Category Archives: Interesting Cases

Dr. Todd Morgan performing a Laparoscopic Spay

Laparoscopic Spay

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We are excited to offer this minimally invasive alternative to traditional spays.  A laparoscopic spay provides up to 65% less pain to your pet compared to a traditional spay.  A laparoscopic spay (medially termed a laparoscopic ovariectomy) is also less traumatic and provides a faster recovery time.

 

Click on our YouTube link below to find out more this procedure and how well Ziggy did undergoing a laparoscopic spay:

 

Why Choose a Laparoscopic Spay?

Laparoscopy is a minimally invasive procedure performed by passing a narrow medical camera (laparoscope) through a tiny incision into the abdomen. The laparoscope provides a magnified view of the organs allowing for greater precision.

A Laparoscopic Spay (medically termed a laparoscopic ovariectomy) requires a second tiny incision (typically <1cm) for the placement of medical instruments to perform the spay.

The ovaries are identified and isolated with endoscopic forceps. A special vessel sealing device carefully cauterizes, seals and cuts the ovarian blood vessels and ligament, thereby freeing the ovary from the rest of her uterus. The ovaries are then retrieved and removed through the tiny instrument incision. The uterus is left intact and in its natural state.

Research has found that there is no benefit to removing the uterus**. Retaining the uterus will not increase the risk of breast cancer or uterine infections, nor will your dog go through any heat cycles.

Lap OVE1

Lap OVE2

Endoscopy - Laparoscopy - website

HOSPITAL TOUR VIDEO

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Clients are always curious with what goes on “behind the scenes” and some of the procedures we perform.

Click on our You Tube link below to get a hospital tour of our facility and check out some of the procedures we perform on a daily basis.

 

Radiograph of Lena with 2 mummified fetuses

Interesting Cases – 2 Mummified Fetuses in a Spayed Cat – Dr. Tina Gagnon

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Lena is approximately a 3 year old female, spayed, calico cat. Her new owner had brought her in within three days of adopting her, because she felt a mass in her abdomen. The mass was confirmed as abnormal on general physical exam and we decided to take an x-ray to find out more. Surprisingly, we saw two fetuses in her abdomen. I confirmed with the veterinarian that performed the spay procedure, at another veterinary clinic, that Lena had both of her ovaries and her uterus removed. The abdominal radiograph (x-ray) shown above does identify 2 kittens in the abdomen (white arrows pointing to each one) and we could see the kitten’s vertebrae and skulls on the radiograph.

We performed an abdominal ultrasound to see if she had any reproductive structures and to find out if the fetuses were alive. If they were not alive, we needed to know if they were attached to any abdominal organs that would complicate the removal of the dead fetuses. The abdominal ultrasound revealed two mummified fetuses in Lena’s abdomen. One was located near the stomach and the other was located between the left kidney and the spleen. These may have resulted from an ectopic pregnancy or, her uterus could have ruptured during a pregnancy, expelling the fetuses into the abdomen, then healed back up.

We then performed surgery to remove the mummified fetuses. One was covered in a membrane and was attached by scar tissue to the side of her abdomen. The other was walled off by abdominal fat and also attached to the back of her abdomen. Both were successfully removed. Lena stayed in the hospital over night on intravenous fluids, pain medications and antibiotics. She was sent home the next day and made a fabulous recovery.

Lena in surgery showing a mummified fetus.

Lena in surgery showing a mummified fetus at the tip of the arrow

 

 

Miche

Interesting Cases – Feline Liver Disease

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Miche, is a 3 year old Seal Point Himalayan. Shortly after adoption from a humane society,  Miche started to sneeze and sound congested.  She became less active and stopped eating.  When she arrived at our clinic she continued to show these signs and she had a fever.  It is common for cats to develop upper respiratory tract infections, especially if they have been in contact with other cats. This usually involves different viruses that affect the upper airways and can involve bacteria as well. These cats usually do not eat because they don’t feel well, they cannot smell their food and they have a fever.

Miche was kept in the hospital on intravenous fluids to hydrate her and was on intravenous antibiotics for the infection and fever. She was being fed by mouth but would not eat on her own and Miche’s fever remained high so a second antibiotic was added. After a few days, Miche stopped sneezing, her temperature normalized, she was brighter and was less congested. She still didn’t eat well, but some cats won’t eat in the hospital due to the stress of being in a different environment. Since Miche made a good recovery we decided to try her at home.

Miche was acting normally at home except she was not eating. This prompted bloodwork to see if there was something else going on causing her not to eat. The bloodwork showed that there was a problem with her liver. Cats that stop eating for as little as 3 days can mobilize their fat to their liver, causing liver disease. Considering Miche’s history of not eating, this was very possible. This is reversible and treatment involves insertion of a feeding tube to make sure the cat is getting enough nutrients.  A liver biopsy would also tell us what is happening in the liver and how to treat it.

This is what Miche's liver looked like during her laparoscopy (a special camera that looks inside her abdomen). The mottled tan liver is seen and her gallbladder is the round grey/blue structure.

Taking a biopsy of Miche's liver. The view is magnified 10 times and the sample is actually only 4 mm diameter. The liver typically is a reddish/purple colour but appears quite pale and mottled here.

Miche’s owner decided to proceed with a liver biopsy and insertion of a tube that would allow her to feed Miche through this tube directly into her stomach.  Although it was difficult at first, her owner was very dedicated and learned how to feed Miche through her feeding tube. The liver biopsies came back as lymphocytic pericholangitis which is a type of inflammation of the tissues surrounding bile ducts in the liver. Miche was put on 2 medications: one to reduce the inflammation and one to help decongest the liver.  Miche’s owner was able to give these medications through the feeding tube.

The stomach tube is placed with the help of an endoscope in Miche's stomach. A catheter is inserted into the stomach through the skin in the ideal location after the endoscope fills it with air and the graspers grab the suture material that is tied to the feeding tube and brought back into the stomach.

This is how the feeding tube appears in the stomach. Food is placed through the tube with a syringe and exits through the holes in the 'mushroom tipped" end. The tube can remain in place for months and once Miche began eating normally on her own, the tube was removed.

 

Miche continued to improve and now she is a loving, active and healthy companion for her human mother.  Three weeks later, a blood test was done to assess her liver function and came back all normal. Miche is now eating well on her own.  Her stomach tube was removed and she will continue to be monitored.  Miche is a fabulous cat and we all care for her very much.

 

Zar

Interesting Cases – Gingival Hyperplasia

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This is a great picture of Zar who is a 9 year old male Boxer who has had some VERY bad breath and even difficulty chewing at times.  The photo below shows what his mouth looked like when we saw him.  Zar is suffering from a condition called gingival hyperplasia where his gums started to over grow inside of his mouth to a point where it was actually covering some of his teeth and he was chewing on his gums when he was eating.  The odour from is mouth is due to food getting stuck in the folds of the excessive gums and forming infections which also accelerated regular plaque and tartar formation in his mouth.

This is a photo of Zar's mouth immediately after being anaesthetized with his endotracheal tube in place to maintain his anaesthesia during the surgery. Some of his teeth are not even visible due to the excessive gum (gingiva) formation.

Boxer’s are one of the breeds that are predisposed to this condition and can progress to a point where they can get quite sick and lose weight due to painful eating.  The next photo show’s Zar’s mouth immediately after surgery where we surgically removed as much excessive gum tissue as possible to reshape the gumline to the orginal location.  He was also placed on pain medication and antibiotics immediately after surgery while his mouth healed.

This is the appearance of Zar's mouth immediately after surgery. You can now see a lot of the teeth that were covered by the overgrown gums. His upper canine tooth was extracted due to being too severely diseased by the condition.

 

Zar did FANTASTIC and his owners were amazed at how much better he felt and was eating.  They also appreciated the dramatically improved breath!!

The final photo was taken at his 2 week re-check where his gums have completely healed and his mouth looks dramatically better then his initial photo.  Since this condition has a genetic component, the hyperplasia could start forming again.  However it took 9 years for Zars mouth to get to this stage and he will likely never need any more surgery in his mouth again.

Zar's mouth 2 weeks after surgery showing that his gums have completely healed and he now enjoys eating pain-free.

 

 

 

 

Chest X-ray of Zoie in November 2011.  Note the dramatically enlarged size of the heart now showing Zoie in advanced stages of congestive heart failure.

Interesting Cases – Congestive Heart Failure

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Zoie is an 11 ½ year old Dalmation.  In April of 2010 Zoie came in for her annual physical examination and routine vaccinations and was found to have a heart murmer.  Since Zoie came in every year for her annual vaccines, we recognized that this was a new finding for Zoie.  Although she was not showing any signs of heart disease at home, her owners agreed to radiographs to evaluate the size of her heart and check for any fluid or other signs of heart disease.  The radiograph below showed a very mild enlargement, but there was no evidence of fluid in her lungs at that time.   To further evaluate the cause of the murmer, Zoie went to the Ontario Veterinary College to have an ultrasound of her heart.  She was diagnosed with mild Mitral Valve Insufficiency.  At this time Zoe was still not showing signs at home so it was recommended to recheck her every 6 to 12 months to listen to her heart and lungs and look for changes on her chest x-rays.

This is a lateral chest radiograph of Zoie's heart in April 2010. Her heart size is nearly normal size at this stage.

A year later in April 2011 the only change on her radiograph was a slight enlargement of her left atrium of her heart.   In August of 2011, however, Zoe started to have a mild cough and show mild signs of heart failure.  At this point she was started on heart medications and improved clinically.  The most recent radiograph in November 2011 showed a 50% enlargement of her heart and a large amount of fluid in her lungs which is called pulmonary edema.

This is a repeat lateral radiograph in April 2011. Note the slightly larger size of the heart silouette.

 

Chest X-ray of Zoie in November 2011. Note the dramatically enlarged size of the heart now showing Zoie in advanced stages of congestive heart failure.

Mitral Valve Insufficiency is a condition that affects the valve of the heart that regulates blood flow from the left atrium to the left ventricle.  It is most commonly caused by a defect in this valve, which allows some of the blood to leak backwards.  This reduces the volume of blood travelling through the body.  The heart also has to work harder to make up for the leaky valve. Over time the heart begins to enlarge and the heart muscle has a harder time pumping in a stretched state causing secondary heart failure.

Diagram of a heart showing normal blood flow through the chambers of the left atrium and left ventricle along with regurgitation (back flow) of blood which ultimately leads to heart failure

Treatment involves medications to remove fluid from the lungs caused by the congestion and poor blood flow, as well as medications to reduce the workload on the heart and improve blood flow to the heart.  While in the past a diagnosis of congestive heart failure carried a very short survival time, the newest medications available to dogs have been shown to extend their life by an average of several months to years.  A lot of small breed dogs (which is the breed that usually gets the disease) often have an increased lifespan of 1 to 3 years with a great quality of life. Since we were closely monitoring Zoie and her disease progression, we were able to start her on medication as soon as her signs of congestive heart failure started, and extend her life and quality of life by a significant amount of time.

The graph shows the average increase in survival days on heart medications. The combination of Benazapril and Pimobendin (which Zoie was on) increases survival even greater than dogs on the individual medications alone.

 

Moses

Interesting Cases – Enormous Tumour on a Spleen (caution photo’s are not for the faint of heart)

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Moses is a 8 year old Labrador Retriever who was slowly gaining weight for almost a year.  Moses actually started appearing like a pregant dog before seeing us which is hard to do for male dog.  He also started to become quite lethargic and he stopped eating.  During our physical examination a large abdominal mass was palpated and Moses was weak from the mass slowly killing him and due to an anemia from the mass bleeding into his abdomen.

It was elected to take him directly to surgery where Dr. Morgan found the mass to be an enormus tumour on Moses’s spleen as noted in the photo.  The tumour was attached to the spleen making it necessary to remove the entire spleen and mass together.

Dr. Morgan in surgery with Moses. His spleen with the tumour attached is exteriorized.

 

The time during surgery and immediately after was a critical time for Moses due to the amount of blood loss and the extent of surgery needed to remove the mass.  However, Moses was eating the very next day and he never looked back.  The photo of Moses at the top of the page was taken a few days after surgery looking like a slender Black Lab once again.  A photo of the mass below shows the impressive size of the mass which ended up weighing almost 21 lbs.  Histology confirmed that the mass was likely benign especially due to its slow growth over a year.  He continues to do fantastic after surgery and is far more energetic and playful again.  He feels great now after losing 21 lbs overnight.

This photo shows the huge size of the 21 lb spleen with tumour attached which was approximately 15 inches in diameter

 

 

 

 

Isis

Interesting Cases – Electrical Burn

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Isis is a 2yr old female boxer.  Recently due to some sudden anxiety, Isis began chewing objects at home.  Unfortunately, one of these objects was an electrical socket.  Isis’s owner heard a fair amount of noise and ran downstairs to find her still attached to the plug.  She quickly released her,  assessed and cleaned the area and then called us.

The left side of her mouth showing the electrical burn. The whitish areas are the areas of dead tissue (necrosis) on the lip and gums that is getting ready to slough off.

Burns are classified as an injury to any tissue from heat, flame, chemicals, or electricity.  FIRST DEGREE burns are red and usually there is minor pain at the site of injury. These burns only involve the top layer of skin and heal quickly.  SECOND DEGREE burns have blisters and can involve deeper layers of the skin.  THIRD DEGREE burns occur when the top layer of skin is lost and there is damage to deeper layers.  This is the category that Isis’s wound was classified as.

We decided to give Isis an anesthetic to surgically remove the tissue we were concerned about and started her on antibiotics. Here is the picture after surgery.

Isis's lip after reconstructive surgery removing the dead necrotic tissue. The sutures were removed in 10 days.

Burns, especially electrical burns, can be very severe and have secondary effects on the electrical activity of the heart as well as cause fluid in the lungs.  The best course of action, even if your pet seems fine, is to apply a cool compress, and seek veterinary attention as soon as possible.