Your Pet's Best Friend

Intussussception

Maddie sort of "fell through the cracks".  That's just a figure of speech, though here she looks thin enough to fall through a crack.  The "crack" she fell through was the one that formed when the marriage split.   She's really Mom's dog, but she liked to go down to the farm shop and hang out around Dad, who was pretty busy on the farm.  So Mom didn't get to see her just every day.  A couple of weeks earlier she noticed that Maddie didn't look just right, but she looked a lot better than this.  We're talking about a beautiful Golden Retriever who's only about a year old, and she looks like she's dying of some terrible disease.

Maddie's attitude was surprisingly good when you consider her emaciated condition.  Her bloodwork was pretty normal, except for the abnormalities you'd expect in a starving dog (anemic, low albumin, etc.).  Of course, she had plenty of food available, so why would she be starving?  Her abdominal X-ray did appear really abnormal, so it looked like an exploratory surgery was in order (after 24 hours on I.V. fluids, that is; she was pretty dehydrated).

This is what we found inside.  And what might this be, you ask?  Uh, the title of the post is "Intussussception", so that would be a pretty good guess.  Right... so what is an intussussception? I mean, besides a really long word that's hard to say?

Here is a diagrammatic representation of what you see in the photograph, minus the blood and stuff.  For unknown reasons, a section of intestine folds inside of another section of intestine, the way the old pirate's telescope collapses as the sections slip inside one another.   This produces a nearly complete blockage.  Liquids can pass through, but solids can't make it.  A slow starvation like this is one presentation, but some individuals get very ill, very suddenly.  Sometimes it happens when a dog has a whipworm infestation.  Sometimes it happens after a bad intestinal infection with lots of cramping (I've seen it as a complication in puppies with parvovirus -- a fatal complication in those cases).  Lots of times we just don't have any idea why it happened.

Here's a cross-sectional view.  Doesn't it look like a telescope?  I mean a floppy, pink, gooey telescope that's full of crap instead of stars?  Sure, it does.  What may not be obvious to you is that the part that's inside has its blood supply pulled around a 180 degree corner.  That pretty much crimps it shut, meaning no blood supply for the "inside part", meaning it dies. SO, even though it looks like we could just pull on the ends and open up the telescope, that doesn't work.  You have to cut out the whole mess and join the rest of the intestine back together again (what we surgeons refer to as "intestinal  resection and anastomosis" -- this post is just full of big words, isn't it?).

Here's Maddie just 10 days later when we took out her stitches.  She's gained 8 pounds, up to 52.  Not back to her fighting weight, but on the right track.  The surgery must have gone okay.

And here she is at a contented 73 pounds, which is about right (maybe even a little chubby).  I love a happy ending (especially when you've taken 18 inches out of the middle).

Pelvic Fractures

They say that cases come in threes, but that's not one of my personal superstitions (and I do have a few).  On Sunday I saw two hit-by-car cases, both with a broken pelvis.  Quite a coincidence, and two was enough for one day, thank you.

The pelvic bones, the pelvis (as in Elvis), the pelvic girdle, the birth canal. Everybody's got one.  It's what your legs hook into on the bottom and your backbone on the top. ["The Leg-bone connected to the -- Hip-bone..."]  If a dog or cat gets hit by a car on the rear, the pelvis often takes the impact.  The patient can't get up and can't walk, even though his legs are okay and his back is not broken.

Here's how it looks from the rear. Notice how irregularly shaped and twisty these bones are.  What you can't see on our little plastic skeleton is the tremendous amount of muscle and tendon that surrounds it.  Both those factors make it very difficult to approach the bones surgically, or to bend and contour a bone-repair plate to fit it.  It takes one heck of a good orthopedic surgeon to get in there and put a pelvis back together.

Fortunately, when the hip joints are intact, you usually don't need to surgically repair things.  All those muscles and tendons that make the bones so inaccesible will also act as a "self-cast".  They will hold it together well enough that most cases will knit back in two to four weeks.  If the spine is okay and the hips and legs are okay, the only treatment needed may be bed-rest and nursing care (including pain control, of course).  This is Sunday morning's dog patient.

This is Sunday afternoon's cat patient.  These patients need help with their toilet work.  Personal hygiene is a little difficult for them.  You'll have to bring them their food and water -- we don't want them dragging themselves around the room.  You have to be alert to be sure that they are able to eliminate, as some individuals have damage to either the bladder, the rectum, or the nerves that control them.  Sometimes the sciatic nerve is damaged along with the bones and the animal loses the use of a hind leg, even though all the bones heal up okay.

Also, while these bones usually knit back together well enough for the patient to walk and go potty okay, the "birth canal" will very likely be deformed.  If the pet is an intact female, it's important to have her spayed, as she will probably be unanble to give birth naturally.

It's a pretty tough injury, but the prognosis is usually good.

Hunter's looking better!

He just seems to get better by the hour. I'm not ready to say we're out of the woods, but he's on his third can of dog food (prescription diet I/D).  No more vomiting, but he's still got some loose feces, still doing a little straining.  He trotted all over the back yard and marked every fence post.  I finally caught him standing still long enough for a picture.

He acts constipated.

Yesterday we had a rather unusual case of the dog who "can't go".  The "take-home message" is that we always take this complaint seriously.

"Acting constipated" is a not uncommon description of a pet's situation.  Upon receiving this complaint, the thoughtful veterinarian's next step is to ask the owner what the pet is actually doing.  Is he straining and producing only small amounts of hard, dry stool?  That would certainly indicate constipation.  If, on the other hand, the pet is "trying to go to the bathroom and nothing happens" or is "squatting a lot and straining", more information is needed.

Often pets who are squatting and straining without producing anything are actually unable to urinate. [As I discussed in a previous post.] This is a life-threatening situation, and prescribing laxatives over the telephone would be a bad idea. Yeah, we need to see him (or her).  Urinary stones, tumors, blood clots, prostate gland troubles -- all can cause life-threatening blockages of the urinary tract.  When the back-pressure builds up too much, the kidneys are unable to do any filtering and waste accumulates in the bloodstream until the patient is poisoned by his own metabolic waste.   More than once I have been presented with a patient whose owner had been giving laxatives for two or three days while the animal's kidney's were shutting down.

Pets can have intestinal blockages from foreign objects,

and from a strange condition called intussussception, where the bowel "telescopes" on itself (a condition whose cause is poorly understood).

Certainly pets can become constipated to the point of great distress.  This often happens with dogs who consume bones.  They love to eat them, but they really cannot digest them.  While larger slivers of bone may become lodged in the mouth, throat, esophagus, stomach or intestine, the more common situation is to have chips of crunched-up bone forming a concrete-like mass in the rectum which is very difficult to pass.

One of our cat patients had repeated episodes of severe obstipation (so constipated it's basically a non-moving, concrete blockage).  His owner noted that the episodes coincided with the cat's escapes outdoors, but had only been going on since construction began in the neighborhood.  He speculated that the cat was acquiring sheetrock dust in his wanderings.  When he groomed himself, he was making plaster inside his bowel.  We never actually documented this, but when all the lots in the neighborhood had houses on them, the cat's problems ended.

Most animals with mild constipation will respond to gentle laxatives like mineral oil or psyllium muciloid (Metamucil).  Sometimes enemas are needed.  On rare occasions, I have had to physically break down the mass of hard stool with external massage and intra-rectal instruments (while the pet is anesthetized, of course).  The first year that I was out of school, we actually had to perform surgery to remove a mass of stool from a Bassett Hound's colon.  It weighed three pounds, and (after removal) could not be broken down without a hammer.  Lots of bones in that guy's diet.

Hunter was a much more unusual case.  He had been straining a great deal since the previous evening.  His owner had seen him urinate freely, so that blockage was ruled out.  The dog had vomited once and his folks commented that it was very foul-smelling "... like stool, but it came out his mouth."  Not only is this a disgusting situation, vomitus with an odor of stool most likely indicates a blocked intestine.  The dog was quite painful when I touched his abdomen, so an X-ray was the next step.

It looked as though someone had inflated his large intestine with a tire pump.  It was huge and gas-filled.  His next step (after heavy-duty pain medication) was exploratory surgery.  Upon opening the guy, we find not only an enormously inflated large bowel, but a small intestine that looks as though it is no longer alive.  The entire length of small bowel was blue and looked "pitted".  The lymphatic vessels draining the bowel were distended and overfilled with lymph, making the membranes that support the intestine (called mesenteries) appear to be milk-filled.   

Further examination revealed something I had previously seen only in horses (and that at post-mortem).  The large bowel had become twisted 180 degrees.  This prevented the exit of stool and gas, hence the ballooning of the colon.  As the pressure increased, the torsion increased and the main blood supply to the entire intestinal tract had become compromised.  I decompressed the bowel with a tiny needle, and "untwisted" things back into their normal alignment.  Within minutes, I was surprised and pleased to see the small intestine recover a normal appearance.  Fortunately, it appears that its circulation was only disturbed for a short time.  The large bowel had not fared so well, still looking somewhat unhealthy.

Twenty-four hours later, Hunter seems to be making steady progress and we have high hopes that he will recover.