Interesting Cases

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.

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 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 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.

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 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!!!

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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