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Abbey

Esophageal Stricture All Abbey wanted to do was eat. She was ravenously hungry all the time. However, she was unable to swallow solid food.
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Leading up to this she had been a happy, healthy puppy who ate normally. All of a sudden, Abbey’s family noticed that whenever she was fed, she had significant difficulty swallowing.

Just before this video, Abbey was fed a small amount of canned dog food. You can see the difficulty she had in swallowing just a small amount of food.

Abbey was referred to Savannah Veterinary Internal Medicine & Intensive Care by her family veterinarian for further testing in hopes of determining the cause.

We performed an endoscopic procedure to evaluate her mouth, pharynx and esophagus.

Canine Dog Esophageal Stricture

This picture was taken during endoscopy and shows that Abbey had somehow developed a severe esophageal stricture.

An esophageal stricture occurs when the esophagus becomes damaged, and subsequently scars and then narrows. The scar tissue is very firm and does not stretch to allow food through. Any food Abbey swallowed had to pass through this pin-point opening in the esophagus. This was the reason that she was unable to swallow anything except water.

Causes of esophageal strictures include swallowing caustic substances, certain medications becoming lodged in the esophagus (especially the antibiotic doxycycline in cats), and, especially in dogs, toys and bones getting stuck in the esophagus.

The exact cause of Abbey's esophageal stricture remains unknown.

For treatment, Abbey began a series of balloon dilation procedures, each 4-7 days apart. During these procedures, Abbey was anesthetized, and a balloon dilator inserted through the endoscope and into the middle of the stricture. The balloon was then inflated with tremendous pressure with saline solution which caused the scar tissue to stretch and tear, and the esophagus to widen.

A larger balloon was used during each procedure, allowing the stricture to slowly widen. It is unsafe to attempt to correct the stricture fully in one procedure, as that increases the risk of an esophageal perforation, which could be a fatal complication.

After several balloon dilation procedures, Abbey began swallowing and eating normally, as if nothing had ever happened!

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Taylor

Babesia infection Taylor, usually quite the athlete, became very lethargic. Also, she seemed to have lost her appetite and was vomiting her food.
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Taylor normally lives a very active lifestyle, going to natural areas around Savannah on a daily basis, and running and playing frequently off-leash. So when she went to her favorite natural area and didn’t feel like participating in the normal activities with her housemates, her family knew that something was wrong.

Taylor visited her family veterinarian for an evaluation, which showed that she had a low-grade fever, was sore on at least one of her legs, and had a low white blood cell count and platelet count. Taylor was transferred to SVIM&IC the following morning for hospitalization and further evaluation.

When we saw Taylor that next morning, her carpi (wrists), tarsi (ankles) and stifles (knees) were swollen and painful. We confirmed that her white blood cell count and platelets were indeed very low. We evaluated the fluid around her joints which showed non-specific inflammation, and submitted a blood test to evaluate for infections that insects can transmit to dogs. The results of the blood panel showed that Taylor was infected with an infectious organism called Babesia gibsoni.

Babesia organisms are small parasites that infect blood cells of dogs and less commonly cats. Dogs usually acquire the infection when they are bitten by a tick that is carrying the Babesia organism. Sometimes Babesia infections can be transmitted to dogs from the bite of another infected dog during a fight. Babesia infections can cause a wide range of symptoms, including the ones that Taylor had. It is also important to note that Babesia infections are common in Taylor’s breed (American Pit Bull Terrier).

Although Taylor was receiving monthly tick prevention, bites from ticks, and infection with organisms that ticks carry still occurred. It is very important for all dogs and their owners to work closely with their family vet to be sure that appropriate protection from all types of insect bites is being used.

We started treating Taylor with anti-Babesia medications and within several days she was feeling much better. The low white blood cell count and platelet count improved, the swelling around her joints disappeared and she once again wanted to go on her play outings. We look forward to seeing Taylor again, but this time at the park running and playing!

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Daisy

Swallowed An Earring Daisy liked her owner’s earrings so much that she thought she’d taste one, and then she swallowed it.
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Fortunately, her owner witnessed her swallow it, and immediately brought her to the hospital for evaluation. Sure enough, X-rays confirmed that the “peace sign” earring was in her stomach.

X-ray canine gastric foreign body

When we reviewed this X-ray, we were very concerned about the sharp post of the earring, and whether this would puncture her stomach, or lacerate her intestines if the earring started to pass down the intestines.

We recommended to Daisy's owner endoscopic retrieval of the earring, and since her owner wanted to avoid surgery if possible, agreed that a minimally invasive endoscopic procedure was the right treatment.

During endoscopy the yellow earring was found stuck in the area of the stomach called the pyloric antrum. Attached to the earring was a large amount of mucus and hair.

Using an endoscopic foreign body instrument, the earring was grasped by the post and mucus, and slowly extracted out of the stomach, up the esophagus, and out through the mouth.

Canine gastric foreign body

The size of the earring can be appreciated when compared to a penny. Also in this picture, the post is clearly hidden by the wad of mucus that was stuck to it.

Within an hour from waking up from anesthesia, Daisy ate a small meal, and an hour later went home.

We enjoyed caring for Daisy and we all hope that she goes on to live a long, healthy, jewelry-free life!

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Frankie

Intestinal Obstruction One day Frankie suddenly refused to eat. This was very concerning to her owner since Frankie normally eats everything in sight.
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Frankie’s owner brought her to her family veterinarian for evaluation, where multiple tests did not reveal the cause of Frankie’s lack of appetite, nor did a variety of treatments improve her appetite. Frankie’s veterinarian decided that she needed an abdominal ultrasound, and referred her to Savannah Veterinary Internal Medicine & Intensive Care.

The ultrasound revealed a very abnormal segment of small intestine that appeared to be blocked, or obstructed. But what was causing the obstruction was not clear.

Frankie's Ultrasound

A small bowel obstruction is considered an emergency, so it was decided that surgical evaluation of her bowel was needed urgently.

Frankie had surgery right away, and a small bowel obstruction was confirmed. The item causing the obstruction was a plastic/rubber “squeaker” found in stuffed dog toys.

During the surgery, six inches of Frankie’s small intestine had to also be removed. This portion of the intestine was so severely damaged by the obstruction that there were concerns that the intestine would become leaky leading to an infection in the abdomen.

Surgery was successful, and afterwards Frankie remained in the ICU for the next several days where she was treated with pain medications, antibiotics, and a slow reintroduction to food. Frankie went home feeling great and has since made a full recovery.

Frankie’s owner promised that in the future she would only get toys when supervised!

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Emma

Nasopharyngeal Polyp For the majority of Emma’s young life (she is 2 years old) she had trouble breathing out of her nose, purring, and even at times had trouble eating and drinking.
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When breathing, she would produce a noticeable wheeze and snore noise.

If you listen closely to this video, you can hear that every breath Emma took was a struggle.

Emma had been seen by several veterinarians both in Florida and South Carolina (where she lived at different times of the year), but the cause of the problem could not be found. Her veterinarian decided to refer her to Savannah Veterinary Internal Medicine & Intensive Care for further evaluation.

When we listened to Emma we were very concerned that she had a nasal blockage from a nasopharyngeal polyp. Emma was anesthetized so that the very back of the inside of her mouth and nose could be evaluated. Sure enough, a nasopharyngeal polyp was seen.

Emma's Polyp

 

The polyp was grasped with an instrument and gently pulled until it popped out.

 

 

Emma's Polyp     Emma's Polyp

Once she was awake from anesthesia, Emma immediately began breathing normally.

Feline nasopharyngeal polyps are benign growths that originate from either the middle ear or the Eustachian tube (a tube that connects the middle ear to the back of the oral cavity).

When the polyps grow extensively, they can hang down and obstruct the back of the nose or oral cavity. The polyps are benign and occur mostly in young cats.

When polyps are removed by gently pulling them as we did, there is a chance that the polyp may grow back (just like a weed will grow back if the root isn’t pulled out). Surgical removal (by opening the bony middle ear) is a more reliable way of preventing them from regrowing, however, Emma’s owner wanted to try to avoid surgery.

The last time we spoke with Emma’s family, she was breathing and purring normally!

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Dixie

Adrenal Gland Tumor (Cancer) Dixie was referral to Savannah Veterinary Internal Medicine & Intensive Care for further evaluation of suspected Cushing’s Syndrome.
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This is an endocrine (hormone) disorder that results in the overproduction of certain hormones by the adrenal glands. These excess hormones can cause increased thirst and appetite, and increased liver enzymes seen on blood chemistry evaluation.

The cause of Cushing’s Syndrome in dogs is either a benign tumor of the pituitary gland, or a tumor of the adrenal gland, which oftentimes is malignant. An abdominal ultrasound is frequently used to evaluate the size and shape of the adrenal glands.

During Dixie’s ultrasound, a tumor was identified involving her right adrenal gland.

Dixie's Right Ultrasound

You can see the difference with the normal left adrenal gland pictured here.

Dixie's Left Ultrasound

Patients with Cushing’s Syndrome caused by an adrenal tumor are treated by surgical removal of the affected adrenal gland. Because there are large blood vessels and other organs in the vicinity of the adrenal glands, a pre-operative CT scan is always recommended to determine if the adrenal tumor is operable.

A CT scan was performed on Dixie which fortunately showed that the adrenal tumor was not affecting any nearby organs or other structures.

Dixie's CT 1     Dixie's CT 2

In these pictures, the larger arrow is pointing to the right adrenal tumor, and the smaller arrow is pointing to the right kidney.

Surgery was performed and the right adrenal gland successfully removed. Dixie remained hospitalized after surgery within the ICU for four days. During this time she was monitored 24-hours a day for complications that can occur after adrenal gland removal surgery. Fortunately, Dixie experienced none of these.

Dixie ultimately went home, and completely recovered from her surgery. Her owner reports that Dixie has never felt better, and we regularly receive updates as to how she is doing!

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Sandy

Immune-Mediated Thrombocytopenia One day Sandy woke up very tired and with spots and bruises all over her skin. She visited her family veterinarian and he determined that she had very low platelets and was also anemic.
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Sandy had less than 5,000 platelets (dogs normally have more than 180,000). Platelets are small cells that circulate in the blood stream which allow blood to clot and prevent excessive bleeding. When a patient has low platelets, they can easily bleed under the skin (skin bruising), from their nose, within their intestinal tract and into their urine, with the bleeding sometimes being severe enough to cause anemia.

The causes for low platelets (thrombocytopenia) include infectious diseases transmitted by ticks and fleas, cancer, certain medications, and immune dysfunction.

We evaluated Sandy for a multitude of diseases with blood tests for infectious diseases, X-rays, and ultrasound. Ultimately she was diagnosed with Immune-Mediated Thrombocytopenia.

During the course of her hospitalization Sandy was treated with a variety of oral and intravenous medications including antibiotics, medications to reduce intestinal bleeding and immune suppressing medications. She required one blood transfusion while she was in the hospital.

After three days of care in our ICU, Sandy was discharged to her family with her platelet count rising and her anemia resolved. All of her bruising had resolved and she had much more energy.

Over the last several months, Sandy has continued to do well and she feels better every day. All of her medications have been able to be reduced, and many of them able to be stopped completely.

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Shelby

Diabetic Ketoacidosis Shelby’s owner noticed that she was becoming thin, weak, and that her thirst was increasing while her appetite was declining. One morning, Shelby was not able to get up.
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Shelby was brought to her family veterinarian where she was diagnosed with a severe form of diabetes mellitus, called diabetic ketoacidosis (DKA). She was immediately transferred to Savannah Veterinary Internal Medicine & Intensive Care for 24-hour care.

Diabetes mellitus is an endocrine disease where the body does not have enough insulin, or cannot use the insulin that it has, to fuel the body’s cells.

Insulin allows all cells in the body to use sugar (glucose) as an energy source. Without insulin, all of the body’s cells starve, even though the body’s blood glucose is very elevated. DKA is a severe form of diabetes mellitus where the body begins resorting to other fuel sources: fat and muscle begins being broken down (metabolized) for energy for the rest of the body.

When Shelby first came to us she was very thin and was so weak that she was not able to stand. Her blood sugar was too high for the glucometer to measure. Shelby was not eating, but her body still needed glucose and insulin to allow the body to use the glucose, so as to prevent the ongoing metabolism of fat and muscle.

Shelby was admitted to the ICU and for the next 10 days, she was treated with an IV dextrose (sugar) and insulin continuous rate infusion (CRI). She was also treated with IV fluid therapy for rehydration, IV antibiotics, stomach and intestinal protecting medications, anti-nausea medications and appetite stimulating medications. Due to severe anemia, she required a blood transfusion during her stay.

After one week in the hospital, Shelby began feeling better: she began eating, drinking and wagging her tail. The insulin and dextrose CRI was able to be stopped, and Shelby was started on insulin given as an injection under the skin which owners can give at home.

When Shelby went home she was feeling well, eating great and had tremendous energy. She continues to eat well and remain happy at home.

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Charlie

Immune-Mediated Hemolytic Anemia Charlie didn’t have enough red blood cells. This caused him to be very listless and have a very poor appetite. His owner brought him to the emergency clinic, and then he was transferred to Savannah Veterinary Internal Medicine & Intensive Care for further testing and treatment.
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Charlie’s initial red blood cell count was 12%. Dogs normally have a red blood cell count of at least 40%. When Charlie’s blood was evaluated on a microscope slide, his red blood cells were clumping and sticking together (autoagglutination). This was indicative of a condition called Immune-Mediated Hemolytic Anemia (IMHA).

Canine IMHA autoagglutination

Microscope slide showing autoagglutination.

Causes of IMHA include tick and flea transmitted infectious diseases, certain medications, cancer and immune system dysfunction.

Charlie was evaluated with a variety of diagnostic tests for the cause of his IMHA, including X-rays, ultrasound and infectious disease blood tests. Ultimately he was diagnosed with immune-mediated dysfunction.

Charlie was admitted to the hospital and treated with immune-suppressing medications, antibiotics, anti-clotting therapy, and intestinal supportive medications. His red blood cell count was checked several times daily, and he was given blood transfusions when it decreased to a low level.

Charlie’s red blood cell count continued to decrease despite multiple transfusions and aggressive immune-suppressing therapy. At that time, it was decided to obtain a medication from the local human hospital called intravenous immunoglobulin (IVIG) to give to Charlie. IVIG contains human antibodies that have been collected from many blood donors. These antibodies, when given to patients intravenously, can help to decrease the abnormal immune response that occurs in patients with IMHA.

Even though IVIG is a human medication, derived from human blood donors, it has been shown to be helpful in dogs with severe, non-responsive IMHA.

Shortly after Charlie was treated with IVIG, his red blood cell count began steadily rising, and it never declined again. After 7 days in the hospital, Charlie was discharged with an increasing red blood cell count, a good appetite and a lot of energy!

Charlie continues to do well at home. At this last recheck visit, his red blood cell count was normal and he was feeling great. We all hope that Charlie continues to feel well!