Anatomy is a wonderful thing. The body is made up of loads of different bits and pieces, all in their rightful place, working in harmony. Hopefully…. but not always, I’m afraid. When we examine young patients over the first year of their lives we always have in our mind to look for any of the common failures of anatomy to develop properly. Some of these hiccups can be purely cosmetic, such as a small umbilical hernia, a small hole on the belly button, that allows a blob of fat to poke through, or an extra dangly dew claw on a back leg. These we note and can happily ignore. However, other anatomical abnormalities may have serious consequences for that individual. Heart murmurs, narrowed airways and twisted limbs are some of the issues we watch out for that may require some sort of surgical correction to give that patient a better quality of life.
For Max, a gorgeous fox red Labrador, it was his teeth we were concerned about. Well, the lack of one to be precise. His baby teeth had come and gone over his first 6 months with no problems but one of his large adult canine teeth just didn’t turn up for the party. At 7 months the upper right hand side of his mouth was sadly lacking the lovely big canine tooth that dogs use for grabbing and holding things. Now, a couple of things can cause a tooth not to appear – it may not have developed at all or it has, but in the wrong place. The only way of knowing is to take an X-ray. Max was booked in for the following week and interestingly a tiny nub of a tooth had started to appear but it didn’t look normal.
However, if we thought it looked weird on the outside, that was nothing to what it looked like on the X-ray – it was huge! It was also quite irregular. We are very fortunate in our profession to be able to call on various experts all over the country to help with unusual cases so Steve asked Norman Johnson, probably the top veterinary dentist in the UK, to cast his eye over the X-ray to see what he would do. He was convinced the tooth needed taking out. This would have to be done carefully, he said, as it was very close to the sensitive tissues of the nose. Steve loves dental surgery so with Norman’s advice he made a large gum flap that exposed the bone covering the root, removed this, and gently extracted the tooth with minimal fuss or trauma to adjacent tissues. The flap of gum was then carefully sutured back in place to cover the deficit. Max won’t miss his tooth as it was never functional anyway but Norman was convinced it was likely to become infected where it was. It won’t now as it’s in a jar on Max’s owner’s mantelpiece!
This is Ella, a lovely gentle German Shepherd who is about 8 years old. She came to see us in the summer as she had a lump on her leg which seems to be growing quickly.
Ella initially saw Hazel who wanted to find out what the lump was and so took a very small sample from the lump during the consultation and sent it to the lab for analysis. When the results came through the next day they were showing that sadly the lump was probably a type of cancer. This was now a more serious issue and Ella was booked in for a bigger biopsy which was done under a general anaesthetic. It was important at this stage to know exactly what type of cancer we were dealing with; different types of cancer need different treatments.
When the results on this bigger biopsy came back they told us that Ella had a soft tissue sarcoma. These are very nasty tumours of the connective tissue under the skin, they tend to grow rapidly and tend to infiltrate through the tissues making them difficult to remove. The only good news at this point was that these soft tissue sarcomas don't tend to spread to other parts of the body. So if we could remove this tumour then we could cure Ella.
Removing these tumours can be straightforward if they are in accessible areas where there is lots of stretchy skin to cover the hole left when the tumour is removed. Because a soft tissue sarcoma tends to infiltrate through the tissues we need to remove them with wide margins, this means that we needed to remove a barrier of 2cm of healthy looking skin all around the tumour. The problem we had was that Ellas tumour was on her knee and so there was no way we could do this and expect the wound to heal.
At this point Ella came for a surgical opinion from Andy and there were only 2 options for removing the tumour completely: one was to amputate her entire leg, and the other was to perform a wide removal of the tumour which would then require a complicated skin graft.
We discussed each option and decided that the best option for Ella was to attempt removal of the tumour and then use a very large skin graft to close the resulting wound.
Andy took lots of measurements and decided that the best skin graft would be to move a large flap of skin from her belly and turn it through 180 degrees and then re-direct this large flap of skin down Ella's leg to close the wound. This is called an axial pattern graft, the original blood vessel to the skin is preserved but it is re-directed to its new site by moving the skin. The surgery took several hours and well over 100 surgical staples were used as well as metres and metres of suture material. When Ella woke up after the surgery she was comfy and was a very brave patient, she had a few quiet recovery days in the practice before going home for a long recovery period.
About 5 days after the operation we got the lab result back which confirmed that the entire tumour had been removed. This was great news as it meant that it had all been worth it and that once her wounds healed she should be cured.
It wasn't all plain sailing from this point, Ella had a few issues with weeping from her extensive wounds and did eventually need a second surgery to re-operate to close one of the wounds again because it had been weeping too much. However over the next few weeks her skin healed more and more and her bandage changes got less and less frequent. The photo we took was at her last check up, all her sutures and staples were out and she had completely healed. All she has to show for it are some very impressive scars and a nipple on her knee! (because her skin graft went to her knee from her belly, her nipples went with the skin so now she has a nifty nipple on the outside of her knee.)
Ella is our star patient because she dealt with all her ups and downs like a real lady. She was always gentle and patient for her bandage changes and came through several major and complicated surgeries without ever losing her kind nature. Well done Ella, a lovely doggie.
Geezer first came in to see our vet Tom on a Sunday out of hours after vomiting a couple of times and not seeming himself. This wasn’t all that unusual for him as he had a naughty tendency of eating things he shouldn’t! Tom gave him a good check over, treated him with some anti sickness medication and booked him for a check up the next day. Many cases of vomiting in dogs are due to dietary indiscretion leading to inflammation within the stomach. These cases are generally self limiting and improve rapidly with symptomatic treatments like those which Tom prescribed to geezer.
Unfortunately the next day Geezer was no better, he was very depressed, not eating and still persistently vomiting. The owner mentioned that little Geezer has been seen having a snack on the rubber parks swings at the weekend but we weren’t sure how much he had eaten! Hazel examined him and decided x-rays where needed to investigate his symptoms further; geezer was admitted that morning for fluids, sedation and abdominal imaging. Initial x-rays revealed an enlarged fluid filled stomach, this suggested that there was either something blocking the outflow of fluid and food, or that the stomach wasn’t contracting properly due to inflammation. The rest of Geezers abdomen looked normal on the x-ray, with no indication of a small intestinal obstruction at this stage. When we are looking for evidence of foreign bodies on an abdominal x-ray we face the problem that many things that dogs will eat do not show up clearly. If a dog eats a stone or a piece of bone we can see it straight away, as these objects appear bright white on the image-just like the dogs own bones. If, however a piece of rubber, cloth or sock is stuck somewhere it will appear the same density as the intestines so we have to look for secondary changes within the guts to suggest a blockage. These include abnormal areas of gas within the small intestine which have built up before the obstruction or areas of intestine which appear puckered up in cases of a long foreign body like a piece of string.
It was still possible in Geezer’s case that there was something obstructing the outflow of his stomach but we didn’t feel there was enough evidence to justify exploratory surgery, as this doesn’t come without increased risks. He ate well with us and felt much better after some IV fluids, so he went home for the evening with the plan to x-ray again tomorrow if things weren’t looking better. Sadly poor Geezer had vomited several times overnight again so he was admitted straight away for further imaging. It was a similar picture, still with no small intestinal gas build up but an enlarged fluid filled stomach. We would have expected a motility issue to be improving by now so our concern was that there was a blockage. After a long discussion with Geezer’s owner we decided that the best course of action was to do an exploratory operation to confirm our suspicion that something was stuck and blocking the outflow of Geezers stomach. Whenever surgery involving opening up the intestine is performed there is a small (~10%) risk of infection and for the first 5 days close monitoring of the patient is required.
Geezer was prepped for surgery and we proceeded straight away. It didn’t take long to find the cause of the problem. There was a piece of rubber from the swing that Geezer had taken a fancy to lodged in the very first section of his small intestine! This was removed routinely and the rest of his abdomen was checked to ensure this was the only finding. Everything else was normal so he was closed up and taken to recover with the nurses. Geezer initially did well and was up and about the next day. Sadly he didn’t continue to improve as we would expect and over the next few days he developed a high temperature and didn’t want to eat. A sample of fluid was taken from his abdomen and this confirmed that he had developed an infection. This was a very serious situation for Geezer as peritonitis (infection within the abdomen) can be life threatening. His owners were completely dedicated and wanted us to do everything so we immediately went ahead with a second surgery to give him the best chance we could. A section of devitalised intestine needed to be removed; his abdomen was copiously flushed with sterile saline, before placing a special drain which would stay in place during his recovery to allow the infected fluid to leave his abdomen. Finally we placed an oesophageal feeding tube which would allow us to get important nutrition into Geezer while his appetite was still poor.
Over the next week Geezer stayed in the vets and really did become part of the family! He required very intensive care, with multiple intravenous drugs throughout the day, cleaning and emptying his abdominal drain, 4-6 tube feeds over the day and not to mention lots of cuddles! Geezer’s owners visited him daily; spending time sitting outside in the sun together and tempting him with food. It was touch and go, but after days of seeing minimal improvement he turned the corner and went from strength to strength. We were all so pleased when he started to play with his favourite ball in the kennels and wag his tail again! The drain was removed and he went home where his owners continued tube feeds while he gained strength. Another couple of days later and we were able to remove this tube and sign him off. We were all so pleased that he was back at home but everyone was going to miss him. Let’s just hope he steers clear of eating unusual objects in the future.
Ollie is a gorgeous puppy who first presented to the practice when he was 10 weeks old for his second vaccine. It was his first trip to the vets with his new family. Sarah gave him a full health check but noticed he had a very loud heart murmur which she was worried about. There are various congenital heart problems puppies can be born with but the type of murmur present made a patent ductus arteriosus (PDA) the most likely cause. This is a vessel which is present during development in the uterus but should seal off when the puppy is born as it shunts blood away from the lungs. If it doesn’t seal the only option for the puppy is to operate to seal the vessel, otherwise the puppy will go into heart failure and usually die by 1 year of age.
After a long discussion with the owners he was booked in to have an ultrasound scan of his heart to establish the cause of the murmur. Glynn and Sarah scanned Ollie’s heart and sent the scan to a cardiologist who agreed the findings were consistent with a PDA.
The owners were obviously very upset and worried about Ollie but were keen we should do everything for him so decided to go ahead with heart surgery to tie off the extra vessel.
Sarah and Andy performed the surgery with Glynn helping the nurses Claire and Jess with the anaesthetic and breathing for Ollie during the operation once his chest had been opened. Sarah and Andy had to carefully dissect and ligate the vessel which joined the aorta to the pulmonary artery. It is a very delicate surgery as this needed to be done without damaging the heart, vessels or important nerves which run across the heart - all with the heart beating away.
The surgery went really well and Ollie’s ribs were closed back together after a chest drain had been placed to empty the air from around his lungs and allow him to breathe on his own again.
He recovered really well and after the surgery and when the vets listened to his heart with a stethoscope the murmur had completely gone!
The next morning Ollie was bright and waggy so that afternoon he was reunited with his family who were thrilled to see him. He is continuing to recover amazingly well and we are all so pleased he should now go on to live a normal life.
After being such a brave puppy Ollie has been awarded Patient of the Month!
Here's an update on a lovely little doggy with a hear that skips a beat when it sees me. To be fair, it skips a beat when it sees anyone because it has a heart condition that interferes with the rhythm of it's heart.
Betty was a normal little active 8 month old Cross-breed pup charging around as normal but one evening last April she suddenly collapsed at home and almost passed out. Her owners contacted us straight away and rushed her down to the surgery....
During the evening of Monday 16th January, a very sick Labrador named Clover was rushed to the Whitchurch branch of Leonard Brothers Veterinary Centre, as a suspected road traffic accident. She was so weak she was carried into the practice by her owner, unable to stand and struggling to breathe and had blood coming out of her nose. Clover was attended to immediately. Many tests were carried out and it became apparent that it was unlikely that she had been involved in a road traffic accident but more likely that she had consumed rat poison.
Rat bait acts as an anticoagulant (prevents the blood from clotting) by depleting the body's supply of vitamin K. Vitamin K is a fat soluble vitamin which is essential in the formation of clotting factors in the blood stream. Signs of intoxication are associated with bleeding and can range from very subtle signs such as tiny bleeds on the gums to frank bleeding from anywhere. Normal everyday movement results in micro damage to blood vessels at the capillary level. When the body's clotting mechanism is working properly, these damages are repaired immediately without us being aware of it.
Clover had lost the ability for her blood to clot at all and for Clover even breathing was becoming more difficult despite being on Oxygen. An ultrasound scan of her chest was performed and it was found that Clover was bleeding into her chest.
Clover was in need of some clotting factors fast. Fresh blood was required, as once blood is frozen for more than 6 months the clotting factors in the blood have diminished, and it was these that were needed to save Clover. Clover would not start producing her own again for 24hours.
We’d tried a couple of the dogs registered as donors at the practice but there was no joy, it was past 11pm by this point. That’s where my boy Alfie stepped in. A rescue Staffy who didn’t have the best start in life. Being rescued from a boarded up house after his previous owner had been sent to prison, but he’s a lovely boy who loves everyone and always aims to please. But it wasn’t all rosy, blood donors are supposed to be over 25kg, but Alfie only weighed 23kg. Under the circumstances he was our only option.
I rushed home and got him out of bed, and returned him to the vets where he had a blood test to check he was healthy enough to give blood. His blood group was tested, he was DEA 1.1 negative, the same as Clover.
The equipment was sorted out ready for the blood donation, and for those of you that have given blood, it’s very similar to human donations. Alfie sat on the table, and the rather large needle was put into Alfie’s jugular vein, and Alfie didn’t move! The blood began to flow and the bag was filling, Alfie was a star, he had to stay very still as any movement could have meant that the needle may have come out of the vein. But he did it, he gave enough blood to help Clover.
Once the bag was filled the rate was calculated for Clover’s weight and it was connected to an IV catheter in Clover’s leg. The transfusion began. Clover needed to be monitored intensely at this stage in case she had a reaction, but she did really well. She was monitored for the next 4 hours until the transfusion was complete. Alfie at this point was very grateful for the big bowl of food he received after his donation and was ready to go back to bed!
At this time of year, whilst enjoying the great outdoors, one of the most common problems we see with our furry friends is the intrusion of grass seeds.
Talbot is a gorgeous 4 month old Cocker Spaniel who had parvovirus. Because he is such a superstar we wanted to share his story with you. Talbot first started with sickness and just being “off colour” about a week ago. At first he did not seem too bad, so was treated like he had a straight forward sickness bug. However 24 hours later it was obvious that he was a very poorly boy....
Max is a 14 year 10 month old doggie who is a regular here for his monthly cartrophen injections to help with his joints and mobility. As part of these appointments he gets a full health check every time he comes in and it was at one such health check we first noticed that he seemed uncomfortable in his abdomen and palpated a lump.
He came in the next day for a scan and x-rays to ascertain what the mass was attached to. It appeared to be his spleen. The worry with splenic masses is that they can rupture and cause a big bleed into the dogs abdomen which can be fatal, or that the mass may be cancerous and unfortunately there are some very aggressive types of splenic tumour which are fairly common.
After chatting through our findings with his owners, we decided to go ahead with an exploratory laparotomy which is an operation to look inside his abdomen and hopefully remove the mass.
During the operation his spleen (which was enormous and lumpy!) was removed and the rest of his abdomen checked to make sure it looked normal. Max's liver also looked slightly unusual so it was biopsied and sent of for histology along with the lumps from the spleen.
Max was very brave and made a good recovery. It took him a couple of days to get his appetite back after the operation but since then he hasn't looked back. We all had to nervously await the results from the lab and when they arrived everyone was relieved to here that the lumps were benign (not cancerous)! Great news!
Having a surgery like Max did would be a big deal in a patient half his age, but he yet again shows that with the right care and dedication, surgeries on senior patients really are possible and can be associated with an excellent outcome.
Due to Max being so brave and his brilliant recovery for a senior doggie we have decided to make Max our 'Patient of the Month' for December.
A Big Thank You...
...to all our patient's owners who gave their kind permission to share their stories
Sat 8.30am - 12.20pm
Leonard Brothers Veterinary Centre
501 Crewe Road
Sat 8.30am - 12.20pm
Leonard Brothers Veterinary Centre
Unit 7-8 Brownlow Street Arcade