Not more anal glands!

Anyone who thinks that being a veterinarian is a glamorous, fun job where you get to play with puppies and kittens all day is delusional! Fun, yes but after your first run in with an anal gland, no glamor! I seem to be having a run of patients needing help regarding their anal glands. With this in mind, I took a picture of one of my most recent sacculectomy cases to show off.

Let's go back to basics. Anal glands are the scent secreting glands located just inside the internal and external sphincter muscles of the rectum. There is one on either side of the anus between 3-4 o'clock and 8-9 o'clock. Normally, when the dog (or cat) defecates, the anal glands are self expressed. Problems occur for a number of reasons. Some of these include when the material becomes too thick to easily be expressed, the ducts leading from the glands to the anus become blocked, the area becomes inflammed leading to blockage of the ducts, the glands become infected or rupture of the gland. The list goes on.

When deciding to go forward with surgery, you have to weigh the pros and cons seriously. Pros: no more smelly glands that can become infected or ruptured (takes 7 - 9 weeks to heal and are much more likely to rupture again). Cons: fecal incontinence, infection, inflammation, dehiscence of the incisions. This is not a surgery to be taken lightly.

So when we have a case where we need to remove them, I want to avoid a particular complication at all costs. Fecal incontinence is no fun. The dog is just walking along, feces falls out and s/he has no idea it happened. I have only had one case where it occured and it resolved in two weeks.

One of my tools is coloured wax. Who knew that Crayola crayons would have so many uses! It can be a bloody surgery and having a contrasting colour really helps. During the surgery prep I infuse both the glands with the colored wax. This allows me to make my incision just that much further away from the anus; thereby decreasing the chance I will tick the nerves to the sphincters off.

Back to the picture. I made an incision over the gland so you could see how thick it was from the chronic infections. At the bottom of the picture you can see the duct. Since I didn't place a ruler by the gland, it is difficult to have perspective on the actual size. Small, but large enough to be a pain in the......well, you get the idea!

Rant time

I have included a cute picture so that if you aren't interested in reading my rant, you can at least see my Cardinal the day I brought him home.

So, this morning, my receptionist, Stephanie, answered a call. It turned out to be a very upset client. A few months ago, she had brought in her dog who was bleeding from the nose. Now, yes, this is an emergency and needs to be seen. Unfortunately at that time, I was in surgery. One of my AHTs went to evaluate the dog and felt that rather than waiting an undetermined time for me to finish my surgery, they needed to immediately go to the emergency clinic. Off they went and it turned out that the dog required humane euthanasia as there were no other options.

Now, we didn't know the client was upset and a vaccine reminder was recently sent out for her other pet. Not quite sure how we were to know that she never wanted to use our services again if we aren't told.

I have two points I would like to make. One, if you want to be mad and take it out on somebody, take it out on me. I was the one performing surgery. Two, I cannot leave surgery!!!! It is non-negotiable!!! If this client were to take a deep breath and put herself in the shoes of the owner who's dog I was performing surgery on, I am very sure she would never want me the surgery room.

If you have made it this far, thank you for putting up with my rant!

A bowlful

So, how do our pets get these tumors called lipomas? Just like any other tissue in thce body, fat cells can become masses. Fatty tissue in a particular area grows more quickly forming a tumor. I generally see them in dogs in their senior years. Our slim dogs and cats don't seem to develop them as easily.

No matter what anyone tells you, you cannot tell if a mass is a lipoma or not without aspirating the contents with a needle. This is a very easy procedure for all involved. I simply use a needle and syringe to remove cells from the mass and look for fat drops on a slide. It is always a relief to see that glossy, clear droplet.

Usually a lipoma is just a cosmetic problem. Only the ones causing issues are generally removed. This one is from a small dog of roughly 22lbs (now 21lbs!). It was growing behind the left shoulder blade and she was starting to have issues walking. Knowing that it was a lipoma before surgery made it much easier to perform. I didn't have to worry about margins, I could just cut over it and scoop it out. It's not a sexy surgery but it sure is fun!

Lipomas

On a fairly regular basis owners bring their animals in for a physical because they have found a mass. I appreciate their concern. When one was found on our old cat, Jasper, we immediately aspirated it and were relieved to see fat on the slide. This great news meant he had a lipoma.

Lipomas are generally soft, usually round lumps of fatty tissue just under the skin. Often they are fairly moveable. Making the diagnosis usually involves taking an aspiration (using a needle and syringe) and placing the contents on a slide. The fat is glossy and starts to take on a round shape.

Periodically I see some rather large lipomas. These are the ones we generally need to discuss surgically removing. Some are in areas where it actually has an effect on how they move. The picture is of a case I had recently. We had been monitoring the mass for a while but when it started to how she walked, it was time for it to be removed. This mass was right in her left armpit. Once it was out, it took both hands to hold it. It was nice to see how much she enjoyed walking out of the hospital at the end of the day.

Getting old sucks!

A few weeks ago, I had a 7 year old female cat come in for a physical exam. She just wasn’t acting like herself. At that time there was a mild fever. We did bloodwork and the results just about floored me. Her neutrophils (white blood cells actively fighting an infection) were six times normal. When I called the owners with the results they told me that she was now licking herself more often. I was a bit confused until the owners reminded me that she was intact. That is when all the puzzle pieces came together.

Cats are induced ovulators. This means that once they go into heat at about 6 months of age, they stay in heat until they mate. If they don’t meet a male for a year, they will literally stay in heat the entire time. Ditto for 7 years. Unfortunately, as they age, the risk of neoplasia (cancer), pyometra (infection of the uterus) and endometritis (inflammation/infection of the uterine wall) goes up.

We scheduled surgery for the next day. As you can see from the picture, it was much larger than it should be. When I opened it up (you’ll have to come in to see that neat picture) I found that she had both endometritis and pyometra. Certainly one of those surgeries where “to cut is to cure”.

Mr. Bynx

I have known Mr. Bynx for a number of years. Recently his Mom gave me permission to share his story so that others could see how well our animals can handle certain ordeals.

Last April, we received a phone call informing us that his left eye wasn’t looking quite right. During the physical exam, his left eye was enlarged and painful. He was sent into the CARE Centre for an examination with one of their eye specialists. It turned out that he had glaucoma (an inherited disorder causing increased pressure in the eye). There was significant damage to the optic nerve causing blindness in that eye.

Another issue was found as well. Both eyes had retinal degeneration (aka progressive retinal atrophy) and it was slowly causing blindness. Unfortunately there is no treatment for this disorder but it is non-painful.

At this point, the best option for Bynx was to have his left eye enucleated (removed) so he would not have to endure the pain associated with glaucoma. There are medications to control pain in the short term but it is difficult to control medically in the long term. His Mom called to ask my opinion on the surgery. I fully supported it and told her that once the hair has grown in, he would still look adorable.

She later told me that part of the problem with making the decision to have the surgery done was that she couldn’t picture how he could possible look normal. Well, as you can see from the picture, this is one cute, happy boy. He still has sight in his right eye and walks with his Mom all the time.

Surgical Surprises

This week we had a couple of surprises when it came to our surgeries. The first one had the owners, staff and I laughing. A new client brought in the families new 16 week old kitten to be neutered. They had been told it was a male but the kids wanted to call him Dolly. When we are admitting for surgery we always double check just to be sure. Well…..turns out he was actually a she and the kids had found the perfect name!

The other neat find was when we were getting ready to do a spay on a 6 month old small breed dog. My AHT, Kelly, asked me to take a quick peak at the mouth as there were some retained baby teeth. There were five upper baby incisors that needed to come out but the bottom teeth were the most intriguing. There were only three adult incisors (supposed to have six) and the baby canine teeth hadn’t fallen out which was causing the adult teeth to erupt to the inside of the mouth.

This can become a major problem. If we did not remove the baby teeth, the adult teeth would continue to erupt improperly and would end up damaging the hard palate. My mouth hurt just thinking about what could happen. I took a quick dental radiograph to make sure nothing else was going on in the lower jaw.

Once I was done with the routine spay, I extracted the baby teeth. This is the one time we do not suture the incisions closed. We want to give the adult teeth every chance to move outward to their normal position.

Revenge on the Ranula

As a student, I discovered my first ranula when my Magic, a female black Lab, woke up and was salivating all over the apartment. Luckily I lived over a veterinary hospital and I was waiting downstairs for one of the vets to arrive. A ranula is a collection of saliva that has leaked from a salivary gland that has become damaged. The most common causes are chewing on foreign materials, choke collars or bite wounds. In her case, a stick was not her friend. Dr. Prowse lanced it and all was well.

Over the past couple of months, I had a patient, Britt, whose ranula kept reoccurring. The first time I lanced it with a very sharp pair of small scissors and out poured the bloody saliva. Of course, I thought it was cool but the reaction by others in the room was more along the line of “oh gross!”

The second time it became enlarged, I attempted to lance it but nothing came out. The lining of the gland was significantly thickened. I warned the owner there was a chance we would need to do a surgical procedure called marsupialization.

Sure enough, it grew again so we went to surgery. Not going to lie, it was pretty neat. Basically I cut out the balloon and sutured the lining of the ranula to itself. Britt woke up pretty happy not to have the saggy balloon hanging out of her mouth.