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Ear Tumor ( Kitten): Surgery

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Harry is a happy and thriving 2 year old male neutered Abyssinian cat. When we first saw him and his brother Ryley for their first kitten appointment in November 2013, he was not doing quite so well. Harry presented with a bad eye infection, nasal congestion and discharge, and an ear infection. On physical exam we noted that there was an infection in both eyes and inflammation in the left eye. The nasal discharge and congestion were worse on his left side, and the ear infection present affected the left ear only. Once the debris was cleaned away we could see a fleshy, lobulated structure deep in the canal: this is called an aural polyp (Ear Tumor). In this case we suspected a viral cause based on his combination of signs and the particular concerns with his eyes. Harry was put on antibiotics to control secondary infections of his upper respiratory tract and ear, and antibiotic drops for his eyes. He was also put on some antiviral therapies to mitigate the viral component of his issues. The polyp in his ear continued to grow with time, totally blocking the  canal so surgical removal of the polyp was recommended.

Harry underwent surgery at our Mississauga (Southdown) hospital to the remove the tumor (polyp) inside his left ear by a procedure called a Ventral Bulla Osteotomy (VBO). This a very detailed procedure in which an incision is made at the base of the bony structure of the ear, just behind the lower jaw. The sensitive muscles, blood vessels and nerves that supply the head and face must be dissected very carefully to access the bony base of the ear canal (bulla). Once this landmark is reached special instruments are used to open the bulla which then allows access to the middle ear. A swab is used to take a sample of the internal contents (including pus) and is submitted for culture. In Harry’s case pus, necrotic debris and the stalk of the polyp were found in this location-the middle ear. Culture of the fluid showed mycoplasma-like species. The stalk of the polyp was cleanly transected within the delicate middle ear and the entire mass was freed to be removed through the external ear canal. The bulla was scraped clean with mini curette/small osteotome then lavaged several times with saline and the overlying muscles, subcutaneous tissue and skin closed with sutures. The opened area in the bulla is left open permanently and a special drain is placed temporarily to facilitate healing.

Ear Tumor: Surgery VBO

Ear Tumor dissected free of the middle ear and removed through the outer ear

 

Harry spent the next few days in hospital then was sent home for his owner to continue care. He bounced back, and has not looked back since.

Our clients have provided the following comment for this article in December 2015 and an brief overview of the experience: “Harry is now 2 years old and a vibrant mischievous boy that is the love of our lives. Although Harry’s early days were extremely difficult, fraught with numerous visits to the clinic, near death experiences and several surgeries, through all of this we never gave up hope that he would survive this ordeal. He has flourished with the tireless care provided by his family and the dedication by the talented Southdown Veterinary Team!

Key Points:

1) Polyps are uncommon in cats

2) In young cats (<2 years old), they are usually associated with an underlying virus

3) Polyps can grow in the ear, nose and throat

4) Polyps are usually benign (non-cancerous) fleshy growths that are infiltrated with inflammatory cells

5) They usually cause copious amounts of pus to be produced and are associated with a secondary bacterial middle ear infection

6) Polyps can also cause nasal discharge, sneezing, pain, voice change and other symptoms

It has been approximately 1.5 years since Harry’s major ear surgery, following 3 to 4  months of health problems as a kitten. Harry and his brother visited our clinic/veterinary hospital for their Annual Health Check in early December 2015 and received excellent health reports. This video shows the beauty of the individuals and their preparation for the trip home from the veterinarian’s.

Anal sac removal in a cat–who is so much happier now!

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Marcus, a 7 year old domestic medium hair cat, is a feisty orange and white boy belonging to Dr. Letic who had a history of anal sac problems. These problems started when he was young: he required regular manual expression of anal sac contents at least 2-3 times per year. At home, he would scoot (drag his back end along the floor) as a sign that his glands were full and that he felt uncomfortable. Over time he began to develop infections in the sacs, particularly the right side. In the fall of 2012, the right anal sac became completely impacted (blocked) and subsequently ruptured. Marcus was treated with antibiotics and anti-inflammatory medications which helped to heal the ruptured gland and surrounding tissue. The healing process however resulted in abormal scarring and complete blockage of the right duct. The only option left to treat Marcus was to have the anal sacs surgically removed. This surgery was done at Southdown Animal Clinic in Mississauga.Anal sacs are paired scent glands in dogs and cats located at approximately 5 and 7 o’clock just inside the anus. Each sac opens onto the margin of the anus through a single duct. Each sac is lined by numerous glands that produce a strong, foul-smelling liquid. A small amount of this liquid is normally expressed each time an animal defecates. Some material can also be released when a pet is startled or scared, or when they are extremely relaxed and happy. Risk factors for anal sac disease (i.e. inability to empty anal sac material normally) include obesity, abnormal anal tone, increased production/secretion of anal sac material, diarrhea and obstruction of the duct(s). Anal sac disease can lead to abnormal distension of the sac(s), infection, pain, discomfort and eventually rupture.

Due to Marcus’ history of chronic anal sac disease and the abnormal scarring and blockage of the right duct, the decision was made to surgically remove both anal sacs (bilateral anal sacculectomy). This was done after the infected/damaged tissue had healed. Pre-anesthetic bloodwork was done to ensure Marcus was a good candidate for anesthesia. He was given a  general anesthetic, started on intravenous fluids, with his breathing, heart rate and oxygenation monitored closely by our surgical team. After aseptic preparation of the surgical site, the location of the left sac and associated opening was confirmed by passing a special instrument through the duct. This was not possible on the right side since the duct opening was completely scarred closed. A small white scar was visible at this site, so a small incision was made around it. The entire right anal sac was carefully removed by gently separating it from the surrounding muscle and nerve tissue. The same surgical technique was used to remove the left sac. Closure of the surgical sites was accomplished with fine absorbable sutures. Post-operative pain medication, anti-inflammatories and antibiotics were provided. An E-collar (cone) was also placed to ensure Marcus could not lick or chew the incisions.

Marcus was kept in our Mississauga Hospital for a few days after surgery to ensure that he was able to urinate and defecate without any problems. He was monitored closely for fecal incontinence. At the time of release from the hospital, Marcus was using the litterbox well and was not experiencing any incontinence problems. Since going home he has stopped scooting, uses the litterbox properly, and overall feels much more relaxed and comfortable. Not only is Marcus a happier cat, his human family is happier too!

We have had several other patients undergo anal sac removal at our Mississauga hospital over the past couple of years. These have included both dogs and cats. The canine patients were primarily German Shepherds who had recurring problems with infections/chronically open wounds called a “fistulas” (most often described as Anal Furunculosis) that did not heal properly without extensive lifetime medication. Once the anal glands glands were healed (Intact before surgery) and removed, these dogs had much more energy, were significantly more comfortable and no longer required any medication to manage their infections and  inflammation.

The cats that had their glands removed also suffered from recurrent infections, inflammation and chronic discomfort. Once their glands were removed, their owners were surprised at how much more comfortable they were. These cats were also able to discontinue all medications required to manage their anal sac problems and were overall much more social, energetic and happy at home. One cat, Sam B., did so well after surgery that his family described him as becoming a “brand new cat”. His owners truly felt that the decision to remove his glands was “the best thing we ever did for him”.

Anal sac removal can be a very rewarding, beneficial  procedure for the right patient. Do not hesitate to ask us if your pet might benefit from this surgery!

Anal sac removal-right side

Anal sac removal-right side

Right anal sac removed
 
Right anal sac removed
 
Marcus relaxing at home
Marcus relaxing at home

 

 

Dislocated hock joint in a 4-month-old Guinea Pig

By | Case Of The Month | No Comments

“Dexter”, a 4-month-old male guinea pig, came to us one day for assessment of a leg injury. His owner noticed that his right hind leg was very swollen and painful to touch, and he had a very pronounced limp when he walked. A full physical examination was done: “Dexter” was bright and alert but had a very swollen and bruised right hind limb. The swelling and bruising extended from his foot to just above the hock (tarsal) joint. The hock joint is equivalent to a person’s ankle joint. No fractures were palpated, however there was grinding in the tarsal joint with flexion and extension. We recommended xrays of “Dexter”‘s leg and his owner consented. Xrays were taken of both hind legs, focusing on the tarsal joints and digits. The xrays showed that “Dexter” had a partial dislocation of the right tarsal-metatarsal joint and moderate soft tissue swelling associated with this injury.

We discussed a few different options with “Dexter”‘s owner to manage his injury and we decided to place a splint on his right hind limb. The splint was composed of several layers: first a layer of tape was placed, followed by cast padding. Special conforming splint material was then custom fitted to his leg. These materials were then all secured with a final layer of special tape. His toes were left slightly exposed so that his owner could carefully monitor for any abnormal swelling or discolouration that could indicate a circulation or lymphatic drainage problem. During splint application “Dexter”‘s leg was held in extension (held

out straight) to make sure that the tarsal-metatarsal joint was properly aligned. “Dexter” was sent home with liquid pain and anti-inflammatory medication for his owner to administer daily.

“Dexter”‘s splint stayed on for 3 weeks and he adjusted very well to having it in place. The splint was removed and the anti-inflammatory medication was discontinued. At the revisit, the bruising and swelling of the right hind limb had resolved and he was using his leg well. Since that visit, “Dexter”‘s leg continued to improve and within another week he returned to full use of the limb.

We are all very happy with the outcome of “Dexter”‘s case, and we are grateful for his owner’s careful attention during his recovery!

 

Dexter at his revisit after his splint was removed.

 
Dexter at his revisit after his splint was removed.

Thyroid Cancer in the dog: Attention to detail and timing is Everything!

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We have been Missy’s health care provider for 11 years. She is a wonderful, gentle and intelligent English Springer Spaniel who represents joy and happiness at its very best.

Over the years she has lived a life enriched with infinite love and very few concerns. We have previously treated her for eye infections and a benign (non-cancerous) skin tumor.  Missy also had routine preventative dental prophies to maintain good oral hygiene.

On August 31, 2011 Missy visited our hospital with a swollen, inflamed and left hind paw. After taking a detailed history, the owner also mentioned she was drinking more water in the last few weeks and panting more often.  The owner authorized the appropriate diagnostics including a comprehensive blood profile to help investigate her increased drinking. Her annual wellness blood test was done in April 2011 and the results were normal -free T4 = 45.8pmol/L (thyroid value). However, now 4 months later she had an elevated free T4 which triggered an immediate concern with our veterinarians. Missy’s free T4 was 65.5pmol/L and the normal range in the dog is 7.7-47.6 pmol/L.  Additional testing revealed a very low thyroid stimulating hormone (TSH) which further supported an overproduction of levothyroxine (thyroid hormone by the thyroid gland).

On physical examination we found a mass in the area of the left thyroid gland.  Based on Missy’s blood results and palpable mass, our index of suspicion was very high that we were dealing with a serious aggressive thyroid tumor. Cervical (neck) ultrasonography and cytology was offered as part of the diagnostic work up.

The following steps were taken:

1) A detailed consultation with the owners outlined that thyroid masses in dogs are most likely a malignant tumor and are very invasive. Permission was given to procede with x rays and then surgery if there was no evidence of tumors in the chest.

2 The owners understood that surgical removal of a thyroid carcinoma is often  difficult because of the marked vascularity and the invasive nature of the lesion.  The good news is that despite the large size, the mass was freely movable on palpation and complications were expected to be minimal.

3) Pre-surgical thoracic (chest)  radiographs were done to evaluate her lungs and other thoracic structures for any obvious spread of the suspected cancerous mass into this area. The green light was on for surgery.

4) Surgical excision of the thyroid mass within the capsule was successful (Thyroidectomy-extracapsular technique).  The recovery was uneventful.

5) The pathologist reported a Thyroid follicular carcinoma and that the  tumor did not extend beyond the margins…this was very exciting information for ALL!

Key Points:

– Follow the symptoms: Missy’s increased water intake and more frequent panting truely were symptoms of this tumor. The majority of owners know their dogs normal patterns.

-Missy is an excellent example of why veterinarians obtain a detailed history and provide a thorough physical examination.

-Although no connection to the thyroid cancer it was the inflamed paw, a detailed assessment by our doctors, appropriate blood tests and going that distance that saved Missy’s life.

We have given Missy a very good prognosis that life will continue to be special in her senior years with the family.

Owners Comments 7 months post-surgery:

“We came with a totally unrelated problem.”

“It has been months and she is totally fine. ‘

“Missy always gets a complete body massage daily and we still did not detect the lump. This head to toe massage is a daily ritual and part of our quality time with her.

“Thank goodness we caught the cancer in time.”

“No matter how small things might appear to be….have it checked out even if it proves to be nothing at all.”

“We are so happy we still have our Missy!”

Update: April 2015-Missy remains healthy and has had only a minor vestibular crises in the past 6 months but has since fully recovered. Her only medication remains an immeasurable abundance of family love and a thyroid supplement daily.