Case of the Week: Sequoia

     Sequoia is a 12 year old Bichon Frise that came to our clinic with a recent history of bloody diarrhea.  Routine blood and fecal testing failed to reveal a definite cause for her problem.  Since Sequoia was otherwise feeling great with an excellent appetite and no weight loss,  she was treated symptomatically for inflammatory bowel disease of the colon.  Her treatment included a special diet with Probiotics, anti-inflammatory and intestinal antibiotic medications.   Unfortunately, these therapies had little beneficial effect and Sequoia's problem progressively worsened.   When it became apparent that standard medical therapy was ineffective, we scheduled Sequoia for a comprehensive battery of advanced diagnostic tests on October 19.  
     Following an overnight fast, an abdominal ultrasound exam was performed.  This exam revealed an unusual tissue change localized in Sequoia's descending colon.  This type of change was suggestive of a possible tumor.  The arrows in the following ultrasound image point to the suspected tumor.

                                          

       The ultrasound exam was then followed by a colonoscopy under general anesthesia to allow for visualization and biopsy of the diseased tissues.   The colonoscopy revealed a mass of severely inflamed hemorrhagic tissue suspicious for colonic cancer.

     Following the colonoscopy, Sequoia was taken to radiology for a specialized x-ray series known as a "barium enema".   These x-ray images allow us to even better define the degree of disease change affecting the colon.   The arrows in the following x-rays point to the mass in the colon that is seen as a "filling defect".

     The most likely diagnosis based on these images was cancer of the colon known as "adenocarcinoma".  This type of cancer is highly malignant and rapidly spreads throughout the body.   Sequoia's owner was informed of the likely diagnosis and agreed to have surgery scheduled as soon as possible to remove the mass, even knowing that it may be too late to save Sequoia.

     Our surgical specialist, Dr. Bruce Berger, was immediately scheduled to perform this difficult and delicate complicated surgery.  The surgery required removing a 12 cm length of Sequoia's colon and took almost 3 hours to complete (even with a second surgeon's assistance for much of the procedure).

     Sequoia recovered from her lengthy anesthesia and surgery without complication.  Following 2 days of ICU post-op hospital care she was discharged to her owner's loving care. 

     The following video shows Sequoia demonstrating her desire to go home less than 48 hours after her surgery.

 

     Sequoia continued to recover beautifully at home and was back to normal with "lovely normal bowel movements" within 10 days of her surgery.

      To make Sequoia's story even better, the biopsies returned a diagnosis of polyploid adenomatous colitis, a pre-cancerous disease that is cured by surgical removal.

     Here's our girl at the time of her suture removal, 13 days following her surgery.

     Sequoia's case is noteworthy for several reasons.   

     First, her disease would not have been diagnosed without the use of our hospital's advanced diagnostic testing services: ultrasonography, endoscopy and digital radiology.

     Second, early diagnosis and aggressive treatment was critical to resolving Sequoia's disease before it progressed to colonic cancer.  Sequoia's disease is very similar to the colorectal disease in people that leads to colonic cancer and is the reason for routine human colonoscopic exams.

     And perhaps most importantly, her case demonstrates that our older pets are perfectly capable of undergoing lengthy anesthetic and surgical procedures.   All too often we see pets that have been forced unnecessarily to live with painful and debilitating medical problems due to the owner's misguided assumption that their pet is "too old for anesthesia".   With proper pre-anesthetic screening tests and our more advanced anesthetic delivery and monitoring systems, we are capable of successfully anesthetizing geriatric patients with a variety of disease problems and returning them to better health.

Sequoia is a shining example.

Blog changes to "Case of the Week"

     I've been finding it increasingly difficult to come up with fresh, entertaining and informative blogs of late.  It's not due to a lack of ideas or important veterinary topics.  It's finding a way to make the blogs entertaining and educational at the same time that's proving difficult.
   
     What I do find to be both easy and entertaining is discussing interesting medical cases that we see in our hospital.  Discussing these cases helps to put a more human face on the veterinary medical problems faced by my clients with their own pets.
   
     So, instead of writing a topical blog, I plan to present an interesting "Case of the Week" to highlight some of the more fascinating veterinary cases that challenge us each and every week.   Beware, some of these cases are sure to break your heart while others will brighten your day.
   
     One of my very first blogs was such a case presentation about "Murphy the Wonderdog".  To finish the Murphy story, I'm happy to report that Murphy enjoyed a full year of good health following her surgery.  This was a year that Murphy and her owner would have been denied without the combined efforts of everyone that contributed to her care.   Murphy served as an inspiration to us all.  It is to Murphy's memory that I wish to dedicate our new "Case of the Week" series.
   
     Check back next week to see our first installment.

Cancer - early recognition and diagnosis

     Just as with people, cancer is one of the leading causes of pet deaths. Also, as with people, early diagnosis of cancer gives us the best chance of curing or managing your pet's cancer. Early diagnosis requires recognition and close monitoring of many factors.   Some cancers show themselves as "lumps" that can be seen or detected by touch.  Other cancers are strictly internal and will require advanced diagnostic testing to detect.
     Pet owners should examine their pets for lumps at least once each month.  This will require a thorough visual and touching exam.  Run your hands over your pet's entire body surface.  Be sure to feel under the arm pits and groin areas.  Feel along the pet's underside for breast lumps.  Examine between the toes and the bottoms of the feet.  Look in and around the pet's ears.  Lift up the lips and examine around the gums.   Feel the glands under the pet's neck.   If you find any lumps, record the date, the location, the approximate size and any other characteristics you notice.   If the lump is painful or ulcerated, have your pet examined by the veterinarian an soon as possible.  Otherwise, schedule a veterinary appointment at your earliest convenience.  If you are unable to have your pet examined right away, recheck the lump(s) every few days and record any changes.  Be sure to bring this record to your pet's appointment.
     Some lumps are difficult to detect while others are very obvious.  This lump is of the obvious variety but demonstrates how massive they may become if left untreated.

     Fortunately, most of the lumps that pets develop are benign growths.   However, many lumps are cancerous growths.  This can usually be determined at the time of your pet's examination by aspiration and microscopic examination of cellular fluid removed from each and every lump.  No lump can be accurately diagnosed by "feel" alone.  Insist that each lump be properly examined.  Lumps that are suspected to be cancerous should be removed and biopsied as soon as possible.  The earlier this is done, the better chance your pet's cancer can be "cured".
     This is a photomicrograph taken of an aspiration sample from a innocent appearing smooth lump under the pet's skin.  The owner had been told previously by another veterinarian that the mass was just a "fatty lump" and not to worry.  The aspiration sample taken as part of our comprehensive exam confirms the lump to be a Grade 2 malignant Mast Cell Tumor.  Surgical removal of the mass was curative.

     This ugly "mass of lumps" around the pet's anus was caused by a type of cancer, perianal adenocarcinoma, that we were able to cure by surgery to remove the cancerous tissues and reconstruct the anus.

     Unfortunately, some of the cancerous growths cannot be cured by surgery alone.  These may require follow-up chemo-therapy, radiation therapy or one of the new cancer vaccines to offer your pet a better chance for long term good health.
     This lump in the pet's groin was found by the owner during a routine home exam.  The patient was seen as a Sunday emergency and the lump was diagnosed as Lymphosarcoma at the time of the exam.  This is a treatable cancer that usually responds well to chemo-therapy and the patient was referred to an oncology specialist to begin therapy.

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     Internal cancers, by their very nature of being "inside" the pet, are nearly impossible for the pet owner to find at an early stage of the disease.  Pet owners usually notice that the pet is "sick" with signs of weight loss, decreased appetite, vomiting, etc.  This usually means that the cancer is quite advanced and our chances of curing the pet are greatly reduced.  However, even these internal cancers can be caught in the early stages with proper diagnostic testing.   
     This x-ray shows a tumor in the lungs and on the spleen.  Neither of these cancerous tumors were evident on routine physical exam or indicated by blood testing.   X-rays were required to show the presence of the masses.  Both of these masses are potentially surgically removable.

     Cancerous tumors of the spleen are are very common in older dogs.  Early diagnosis is best done by ultrasound examination.   Ultrasound allows us to determine the size and shape of the mass and to better assess the possibility of surgical removal.   Ultrasound also allows us to biopsy an internal mass without the need for full exploratory surgery.   This ultrasound image is from the spleen of the dog in the previous x-ray.

     This x-ray shows the presence of a large cancerous mass in the abdomen of a captive Bobcat.  This mass was detected far beyond the point of being curable.

     At risk pets should be thoroughly examined and properly tested every 6 months.  These tests include a complete blood count (CBC), chemistry profile, urinalysis, chest x-rays, abdominal x-rays and abdominal ultrasound exams.   At risk patients include large breed dogs over 7 years of age, small breed dogs and cats over 10 years of age and certain breeds that are prone to cancer.
     If your pet falls into one of these categories, consider having a proper cancer screening scheduled for your pet at your earliest convenience.
     We at the Verandah Pet Hospital are committed to providing the very best medical care to help insure a long and healthy life for your pet.  To that end, we have developed discounted diagnostic cancer screening packages to help make proper medical testing for your pet more affordable.   Please call us to find out what we recommend for your pet.