OP Exam

A Rhodesian Ridgeback came in coughing and gagging.  The doctor did a preliminary examination of the mouth to see if there were any visible reasons for these symptoms, however it was difficult to keep the dog's mouth open for an extended period of time and the tongue out of the way.  We intebated the dog in hopes of getting a better view of entire mouth.

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Inflammation is the first thing the doctor will look for during the OP exam.  If any tissue seems upset, there is a chance that something (like sticks, dirt, or foxtails) could be poking into the skin. 

One of the more common places for debris to get caught in the mouth is in the tonsils.  The tonsils of a dog are located in these little pockets, called tonsil cavities, on the roof of the mouth.  Sometimes, irritants can get caught into those pockets and cause coughing and gagging.  

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Lucky for this dog, we found some dirt inside of the tonsil cavity.  We used saline solution to flush out the cavity.  Although the debris found in the tonsil cavities could have been the reasons for the symptoms, we placed it safe by continuing to explore the dog's mouth.  If there was somethig else that could cause irritation, it would be good to get it out now!  We checked in the indentations of the hard palate, deep into the soft palate, in between the teeth, and under the tongue and in the gums but nothing else was found.

The dog was sent home with a non-steroidal anti inflammatory drug. 

Ultrasound

An ultrasound is a type of imaging tool used by doctors to inspect the inner structures of animals.  The ultrasound has a series of probes called transducers.  Each transducer produces a different frequency of sound that can penetrate the body.  In turn, the sound echoes off of the organs creating a clear view of whats going on inside.  Depending on the type of tissue the sound is echoing off of, the image on the screen differs.  If more echoes are returning to the transducer, the brighter the object will be on the screen. 

Ultrasounds are excellent tools for doctors who want to get an interactive or 'moving' picture of what is inside of the body.  If an organ or tissue is not functioning properly, a radiologist can see that in an ultrasound. 

On the ultrasound machine used at the practice I work at, there are four different probes, each of which send out different wavelengths of sound.  Gel is rubbed onto the skin of the patient to help the sound waves penetrate the body without getting distorted by stray hairs or the skin itself. 

The images that the ultrasounds give us is one that can look, to most people, like a bunch of shadows and masses.  However, to a trained radiologist, the ultrasound gives a 3-D image of what is going on inside of the body.  One of the key parts of using an ultrasound is understanding the aatomy of the patient.  A radiologist must be able to place the probe on the body and know which organs would be expected to see in that location.  They also need to understand anatomy based on how deep they are looking in the body.  Depending on the probe and the how hard they push onto the body will expose different parts of the body. 

Prolapsed Rectum Kitten

The Humane Society brought in a kitten that was found in a drainage pipe on the side of the highway across from the hospital.  Although appeared to be in good spirits, the kitten had a prolapsed rectum.

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A prolapsed rectum is the term used when part of the rectum has slipped out of anus.  Normally, the rectum is secured to the pelvis by muscles and ligaments, however stress and certain parasites can sometimes weaken the muscles securing the rectum so it slips out of place.

This condition can happen to any cat of any age, however depending on the age and sex, different reasons can be the cause of the prolapsed rectum.  In older cats, straining to urinate or to defecate, and in females, giving birth, can cause the rectum to be pushed from the body.  However in kittens, some of the most common causes of a prolapsed rectum are diarrhea, constipation, parasites, and stress.

Although it can appear unnerving, prolapsed rectums can be fixed manually.  A 60 cc syringe filled with heparin saline was sprayed on the rectum to clean the rectal area.  Next, non-steroidal lube was applied to the rectum and the doctor pushed the rectum back into the anus.  Because the kitten was very nervous and kept clamping his anus, sedation was necessary.  Once the rectum was back in the anus, the doctor used a purse stitch to suture up part of the anus to restrict the rectum from coming out again.  The stitch will stay in for only 48 hours. 

The sooner this procedure is performed, the better off it is for the kitten.  If a prolapsed rectum is left untreated, stool can build up in the colon.  Unable to excrete, excess amounts of stool in the body will make the kitten very sick and eventually he would have died.

Ethylene Glycol Poisoning

A dog came in with anorexia and because he was extremely sensitive and painful on and around his abdomen.  During preliminary examination, not much was found, however we noticed that the dog had a sweet, almost maple syrupy smell to him.  The doctor worried of Ethylene Glycol Poisoning.

Ethylene Glycol is a major ingredient in film processing solution and antifreeze.  Because of its sweet smell and taste, dogs and cats are attracted to it.  Ingestion of even the littlest amount can be toxic.

When ethylene glycol enters the system, it is first absorbed through the GI tract.  Most of the ethylene glycol goes straight through the kidney's, unaffected in its attempt to cleanse the blood.  Once the ethylene glycol reaches the liver and kidneys, a series of oxidation reactions occur, which transforms the ethylene glycol into a metabolite called glyoxylic acid, which will acidify the blood.  These metabolites are extremely toxic to the central nervous system and can cause the extreme sensitivity the patient exhibited.  

Like any case of toxin ingestion, time is of the essence!  Because there is no way to reverse the damage that has been done on any of the organs, doctors focus on getting the toxin out of the body as quickly as possible.  If not taken care of immediately, the patient could suffer severe organ damage or die.

We first administered apomorphine to induce vomiting; if there is anymore ethylene glycol in the stomach, it is best if the dog gets it out of his system rather than begin to digest more of it.  Next, we hooked the dog to IV fluids to keep him hydrated and orally administered activated charcoal.  Activated charcoal binds to any toxin that could be left behind in the stomach and helps it to pass through the system.  

Oddly enough, the best treatment for ethylene glycol poisoning is alcohol- alcohol dehydrogenase inhibitor 4-Methylpyrazole to be exact.  4-MP inhibits the body's ability to metabolize the ethylene glycol and makes it easier for the kidneys to eliminate the glyoxylic acid. 

We were fortunate that we had caught on to the toxicity very early because there was barely any lasting internal damage. 

Pneumoperitoneum

A cat came in today with trouble breathing.  The cat was immediately placed into an oxygen tank, however that did not seem to work.  An ultrasound was completed and it was confirmed that there was air in the abdomen.  This condition is called Pneumoperitoneum.

Pneumoperitoneum is defined as air or gas in the abdominal cavity.  When there is air in the abdominal cavity, it pushes against the lungs, making it difficult for the lungs to expand with each breath of air.  If enough air gets into the abdominal cavity, the patient could suffocate.

To help this cat, we used an ultrasound to find pockets of air in the abdomen.  The doctor inserted a butterfly needle into the pocket of air and a nurse on the other end of the butterfly would pull on the syringe to see if air would come out.  The trick with this procedure though is to release when you feel negative pressure on the needle.  You can't pull against something that is not there.  Once you hit that negative pressure, the doctor will move the needle to a new air pocket.

This procedure is only temporary.  Somehow, the air got into the abdomen and taking it out won't solve the overall problem.  It was believed that there was a hole in the cat's lung; when the cat took a breath, a little bit of air was able to escape from the hole and into the abdomen.  It was determined that the hole was too big to be repaired on its own.  Instead, the cat was scheduled for a lobectomy to remove the lung lobe with the hole in it.  Removing the lobe with the hole will hopefully help the cat's breathing. 

Because of the severity of the pneumoperitoneum, the cat did not make it to surgery.  Air was filling the abdomen quicker than we could remove it, making each breath extremely difficult and painful.  The cat was euthanized

Foxtail [1]

A yellow lab came in because she began to sneeze constantly during a hike.  The doctors suspected it was a possible foxtail in the nose.

Anyone from the Bay Area knows what a foxtail is. These pesky seed dispersers tend to find there way up the noses, down the ears, in between toes and pads, and through the skin of our canine friends. 

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This yellow lab, unfortunately had sniffed the foxtail into his nose and was sneezing up a storm!  Unlike other seeds that attach themselves to the coats of animals and eventually fall off or get matted in their fur, foxtails bury themselves deep into an animal's tissue.  Their jagged barbs help them to navigate deep into an animal and it can be quite uncomfortable!

The only way to diagnose a foxtail is to find one.  Most dogs will not hold still long enough for a doctor to stick the otoscope down their nose, let alone explore all of the nasal passages until successful.  So, dogs in general, need to be sedated for a rhinoscopy.  Either a doctor or registered vet technician will go into the nose with a illuminated otoscope.  They will look for either swelling or inflammation.  Usually around an inflamed area, a brownish foxtail will be sticking out.  With alligator forceps, the doctors will pull it out. 

Its an easy procedure but foxtails can definitely be a pain in the butt.  If you ever see a foxtail on your dog, make sure to pull it off before they bury themselves into the skin!

CBC

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A CBC (complete blood count) is a type of blood test that calculates the number of each cellular element, including red blood cells, white blood cells, platelets, and hemoglobin within a blood sample. Doctors will want this blood test to be done to test a patient for anemia, infection, inflammation, and the healthiness of the red blood cells.

Cardiac Arrhythmia

A dog came in today for a check up to see if she was eligible for surgery.  When we hooked her up to the EKG, we discovered a small heart arrhythmia.

A heart arrhythmia is a disturbance in the beating rhythm of the heart.  This could either be in the amplitude, the frequency or the regularity of the beating.  All of these different kinds of heart arrhythmias involve abnormal electrical activity in the heart muscle.  They can be caused by congenital heart abnormalities, genetic factors, breed disposition, stress, infection or heart disease.

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Every heart beat begins in the sinoatrial node (SA) in the upper right chamber of the heart called the right atrium.  The electrical impulse then travels through the right atrium to an intermediate station called the atrioventrical node (AV) and then to the left and right ventrical chambers at the bottom of the heart.  This journey through the heart creates a pattern that can be seen on an electrocardiogram (EKG).  When there is a disturbance or difference in the electrical impulse's movement through the heart, it is called a heart arrhythmia.

There are two broad umbrella terms that define the different kinds of heart arrhythmias: tachycardia and bradycardia.  Tachycardic arrhythmias are when the heart beats faster than normal.  Although the clinical signs are minimal and sometimes go undetected, tachycardia can be very dangerous for the dog's health.  If the heart rate remains high for too long, the dog could suffer from damage to the heart tissue or heart failure due to pulmonary edema.

Bradycardic arrhythmias are when the heart beats slower than normal.  When the heart beats slow, the amount of oxygen getting to the body is decreases, making it difficult for the organs and tissues to do their jobs.  Patients with bradycardic arrhythmias tend to become dizzy, and confused when not enough oxygen is getting to the brain.  It can also lead to fainting and collapsing.   

A bradycardia arrhythmia is what we saw on the EKG of this dog.  It appeared as if the heart was skipping a beat, however there was just a longer pause before the next beat.  This was valuable information for the doctors and nurses who were planning to take this dog to surgery.  This could possibly cause some problems for the dog while under anesthesia.

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Because there are so many kinds of different arrhythmias, it is hard to say how to prevent them.  Regular veterinary check ups, good exercise, and a healthy diet are a good start though!

Pulmonary Edema

A cat came in with trouble breathing.  He was panting and open mouth breathing.  Immediately, x-rays were taken of the cat's thorax and it was determined that there was liquid in the lungs.

In medicine, this is known as a Pulmonary Edema.  It is the accumulation of fluids in the interstitium and alveoli of the lungs.  When fluid in the lungs builds up, it hinders the exchange of oxygen and carbon dioxide.  If the blood is not getting oxygen from the lungs and going off to the body without the oxygen, the organs and tissues that need to dispose of their carbon dioxide waste products and pick up more oxygen molecules have difficulty doing so.  Patients with this condition usually show symptoms of heavy, difficult breathing (sometimes breathing through the mouth), shortness of breath, wheezing, and lethargy. 

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The most accurate way to diagnose a Pulmonary Edema for any patient is to get a chest x-ray.  When a doctor looks at the x-rays, they can see a white haze or patchy, fluffy fluid infiltrates rather than a dark and clear fully aerated image of the lungs.  In some cases, the patient will also have an enlarged heart.

The patient was then given a diuretic called Lasix (also known as Furosemide) to help remove the fluid.  Diuretics are a type of medication that prevents fluid retention in the body and helps to manage Pulmonary Edema.

Once the patient was stable with diuretics and oxygen, we began to investigate the reasons for the Pulmonary Edema.  Usually Pulmonary Edema is related to heart disease, so an ultrasound was scheduled to determine whether heart disease was the cause.

Hyperthyroidism in Cats

An elderly cat came in because he was losing massive amounts of weight very quickly.  It was suspected that the was hyperthyroid and so blood was taken and sent to IDEXX for testing. 

Hyperthyroidism is common in elderly cats, and usually older cats begin to show symptoms of this at around age thirteen.  The thyroid glands, located on opposite sides of the windpipe in the neck, regulate the speed at which the body metabolizes food by using a hormone called thyroxine (also known as T4).  An enlargement of or a nodule on that gland stimulates an excess of thyroxine to be produced.  This is called hyperthyroidism.

The test we sent out to IDEXX was the T4 test.  The T4 test determines the level of circulating hormone in the blood.  This will tell us whether or not the thyroid gland is producing too much thyroxine.

Some of the most common clinical signs of hyperthyroidism in cats are weight loss, voracious appetite, vomiting, diarrhea, and excessive thirst.  Many hyperthyroid cats are also hypertensive (have high blood pressure).  Because the hormone thyroxine affects the speed at which all chemical reactions are occurring in the body (the basal metabolic rate), this disease affects multiple body systems including your pet's kidneys, liver, heart, eyes, nervous, and digestive systems. 

Dog owners don't need to be as worried about hyperthyroidism as cat owners because it is a rare condition in dogs.

PCV & TP

One of the most commonly used and simplest blood tests in veterinary medicine is the packed cell volume.

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Also known as the PCV or the hematocrit, the PCV measures the percentage of red blood cells to the total blood volume.  Blood is placed into a small hematocrit tube.  One side is sealed in clay. Next the tubes are placed in the centrifuge (clay must be facing the outside) and spun for about three minutes.  This spinning separates the different layers of the blood, depending on each components density. At the bottom are the red blood cells.  At the top is the plasma, which mostly made up of water with dissolved proteins, glucose, clotting factors, mineral ions, hormones and carbon dioxide.  Separating these two layers is the buffy coat, which contains the white blood cells and platelets.

There are several different things that you can tell about the health of a patient, just by looking at the results of the PCV.  Firstly, and most importantly, you can determine if the blood contains a normal amount of red blood cells.  The normal percentage of red blood cells would be around 40% - 45%.  If the red blood cell count is extremely high, it could mean that the animal is dehydrated and needs fluids pronto!  If the red blood cell count is extremely low, it could mean that the animal is anemic.

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Anemia is a condition of the body where the body does not have enough hemoglobin.  Hemoglobin is the protein in red blood cells that bonds to oxygen and carries it to the body tissues.  If there are low levels of red blood cells with hemoglobin, the amount of oxygen reaching the organs is not going to be enough to sustain them for very long.   Anemic patients can be spotted very quickly, even before running the PCV though.  Doctors will usually check animal's gums to see if they still have that pinkish tint.  If their gums are white, it is a sign that they are anemic. 

Sometimes the plasma has a yellowish color, meaning that the animal is icteric.  Icterus is not a good diagnosis; there are three causes to Icterus, including hemolysis (the destruction of red blood cells), liver disease, or an obstruction in the bile duct.  With this information, several different diagnoses are considered and usually more blood work is done to narrow the possibilities down. 

Another test that we do once the PCV has been measured is to measure the total proteins within the blood sample.  The hematocrit tubes are cracked right at the beginning of the plasma and the plasma is tapped onto a protein refractometer.  Next, you hold the refractometer up towards the light and measure the amount of total proteins on the scale.

Total proteins is an important test to run because it tells you the amount of all the proteins flowing in the fluid portion of the blood.  The total protein test is important in telling you whether the patient might have nutritional problems, kidney disease, or liver disease.  The normal range of total proteins falls between 6 - 8.3 gm/dl (grams per decaliter).  If the test shows higher than normal levels of proteins, this may be a sign of chronic inflammation or infection or a myeloma.  If the tests show lower than normal levels of protein, this may be a sign of malnutrition, a hemorrhage, malabsorption, or liver disease.

Seizure Watch

Black lab came in because he had a seizure at home and the owners wanted him to be checked out and watched. 

Animals who have seizures at home will be placed on seizure watch when they are at the vet. A bell collar is placed around the animal's neck.  If the animal does have a seizure, the bells will ring and either a doctor or vet tech can help to control the seizure. 

Seizures can be extremely scary but always remain calm when you witness an animal having one.  Animals will begin to shake, their head and neck will strain upwards, they become rigid and eventually they lose consciousness.  Their jaws will clench, they begin to convulse, and more than likely they will begin to drool.

Ok, so its scary... but what is a seizure?  Seizures are the result of abnormal bursts of nerve signals to the brain.  Sometimes they can be symptoms of toxicity or a neurological problem.  Other times, like idiopathic seizures, the causes are unknown.

Age is a determinant factor in concluding on how serious the seizure or series of seizures are.  Young dogs usually get seizures because they have epilepsy.  Although that can be a scary diagnosis, epilepsy is manageable and treatable.  In older dogs, seizures can be a sign of a brain tumor or neurological problems, sometimes which are untreatable. 

When an animal has a seizure at the hospital, a nurse will inject the patient with Valium.  Valium, also known as Diazepam, is a fast acting anti-convulsive drug that can be effective when attempting to stop cluster seizures (a series of seizures).  Although Valium is good for sporadic use, dogs can build up a resistance to the drug, making it not as effective when needed the most. 

Echinococcosis

A Corgi came in for vomiting, lethargy, fever, and chest and abdominal pain.  X-rays were taken of the Corgi's abdomen and what appeared to be bubble wrap lined his abdominal wall. 

Every once in a while a unique case comes up that has the doctors' saying "Ah ha, I vaguely remember learning about this extremely rare disease in vet school!  Could it be?" And yes, it turned out to be Echinococcosis.

Echinococcosis is a parasitic disease caused by the zoonotic Echinococcus tapeworm.  This unique worm requires two different hosts to complete its life cycle.  The intermediate host is usually a rodent.  Once ingested by the intermediate host, the eggs will hatch in the digestive system and enter the blood stream.  Blood will then carry the eggs to the lung, liver of brain, where they can develop cysts.  These cysts act as incubators for immature forms of this parasite.  These cysts can take over specific organs and eventually lead to death in the intermediate host.

Dogs can act as their definitive hosts, getting this parasite into their system by ingesting the eggs that are in feces of animals who have the Echinococcus tapeworm or by consuming the organs of an intermediate host that contain these parasitic cysts.  Once ingested, the tapeworm will make its way down to the intestines and begin laying more eggs, which will create more cysts throughout the abdominal wall.  These cysts (known as hydratid cysts) can be very painful and can cause an obstruction or pressure on neighboring organs.  One thing to be extremely cautious about with these cysts is the fact that they can rupture and release 'daughter' cysts throughout the body.

The doctor elected to take the dog into emergency surgery.  When the surgeon opened up the dog, we saw exactly what we saw in the X-rays, and more!  Hundreds of cysts throughout the abdomen were cut out and the body was flushed with saline, to make sure nothing was left of the tapeworm takeover.  To the right is a picture of the cysts the surgeon found on the dog's abdominal lining.  (Note, this picture is not from the surgery, just a picture of the cysts I found on www.cfsph.edu)


Recovery for the Corgi was long and uncomfortable-- I mean, imagine a surgeon going in and slicing all of these cysts off of your abdominal wall!  The dog was placed on a Norm-R IV with a painkiller and antibacterial.

The Corgi is now doing great!  He is back at home and happier than ever!

So, how might you minimize the risk of your dog getting this tapeworm? Simple, don't let your dog consume the carcasses of wild or domestic animals.  If your dog has been feasting on a carcass, you might want to talk to your veterinarian bout possible deworming techniques... just to be on the safe side.

Cranial Abscess

Tabby cat came in today with an abscess on his head, right below his ear.

An abscess is a very common site in veterinary medicine.  As scary as they look, an abscess is only a collection of pus in an inflamed and swollen area.  They are formed when the body's immune system is attempting to fight off an infection in the tissue.  Abscesses can form anywhere on the body however some of the most common places they are found are on the face or on the tail.  One of the more common ways for cats or dogs to get an abscess is through a bite, usually from a fight with another animal.  The teeth penetrate the skin and leave behind some nasty bacteria.

To treat this, the doctor first shaved and sterilized the area.  Next, a blade is used to open the abscess and drain the pus out of it.  Once it appears to be completely empty, gauze with chlorhexidine scrub is used to clean the abscess out, as not to leave any bacteria that could possibly reinfect the site.  The abscess is left open to drain.

The doctor prescribed Clavamox to the patient.  Clavamox is an oral antibiotic that can kill a wide range of bacteria.  This drug was prescribed to make sure that any left over infection in the abscess would die.

Parvo Puppy

This morning we had a yellow lab puppy in isolation because he was Parvo positive.

Parvo is a contagious virus that spreads through dog feces.  Although it can affect dogs of all ages, parvo usually affects puppies who do not have the antibodies to fight off the virus or are old enough to get the vaccine against it.  The most common symptoms of Parvo are lethargy, high fevers, vomiting, diarrhea, and in rarer and more serious cases, it can cause respiratory and cardiovascular failure.  One of the most common ways of detecting whether or not your dog has Parvo is by the smell of his feces.

Once the Parvovirus is ingested into the puppy's system, the virus settles into the lymphatic system where it can replicate and grow.  Soon after, the bloodstream is infected and the virus begins its journey through the body, attacking the bone marrow, the lymphatic cells, and the intestines.  The attack on the intestines is extremely serious because it affects the dog's digestion.  Necrosis of the intestinal lining begins to occur and the bacteria contained within the intestines is released into the body.  The white blood cell count goes down and eventually, if not treated immediately, can lead to death.

To treat this puppy, we gave him a blood plasma transfusion from a dog who has already survived the Parvo virus.  This blood plasma transfusion is beneficial for the puppy because it contains antibodies against the virus.  He was also on IV fluids to keep him from getting dehydrated or malnourished.  Because this virus causes puppies to become extremely nauseous, we also injected him with an anti-nausea medication to prevent him from losing any more fluids from vomiting. He was kept in isolation for four days before being sent home.  His owners were given very strict instructions about keeping him away from other dogs.  This puppy could remain contagious for up to three weeks!

So if you have a puppy and want to keep them safe from the Parvovirus, the best thing to do is to get the vaccinations.  Vaccinations should be given right after the puppy has been weaned off of their mother's breast milk (which does contain the antibodies against Parvo) at around 6-8 weeks.  The first shot is followed by a series of several booster shots and then are given annually after the first few years of the dog's life.

The Beginning

So, this is my first blog, the fact that I'm completely speechless as to how to start a blog is quite sad, especially considering the fact I've been thinking about this blog all day.  I am a pre-vet student at Skidmore College in Saratoga Springs, NY, hoping to major in biochemistry and minor in art history.  I've always wanted to become a vet, but I thought that it was just some childhood dream, close to getting a unicorn under the Christmas Tree.  But once I took my first steps into my biology lecture, I knew that working in medicine is something I really want to do.  I thought about working in human medicine, but one thing that really attracts me to veterinary medicine is the fact that our patients can't talk to us.  Instead of telling you, "I have a head ache," a veterinarian must explore how the body is telling you that the animal has a head ache.  I am interesting and attracted to the cures and possibly miraculous recoveries, but the puzzle of discovering what is going on with that animal is much more alluring.

All of this sounded interesting but I wanted to make sure that my hopes of becoming a vet could turn into a reality.  I mean, can I really work day in and day out in a hospital? So, I decided to jump right in! This summer I am working at three different vet hospitals throughout the Bay Area, each extremely different in the services they provide and the styles of veterinary medicine practiced by the doctors.  Turns out, I love it! I wake up every morning excited for work- I love what I'm learning, I love the cases I see, I love the doctors I'm working with, and I love satisfaction I get when an animal walks out the doors feeling happy and healthy

Throughout the summer, I decided to keep a diary of the case, diagnoses, and after care I see at work.  Each day, I bring my little orange notebook and scribble down notes and later talk with the doctors about their plans of action for their patients.

Just this past week one of my coworkers suggested I make a blog of my little orange book.  I thought that this blog would be an interesting way to share my experiences with whoever would listen.  If not, this blog would be a good way for me to reflect on the cases and possibly get some feedback on some of the cases I've seen. Or maybe this blog will be a stepping stone for someone else who is also interested in pursuing veterinary medicine.

Alright, let's get started! Bare with me, I've got to catch up on a month's worth of interesting cases.  
~L