Pyometra - another reason to spay your pet!

We all know the benefit of spaying our female pets to prevent unwanted heat cycles and litters. But did you know that spaying also prevents a life-threatening disease known as pyometra? The term pyometra is derived from Latin pyo meaning pus and metra meaning uterus. The disease occurs when the uterus becomes infected resulting in an abscessed pus filled uterus. The infection causes bacteria and toxins to leak into the bloodstream. Without treatment death is inevitable from the resulting septicemia and toxemia.

The typical patient is a middle-aged to older female dog that has undergone a heat cycle within the past 2 months. The heat cycle results in fluid accumulating inside the uterus; bacteria then ascend from the vagina and the uterus becomes infected and ultimately pus filled. The patient usually loses her appetite while drinking an excessive amount of water. As the disease progresses, she becomes weakened and lethargic and usually begins vomiting. The patient may have a discharge from her vagina if her cervix is open and allows some of the fluid to drain. However, many patients have a closed cervix and no discharge is seen. These patients tend to be sicker since the toxins and pus have no outlet.

The diagnosis is best made by ultrasound examination which quickly confirms the presence of a fluid filled uterus. Without ultrasound the diagnosis can be quite challenging and may require exploratory surgery.

Treatment requires immediate surgery to remove the uterus and ovaries. The surgery can be very challenging, especially if the patient is toxic. Aggressive antibiotic and IV fluid therapy are also essential to resolve the infection and reverse the toxic damages to the body.

Due to the complexity of the surgery and additional supportive therapy, the pyometra surgery typically costs 4-5 times as much as a routine spay surgery.















This is a picture of a normal uterus of a 55 pound dog following a routine spay surgery. Note the size of the uterus in relation to the ruler & surgical instruments.














This is a picture of a uterus filled with fluid which has not yet become infected. This patient would have developed a pyometra in the near future if the owner had delayed spaying much longer.
















This is an ultrasound image showing a section of the uterus filled with fluid. The patient was taken to surgery and the uterus was removed.

This is the pyometra uterus that was surgically removed. Note the size of the uterus in relation to the surgical instruments. This patient was also 55 pounds. As expected, the fluid filling the uterus was pus.

Spaying represents complete prevention of this disease and cannot be over-emphasized. Often owners plan to breed their pet or are undecided, time passes, and they fear she is too old to be spayed. A female dog or cat can benefit from spaying at any age. The best approach is to figure that pyometra will eventually occur if a female pet is left unspayed; any perceived risks of surgery are greatly out-weighed by the risk of pyometra.

Murphy the "Wonderdog"

Murphy is a sweet 12 year Boston Terrier. She is the constant companion to a wheelchair bound paraplegic client. Ten days before this past Thanksgiving, Murphy came into the hospital with labored breathing and coughing.

Murphy's exam revealed a heart murmur and diminished lung sounds suggestive of fluid in her chest. Digital x-ray imaging of Murphy's chest confirmed the presence of a moderate amount of free fluid in Murphy's chest cavity. Murphy's heart also appeared somewhat enlarged which is suggestive of additional fluid accumulation within the pericardial sac which surrounds the heart. Some of the fluid was aspirated from Murphy's chest and submitted to our pathology service for diagnostic interpretation. The pathology results suggested the presence of a tumor as the source of the fluid accumulation.

Digital x-rays of Murphy's Chest:

The digital x-rays were forwarded through the utilization of our hospital's telemedicine capabilities to both a veterinary radiologist, Dr. Ron Burk, and veterinary cardiologist, Dr. Wendy Arsenault, for additional interpretation. Both of these specialists believed a tumor was likely and an ultrasound exam of Murphy's chest was recommended. Our ultrasound exam confirmed the presence of fluid within the pericardial sac which is even stronger evidence for the presence of a tumor at the base of the heart.

Ultrasound images showing fluid in pericardial sac:

Arrangements were then made to have one of our clinic family members transport Murphy to Dr. Arsenault's clinic in Bonita Springs for a definitive cardiac ultrasound evaluation. That exam revealed the presence of a "chemodectoma" tumor arising from the base of her aorta. The tumor was causing a progressive buildup of fluid within the pericardial sac and would soon end Murphy's life. A life saving open-heart surgery known as a "pericardectomy" would be needed if Murphy was to survive.

Arrangements were made to have a veterinary surgical specialist, Dr. Bruce Berger, perform the surgery in our hospital on the Tuesday before Thanksgiving. On that same day, Murphy's owner was having surgery to remove her gall bladder.

Murphy's surgery required Dr. Berger to open up Murphy's chest to completely expose her heart. Dr. Berger then made an incision into the pericardium and meticulously dissected the pericardium for around her entire heart. Throughout this procedure, Murphy was unable to breathe for herself and required our nurse-anesthetist to breathe for her using manual intermittent positive pressure ventilation. Each breath had to be carefully coordinated with the surgeon to insure proper safety during the surgical dissection and proper inflation of Murphy's lungs. The surgery lasted almost 2 hours and Murphy resumed normal breathing on her own at the completion of the surgery.

Murphy spent the next 3 days recovering in our hospital and at the Piper family home. She was the star guest at the Piper Thanksgiving celebration. Murphy was discharged back to her owner's loving care 3 days after her surgery where she can once again be found in her favorite place - mom's lap.

Murphy at the time of her discharge:

I wanted to share Murphy's story with you for several reasons. First of all, this was a great Thanksgiving blessing to all of us at the hospital that worked so hard to save Murphy's life and to Murphy's lovingly devoted owners that entrusted us with her care. It was truly one of the most uplifting and satisfying things we have ever done in our 29 years of service. Secondly, Murphy's case demonstrates the advanced diagnostic and therapeutic services we are able to provide our patients in their time of need.

Urinary Calculi: Bladder and Kidney Stones

Just about all of us have heard stories of people "passing kidney stones". However, most of my clients are surprised when their pet is diagnosed with either kidney or bladder stones. Dogs, in fact, are quite commonly affected by the formation of stones in both their kidneys and bladder. The stones are composed of varying mixtures of minerals that accumulate within the urinary tract. The particular type of stone that forms is determined by several factors including diet, water consumption, breed predispositions, urinary tract infection and medical conditions that affect the pet's metabolism.

The most common symptom observed in patients is an increased frequency of urination. This may also be accompanied by straining to urinate, dribbling of urine or the passing of blood in the urine. These are symptoms that should be checked out by veterinary examination ASAP.

Male pets (canine and feline) frequently become partially or completely blocked when trying to pass the stones. A urinary blockage is a life-threatening emergency and requires immediate veterinary attention. The first x-ray image is a cat that was completely blocked with small bladder stones that had become wedged into the urethra. This cat required emergency catheterization to relieve the obstruction and surgery to remove the stones. The second x-ray is a dog with numerous bladder stones in the bladder and a large accumulation of stones in the urethra at the base of the penis. This dog also required emergency catheterization and surgery to relieve the urinary obstruction.

The most common type of bladder stones are known as "Struvite". These typically form in response to a bladder infection and are most commonly found in female patients. This type of stones can be dissolved with special prescription diets fed over a period of several weeks coupled with long term antibiotics to resolve the underlying infection. Unfortunately, not all patients are candidates for dietary dissolution and surgery is required to resolve the problem. Following surgery or dietary dissolution, modifications in the pet's diet can usually prevent the formation of new stones.

The seond most common type of stones are composed of calcium oxalate. These cannot be dissolved and must be surgically removed in all cases if the problem is to be resolved. There are no diets available to reliably prevent the formation of new calcium oxalate stones. However, with proper dietary management and the use of appropriate medications we can decrease the chances of new stone formation.

The photos are from 4 different cases that required surgical removal of the stones. The top and bottom pictures are two variations of calcium oxalate stones. The middle two pictures are struvite stones.

Other types of bladder stones may be formed due to liver disease and metabolic disorders. Occasionally we seen bladder stones being formed due to a pet being fed an inappropriate diet.

Certain breeds of dogs are notorious for forming bladder stones. Most notably these include the Schnauzer, Bichon Frise and Dalmation breeds. However, all dogs and cats are at risk.

If your pet shows any signs of urinary problems (urinary accidents, increased frequency of urination, straining to urinate, passing blood in the urine or change in urinary odor), have your pet examined as soon as possible. Insist on a urinary ultrasound exam or x-ray to rule-out this potentially life-threatening problem.

Hip Dysplasia: Diagnosis

One of the most common causes of lameness and degenerative arthritis we see in dogs is a genetic disorder known as Canine Hip Dysplasia (CHD). The disorder most commonly affects the larger breeds of dogs, but has been diagnosed in all breeds. The frequency of CHD runs between 15-50% in different breeds.

The hip joint is what's known as a "ball and socket" joint. The "ball" is the head of the femur (thigh bone) and is normally seated firmly within the "socket" (acetabulum) of the pelvis. This allows for the smooth rotation of the hip through a wide range of motions. The top left x-ray shows a patient with normal hip joints.

CHD causes an abnormal development and formation of the hip joint which compromises the mobility and stability of the hip. Frequently the socket is abnormally shallow and the ball is misshapened. The end result is progressive degenerative joint disease and osteoarthritis as the dog ages. Mildly affected dogs may show little problems until later in life. More severely affected dogs may be severely crippled at a very early age. The top right x-ray shows a dog with a severely deformed left hip joint.

The disorder can be positively diagnosed as early as 6 months of age. The diagnosis is made by radiographic (x-ray) and manipulative examination of the hips. These examinations require that the patient be sedated for proper positioning and joint relaxation. All larger breed dogs (adult weight greater that 50 pounds) should have these examinations performed between 6-8 months of age.

There are several medical and surgical options available to help pets afflicted with CHD. If diagnosed at an early age before degenerative changes occur, a repositioning surgery known as Triple Pelvic Osteotomy (TPO) can be performed to allow for deep firm seating of the ball within the socket. Once degenerative changes have occurred, the best surgical option is a Total Hip Replacement (THR). The x-ray on the bottom shows a dog that had a TPO procedure done on the left hip and a THR on the right hip (the "R" marker denotes the right side). Both of these procedures require the expertise of a "board certified" veterinary surgeon.

A less desirable, but much less expensive, procedure known as a Femoral Head Ostectomy (FHO) can be performed to remove the deformed ball and reduce the pet's discomfort. This procedure works marvelously well in the smaller dogs but has variable results in the larger dogs. The x-ray on the top right shows the appearance of the right hip following this procedure.

Pets unable to have surgery can frequently be kept comfortable by the administration of dietary supplements to support better joint function and anti-inflammatory pain relieving medications. Weight management is also critical to help prevent unnecessary stress to the hip joints.

Since this is a genetically determined disorder, all affected pets should be surgically neutered. Those pets intended for breeding should have their hips thoroughly examined for any signs of CHD and certified for breeding if normal. Never buy a large breed pet without documented proof that both parents were certified free of CHD by the Orthopedic Foundation for Animals (OFA).

Smelly Dog Breath? Think "Dental Disease"

Does your pet have bad breath? If the answer is yes, lift up the lips and look at your pet's teeth. There's a good chance your going to find your pet has some degree of dental disease. This problem is caused by the bacteria that lives in the mouth. The bacteria causes the buildup of dental tartar, infection of the gums and damage to the periodontal ligament (the critical structure that attaches the tooth to the jaw). Over time the infection causes damage to the tooth roots and tooth loss. Furthermore, the constant infection in your pet's mouth is a persistent stress to the immune system and may eventually lead to other serious medical problems.

The pictures in this blog show a patient with advanced dental disease before and after the extraction of several diseased teeth and cleaning of the remaining healthy teeth. You can only imagine how lousy we would feel with a dental infection such as this. We owe it to our pets to not let it get to this point. We also owe it to ourselves - this pet's dentistry cost over $500.00

The very best way to prevent dental disease is to brush your pet's teeth at least once everyday. Most pets (yes, even cats) readily accept brushing of their teeth if using an appropriate veterinary toothpaste and properly sized tooth brush. It only takes 1-2 minutes each day and can prevent so many problems. There are also dental sprays and dental chews to help prevent dental disease - but nothing is as effective as brushing.

Go ahead now, lift up your pet's lips and look at those teeth - especially those teeth in the back. If your pet's teeth look like the "before" dental cleaning picture, with tartar buildup or red sore looking gums and stinky breath, schedule an appointment to determine what level of therapy is needed to return your pet's mouth to good health. If your pet's teeth look beautiful, like the "after" dental cleaning picture, schedule an appointment to have us show you how to best care for your pet's teeth.

Preventative dental care is much better for your pet's overall health and a lot less expensive than treating dental disease.

Name that Critter!

Can you identify this parasite? If you guessed Scabies, you would be close. This parasite is in the same family of mites - it's the pesky EAR MITE.

These little critters feed on the lining of the ear canal causing an intense inflammation. The ear responds to this inflammation by producing an excess of wax which leads to secondary infections of the ear with yeast and bacteria which thrive in the waxy environment.

Ear mites are very active little creatures that are highly contagious from pet to pet. The mites prefer the dark moist environment of the ear canal but can sometimes be found on the head, neck and feet of the pet. This happens when the mites become dislodged by the pet shaking it's head and scratching at the ears. This is how they can then be transferred to another pet. If one pet in your family has them, it won't be long before others become infected.

Cats are most commonly affected by these mites and cats that go outdoors are at greatest risk. If your cat has a significant amount of dark wax in the ears, mites are the most likely cause. If you try to "scoop out" some of the cat's wax with a Q-tip you will noticed a severe itching response from an infected cat.

Dogs can also be affected but this is much less likely that with cats. Most dogs with wax in the ears have either yeast or bacterial infections unrelated to ear mites. Blindly treating your dog's ear problem with ear mite drops is almost always unsuccessful.

Early signs of infection are increased shaking of the head and scratching of the ears. More advanced signs of infection include excessive wax accumulation and painful infection of the ears. If any of these signs are observed your pet should be examined and treated as soon as possible.

There are several therapies available for the treatment and prevention of reinfection for both cats and dogs that can be tailored to your pet's lifestyle and your ability to medicate your pet's ears.

If you suspect your pet has ear mites or any other problem with it's ears, call and schedule an appointment ASAP. The longer the problem goes untreated, the more difficult the problem will be to resolve. Your pet will thank you for taking care of this uncomfortable pesky problem.

WORMS around us!

How would you like to wake up in the morning and find an 18" worm in your bed? That is exactly what happened to one of our clients earlier today. This client has 3 cats that sleep in bed with her. She suspected the cats to be the source of the worm and brought it to us for identification. The owner was correct, this worm was vomited-up by one of her cats. This particular worm is a type of tapeworm known as Spirometra. Cats and dogs get this worm by eating frogs. Spirometra infections can cause chronic diarrhea and weight loss. Needless to say, the owner made immediate arrangements to have her cats dewormed.

That's the worm next to my hand in the picture and it truly measured 18" when stretched out. The black end of the worm is the head (scolex).

Spirometra tapeworms are just one of many intestinal parasites that potentially plague our pets. Many of the parasites can also infect people, and all of the parasites have the ability to cause medical problems for our pets. All of our pets should be regularly examined for intestinal parasites to help protect their health. Pets that spend time outdoors should have a feces sample tested for worms 3-4 times each year. Indoor pets, such as the above 3 cats, should be tested at least once each year. Frequent testing and early diagnosis is just smart medicine.

There are several medications available to help prevent some of the more common parasites. These preventatives are frequently combined with products to help control fleas and ticks. Be sure to get your pets tested regularly and on proper preventative medication, don't wake-up to find your pet's worm sleeping on your pillow.

Pet Insurance - What's out there?

There are few things more frustrating, or heartbreaking, to a veterinarian than to have a patient denied critical medical care by the owner due to a lack of ability to pay for the pet's needed care. With today's rising veterinary costs, and our currently weak economy, this is becoming a too frequent problem.
Fortunately, there is a solution to this problem - PET INSURANCE!
There are several pet insurance plans available to the pet owner. As would be expected, each plan has different restrictions, qualifications, coverage options, benefits schedules and premium payment plans. There are plans administered by humane organizations, pet food companies, corporate veterinary hospital chains and private corporate providers. Of all the plans, only one has stood the test of time. That plan is VPI (Veterinary Pet Insurance), which has operated without interruption since 1983. VPI was founded by a group of forward thinking veterinarians in California that developed a plan that would work well with the veterinary community.
We began offering VPI insurance to our patients in 1985. Since then, many of our clients have utilized their pet's insurance plan to provide for needed orthopedic surgeries, neurologic surgeries, bladder surgeries, cancer chemo-therapy and treatment of a host of more routine medical problems. Insurance in some of these cases made the difference between life and death for the owner's pets.
VPI offers a variety of coverages to help provide whatever level of care you may need. VPI's basic policy offers coverage for illness and injuries, which includes associated diagnostic tests, hospitalization, surgery and medications. They also offer wellness care coverage which partially reimburses you for routine care such as vaccinations, dentistries, spaying/neutering, deworming, heartworm & flea preventatives, etc. Additionally, they have a major-medical policy to cover chronic long term illness care and a policy to cover cancer and attendant cancer therapies.
VPI offers a variety of premium payment plans to help make insurance affordable to virtually everyone.
While we have an established comfort level with VPI, we will gladly assist you with any insurance plan you may have.
As I said earlier, there are multiple insurance plans, any of which may be a life-saver for your pet. We owe it to our pets to be able to provide for their care when they need it most.

Monday in the Veterinary World

Monday is the day of the week that usually presents the greatest challenges. There is a natural tendency for pet owners to take a "wait and see" approach to their pet's medical problems during the weekend. If the problems don't resolve with home therapy, a phone call to our hospital is the first order of business come Monday morning. Naturally, we try to accommodate all of our clients' and patients' medical needs as quickly as possible which can present some real scheduling challenges if our Monday appointment book is already full.
Today was one of those Mondays with all appointments filled before close of business Friday. Therefore, I came to work this morning prepared for a scheduling challenge. However, good fortune smiled on us, and we had no Monday morning emergencies. This made for one very pleasant Monday with a good steady work flow and little stress.
We saw lots of healthy happy pets for their annual exams, several patients for post-operative rechecks and a couple of new patients with some troublesome skin and ear problems. We also scheduled another patient for reconstructive knee surgery with our surgical specialist Dr. Berger.
We want to congratulate our patients Kalua & Mandy on their recovery and healing following their orthopedic surgeries.
All in all, a very satisfying day.

The weekend is a great time for contemplative reflection. Each veterinary work week is filled with both happy and sad events, successes and disappointments. The goal is to learn from each and every case and to keep moving forward with a positive attitude. Sometimes the disappointments are particulalry difficult to overcome. Such was the case with "Kato". As I wrote earlier, Kato was diagnosesd with a cancerous growth at the base of the heart. Following 2 good days at home, he developed an acute gastric dilitation (bloat) and had to be euthanized. Our sympathies go out to Kato's family. We will all miss this wonderful patient.Due to the relatively short life span of the average veterinary patient (12-14 years), 6-8% of our patients pass away every year. With a base of approximately 4000 patients, that means we can expect to lose the lives of about 250-300 patients each year. That translates to almost 1 patient every day. Many of these pateints we have taken care of since they were puppies and kittens. They are like family to us and their loss is quite heartbreaking.Fortunately, this negative aspect of veterinary medicine is well compensated by the outright joy we experience everyday with new puppies, kittens and older new patients coming into our hospital to become part of our veterinary family. The trust our clients place in us with their pet's medical welfare is what motivates us and helps to keep a smile on our faces. We hope that our sincere enthusiasm for our patient's care is felt each time you come into our hospital.The bottom line is: through all the sad times and all the happy times, "We love what we do".