Monthly Archives: September 2015

Surgery Patient of the Month – July – Typhlectomy, Intussusception and Septic Abdomen

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We wanted to share with everyone a very touching story about Rosie.

Rosie, a beautiful 1 year old mix breed, was presented to West Hills Animal Hospital on referral from her primary veterinarian for continued care of persistent diarrhea and loss of appetite. Rosie was initially evaluated 2 days prior to presentation by her primary veterinarian, where blood work revealed a low white blood cell count and low protein, and fecal examination was negative. She was treated supportively with fluids and antibiotics; however clinical signs persisted, leading to referral to West Hills. Prior to this episode Rosie had been an otherwise healthy dog.

Upon arrival at West Hills, Rosie was admitted to the hospital for additional diagnostics and intensive supportive care by one of our primary care veterinarians, Dr. Lancer. Radiographs (x-rays) did not reveal an obvious cause for her signs. The following day an abdominal ultrasound of the abdomen was performed, which also did not pinpoint an exact cause of the clinical signs, but showed evidence of dilation of her intestinal tract with fluid and ileus, which is a lack of movement of material within the digestive tract. Rosie was continued on supportive care, but her signs progressed to include nausea as well as continued diarrhea, and she was very lethargic. Repeat blood work was consistent with sepsis, a systemic wide infection that was not responding to supportive care. Following consultation with Dr. Ries and Dr. Hirshenson, our board certified veterinary surgeon, Rosie’s owners elected to pursue an abdominal exploratory surgery.

In surgery, 2 small perforations were found in the cecum which is a small section of the intestinal tract that connects the small intestine to the large intestine. This, caused intestinal contents to leak into Rosie’s abdomen. The affected portion of her intestinal tract was removed. Dr. HIrshenson suspected that the perforations developed secondary to an intussusception. This is a condition where a loop of intestines slides inside another loop, causing inflammation, and in some cases, necrosis of the intestinal tract. The condition typically occurs in young dogs and in some cases can be life threatening. In Rosie’s case, the leakage of intestinal contents into the abdomen was causing a severe systemic infection, along with severe pancreatitis (inflammation of the pancreas) and secondary changes to her heart and liver.

Rosie required intensive monitoring and supportive care following surgery including two plasma transfusions, medication to help support her heart contractility and blood pressure, and a feeding tube to provide nutrition. Each day she showed slight improvement and exactly one week following admittance to the hospital (5 days following surgery) Rosie began eating small amounts on her own. Four days later (a total of 11 days in hospital) Rosie was discharged!

Over the following 2 weeks at home Rosie continued to regain strength and put on weight and rechecks of her blood work showed continued improvement. Through the hard work of the entire West Hills staff, the dedication of Rosie’s family, and of course the determination of Rosie herself, she is back at home where she belongs running through trails!

Surgery Patient of the Month – August – Limb Sparing and Amputation for Osteosarcoma

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Scooby is our Surgery Patient for the month of August!

Meet Scooby, the gentle giant! Scooby, a 7-year-old Great Dane, initially was presented to West Hills Animal Hospital in mid-January for right forelimb lameness. Radiographs were obtained, revealing a lesion in his radius, concerning for a primary bone tumor. A week later Scooby was evaluated by the surgery service and a biopsy of the bone was performed to obtain a definitive diagnosis. Results showed osteosarcoma, the most common type of primary bone cancer, seen in dogs.

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The recommended therapy following diagnosis of osteosarcoma is amputation of the affected limb followed by chemotherapy. Amputation serves to control the disease locally, as well as relieve the patient from the source of pain. An alternative option is a procedure called a “limb-spare,” where the affected portion of bone is removed and replaced with an implant and a large metal plate. Unfortunately, limb-spare surgery carries the risk of many possible post-operative complications compared to amputation surgery. 

Scooby’s owners elected to pursue the “limb spare” surgery and additional testing confirmed that he was an ideal candidate for this procedure. Surgery was performed by Dr. Hirshenson, our board certified surgeon, who is one of a small number of veterinarians in the world trained in this complicated procedure. He then started chemotherapy as previously recommended.
Unfortunately Scooby experienced some of the more common complications associated with limb-spare surgery including an infection associated with his metallic surgical implants, requiring long-term administration of antibiotics, and ringworm, a fungal infection, along his skin. These setbacks caused several delays in his planned chemotherapy treatments. However, Scooby handled all the vet visits with his typical patience and gentle demeanor.

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Unfortunately, in July (5 months after the initial “limb spare” surgery), Scooby‘s lameness returned and radiographs showed tumor growth in the ulna (the bone next to the previously affected radius). Given the discomfort this lesion was causing, an amputation of Scooby’s right forelimb was recommended. He underwent this surgery the following day and in typical “Scooby fashion”, never looked back!

Now, Scooby is hopping around on 3 legs and continues to be admired by all who know him. He is still undergoing chemotherapy, but is taking everything in stride and is comfortable and happy. Scooby holds a special place in our hearts here at West Hills and he continues to impress us all!

Surgery Patient of the Month – September – Laryngeal Paralysis

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Angel is our Surgery Patient for the month of September!

Angel, a lovely 13 year old chocolate Labrador, was initially presented to the West Hills Animal Hospital surgery service in November 2014 with a primary complaint of increased respiratory effort when active and slight change to the sound of her bark. Based on Angel’s age, breed, and clinical signs, Dr. Hirshenson discussed concerns about a condition called laryngeal paralysis.
As Angel’s signs were fairly mild at the time, a conservative management plan was created, including ensuring she was kept in a cool environment and not allowed to overheat. Angel did well at home through the winter, but re-presented to the surgery service in April 2015 for worsening signs, including several episodes of collapsing with activity.

Laryngeal paralysis (“Lar Par”) is typically seen in older dogs. Labrador retrievers are more frequently affected; though any breed could develop this condition. Laryngeal paralysis results from degenerative loss of neurologic function to the muscles responsible for opening the larynx, the part of the airway located at the back of the throat. When the larynx fails to open, air cannot pass normally from the mouth or nose into the lungs.

Owners of dogs with laryngeal paralysis frequently note their dogs showing signs of exercise intolerance, increased panting and occasionally a change to the sound of their bark. Dogs can still breathe with this condition, but exercise, heat and inflammation can rapidly exacerbate their signs, making it difficult for them to breathe.

In extreme cases, pets collapse from lack of oxygen! It is unclear exactly why dogs develop laryngeal paralysis, but evidence supports the theory it is part of a systemic neurologic degeneration that occurs as dogs age.

Patients with mild clinical signs can often be managed conservatively, where owners must keep their pets in cooler environments (i.e. air conditioned houses and cars) and not allowing them to become too excited. For severely affected dogs, like Angel, surgery is recommended.
The recommended procedure is called an arytenoid lateralization or “tie-back”, and entails making an incision into the neck and suturing one side of the arytenoid cartilage in a fixed position to widen the airway opening. The procedure works well, but carries a moderate risk of a complication called aspiration pneumonia. Angel’s signs were severe enough she required surgery to maintain a good quality of life.

Angel had surgery and recovered with flying colors! Following recovery, her breathing was quieter and she was more relaxed. She was able to sleep through the night without respiratory difficulty and can now go on longer walks and enjoy the yard without effort, even in the dog days of summer!