Midge is a 5 year old spayed female Yorkshire Terrier mix that has had prolapsed glands of the third eyelid for 3 years. The prolapsed gland appears as red masses (also know as Cherry Eye) that protrude from behind the third eyelid( Midge in pre:surgery photo).This gland is vital for aqueous tears. Surgical replacement of the prolapsed glands of the third eyelid was reviewed with the owners in detail before proceeding with surgery. The advantage of the Modified Morgan Pocket technique is that it allows the third eyelid to move normally after surgery. There are a number of key fundamental steps to ensure optimum success with this procedure including attention to detail suturing and innovative thinking. It is important to note that Surgical Treatment For Dogs with Nictitans Gland Prolapse of several months’ duration has a less favourable prognosis for success. We fully discussed the benefits of surgery with the owners and the possibility of unsuccessful results. We always approach these cases with favourable outlook and with goal of excellent results. Surgery was performed in our surgical suite at our Mississauga Hospital (Southdown Animal Clinic) on October 07, 2016.This technique uses the scar tissue of the subconjunctival to hold the gland in place. Things that must be considered for a successful outcome: 1) Schirmer tear test-that measures that for adequate tear production is still good ( greater than 16 mm/minute ). 2) Use of topical steroids for 1 to 3 months to reduce inflammation and swelling of the nictitans gland before surgery. 3) The sooner surgery is done after obvious prolapse of the glands the higher the success rate. We are always reluctant to unequivocally state that something is beyond hope no matter how chronic. There are a tremendous number of variables that enter into the picture. 4) Attention to detail in surgery. 5) The bodies ability to heal. 6) With the Pocket Technique once the gland stays down for 30 days then it most likely will stay down permanently 7) The breed of dog maybe a factor; for example, the British Bulldog may have a higher failure rate. The owners comments on the last follow up at 6 weeks post surgery: “It is the first time in many months that Midge has been able to sleep with her eyes closed!” Midge has done amazing well with perfect vision up to the time of this update September 2017.
Canadian Chinchilla Rescue (Canada) It all happened Summer 2014 when an 80 gram chinchilla came to us at Southdown Animal Clinic under the guiding care of “TLC” an individual with Chinchilla Rescue, Canada. Jasper was just a baby Chin, D.O B. April 19.2014 with a big problem! The left front leg was useless/non-functional with no blood or feeling in the lower extremity. This most likely would have been the result of limb entrapment (strangulation). These guys are very gregarious and the environment must be safe. Our clinical finding was a strangulated/devitalized left front leg with no chance of recirculation. The recognized descriptive diagnosis would be gangrene. The only chance for survival and a future was major surgery. Authorization to proceed was given for live saving surgery which meant a complete limb amputation. Key Points: 1) Chinchillas are very active acrobatic animals and require lots of safe space/housing for play, climbing, jumping etc.. 2) Everyone deserves a chance to experience the beauty of life. 3) The advances in modern day medicine in the areas of anesthesia, pain management, current therapies and the competency/skill of the surgical team makes anything possible. 4) Youth, age, mini size should not be a deterrent -do no harm and just do it! 5) Conversation in August 2015 with TLC speaks to the success and the great uninhibited life that this nearly 500 gram individual lives. A more recent conversation in April 2016 with “TLC” indicates that for this individual it is all great!
We are please to share Peika’s ( a Shih Tzu, female, D.O.B. April 15, 2006 ) and Rue’s story (a Coton De Tulear, female D.O.B September 13, 2011) who both have experienced thoracolumbar disc disease with spinal cord compression, pain, hind leg paralysis and expedient recovery after back surgery here at our Mississauga Hospital/Clinic. Surgical intervention was the best choice for both these dogs as both had been staged Grade 4 paraplegics. This means the inability to move hind legs (non ambulatory) but still with nociception in place (the ability to feel pain). Surgery within the shortest time period 24 to 72 hours after the acute insult and major neurological dysfunction gives the best prognosis for a full recovery. This is what happened here in both these pets. The ability to stand followed by the ability to walk somewhat was within 24 hours to 5 days in Peika’s and Rue’s cases respectively.
Rue and Peika are typical family pets who live great lives, live for the moment, cherish exercise and thrive on family affection.
Note: The #’s below correspond to findings on Rue’s survey radiographs above.
The survey radiographs of both patients have evidence of disc disease as follows:
1) Narrowing of the disc space
2) Narrowing of the intervertebral foramen
3) Collapsing of the articular facet(s)
4) Increase density (calcified disk) of disk material at the site or adjacent disk spaces
The myelograms of both patients are excellent and identify the problem area precisely:
1) Dye in the columns which is in the subarachnoid space (meninges) around the spinal cord.
1) Elevation of the dye in the ventral column
2) Narrowing or absence of contrast material through the ruptured disc area
In both these cases we were able to not only identify the problem area on survey radiographs but confirm precise compression of the spinal cord using contrast dye by performing a L4-5 lumbar myelogram. Surgical dorsolateral hemilaminectomies + fenestration of the specific problem disc were performed immediately following confirmation in both cases.
Video 1 show Rue with no ability to walk minutes before having her back surgery.
Video 2 shows Peika 48 hours after back surgery with the ability to stand and take steps forward.
Video 3 shows Peika 21 days after back surgery demonstrating mobility without pain.
-Chondrodystrophoid breeds of dogs such as Rue and Peika are more prone to disc disease.
-Grades 1 and 2 are good candidates for conservative/medical management including the use of Class IV laser therapy
-All severe Grade 3,4,5 disc cases should be regarded as surgical emergencies
-Neurological grading of disc disease is one critical determinant as to the ideal treatment plan.
Grade1-no deficits/pain only, reluctancy to move
Grade 2-paresis/walking-wobbliness with mild ataxia but does not fall
Grade 3-paresis not walking, falls, an inability to bear weight
Grade 4-paraplegic with deep pain sensation,cannot move legs (no motor function) even when supported (non ambulatory), urinary incontinence
Grade 5-parplegic with no pain sensation (nociception)
It is always very exciting for our caring staff at both our Southdown Animal Clinic and Oakville Animal Clinic to see legs moving, a pain free status and ultimately the ability for the pet to “walk the line” again with their love ones.
It has been nearly one year since Rue had surgery for a compressed spinal cord. We are please to provide the client’s update.
“We were just talking today about how it is coming up to a year that she had her surgery. We can’t thank you enough for all that you have done for her. You would never know that a year ago she couldn’t walk. Her recovery has been incredible. We are so happy and grateful to have her still in our lives.”
Mack is 5 year old male neutered British(English) Bulldog who has always exhibited all the enthusiasm for life that this breed is known for. In the last few years this level of joy had become markedly muted as his breathing became progressively difficult with any degree of exercise or excitement. This summer the owner noted that Mack’s respiratory distress had become more troublesome and appreciated that something had to be done to help Mack.
On presentation to Southdown Animal Clinic Mack’s symptoms were classical of advanced brachycephalic airway disease with stridorous/sterterous breathing, exercise intolerance, frequent retching, choking and gagging up of phlegm, with anxiety and restlessness after any form of exertion. After a full physical examination we performed blood work and radiographs of Mack’s larynx and thorax. Mack was admitted to our hospital for upper airway surgery. Once under general anesthetic we were then able to evaluate the upper airway structures in greater detail to determine the degree of pathology and take an appropriate course of action.
The major findings were as follows:
1) Severe stenotic nares, as pictured above, creating a resistance to airflow
2) Elongated soft palate – approximately 6.0 cm too long
3) Everted laryngeal saccules blocking the lower rima glottis
4) Stage II and Stage III laryngeal collapse
There was no significant redundant pharyngeal tissue, the tracheal diameter was good with no evidence of collapse and the tonsils were within their respective crypts.
Surgical intervention was as follows:
1) Stenotic nares – A combination of a vertical wedge technique and horizontal removal of alar wing tips
2) Everted saccules – Removal of everted tissue-see more recent photo showing #2 and # 4 in the article “Smelling the Roses and a whole lot more after early brachycephalic surgery”.
3) Soft palate – Shortened the elongated soft palate by about 6 cm (> 3.5cm is a lot of redundant soft tissue sucking into glottis on inspiration and back up into the roof of the mouth on expiration) just to cover the tip of the epiglottis
4) Laryngeal collapse – Transect the folded tissue (on one side only) that was obstructing the entry to the glottis which leads directly to the trachea
As brachycephalic airway syndrome progresses many of the secondary components of the disease are irreversible. Mack’s recovery has however been excellent as best described by the owner’s comments (also note the increased size of Mack’s new nares!):
“Mack is much happier and has more energy. He is sniffing more when outside and now enjoys being outdoors. He has the ability to be included in activities for hours not just minutes and loves going to the leash free park. After the leash free we can’t hear him breathing. He still pants after exercise but no longer has stressed breathing. Mack has a much quicker recovery after activity with no vomiting, choking or gagging. Mack is now able to lie down and rest comfortably, something he could not do in the past after any exertion. It is the best thing we ever did for him- we should have done it earlier!”
Note: That the tissue pinkness just inside the wider nasal opening will re-pigment.
Update: In October of this year 2013, the owners say Max now 7 years old has been given extra years of quality life since upper airway surgery 2 years ago at Southdown Animal Clinic in Mississauga.
Update: Max just had his Annual Health Examination and Screening Test at our Mississauga Hospital in May 2015. He remains healthy with the ability to breath without distress.
Mack lived a very rewarding active life after having airway surgery. It was in the late summer age 11 years, 2017 that he departed with unrelated critical illness.
Brachycephalic Airway Syndrome (BAS) is a result of many soft tissue factors directly related to design with shortened skull bone length . Various breeds are recognized as brachycephalic including Boston Terriers, Shih Tzus, Boxers, English and French bulldogs, Lhasa Apsos, Pekingese, Pugs and Shar Peis. It should be noted that not all brachycephalic breed dogs suffer from this syndrome. Bulldogs are usually the most severely affected.
The primary soft tissue abnormalities are stenotic nares and soft palate elongation. The secondary changes include eversion of the laryngeal saccules (Stage 1 laryngeal collapse), further elongation of the soft palate, tonsil enlargement, more advanced irreversible laryngeal collapse and often gastrointestinal symptoms. These changes can be halted by early surgical correction of the primary airway obstructive problems. Stenotic nares may be the only issue that needs correction.
Stenotic nares is a congenital abnormality where the nostril diameter is diminished and therefore reduces airflow as the pet breathes. BAS is a progressive disease and the best treatment is an early treatment. Air passage through the nasal cavities accounts for approximately 75 % of total airflow resistance in dogs. It is a known fact that a 50 % reduction in tube radius (the narrow nasal opening ) leads to a 16 fold increase in resistance to air flow. (Poiseuille’s Law)
BAS individuals may have laboured breathing example, snorting, noisy breathing, gagging etc….. as they struggle to obtain sufficient oxygen. The reason this occurs is due to the excessive negative pressure that occurs with every breath they take. With their airway pathway being reduced, the individual exerts this negative pressure during inspiration in attempt to maintain air flow which distorts the pharyngeal tissue. This results in a vicious cycle of more tissue stretching, swelling and more severe laryngeal collapse. It just goes from bad to worse!
Here are two recent surgical cases that have been performed at our Mississauga hospital that have greatly benefited from early corrective upperairway surgery! In the majority of cases once corrective surgery has been performed, the dog has carefree, effortless breathing with a much more active, healthier lifestyle.
1) Wyatt is a male, neutered, English Bulldog, who had BAS surgery when he was 7 months old.
Structural findings were as follows: (All these features are visible in the photos)
+severe stenotic nares ( surgical correction)
+laryneal saccule evertion/Stage 1 Collapse ( surgical correction)
+Inwards position of the aryepiglottic folds/Stage 11 Collapse)
+normal length to soft palate with a deformed shortening on the left side.
- A view of Wyatt’s Larynx during surgery
Wyatt’s photo clearly demonstrates that his good looks will forever be adorned.
2) Oliver is a male, neutered, French Bulldog, who had BAS surgery when he was 5 months old.
Structural findings were as follows:
+severe stenotic nares (surgical correction)
+laryngeal saccule evertion (surgical correction)
+enlarged tonsils (common)
+normal length soft palate
In this photo Oliver’s nose has completely re-established pigmentation 2 months later.
It is expected that both these pets will do very well in life now that corrective surgery has created a good airway!
Time does fly when every day counts. Both these dogs have maximum activity and ability to breath-September 2017
1) Owners always comment that after surgery as in the case of Wyatt and Oliver smelling everything is a new found gift.
2) People always say that they are surprised that their dog doesn’t make any noise when he/she breathes.
Pleased note that these advanced airway surgeries are done at both our animal hospitals in Mississauga and Oakville.
Our health care team at Southdown Animal Clinic in cooperation with Wyatt and Oliver and their respective parents are proud to share their success stories.