Tetanus - Lock Jaw

What shall the topic be for this article? It is Sunday night and I am out of fresh ideas of what to present as an overall topic.  What I am hoping is I start typing and the words will appear on my monitor screen.  Oh is not that what is called dreaming.  Somehow, this carbon based country boy is snared in the electronic age trying to recapture my youth or at least the semblance of an idea.   Let me present an interesting case from years ago.

I am impressed by the confidence clients place in my abilities as a Veterinarian.  Sometimes my enthusiasm exceeds my abilities.  You know how it was back when you are immortal and still under thirty years of age.  If you can get a rope on it you can ride it or lead it.    One of my clients was visiting the Monroe County Fair Grounds about thirty-some years ago.  A traveling circus showed up to perform that day or the next.  There was a kicking accident where a zebra kicked through the metal front of a semi-trailer.  This client was puffing my reputation up so much that I was in awe of the description.  I really wanted to meet this person.    It really sounded great, until I realized I was the one that had to live up to a big showy description. 

The circus manager described it as a Grevy's zebra when he called.  I looked for the available drugs I had to sedate this animal.  I called a Veterinarian I knew had experience working with exotic animals.  He mentioned his treatments several times at a local Veterinary Medical Association meeting.  I got a hold of him and asked what works when sedating a Grevy's zebra, His response "Nothing".   Oh, joy.  Now what was I going to do? I had accepted the call and there was no way of contacting the manager back.  This was before cell phones were invented and readily available.  I loaded up what supplies I thought would be helpful and headed down to the Fairgrounds.  My wife and our son went with me.

When I arrived, it was easy to locate the circus encampment.  Circus people do know how to deploy trucks and off load critters into make shift corals with metal gates.  The male zebra in question was in a pen next to a trailer with the truck cab-body parked at a ninety-degree angle to the trailer.  I assessed the injury from the far side of the pen.  I could see the sheet metal kicked out spot on the corner of the trailer.  These injuries are very nasty to tissue and are very challenging to put back together in a functional manner.  They make slicing cuts to a body part that does not have any loose or spare skin to put back together.  If you imagine ramming a finger through an aluminum soda pop can.  Now you are terrified and start jerking your appendage multiple times to get it back out of this one-way collapsing set of very sharp blades.   If you understand Julian sliced meat, imagine it done with great force and irregularity.  There are very important nerves, blood vessels, tendons, and ligaments that are vital for walking and ambulating.  There is always concern of tissue damage and infection by bacteria.  One of the worst infection cases an equine can get is Clostridium tetani.   The neurotoxin produced by C. tetani is what causes lockjaw to be deadly.  It effects skeletal muscles and eventually will get to the diaphragm muscles and will result in death by suffocation.   If you do the muscle math vectoring you can "visualize" what happens.   You understand the muscles that close the mouth are bigger in mass; number of fibers and have mechanical advantage due to location are greater than the muscles that open the mouth..   The muscles that open the mouth are contracting also but the net effect is a clamped tight jaw.   You may have seen this on reptile shows where alligators have their mouths closed with the universal fastener, duct tape.

I knew I would have to get closer to evaluate treatment options for the zebra.  The injured leg was the left rear fetlock (first bulge above the hoof) to hoof area.  Due to his placement inside the metal stock gate, the assigned apprehensive helpers were able to crowd him next to the cab side of the pen.  This left me only one approach, I would have to crawl under the frame and evaluate the injury.  When I was in position lying on my belly I could see this injury was one that fortunately was close together partial and full thickness cuts that would not hold a suture.   Did I mention there was a local oil company employee fueling the truck and had diesel dripping while I was working under the truck.

I treated the leg with a yellow nitrofurazone (Furacin) spray and recommended long acting antibiotics a dose of Tetanus antitoxin and a dose of tetanus toxoid. I discussed bandage wrapping but the animal handlers were adamant they were not going to touch this particular zebra.   Matter of fact I had a very hard time talking them into using four by eight sheets of ¾-inch plywood as squeeze panels while I was giving antibiotics, tetanus toxoid, and tetanus antitoxin.  It turns out this male zebra did have a well-deserved reputation.  I lost track of this case as the circus moseyed on down the road. 

I have treated other cases of tetanus in horses, cattle, lambs and calves.  Tetanus or Lockjaw in lambs and calves is usually seen ten to fourteen days after applying rubber bands for neutering or tail docking in lambs.  The bacteria C tetani gets between the band and body where there is no oxygen for the spores to grow and develop anaerobicly.   Treatment in horses also may include support slinging the horse, or digging holes for all four legs and getting the horse to stand upright.  Massive antibiotics and huge amounts of anti toxin to bind the neurotoxin are used for any case of tetanus.  A nasal gastric tube for hydration and nutrition are placed to have a chance of surviving.  Survival rate is about 25 -30 %.

Dogs are more resistant to tetanus but they will get it. I have treated four or five cases to date.  It usually involves an infected deciduous (baby tooth) but any deep puncture wound will support growth of the tetanus organism.  Interestingly dogs show a peculiarly odd "grinning" face and head.

Prevent Lockjaw.  Vaccinate for tetanus.

For more information about a specific case, consult your veterinarian.         
The outside of a pet is good for the inside of a human.