Hospital Cases

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Diaphragmatic Hernia in Maltese Terrier

Cassie, a 3 year old Maltese Terrier, had always been short of breath when running around- even as a pup.

The right side of her chest was very dull when percussion was done by tapping her chest with a finger.

X-rays showed a large number of organs, that normally reside in the abdomen, were actually in her chest cavity e.g. intestines.

She was given lots of oxygen before being placed on a drip and anesthetised with IV Alfaxan and placed onto 2% Isoflurane gas.

Tony  made an incision into her abdomen and found a 2cm tear in the diaphragm that separates the abdomen from the chest.

He then pulled most of the small intestines back through this hole into the abdomen. This was followed by an enlarged spleen that took a bit of coaxing to come back out.

The tear in the diaphragm was sutured closed with some nylon sutures, Tony then closed the abdominal muscles and skin.

While all this was going on, one of the nurses was doing the breathing for Cassie- filling up the anesthetic bag and gently squeezing it at approx. the same breathing rate as a human.

Otherwise once the chest is open ot the air, it loses its vacuum and the lungs collapse.

Cassie made a great recovery and is now running around the yard with much more energy than ever before.

It's thought someone may have accidentally trodden on her when she was a pup, causing a small tear in her diaphragm. Over the years, more and more of her abdominal contents slowly "fell into" the chest cavity collapsing her lungs on the right side. 

See also...
Diaphragmatic hernia repair in a tiny puppy

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Kebab Skewer Removal from Stomach

Rex, a 6 year old Rhodesian Ridgeback, snatched a whole chicken kebab skewer from his owner's hands and swallowed it whole. 

Mark saw him late on Sunday night. He was not in distress and had no pain on palpating his abdomen. His stomach was still full of food.

Kebab sticks and VERY DANGEROUS for dogs as they can puncture through the stomach wall in any direction and damage vital organs e.g. intestines, liver, heart and lungs.

Making the dog vomit is not an option as there is a high probability the stick will go through the stomach wall or oesophagus with the force of the muscle contractions.

Early Monday morning, Max was sedated and x-rays eventually showed the skewer in the stomach.

Mark anesthetised Rex after placing him on a drip, and opened the abdomen. The skewer could be felt in the stomach, with some food still attached to it. 

Mark manipulated the skewer so it was pressing hard against the stomach wall. He then made a small incision over this point, and removed the stick.

The stomach hole was stitched up. Antibiotics and sterile saline were applied to this area before the abdomen was also closed.
Rex made a great recovery, luckily for him.

It could well have been a disaster had the skewer gone through the stomach wall into the chest or intestines.

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TTA Cruciate Repair

Roger had ruptured his anterior cruciate ligament whilst jumping off a bed. He was a bit overweight at the time which was probably a contributing factor.

When the anterior cruciate ruptures, the knee is unstable and damage to the cartilages (menisci) occurs setting up arthritis, inflammation and painful swelling.

Xrays showed no major bone damage. Because of the size and weight of Roger (35kg), it was decided that the best form of repair would be a Tibial Tuberosity Advancement (TTA).

This involves moving the tibial crest (where the patella tendon attaches- the same tendon a doctor taps below the knee to test your reflexes) forward and keeping it in the position by placing a special titanium cage behind it. Over time, the cage gets infiltrated by bone.

By changing the shape of the tibial crest, the knee becomes much more stable and the chance of damage to the cartilages and arthritis is greatly reduced.

Tony Kuipers performed the surgery. Roger was placed on a IV drip and anaesthetised with IV Alfaxan before going onto 2% Isoflurane gas. Tony made an incision into the knee and found that one of the cartilages had a big tear in it. He removed this damaged cartilage which can be a source of great pain in dogs (and people).

Using a special Stryker bone saw and guide, Tony cut the tibial crest approx. 75% of its length. Suing a bone spreader in the top of the incision, he slowly spread the gap with the crest still attached at its lower point to the tibia.

A special 4-hole titanium cage was inserted into the gap and screwed into place after drilling 4 holes.

Roger made a good recovery and went home the next day on antibiotics and pain relief. He has a 12-week post op recovery programme but is already weight bearing after just 1 week.

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Face Abscess

Gemma was presented with a large and very sore swelling over her right face. There was lots of bruising and inflammation, and her right eye was closed up.

She was self-mutilating herself as her right eye was very sore and she was trying to relieve the pressure.

The abscess had formed over the weekend.

We gave Gemma a pre-med combination of  with sedatives, pain killers and antibiotics. She was placed on an IV drip and anesthetised with IV Alfaxan and then placed on 2% Isoflurane.

Mark found a right upper molar tooth had been fractured and exposed the root canal. Small particles of food had travelled up into the centre of the tooth via the exposed root canal. A large abscess formed in the bone and soft tissue under the right eye socket.

Mark opened up the abscess and because the skin was effectively dead, left a area open (approx. a 50 cent piece sized space). The open area was flushed with chlorhexidine and saline, and Flamazine cream was placed inside the wound to promote healing.

Gemma was given post op pain relief and eye ointment to protest the surface of the eye.

She woke up very well and looked much happier by the afternoon. She stayed overnight on the drip.

We flushed the wound daily with sterile saline and inserted more Flamazine ointment into the wound each day.

The wound slowly closed up over 10 days and Gemma made a full recovery.

See also...

Bones for Pets

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Benign Bone Tumour

Jack, a 2-year-old male German Shepherd was seen for a fast-growing solid lump that had appeared on his right lower neck.

It had grown over a few weeks. It was rigid with an irregular shape, and approx. plum sized. It was not worrying Jack.

Mark performed a needle biopsy and got a milky white fluid with some odd shaped cells. X-rays showed a solid growth in the right lower neck adjacent to the spine and windpipe, with a speckled bony appearance.

We decided to explore the lump to see if it could be removed and to get a good sample of it for the pathologist to examine. Jack was placed on a drip and given IV Alfaxan, and placed on Isoflurane gas to keep him anaesthetised.

Mark had to split his neck muscles first one direction and then the other to access the tumour.

It was firmly attached to the surrounding muscles and cervical vertebrae. It took over an hour to slowly free it of its attachments before it was removed. The space left behind had a Penrose drain placed in it to drain away any blood that might accumulate.

The muscle layers were closed with dissolving sutures then the skin was sutured.

Jakck was given post-op pain relief and antibiotics.

The tumour was sent to a pathologist who diagnosed a benign growth called Calcinosis Circumscripta. They are found in young large breed dogs often over an area of trauma. Even though they look nasty, they are benign.

Jack made a great recovery is back to running down the beach and being up to mischief.

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Snake Bite: Black

Mark had to treat a Jack (an inquisitive cocker spaniel) last weekend who had been bitten by a very large black snake. Luckily, the owners phoned ahead, allowing Mark time to setup the IV drip and anti-venom while they were on their way.

The side of his face was very swollen and painful, and he was very weak and had distressed breathing.

There were 2 large puncture wounds on the side of his neck (see photo). He was given snake anti-venom and placed on a drip and oxygen overnight. By the next morning, he was barking and looking much better and went home on Monday full of beans.

Make sure your yards contain no rubbish that snakes can hide under. If bitten, make sure you phone ahead to save precious minutes. 

See also...

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Adrenal Tumour

Ella, a 12-year-old desexed female Keeshond, had been treated for 6 years for Cushing’s Disease with a high dose of Trilostane (120mg once a day). She had been doing very well until recently when she started drinking more and her coat started falling out in big clumps.

The thought of having to increase the dose of Trilostane was worrying, as it is a very expensive drug to use.

Mark examined Ella and found a large firm mass in the front part of her abdomen that was the size of a orange. Blood tests showed normal kidney and liver function, but a test on her Adrenal Glands (ACTH Stimulation Test) showed uncontrolled Cushing's Disease despite being on the high doses of Trilostane.

X-rays showed a large mass in the front half of her abdomen adjacent to the left kidney and just behind the liver. Her lungs appeared clear. An ultrasound exam confirmed the x-ray findings, and the liver did not show any sign of spread from the main tumour.

Mark and Ella’s owners decided to operate to see what the mass was. Ella was placed on an IV drip and anesthetised.

Upon opening the abdomen, Mark found a very large firm tumour with a smaller peach stone sized tumour attached to it. The tumour had a thin transparent capsule around it which had several very big blood vessels in it.

Using a cautery unit and suction, Mark slowly shelled out the tumour and its smaller appendage. It was attached to the left kidney, a section of small intestine, and the pancreas. The whole dissection took approx. 1 hour.

Mark suspected an Adrenal Carcinoma at this stage.

The caudal vena cava was checked and no sign of tumour spread was seen. Occasionally, adrenal carcinomas can invade this big blood vessel, which returns blood to the heart, making surgery very difficult (if not impossible).

Mark checked the other kidney, liver, spleen and intestines and found no evidence of spread.

Ella was kept on an IV drip overnight and made a great recovery. She went home the very next day.

Pathology confirmed a diagnosis of Adrenal Carcinoma which is a pretty rare finding in dogs with Cushing’s Disease.

The fact that we had been able to remove it meant Ella no longer had to be on Trilostane. In fact, her owners mentioned her thirst had already gone by day 4.

We are going to be keeping a very close eye on Ella for any sign of tumour spread but at this stage of her old life, it’s a great result.

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Bones and pets

Bones have some advantages and several disadvantages. They are mainly given to pets to keep their gums and teeth clean and healthy.

By themselves, they can be a complete meal, just like pets in the wild.

However, vets are often faced with pets who have damaged themselves when eating bones.

Constipation

Cooked bones are NOT suitable for pets.

The stomach acids can not dissolve them, and they come out of their bottom the same way they swallowed them.

We often have to deal with constipated pets on Monday or Tuesday after they have been fed the weekend BBQ chop bones or Sunday roast bone.

Occassionally, the bone fragments don't get as far as the rear end, and cause a blockage in the stomach or intestines. If severe, bone blockages can kill a pet.

Some cases require emergency surgery to open the bowel and remove the bones which is a very expensive exercise.

See also...
Chicken bone bowel blockage

Fractured Teeth

We probably remove 2-3 fractured main upper molars in dogs every month. There is a trend amongst vets specialising in dentistry to avoid large "dinosaur" or "soup" bones.

Some dogs don't realise their own jaw strength and bite down so hard they fracture their main upper molars (carnassials). This can exposes the root canal leaving a very sore tooth and potential for a large painful tooth abscess to form. These teeth have to be removed which unfortunately means the lower teeth now don't have a tooth to "match-up" with, and they are more prone to getting plaque and tartar buildup.

Choking

I have seen 3 smaller breed dogs die suddenly when trying to swallow a whole chicken neck/wing or a smaller piece of gristle/bone (see photo below).

I have also seen some mighty big bone fragments get stuck in the oesophagus (the food tube between the mouth and stomach) in large dogs (see the xrays below)

I have sent 3 dogs to a specialsist centre to have large bones removed from their oesphagus at a cost of approx. $4,500 each, and that was over 7 years ago (see radiographs below).

Be very careful when thinking about feeding bones to your pet. Consider the dog's size and the possibility of it breaking off a large section and swallowing it, only to have it get stuck in their throat or chest.

See also...
Bone stuck in throat case

Food Poisoning from Raw Chicken

Yep...this is one of the biggest urban myths I have come across. A client of mine 20 years ago was doing a PhD at Wollongong University. She went to the local big name supermarket and cultured up all of their raw chicken (in both the human and pet food sections). She showed me the results and there it was- lots of E.Coli,  Salmonella and a host of other nasty bacteria.

I have to admit, I had been "suckered in" on the belief that raw chicken necks and wings were great for dogs and cats. We were recommending them to all our clients.

But after seeing the results, I suddenly realised we were seeing lot of pets with severe gastroenteritis- sometimes with blood and mucous in the vomit and diarrhoea.

I also thought to myself, when cooking chicken you have to extra careful about contaminated plates and cooking utensils and making sure the chicken is cooked through. Not so much of a worry with red meats - a medium raw steak is no issue.

The chicken industry sometimes have to use antibiotics, but overuse has led to the emergence of lots of nasty bacteria in the industry.

If anyone tries to tell me otherwise, I tell them "Let's sit down and I'll eat a raw steak and you eat some raw chicken necks, and let's see how we go".

Pets can develope colonies of these nasty bacteria in their intestines. They can easily spread to owners and especially children handling the pet and not taking the necessary hygiene precautions. 

See also...
Raw Chicken The Myth

What Bones are Best?

Well, this depends on the size of your dog, how intent it is on breaking the bone withs its teeth etc.

Some of the specialist vet dentists don't recommend bones at all!

Personally, I don't mind raw brisket bones for most dogs. They can be a bit fatty, so if a dog is porne to pancereaitis, they are off the menu.

To keep the teeth clean, use pigs ear, rawhide chews, dental sticks, Hills T/D or Vet Essentials dry foods and daily brushing.

Summary

 

 

 


 

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Rabbit Hernia Repair

Loppy, a 6 year old male rabbit, presented with a large hernia in his scrotum. The actual swelling was his urinary bladder which had slipped through a hole in his abdomen wall and positioned itself in his scrotum.

It was difficult for him to urinate as his bladder was just under the skin and did not have the abdomen muscles around it to press down on it when it was time to pee. His family wanted the best for him, so we decided to repair the hernia.

Loppy was gassed down with Isoflurane gas, and Mark made an incision next to the hernia.

The bladder was encased in a very thin sac and had adhesions to the skin. In order to get the bladder back into the abdomen, Mark removed the adhesions and overlying sac then emptied the bladder with a needle and syringe before pushing it back through the hole into his abdomen.

The hernia was big enough for Mark to place his finger in. It was closed by using none-dissolving nylon sutures that overlapped the two edges of the hernia, so one muscle layer was on top of the other layer. This would give it a maximum change of scarring up and not reforming.

Loppy woke up very well form the surgery and was eating and urinating all night. He went home the next day and is due back later this week for his skin stitches to be removed.

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Head trauma

Walter was helping Mum and Dad unpack into their new house late one night when part of the heavy furniture fell on top of his head. His parents rang Mark straight away and he was seen at the Shoalhaven Heads Clinic. Mark placed him on oxygen before anything else was done.

A quick examination showed Walter was disorientated and having the occasional seizure. He was also weak down his right side. His pupils were equal in size and responded to a bright light being shone in them, which was a good sign.

Mark suspected a bleed into the brain or a blood clot putting pressure on his brain. There was a possibility of a skull fracture but no uneven parts of the skull could be palpated. Walter was given some pain relief and anti-convulsing drugs.

Mark setup an IV drip which he ran at low levels to avoid raising the blood pressure too much and causing more bleeding onto the brain. He injected some intravenous frusemide (a diuretic) to try and lower the blood pressure and reduce the amount of bleeding as well as take away some of the brain swelling.

An oxygen tube was placed up Walter’s nostril and kept in place with some superglue. He was given more anti-convulsing drugs during the evening and was kept propped up on his chest with his head just level with his body to try and avoid changes in the blood pressure inside his brain. X-rays failed to show any skull or neck injuries.

He made gradual small improvements each day, and his reflexes and strength increased with physiotherapy 3 times a day.

His biggest moment was when his best mate came down from Sydney for a special visit- he almost stood up on all four legs and devoured a meal all by himself. After that, there was no stopping him and he went home 2 days later.

The video shows Walter approx. 1 week after the injury. He was looking for our clinic cat, Tigs, and possibly her food bowl. He has slight weakness down his right side but we feel he will be close to normal over the next few weeks.

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Patella surgery

Deesha had a chronic lameness with her right hindleg. She would carry it or have a slight limp when walking.

On examining her leg, Mark found she had a dislocating kneecap (patella). Each time the leg bends, the patella normally slides up and down a nice smooth groove in the underlying bone.

In Deesha’s case, the groove had flattened (i.e. it was very shallow) and there was no ridge to stop her patella from sliding sideways to the inside of her leg. Each time her knee bent, the patella would slide sideways out of position. Over time, this has led to some arthritis.

The patella has a large group of muscles attached to the top of it, the quadriceps. The bottom part of the patella is joined to the bone below (the tibia) by the patella tendon (the one the doctors like to tap with their small hammer)

Because the patella had been pulling on the bone below from a different angle than normal, the attachment area (tibial crest) re-modelled itself and “moved” to the inside of the leg.

In other words, the whole quadriceps, patella, patella tendon and tibial crest were all out of alignment and had “moved” to the inside of the leg.

Fixing the problem meant 2 things:

  1. Deepen the groove the patella slides up and down in
  2. Moving the patella tendon and tibial crest back towards the midline

Deesha was placed on an IV drip and anesthetised with IV Alfaxan. She was then placed on Isoflurane gas and prepared for surgery.

Mark made an incision down the inside of her knee so he could see what the joint looked like. The groove was very flat and there was some arthritic bone build-up.

Using a bone saw and chisel, Mark removed a rectangular piece of the groove made up of shiny smooth cartilage on top and bone underneath. The underlying bone was deepened using a special bone rasp. The rectangular piece of bone and cartilage was then placed back into the deeper groove creating a nice ridge to stop the patella sliding sideways.

Mark closed the joint capsule and moved onto the second part of the surgery.

This involved moving the attachment of the patella tendon to the midline by sawing off the tibial crest and fixing it into a new central position using 2 small bone pins.

Mark closed the surgery site after it was flushed with sterile saline and Cephalexin antibiotic.

Deesha was given post op pain relief and Cephalexin antibiotic injections and kept on the IV drip overnight. The next day she was looking very bright and alert and she went home at lunchtime.

At day 4, the wound looked great with minimal bruising and swelling. Deesha was already placing some weight on the leg even though she was under strict confinement orders.

The stitches were removed at day 10 and a course of Cartophen injections started to improve healing.

Deesha is expected to make a great recovery as long as she take sit slow and steady over the next few months.

See also...
Dislocating Patella

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Gastric impaction

Sneaky Sophie found a nice bag of tasty chook food at her neighbour's place. Being the true Labrador that she is, she set out to see how much she could swallow in one setting.

The only problem was she got quite thirsty afterwards and drank a lot of water, which made all the chook food in her stomach form into a large semi firm mass. This mass of food set firmly and stopped her form wither vomiting it up or passing it further into her intestines.

Despite eating a lot of grass and drinking more and more water, she was in still feeling uncomfortable and had no energy. Sophie was vomiting a few times during the day.

X-rays showed a very distended stomach full of food. A second lot of x-rays 24 hours later were not much better. Because her stomach was so distended and she was weak, it was feared giving her something to make her vomit might either rupture the stomach wall or cause her to choke.

Sophie was placed on an IV drip an anesthetised with IV Alfaxan the placed on Isoflurane gas. Mark made an incision onto her stomach wall which was held open by some sutures while Mark used a sterile spoon to slowly remove the firmly set chook food.

Mark then closed the stomach incision using a double layer of inverting sutures to ensure no leakage occurred. The area was cleaned with sterile saline and an antibiotic powder was spread around the site. A fresh surgical kit was opened and the muscles, fat and skin layers were sutured closed.

Sophie was given injections of antibiotic and pain relief. Overnight she was quite comfortable and at 1130pm was sitting up relatively bright.

The next morning, Sophie went out for a short walk and was actually pulling on the lead. She was not allowed anything by mouth for the first 24 hours. After that, Sophie was given a liquidised intensive care diet and went from strength to strength. She went home on day 3 and at check-up was full of beans and eating well.

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Heart Failure in a Cat

Soxy was presented with breathing troubles, weight loss and poor appetite.

On listening to his heart, there was a loud murmur and a heart rate of approx. 220 beats a minute (nearly 3-4 beats a second). His breathing was laboured and there was fluid in his abdomen.

An ECG confirmed the rapid heart rate was made up of normal heartbeats running at an accelerated rate.

Xrays showed a lot of fluid in the lungs (pulmonary oedema) and free fluid in his abdomen.

A cardiac ultrasound showed very thick heart chamber walls- so thick that the main left heart chamber (left ventricle) that pumps oxygen rich blood around the body was only about ¼ of its normal size.

Soxy had thickening of all the muscles in his heart- a condition known as hypertrophic cardiomyopathy (HCM). Not enough blood was being pumped out of his heart to his vital organs.

The very rapid heart rate also meant that the small left ventricle chamber was not filling up to the top before contracting, so it was only pumping out a fraction of what it normally would do with a slower heart rate.

We gave Soxy intravenous injections of Frusemide which shifts fluid out of the lungs via the kidneys. We also placed him on some tablets (Cardizem) to slow the heart rate down, so in between beats the left ventricle could fill to the top and therefore pump out larger volumes to the vital organs.

Because his heart was not pumping blood out of the heart, blood trying to get into his heart was “pooling” in his lungs and abdomen. After a while, this “backlog” of blood built up pressure and starting leaking into the lungs and abdomen as a clear fluid.

Sadly, despite out best efforts, Soxy’s heart was too far gone and a decision was made to euthanise him.

See also..

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Liver tumour removal

Jack's Liver and Spleen Surgery

Jack, a 10 year old dog, had been off colour for a few days with an uspet stomach, lethargy and discomfort in the abdomen. He appeared to make a recovery over a long weekend but was not 100% at a recheck.

Mark was able to palpate a large firm mass in Jack's abdomen. Chest xrays were clear but a large mass could be seen in the abdomen.

Mark decided to have a look inside to see if anything could be done.

At surgery, Jack had a large firm tumour growing on the edge of his liver. There was also a small tumour growing on his spleen. Mark removed the affected part of the liver after checking the rest of the liver looked normal.

The spleen was then removed in case the small tumour turned into something bigger. 

Jack went on to make a great recovery and was back to his bouncy self in a few days.

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Bone stuck in throat

Sally presented on a quiet Friday afternoon in great distress.

She had been chewing on a bone when she suddenly decided to swallow it in one piece. The bone got stuck in the food tube connecting the mouth to the stomach (oesophagus).

It had some sharp edges and caused bleeding from the oesophagus that went back upwards into her mouth and nostrils.

Mark sedated Sally (ACP and Butorphanol SCI) and took an x-ray to check exactly where the bone was. It was in the oeshgus just below the vocie box (larynx).

After placing Sally on a drip, she was anesthetised with an IV drug (Alfaxan) and placed on a gas (Isoflurane) anaesthetic. Luckily, we were able to get an breathing tube into her windpipe as her vocal cords were not obstructed by the bone; it was further down the throat behind the larnynx.

We were worried that with the amount of bleeding there may be a tear in the oesopagus.

Mark made an incision along the midline of Sally's neck and gently worked his way down to the trachea and oesphagus. He found a large bone had wedged itself just behind the larnynx. By gently squeezing the oesphagus below the bone, he was able to push it forward, over the larnynx and into the back of the mouth where using a pair of forceps he was able to extarct it.

Mark inspected the oesphagus to make sure it had not been torn by the sharp bone edges before closing the wound.

Sally made a great recovery and was standing up and wagging her tail 30 mins after waking up. What a tough dog!

She was placed on soft food for 10 days and had her stitches taken out 10 days later.

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Rat Sac Poisoning in a Dog

Milo ate a large block of Rat Sac when his owner's back was turned a few days earlier.

He presented with life threatening bleeding in his lungs. There were fresh blood clots in the mouth and blood was dripping from his lips and gums. Milo’s breathing was harsh. The gums were slightly pale. On close examination of the gums, small pinpoint red spots (haemorrhages) could be seen.

Mark gave an injection of Vitamin K (the antidote for Rat Sac) but the bleeding continued to get worse. A quick clotting test showed a very slow time for Milo’s blood to clot.

We suspected Milo had bled so much his body had run out of platelets which are special blood cells that cause blood to clot. In cases like this, the platelets have been trying to clot the blood wherever it is leaking from but eventually their numbers are too low.

Giving Vitamin K only works against the poison itself- it does not replace these “lost platelets” so the bleeding continues.

Fresh blood was required. Sia, a very brave gentle giant, put her paw up. Her Mum brought Sia over to the hospital where she was sedated and donated one unit of fresh blood.

Within 20 minutes of giving Sia’s fresh blood (and platelets), Milo's bleeding stopped and he went on to make a great recovery.

Sia was a bit sleepy that evening but was back to old tricks the next day. Milo’s owners were very grateful for Sia’s kind actions.

See also...

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Bowel Diverticlum

Gus presented with constipation after eating a lamb roast bone a few days earlier. He was straining quite a lot but was not able to pass anything. There were firm faeces palpable in his abdomen and a rectal exam revealed a “spongy” feel to the right side of his pelvic inlet (like a cystic structure). This was at first thought to be a prostatic cyst, but he had been desexed at a young age.

Xrays showed pieces of bone in the colon and lots of faeces backed up behind them. There was also a marked narrowing of the colon as it entered the pelvic cavity. A faintly outline oval shaped mass could be seen in the pelvic region next to where the colon was constricted. This matched up with what we could feel on rectal examination.

We gave him a microlax enema and some liquid paraffin by mouth, but nothing passed. A high soapy enema under sedation failed to clear the blockage, so we opted for exploratory surgery.

Gus was placed on IV fluids and anaesthetised with Alfaxan IV and then 2% Isoflurane gas.

Upon opening the abdomen, we found a large sausage shaped mass in the pelvic canal which felt like a cystic structure under tight tension. We were able to remove it quite easily by just running our fingers around it and freeing it of some attachments. It did not appear to have a large blood supply or be connected to anything else.

The bones and hard faeces were massaged into the lower colon where an assistant was able to remove them with a finger.

The abdominal wounds were closed as per normal and Gus was given post op pain relief and antibiotics. He made a great recovery and was passing faeces then next morning.

On incising the mass, it was filled with a greenish smelly sludge. After inverting the mass and rinsing it under the tap, the lining looked just like the lining of the large colon (much like tripe looks like at the butchers).

It was suspected to have originated from the bowel wall some time ago as a small “out pocket” of the bowel wall (a diverticulum) and possibly had filled up like a water balloon with faecal material before it eventually closed off the connection to the bowel, and became an isolated mass.

At 10 days post op, Gus came in for his stitches to be removed and he could not wait to get his share of treats that were on offer.

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Tonsilitis

Dogs and cats have tonsil, just like humans. Jack, a 2 year old terrier, was presented for a harsh hacking cough of 5 days duration.

The owner was worried that he may have had something stuck in his throat. We decided to give Jack a very light anesthetic and have a quick look. On examining his throat, we found some very enlarged and inflamed tonsils.

Jack was placed on an antibiotic, Vibravet. It contains a tetracycline which is renowned for its effectiveness in respiratory tract infections.

At check-up 5 days later, the cough had gone and Jack was back to his usual self.

Tonsils are an important part of the defense system in mouths. They can get enlarged and inflamed when they are overcome by bacteria. They normally reside in a small pocket of tissue in the back of the throat.

When enlarged, they stand out and are very easy to see on examination of the throat. Quite often, the lymph nodes (glands) under the jaw are inflamed and swollen as well.

It is very rare that we need to remove tonsils as most cases respond to antibiotics and rest.

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Chest injuries following a car accident

Lola managed to escape from home only to be hit by a car.

One of our clients was driving by, and picked her up and brought her straight to the surgery. She had pale gums and was breathing very rapidly with short shallow breaths. Lola was able to walk on all 4 legs but was unsteady. There was a graze on her forehead. There were no detectable injuries to her abdomen or legs.

Mark administered pain relief and setup an IV drip as she was in shock. X-rays showed she had fractured 5 ribs on the right side, and her right lungs had filled up with blood (pulmonary contusion). This had happened due to the whiplash effect of internal organs from direct blunt trauma to the body. Luckily, none of the ribs appeared to have penetrated the lungs.

There was no evidence of a punctured lung or pneumothorax (air inside the chest cavity).

At 10pm that night she was slightly better and managed a wag of her tail. Her colour had improved but she was still breathing rapidly. The oxygen and IV drip were continued. Mark gave more pain relief for the evening.

The next day, Lola was still breathing rapidly, but she was generally stable. Her vitals were all ok. The oxygen was continued, but the rate of IV fluids was lowered in case it had started to leak out of the damaged lungs. As a precaution, we gave an IV injection of a diuretic to try and shift some of the bloody fluids inside her lungs. Lola did a big wee an hour later, and during the day here breathing slowly improved.

On day 3, Lola was feeling a whole lot better and was sitting up and moving around freely. She started to eat with gusto (as most labs do!).  The oxygen and IV drip were removed and she went home that evening on strict confined rest.

At check-up 48 hours later, Lola was back to her old self but was still slightly sore. Her colour was great and her breathing was normal. She is on strict rest and pain killers for the next few weeks.

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Foot tumour

Jackie presented with a rapidly growing tumour on her back leg. She was in good health and did not seem bothered by it. It looked pretty nasty and we were worried it was malignant and may have spread to other parts of her body.

Before deciding between an amputation or an attempt to remove the tumour form the toes it, we ran some blood tests and x- rays of the chest looking for evidence of any spread to other parts of the body. All the blood test and x-rays were clear. A needle biopsy of the lump failed to show any malignant cells so we decided to have a go at removing the tumour from the toes.

Lucy was placed on an IV drip and anesthetised with IV Alfaxan then placed on Isoflurane gas. Using our new electrocautery unit, we carefully dissected the mass from the toes leaving a lagish skin defect. The surgery took approx. 1 hour to complete.

We packed the wound with a special cream for burn victims (Flamazine) and bandaged it for 3 days. At the first bandage change, the wound was a bit messy so we cleaned it up with sterile saline and repacked it with Flamazine. At the second bandage change, it looked a lot healthier and the skin defect had filled in with granulation tissue. By the third change, new skin could be seen to be growing in from the edges.

After 2 weeks, we removed the dressing entirely and Lucy was walking well on the leg. She had an Elizabethan collar put on and we envisage it will be all healed within the next 2 weeks

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Tumour Removal From Dog’s Ankle

Bully presented to us with a large solid tumour attached to his right ankle. It been slowly growing for 2-3 years, but had reached the point where it was uncomfortable.

We placed Bully on an IV drip and anesthetised him with IV Alfaxan, and then placed him on Isoflurane gas. We made a 1cm margin cut around the base of the tumour and, using blunt dissection, slowly peeled it away from the underlying tendons and bones. There were several tough adhesions that had to be cut, and numerous blood vessels had to be clamped and tied off to prevent bleeding. The surgery took an hour to complete.

We were left with a large deficit in skin that we were unable to close. The wound was packed with Flamazine ointment (used for treating burn victims), covered with sterile gauze then bandaged.

Bully was given post op pain relief (Meloxicam) and placed on Cephalexin antibiotics.

The bandage was changed every 4-5 days, and it did not take long for some nice healthy granulation tissue to fill in the gaps to give us a smooth surface for the surrounding skin to run along and close the gap.

Granulation tissue is the cherry ripe looking tissue in the middle of the wound that you can see in the post op photos. It’s the body’s way of healing naturally, and provided there is good blood supply, nearly always forms where there is a tissue deficit.

Once it is laid down, the skin edges naturally creep along the top of it and new skin is formed. It is unusual to need skin grafts in dogs and cats as they are pretty good at this type of healing.

By 30 days, the wound had completely closed over with fresh skin and Bully was a much happier dog.

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Large Benign Stomach Tumour

Priscilla, a 12 year old female Siamese cat, presented to us for being unwell. She was off her food and lying around more than normal. There was the occasional vomit of undigested food.

On examination, her vitals were all normal- good gum colour, heart and lungs ok, temperature normal and she was reasonably bright and alert. On palpating her abdomen, a very large firm mass could be felt. It was approx. the size of a mango and had smooth edges and an undulating surface. It was the largest mass I had ever felt in a cat.

We suspected a nasty tumour in the abdomen and offered exploratory surgery just in case it was benign. Priscilla had some bloods taken and all the biochemistry and haematology results came back normal.

X-rays showed a solid large mass in the abdomen displacing her intestines to the rear. Her lungs were clear.

She was premedicated and placed on an IV drip. We gave Priscilla some IV Alfaxan and then placed her on Isoflurane gas for the surgery.

Upon opening the abdomen, we found a large dark mass which we were able to pull out. It only had one attachment to the stomach wall- approx 2cm wide and 3mm thick. The rest of the stomach looked ok as did the other organs in the abdomen. We cut the attachment to the stomach wall and removed the entire tumour. An incision was made in the stomach wall around the attachment’s base and the hole that was left was closed using a double layer of inverting dissolving Monosyn 3-0 sutures.

Some cephalexin antibiotic powder was placed in the abdomen and we closed the wound using normal sutures. Priscilla made a quick recovery and was sitting up crying out for food 2 hours later.

On cutting the mass in half, we found large chunks of food in the middle mixed with lots of inflammatory scar tissue. We thought there may have been a previous sharp object e.g. chicken bone; perforate the stomach allowing food to slowly enter the abdomen where the body’s self healing process sealed it off. This had probably happened over several months.

Priscilla looked well on the road to recovery that evening. We kept her on the drip along with pain killer injections and antibiotic cover.

The next day she was a bit flat. Her vitals were all normal and temperature ok. We kept the drop running and eventually offered her first meal 24 hours post op. This went down well.

On day 3, she refused to eat and was drooling and lethargic. Her temperature had risen and she vomited some of the special Hills A/D (recovery) diet she had eaten. Being a Friday evening, we decided to open her up just to check there were no adhesions or leaking for the stomach wall surgery site.

On examining the operation area, all looked fine. There was some mild localised peritonitis, but nothing major. However, her liver was slightly enlarged and had a fatty texture throughout. We flushed the abdomen with sterile saline several ties, and placed more antibiotics inside. She made another quick recovery and on Sat morning looked brighter thane the day before.

Over the weekend, she had to be force fed and given anti vomiting injections (Cerenia) and continued pain relief and antibiotic cover. At 11pm on Sat night, she looked like she was ready to go to Devon (“Dog and cat heaven”). We kept up the pain relief and fluids and lots of TLC.

We thought she may have developed fatty liver necrosis (damage to the liver) as a result of the major surgery. The only cure for this is what we were doing- force feeding, pain relief, IV fluids etc.

On Sunday morning, she looked a bit stronger and she even ate a tiny amount of cooked chicken brought in by her Mum. Each day for the next week she made tiny improvements. On day 10, Priscilla went home even though she was till weak and only picking at her food.

She was given a nice low voltage heat mat to sleep on and her Mum kept up the nutrition, antibiotics and pain relief.

By 3 weeks, she was a much happier cat. She is eating 7-8 times a day, running around following her Mum everywhere she goes and demanding to be allowed on her lap at every opportunity.

This was one of our trickiest cases and just goes to show that even though I have been in practice since 1981, I still have not seen all the different possible medical and surgical cases that present themselves to vets. It was a great result and one where we just had to go with the flow and get on with the surgery and intensive care.

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Snake Bite: Unusual

In early December, late in the afternoon, we were presented with a 6 year old female kelpie, Molly who was slightly off colour and had a mild left head tilt and a throaty gag. Her left eye had a sluggish, poor response to bright light (the pupil was slow to constrict) and the eyelids did not blink when I pretended to flick her in the eye with my finger.  When I put my hand down Molly’s throat, she did not have a gag reflex. Everything else was fine. Her reflexes in all 4 legs were normal and she was not weak in the hindlegs. Her vitals were all ok and her colour good.

All the symptoms suggest an issue with the nerves that supplied the left head and neck area. Our main concerns were a paralysis tick or mini-stroke (even though she was a young dog). Because her leg reflexes were ok, we ruled out a stroke. That left us thinking a tick until proven otherwise.

Well, after several extensive tick searches and an after hours clip, we had not found a tick or crater. On my final tick search, I was running my fingers very tightly down the edges of Molly’s left ear flap and felt a tiny area of swelling and heat approx. 1 cm in diameter. On shaving the area very closely, we found 2 tiny snake bite marks surrounded by some bruising.

We immediately setup two IV drips with a bottle of snake anti-venom in one and fluids in the other. We ran the anti-venom in over 60 minutes and had adrenaline drawn up and ready to inject IV in case of an anaphylactic allergic reaction to it. The IV fluids ran all night to flush toxin out of the body.

While the fluids and anti venom were running in, we drew up some bloods and ran them on our in-house laboratory. The kidneys and liver were fine and her blood picture normal. However, when we spun the blood down in our centrifuge, the serum (the watery part of the blood) was tinged red rather than being clear. This was due to the snake toxin damaging red blood cells and causing them to leak their contents into the blood stream.

At 11.00pm, I came in to check on Molly, and lo and behold, she was sitting up and wagging her tail. After checking her vitals were all ok I put another litre of IV fluids on her drip. The next morning, she was up and out for a walk, but still had a slight gag. She was definitely on the mend.

We sent her home that afternoon. The owners mentioned they had found some piles of vomit in the yard which I suspect was the dog’s initial response to the snake bite. It looks like she got just a small amount of venom when bitten and it only affected the local nerves near the bite wound, but the discoloured serum was a warning to more serious things on the way.

At recheck 2 days later, Molly was bouncing around and looking for her treats. What a champ!

See also...

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Intestinal Strangulation

Mac, a 2 year old pointer, had just returned from a weekend on the farm. His owner noticed he was vomiting everything he ate and drank and was very quiet.

On examination, his gums were nice and pink and filled up with blood quickly when pressed by a finger (capillary refill time). His temperature was ok and heart and breathing rates ok. 

Mac was very uncomfortable when palpating his abdomen, even with a heavy pain killer sedation. We were concerned he may have a foreign body in his stomach or intestines or had some kind of blockage in his intestines. Blood tests showed healthy organs but his white blood cell count was elevated indicating infection and/or inflammation.

X-rays showed a lot of gas building up in his intestines but no real evidence of a solid foreign body.

The fact that he had severe vomiting and marked pain in his abdomen and gas building up in his intestines was enough to warrant us having a look inside straight away.

Mac was placed on an IV drip and anaesthetised with IV Alfaxan before being placed on Isoflurane gas. Upon opening the abdomen, there was fresh blood lying around and a very nasty looking section of bleeding and dying small intestine.

On close examination, approx. 50cm of his small intestine had slipped through a naturally occurring small hole in some tissue called the mesentery, and then twisted around and cut its own blood supply off.

The mesentery is a transparent tough “cling wrap” like which lines the abdominal contents. Unfortunately, it has a small hole (foramen) in it as part of its normal structure. Very rarely in dogs, but more so in horses, a piece of intestine slips into this hole. Once it slips through, the intestine twists around on itself and cuts its own blood supply off. This is very painful, and it is not long before the intestine dies and leaks all the food and bacteria it contains into the abdomen causing sudden death.

We removed the dead piece of small intestine and then joined (anastomosed) the 2 fresh edges together. Luckily, there was 1.5cm of normal small intestine to work with before the junction of small and large intestines was involved (where the appendix is). If we had had to remove this junction, there was a very high risk of chronic diarrhoea issues and breakdown of the surgery site as we would be trying to join a narrow “tube” (small intestine) to a wide “tube” (large intestine).

The whole area was flushed several tines with saline and then Cephalexin antibiotic was sprayed over the operating site. We then wrapped the anastomosis in some tissue called omentum which has great at healing powers and is good at sealing any small leaks.

Mac stayed on a drip of 48 hours and was offered water after 36 hours which he kept down. After 36 hours, we fed him on hourly small amounts of tin food made into slurry. He went home 3 days after the surgery looking a whole lot brighter and stronger. At stitches out 10 days post-op, he was bouncing up our stairs eager to get his special treat before having his stitches removed.

All in all, a very tricky surgery with great results.

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Soft Tissue Sarcoma

Chloe, an 11.5 year old Labrador presented with a fast growing mass over her right hip. A needle biopsy of the lump revealed cancer cells. She appeared to be in good health. There was also a smaller soft mobile lump just in front of the bigger one, which on examination of a needle biopsy turned out to be fatty in content (lipoma).

Chloe was placed on an IV fluid drip and anaesthetised with IV Alfaxan followed by Isoflurane gas. A skin incision was made over the tumour. Using blunt dissection and tying off blood vessels attached to the tumour, it was eventually removed after approx. 45 minutes. The underlying tissue was then sutured together using approx 20 dissolving sutures.

There was enough skin left behind to close without excess tension. A darin was placed in the wound and removed 4 days after the surgery.

The tumour was sent for pathology testing and came back as a soft tissue sarcoma which was more likely to regrow in the same area rather than spread to other parts of the body.

At 10 days post op, the skin stitches were removed. Chloe was a much brighter and happier dog and was eating like a trooper.

The plan is to monitor the area regularly and give Chloe regular health checks to pick up any signs of regrowth or spread of the tumour.

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Open chest injury

Victor, a 14 year old cat, was having a nice sleep on the front verandah when 2 stray dogs came along and tried to kill him. He presented to us in severe shock and had difficulty breathing. There was a "sucking/whistling" sound coming from a skin laceration on his left chest. There did not appear to be any other major injuries. His colour was surprisingly good.

We suspected one of the dogs teeth had broken some ribs and punctured the chest wall. Each breath he took would result in air from outside his chest being sucked in then pushed out as the lungs inside his chest collapsed and expanded.

Victor was placed on a drip and given I.V. antibiotics, pain killers and cortisone IV for shock. He was placed on an oxygen face mask and then anaesthetised. We opened up the skin wound on his chest to find a large hole looking straight in at his lungs and beating heart. One of the nurses did his breathing for him by filling and gently squeezing his breathing bag on the anesthetic machine in time with his own breathing.

We placed several large sutures around the ribs in front of and behind the opening. Once they had all been placed, we tied them off one at a time. We placed some sterile saline over the closure to check for leaks which would show up as bubbles. The overlying muscles had been torn. We stitched them back together to make a second layer covering the hole.

We flushed the inside of the chest and wounds with sterile penicillin. A chest drain was placed into the chest in case there was leakage of air/blood into the chest over the next few days. We emptied the chest cavity using the drain 3 times a day.

Victor made a great recovery and was eating the next day. His wounds healed after 10 days and the stitches were removed.

After 72 hours, we were not getting much fluid or air from the chest drain so it was removed. Other drains that had been placed under the skin where the torn muscles were were removed on day 4.

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Furball Bowel Obstruction

Chester presented late one day after suddenly being off colour. He was fine the previous day before suddenly becoming very quiet and lethargic. There was nothing new at home and he had no upset stomach.

On palpating his middle abdomen, a thick firm irreglaur shaped swelling approx the size of a plum, could be felt. It was painful to touch. His bladder and kidneys felt fine. Temperature was normal and his colour and gum refill time were also normal. His heart sounded strong with no murmur.

Xrays showed a lot of gas building up in his small intestines and some faeces in his colon and an indistinct swelling in the mid-abdomen.

The fact he was in sudden discomfort from being a healthy happy cat, it was suspected he may have an acute intestinal blockage, intestinal thrombus or a tumour causing an acute abdomen.

Chester was placed on a IV drip and anaesthetised with IV Alfaxan followed by Isoflurane gas. On examining his intestines,  we found a 10cm section of small intestine which was very inflamed, thickened and swollen. There was a lot of free clear watery fluid in the abdomen, possibly leaking from the swollen intestinal surface.

An incision was made into one end of the swollen intestine. A large furball mixed with grass was found inside the intestine. It was gently removed using slight traction. The incision was closed using a soluble suture in an inverting continuos pattern (Connell Cushing). The area was washed in sterile saline several times then a soluble antibiotic (Cephalexin) was applied to the area. The incision was covered by omentum (fatty tissue in the abdomen), which provided an extra seal to the wound.

A fresh surgery kit and gloves were used to close the abdomen and skin.

Chester was kept on IV fluids and offered soft food 36 hours later. He went home 48 hours post op and made a great recovery.

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Dislocating Patella: Block Stabilisation

Hazmat, a young male terrier cross, had a nasty limp in his right hind leg. On examination, he had a dislocating kneecap (patella) which continually locked itself in an abnormal position on the inside (medial aspect) of his knee (stifle).

Surgery was scheduled using a new technique to deepen the groove in which the patella slides up and down. In Hazmat's case, the inside (medial) ridge of this groove had flattened out due to the patella continually dislocating medially and wearing the ridge out.

The patella is attached to the big group of muscles at the top front of the leg- the quadriceps. The patella is attached by a tendon on its lower edge to the tibial crest ( a ridge of bone on the top front of the tibia).This is the same tendon the doctors tap on to test your reflexes. If you feel that tendon, you can see how it is attached to the ridge of bone below your knee- the tibial crest.

In Hazmat's case, he had been born with a tibial crest that was off centre and was positioned too far medial (inside) which gave an unnatural "pull" on the patella tendon attached to it above. This "pull" was towards the medial (inside) aspect of the leg. The constant "pulling" made the patella slide out of its groove and flatten the inside ridge. In other words, the whole patella apparatus was out of alignment with a natural tendency to pull the patella out of its groove in a medial direction.

Hazmat was placed on an IV drip and given IV Alfaxan to anaesthetise him. He was then placed o Isoflurane gas to maintain the anaesthetic.

A lateral (outside) approach was made to the stifle (knee) joint. After incising the lateral tissues (fascia lata) the joint capsule was exposed. This was also incised exposing the inside of the joint. The flattened ridge of bone in the groove below the patella could be seen.

Using a small bone saw, 2 parallel cuts were made in this groove running form top to bottom. Then using a bone chisel, 2 parallel cuts were made across the joint forming a rectangular/block cut. The chisel was then placed at the top and bottom of the block and the whole section was gently lifted ff the bone.

The underlying groove was deepened using a special bone rasp. The rectangular block was then replaced into the deepened groove giving a nice ridge to stop the patella from slipping out of the groove.

The next part of the operation was to move the tibial crest to a more outward (lateral) position in order to straighten up the pull of the quadriceps muscles on the patella. Using a bone saw, the tibial crest was cut off its attachment to the tibia. It was moved approx 3-4mm laterally before it was pinned in its new position using 2 thin orthopaedic pins (K wires).

The final part of the operation was to overlap the tissues (lateral fascia lata) on the outside of the stifle thereby pulling the patella laterally and away from its tendency to want to dislocate medially.

The stifle was irrigated with sterile saline and a soluble antibiotic was placed in the joint. Hazmat received post op pain relief and made a great recovery.

At 3 weeks, Hazmat is starting to weight on the leg and we expect a great result.

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Chicken Bone Obstruction

Olle, a 5 year old Beagle, figured out how to push the pedal on the kitchen bin and get to the food scraps.  All was well and good until he ate a plastic bag full of cooked chicken bones. A day later, he was presented for depression and severe vomiting of all his food and water 1-2 hours after eating. He was also passing a small amount of foul smelling diarrhoea.

On palpation of the middle of his abdomen, we could feel a large firm mass. X-rays showed a distended section of his intestine full of bones.

Olle was placed on an IV drip. His liver and kidney function were normal except for slight dehydration. He was anaesthetised with IV Alfaxan and placed on Isoflurane gas. An exploratory laparotomy found a hugely distended section of the last part of his small intestinal where it joined the large intestine (colon) right above the cecum (appendix).

An incision was made in the relatively normal part of the small intestine above the obstruction. A plastic bag was removed followed by huge amounts of foul smelling bones, grass, faeces and food. A small piece of bone was discovered in wedged in the junction of the small and large intestines.  A second incision was made just below the junction in the colon and using forceps, a small shrp piece of jagged bone was removed.

Both bowel incisions were closed using 3-0 Monosyn with a double layer inverting suture pattern (Connell- Cushing). The areas were flushed several times with 0.9% Saline and antibiotic solution (Cephalexin). The abdominal wall and skin layers were closed routinely. The whole surgery took 1.5 hours. Olle was given post-op pain relief and antibiotic injections.

The IV drip was continued for 48 hours as Olle was not allowed food for 24 hours while the bowel healed. He was stated on an oral electrolyte solution (Lectade) and soon placed on a high energy recovery diet (Hills A/D recovery diet).

After 2 days, Olle was much brighter and more alert and had a normal temperature. There was no vomiting and he started to pass normal solid stools. He was sent home and made a steady recovery over the following week. At stitches out 10 days post op, Olle had put on weight and was on the road to a full recovery.

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Urogenital Tumour

Cindy, a 12 year old Maltese terrier, came into BHVG for the first time in regards to her foul breath. She appeared fit and well but had rotten teeth and gums. Cindy had not been desexed and had had a litter of pups when young.

On physical examination prior to the dental work, Cindy was found to have a large solid mass in the lower abdomen near her bladder and pelvic rim. An ultrasound showed it to be a solid mass around the base of the bladder with varying degrees of denseness. 

Blood tests and chest x-rays were clear prior to surgery.

Cindy was placed on an IV drip and anesthetised with IV Alfaxan then placed on 2% Isoflurane. Her arterial blood pressure was a nice 95mm Hg throughout the Anaesthetic

We performed an exploratory laboratory. On examining the bladder, a large soft tissue mass with an irregular shape had wrapped itself around the base of the bladder. The neck of the bladder and urethra were stretched over the mass.

The liver and kidney looked ok. Her uterus was slightly enlarged as were the ovaries.

We desexed Cindy and tied off the ovaries and uterus leaving them attached to the mass which appeared to originate off the vaginal wall.

Over 1&1/2 hours, the mass was slowly dissected away from the bladder and urethra which were very closely adhered to the tumour. Eventually the mass was removed and the bladder was gently squeezed to check it worked ok. Urine could be seen to travel down the neck of the bladder into the urethra.

The abdominal wounds were sutured and work began on her teeth which were in bad shape. There were many extractions so we placed 4 local nerve blocks in her jaws to lessen the pain on recovery.

Cindy was given post op pain relief and antibiotics. She as kept on a drip overnight and the next day she was standing up looking at us as if nothing had happened. She went home that afternoon and has not looked back.

She has eating and drinking well and urinating freely. She is walking with a new spring in her step and feels a lot happier now that the bad teeth have been removed and her gums are healing.

It is suspected the tumour is a malignant growth off the vagina, probably as a result of not being desexed when an immature pup. Hopefully it will take some time before it re-grows. In the meantime, Cindy is a happy dog once again.

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Large Soft Tissue Tumour in Right Elbow

Jeff, a 12 year old Cattle dog presented with a slow growing large tumour on his right elbow. It had been previously removed 2 years ago at another vets and been given a poor prognosis with regards to it re-growing.

Jeff is still an active and happy dog, but the tumour was unsightly and starting to slow him down. Xrays of his chest were clear. Blood tests showed his liver and kidneys were working well.

It was decided that if the tumour had taken 2 years to re-grow, removing it again would hopefully give Jeff another 2 years of quality life.

Jeff was placed on an IV drip and anaesthetised with IV Alfaxan and then placed on 2% Isoflurane gas. His arterial blood pressure stayed around 100mmHg most of the time. When his blood pressure dropped to 80mmHg the IV fluid rate was increased to bring it back up so his kidneys kept functioning well.

We made an elliptical incision over the tumour so there was some skin left to close the wound. This ellipse of skin contained the damaged skin that had been stretched by the tumour growth and did not look healthy.

The tumour had a capsule around it, and it was slowly dissected out while tying off many blood vessels. It extended around the elbow and into the armpit (axilla). The tumour appeared to originate from the tough connective tissue on the outside edge of the elbow joint.

The area was flushed with sterile saline and a rubber drain (Penrose) was placed in the empty space to allow drainage of bloody fluid over the next few days.

Jeff was given post op pain relief and antibiotics. He woke up very well and was kept on a drip overnight to ensure his kidneys got a good "flushing out". The next day, Jeff was up an wagging his tail and could not wait to get home.

He was given an Elizabethan collar in case he chewed his stitches, but it was not required. At drain removal the wound looked great with no breakdown and minimal bruising and swelling.

At stitches out 12 days post op, the leg looked fully healed and Jeff and his owner were very happy.

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Nostril Tumour in a Dog

Animal Referral Hospital

Lady developed a nasty bleeding tumour just inside her right nostril. It made her sneeze and each time she did so, it would bleed.

We placed Lady on an IV drip and anaesthetised her to have a good look. It was a raised, nodular and raw surfaced tumour. A biopsy showed it to be a squamous cell carcinoma. It was attached to the cartilage between the two nostrils. We performed two freezing (cryosurgery) sessions on the tumour, but it kept bleeding and irritating Lady.

Lady was referred to the Animal Referral Hospital at Homebush to see Sarah Goldsmith and David Simpson.

Lady had a cat scan done on her chest to ensure there were no secondary tumours in her lungs- the results were clear.

An MRI of her skull showed a well defined tumour in her right nostril (see images below).

Sarah decided to open the nostril up by making an incision along the nose. Using retracting forceps, she was able to visualise the raised, nodular tumour attached top the cartilage which separates the nostrils. The tumour was cut out with 4-5mm margin leaving an open defect between the front of the two nostrils (a great spot to hand a nose ring if Lady had been a bull).

The wound was sutured close. A histopathology report gave clear margins.

Lady recovered very well with her slightly re-shaped nose and has not had any more bleeding episodes.

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Spleen Tumour

Zac was presented for lethargy and innapetance for the last 2 days. There was no history of upset stomach or coughing. His appetite and thirst had been the same up to a few days earlier.

His gum colour and refill time were normal and his pulse strong.

Zac's temperature was very high at 40.0 degrees.

Routine bloods were performed showing normal liver and kidney function, however, the haematology results showed he had lost blood - the percentage of his blood made up of red blood cells (Packed Cell Volume - PCV) was 32.8% (normally 37-55) and he had signs of new red blood cells (RBC) being made.

Xrays of the abdomen revealed a large rounded splenic tumour. There was no evidence of bleeding into the abdomen on xrays. The lungs appeared clear on chest xrays.

Zac was placed on an IV drip to correct any dehydration and build his strength up.

At surgery, we removed a 6cm diameter splenic tumour along with the remaining normal spleen. The liver looked normal and all his other organs appeared healthy.

Zac was given post op pain relief and antibiotics.

A pathology report on the tumour diagnosed a Splenic Lymphoma which has a much better outlook than a Haemangiosarcoma.

See also..

Spleen tumours in dogs

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Anal Gland Abscess

Dogs and cats have 2 scent glands located at the 4 and 8 o'clock positions around the anus. They are normally pea sized and produce a foul fishy smelling liquid which is squirted onto the faeces as a way of marking a pet's territory.

Pet skunks have the worst smelling anal glands.

Some breeds of dogs (e.g. Cavaliers) can have continual problems with blocked anal glands. Affected pets drag their bottom along the ground (scooting) and/or chew their tail base (looking like they have a flea problem). The other cause of scooting is a tapeworm infection, when small rice grain sized worm segments crawl out of the anus and move like leeches around the sensitive skin.

Anal gland can be surgically removed if they cause continual problems.

Sophie, a 6 year female cat presented with a firm painful swelling over her right perineal region. There was heat, swelling and redness present, and she was reluctant to go to the toilet as it hurt every time she tried tp pass a motion.

We placed Sophie on an IV drip and gave her Alfaxan IV to induce anaesthesia. She was then placed onto Isoflurane as a gas anaesthetic.

The area was clipped and sterilised. An incision was made into the abscess and pus was released. We removed a dried up piece of pus that had a cheesy consistency. The area was flushed with saline and a rubber Penrose drain was placed in the wound.

Sophie was sent home with antibiotics (Amoxyclav) and pain relief (Metacam drops for cats)

The drain was removed 4 days later and the skin stitches were taken out at 10 days.

Sophie made a full recovery.

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Corn Cob in Stomach

Jake swallowed a corn cob a few weeks ago and although he was not too ill, he did have repeated vomiting episodes with food and sometimes just bile and froth.

We decided to do a barium series of xrays to see if he had the corn cob in his stomach as plain xrays did not show evidence of it in his intestines.

Barium is a thick chalky solution which shows up very well on xrays as a white liquid. It coats and sticks to rough surfaces very well.

We gave Jake 20mls of barium and took xrays every 15 minutes. After 1 hour, we could see that there was still some barium in the stomach coating a rectangular shape. It was still present 3 hours later whihc gave us enough information to be sure there was a corn cob still in the stomach.

Jake was placed on an IV drip and anaesthetised with IV Alfaxan and then placed onto Isoflurane gas. Mark made an incision into the abdomen and located the stomach. The corn cob could be felt inside the stomach. An incision was made into the stomach wall (a gastrotomy) and the corn cob was removed. The incision was closed with a double layer inverting pattern using dissolving Monosyn suture. The area was flushed with saline and antibiotic.

Jake was not allowed food or water for 36 hours so he was kept on the IV drip to prevent dehydration. After 36 hours, we started Jakes on a sloppy high energy food which he devoured.

He was discharged 48 hours post op and made a great recovery.

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Skin Flap Rotation

Ginger was presented as a stray cat a couple of months ago. She had put her right foreleg through her cat collar and it had lacerated the skin in the armpit and caused a lot of damage.

She was not microchipped and was in season. No one came forward to claim her as their lost pet. Because she had a lovle temperament, we decided to give her a chance.

We desexed Ginger and tried to close the skin wound by freshening the edges, under-running the skin to make it looser and suturing the underlying tissue and skin together.

Unfortunately, the skin wound broke down and despite it being a smaller wound, it failed to heal over using special creams (Flamazine) deigned to make skin wounds close over.

We decided to perform a skin flap rotation taking loose skin off the back of the elbow (with its base still attached).

The skin edges of the defect were trimmed and the underlying tissue scraped with a scalep blade to promote healing

The loose flap of skin was rotated 90 degrees and sutured to the fresh skin defect edges.

A Penrose drain was placed underneath the surgery site to remove any blood or fluid buildup. The drain was removed 4 days later.

Ginger was given a long acting antibiotic injection (Convenia) and placed in strict confined rest with an Elizabethan collar on her head to prevent her from pulling the stitches out.

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Skin Tumour

Rebel presented with a fast growing mass on his lower abdomen. Despite his age, he was a very fit and active dog. Pre anaesthetic blood tests were normal. X-rays of his chest were clear of secondary tumours, but he did have some congestion on his lungs which we suspected was due to a low grade bronchitis.

Rebel was placed on an IV drip and anaesthetised with IV Alfaxan followed by Isoflurane gas.

Mark removed a small lipoma on Rebel's stomach before turning his attention to the larger tumour

A wide an excision was made around the large skin tumour. Several large blood vessels had to be tied off (ligated) and cut.

Once the skin had been incised, the tumour was removed form its underlying attachments by careful blunt dissection. It appeared to have good clean margins.

This left behind a large defect which had to be closed. Mark used several layers of dissolving sutures (Monosyn 2-0) to bring the skin edges close together. This took longer than it did to remove the tumour.

The skin was closed using a skin stapler to speed up surgery time and reduce the length of anaesthesia.

Part of the lump was sent for pathology examination to determine its nature.

Rebel was given an antibiotic injection and post op pain relief. His drip was continued overnight to "flush out" his kidneys.

The next day, Rebel was wide awake, making lots of noise and looking very comfortable. He went home on antibiotics and pain relief and will have his stitches out in approx. 10 days.

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Kidney Tumour

Jaydee had been traveling around the country for 6 months, but she was off colour since returning home.

On examination, Mark noticed a large firm swelling bulging from her right abdominal wall. It was the size of an orange. X-rays show a large well described mass in the abdomen.

A full blood count and biochemistry profile was normal.

We placed Jaydee on an IV drip then anaesthetised her with Alfaxan followed by Isoflurane gas. Mark made an incision into Jaydee's abdomen to find a very large irregular shaped right kidney.

The mass was adhered to the descending colon and pancreas, but did not involve these organs. By very careful blunt dissection, Mark freed up the kidney so it was only attached by its blood vessels (renal artery and vein) and the ureter (which sends urine from the kidney to the bladder).

The renal artery and vein were clamped using 3 forceps right next to the caudal vena cava (the large vein carrying oxygen poor blood from the lower 1/2 of the body to the heart). The ureter was also clamped and tied off.

We flushed the abdomen with saline and inspected the liver and other ogans one more time to make sure there was no spread of the tumour.

Jaydee was given an antibiotic injection (Clavulox) and a pain killer injection (Butorphanol). The IV drip was continued overnight.

She made a good recovery and was sent home late the next day. At checkup 2 days later, Jaydee's appetite had greatly improved and she was wanting to go outside for a walk in the garden.

A pathology report found the mass was a renal adenocarcinoma. Up to 50% of these type of tumours spread to local lymph nodes and/or adjacent porgans e.g. liver.

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Fractured Tibias

Poor young Little Girl presented with sudden hindleg weakness. Initially, we were thinking another paralysis tick case, but on examination we found she had broken both tibias in her hindlegs in approximately the same position.

We decided to pin both hindlegs using special metal pins. Mark incised over the fracture site to find the broken ends of bone.

Once he found the end of the top half of the tibia, he placed a suitably sized intra-medullary pin up through the middle of the tibia (in the medullary cavity where bone marrow resides). Keeping the knee (stifle) bent, the pin came out just below and to the side of the tendon attached to the kneecap (patella).

The pin was then pulled up through the top of the tibia while the bottom part of the broken tibia was aligned with the top half. Once reasonable alignment was present, Mark drove the pin back down into the lower half. Using a second pin of the same length as a guide, Mark was able to tell when the pin was in the very end of the lower tibia.

Due to some instability in the left tibia, a second small pin (K-wire) was placed alongside the larger pin to decrease the rotation that was present. A loop of stainless steel wire (cerlcage wire) was placed around the fracture sites to reduce rotation of the fragments around the pin.

Both surgery sites were flushed with saline and an antibiotic, and Little Girl was given some injectable pain relief and antibiotic.

Both legs were bandaged in a Robert Jones Dressing to provide additional support while the bones healed.

The bandages were changed at 2 weeks and removed at 4 weeks when x-rays showed new bone formation (callus).

Little Girl has gone home on strict cage rest for the next 3-4 weeks but appears to healed very well form a nasty situation.

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Large Lipoma Removal

Buster had a large, very slow growing fatty tumour (lipoma) on his right chest wall. Previous needle biopsies revealed it was composed of fatty tissue.

We decided to remove the lipoma as it was slowing him down and his right elbow would bang into it when walking and running.

Buster was placed on an IV drip and given IV Alfaxan to anaesthetise him, then placed on Isoflurane gas to keep him asleep. Mark made a long incision over the lipoma and bluntly dissected down to its capsule underneath the skin.

Using his fingers to shell out the lump, Mark was left with a large defect to close. He placed a rubber Penrose drain in the wound to remove any fluid buildup whilst healing.

The tissue underneath the skin was brought together using approx. 30 single dissolving sutures. At this stage, the skin edges were adjacent to each other.

To speed up surgery time, Mark used skin staples to close the skin wound and left one end of the Penrose drain exiting through a separate incision below the skin wound.

Buster was given some nice pain killers upon wakening, and an injection of antibiotic.

He went home the next day after having more IV fluids to make sure the anaesthetic was out of his system and the kidneys had had a good flush.

Buster went home on antibiotics (Cephalexin) and pain killers (Tramadol). The drain was removed 4 days later. Some fluid had been draining from the wound.

The staples were removed 10 days post op and the wound healed beautifully.

Buster was a much happier dog and was last seen running around the paddock helping his Dad with his farming chores.

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Brazil Nut Bowel Obstruction

Sooty presented with a history of lethargy, weight loss and vomitting over the last few days. He had a history of swallowing foreign bodies: 6 months ago he had surgery to remove a hazel nut from his intestines.

Sooty was very dehydrated and had lost a lot of weight. A firm mass was palpable in the middle of his abdomen.

Blood tests showed the kidneys were not too happy with the lack of fluids (elevated BUN and Creatinine).

We placed Sooty on an IV drip of Hartmans. After a few hours, we anaethetised him using IV Alfaxan followed by 2% Isoflurane gas.

An exploratory laparotomy revealed a firm mass in middle of his intestines. We removed a foreign body (which was a large brazil nut) through an incision in the intestines, but on attempting to close the wound, the intestinal wall kept breaking. This was probably because the nut had been present for a few days, and caused damage to the integrity of the intestine wall.

We decided to remove the 7cm of affected intestine and suture the remaining fresh and healthy ends. We used single interupted sutures of 3-0 Monosyn to bring the ends together. The area was flushed seveal times with 0.9% saline before a local application of anitbiotic (Cepahlexin) was placed around the site. Finally, the piece of intestine was wrapped in omentum (a fatty net-like protective lining of the abdominal contents) to seal any leaks should they occur.

Sooty was given injections of antibiotic (Clavulox) and pain killers. He made a rapid recovery but was not allowed any fluids or food for 24 hrs. Later the next day, we gave Sooty a small amount of concentrated recovery diet (Hills A/D) mushed up with water.

Sooty  looked much stronger the following morning and was allowed several small meals of sloppy A/D during the day. He was discharged 2 days after the surgery and made a full recovery.

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Blood Transfusion for a Splenic Tumour

Belle, a 12 year old dog, presented with sudden collapse and weakness. Her gums were very pale indicating she had lost a lot of blood and had low blood pressure. Her abdomen was uncomfortable to touch and had a large firm swelling in the middle of it.

X-rays and ultrasound showed a massive splenic tumour (approx. grapefruit size) in her abdomen. There was no free fluid in the abdomen so we suspected the bleeding had gone into the tumour itself rather than the tumour rupturing and blood pouring into the abdomen.

Chest x-rays were clear and an ultrasound of her liver did not show any evidence of secondary tumours (metastises).

Bloods showed Belle had lost a lot of blood. Her Packed Cell Volume (PCV) was 10%, meaning only 10% of her blood was made of red blood cells (RBCs). A normal PCV is approx. 35-45%. Our in house haematology analyser (Idexx Lasercyte) did not show any new RBC (reticulcoytes) which was probably because the bone marrow had not had time to increase production of RBC.

Belle's anaemia was so severe, anaesthesia would have been very risky. The RBC carry oxygen around the body, and if there aren't enough of them present, keeping Belle asleep with good blood oxygen levels would have been near impossible.

Luckily , we had one of our good cleints offer her own Boxer, Storm, as a blood donor. Mark collected Storm from home and sedated him when back at the clinic. We shaved up his neck and got 1 unit fo fresh blood from his jugular vein.

We connected the fresh blood to Belle's IV drip and slowly transfused her over 2-3 hours.

Belle was anaethetised with IV Alfaxan and placed on 2% Isoflurane. An exploraory laparotomy revealed a large splenic tumour (see picture below). There were several dilated and tortuous blood vessels feeding the spleen. These were tied off and the spleen was removed.

The liver and other organs all looked clear at time of surgery. A biopsy fo the spleen was sent to the lab and we are waiting on a report to let us know if it is benign or malignant.

At stitches out 10 days later, Belle had beautiful pink gums and lots more energy. Her owners were very grateful to Storm who saved the day.

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Intestinal Inflammation and Splenomeglay

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Dislocating Patella and ACL Injury

Boston, a very excitable 2 year old boxer, injured his knee and was presented with a right hindleg limp. On examination, the kneecap (patella) was loose and dislocated to the inside of the knee (medially) each time it was flexed. There was some palpable crunching (crepitus) present when feeling the patella while flexing the knee (stifle). Under sedation, the stifle appeared stable when testing for any other injuries e.g. ruptured anterior cruciate ligament (ACL), lateral ligament tears.

Boston was rested and placed on some anti-inflammatory drugs for a few weeks to see if it improved by itself. Unfortunately, the leg did not improve so surgery was planned.

Boston was placed on an IV drip and given Alfaxan IV. Once asleep, he was placed on Isoflurane gas to maintain anaesthesia.

On examination, the right stifle had markedly thickened since the first visit, and there was slight laxity when performing an anterior drawer test to determine the stability of the ACL. This suggested there may be more than just a dislocating patella to repair.

The stifle was incised on the outside (lateral) surface. On opening the joint, the groove which the patella rides up and down (trochlea groove) had a large chunk missing on the top inside (medial) surface. This allowed the patella to slide in and out of the trochlea groove each time the stifle was flexed and extended.

On examining the inside of the stifle joint, the ACL was found to have been ruptured, which accounted for the laxity (anterior drawer) noticed prior to surgery. It was suspected that at initial presentation, Boston may have had a partial tear of the ACL which had recently become a complete tear. A traumatic event to the stifle may have caused the damage to the patella groove and the ruptured ACL.

Using a small bone saw, a wedge of the trochlea groove was taken out and wrapped in a saline soaked swab. The groove was then deepened and widened using a bone rasp. The wedge was replaced in the groove giving a nice edge on the medial surface, stopping the patella dislocating medially.

Inside the stifle, the remnants of the ACL were removed and the cartilages inspected for damage. A Securos repair was performed after drilling 2 holes in the tibial crest and placing a nylon loop in the stifle to prevent further instability.

The joint was flushed with antibiotics and saline before being closed using an overlapping technique in the deeper layers which further prevented the patella dislocating medially.

Boston had had a long anaesthetic and was given more pain relief injections and IV fluids through the night. He is on a strict rest programme and currently on antibiotics and pain killers while recuperating.

See also...
Anterior Cruciate Repair
Anterior Cruciate Injuries
Dislocating Kneecap (Patella)

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Large chest laceration

Tilly was presented late in the day after running under a trailer which had a sharp bolt sticking out underneath it. The bolt got caught on the skin between her shoulder blades and tore a huge section of skin backwards towards her tail.

We sedated Tilly and gave her some pain relief and antibiotics. Amy, our head nurse came in from home and helped with the surgery. Tilly was placed on an IV drip and anaethetised with IV Alfaxan followed by Isoflurane gas.
The wound had lots of hair, grass and leaves in it. After flushing several times with sterile saline, the vet removed the debris in the wound. The skin edges were trimmed to provide a fresh edge. The fatty tissue and muscles under the skin were stitched together using an absorbable suture. Two Penrose drains were placed under the wound.

Tilly was sent home under restricted movement instructions. At drain removal 3 days later, there was pus oozing from the drains and the central part of the wound was breaking down. We decided to give Tilly another anaesthetic to clean up the wound.

At the second surgery, we removed some dead skin between her shoulder blades and on her sides. We resected dead infected fatty tissue under the skin. We decided to leave the wounds open to granulate, but left some stitches in place to keep the skin edges reasonably close together.

We applied Flamazine ointment to the open wounds and will be flushing them twice a day for the next few weeks.

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Abscess on a dog’s leg

Berry Haven Veterinary Group Surgical Case

Lucy is a lovely and friendly 15 year old Kelpie x Cattle dog. Lucy was brought into the Shoalhaven Heads clinic one Friday morning by her concerned owner. Her owner said to us that she had not been herself for the past day and was still no better this morning. She said Lucy was depressed, couldn’t move, wouldn’t stand up, didn’t get up to eat her dinner last night (which is very unusual for her because she LOVES food) and was just not herself. Lucy was able to eat out of her owner’s hand. She said she found a large, crusty lump on her right, hind leg and the leg felt stiff and was sore to touch. She thought that their other dog had bitten her. Two nurses helped carry Lucy out of the car and put her in a nice, comfortable cage.

While one nurse rung the vet to inform him of the situation (who was at the Albert Street clinic doing consults), the other nurse took all Lucy’s vital signs and discovered she had an elevated temperature. A tick search was also carried out to make sure there were no paralysis ticks (thankfully no ticks were found). She was monitored closely and kept comfortable until the vet arrived.

The vet examined her and realized how swollen and hard the leg was. He said it is either an abscess from a dog bite or a mast cell tumor. He decided she needed an operation on her leg. Lucy was given an antibiotic injection of Noroclav (her high temperature and swelling indicated an abscess). She was also given a premedicant which is given to animals prior to an anaesthetic to sedate them, relieve pain and make the anaesthetic smoother. She had a pre-anaesthetic blood test and all her levels were fine.

Once the premed had kicked in, Lucy had an IV (intravenous) catheter placed and was put on IV fluids which she was to be on from the beginning of her surgery till the time that she went home. The vet then induced her into general anaesthesia. While one nurse monitored her anaesthetic, the other nurse clipped up and cleaned her leg, ready for surgery.

As soon as the vet made the first incision into her leg, the puss poured out which confirmed it was an abscess. (a dog fight abscess is caused when the skin heals over after a dog bite wound and the bacteria is trapped underneath which then forms a pussy abscess. A larger incision was made to allow the puss to drain, the dead tissue to be removed and the wound to be flushed. A penrose drain was placed in the wound to allow it to drain and the edges of the wound were sutured. Over all, the surgery went very well.

She was given more pain relief after surgery and she recovered well. She was sent home on Cephalexin tablets which are antibiotics and Meloxicam oral suspension which is pain relief given orally. Her wound healed up well over the next 2 weeks with check ups from the vet.

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Ruptured Bladder

Johnny had been bought in after his owner accidently rolled over him in his car. He presented with soreness in the rear end but all vitals were normal. We took some bloods for testing which showed us that Johnny’s kidneys were struggling slightly.

After putting him on pain relief and fluids, we x-rayed his spine and hips to discover that he had a dislocated hip. We also checked that his bladder was ok. We could see it on the x-rays so we inserted a catheter to make sure he was producing urine. He produced plenty of urine through out the day so that night the catheter was removed.

The next Morning when the nurse arrived his vitals were taken again and again were normal. She noticed that his groin area had a lot of swelling so took him out to see if he could go to the toilet. Johnny didn't even think about urinating and after being on fluids all night this was highly unusual. We decided to try to catheterise him again but found that even though the catheter was in the bladder, we couldn't express any urine and it was not free flowing.The alarm bells started ringing so we took him straight in to x-ray his lower spine, hips and bladder again. We inserted air into the bladder but couldn't suck the air back out, a defining sign that the bladder had ruptured. The x-ray showed a very small deflated bladder so Johnny was taken into immediate surgery.

The fluid had seeped into the sub-cutaneous tissue, turning it a murky colour, hence the swelling. His Bladder had a 1.5cm tear in it. To close this up we used the connell-cushing inverting suture method then filled the bladder with saline to check for any leaks. We then flushed out his abdomen with saline several times and last of all an anti-biotic flush was used to clean all the urine out. The sub-cutaneous tissue began to turn back to its normal colouring so he was closed up and placed into a heated cage to recover.

That night Johnny was a lot more comfortable and passing urine freely again. The next morning more blood was taken and it showed the kidneys were working a lot better.  Johnny is now on the mend and will need further surgery at a later date to fix his dislocating hip.

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Bladder rupture 1
Bladder rupture 3
Bladder rupture 4
Bladder rupture 5
Bladder rupture 6
Bladder rupture 7
Bladder rupture 8
Bladder rupture 9
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Hills Atlas: Lymphatics

Lymphatics images from the Hills colour atlas

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Hills logo
Lymph normal-2
Lymph lsa-2
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Hills Atlas: Skin

Skin disease images from the Hills colour atlas

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Hills logo
Abcess-2
Fad-2
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Hills Atlas: Urogenital

Urogenital disease images from the Hills colour atlas

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Bladder normal-2
Normal dog lower-2
Bladder stones-2
Ovariohysterectomy-2
Pyometra-2
Castrate-2
Obstruction male dog-2
Prostate normal-2
Prostate enlarged benign-2
Testicular tumour
Normal cat lower-2
Cat fus-2
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Hills Atlas: Parasites

Parasite images from the Hills colour atlas

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Hills logo
Cheyletiella-2
Demodex-2
Ear mites-2
Fleas-2
Giardia-2
Heartworm-2
Hookworms-2
Roundworms-2
Scabies-2
Tapeworms flea-2
Tapeworms taenia
Ticks-2
Whipworms-2
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Hills Atlas: Ears

Ear disease images from the Hills colour atlas

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Hills logo
Hearing-2
Otitis-2
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Hills Atlas: Organs

Organ disease images from the Hills colour atlas

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Hills logo
Kidney normal-2
Kidney failure acute-2
Kidney failure chronic-2
Liver normal-2
Liver cancer-2
Liver end stage-2
Pancreas normal-2
Pancreas inflammed-2
Pancreas insufficiency-2
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Hills Atlas: Gastrointestinal

Gastrointestinal disease images from the Hill's colour atlas

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Hills logo
Mouth small
Stomach normal outer small
Stomach normal inner small
Stomach hge small
Stomach gdv small
Si normal small
Si foreign body small
Si intasusception small
Si parvo small
Colon cat-2
Colon normal small
Colitis-2
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Hills Atlas: Eyes

Images of normal and diseased eyes courtesy of Hill's Pet Nutrition

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Hills logo
Normal canine eye-2
Normal feline eye-2
Corneal ulcer-2
Glaucoma-2
Nuclear sclerosis-2
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Hills Atlas: Musculoskeletal

Musculoskeletal images from the Hill's colour atlas

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Hills logo
Shoulder-2
Shoulder ocd-2
Elbow-2
Elbow ununited process-2
Femur-2
Femur fracture-2
Hips-2
Hips dysplasia-2
Stifle lat-2
Stifle cruciate rupture-2
Stifle ap
Stifle patella luxn-2
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Hills Atlas: Cardiovascular

Heart disease images from the Hills colour atlas

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Hills logo
Tonsilitis
Cat chest-2
Cat normal heart-2
Cat dilated cadiomyopathy-2
Cat hypertrophic cadiomyopathy-2
Dog chest-2
Dog normal heart-2
Normal inner heart-2
Canine dilated cadiomyopathy-2
Heartworm  disease
Heartworm
Valve disease-2
Pulmonary oedema-2
Trachea collapse-2
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Hill’s Anatomy Atlas

This has taken a lot of work to setup and, courtesy of Hill's Pet Nutrition, has great pictures explaining common illnesses and normal anatomy. It is ideal for school projects.

Use the atlas to better understand the hospital cases listed below.

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Hills logo
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Introduction to Hospital Cases

I have gathered together some very interesting hospital cases over my last 15 years in practice, and included them here for your enjoyment.

They are separated into Medical and Surgical cases, but some cases could fit into either category.

Our cases of the month are added to the list, so keep coming back for more interesting and exciting cases.

Just click on the menus on the right and enjoy,

Cheers,
Mark Allison

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Fb sinker stomach 3
Fb dog ball 4
Ortho fx radius 3
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Desexing a female dog

Berry Haven Veterinary Group Surgical Case

Blossom, a 2 year old female Cavalier King Charles Spaniel was presented for desexing after having had a litter a few months earlier.

To ensure good blood pressure to her kidneys during the anaesthetic, we placed her on an IV drip. She was induced with Alfaxan IV then placed onto 2% Isoflurane gas.

A midline incision was made and the uterus removed after tying off both ovarian stumps, followed by the uterus just above the cervix.

Blossom was given a long acting antibiotic injection and a pain killer (Meloxicam). At a post op check 3 days later the wound looked great and she was very bright and alert. The wound healed very well and stitches were taken out 10 days after the surgery

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Desex fd 01
Desex fd 02
Desex fd 03
Desex fd 04
Desex fd 06
Desex fd 07
Desex fd 08
Desex fd 09
Desex fd 10
Desex fd 11
Desex fd 12
Desex fd 13
Desex fd 14
Desex fd 16
Desex fd 17
Desex fd 18
Desex fd 19
Desex fd 20
Desex fd 21
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Pyometra in a cat

Minx, a 12month old female cat was presented to us as she was very lethargic and had been passing blood from her vulva. She had not been desexed. The owners were not sure if she had been mated or not.

She had a large distended abdomen, her gums were slightly pale suggesting anaemia from blood loss and her temperature was 39.4.

We decided she most likely had an infection of the uterus (pyometra). We decided to go straight to surgery.

Minx was placed on an IV drip and given Alfaxan IV to induce an anaesthetic then placed on 2% Isoflurane to keep her asleep. Upon opening her abdomen, we found a large infected wound with no sign of kittens inside it.

We removed the uterus and gave her an antibiotic injection (Convenia) which lasted 3 weeks.
Minx made a great recovery by the next morning and went home. At stitches out, her gums were much pinker and she was a much happier and stronger cat.

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Cat pyometra 01
Cat pyometra 02
Cat pyometra 03
Cat pyometra 04
Cat pyometra 05
Cat pyometra 06
Cat pyometra 07
Cat pyometra 08
Cat pyometra 12
Cat pyometra 13
Cat pyometra 14
Cat pyometra 15
Cat pyometra 16
Cat pyometra 17
Cat pyometra 18
Cat pyometra 19
Cat pyometra 20
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Stone in the intestine

Mercury was presented for severe vomiting. He had been seen eating some garden rocks earlier in the day and had already vomited several of them prior to her visit. He was very uncomfortable when we palpated his abdomen, and he was a lot quieter than normal.

An X-ray showed two stones- one in the stomach and one in the descending colon.

We gave Mercury some drugs to make him vomit but all that came up was some grass he had been eating in an attempt to get rid of them himself.

We decided to perform an exploratory laparotomy to remove the stones. We placed Mercury on an IV drip beforehand to correct his fluid and electrolyte losses.

Once inside his abdomen, we found the rock in the stomach had already started moving down the intestines and was stretching them badly on its way.

We made an incision in the intestine (enterotomy) to remove the rock, and then closed the hole we made with a two layer inverting suture technique (Connell-Cushing) to avoid spillage of intestinal contents out through the hole while it is healing. We packed the surgical site with an antibiotic (Benacillin) and wrapped the incision in omentum (the web like fatty tissue that covers abdominal contents. The omentum has great healing and sealing properties so it seals any small leaks should they appear at the surgical site.

The smaller rock was already in the descending colon so we were able to massage it towards his bottom where a nurse removed it.

We gave Mercury an antibiotic injection (Amoxyclav) and post op pain relief. He stayed on a drip for 2 days, and then went home on a liquid slurry diet- no bones or dry food. Mercury was given oral antibiotics (Amoxyclav) to take at home

Mercury made a great recovery, and at a recheck 3 days he later looked fit and healthy, although a little sore.

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Enterotomy xrays
Enterotomy 01
Enterotomy 02
Enterotomy 03
Enterotomy 04
Enterotomy 05
Enterotomy 06
Enterotomy 08
Enterotomy 09
Enterotomy 10
Enterotomy 11
Enterotomy 12
Enterotomy 13
Enterotomy 14
Enterotomy 15
Enterotomy 16
Enterotomy 17
Enterotomy 18
Enterotomy 19
Enterotomy rocks
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Femoral head excision

Jade, a 6 year Cavalier King Charles Spaniel decided to run out of the front yard one evening in pursuit of a cat only to be hit by a car. She was lifted into the air and landed approx 10 meters away. She was presented in shock with pale gums, raspy chest sounds and pain.

We placed Jade on a drip, setup an oxygen mask and gave her pain relief. Chest and abdominal x-rays showed the lungs had some contusions (bleeding) and a fractured left hip. She stabilised over 24 hours and went home 2 days later on pain killers.

At a re-check 3 day later, we detected an irregular heartbeat. Jade was well in herself and her colour had improved. She was eating well but in some discomfort from the fractured hip. We postponed the hip surgery due to the irregular heartbeat which we suspected was a result of some bruising to the heart muscle when the car hit the chest and sent the heart and lungs on a rebound around the chest.

At 2 weeks, the heart beat was steady and Jade was much happier in herself. We decided to perform surgery on her fractured left hip. The hip is a ball and socket joint. In Jade’s case, the ball had broken off from the femur to which it was previously attached.

In dogs under 20kg, we perform an operation called a femoral head excision (FHE) where we remove the fractured ball. The end of the femur is rasped down so it is nice and smooth and has no jagged edges whihc can bump into the pelvis.

Jade was placed on an IV drip and anaesthetised with Alfaxan and 2& Isoflurane. We made an incision over ehr left hip, dissected through the superficial tissues and then cut through some muscles insertions and the joint capsule to find the loose femoral head which was removed.

The neck of the femur, where the ball had been attached, was smoothed down using a bone rasp. The joint was flushed with saline and an anti biotic powder was placed in the surgery site (Ampicillin). The joint capsule was closed and the severed muscles re-attached using Monosyn sutures.

Jade made a smooth recovery and was sent home the following day on antibiotics and pain relief (Meloxicam). At stitches out 10 days later, Jade was using the leg well. At 3 weeks, Jade was pain free and placing full weight on the leg.

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Uni 0871
Uni 0872
Uni 0873
Uni 0874
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Cherry eye operation

Berry Haven Veterinary Group Surgical Case

Bundy had a problem where his third eyelid was protruding outwards i.e. prolapsed. We tried to replace it a few times under local anaesthetic but it kept on "popping out".

We decided it was best to do some surgery to put the third eyelid back in its correct position. The problem with cherry eye cases is swelling of the gland at the base of the third eyelid. This gland gets so swollen that it "falls out" of its pocket deep in the corner of the eye next to the nose and drags the third eyelid with it.

Bundy was placed on an IV drip and placed under anaesthetic using Alfaxan and 2% Isoflurane. The third eyelid is gently pulled outwards, the enlarged gland is held in some forceps and two parallel incisions are made just below the gland on the inside surface of the third eyelid. Using blunt dissection, we made a pocket under these incisions where we then placed the swollen gland.

A fine suture, Vicryl 4-0, was tied to the outside of the third eyelid surface level with one end of the two parallel incisions. The suture was passed through the third eyelid to the inside surface. At this stage, we started an inverting continuous suture pattern which "buried" the swollen gland in a new pocket.

Once the suture reached the other end, it is passed back through the third eyelid to the outer surface where it is tied off.

See also...
Cherry eye

 

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Uni 0669
Uni 0670
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Uni 0673
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Uni 0677
Uni 0678
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Spindle cell tumour

Mack, a 12 year old staffy, was presented with a large ulcerated tumour on his foot which had previously been diagnosed as a spindle cell tumour. It had grown rapidly in the recent weeks and had now burst through the overlying skin. Being an active dog, the owners wished to save his leg if at all possible.

Spindle cell tumours are highly malignant and invade soft tissues. They can be very hard to control and oftne necessitate amputation of the affected limb.

X-rays showed destruction of the bone inside Mack's outside toe by the tumour, but there appeared to be no involvement of the adjacent toe or wrist joint. Chest xrays were clear and his blood picture was normal. The draining lymph node was normal. It was decided to try to remove the tumour to give Mack some extra quality time in his senior years.

At surgery, we had to aggressive and remove the entire toe right up to the wrist (carpal) joint and down to the adjacent bone (metacarpals). This left us with a large defect which was far too big to close over with skin. The wound was packed with Flamazine ointment (used for treating burns victims) and covered with a none adhesive dressing (Jelonet) and then padded with Soffban. The whole bandage was supported by a half cast made from a re-usable material called Vet Lite.

By day 5, we had some granulation tissue filling the defect (nice bright red material seen in the photos below). Once the granulation tissue fills in the defects and gives a nice smooth, highly vascular bed, the skin edges start to creep along the edges and slowly close the wound.

A fantastic demonstration of the way nature heals. We may need to do a skin graft at a later stage should the skin not completely cover the wound, but so far so good.

Bandage changes are still in progress every 5 days. So far, the wound healing has been excellent and the deficit is closing nicely.

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Spindle cell tumour day1a
Spindle cell tumour day1b
Spindle cell tumour day1c
Spindle cell tumour xray2
Spindle cell tumour xray1
Spindle cell tumour day1d
Spindle cell tumour day1e
Spindle cell tumour day1f
Spindle cell tumour day1g
Spindle cell tumour day1i
Spindle cell tumour day1h
Spindle cell tumour day4a
Spindle cell tumour day4b
Spindle cell tumour day7a
Spindle cell tumour day11b
Spindle cell tumour day14b
Spindle cell tumour day18c
Spindle cell tumour day23g
Spindle cell tumour day28c
Spindle cell tumour day28b
Spindle cell tumour day32c
Spindle cell tumour day32b
Spindle cell tumour day32a
Spindle cell tumour day35a
Spindle cell tumour day35c
Spindle cell tumour day38b
Spindle cell tumour day38c
Spindle cell tumour day44e
Spindle cell tumour day44b
Flamazine
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Wobblers in a Doberman

Jack was presented to us on a few occasions over the last 2 years with neck pain and being slightly wobbly in all 4 legs. On previous occasions, plain X-rays did not really show any evidence of a slipped disc problem. After running bloods to make sure his liver and kidneys were functioning ok, we had placed Jack on cortisone tablets for a few weeks. This had resulted in good improvement in the past. However, this time around we did not get such a good response and he became more wobbly in the legs and had neck pain when it was extended.

We referred Jack to the Animal Referral Hospital (ARH) in Sydney where Dr David Simpson looked after him. Dr Simpson injected a special dye into the space surrounding the spinal cord which highlights the spinal cord on x-rays.  The spinal cord, it was possible to see a marked "squeezing" on the spinal cord in his neck (at the 5th-6th inter-vertebral space)

Jack underwent surgery where Dr Simpson went in from below the spine to remove the bulging disc. He made a great recovery and has been off cortisone since. His leg movements have improved considerably and he is a much happier dog.

 

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Ortho wobbler 4
Ortho wobbler 3
Ortho wobbler 1
Ortho wobbler 2
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Uroliths in a dog

Lady, a 12 year old female Labrador was presented in distress straining to pass lots of small volumes of bloody urine. The problem had been going on for a few months but was getting worse.

Her vitals were normal but a large firm bladder was palpable. We suspected she may have several stones (uroliths) in the bladder.

Xrays showed a huge number of uroliths in the bladder. Blood tests showed her kidneys and other organs were ok.

We placed Lady on an intravenous drip and started her on some strong antibiotics (Enrofloxacin). She was premedicated, then given an injection of short acting anaesthetic (Alfaxan) then placed on Isoflurane gas anaesthetic.

Upon opening the bladder through an incision (cystotomy), we could see large numbers of uroliths. We removed the uroliths and found Lady had a much thickened bladder wall as a result of the chronic stone irritation and suspected secondary bacterial infection in the urine. We flushed the bladder with saline several times to make sure we had all the stones out.

We closed the bladder wall using a double layer of inverting stitches (Connell-Cushing pattern) and flushed the surrounding area with saline and an antibiotic flush (Ampicillin).

We closed the abdominal wall and skin. Lady made a quick recovery and was discharged 2 days later. The stones were analysed and found to be made of struvite, so Lady was placed on a special prescription diet (Hills S/D) to prevent them coming back again.

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Dscf4983
Dscf4985
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Bladder stones 003
2009 06030706090285
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Bladder stones (uroliths) in a cat

Berry Haven Veterinary Group Surgical Case

Shirley was presented with a history of repeat visits to their normal vet for re-occurring cystitis symptoms. She was passing blood in the urine and only passing small volumes of urine and going more often. The previous vet had not analysed any urine samples nor performed any additional testing. She had been on antibiotics and special prescription diet (Hills C/D) to make her urine acid in the hope she had struvite crystals which is one of the most common causes of cystitis in cats

We x-rayed Shirley and were surprised to see some bladder stones (uroliths). Blood tests were all normal. We placed Shirley on an IV drip and using Isoflurane gaseous anaesthesia and some sedatives, we operated on the bladder to remove the stones.

A cat catheter was passed up into the bladder to try and prevent smaller stones from traveling down the neck of the bladder and "escaping" the efforts of the surgeon trying to remove them.

After making a small incision in the bladder, we removed the stones using a small sharp-edged spoon shaped instrument (a curette). We did not apply too much pressure to the bladder walls when using the curette to avoid damaging it. The bladder as irrigated with 0.9% saline to get the smaller stones out in the neck of the bladder.

When closing the bladder, we used a Connell-Cushing closure technique which involves 2 layers of continuous inverting sutures. This results in a better seal as the bladder stretches quite a lot when filling with urine and the last thing we wanted was urine leaking into the abdomen.

The stones have gone to the USA for analysis by Professor Carl Osborne using an X-ray diffraction technique. This is a service offered by Hill's Pet Nutrition who make special diets designed to dissolve and prevent further urolith formation.

At check-up, Shirley was very comfortable and passing normal volumes of urine. Once we know the composition of the uroliths, she will be placed on the correct Hill's prescription diet to prevent them re-forming.

See also…
Feline Urological Syndrome (FUS)

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Ug uroliths cat 9
Ug uroliths cat 10
Ug uroliths cat 4
Ug uroliths cat 1
Ug uroliths cat 2
Ug uroliths cat 5
Ug uroliths cat 6
Ug uroliths cat 3
Ug uroliths cat 7
Ug uroliths cat 13
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Perineal urethostomy

Trevor was presented when the owner noticed he was having trouble urinating. He had been squatting and not passing any urine, and was uncomfortable when his abdomen was touched. On examination, he had a very distended bladder, about the size of a tennis ball. 

We made a tentative diagnosis of Feline Urological Syndrome (FUS) where a small percentage of cats make crystals in their urine, similar in appearance to salt granules.

In male cats, the crystals can cause a blockage in the urethra (the tube running from the bladder to the end of the penis along which urine travels). In female cats, the urethra is wider than in males, so it is pretty rare to see an obstruction.

When the urethra gets blocked, urine builds up in the bladder as the kidneys keep producing it. Before long, the back pressure can cause damage to the kidneys and levels of potassium in the blood start to rise. The high potassium (hyperkalemia) can stop the heart beating within 24 hours.

A blocked FUS case is an emergency. Pressure must be relieved ASAP otherwise damage to the kidneys can be irreversible and death is rapid.

Trevor was given a gas aesthetic using Isoflurane and oxygen.
 
We inserted a needle into his bladder and emptied out 200 ml of urine. This brought us some time as it took the pressure of his kidneys. We then tried to flush out the blockage in his urethra by passing a soft rubber catheter into his penis and flushing fluid though the end of it as we advanced it towards his bladder. Unfortunately, the tube would go no further than 1" in.

After 20 minutes and several attempts to remove the blockage, we decided he needed to have surgery to remove the crystals at their point of obstruction.

We performed an operation where we opened up the penis along its entire length and stitched its edges to the surrounding skin. The incision went al the way to the level of the blockage where we found a large mass of crystals.

Trevor recovered very well and was using his litter tray by day 2. We took his stitches out 10 days later.

We placed him on a special diet called Hill's Feline S/D (Struvite Diet) which makes his urine more acidic thereby dissolving the crystals (much like sugar dissolving in a cup of tea). Once he has "cleared his system out" and has no more crystals, we will be placing Trevor onto Hill's Feline C/D/S diet (Cystitis Diet Struvite) to prevent any reoccurrence.

See also…
Feline Urological Syndrome (FUS)

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Normal cat lower
Cat fus
Ug urethostomy 1
Ug urethostomy 2
Ug urethostomy 3
Ug urethostomy 4
Ug urethostomy 5
Ug urethostomy 6
Ug urethostomy 7
Ug urethostomy 9
Ug urethostomy 10
Ug urethostomy 18
Ug urethostomy 11
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Mast cell tumour removal

Jerry was presented for a small rapidly growing mass on his lower chest wall. It smelt infected and was quite inflamed. Because of its appearance and history, we suspected a nasty malignant type of tumour.

We took a good 3cm margin around the tumour and went down as low as possible beneath it to make sure all of it was removed.

We were left with a large oval shaped defect which we closed by changing it to a Y-shape. We placed several large thick dissolving sutures underneath the skin to bring the skin edges together without tension. The skin stitches were not under much tension.

The lump was sent for pathology and it was found to be a mast cell tumour which are highly malignant. Excision appeared to be complete.

Jerry has the stitches removed 14 days later and it healed very well. We have not seen any sign of re-growth to date.

Click on thumbnail images to enlarge
Tumour mast cell 10
Tumour mast cell 11
Tumour mast cell 12
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Mammary tumour

Lady, a 12 year old female dog, was presented for a rapidly growing bleeding tumour on her abdomen. It was infected and had a horrible smell. It had doubled in size over 1 week.

We suspected a nasty malignant tumour. Prior to surgery we took some x-rays of her body to make sure there was not any evidence of spread to other parts of the body.

Unfortunately, we found a large solid mass in Lady's chest which was probably a secondary (metasises) from the lump on her abdomen. In herself, Lady was very bright and alert. The owners wished to have her a bit longer and so we decided to remove the offending tumour.

It is now 2 months since surgery and Lady is still bouncing around, eating well and looking very happy. We believe the mass in her chest is growing very slowly.

See also...
Advantage of desexing female dogs

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Tumour mammary 12
Tumour mammary 17
Tumour mammary 18
Tumour mammary 13
Tumour mammary 14
Tumour mammary 15
Tumour mammary 16
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Liver cancer

Cancer is nasty disease affecting both humans and animals alike. Some breeds are more prone to cancer than other, suggesting a genetic cause e.g. splenic haemangiosarcoma in German Shepherd dogs.

This month's case is 14 year old cat who was initially presented for weight loss and vomiting. On examination, we could feel a firm mass in the middle of the abdomen. X-rays showed some constipation and not much else. Blood tests were unremarkable.

Despite enemas and soft diets, the cat continued to lose weight and have the occasional vomit. The mass was still palpable after 2 days so we decided it was time to have a look inside.

During the surgery, we found the firm mass was a cancerous lymph node that was swollen up to 3 times it normal size. On further examination, we found a malignant cancer of the liver. It was reasonably flush with the liver surface; hence it was not evident on x-rays. The lump had been hiding behind the constipation on x-rays.

It was decided to euthanise the cat as the prognosis was hopeless and it was the kindest thing to do.

One interesting feature of the case was the normal blood tests, including liver enzymes which we would normally expect to be very elevated when there is liver damage. Some liver cancers just slowly grow and push normal; liver tissue out of the way without causing too much destruction. We suspect this was the case.

See also…
Splenic tumours

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Tumour liver 1
Tumour liver 2
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Eyelid tumour removal

Lady was presented to us for a very sore right eye. The cause of the problem was a benign wart growing on the upper eyelid which rubbed against the eyeball each time she blinked. We used the electrocautery unit to make an "H" shaped incision n which the wart was in the bottom half of the "H"

The wart and adjacent skin was removed leaving a square deficit in the upper eyelid region. If this gap is not filled, the eyelid losses it’s shaped and collapses. To prevent this happening, the upper half of the "H" is moved downwards into the gap and stitched in place.

Recovery was uneventful and the stitches were removed 12 days later.

This procedure is called a sliding flap technique and is used wherever a large defect has to be filed for cosmetic reasons.     

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Tumour eyelid 8
Tumour eyelid 9
Tumour eyelid 10
Tumour eyelid 12
Tumour eyelid 11
Tumour eyelid 13
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Ruptured windpipe (trachea)

We were having a quiet morning after a very hectic week, when a frantic dog owner suddenly rushed in with her dog, Meg. She had got into a fight with a bigger dog which bit her around the throat and given her a nasty shake. Suddenly, she was very short on breath and air was building up under her skin. Her tongue was blue and there were whistling sounds of air rushing in and out of one of the dog bite wounds on her neck.

We suspected an injury to her windpipe (trachea) which was leaking air into the tissues around it. The fact that her colour was blue was a poor sign, suggesting major problems with her getting air to and from the lungs. We made the dog bite wound larger so air could more easily go in and out of the lungs even though it was not the normal route.

We gave Meg an IV anesthetic and passed an endotracheal (ET) tube down her trachea from the back of the throat. It would only go half way down her neck but  improved her breathing considerably.

A quick incision was made down onto the trachea to find it had been completely cut in half. The lower half of the trachea had retracted down her neck and there was a gap of approx 5cm between the 2 ends.

We placed a strong suture around the retracted part of the trachea and gently pulled it forward towards the head. We were then able to pass the ET tube into the lower half of the trachea down into her chest to give a better anesthetic.

We then placed 6 stitches on the far side of the trachea, joining one side together. When the gap narrowed, we partly withdrew the ET tube back into the throat and placed a new ET tube into the lacerated area down into the chest. It had a smaller diameter allowing us to place more stitches.

Once we had stitched approx 75% of the trachea together, we removed the ET tube and pushed the original one back down into the chest. We then finished stitching the trachea together.

We left the surgical site open in case there were any small leaks of air. If we had not done this and air did in fact leak, it would have built up under the skin and caused severe post operative complications.

Just to prove how tough a dog she was, Meg sat up 2 hours after surgery and devoured a bowl of tin cat food. Over 10 days, this hole slowly closed and the trachea had healed.

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Trachea tear 1
Trachea tear 2
Trachea tear 6
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Stenotic Nares

This is a congenital defect in some of the short nosed dogs e.g. Pekingese, Bulldogs, Boxers where the opening to the nostrils is too small. Affected dogs have trouble getting air into their lungs and often make a reverse snort type of sound. Left untreated, it can lead to other problems in the back of the throat or even the lungs.

It is treated by surgically removing a wedge of nostril from the outside surface and stitching the gap closed. This opens up the nostril- a bit like having the tape applied across the bridge of your nose for running.

There is a quick recovery from surgery and immediate alleviation of symptoms.

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Spinal cyst in a puppy

Zoe, a 16 week old cross bred dog, was presented with very wobbly hindlegs. She was dragging the feet to the extent that the skin on top of her toes was wearing away.
She appeared to not know where her feet were. The front legs were ok and she was otherwise, a bouncy lively puppy. The owner had noticed the problem since they purchased her  at 8 weeks but it had appeared to slowly get worse.

We took plain x-rays which did not show anything abnormal. When we "knuckled" her back toes, she did not realise we had done so and would stand and walk on the tops of her toes. There was reduced pain sensation in both hind feet. We suspected some type of abnormality in the spinal cord that was interfering with the messages traveling up and down the cord between the brain and feet.

We referred Zoe to the Animal Referral Hospital (ARH) in Sydney where Dr David Simpson looked after her.

Dr Simpson anaesthetised Zoe and carefully inserted a needle into a space between the actual spinal cord and the surrounding tissues that fit over the spinal cord like a tight fitting sleeve. This space is filled with a fluid called CSF- cerebrospinal fluid, which is made in the brain. He then injected a special dye into this space which showed up on X-rays as a white line.

The dye flowed in the CSF up and down the spine and showed a cyst, filled with CSF, that was pressing on the spinal cord at a level just behind the last ribs.

A cat scan was done to get a clearer picture of the pooling of dye. The scan showed the dye in a CSF filled cyst, which was pressing on the spinal cord and interfering with the messages traveling up and down the cord between the brain and feet.

Dr Simpson decided that surgery was in order to relief the pressure on the spinal cord. Using a very special high speed air drill, he slowly and carefully remove the bone from above the cyst and exposed the cyst. He then incised the thin membrane wall of the cyst and drained the CSF out of it. He left the incision in the membrane open and packed the area with fat trimmed off some adjacent tissue.

Zoe was not much better straight after surgery but by day 3 she was back to where she was prior to surgery. Over the next week, she slowly started to get better use of her hindlegs and she is due for a check up in another 2 weeks to see how things are going. It is hoped there has not been too much permanent damage to the spinal cord form the compression it suffered form the cyst.

The cyst was probably present at birth and slowly got bigger as Zoe grew. It was benign but in a rotten place as it was squeezing the spinal cord below it as it had a bony roof above it.

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Surgery to Remove a Facial Tumour

Maxine, a 12 year old poodle, had a rapidly growing tumour on the forehead right next door to the left eye. We decided to remove it before it got to big and started pressing on the eyeball.

Because of its size and position, we were left with a sizeable gap when we removed the tumour using our electrocautery unit.

To fill the defect, we created a sliding flap of loose skin from the forehead.

The margins of the excision were extended up the forehead as 2 parallel lines, making a rectangular flap. We used sharp scissors to loosen its attachments underneath (keeping the major blood vessels attached to it though) before sliding it down the forehead to fill the gap.

Using very fine suture material, we stitched the flap into its new position for 14 days.

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Pyometra in a dog

I have to admit, I have performed a large number of emergency hysterectomies in dogs with infection of the womb (pyometra) but this was the biggest one I have ever seen.

Helga, a breeding Siberian Husky, was presented out of hours at 10pm with what the owner thought was sudden swelling of the stomach and discomfort soon after eating a large meal. We were thinking possible gastric dilation/bloat when we saw the large firm swelling. The owner mentioned she had been in season approx 4 weeks ago and had never had pups. She was drinking more than normal.

The swelling did not have a hollow sound to it when we tapped it with out finger so the next thing we thought of was over-eating or possibly a large pyometra. X-rays showed a massively enlarged thickened loop of the uterus. Given the history and findings, we diagnosed a massive pyometra.

Because of the size of the pyometra, we decided to operate then and there to avoid it rupturing overnight which would have led to sudden shock and death. We placed Helga on an IV drip and gave an injection of antibiotics and pre-anaesthetic medications.

We anaesthetised her using Isoflurane and at surgery we found a 5.5kg (12lb) infected uterus which we removed. At midnight, we placed the final stitches in. Helga made an uneventful recovery over the next 24 hours and went home the next night.

Pyometra is a common problem in older un-desexed bitches. It normally presents as a draining infection from the vagina but in some dogs, like Helga, the cervix remains closed and there is nowhere for the pus to drain away. This is termed "closed" pyometra versus and "open" pyometra.

The risk of a pyometra infection, after hours callouts and emergency surgery are additional reasons why none breeding pets need to be desexed.

See also…
Advantages of desexing female dogs

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Paraphomosis (protrusion of the penis)

Frank was a 2 year old de-sexed Staffordshire Bull Terrier who had a problem where his penis would continuously hang out of the prepuce. It was getting damaged by the sun and air and was very bruised and sore. An earlier conservative attempt at surgical repair had not worked so we decided to move the whole of the skin surrounding his prepuce forward towards his belly button.

Using the electrocautery unit, we removed a crescent shaped piece of skin from in front of his penis. We then made incisions down each side of the prepuce from tip to base. We removed a second crescent shaped piece of skin at the base of his penis which was the same shape and size as the piece we removed at the front of his penis.

We then slid the loosened skin forward and stitched it to its new position. The hole through which Frank's penis was sticking out was too big, so we trimmed its edges and made it much smaller.

The skin wound at the base of the penis was left open as it was designed to relief tension in the moved skin flap. The owners placed a special cream on the wound twice a day to help healing. Frank had an Elizabethan collar placed on his head to stop him linking the wounds. The wound eventually closed after 3 weeks.

At stitches out, the owners were very happy to say Frank's penis had not been "stuck out" since the surgery and he was a much happier dog. He was able to urinate properly.

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Infected knee (stifle)

Mate was presented to us as a second opinion. He had undergone 2 previous operations on his knee (stifle) to repair a ruptured cruciate ligament. He was in a lot of pain and not putting any weight on the leg despite being on anti-inflammatory drugs. X-rays revealed bony changes suggestive of an infection and/or foreign body reaction inside the joint.

We suspected the nylon suture inside his stifle from the previous surgeries was a source of infection and/or causing a foreign body reaction. We ordered some special antibiotic (Gentamycin) impregnated beads for the Animal Referral Hospital in Sydney.

At surgery, we removed the offending thick nylon suture and took a swab of the fluid inside the stifle for a culture. We packed the stifle with some antibiotic powder, then placed the Septopal beads inside the joint when closing.

At 10 days post op, Mate was a different dog. He was much happier and already starting to put weight on the leg. The culture was negative for bacteria, but we did not discount an infection as sometimes there are false negative results.

At 6 weeks post op. we anaesthetised Mate once more to remove the beads. To date, he has had good use of the leg and is not on any anti-inflammatory drugs.

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Fractured Foreleg

Bailey presented with a possible fractured or dislocated wrist (carpus) after jumping of a balcony.

Plaster casts do not go very well with these type of fractures as it is difficult to get good alignment of the broken ends of bone.
We gave him some pain killing injections and sedatives and took some x-rays hoping it was a dislocated carpus rather than a break. The radiographs showed a nasty fracture.

We decided to place some metal pins in the leg. At surgery, we placed two pins at angles to each other giving excellent alignment of the bones.

Following the surgery, we placed Bailey's foreleg in a half cast to give it some extra support. He had a bucket on his head to stop him chewing his bandages. By 6 weeks, the fracture had healed.

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Premature closure of a growth plate

Lizzy, a 7 month old cross bred dog, was presented for a lame left foreleg with a slight outward rotation of the wrist joint. There was no history of trauma. She was a very young active and adventurous pup.

There are two bones between the elbow and wrist in dogs called the radius and ulna. In young dogs, there are "growth plates at each end of the bones. This is where new bone is made making the bones longer. Normally, the growth plates close (stop making new bone) when a dog reaches maturity.

In Lizzy's case, X-rays revealed the growth plate in the lower end of the ulna had closed too early. The adjacent growth plate in the radius was continuing to grow, causing the wrist and paw to turn outwards.

Even though the ulna had now stopped getting longer, the radius next to it was making the leg longer. Eventually, this pulled the ulna out of the elbow joint causing a dislocated elbow.

Lizzy was referred to the Animal Referral Hospital in Sydney where Dr Sarah Fitzgerald performed corrective surgery.

Sarah cut out a piece of the lower ulna to free up the bottom section so the elongating radius no longer caused the wrist and paw to turn outwards. The next incision in the upper ulna freed the top part which snapped back into its normal position in the elbow joint with the pull of the forearm muscles attached to it.

Sarah placed a metal pin into the top parts of the ulna to keep them straight whilst they healed.

Lizzy was ordered to rest for a few weeks with a light dressing. The pin was removed 8 weeks later and Lizzy is now using the leg extremely well with no turning out of the paw.

 

 

 

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Diaphragmatic Hernia in a Puppy

Zack, a 9 week old Pomerian 500gm pup was presented with sudden shortness of breath and vomiting. There was no history of eating a foreign body.

Tapping a finger on the chest wall gave a dull sound instead of a nice hollow sound.

Zack's colour was slightly blue and he had great difficulty getting his breath. He was placed on oxygen and a quick chest x-ray showed loss of detail- the heart and lungs were not visible and in their place was a solid mass with gas shadows. We suspected a diaphragmatic hernia.

The diaphragm is a flat muscle sheet that keeps the contents of the abdomen (liver, intestines, stomach etc.) out of the chest where the lungs and heart reside. When breathing, the diagram moves backwards and forwards and helps the lungs breath.

In Zack's case, his diaphragm had been torn and the liver and small intestines were in the chest cavity squashing the lungs and heart. These hernias often happen after massive trauma e.g. hit by car, falling from a height, being trodden on.

We anaesthetised Zack after placing him on a drip and one of our nurses did the breathing for him by gently filling and squeezing the re-breathing bag.

We kept the chest drain in place and removed 10mls of fluid twice a day for the first 2 days. On day 3, there was no fluid so the drain was removed.

Zack made a great recovery and at stitches out 10 days later, he was barking and trying to jump up on our legs to say hello.

See also...
Diaphragmatic hernia repair in a Maltese Terrier

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Fractured Metatarsals (Foot)

Max, a 5 year old cat, was presented with fractures to two metatarsal bones (between the ankle and the toes) in  the left hind foot. Although the cause of his injury was unknown, it was suspected that he had been hit by a car.

Max was prepared for surgery and given anesthetic gases (Isoflurane and Oxygen). Tendons and blood vessels had to be retracted to the side to allow for the insertion of 2 small pins (K-wires) into the metatarsals and to get correct alignment of the bones. The pins were then trimmed close to distal metatarsals.
The wound was flushed with antibiotics prior to closure.

A half cast was applied to the rear of the foot and a bandage applied. Max was given injections for pain relief and antibiotic injections.

Over the next few weeks and a few bandage changes later, the foot healed. The skin defect closed completely without a skin graft. Fresh x-rays are planned for 1 months time to determine if the pins need to be removed or not.

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Removing a T-shirt from a dog

Zack had a history of swallowing things off the clothes line. He had lost a lot of weight and was vomiting everything he ate and drank.

We could feel a large mass in his abdomen, so we elected to have a look inside to see what was going on after giving him some IV fluids for 2 hours. This corrected some of his fluid and electrolyte imbalances making the anaesthetic a lot safer.

The small intestine had contracted down onto the long cord which was attached to the shirt in the stomach. One part of the small intestine had "swallowed" an adjacent part of intestine. This is called an intasusception.

In Zack's case, we could not pull the intasusception apart without damaging the intestine walls.
We decided to remove approx. 1 metre of damaged small intestine and join 2 healthy ends together. The main part of the shirt was in the stomach. This was removed via an incision in the stomach wall.

A long cord was attached to the shirt and went into the small intestines. We closed the stomach wall using a double layer of inverting absorbable sutures

Zack make an uneventful recovery but was not allowed anything by mouth for 48 hours.

We then started Zack on sloppy tin food (Hills I/D) fed in frequent small volumes.
After 1 week, we gradually increased the quantity of each meal.

By 2 weeks, Zack was back to old tricks, but the washing got hung out somewhere else.

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Removing a dog from a ball

Poor old Max thought he would have a good old chew on his favourite ball which dropped small bits of food out of a small hole.

Unfortunately, his lower teeth went into the hole while the upper teeth scrapped the outside surface. No problems so far, but when Max forgot the strength of his Staffy jaws of steel, his lower teeth sank right into the thick plastic of the ball and his lower jaw was wedged tight inside the small hole.

There was no way the ball was coming off with just a good tug. So it was time for an anaesthetic and a little sawing before we could the ball off Max's very sore lower jaw.

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Lateral ear resection

Terry, a male boxer, had been seen several times over the last couple of months for a recurrent right ear infection. The ear was too sore to look down on each occasion and often had some nasty bacteria in it. We decided to examine his ear under anaesthetic. We found a polyp growing deep down his ear canal which was blocking off the ear canal and trapping moisture and wax.

The only way we could get to the polyp was to perform plastic surgery where we remove one side of the ear canal (which is shaped like an ice cream cone) and stitch the flap to the skin below his ear. This is called a lateral ear resection. The wound healed very well and Terry is a much happier dog now.

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Pregnant cat desexing

Although not an ideal operation, sometimes pet owners get caught out and don't realise their little 6 month old "kitten" is actually a little bit mature than it appears to be. Rather than add to the already huge cat over-population, we desex these cases before things get too late.

Cats in the late third of pregnancy are left have a normal litter as surgery is riskier for them

See also…
Advantages of desexing female cats

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Oral Nasal Fistula from “Trench Mouth”

Lucy, a 8 year old Burmese cat, was presented with rotten teeth, difficulty eating, bad breath and lethargy. She was slightly dehydrated.

On examination, we found several rotten back molars which had large amounts of tartar and hairs attached to them. The gums were very inflamed and had receded away from the teeth margins.

There was a hole in the mouth where the upper left canine had previously fallen out. The hole connected through into the nose as were able to flush saline into the hole and watch it come out the left nostril. These types of holes are called fistulas.

It had been formed when the canine tooth fell out leaving a large empty socket which had become infected. Destruction of the thin layer of bone between the root and nose had occurred creating a connection.

We ran blood test to make sure Lucy was in good shape for long surgery. All was normal. We placed here on an IV drip during the operation to keep the blood pressure up to her kidneys and correct the dehydration..

Under general anaesthesia using Isoflurane, we removed the rotten molars.

Using an electrocautery unit, we created two flaps of tissue adjacent to the hole and slid them across the hole. The two flaps met over the hole creating an H-shaped piece of plastic surgery. They were stitched together using a fine dissolving suture material.

Lucy made a good recovery. We placed her on some oral pain killers (Metacam) and antibiotics. She was a much happier cat at checkup 5 days later and was eating much better, even though she did not have and molars.

It is important that pets have annual health checks and vaccinations. It gives the vet a chance to check for health problems such as bad teeth and gums, sore ears, measurement &/or assessment of any lumps etc.

See also...
Annual health checks
Dental care

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Massive stone impaction of the colon

Boof, a 7 year old un-desexed male German Shepherd was presented with problems defecting. He was straining a lot and passing a foul smelling bloody watery fluid from his bottom.   He was in a great deal of pain when handled.

Boof had a chronic history of eating pebbles in the back yard and they had never bothered him in the past. His vaccines were current, so we were confident the bloody diarrhoea was not due to Parvovirus. We sedated him with a nice pain killer mixed with a sedative. This allowed us to place him on a drip, examine him more closely, collect bloods for testing and take x-rays of his abdomen.

His abdomen had a firm elongated large mass in the middle of it. Blood tests showed mild dehydration and elevated white blood cells which suggested infection and/or inflammation somewhere in the body.

X-rays of his abdomen showed a spectacular blockage in his large bowel caused by hundreds of small and large pebbles/rocks. A rectal examination revealed the blockage started just forward of an enlarged prostate gland, which is a common condition in older un-desexed male dogs (and men!). The enlarged prostate compresses the colon which lies above it, forcing faeces to make a deviated path upwards before being passed.

Boof was anaesthetised and we performed major surgery to remove the rocks from the colon. We made a 1.5" long incision in his descending colon and milked out handfuls of small pebbles. We had to take great care that the contents of the bowel did not leak into the abdomen as it was full of bacteria. There were 3 large rocks stuck just in front of his prostate. One surgeon pushed them as far backwards towards the rectum while another surgeon passed some large intestinal clamps up the rectum to slowly and gently dislodge them from their impacted position.

We closed the incision in the colon using a double layer inverting suture pattern (Connell-Cushing). We flushed the incision area with some antibiotics (Benacillin and Baytril). We then wrapped some omentum (fatty tissue in the abdomen) around the incision to help seal any potential small leaks. A brand new set of drapes, instruments and sterile gloves were then opened up.

We then flushed out the lower abdomen with 1 litre of sterile saline and placed another bottle of Benacillin into the abdomen.

The abdominal muscle were closed followed by the sub skin layer and eventually the skin. Boof was given some pain killer injection and antibiotic injections (Baytril).

All in all, the surgery took close to 2.5 hours. Boof was kept on a IV drip for 2 days and after 36 hours we stared him on very small amounts of soft sloppy food (Hills I/d tin)

He made a great recovery and was a much happier dog the next day. At check up at 6 days, he was bright and bouncy and the wound was looking great.

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Cruciate ligament repair

Berry Haven Veterinary Group Surgical Case

Unfortunately, many dogs are prone to rupturing the anterior cruciate ligament (ACL) in their knee (stifle) joint. It is the same injury that affects many a sporting person- usually a twisting falling type of injury.

For small to medium dogs with good conformation, we place a thick nylon suture through the stifle to replace the action of the ruptured ligament. The nylon suture is similar to fishing line used to catch marlin, so it is pretty tough. Large dogs and those with poor conformation are candidates for a technique called Tibial Plateau Levelling Operation (TPL/TPO).

Mack ruptured his ACL and being a medium sized dog, the owners decided to go for the De-Angelo's repair. He was placed on IV fluids and anaethetised with Alfaxan an Isoflurane.

An incision was made on the outside of his knee and the joint was opened up by incising through the joint capsule. After removing the remnants of the ruptured ACL, we inspected the joint cartilages to make sure there were no tears in them. The joint was flushed with saline and had antibiotics placed in it. The joint capsule was then closed.

We drilled a hole through the tibial crest and placed a thick nylon suture through it before looping it around and behind the fabella (a small bone located on the outside surface of the lower femur). Once a loop of nylon was made, it was tied off using a crimping technique. The joint was very stable after this loop was tied.

The outer tissues we incised on our way through to the joint capsule were closed using an overlapping technique to give additional support to the knee.

Mack was placed on antibiotics and pain killers and restricted exercise which was gradually built up over 2-3 months. He started a course of Cartrophen injections two weeks after surgery to promote cartilage and joint fluid healing.

At 3 months he was using the leg very well.

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Gastric dilation (GDV) case

Lucky, a 5 year old, male Weimaraner presented to us with a history of vomiting over the past 24 hours. On physical examination, Lucky’s gums were pale and he had severe abdominal pain.

To get a better understanding of what was causing Lucky’s very painful abdomen, we took some x-rays of his abdomen. These revealed that he had an extremely distended, gas filled stomach (gastric dilation). In addition, a number of large bone fragments were also identified that were blocking the outflow tract of the stomach.

With these findings, we were able to conclude that Lucky had severe gastric dilation secondary to obstruction, and potentially volvulus. Once diagnosed, we had to respond quickly in order to maintain adequate blood flow to the heart and protect against shock. To achieve this, Lucky was placed on an IV drip and given aggressive fluid therapy. These fluids would only provide temporary stabilisation. To decompress the stomach and remove the bone fragments, Lucky required surgery.

In the following hours we gave Lucky some sedatives (acepromazine and butorphanol) and anaesthetised him using Alfaxan and Isoflurane. A stomach tube was then placed into the stomach, from the mouth, and 1.5 litres of foul smelling fluid siphoned out.

The abdomen was then opened up. To protect against future episodes of GDV, the stomach wall was permanently adhered to the right body wall (gastropexy). This was achieved using a surgical technique known as a circumcostal gastropexy. To perform this, a small flap was created using the outer layers of the stomach wall (the seromuscular layer).  The flap was then passed through a tunnel made beneath the eleventh or twelfth rib before being re-sutured to the area of the stomach wall from which it was created. With the stomach wall now anchored to the rib, it will not be able to twist and therefore Lucky is protected against GDV returning.

With the stomach anchored, our next step was to remove the bone fragments from the stomach. To do this, a small incision was made in the wall of the stomach (gastrotomy). With the stomach open, we were able to locate and remove the several pieces of gristle and bone that were obstructing the outflow of the stomach. The remaining stomach contents were then suctioned and the stomach wall closed using a Connell-Cushing closure technique. This technique involves two inverting layers of continuous sutures. The pattern helps to create a strong, water tight seal, which is a very important consideration whenever a fluid containing organ capable of great expansion, such as the stomach, is entered.  Following closure of the stomach, the abdomen was closed, and Lucky woken up from his anaesthetic.

At checkup a few days after his operation Lucky was doing very well. His appetite returned to normal and his vomiting ceased. Most importantly, to this day Lucky has had no other episodes of GDV.

See also...
Gastric Dilation and Volvulus        

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Aural haematoma (blood clot in the ear)

Berry Haven Veterinary Group Surgical Case

Occasionally, dogs traumatise their ear flap and rupture a blood vessel inside it e.g. if they are scratching their ears due to an infection. Blood leaks out into the space between the skin and cartilage flap that gives the ear its stiffness.

It looks like a soft fluid filled mass on the inside surface of the ear. Left untreated, the blood clot shrinks and shrivels up leaving the ear looking like a shrivelled up cauliflower. This can result in chronic skin problems as the deep "valleys" of the cauliflower harbour moisture and bacteria, meaning lots of visits to the vet.

Rather than letting this happen, we drain the ear by removing an elliptical piece of skin from the inside surface. Once we have drained the blood clot, we place several stitches through the full thickness of the ear i.e. from inside to outside; to apply pressure while it heals and to prevent repeated bleeding.

The stitches are removed 10 days later. At the same time of the ear surgery, we examine both ear canals looking for any evidence of an infection that may have caused the dog to scratch the ear in the first place.

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Anconeal Process in Elbow Dysplasia

Berry Haven Veterinary Group Surgical Case

Max, a 4 year old German Shepherd, was quite lame in his right foreleg. On moving and examining the elbows, both joints were thickened and had some crunching (crepitus) in them. We suspected arthritic changes in both elbows, possibly due to a condition called un-united anconeal process.

In young animals, new bone formation occurs in the near the ends of each bone. Just below the end of each young bone is a thick layer of cartilage called the metaphysis. The top layer of the metaphysis is made up of new cartilage and the lowest layer is made of new bone. This is where new bone is made and the long bones grow.

This process continues until the pet matures. At this stage, the metaphysis turns to solid bone and joins the end of the bone (epiphysis)  to the long shaft of the bone.

Its a bit like a chicken drumstick. You can break off the end of the drum stick (epiphysis) with your fingers. However, if you ate the same chicken leg when the chicken was a few years old, you would not be able to break off the end, It would be fused to the long bone.

In young animals, the elbow joint is made of of a few pieces of separate bone all growing by themselves. Eventually, when the animal matures, they fuse together to form a solid joint. Occasionally, one of the pieces of bone, the anconeal process, does not fuse to the underlying bone and is left floating around in the joint. This causes a lot of discomfort and can lead to arthritic changes.

Treatment is usually surgical to remove the united anconeal process from the joint. This is usually bets performed by a specialist surgeon to get the best results.

In Max's case, both of his elbows were affected but the right was causing him the most trouble. We referred Max to the Animal Referral Hospital (ARH) in Sydney where Dr David Simpson looked after him. A cat scan showed the presence of un-united anconeal processes in both elbow joints.

Dr Simpson operated on the right elbow and removed the un-united anconeal process (see picture). He decided the left elbow was not casing significant discomfort so it was
left alone. Max made a great recovery and is now using the right foreleg much better.

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Abscess on a dog’s shoulder

Berry Haven Veterinary Group Surgical Case

Rolex was presented with a large fluid filled swelling over his left shoulder. He had been in a dog fight about 1 week ago but the owner thought there had been no injuries. We clipped the area and inserted a needle and found the swelling was full of pus. We suspected he had received a bite and it had got infected.

We anaesthetised Rolex and using blunt dissection, opened up the large abscess. We drained out approx. 150mls of pus. There was no foreign body in the abscess.

We placed a special rubber drain (penrose drain) in the abscess above and below the swelling. Rolex was placed on strong antibiotics- Flagyl and Clavulox

We removed the drain 4 days later. There was some swelling for a few days but it resided. The abscess was fully healed by 10 days.

We see abscesses quite commonly in practice. They are mostly seen in cats following a cat fight. In dogs, the most common causes of abscesses are grass seed penetration and dog fight wounds.

If you suspect your dog or cat has been in a fight, take it to the vet immediately for antibiotics and pain killers. If treated early enough, a large abscess and surgery can be avoided.

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Abscess dog 6
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Cat abscess

Berry Haven Veterinary Group Surgical Case

Monty presented with a nasty abscess on the top and side of his head. It had spread from an initial injury to the top of head a week earlier. He was slightly off colour and had a poor appetite.

We gave him an anaesthetic and trimmed off the dead skin on the side of his face. We then cleaned the infection out and placed a rubber drainage tube (Penrose drain) under the skin before stitching the edges together.

We are removing the drain in 4 days and the stiches come out in 10-12 days. Monty was much happier the next morning and woofed down his breakfast.

N.B. Most cat bites/scratches result in an abscess a few days later. If you suspect your cat has been in a fight e.g. heard a fight late last night and the cat is limping or slightly off colour this morning, it's well worth making a trip to your vet to get him/her checked over and onto some antibiotics before an abscess develops.

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Abscess cat 1
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Trench mouth and a broken jaw

Junior presented to us late one evening in a great deal of pain. It had happened suddenly. He was very sore when examined around the mouth. From a quick glimpse of some rotten teeth and an obvious horrible breath, we suspected one or more tooth abscesses were the problem. We admitted him for an anaesthetic and examination.

We found Junior had what we term "trench mouth" where nearly all the teeth are rotten and/or lose and there is severe inflammation/infection of the gums. On closer examination, we found he also had a fractured lower left jaw bone.

We suspect the infected tooth in this region had affected the surrounding bone making it weaker than normal. A small bump to the jaw, or biting on something hard, may have been the last straw. Once we had removed the rotten teeth and cleaned up the gums, we placed a stainless steel loop of wire through the two broken ends of bone and tightened it.

The next morning, Junior was up and wagging his tail and woofed down 2 bowls of soft food with no problems what-so-ever. We plan to remove the wire in 6 weeks time.

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Dental trench mouth 1
Tartar 4-2
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Paralysis Tick Cases

Case 1

Ned was presented with severe tick poisoning. He was having trouble breathing and could not walk at all. He was gruinting and gagging and went "blue" when stressed.

We placed an oxygen catheter up his nose and connected him to a humidifier and a large oxygen bottle. Despite this, his breathing was very laboured and he was stressed.

Mark decided to give Ned a long acting anaesthetic (Pentobarbitone) with an endotracheal (breathing) tube placed down his windpipe (trachea). As soon as he was asleep, his breathing improved and his body relaxed (see... The The Brain is its Own Worse Enemy for an explanation).

Mark took Ned home so he could "top up" his anaesthetic every 2-3 hours during the night. The next day, Ned was kept anaethetised and we slowly let him wake up in the evening. Upon wakening, he apppeared to be in much less stress than he was previous to the anaesthetic.

Over the next 24 hours, Ned made slow and steady progress. He was discharged 2 days later.

Case 2

Jes, an excitiable 4 month old fox terrier puppy, presented with acute severe respiratory distress due to a paralysis tick on her upper neck causing local paralysis of her vocal chords and swallowing reflexes.

Her gums were blue with her struggling and not being able to get enough oxygen from her lungs.

We sedated Jes and placed an oxygen tube up her nose. The tick anti-venom was injected using a syringe pump attached to an IV line over 1 hour. During the night she settled down and by the morning she was breathing well by herself. She was discharged that night and at a recheck 2 days later, was back to old tricks.

See also...

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Tick puppy
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Swallowed sewing needle

Max, a young health German Shepherd, was presented with sudden neck pain, He would cry out in pain if one handled his throat region and was making a gagging sound whilst yelping. We sedated him and took x-rays as the presentation was most unusual.

We could see a sewing needle stuck in the pharnynx.

We gave Max a general anaesthetic and found the sewing needle stuck into the tissue at the back of this throat. Thee was a cotton thread attached to the eye of the needle and by gently pulling the thread, the needle was extracted safe and sound. Max was still a bit sore for a few hours, but back to full bounce after that.

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Sewing needle 2
Sewing needle 1
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Treatment of Squamous Cell Carcinoma

Tiger was presented 15 months previously for a Squamous Cell Carcinoma (SCC) on his nose. We treated it using cryosurgery which involved freezing it by applying a liquid nitrogen frozen tip to it. At 2 weeks post op, it looked like it was healing very well.

However, the right nostril lesion continued to re-grow despite a second go at cryosurgery 15 months later. At 2 weeks post op, it appeared to be healing but there was one small area of ulcerated skin which refused to heal. It slowly got bigger a few months later it was starting to destroy normal healthy tissue

We decided to try a new technique. Tiger was anaesthetised and we used a special instrument called a curette (like a small spoon with very sharp edges) to scrape out all the cancer tissue. We then applied an electrocautery tip to burn the base where we had just scraped away the SCC. We then scraped the burnt tissue away with the curette and burnt the next layer down.

By 4 weeks post op, the areas was healing very well although the right nostril opening was a bit narrowed by a thin piece of scar tissue. We plan to trim this away at his next visit provided there is no evidence of re-growth.

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Scc cryo 4
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