Wildlife blog of Dr. Palazzolo and the Long Beach Animal Hospital | Long Beach Animal Hospital

LBAH Informational Articles

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.

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Fluid Therapy

Fluid therapy might just be the most important medical therapy we perform on sick animals. Dehydrated pets feel ill, cannot fight disease well, 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 needs 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 and 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!

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 %. A 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.

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.

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.

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.

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.

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 are monitored carefully, and given with a special 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

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

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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.

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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

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Liver Surgery

If you are interested in watching a surgery of a cat with a liver disease called a shunt follow the link below.

Liver (PSS) Shunt Surgery

 

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Liver (PSS) Shunt Surgery

A problem can occur where the blood flowing to and through the liver has a problem. There are several variations on this problem blood flow. In this page we will be correcting the blood flowing from a blood vessel that is directing the blood away from the liver and not into the liver like it should. This is called a liver shunt, also known as a porto systemic shunt (PSS).

This page shows a surgery to correct an extra-hepatic PSS (porto systemic shunt) in a cat using an ameroid ring. More than one year after surgery this cat is doing fine, so the surgery was a major success. The same procedure would be used in a dog, a species that gets this problem much more often than a cat.

Once our diagnosis was confirmed we put our little friend on medication to minimize the symptoms and make him a much better candidate for surgery. You can learn all about how we diagnosed and treated this problem before surgery on our Liver Diseases Page.

Graphic surgery photos on this page.

Dr. Adam Gassel of the Southern California Veterinary Specialty Hospital performed the surgery. This surgery is not performed by any veterinary surgeon. Dr. Gassel has the special training, expertise, and experience to perform this delicate procedure.

Aftercare is just as important as surgery in correcting this problem surgically, so this surgery needs to be performed at a 24 hour veterinary hospital where the staff is trained in this care.

A special constricting device called the Ameroid Ring is used to occlude the problem blood vessel to the liver

The ameroid ring is made of casein (a type of protein) that is surrounded by a ring of stainless steel. Over 4-5 weeks the normal fluid in the abdomen causes the casein to swell. Since it is encased in metal, the swelling slowly occludes the blood vessel with abnormal blood flow to the liver.

It is important that the casein swells slowly to allow the liver to adjust to the new pressure within it from the other blood vessels that are now increasing their blood flow to the liver. If the problem blood vessel decreases its flow to the liver too fast there can be serious consequences and even liver failure.

This surgery is performed after a careful review of all data and a discussion with the owner of the possible complications due to surgery. Cats tend to have more post operative complications compared to dogs, so special care is paid to their needs to help ensure a successful surgery.

PSS Surgery

Dr. P watched the surgery and took these photos to help explain this procedure.

Our friend is carefully prepared for surgery to minimize any chance of infection

While our patient is prepped Dr. Gassel is preparing his instruments


Our surgeon preparing to start the surgery while his anesthetist closely monitors our patient

The procedure does not start until our patient is under the proper plane of anesthesia and is stable

Our patient’s blood pressure is manually monitored throughout the procedure

Before making the initial skin incision Dr. Gassel confirms with his anesthetist that our patient is ready for surgery

The skin is incised gently to minimize trauma that could post operative discomfort and can delay healing

Small blood vessels are cauterized before proceeding further

The abdomen is entered at a special location in the muscle called the linea alba. This is where two tendons of the abdominal muscles come together. This area is stronger than muscle tissue, and will hold the final sutures when we put the muscle back together at the end of the procedure. This will prevent a hernia. 

As soon as the abdomen is entered the swollen and yellow discolored liver appears. You can see it between our surgeon’s fingers. The liver is this way because of the disease process going on. 

Finding and exposing the extra hepatic blood vessel for correction amidst all of the blood vessels, fat, and tissue in the area is tedious, and takes delicate dissection to get the vessel completely exposed for the Ameroid Ring to be placed. This is where Dr. Gassel’s expertise comes into play.

After much dissection you can see him starting to expose the vessel with his instrument. The extra hepatic blood vessel is the reddish horizontal object under the swollen and yellow-colored liver.

You can easily visualize the extra hepatic blood vessel over the hemostat as it is exposed carefully enough to put on the ring

The next important part of the procedure is picking the correct sized Ameroid Ring. If it is too big it won’t occlude the extra-hepatic vessel enough to help. If it is too small it will occlude the blood flow too rapidly and cause the liver to fail. 

The ring is prepared by removing the locking pin

The extra hepatic blood vessel is very gently placed in the ring through the opening in the ring where the pin was

When Dr. Gassel feels the ring is the correct size the locking pin is placed back in

The final appearance of the Ameroid Ring before our patient’s linea alba and skin are sutured back and our patient is awakened

Dr. Gassel and his surgical assistant after a successful surgery

One of the ways we diagnose a PSS is with a bile acids test. After surgery the bile acids test should be back to normal. We are happy to say that after over one year our patient’s bile acids test is back to normal and he is feeling great!

This was the original bile acids test on this cat. It should be less than 13, and is over 135. To have it go from this, to perfectly normal, is a testimonial to the expertise of the surgical team at the Southern California Veterinary Specialty Hospital.

There is much more to liver shunts, which you can learn about on our Liver Diseases Page.

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Rabbit with a broken front leg

This bunny broke his front leg. Learn how we diagnosed it and applied a splint by visiting this link on our web site.

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Front Leg fracture

This bunny was presented to us unable to use his left front leg. After an exam by one of our doctors it was determined that the leg might be broken.  A radiograph revealed the extent of the injury.

Our friend is nice and cozy just before his radiograph

You can see his fracture/dislocation near the L marker 

A special lightweight but strong plastic splint with foam padding is custom sized for his leg


Several layers of cotton padding are used to hold the leg stable yet keep him comfortable 

It looks heavy but it is actually light. This much cotton is needed to stabilize the fracture.

Once the final cotton wrap is applied and checked for comfort an outside wrap is applied to keep the cotton in place and also keep it clean

Looks like we ran out of “bunny” wrap and had to use “rooster” wrap for the outside bandage

Our friend is good to go and feeling much less pain now that the fracture has been stabilized and the leg is comfortably in the splint

This bunny will need up to 2 months of healing for the fracture to heal. It needs to rest during that time and use the leg sparingly so the fracture can heal. The splint lets him walk on it comfortably, which is an important part of the healing process. Without using the leg slightly the bone has less of a tendency to heal due to the effectiveness of the splint. If this does not heal surgery might be needed. We will keep you posted.

Return to Rabbit Diseases Page

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Guinea Pig with bladder stones

This is Mr. Darcy and his mom. He had bladder stones that we removed this week. You can learn more about it from this link at our Guinea Pig Diseases page.

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Bladder Stone Removal

Mr. Darcy was having symptoms of not feeling well and with blood in his urine, so his mom brought him to see Dr. Meredith Kennedy for a thorough exam.

During his exam, Dr. Kennedy palpated Mr. Darcy’s bladder, and noticed he was uncomfortable. As part of his routine diagnostic tests a radiograph was taken.

Mr. Darcy has not one, but two, stones in his bladder. Do you see them in this radiograph, just to the right of center?

If you can’t see them this view might help

It is not too often that Guinea Pigs get these stones. Bladder stones have several names. These include cystic calculi and urolithiasis. There are many different types of bladder stones, all with different causes. Our Bladder Stone page goes into this in more detail.

Graphic surgery pictures to follow.

Before surgery was performed we needed to make sure he is ready for surgery with a blood panel and medical treatment. Once we were sure he is ready for anesthesia we can begin the surgery to remove the stones. This surgery is called a cystotomy.

Mr. Darcy has had his tummy shaved, is connected to the anesthetic monitor, and has been scrubbed for his surgery

While Mr. Darcy is being prepared for surgery Dr. K is getting her sterile instruments ready

Our anesthetist closely monitors anesthesia, and only when he is stable, and at the proper level of anesthesia, does the surgery begins

After draping the first thing Dr. K does is infuse a long acting local anesthetic. This allows us to use less anesthesia during the procedure, and also allows Mr. Darcy to wake up pain free from his skin incision.

The skin incision is made just long enough to exteriorize the urinary bladder. Once through the skin Dr. K cuts through the subcutaneous (SQ) tissue to get down to the muscle layer

Mr. Darcy is 10 months old, and is being neutered at the same time, so that will also be done through this incision instead of through his scrotum. The less incisions the better for healing.

After the skin incision is made a scalpel is used to enter the abdomen by going through an area of the abdominal muscle where the tendons are located. This tendinous area causes minimal bleeding, and has better holding ability when the sutures are placed here at the end of the surgery.  This will prevent a hernia.

The tendon incision at the abdominal muscles is extended to the proper length with a special surgical scissors

Once the abdomen has been entered Dr. K palpates the area to find the urinary bladder

Guinea Pigs have a large cecum (our appendix), that wants to come out through the abdominal incision. You can see the urinary bladder between Dr. K’s fingers on the right. 

Once the intestines are put back where they belong (they want to keep coming out during the surgery) a special suture called a “stay” suture is put in the urinary bladder to keep it exteriorized and away from the intestines. In this picture Dr. K is using our laser to make the initial urinary bladder incision. 

This bladder is inflamed and painful due to the stones irritation the lining. We use our carbon dioxide laser routinely on problems like this due to its tremendous ability to minimize bleeding during the surgery, and post operative pain and inflammation after the surgery. We have a page dedicated to laser surgery for more information.

As Dr. K continues to use the laser to enter the urinary bladder the stones become apparent

Once the urinary bladder is fully incised the stones are brought out with a hemostat

After the stones are removed the urinary bladder is carefully palpated to make sure there are no other stones or problems before being sutured closed. 

A special suture material is used that is strong, will not inflame the bladder, and will dissolve slowly on its own over several months. This is an important part of the procedure, and the bladder is sutured carefully. 

Dr. K neuters Mr. Darcy through the same incision. You can see the testicle in her hand as she is getting ready to remove it.

Our patients with skin incisions are given companion laser treatment before they are awakened from anesthesia. This laser allows for faster skin healing with less pain and inflammation. 

Mr. Darcy is in good hands just after his surgery

We keep a close tab on him before he is put in recovery

Once in recovery he is closely monitored for temperature, breathing, pain, and bleeding

Mr. Darcy recovered rapidly and feels much better now that those stones are not irritation his urinary bladder. The next day he is checked carefully by Dr. K.

His incision looked great with no inflammation or sign of pain or infection. He was cleared to go home.

Mr. Darcy’s mom is happy he is feeling better

She sent Dr. K flowers as a token of her appreciation

You can learn more about how we do surgery in general on a wide variety of species at the Long Beach Animal Hospital from this link.

Return to the Guinea Pig Diseases page

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Orphaned Kitten Care

Dr. Kennedy volunteers as foster care for orphaned kittens, with the Southern California Siamese Rescue organization (cs.siameserescue.org). Animal shelters typically get flooded with young orphaned kittens in the springtime, and this year is no exception. Unfortunately, they cannot provide the care needed by very young kittens, who are often suffering from a variety of respiratory and intestinal infections, as well as fleas and viruses.
Kitten rescue organizations such as SCSR pick up these orphans and find foster volunteers who can raise them until they’re old enough to be adopted out. They’re spayed and neutered before adoption, as well as being tested for Feline Leukemia (FeLV) and Feline Immunodeficiency virus (FIV).
All of Dr.Kennedy’s foster kittens are viral negative, but many have worms. Some of the kittens have been hospitalized and given IV fluids, which is why some have shaved patches on their front legs. These protozoal infections can be very persistent and sometimes deadly in young animals, so it’s extremely important for puppies and kittens to be dewormed and tested several times throughout their first year. Our web site has much more information on worms (internal parasites).
Dr. Kennedy’s kittens very likely were infected with Giardia and Coccidia before they were born, and needed some help getting over their infections and returning to health. Most are doing very well, even ‘Jamaal,’ who was only six ounces when he arrived from Tijuana. Being so small, he’s needed more intensive attention, including assist-feeding to help him gain weight. He’s a trooper, and is now nearly eleven ounces. Once he reaches two and a half pounds he’ll be neutered and ready for adoption. You can find out more at cs.siameserescue.org.
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