Bloat – A life threatening emergency

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


What to do if you find orphaned wildlife

What to do if you find an orphaned animal

By: Dr. Kelli Klein ER doctor – Veterinary Specialty Care; Mt. Pleasant

We all enjoy finding baby bunnies, squirrels, and birds. Trying to help them involves several steps. The most important thing to do first is to stay quiet and not bother the little critter if possible as there is usually a mom hanging around somewhere close by. This may not only stress her out and deter her from coming to care for the young but may also put you in danger. If you can try to evaluate if the animal appears to be injured that is the next step. If the animal is injured you can contact your local wildlife rehabilitator or in some areas there are businesses designated to catch and treat wildlife. If you cannot reach anyone and you can safely catch the animal bring it to the nearest veterinary clinic. If the animal is not injured it is best to leave it alone and allow the mother time to come back. She is usually off gathering food or looking for a place to move the babies if she feels threatened.

Squirrels commonly fall from trees during storms because their nests are generally high up in trees. The wind blows the nests out and the babies end up on the ground. Believe it or not the mother squirrel will be able to care for these squirrels. The best thing you can do is try to put them back in the nearest tree as high up as possible. If it gets dark outside and the mother has not yet returned bring the squirrel(s) in to a veterinary clinic. The same rule applies to birds. Animals that do not live in nests are often found in yards or fields. Again, the mother is usually somewhere close by probably trying to get food for the babies or keeping predators away.

Sometimes the best thing you can do for wildlife is step back and let them be. Just as people need time to grow and learn animals do as well and sometimes they encounter some roadblocks along the way. By bringing them into captivity we are not always doing the best thing for them. It is also very stressful on the mother to have her babies abruptly removed. Injured animals are a different story and we welcome the chance to try and help any animal we can. Please remember though that nearly all of our wildlife is rehabilitated by Keeper of the Wild and this group runs solely on donations and volunteers. If you are put in the position of bringing an orphaned wild animal to a vet clinic consider making a donation to help care for it.

TheEmergencyUseof HyperbaricOxygenTherapy

By:  Peter Brofman, DVM, MS, ACVIM (Neurology & Internal Medicine)as seen in  Lowcountry Dog


The nervous system can respond to an injury to the spinal cord and brain in only a limited number of ways; and, similarly, there are only a few medical treatments available to us that may aid in the body’s recovery. Due to this limited arsenal of treatments, as a veterinary neurologist and neurosurgeon I am always looking outside of the box for additional treatment options.

Sometimes this thinking takes me back to ancient treatments ( I am a big proponent of acupunc­ture); but sometimes it takes us forward to newer treatment options.

Recently I have become interested in hyperbaric oxygen therapy (HBOT). Briefly, hyperbaric oxygen is the medical use of oxygen at a level higher than atmospheric pressure. Hyperbaric oxygen therapy allows you to breathe 100% pure oxygen under increased pressure. This level is much higher than the 21% oxygen found in room air. The air inside the hyperbaric chamber can be compressed up to three times the pressure found at sea level. The combination of high pres­sure and pure oxygen drives oxygen into the bloodstream at a very high concentration so that it can spread deep into the body tissues to help fight many types of illness. It is also quite effec­tive at reducing pain, inflammation and swelling, due to several mechanisms.

I have been somewhat frustrated by the limited number of treatment options available for my patients with strokes, spinal or brain trauma, disk disease, etc…, so I initiated incorporating HBOT into our hospital. I soon found out how effective it could be for other conditions as well. Some of the other conditions include snake bites, trauma, skin burns and crush injuries, inflam­matory diseases, anemia, etc.

A recent case of an English bulldog with a large spinal tumor was a great example of the useful­ness of HBOT for conditions outside of the nervous system. English Bulldogs are known to have difficulty breathing after anesthesia because their head and facial conformation make it difficult for them to take good breaths; this is often exacerbated after the breathing tube used for anesthesia is removed because the tube causes swelling of the larynx (airway entrance). This often results in a need to heavily sedate the patient, place them in an oxygen cage, and some­times even replace the breathing tube. This may result in a vicious cycle causing worsening of the swelling.

Following surgery, he again had difficulty breathing when the tube was removed but the conser­vative care that was successful the previous day was not effective this time and he required having the tube placed again. To avoid the vicious cycle of replacing the tube and causing more swelling I removed the tube and placed him in our HBOT chamber. Upon placement in the chamber his oxygen levels in his blood were low and he had very loud noises as he tried to take each breath. Within a few minutes of treatment he was resting more comfortably as his oxygen levels rose.

The treatment lasted an hour and when he was removed from the pressurized tank he was wag­ging his tail, breathing with ease, had normal oxygen levels in his blood, and was actually bark­ing. It was such a relief to finally have this treatment modality available to us to avoid the life threatening swelling of the larynx that we so commonly see in this breed.

 Our hyperbaric oxygen chamber is the only one of its kind in Charleston, the state of South Car­olina, and all of the bordering states. It makes me proud to be a member of such a progressive and advanced veterinary team at Veterinary Specialty Care to be able to provide such a unique and successful treatment modality for your pets.

 Veterinary Specialty Care is a veterinary practice providing specialized surgical and medical  care as well as emergency Board Certified medical and surgical services. We have locations in Mount Pleasant and North Charleston. Both the Mount Pleasant and North Charleston locations provide emergency services 24 hours a day, 7 days a week, as well as internal medicine and sur­ gical referral services on weekdays. Board Certified Surgeons and Internal Medicine doctors provide after hours support as needed in cases that require a specialist.

Bumper by Dr. Holly Mims

Bumper, a 10 year old Pit Bull, was presented for further evaluation of anemia and a distended abdomen.  She was found to have Babesia gibsoni, a protozoal infection that can be seen in Pit Bulls.  This infection was causing the anemia and protein loss in her urine which was resulting in abdominal fluid and abdominal distension.  Bumper was treated with multiple medications and blood transfusions.  She has responded to treatment and at the current time is doing very well!   Image

Ellie Mae’s Story: Dr. Mike Schlicksup

Ellie Mae is a sweet 6 month old mixed breed that stopped using her left forelimb after running into a wall at doggie daycare. Her owner took her to her primary veterinarian who, following an exam and x-rays diagnosed her with a fractured left humerus (Figure 1). She was referred to Veterinary Specialty Care that evening for management of her pain and to have the fracture repaired. Once in the emergency room the emergency veterinarian assessed her and her x-rays and agreed with the diagnosis. That night an intravenous catheter was placed and she was kept comfortable with frequent injections of a morphine like medication and a powerful anti-inflammatory. The following morning she was transferred to my care to have the fracture repaired.

Broken bones, or fractures, are a common problem we see at VSC. While the bones of dogs and cats are incredible strong certain traumas can lead to brakes in any part of a dog’s bones, but most commonly happen in the forelimbs, hind limbs and pelvis. Ellie Mae had fractured her humerus, the long bone between her elbow and shoulder. Her fracture was considered ‘simple’ because the bone broke into two pieces only. The two main ways fractures are repaired include bandaging/casts and surgery. Unfortunately Ellie Mae’s fracture required surgery, as the humeral bone cannot be effectively casted. Later that day she was placed under general anesthesia for surgery. Prior to the procedure a local anesthetic was injected around the nerves that supply the forelimb in order to help control her pain after surgery and make her anesthesia safer. At surgery a large stainless steel rod and wires were used to bring the broken ends of the bone back together and hold them in place during the healing period (Figure 2). That evening Ellie recovered in our ICU making sure her pain was well controlled and she had a smooth recovery from the procedure.

In order for broken bones to heal, as a surgeon we have to get the fractured ends perfectly back into their original position and then make sure the repair method will keep them stable for the next 6-8 weeks. This is the average length of time it takes bone healing to be complete. While in Ellie Mae’s case we used a rod and wires to repair the fracture, other implants can include metal plates, screws, pins, external fixators and interlocking nails. Its important that a surgeon be trained and skilled in multiple ways to repair broken bones because once you are in surgery the plan can change if the fracture is different then anticipated.

The most important part about the recovery period is rest at home. While the implants are strong they cannot withstand unlimited force. Prior to surgery and at discharge we discussed with Ellie Mae’s owner the importance of restricting activity during the healing period. The next morning bruised and swollen she was using the leg again and was discharged home to a very happy owner. While not yet healed she’s one her way to making a full recovery.


Pet Safety Sunday – Mark Your Calendar

Did you mark your calendar for the next Pet Safety Sunday?

All Pet Owners Invited To This FREE Educational Event

March 30, 2014 @ 4:00 PM
Veterinary Specialty Care – SC
985 Johnnie Dodds Blvd.
Mt. Pleasant, SC 29464

“Why is my dog limping?
Common causes of lameness in dogs”
Dr. Mike Schlicksup, one of our board certified surgeons, will be discussing common causes of lameness in dogs. Learn about cruciate disease (ligament damage in the knee), luxating patellas (knee cap issues common in toy breeds), hip dysplasia and more.


Ashley’s Story




Ashley is a 4 year old female/spayed Standard Poodle who presented to Veterinary Emergency Care (VEC) on 19 January 2014 for acute onset vomiting after ingesting chocolate.


Prior to presentation Ashley helped herself to her owner’s pantry. She consumed 8oz of Bakers Chocolate and some chocolate chips.  This amount and type of chocolate contains a very dangerous dose of theobromine, the active ingredient in chocolate, even for a large dog.


Upon presentation Ashley had a high heart rate and was nauseous.  However, due to the large amount of chocolate ingested, vomiting was induced.  Ashley produced approximately 4 cups of chocolaty liquid vomitus.  She was then given medication to help calm her stomach and stop the vomiting. 


Ashley was hospitalized for continued decontamination, supportive care, and symptomatic treatment.  Activated charcoal was administered to bind any remaining theobromine within her gastrointestinal tract.  She was also placed on a high rate of IV fluids to help flush the toxins from her body.


Ashley did continue to vomit for a few hours and she did develop urinary incontinence, another common clinical sign of chocolate toxicity.  But with aggressive support and care, Ashley responded very well and returned home 24 hours after initial presentation to VEC.



Some information about chocolate toxicity:


Caffeine, theophylline, and theobromine are methylated xanthines (methylxanthines) found in coffee, tea, and chocolate, respectively.  Some chocolate products contain caffeine; caffeine is considered to enhance the clinical toxicity of chocolate.


Although symptoms of chocolate toxicosis occur with ingestion of theobromine at a dose of 100mg/kg, every animal has different sensitivity to chocolate.  Animals with a history of heart, liver, kidney, or seizure disorder may be more sensitive to chocolate.

 Methylxanthines are rapidly absorbed orally and distributed throughout the body.  Clinical signs of these toxins are restlessness, hyperactivity, urinary incontinence, vomiting, and diarrhea.  Later clinical signs can include excessive hyperactivity, muscle twitching, seizures, elevated respiratory rate, elevated heart rate, and high body temperature.  These clinical signs can be life-threatening; therefore hospitalization is advised. 

The good news is that patients usually recover with hospitalization and aggressive therapy.  Methylxanthine toxicosis is occasionally fatal if a large amount is ingested and allowed to be absorbed.

Dr. Shelley Ann Fetterolf, MS, DVM

Heisenburg’s Story by Dr. Jeremy Libby

A very concerned pet owner returned home after work to find her beloved female juvenile Green Tree Python, Heisenburg, hopelessly adhered to the very sticky backing of her terrarium’s humidity gauge.  Apparently Heisenburg was a little too active and adventurous during the evening and dislodged the humidity gauge from the glass wall of her enclosure.  After realizing just how stuck and uncomfortable Heisenburg really was she rushed her into the clinic for emergency treatment.
Heisenburg was a bit anxious and perhaps a little embarrassed upon arrival, but was very cooperative for the procedure.  One technician held her gently while another rubbed a mineral oil derivative on her skin with a cotton swab where the gauge was adhered to her skin.  With persistent application and gentle traction the gooey adhesive was removed, the gauge came off, and Heisenburg was free again.  With a little dilute Dawn dishwashing liquid the mineral oil derivative was removed and all was well with Heisenburg and her owner. 
This case brings up a few points about pets and adhesives.  Please do not use mineral spirits or harsh petroleum based paint or adhesive removers.  Some brands of nail polish removers can also be too harsh for use on your pets skin.  Mineral oil or a mineral oil derivative would be the safest choice. 
Never use force to remove any glued object from your pet as this can remove skin; which may lead to a long wound healing scenario. 
Dr. Jeremy Libby

Friday’s story


I have a thirteen year old Dachshund named Friday.  Dr. Lori Ludwig saved Friday’s life not once, but twice!  In 2009, my precious Friday had to have back surgery.  I was terrified and afraid I was going to lose my best friend.  Veterinary Specialty Care was amazing!  As I waited in the lobby while his surgery was being performed, the wonderful employees kept me informed and made me feel more comfortable with with procedure.  After the surgery, he started to have a seizure.  Dr. Ludwig gave him a Valium to calm him down.  I was asked to come back to see him to get him to calm down until the medicine kicked in.  It broke my heart to see him on IV’s and all stapled up, but I was in tears of joy that he was going to be alright.  I went back every other hour throughout the night to check on him.  Again, the employees were amazing!!!  The first two weeks back at home were rough, but we did together!
In November 2012, Friday got sick and had a blockage.  I chose Dr. Ludwig to perform the operation on Friday again since she made miracles happen the first time.  Dr. Ludwig removed an eight inch tumor out of his small intestines along with a few bladder stones.  Again, I sat in the lobby waiting during surgery, which I might say felt like a lifetime!  Dr. Ludwig came out after the surgery and updated me thoroughly with everything she did during the exploratory surgery.  Although I wasn’t suppose to see Friday right after surgery, Dr. Ludwig, again, let me go check on him.  Good news is his tumor was not cancer!  The tumor was sent off to the pathology, but we still have no clue what exactly it was.
Friday just celebrated his thirteenth birthday on July 25!  He is slowing down and now has two small masses in his liver.  He is not in pain and thinks he is still Wonder Dog.  It’s all about the quality of life and I am beyond blessed to have him for this long.  I feel like I am already on borrowed time, but we make the best out of it each day that we still have together.  Words cannot explain how grateful I am for Veterinary Specialty Care.
We send Halloween and Christmas cards every year. 



Bliss’s Story

A few weeks ago I asked for our Facebook followers to share their stories about their heartwarming moments with their pets. Boy, I didn’t realize what a tear-jerker this task would be.  But even so, with a tissue in hand we were touched by these heartfelt stories and want to share them with you.  I hope they touch you as they did us.Image

We have such long story full of blessings and disappointments it’s difficult to know where to begin. On Sunday, May 28, 2012 (a holiday weekend) we were very grateful for our local Vet, Dr. Gwynn Hardee (we live in Myrtle Beach and he was in Loris). He was able to find to compassionate techs to help him perform an Emergency Splenenectomy followed by a blood transfusion on our beautiful 9 year old Australian Shepard, Bliss.

He saved her life that evening and we thought we were home free until he called us a week later with the Pathology results…Hermangiosarcoma. We had never heard of it and were heartbroken. Our plan was just to enjoy her but he suggested we come to VSC for a consult. We met the beautiful and bubbly Dr. Michelle Wall who gave us hope, not necessarily for a cure but at least some time. Bliss also had the MDR1 gene mutation which made her very sensitive to vaccines and several medications but we decided to proceed. She did great the first few months but by the 4th treatment her body was having a difficult time recovering. In October 2012, a secondary malignant tumor was found on her thyroid and Dr. Ludwig performed surgery to remove it. She was so reassuring that she could remove it all with no further treatment needed. Bliss recovered fully and we continued. In December, 2012 we were convinced it was something with the cancer and drove down to VSC Emergency at 2 am. It turned out to be a severe Urinary Tract infection. Even after hours, wonderful compassionate care. In May, 2013, again we just knew it was the cancer and rushed back to VSC. Dr. Brofman, discovered an iliopsoas strain which we took as good news but looking back it may have been all related. In July 2013, when we were almost complete with the chemotherapy protocol and had hope that maybe just maybe Bliss would be in the 5% that beat it, another mass was found on her liver and it was bleeding. We had to make a difficult choice and followed the advice of Dr. Taylor and Dr. Bianucci to go with surgery. Bliss sailed through surgery but ended up staying at VSC 6 days. Dr. Bianucci gave us his cell # and called us every day to reassure us. After 3 days , we visited every day and she again recovered to her happy self. After about 5 great weeks, Bliss was full of infection with Aspirated Pneumonia, Pancreatitis and either abscess from the last surgery or cancer reoccurrence on her liver. We were crushed. She was hospitalized 2 days and responded well but a few weeks later more infection and it seemed one thing after the other. With the support of Dr. Wall during her last weekend we brought Bliss in on Monday, October 14th and decided it was best for HER to let her go. She and her tech (I should know her name?) were so wonderful. They made the worst possible situation as bearable as possible. We were all 4 crying and three weeks later I’m still crying. I should remember names because after over 30 visits to VSC and 3 surgeries, there are so many wonderful and caring compassionate people who helped us through it all. Jess, became a friend always greeting us with a smile and Jeff made us feel like we were always in the best of hands. But really everyone we encountered ( I just can’t recall all of the names ) in the last 17 months was fantastic. We are forever grateful and hope we won’t need to come back for professional reasons but know if we do we will be greeted as old friends 🙂 After all that Bliss went through she never lost her love of life. She had such a strong will to live and an amazing love for family…so devoted. A forever puppy. I could not have named a dog more appropriately…she truly was Blissful and her paw prints will be forever in our hearts.


Ginny (and Jim)