As the weeks went on the frequency and severity of these episodes seemed to be increasing and another visit to Riverside was in order. During this exam Harley did not experience any locking but given the progression of symptoms and his facial conformation sedation and radiographs were recommended. With sedation, the joint that hinges the lower jaw (Temporomandibular Joint – TMJ) was noted to be loose, more significantly on the right but also on the Left. These radiographs were sent for assessment by a board certified radiologist at Idexx telemedicine. The radiologist diagnosed a congenital deformation of the TMJ; a CT scan was recommended along with consulting a specialist surgeon to explore options to correct the defect.

Fortunately for Harley a specialist in Kelowna was able to provide the recommended diagnostic tests. A CT scan was performed in early December and Harley was diagnosed with bilateral dysplasia of TMJ, in short deformed joints. This deformity is uncommon but when occurs tends to be in specific breeds including the Boxer. Surgery to correct the abnormal anatomy was recommended.  This particular surgery is not very common and involves removing some of the bone which obstructs function of the TMJ. The initial surgery was performed on the right TMJ, this seemed to correct the right side locking but in turn the left side began locking the day after surgery. Two days later surgery was performed on the left side as well.

Aside for a couple of minor post operative complications, Harley has made a full recovery and now enjoys each normal yawn!

For most owners managing a condition like Harley’s would have been a huge financial investment and one which would have not been possible in many cases.  Fortunately as a puppy Harley’s owners chose to purchase health insurance, they realized a puppy that is healthy at 8 weeks can have health problems develop at any time.  In Harley’s case the majority of cost for the above diagnostics and surgery were covered by Trupanion Pet Insurance.  This is Murray and Bjorka’s second insured pet and they are more than convinced that insurance is the way to go.

True to her nature, when we first saw Marly she was still friendly and wagging her tail, but she was looking a little pale, showing us she had lost quite a bit of blood. She was still bleeding and the wound was too painful to explore properly.

The first thing we did was to put in a catheter and get intravenous fluids running into Marly. This helped support her blood pressure and gave us a route to get medications and if needed a blood transfusion into her. It was very quickly apparent she would need a general anaesthetic to investigate the extent of the wound and repair it.

We assessed that we didn’t think the presumed stick had penetrated right into her thoracic (chest) cavity, but we were ready to start ventilating (breathing for her) when we induced anaesthetic. This is because the lungs need the thorax to be sealed for them to work properly. If there was even a small hole it would become more and more difficult for Marly to breath. Sometimes a hole can be partially covered with a blood clot and we don’t find it until we start cleaning up the wound. Luckily for Marly we had been correct and her thorax was intact.

The stick had punctured her skin and muscle layers just behind her elbow and torn around to her sternum. The laceration was quite deep and penetrated through almost all muscle layers exposing ribs. - WARNING THESE PHOTOS ARE GRAPHIC)

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The next job was to clean the wound. We cleaned hair, grass, soil and little pieces of stick from Marlys wound. We cleaned with the same solution we use to sterilize the skin prior to surgery then flushed and flushed with sterile saline. There was no way we could get this would sterile, but the closer we got the less her chances of developing an infection in the wound in a few days.

Once the wound was clean, the surgeon had to assess what tissue was damaged beyond repair and remove it and put the remaining tissues back together. They had to consider which way the muscles pull to maintain their original functions and how to get enough skin to cover over everything. Marly didn’t lose much muscle, but a large portion of skin had been torn too far from it’s blood supply to ever survive. This required the surgeon to move skin round from other parts of her body in order to close the wound. What was very helpful for Marly was the short time between the injury occurring and us repairing it. With all wounds, the longer they’re left the more tissue has to be removed, due to drying and infection, and the more difficult they are to close.

During closure three drains were stitched into the wound and left exiting through new holes in the skin. These rely on gravity to pull any fluid that oozes from the healing tissues away from the site of injury thus reducing the risk of infection and abscess formation. These were particularly vital given how dirty the wound was when we started.

The skin was finally closed with staples, which although are not pretty for the first 10 days are very useful for large skin closures as they are quick and they significantly reduced Marlys anesthetic time.

After surgery Marly recovered well and was sent home that night with antibiotics, painkillers and sadly wearing a buster collar to keep her from licking her incision or pulling her drains out. Her drains were removed after 4 days and the healing was well underway. After 10 days the staples were removed from a fantastic looking incision with no concerns about infection or further die back of damaged skin or muscle. Marly was good as new with the exception of the “bad hair cut”.

At that time she wasn’t using her leg at all and there was a swelling just behind her carpus (wrist joint) That joint was overextending and collapsed if she tried to put weight on it.

X-rays had been taken by her original vet who confirmed there were no fractures but the joint space was abnormal which led the veterinarian to suspect Hailey had torn the ligaments that run up the back of the carpus.

It was decided to put Hailey in a cast to support the joint and hope the ligaments would heal. Hailey initially did well but her leg became ulcerated by cast rubs (pressure sores) and she came to Riverside Small Animal Hospital to see if anything else could be done.

 Upon examination two conclusions were reached; the tendons were not healing, and would not heal by that method as the leg was too ulcerated and infected to remain in a cast. Hailey’s owners were faced with a difficult decision between two treatment options; either surgical fusion of the joint or limb amputation.

 The surgical fusion option is called Carpal Arthrodesis. To do this the surgeon removes all the cartilage surrounding all the little bones of the carpal joint. The space is then packed with bone graft (bone tissue taken from same patient and used elsewhere) and fixed in place with a metal plate and screws. This means the joint stops being a joint that can bend and becomes more like an extension of the long bone of the front leg.

 Hailey’s owners were presented with the pros and cons of each procedure to consider which option fit best for Hailey’s lifestyle, age and the financial commitment required.

 The primary advantage of arthrodesis was that after a long recovery she would have a very functional leg. The primary disadvantages of arthrodesis were the need to delay until the ulcerations were healed, and it is an advanced surgical technique done only by specialist hospitals. It is also a very expensive procedure.

 Amputation was the other treatment option available and its primary advantages were the surgery could be performed locally and at significantly lower cost. The disadvantages were, it is more difficult for dogs to adapt to front leg amputation, and Hailey’s opposite front leg was beginning to show signs of carpal over extension and was, therefore, considered at risk of failure. Of course once a limb has been amputated there are no other options for that limb.

 After careful consideration of the all the advantages and disadvantages Hailey’s owners elected for carpal arthrodesis to be performed at the University of Saskatchewan’s Western College of Veterinary Medicine.

Hailey’s owner could stay with family rather than having hotel costs for the 9 day stay.

 In preparation for surgery the infection and ulcerations on Hailey’s leg needed to be healed. Her pre-surgical treatment consisted of antibiotics for the infection and pain medication to keep her comfortable. Hailey was able to walk but with each step the joint bones moved causing significant pain and no wraps or splints could be used in order to allow the ulcers to heal.

 Hailey went to Saskatoon for surgery on October 27^th, 2011 Her pre-surgical assessment included a blood profile and urine test to make sure she was fit for anesthetic, and radiographs (x-rays) of the leg to assess the full extent of the injury at that date.

The surgery was performed and went smoothly. The bone graft was collected from Hailey’s shoulder and Hailey’s carpus was fused with cross pins and a metal plate.

Hailey required weekly dressing changes for 6 weeks post surgery, during which time we had to deal with her occasionally chewing the dressing and some minor bandage rubs. Immediately after Surgery she had very restricted exercise for 12 weeks and monthly x-rays to check on the progress of healing.

 She had painkillers as needed throughout the process.

 Now 8 months after the initial injury she is using the leg well and has the green light to exercise normally!! Hailey’s owner would be more than happy to share her experiences/advice having been through this with other pet owners who may be considering this procedure, please contact our hospital for contact information.

The previous two months have featured hyperthyroid cats, one of whom received radioactive iodine treatment and one who had surgical treatment. This month we look at Ashes, who is the first patient at our hospital to receive a new, breakthrough medical treatment, using dietary manipulation. We will let her owner tell the story in her own words.

“Ashes, is a grey domestic shorthair, about nine years old whose previous owner was no longer able to care for her. She was re-homed to me in about April of 2011. Ashes is very playful and active for being a senior cat and also talks a lot. Her meows’ great anyone who comes over, before they even reach the door.

A few months ago I decided to have a geriatric blood profile performed on her so that in her later years I would have a baseline. However upon weighing her that day I noticed she’d lost weight since arriving. The blood work revealed Ashe’s thyroid level was close to the top of the charts and she was diagnosed with hyperthyroidism by Dr. Welsman.

After having a urinalysis performed to ensure that her kidneys were functioning and that the rest of the blood work revealed no worrying parameters Ashes would have been placed on a twice daily medication called methimazole. However, timed with her diagnosis was the release of the Hills Pet Food: y/d.

In the month since Ashes has been eating y/d her thyroid levels have been cut in half, putting them back in normal range. She has gained back almost all the weight she had lost, and though she still likes to chat she doesn’t do it quite as much and seems content to sleep through the afternoons in her sunny window seat. She loves the taste of both wet and dry y/d and never leaves a morsel behind.”

Hills y/d therapeutic diet controls the clinical signs of hyperthyroidism by restricting dietary iodine. Iodine is essential for the production of thyroid hormones, and is usually present in excess of requirement. y/d restricts the amount of iodine to the amount that is essential for life. Without extra iodine the abnormal thyroid cells cannot overproduce thyroid hormone. It is important to emphasize that y/d does not cure hyperthyroidism, it is a lifelong treatment and cats eating y/d must not be fed any other food or treats. However, it is a great option for many patients including those individuals who also have kidney disease, as Hills y/d is also optimized for cats who have kidney problems.

Just over 2 years ago Scooby was found as a stray by the Hendricks family. He was very skinny, had a tremendous appetite but seemed to be otherwise healthy. Scooby couldn’t have made a better choice, and settled in with his new family.

Late this summer it seemed Scooby was losing weight. Despite being bright, active and eating more than his share, he just seemed to be shrinking away. It was time to have Scooby examined, so he was brought to Riverside Small Animal Hospital.

On examination Scooby was very lean weighing only 3kg when he should have been nearer to 5kg. Scooby had a significantly elevated heart rate, small feeling kidneys and generally poor muscle tone. Palpation of his neck suggested a possibly enlarged thyroid gland (the thyroid is not normally evident in cats). A senior blood health screen including a complete blood count, serum biochemistry, thyroxine (T-4, thyroid hormone) and urinalysis was performed. Based on these tests it was determined that Scooby had hyperthyroidism and renal insufficiency.

Hyperthyroidism is a common disorder that occurs in cats, it is caused by hyperfunctioning nodules that develop in the thryroid gland and release abnormal amounts of T-4 into circulation. It typically occurs in cats over 8 years of age. Hyperthyroidism affects multiple body systems including the heart, intestinal tract, the kidneys, the nervous system and behavior. Fortunately management of hyperthyroidism is available and generally successful in reducing severity or alleviating many of the secondary effects of elevated T-4. The goal is to reduce the amount of T-4 being released into circulation. Given Scooby’s good nature and dedicated owners, it was decided to place Scooby on oral Methimazole. Methimazole is a medication that selectively controls the abnormal production of T-4.

Soon after methimazole therapy commenced; Scooby’s owners noted that he was scratching face and ears more than he ever had before. Facial itchiness, is a know symptom of methimazole hypersensitivity (allergy). If this symptom develops there is no other oral medication which can be used to successfully manage hyperthyroidism. Once Scooby was taken off the methimazole his itchiness resolved, confirming the allergic response.

With this treatment complication there were only two other ways of addressing Scooby’s hyperthyroidism. One being radioactive Iodine treatment which meant a trip with Scooby to Vancouver for treatment.  Then following treatment a number of days where the cat is kept in isolation (because they are temporarily radioactive) until it can safely return home. The other procedure is surgical removal of the thyroid glands (thyroidectomy), a more invasive procedure and there can be local damage to associated structures such as the parathyroid glands or local nerves.

After weighing their options, Scooby’s owners chose thyroidectomy and on November 22, 2011 Scooby had both of his thyroid glands removed. When conducted by an experienced surgeon the surgical risks are very small, and follow-up examination and blood work confirmed that the parathyroid glands are functioning and there was no significant damage to local nerves. Scooby has recovered well from the procedure, doesn’t require daily medications and will be monitored for any changes including return of symptoms or weakness. Although Scooby still has to deal with his reduced renal function, close management of his diet should help him live a long and happy life!

Tiger is a 17 year old neutered male domestic short hair cat. His owner describes him as sensitive, bossy and definite creature of habit, reminding his owner of feeding time, litter box cleaning time and cuddle time. He even reminds his owner when it is pill time. In April of 2011 Tiger stopped eating. His owner had noticed that for weeks prior to this Tiger seemed ravenous; he wanted to eat anything anyone else was eating but he was losing weight. Tiger’s weight loss was what concerned his owner the most.

When Tiger was examined at the Riverside Small Animal clinic, he was thin, dehydrated and had a very high heart rate. A blood panel and urinalysis were recommended. Tiger is a wonderful cat to work with and was very co-operative and happy to oblige with the blood and urine taking. After the lab tests were done, Tiger was diagnosed with hyperthyroidism as well as a urinary tract infection (UTI).

Nothing is simple, however, because hyperthyroid cats are supposed to be hungry not anorectic. Tiger was hospitalized and hooked up to IV fluids to rehydrate him. He was also started on thyroid medication as well as antibiotics for his UTI. Unfortunately, Tiger continued to not want to eat and started vomiting. The reasons for the vomiting was not immediately apparent from his presentation or his disease so Dr Carrigan discontinued all Tiger’s oral meds and the vomiting stopped! The thyroid medication was added back to the treatment protocol and Tiger seemed to tolerate that well. When the oral antibiotics were added back poor Tiger started vomiting again. The culprit was identified and the oral antibiotics replaced by a long acting injectable antibiotic.

Despite being rehydrated and treated for his hyperthyroidism, Tiger still refused to eat. We encouraged him to eat by syringing mushy food into his mouth, which he seemed to like. The problem with continually syringe feeding cats is that they can develop a food aversion, which we really did not want to happen. Dr. Carrigan discussed a feeding tube with Tiger’s owner, but it was decided to try feeding Tiger at home. True to form, Tiger was a trooper and tolerated syringe feeding then started eating on his own!

Over the next few months we monitored Tigers thyroid hormone level and kidney function. When cats are hyperthyroid, they have really high blood pressure, which pushes lots of blood through the kidneys. When we treat them, and their blood pressure returns to normal we unmask any underlying kidney issues which were hiding. Knowing Tiger’s owner wanted to send Tiger to Northwest Nuclear Medicine (NWNM), in Vancouver, for radioactive Iodine treatment, we kept in close contact with them, constantly reviewing the blood results and how Tiger was doing. After several months of treatment, with stable kidney function Tiger came off his medication and went off to NWNM!

Tiger spent a week in Vancouver after his injection with radioactive Iodine. The iodine attacks the overactive cells in the thyroid gland and destroys them, offering a clinical cure for hyperthyroidism. The cats have to stay in hospital for around a week as they shed the radioactive Iodine in the urine, saliva and feces. They have to be barrier nursed and all their waste handled as Radioactive until the radioactivity decays away so that their owners and caregivers are not to exposed to this potentially dangerous compound. Tiger has never looked back. He is gaining weight, eating and d drinking normally and all round a happy kitty.

Tiger’s owner’s decision to take Tiger to NWNM was a difficult one. She weighed the pros and cons of the other treatment protocols and because she works shift work and could not guarantee giving Tiger his medication every 12 hours, she opted for radioactive Iodine treatment. She also worked out the cost for treatment and monitoring blood work for 3 years and found that the costs were comparable.

Tiger holds a very special place in his owner’s heart; a few years ago she had a back injury and while bed ridden, every night Tiger would lay beside her and rest his head on her shoulder and purr her to sleep. Tiger starts purring the minute he comes through the hospital door. He is always so happy to see everyone. Tiger is a true gentleman and has never been anything but wonderful to work with. We are glad that Tiger’s treatment went so well and he and his owner are back to their normal routine of him telling her what to do!

In June of this year a co-worker of Nukka’s owners found Nukka tied-up and starving while a few local kids threw rocks at her in Cape Dorset, Nunavut. Nukka is a female Husky mix sled dog; she was 12 weeks old when her rescue journey began.

As with many other northern communities of Nunavut, stray dogs are abundant, poverty is high and immunizations are rare in Cape Dorset. Most of these communities control their dog populations through dog culling days, on which unclaimed or unwanted dogs are shot. A loose network of Husky rescue volunteers attempts to relocate some of these dogs to southern homes.

Nukka’s journey to Kamloops was spent on 4 different planes. To the disappointment of her owner travelling with her, she was relegated to the cargo hold. She flew from Cape Dorset Iqaluit and then to Ottawa at which point the airline couldn’t find room for her to carry on west. After one phone call and without hesitation, a local Ottawa couple drove to the airport and picked Nukka up to look after her overnight. The next morning they took Nukka back to the airport and made sure she continued on her journey to Vancouver and then Kamloops. Finally, Nukka arrived in Kamloops bewildered and with evidence that air travel was not her bag. Almost immediately, Nukka began bonding with her new family. We first met Nukka when she came to see us for a health check and vaccinations.

Nukka’s quickly got into her new routine of regular hikes, mountain bike rides and runs with her owners… a far cry from her northern life. Unfortunately, while she was out for a run in September, a larger dog playfully pounced on her, resulting in a broken femur. Her owners brought her to Riverside and Dr Buist repaired the fracture with twin intra-medullary pins. After six weeks her fracture had completely healed and it was time to remove the pins. Since Nukka was also needing to spayed we were able to combine these two procedures in to a single anaesthetic.

Nukka’s owners elected for Nukka to have a Laparoscopic Spay. Laparoscope is a camera system which enables us to carry out complex abdominal procedures through a 10mm ‘keyhole incision’. This means reduced pain and discomfort post surgery when compared with traditional open abdominal surgery and a much quicker return to full activity post surgery. This was important for Nukka and her family after 6 weeks of convalescence after her accident. Just in time for winter, Nukka is getting back into shape in a more familiar snow covered environment, running behind skis.

Nukka is a great dog and was a perfect patient. We wish her good fortune in her new life.

September 30th, 2011 is a night that won’t soon be forgotten by Margit Bull and her 3yr old Great Dane Shelby. The evening was like many others in the Bull household, Margit was playing her guitar and her two Great Danes were at her feet enjoying the music, or so it seemed. Shelby though present, was not herself, she was fidgiting and moving about trying to get comfortable. Soon she was attempting to vomit and just not producing any material. This is when Margit decided it was time to call the emergency service who that evening was Shelby’s regular clinic Riverside Small Animal Hospital. After a brief discussion and a 40 minute late night drive to the clinic Shelby was examined and radiographs revealed a dilated and twisted stomach; a true life threatening condition that occurs most frequently in large deep chested dogs.

Gastric Dilation and Volvulus (GDV) or in general terms bloat, is a rapidly fatal condition where the stomach becomes distended with gas and abnormal motility leads to twisting. Early in the condition the dog seems unsettled, attempts to vomit unsuccessfully, visible evidence of abdominal distension will soon follow. Internally there are changes in circulation, respiration and cardiac function occurring. The condition tends to progress rapidly and can be fatal within hours. The exact cause is not known but seems to be related to body type (large, deep chested), timing and volume of meals, gastrointestinal disease and perhaps even temperment.

Shelby was fortunate that Margit was knowlegable about the condition and wasted no time getting her to the clinic. Shelby was stabilized by providing IV fluid support for her pending shock, her stomach was partially deflated with a small trocar through her body wall and then a stomach tube was passed. Shelby was then taken to surgery which involved untwisting the stomach, observing for any damage to the stomach and other oragans due to loss circulation, and permanently suturing her stomach to her body wall (tacking or pexy). In the future if her stomach distends this should act as an anchor to prevent the life threatening twisting. This procedure is at times is done in at risk dogs as a preventative, in fact Margit’s other dog Jezabelle was ‘tacked’ at her spay (Shelby is a breeding female and not spayed).

Surgery was complete and Shelby was in recovery by 2am, just under 3 hours after her owner called the clinic. By 8am Shelby was standing at her kennel door waiting for a morning walk. Through the next 24 hours Shelby continued to improve and went home for the remainder of her recovery. She has been doing very well since her surgery; the hardest part of her recovery has been trying to keep her quiet!

Daisy is a wonderful cat who has demonstrated to us all the strength and determination of our four legged family members, and also the persistence and patience of her amazing owners. Daisy presented to us for a routine spay in April but she had symptoms of an infection of her urinary tract. A simple urinalysis revealed significant infection so it was elected to treat her, spay her a week later when she would be healthy, and let her live like a princess the rest of her days. Daisy, however, had other plans.

Shortly after being discharged from the clinic Daisy came into heat and became pregnant. The owner elected to allow her to have the kittens and she proceeded with her pregnancy in a routine manner. In early June Daisy’s owners were horrified to find her hanging by her hind leg from a truck. The owners managed to cut her free but she ran off in a blur only using three of her legs. The owners searched for her in vain and were very worried about her only to have her return of her own accord 4 days later. She was rushed into Riverside Small Animal Hospital to assess the extent of her injuries and to see how her unborn kittens were doing. Her xray revealed a compound fracture of both the tibia and fibula with multiple fragments. Fortunately an ultrasound of her abdomen revealed 5 kittens with strong and vibrant beating hearts.

It was elected to send Daisy to Dr. Mark Smith in Kelowna who specializes in orthopedic surgeries. After a careful assessment he chose to place an external fixator on the limb. This technique involves placing pins horizontally through the bone on both sides of the fracture and then joining them with a stabilizing rod. Daisy also had open wounds with her injuries which needed to be managed with daily bandage changes, frequent flushing of the wound bed and the application of honey to promote healing and reduce infection. Daisy greeted us daily with warm chatter and her trusting purrs. She was always gracious and well mannered through her treatments and made us all admire her toughness and her unlimited capacity for forgiveness. It must be mentioned that Daisy’s owners the Bisgaards did an amazing job caring for Daisy and were simply wonderful throughout Daisy’s ordeal.

Beneath the surface of her sweet nature there still remained Daisy’s determined independence. One evening she escaped with her very bulky bandage and managed to hide in a culvert. No amount of convincing could get her to leave her new hiding spot so a camp was made and Mr. Bisgaard slept out all night keeping watch over his ward. In the morning Daisy was finally convinced to come out from her hiding place and while she was none the worse for wear, her bandage was soaked through and Mr. Bisgaard was in need of a good rest.

Daisy had her kittens that very night. Five vibrant healthy sweethearts that we saw grow into dynamic kittens before our eyes. Daisy was an attentive and caring mother and before we knew it the kittens had been weaned and placed in great homes. Daisy is now on the home stretch of her recovery but still has one small but important procedure to be completed. She is due to be spayed very soon!

Coco and Louis are a tribute to early, low stress handling as puppies. We routinely see the two of them for nail trims and to express their anal glands.

The anal glands in dogs can frequently become impacted, making it painful for your dog to pass feces and possibly leading to infection. As this can be extremely painful many pets will require sedation or anesthetic for the treatment. For those dogs that seem to be prone to problems with their anal glands, we routinely express them to help prevent impaction.

Not surprisingly many dogs are nervous when coming into the clinic and will struggle when restrained. It is important that our pets trust us to handle them gently and that nothing bad will happen to them.

Coco and Louis’ owners have gently handled them both so they do not fear this type of handling – all puppies should learn this – for more information www.drsophiayin.com

In honor of these stars, and all others like them we have recently implemented the “good dog nail trim” discount!

Congratulations to all owners who help their pets to understand our world.