Case Of The Month

August

Written by: Cecily Reynolds, DVM

“Angel”

“STOP” IN THE NAME of LOVE

(The abandoned dog found tied to a stop sign)

Angel is a male, intact German Shepherd who looked about 7 years old that was brought to Route 516 Animal Hospital by the East Brunswick Animal Control. He was an abuse case who was found tied with a rope to a stop sign in the heat of the summer with note stating he was “a good dog that gets along with children”. When Officer Blumig brought Angel in he was an absolute mess. An astounding odor followed him and all employees were required to wear gloves to handle him. His hair coat was very thin and revealed skin that was very greasy, darkened and thick. He was very itchy and covered in abrasions and wounds secondary to the constant scratching with his overgrown nails. He had terrible bilateral ear infections and was infested with blood-sucking ticks. Excluding his severe dermatological (skin) issues, Angel exam was fairly normal. His bloodwork, fecal test, heart, lungs, lymph nodes, abdomen, and teeth were normal. The only abnormalities were his enlarged prostate (which was likely secondary to not being neutered) and him being underweight.

As the official township animal hospital, it became our duty to nurse the neglected shepherd back to health and make him adoptable. Angel’s demeanor was incredible; he was a big mush and never aggressive towards our staff during his various treatments. His therapy involved many oral and topical medications for his skin including anti-fungals, antibiotics, anti-inflammatories, and medication for mange. Angel also had daily medicated baths with soaking. Unfortunately, he then developed diarrhea from the various treatments and needed meds for his stool also. During Angel’s stay here his symptoms improved each day. After two months we were able to wean him off the medications and his fur grew in nicely. Angel gained 10 lbs and has energy and added muscle mass. We recently neutered him and performed a scrotal ablation (removal of the scrotum).

Before

After

Although this case of the month was less educational than most, we were so pleased with Angel’s transformation that we wanted to share his journey with you and to reiterate what a good boy he is. We’d like to thank the East Brunkswick Animal Shelter and the various donors who contributed towards Angel’s care after reading about him in the Star Ledger Paper. Did we mention he has a fantastic new home?! :)

May

“Osteosarcoma ”

(Bone Cancer)

Lady is a 14 year old dog who presented to the Route 516 Animal Hospital with a 1 month history of intermittent limping. She had been healthy, in general, although her owner was concerned about arthritis in her legs or hips. Upon physical exam, Lady had few abnormalities. She had advanced dental disease and was not bearing weight on her left front leg. An orthopedic exam revealed a large swelling in the shoulder area and she greatly resisted full extension of her front limb. Lady’s owner agreed to various diagnostics including radiographs of her arm and bloodwork. The x-rays revealed that a large mass was growing in her shoulder area and had obliterated much of her humerus (the upper long bone of the arm). The tumor was soon after biopsied and the pathology report revealed it was an osteosarcoma (OSA).

Bone masses are very serious in nature because they are invasive in nature and usually are malignant. Osteosarcoma accounts for 85 % of primary bone tumors and can occur in cats and dogs and even exotic animal such as ferrets . It is most common in large and giant breed dogs especially Great Danes, German Shepherd, Rottweilers, Saint Bernards, Boxers, and Irish Setters. The median age for osteosarcoma is 7 years although it can occur at a much younger age. Symptoms of OSA can be subtle in the beginning. Often pets will exhibit a slight limp or have an area of tissue swelling. Some pets show no symptoms and will acutely fracture their leg in the area where the tumor has eaten away at the bone. OSA occurs primarily in the long bones of the skeletal system but can occur in any bony area . In the front leg it is often found in the shoulder or wrist and in the hind leg near the knee.

Osteosarcoma is best diagnosed with radiographs. On the x-rays the bone will have a mottled look (moth-eaten) where bony lysis (erosion) has occurred. A bone biopsy will verify the type of cancer. Sometimes the biopsy process can be risky because the bone is in a weakened state and could splinter and fracture. After confirmation of OSA, it is important to check radiographs of the lungs. By the time limping is evident, the cancer has often already metastasized to the lungs. Even if the lungs appear normal to the naked eye, there are often microscopic nodules in the lungs already. The median life span for a dog with OSA that has spread to the lungs is 1 ½ months.

The prognosis for osteosarcoma is poor. With no medical intervention, the patients without metastisis, have an average life expectancy of 2-3 months. Because OSA is a very painful disease, owners often opt to humanely euthanize their pets to end any future suffering. Another option includes amputation in order to remove the source of pain. This is not a good option if the pet has other orthopedic problems with the 3 remaining legs such as hip dysplasia or advanced arthritis. However, many pets ambulate well on 3 legs. Even though the cancerous leg is gone, these pets still have an average life span of 3-4 months (due to likely microscopic circulation of cancer). Another option includes pairing amputation with chemotherapy. These pets have a slightly longer survival time of 9 months.

Lady’s owner opted to remove her leg and to administer chemotherapy. Unfortunately, Lady did not tolerate the chemo well and had to discontinue the treatments. She did well on 3 legs and lived for an impressive 17 more months. If you notice your pet has a limb swelling and limping, have your veterinarian take radiographs of its leg. There are many possible causes ranging from a soft tissue sprain to a torn ligament to a fracture to cancer. It is important to rule out osteosarcoma as a possible cause due to the severity of the disease, especially if you own an older, large breed dog. Many causes of limping can be managed with rest and pain medications or with surgical intervention. However, a diagnosis of OSA is a much more serious and holds a grave prognosis.

April

“Not So CUTE-rebra “

(Cuterebra)

Thumper is a 1 year old male Netherland Dwarf rabbit that presented to the Route 516 Animal Hospital for a lump on his neck. His owner was concerned that he had been bitten by an insect or tick. Upon examination, Thumper was a healthy bunny. The lump was located on the dorsal, middle area of his neck. His skin was red, thickened, and hard to the touch. The raised lump had a very symmetrical hole located centrally with a small amount of fluid visible. After seeing this lump we diagnosed Thumper with Cuterebra.

Cuterebrae are large bot flies which 3 larval stages that commonly infect rabbits, rodent, and even outdoor cats. The life span of the adult is short and focused solely on reproduction. The larvae hatch under the rabbit’s skin in a fatty layer called the subcutis. They tend to pupate in the axillary (armpit), inguinal (groin), and cervical (neck) areas which results in a 1-3 cm swelling that encapsulates the larvae. The hole seen at the center of the swelling is the breathing hole. Cuterebra larvae can cause different levels of pathology. Some rabbits are unaffected while others can become weak, dehydrated, lame, and go into shock. Some larvae will migrate through the nose, eyes, sinuses, ear canals, and brain which can be fatal.

Treatment involves surgically removing the offending larvae through the breathing pore. This must be performed with care because crushing the maggot can release a toxin that results in anaphylaxis. After this, the dead tissue should be cut away and the patient placed on antibiotics and pain meds. Cuterebrid infection is prevented by keeping pets indoors and with fly control.

The larva in Thumper’s neck was removed without incident and he recovered nicely. However, it took his owner longer to recover from the shock of seeing a live squirmy maggot peeping out of a breathing hole in her beloved bunny’s neck. If your cat, rabbit, or pet rodent has a lump on its body, especially if there is a hole in the middle, take him or her to your veterinarian.

March

“With A Cherry on Top”

(Cherry Eye)

Lucy is a five month old female Cocker Spaniel who presented to the Route 516 Animal hospital for an acute abnormality with her right eye. Her eye was normal one minute but after roughhousing with a playmate, her owner noticed a pink structure protruding from the corner of her eye. She was concerned that Lucy’s eye might have been injured or was about to rupture. Upon examination, Lucy was a healthy normal puppy with the exception of dark pink tissue in the right eye’s medial canthus (the inner corner). Her diagnosis was a prolapsed third eyelid gland, often referred to as a “cherry eye”.

Dogs and cats differ from humans in that they have an extra, third eyelid which helps protect them during hunting or fighting. Contained in this lid is a gland which produces tears and tear film which keep the eye moist. It is this tear gland that is seen with the cherry eye condition. These gland prolapses can vary in size depending on the amount of tissue that prolapses and sometimes appear intermittently. They can occur unilaterally or in both eyes. Despite the alarming appearance cherry eye, it is not a painful condition.

Cherry eye is not typically caused by a traumatic event. It is due to a weak fibrous attachment which is common in many breeds. These include Cocker Spaniels, Bulldogs, Beagles, Bloodhounds, Lhasa apsos, Shih-tzus, and brachycephalic breeds (dogs with “squished faces”). Burmese and Persian cats are also predisposed. Lucy’s cherry eye was a result of her breed, not her playtime.

Treatment of cherry eye involves surgically replacing the third eyelid gland. In the past, this gland was removed. However, research has shown this gland creates 50 % of tears and removing it puts the patient at risk for KCS in the future. KCS is keratoconjunctivitus sicca, basically “dry eye”, and can result in substantial changes to cornea (the eye’s surface) and even result in blindness if left unmanaged. Therefore, it is important to keep the gland intact and attempt to surgically tuck it back into a pocket made in the third lid. The surgically replaced gland can function normally within a few weeks of surgery. However, up to 25% of cases will re-prolapse and require additional surgeries. Also, many pets that were affected unilaterally will have the other gland prolapse as well.

Lucy had the surgery to replace her cherry eye and went home with an E-collar (head lampshade) and triple antibiotic ointment. She has not had a reprolapse and her left eye continues to do well also. If you see pink tissue in the corner of your pet’s eye, call your veterinarian. If the lacrimal gland is still normal, it should be replaced, not removed.

February

“Dusty’s Keen Spleen”

(Splenectomy)

Dusty is a 5 year-old male, neutered Skye Terrier who presented to the Rt 516 Animal Hospital for lethargy of couple days duration. Dusty had also vomited bile a few days prior, and his tongue appeared white to the owner. A physical exam revealed that Dusty’s gums were slightly pale, his abdomen was very tense when palpated, and he had a fever of 103.3. In-house bloodwork confirmed that Dusty had a decreased red blood cell count (anemia) and a low platelet count (thrombocytopenia). Radiographs (x-rays) were taken and revealed a very large tumor in Dusty’s abdomen. In order to determine the origin of Dusty’s mass, an ultrasound was performed. It showed that the tumor was on his spleen and that there was some free floating blood in his belly. This means that the tumor was leaking and Dusty was slowly bleeding internally. The ultrasound also showed no evidence of metastasis (cancer spreading to other organs) anywhere else.

The role of the spleen in the body is to act as a filter for red blood cells (the cells which transport oxygen in the bloodstream) and as a red cell reservoir. It also aids in the production of some types of white blood cells (the cells that fight infection and inflammation in the body). Tumors on the spleen can vary greatly in nature. The worst type of splenic mass is the hemangiosarcoma. This type of tumor is malignant and tends to spread quickly through the body. Other types of malignant splenic tumors include mast cells tumors and lymphosarcoma. Some splenic tumors are benign, such as the hematoma. Although they can grow very large in size, hematomas do not metastasize to other organs. Their danger lies in the fact that they can leak internally and excessive blood loss can be fatal. There is no way to know which type of tumor a patient has until it is removed and a biopsy is read by a pathologist.

Dusty’s owners agreed to take him to surgery for a splenectomy (removal of the spleen and the tumor). Because spleens are so vascular, splenectomies tend to be bloody surgeries which can require blood transfusions. The tumor was on the tail of the spleen, was very large (8 cm), and friable in nature. The free blood was flushed out and suctioned after the abdomen was explored for any abnormalities. Dusty?s surgery went very smoothly and a transfusion was not needed. He recovered well and went home with pain medication and instructions to rest quietly. The good news from the pathologist came a few days later: his tumor was a hematoma. This means Dusty’s mass was benign and he can now live a normal life without his spleen.

If your pet has decreased energy levels or weakness, pale gums, or its belly looks distended, call your veterinarian immediately to have it examined.

January

“Can you hear me now?”

(Aural Hematoma)

Sambucca Moroney is a 2 year old mixed breed dog who presented to the Rt 516 Animal Hospital for what the owner feared was a large tumor in his right ear which developed overnight. His exam revealed a young healthy dog with a right ear that was swollen approximately 4 times the normal size. It felt much like a filled water balloon and was warm and painful to the touch. There was also a pungent odor emanating from the inner ear canal. The owner also reported that Sambucca had recently been rubbing his head along the carpeted floor and pawing at his ears.

Much to the relief of his owner, Sambucca‘s ear was not a tumor but instead was a condition known as an aural hematoma. Aural means “pertaining to the ear or hearing” and a hematoma is a “pocket or swelling of blood”; basically, Sambucca had a large blood blister in his ear flap. Aural hematomas can occur in dogs or cats who sustain injuries to the capillaries or blood vessels located between the 2 flaps of cartilage which make up the outer ear. The injury can be secondary to rough play, a traumatic injury such as a bite, or most commonly as sequela to an ear infection, also known as otitis.

Pets can develop ear infections from bacteria, yeast, ear mites, or a combination of these. The infectious agents can be due to allergies, excessive hair in the ears, inadequately dried ears after bathing or swimming, or due to lack of circulation in pendulous, heavy-eared breeds. Otitis tends to be very pruritic (itchy) and the pet’s shaking, scratching, rubbing and pawing can cause the hematoma to form. It can occur in either ear (even an un-infected one) or both and can involve a small portion or the entire pinna (outer ear flap).

Addressing large aural hematomas consists of surgically correcting the ear swelling, identifying the underlying cause, and treating. There are many variations of surgical technique. The overall goal is to release the blood trapped in the ear’s pocket and to tack the two sides back together. Sambucca was taken to surgery and an S-shaped incision was made on the inner surface of his ear flap. After flushing the fluid and clots out, many strategically placed stitches are used to suture the 2 layers back. A bandage was placed on his head and the stitches were removed after 3 weeks. During that time, Sambucca’s owner treated his bacterial ear infection with the prescribed antibiotics and ear cleaner. At a 1 month check-up, Sambucca’s ear looked great and the infection was resolved.

Some owners choose not to surgically correct aural hematomas. With smaller hematomas this is acceptable as long as the ear infection is treated and a pain medication is provided. However, the smaller hematomas can sometimes still grow into larger ones which need surgery. With large unaddressed hematomas, the fluid will eventually reabsorb but will result in a deformed and scarred ear often referred to as a “cauliflower ear”. Surgical intervention is preferable because it alleviates the discomfort immediately and is more cosmetic in appearance.

If you notice your pet scratching at its ear or shaking its head, take him to your veterinarian to check for otitis. Delaying this can unfortunately result in aural hematoma formation and therefore a much larger problem than initially anticipated.

July

“Between a Rock and a Hard Place”

(Cystic Calculi-Bladder Stones)

Puffy is a female, spayed 7 year old Bichon who presented to our hospital for straining to urinate. When outside, she would attempt to urinate several times in a row but would only urinate a few drops each time. She was also mildly incontinent and dribbling out small amounts of bloody urine. Puffy had a history of inappropriate urination several years prior.

Examination revealed a healthy dog except for a large, hard mass that was palpable in the area of the bladder. Radiographs (x-rays) revealed a thickened, distended bladder full of calculi or uroliths (bladder stones). Puffy’s blood work was unremarkable.
Stones in the bladder can form secondary to many causes including diet, breed predisposition (Dalmatians, mini Schnauzers, Lhasa apsos, Yorkies, Bichons, Shih Tzus, and mini Poodles) and water intake. They are a painful condition for pets and can cause many types of urinary problems including infections, incontinence and most seriously, complete blockage. They can occur not only inside the bladder but also in the kidneys, ureters or urethra. Patients can urinate out some small stones, but the large ones must be removed surgically. Usually they must be diagnosed with a radiograph or ultrasound.
Puffy underwent a procedure called a cystotomy. This procedure involves opening the bladder, removing all stones, flushing out any blood clots, and closing the bladder wall tightly to ensure no leakage. An x-ray is taken after surgery to ensure no stones remain. A total of 55 uroliths were extracted from Puffys distended bladder. She was kept hospitalized on fluids, antibiotics, and pain medications until normal urination was confirmed.

Cystic calculi can occur in pets of varying species, ages, breeds, and sex. If your pet is straining to urinate, has bloody urine, or squatting repeatedly with little urine production, have your veterinarian assess your pet for bladder stones or other possible urinary illnesses. If your pet has cystic calculi, it may need to a cystotomy in addition to a possible diet change too.

June

Stitch was a young kitten when he first started coming to the Route 516 Animal Hospital for vaccines and his subsequent castration. He was a healthy, male domestic short hair who had lots of energy. Like most kittens, he was curious, playful and loved to explore his world. At one year of age, Stitch’s owner brought him to the animal hospital after three days history of not acting like himself. He was vomiting frequently, had diarrhea, was acting lethargic, and beginning to lose weight. Upon examination, Stitch appeared depressed and was uncomfortable when his abdomen was palpated. Radiographs (x-rays) were taken of Stitch’s abdomen to assess for abnormalities. His intestines were abnormally clumped and tightly coiled with abnormal gas patterns in many areas. Based on these findings, we were concerned that Stitch had a linear foreign body in his intestines. Ingested foreign bodies are more common in younger pets that tend to be mouthier during times of teething and tend to play with more abnormal objects and toys than their adult counterparts. Foreign bodies can be any non-digestible object but frequently include pieces of toys, rocks and articles of clothing in dogs and pieces of string or yarn in cats. When long strings (linear foreign bodies) are swallowed by cats, it can be very dangerous if not diagnosed immediately. The string can lodge and anchor under the cats’ tongue and eventually pass through the stomach and stretch into their intestines.  Once in the bowels, it can embed and cut into the soft digestive tissue which puts the cat at risk for a life-threatening bowel perforation. Diagnosis of foreign bodies can be difficult since they are rarely obviously apparent on radiographs, and patients cannot tell us what they put in their mouths. Therefore, we also have to base our diagnosis on physical signs such as vomiting, abdominal discomfort, missing toys/clothes in the house, and sometimes a special x-ray series with barium or even an ultrasound.  Often it is necessary to perform an exploratory surgery to look for the foreign body and remove it via one or more incisions in the stomach (gastrotomy) and/or intestines (enterotomies). After Stitch’s blood work was deemed normal, he was stabilized with IV fluids, antibiotics, and pain medication. An exploratory surgery was performed and a long strand of sewing thread without the needle was found tightly wound in his intestines. After a gastrotomy and several enterotomies, Stitch recovered without incident and began to thrive again. In order to prevent your pets from ingesting foreign bodies, we recommend supervising playtime with toys and keeping tempting objects such as yarns and sewing string in locations not accessible to kittens or puppies. Also, if your pet is vomiting and acting abnormally, you should call your veterinarian immediately.