The keynote speaker at the American College of Veterinary Surgeons conference in October 2016 was board-certified veterinary surgeon Jim Giles, DVM, MS, DACVS-SA. A retired lieutenant colonel in the U.S. Army Veterinary Corps and former chief of surgery for the Department of Defense Military Working Dog Veterinary Service, he now works as a surgeon at South Texas Veterinary Specialists in San Antonio. In a packed conference room, Dr. Giles delivered a very emotional presentation about the critical role of military working dogs (MWD). I recently interviewed Giles about his experience on the front. Dr. Zeltzman: Share how one MWD helped physicians and nurses regain their humanity. Dr. Giles: Nurses and physicians are able to maintain complete composure and do their jobs when dealing with humans who have devastating injuries. The surgery and trauma teams deal with countless amputations on humans. One day, two OR nurses came to visit MWD Lucca, who had a forequarter amputation due to an improvised explosive device blast. Her handler, Corporal Juan Rodriguez, was sleeping in her cage beside her. When the nurses saw the three-legged dog and the handler who wouldn’t leave her, they were overcome. Many of the human health providers routinely commented that they didn’t know how we could do the kind of work we do on dogs and keep it together. Ironically, I had the same thought about them. It occurred to me then that when we become accustomed to death and terrible human tragedy, it can take an injured dog to remind us of our humanity. Zorro id s military working dog who had a temporary colostomy to recover from a GI injury. He now works as a training aid for new handlers at Lackland Air Force Base in Bexar County, Texas. Dr. Zeltzman: Where did you perform surgery on the front? Dr. Giles: There are different levels of veterinary care provided at different locations. Veterinary squads providing Role II care have one general practitioner veterinarian who provides routine care and basic surgical care. A Role III facility has a residency-trained specialist but not necessarily a surgeon. Both Role II and Role III operate out of a climate-controlled tent. In some circumstances, the veterinary unit may operate out of an existing fixed facility. In situations where we have had a long-term presence, such as Kandahar and Bagram (in Afghanistan), veterinary facilities have been constructed. Many of the major surgeries are performed in a human hospital OR. Veterinary hospitals are typically collocated with human facilities. Dr. Zeltzman: What were the most common injuries you dealt with? Dr. Giles: The injuries and illnesses covered the spectrum. While combat-related injuries garnered the most attention, as is the case with people, noncombat injuries and illnesses were most common. Lacerations, foot-pad wounds, and heat injuries were common. Gastric dilatation volvulus (GDV) was uncommon in working dogs owned by the Department of Defense, as most had been gastropexied. However, most contract working dogs were not pexied and, interestingly, GDVs did occur. Gunshot wounds and blast injuries were more common during peak periods of combat operations. Bbrazas is a Lackland Air Force Base puppy program military working dog (MDW) who was in training at the time of this picture. He was named after Navy MWD handler Master at Arms Second Class Sean E. Brazas, who was killed in Afghanistan in 2012. Dr. Zeltzman: Did you have to improvise frequently equipment-wise? Dr. Giles: We definitely had to improvise. Our human medicine counterparts were extremely helpful with equipment and supply issues when we needed them, in addition to providing clinical expertise. We also relied on human hospitals for diagnostic imaging, such as X-rays and CT scans. Veterinary units in a combat setting are not equipped to perform definitive orthopedic surgery, so MWDs are evacuated out of the combat theater for fracture repair. In the case of contract working dogs, the owning unit may opt to not evacuate the dogs for a variety of reasons. In those instances, we created a solution, and we used supplies and equipment from human hospitals to provide definitive surgery in the combat theater. Dr. Zeltzman: How did you sterilize instruments on the front? Dr. Giles: Veterinary teams had a tabletop steam autoclave. Larger packs were frequently sterilized at a human hospital with steam or gas. Dr. Zeltzman: How did you get blood products for transfusions on the front? Dr. Giles: There was no means to ship animal blood products into the combat theater. So our main option was to perform fresh whole blood transfusion from other MWDs. However, we were able to obtain human equipment in Kandahar that allowed us to collect and distribute fresh frozen plasma to the veterinary hospitals. There has been some progress recently on amending the policy, and dog blood components may be shipped to combat zones in the future. Lucca, Gunnery Sergeant Willingham, and Lieutenant Colonel Jim Giles. Lucca lost her leg to an IED blast in Afghanistan. Dr. Zeltzman: How did you handle aggressive dogs that were injured? Dr. Giles: All MWDs had to be muzzled prior to administering care. If the handler was present, they were responsible for restraining their dog. The biggest challenge was when human health care providers had to treat an injured MWD, which happened frequently. When the handler was killed or injured, the providers were a dangerous situation. Human health care providers received training on applying a muzzle to a working dog, but it’s still a significant hazard. Pain management and chemical restraint also were used. Dr. Zeltzman: Talk about the bond between soldiers and dogs. Dr. Giles: The handler and MWD are a team that has trained together for months or years. When they are deployed, they live together. They have one of the most dangerous jobs in the military, including leading combat patrols and searching for bombs. Not only do dog and handler depend on each other, but the troop’s safety also depends on that team being functional and proficient. The veterinary team has an integral role in that relationship. Handlers have very high expectations of excellent care for their dogs—care similar to what they would receive if they were injured themselves. Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. His traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. For more, visit his websites at DrPhilZeltzman.com and VeterinariansInParadise.com.
