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Case Of The Month

Exophthalmia Eddie Pug

This Is An Eye Popping Read!

By | Case Of The Month, Interesting Cases, What's New | No Comments

Eddie presented to Southdown Animal Clinic for his initial puppy examination and vaccinations at 14 weeks of age.  On physical examination our primary concerns included his eyes and his nostrils.  Eddie had shallow eye orbits causing exophthalmos (bulging of the eyes) such that he was unable to close his eyelids.  Since he was unable to close his eyelids his corneas were exposed at all times to the environment leading to abrasions on the surface of the eyes, redness of the conjunctiva and dryness of the surface of the eye.  There was also minimal tear production in both eyes.  Eddie had stenotic nares (narrow nasal openings) leading to difficulty with breathing.  Eddie was started on medications to treat the abrasions on his corneas and to keep the eyes lubricated.

Eddie was scheduled for surgery. We elected to do multiple procedures – neuter, stenotic nares correction and eyelid surgery.  Check out our other posts for details on stenotic nares surgery.  For surgical correction of the eyes we elected to do a tarsorrhaphy, which is a surgical procedure in which the upper and lower eyelids are partially sewn together to narrow the eyelid opening.  Once the eyelid opening is narrowed the cornea is able to heal.

As you can see in this photo Eddie’s eye is bulging out of the socket and the upper and lower eyelid are so far apart, hence unable to close.

The left eye has been surgically corrected by carefully suturing the upper and lower eyelid medially.  Great care must be taken to not incorporate the tear ducts into the suture line.

Both eyes have been surgically corrected.  As you can see the upper and lower eyelids are now closer to each other and once the swelling is gone he will be able to close them for the first time!

Eddie has a new face! He will now be able to blink and he will be able to breathe better now that his nares have been opened up.  This is Eddie the next day.  Both eyes and his nares were surgically corrected. He also got neutered. He is just so very cute!!!

Eddie recovered very well from his surgical procedures and is a happy puppy!

 

 

white dog with big ears

Wyatt and Oliver “Smelling the Roses” and A LOT MORE after early Bachycephalic Surgery

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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)

+enlarged tonsils

+normal length to soft palate with a deformed shortening on the left side.

A view of Wyatt's Larynx during surgery

A view of Wyatt’s Larynx during surgery

Wyatt Evans Pre Op WebNostrils opened surgicallyIt's my good looks that most people adore!

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

 

 

Oliver Batchelor Pre Op WebOliver Batchelor Mid Op WebOliver Batchelor Post Op Web

Oliver Batchelor Web

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

 

Key Points:

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.

 

 

 

 

 

 

 

 

 

 

 

Giving back to the community

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On September 8, 2013 the staff at Southdown Animal Clinic along with family, friends and our four legged companions participated in the Oakville & Milton Humane Society’s Mutt Strutt and Fall Fair.  Our team, The Heinz 57’s, walked 5-km and raised $1678.00 through the generous support of our family, friends and clients.  Our goal was to raise as much money as we could to help care for all the many amazing, loving souls that come into the OMHS’ care.  There is nothing better than a four legged friend.  They love with all their hearts and they make our lives better.  Anyone who has lived with an animal knows you can not find better love anywhere else! All the money raised goes toward Oakville & Milton Humane Society’s efforts to promote the Human/Animal Bond through adoption, education, prevention and protection emphasizing kindness, compassion and respect for life.  The event raised $32,000.00 – we look forward to doing this again!

Here are some pictures from the day and the names of the dogs who walked 5-km (and their humans!).  Oliver with Nancy & Matt, Sadie with Michelle & her children, Henry with Amanda & Brandon, Tina with Sammy, Mylo with Gabby, Lola with Schere, Cali with Chantal, Stanley with Ryan, Pupdog & Lilly with Samantha, and Cujo with Melissa & Karen.

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

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“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.

MJ – Bearded Dragon

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MJ a five year old female Bearded Dragon presented to Southdown Animal Clinic April 2012 for examination of a mass in her left axilla/lateral thorax area (armpit/chest).  The mass was round, soft, moveable and non-painful to touch.  The mass measured 1.5 cm around.  The owner elected to monitor the mass to make sure it did not cause any discomfort to MJ or impede mobility of her left fore limb.  MJ was reexamined in September 2012.  The mass had increased in size to 4.8 cm, was firmer on palaption and was affecting mobility.  On discussion with the owner surgical removal of the mass was determined to be the best course of action.

MJ was admitted to Southdown Animal Clinic for surgical excision of the mass.  A full physical examination and a complete blood profile were done and no abnormalities were noted.  MJ was sedated with a combination of drugs determined to be safe anesthetics for reptiles.  A local anesthetic was injected into the subcutaneous tissue around the mass to provide additional pain control.  During the surgical procedure oxygen and isoflurane gas by face mask were administred.  MJ’s heart rate and respiration were closely monitored by our registered veterinary technician.  During the surgery “the mass” was actually two masses adhered to each other – the first mass was 4cm X 4.5cm and the second mass was 3cm X 3cm.  Once the masses were excised the area was closed with absorbable suture material to decrease the space left behind by the masses being removed.  MJ recovered well post surgery.  This is a picture of MJ at Southdown Animal Clinic.  She had a card from her friend Oufer in her compartment to wish her well during surgery!

At MJ’s follow up visit her incision had healed very well and her sutures were removed.  According to the owner since MJ’s surgery she is more active, playful and is even eating fruits and vegetables she did not enjoy prior to the surgery!

Bearded Dragons originate in Australia and in the wild spend most of their waking hours in bushes, trees and basking on rocks.  They are tan to yellow in colour and are called “bearded” because of the dragon’s ability to flare out the skin in the throat region when it is threatened or territorial.  Bearded Dragons are typically social, mellow and docile – they enjoy human company and make good pets.

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.

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!