Have you ever had a puppy that just presents with lethargy, exercise intolerance and sleeps all the time?
This is normal for my teenage daughters, but not so for a young Lhasa apso that presented to my surgery. Physical exam was unremarkable, but the dog was so sleepy we administered IV fluids to perk it up.
Routine biochemistry revealed a low blood urea nitrogen (BUN), and a urine sample demonstrated the presence of urate crystals.
This triggered a request for a bile acid stimulation test, which showed markedly abnormal elevation postprandial levels.
Our diagnosis of hepatic portosystemic shunt was confirmed at Davies Veterinary Specialists and luckily this was shown to be extra hepatic. So, after some very smart surgery, the dog went on to live an energetic life.
As little as 50 grams (1.8 oz) of general chocolate can be enough to poison a small dog, but the concentration of theobromine in dark chocolates (approximately 10g/kg) is up to 10 times that of milk chocolate. (source: Wikipedia)
Chocolate is digested much more slowly by dogs than people. Therefore symptoms may not appear for many hours after the chocolate is eaten.
Do not be fooled by this into thinking that everything is okay. The earlier chocolate poisoning is treated the more likely you are to save the dog’s life.
No antidote
In addition, the very slow deactivation of theobromine by dogs means that the effects of chocolate poisoning can be very prolonged – up to three days, so the dog may need to be hospitalised throughout this time.
Theobromine has no specific antidote – cases are treated symptomatically. The prognosis depends on how much chocolate or cocoa powder the dog has eaten, and how long prior to being seen by the vet that the dog ate it.
Don’t delay
Up to 50% of dogs will die if treatment is delayed until severe, persistent vomiting has developed. If seizures have begun then an even higher proportion of dogs will die.
Treated early enough, except for dogs that have consumed very large quantities of chocolate or cocoa powder, the outlook is generally quite good. Recovered dogs show no long term ill effects from the poisoning.
Idiopathic head tremors are common in young to middle aged dogs especially bulldogs, boxers and Labradors.
Although upsetting to owners, episodes are not painful or upsetting for the dog.
There is often a familial component and the tremors can be triggered by:
a recent painful event
a temporary dip in blood glucose
lowering of blood calcium
allergens
trauma
nothing discernible at all
It is easy to confuse the condition with focal seizures.
Anti-epileptic medication is not beneficial in true cases of idiopathic tremors. There is anecdotal evidence that feeding a sugar-rich meal can immediately alleviate the tremors, even in those cases where blood glucose levels have been normal.
Idiopathic head tremors in Bailey the boxer. Video: LaurenDu / YouTube
Rupture of the cranial cruciate ligament in an English Bulldog by Uwe Gille, licensed under CC-BY-SA-3.0
For dogs weighing less than 15kg, cranial cruciate disease can be managed conservatively – weight loss until an appropriate Body Condition Score (BCS) is achieved, exercise restriction for 3 to 6 weeks, and possibly physical therapy and pain medication – allowing acceptable comfort and function.
In dogs weighing more than 15kg, cruciate disease will eventually cause significant arthritis, and dysfunction is inevitable without surgical treatment.
No single surgical technique is clearly superior, so the choice of surgical repair should be decided by the surgeon and the needs of the owner.
It is advisable to always spay a bitch having a mastectomy.
Approximately 50% of malignant mammary tumours in the dog have receptors for either oestrogen or progesterone. This means the presence of these female hormones promotes the growth of these tumours.
Benign tumours also have female hormone receptors and can also be stimulated by hormonal cycling of the female dog. This means spaying is important, even if a tumour has already developed.
In one study, bitches spayed at the time of mammary tumour removal (or two years prior) lived 45% longer than those that remained unspayed.
Starting treatment for epilepsy in dogs is slightly controversial as the adverse effects of medication, and the fact that most dogs will be on treatment for life, puts many owners off.
Many dogs will only seizure once, and never again.
I was taught to advocate treatment after the second seizure episode, once other organic causes have been ruled out.
Experimental evidence and a single study in dogs suggest that early treatment offers better long-term control of the seizures as compared to animals that are allowed to have numerous seizures prior to the onset of treatment.
A histiocytoma on the ear of a boxer dog. Image by Joel Mills (own work) [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons.Histiocytomas are common, benign skin tumours that begin in the immune cells. They usually present as small, firm, dome or button-shaped masses on the skin surface, which are fast growing, non-painful, and usually solitary.
Common sites include the head, nose, ear edges, and limbs. Occasionally, multiple skin nodules or plaques are present. Rarely, an autoimmune blistering is possible that may ulcerate.
Histiocytomas can also occur internally – in the stomach, lungs and intestines.
Retrievers, bull terriers, cocker spaniels, and great Danes are more susceptible to histiocytomas. The masses often spontaneously regress over two to three months.
The most common problem that arise from histiocytomas is when they become pruritic, triggering self-excoriation and infection. Excision is then required.
Angiostrongylus vasorum is the most common cause of haemorrhagic cerebrovascular accidents in dogs.
Bleeding in the brain or spinal cord can cause neurological symptoms. Craniotentorial bleeding can cause epileptic seizures, paresis and abnormal postural reactions.
In cases of cerebellar bleeding, hypermetria, vestibular symptoms and opisthotonus are observed, and if the brainstem is affected, abnormalities of the cranial nerves can be seen.
Inflammation, hypoxia and parasitic emboli may cause neurological signs too.
It is worth treating any dog with a suspected stroke for A vasorum with Advocate (moxidectin and imidacloprid).
An experienced vet could complete the entire procedure easily within 10 minutes. We “tentatively ambled” through our surgeries in 20.
Having finally settled in one place in Jaipur, India, my friend and I were able to relax a little, safe in the knowledge we had two weeks of neutering for population control ahead of us.
Being in an unfamiliar environment, and with our patients mainly being strays, we were prepared for very different methods of anaesthesia, variations on drugs we’re used to at home, and potentially questionable sterility. Even so, when the vet, stood with his scalpel at the ready, said “oh yes, we use the right flank method” as if it were the norm, we were a little surprised.
At home, we’re so used to seeing flank cat spays and midline bitch spays, my gut reaction was “is that even anatomically possible?”. As it turns out, it is.
The method
A small incision (<2cm) is made on the right flank, first through the skin and then each of the 3 underlying muscles (transverse abdominis, external abdominal oblique and internal abdominal oblique). A spay hook is then used to exteriorise the right uterine horn.
Once identified, the surgeon follows the horn to the ovary and applies tension caudally to break the suspensory ligament. A ligature (note single) is placed around the blood vessel and the ovary cut from it using the three clamp method in the same way as spays in the UK. The surgeon then follows the uterus to the cervix and along the left horn to the left ovary, where the procedure is repeated. A ligature is placed just above the cervix (again using the triple clamp method) and the uterus removed.
Closing the incision comprises placing a horizontal mattress suture in each of the muscle layers, a cruciate suture in the subcutaneous fascia, and intradermal sutures in the skin.
The positives
While the very idea of flank spays in the bitch just seemed alien, this method seems to be successful and works well in a charity environment in a country where certain resources are unavailable.
The reasons for choosing this method include easier wound checking, a shorter wound healing time (meaning the dogs can be re-released sooner) and less tension at the incision site, decreasing the risk of wound breakdown – essential for animals that, once released, are unlikely to be seen again.
Despite her initial surprise at the method used, Jordan admits the flank approach is the best compromise, considering the resources available.
The surgeons at the charity have found, over the years, the single horizontal mattress suture seems to be the least aggravating to the body wall muscles, and intradermals are the closure of choice in any stray or vicious animal that would be difficult to get near to remove sutures.
Another key advantage to the flank approach is speed; important for two reasons:
The sheer number of stray dogs to neuter to reach an adequate level of population control means faster surgery is required to reach the target numbers.
The surgical time under IV anaesthesia should be kept to a minimum to avoid prolonged or rocky recoveries and minimise side effects.
The experienced vet could complete the entire procedure easily within 10 minutes (in a normal young bitch, opposed to a pregnant or in season girl), and we, tentatively ambling through our surgeries, could complete within 20.
The negatives
Disadvantages to this method include more potential bleeding due to incising through the three muscle layers, a possibility of more postoperative pain and increased difficulty in extending the incision if there are complications. The most important, however, is that recovery of a dropped or bleeding ovarian stump is extremely difficult (or near impossible).
The anaesthesia protocol used is premed: xylazine, induction/maintenence; IV ketamine and IM meloxicam as pain relief. Hence, the speed of the flank approach will also minimise the number of top ups needed and reduce the anaesthetic hangover comparing to a technique (such as midline) that is more time consuming.
Compromise
The method seems to be the best compromise, considering the resources available. I think the overruling disadvantage is that, if you were concerned about a slipped ligature, the ovarian and uterine stumps would be virtually impossible to find again via the original incision.
However, that said, the only postoperative death we saw during our time on postmortem had all ligatures intact.
It was eye-opening to see an entirely different approach to a bitch spay, and while it may not be the same as the routine at home, I still felt that we gained a lot of surgical experience and developed transferable skills.
Golden retriever puppy with juvenile cellulitis. Photo: Trisha Shears, via Wikipedia.
Puppy pyoderma (also known as juvenile cellulitis) typically occurs between three weeks to four months of age, in any breed of puppy. It is characterised by an acute swelling of the face, especially the lips, eyelids, chin and muzzle.
It can be confused with an allergic reaction (e.g. a bee sting or vaccination reaction) and can develop into pustules that drain and scab.
The submandibular lymph nodes enlarge dramatically, hence giving the disease its other name of “strangles”.
Puppies are often lethargic, with appetite loss, pyrexia, and pain in the joints.
There may be an immune aetiology to the disease because affected animals respond well to steroids.
