Sunday, March 25, 2012

Not for the faint of heart

I was going through my photos today and saw this picture. It is a case that did not end so well.

An owner brought in her cat, roughly five years old, that was having trouble breathing. His gums were a pale pink and he was using his abdominal muscles to help him breathe. When I tried to listen to the heart, I could barely hear it. We took a radiograph of him laying on his side (he became a bit panicky when my AHTs, PJ and Kelly, tried to take a picture of him on his back). The radiograph showed so much fluid in the chest that I couldn't see the heart. As his prognosis was so guarded, his owners chose to humanely euthanize him.

In odd cases like this, that just don't seem to add up, I asked the owners to let me do a necropsy (autoposy on an animal). Fortunately, they also wanted to know why they had to loose him at such a young age.

I always start by looking in the abdomen and in this case, it was clean. The chest, on the other hand was surprising and amazing (more proof that I don't get out much). The fluid I could see on the radiograph was bloody. The reason he was having problems breathing was because the blood was basically squishing the lung lobes. There was no evidence of trauma, so I knew there was something pretty weird going on. Once I was able to remove the blood, I found the heart. It was huge because there was also blood in the pericardial sac (sac around the heart).

Blow the picture up (sure, it is a bit gross, but you have to admit it is cool too!!). Alright, the blue dashed lines outline the very thin layer that should be muscle. The arrow points to my thumbnail that you can actually see through the fibrous layer. The yellow line indicates how thick the muscle should be throughout the heart.

My hypothesis is this heart defect was something he was born with. Over time, the area became thinner and blood began to ooze into the pericardial sac. Since he was starting to have difficulty breathing, it cause increased stress on the lungs leading them to ooze bloody fluid. There is no way he could have survived.

Friday, March 23, 2012

Alien brain

My staff knows that I get really excited when there is a mass that I will be able to poke (oh yeah, should be professional – “take an aspirate of”). The other day I had one to check and on first look, it seemed like a straight forward cyst full of liquid. I cleaned the area with my antibacterial soap and in went my needle. Once all the fluid was out, I could feel there was more tissue moving around. I used both hands to feel around it, when……out it birthed. Everyone in the room, including the dog, just looked at me as I sat on the floor in complete disbelief. It looked like I had a little alien brain in my hand.

I will keep you posted on the alien as it is being sent away for histopathology.

Sunday, March 18, 2012

Lance teeth

I promised a couple of blogs ago to tell you about a neuter that was a little different. As per usual, a full physical exam is done prior to surgery. PJ, one of my AHTs, called me over to see the Sheltie’s mouth. He had what is commonly known as lance teeth. This is a hereditary problem whereby the adult upper canines grow straight forward. The green lines show where the tooth should be positioned.

The main issue is periodontal infection. Remember that the tooth has enamel. Enamel does not attach to the gum so this creates a huge pocket that becomes a great place for plaque and bacteria to take over. Periodontitis (infection and inflammation of the periodontal ligament) affects the local area as well of being a source of bacteria for the rest of the body.

So, how to fix the problem? There are two options. One is to refer to the dental specialist who can basically apply braces so he can have a normal mouth. The other is to remove the lance teeth. Due to financial and time constraints (Robby would need to see the specialist every two weeks until the problem was resolved), the owners and I elected to go forward with tooth extraction.

After taking radiographs (too make sure there were no other surprises), I elevated the gingival flap. I will admit I was surprised to see how much of the tooth was exposed without any bone over it. (The blue line shows where the gum line was.) I really took my time elevating the teeth cause I didn’t want to send the roots into the nasal canal. I was so glad I did. I could actually see the nasal turbinates through the bone. You can be assured the gingival flap was closed very carefully.

Friday, March 16, 2012

Always learning

So, today a lady stopped in to ask about her young cat. Snowflake had chewed on a plant earlier in the week and didn't want to eat much. Luckily she knew the scientific name of the plant - Dieffenbachia. I tried to go onto VIN (Veterinary Information Network) but it was temporarily down. So I hit Google and then asked my receptionist, Belle, to tell the owner to go home to get Snowflake.

It turns out that this beautiful houseplant is completely toxic to cats, dogs and young children. When chewed on, the plant cells release calium oxalate crystal that cause pain in the mouth and skin. There are also toxins that cause swelling and burning in the mouth and throat. The other fun symptoms include hypersalivation and difficulties eating and drinking. In some cases, the throat can close causing suffocation.

Well, our little Snowflake had eaten a very tiny amount and had vomited the little piece of plant. He continued to vomit periodically and had a poor appetite. Lucky though, no issues in the mouth and only a little dehydrated. Even though he wasn't thrilled with the fluids given subcutaneously, he should do very well on the tasty food his Mom can syringe in for him.

The other name of this plant is Dumb Cane because it can render a person speechless (from pain) for a short period of time. Hmmmmm.........

Monday, March 12, 2012

She's how old?

Amongst the Monday surprises I saw today, this one had me speachless for a period of time. I had three cat spays and one dog neuter scheduled. Started with the spays cause I had an added procedure with the neuter (next blog). Two of the girls were almost 6 months old (sisters) and the other was 18 weeks old.

I was so surprised when I found the uterus in the youngest. She was in heat!!! I have only seen one other kitten this young go into heat (of course she was mine). I came home one day from college and my kitten, Carob, was making some interesting noises. After a sleepless night, I headed downstairs with her and left her to get spayed. There were a number of perks about living in the apartment over the veterinary hospital when I was a student.

To get a better perspective of the size difference, double click on the picture. The one on the left is of the in-heat uterus. So, while the older cats were double the size of the kitten, her uterus was double the size of theirs.

Thursday, March 8, 2012

Incredible surgery!

So today was the day to remove THE stone. It was like birthing out a calf from that poor little bladder. The wall of the bladder so thickened that closing my incision was rather interesting. The sutures kept trying to rip through the muscle - I have had more fun in my time with bladders. I did have a hugh sigh of relief when we filled the bladder with saline to make sure my two layers would hold.

Wish I could save the stone but we are going to do the responsible thing and send it away for analysis.

Tuesday, March 6, 2012

One more nail in the raw diet coffin!

I walked into an appointment for a sore ear last week. While I was getting a history, the owner happened to mention the dog had just urinated on the floor and thought there was blood in it. Well against all of Murphy’s laws, little Molley squatted again and out came some bloody urine.

I always start at the head and work my way back when doing a physical exam. By doing the same pattern over and over again, you know you will get everything covered. I got a sample of the ear debris and gave it to one of the techs for cytology analysis. I continued on and when I got to the caudal abdomen (back half of the abdomen), I had to maintain a poker face. I felt a kiwi sized moveable yet firm mass. What was running through my mind – this is where the bladder should be but what in the world is this. Is this a mass benign or malignant? I told the owner that I had found an abnormality and could I take Molley back to the treatment room so I could do a cystotomy (get urine directly from the bladder).

I wish I could have seen my face when I inserted the needle. It hit something hard. I pulled the plunger back and got bloody urine. That’s when I started to get an idea of exactly what I was up against. I stuck my head back in the room to ask her owner if I could do a radiograph of her abdomen. Well, I think the picture speaks for itself. The red outline is of the irritated bladder wall. The stone itself is 4.4cm by 3.5cm.

Now for the part that makes me see red. A number of our small breed dogs are predisposed to developing crystals in their urine as well as bladder stones. The two most common stones are struvite and calcium oxalate. Look at the size of the stomach and try to figure out what is in it. Look again where the green arrow is. Can you see the outline of the chicken necks that are made up of…..bones? Let’s think this through folks. I know we all want to feed the best quality food we can to our pets. But feeding raw diets is not the way. (If you are currently feeding a raw diet, I dare you to send a portion away for laboratory analysis. I will bet that the diet will not come back as balanced. The mineral/vitamin levels will not be appropriate for long term feeding.) So, guess what can happen when a dog is fed high levels of calcium? Some will develop bladder stones.

We are doing the surgery later this week. We elected not to do it immediately as I wanted to give the antibiotics time to heal the bladder wall so it will be a little less delicate to work on during surgery. Don’t worry, I’ll be taking more pictures and will update the case on Thursday or Friday.