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.
A New Era in Cancer Therapy for Our Pets and People
Kathryn Taylor, DVM, MS, DACVIM (Oncology)
We have been battling cancer in pets for more than 30 years, and for much of this time we have looked toward human cancer therapies for guidance on how to treat and which medications may be best. For decades, people have been investigating cancer therapy and new drugs using laboratory animals such as mice and rats. No one likes to think of any animal being injected with cancer and then further injected with experimental medications only to eventually die or be killed to determine the results of a study. This sounds inhumane and brutal, but has been one of many research approaches for years. We have learned an infinite amount about cancer behavior and therapy from these “ethically challenging” studies. We cannot ignore the benefits of these studies but we can look forward to try and find a more humane and clinically relevant approach.
While mice and rats are similar to people, the cancers that they develop are experimentally induced by the researcher. In other words the cancers are not spontaneous. The cancer cells are derived from cell lines kept in a laboratory, and they do not always behave in the same manner that spontaneous cancers behave in people. Additionally, in order to get the cancers to grow, the animals have been genetically altered to have a reduced immune system which makes these animals even less like the average person with cancer. How can we take a step away from these rodent model experiments and find a better model for human cancer?
The answer is right in front of me every day. Dogs and cats get the same variety of spontaneous cancers that people will get, and we already know so much about them. Our approach in veterinary medicine and human medicine is changing. As the world connects with social media and the internet and research can be right at everyone’s fingertips, we are beginning to realize that instead of working separately toward the same goal of cancer therapy, we should work together. We are becoming One Medicine. Around the world we are working together to solve complicated questions about cancer therapy. For example, since a dog’s average life span is 10 to 12 years, we can learn much more about their response to cancer therapy in just a few years than what we can learn in people. A study that may take 20 years in people can be done in just 5 years in our pets. We can learn more in less time!
Please understand, I am not advocating making our pets laboratory subjects or victims of harmful research. That would be against my veterinary oath and all that I believe in for our beloved pets. However, when I see a pet with cancer and know that I cannot cure them with any current medical therapy, I would love to have the chance to try a new medication that could give us some hope and help us learn more for people as well. Clinical trials in veterinary medicine are being performed at hospitals and Universities across the world with the hope of advancing not only our care for pets but also people. To find out more about these research trials you can visit the following website:
All clinical trials are strictly regulated for the safe and humane treatment of our pets. We take this responsibility seriously. Trust that if you wish to consider a clinical trial for your pet, they will be treated like royalty. Not only will they be helping further our veterinary understanding of cancer but they may just help save countless lives in the future.
Meet General – Male Mascot for The Citadel!
General presented to VEC early Thursday morning for acute onset shaking and not acting himself. He really was not feeling well, therefore Boo (his wife and co-mascot) accompanied him.
He was diagnosed with a yeast infection in both of his ears and a corneal ulcer of his left eye.
Dr. Fetterolf noticed a cloudy appearance to a portion of his cornea upon presentation. Then she used a special fluorescent stain to confirm the presence of the ulcer or erosion. Normally, water will run smoothly off the surface of the cornea, like rain washing off a windshield. If the cornea is damaged, the stain will stick to the damaged area and show bright green.
General was treated to a thorough cleansing of his ears while here. And he was send home with oral pain medication, antibiotic eye drops, and anti-yeast ear drops.
We hope he is feeling better very soon! It was a please to work with such a celebrity!
Common causes of corneal erosions include:
• Rough contact with plants, thorns, or bushes
• Scratches from another animal (note: the cat scratch wound can be especially serious as the wound quickly heals over, sealing infection within the eye.)
• Self trauma (rubbing or scratching at a painful ear or even at the eye due to some other eye problem can lead to an inadvertent scratch to the eye.)
• Chemical irritation (such as getting shampoo in the eye during a bath.)
• Foreign body injury (plant material can get stuck under an eyelid and can scrape the cornea.)
Some interesting information about General and Boo: http://externalaffairs.citadel.edu/mascots
Bile is a yellow fluid that is made in the liver and helps in the digestion of fats. Bile drains from the liver through ducts into the gallbladder. In the gallbladder the bile is concentrated and stored. The gallbladder contracts and releases bile into ducts that drain into the intestine when a meal has been ingested.
It is common for dogs to develop problems with the gallbladder that require surgical intervention. Most commonly we see dogs develop mucous accumulation in the gallbladder (called a gallbladder mucocele) A mucocele can cause obstruction of the duct draining the gallbladder and eventually cause rupture of the gallbladder wall. Dogs and cats can develop gall stones, but they usually only cause a problem if there is infection associated with the stones, or one of the stones blocks the duct that drains the gallbladder. The gallbladder can also rupture from blunt or penetrating trauma. It is rare to see cancer of the gallbladder in small animals.
Animals with gallbladder disease often present with mild signs of lethargy, decreased appetite and/or vomiting. In cases of prolonged obstruction or trauma, they can become very sick and present to the hospital in shock. Blood tests are helpful to determine if the gallbladder is obstructed and an abdominal ultrasound is accurate at diagnosing gallbladder disease and determining the need for surgery. Early treatment of gallbladder disease results in the best prognosis.
Surgical treatment of gallbladder disease usually involves removal of the gallbladder. Dogs and cats can live normal lives without a gallbladder as long as the ducts draining bile from the liver are not obstructed. If the ducts are blocked, a biliary rerouting surgery needs to be done. This involves making a hole in the gallbladder and sewing it to a hole made in the intestine so bile can flow directly from the gallbladder into the intestine.
The recovery after surgery depends on the underlying disease and the health of the patient prior to surgery. Dogs and cats that are not very sick prior to surgery can often go home the next day. If the gallbladder is ruptured and there is severe infection, the prognosis for recovery is only about 50%.
Sam is a very sweet and friendly 11 year old male/neutered Yorkhire Terrier. He saw his regular veterinarian earlier this week for acute onset vomiting and anorexia. His owner also noted a several week history of polyuria & polydypsia (pu/pd – increased urination / increased thirst). He was diagnosed with diabetes mellitus and diabetes ketoacidosis (DKA). He was transferred to Veterinary Emergency Care for additional work-up and care. Abdominal ultrasound revealed severe Pancreatitis, secondary to the DKA. Sam has been with us for several days now; he has been on IV fluids, injectable medications, and has received a Fresh Frozen Plasma (FFP) transfusion. We are happy to report that he has been responding very well to treatment and is on his way to recovery.
To learn more about canine / feline diabetes mellitus, diabetes ketoacidosis, and pancreatitis, please see the following website: www.veterinarypartner.com
Bowel (or gastrointestinal) obstructions are one of the most common causes of vomiting and decreased appetite in dogs and cats. By far the frequent cause of this is foreign body ingestion. Dogs and cats love to c…hew on and eat everything they come in contact with. While their stomach is capable of digesting and breaking down a lot of items, certain materials cannot pass through and ultimate get stuck leading to an obstruction or blockage. Common foreign bodies include socks, underwear, t-shirts, rope toys, any type of string in cats, rocks, leashes, trash, etc. Once obstructed patients tend to vomit, especially right after eating, become lethargic or weak, not be interested in food or water and ultimately act like they feel bad. Typically the key diagnosis of a GI obstruction is made from x-rays. While most foreign material cannot be seen on an x-ray there are characteristic signs that make a veterinarian suspicious for a GI obstruction. More challenging cases can require a barium series or abdominal ultrasound to make a diagnosis. Some animals can naturally pass foreign material on their own but unfortunately the vast majority require either endoscopy (removal via a camera placed into the stomach) or surgical removal. GI obstructions caused by foreign body ingestion are normally considered emergencies as with time the intestine can be damaged and leak, leading to a life threatening condition (peritonitis). Surgery usually involves opening the stomach or a portion of the intestine to extract the foreign material, however in extreme cases can even involve removing a portion of damaged intestine. Most animals are usually discharged within a day or two following surgery and are back to normal in a short period of time. Unfortunately they do not usually learn any lesson and ‘repeat’ offenders are common. Ways to prevent foreign body ingestion is to choose toys carefully (look for toys that cannot be destroyed), avoid leaving laundry loose around the house and immediately remove anything you find your pet chewing on. While a GI obstruction caused by a foreign body is not the only reason dogs and cats vomit any time your pet is sick we recommend having them evaluated by a veterinarian. – Dr. Mike Schlicksup, Board Certified Surgeon
Bloat is a life-threatening emergency that affects dogs. The term “bloat” refers to two conditions: The first is gastric dilatation in which the stomach becomes distended with gas, food, and fluid stretching the stomach many times beyond its normal size. The second is volvulus, in which the markedly distended stomach rotates, leading to kinking/obstruction of the esophagus and the intestine as they leave the stomach trapping gas and food inside. Additionally, the spleen is located near the wall of the stomach and thus can rotate as well. As the stomach continues to distend with gas, the blood supply to the stomach becomes obstructed, which can lead to death of the stomach wall. The development of Gastric dilatation and volvulus (GDV) can lead to a number of other secondary conditions including dehydration, shock, sepsis, and irregular heart rhythms (cardiac arrhythmias).
GDV often occurs in middle aged to older dogs, but can occur in a dog at any age. Large and giant breed dogs with a deep chest confirmation are often predisposed. These breeds include the Great Dane, German Shepherds, Labrador Retriever, St. Bernard, and Weimaraner. Small breed dogs are rarely affected, however, bloat can occur in small breeds with a deep confirmation such as the Dachshund. Dogs may have a history of recently eating a large meal, or vigorous exercise either before or after eating. Common signs of GDV include lethargy, salivation, retching/unproductive vomiting, distention of the abdomen, and pain or restlessness. If you own an at-risk breed and they are exhibiting any of the above clinical signs it is important to seek immediate veterinary care.
Diagnosis of GDV is confirmed by taking x-rays of the abdomen. Once the diagnosis of a GDV has been made, emergency surgery is required to reposition the stomach and the spleen. Before anesthesia and surgery are performed patients are stabilized with intravenous fluids, decompression of the stomach by passing a stomach tube, and pain medications. During surgery, a gastropexy can be performed to prevent recurrence of GDV. This is where the stomach is permanently attached to the abdominal wall to prevent twisting. If you own an at-risk breed please consult with you primary veterinarian about having this procedure performed at the time of their spay/neuter.
– Ashley Williams, DVM – Emergency DVM