Parker’s Foreign Body Ingestion and His Devoted Owners

We’re just coming out of Easter,  and most of us probably ate stuff we probably shouldn’t have. But aside from those “My Strange Addiction” episodes, most of us haven’t been eating socks, rocks, diamond rings and other weird things. But dogs do. It’s one of those things that remind us that dogs are not just furry little humans. And it is one of those things that can get them into a lot of trouble.  

Parker is a happy, friendly, beautiful yellow Labrador retriever who came to see me because he had vomited four times the night before and was not as active or interested in food as usual. After a physical examination and because we were worried that Parker may have eaten something, we obtained some radiographs(xrays).

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When animals eat an object that they shouldn’t, we call that thing a foreign body. A lot of times, the objects will pass through or get vomited up before they leave the stomach. If something gets through the stomach and into the twists and turns of the intestines, it has a greater chance of getting stuck. When coupled with sharp edges, strings or rigidity, the danger level increases. The longer something stays lodged in the intestines, the more the inflammation, stretching and lack of oxygen lead to loss of viability and eventually rupture.

Signs of a foreign body obstruction(when it has gotten lodged and will not move) are vomiting, fever, belly pain, lethargy, lack of appetite, and infrequent stools to name a few. Unfortunately, animals may only show one sign which can make it hard to diagnose without tests such as an xray.  The tests may need to be repeated to track progress of the suspected object. Recheck exams also help us determine if the patient is feeling better, worse or the same.

Parker was given fluids and an injection of an anti-nausea medication and sent home with instructions to call us back if things were not improving. The next morning, Parker still did not want to eat. Even though the owners were at work, they took time off to drive back home to get Parker and bring him back in to stay with us for the day.  As  mentioned before, tests may need to be repeated and we decided to repeat his xrays. They looked a lot different than they had the day before and we were concerned that there could be a blockage in his intestines.  We discussed that we wanted to do an exploratory surgery. While we could not be certain that there was something blocking him up,  the owners wanted to make sure and consented to the surgery.20131227_131502

they took time off to drive back home to get Parker and bring him back in to stay with us for the day

We found that an object had been ingested part of which was in the intestines. Unfortunately, the other part was anchored in the stomach and the intestines were bunching up in between. One incision in the stomach and two incisions in the intestine were needed to remove the whole object.

His intestines were very inflamed and close to looking like they needed to have portions removed entirely, but after consulting with all doctors on hand, we decided to not remove any portions. There are many pros and cons involved with taking or leaving a segment of intestine and many factors involved when making this decision. Regardless, these patients are watched over and worried about for days, not only by their owners, but by  veterinarians and veterinary staff.

Fortunately for everyone, Parker made a complete recovery. The timeliness of his family’s decision to get him back in to us made all the difference in the world in my opinionand proves that waiting and seeing is not always the best course of action.

The timeliness of his family’s decision to get him back in to us made all the difference in the world in my opinion

A few weeks later, I saw this picture on Facebook which was posted by one of his owners, and we had a good laugh. Although I would never recommend taking advice from this doggy doctor, I think you’ll enjoy it, too!!

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Orchard Road’s Doctors Reflect and Anticipate

 

 

 

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Orchard Road’s Doctors at our Christmas Party from left to right:  Joel Huffman, Linda Flieg, Kristen Kennedy, and Cheryl Distajo

About one year ago, I promised that I’d be a better blogger and true to many New Year’s Resolutions, that one fizzled like a candle in a rainy Illinois winter. The good thing about failed resolutions is that it isn’t hard using them again-the hard part is doing better.

As a veterinarian, my job is stressful. Trying to provide the utmost in patient care while trying to stay on time during a busy day and doing the most with an owner’s financial means is hard. But, it’s hardly ever boring. But, it also can be fun. Reuniting a recovered patient with its family after a devastating illness and welcoming new kittens and puppies are what fuels my tank.  I have to enjoy those moments and not let the euthanasia of a pet I’ve seen for my whole career and its whole life or a case with a bad outcome sap my desire to keep working hard.

The other great thing about my job is my co-workers. See my previous blog about the Unsung Heroes. Three especially great co-workers are my boss, Dr. Linda Flieg and the other two associates, Dr. Cheryl Distajo and Dr. Kristen Kennedy.  We talk about cases daily, vent our frustrations(about anything from cases to refrigerator repairmen), help each other with surgeries, engage in heated debates, share stupid YouTube videos, and do the best we can to make sure that your pet receives the best continuity of care regardless of who is in the building.

I wanted to start this New Year’s blog thanking them and giving them a chance to share their reflections on 2015 and anticipations/hopes for 2016:

Dr. Kristen Kennedy:

Looking back on the past year, there have been many ups and downs. We have had some great success stories and some heartbreaking endings. This year has been true evidence of our philosophy that our patients and clients are part of our family with the amount of emotional and intellectual investment that all of our staff has put into helping our patients get better. I have been the most proud this year of how all four of the doctors work together. We are constantly discussing difficult cases and making sure the hospitalized patients get excellent continuity of care. If you are unfortunate enough to have a very sick patient in the hospital, you will know that your pet will be in good hands no matter what. Our success stories have been because of the hard work of all of the doctors and our support staff. This year has also been a challenge learning how to balance family with work as my son just turned a year old in October. Being a mother is a new role for me, but it is so much fun and I wouldn’t trade it for anything. Looking forward to 2016, I am eager to continue learning new things. I am going to be signing up for more ultrasound training so we can begin to offer echocardiography (ultrasound of the heart) at Orchard Road. I’m excited about the challenges ahead and hope to keep learning and growing as a veterinarian—always trying to do better for our patients every day.

Dr. Cheryl Distajo:

I’m trying to wrap my brain around the fact that another year has passed. I saw many familiar faces and noses and some brand new ones. I am very blessed to have so many wonderful animals and people in my life. We have been through some wonderful times together and some heartbreaking ones but I am so grateful to have been a part of each of your lives. A great man once said “With great power comes great responsibility.” Well, maybe not a great man, but Spiderman. I also know I don’t have great power but I have a great responsibility to you and your animals. They are family and many of you are like extended family to me. I have laughed and cried with you and always try to treat your animals as if they were my own. I thank you for letting me be part of your lives and for trusting me to care for your family.

I have the honor of working with some amazing doctors and staff. I couldn’t do my job without them. They make my job look easy and they easily keep up with my long list of demands. I want to say thank you to each of them. You are the heart of ORAH and an amazing team!

Dr. Linda Flieg:

When I look back at 2015  I see many loyal clients, some of whom have been with me since 1992 and a few that have been with me before I opened the doors to Orchard Road Animal Hospital. I know that behind that success is a great team of doctors that are working with a great core staff. The doctors have been here 13, 12 and 7 years. Many clients would have been amazed that all 4 doctors were working on a case electronically on Christmas Eve! What a great group of people to work with!
We have also watched new additions of digital radiography for both the body as well as our dentals. We have seen over 100# of weight loss in our Fitter Critter Club. We watch those animals become more active and more playful and their proud owners beam at their own success stories.

Looking forward to 2016, we will continue to help our patients become healthier, our patient owners more informed and keep ourselves healthy as well!

THE AMAZING CAT UTERUS IN PICTURES(or Why to Spay Your Animal)

It’s been forever since I’ve written so I’ve been given a topic. Not only did I get inspiration thrust upon me, but it was a topic that usually ends up preachy.  No one likes to get preached to unless you’re in church(and sometimes not then, either). However, I feel that if you can find real-world applications for new information, it makes it more interesting and also sticks with you. SO…LET’S GET STARTED.

A normal cat uterus in a young cat will look like the first picture (taken during surgery).

Normal uterus in a young cat.
Normal uterus in a young cat.

A uterus is shaped like a Y with the cervix near the intersection of the three straight lines and the forks of the Y being the uterine horns. The ends of the horns are where you’ll find the ovaries. When we do an ovariohysterectomy(or spay) we remove the uterus and ovaries by tying off ovarian arteries and uterine arteries that supply the uterus and ovaries and removing everything in one piece. In large, overweight animals this can be difficult as fat obscures vision and makes it more difficult to secure your suture. As these arteries branch directly from or close to the aorta, a slipped knot can be extremely dangerous. This is why we never call a spay a ROUTINE SPAY. Spays are done frequently, but are not to be taken lightly as they are a major abdominal procedure.

Cats rarely have problems giving birth, but the following is from one of the exceptions. I had to perform a C-section on this particular cat(see x-ray below).

This is a side view of the mother cat. Notice that the kitten takes up the entire abdomen.
This is a side view of the mother cat. Notice that the kitten takes up the entire abdomen.

Cats normally have multiple kittens in a litter instead of one gigantic kitten like this one. Happily, the surgery was successful. The wow factor of the size of the kitten makes for a good story, but remember that pet overpopulation is a serious issue. For everyone that lets a cat(or dog) roam free without being spayed or neutered, for everyone that just wants their pet to have one litter because it would be fun or educational, they are bringing another animal into the world and taking the chance for a shelter animal to find a home. YouTube has plenty of videos of animals giving birth if you want an educational experience!!

Look again at the first picture and look at the size of the uterus. That’s normal. What you see in this next picture is a uterus full of pus and what is called pyometritis.

Instead of the two small uterine horns like you see in the picture from earlier, notice how huge the horns are now.
Instead of the two small uterine horns like you see in the picture from earlier, notice how huge the horns are now.

In some animals, especially as they get older, material  that would normally get expelled by the smooth muscle in the wall of the uterus remains and becomes a wonderful growth media for bacteria. If the cervix is closed at this time, there is no where for this pus to go until it ruptures and causes a septic abdomen. If the cervix is open, you will often notice a nasty discharge from the vulva.  Some people assume it is diarrhea because all they notice is nasty junk under the dog or cat’s tail.

Finally, I need to mention that risk of mammary cancer can be greatly reduced and the risk of uterine or ovarian cancer eliminated by spaying your animals. Due to protection issues with photos, I did not upload an image of a mammary tumor in dogs or cats, but there are plenty on the internet.

It is still your choice to spay and neuter, and not every animal that is intact will have these complications; however, being prepared and educated can make you a better, wiser person. Thanks for reading!!

PRINCESS-THE HOSTESS OF UNWANTED GUESTS

I have known Princess since she was a puppy and that made it even more difficult to see her in bad shape. When I came into the exam room, she was on her side and didn’t even get up to greet me.  She had escaped from her yard on Memorial Day and was found three days later.  Luckily, she has a collar with her name and number embroidered on it and is also microchipped. If it weren’t for that, she may not have gotten the medical attention she needed right away.

Unfortunately, she needed a lot of attention. At first she just looked like she had some matted mud and dirt in her gorgeous husky coat, but upon closer look it was matted with dirt and infection. As we started to shave her hair we noticed not only wounds, but thousands of maggots! Infected skin had attracted flies to deposit their eggs and shortly thereafter, Princess was hosting their young. Some skin was so diseased, it could be peeled away. Some tissue could be scrubbed dry only to watch it become moist with infection seconds later.  Our best theory was that she was attacked by coyotes and that most of the injuries were made as she struggled to get free.

Princess on day 2
Princess on day 2
Another view on day 2
Another view on day 2

We knew from experience that she could heal and that in the coming days, more skin which once looked healthy could start to look bad. That bad skin would end up becoming leathery, die and need to be removed.  She started eating, taking her medication and was doing well, but over the next few days, she stopped eating and became more lethargic. She needed to be hospitalized and given intravenous(IV) fluids. The wounds had seeped so much that she lost valuable proteins; therefore, we had to give her fluids rich in a molecule that mimics naturally-produced protein. If she did not have this, fluid given IV would not stay in the vessels, but would leak out into her chest or her abdomen and not get to the tissues and organs where it was so desperately needed.

She continued to fight, but her recovery was slow initially and it was taking a toll on the family both emotionally and financially.  The family remained strong and never gave up on her, and we all reaped the benefits by watching her make a wonderful recovery. The going was slow initially, but I have never seen wounds heal so fast.

If a wound is not sutured closed, it can heal, but the healing is slow. Sutures bring healthy wound edges together and the edges of the wound contain substances that allow a seal to form which usually heal nearly completely in a week. If the edges are not closed, the wound has to fill in naturally.  The wound heals in from the bottom up eventually forming a bright pink, glistening, bumpy bed of healthy tissue called granulation tissue. Concurrently, the wound begins to contract inwards from the outer edges. Scar tissue is formed and it is always a waiting game to see how much of the new tissue will grow hair. In Princess’s case, she is growing hair on almost every part of the healed wound although some of it will likely be darker than before.

This was taken on June 13th-remember that it happened on Memorial Day weeken
This was taken on June 13th-remember that it happened on Memorial Day weekend
Cannot see the wounds well, but what a cute face!
Cannot see the wounds well, but what a cute face!

 

I apologize for the lapse in my blog for those of you who read, but I thought her story should be told as it is informative and inspirational. Thank you to our whole staff as nearly every doctor saw Princess during this time, countless assistants and technicians helped with wound care. Thank you also to those who returned her and especially to her wonderful family who ensured someone knew who her family was and that the family she would be returned to would love her back to health.

Thanks for reading!

Dr. H.

July 2nd and notice hair growing back and the little wound compared to the end of May.
July 2nd and notice hair growing back and the little wound compared to the end of May.

 

Brady, my favorite Jack Russell Terrorist

I met Brady five months after starting my career at Orchard Road Animal Hospital and Brady and I saw a lot of each other since that initial visit for a torn nail. Brady was memorable for many things- some little like checking in for boarding with a “headless bunny” toy in his personal possessions, and some huge like his visit in January 2005:

Brady, like so many other sick dogs, was just not acting right. He would eat slowly, shake a little, throw up most of what he ate, and the odd behavior seemed to come out of nowhere.  Without obvious problems on his physical examination, we decided to do some blood tests, and the results were astounding. His liver was taking a beating from something. We knew this because there were significant changes in his ALT which indicates liver damage. His ALT was 4968 units/L when a normal result is between 5 and 60.brady

Brady stayed in the hospital for two days and was a pistol to say the least. He was always wanting attention and chewing his IV line even if we had a cone on him.  One night I stayed a bit late to make sure he was ok before driving 20 minutes to watch an Illini-Wisconsin basketball game at a restaurant. As I pulled into the parking lot of the restaurant, the late staff called to tell me he chewed his line out AGAIN! I drove all the way back, replaced the line, checked Brady out from top to bottom again and rededicated my goal of trying to get him home as soon as possible.  We checked his results the next day and the ALT had come down to 1309 and since he had begun eating, we decided to have the owners continue treatments at home.

Within a month, his values were all normal and stayed normal for nearly 10 years. We recently lost our little friend in January of this year just a few months shy of his sixteenth birthday to unrelated issues.

The liver is often talked about by medical professionals as being an innocent bystander. All of the toxins we ingest can affect the liver—anything involving the gallbladder, pancreas and upper intestinal tract can also affect it. Naturally occurring steroids such as cortisol as well as manufactured steroids such as prednisone will cause certain changes in the liver. Infectious diseases, nutrient imbalances, genetic disorders, cancer and inflammation can also affect it. Finding the reason is often difficult and sometimes the changes are not felt, but found on blood testing before anesthesia or as part of a sick animal exam or senior pet evaluation.

We did some tests on Brady that indicated that Brady had leptospirosis. Leptospirosis is caused by Leptospirosis spp. organisms. The disease is transmitted from animal to animal and from animal to person. A disease that can be passed between animals and humans is called a zoonotic disease. Diseases such as leptospirosis, rabies and roundworm infestations are all zoonotic and a very important part of what makes veterinarians so important. Human physicians and veterinarians are teaming up more than ever especially when it comes to eradicating, diagnosing and monitoring  some exotic zoonotic diseases that may be used as bioweapons.

Nonetheless, leptospirosis is most commonly contracted from coming in contact with urine or blood from an infected animal, often near standing water sources or damp soil where an infected animal may have urinated. Although there are other ways to contract the disease, this is by far the most common. Luckily for Brady, he responded to treatment, and like I said, lived another 10 years with no ill-effects.

There aren’t many weeks that go by without seeing a blood test with some liver enzyme elevation. I often tell owners about how high Brady’s levels were and how well he did when discussing treatment and testing options for their pets with elevated liver enzymes. He also comes up in conversation when we discuss vaccinations as leptospirosis is something that we routinely vaccinate against.  He was a character and I loved knowing him all these years. As much joy as he brought me, he also brought sadness to our hearts and the hearts of his family when the time came to say goodbye. But he will always live on through my memories and the little lectures I give in the exam rooms. There’s no substitute for real-world experience and no experience like knowing Brady, my first Jack Russell Terrorist.

New Year, New Format(The stories of Bentley and Brady)

This is Bentley relaxing at home.
This is Bentley relaxing at home.

A New Year is well upon us and I’ve made a decision to change the format of my blog. The old, preachy topics of heartworm, flea, spay/neuter and the holiday poisonings are very important, but boring and well…preachy. Then, a new year comes along and it’s spring and time to talk about fleas again.

This, however, left me with no good ideas, so I decided to center my blog on the happenings in the clinic. Every day, something sad, funny or great happens and I hope that sharing some of them and perhaps sharing the medical relevance will both entertain and enlighten all four of my readers!!

Bentley is a golden retriever who is neutered and will be turning four in a few weeks. Just after the new year, he came to see us because he vomited some foam three days prior. His food had changed a few weeks back and  he seemed lethargic. Otherwise, all was good. Because he was young and golden retrievers are known to eat things they shouldn’t, we did xrays. His xrays looked pretty good but his blood work showed there was inflammation or infection somewhere. We sent out blood for a complete blood count, gave him some fluids and sent him home on an antacid while we waited for results.

That night he perked up quickly, but it did not last. He came back with a fever that he didn’t have  before. His blood work showed he had a high white blood cell count so we did some chest xrays because of a concern that he could have an infection in his chest, and because we’d seen some fungal infections this summer. We started him on antibiotics, ordered an antifungal and sent out a test for the fungal infection called Blastomycosis. The test came back positive.

Blastomycosis(Blasto, for short) is a fungal disease caused by inhaling spores from soil or sand into the lungs. The fungus can then spread throughout the body. We have seen dogs with the infection limp, become blind, or even die from this disease.

Luckily, Bentley is doing well but will need treatment for quite some time, perhaps up to one year. The other fortunate thing going for Bentley is that he has a family willing to do a lot for him. Vomiting is not a very specific sign and neither is a fever or lethargy. We needed to do a lot of tests including one for Addison’s disease which he turned out not to have. All of these tests helped us get to the answer.

Bentley’s case is an example of a time where although it took a lot of time, effort and money, we arrived at a diagnosis and a treatment plan with high hopes of success. Sometimes, our answers come quickly and at other times,  we cannot narrow it down without extensive surgeries or expensive tests such as CT scans or MRIs.

Be up front with your vet, make sure they listen, and be honest about what you can afford. If you feel that they are not listening, find someone who will. If you feel they are being judgmental, find someone who isn’t. We are here to help you, and although we may want to do tests you cannot afford, we work with varying budgets all the time( both at work and at home). We understand and aim to work with you, as a team, to help your pets.

The joy our staff felt when Bentley came back in for a recheck was amazing and made for a great day. When Bentley was not feeling good, it made for hard days and restless nights and we all smiled when his owners sent a picture of him feeling better at home. Each day, there are highs and lows. Hopefully, this new format will inform you on some diseases and more of what it is like working in a veterinary clinic.

Next time, although he has passed, I will tell the story of an amazing little dog named Brady.

Thanks for reading!

Dr. H.

HOW DO YOU BECOME A VETERINARIAN AND DO YOU WANT TO?

This is NOT me, by the way.
This is NOT me, by the way.

As a veterinarian, I’ve often heard people say that they at one time thought about becoming a vet. I also hear a lot of parents and grandparents talking about one of their children or grandchildren thinking about becoming a vet. I’d like to use my blog today to talk about some of the myths and to give some helpful hints.

I chuckle when someone tells me their 18 year-old is pre-vet. Heck, when you start college, you’re pre-EVERYTHING. As a freshman, you can be pre-rocket scientist or even pre-“college isn’t for me.” In order to get into veterinary college, you just need to look at the requirements for admission, take those classes and do well. There are a lot of math and science classes needed, but you could be an art major and still get into vet school. In fact, diversity is smiled upon when applying. After all, who wants every doctor to be the same?

Oh, yes, veterinarians are doctors. Not the physician or human surgeon kind, but we obtain a Doctor of Veterinary Medicine(D.V.M.) degree unless we go to the University of Pennsylvania(they give a V.M.D.). Most vets get a bachelor’s degree first, but it is possible to get into vet school without first getting a bachelor’s degree; however, those few people study intensely for two or three years in a program that is geared strictly for the goal of applying to vet school. If after that intense training, they don’t get in, they either reapply or use what credits they have towards some other bachelor’s degree.

Vet school admission committees look at grades, but they also look at the standardized test(graduate record exam(G.R.E.)) scores, experience, letters of recommendation and interview to make their decisions.  In order to gain good experience, most applicants have worked in a clinic before. This is good because this career is not for everyone. Young adults need to see the good, the bad, the fun and the sad to determine if it is for them. It’s ok if it doesn’t fit what they want to do…better to find out before you rack up over $150,000 in debt for a job that pays around $60k/year which is another important factor to consider(maybe another blog topic?)

Now, I am flattered when people talk about the acceptance process. People talk about vet school like I went through S.E.A.L. training. I have some smarts but my mental abilities are not analogous to the physical and mental toughness of elite warriors. In fact, 1 in 10 applicants are accepted to the University of Illinois. I get to see the numbers every year because I am honored to serve on one of the interview teams. But…if you break these down, 800 of these are out-of-state students who will likely turn down an acceptance because of the costs of out-of-state tuition. So, when it really comes down to it, if you are applying to your in-state school and meet the requirements, you have more like a 50:50 chance. Granted, the group you compete against are very qualified, but again, you’ve got a chance when you consider I’ve put the milk in the cupboard and the cereal in the fridge!!

This kind of information is something I like people to know and the kind of stuff I like to talk about. I love to talk to kids of all ages, and we often have students observe us in exam rooms and even surgery. The more you see, the more you understand and the more you can decide on what might be for you.

As usual, thanks for reading and give me ideas of what YOU would like to read about.

Dr. H.