Dogs | Long Beach Animal Hospital - Part 3

Category: Dogs

Hip Dislocation

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On occasion a dog or cat will dislocate its hip. This page shows the treatment of a poodle mix that fell while running, and is now completely lame on its rear leg.

Diagnosis

The diagnosis in this case is made with x-rays after an initial examination. The exam gave us clues that the pain was caused by a dislocation. When we gently extended the rear legs (depending on the type of dislocation) the dislocated leg appeared shorter than the normal leg.

This x-ray is of a dog with a dislocated hip. The ball of the left femur is completely out of the socket. Ligaments and the joint capsule have been torn for this to occur.

 

Medical Correction

Some pets with dislocated hips can be corrected without the need of surgery. Whether or not this occurs depends on the extent of the damage, especially to the ligaments, tendons, and joint capsule.

This pet was anesthetized and the head of the femur was gently placed back into the socket. It was securely taped so that the femur was held firmly in the socket. a special type of sling was applied to keep the head of the femur (the ball) pushed back into the socket. This method is not always successful, but it is worth trying to prevent surgery.

 

 

A radiograph is taken immediately after application of the splint to be certain the femoral head is still in the socket. One week later we repeated the x-ray to be certain it was still in place. This splint stayed on for 3 weeks, and this pet eventually healed completely.

 

Pain medication will be given to minimize discomfort. This dog will need to be confined and have minimal activity for several weeks.

Surgical Correction

In many cases we have to resort to surgery to correct the dislocation. When the hip is replaced in these dogs it does not stay in the socket.  We have pictures of the surgery

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Forearm Fracture in a Dog

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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 plates or pins. In small breed dogs, due to their bone anatomy and blood supply, and splint will not suffice, and a plate is needed surgically for proper healing.

Radiograph

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.

Splint

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

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.

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.

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!

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.

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).

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.

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.

Surgery

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.

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.

During and immediately after surgery we will give pain medication.

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.

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Ear Cleaning

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One of the most important things you can do to keep your pet’s ears clean and healthy is to clean them periodically, especially if they have been prone to infection. This page will show you the proper technique using a medium sized dog as an example. The technique for a cat is similar, the only major difference is in restraint. No matter which species you are restraining, pick a room that is quiet and free of small children. Please let one of our nurses give you an actual demonstration of this technique to develop your confidence.

Before we institute any cleaning of problem ears it is important to make a diagnosis. Not every case of ear infection is caused by ear mites, as many people are prone to think. Ear infections are commonly caused by bacterial infections, hypothyroidism (low thyroid), and allergies. We have found a consistent cause of chronic ear problems and infections is due to a food allergy, which is why we recommend Hill’s z/d, the gold standard for this type of food.

Canine Restraint

Depending on its size, put your dog on a table so that it is approximately chest high. Gently hug your pet under its neck with one of your arms, and put the other hand on the back of its head if necessary. Be patient, yet persistent. If your dog is small you can use the cat restraint technique.

Hugging your pet with your left hand under its chin gives you control and flexibility as to how much restraint is needed.

Feline Restraint

Wrapping your cat with a towel is a good way to restrain it for ear cleaning. In essence you will be wrapping it like a burrito. For cats in general the less restraint the better- let the towel do the work.

Put a large towel on a table and put your cat towards the front end of this towel.

Bring each side of the towel over the cat and leave only the head and tail to stick out

Bring the back, unfolded section of the towel over the front just up to the back of your cat’s head.

Finish the “burrito” by wrapping the towel under each side of your cat. The only thing sticking out of the towel at this point is the head.

Hug your cat gently to you with one hand and you will have your other hand free. Besides cleaning ears this restraint technique enables you to administer oral or topical medication.


Cleaning

Never put anything in your pet’s ear canal without proper restraint. As a general rule you should clean the ears by letting the cleaning solution bring the infection and discharge to the outside of the canal to be wiped away. You should not put Q-tips into your pets ears unless we tell you to and you have been shown the proper technique, and your pet is adequately restrained. Q-tips can damage the sensitive tissue that lines the ear canal. Also, an ear drum can easily be ruptured by placing objects in the ear canal, especially if the ear has an infection.

This is a typical picture of what might be encountered in an ear that needs cleaning.

The first thing to do is use a gauze to wipe away discharge that is on the surface.

Gently pull up on the ear and partially fill the ear with the cleaning solution. By straightening out the ear you allow the cleaning solution to flow down the ear canal to where the infection and debris are located.

After the canal had been partially filled massage the base of the ear canal very gently. Most pets find this part soothing.

Let your pet shake its head if it wants to. Then use a gauze to soak up the fluid that comes out of the ear.


Instill several drops of the actual medication we prescribe after the cleaning solution is out of the ear and the ear is relatively free of discharge. Most pets do fine with daily cleaning and medicating, your doctor will let you know if it should be done more or less frequently than daily.

Now is the time to reward the cleaner and cleanee for a job well done! If you think that was tough, how would you like to restrain this pet and clean its ears? The hugging under the chin technique doesn’t always work on a 300 pound tiger!

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Canine X-Rays

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A few of the many radiographs we take each month. Click on some of them and they will enlarge. You can see the detail available with our Digital Radiography.  Click on them and most will enlarge.

All of these metallic objects (see arrows) are stainless steel sutures in Spunky. He is a Schnauzer that has gone through 3 abdominal surgeries. Two have been to remove bladder stones, one was to remove something he ate (you wouldn’t want to know what it was) that got lodged in his stomach.

 
The round white thing on the far right is a bladder stone in a different dog (urolithiasis). It is a Digital Radiograph, so click on it to enlarge. Do you see anything else in this radiograph?

The diffuse white area in the center of this dog’s abdomen is an abdominal tumor. Ultrasound will help pinpoint the exact location and will also enable us to perform a relatively simple biopsy.

 

That very large and rounded object in the chest of this dog is the heart. This is called cardiomegaly, and is due to heart failure.

This is what it is supposed to look like

Radiographs-VDChest1

Radiographs-VDChest

Severe Hip Dysplasia

Radiographs-HipDysplasia

Screw holes that remain after a plate to fix a fractured tibia (shin bone) is removed

OLYMPUS DIGITAL CAMERA

After surgery to lengthen the ulna. Damage to the radius has caused a deformity in this growing dog, and lengthening the ulna helps straighten it out.

OLYMPUS DIGITAL CAMERA

Normal knee joint

OLYMPUS DIGITAL CAMERA

This dog had chronic diarrhea that was finally diagnosed when an x-ray was taken. Those are 3 pennies in the rectum at the far right of the x-ray.

 

This Irish Setter has a condition know as bloat (GDV- Gastric Dilatation Volvulus). The large dark and circular area in the middle of the x-ray is a twisted and distended stomach. This is a very serious condition that requires immediate care.

Here is GDV one on a different dog. You can see the greatly distended stomach along with all the gas (dark areas) in the intestines on the right of the radiograph.

This is what a fractured femur (the one on the left) looks like months after it has healed

How many puppies can you count in this pregnant dog ? Do you want to see how a C-Section is performed?

With our Digital X-Ray you can see more detail on a different dog

The arrow points to arthritis in the spine, known as spondylosis. This is a common problem in many dogs as they age. We have numerous medications at our disposal that will help alleviate this painful affliction.

In this Digital Radiograph the spondylosis is so severe that nerves to the urinary bladder are not working well. The large round object on the right is the urinary bladder filled with urine because this pet cannot urinate properly. This is a painful condition that can lead to secondary infection and severe kidney problems.

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Cancer

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The scientific word for cancer is neoplasia, meaning new growth. In reality, it is an abnormal growth of cells that interferes with an organ’s ability to function, resulting in a degree of failure in that organ. Some of these abnormal cells break off from the organ and spread to other organs in the body, causing them to fail. This process is called metastasis, and is the hallmark of malignant cancer.

The enlarged sublumbar lymph nodes in this dog’s abdomen are the whitish areas under the circle. A cancer called adenocarcinoma spread to them through the process of metastasis.

This is what severe bone cancer looks like on the front foreleg (radius and ulna) of a dog. It is a malignant cancer called osteosarcoma. Compare it to the normal radius and ulna below to see the signifiant bone destruction. 

A normal radius and ulna on a radiograph

 

Cancer it is not one disease, has many different causes, and can affect every organ. This makes it quite a challenge to diagnose and treat. Even though the cause is not known in many cases, we do know of major factors that predispose pets to getting cancer. An example is squamous cell carcinoma (SCC) in white cats that are exposed to the sun. We tend to see cancer more commonly in our geriatric patients.

A major predisposing factor is dogs, cats and rabbits that are not neutered and spayed when they are young.  Their chances of getting breast, testicular, and prostate cancer increase significantly when they are not altered at an early age. The following pages have detailed information on this:

Reproductive Cancers

Dog Spay

Dog Neuter

Cat Spay

Cat Neuter

Rabbit Neuter

Rabbit Spay

Dog and Cat Non-Reproductive Cancers

Intestine

Kidney

Liver

Lymph node

Mammary (breast)

Mast cell

Spleen (hemangiosarcoma)

Squamous cell carcinoma (SCC)

Ferrets

Adrenal disease

Insulinoma

Liver

Rodents

Mammary (breast)

Ovarian

Reptiles

Tegu oral tumor

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Kidney (Renal) Cancer

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Its not that often that we see a primary kidney cancer in a young pet. This page will show you how we diagnosed and treated it on a one year old Basenji.

This story emphasizes how fast things change, and a pet that is perfectly healthy on a physical exam and blood panel, can change for the worse in a short period of time.

Click on the lab data and ultrasound report photos to enlarge them and see how we made the diagnosis.

Graphic photos of a kidney with cancer on this page.

Normal Physical Exam

As part of our routine pre-operative spay exam, a blood panel is run. It came back normal.

Kidney-Tumor12 copy

Note the circle over BUN and Creatinine. They are tests of the kidneys, and they are normal.

Surgery and healing progressed as expected for a young dog, and within a few days it was back to normal. Over the next several months there was no indication of any problem.

Physical Exam

History

Three months later this young dog was presented with signs of decreased appetite and not feeling herself. There were no other problems.

Physical Exam

Body Temp- 101.6 degrees F

Mucous membranes- pink

Respiratory rate- 40 breaths per minute

Heart rate- 150 beats per minute

Haircoat- normal

Musculoskeletal system (bones and muscles)- normal

Mouth- normal

Eyes- normal

Abdomen- normal

Peripheral Lymph nodes- normal

Ears- normal

Heart- normal

Urogenital- normal

Weight- 22#, no change from 3 months prior

Interpretation- Even though this exam is essentially normal, a lack of appetite in a young dog is of concern. Also, no weight gain over the last 3 months is cause for concern in a young animal that is still growing, and confirms the owners observation of lack of appetite.

Diagnostic tests are now needed to find out why the lack of appetite and weight gain. On any sick pet a minimum database is needed to start looking at all of the numerous possibilities as to the cause of these problems in a young dog.

Diagnostic Tests

Blood Panel

Kidney-Tumor6

It is obvious there is a serious problem with the kidney tests compared to 3 months prior. In addition, other tests are elevated, all leaning towards a serious kidney problem.

Ultrasound

This is the abdominal ultrasound report. Read it carefully to see how detailed it is and note the abnormalities. The abnormalities are marked in the pictures to follow.

Kidney-Tumor1

Left kidney

Kidney-Tumor2

Right kidney

Kidney-Tumor3

Liver

Kidney-Tumor4
Kidney-Tumor5

Small intestine

Kidney-Tumor13

Cytology

A fine need aspirate (FNA) was obtained during the ultrasound. This is a non-invasive way to obtain a sample as compared to a highly invasive (and more expensive) exploratory surgery. The skill of our ultrasound doctor gives us confidence in the accuracy of the FNA, although there is no guarantee it will give us an accurate cause to the enlarged kidneys.

The sample is sent to a pathologist for microscopic analysis. It came back a malignant cancer called lymphosarcoma (LSA), also known as lymphoma.

Kidney-Tumor9

Necropsy photos of a different pet

Necropsy photo of an elderly cat with kidney cancer. The kidney is split down the middle and opened up to see the inside. This is how lymphoma looks in a cat, not the dog above. The cancer is at the arrow, from the 8 PM to 2 AM position on the left.

cancerouskidney

Treatment

This dog has a serious problem that needs to be treated by a veterinary oncologist. We send all of our cancer cases to the Veterinary Cancer Group.

Kidney-Tumor14

They have many doctors and several offices throughout Southern California 

This is the chemotherapy treatment protocol they instituted. They also do many other types of therapy including radiation therapy.

Kidney-Tumor11

Four months later this dog is doing well, with the kidney tests dramatically improved:

BUN- 35

Creatinine- 1.8

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Hemangiosarcoma

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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 causes internal bleeding, and oftentimes it becomes cancerous. This page will emphasize cancer of the spleen, called hemangiosarcoma.

In breeds that have a high incidence of splenic tumor we recommend yearly exams starting at 5 years of age,  with radiographs and ultrasounds to catch this problem early before complications and spread, 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. This occurred with a Labrador Retriever that was presented to us with the owner telling us “he just wasn’t doing right”.  He was eating good, was not vomiting, had no diarrhea, and was not coughing. This owner was astute and brought him in for an exam just in case.

A thorough exam and blood panel revealed no problems, so a radiograph was taken. This radiograph revealed a large abdominal mass. This could have been coming from the liver, spleen, intestines, kidneys, pancreas, or mesenteric lymph nodes. An ultrasound revealed it was from the spleen. The next day we removed an 8 pound rupturing spleen! You can see pictures of the surgery to remove this large mass in the surgery section later in this page.

Graphic surgical photos are on this page

Nomenclature

We will use some medical terms regarding the spleen:

  • Extra medullary hematopoeisis – The making of red blood cells outside of the bone marrow
  • Reticuloendothelial system – in regards to the spleen, it is the system that recycles red blood cells
  • Anemia – a low amount of red blood cells or hemoglobin
  • Thrombocytopenia – a decrease in thrombocytes, which are an important part of the clotting factors when there is bleeding.
  • Hemoabdomen – free blood in the abdomen
  • Splenomegaly – enlargement of the spleen as a result of any cause
  • Splenectomy – removal of the spleen
  • Hypersplenism- an enlarged spleen that is normal and not causing any problem

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  small 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.

Physiology

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

  • Storage of cells
  • Production of red blood cells
  • Filtration of the bloodstream
  • Production of cells for the immune system

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.

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:

    • poor appetite (anorexia)
    • weight loss
    • discolored urine
    • vomiting- might be intermittent
    • weakness
    • weight loss.
    • collapse
    • death

Examination of a pet with splenic torsion might reveal:

    • pale mucous membranes (gums)
    • rapid heart rate (tachycardia)
    • painful abdomen
    • a large mass in the abdomen upon palpation
    • fever
    • dehydration
    • jaundice (icterus)

A blood panel might reveal:

    • anemia
    • low platelets (thrombocytopenia)
    • elevated white blood cells (leukocytosis),
    • elevated liver enzyme tests,
    • hemoglobin in the urine (hemoglobinuria)

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), hemagioma (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 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:

    • heart
    • lungs
    • muscle
    • skin
    • bones
    • abdomen
    • diaphragm
    • brain
    • kidney

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

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.

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:

    • German Shepherds
    • Golden Retrievers
    • Portugese Water Dogs
    • Boxers
    • English setters
    • English pointers
    • Great Danes
    • Skye Terriers
    • Bernese Mountain Dogs

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:

    • lethargy
    • inappetence
    • weight loss
    • diarrhea
    • vomiting
    • collapse
    • discolored urine
    • abdominal distention

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.

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 its called hepatosplenomegaly.

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

Splenectomy -SpleenRadSplenectomy -SpleenRadSplenectomy-LateralRad

The red circle delineates the enlarged spleen.

L.I. – Large Intestine

Pr- Prostate

Splenectomy -SpleenRadSplenectomy-SpleenRadCircle

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.

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.

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. 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.

The lines demarcate the margins of this spleen

Do you see the spleen in this picture without the demarcation?

A typical ultrasound report on a dog with a cancerous spleen

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.

ECG (Electrocardiogram)

This tests the electrical activity of the heart. I some HSA’s there will be an arrhythmia

Definitive Diagnosis

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

Histopathology

Treatment

Surgery is a common treatment for splenic disease. This 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 alonge 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.

After doing a cross match to ensure compatibility we obtain whole blood for the transfusion

Splenectomy

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.

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.

This is a sterile abdominal surgery, and our surgeons scrubs with a special antiseptic soap prior to gowning and gloving

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

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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

Surgery-Monitor

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. Our anesthetist is using a special stethoscope (esophageal), that is passed down the esophagus and lays right over the heart. This gives us a clear sound of the heart and how it is beating.

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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.

By working together early in the surgery we minimize anesthetic time.

For a pet that might already be anemic it is important to minimize blood loss during surgery. Special care is taken on entering the abdomen to minimize loss. There is minimal bleeding at this point as our surgeon gently dissects the sub Q (subcutaneous) tissue just under the skin.

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.

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.

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.

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.

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.

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

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.

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

Our surgeons work simultaneously, each starting at a different end of the spleen, so they can complete this tedious part of the surgery sooner. Its 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.

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.

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.

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.

Post operatively we take radiographs of the chest and perform and ultrasound every 2 months for cases of HSA looking for distant and local metastasis.

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. Removing it was like delivering a baby!

The size was obvious as soon as we entered the abdomen. At this point in time we were not sure if it was a boy or a girl! Dr. P is coaxing it out of the abdomen at the beginning of the surgery, being very careful not to rupture it.

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

Ligating the blood vessels to the spleen was more difficult than usual because of the size, scar tissue, and 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.

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.

Splenic Hematoma – good

Splenic Torsion – good

Hemangiosarcoma – guarded to poor.

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Lymph Node Diseases

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The lymph nodes are part of the lymphatic system. They have several important functions regarding the immune system, and are good indicators of disease. The mammalian body has many internal lymph nodes. These can only be visualized by exploratory surgery, a CT scan, an MRI, a radiograph, or an ultrasound.

During a physical exam the external ones can be palpated to determine if they are enlarged. The medical term for enlarged external lymph nodes is lymphadenopathy. The lymph nodes are always examined as part of our routine head to tail (if they have one!) exam on all pets presented to us.

Dr. P is getting ready to perform a lymph node exam on this cat. He will start with the paired lymph nodes under the jaw, called the submandibular lymph nodes.

Causes

Lymph nodes can enlarge due to several reasons:

  • Inflammation

    A reaction to a foreign body might cause this. If mild this will go away by itself in most cases. If not, we will use medication like cortisone to get the swelling down. Even though this type of problem is benign, if the lymph nodes get large enough they can interfered with normal physiologic functions like swallowing.

  • Infection

    Bacterial, viral, or fungal infections can cause them to enlarge. This enlargement might be a sign that they are performing their job as expected. When the infection subsides the lymph node should return to normal size. Sometimes though, and enlarged lymph is a sign that the lymph node needs help in fighting inflammation or infection, and we put that pet on antibiotics or anti-inflammatory medication.

This badly infected toe on this cat would cause the regional lymph node, in this case it would be the axillary lymph node, to be enlarged. 

  • Cancer

    The most common cancer that causes this problem is called lymphoma (also know as lymphosarcoma). This is malignant cancer.

This is the report of a dog that has lymphoma

Examination

Internal Lymph Nodes

Numerous lymph nodes exist within the thoracic and abdominal cavities. They can not be palpated, and their enlargement does not show up on routine blood samples. They might be seen on radiographs or ultrasound if they are significantly enlarged.

This radiograph of the chest shows the heart and lungs clearly. The lower arrow points to the location of the sternal lymph node. It is not visible in this dog because it is normal. The top arrow points to a round, white structure. It is a tumor nodule that has spread from cancer elsewhere in body.

This radiograph of the abdomen shows the liver and stomach clearly. The lower arrow points to the general location of the mesenteric lymph node. The top arrow points to the location of the sublumbar lymph node. Neither one is visible.

The greatly enlarged sublumbar lymph nodes are circled in this dog with cancer. See the close up below

The sub enlarged sublumbar lymph nodes are the circular whitish areas

Lymph nodes can also be seen with the ultrasound. This takes an experienced veterinarian, usually a veterinary radiologist.

This is a lymph node in the center of the abdomen called the mesenteric lymph node

This is a lymph node at the back of the abdomen just under the spine called the sub lumbar lymph node

This is a close up of a lymph node when seen by ultrasound

Enlarged lymph nodes can be found when performing an exploratory surgery.

The scalpel blade is pointing to the mesenteric lymph node. This node is found at the center of the small intestine loops. This one is enlarged because this cat has kidney cancer, which has spread to the mesenteric node.

Here is another enlarged mesenteric lymph node from a cat with intestinal cancer called lymphosarcoma

External Lymph Nodes

Mammals have numerous external lymph nodes (also called peripheral lymph nodes) that can be palpated during a physical examination. This is of great advantage because we can easily feel if they are enlarged without having to rely on diagnostic tests.

Reptiles and birds do not have these external lymph nodes, so they cannot be palpated during an exam.

Good luck trying to palpate the external lymph nodes on this 120# python in for its yearly exam. The only thing you will find is how powerful it is as your assistants try to hold it still for an exam.

The tonsils are lymph nodes also, but they are not palpated, just looked at during our routine exam. We do not recommend that you check them yourself because they are deep in the oral cavity,  you can injury your pet while opening the mouth wide enough to see them, or you can be injured by a bite or scratch from your pet.

Five external lymph nodes are routinely palpated during a physical exam. All of them are paired, which is another advantage because we can compare one to another and notice subtle changes in size.

  1. Submandibular

    They are located in the neck area near the angle of the jaw. They lay right next to the salivary glands, so it is important to palpate the correct structure.

  2. Prescapular

    Located just in front of the shoulders. Follow the arm up to the point of the shoulder to find them.

  3. Axillary

    Found on each side of the chest in the armpit area. They tend to be small, and are more forward then most people realize.

  4. Inguinal

    Found on the abdomen towards the inside of each rear leg. There is significant fat in this area, so they might be difficult to find, even if enlarged. Also, there is mammary tissue in the area that can easily feel like an enlarged lymph node if the mammary tissue has an infection or cancer.

  5. Popliteal

    Found on each rear leg on the opposite side of the knee. They are relatively superficial and easy to feel.

We will gladly teach you how to palpate these lymph nodes whenever you bring your pet in for a physical  exam. These are sensitive organs so they are always palpated in a gentle manner. You might want to palpate them on a weekly basis at home. If you think they are enlarged bring your pet in for an exam so we can determine if there is a problem.

Diagnosis

Fine Needle aspiration

This test is a relatively simple way to obtain a significant amount of information from an enlarged lymph node. In this test we use a small needle (similar to the one we use to give vaccines) and gently insert it into the enlarged lymph node. We aspirate some of the lymph node material and put it on a microscope slide.

This ferret has a very large right submandibular lymph node. Do you see the needle on the left side of the picture that we are using to obtain the aspirate sample?

The aspirated material is put on a microscope slide for analysis by a pathologist. They will put special stains on the material and carefully scrutinize it under the microscope.

The fine needle aspirate test is not infallible at finding a problem. When the needle is inserted it is put in only by feel. It is possible for the lymph node to have a problem area that the needle missed. Also, we are giving the pathologist only a very small sample to read. It can be difficult to determine the health of the whole lymph node when only a small sample is taken.

Due to these limitations the pathologist sometimes can not say for certain what caused the lymph node to enlarge. If it comes back inconclusive then we might keep the lymph node under close observation. If there are other changes in the rest of the physical exam, or laboratory data indicates there might be a significant problem, we will remove the whole lymph node and submit it for analysis.

If the fine needle aspirate report comes back that cancer is suspected we will remove the lymph node, no matter what the other laboratory tests indicate. You saw that earlier when we showed you the report of a dog with lymphoma.

Biopsy

The most accurate way to determine if a lymph node is seriously diseased is to remove the whole lymph node and submit it for analysis. It gives us significantly more information than the fine needle aspirate. It requires anesthesia and an small incision in the skin. We routinely use our laser for skin incisions for its great ability to minimize bleeding, swelling, and post-operative pain.

This cat has an enlarged popliteal lymph node

We used the laser in this case to make the skin incision

The inflamed lymph node is easily visualized. Note the lack of bleeding due to the laser cauterizing the blood vessels.

The anatomy of this lymph node is not normal, an indication that it is diseased.

Because of the unique qualities of the laser we are able to perform this surgery with a small incision that heals rapidly

 

Biopsy Reports

The report on this dog gave us a diagnosis of valley fever, which is a fungal infection. You don’t have to read through all of the medical mumbo jumbo to get to the valley fever diagnosis at the end. In the last paragraph you can see that special stains were needed to make the final diagnosis. These special stains are not easily performed on a fine needle aspirate.

This report of cancer came back on a Labrador Retriever

Treatment

Inflamed lymph nodes are treated with an anti-inflammatory like cortisone. Pets with bacterial or fungal infections are treated with antibiotics or anti-fungal medications. There is no specific treatment for a lymph node that is enlarged due to a viral infection. If cancer is the cause of the enlargement it will be treated with surgery, chemotherapy, radiation, or a combination of all of these.

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Neuter-Canine

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One of the most common surgical procedures we perform is a dog neuter, know medically as an orchectomy. It is performed for several reasons:

It minimizes roaming

It minimizes aggressive behavior

It prevents male dogs from impregnating females

It prevents most prostate problems

This is what the prostate gland looks during ultrasound 

At the Long Beach Animal Hospital use of the laster is mandatory for all neuters. In this page we will first show you the surgery using the laser, then the traditional way this surgery is performed without the laser. The advantages of using the laser will be obvious.

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

Several days prior to any surgery please bring in your pet for a preanesthetic exam and blood panel to confirm your pet is ready for anesthesia. At that time one of our doctors will go over any questions you have.

On the day of surgery we need your dog in the hospital between 7:30 AM and 8 AM. Please take away all food and water when you go to bed the evening before surgery, and do not give your dog anything to eat or drink the morning of surgery.

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

This page shows the surgical procedures for:

A normal testicle using the laser

A short video of a bloodless laser neuter at our hospital

A testicle that has not completely descended into the scrotum and is in the inguinal canal using the scalpel blade

A testicle that is still in the abdomen using the scalpe blade

The use of neuticles

The following contains graphic pictures of an actual surgical procedure performed at the hospital. 

Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine. Surgery is not an area to cut corners. All of our neuters receive a physical exam prior to surgery.

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The pre-surgery physical exam is performed before any anesthesia by the surgeon doing the neuter that day

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We prefer to take the pre-anesthetic blood panel one week prior to surgery. If we haven’t already taken a blood panel prior to surgery, we can take one the day of surgery and have a report within 30 minutes

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

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. Our patients are carefully monitored to detect any abnormalities before they become a problem.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

In addition to our monitoring equipment, our anesthetist stays “hands on” in monitoring important physiologic parameters.

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Our anesthetist is checking this pets mucous membranes to make sure enough oxygen is in the cardiovascular system

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Even though our monitor check the heart rate and shows the EKG, our anesthetist checks the heart with a stethoscope periodically throughout the procedure

_D2A8630Once our surgeon has scrubbed up and is in a sterile gown, gloves, and mask, the surgery begins

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

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Sterile instruments are used on every surgery

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Our surgeon does one final check on your pet’s stability and level of anesthesia before beginning the procedure

Laser Neuter Surgery

Using the laser has many advantages over using a scalpel blade. These include negligible bleeding during the procedure and minimal to no post operative pain. Click on any of these pictures below for a larger version.

This dog is laying on its back, with its head towards the right. The red line show where the prescrotal neuter incision will be

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Once our patient is draped the procedure can begin

Surgery starts with our surgeon gently palpating the testicles and make the laser incision just in front of them in the prescrotal area (red line above)

The initial skin incision in the skin just in front of the scrotum

Notice the lack of bleeding from the skin as we enlarge the incision for room to remove the testicle. The white structure in the center is the testicle covered with protective tissue.

When the skin incision is large enough the testicle is gently exteriorized

The testicle is covered with a tissue called tunic. This tissue is gently opened with the laser to reveal the actual testicle.

The laser incision of the tunic is continued until the testicle comes completely through

From this video you can see the lack of bleeding

Video of another dog being neutered with the laser

All of the pertinent structures associated with the testicle are apparent in this picture. The white horizontal line below the surgeon’s thumb is the epididymus. The dark structure to the right of this is the panpiniform plexus. This plexus contains arteries and veins to cool the testicle, supply it with nutrients, and allow testosterone to go into the bloodstream.

Our surgeon is using a clamp to remove the excessive tissue of the tunic before ligating the vessels

The suture material is strong, and one would suffice to prevent bleeding. We always put two sutures on the blood vessels for that extra margin of safety.

We use the laser to cut the tissue. The testicle is to the right, and will be completely removed once the laser finishes the cut. The body is too the left, and once our surgeon makes sure there there is no bleeding, this blood vessel is allowed to retract back into the body cavity.

The appearance of the blood-free incision just prior to suturing the skin

The final appearance of the sutured skin, with no swelling or bleeding. 

In addition to using the carbon dioxide laser to perform the surgery, we use the companion laser to aid the healing process at the incision before our patient is fully awake. This decreases post operative swelling so your pet is much more comfortable. When combined with the actual medication for pain we administer, our patient wakes up with minimal to no pain, and the healing process progresses faster.

Companion Laser in use immediately after a laser neuter

Click on the video to see it in action after a neuter surgery

Most dogs recover from this laser neuter surgery by the next day. It is important to keep these dogs quiet for a few days postoperatively to allow the incision sites to heal. In most neuters we put in sutures that are just under the skin and dissolve on their own, so there is no need to return for suture removal. If sutures are placed in the skin, we usually remove them in 7-14 days.

Our Laser Page has detailed information on the use of the laser for various other surgeries besides neuters.

Cryptorchid surgery

The dog being neutered in this picture has only one testicle in the scrotum, called a cryptorchid, monorchid, or retained testicle. This happens in only a small percentage of the animals we neuter. The other testicle can be in the abdomen or in the inguinal canal (inner thigh region).

In this dog’s case it is in the inguinal canal, as evidenced by the bulge (arrow). It is important to remove the retained testicle because it can become cancerous later in life.

First we will remove the normal testicle in the scrotum with a prescrotal incision you have already seen above. Since our patient in this case has one of his testicles in the inguinal area, the surgery is not finished yet. The skin incision and exposure of the other testicle is similar to the normal testicle removal.

In the inguinal area there is significant fat under the skin.
The actual structures of the testicle and its blood supply are exposed, ligated with two sutures, and placed back into the inguinal area.
The incision is closed in two layers. First the subcutaneous tissue, then the skin.

Here is a final view of our patient and his two incisions. As he wakes up from anesthesia he will be given an injection for pain.

When the retained testicle is not in the inguinal area it is located in the abdomen. This testicle can also become cancerous so it is important to remove it.

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This patient only has one testicle in the scrotum. The other is in the abdomen.

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In this picture the testicle has been brought out through the inch incision in the abdomen

A closeup of this testicle, which is smaller (atrophied) compared to the one we removed from the scrotum

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The post operative appearance showing both incision sites, with the abdominal incision on the right

You can easily see the difference in size between the atrophied testicle in the abdomen (left) and the normal testicle from the scrotum on the right. The testicle in the abdomen was removed at a young age so it never had a chance to become cancerous.

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This is the appearance of a different dog that had a cancerous testicle, called a seminoma. It was not removed until later in life, so it had a chance to enlarge tremendously.

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Both incisions are treated with our companion laser just after surgery just like we do when both testicles are in the scrotum

Neuticles

An interesting variation on this neuter surgery is the placement of solid silicone implants in place of testicles. This gives a natural look after neuter surgery that is desirable to some people. We highly frown upon having this done, have only performed it once decades ago on a special case, and don’t plan on doing it again.

This is the appearance of a normal dog scrotum prior to neuter surgery. Use it as a basis of comparison at the end of this section to see what the scrotum looks like when we have implanted neuticles in place of the testicles.

In this surgery the testicle is removed and the neuticle is placed in the sack that holds the testicle, called the tunic.

This is the sterile neuticle on the surgery tray ready for placement. Neuticles come in various sizes and shapes to be custom fitted to each individual.

The neuticle is gently implanted in place of the testicle. A proper fit is imperative, so it is important to order the proper size ahead of time.

When we are sure of a proper fit we carefully suture the tunic with a suture material that will eventually dissolve

This is the final appearance after the placement of the neuticles

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Parvo Virus

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Disease associated with the canine parvovirus started appearing around 1978. It is postulated that this virus is a mutation of the feline distemper virus. Since so few dogs had developed natural antibodies in the late 1970’s, a large number of dogs died from this disease. In some cases, the virus affected the heart, and caused death within a few hours.

We can still remember people coming into our clinic in droves to get their dogs vaccinated. There was no parvo vaccine for dogs then, since we did not even know what parvo was. The vaccine we gave initially was the cat feline distemper vaccine since there was no dog parvo vaccine available at the time. Our universities and drug companies immediately responded to the challenge, and identified the virus and manufactured a highly effective vaccine.

Decades later most dogs have encountered the parvovirus, either naturally (maternally) or through vaccines. These natural antibodies pass on to puppies (called maternal antibodies) when they nurse in the first few days of life. Maternal antibodies initially give a pup protection from parvovirus, along with many other viruses and bacteria. They last for a variable period of time, and start diminishing by around 2 months of age, yet can stay around until 5 months.

It is at this time that a pup starts becoming vulnerable to the parvovirus, so we begin vaccines then. We never know exactly when these maternal antibodies diminish, which is why we give the parvo vaccine in a series. If we start the series much before 2 months of age we are wasting it because the maternal antibodies will negate the effects of the vaccine. In essence, we are trying to give the vaccine just as the maternal antibodies are diminished, and just before the pup becomes susceptible to an exposure to the parvovirus.

There are reports of people and cats getting this disease, but in our locale this is almost non-existent. The big cats in places like Africa get this virus. Pigs can get their own version of parvovirus, but it does not affect dogs or act in a similar manner.

This disease is still prevalent, as evidenced by the number of e-mails we receive regarding this topic. Many of these dogs would not suffer this problem if they were properly vaccinated. Preventing this disease is dramatically more effective (not to mention less expensive) than treating it.

There are several graphic pictures at the end this page of the intestines of a dog that has complications from parvo.

Cause

The disease is caused by a highly contagious virus that is transmitted mostly by dogs orally contacting infected feces. Being a virus, they contain only DNA or RNA, and are not capable of reproducing unless they invade a cell. Once inside the cell they take over and force the cell to produce so many new virus particles that the cell eventually bursts, releasing these new virus particles into the bloodstream and tissues so they can invade other cells. The only thing that can stop this is the immune system.

Viruses are the smallest of know living organisms, and can only be seen with special microscopes called scanning electron microscopes, that cost millions of dollars (ours is on order). The parvovirus is extremely small (the Latin word for small is parvo)- just 1 thimble full of stool can contain millions of virus particles. It is easy to see why contamination occurs so readily. Incubation period varies from 5-10 days. As in many viral diseases of the intestinal tract, some dogs can pick up the disease and shed the virus without significant symptoms in themselves. These carrier dogs have what is called a subacute infection.

This is an electron microscope view of a cluster of parvo virus particles. It is courtesy of Dr. Cornelia Büchen-Osmond Biosphere 2 Center. “Universal Virus database of the International Committee on Taxonomy of Viruses, ICTVdB. The scale at the bottom shows the length of 100 nanometers (nm). A nanometer is 1 billionth of a meter, so it is obvious these particles are real small

The virus has 3 basic strains:

  1. CVP2 which was the first one found in 1978
  2. CVP2a came on the scene in the early 80’s
  3. The strain most prevalent today is CVP2b

Eventually a new strain will appear because the virus will adapt to the immune system of dogs.

The parvovirus can linger in the environment for many months, allowing it to affect other dogs. It can withstand common household disinfectants (except bleach) and can withstand freezing winter temperatures. It can be spread on the hair and feet of dogs, in addition to shoes, clothes, and eating utensils.

We tend to see parvo in dogs that have other diseases, especially intestinal parasites (worms). This might be because these dogs have immune systems that are weakened, making them more susceptible to a viral infection. Also, the parvo virus capitalizes on the fact that the lining of the intestines of these dogs with intestinal parasites are damaged and susceptible to the parvovirus.

Pathophysiology

Parvovirus has a predilection for rapidly dividing cells (similar to cancer). The rapidly dividing cells in a dog are the intestines, bone marrow, and the immune system. When the virus infects these areas the lining of the intestine literally dies, the bone marrow cannot make red or white blood cells in adequate quantity, and the immune system can become impaired.

Initially the virus replicates in the tonsils (which are lymph nodes) after oral ingestion. The virus rapidly multiplies and enters the bloodstream within a few days. From here it spreads to those parts of the body that contain rapidly dividing cells as mentioned above.

The main cause of death in parvo infected dogs is septicemia. Poisons from bacteria that are attacking the susceptible lining of the intestines release toxins into the bloodstream. These toxins add to the complications of a puppy that is dehydrated from vomiting, diarrhea and not eating, is hypoglycemic from not eating, and has electrolyte imbalances from vomiting and not eating. The bodies immune system becomes overwhelmed and death ensues if treatment is not instituted early and aggressive enough. Even if toxins are not released by bacteria, the dehydration and electrolyte imbalance that occurs can lead to shock and eventual death.

In actuality, whether a pup recovers from the virus depends on a race between parvovirus particles causing septicemia and dehydration, and the immune system’s ability to neutralize the virus. Fortunately, for most pups that get medical care early enough, the good guys win the race.

Symptoms

The majority of dogs presented with parvovirus show signs of fever, lethargy, vomiting, diarrhea, and lack of appetite. In severe cases the diarrhea is very watery and frequently bloody, with a telltale odor. They are very ill, with significant abdominal pain. The virus is so strong that it literally causes the lining of the intestines to slough. It is painful to eat, and with the severe diarrhea and vomiting that is present, they rapidly become dehydrated. The also have a disruption in their electrolytes (sodium, potassium, chlorine) that adds to the weakness.

There is a complication that can occur from all the intestinal activity regarding vomiting and diarrhea. It is called an intussusception, which is literally a telescoping of the intestine into itself. This will cause the intestine to die, resulting in death of the pup. Treatment is surgical, unfortunately, these pups are in no shape for surgery. Luckily we do not encounter this very often, if at all. Graphic pictures of intussusception to follow.

In the peracute form of this disease the virus attacks the heart and causes rapid death. Fortunately, it is rare to encounter this nowadays.

Diagnosis

The diagnosis of canine parvovirus is frequently made by age of pet (usually under 6 months of age), symptoms exhibited, and physical exam. Other diseases can mimic the signs of parvovirus, so x-rays and routine blood samples are sometimes run to help eliminate them as a cause. A CBC (complete blood count) might show a reduced white blood cell level, an indication that a virus is present in the body. A blood sample can be run looking for Parvo antibodies, but the results are open to interpretation as to whether the dog has an active infection or not.

 

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An accurate, simple to perform, and inexpensive test has been developed to test the feces for the virus. It can be performed by our in hospital lab within 15 minutes.

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If only one vertical bar appears the test is negative

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When two vertical bars appear the test is positive

Recent vaccinations can interfere with the interpretation of this test. No test is perfect though, and like many diagnostic tests for diseases, there can be false positives and false negatives.

Treatment

Dogs with parvovirus need immediate veterinary care because they are usually very sick. They should not be treated at home if they are significantly ill. This care involves large amounts of intravenous fluids, added electrolytes, antibiotics, and special medications to minimize vomiting. It is common for them to be hospitalized for anywhere from 3-7 days.

We monitor red blood cell counts and protein levels to identify those dogs that are not responding to routine treatment. If the protein level becomes low we institute therapy with additional fluids (called colloids) to combat the problem. Dogs that continue to decline in spite of therapy may also need a blood transfusion because they can become anemic and deplete their protein. We will also treat the internal parasites (worms) that can be an integral part of this disease.

Special precautions are taken when we treat parvo dogs. They are put in a special area so that we can monitor them closely. They are also isolated so that other dogs in the hospital are not exposed to the virus.

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 Staff members that treat them wear disposable gloves and gowns, and clean their shoes in a special chlorine foot bath to prevent hospital contamination of the virus.

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We do all of our work in our isolation room, including placing an intravenous (IV) catheter and treatments

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Intravenous fluids, given with a special fluid machine that gives out the exact quantity of fluid needed as determined by a doctor, is crucial in the treatment

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Parvo patients are very ill and need special treatment and nursing care if they are to pull through it

We do not feed them until they have had some supportive care like fluids and antibiotics. We need to get them eating soon so the lining of the intestines can function properly, and so they don’t go into a negative nitrogen balance.

We will send your dog home if it is eating and not vomiting for 24 hours. We expect it to have a persistent soft stool or diarrhea for several days after returning home. You might even send home supplemental fluids for several days.

Fortunately, most dogs recover with our intensive therapy, although there still is an occasional dog that does not. This may be due to a weak immune system that cannot produce adequate antibodies, or a particularly strong (virulent) strain of the virus that we encounter occasionally. Dobermans and Rottweilers seem to be especially sensitive to this virus, and have the most difficult time recovering from an infection.

Some dogs strain so much from the diarrhea that they develop an intestinal blockage called an intussusception. This is where the intestines telescope into each other, and requires surgery to correct. It is fatal if not corrected. An intussusception is diagnosed with a radiograph and confirmed with ultrasound.

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The advent of digital radiography has dramatically improved our ability to diagnose problems like this

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This is what the intussusception looks like internally

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A different dog with intussusception

Once your dog is well on its way to recovery we will send it home with supplemental fluids, antibiotics to be given orally, along with a special bland food made for recovering patients with gastrointestinal disease . It is called I/D (Intestinal Diet). Even though the pup might be ravenous, feed the food in small amounts frequently.

Your dog should be rechecked within a week to make sure it is putting on weight and thriving. At that point we will continue (or in some cases begin) its routine vaccination series. Since the pup is potentially contagious to other dogs, it is well advised to keep it away from other animals for at least 30 days since it can still spread the virus.

Pups that have recovered from parvo do not get the disease later in life. They can completely recover and lead a normal life.

Prevention

As with all infectious diseases, minimizing exposure from infected animals is the most effective means of prevention. Since infected dogs shed large amounts of virus in their stool, contamination is always a possibility. The virus is quite resistant in the environment, especially in public areas that are not disinfected. This is a good reason to keep your pup away from these areas until it is older, worm free, and had its full series of dog vaccines.

Since this disease occurs mostly in puppies, worms (internal parasites) and poor nutrition add susceptibility. Puppies should be wormed frequently until they are 3 months old.

Any dog you already have in the household before you exposed it to a parvo dog you recently brought in (whether it died or recovered from the parvo) should be current on its vaccines and should have minimal exposure, if possible, to the contaminated areas. It is rare for an adult dog that is current on its parvo vaccine (yearly boosters) to get parvo.

If you had a dog die of parvo we recommend thorough cleaning with diluted bleach (1:30 with water, or 4 ounces of Clorox in a gallon of water) and waiting 1-2 months before introducing a new dog to the area. Spray the yard as best as possible with a hose and keep new dogs away from the area for 1-2 months. Do not put bleach on your dog to rid it of parvo.

Vaccines are highly effective. Dogs should be vaccinated at 8, 12, and 16 weeks of age. Ideally, we should vaccinate pups every 2 weeks starting at 6 weeks of age and lasting until 5 months of age, especially in the more susceptible diseases. Puppies should not be exposed to other dogs or their feces until at least one vaccine is given. Puppies need to socialize at the critical 6-16 weeks of age mark, and if you do not expose them to other dogs early in life you might have a serious behavior problem later as an adult. So use precaution until your pup’s vaccine series is complete.

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