing periods of time until Dollar has readjusted and returned to the normal shipboard routine.

This is simply an example that, given a good patient and pet-owners who are willing to follow doctor’s directions to the letter, out here, even under less than optimum circumstances, a pet health problem can end with a rousing success. Happy sails to all the cruising pets and pet owners out there!          END

Hope you found this interesting. Let me know with a “like” and please share it with friends. Thanks for reading!

 

 

2 thoughts on “Shipboard wilderness surgery

    1. Ginny,
      Thanks for the question. Yes I always wear gloves in surgery. It’s been 10 years since this surgery was done but I’m pretty certain that the reason for no gloves was that I had only brought a few pair with me on our cruise and felt that I needed to preserve what I had on hand in case I encountered a situation where I needed to do a much more invasive surgery (like an open abdomen, etc.). This ear and tumor removal were very superficial and I did have plenty of surgical scrub with me so was able to scrub in properly. Not a good excuse, but apparently good enough at that time!
      Dr. Dave

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