February is American Heart Month – for pets too! So, let’s take a moment to raise our awareness. While most forms of heart disease in dogs and cats cannot be prevented, the exception is heartworm disease.
In January, a young dog from Charleston Animal Society was referred to Veterinary Specialty Care for heartworm disease treatment. There was such a heavy worm burden that blood flowing through the heart was physically blocked by a large mass of worms. This is called caval syndrome and can be life-threatening. Quick surgical removal of the heartworms is the only treatment option.
Most pet owners are familiar with heartworm disease. This mosquito borne parasite is extremely prolific in the Southeast. The worms penetrate the dog’s tissue, migrate to the bloodstream, and enter the heart and lungs. Severe damage can occur to vital organs like the heart, lungs, liver and kidneys.
Heartworm removal was accomplished by passing an instrument down the jugular vein, into the right heart, entwining the worms and removing them. The worms were removed and the patient recovered well.
If left untreated, heartworm disease can be fatal, and treatment is expensive and painful for your dog. The good news, however, is that prevention is very effective.
Since mosquitoes need to be present to deliver an infected bite, keep your dog away from mosquito infested areas. Use a mosquito prevention, such as a spot treatment, and give your dog monthly heartworm pills to prevent an infestation.
Regular routine checkups are very important to diagnose this disease. All dogs should be tested for heartworm disease annually. It doesn’t matter if your dog is on a prevention program and is taking anti-heartworm medication – there is always a risk of infection. Consult your veterinarian to understand which prevention plan is best for your dog.
DVM, DACVIM (Cardiology)
Initially when asked to write this blog, I was unsure how to connect the topics and struggled to find a starting point. Needing help, I decided to ask the experts, our technicians Erin and Charlie, as they are not only in charge of walking patients outside, but are also the first to greet pets from owners coming into the clinic. I was amazed at what they came up with!
Right off the bat, they both said “no retractable leashes”! I assumed this was due to the fact that pets on retractable leashes always seem to circle around your feet, creating a tripping hazard for people. While this is one of the reasons that retractable leashes are not ideal, Charlie actually shared that they are dangerous from the standpoint of loss of control of your pet, which could result in a serious injury or even fatality. Earlier this week, while working an ER shift, Charlie witnessed a fatality, when a dog that had been on a retractable leash, ran out into the street and was hit by a car. Another common incident that the ER sees is a dog attack/bite. This can happen when a friendly dog, on a retractable leash, runs over to an unknown dog or when a dog, known to be aggressive, is on a retractable leash and the leash malfunctions. In all scenarios, there is a false sense of security with these leashes; therefore, care should be executed when using them.
Additional concerns when walking pets include temperature and situational awareness. Living in South Carolina, the weather can get hot! Ideal times for walking pets, in the warmer months, are earlier in the day and in the evening. Unfortunately, wildlife tends to be more active during these times, as well, so making sure that your pet will not bolt if they hear noises and keeping them on leash to avoid exposure to wildlife, if on trails, is advised. Additional reasons to keep your pet on leash when walking are to avoid exposure to trash, foreign material, mushrooms, and contaminated water that they might ingest.
The benefits of walking your pet are endless! Walking is a healthy form of exercise (for both you and your pet) and promotes joint health and mobility. It also strengthens the bond between you and your pet and, in most cases, helps to promote relationships with others. How often has a stranger commented “how cute is your dog? Or what is his/her name?!” Getting out and walking increases the chance of speaking with neighbors and, in some cases, helps initiate conversations to make new friends!
Now, to tie it into National Pet Travel Safety Month! Perhaps one of the great stresses when traveling on airplanes with pets is the scenario of having them locked in a crate for hours, not being able to walk outside. I did a little research and found a website that has an interactive map listing the airports, in each state, that have designated pet walking areas. You can visit www.petfriendlytravel.com for more information. Contacting airlines about regulations, as well as being aware of length of travel and the time of year, (weather conditions) is important in planning a flight. Temperatures can vary depending on where your pet will be held during and in between flights. Make sure that there are plans for designated feeding/watering times, required medications to be given, as well as walks if able.
Other important things to remember when traveling with pets include updating microchip information, in the event that you are separated, having a copy of current health/vaccination records and preparing, in advance, to have all required medications with refills on hand. Check all carriers and leashes, prior to heading out on a trip, to be sure they are secure. For car trips, I recommend seat belts or harnesses that are attached to seat belts, for dogs, and that cats be secured in carriers. It is NEVER safe for you or your pet to have your pet freely able to move around the car.
Jack Kinon is a 9 year old Standard Poodle that presented to our Internal Medicine service in August of 2016 for severe lethargy and a decreased appetite. His family veterinarian suspected possible gastrointestinal cancer. Our internist performed an abdominal ultrasound and a mass was noted in the small intestine. Jack had surgery performed the following day and a mass was removed from the small intestine. The mass had perforated, but was able to be surgically removed. Jack never missed a beat and revered beautifully post-operatively.
The mass was submitted for analysis and was determined to be lymphoma. Jack never let this subdue him and get him down, he started a 6-month chemotherapy regime as soon as he healed from surgery. With 25 weekly visits, he truly became part of the Veterinary Specialty Care family. Jack is currently 21 months post chemotherapy and is still disease free! He is such a fighter, and his wonderful loving family refers to him as “his majesty.”
Ways to keep your pet safe during the Fall/Holiday season
I LOVE October! It is my favorite month of the year. Why you ask? It isn’t due to Starbucks pumpkin lattes although I do enjoy these immensely! I love October because it is the start of the cool weather in Charleston and what I like to call the “season of anticipation”. The temperatures tend to drop a little towards the end of the month and you can start to feel the growing energy leading up to the holidays. October also happens to be Animal Safety and Protection Month and so I thought I would offer a few reminders of how to make sure they stay safe and enjoy the Fall/Holidays.
1) Remember that it it still hot outside during the day. Continue to make sure your pets have access to adequate water and shade.
2) Continue to be wary of waterways, brush, shaded areas, and allowing off trail running. Snakes are still out there and still active.
3) Perhaps this should be #1. Continue heart worm prevention! In South Carolina, heart worm preventative is recommended ALL YEAR LONG. We still do have mosquitoes that can transmit heart worm disease in the Fall/Winter.
4) Halloween will be here before you know it. Be vigilant about what you (or your kids) leave out. I had to endoscopically remove 5# of fun size MM and Kit-Kat packets from my lab Ariel’s stomach one Halloween after setting out the “grab bucket” on Halloween night! Chocolate can be toxic!
5) Thanksgiving is a time for feasting and being thankful. Remember to secure the garbage can lids so that your pets don’t get into them and get GI upset or ingest something that could cause obstruction (corn cobs, turkey bones,etc).
6) Christmas time brings decorations. Tinsel is particularly bad for cats who like to ingest it. Poinsettias can cause oral ulceration, salivation, and GI upset. Breakable ornaments can get knocked down creating to potential for lacerations. Extension cords can get chewed on by puppies (and older pets) resulting in electrical shock.
7) When ringing in the New Year, remember to plan in advance if your pet has any noise anxiety. Getting medications on board before the festivities begin can really make a big difference! Also, be sure they are not left in a place that they can destroy or escape from. Crating your pet if they have anxiety can help keep them calm and prevent them from hurting themselves or running away.
8) Finally, left unattended, candles can lead to severe burns and potentially even fires in your house. Perry and I got lucky one year when we smelled burning hair only to find that Big Winky, our long haired cat, was standing by a lit candle with her tail on fire! Fortunately, no harm was done, but it could have been terrible!
Hopefully, these reminders will help you all enjoy the Fall/Holidays safely!
At Veterinary Specialty Care, our days are filled with a plethora of furry patients. All of these pets are special to us and we pride ourselves in giving our patients the best care that we possibly can. Some of these pets we may only meet once, some we have affectionately deemed ‘frequent flyers’ and are blessed to have the chance to get to know, and care for, throughout their journey through life and any obstacles that they may encounter. Though many will walk through our doors, some will leave a lasting impression on the minds and hearts of our staff members. Sometimes, it isn’t just the patient but the owner(s) that we bond with as well. Willow is one of those dogs and this is his story.
In mid-May of 2018, Willow presented to Dr. Mims with our Internal Medicine department in North Charleston. Willow was exhibiting symptoms of a fever, diarrhea, inappetance and rapid weight loss. Our Internal Medicine department performed bloodwork and an abdominal ultrasound which showed that Willow was suffering from a mass in his small intestines. The findings were pointed to either a benign mass, fungal disease, or that scary C-word, cancer. Surgery was the recommended plan, to remove the mass and find out exactly what was being dealt with. Dr. Mims scheduled Willow that next morning for mass removal with Dr. Bianucci at our Surgery department in Mount Pleasant. The mass was a ‘proximal jejunal mass-intraluminal’ (mass on the small intestine). Dr. Bianucci felt confident in the surgery and the removal of the mass and it was sent out to the lab for testing. It would be a few days before biopsy results were received. Willow stayed overnight for post operative care, as is the norm for any invasive surgery.
Fast forward several days — the test results came back. The mass was deemed malignant – lymphoma. Lymphoma is a very common cancer of dogs and is one of the most common forms of cancer in dogs that we treat here at Veterinary Specialty Care. It is not known why certain dogs develop lymphoma. In some dogs there is an underlying genetic component and in others there are no predisposing factors. Lymphoma usually arises in the lymphoid tissues of the body (lymph nodes, spleen and bone marrow), though lymphoma can affect any part of the body. In Willow’s case the lymphoma was located in the GI tract.
For those that don’t know, there are five stages of lymphoma (I – V) and these stages are based on what areas of the body are involved with the lymphoma. With stage I lymphoma, only one single lymph node is involved, or a single lymphoid organ. Stage II lymphoma, means that the lymph nodes are enlarged on one side of the diaphragm. With stage III lymphoma, which is the most common form, lymph nodes on both sides of the diaphragm are enlarged. If the liver and/or spleen are involved this is classified as a stage IV. Stage V lymphoma is when it is in the blood, bone marrow, or organs other than a lymphoid organ such as the eye, skin, nervous system, or gastrointestinal tract. A PARR test was done to determine the type of lymphoma Willow had; and it was determined that he had Stage V, T-cell gastrointestinal lymphoma.
According to the literature, T cell lymphomas have shorter remission and survival times (usually of approximately 6 months average survival), but we have certainly had T cell lymphomas and stage V lymphomas that live much longer than 6 months with a very good quality of life. Lymphoma is the most chemotherapy responsive tumor that dogs have, so we always encourage owners to treat lymphoma patients with chemotherapy. Approximately 92% of dogs with lymphoma will go into a state of remission after the first 1 – 2 treatments.
Because of the good response of lymphoma to chemotherapy, it was recommended that Willow start chemotherapy under the care of our oncologists, Drs. Taylor, Wall and Angelo. Chemotherapy treatment involves a variety of drugs that destroy only rapidly growing cells, (like most cancer cells), and some healthy cells that are innocent bystanders. These drugs may be administered orally, subcutaneously, or intravenously. Fortunately, unlike humans, animals generally have mild side effects from chemotherapy.
Over the course of 2 months, 3 chemo protocols were employed (CHOP, MOPP and CCNU). When one started to show ineffective, we would move on to another. Throughout the entire process, Willow’s parents were concentrated only on his quality of life, getting Willow feeling well with as little complications and side effects as possible. They did not want Willow to feel any pain. Affectionately referring to the Oncology technicians as Willow’s ‘girlfriends’, they would often bring in special treats. Willow’s parents constantly did everything they could to make sure Willow was enjoying life, not suffering, and even lovingly poked fun at cancer at times. Trips were made to Willow’s favorite places like the beach, the neighbor’s house, family photo sessions were done; they even created a Facebook to share hopeful thoughts and Willow’s story, appropriately naming it, ‘Willow the Warrior’, @willowpunchescancer. To remain in such positive spirits, his parents were determined to do everything in their power to help Willow, while facing such a difficult battle, and that is truly amazing.
On a mid-August day, after a downhill battle for 2 days and being so weak he could hardly stand or walk on his own, Willow’s parents knew it was time. Our staff members cried along with Willow’s parents; they had become like extended family to us in the last few months. A few short days after Willow crossed the rainbow bridge, his mom celebrated her birthday by bringing pizza to our staff, thank you cards and photos to share of Willow. Though Willow’s body is gone, his soul and spirit will never be forgotten and the bond between Willow and his parents, and their selflessness and dedication throughout Willow’s journey, have truly touched the lives of all of us here at Veterinary Specialty Care.
Some thoughts from Willow’s friends here at VSC:
“Willow was a special dog with a loving family by his side from day
one. He had a very aggressive disease but always managed to have a
wag for everyone here at the hospital.”
-Dr. Gabrielle Angelo, DVM – Oncology
“Willow was such a sweet boy, always up for a cuddle! He was so lucky to have a family that loved him unconditionally and will stay in our hearts forever”
– Simone, Client Service Representative – Internal Medicine
“I could tell that he [Willow] meant a lot to her and that she [his mom] would do anything for him and was not ready to give up. They sent me a lovely thank you card this week along with a picture. It is cases like this that remind me that each family and their hopes/expectations/values/beliefs are different and our job is ALWAYS to provide the best medical advice and to give options. Some families might not have moved forward with surgery and might have considered humane euthanasia due to the initial findings. Some families might not have pursued chemotherapy. Some families might feel like the additional 3.5 months of quality time was not worth the expense. Not the Punch Family. She was so grateful for the additional quality time with Willow. While I am sad that he has passed, I was glad to hear that it was peaceful and surrounded by his loving family.”
-Dr. Holly Mims, DVM – Internal Medicine
“I had the great pleasure of working with Willow and his parents during his chemo treatments. There are so many things that I loved about him and his parents but the one thing that sticks out is how thankful they were for the time that they had with him that they would not have had without chemo. People always ask how we do what we do because it is so sad, Willow’s parents hit the nail on the head.”
-Christi, Technician – Internal Medicine
“Willow and his family were so kind to us girls up front every time they came in even when things were not going well for them. Willow was such a sweet boy and always loved attention. We always loved giving him some cuddles when in treatment area in back. He is so missed around here as we are always talking about them up front!!!!”
-Coranna, Client Service Representative – Internal Medicine
Growth plate fractures, also known as Salter Harris type fractures, are a common cause of lameness seen in young dogs (under 8-12 months of age). The growth plate is a soft area of the bone that is responsible for the increase in the length and formation of bones. Since they are softer spots of the bone they are weaker then the remaining areas and can lead to fractures. Common places include the femoral head (ball of the hip joint), distal femur (above the knee joint), tibial tuberosity (front of the shin bone) and within the distal humerus (above the elbow). Surgery is typically recommended as the primary treatment option since these fractures are usually associated with the joints and can lead to angular deformities or chronic limping if they do not heal properly. The hope is that with surgery the fracture is repaired and some portion of the growth plate continues working, which allows for continued growth.
Last Friday Dr. Schlicksup saw two cases of tibial tuberosity growth plate fractures in a young Yorkie, Prada, and a young mixed breed, Guinness. In this specific type of fracture the patellar ligament (attached to the kneecap and quadriceps muscles) pull the tibial tuberosity (front of the shin bone) loose. In most cases it does not completely break free and instead only partially pulls loose. X-rays show an image of the normal growth plate at the front of Prada’s shin bone (figure 1) and the fractured growth plate in her and Guinness (figure 2 and 3). Surgery is performed to prevent the piece from breaking free completely, because once the tuberosity lifts up, it allows the kneecap to ride higher then normal and can lead to kneecap (patella) luxations. Both cases had surgery early Friday morning. The procedure takes a little over an hour and the fracture is repaired using stainless steel pins and wires (Figure 4) to form a tension band apparatus. Both Prada and Guinness recovered in ICU that night and were discharged early Saturday morning. Recovery is usually around one month at home and most dogs return to full function after the recovery. We wish both of them good luck in their recovery and we will see them in 2 weeks to remove the staples and in one month for follow-up x-rays.
Mandy is a 12yo FS Rat Terrier. I began seeing Mandy in April of this year in Myrtle Beach. She had previously been diagnosed with a protein losing nephropathy. This is a disease in which the kidneys are letting protein leak out into the urine. Mandy was in renal failure and was on several medications and supplements to try and protect her kidneys and improve her kidney function. At the time that I saw her, she was acutely unable to walk in all 4 legs and was severely anemic (low red blood cell count). Her inability to walk was felt to be related to a stroke or disk disease in her neck. A lot of people would consider saying good bye at this point due to her inability to walk, chronic kidney failure, and need for a blood transfusion, but not Mandy’s mom and not Mandy. Mandy is a fighter and so is her mom. We brought Mandy home with us from Myrtle Beach and hospitalized her in Mt. Pleasant. She was given a blood transfusion and we continued to treat her supportively for suspected intestinal blood loss secondary to her kidney disease. She responded to treatment and even though she still was not able to walk, she was sent home where her mom continued to perform physical therapy. Seventeen days later, Mandy is now walking (although still wobbly) and is doing great!
Below is a video link showing Mandy walking!! https://www.youtube.com/watch?v=krsE1kJKTNY
It’s hard to believe that summer is right around the corner! With the weather heating up, we all need to be more conscious about keeping out pets cool. In preparation for the hot summer months, we’ve provided a short overview of heat stroke. This will prepare you for signs to look for and things you can do to help your pet if you think he/she may be suffering from this condition.
Heat stroke is an acute, progressive, life threatening emergency characterized by a core body temperature of >106*F. It causes multi-organ dysfunction including changes in the nervous, cardiovascular, respiratory, gastrointestinal, urinary and integumentary systems. Heat stroke can occur quickly and the disease state can progress rapidly. It is extremely important to seek immediate medical care!
Signs to look for:
- Excessive panting, drooling
- Wobbly, drunken, or abnormal gait
- Weakness or collapse
- Bloody or tarry stool
- Depression, decreased responsiveness, seizures
What to do:
- Quickly remove your pet from the environment where the over-heating occurred into a shaded/cool place
- Begin cooling efforts! Place cool wet towels or tap water along the back of the neck, in the armpits, and in the groin region. You may also wet the ear flaps and paws with cool water. Directing a fan over these wetted areas will help to speed evaporative cooling.
- Transport to the closest veterinary facility immediately!
Cooling your pet too aggressively or overcooling can also have significant adverse affects. Below are some guidelines to help prevent overcooling of your pet.
What not to do:
- Do not use cold water, ice, or ice baths for cooling
- Do not attempt to force water into your pet’s mouth, but you may have fresh cool water ready to offer should your pet be alert and show an interest in drinking.
- Do not leave your pet unattended
Keeping pets indoors during peak hours is ideal. For pets kept outside, please be sure to provide cool, shaded areas and free access to water at all times. Never, ever leave pets in cars – even if the windows are open, temperatures inside the vehicle can climb rapidly. We hope you and your pets enjoy a safe and happy summer season!
While working emergency shifts over the years it is always concerning to hear that a pet may be choking. There are many conditions that can lead to symptoms that are described as choking. Some of these conditions can become life threatening very quickly while in other cases the symptoms may seem very dramatic with little or no danger to the pet. I will review some of the primary causes of such symptoms and discuss which cases may require a quick trip to the emergency room for potentially lifesaving intervention.
Laryngeal and tracheal (upper airway) and esophageal (upper GI) obstructions: The larynx is the opening from the mouth into the windpipe (trachea). The windpipe travels into the lungs. If this gateway into the windpipe or the windpipe itself is blocked by an object or swelling the pet may not be able to get enough oxygen. In these cases there may be a history of the pet chewing on a bone, treat, ball or toy immediately before the onset of symptoms.
These cases can be very life threatening and may require immediate sedation or anesthesia for removal of an object and to provide oxygen. Pets with these conditions tend to be gagging and hacking constantly with no rest and often times are frothing at the mouth or salivating and their gum color may become purple or blue. In rare cases performing a tracheostomy (surgical opening of the windpipe below the obstruction to allow air into the lungs) or endoscopy (scoping) of the trachea or esophagus to attempt to grasp and remove the obstruction may be required.
These symptoms can also occur if an object blocks the esophagus (tube from the mouth to the stomach). Generally the degree of choking is not as severe as when the airway is blocked, but sometimes objects in the esophagus can compress the trachea/windpipe and cause severe symptoms of choking.
With both airway and esophageal obstructions, the Heimlich maneuver can be attempted. With the head down and the hind limbs up, the sternum (breastbone) or ribcage may be compressed in an attempt to expel the obstruction. This is generally not recommended at home unless it is apparent that the pet cannot breathe and is imminently life threatened.
Laryngeal Paralysis: In large breed, older dogs (and rarely in cats) paralysis of the nerve that is responsible for opening the larynx (gateway to the trachea/windpipe) can occur, which causes narrowing of the glottis (vocal chords and the space between them). This disorder causes poor oxygen flow into the lungs and is associated with exercise intolerance and increased breathing effort with wheezing (stridor) upon inhalation. It is common for dog owners to notice a loss of bark or voice change in their pets. These dogs are prone to overheating and choking on phlegm or vomit because the airway does not seal completely.
Pets with laryngeal paralysis oftentimes require sedation and oxygen therapy until corrective surgery can be performed to allow more complete opening of the airway.
Brachycephalic Syndrome: Brachycephalic (broad head, short nose) dogs include species such as the English Bulldog, Boston Terrier, Pug, Pekingese, Boxer, Lhasa apso, and Shih Tzu. Brachycephalic cats (Persians and Himalayans) can uncommonly require treatment. These breeds can have anatomical malformations of the nostrils (too narrow), soft palpate/roof of mouth (too long), laryngeal saccules (everted and swollen tissue of the larynx), trachea/wind pipe (too narrow), among other airway abnormalities. Upper airway obstruction with choking and poor air flow can be caused by any combination of those abnormalities. In many cases the affected animals may require surgical intervention to remedy anatomical airway abnormalities to provide better exchange of air.
Any brachycephalic animals with symptoms of upper airway blockage, choking, or difficulty breathing should be assessed immediately as these symptoms can become threatening without rapid supportive care.
Tracheal Collapse: Collapse of the windpipe/trachea is a condition that occurs most commonly in toy breed dogs. The Yorkshire Terrier is the most common breed affected. The windpipe is generally rigid, but in these pets it can become weak and collapse on itself due to pressure from inhalation. A harsh cough that worsens with activity or stress and sounds like a “goose honk” is commonly described.
These patients are oftentimes treated with sedation, anti-cough (antitussive) medications, oxygen, and anti-inflammatories to reduce swelling. Stress can create a vicious cycle and worsening of the condition so keeping the pet as calm as possible and getting them into the hospital is recommended.
Kennel cough (infectious tracheobronchitis): Viral and bacterial infections of the upper airways of dogs and cats can cause a harsh hacking, gagging cough. These infections are most commonly acquired at kennels/boarding facilities, pet shops, shelters, dog parks and animal hospitals. Owners often describe the cough as sounding like the pet has something caught in their throat and they are trying to hack it up. Sometimes a small amount of white or clear froth, foam or thick phlegm is produced after coughing and there is confusion as to whether or not this material has been vomited up or coughed up. Symptoms usually occur 3-10 days after exposure to the infectious agents. While kennel cough infections create a harsh “choking” cough, these pets are generally stable and eating and drinking with some rest between coughing episodes.
Kennel cough usually has to run its course because it usually begins as a viral infection, but antibiotics and anti-cough (antitussive) medications can reduce severity and longevity of the symptoms and reduce the potential for pneumonia (lower respiratory infection) in young and old pets.
Reverse sneeze syndrome: The reverse sneeze syndrome is oftentimes described as a “hyperventilation” with an audible inspiratory (inhalation) and expiratory (exhalation) component without a forceful expiratory cough. These pets are often times snorting or wheezing upon inhalation and they appear to be unable to “catch their breath.” While this syndrome is dramatic and appears threatening, it tends to spontaneously resolve within moments with no long term ill effect. Irritation of the nasal passageways or the back of the throat (pharynx) is the usual cause.
These are just some examples of conditions that may cause concern for choking in your pet. While some conditions are not necessarily life threatening and may not constitute a true emergency (such as kennel cough or reverse sneeze syndrome), others may require rapid intervention to stabilize your pet and offer life saving treatments (upper airway obstructions, laryngeal paralysis, brachycephalic syndrome, tracheal collapse). The safest approach is to always utilize our emergency services and have a veterinarian assess your pet if it is having symptoms of choking or difficulty breathing. It is much safer to err on the side of caution with breathing difficulties.
Dr. Jeremy Libby, Hospital Director, North Charleston Veterinary Emergency Care
Bones prove to be a danger to dogs
It was a delicious ham. It debuted on Christmas Eve, and although all partook, it survived largely intact. Through the following week, and into the early part of the new year, the family fed upon it. A ham sandwich here, ham on pizza there, but apart from an occasional morsel, there was one family member who was largely excluded from the feast: Muggs, the family bulldog. He watched as the rest of the family consumed ham-based treats, only grudgingly sharing a piece with him. As they ate, he stood watch, ready, should the opportunity present. After the last piece of ham was excised from the bone, the family slipped up. The bone was thrown into an open garbage can. Muggs saw it and knew it was his. From the television room, they heard the can topple over, they ran into the kitchen and saw some garbage strewn on the floor but didn’t notice that the bone was gone.
Two days later, Muggs was definitely off. He had stopped eating and drinking, and now was salivating and vomiting. He was presented to our Mount Pleasant Emergency Clinic, and after a brief exam, an X-ray told the story. It was the ham bone. It was lodged in his esophagus between his heart and stomach. It looked enormous relative to its surroundings, and it definitely was not going anywhere on its own. The owners were suddenly facing a life-and-death situation for Muggs. He cannot live with that thing in there, and the choice of how to remove it, what it will actually take to get it out, and even the prognosis, were not immediately clear. This uncertainty translated to an unusually wide estimate of costs.
The first, and probably best, first step would be an endoscope passed down the esophagus. This would be used to try and push the bone into the stomach, where it can be harmlessly dissolved by gastric acids. An added benefit of this approach is that it allows us to visualize the esophagus and assess the damage that the bone has caused. The problem is that if the scope cannot dislodge the bone, surgery is required, which amounts to an additional expense on top of the endoscopy. Surgery will result in the removal of the bone, but it is an invasive step, and even this step is fraught with risk. We can try and open the stomach and pull the bone into it, but if this fails, we are forced into a riskier surgery in which we have to open the thorax and cut into the esophagus. This is a concern because the esophagus is a sensitive structure, and with poor healing qualities. This means an increased risk of complications. It also means that we are opening the chest and working around the lungs. This requires a temporary chest tube to be placed after surgery. It also means that we have to feed through a stomach tube, for a while, as the esophagus heals. So, it could be as simple as a scope removal, or as complicated as an unsuccessful scope, followed by two different surgical approaches, a chest tube, a feeding tube and hopefully no further problems, but you can’t even be sure of that. Depending on the degree of damage the bone has caused, this case could deteriorate rapidly, or be plagued with long-term esophageal problems.
In Muggs’ case, we decided to forego the scope in favor of a direct surgical approach. The stomach was opened and I reached a finger up the esophagus to the bone. I applied a clamp to it and applied traction, but it soon became clear, the bone was lodged so tightly, it could not be pulled out intact. A bone cutting instrument was deployed blindly. Using touch alone, the blades were directed through the stomach, up the esophagus and onto the bone. Luck prevailed, and the bone was sectioned without damaging the esophagus The bone was removed completely in pieces. Muggs was lucky, but many dogs are not. Some owners choose not to pursue treatment due to expense, and sometimes the damage is so severe that even aggressive treatment is not enough to save them.
The message is that it is not OK to allow dogs to have access to a bone they can swallow. I (Dr. Henri Bianucci) hear people say, “I’ve always given my dog bones and have never had a problem.” It’s like saying you have driven without seat belts and never had a problem. The only difference is that it is your dog’s life you are risking.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org or veterinaryspecialtycare.com.