Demodectic mange (Demodecosis) is caused by an external parasite that is also present in low numbers on healthy animals and pets, including people. Whether or not a pet shows symptoms of this disease depends primarily on their immune status.

Since there is no easy test to determine immune status, it is impossible to predict which dog will get this disease, or how well a dog will heal if it shows symptoms of Demodex. It is important to note that the diagnosis of this skin condition, like most skin conditions, cannot be made just by looking at a pet.

Diagnostic tests are mandatory to arrive at a correct diagnosis and achieve a satisfactory outcome to therapy. Stating that an animal looks “mangey” is not the same thing as making a positive diagnosis of mange. Pets that have Ringworm, allergies, Cushing’s or Sarcoptic mange can look like they have Demodex.

We work in conjunction with the American College of Veterinary Dermatology in caring for this disease.

Cause

Demodectic mange is caused by a mite called Demodex canis, a microscopic ectoparasite that infects the hair follicles. Most pups pick up these mites from their mother when they are nursing, and the mites do not normally cause any problems. It is those pets that have an inadequate immune system that develop this disease.

Drawing of a Demodectic mange mite
The parasite is cigar shaped and has several pairs of legs. It is only visible under a microscope. This is a picture of one that is laying on its back, its legs are towards the right, and its mouth is at the far right.

There are underlying causes that can weaken the immune system and make a pet more susceptible to this disease. These include the chronic use of cortisone, Cushing’s disease, heartworm, cancer, and hypothyroidism.

Symptoms

One of the most common symptoms of this disease is small patches of hair loss (alopecia), towards the front of the body initially, with the ability to affect the whole body. When it is present in adult dogs it commonly affects the feet.

If a pet has only a few small patches of alopecia the disease is classified as localized. If it has spread throughout the body it is classified as generalized. Most pets that have Demodectic mange are young, which is a big aid in the diagnostic process.

Hair loss on dog muzzle
The patch of hair missing on this pups face is caused by Demodex, and is an example of the localized classification
Hair loss on muzzle of dog under the eye
Another pup wit the hair loss near the eye
Hair loss on front legs and chest of dog
This is generalized Demodecosis

Diagnosis

The primary way to diagnose demodectic mange is to do a skin scraping where the patches of alopecia occur. The fortunate thing about demodex is the ease of diagnosis in most dogs (Shar Pei’s can be an exception). In most cases the mites are easy to find under the microscope, and if your pet is diagnosed as having this disease, one of our staff members will show them to you under the microscope. A positive skin scraping of large numbers of demodex mites, along with alopecia (remember demodex is naturally found in the skin also), is verification of demodectic mange and necessitates treatment.

Treatment

We are fortunate to have several medications at our disposal to treat Demodecosis.  These medications have proven to be highly effective, and have saved many pets from suffering, and even euthanasia.

Severe Demodex skin condition

This dog has a severe case that did not respond to many different treatments because of its immune system. Unfortunately, euthanasia is the only viable option at this point. 

Sometimes the most we can hope for is to control the problem, not cure it. Treatment duration needs to based on skin scrapings, not just the appearance of the skin. A skin that looks like it is healed can still harbor demodex mites. This is especially true for adult dogs with feet lesions. Adult dogs that have Demodex take longer to treat than young dogs.

Depending on the breed, the immune system of dogs is not fully developed until 12-18 months. During this time a dog with a successful treatment outcome can relapse.

Unfortunately, due to the fact that the immune system is paramount in whether or not your pet gets this disease, no guarantee can be made that these medications will work. No matter which form of demodex is treated, several ancillary issues need to be addressed.

Your pet needs to be on optimum nutrition, stay current on vaccines, and be free of internal parasites (worms). Like any disease process, the psychological needs of your pet need to be met, which includes plenty of exercise, TLC, and access to fresh water at all times. Other skin conditions, like allergies, can occur simultaneously, and need to be treated also.

Localized Treatment

Bathing with an antibacterial shampoo is the first step in therapy. This loosens up scales, removes oily discharges, and decreases the secondary bacterial infection that is usually present.

A benzoyl peroxide shampoo rubbed at the area of hair loss can be helpful. Rubbing it in will make the hair loss area appear larger initially. It might take up to one month for the hair loss areas to resolve.

Another treatment for localized demodex involves the use of Mitaban mixed into olive oil. This mixture is applied on the areas of hair loss daily. It is possible for localized demodex to progress to generalized demodex even if it is treated. Mitaban is no longer available.

Localized demodex might even resolve without any treatment.

Generalized Treatment

Generalized demodex is treated with a combination of medications and modalities. It is important to understand that treatment may take 2-3 months to be effective. There can be no guarantee that they will work, especially in a disease that is so closely associated with the immune system.

The hair is usually clipped to allow the topical medication easy access to the skin, which makes it substantially more effective.

Secondary pyoderma (skin infection) is usually present also, so your pet is put on oral antibiotics for several weeks to months.

Amitraz (Mitaban®) dips have been the mainstay of therapy for decades. It is effective in many cases, but side effects were possible.

Oral Ivermectin and Milbemycin (Interceptor® and Sentinel®), afoxolaner (NexGard®) and furalaner (Bravecto®)  can be used. Side effects like excess salivation, incoordination, even coma and death are possible, so they must be used judisciously. Ivermectin should not be given to Collies, Shelties, australian shepherds, or dogs that are positive for heartworm.

Promeris, a flea and tick treatment is highly effective.  Pfizer no longer makes it so it is hard to get.

Prevention

Pets that have this disease should not be bred. Otherwise, it is difficult to predict just what pets will get this problem.

Spaying infected females is helpful.

Return to Canine Diseases page.

Spleen Disease (Hemangiosarcoma, Hematoma)

It is not uncommon for us to encounter problems with the spleen. Sometimes it just enlarges without any major problems, sometimes it twists on itself, sometimes it ruptures and causes internal bleeding, and sometimes it becomes cancerous. A rupturing spleen is called a hematoma. Cancer of the spleen is called hemangiosarcoma (abbreviated as HSA).

In breeds that have a high incidence of splenic cancer we recommend yearly exams starting at 5 years of age, with blood panels, radiographs and ultrasounds. This will enable us to catch this problem early before complications start and it spreads, since the prognosis is poor in most cancerous spleens because they have already spread by the time of diagnosis.

Unfortunately, some pets, especially large breed dogs, will not show any symptoms until the spleen is huge and possibly rupturing. A rupturing spleen is a medical emergency requiring immediate veterinary care. These dogs can collapse and go into life-threatening shock.

The Long Beach Animal Hospital, staffed with emergency vets, is available until the evenings 7 days per week to help if your pet is having any problems, especially collapse, seizures, fractures, shock, pain, breathing hard, or bleeding.

Think of us as your Long Beach Animal Emergency Center to help when you need us for everything from minor problems to major a major emergency. We serve all of Los Angeles and Orange county with our Animal Emergency Center Long Beach, and are easily accessible to most everyone in southern California via Pacific Coast Hwy or the 405 freeway.

If you have an emergency that can be taken care of by us at the Animal Emergency Hospital Long Beach always call us first (562-434-9966) before coming.  This way our veterinarians can advise you on what to do at home and so that our staff and doctor can prepare for your arrival. To learn more please read our Emergency Services page.

You can see pictures of the surgery to remove large spleens in the surgery section later in this page. After that, there is a link to another page where we remove a 14# spleen hematoma!

Graphic and bloody surgical photos are on this page

Nomenclature

We will use some medical terms regarding the spleen:

Spleen Anatomy

The spleen is an elongated and relatively flat organ that resides in the abdomen of mammals along the outer edge of the stomach. It has a tremendous blood supply that is closely attached to the blood supply supporting the stomach. It is the largest filter of blood in the body.

It has an outer capsule composed of smooth muscle and elastic fibers. The internal part of the spleen (called the parenchyma) has white pulp and red pulp. The white pulp is lymphatic tissue and the red pulp is part of the venous blood system. In between these pulps is elastic tissue that can fill up as needed.

A normal spleen in a cat

A normal spleen in a cat

A normal spleen in a  small dog

A normal spleen in a  small dog

A normal spleen in a medium sized dog
A normal spleen in a medium sized dog

A swollen spleen in a medium sized dog

The blood supply to the spleen is closely adjoined to the stomach. You can see the dark vertical blood vessels in this photo as they enter fat between the stomach and a very enlarged and dark spleen in a semi-circle at the far right.

Spleen in an Iguana

Let’s have a little comparative anatomy fun and show you what the spleen of an Iguana looks like during surgery to remove eggs from her. As you can see it is more cylindrical in shape compared to the elongate shape in mammals. 

Physiology

The spleen has many functions. The four primary ones are:

Iron that has been recycled from old red blood cells is stored in the spleen where it awaits transport to the bone marrow.

Fortunately, the body can get by without a spleen in most cases, so if there is a serious problem, and all other factors are equal, we will remove it. We tend to remove only spleens that are cancerous, rupturing, or have a torsion.

Diseases

Splenomegaly

Splenomegaly is a generalized term that simply means enlargement of the spleen. In some species, like ferrets, an enlarged spleen can be normal, and is called hypersplenism. A spleen can be enlarged diffusely or it might  have nodules in certain areas.

There are many causes for an enlarged spleen. The most common and important are listed in more detail below. Some of the more uncommon ones are due to infectious agents (erlichiosis, babesia, hemobartonella), FIP, medications, and immune mediated diseases.

Large spleen with nodules

This spleen has splenomegaly in addition to numerous nodules

Splenic Torsion

In this problem the spleen twists on itself, compromising the blood supply. When the spleen twists the blood keeps on pumping into it by the arterial system, but this same blood is not able to leave through the venous system, and the spleen becomes grossly engorged.

It can occur on its own, after excessive exercise, or due to trauma. It can occur in conjunction with Gastric Dilatation Volvulus (GDV), also known as bloat. We tend to see this torsion, along with GDV, in large and deep chested breeds.

If the torsion is chronic, there might be no symptoms at all, or there might be:

Examination of a pet with splenic torsion might reveal:

A blood panel might reveal:

This disease is diagnosed by imaging tests when the above symptoms are present. A radiograph might reveal a mass in the abdomen with the spleen abnormally located. Ultrasound can confirm the problem and give us an idea of its severity.

A splenic torsion is considered an emergency, so the treatment of choice is surgical removal after a pet has been stabilized by treating for shock. On the deep chested breeds we might even tack the stomach to the abdomen to help prevent potential GDV in the future.

Splenic Cancer

Some splenic masses that are cancerous are classified as benign, meaning they do not generally spread (metastasize), and only take up extra space within the abdomen. Even though they do not spread, sometimes this extra space they take up can interfere with other organs.

Some benign cancerous masses include lipoma (fatty tumors), hemangioma (associated with vasculature), and plasmacytosis (infiltration of plasma cells throughout the splenic nodule or tissue in general). Unfortunately, when a spleen has cancer it commonly is the malignant version called hemangiosarcoma and not this benign version.

The most common malignant tumor in the spleen is the hemangiosarcoma (HSA). It is also called malignant hemangioendothelioma). The cause is not known. It can spread to many different organs, making it highly malignant:

HSA can also cause complications, such as disruption of the coagulation cascade which causes a mixture of abnormal clot formation as well as inability to control internal bleeding (known as disseminated intravascular coagulation, DIC).

Symptoms of HSA vary, and range from mild to severe. In extreme cases sudden blood loss can lead to sudden death.

These large nodules on this spleen are a malignant cancer called hemangiosarcoma

Another common type of malignant splenic cancer is lymphosarcoma, a type of cancer that can have a primary tumor in any other organ (i.e. lung, gastrointestinal tract, liver). Lymphosarcoma is one of the more common tumor types observed in the spleen of cats. Sometimes the tumor within the spleen is not even the primary tumor, but rather a single nodule or multiple nodules due to metastasis from a distant primary tumor.

Hematoma

Hematomas are one of the most common causes of an enlarged spleen in dogs, representing over 50% of splenomegaly cases. This type of splenic mass is basically an accumulation of pooled blood within the splenic tissue; many stop growing and are then resorbed after a period of time, but others grow exponentially and eventually rupture.

A ruptured hematoma originating from the spleen is an emergency, and often the pet experiences an acute collapsing episode followed by a significant loss of blood into the abdomen (hemoabdomen). You can see the surgery of a dog with an 8 pound hematoma later in this page

Spleen hematoma opened up

A spleen hematoma that has ruptured

Other causes

Congestions of the spleen can occur from iatrogenic causes, which are those associated with administration of certain drugs (i.e. anesthetic agents or tranquilizers). Congestion can also occur due to increased blood pressure within the vasculature of the liver (known as portal hypertension), which can occur secondary to congestive heat failure among others.

The spleen can over-react to particular conditions, resulting in a disease process known as hyperplastic, or reactive, splenomegaly. A spleen can become reactive when there is excessive stimulation of the immune system from conditions such as immune-mediated disease, bacterial infections, tick-borne diseases, and many more.

Spleen laceration

This spleen has a laceration

Diagnosis

Signalment

Dogs, cats, and ferrets can get splenic diseases, although it is much more of a problem in dogs. Splenomegaly itself can occur in most any age due to the numerous causes of the condition. For instance, if the cause of splenic enlargement is infectious, then the pet may be quite young.

However, if the enlargement is cancerous, the pet tends to be middle aged (average 10 years in dogs). Due to the wide range of causes, there is no known gender predilection (males tend to be affected equally as often as females). Certain disease processes tend to be over-represented by specific breeds:

Splenic torsion tends to occur in large breed, deep-chested dogs:

Splenic tumors like HSA tend to occur in several breeds. It can be some common in some breeds that we  recommend physical exams, blood work, abdominal radiographs, and especially abdominal ultrasounds, yearly in these dogs as they reach 5 years of age:

History

In many cases, a patient with splenic disease has very little or no specific clinical signs. Observations made by owners at home might include non-specific indicators of illness:

Physical Exam

Upon palpation of the abdomen, significant abnormalities of the spleen can usually be detected, especially when a large mass is present within the cranial aspect of the abdomen (toward the chest). However, a mass or enlarged organ in the cranial abdomen cannot always be differentiated from a mass or enlargement of the liver.

In some cases, decreased pallor (pale gums) can be a sign of anemia or shock, which in combination with an abdominal mass can indicate a ruptured splenic mass or torsion. We confirm this with an ultrasound before surgery.

If the gums are pale, certain diseases of the spleen may lead to free blood in the abdomen, which can sometimes but not always be detected by palpation of a fluid wave.

Other generalized signs might include weakness, fever, dehydration, poor pulses, increased heart rate (tachycardia), increased bleeding at site of blood draw (due to coagulopathy), and/or increased size of peripheral lymph nodes.

Palpating submandibular lymph nodes

The peripheral lymph nodes can be palpated. This dog is getting its submandibular lymph nodes checked. We have an In-Home Exam Page where we teach you how to check these lymph nodes on your own for early warning sign of disease. Next time you come to the hospital we can demonstrate how to find them on your pet.

Lymph node during ultrasound

Many lymph nodes are internal, and can be seen only with special imaging like ultrasound. This mesenteric lymph node. that lays within the small intestines, is being measured to determine if it is larger than normal. This enlargement could a sign that it is doing it job normally fighting inflammation or an infection. Unfortunately, it far too often is a sign of malignant cancer

Diagnostic Tests

Some diagnostic tests which provide significant information include radiographs, blood work, ultrasonography, evaluation of the cells (cytology) through a fine-needle aspirate sample, and surgical exploration.

Radiography

The arrow points to what a spleen looks like on a radiograph. It is enlarged, although a lobe of the liver can easily overlap the spleen and make the spleen look enlarged. So in this case, technically it’s called hepatosplenomegaly.
X-Ray of dog spleen

The arrow points to a normal spleen

Splenectomy -SpleenRadSplenectomy -SpleenRadSplenectomy-LateralRad

Here is a dog with an enlarged spleen. Can you see it?

Splenectomy -SpleenRadSplenectomy-SpleenRadCircle

The red circle delineates the enlarged spleen.
L.I. – Large Intestine
Pr- Prostate

Blood Panel

Blood work (clinical chemistry and complete blood counts) is a crucial component for detection of compromised organ function. Splenic involvement might reveal anemia (decreased red blood cells), thrombocytopenia (decreased platelets for clotting), leukopenia (decreased white blood cells) and reticulocytosis (increased immature red blood cells to indicate that the body is trying to compensate for the loss of mature red blood cells).

This is a blood panel that might be seen with splenic disease, although many other diseases can also cause this type of blood panel. The primary problem in this blood panel is anemia.

Anemia blood panel

Red blood cells (RBC), Hemoglobin (HGB), and Hematocrit (HCT) are all low in this dog

Fluid Analysis

If abdominal fluid is present we can remove it and analyze it. This is called abdominocentesis. There is no guarantee this will make a diagnosis since many cancers, including HSA, might not be found in this fluid. If we take a radiograph and see fluid we might perform abdominocentesis to see if the fluid is blood. This helps us determine if there is a ruptured or bleeding spleen.

Draining fluid from dog abdomen

Tapping the abdomen allows us to see what kind of fluid is present and also to send it in for analysis. It is also therapeutic for the pet when the fluid causing distention of the abdomen is no longer pressing on sensitive internal organs. 

Ultrasonography

Ultrasonography has revolutionized diagnosis in animals, and prevented many unnecessary exploratory surgeries (called celiotomies or laparotomies), while at the same time alerted us to the fact that we need to do immediate surgery. Keep in mind, our patients do not talk to us, and  an enlarging tumor in the abdomen in one of us humanoids would be uncomfortable, and cause us to seek medical care long before we see a dog or cat with a tumor growing in the abdomen.

Ultrasonography of the abdomen is an important modality for diagnosis of splenic disease because of its sensitivity to changes of organ size, shape, location, and even texture. An ultrasonographic examination in combination with radiographs provides a comprehensive understanding of which organs are involved and often helps to narrow the possibilities down to a select few differentials.

We use ultrasound to confirm our suspicions of a splenic tumor based on the breed, history, exam findings, and blood panels and radiographs. Ultrasound confirms the diagnosis, lets us know if the spleen is already rupturing, tells us the size of the spleen, and if there are any other internal organ problems.

Spleen ultrasound

What an ultrasound of the spleen look like

Spleen ultrasound

Ultrasound of a different spleen

Ultrasound of splenic nodule

A splenic nodule

Ultrasound report showing cancer

A typical ultrasound report on a dog with a cancerous spleen

A critical component of the ultrasonographic exam in HSA is echocardiography (evaluation of the heart). A key site of metastasis associated with hemangiosarcoma is the right atrium. HSA that has spread to the right atrium of the heart is a serious sign, and the prognosis is not good. This is important information if we are thinking of surgical removal of the spleen.

Ultrasound showing tumor in the heart

This ultrasound of the heart (echocardiogram) shows spread of the tumor to the right atrium, which is a poor prognosis
RV- Right ventricle
RA- Right atrium

Cytology

Aspiration of the cells in an organ for cytological exam by a pathologist is an important part of most abdominal ultrasounds. It helps prevent an exploratory surgery, and can lead to a diagnosis in many cases. Cytologic evaluation of splenic problems is not always indicated and can sometimes be contraindicated depending on certain disease processes.

Certain cancers of the spleen, as well as hematomas ,may result in significant blood loss if stuck with a needle due their fragile nature. Even though the ultrasound guides the biopsy location, if the disease process only involves a small portion of the splenic tissue, or is sporadically located throughout, then a small needle-sized sample may not obtain the affected tissue at all.

We run a clotting panel on these patients before doing any ultrasound guided aspiration or biopsies to minimize any chance of internal bleeding from the needle.

Clotting panel report

This is a normal clotting panel. APTT is Activated Partial Thromboplastin Time

ECG (Electrocardiogram)

This tests the electrical activity of the heart. In some HSA’s there will be an arrhythmia that needs to be monitored closely during anesthesia for surgery.

An EKG Report

This is an example of an arrhythmia

Definitive Diagnosis

Histopathology is the analysis of the spleen  microscopically by a pathologist after it is removed. This gives us our final diagnosis.

Histopathology




Treatment

Surgery is a common treatment for splenic disease. Removal is called a splenectomy. If there is trauma or a problem in only a small part of the spleen, we might do a partial splenectomy since we always want to preserve as much function of the spleen as possible. This partial splenectomy is not common.

We do the surgery to remove the tumor, and if malignant add chemotherapy to help prevent spread after we do the surgery. Prior to surgery we do an ultrasound of the heart as already mentioned, and also take chest radiographs to check for spread of a tumor.

We also perform a clotting panel since blood loss is common in this surgery and we do not want post operative bleeding.

Unfortunately, survival time for dogs and cats with surgery alone HSA is only 1-3 months, with most dogs dying due to spread of the HSA to other organs, causing these organs to malfunction. This emphasizes the need for an early diagnosis in the breeds prone to this cancer.

Dogs that have surgery to remove the spleen, and that are also treated with chemotherapy, might survive up to 9 months. This depends on whether the tumor has spread, and again emphasizes the need for an early diagnosis. Dogs and cats have less side effects than people on chemotherapy, and their quality of life is high if this therapy is instituted immediately after surgery.

Dogs that are diagnosed at a young age, have had the HSA rupture prior to surgery, have evidence of spread to other organs when the splenectomy is performed, or have a more aggressive grade of tumor, do not tend to live 9 months after surgery.

The primary chemotherapy drug for HSA is Adriamycin (doxorubicin). It will slow the disease process, but it will not cure your pet of this disease. The doctors at the Veterinary Cancer Group in Tustin institute this therapy.

If a pet is anemic, or we anticipate significant blood loss during surgery, we will give a blood transfusion prior to surgery or during the procedure. Post operatively if a pet is not doing well we will give a blood transfusion also.

The first step in a blood transfusion is to do a crossmatch from recipient to donor to minimize the chance of a transfusion reaction. Dog’s have no iso-antibodies, so you can give a dog one transfusion with minimal risk of a reaction. Unless we have an emergency and time is of the essence, we prefer to test for a reaction.

Blood transfusion test kit

The crossmatch involves a series of steps with tubes like these

A bag of canine blood

A unit of whole blood

Pre-anesthetic preparation

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners.  Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

Surgeon scrubbing hands before gloving

Once our surgeon has reviewed all lab data, and has performed the pre-anesthetic physical exam, he starts his aseptic scub while our patient is being anesthetized

Surgeon organizing sterile instruments

After scrubbing and gowning our surgeon opens the sterile instrument pack to make sure everything is in order and all instruments are sterile

While all of this is transpiring with our surgeon our patient is brought into the surgery suite and a final prep is performed.  We want our surgeon waiting for her patient, not the other way around.  All of this is to minimize anesthetic time.

Anesthesia

When everything is to our satisfaction we will administer a sedative. This will calm her down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Many pets with Fentanyl patches do not need any additional sedative.

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. This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Screen of anesthetic monitor

This is the screen we constantly monitor during surgery

The background noise you here in this video is the oxygen generator

Nurse anesthetist with stethoscope

In addition to our monitoring equipment, our nurse anesthetist stays “hands on” in monitoring important physiologic parameters like heart and respiratory rate and quality

She also checks something called Capillary Refill Time to make sure the heart is pumping enough oxygenated blood to the organs. When she presses on the gums to make them blanch white for a second, she measures how long it takes them to go back to their original pink color. It should be less than two seconds.

We have a detailed page on anesthesia to learn much more on how we anesthetize a wide variety of different species (like the duck below) at our hospital.

Wildlife duck anesthetized

Modern anesthetics allows us to safely anesthetize high risk animals like this duck with a fractured wing. You can see her surgery in our Wildlife Care page.

Splenectomy #1

A splenectomy is performed to treat and sometimes cure this problem. It is sometimes done as an emergency procedure if the spleen has ruptured and there is significant internal bleeding.

Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

Two surgeons draping patient

To minimize anesthetic time we routinely have 2 doctors working as a team performing the splenectomy.  They work together as a well orchestrated team.Our patient is under anesthesia and our surgeons are completing the draping process while our anesthetist is adjusting the surgical lights.

Towel clamps to secure drape

By working together early in the surgery we minimize anesthetic time

Dissecting tissue under skin

 Special care is taken on entering the abdomen to minimize blood loss. There is minimal bleeding at this point as our surgeon gently dissects the sub Q (subcutaneous) tissue just under the skin.

Hemostat on blood vessel

As the surgery progresses we sometimes encounter significant bleeding from blood vessels in the sub Q fat and from muscles that are cut. All of them are clamped or cauterized before proceeding further. For a pet that might already be anemic this added blood loss is important to control, and it is stopped immediately.

Scalpel entering abdomen

When all bleeders are under control (called hemostasis) we enter the abdomen. We make our incision at a specific spot in the abdominal muscles called the linea alba. It is at this spot that there are minimal blood vessels. The linea also has strong tendinous attachments to the muscle, so when we sew it back together these tendons attachments have more holding ability than the abdominal muscles alone. This will prevent a hernia.

Finding the spleen

Our first view of the spleen once we have entered the abdomen. It is the round and reddish structure at the top of the abdominal opening and just to the left of our surgeon’s finger.

Starting the process of removing the spleen

Our surgeon gently starts the process of bringing the spleen out of the incision with the of the assistant surgeon

Spleen almost out of abdomen

A spleen that is not healthy is friable and can easily rupture when handled. Our surgeon has to gently coax it out to prevent  this from happening.

Bleeding spleen out of abdomen

Once it is finally exteriorized the problem is obvious. At this point we do not know if it is cancerous or not. We do know it is in the process of rupturing and glad we are getting it out now.

Now that we have it ready for removal we have to ligate its blood supply. As you remember from your surgical anatomy above the blood vessels to the spleen are closely related stomach. It is important to ligate the blood supply very close to the spleen so as not to compromise the blood supply to the stomach, leading to serious consequences.

Dissecting vessels to the spleen

This blood supply can be surrounded by fat. We have to isolate segments before we ligate.

Ligating spleen blood vessels

In the center of this picture you can see one blood vessel that is already ligated. On the right our surgeon is in the process of ligating another blood vessel.

Ligated splenic blood vessels

We have completed 3 ligations at this point, with many more to go

Surgeons working together to ligate blood vessels

Our surgeons work simultaneously, each starting at a different end of the spleen, so they can complete this tedious part of the surgery sooner. It’s all about secure ligation of these blood vessels and minimal anesthetic time.

As part of the natural healing process there is a tissue in the abdomen called omentum. It is like a net, and surrounds an organ that might be diseased. For example, a ruptured intestine that is leaking intestinal fluid (extremely irritating to the abdomen and will cause a peritonitis), will have this net surround the intestine to wall off the leak.

Blood clots at omentum

In the case of this rupturing spleen the omentum covered the spleen to help prevent further blood loss. These are clots on the omentum from that. At this point in time during the surgery we cannot determine for sure if these are clots or spread of tumor. The report from the pathologist will tell us for sure. It turns out that this time they are clots.

Suturing long incision

When the spleen is completely removed we complete our exploratory surgery by checking the other internal organs, especially the liver. Once this check is complete we suture the muscle layer (the linea alba) closed. Again, we work as a team, with each surgeon (they are both lefties) suturing the linea until they meet in the center.

This is a long incision that is painful. At this point we also inject local anesthetic on the incision line so our patient awakens pain free. We also use our Therapy Laser on the incision for post operative pain.

Once we have finished suturing our patient, who is already on a pain patch (Duragesic or Fentanyl patch- which is removed in 3 days), is given an additional pain injection and carefully monitored post-operatively.

As part of the monitoring we perform a simple blood panel to make sure there was no problem with blood loss during surgery. If the blood loss is significant we will give a blood transfusion with the blood we have already set aside specifically for this patient.

Splenectomy #2

Occasionally we come across a spleen that is so large it is hard to believe it can get this big. The following spleen was over 8 pounds, removed for a 65 pound labrador named Jake.  Dr. P and Dr. R had to do this one together.

The size was obvious as soon as we entered the abdomen. Removing it was like delivering a baby! At this point in time we were not sure if it was a boy or a girl!

Attempting to remove large spleen from abdomen

Dr. P is coaxing it out of the abdomen at the beginning of the surgery, being very careful not to rupture it

Large spleen falling apart

He had to be very gentle  because it was quite delicate(friable) and already rupturing

Large spleen rupturing
It literally was falling apart in his hands as he took it out

Ligating blood vessels to spleen

Ligating the blood vessels to the spleen was more difficult than usual because of the size, scar tissue, and the omental tissue that covered the rupturing spleen

It turns out that this was a hematoma and the dog did fine for several more years. Lucky this spleen did not rupture before the surgery.  Most likely, with a hematoma this large, death would have ensued rapidly.

As big as that one was, it is still not as big as this one, that weighed 14 pounds. Click on the X-Ray picture below to see the whole case from beginning to end, including the surgery.

Enlarged spleen on X-ray

That is 14# of tumor in one dog!

Labrador with owner

This is that 14# lighter labrador and his happy owner on his recheck exam two weeks later

Ancillary Treatment

After surgery we will consult with the oncologists at the Veterinary Cancer Group for further treatment Post Surgical Treatment



Prognosis

A successful outcome from surgery depends on what disease process is present and how long it has been present.

We routinely monitor our post-splenectomy HSA patients every few months with exams, blood panels, radiographs, and ultrasounds due to the highly malignant nature of this disease and the potential for metastasis (spread to other organs).

Return to Canine Diseases Page.

It is not uncommon for a dog or cat to fracture its forearm. The two bones that are usually involved are the radius and ulna. Depending on the severity of the fracture, it is either splinted or surgery is performed to stabilize the bones with a bone plate.

Puppies heal well with a splint. In small breed adult dogs, due to their bone anatomy and blood supply, a splint will not work, and a plate is needed surgically for proper healing. If a splint is used there is a good chance there will be what is called a non-union. Sometimes when this happens the leg needs amputation, so it is best to perform the surgery and not take a chance.

This page will do a summary of each treatment for a forearm fracture. These are very painful, and some dogs can go into shock. This is an emergency.

The Long Beach Animal Hospital, staffed with emergency vets, is available until the evenings 7 days per week to help if your pet is having any problems, especially shock, seizures, pain, difficulty breathing, or bleeding.

Think of us as your Long Beach Animal Emergency Center to help when you need us for everything from minor problems to major a major emergency. We serve all of Los Angeles and Orange county with our Animal Emergency Center Long Beach, and are easily accessible to most everyone in southern California via Pacific Coast Hwy or the 405 freeway.

If you have an emergency that can be taken care of by us at the Animal Emergency Hospital Long Beach always call us first (562-434-9966) before coming.  This way our veterinarians can advise you on what to do at home and so that our staff and doctor can prepare for your arrival. To learn more please read our Emergency Services page.

Case #1

This pup had a mild fracture of the radius and ulna (forearm). Since young animals heal rapidly, and because the fracture was relatively stable, a special type of padded plastic splint was used to stabilize it. It will stay on for 4-6 weeks.

X-Ray of fractured radius and ulna

After the pup is sedated an anchoring tape is applied to prevent the splint from sliding off.

Putting tape on to start splint

A heavy layer of cotton is wrapped around the leg, and the plastic splint is placed along the bottom of the leg outside this cotton layer.

Cotton layer over leg
Several layers of gauze are tightly wrapped over the cotton and plastic splint, and the initial anchoring tape is adhered on top of this gauze. This prevents the splint from sliding down.Gauze wrapped over cotton

A final layer of tape is wrapped over the gauze. This helps keep it dry, adds to the stability, and identifies this as a girl dog!

Final taping using vet wrap

Case #2

We can trace the progress of healing on a different dog (his name is Kaiser-he is a large Doberman puppy) with a radius and ulna fracture, by taking x-rays at 3 week intervals. This first x-ray shows Kaiser’s fracture, which he obtained by running into a table.
X-ray of fractured radius and ulna
Here is Kaiser after his splint was applied. He is hiding his face because we used pink tape instead of blue (hey, that’s all we had at the time).
Splint on Dobie with fracture

Three weeks after the splint was applied a routine x-ray was taken to assess healing. Both the dark areas and white areas at the fracture site are normal stages in the healing process.

X-ray of healing fracture

Six weeks after the fracture (and not a day too soon for his dad), the bone has not only healed, but it has remodeled making it smoother and anatomically more correct. This bone will continue to remodel for many months.

X-Ray of healed radius and ulna

Case #3

Surgical correction of a radius or ulna fracture frequently involves plates.  In toy and small breed dogs a splint will not suffice. Plates are mandatory to prevent a malunion or nonunion, which could lead to amputation. It is a specialized surgery requiring special equipment and expertise, along with meticulous placement of the fractured pieces.

If you look at this view of Pebbles’ fracture it looks like a splint could be utilized for stability.

On this view of the same bones the severity of the fracture is obvious. Surgery is needed due to the amount of displacement at the fractured edges and the fact it is a small breed dog.

X-Ray of fractured radius and ulna

Here is a view of the bones after a plate has been applied surgically. As you can see from the fractured ends, the alignment is perfect.

Another x-ray gives you an indication of the size of the plate from the top. The amount of cotton padding around the splint can be visualized also.

Tope view X-ray of bone plate on radius

A splint is put on for additional support, comfort, and to prevent Pebbles from chewing at the surgical site. Pebbles will need to wear this splint as additional support until the fracture heals. This will take up to several months.

During and immediately after surgery we will give pain medication.

We have a detailed page on anesthesia to learn how we anesthetize a pet for surgery.

We have a page on surgery on a tibia (shinbone) using a plate.

How about a page on a rabbit with a fractured femur?

Return to Dog Diseases Page.

On occasion we are presented with a dog or a cat that has a swollen ear flap (pinna). The swelling is due to blood vessels that have ruptured inside the ear flap, between the inside and outside layer of cartilage. This causes the ear to fill up with bloody fluid, and after a period of time the blood in the ear clots and there is a firm swelling.

If left untreated the ear will be painful and will eventually scar down, similar in appearance to a cauliflower ear in a prized fighter that has spent a lifetime in the boxing ring.

This problem is usually corrected surgically. We use the surgical laser because the ear is much less painful during the healing period as opposed to a scalpel blade. The ear is already painful enough with the swelling.

Dr. P teaching laser surgery to a student extern

Dr. P has been teaching laser surgery to students and young doctors for decades. Click here to learn more about our surgical laser.

Graphic photos on this page.

Symptoms

The symptoms of an aural hematoma are obvious. The ear flap will be swollen to some degree, sometimes extensively. Almost every pet will either be holding the head to one side or either shaking and pawing at the affected side. It is obviously uncomfortable at the least.

Swollen ear of a dog with a hematoma

The pinna is swollen and painful in this dog

Cat with a swollen ear

It happens in cats, but far less commonly than in dogs

Cause

Canines and felines that paw at their ears or shake their heads vigorously, especially those with large ears, can cause an aural hematoma. This pawing and shaking can be due to irritants around the face and ears, or irritants in the external ear canals like infections or foreign bodies (foxtails).

Food allergy is another cause of inflamed ears, causing your pet to shake its head excessively and burst blood vessels.

Medical Treatment

In some cases we can alleviate a small hematoma by removing the fluid and injecting cortisone into the ear and wrapping it to the head. It works 50% of the time at most, and the hematoma in this dog or cat needs to be small.

Your pet will also go home with oral medication to be used for 10 days. This treatment is usually repeated in one week, although some cases are healed after the first week of therapy.

Pets that don’t heal after the second treatment need surgical correction. The initial cause of the hematoma, often times an ear infection or food allergy, will be treated simultaneously.

Surgery Preparation

Even though this is not a major abdominal surgery we treat it as if it was from the surgical and anesthetic point of view. It starts with a thorough pre-anesthetic exam, and the administration of  intravenous fluids.

Anesthetic exam

One of our student externs is learning how to perform a pre-anesthetic exam from Dr. Wood

During this exam important organs regarding anesthesia are checked. These organs include the lymph nodes, heart, and lungs.

After the exam a pre-anesthetic blood panel is run. We usually do this in-house so we can get the results within 30 minutes. We don’t want a patient with a painful ear to wait for a blood panel from our main lab to return, which will not be until the next day. We need to get into surgery and alleviate the pain today!

Calibrating in-house blood machine

We calibrate our blood machine every day to make sure it is accurate

In-house blood panel report

This is the first page of a two page detailed report. This pet is anemic.

For elderly pets, or those with heart murmurs or heart conditions, we perform an electrocardiogram just prior to surgery.

Pre-Anesthetic EKG Report showing a rhythm problem with the heart
This one has a potential problem that needs to be addressed

Once our surgeon has reviewed the exam and diagnostic test findings anesthetic is given and he starts prepping. Our anesthesia page is very thorough if you want to learn more.

Surgeon scrubbing hands

While our patient is being prepped our surgeon is scrubbing up

Sterile surgery pack showing gauze and instruments

When our surgeon is done scrubbing and is capped and masked he prepares his sterile instruments. 

Nurse anesthetist monitoring anesthesia

Anesthesia is carefully monitored by our nurse with our anesthetic monitor and her stethoscope

Surgical Treatment

We use the carbon dioxide laser for this surgery for its great reduction in bleeding and inflammation. This is important on an ear that is already painful.

Calibrating the surgical laser

The laser is calibrating for this specific surgery. There are special canine and feline settings

Nurse anesthetist wearing laser safety glasses

When the laser is in use safety goggles need to be worn

Draped and prepped and ready for surgery

The swollen ear is prepped, draped, and ready for surgery

Making opening in ear with the laser

As soon as the laser makes an open for drainage blood appears

Fluid draining out of ear

The ear is so distended that the blood is under high pressure and streams out immediately

Once all of the fluid is drained out through several openings, and any blood clots removed, the opening in the ear is sutured and it is bandaged. The bandage will stay on for approximately 7 days, your surgeon will let you know. Any sutures placed in the ear will be removed in 10-14 days.

When you pick up your pet you will be given customized home care instructions. Our Home Care of the Surgical Patient page has more details.

Some patients with an aural hematoma are very painful. These dogs and cats can traumatize the painful ear and become an emergency situation. The Long Beach Animal Hospital, staffed with emergency vets, is available until the evenings 7 days per week to help if your pet is having any problems with a painful or traumatized ear.

Think of us as your Long Beach Animal Emergency Center to help when you need us for everything from minor problems to major a major emergency. We serve all of Los Angeles and Orange county with our Animal Emergency Center Long Beach, and are easily accessible to most everyone in southern California via Pacific Coast Hwy or the 405 freeway.

If you have an emergency that can be taken care of by us at the Animal Emergency Hospital Long Beach always call us first (562-434-9966) before coming.  This way our veterinarians can advise you on what to do at home and so that our staff and doctor can prepare for your arrival. To learn more please read our Emergency Services page.

Once your pet has a hematoma it is possible for it to recur. You should check your pets ears daily for any recurrence, treat the initiating cause, and clean them frequently.

Return to Diseases Page.

Growing old is a natural process and a fact of life, for all of us, including our four-legged dog and cat family members. This is especially prevalent in dogs and cats since they age faster than us humanoids. Family members will probably be the first to notice the subtle changes of Canine Cognitive Dysfunction Syndrome or CDS. It may be more than just “getting old.”

There is a  Prescription Diet food made by Hills that is used to treat this problem. You will learn more about it later in this page.

Dogs with CDS may show signs of confusion, forgetfulness, less responsiveness, and/or other various behavioral changes that are not a normal part of aging. They are similar to dementia and senility in older people. These subtle signs might not be exhibited in the examination room so we may not see them during an examination.

A common problem we encounter is an owner thinking their canine is getting old as it slows down and does not go as far and as fast on walks anymore. These dogs more often have arthritis than CDS, and this arthritis is treatable. Please read our Arthritis Page to learn more.

Xray of normal canine spine

This is a digital radiograph of a normal canine lower spine

Xray of arthritic canine spine

The painful arthritic areas are circled in this dog with arthritis of the spine called spondylosis


Cause

CDS is believed to be caused by physiological and chemical changes in the brain of aging dogs that affect brain function. These may include accumulation of B-amyloid, declining neurotransmitter activities, or increased activity of monoamine oxidase-B, an enzyme that may catalyze the metabolism of dopamine.1

In MRI (Magnetic Resonance Imaging) studies of the head, images show black and white cross-section “slices” of the brain. In MRI studies of older dogs with CDS, we see changes when compared to MRI studies of younger dogs. In the images below, note the ventricular space enlargement (V arrows) and hippocampus tissue shrinkage (H arrows) seen in the older dog image on the left, compared to the younger dog image on the right.1

MRI of dog brains

MRI of dog brains

Symptoms

Photo of dog showing typical CDS symptoms

Disorientation
(not due to vision or hearing loss)
Wanders aimlessly
Appears lost or confused in familiar surroundings such as the house or yard
Gets “stuck” in corners or under or behind furniture
Stares into space or at walls
Has difficulty finding the door
Stands at the wrong door to go outside
Stands at the “hinge” (wrong) side of the door
Does not recognize familiar people
Does not respond to verbal cues or their name
Appears to forget the reason for going outside
Activity and Sleep Sleeps more in a 24-hour day (overall)
Sleeps less during the night
Decrease in purposeful activity in a 24-hour day
Increase in aimless activity (such as wandering, and pacing) in a 24-hour day
Housetraining (for dogs previously housetrained) Has “accidents” (urinates or defecates) indoors
Has “accidents” indoors in view of family members
Has “accidents” indoors soon after being outside
Signals less to go outside (for dogs who previously signaled/asked to go outside)
Interaction with Family Members Solicits attention less
Less likely to stand/lie for petting (walks away)
Less enthusiasm upon greeting
No longer greets family members (once the dog has realized that family members have arrived)

Diagnosis

Since a biopsy of the brain is not usually a diagnostic option, a presumptive diagnosis can be made when there are clinical signs consistent with CDS and the absence of any underlying medical causes.

For a suspected case of CDS, as for any behavior problem, a history, physical examination, and diagnostic tests are needed to rule out the presence of any medical conditions that might affect behavior. These might include diseases of the internal organs, especially liver, kidney, and heart.

Additionally, primary and secondary behavioral problems need to be ruled out such as separation anxiety, noise phobias, or housesoiling.

Medical Conditions with Behavioral Components:

Medical condition Associated clinical signs

Sensory dysfunction

(loss of sight, hearing, smell)

Increased irritability, fear or aggression
Decreased appetite
Increased vocalization
Changes in sleep-wake cycle
Disorientation
Decrease in greeting behavior
Inattentive, decreased responsiveness to verbal commands

Urinary tract disease
Renal disease
Lower urinary tract infection

Incontinence, loss of housetraining
polyuria (urinating more)
polyphagia (eating more)
stranguria (painful urination, straining to urinate)
pollakiuria (urinating more frequently)

Osteoarthritis

Weakness, reduced mobility and activity
Increased pain, irritability
Possibly inappropriate elimination

Hypothyroidism

Decrease in activity
Increased irritability or aggression
Reduced tolerance to cold

Hyperadrenocorticism
Cushing’s disease

Polyphagia (eating more), polyuria (urinating more), restlessness
Decreased social interaction, responsiveness to commands and greeting behavior
Reduced activity
Loss of housetraining
Disrupted sleep-wake patterns

Neurological disorders

(primary or secondary
intracranial neoplasia)

Changes in sleep patterns, eating habits, housetraining, aggression, docility

To obtain a complete medical and behavioral history, we may ask many questions because signs of CDS may be subtle and not be exhibited in the examination room during during an examination. A printable Senior Dog Behavior History Form to aid in diagnosis of CDS is available by clicking here.

We will perform a thorough physical examination. In addition, a brief neurological examination will include assessment of cranial nerves, evaluation of postural reactions, especially conscious proprioception, and evaluation of the perineal reflex to assess sphincter function.

Typical diagnostic tests would include a serum chemistry profile, complete blood count (CBC), and urinalysis. Additional tests may be warranted based on the patient’s history and physical examination results.

Treatment

The best treatment for this problem is a food from Hill’s called b/d. It stands for brain diet.

Ingredients in Hills B/D Food

Bag of Hills B/D food

An occasional dog have severe symptoms of CDS and fall down the stairs or have a similar type of accident. If you suspect your dog has this disease it needs to be watched closely for a serious injury.  The Long Beach Animal Hospital, staffed with emergency vets, is available until the evenings 7 days per week to help if your pet is having any problems, especially any injury related to CDS like a fracture of the bones or a concussion.

Think of us as your Long Beach Animal Emergency Center to help when you need us for everything from minor problems to major a major emergency. We serve all of Los Angeles and Orange county with our Animal Emergency Center Long Beach, and are easily accessible to most everyone in southern California via Pacific Coast Hwy or the 405 freeway.

If you have an emergency that can be taken care of by us at the Animal Emergency Hospital Long Beach always call us first (562-434-9966) before coming.  This way our veterinarians can advise you on what to do at home and so that our staff and doctor can prepare for your arrival. To learn more please read our Emergency Services page.

Return to Canine Diseases Page.


Additional Reading:

1. Cognitive Dysfunction Syndrome and Other Geriatric Behavior Problems; CE Advisor a supplement to Veterinary Medicine, Feb 1999.[view PDF format].
2. Controlling CDS with Anipryl®: Post Approval Field Research Results from Private Hospitals in the US; Pfizer Animal Health Technical Bulletin, Dec 2000. [view PDF format]


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References:

  1. Adding New Science to the Practice of Medicine – Senior Dog Health, canine Cognitive Dysfunction Syndrome and anipryl® Senior Health Care advisor Program, Pfizer animal Health
  2. Campbell, S; Controlling CDS with anipryl®: Post approval Field Research Results from Private Hospitals in the US; Pfizer animal Health Technical Bulletin, Dec 2000.

Developed for Long Beach Animal Hospital, by Glenna M Gobar DVM, MPVM, MS, courtesy of Pfizer Animal Health; Sept 2001

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