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Tuesday, October 21, 2014

A Tale Of Three Uteruses....Why You Should Spay

**CAUTION--Graphic images from surgery.  Proceed at your own risk.**


Recently I had a rather interesting day.  I had three dogs in to be spayed, but each one was a completely different situation.  And I realized that the comparison between these dogs was a good discussion on why you should have your own pets spayed.

Let's start with the first one who was a six month old healthy German Shepherd mix.  She weighed around 58 pounds (26 kg) and had not gone through her first heat cycle.  The surgery went smoothly and there were no problems.  Here is what her uterus looked like once it was removed.


For those who aren't used to seeing these things, the tubular structures in the center of the "V" are the horns of the uterus, with the ovaries at the top of the photo.  The fatty material extending past the tubes and towards the sides is the connective tissue surrounding the uterus.  Pay attention to the scalpel, which is provided for scale.  That becomes very important in a minute.

The next patient was a pure-bred German Shepherd, also at six months old.  This patient was in the middle of her first heat cycle, but the owner didn't want to reschedule so we went ahead and did the surgery.  This dog was 46 pounds (around 21 kg) and her uterus was about three times the size of the first one.  Here's what it looked like post-operatively.


It may not be obvious when you first look at the photo, but look at the scalpel handle for scale.  This uterus is several times thicker than the other one and though you can't see them there are much larger surrounding blood vessels.  Doing a spay on a dog in heat takes longer, uses more suture material, and carries a slightly higher risk of bleeding.  Even so, it can be done safely and this dog also recovered without problems, though the surgery took me over 30 minutes rather than my typical 20 minutes.

The last dog was an 11 year old shih tzu who weighed just under 14 pounds (about 6 kg).  She had developed a life-threatening uterine infection that required immediate surgery.  This is called pyometra, and involves an infection of the uterus so severe that the organ fills with pus and can kill the dog if it ruptures.  The only treatment is usually to do rapid surgery and remove the offending organ, though this is a high risk procedure since even handling it can result in a rupture, spilling pus into the abdomen.  Thankfully this surgery went smoothly, but the uterus was obviously abnormal.  Compare this one to the other two.


Again, go back and look at the other photos using the scalpel for scale.  This uterus is very obviously swollen and discolored.  And if that's not gross enough, here is what it looked like when I opened one section.



All of that nasty fluid was inside the uterus!  And it could have been prevented by spaying her at a young age.

So let's recap the situation.  The largest dog had the smallest uterus and the smallest dog had the largest uterus.  All three came through their surgeries with flying colors and all three were doing great on their post-op recheck 10 days later.  But the dog who had not gone into heat yet had the lowest risk of all of them, so the other situations, especially the last one, could have turned out much worse.

Let's also look at the cost differences.  The first surgery was routine and ran around $350.  Since the second one was in heat and that takes longer, it ended up being around $430.  The pyometra case was over $800.

Do you see the lesson here?  It's better for your dog and for your wallet to have the spay done before their first heat cycle.  Do yourself and your pets a favor and have them spayed by six months old.

Saturday, October 18, 2014

Removing A Hamster's Ear Tumor

I like to see "exotic" pets and therefore I do things that most other vets won't.  I'm certainly not the only one, but I know that not many of my colleagues would do surgery to remove a hamster's ear.

This little guy came in with a growth on its ear that looked pretty nasty.  It was growing quickly over a week or so of rechecks and the decision was made to try and surgically remove it.  By the time we got to this day it was beyond just a tumor and had encompassed most of the ear, including the canal.  I quickly realized that I wouldn't just be removing the mass from the skin, but removing the entire ear.

Here's what things looked like before the surgery.  He was heavily sedated and this was just before the surgery.



Here he is while under anesthesia.  When dealing with pets this small we sometimes have to get creative.  There aren't tracheal tubes small enough, and the face masks for anesthetic gas are too large to fit.  I've learned to place a latex exam glove over the end of the mask and then make a small hole to place the patient's face so they can breathe in the oxygen and anesthesia.  That's a pulse oximeter on his leg, which measures the heart rate and blood oxygen.  It actually worked really well through his leg.


And here he is after the surgery with the mass removed.



I know it's a little hard to see here, but the surgery site closed really well and other than the missing ear there was no deformation of the face or head.

This is what the mass, ear, and ear canal looked like postoperatively.


He recovered well that day, then came back 10 days later for a recheck and to remove the sutures.  Unfortunately I didn't take a picture then, and now I wish that I had done so.  He looked great and was showing no bad effects of missing an ear.  It was a completely successful surgery.

These kinds of cases make the job really interesting!

Wednesday, October 15, 2014

In Your Pet Food But NOT On The Label

There was an interesting recent article that looked at ingredients in pet foods and whether or not there were things found in the food that wasn't on the label.

"In order to see whether mislabeling occurred, the researchers tested 52 products by extracting DNA and testing it for the present of eight meat species: beef, goat, lamb, chicken, goose, turkey, pork and horse. In the end, the researchers found that chicken was the most common meat species found in the pet food products. Pork was the second most common, followed by beef, turkey and lamb. The least common was goose, and none of the products tested positive for horsemeat.

Of the mislabeled products, 13 were dog food and seven were cat food. Of these 20, 16 contained meat species that weren't included on the product label, with pork being the most common undeclared meat species."

This may seem a little shocking to some, but honestly it doesn't really concern me for most pets.  Most of these ingredients are probably trace amounts, meaning that rather than a big chunk of chicken being thrown in there would be some residual bits on the equipment.  So I wouldn't be concerned about this for my own dogs.

The concern is for pets that might have food allergies or other sensitivities to ingredients.  This study is exactly why dermatologists don't consider any over-the-counter foods to be sufficient for a diet trial to rule out allergies.   Let's say that a dog has a beef allergy.  In order to prevent a reaction you pick a food that doesn't have beef on the ingredient list.  So your dog shouldn't react, right?  Well, maybe, except for the fact that there is a good chance that there are trace amounts of beef in the food anyway and even a small amount could trigger a reaction.

If your pet isn't allergic to food ingredients, this is a non-issue and really isn't news.  But if your pet is known or suspected to have food allergies, please listen closely to your vet when they recommend a very specific diet.  There is real science behind the recommendation.

Sunday, October 12, 2014

Hit By Car: Broken Leg And More

One of my long-term clients brought their dog to me for a broken leg after being hit by a car.  She had let the dog, an older poodle, outside when the dog wandered too far and got into the road.  A car hit her but didn't stop.  The dog was limping and the leg had an obvious break, so she brought her in.
On the initial exam the dog was breathing heavy but was alert and stable.  There was a bad fracture in the middle of the left tibia, something that I could tell just on palpation.  Surprisingly there didn't seem to be any worse injuries and I was hoping that it was just a broken leg.  In order to assess the damage and see what would be needed for treatment we took some x-rays.

Here's the leg.  This is a bad fracture, but not irreparable.  A splint/cast alone probably wouldn't stabilize the bone well enough, but a pin or plate would result in a very good chance of healing and normal use for the rest of her life.



This is the point where instinct and training take over.  With just the exam I could tell that the leg was broken and there weren't obvious injuries otherwise.  So it would make sense to take radiographs of the legs.  However, a thorough doctor will be aware of other possibilities.  And just to be on the safe side I took some views of the chest.



Notice the haziness in the area of the lungs between the heart and the spine.  This should be much more black, representing the air in the lungs.  Also look below the stomach in the abdomen.  You'll see some hazy, mottled objects running along the direction of the body.  These are feces in the colon and they should not be in that location.  At this point I knew what had happened, but I took the last view.


Even if you know nothing about reading x-rays, I'm sure you can tell that the right side of the chest is just "off".  What's going on?  Those are abdominal contents in the right half of the chest.  Feces within the colon show how that part of the intestines is now within the space normally occupied by the right lung lobes.  Notice the air-filled (blacker) object on the right-hand side of the image at the last ribs?  That's the stomach.  Follow it to the right side of the body and you'll see a finger-like projection pointing "up" into the chest.  This is not normal, and represents the pyloric region of the stomach, which should empty into the upper small intestine. That part of the stomach is now going into the chest.  And lastly, look at that oval whiteish object in the center-left of the chest.  That's the heart, and it's being pushed from the center until it is touching the left wall of the thorax.

This is a diaphragmatic hernia, and was the reason I decided to view the chest.  When there is a hard, sudden impact against the body, the force can push the air and organs against the diaphragm, causing it to "pop" like a balloon. The diaphragm is a muscle, so this results in a tear and hole in the structure.  The inside of the chest has negative pressure in order for the lungs to be able to inflate without pressure around them.  That small vacuum helps to suck abdominal contents into the chest.  Once the diaphragm ruptures it's pretty simple for liver, stomach, and intestines to move through that hole. 

A diaphgramatic hernia is much more serious than a broken leg.  This dog had difficulty breathing because at least half of its normal air space was taken up by abdominal organs.  It should be obvious that she couldn't live well this way.  That being said, I've known cases where a hernia of the diaphragm goes unnoticed for a long time because the dog compensates for its breathing.  This is not an ideal situation, so surgery is always strongly recommended.

I've done this surgery, but it's a very risky one.  It involves opening the abdomen pulling everything back into the proper place.  This allows the thorax to have exposure to outside air, collapsing the lungs.  You have to forcably breathe for the patient and remove excess air from the chest afterwards.  Depending on the size of the herniation it can be difficult to pull the liver back into the abdomen.  There is also a very important nerve along the diaphragm that can be damaged, resulting in paralysis of the breathing muscles.  The surgery carries a lot of significant risks, but not doing it is even riskier.
In this case the owner didn't have good options.  She simply didn't have the money or credit to do any kind of surgery, let alone the thousands of dollars it would have cost to repair the diaphragm and leg.  This little girl ended up being euthanized so that she wouldn't suffer.

Not all traumatic injuries are obvious on first glance.  A broken leg is bad enough but it's not a life-threatening injury.  Please be careful with your pets.

Thursday, October 9, 2014

A Dog With A Shell

Recently I saw something new, which after over 17 years in practice becomes more difficult.  This is something that I've only ever heard about in text books and never seen in person so this excited me.

This dog came to us from a nearby pet store for a routine outpatient nail trim, something we'll occasionally do.  When it walked in we were shocked at the visible condition of the skin.  This looked like one of the worst skin infection possible and I was worried that the dog was being neglected.  Even though he wasn't being seen by a doctor, I went over to take a brief look.

When I touched the skin my eyes became wide with surprise.  The skin was hard!  And we're not talking about "I have inflammation and my skin is thickened and tough to bend".  We're talking "I'm part turtle" hard!  The affected areas of the skin were literally as hard as rock and formed a shell over those parts of the dog's body.  Take a look for yourself!




Right away I knew what I was seeing even though I had never been faced with a case of it.  This is a condition called calcinosis cutis and results when calcium deposits form in the deep layers of the skin.  Most commonly this happens as a consequence of Cushing's disease, a disorder where the body over-produces glucocorticoids (steroids), but it can also occasionally result from diabetes, chronic kidney disease, and some forms of cancer.  Blood calcium levels can become persistently high, leading to deposits under the skin. 

Most of the time this results in small, localized plaques of little consequence by themselves.  Sometimes the problem becomes generalized, with calcified skin over a more generalized area of the body.  This particular dog beat even that!  I could get my fingers under large sections of calcified skin, tap hard on it, and even try to move it.  This was thick, hardened skin unlike anything I've ever seen.

We talked to the owner and she was well aware of the problem.  Her dog did have Cushing's disease and was being treated.  She had been to several vets and each one was astonished (as was I) at the extent of the problem, never having see it that bad.  Unfortunately once the skin calcifies it's irreversible and you have to make the pet as comfortable as possible while treating the underlying condition.  This dog had permanent, severe skin damage in addition to the other symptoms of Cushing's disease.  And surprisingly he seemed like he was in good spirits.

I feel really bad for the dog and for the owner, but at the same time this was one of the most interesting things I've seen in a long time.

Monday, October 6, 2014

The Dangers Of Rubber Band Bracelets

A recent fad among kids is rubber band bracelets, sometimes called loom bands.  I know that you've seen these, made of colorful small rubber bands that can be either bought or made.  My daughter has a loom and a kit and has made several of them.  Personally I think they are actually pretty neat (she made me one with black and yellow, Batman's colors!). But there is a hidden danger to them.

A client brought a shih-tzu to us for pain and limping.  The fur was really long and matted around the leg, but it was pretty obvious where the problem was.  We tried to get a better look, but the pain was so severe that she wouldn't let us touch it or even take x-rays.  It really looked like there might be broken bones due to the degree of pain and the fact that there was some swelling.  After sedating her, though, the true cause came to light.

Once she was sufficiently sedated I started looking at the paw and noticed that there seemed to be some scabbing.  Expecting a wound and worrying that bone might be protruding I started shaving the matted fur away.  That's when I noticed the linear wound.  And then I saw something green buried deep inside the wound and I realized what had happened.  It didn't take more than a few seconds to confirm my suspicion.  A small rubber band had tightened around the dog's wrist, cutting through the skin and digging down into the underlying tissues.

After clipping and cleaning, here is what the leg looked like.





Yes, this goes completely around the leg and was deep enough that I could see the muscles.  I was able to cut the band and remove it.  Here is the clear culprit.


If this had gone on much longer it would have started digging through the muscles and tendons, potentially causing permanent damage or requiring that the foot be amputated.  There was already infection and the skin was severely damaged, but there was still a chance of saving the foot.

I talked to the owner and informed her of what we found. She literally almost passed out.  Her youngest daughter had loom bands, and they had caught her trying to put the bands on the dog.  They had told her to stop, but it was obvious that she didn't.  One of those bands had been placed around the dog's wrist and caused severe damage and pain.

The story has a good ending, though.  I was worried that there was enough damage to the blood supply of the skin that the lower part of the paw might die and need amputation.  With bandage changes, antibiotics, and time, the leg fully healed and the dog did fine. But that woman's daughter got the scolding of her life!

When you have children, be sure to supervise them around your pets.  Something small and innocent can lead to severe, expensive problems.

Friday, October 3, 2014

Let Sleeping Dogs Lie....With You?

Recently I was asked whether or not it was okay to allow your dog to sleep in the same bed with you.  To give you some indication of my stance on the issue, both of our dogs spend a lot of time on our bed.  Sometimes we'll have both 65 pound dogs and 2-3 cats lying around our bodies on a queen-sized bed.  The dogs don't stay there all night because I tend to kick with my feet if they lay on top of them, something they quickly learned.
 
So why would you not want to share your bed with the dogs?  There actually are a couple of good reasons.
 
Some parasites can be transmissible to humans, particularly roundworms and hookworms. The eggs from these parasites have been found on the fur around the rectum, tail, and hind legs, not just in the feces.  If a person comes into contact with these areas on an infected dog and then touch their faces or food before washing hands there would be a risk of swallowing the eggs and becoming infected.  Somtimes the worm eggs can actually be regurgitated into the mouth and mix with saliva, leading to infection risk when being licked around the face.  If a dog sleeps with you these parasite eggs can become attached to the bedding and become a source of transmission.
 
Now that I've grossed you out and made you push Fido off the bed, let me try and set your mind at ease.  A dog properly cared for should have minimal or no risk of having these parasites.  All heartworm preventatives on the market also prevent hookworms, and most of them will cover roundworms as well.  So if your dog is on consistent heartworm prevention your risk is minimal.  It is also recommend to have a fecal sample checked 1-2 times annually to screen for these parasites.  Obviously I don't worry about it in my family.
 
The other reason has to do with behavior.  In a dog's mind the human furniture is a place of authority and power.  Those who sit on it are "higher" in the social hierarchy.  This really isn't a problem for your average dog as they are comfortable with their position in the "pack".  But sometimes dogs will become aggressive towards the humans or their canine housemates.  In these situations one of the first things that should be done is to keep the dog off of all furniture.  This includes the bed!  By restricting them to the floor and off any human objects we are working on their psychology and forcing them to a lower rank within the family.  If a dog is used to sleeping on the bed this can be a difficult transition for them and the people.
 
With precautions and care, I don't think there are problems with sharing your bed with your four-legged family members.