What to do if your dog has a stroke... On Christmas Day

My dog Whiskey

Whiskey- 6 year old Male (dog)

Presenting Complaint: Change in behaviour

History of Presenting Complaint: Was pushed by reckless owner (me) against some stairs and proceeded to run down the driveway. Ran back up to owner in a daze and just stood staring: tail between his legs, ears flat on his head, did not respond to his name. (If you have ever met Whiskey, you'll know that this is highly unusual. He is practically a circus dog.) This was later associated with ataxia (walking like a drunk), uncontrollable drooling and spasticity (stiffness) of his limbs- mainly on the left side. Episodes of this 'odd behavior' lasted a few minutes during which he sometimes ran around aimlessly. They were followed by lucid intervals which also lasted a few minutes.

No past medical history, not on any regular medication, no family history of note.

Social History: Lives with one other dog ('Vixen', 10 years old, fit and well) and 4 people.

Differential Diagnosis:
Transient Ischaemic Attacks (TIAs aka mini strokes)
Seizure, ?brain tumour
Prolonged 'dizzy spell' after being pushed against the stairs
Subdural Haemorrhage (unlikely as he did not hit his head and inappropriate time frame)
Severe anxiety (fireworks went off earlier in the evening; unlikely as he has never exhibited this response to them before)

Impression: TIAs

Plan:
1. 37.5mg clopdigrel stat (the only antiplatelet we had in the house) ie half the human dose
2. Regular clopidogrel daily for 1 week
3.Any further attacks, call for veterinary review (will have to wait until the new year as closed for Christmas)
4. Discuss events with family
5. Review tomorrow

Consultant Ward Round following morning:
(ie I went with my mother the following morning to see if he was still alive)
Patient 'back to usual self' according to owner: Running around, attentive.
Stood on hind legs and sat without difficulty. Normal gait. Drooling resolved.
Eating and drinking.

Impression: Resolved TIAs

Plan: Continue clopidogrel, watch and wait.

What I learned from a patient who had a Laryngectomy

A Laryngectomy is a procedure where the larynx (or voice box) is removed (-ectomy) often because of cancer. It leaves the patient with a hole in the neck to breathe and talk, albeit with some difficulty.

I don't think I properly had many dealings with people who have had this procedure done (ie laryngectomees) until I came across this particular patient. In my mind, having a laryngectomy was a life-changing procedure to the point where it could be life-limiting. I couldn't imagine being put to sleep on an operating table and then waking up not being able to talk without great effort or assistance. Talking effortlessly is definitely an everyday luxury I take for granted.

I don't know what I was expecting before I went to see this gentleman at the bedside. Perhaps someone who was depressed, withdrawn, brusque... All the things I imagine I might be, had I been in that situation. I clearly need to work on my coping mechanisms for difficult life events. However, I met a man who was fiercely independent despite various other physical ailments. He was the kind of person you would have thought was in the army in his younger years. I thought communication between us would have been so strained that it would just dissolve in frustration but he used every last ounce of breath to finish each sentence. He even added unnecessarily polite words like please and thank you although I wouldn't have held it against him in the slightest if he chose to forgo these niceties to conserve energy.

I don't know much about this gentleman's story so who knows if he had a hard time coming to terms with it at first. Perhaps he was all those things I imagined but made his peace with it. Or maybe he was totally fine with it and was grateful to have the operation done for whatever reason. But he stayed on my mind because he taught me something about loss. What it's like to lose a part of yourself but not let it defeat you. Losing my voice would mean losing my accent, my sing-song intonation and my slightly sarcastic tone of voice. That would take a toll on how I see myself, my identity. And I suppose people who lose a limb or their eyesight or hearing would go through a process of coming to terms with their own loss, how ever that looks for them. But the human spirit is one of vigor and resilience and we would do well not to forget that.