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Hepatic Lipidosis (Fatty Liver ) in a Cat

By | Case Of The Month

Sammi, a 7 year old domestic long haired cat, presented to us in December with a history of not eating for approximately 1 week.

On physical examination, she was found to be very lethargic, very dehydrated, had lost weight and was jaundiced or icteric. The term jaundice means yellow discolouration of the skin, sclera (the white part of the eye), and the mucous membranes and gums. It is caused by an over abundance of bilirubin in the blood, and generally occurs when the bile duct is blocked, preventing the flow of bile into the gall bladder. Sammi was very nauseous, and would gag and wretch when presented with food. She was admitted to our hospital for some diagnostic tests and supportive care.

Bloodwork performed on Sammi indicated that, as suspected, her bilirubin was four times the normal level! Radiographs of her abdominal organs showed a slightly enlarged liver. The gall bladder is nestled among the lobes of the liver, and when something causes the lobes to become enlarged, they can pinch off the bile duct, preventing the normal flow of bile. When the bile duct becomes obstructed, the patient becomes icteric. While we continued to work on obtaining a diagnosis for Sammi’s icterus, she was started on IV fluids and supportive medications to help her liver to function, control her nausea, and improve her appetite.

Over the next few days, Sammi’s bilirubin levels continued to climb and a diagnosis of hepatic lipidosis or fatty liver syndrome was made. Hepatic lipidosis (HL) is a disease that is unique to cats. The typical cat with HL is overweight, and has recently gone through a period of a severely decreased appetite. In an effort to support itself through this period of calorie and nutrient reduction, the body responds by rapidly breaking down the body’s fat stores and attempts to use the fat as an energy source. The sudden accumulation of large amounts of fat overwhelms the liver and the fat is stored in and around fat cells, gradually leading to liver failure and bile duct blockage. There are many reasons why a cat’s appetite might suddenly drop, but in many cases, that specific reason is never found. HL is a treatable disease, but the most important part of treatment is nutritional support until the appetite returns. Processing of the excessive fat in the liver takes time, and nutritional supplementation may be required for a period of several weeks.

In order to support Sammi nutritionally, a feeding tube was placed in order to deliver a high quality diet, without having to actually force feed her and compound her nausea. Initially, a naso-esophageal (NE) feeding tube was placed. An NE tube is inserted into one of the nostrils, down through the back of the throat and into the esophagus (the tube that carries food from the mouth to the stomach). This type of tube is great because it can be placed quickly, with the patient awake. It does however, have the limitations of being narrow (therefore only allowing liquid diets), and if left longer than a few days, it can be very irritating to the nose. Once a diagnosis was established, and we knew Sammi was going to be supplemented for a significant period of time, we elected to place an esophageal feeding tube, which is inserted thru the side of the neck, directly into the esophagus. This type of feeding tube requires general anesthetic for placement, however it can be left in place for several weeks, and allows a great deal of flexibility in terms of the type of diet that may be fed through the tube. The best part about an esophageal tube is that feeding through it is very easy for owners to do and Sammi was able to leave the hospital and go home to recuperate!

Image of a cat with an esophageal feeding tube. The tube is secured to a light bandage or collar to keep it in place.

Sammi’s owners tube fed her 4 meals per day for almost 4 weeks before she started eating on her own. After about 7 days of eating all of her daily caloric requirements on her own, Sammi’s feeding tube was pulled and she was declared 100% healthy again!! Her bilirubin was retested and had returned to normal levels. Sammi’s family is very happy to have Sammi home, healthy and back to normal!

 

Fractured Femur in an 8 week old puppy

By | Case Of The Month

“Black Jack” was rescued from a shelter by Labrador Retriever Adoption Services at approximately 7 weeks of age. He was brought to the shelter after he was found as a stray, limping. On examination, “Black Jack” was very painful on his right hind leg, and radiographs (xrays) were taken in order to determine the full extent of his problem. On radiographs, “Black Jack” was found to have a transverse fracture of his femur. The femur is the ‘thigh bone’ in the hind leg, and is the biggest bone in a dog’s body. A transverse fracture is a fracture that crosses the width of the bone and is at an angle of no more than 30 degrees to the long axis of the bone.

 

 

“Black Jack” had surgery to repair the fracture in his leg. The fracture was reduced (realigned into proper position) and a plate with 5 screws was placed on his femur in order to stabilize the fracture. By keeping the fracture reduced and stable, the body encourages the bone to proliferate and new bone forms in the fracture site, eventually making the bone as good as new!

The length of time needed for full healing depends on the area/extent of the fracture, the level of stability of the reduced fracture, and the age/general health status of the patient. Because “Black Jack” was so young at the time of fracture (therefore had great healing abilities), and because the plate provided significant stability, “Black Jack” was back to bouncing around in typical ‘puppy-ness’ in no time! He was adopted shortly after his repair surgery and spent the next 8 weeks recovering in his new home. Follow up radiographs at his 8 week check-up indicated that the fracture had healed well, and the plate was ready to be removed. A second surgery was performed to remove the plate, and “Black Jack” is now ‘metal-free’! He is thriving in his new home!

As an aside, while “Black Jack” was under anesthetic for his fracture repair, it was discovered that he had roundworms. Roundworms are a very common type of gastrointestinal parasite in puppies and are contracted directly from the mother in utero, through milk when nursing, or by consuming contaminated soil. Roundworms are generally detected through fecal samples at routine puppy examinations, and are an easily treated infection. In “Black Jack’s” case, the worms were found very shortly after administering anesthetic. Anesthetic causes intestinal worms to become hypermotile (excessively mobile) and they tend to look for an exit from the gastrointestinal tract very quickly! Once anesthetized, “Black Jack” defecated a large amount of the still-live worms! Upon awakening from anesthetic, he was treated with a dose of an anthelmintic (an anti-parasitic drug) in order to treat the roundworms.

Mammary Mass

By | Case Of The Month

Martha is a 9 year old, intact (unspayed) Labrador Retriever who presented for examination of a very large skin growth that appeared to be associated with the mammary glands. The mass had slowly grown over the course of a year, and eventually Martha was having difficulty playing and running due to the position of the mass on her abdomen.

Surgical removal of the mass, along with an ovariohysterectomy (spay), was recommended. Removing the mass would serve not only to provide Martha with some relief, but also allow us to submit tissue or biopsy samples from the mass to obtain a diagnosis. A spay was recommended because mammary masses are generally hormone associated, and studies show that dogs spayed at the time of mass removal live 50% longer than dogs that are not spayed.

The biggest concern with removal of a mass this size is a sudden loss of a large volume of blood, leading to shock. Tumours or masses, whether cancerous or not, often have a very extensive blood supply. When removed, the blood contained within the tissue is taken with it, and there is some concern that there is a sudden removal of too large a volume of blood. We can prevent shock by administering IV (intravenous) fluids during surgery in order to maintain blood pressure, and in some cases may even provide a blood transfusion if the blood loss is significant and life threatening.

Martha’s mass was very well attached to the tissues on the abdomen, and there were very large blood vessels supplying the mass. In order to safely remove the mass without causing a significant amount of bleeding, blood vessels are clamped, then ligated (tied off) with suture material before they are severed. Once the tumour is removed and all of the bleeding is under control, the incision is closed in 2 layers (the subcutaneous layer and the skin layer).

Many types of mammary tumours exist, each one carrying a different prognosis for survival, and a different course of treatment. Tumours may be benign (non-cancerous) or malignant (cancerous). Martha’s biopsy results came back as a low grade mammary adenocarcinoma. Although this type of tumour is malignant, it has a low chance of metastasis (spreading to other organs and tissues in the body), and surgical removal appears to be curative. Other types of malignant or aggressive tumours may require chemotherapy following surgery in order to increase the chances of survival. The best way to prevent mammary tumours is to spay your dog prior to her first heat – dogs spayed following their second heat have a 4-7 times greater chance of developing mammary tumours later in life.

Martha has been doing great since her surgery and is able to run and play like she used to!

Other surgery photos:

 

 

Foreign Body Surgery

By | Case Of The Month

Daisy

Daisy is a 6 year old, female West Highland Terrier. Shortly after Christmas, Daisy began vomiting, stopped eating, and was seeming very lethargic at home. Unsure of the cause of Daisy’s illness, Daisy’s owner brought her in for examination.

When Daisy was examined, she was dehydrated and seemed very tense when her abdomen was palpated. Although Daisy’s mom doesn’t normally feed Daisy any table scraps, or human food, with so many guests visiting her home for the holidays, she wasn’t sure what Daisy may have gotten into! Bloodwork and radiographs (xrays) were recommended and Daisy was admitted into hospital for IV fluids (to treat her dehydration) and supportive care.

Daisy’s radiographs showed a suspicious pattern of gas in her intestines. When a dog ingests a foreign object or ‘foreign body’ that is unable to pass through the gastrointestinal system (such as a toy, rock, part of a blanket or clothing, etc), it may cause an obstruction. An obstruction may show up on radiographs as a build-up of gas in the blocked portion of intestine. In order to confirm the presence of a foreign body, a patient is fed a liquid called barium, a radioopaque dye that shows up on an xray to outline the problem area. In Daisy’s case, the barium showed there was an obstruction present in the small intestines, and an exploratory surgery was recommended in order to evaluate and remove the foreign body.

Radiograph of intestine showing barium dye (bright white material) and pockets of gas (black areas in intestines).

During surgery, a thick, firm foreign body was located in the jejunum, the middle segment of the small intestines, between the duodenum and the ileum. The jejunum surrounding the foreign body was red and inflamed, and the tissue directly overlying it was black and thinning, indicating necrosis, or dying tissue. Unfortunately, once a piece of tissue has undergone necrosis, it can no longer heal itself and has to be removed. An intestinal anastomosis was performed on Daisy – a procedure during which a piece of intestine is removed, and the two healthy ends are sewn back together. This procedure removed not only the offending foreign body (which was a piece of Daisy’s toy), but also the necrotic tissue. If necessary, dogs can survive after removal of up to 65% of small intestines without long term consequences. Fortunately for Daisy, she only had about a 6-8” segment removed!

Area of intestine that contained the foreign body. Note the area of blackened/thin tissue lying over the toy found in the intestine. This is the area of necrosis.

Piece of toy found in Daisy's intestine

Daisy has done great since surgery! She’s home, eating her normal diet with gusto and hasn’t had any vomiting since the surgery!

Atopy/Allergies

By | Case Of The Month

“Molson” , a 2 year old, male Labrador Retriever, was surrendered to Labrador Retriever Adoption Services by an area shelter after a six month stay there. He was surrendered by the shelter due to a chronic skin condition that was not responding to the minimal treatment the shelter was able to provide. When Molson first came to us, he had a very thin hair coat all over, and was bald in multiple spots, including his chest and abdomen, around his eyes, and on the insides of his legs. His skin was very red and irritated, and he had multiple areas of deep scratches, where he had attempted to relieve his pruritus (itchiness) by scratching on his cage door.

In order to evaluate all that was going on with Molson, we decided to perform a complete dermatologic work-up which consists of bloodwork, and multiple tests on his skin. When a pet is pruritic (itchy), there are many possible causes (such as food or environmental allergies, fleas or other ectoparasites, fungal or other infections, etc.), so it is very important to rule in and out some of the possibilities in order to determine the best treatment plan.

Molson’s bloodwork came back essentially normal, aside from an elevated white blood cell count, which is indicative of bacterial infection. His bloodwork indicated that his liver, kidneys, and pancreas all seemed to be working normally, and that his thyroid gland (often associated with skin problems) was healthy.

Multiple tests were performed on Molson’s skin:

  • Skin scraping: A scalpel blade is run along the skin to obtain skins cells and tissue. We then view under the microscope looking for ectoparasites such as Sarcoptic mange mites (scabies), and Demodectic mange mites
  • Impression smear: A microslipe slide is pressed against the skin to collect skin cells, any bacteria that may be present, etc. This works best in moist or oozing areas. The slide is then stained with special stains and viewed under the microscope.
  • Tape prep: Tape is pressed against affected areas of skin to pick up skin cells, bacteria, yeast, etc. The tape is placed on a microscope slide, stained and viewed.
  • Ear cytology: Infected ears typically produce a lot of debris. This debris is swabbed, smeared onto a microscope slide, stained, and viewed looking for bacteria, yeast and white blood cells.

Molson’s tests didn’t reveal the presence of any parasites, but there were large numbers of bacteria and yeast both on the skin, and in the ears. This indicates a bacterial and fungal infection, which was likely secondary to atopy, or allergies. As mentioned above, atopy results in pruritus, and excessive scratching occurs. This scratching causes microabrasions, or tiny cuts in the skin, allowing bacteria and fungus from the environment to enter. These infections intensify the scratching, and a cycle starts. These infections may also be the source of the odour that many owners complain about in their itchy dog.

Molson was immediately placed on antibiotics, antifungals, and a corticosteroid. Corticosteroids are commonly used in allergy cases, in order to eliminate the scratching and allow the pet to have some relief, and the skin to heal. Molson was also bathed in a medicinal shampoo, and was scrubbed in his problem areas daily with an antifungal wipe. An immediate improvement was noted in his comfort level! Over the next several weeks, Molson’s skin gradually improved, the redness disappeared and hair started to regrow! He has since been adopted, and although he will likely always have to take medication to control his allergies, he is a much happier, and much hairier dog!

 

 

Heartworm Positive Dog

By | Case Of The Month

‘Lola’ is an approximately 4 year old, female mixed breed dog who was picked up by a shelter early this year.

As part of routine screening, ‘Lola’ had a heartworm antigen test, and her test came back positive! A heartworm antigen test is a very sensitive test that detects the presence of adult heartworms, so a positive result means heartworm infection! Although (fortunately!) Lola was not showing any clinical signs, treatment was recommended because untreated heartworm disease can lead to major complications, including death.

Following a heartworm antigen test, a filter test is run to check for the presence of microfilaria (heartworm larvae) in the bloodstream. The standard treatment for heartworm infection involves killing off the adult worms. Since the microfilaria will eventually mature and form adult heartworms, it is important for us to also provide treatment to kill off the microfilaria if we find them to be present. Lola’s filter test came back positive with a whopping 3 160 microfilaria per 1 ml of blood!!

In order to formulate a treatment plan, a positive heartworm patient needs to be classified into Class I (virtually no clinical signs or changes on x-rays), or Class II or III (moderate to severe clinical signs, and evidence of heart and lung damage on x-rays). Since Lola was not showing any clinical signs and her radiographs (x-rays) were normal, she was classified as Class I. Heartworm treatment consists of 2 or 3 injections (depending on disease severity) of Immiticide, a medication that works by killing off adult heartworms. Patients must be strictly rested for 4-6 weeks following treatment because of the risk of pulmonary thromboembolism (blood clot to the lungs) occurring secondary to the dying worms. Following Immiticide treatment, Lola was placed on Heartgard, a medication generally used as heartworm preventative that kills of the microfilaria (larva), preventing them from developing into adult heartworms.

Lola is doing very well post-treatment, and we will be following up with heartworm antigen tests in the months to come. She looks forward to finding her ‘forever home’ and remaining heartworm free for the rest of her days!

What is heartworm and how is it transmitted?

Heartworm is an internal parasite that affects dogs, and less commonly, cats. While many internal parasites of animals live in the gastrointestinal system and are detected in the stool, heartworm larvae live in the bloodstream, with adults living in the pulmonary (lung) blood vessels and the heart. It is transmitted from dog to dog by mosquitoes. A mosquito bites an infected dog, and ingests some larvae along with the blood meal. Over the next 3-4 weeks, the immature larvae develop into a stage capable of infecting another dog. The mosquito then bites an uninfected dog, transmits a small amount of saliva with the bite, and in turn, infects the dog with heartworm larvae. Over the next 5-7 months, the larvae develop into adult heartworms, and inhabit the heart and blood vessels.

What are the clinical signs of heartworm disease? How would I know if my pet had it?

Clinical signs of heartworm disease can vary greatly. Coughing and exercise intolerance (tiring easily while walking or running) occur due to damage to the lungs. Lethargy, cachexia (severe weight loss) and a swollen abdomen may occur secondary to heart failure. Your veterinarian may notice tachycardia (increased heart rate), hepatomegaly (an enlarged liver), pale mucous membranes (gums), weak pulses and/or increased lung sounds.

On the other hand, as was the case with Lola, a dog infected with heartworm may not show any clinical signs. A dog can have a moderately severe infestation and still act, exercise, and breathe normally. Although these dogs will eventually develop enough adult heartworms to demonstrate many of the signs described above, a routine screening test may show a positive result before any signs are seen by the owner. This is why yearly testing is so important, even if your dog is on regular heartworm prevention. While finding and treating heartworm disease early is important, preventing heartworm disease all together is, by far, the best option for your pet!

Watch the video below:

‘wet mount’ of Lola’s blood containing Microfilaria Video

microscopic microfilaria……

Sam – Cystotomy

By | Case Of The Month | No Comments

Sam a 9 year old Domestic Shorthair cat presented to our hospital for increased drinking. We obtained a detailed history from the owner that indicated that there were no changes in diet, litter or the environment. On physical examination and bloodwork no abnormalities were noted. We did an ultrasound of the urinary bladder and noted an abnormal density within the lumen of the bladder. We then obtained urine from the bladder and performed a full urinalysis. The urinalysis report indicated the presence of blood in the urine, calcium oxalate crystals and a trace amount of protein. Overnight there was no bacterial growth. Our next step was an abdominal radiograph. As the images below illustrate – there is a large solitary density within the urinary bladder – a cystic calculi or bladder stone.

Sam was admitted to Southdown Animal Clinic for a cystotomy which is surgery performed to remove cystic calculi from the urinary bladder. Sam was on intravenous fluids throughout the procedure and had a urinary catheter placed in the urethra. An incision was made into the urinary bladder and the cystic calculi was removed without complications. The calculi as pictured below is 13 mm round and 7 mm tall with multiple sharp and rough edges that lead to irritation and inflammation of the lining of the urinary bladder.

The surgeon closed the incision with a double layer inverting suture pattern using absorbable suture material to provide a watertight seal. We flushed the the catheter to make sure it was free of any debris. Sam recovered well from the procedure. Since surgery Sam is urinating well and is back be being playful and purring!

Urinary problems in cats can be characterized by one or more of the following signs: increased urination, straining to urinate, blood in urine, increased frequency of urination, vocalizing when urinating, inappropriate urination and a blockage of the urethra preventing urination. Causes include inflammation of the lower urinary tract especially the bladder wall due to the formation of crystals or stones obstructing the passage of urine. As crystals are made up of minerals, too many minerals in your cat’s food can increase the chance of developing them. Crystals can clump together to form stones causing inflammation and pain. In male cats especially, the stones can completely obstruct/block the urethra preventing the cat from urinating – this is a potentially life threatening situation. Being overweight, not getting enough exercise and stress can also contribute to urinary problems. Now that the stone has been removed Sam has been started on a new veterinary diet formulated to prevent the reoccurence of crystal/stone formation. The diet is designed to reduce the mineral building blocks in food. It also changes the acidity of the cat’s urine to aid in dissolving some types of crystals. Sam’s new diet has an increased level of omega-3 fatty acids that help soothe the bladder as it heals. Sam is enjoying his new diet and we will do follow up urinalysis’ to monitor his progress. The calculi has been sent to the laboratory for analysis and we will post the results as soon as they are available.

 

Freddy – Upper Respiratory Tract Surgery

By | Case Of The Month

We first met Freddy, a French bulldog, as an 11 week old puppy. On physical examination the only abnormalities noted were a low grade respiratory infection and stenotic nares. Stenotic nares are congenital malformations of the nasal cartilages such that the nostrils appear pinched together with abnormally narrow openings. Stenotic nares are part of a condition called brachycephalic airway syndrome (BAS) commonly seen in breeds like English Bulldog, French Bulldog, Boston Terrier, Pug, Pekingese, Lhasa Apso, Shih Tzu, Sharpei, Boxer.

The primary components of brachycephalic airway syndrome (BAS) are a combination of stenotic nares and soft palate elongation. The secondary components may include everted laryngeal saccules, laryngeal collapse, redundant pharyngeal tissue and enlarged tonsils. These findings are found singularly or in various combinations and degrees – age is a major factor. Breeds with BAS tend to present with some or all of the following concerns – noisy and difficult breathing, retching or gagging up of phlegm, trouble swallowing, exercise intolerance, restless sleeping and in severe cases collapse. These signs are worse in situations of excitement, stress and increased heat and humidity. Early treatment of the primary components of BAS will provide healthy breathing and reduce the probability of the secondary problems developing.

Freddy was admitted to Southdown Animal Clinic at six months of age for an orchiectomy (neuter) and BAS surgical correction. With a general anesthetic we were able to evaluate the upper airway structures in detail to determine a course of action.

1. Freddy had stenotic nares – a 50% reduction in nasal opening radius will result in a 16-fold increase in resistance to airflow – so we surgically removed a ‘V’ shaped wedge of nasal cartilage from both nares creating a wider passage to allow for an improved airway. This will make a significant improvement to the quality and quantity of Freddy’s breathing.

2. Freddy had everted (prolapsed) laryngeal saccules which is Stage I laryngeal collapse. Prolapsed laryngeal saccules appear as shiny, white, convex structures protruding into the airway by the vocal cords, this leads to increased effort required to achieve optimum airflow into the trachea and lungs. This is a condition that worsens over time. These structures were surgically excised.

3. Freddy’s soft palate appeared normal with the end just covering the tip of the epiglottis, so no surgical intervention was required.

4. Freddy’s orchiectomy was successfully performed.

Freddy has returned to the clinic for his follow up visits and he has recovered remarkably well. Surgical intervention at a young age is going to allow Freddy to have a much more comfortable and easier breathing system and he has retained his good looks!

Barclay – Cuterebrosis

By | Case Of The Month | No Comments

Barclay is an 11-year old miniature Schnauzer who presented to our hospital to have a ‘lump’ assessed. On physical examination there was a firm, painful swelling that measured 3cm X 3cm on the right lateral flank. There was a small opening in the center of the ‘lump’ with purulent and bloody discharge present.

The affected area was shaved and lidocaine (a local anesthetic) was administered under the skin. The small opening was then made larger using a pair of surgical hemostats. At that time we noted ‘movement’ under the skin and we were soon able to visualize a live larva. A small pair of forceps was used to remove the larva – it is important not to squeeze the lesion because this may rupture the larva and lead to a chronic foreign body reaction and secondary infection. The area was thoroughly flushed with sterile saline and antibiotics were administered to treat the infected area.

Adult female Cuterebra flies lay eggs on blades of grass or in nests or burrows of rodents (eg. rats, squirrel, chipmunks) or lagomorphs (eg. rabbits, hares). A female fly may lay up to 5-15 eggs per site and over 2,000 eggs in her lifetime. The eggs hatch and crawl onto the skin of the passing animal host. The small larvae enter the host through the mouth or nares during grooming or through an open wound. The larvae then migrate through various internal tissues until they form a warble, a subcutaneous area under the skin containing the larva. The larva communicates with the outside via a breathing hole in the skin.

Cuterebra lesions are most common in the summer and fall. Dogs and cats usually present with a firm, painful swelling of the skin with a hole in the center as Barclay did. This is considered the dermatological presentation involving the skin and underlying tissue only. The larva can migrate to the respiratory, neurologic or ophthalmic systems causing signs like coughing, paralysis or blindness. These are more severe presentations with different treatment options.

Barclay returned for a follow-up examination in 7 days. The swelling had decreased and the skin in the area had granulated in and healed.

 

 

Rabbit Eye

Bunny Maestre -Rabbit with a Blocked Tear Duct and secondary dermatitis.

By | Interesting Cases | No Comments

Bunny Maestre is a 3 year old, male neutered, cottontail rabbit who presented to us with epiphora (chronic tearing), conjunctivitis (inflammation of the conjunctiva) and inflammation of the tissue (skin) adjacent to the right eye. The condition originally responded to topical eye medication but over time the right eye progressively reddened and the skin surrounding the eye was wet and irritated.

Bunny Maestre’s eyes were swabbed and cultured to test for bacteria. Blood was taken and tested for the DNA of Pasteurella, Staphylococcus and Bordetella Bronchiseptica. His results confirmed a positive infection of Bordetella Bronchiseptica. Along with topical eye medications, Bunny Maestre received two injectable antibiotics on a regular basis to help with the underlying systemic infection. Radiographs were taken and abnormal nasal sinus cavities were noted. The abnormalities of the sinus cavity typically represents damage/change or possible infection of the bones in that area. Based on the radiographs and clinical presentation we diagnosed blocked tear ducts causing the excessive tearing.

Bunny Maestre was placed under a general anesthetic and the tear ducts were evaluated for both eyes. The left eye’s duct was patent and flushed readily. The right eye’s duct was completely blocked approximately 2 cm from the opening of the eye. With special instrumentation we were able to break down the scar tissue blocking the tear duct and reestablish excellent tear flow. Within a week, Bunny Maestre’s right eye had no discharge and the skin surrounding the eye was dry and no longer red.

One month later, Bunny Maestre was off all medications and the skin around his right eye had normal hair growth. His epiphora has been resolved successfully.