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Interesting Cases

Exophthalmia Eddie Pug

This Is An Eye Popping Read!

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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!

 

 

mouse

A Young 80 gram Chinchilla: Life Saving front leg amputation

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Chin LF PO Jasper All 80 grams (3 Legged)

Jasper on a revisit to our hospital 1 month after surgery-Happy and very energetic.

Canadian Chinchilla Rescue (Canada). Jasper still rocks with enthusiasm and with optimum mobility in the year 2019. 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!

CHIN Presurgery LF (2)

Minutes before the anesthetic encouragement with the support of loving hands.

Chinchilla LF Surgery Table

Ready to proceed with surgery while under a general anesthesia

 

CHIN Surgery Team LF (7)

Our Mississauga veterinary surgical team in action in surgical suite at Southdown Animal Clinic

big eyed cat

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.

Pet Surgery

Disc Disease (IVDD)-After acute paralysis and back surgery- Rue (Rue update-Nov 15)and Peika are “Walking the Line” again.

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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.

Rue-Media Disc T12-13 IVDD web

Rue’s survey radiographs indicate a suspect lesion at T12-13

Peika Henderson Survey T13-L1 Web YES

Peika’s survey radiographs with a suspect lesion at T13-L1

 

Rue #3_ mediaSzostok DYE extradural lesion

Rue’s Myelogram: Confirming a compressive lesion at T12-13

Peika_Henderson  YES DYE web T13-L1

Peika’s Myelogram: Confirming a compressive lesion at T13-L1

 

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.

Key Points;

-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.

Rue 1

Rue’s Puppy Photo

Peika 1

Peika

 

 

 

 

 

 

 

 

It has been nearly one year since Rue had surgery for a compressed spinal cord. We are please to provide the client’s update.

Hello,
“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.”
Thanks again,
The Family

Video provided:

British Bulldog

Mack- Major Upper Respiratory Tract Surgery (a 5 year old English Bulldog)-and 4 years later doing WELL!

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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:

Severe stenotic nares before surgical interventionSurgical correction of the left stenotic nose

SurgeryElongatedSPMackweb (2) - Copy copy

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!):

A happier healthier English Bulldog

“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.

 

 

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

 

 

Rabbit Eye

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

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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.