when do you stop feeling D-U-M-B??

i am taking care of a 14 week old puppy whose head was crunched by a much larger dog. it's pretty terrible. the puppy is disoriented, vocalizes constantly, has a severe head turn (torticollis), rolls like an alligator, and is generally effed up pretty bad.

at the owner's request, i took xrays of the skull. for what it's worth - xray is a crappy way to look for skull fractures. unless it's a humongous, depressed fracture - it isn't going to show up on a plain film. ct scan is much, much better. but much, much more expensive, too.

so anyway, xrays show a "fracture" in the middle of the skull - which would be consistent with all the signs i am seeing in this dog. i diagnose a fracture of the calvarium.

i worked on her all day, and despite that, she is doing horribly. the cherry on the sundae is that tonight - after reviewing stuff on VIN (veterinary inter-network) and in my diagnostic radiology book - it turns out that the "fracture" i saw is really an open suture line (growth plate in the skull). so this fracture isn't really a fracture.

in my defense - the suture line is much too wide - likely due to significant swelling of the brain. it's possible that there is a fracture there too.

when will i start knowing EVERYTHING so i won't feel so stupid all of the time?

oh, right. NEVER.

on the bright side - skull fracture or not - management of head trauma is the same. so my "misdiagnosis" doesn't affect the patient. unfortunately, she's in bad shape. i don't expect her to survive much longer.