LBAH Informational Articles

Chameleon Bone Disease

We have a new page on this serious problem in reptiles. Click on our friend below to learn more.

 

Continue Reading

Chameleon Bone Disease

Metabolic Bone Disease (MBD), also know as Nutritional Secondary HyperParathyroidism (NSHP), occurs in many reptiles that are non-carnivorous. This page talks about MBD in chameleons, although it is most common in the green Iguana.

There are differences in why chameleons get this problem as opposed to MBD in the green iguana, but the main problem of inadequate husbandry stays consistent. You should visit our Iguana page on MBD for much more information regarding cause and treatment of this terrible disease.

Veiled chameleons are highly susceptible to stress, and usually do not do well in captivity. Therefore it is important to pay as much attention to proper husbandry as possible. Veiled chameleons do not drink from a water bowl, and need to be misted. They need a basking spot with a heat bulb that gives them a heat range of 72-80 degrees F. They should have exposure to direct sunlight, or else a full spectrum UVB (ultraviolet B) light. Adult chameleons should be fed gut-loaded crickets (feeding the crickets collard greens, mustard greens, and squash), dusted with calcium and vitamin powder.

This is what we prefer to see, a normal veiled chameleon with an attitude!

This female veiled chameleon came to us with a problem.  She was unable to eat or walk wellAny time we have an ill chameleon we handle them gently because they are fragile.

Notice anything wrong?

Maybe this picture will help in your diagnosis

Her MBD problem is so severe that her tongue just hangs out

She was dehydrated, so we rehydrated her medically with fluid injections We were worried her tongue would dry out, so we dripped water on her on tongue.

We kept her surrounded by warm blankets and soaked paper towels

She was able to pull her tongue into her mouth once she was better after our rehydration and medical treatment

We applied a temporary porous tape bandage to keep the tongue inside when we were not feeding her

MBDChameleonRad

In addition to the tongue problem, she is filled with eggs and has fractures of her bones. This chameleon is seriously ill, and if we can get the bone problem solved we would think about spaying it to remove the eggs.

The splint we put on her fractured leg

Their eyes are amazing!

This is another chameleon with MBD, although the tongue is not affected on this one.

This chameleon is weak and cannot walk

 It has a spine curvature, along with fractures in all four legs.

This is the radiograph of this chameleon, see if you can see the fractures on all 4 legs. The bones lack density, and do not show up well on this radiograph, further evidence of the severity of this chameleon’s MBD. Compare it to the normal uromastyx below.

The straight spine, and increased bone density, is apparent

Before we can correct the husbandry and nutritional problems that caused this, we need to stabilize these fractures. It will be done with custom splints that will stay on at least one month.

Talia, our ace RVT (Registered Veterinary Technician) went to work, and made custom splints

It is important to put lots of padding under the splints

The left front leg is getting its first layer of gauze wrap

Half way there, both front legs are done

Our finished product, a four banger splint

Return to Reptile Diseases Section

Continue Reading

There are lions on the runway!

Lets hope nobody encounters this when flying in the United States. I am not sure the pilots here are as used to this as the bush pilots in Africa. They have seen this before, and make sure the coast is clear (and they do the clearing) before unloading passengers.

Continue Reading

Peregrine Falcon Eating a Pigeon

This peregrine falcon is being trained for release back into the wild. After it was exercised for the day it was give its dinner of pigeon, a natural prey for it.

Continue Reading

Laser Neuter -Guinea Pig

We neuter (castration or orchiectomy) Guinea Pigs in a manner similar to other animals. We always use the laser for its major advantages of minimal to no bleeding during surgery, and minimal to no pain, swelling, and inflammation after surgery. Those of us that have had surgery are aware of how much pain there is after surgery, and we do anything we can minimize that pain for our patients.

Our laser is warmed up and calibrated for the specific surgery we are doing before we start the procedure

The laser is so important for our patients we use it on all of our neuters. Here is a short video of how we use it on a dog. Notice the lack of bleeding.

Sometimes people get a jaded mindset when it comes to routine surgeries like neuters, that are performed by the thousands, especially at low cost spay and neuter clinics. It is a major surgery, and we treat it as such at the Long Beach Animal Hospital, which you will learn about in this page when we neuter a cutie named Felix.

Several days prior to any surgery one of our doctors will perform a physical exam to confirm your pet is ready for anesthesia. At that time we will go over any questions you have.

On the day of surgery we need your Guinea Pig in the hospital between 7:30 AM and 8 AM. Feed your Guinea Pig the morning of surgery, and we will feed it also when it is here. We don’t fast them like we do with some other animals.

Our surgeon will call you after the surgery is complete and your Guinea Pig is awake. It can go home in the late afternoon the day of surgery unless instructed otherwise. Please call our office at 4 PM for pickup time, you will be given written post operative instructions then. We are open until midnight if you need to pick up later.

_D2A8630

This is a sterile surgery, and our surgeon starts the pre-surgical process by using special soap to clean his/her hands

We scrub all the way to the elbow to minimize any chance of spreading an infection during surgery

OVH-rabbit-3

While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

We keep a close tab on important physiologic parameters for all of our surgeries to minimize the risk of anesthesia. Minimizing the anesthetic risk also allows our patient to recover from anesthesia faster and recover from surgery faster.

Brianna is listening to the heart rate of Felix during the surgery

Monitors give us an early warning of an impending problem. Instruments like this give us a big safety margin since we can anticipate problems before they cause any trouble.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Important anesthetic data is recorded for this surgery 

Graphic surgical photos coming up

Most Guinea Pigs have both testes in the scrotum, making them readily accessible by a scrotal incision. On rare occasion they might be undescended and in the abdomen, although this is more of problem in dogs and cats.

Brianna, our anesthetist, is keeping Felix cozy and warm as she brings him into our surgical suite

Felix is put on a warm water blanket and Dr. Wood performs an exam on him to make sure he is ready  for anesthesia. When the OK for anesthesia is given Felix gets a pain injection. 

After the pain injection he is placed in a chamber with 100% oxygen along with an anesthetic

When Felix is relaxed his oxygen and anesthesia are administered by a special mask that fits over his face

Felix is given fluids under the skin (SQ or subcutaneous) to help support important internal organs like liver and kidney

Felix’s boy parts are cleansed carefully prior to surgery

Extra attention is paid to keep Felix warm due to his small size. Starting at the bottom, you can see three things in this photo to accomplish this:

Warm water blanket on the bottom

Fluids that have been warmed up above the blanket

Warm blankets that surround Felix on top


When our patient is ready for surgery we start the scrotal incision with the laser

The lack of bleeding on this highly vascular and sensitive organ is because of the laser, as opposed to a scalpel blade. In the above photo the scrotum has been incised with the laser and what you are seeing is a strong tissue covering the teste called the tunic. 

Notice in this video how there is no bleeding as the testicle is brought out of the incision with the tunic still covering it.  The laser will now cut through the tunic to expose the testicle.

Guinea Pig testes have substantial fat around them

The fat is ligated first. This fast has minimal blood supply so one suture suffices. 

The teste has a much greater blood supply than the fat.  It  is double ligated as an extra safety margin to prevent any bleeding after surgery


After transecting the blood supply to the teste our surgeon checks for suture integrity and any bleeding from the cut edge. We use the laser to cut the edge for control of bleeding and for comfort. 


When our surgeon is sure there is no bleeding the blood supply to the teste is placed back into the tunic

The tunic is sutured to prevent any hernia

A close up of the teste after it has been removed. On the right is the epididymis, on the left is the teste. 

The scrotum is closed with surgical tissue glue, which is much more comfortable than sutures

Our surgical patients are given cold laser (we call it Companion Laser) treatment to aid in healing and minimize post operative swelling and discomfort. You get to wear cool glasses when using this type of laser!

Dr. Wood is making sure our patient is doing OK before bringing him to recovery.

Felix recovered without any problems, and was soon munching away at his favorite food. The pain inject he was given prior to surgery is in full effect when he wakes up from surgery. If he needs more he will be given another one, although that is rare when we use the laser. He was a great patient, and will be back to doing his Guinea Pig thing in no time.  

Return to Guinea Pig Diseases Page

Continue Reading

Birds in Flight (BIF)- Peregrine Falcon

First things first, if you want to shoot a flying falcon you need a flying falcon. Dr. Palazzolo has a friend that is a licensed falconer. She has a wild falcon that was given to her when it was young because the parents were attacking it. She has been training it and will be releasing it soon.

This very fast flying bird is an ideal candidate to practice BIF photography. Hang on to your hats for this one, because it doesn’t get any faster than this in the natural world. A peregrine falcon on a dive can go up to 240 mph! On two separate occasions Dr. P had a chance to photograph this female falcon as it was flying around him preying upon pigeons.

Birds in flight is one of the most difficult photographic situations encountered in wildlife photography (or any photography for that matter). Birds fly very fast, faster than people realize. A bird that is flying at 40 mph, which is par for the course, is going almost 6o feet every second!

It usually takes one of the higher end DSLR cameras with regards to autofocus and frame rate to consistently get your BIF shots in focus and with the right pose. More important than that though, is to practice with whatever equipment you have.

Dr. P’s equipment are a Canon 1Dx Mark II camera with a Canon 400mm f/4 D.O. version II lens handheld. The aperture was kept at f/4 for all photos, and the ISO was at 400, giving a shutter speed that varied from 1/3000th of a second to 1/8000th of a second. The camera was set to manual mode, and all autofocus points were active in a custom setting for flying birds.

On a camera that shoots ten frames per second (10 pictures per second), a bird at 40 mph is going 6 feet in between each of those shots. Ten frames per second is just marginal for a bird at 40 mph, let alone the speed of this peregrine which can be much faster. 

The falcon is always transported hooded to keep it calm. Once we got to the beach the hood comes off, although it cannot fly away because of the jesses being held by the falconer. 

The falcon has not been fed, so its senses are keen and it is ready to hunt. You can tell by the way it moves its head, even though it is hooded, that it is primed to go.

The hood is off and its time to find something to eat

In no time it is off

While it is still close now is the time to see if your camera settings are appropriate

It needs height to assess its prey and to have enough speed to dive, so the first thing it does is go up. Now is when the fun starts!

It banked right past as I tried to keep the lens right on her

One time she flew right at me lower than usual because the pigeon she wanted was flying just above the sand

Unfortunately, the falcon was far away when it got the pigeon

It flew off to a sand dune and enjoyed its pigeon dinner

The bird has complete trust in our falconer, and she was able to walk right up even though it was eating

She was able to put the jesses back on with no problem

The bird didn’t miss a beat and kept on eating in between shaking feathers out of its mouth

Another day, another try…….

Off it went to find a new pigeon, and a pigeon it found

It always wants to go high for a good vantage point and to be able to dive

When it spotted the pigeon it banked hard to the right

And streaked down at high speed

This time the pigeon stayed low, and used a garbage can for cover

The falcon closed in…..

….. but the pigeon made a hard turn at the right time

This pigeon lived to see another day

Our falconer called the falcon back for some food she had for it

When it saw the food she had it came right in

Dinner time

 













 

Continue Reading

Killer Whales (Orcas) of Washington State

In September Dr. P met his cousin in the Puget sound area to enjoy the beautiful scenery and look for Orcas. We hired a private boat and guide from Maya Legacy in Friday harbor. Allen our guide did a great job, and we learned much and saw many pods. His assistants April and Zoe also helped out.

We were in a part of a large ecosystem called the Salish Sea that is filled with salmon breeding grounds, which has attracted Orcas.

The resident (there are transients here also that eat marine mammals) Orcas are in serious danger of extinction. This is due to a major decrease in their main food source, chinook salmon. It is also due to pollution in the waters around them, and excessive sounds in the water, confusing them and making communication difficult. These sounds come from all the boats (the cavitation from the spinning propellors) in the area, and also the active sonar from Navy ships.

We stayed in Friday Harbor and went whale watching 3x all around the area

Friday Harbor is in the San Juan Islands, just east of Victoria, Canada

 

The people that live in this part of the world know their Orcas. This ranged from the naturalist that talked to us about them on the ferry ride over to Friday Harbor, to the captain of our boat and his assistant. They know all of the pods, whether they are local or transients, each family member, and what they eat. 

It takes a team effort to find them in these vast waters. There are biologists and naturalists that continually do research on the Orcas. Their knowledge is critical to understanding them. They worked together well as team with the local guiding companies that take people out to see them. The companies that take tourists out to find the Orcas are professionals, and share their knowledge with each other to help everyone see them. These guides have a private radio channel and private Facebook page to help facilitate this communication. It was a job well done!

The Orca kids!

Allen our captain working hard to find the whales

Allen with his assistant Zoe scanning for the mist from the whale blowholes when they exhaled

Zoe using Allen as a tripod to keep her binoculars steady. Hey, whatever works to find them!

Nicole was part of our team of Orca scanners

It takes a lot of eyes to find them, so Hugh used his “eagle eyes” and helped out also

Hugh got his chance to use the big glass. The most important things he learned was not to drop it in the water!

Chloe got jealous when Hugh got to use the professional camera and lens, so we had to let her have a go at it

This is a large male, as evidenced by his large dorsal fin, near our boat

You never know what direction they are coming from, so you need to be observant at all times

They are not easy to photograph. You need to be ready and time your shot for the few seconds they pop to the surface to breathe. In a bobbing boat this can be a challenge!

They were quite active and breached several times

Allen did a great job of anticipating where they would go. One time several members of a pod swam just a few feet in front of our bow.

Allen put a hydrophone in the water as they swam by

Their eerie sounds as they communicate with each other are mesmerizing. They can communicate like this for vast distances

Even though we were close to them, sometimes it was nice to see them in the distance

We even came across a humpback whale (Allen called them HB’s). He positioned us just right to get some nice backlight shots of them exhaling

There is plenty of other wildlife throughout the area, including southern sea lions, bald eagles, and several different species of seals.

Continue Reading

Laser Surgery

We have been using the carbon dioxide laser at the Long Beach Animal Hospital for over 20 years.  We are one of only a handful of animal hospitals in California that have this capability. It is a highly advanced and technical piece of equipment that we never dreamed about having while we were training to be veterinarians. Its one of the ways we offer state-of-the-art care at Long Beach Animal Hospital.

The laser is a high precision instrument 

It is carefully calibrated for each individual surgery

This video shows how we set up one for a dog neuter, and how the laser checks its circuits and calibrates itself.

You get to wear these cool glasses when the laser is on

Dr.P has taught many surgeons how to use the laser. Here he is teaching one of our externs.

GPig-EyeSx-11

Dr. Ridgeway is using the laser on a guinea pig for eye surgery.  He is using magnifying glasses due to the small size of his patient. Small patients cannot tolerate blood loss, so the laser has been a tremendous tool for surgery in animals that only have a few drops of blood in them to begin with.

Laser-Tortoise

Here he is teaching one of our externs on the use of laser in a tortoise. Veterinary students do not get exposed to the laser routinely while in veterinary school, which is one of the reasons they do an externship at our hospital. Our goal is to impart all of our knowledge to them as they start their careers.

Laser Theory

A carbon dioxide laser emits a high energy beam of infrared (invisible to the human eye) radiation in the form of light waves that has many veterinary applications. If you would like to learn more about the mechanics of lasers in general, including safety procedures, how they work, and why we use the carbon dioxide laser as opposed to other lasers, click here.

Graphic photos on this page.

Advantages

There are several advantages to the COlaser surgery:

  1. Pain Reduction

    Your pet will experience significantly less post operative pain in almost every instance. As a matter of fact, the pain reduction is so great that we perform declaws on cats only with a laser beam. This reduction in pain is a result of the unique characteristics of the laser beam as it cuts nerve endings, preventing the raw ends that are characteristic of scalpel blades.

  2. Swelling Reduction

    Whenever an incision is made in tissue with either a scalpel blade or scissors, inflammation is started in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system, there is much less post operative swelling. This makes your pet much more comfortable while it is convalescing from surgery.

  3. Control of Infection

    The laser beam operates at a temperature of over 200 degrees Fahrenheit. This makes it highly effective at killing bacteria that have the potential to cause an infection. This is particularly important in areas where it is difficult to prevent bacteria from contaminating the surgical site. Examples include abscesses and cat declaws.

  4. Minimal Surgical Bleeding

    When an incision is made with a scalpel blade, small blood vessels are cut in the skin and the layer of tissue just under the skin. These blood vessels can ooze throughout the surgery and even postoperatively. Traditionally they are taken care of by clamping them with hemostats, cauterizing, or holding gauze sponges on them until they stop. All of these procedures take time, which means the surgery takes longer and there is more post operative swelling. The laser beam is a highly effective coagulator of small blood vessels. Less bleeding during surgery means less anesthetic time and faster recovery time.

    Even though lasers are used effectively in many surgical procedures they are not used in every surgery. They are especially useful in oral surgery, neuters, growth removals, and amputations of small extremities. We also use it in small animals, especially birds, because of the laser’s great effectiveness at minimizing bleeding.

    The following sections give specific examples of the use of the carbon dioxide laser in our hospital.

    Neuter

    The laser is particularly advantageous in this surgery. Prior to using the laser we used a scalpel blade to make the scrotal incision and throughout the whole procedure. When using the scalpel like this, the scrotum would swell over several days post operatively as small blood vessels oozed. This was obviously very uncomfortable in such a sensitive area. The laser has eliminated this completely.

    Canine-neuter6

The laser is being use to cut through the outer layer of the testicle, called the tunica vaginalis

Canine-neuter7

The testicle is exposed, along with the epididymis and blood supply. Notice the lack of bleeding.

We neuter a wide variety of animal:

Cats

Rabbits

Dogs

Rats

Bladder Surgery

Bladder stones are not uncommon in animals. The bladder is usually inflamed and highly vascular, causing significant bleeding when we incise the bladder to remove a stone. The laser has revolutionized this surgery. This is a very sensitive internal organ, and anytime we can make an incision in such an organ without any bleeding, the healing period is much faster and less painful.

Surgery-CatLaserBladder

Here is the initial incision in a cat with no bleeding from the bladder

Laser-cystotomystone

This is a dog with the stone being removed from the bladder after the laser incision

Our bladder stone page has much more detail, including a movie of removing bladder stones from a dog. We also have pages that show removal of bladder stones in Iguanas and tortoises (you don’t want to miss this tortoise bladder stone page)!

Feline Mammary Tumor

These tend to be malignant and highly vascular, causing substantial time during surgery controlling bleeding, along with considerable bruising after surgery. The laser has revolutionized this surgery.

In the video note how diseased the subcutaneous tissue looks and the total lack of bleeding in this highly vascular area. Also notice as milk is excreted from the gland as the surgery progresses

Our web site has a detailed page on mammary tumors in animals.

Rat Mammary Tumor

Rats get a mammary tumor under the skin very commonly. The laser is huge when it comes to removing them with minimal bleeding, which is important in a small animal.

Surgery-RatMammary-3

Surgery-RatMammary-4

Click here to see the full surgery

Oral Tumor

A tumor that can be encountered in dogs and cats is called sqamous cell carcinoma. These pictures are of a dog that had one on its left jaw, called the mandible. The only way to completely cure this tumor is to remove the jaw on that side, a surgery called a hemimandibulectomy. In this case the owner decided against it, and will have the growth removed as much as possible with the laser, following up with radiation therapy.

The tumor is identified by the white arrow. It had been removed 1 year earlier, but as expected with this type of tumor, has recurred. This time the surgery will be with the laser for maximum comfort for Jackey.

The post operative appearance immediately after it has been removed by the laser. Minimal bleeding and swelling are apparent.

We were able to suture gum tissue over the defect left by the surgery. It is hard to tell in this picture that any surgery was performed at all.

This tumor is in a Tegu

LaserSurgery-IggieJaw

The arrow points to the tumor

LaserSurgery-IggieJaw-2

No sutures, no bleeding, no pain, and no inflammation

Declaws

This is a request from people that want to keep their cats indoors. Prior to a declaw, we advise keeping the nails trimmed short or the administration of Soft Paws on the nails, along with a scratching post. One of our nurses will gladly give you a demonstration of these options.

We prefer you use other options before thinking about laser declaw, and will show you how to gently trim the nails

If this does not work you need to make an appointment to have your cat examined by one of our doctors and determine if it is a candidate for the surgery. We do not do this surgery routinely.

Prior to the introduction of the carbon dioxide laser all declaws were done with a scalpel blade. It is a very precise surgical procedure that our doctors have performed thousands of times. Unfortunately, the post operative period was painful, the feet were bandaged, and most cats had to stay in the hospital for several days. On older cats this surgery was even harder on the pet.

The advent of declaws with the laser surgery has substantially minimized these drawbacks. There is usually no bleeding during the surgery so a tourniquet is no longer used. Most of them can even go home the day of surgery but we prefer to keep them for observation for 1-2 days. Most cats have so little pain or discomfort they are jumping and running before nature has had time to complete the healing process. Always restrict their activity at home for the first few days to prevent this problem.

This cat’s nails have grown into its pads due to the owner’s inability to care for it properly. This is a painful situation and makes him a candidate for a front declaw.

Feline-NecroticNail

Sometimes the problem is even more severe, and the severely infected toe (on the right) needs amputation. This is where the laser shines.

The following pictures are from an actual declaw that we performed at our hospital.

Surgery-CatLaserDeclaw

The nail is gently pulled forward prior to surgery to open up the area behind the nail where the incision with the laser will be. Bone is not cut during the procedure at any time, only tendons and ligaments are cut.

Surgery-CatLaserDeclaw-4

The laser beam (it is invisible to the naked eye) has started the incision at the top of the toe. It will cut through skin and tendons along with ligaments in between the digits.  The nail, with its attached bone (called phalanx 3), is removed.

The surgery is complete with no bleeding, swelling,  or trauma to any bone. The top arrow in this picture points to the bone at the joint of the 2nd knuckle. The bottom arrow points to the intact pad that has not been touched either. A drop of surgical tissue glue will be put on the pad to cover the end of the bone.

The foot immediately after surgery. There is no need for a bandage.

Return to Canine Diseases Page.

Continue Reading

Fluid Therapy

Fluid therapy might just be the most important medical therapy we perform on sick animals. Dehydrated pets feel ill, cannot fight disease, do not eat well, and cannot metabolize drugs efficiently. Dehydration decreases the circulation to two very important organs, the liver and the kidney. These organs are then unable to perform vital functions, some of which include detoxifying drugs and removing waste products.

We give fluids to a wide variety of species in addition to dogs and cats. They can be ill, and need fluids for many different reasons.

This guinea pig being examined by one of our externs has a problem with overgrown teeth and cannot eat well. This has caused him to become dehydrated, and in need of supplemental fluids.

Before coming in for treatment this rabbit was painful from a broken leg and not eating well, so it became dehydrated. Supplemental fluids to correct the dehydration, and a splint to take away the bone pain and allow the healing, were needed to get him back to being a normal bunny again. You can see how we treated his fracture here

Yup, we even give fluids to 120 pythons when they are ill or dehydrated. This is probably not something you want to try at home!

Fun Facts

Before we get started on the specifics, lets go over a little background on fluids.

The body weight of a normal dog or cat is about 60% water, puppies and kittens are up to 80% water. These numbers show the importance of a proper fluid balance for normal physiology, especially in puppies and kittens when these animals become dehydrated.

The fluid in the bodies of normal animals resides in 3 areas:

Inside the cells of an individual organ, called the intracellular space. 65% of the total fluid in the body resides in this intracellular space.

In the bloodstream, called the intravascular space. 25% of the total fluid in the body resides in bloodstream.

In the tissue surround the cells, called the interstitial space. 10% of the total fluid in the body resides in the interstitial space.

When the intravascular fluid is low hypovolemia results. Hypovolemia means the body cannot deliver adequate oxygen to the cells, and a pet can go into shock. If not treated death can ensue. We assess this low oxygen problem with an instrument called a Pulse Oximeter, which measures the oxygen saturation of the hemoglobin molecule in the red blood cells. It should be in the 90 percent range.

This pot-bellied pig, with a 92 % oxygen saturation, and a heart rate of 82 beats per minute, is normal

Pets with hypovolemia are very ill and can exhibit some of the follow symptoms:

Elevated heart rate, called tachycardia.

Slow heart rate, called bradycardia. This occurs when your pet is in the act of dying.

Weak peripheral pulses. We detect this on an exam by palpating the femoral pulses while simultaneously listening to the heart.

Prolonged capillary refill time (CRT). For a normal animal this should be under 2 seconds.

This is how we check the CRT. This pet is under anesthesia, a time when we carefully monitor this parameter

Cold extremities

Low blood pressure (hypotension).

Hypothermia (low body temperature)

When the interstitial fluid is low dehydration results. This is not usually life threatening until the dehydration progresses to around 10%, which now causes hypovolemia. Dehydration is detected during an exam when any of the following occurs:

Tacky or dry mucous membranes (the gums)

Skin tenting

Sunken eyes

Elevated BUN or Creatinine on a blood panel

Elevated hematocrit and total protein

blood sample will also give clues to dehydration, especially the total protein level and the hematocrit.

This is the hematocrit test, checking the percentage of red blood cells in the serum, giving us information on the state of your pet’s hydration

After the hematocrit is measured we break the tube in the middle and place the serum on an instrument called a refractometer to check the protein level. In conjunction with the history, exam findings, and hematocrit level, the protein level helps us determine the degree of dehydration.

Hypovolemia and dehydration can occur independently. A dehydrated patient might not be hypovolemic, and a hypovolemic patient might not be dehydrated.

Our doctors decide on how much fluid to give your ill pet based on the following:

The normal (called maintenance) amount of fluid your pet needs every 24 hours to maintain normal physiology (called homeostasis).

For a dog this is 60 ml for each kg of body weight. For a 20 pound dog this is 545 ml (1/2 of a liter, or 30 ounces) per 24 hours.

For a cat this is 45 ml for each kg of body weight. For a 10 pound cat this is 204 ml (0.2 liters or 7 ounces) per 24 hours.

The degree of dehydration of your pet

A 20 pound pet that is 7% dehydrated needs 600ml to correct this dehydration. This is more than pet owners realize, and why proper fluid therapy is so important when we hospitalize your pet.

Ongoing fluid losses like vomiting or diarrhea. As pet that has been burned has tremendous fluid losses due to seepage of serum at the burned skin area. This ongoing loss is subjective, but it needs to be added to the calculation above if your pet continues to have these fluid losses.

Symptoms of Dehydration

Signs of dehydration include lethargy, anorexia (poor appetite), sunken eyes, sticky gums, constipation, and a general feeling of malaise. It is diagnosed based on a history of anorexia, vomiting, diarrhea, or extra fluid loss, in combination with a physical exam and diagnostic tests. During an exam a dehydrated pet will shows signs of dehydration when the problem is greater than 5 %. The page talks about the two primary methods used to give fluids to pets. The first is intravenous, and is performed only by us in the hospital. This is not a treatment method you will do at home.

Types of Fluids

The type of fluids we will be describing are called crystalloids. This are the kinds most people are used to, and are usually lactated ringers solution (LRS) or sodium chloride (NaCL), and variations thereof that we might use in specific situations.

These are some of the ingredients in LRS

Another type of fluid is called a colloid (hetastarch or hydroxyethyl starch). Colloids are used only in specific situations, which are not common. For the remainder of this page we will be referring to crystalloids.

Intravenous (IV) Fluids

I.V. (intravenous) catheters are used extensively in pets that are sick or those pets that are about to be anesthetized. These catheters allow us to administer medication directly into the venous system for rapid distribution to the whole body. Medication given this way acts faster and is more controllable, a significant advantage for an ill pet or in an emergency. IV administration of fluids is critical in pets that are hypovolemic.

Intravenous fluids are important during surgery. We monitor this closely in many ways, especially with the blood pressure.

If your pet is ill and staying in the hospital, or about to undergo anesthesia for any reason, an I.V. catheter to allow fluid administration is one of the most important therapies we can institute, and can literally be life saving.

This dog getting his teeth cleaned was put on IV fluids before the procedure to stabilize the kidneys for the anesthesia. The fluids are continued for the duration of the procedure, and will be administered until this pet is fully awake and its owner is picking it up.  

The placement of the catheter requires technical skill and knowledge, particularly in small or dehydrated pets (the veins in these pets are small and damage easily). Improper placement of the catheter can literally cause more harm than good. Our nurses excel at placing I.V. catheters in all species.

Because the catheter is introduced directly into the venous system, it must be placed in an aseptic (sterile) manner. The hair over the vein is shaved, and special tape is placed over the catheter. 

Comfort is also important when placing the catheter due to the small nature of some of our patients, and the duration the catheter must stay in the vein. This tape and catheter is constantly monitored by our staff for comfort and sterility. After 3-5 days we usually replace the catheter in order to minimize the chance of the catheter causing an infection. 

I.V. catheters are usually placed in one of three veins:

Cephalic Vein-This is by far the most common vein to use. It runs along the top of the foreleg of dogs and cats. The illustration below shows the placement of this catheter in a large dog.

Jugular vein-This vein is in the neck. A catheter placed in this vein allows longer term use and the ability to give larger volumes of medication with different viscosity’s.

Saphenous-This vein is on one of the back legs. It is mostly used when the cephalic vein is unusable, but can be used at any time.

Various other veins are sometimes used, by they are reserved for some of the more unusual species of animals we deal with. In some of these pets like birds, that have minuscule seized veins, we cannot give the necessary emergency fluids intravenously. In these cases we use what is called an intraosseous catheter. This catheter goes directly into the bone marrow, and allows us to give the necessary fluids to a small creature rapidly and effectively. In birds it is put in what is called the tibia tarsal (tiboitarsus) bone. This is equivalent to our tibia or shinbone. It is put in at the knee joint.

This radiograph shows the placement of an intraosseous catheter. It is going down the shaft of the tibiotarsal bone in this bird that came in collapsed and in shock. The bird responded and recovered completely after we administered fluids through this catheter. 

Your pet’s catheter will stay in for the duration of its hospitalization or procedure, and will not be removed until you return to pick up your pet. Your pet may go home with a small piece of tape and cotton where the catheter was. It can be removed several hours later after you return home.

We use many different types of fluids, the most common one being Lactated Ringer’s Solution. The amount of fluids given are calculated and  monitored carefully.  We use a special fluid pump that gives a consistent amount of a period of time.

Each patient receiving fluids has a custom fluid chart outside its cage for close and constant monitoring of the fluids. Our doctors make adjustments in the type and amount of fluids as diagnostic tests like blood panels, and your pet’s response to treatment, are analyzed. 

Subcutaneous (SQ) Fluids

The second method used to administer fluids is subcutaneously (under the skin) between the shoulder blades. The administered fluid slowly absorbs over several hours. In this hospital and on an out-patient basis, this method is used for pets that are not seriously ill, but just need some additional fluids to maintain hydration, fight a fever, or stimulate the appetite.

If your pet needs to be on SQ fluids on a long term basis due to a chronic disease, think of it as bonding time and make it a positive experience

This section on SQ fluids contains  detailed step-by-step descriptions on how to give fluids at home on an ill pet, an older pet, or a pet with kidney disease. When you first read it you might think there is no way I can do all of that. Once you observe us do it in front of you, and then do it yourself, you will realize it is not anywhere is difficult as you think when you read about it the first time.

This video is how we give sq fluids at our hospital. Notice how calm this dog is.

SQ fluids are of special benefit for pets that need long term fluid administration at home, usually older (geriatric) cats or those with kidney disease. This is the animal version of dialysis in people, and it works extremely well. These fluids at home are highly beneficial, and have had cats with chronic kidney disease do well for years with this treatment at home.

If your doctor feels your pet needs SQ fluids at home you will be taught how to administer them by our nursing staff. At first it might seem an impossible notion to give your pet fluids at home. Not only is there the psychological fear of using a needle, or worry about hurting your pet, there is also a worry that your pet will not stay cooperative long enough for the few minutes it takes to give the fluids.

Rest assured that you will not be forced into giving these fluids if you feel uncomfortable, although we have yet to encounter a client that was not able to perform this procedure at home. This is because we have extensive experience in this area, and we teach you at your own individual pace. Only when you feel you are ready will you proceed on your own.

You will be given as many personal demonstrations as necessary, and can return to the hospital at any time for further demonstrations or to make sure you are performing the procedure properly. You are welcome to bring your pet in at any time for assistance in giving the fluids, so do not feel you are on your own. If you are out of town, your house sitter can bring your pet in for these fluids. We consider you part of our nursing team and are willing to give any assistance needed. Before you are given a live demonstration the following basics will help prepare you.

The scariest part of the whole procedure for most people is the actual insertion of the needle into the skin so that the fluids flow under the skin (SQ). You will watch us do this as many times as you need to overcome any fear you might have. When you realize it is not all that difficult by watching us do it, we will hold your hands when it is your turn if needed.

Practicing by inserting a needle into an orange or similar fruit can be helpful. Different sized needles, ranging from 22 gauge to 18 gauge, are used to give SQ fluids. During the demonstration we will show you which one works best for your pet.

The 18 gauge needle, at the top, has the largest diameter. Fluids flow fast through this needle, taking less time to give them. If this size needle is uncomfortable for your pet, we will try the 20 gauge next because it is smaller, although the fluids will flow more slowly. On small pets we might even use the 22 gauge needle. 

During this demonstration you will be told exactly how much fluids to give. For most cats with chronic kidney disease, this is 100ml once or twice daily. The fluid bag has 1000ml (1 liter), so for the average cat you will be able to give these fluids for ten days. This might vary depending on many factors, and your doctor will determine the amount and frequency. Do not change this unless instructed to.

Keep children and other pets away if they are disruptive during the process of giving the SQ fluids at home. Have all of your equipment readily available, usually on the same table as your pet. Depending on the size of your pet, the table should be around waist to chest high. It is helpful to set up one area of your house to give the fluids. Hang the fluid bottle in this room for easy access. It should be at least a few feet above the table for optimum flow. You will be shown how to set this up by one of our staff.

Store the fluid bag at room temperature and cover the bag so no light hits it. We sometimes add medications like vitamins and electrolytes to the bag, and light can affect them.

When you purchase a fluid bag from us it needs to be set up with the IV line. We will show you how to do this in person. You only need to set it up when you purchase a new bag. After that, you give the fluids with a new needle each time, keeping the IV set attached, until the bag is empty.

Never use the needles more than once since they are sterile and very sharp when first opened. Repeated use could cause an infection in your pet, and makes the needles dull, causing discomfort on administration. Needles are inexpensive, so don’t take the chance by re-using them.

When you purchase the bag it comes wrapped in a plastic wrapping. Remove the wrapping at home when you are ready to set it up to give fluids to your pet. After you remove the outer wrapping lay the bag on your table or hang it from a coat hanger. 

Open the sterile IV set and lay it on the table


These are the components of the IV set

The large white end with clear receptacle goes into the fluid bag once the white cap is removed. The clear container above will be filled part way with fluid once attached. 

 At the opposite end of the IV line is a small blue cap. You remove this blue cap when you attach a needle, which you will learn about later. 

The large blue plastic piece in the center allows you to turn the flow on and off, and also adjusts the rate of flow. Make sure the white wheel is in the off position like this when first setting it up. 


Remove the white plug from the bottom of the bag. The cap is in solidly, so you will need to pull hard to remove it.

 You can do this while the bag is hanging, or while it is laying on the table. Discard the white cap, it will not be used again. 

Remove the white cover from the IV set receptacle. It is sterile, so do not touch it to anything at this point. 

Hold the hanging bag steady, or lay it flat while doing this, so you can put it straight in without touching anything else. 

Insert it all of the way into the fluid bag 

Hang the bag, then squeeze the receptacle until the fluid fills half of the receptacle

It should look like this when you are done

Lay the needle next to the end of the IV set that has the blue cap

Remove the clear plastic at the base of the needle by twisting it either direction. The open base of this needle is sterile, so do not touch it to anything until you insert it into the IV line. 

Remove the blue cover at the end of the IV set. Turn the fluids on and let a few seconds of fluids flow through the IV line to remove the air. Let these few drops flow into a small bowel or on to a towel. Do not touch the end of this line to anything. 

A few air bubbles left inside the IV line will not cause any problems 

Insert the needle straight into the opening. Hold you left hand still as you twist clockwise with your right hand to lock it tight

Hang the IV set over the fluid bag. You are now set to give the fluids. 

Every pet reacts differently to the actual giving of the fluids, and they feed off of your emotions, so cool and calm usually works best. If either one of your gets worked up, stop and try again later.

Make sure the location to give the fluids is subdued and calm, with no excessive lighting or noise to alarm your pet. Take your time by bringing your pet to the table and interacting with it by petting it and holding it. You can even feed it while giving the fluids. A towel for restraint, or another person holding the head, might even be appropriate.

Hold your pet to the side, make a small tent of the skin between the shoulder blades, remove the cap over the needle, and rapidly insert the needle between the shoulder blades in one motion.

Insert it all of the way in until the hub touches the skin. Turn on the fluids completely on by moving the white wheel all the way to the top, and give the prescribed amount of fluids. For most pets, this takes only a few minutes of your time daily, a few minutes of your time that will be highly advantageous to your pet. 

When you are finished giving the fluids remove the needle from your pet and cap it. Remove the used needle and place a new sterile needle at the end of the IV set, and hang the IV set over the bag as before. You are now ready to give the fluids again the next time one of our doctors prescribes.

Finally, pat yourself on the back for a job well done, have a seat, and breathe deeply (or get a stiff drink if needed to calm your shaking hands).

Place all used needles in a safe place with no access to children or pets. A sharps container to hold these needles is the best place to put them until disposal. Dispose them according to the guidelines in your community. Here are some local disposal centers for needles. If you are not near one of these areas call us at 562-434-9966 for other locations:

EDCO Recycling and Transfer Center

2755 California Ave.

Signal Hill, CA 90755

562-597-0608

L.A. County Sheriff- Lakewood Station

5130 N. Clarke Ave.

Lakewood, CA 90712

Huntington Beach Collection Center

17121 Nichols Lane

Huntington Beach, CA 92647

Return to Diseases Page

 

 

Continue Reading

Gall Bladder Removal in a Dog

Surgical removal of the gall bladder is called cholecystectomy. Most of us have heard of gall bladder surgery in people. It is not as common a surgery in animals. This page has pictures of a surgery to remove the gall bladder in a dog. At the end of this page you can see what gall stones look like.

Graphic surgical pictures on this page.

Our patient is an 11 year old Silky Terrier that came to us with some significant symptoms. They included anorexia for several days and lethargy. Her initial blood panel showed high elevations in Alk Phos., AST, and bilirubin.

Her blood panel is typical of a dog with this problem. You can see the significant elevations in her liver enzymes and bilirubin. Even the electrolytes are abnormal.

Her urinalysis showed significant amounts of bilirubin 

We could see hepatomegaly on her radiograph. Initial treatment consisted of antibiotics, fluids, vitamin supplements, and I/D food. Heather rapidly got better on the treatment.

This is what the liver looks like on an abdominal radiograph

She had a recurrence of the problem 3 weeks later. At that time an ultrasound was performed and it was determined that she had a  problem with her gall bladder.

Her gall bladder, the dark area on the top left had a problem. The line in the center is measuring the size of her common bile duct, which is large in her case. 

This is her ultrasound report

She responded well to treatment with antibiotics and actigoll. When her enzyme test were almost back to the normal range we removed her gall bladder.

Before we do any surgery on the liver we make sure the clotting system of the body is working well. The liver is intimately involved with the bodies clotting mechanism, and we need to make sure we are not going to encounter a severe bleeding problem during and after surgery. This test is making sure her red blood cells are adequate (no anemia is present), along with the 4 clotting tests on the bottom, starting with Prothrombin Time. 

Our patient is now ready for gall bladder removal This is a specialized surgery that is tedious and requires an experienced surgeon. In Heather’s case we called in Dr. Linda Larsen, a specialist in surgery.

Dr. Larsen is a board certified surgeon, and experienced at this surgery

Monitoring of anesthesia is critical in an older pet with liver disease. Monitoring Heather’s blood pressure is an important aspect of anesthesia.

Surgery-Monitor

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

_D2A8630

Once our surgeon has scrubbed up and is  in sterile gown, gloves, and mask, the surgery begins

The incision into the abdomen is made at a special location called the linea alba. It is here that the tendons of the stomach muscles come together, and will hold the sutures after we close the abdomen.

The swollen liver is apparent as soon as she enters the abdomen

The first thing our surgeon does is locate the gall bladder

Now the careful dissection of the gall bladder starts so it can be removed

After careful dissection it almost full exposed at this point

As dissection of the gall bladder continued she traced it down to the common bile duct. The arrow points to the gall bladder under our surgeon’s finger. The vertical bluish structure below the gall bladder is the enlarged common bile duct.

The bile that is stored in the gall bladder is removed with a suction apparatus. This allows better visualization.

When she is satisfied with the exposure she puts several very strong sutures where the gall bladder attaches to the liver

Here is the trouble maker after it has been removed


A biopsy is taken of the liver to give us substantial information as to its health

The abdomen is flushed many times to remove any contaminants 

The long incision in the linea alba is sutured. After this layer, there are several more layers of sutures placed in the subcutaneous tissue and the skin.

At this point our patient is given a local anesthetic on the suture line, an additional pain injection, and the skin incision is treated with companion laser to decrease swelling and aid in healing,. You can its use on the video below.

Gall Stones

This is a different gall bladder removed from a different patient. This gall bladder was thickened due to stones in it.

The inside of the gall bladder after removal. The chronic thickening is apparent.

These are the gall stones that were found inside of it

The pathology report on this gall bladder

This is the analysis of these stones

Return to the Canine Diseases Page.

 

Continue Reading