James Herriot in the Making

Intestinal Resection and Anastomosis in a Female Shih Tzu

2011-11-06T18:24:00.000-08:00

An 8 year old female shih tzu was first presented to the hospital a month ago. It had hematuria for months and the owner only thought that it was having its period of menopause - probably thinking that her dog was having the same condition like her. The dog was mainly on dog food. Only then that she decided to bring her for check up when she observed her pet having dysuria.

My physical examination gave me a differential diagnosis for urolithiasis. I tried to palpate the urinary bladder but the dog was uncooperative, maybe due to abdominal pain. I decided to do ultrasonography, urinalysis and blood work up on the dog. The ultrasound showed small round hyperechoic structures inside the urinary bladder. Complete blood tests showed moderate WBC count increased and low platelet count. Creatinine level was also high.

I treated the dog with Doxycycline for suspected Ehrlichiosis and urinary acidifier to apparently dissolve the cystoliths. Surgery did not came to mind that time because of the infection and low platelet count.

The dog was discharge after 5 days of in-patient monitoring with good urination and appetite.

The client came back after two weeks with their dog having dysuria again. Platelet count and creatinine were already normal. Cystotomy was done last October 28, 2011. The dog was confined for two days for urine monitoring. The dog was discharge on October 30, 2011 like nothing happened to the shih tzu.

On November 3, 2011, the owner brought her dog with its small intestines out of the wound. The dog had self inflicted trauma causing the intestines to come out off the wound. We did intestinal resection and anastomosis on the dog leaving behind 10 cm of duodenum and 8 cm of jejunum. While doing the surgery, we were thinking of the possibilities of shock and at the same time survival from the surgery would still cause short bowel syndrome - increased chance of recurrent bacterial enteritis and malabsorption of the ingested food.

When we were about to close the wound, the dog went to shock. We tried to revive the dog for a few minutes but the dog died on the surgery table.

The owner was very sorry and cried for minutes when we told her what happened. It was to late when she did not comply on the management of her dog at home. She never bought an E-collar which we advised her upon the dog's discharge on the cystotomy procedure. If she only complied, the dog might still be alive and doing well now.

A Long Wait

2011-10-23T20:41:00.000-07:00

It's my rest day. I should try to rejuvenate myself from the long week at the veterinary hospital. Doing in-patient monitoring is quite stressful but fulfilling - when you see happy clients together with their pets being discharge.

Sometimes I ask myself if it's worth the work hassle. It's a win-win situation for me. I love my work and am gaining enough experience from a premier university's veterinary hospital.

By the way, I applied for a faculty position in the same university. I have been waiting for response for almost a month now. The good news is that they have considered my application. Imagine working side by side with your college professors. I admire them so much; their knowledge, in my college days.

Hoping that I will get the position, but for now I need to practice for the teaching demo. If the job's really for me, fate would decide...

The Albino Burmese Python

2011-04-16T19:39:00.000-07:00

I encountered this albino Burmese python during my clinical duty in wildlife. This snake was confiscated by the rescue center, 3 years ago. Some of the wild animals are endangered because of illegal trading. Despite of the laws that are imposed on wildlife, there are still people who find ways of exploiting these poor animals.

Perineal Hernia Repair in a Shih Tzu

2011-04-16T18:43:00.000-07:00

Last April 14, 2011, a client brought his 3 year-old female shih tzu with signs of pruritus and pyoderma on the tail. I diagnosed his dog with dermatophytosis and recommended the pet for grooming.

The owner came back in the afternoon and I was surprised to see a 2 inch diameter swelling on the right side lateral to the anus. I found out that the dog had unilateral perineal hernia and required surgery. The owner wanted to have the surgery done so we scheduled it the next day.

On April 15, 2011, I did perineal herniorrhaphy together with my senior veterinarian. Upon incision, we were glad that the swelling was due to fats. I bluntly dissected the adipose tissue but was not able to reduce. I opted to excise the fat tissues instead. We only found one levator ani muscle, so we had to suture the muscle to the external anal sphincter muscle careful enough not to make a fistula on the rectum. We also did transposition of the internal obturator muscle. We did routine closure of the subcutaneous tissue and skin. I also required the owner to have the follow-up after two weeks for suture removal of the skin.

There are things to do post-surgically on your pet. First, an Elizabethan collar should be put on the animal to restrain the animal from biting the sutures. Healing wounds tend to be itchy and some pets tend to bite the wound because they get irritated.

Another thing is to consider the dog's defecation. Because the surgical incision is lateral to the anus, pets have fear of the pain when they poop. That's why, there are drugs that we prescribed to be taken at home to manage the pain. In this case, the animal might not defecate that much, so it's important that you observe the frequency of defecation and the amount that the animal would excrete.

In some cases, pets that have undergone this kind of surgery have recurring perineal hernia after months or years. Those observed are pets at their senior ages and those that have constipation or tendencies to strain too much.

Perineal Herniorrhaphy with Internal Obturator Transposition
(Not the Actual Surgery)

Follow up: Bone Cancer in a Labrador Retriever

2011-04-14T04:53:00.001-07:00

Yesterday, radiography of the thorax apparently showed normal lungs in the dog. The Labrador was scheduled for surgery this afternoon.

The dog's right forelimb was amputated from the paw to the scapulo-humeral joint. The dog is in pain right now despite of the analgesic that we have given. The dog was howling for hours. He have to isolate the Labrador Retriever since he was causing to much stress for the Collie who was with him in the same room.

Afternoon of April 15, 2011, the owners came to get the dog. He was very eager to go home. Hopefully, he will recover with his medications and just having 3 limbs.

Heartworm in Dogs

2011-04-14T04:05:00.001-07:00

Heartworm is a disease condition caused by the filaroid, Dirofilaria immitis. These are roundworms that usually lodge on the pulmonary arteries and heart. Dogs when infected usually have respiratory signs such as coughing, difficulty in breathing and exercise intolerance. Some cases also present large abdomen (ascites) in physical examination due to congestive heart failure.

Dogs can be infected with heartworm through mosquito bites. Female mosquitoes feed on warm-blooded animals for reproduction. The proboscid which is like a needle functions as the mouth of mosquitoes. They transfer larvae (L3) of the parasite through their saliva while they suck blood from their host, in this case, dogs. The larvae (L3) would molt into 4th stage larvae (L4) under the skin at the site of mosquito bite. The L4 would molt into premature adultworms (L5), which then migrates into the blood circulation going to the heart and the pulmonary arteries. The adultworms would mate and the female would produce the microfilaria.

Direct microscopic examination and heartworm antigen test kit can be used to diagnose heartworm. Hematocrit and direct smear can be diagnostic, if microfilaria can be seen.

Treatment with microfilaria can be done by using immiticidal drugs. We have two treatment procedures, 1) fast-kill of heartworms and 2) slow-kill. There are two treatment regimens using Melarsomine dihydrochloride for fast-kill. Two injections are required with 24-hours interval or 1 month interval (ivermectin is given two weeks after first injection) then ivermectin is given every month thereafter until the dog is negative for heartworm. The slow-kill only involves monthly treatment of ivermectin. Aspirin is usually prescribed during the first treatment of either procedures to prevent possible intravascular clotting.

Heartworm can be prevented by regular treatment with microfilaricidal drugs such as ivermectin, moxidectin and selamectin. These drugs are not just for heartworm prevention but at the same time they have deworming and ectoparasitic activities.

Bone Cancer in a Labrador Retriever

2011-04-13T06:34:00.001-07:00

Three days ago, a Labrador Retriever was presented to the hospital with a hard mass on the left forelimb. The mass can be observed on the distal region of the radius and ulna. We recommended the pet for radiograph.

The x-ray showed a radiopaque sunburst appearance diagnostic of osteosarcoma. We needed to check for metastasis in the other parts of the dog's body, especially the lungs. If he would be lucky, he can still live with the affected limb amputated otherwise we would recommend him for euthanasia or the owner would still have the option to keep his dog alive until his natural death would come.

Everybody might be curious on how the dog got his ailment. There are possibilities that we are looking at 1) would be due to genetics and 2) trauma that we incurred during the past years. Genetics would be one answer that can be related to the pathophysiology. Rapid growth can predispose the animal for cancer. Trauma with the affected area can also predispose the pet with the malignant cancer. The affected region might not be painful and still locomotive but abnormal cell proliferation can occur with the incident.

The disease would progress to respiratory problems due to metastasis of cancer cells. Aggressive treatment (amputation of the affected limb) can be done if the lungs are still okay.

Ascites in a Mixed Breed Dog

2011-04-12T18:50:00.000-07:00

Yesterday, a dog was brought to the hospital with a presenting sign of enlarged abdomen. The owner reported that it has been a week since they had observed that the dog's tummy was getting larger. The dog was still eating but in small amounts. We had a blood check done on the dog.

The results showed signs of bacterial infection and thrombocytopenia. There was liver and kidney problem too.

We required the dog to be confined for critical monitoring. I gave vitamin supplementation and a natural supplement for diuresis. The dog was put in IV fluid therapy. A liver tonic drug was also given. I had to catheterized him last night to release pressure in the urinary bladder (He can not pee on his own.)

We also did x-ray and ECG. Results should fluid in the abdomen and left enlargement of the heart.

Hepatozoon in a Pup

2011-04-12T18:42:00.001-07:00

Two days ago, a puppy was presented in the hospital with history of inappettence and weakness. The 6-month old Labrador Retriever was then physically examined and check for blood values.

The results suggested bacterial infection and thrombocytopenia. Our med tech observed blood parasites severely infecting all the white blood cells.

The dog was diagnosed with Hepatozoonosis. We prescribed antibiotic treatment for the disease and had to follow up on this case after a week.

Why Veterinarians Require Pet Follow-ups?

2011-04-09T21:44:00.000-07:00

Most pet owners only visit a veterinary clinic or hospital when their pets had become weak or their condition had not change for days. But a simple abnormality can be life threatening.

I remember one pet owner who brought her rabbit infested with ear mites. I gave her pet ivermectin medication and advised her to clean the rabbit's cage thoroughly. I also required her to bring her pet for follow-up after two weeks. She did came back after two months complaining about the same symptoms observed in her pet. Well, I have to scold her since she was the one who never came back on her scheduled appointment. Nevertheless, I had to let her understand the importance of follow-up checks for her pet.

Usually I recommend follow-ups around one week to one month from the day the pet was presented. I listed common diseases that I encounter below and the respective follow-up dates.

Disease/Pathology - Follow-up Date

Ear mite or yeast infections - after 2 weeks
Demodicosis /dermatophytosis - after 2 weeks to 1 month (depending on the severity)
Blood parasitism (i.e. Ehrlichiosis) - after a week to 2 weeks
Gastrointestinal problems - after a week to 2 weeks
Fractures - after 3 weeks to 6 weeks (day after casting/surgery)
Post-surgery follow-ups - after a week or 2 weeks

It is important for pet owners to understand the need for follow-ups. We do not require you to have another visit just for some reasons, we need you to return for follow-up because we care about your pets.

Antidotes for Pet Poison

2011-04-09T08:19:00.001-07:00

Poisons can be fatal to pets if they accidentally ingest them. Household items such as insecticides and rodenticides are common chemicals that can intoxicate our pets.

Warfarin, a toxic substance found in most rodenticides, can cause hemorrhage to dogs and cats. Rush your pet immediately to a nearby clinic or hospital so that the veterinarian could give Vitamin K as antidote and stabilize the dog's vital signs.

Organophosphates are also common substances that can poison pets. These can be found in pesticides or insecticides. Atropine is usually given as antidote, in conjunction with pralidoxime. Signs that are observed in OP poisoning would be salivation, miosis (pupil constriction), vomiting and defecation.

In cases that your pet have ingested these toxins, you can opt to give the animal with activated charcoal then induce vomiting. Rush to your veterinarian immediately so that they can treat your pet with the necessary antidote for the toxin.

Most importantly to avoid these accidents, store these toxic substances carefully so that your pets would not have access to it.

Follow up on the Poisoned poodle

2011-04-09T08:06:00.000-07:00

Last night, around 11 PM, the dog died with cardiopulmonary arrest.

Dexamethasone was given at 8 PM but seizures were still recurring. I tried to revive the dog with epinephrine and cardiopulmonary resuscitation yet the dog did not respond at all. I am still sad with the incident but I know that I did the best that I can to help the dog.

Poisoning in a Poodle

2011-04-08T04:00:00.000-07:00

This morning, a poodle was presented to the hospital with signs of seizure and salivation. The owner gave milk orally to neutralize the possible toxin in the gut. I did not get additional information on what toxin might have cause this emergency case.

Luckily, I had the IV cannula in the cephalic vein on my first try. I used 0.9% sodium chloride as intravenous infusion. Well, normal saline solution (NSS) is the safest fluid to give intravenously if you are not sure of the pathology of a certain disease. NSS is isotonic. It has only sodium and chloride. It's osmolarity is more or less alike with the saline in blood. I gave the IV fluid for the purpose of flushing away the toxin in the dog's system. The body excretes waste through the urine, the more hydrated the body, more likely toxins would be eliminated faster.

Since, I did not know what poison the dog might have ingested, I gave Vitamin K and atropine. Vitamin K is the antidote for warfarin poison. Warfarin poison is found in rodenticides. Organophosphate and carbamate poisons can be treated with atropine. These poisons are usually the most common toxins that can be ingested by your pet if they are not safely stored.

For the seizures, we do not have any drug such as phenobarbital or diazepam that can alleviate these symptoms. I had to first check, the dog's temperature. Normally, the dog's temperature would range from 38.5 to 39.5 degrees Celcius. My dog had convulsion (41.2°C), I thought that the seizures might be due to high temperature.

I had set the microdrip to 1 drop per 2 seconds and the IV line soak in a water bath with ice cubes. I also rubbed alcohol on the dogs body and ears. Alcohol has a cooling effect. Well, that works perfectly and the dog's temperature dropped off to 39.3°C. What a relief.

Other drugs that I gave were Ornipural (liver tonic) and Biodyl (Vitamin B and amino acids). The liver tonic would serve as a protectant for the toxins and the vitamins to boost the dog's system. But even with the treatment that I gave, the dog was still having mild myoclonus or muscle twitching. At this moment, the dog is still in observation. Hopefully by tomorrow, he would be up and wagging his tail like nothing ever happened to him.

Vaccination in Dogs and Cats

2011-04-03T06:37:00.000-07:00

Immunization in companion animals is a necessity. Some of the diseases that we encounter in dogs and cats can be prevented through regular vaccinations. Most of the viral infections can be fatal to our pets. Vaccinations can give immunity to them, although it would not guarantee 100% protection. But why do vets require your pets to have their shots? This would give the animal a higher chance to fight these diseases.

Vaccinations are done at 6 weeks of age up to 16 weeks. Dogs are given modified live vaccines for parvovirus, distemper, hepatitis, parainfluenza, kennel cough and Leptospira. These MLVs are commonly known as 5-in-1 or 6-in-1. Cats are also immunized with vaccines that can give protection to rhinotracheitis, calicivirus and panleukopenia. Anti-rabies vaccines are both given to cats and dogs.

Depending on the prevalence of a disease, MLVs for dogs and cats can be given at 2-week or 3-week intervals. These are given to young puppies and kittens with first, a primal dose then up to 3 booster shots before they are given annual boosters. Unlike MLV's, anti-rabies vaccinations are only given with a primal dose then annual boosters would be needed thereafter. In areas where Leptospirosis is endemic, vets usually give boosters every 6 months depending on the prevalent serovars of this bacteria.

Vaccinations can be protective to your pets as long as they are healthy. Good nutrition and vitamin supplementations are recommended to boost their resistance from certain pathogens that would cause these diseases.

Splenectomy in a Dachshund

2011-04-03T04:05:00.001-07:00

Last March, a dog was referred by another veterinarian to the the hospital. Upon presentation, the 9-year old female dachshund was recumbent and lethargic. It was not improving despite the medications that was given. The dog was still inappettent and had decreased water intake.

The dog was treated for blood parasitism. I did several laboratory tests and radiographic exam to check for differential diagnoses. The laboratory test that I have done pointed out to Ehrlichiosis but the x-ray showed two round radiopaque masses with 7 cm and 3.5 cm diameters. I told the owner that I would be requiring exploratory laparotomy and biopsy to check for possible tumor in the dog's abdomen. I did some research in the Internet for possible radiographs similar to the case. I found a site which helped me have a tentative diagnosis of splenic hemangiosarcoma.

The next day we had to open up the dog. We found masses on the spleen which apparently appears like hemangiosarcoma. I had to do subtotal splenectomy. I collected samples for impression smear and histopathology. The results showed morulae of Hepatozoon sp. and eosinophilic granulomatous inflammation which have been brought about by the blood parasite.

After two weeks, the dog had to be euthanized due to the chronicity of the case and possible surgical complication. Even though the treatment did not went well, the owner still thanked me for doing my best to at least save their pet...

Splenectomy in a Dog
(Not the Actual Surgery)