Category Archives: Surgery Patient of the Month

Surgery Patient of the Month- June- Portosystemic Shunt (PSS)

Nacho with his mommyCongratulations to Nacho for being our June Surgery Patient of the Month!

You would never know by looking at him, but Nacho was recently diagnosed with a life-threatening condition for which he showed no signs whatsoever! When Nacho turned one, his owners wished to have him neutered. He was an active and happy pup, and as expected, his exam was completely normal. As part of routine diagnostics done prior to any surgical procedure here at West Hills, Nacho had blood work performed. Results showed a single value related to liver health was slightly elevated. You might argue that a slight elevation of a sole value on a blood panel is likely insignificant, but at West Hills we are committed to practicing the highest standard of care for our pets. Therefore, Nacho’s veterinarian, Dr. Sikalas, recommended further testing to ensure it was safe for him to undergo anesthesia and surgery.

An additional blood test (called bile acids) was performed and Nacho’s results returned abnormal. When this occurs in a young small breed dog, a likely possibility is a congenital abnormality associated with the liver called a portosystemic shunt (PSS). In dogs and cats, blood carrying toxins, such as ammonia, from the digestive tract is first transported to the liver through the portal vein. The liver removes all the harmful substances before returning the detoxified blood to the general circulation. Nacho on Halloween!

In pets with a PSS, there are one or more abnormal vessels that bypass the liver, allowing those harmful substances to the rest of the body before detoxification occurs. Pets with this condition often times suffer from a smaller liver with impaired function, and can have stunted growth or abnormal neurologic behavior, particularly after eating. They may also have problems metabolizing medications, especially anesthetic drugs, and this can be fatal for some pets.

Surgery is frequently recommended for dogs with PSS and consists of an abdominal exploration to identify the abnormal “shunting” vessel and a procedure to redirect blood flow back to the liver. Nacho underwent surgery with our ACVS Board Certified Veterinary Surgeon, Dr. Marc Hirshenson, who identified an abnormal vessel consistent with a PSS. Dr. Hirshenson placed a small device called an occluder on the vessel. This allows for gradual closure of the vessel and redirection of blood flow to the liver.

Nacho handled surgery like a champ and recovered without any complications. At home, Nacho continues to thrive. More importantly, his most recent bloodwork showed normal liver values! Congratulations Nacho!

Surgery patients of the Month- February- Patella Luxation & Fracture Femoral

Congratulations to Simon and Charlie for being our February Surgery patients of the Month!They love to snuggle!

February is considered the “month of love”, so we decided to share the honor of “Surgery Patient of the Month” between a very loving brother and sister combination, Simon and Charlie! Both are equally deserving of recognition, as they underwent surgery only a few days apart from each other.

Simon is a 2 year old English cocker spaniel who was referred to see our ACVS board certified surgeon, Dr. Marc Hirshenson, for evaluation of left hindlimb lameness. Dr. Hirshenson diagnosed Simon with a left medial patella luxation.

Medial patella luxation occurs when the patella (knee cap) does not sit correctly within the groove of the femur (thigh bone). The patella “pops” in and out of the groove, causing inflammation and discomfort. Over years, this causes break down of cartilage within the knee joint and osteoarthritis. Surgery is recommended to stabilize the patella for dogs showing signs of pain related to a luxating patella. The goal of surgery is to keep the patella in the groove through a full range of motion of the knee joint.  

Simon underwent surgical correction of his luxating patella, and recovered quickly, after spending a few days in the hospital.

The day before Simon’s surgery, his owners adopted their second dog, Charlie, a young female  Miniature Pincher. At the time of her adoption, Charlie would not bear any weight on her left hindlimb.

While Simon was recovering at West Hills, Charlie was brought to her primary care veterinarian for evaluation and radiographs (x-rays) of her affected hindlimb. X-rays showed her left femur was fractured!  Charlie was then referred to Dr. Hirshenson. He determined the fracture occurred at least 2 weeks prior to her adoption. Surgery was recommended, and Charlie was admitted on the same day Simon was discharged.

Charlie’s femur fracture was stabilized with a plate and screws. She experienced no complications during or after surgery, and just like Simon, recovered well post-operatively.

Simon and Charlie continued their together at home, gaining back strength in their respective left hind limbs have now resumed  normal activity. They will forever have a special bond, and share dedicated owners who take fantastic care of them!

Congratulations on your recovery Simon and Charlie! Simon   Charlie

Surgery Patient of the Month- January- Bilateral Cruciate Ligament Rupture

Congratulations Keifer on being our January Surgery Patient of the month! Keifer , a 10-year-old  mixed breed dog, was presented to the West Hills surgery service for evaluation of a two-day history of reluctance to walk and hind limb pain.Keifer

Two weeks prior, Keifer was diagnosed with an acute right anterior cruciate ligament (ACL) rupture at an Emergency Hospital. A few days later, he suddenly showed lameness of his left hind limb. Dr. Hirshenson, our ACVS board certified su…rgeon, examined

Keifer, and diagnosed him with cruciate ligament tears of both hind limbs. A cruciate ligament tear is diagnosed via palpation of instability in the knee joint. The instability causes intense inflammation and pain, manifesting as lameness.

Cruciate ligament rupture is the most common orthopedic disease in dogs, occurring secondary to chronic degeneration of the ligament over time. The weakened ligament can suddenly fragment, causing acute lameness.

A dog with a ruptured cruciate ligament in one knee is likely to develop a tear on the opposing limb 50% of the time, and 25% of these dogs may develop another tear within the same year.  A smaller proportion, like Keifer, will develop tears in both limbs in a much shorter time frame. While dogs with only one limb affected can ambulate by bearing weight on the opposing back limb, dogs with bilateral cruciate ligament tears can be rendered immobile from pain in the most severe cases.

The treatment of choice for cruciate disease in dogs is surgical repair. Dogs with bilateral tears typically have surgery on one limb, followed by the other 2-3 months later. These dogs experience eventual return to a normal level of physical activity; however this can take upwards of 4-6 months or more when the surgeries were separated. Dr. Hirshenson is one of a small number of surgeons, who has extensive experience repairing both knees during a single surgery and offers this option for appropriate cases.

The pros to simultaneously repairing both sides are that the patient experiences a single anesthesia and hospitalization and a more rapid return to their normal physical activity. The con is the increased physical rehabilitation required in the immediate post-operative period.

Keifer’s owner was willing to take on the extra post-operative care and pursued bilateral surgery. Keifer immediately started physical rehabilitation exercises after surgery, and his owner continued therapy at home.

Just three short weeks after surgery Keifer was walking well on his own, and was cleared to resume his normal activities, including running and playing after 10 weeks.

Through the dedication of his owner and the staff at West Hills, along with Keifer’s toughness and determination, he was able to get back onto all four feet with flying colors. Way to go Keifer!

Surgery Patient of the Month- December- Front Limb Amputation

Cooper recovering

Cooper recovering

Cooper is a stunning 7-year-old Golden retriever and a long time patient at West Hills Animal Hospital. He was recently was seen by Dr. Ries for evaluation of several skin masses. Each of the masses was tested, and one located on Cooper’s left carpus (wrist) was suspicious for a cancerous process, called a soft tissue sarcoma.
Dr. Ries removed the suspicious mass, and biopsy confirmed a diagnosis of a soft tissue sarcoma, with incomplete surgical margins. This means tumor cells are still present at the surgery site on his leg, leaving Cooper at significant risk for regrowth of the tumor or spread of disease (metastases).

Cooper’s owners were scheduled to meet with an oncologist to discuss his diagnosis, however in the two-week span between surgery and the appointment, his tumor began to regrow. Cooper was then referred to Dr. Hirshenson, our board certified veterinary surgeon and surgical oncology specialist, for consultation regarding more aggressive treatment for his cancer.

Dr. Hirshenson discussed several options with Cooper’s owners, including repeating a localized surgery followed by radiation therapy, radiation therapy followed by localized surgery, and amputation of the affected limb. Though the last option may seem dramatic, it is one that would likely be curative for Cooper.Cooper

After much consideration, Cooper’s family elected to pursue amputation. It was a difficult decision, as he showed no pain from the tumor and was using the affected limb normally, but they knew it would be the best chance for him to be cured.

Cooper was a rock star! The day after surgery he was able to walk with only minor assistance. He spent several days in the hospital recovering and undergoing early physical rehabilitation to help him get used to his new life on three legs!

At his 2-week recheck appointment with Dr. Hirshenson he was so excited to be back at West Hills and showed off by jumping up on the couches in the waiting room!
Cooper is a frequent visitor to us at West Hills and continues to impress us all! We all love you Cooper ❤️

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Cooper doing well at home!

 

Surgery Patient of the Month- November- Septic Abdomen

Thor

Thor, a very handsome 2 year old Rhodesian Ridgeback, presented to West Hills with a several day history of lack of appetite and lethargy. His owners reported that he had vomited three times over the two days prior to presentation. Thor was previously very healthy with no major medical problems.

Dr. Jared Coren evaluated Thor and determined that other than a fever, Thor had no changes on his exam. He recommended preliminary bloodwork and radiographs (x-rays) of his abdomen to help delineate the cause of Thor’s clinical signs.

Bloodwork revealed an elevation in Thor’s white blood cell count and other changes consistent with a systemic bacterial infection, called sepsis.  On evaluation of the x-rays, a possible mass effect was seen in the mid-abdomen, but it was unclear as to where the mass was arising from.  Given these findings, Dr. Coren consulted with our board certified surgeon, Dr. Marc Hirshenson, who agreed that the next best step for Thor would be an abdominal exploratory surgery.

Thor was taken to surgery, where a mass the size of a softball was found arising from the omentum. The omentum is a collection of fat, blood vessels and lymphatics and is known as the “abdomen’s natural bandaid.”

Thor's Lesion post-operativelyThor’s Lesion post-operatively

On further evaluation, it was clear that the “mass” was an abscess, or walled off localized infection. Purulent material was arising from the abscess and leaking into the abdominal cavity. The abscess was dissected away from any vital organs and was able to be removed in its entirety.  A closed suction drain was placed prior to closure to ensure that all residual bacteria and fluid could be evacuated during Thor’s recovery.

Intra-abdominal abscess formation is rare in dogs and cats, and it was unclear as to why Thor developed this condition. Possible causes include a penetrating foreign body from the intestinal tract or an underlying cancerous process that becomes infected.  To rule out this possibility, the tissue was submitted for biopsy.

Thor spent the next four days in hospital recovering with intensive supportive care. Each day he

Thor Post Op

gained more strength and began eating again. He required a lot of monitoring and care in hospital, but by the time he went home, he was energetic and comfortable.

A pathologist reviewed the mass and confirmed the presence of an abscess. While no underlying cause could be determined, no cancer was found in the sample. Surgery was considered curative.

Thor continues to do well at home and has not looked back since his rare experience!

Surgery Patient of the Month – October – Pelvic and Left Ileum Fracture

A fewdays post op
Ginger is an exceptionally sweet 9-year-old Havanese who was presented to the West Hills Emergency Service after falling out of a van window, landing on a sewer grate, and possibly being hit by a car.  Ginger’s owners did not witness her accident, but brought her in for evaluation once they saw she could not bear weight on her right hind limb.

Our emergency veterinarian, Dr. LeBars, noted that Ginger had significant bruising and swelling of both of her hind limbs and along the underside of her belly.

Radiographs (x-rays) showed multiple fractures along both sides of Ginger’s pelvis (see picture 1). The x-rays also showed Ginger had air/gas trapped underneath the skin of her broken pelvis. This is called subcutaneous emphysema.

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The air/gas could have been introduced from “outside to inside” (air from the environment becoming trapped in a wound secondary to the trauma), or from “inside to outside” (gas leaking from an ruptured internal organ that passes through a tear in the body wall–the layers of muscle and tissue that separate the abdominal contents from the skin). The latter scenario represents a critical emergency and can be life-threatening.

Once she was stabilized, our board certified veterinary surgeon Dr. Hirshenson, evaluated Ginger. He recommended a CT scan of her abdomen and pelvis to better delineate the extent of her fractures and to further examine the cause of the air/gas seen on the radiographs.

The CT scan revealed multiple pelvic fractures including a left ileal-wing fracture and bilateral ischial and pubic fractures). Fortunately, Ginger’s body wall was found to be intact, eliminating an internal cause of the air/gas seen under her skin.

Despite her multiple fractures, restoration of the structural support of her pelvis required repairing only the left ilial wing with a plate and screws (see picture 2). With the help and dedication of the staff at West Hills (and Ginger’s owners) she progressively gained strength and at the time of discharge was able to walk comfortably on her own!

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Nearing 2 months post-surgery, we are glad to report that Ginger is back to her happy, playful self and is getting stronger every day.  With the diligent care provided to her at home, Ginger is on the path towards a full recovery!

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!