Today I saw a cat who had been vomiting 2-3 times a day for the last 4 days.  He was bright and happy and eating well, but the owner was concerned about him so they brought him in.  We took an xray and look what we saw:

It’s not the straightest xray…he was a squirmy cat!  But the problem is pretty obvious, even if you are not used to looking at radiographs.  What an earth is that circle?  I asked my Facebook fans and here is what some of them said:

Soooo….one of you was bang on!  I had one of my technicians shoot a video as we did surgery.  (Thanks Kim!)  Warning…it’s a little graphic.  You’re going to see intestines, blood and of course, a mystery object:

Irish Setter photo credit to Janticom.

What is an umbilical hernia?

Some animals can be born with a small hole present on their body wall where the umbilicus (belly button) is.  This is always a genetic issue. (Many breeders will claim that the hole was made by the mom chewing too vigorously on the umbilical cord, but this is not true.) In most cases, the hole is very small.  Often it is so tiny that just a small amount of fat can poke out.  The fat is covered by skin and looks like an “outie” belly button.  But, sometimes, such as with this kitty, the hole is much larger.  This poor girl had a hole the size of a plum.  It was so large that her intestines were able to get into the hole.  This meant that the only thing between her hanging intestines and the outside world was a thin layer of skin.

Animals like this need to have their hernia repaired as soon as possible!  For animals with small hernias, it is still recommended to repair them, but we can often wait until it is time to perform their spay or neuter.

Here is a picture of the hernia on this cat with her belly shared as we started to prepare for surgery.  (Her head is to the right of the picture and she is lying on her back):

The surgery:

We prepared her for surgery and moved her into the surgical suite.  I gently made an incision over the hernia.  I had to be very careful, because there was no body wall underneath.  If I was too rough I would have cut right into her intestines!  Once I made the incision, here is what I saw:

You can easily see that her intestines were very vulnerable!

The edges of the hernia were covered in fat.  The fat was adhesed to the lining of the hole.  (Adhesed means that it was basically glued on to the body wall.)  I found some very interesting adhesions.  Check out the photo below!  I noticed that there was a large adhesion that was pulling the liver down into the hernia.  As an interesting note, this cat had an elevated ALT level before surgery.  ALT is a liver enzyme and I’m wondering if this adhesion was causing trauma to the liver as gravity would tug on it as it fell down into the hernia. (You can click on the photo to enlarge it.)

I carefully worked to break down the adhesions without doing any damage to the organs.  Next, what I had to do was cut a fresh edge along the edge of the hole.  If you suture the hole without having fresh tissue, it will eventually come apart again.  Here I am cutting the edges of the hernia:

Once the edges are fresh, then the next step is to place some strong stitches.  I used a suture material called 2-0 PDS.  PDS is a suture that takes a long time to dissolve and is very strong.

Once I had the hole closed, then the next step was to stitch the subcutaneous (under the skin) layer and then the skin.  However, because the skin had stretched I had to trim off a good amount of it before closing the incision completely:

Prognosis:

This cat should heal completely and not have any lasting problems because of the hernia.  Occasionally, when there is a large hole, part of the incision can come apart and sometimes multiple surgeries need to be done.

I will randomly choose 10 winners.  If you win you can choose either a bag of:

Hill’s® Science Diet® Ideal Balance™ Grain Free Adult Chicken & Potato Dinner dog food (12 lbs)

or

Hill’s® Science Diet® Ideal Balance™ Adult Chicken & Brown Rice Dinner cat food. (15 lbs)

For those of you who are label readers, these foods have meat as the first ingredient, contain no corn, and are grain free.  (If you’re following my nutrition series, I’ll be writing soon about the truth about corn and grains in pet food.)

How to enter

To enter the contest you need to do three things:

1. Leave a comment at the end of this blog post telling me something about the pet who will be eating the food that you win.

2. Become a fan of Dr. Marie on Facebook.  (If you’re already a fan, then that’s great!  You can skip to step 3).

3. Share this post on Facebook by either clicking “like” at the top of this post or the facebook share button at the bottom of the post.

Contest Details:

Valid only in the USA.  Contest ends Wednesday, December 28th at midnight.  The winners will be contacted via the email that you use in your blog comment.  Winners will be provided with a promo code which is valid at PetFoodDirect.com which includes shipping.  The promo code is valid until December 31st, 2011.

Want to Contact Hill’s?

Hill’s would love to hear your thoughts on this food.  What do you think of Hill’s producing a grain free food?  Are you excited about this product?  To tell Hill’s what you think, visit their Facebook Page.

This contest is listed at www.contesthound.com and www.sweepstakescrazy.com

I never recommend feeding bones to dogs.  I tell my clients about the types of cases where I have seen bones cause problems.  I’ve seen dogs chew pieces off that caused an intestinal obstruction.  I’ve seen lots of dogs break teeth on bones.  Today’s case was another good reason not to feed your dog bones.

Emergency!

It was a busy day full of appointments when suddenly I heard a commotion.  A client had come in saying, “I have an emergency!”  And here was her poor little doggie with a bone stuck on his lower jaw.  The bone was the end of a cow femur, or at least that’s what it looked like to me.  Apparently he had been chewing on it for a quite a while when suddenly it got stuck in his mouth.  The owner tried to remove it but couldn’t so she rushed in to see if we could help.

Here’s a picture of the poor little guy:

We did what we could to try to remove this thing but it was S-T-U-C-K!!!  We ended up administering an IV anesthetic called propofol and worked on a way to cut through the bone.

We tried all sorts of instruments but nothing we had would cut through it.  I finally got the idea to use an instrument called rongeurs (pictured on the right).  Rongeurs are used in bone surgeries to cut little pieces of bone.  It took a lot of muscle power and sweat to work away at this thing.  Bit by bit I managed to chip off some bone until I got all of the way through.  Eventually after about 20 minutes of intensive work the darn thing came off.  There were cheers from all of the staff!

Here is the bone once we removed it.  

Our patient recovered quickly.  We gave him an injection of an anti-inflammatory drug called Metacam and sent him home with strict instructions not to have any more bones!

For those of you who are reading this now, I originally posted this with no diagnosis.  But now, the diagnosis is written at the end of the story.

Signalment:

This is a 4 month old Labrador Retriever.  She is not spayed.

History:

She was playing roughly with her “older sister” who is a much larger lab when suddenly the owner heard her scream very loudly.  This happened early on Saturday morning.  (It is now Monday morning.)  Since then, she has been bright and happy and eating well, but she is barely putting any weight on her left hind leg.  It hasn’t gotten any better or worse since it happened.

Physical Exam:

The dog was crazy excited and just wanted to lick me instead of being examined.    The first thing I noticed is that she was not putting any weight at all on her left hind leg.  Her heart rate was 130bpm.  Her temperature was 38.6 C (101.5 F).  Here is what I noticed when I palpated her leg:

• I didn’t see anything unusual on her toes, toenails, or skin anywhere on the leg.
• She let me flex and extend her toes and her stifle (knee) without concern.
• At first I thought she was sore when I extended her hock.  But, when I repeated this, she didn’t seem sore.
• None of the joints were obviously swollen.
• There was no drawer sign in her stifle.  (This is a test that we do to determine if there is a tear in the cruciate ligament.)
• She was reluctant to extend her hip.  She could do it, but she pulled back against me when I tried, and she cried if I tried to do it repeatedly.  She could abduct her hip.  (“Abducting” is the movement a dog would make when they lift their leg to pee.)

When I finished the exam she was even more sore on the leg.  (Yeah, I know, I’m kind of mean, but hey…you have to do stuff like this when you are a vet.)

Tests:

We decided that we needed to take some hip xrays.  She shouldn’t be this sore.  She was a little difficult to keep still on the xray table, so we ended up using a cool padded trough that we have which helps dogs to be more comfortable when they lie on their back.  Here’s the xray we got (click to enlarge):

On the xray above, she is on her back, so the bones on the left of the picture are actually her right side.

Diagnosis and Treatment:

So perhaps I have been a little tricky in giving this case as a “Guess the Diagnosis” case.  I say this because the xrays really don’t tell me anything at all!  The hips look fine.  A few of you mentioned the possibility of hip dysplasia.  Dogs with hip dysplasia will have a number of changes that we can see on xrays.  You will see that much of the “ball” portion of the ball and socket joint is not sitting in the “socket”.  In medical terms, the head of the femur is not well seated in the acetabulum.  You will also see that the neck of the femur is wider than it should be.  And, the head of the femur tends to get flatter than normal when a dog has hip dysplasia.  I’ve created a graphic to show the difference.  The hip on the left is the one from our patient.  The hip on the right is a dysplastic hip (click to enlarge):

So, the final verdict was that there was likely nothing serious going on.  I suspect that she had a deep muscle bruise.  I put her on a pain reliever called Previcox.  (This is an NSAID drug very similar to Metacam, Rimadyl or Deramaxx).  She was also instructed to rest, which is a very difficult thing to ask of a lab.

How is she now?

Today (24 hours later) I gave the owner a call to see how our patient was doing.  It turns out that she is 90% better already!