Category Archives: Interesting Cases

Duke Rampado

Interesting Cases – Physiotherapy

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Duke is a high energy 3 year old labrador retriever who had surgery at the Veterinary Emergency Clinic referral center in Toronto for an instability in his right hind tarsus (hock). After surgery in January 2012, he wore a splint for 6 weeks and then a supportive bandage for an additional 4 weeks. After removal of the bandage, there was significant muscle wasting on that leg and subsequent weakness. Although he was still using the leg, there was a mild to moderate lameness still present. At this point it was decided that Duke would benefit from physiotherapy to regain strength and muscle in that leg.
Duke’s physiotherapy consisted of massage therapy, side steps off and on curbs, sit/stand exercises, cold therapy laser treatments, and slow controlled leash walks on uneven ground. Within 3 weeks, he was able to stand on the right hind leg for 30 seconds when the left hind leg was lifted up, and his strength and coordination was improving.
He continues to improve and is expected to be returning to normal function in the future.

SEE DUKE’S PHYSIOTHERAPY WITH US, CLICK ON THE YOU TUBE LINK BELOW:

http://www.youtube.com/watch?v=G3NIzVN-2vg&feature=youtu.be

Jack

Interesting Cases – Very Sick Kitten

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Jack was found as a stray kitten at about 6 weeks of age. He was brought to our hospital by good Samaritans who agreed to give him the care that he needed. He had pus caked to his nostrils indicating an upper respiratory tract infection and pus covering his eyes. One of his eyes was actually crusted closed.  This is a picture of Jack shortly after his visit and after being cleaned up.  Jack also had diarrhea that adhered to his skin and fur and created an environment for maggots to live. In addition to everything Jack was suffering from, he also had fleas that were feeding on his blood, causing his gums to look white due to an anemia. Jack’s blood was so watery since he didn’t have enough red blood cells, and this led to turbulence of blood flow in his heart causing a murmur to be heard on auscultation.

Jack needed an oral antibiotic for his upper respiratory tract infection, 2 different eye ointments to clear up his eye infection, he was cleaned and treated for the maggots and fleas, and his diarrhea was treated with probiotics and special food. It is very common for kittens to be infected with intestinal parasites.  Some kittens get parasites through the placenta before they are born or they can get parasites from the mother’s milk during nursing and they can also get parasites from the environment shortly after birth. Some of these intestinal parasites can also rarely cause problems in people. We regularly deworm puppies and kittens twice. The first dose kills adult worms and if any eggs develop then the second dose in 2 weeks will kill those parasites. Since there is no drug that will control all types of intestinal parasites, we also sent a stool sample away to see if there were any other parasites that were not treated for.

Three days later Jack was having difficulty urinating and had blood in his urine.  He was dehydrated at this point and was given fluids under his skin that helped to hydrate him over time.  A second oral antibiotic was added for his bladder infection. About 7 days later Jack was suffering from constipation and was given an enema and fluids under his skin. After approximately 10 days, Jack started to rally from his ailments and has never looked back.  Thanks to the care, time and commitment of his owners, Jack made a full recovery and is now part of a loving family with “brother” and “sister” cats.

This is Jack Now!!!

 

Officer Pam Carter with Scout

Interesting Cases – Niagara Regional Police Service dog “Scout”

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Scout has had a long productive career as a Niagara Regional Police Service Dog since he became a part of the department in 2001 as a young adolescent 1 year old German Shepherd.  Officer Pam Carter and Scout flew through training and the two have caught numerous “Bad Guy’s” over the past decade and were instrumental in keeping Niagara safe.

The handlers become very intuitive to their dogs and develop a symbiotic relationship as the dogs and handlers learn to read each other’s body language with clear precision. Unfortunately on July 22, 2010, Pam noticed something dramatically wrong with Scout.  He suddenly became very lethargic and was trying to vomit but nothing was coming out.  His abdomen also started to become distended and he was pacing and very restless in the vehicle.  Pam immediately realized that this could be a GDV (Gastric Dilation and Volvulus) which is fairly common in German Shepherd dogs.  She also realized he required immediate emergency surgery if this was the problem or else he would die within 24 to 48 hours.

It is because of this early recognition that we were able to see him immediately and confirm the diagnosis of a GDV on radiographs.

Scout’s stomach on X-rays revealed a very large distended stomach (outlined with red arrows) that was full of air.

A GDV can occur when the stomach over distends with food, water and/or air and then “twists” onto itself and cuts off all the blood circulation to the stomach.  This strangulation of the stomach starts to cause the stomach to die and the stomach can change from a healthy pink to a dark purple within a couple of hours and an irreparable blackish colour as it progresses.

Appearance of a NORMAL stomach

Appearance of the stomach during a GDV

German Shepherds and any large or giant breed of dog are prone to this condition due to genetically having a very deep chest which gives more room for the stomach to move around in the abdomen.  The Niagara Regional Police Canine Unit are well aware of these factors and the necessary steps to reduce this condition from occurring.  However, even with the best preventative measures, German Shepherds are more than 4 times at greater risk of developing a GDV then a mixed breed dog.  Great Danes are 41 times more likely and have the greatest risk of developing a GDV than any other breed.

Scout was immediately taken to surgery and his stomach looked very similar to the diagram above. Approximately 1/3 of all dogs with GDV die despite surgery, however the success rate dramatically increases with early recognition and intervention which was the case with Scout.  In surgery, the stomach was deflated and rotated back into the proper location.  A gastropexy was then performed which involves making an incision in the surface of stomach and overlying body wall and suturing them together.  This helps to prevent the stomach from twisting again in the future and once the sutures are absorbed by the body, the incisions will have formed scar tissue to keep the stomach in the normal location for the rest of the dog’s life.  Numerous complications can develop during and after surgery, however Scout made a full recovery and was back to work and doing what he loved best within a month.

For owners who have a large breed dog or ones that are “high risk”, there are certain recommendations that help to reduce the risk:

  • Owners should be aware of the clinical signs of a dog developing a GDV (similar to Scout’s clinical signs)
  • Feeding dogs 2 to 3 times a day dramatically reduces the risk rather than feeding once a day.
  • Water should be available at all times, but should be limited immediately after eating.
  • Vigorous exercise or excitement should be avoided for a few hours after eating
  • Studies have shown that dogs fed from elevated feeders have an increased risk of GDV and at this time pre-disposed breeds are recommended to be fed at floor level.

Scout developed his GDV at 10 years of age and he continued on as a service dog until his retirement later that year.  Unfortunately he developed bone cancer (osteosarcoma) when he was 11 years old and was eventually euthanized in April 2011. He is sorely missed by everyone in the NRPS but his legacy lives on.  We hope that Scout’s story may help people recognize or ideally prevent GDV’s from happening to other dogs in the future.

If you have any questions about this condition, do not hesitate to call us at 905-354-5645.

 

 

 

 

IntestinalForeignBody1

Interesting Cases – Intestinal Foreign Body

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Diesel is a 6 year old Chocolate Labrador Retriever who presented to us for vomiting a latex glove 4 days ago and has been vomiting and not eating since. On physical examination he was bright and alert and otherwise normal. However radiographs (X-rays) revealed a suspicious area in his intestines that was dilated with a lot of gas around it. This was highly suspicious of a foreign body and he was immediately taken to surgery.

A lateral x-ray view of Diesel’s abdomen revealing gas in his intestines (dark loops).

Diesel was sick a few months prior to this event and blood results revealed elevated liver enzymes. He had a laparoscopy procedure which is a special camera that travels into his abdomen to get a biopsy of liver which revealed a very small liver due to a liver shunt (Porto-systemic Shunt – PSS). This is a birth defect that he was born with where the blood bypasses his liver. This makes it more difficult for him to metabolize drugs or break down toxins. We therefore needed to choose his anesthetic drugs carefully to minimize any stress to his liver.

During surgery, the foreign body was found in his intestines (duodenum) and was surgically removed.

Diesel’s intestines in surgery. Note the white structure in his intestines which turned out to be a obstructed latex glove.

 

Diesel’s intestines inmmediately after removing the latex glove with sutures closing the surgical site.

Diesel was kept in the hospital on IV fluids along with pain medication, antibiotics and medications to reduce acid formation in his stomach. After 3 days he was eating well on his own and was sent home. He has since made a complete recovery. However his desire to eat bizarre objects did not change since this was his second incident of eating latex gloves. Labrador Retriever’s love getting into trouble and Diesel is no exception.

Laser Therapy 2011

Interesting Cases – Laser Therapy

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Simba enjoying getting his “painless” laser therapy on his arthritic elbow

Simba is a 12 year old golden retriever who had a history of limping on his left front leg. Despite being on anti-inflammatory medication, Cartrophen injections to improve the cartilage in his joints, and a high quality prescription joint diet, Simba still was having pain on his left front leg. We were able to isolate the source of the pain to Simba’s elbow and decided to radiograph it to further assess the joint.

Lateral X-Ray view of a normal elbow joint
 

Lateral X-Ray view of Simba’s elbow. Thr RED arrows point to osteophytes which are calcified bone spurs seen with chronic arthritis

 By taking the radiograph of Simba’s elbow we were able to rule out causes of joint pain in an older dog such as cancer, and diagnose significant arthritis in his elbow joint. We decided to add treatment with a Cold Therapy Laser to see if we could get better control of Simba’s painful arthritis. The procedure is very non-invasive and involves placing a laser probe over the area of concern for approximately 7 minutes, exposing the joint to a mixture of ultraviolet and laser light. Simba’s treatment plan involves 2-3 treatments a week for 2 weeks, once a week for 2 weeks and then monthly for maintenance. He has currently received his first 2 treatments and his owner has noticed a significant improvement with his mobility and comfort beyond the other treatments he is receiving.

Therapeutic lasers are used more commonly in human medicine for sports related injuries, arthritis, and tendon injuries. More and more uses are constantly being investigated and have included the control of skin infections resistant to antibiotics, herpes virus infections, fungal infections, and even anti-aging treatments. Their use in animals is newer but is becoming more and more common. If you have any questions about the use of laser therapy, please don’t hesitate to contact our office.

LaparoscopicCastration1

Interesting Cases – Laparoscopic Castration (Cryptorchidism)

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Dusty was just like any other playful and energetic 6 month old male Cockapoo except for one difference. Usually by 6 to 8 weeks of age, the testicles of male puppies would have descended into their normal location inside the scrotum. Unfortunately for Dusty, his did not even by 6 months of age.

This condition is called “Cryptorchidism” and occurs in approximately 0.8 to 10% of dogs depending on the breed. When it occurs the undescended testicle(s) may be located in the abdomen or in the groin (inguinal) area. Dusty had 1 testicle in each location. Castration(neutering) in general is recommended for any non-breeding male to help deter some behavioural issues in male dogs as well as reducing some aggressions. Neutering also prevents tesicular infections, torsions and cancer and also significantly reduces prostate disease and cancer. For cryptorchid dogs, the undescended testicle is 13.6 times more likely to get cancerous than normal male dogs and further justifies castration.

Normal male dog with the testicle located in the scrotum

 

Performing castration on a dog with cryptorchdism is significantly more difficult due to trying to locate the testicle(s) and trying to remove them with minimal trauma. The testicles that are located in the abdomen are especially more difficult since the testicle may be located as high as the level of the kidneys to where they exit the abdomen (inguinal ring) next to the prostate and bladder (see diagram above). Using traditional surgical techniques, this uncertaintly can lead to a very large incision in the abdomen in an attempt to locate the testicle and therefore dramatically increase the amount of post-op pain and increase the chance of infections, etc.

Using endoscopy and in this case “Laparoscopy” allows us to make a very small 2-3 mm incision to allow the camera to enter the abdomen to locate the testicle. Once the testicle is found, a separate small incision can be made directly over the testicle to grasp and remove the testicle (i.e. laparoscopic assisted). The tesicle can then be ligated (tied off) as usual leaving only 2 very small incisions that need to be closed rather then a very large one.

Dr. Todd Morgan with Laura Froud VT performing laparoscopy on Dusty

 

The cryptorchid testicle was located in the abdomen resting on top of the colon and next to the bladder. The graspers are seen getting ready to grab the testicle.

 

The testicle is brought to the abdominal wall to be removed.

 

The testicle is now removed from the abdomen.

Dusty healed well from his surgery and is running around playing with his family as if nothing ever happened. If you have a cryptorchid dog or any questions about this new surgical technique, do not hesitate to call us.

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Interesting Cases – Heart Disease (Sick Sinus Syndrome)

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Pico is a 12 year old, male neutered, Miniature Schnauzer. Pico began to have episodes of weakness and collapse that seemed to worsen over a period of 2 weeks. Although he would recover quickly after an episode of collapse, his owner felt Pico should be examined.

Pico was diagnosed with a condition called Sick Sinus Syndrome. In the heart is an area called the sinus node that is responsible for forming the stimulus for the heart to beat. If the sinus node is not stimulating heart contractions properly it is termed as “sick”. Miniature Schnauzers, West Highland White Terriers, Cocker Spaniels and Dachshunds are predisposed to the syndrome. In the Miniature Schnauzer and the West Highland White Terrier, Sick Sinus Syndrome may be a condition that they could inherit.

Picture of the heart showing the S-A (Sinus) Node in the upper left where the stimulus originates to beat the heart

 

Sick Sinus Syndrome is a condition that affects the heart rate. The heart rate may be very slow (bradycardia), very fast (tachycardia), or there may be a break/stoppage in the heart rhythm (sinus arrest). The diagnosis is made on history, physical examination, a holter monitor reading (ECG machine worn by the pet for 24 hours while he goes about his normal activities) and an ultrasound. Bloodwork and urinalysis is recommended to be sure that there are no other health problems present.

Pico wearing his Holter Monitor that is recording his heart beats.

 

Pico appearing quite comfortable while the Holter Monitor is working.

 

The monitor revealed that Pico had a heart rate that varied from 28 beats per minute to up to 229 beats per minute. The normal heart rate for a dog is 70-120 beats per minute. There were stoppages in the heart rhythm of up to 6.85 seconds long.

Normal ECG reading showing a regular heart beats with regular intervals

 

Sick Sinus Syndrome showing a long delay in between heart beats

 

Treatment involves medication (in Pico’s case Propantheline Bromide and Theophylline) or if necessay the placement of a pacemaker. Fortunately, Pico has been improving on his medications alone. He used to have 10-20 episodes of weakness and collapse an hour, but has improved to 10 or so much milder episodes a day (no collapse – Pico just pauses for a minute and then carries on doing what he is doing). Although quieter, Pico is enjoying his normal activities and hopefully will continue to do so for some time.

Skin appearance at diagnosis - looking very anxious and itchy

Interesting Cases – Sarcoptic Mange

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Riley and Ginger are two Springer Spaniels that presented to us in June of 2009 for extreme pruritis (itching) and hair loss that had been going on for approximately 7 months. The owners had tried food diet trials and corticosteroids but nothing had worked. Ginger was definitely more severely affected than her brother, with hair loss over 80 % of her body, scabs and crusts on her ears, body, and legs. Riley had similar signs but less of his body was affected. The owners were asked if they were showing any signs at home, and they commented that they were itchy as well, and had some white bumps on their arms.

Skin appearance at time of diagnosis

 

Skin appearance at diagnosis – looking very anxious and itchy

 

Sarcoptes Mite seen under microscope

 

Sarcoptes Lifecycle

 

Skin scrapings were performed and revealed that the dogs had a mite in their skin called Sarcoptes. Sarcoptic mange is caused by a parasitic mite that burrows just beneath the surface of the skin. The mite feeds on material in and on the skin. Sarcoptes is a zoonotic disease, meaning that it is not only very contagious between animals, but is also contagious to humans. Although the diagnosis is best made by a skin scraping examined under the microscope, it is common not to see mites when performing a skin scraping. This is due to the fact that the mites burrow deep into the skin and that it takes only a few mites to cause significant itching. At times only a presumptive diagnosis can be made on clinical signs and treatment can be initiated.

2 weeks into treatment – starting to feel bet

 

2 weeks into treatment

 

Riley and Ginger were treated with a drug called Revolution, as well as antibiotics, and antifungal medications for their secondary bacterial and yeast infections on their skin. Riley and Ginger’s owners were also treated with medication prescribed by their doctor.

1 month into treatment – feeling like new dogs

 

1 month into treatment – hair is back normal

 

One month into the treatment and Riley and Ginger are now back to their normal selves and are acting like puppies again!!!

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Interesting Cases – The Monster Hairball

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Murphy is a 10 year old male Himalayan cat who presented to us with a history of not eating for a few days. He was also vomiting and the owners noticed blood in the vomit at times. Murphy was admitted for bloodwork and abdominal radiographs (x-rays) to try and track down the cause of his illness. The blood results were normal, however the x-rays revealed an object lodged in his stomach.

Lateral abdominal radiograph view with Murphy lying on his side showing an object in the stomach (outlined by the red arrows). The heart, lungs, and chest are seen to the left and the rest of the abdomen is seen to the right.

 

A V/D radiograph view (with Murphy lying on his back) is usually taken at the same time. Murphy’s chest is at the top of the image, while his pelvis (hips) are located at the bottom of the image. The arrows point towards the object in the stomach which is also obstructing his duodenum (first part of his intestines).

 

Based on the findings it was opted to perform endoscopy on Murphy which is a specialized minimally invasive camera that can travel to the stomach to assess the problem. The object was removed using endoscopic graspers which removed the object from the stomach and intestines and brought it out through the mouth.

The obstructed object turned out to be a massive 10 inch hairball which was blocking the passage of any food and making Murphy quite ill. Removing the hairball with endoscopy alleviated the need for more invasive surgery and the associated pain and other potential complications. Murphy woke up from his anesthesia slightly groggy but feeling a lot better. He was home again within a few hours and back to his regular routine.

Himalayans are beautiful cats and generally have a fantastic temperament. Unfortunately however, they have very thick dense hair coats and are quite prone to hairballs. The majority of hairballs are vomited up as most cat owners can testify to. In Murphy’s case, the hair continued to accumulate forming a large mass that was too large for the stomach to digest or vomit up. Routine brushing/grooming, hairball formulas, and special hairball diets will help to reduce the formation of hairballs. Despite this, hairballs are a common part of cat ownership especially with long haired cats. However a hairball as large as this could be in a “Sci-Fi” movie.

Demodex1

Interesting Cases – Severe Skin Disease – Demodex

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Sam is 4 year old mixed breed dog who came to see us for the first time in the summer of 2008. He had never had any health issues in the past and prior to this issue loved walking, swimming, and spending time with both of his owners.

Approximately 3 months earlier, Sam started scratching and losing his hair coat. The owners initially thought the dog was losing his winter coat but realized that something else was going on. They tried a pet store flea treatment and flea shampoos, which did not help at all and he seemed to be worsening. Sam’s was at the point where his quality of life was very poor and was suffering and losing weight.

We had the privilege of meeting Sam for the first time in June 2008 (seen in above photo). At that time approximately 80% of his hair coat was gone and replaced by raw, scabby, and bleeding skin from his scratching. He was quite emaciated but still a very sweet dog with normal vital signs otherwise.

Dr. Tummon took skin scrapings of the skin to look for any microscopic parasites. When looking through the microscope, the problem became immediately apparent when dozens of Demodex mites were seen (an example of the “cigar-shaped” Demodex mite can be seen in the photo on the left).

These mites are actually normal inhabitants of dogs skin (and actually humans) and the immune system keeps the mite numbers to a very low amount. In a normal dog, the typical number of mites on their skin will never cause any skin disease. However, dogs can develop immunosuppression (where the immune system is unable to fight off disease) for a variety of reasons which is what happened with Sam. The problem eventually spirals out of control and will eventually cause death.

 

The treatment for Demodex revolves around killing the mites and addressing the reason for the immunosuppression. Sam was placed on antibiotics and medicated baths to treat the secondary skin infection and treated with a product called Advantage Multi weekly to kill the Demodex mites on the skin.

The treatment of Demodex takes months to see the new hair growth. However after 1 month, Sam was feeling great as he pranced into the exam room with his head held high and tail wagging. By the second month, his hair was growing in very well (as seen in the photos below) and is starting to look like a normal dog again. Unfortunately, some of the skin has been permanently scarred and may never grow hair. However, Sam is now enjoying a great quality of life now and is now “itch-free” as his hair slowly re-grows.