Tuesday, September 20, 2011

The Importance of Pre Anesthetic and Routine Annual blood work

Many people overlook the importance of pre anesthetic and routine annual blood work for their pets.  A common misconception is my dog or cat is acting normal and showing no signs of sickness, therefore it is not necessary to spend the extra money for additional testing.  As a veterinarian I cannot stress enough the importance of routine blood work and pre anesthetic blood work.  Too many times I perform a CBC and Chemistry on completely health animals, and discover underlying diseases that have not become clinical yet.  Or I will schedule a routine dental or surgery for a pet, and have to cancel the surgery because there are some abnormalities on the blood work and anesthesia is too risky. 


Meet Sugar.  Sugar is a 10 year old female spayed Maltese that came to see me for an examination of her mouth and to schedule a routine dental cleaning.  On physical examination moderate dental tartar and grade II gingivitis was noted, heart and lungs auscultated clear, and all vital parameters were within normal reference range.  Her physical examination was normal and she looked great other than needing her teeth cleaned.  Her parents reported that she is doing great at home and have noticed no changes in her behavior, eating, or drinking habits.  She had blood work performed 2 years prior which was all within normal parameters.   We performed a senior wellness profile which included a Urinalysis, CBC, Chemistry 17, and electrolytes.
Blood work revealed moderately elevated liver enzymes.   We immediately recommended further diagnostics to evaluate her liver.  Bile Acids were performed which were elevated indicating that her liver was not functioning properly.  An abdominal ultrasound was performed which showed an enlarged liver and a nodule.  A needle was placed in the nodule via ultrasound guidance, aspirated, and submitted for Histopathology .  The report concluded an active inflammatory hepatitis.  
Sugar was placed on liver supplements, steroids to bring down inflammation, and her diet was changed.  She will be coming back in 2 weeks for follow up blood work to reassess her liver enzymes.
Sugar is doing great at home.  We have caught her liver disease early and are hoping to will respond well to medications and her new diet.  Needless to say, we have elected to not place her under anesthesia and delay her dental cleaning until she has stabilized. 

My dog Nemo

Sugar’s story is one of many that I see.  In fact I recently performed routine blood work on my own dog Nemo and found out he was hypothyroid (his body was not producing enough thyroid enzyme).  Nemo is now getting thyroid supplementation daily and has a new swing is his step.  I would have never thought anything was different for him.
Animals cannot tell us subtle changes with their bodies that they may be feeling.  A person can say, my head hurts, or I feel weak, or I am not feeling 100% myself.  Dogs and cats cannot tell us these subtle clinical signs that they may be feeling.  Often times, it is not until they are very sick where we are actually seeing a change in their behavior or obvious clinical signs.  Many times their disease is so advanced at that point that there is very little we can do.

 Sugar and my dog Nemo are great stories.  We have diagnosed their diseases in the early stages and prevented further degeneration and advancement.
Our pets rely on us to keep them healthy and happy.   They cannot tell us when they are not feeling just right, or something is off.  Routine and pre anesthetic blood work is a great way to ensure our pets are healthy and are not at risk for anesthesia.  Our pets deserve the best! 
 Lets give back to them the health and happiness they deserve for a lifetime of love and devotion they give to us.   

Liver HealthThe liver is your dog's largest internal organ with many functions, including the digestion and conversion of nutrients, the removal of toxic substances from the blood and the storage of vitamins and minerals. The liver has an amazing ability to repair and regenerate itself, and nutrition plays a vital role in this process.
At Hill's, nutritionists and veterinarians have developed clinical nutrition especially formulated to help support your dog or cats liver function during its healing process. 
Canine and Feline L/D diet.

Tuesday, September 6, 2011

Meet Papito!

He’s a 3 year old make neutered Persian.  We call Papito our “Miracle Kitty” and here’s why………….
Papito came to Victoria Park Animal Hospital 2 months ago for 2 YEARS of vomiting daily, lethargy, and weight loss.  After years of failed attempts at treatment and not improving, he came to see Dr. Birken for one last try to hopefully become healthy. 
On physical examination, Papito was depressed, emaciated (he weighed 4 pounds- a far cry from his normal 10 pound healthy physique), and he was dehydrated.  Blood work revealed a low albumin (from chronic mal nutrition) and an extremely elevated White Blood Cell Count (from chronic infection).  A barium study was performed and radiographs were taken to examine his gastrointestinal tract.
A Barium Study is a medical imaging procedure used to examine the GI (gastrointestinal tract), which includes the esophagus, the stomach, the small intestines, and large intestines.  Barium sulfate is a type of contrast medium that is visible on X-rays. As the patient swallows the barium suspension, it coats the gastrointestinal tract with a thin layer of the barium. This enables the hollow structure to be imaged by radiograph.

                      Here are some pictures of Papito’s Barium Study:

 Dr. Birken reviewed the barium study and diagnosed a partial outflow obstruction right at the Pyloric region of the stomach.  Something was preventing food and liquids from going into the rest of the gastrointestinal tract.  Papito was getting some nutrients, but not enough to keep his weight up and maintain his health.  The next step was surgery. 
Papito was hospitalized, placed on IV fluids to hydrate him, a plasma transfusion was administered to increase his plasma proteins and prepare him for surgery.  Once Papito was stabilized Dr. Birken took him to surgery and here is what she found.  Once the stomach was exposed, a large mass was isolated right at the position where the barium study showed an obstruction.  The mass was located right at the portion of the stomach where the Common Bile Duct and Pancreatic Ducts flowed into.  Therefore, Dr.Birken could not remove the mass.  This created a huge dilemma.  If she could not remove the mass, which was causing the obstruction, than how was Papito going to keep food and nutrients down without vomiting? 
Dr. Birken performed a gastrojejunostomy- which is a procedure that connects the stomach to the small intestine.  She created a bypass for the food and nutrients to leave the stomach and enter into the small intestine completely bypassing the mass.  A biopsy of the mas and lymph node was taken for analysis, a feeding tube was placed, and Papito was recovering and waking up from surgery.

Post operatively, Papito was maintained on IV fluids, hourly tube feedings, antibiotics, and his vital signs were checked every few hours.  He did well and was sent home after 2 days for the owner to continue hourly tube feedings and care. After one week the feeding tube was removed and Papito began eating on his own and gaining weight.  The mass and lymph node came back as benign hyperplasia (it was not cancer!)
Here is the new barium study  that was done after the surgery. 
            See how the contrast material now splits and moves in 2 directions

Papito and family
 Papito was in for a recent recheck.  He has gained 2 pounds, is eating readily, with very few episodes of vomiting.  His owner reports he is running around, jumping up on the refrigerator, playing with his sister, and eating up a storm.  She told Dr. Birken that her kitty has not been this active and happy in years and she could not be more pleased with his recovery and progress.  Dr. Birken felt the same!

A special thanks to his adoring, wonderful, attentive, devoted, and dedicated mommy.  Without her continued perseverance and faith that Papito would fight and get stronger, he would not be doing so well.  And of course to Papito for being the strong little fighter and sweet natured “Miracle Kitty” that he is.