Lunch table eavesdroppers get what they deserve when trying to overhear conversation among a group of veterinarians. Like most groups of people, vets search for common ground : they talk shop. One-up-man-ship takes the form of gleefully recounting horror stories of the bloodiest surgery, ugliest tumors, biggest bladder stones and the exploding abscess. Not an aperitif for most lunches. Back in the day when we local veterinarians covered our own emergency work at night we often cowered at the ring of the telephone, never knowing what might be facing us at the other end of the line. I still recall in vivid detail the late night phone call from a distressed turtle owner, claiming that their pregnant turtle was egg bound and insisting that no price was too great but that the turtle needed a C-section NOW. (Yes, egg bound turtles can happen. Yes, surgery is possible, using a sterilized striker cast saw to penetrate the shell, boat fiberglass to close it back up.) The man was persistent and very pushy. Irritated at his manner I became a little short, at which he immediately switched his focus to my “snippy temper”. I took a deep, stormy breath and before I could reply I was startled to hear him break into a deep belly laugh. It was Dr. James Barger, a colleague with a wicked sense of humor. He was also the one who took one look at the Christmas sweatshirt from my mother, customized with a duck and the vet hospital name and said, “She got that right! Quack, quack, quack!” Hmph.
But perhaps you aren’t eating lunch and we can talk about abscesses. What IS an abscess? First off, it starts as an infection. If bacteria has entered the body, say by a puncture from a cat’s claw or a dog’s tooth, the body responds. In self-defense it sends white cells to do battle and get rid of the bacteria. An accumulation of dead white cells and bacteria plus some cell fluids becomes a creamy yellow or grey goo we call pus. When the pus pools in a pocket under the skin or in a body part we call that an ABSCESS. Tissue swells around the abscess or pus pocket, turning red. Pressure builds and it can be very painful. Gravity works against healing, as the pus will infiltrate down an arm or leg, tunneling under the skin. If the pressure is very high the skin covering the abscess may rupture, leaking pus everywhere.
Although the opening of an abscess for drainage is one of the first orders of treatment, it is desirable that this be a controlled opening, or lancing, of the wound. Skin that ruptures will be torn and jagged and cannot easily be sutured into a cosmetic closure. If the skin on the surface has been stretched too long it may suffer from pressure necrosis and when it finally breaks open so much skin is dead that only a big hole is left. There is no skin to close over it. This could require skin grafts in future to heal properly.
Surprisingly, pus itself may not yield the bacteria causing it when cultured. This is because so much of it is dead cells. Lightly scraping the walls of the abscess will yield best results. Although many abscesses do not require cultures for treatment, a culture to identify the bacteria that caused the infection will also identify the antibiotics best chosen to fight the infection. This is very important when dealing with a chronic infection or an unusual presentation.
The placement and size of the abscess will determine if it requires minor or major surgery. Drains to allow further guided leakage of pus from the body may be placed, to be removed after several days. A culture may have been taken. Once the abscess has been opened and cleaned out an antibiotic is administered, without waiting for culture results. Cultures require growing the bacteria, separating individual strains if more than one type of bacteria is present, identification of each bacterial type and antibiotic sensitivity or resistance testing of each, a process of 3 to 7 days. Medication can then be modified if needed. Phew!
It sounds so clinically neat, written in little letters on a page while you enjoy another cuppa. Reality is they are smelly, messy gooey messes spewing from rotting body parts and oh! Lesson learned. Don’t eavesdrop on veterinarians!
Christine B. McFadden, DVM