I finally got to meet one of my fellow bloggers and utilised her photography talent to the maximum.

I really can’t thank you enough Vicki for being such a good sport during the whole photo shoot. It was just a great and very fulfilling experience for both of us. I absolutely enjoyed reading Vicki’s blog on our photo shoot experience and she simply describes the whole event so well that I don’t need to add a thing to it. She took so many amazing photographs and her a few of my personal favourite:

 Posing with my favourite boys (Lewi our cat was the missing family member)

A wonderful profile picture. Too bad the boys weren’t looking in the same direction.

‘Shepo’ flying up in the air to catch his ball.

‘Punchkin’ proving to be the next hover dog.

My boys happily parading back with the successfully retrieved ball.

Last weekend I was on emergency call and as always I was kept fairly busy. My entire weekend on call was packed with difficult and interesting case; they ranged from a horse with colic to a blocked cat and a blocked dog to even a dog with snakebite. I shall however focus on discussing only one of these cases as it continued well into the middle of the week.

As soon as I received the call from ‘Ernie’s owner, I knew he had to be seen immediately.

‘Ernie’ the 12-year-old male de-sexed Dalmatian was dribbling urine. He had been examined the day before and was sent home on antibiotics but had deteriorated overnight. He was so lethargic and constantly trying to urinate to no avail. On examination, I found he was very sore and was guarding his private part. He made it clear that I would not be allowed to pass a urinary catheter while he was conscious.  I quickly decided it was best to  give him a premedication containing a combination of pain relief and sedative.

This was followed with me juggling another few consultations until I finally got an opportunity to go back to examine ‘Ernie’. At that stage, he appeared quite sedated but was still not refusing me trying to catheterize him. I deemed it necessary at that stage to proceed with a full anaesthetic. Even under full anaesthetic, I struggled to pass the urinary catheter. I kept rubbing against a very gritty structure (suspect urethral stone referred to as a ‘urolith’). I took radiographs of his abdomen and could see a suspect bladder stone but nothing showed up in his urethra on x-rays.

Sometimes the bladder or urethral stones are not opaque (visualized on x-rays).

After multiple unsuccessful attempts at catheterization, I called Ernie’s owner and advised her I had to perform abdominal surgery and try to flush out the urethral stone/s retrograde (pass the catheter the other way around via his bladder).

We positioned ‘Ernie’ on his back and were about to start scrubbing his abdomen up with antiseptic in preparation for surgery. I suddenly felt an urge to attempt to catheterize him one last time. And voila, success… I was able to pass the urinary catheter with a tiny bit of force and drain his much distended bladder. I sutured the catheter in place and we aborted the surgery.

I then did a full urinalysis on his urine to determine the type of crystals he may have. I could not see any crystals but simply lots of sludge. I updated his owner and explained ‘Ernie’ will most likely still require surgery to remove the bladder stones as they will ultimately lead to further urethral obstructions. ‘Ernie’ made a great recovery. I knew he was ready to go home as soon as he reverted to his usual ‘whinge bag ways’ which is clearly illustrated in the video footage below:

Sunday afternoon, I sent him home with an indwelling urinary catheter as it is important to leave in the catheter for at least 24-48 hours afer insertion. I booked him in to see me again on Monday in the late afternoon. Monday afternoon arrived and ‘Ernie’ was back for his revisit.

Needless to say ‘Ernie’ or as I like to call him ‘Ernito’, was not at all impressed to see me again.

Me attempting to help ‘Ernie’ feel less uneasy about seeing me again.

Liver treats finally working their charm on ‘Ernito’

His mom reported he was doing well at home and easily urinating through his urinary catheter. I pulled out his urinary catheter and emphasized the importance of closely monitoring his urine output for the next few days.

All was going smoothly until I received a call from his owner two days later on Wednesday around 12 o’clock.

She informed us ‘Ernie’ was struggling to pee again.

She was already on her way to the clinic and was well aware he would require surgery this time around.

I gave him a premedication as soon as he arrived and started him on a low rate of iv fluids. We then proceeded with what we often consider quite an easy and routine surgery. I could not pass the urinary catheter and it was proving to be blocked in the same exact spot I struggled with only 4 days before. I opened up his abdomen and put in a stay suture in the apex of his bladder to allow me to externalize his bladder.

Suddenly I found urine gushing out of the bladder as my suture had ripped through the bladder wall.

I was utterly shocked at what had just happened. Obviously his bladder wall was just so friable. I called in my vet colleague Liz to scrub in and help me repair the damage. We emptied his bladder outside of his abdomen to prevent further contamination of his abdominal cavity. I then extended my bladder incision (cystotomy) to facilitate an appropriate examination of the inner workings of his bladder. I discovered his bladder was full of tiny stones and that only a few had formed into larger ones. All these larger stones were impacted in the neck of bladder ; which is a very narrow and difficult spot to access.

At this very moment, I had a rude awakening. I just knew that this surgery was going to take much longer than I expected. We had to pass in the urinary catheter normograde (via his penis) well knowing that we can’t pass it far enough because of the stone lodged in his urethra. We then started infusing the urinary catheter with large amounts of flush to help dislodge the urethral stone and the bladder stones. This process had to be repeated several times until we eventually managed to successfully flush out all the stones in the trigone area of the bladder.

I started to celebrate the removal of all these bladder stones forgetting about the urethral stone that was yet to be addressed. I had again under estimated the rest of the surgery. Usually you should be able to easily flush it out retrograde. I passed the urinary catheter retrograde (vie the cystotomy site) and for the life of me, I could not get this stone to budge. We had to keep trying to flush it through both methods normograde then retrograde then vice versa. After 1.5 hours of doing so without any sign of progress, you could only imagine how frustrated and deflated I was feeling.

I mean ‘Ernie’ had been under anaesthetic for almost a total of 3.5 hours which was far too long.

Don’t ask me how but miraculously the stubborn urethral stone finally moved and we flushed it back into the bladder and pulled it out of there. We then passed the urinary catheters both ways and flushed the bladder several times to be %100 sure we got rid of all the stones. I then sutured up the bladder and tested it for any leakage. We then thoroughly lavaged his abdomen with warm saline to get rid of any contamination (urine or bladder stones) and I finally closed ‘Ernie’ up. I have to thank my colleague Liz for her support and assistance throughout this complicated surgery!

The critical period was the next 12-24 hours. We had to warm up poor ‘Ernie’ as he was hypothermic. We had him sandwiched with a bear hugger (bag filled with hot air) and heat mat. We also wrapped him up with lots of warm bedding. When he first woke up, he felt very nauseous and did a big vomit. We had to put drape his head over a towel to prevent him aspirating any of his vomit. My colleague was on afterhours duty and monitored ‘Ernie’ for the first 4-5 hours post surgery. I could not sleep without checking up on my darling ‘Ernito’. I did a total of  3 checks over the course of the night and early morning during of which I had to give him more pain relief and cut down his fluid rates.

The next morning, he was still feeling very sorry for himself.

After all, we had probed and prodded his urethra intensively over the course of a couple of hours.

Check out the picture of both his bladder and urethral stones.

The urethral stone covered with so much blood is the one that created most havoc.

 They may appear like tiny stones but they are big enough to plug your urethra!

The following day, we sent those stones for free analysis to the hill’s science laboratory. We highly suspect they are urate crystals but we could be wrong. Dalmatians are predisposed to urate crystals because of their unique composition. I will wait to see his results before delving into a discussion on this particular type of crystal.

As far as I know, ‘Ernie’ is recovering well at home. I will be calling his mom tomorrow to check up on his progress.

Morale of this story is you should pay attention to your dog’s urination habits. If you don’t, it may cost you his/her life!

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She was found to be in season and her uterus was fairly enlarged and vascular.

Surgery went smoothly but then she developed very pale gums a few hours post operatively. Unfortunately, that un-nerved me and I felt compelled to go back into surgery to make sure non of my ligatures had slipped off. My colleague convinced me to apply an abdominal bandage on Milky instead. The tight bandage seems to always help in preventing further bleeding and allows for a stable clot to form. I called and informed Milky’s owner about our predicament and advised them she will be kept hostage for close monitoring overnight.

Milky was not all too baffled with the sticky situation she was in.

Basically we always inform clients we do not want to desex their pets if they are in season. It is too risky and potential for post-operative bleeding is just very high.

We usually check over the patients and when we discover any signs indicating the patient is in season, we call off the surgery.

Anyhow back to my day, I then proceeded with collecting blood from our donor ‘Bella’. She was a hyper labrador and required a small sedative to allow for a successful collection. Oh, and I had brought in my cat, Lewi, in for blood testing, a grooming and vaccination. I doubt any of my pets are pleased with the fact I am a vet. One limp, one wink, one itch and I am all over them making sure they are okay.

Poor Lewi spooked me with his unusual and unkempt coat and I was concerned he may have underlying kidney disease. Thankfully his blood results came back normal and we didn’t need to sedate him for his quick grooming session. It is kinda ironic that I could not successfully collect blood from my own cat. I was the better holder of Lewi but my colleague Alana did the ace job of managing to get blood from my cheeky cat!

Here’s Lewi all trimmed and proper and keeping an eye on Punchkin’s movements.

As for the afternoon, we were booked solid with consults and everything went smoothly.

I re-examined Milky and her gums were looking much pinker and she was heaps brighter.

Here she was imploring us to let out of her cage..

Tuesday morning came and I walked into the clinic and there was a mad rush. An emergency case had just been admitted (referral from another vet) that I had to simply dive into. Poor ‘Shani’ had a very distended abdomen and fever. Shani is one of the sweetest natured dogs I have ever met.

She snuggles up to you and looks intently into your eyes and will gently give you a kiss.

This is her below when we first admitted her. You can tell she was very unwell if you look at her facial expression!

We took radiographs and confirmed she had pyometra(pus filled uterus); a totally preventative life threatening condition if she were desexed! We had to perform the surgery immediately.

I opened up her abdomen and was relieved to see that her uterus had not ruptured.

Please stop eating right now and be prepared for the next two pictures. I ofcourse have to share photos of Shani’s enlarged uterus and show you what was inside of it!

I double checked all my pedicles(the ligatures placed on the ovarian and uterine stumps) and they were secure (not bleeding).

My biggest concern was her getting toxic/septic.

She was recovering slowly in her cage and then seemed to develop pale gums. Pale gums can be due to hypothermia (very low temperature) or blood loss or even pain. I made sure she was warmed up and given sufficient pain relief but her gums remained pale. Again I felt a huge knot in my tummy. I could not have done a better job than I did and was now seriously concerned. I had to monitor her CBC (complete blood count) to ensure she isn’t actively bleeding.

Needless to say, I had a sleepless night because I kept ducking in and out of the clinic making sure my little Shani was doing okay. I was very tempted to give her a blood transfusion but didn’t. I was worried that her body is already working really hard to fight against the infection in her blood stream and so a blood transfusion may ultimately lead to a transfusion reaction.

Thankfully Shani has pulled through after intensive monitoring and gone home and is currently being managed by her regular vet.

The rest of my Tuesday was packed with other routine surgeries and consultations…

Wednesday came and it was fairly quiet but then during our lunch break, we got a very distressed call. A client was bringing in his friend’s dog that he had just run over. Poor ‘Kellie’, a Rottweiler cross, was breathing rapidly and knuckling her left forepaw and had a few gashes here and there. I gave her immediate supportive care which included pain relief and iv fluids. She was not only in shock but also suffered from head trauma and multiple wounds.

In those situations, you must triage and treat the most critical symptoms first. My biggest concern was her rapid breathing. I had topped her up with so much pain relief and her breathing pattern was not changing. I decided to take chest x-rays at that stage. I found she had tension pneumothorax (too much air in her chest cavity preventing her from expanding her lungs properly).

I immediately proceeded with a thoracocentesis (put a catheter in her chest) and drained 36 ml of air.

Thankfully that did the trick. She seemed much more comfortable and was finally able to lay down and breathe better.

The next morning, ‘Kellie’ was ready to bolt out of her cage.

However, now that she was stable, we still had to reassess the rest of her wounds and determine the next treatment step. We started by taking x-rays of her left forelimb and ruled out any fractures or luxations. She had a huge haematoma (blood clot) in her axillary region which was compressing her radial nerve function and that is why she was dragging her left forepaw.

Unfortunately if our medical therapy + acupuncture sessions don’t help her re-gain full function of her left forelimb, she will need to have an amputation!

By Thursday, I was feeling pretty tired and looked like Punchkin below.

We had a huge start to the week. Thankfully we didn’t have too much of a chaotic Thursday or Friday.

Now I must get ready for a whole new week packed with surprising cases and adorable patients and hopefully not too many critical cases.

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To make matters even more dramatic, I was pretty sick and had to be worked up to the nine by a mob of great doctors.

Feeling so unwell simply gave me a rude awakening and pushed me to embrace a healthier lifestyle.  Even though I am a vegetarian and exercise regularly, my eating habits could do with a bit of improving. Anyhow I’ll quit boring you with gory details of why I have been unable to blog regularly in these past few weeks.

I finally went back to work last Friday and was so excited about seeing my patient ‘Tenzing’. He did not share the same sentiment because he is a shy fellow that hates the vet clinic. He had not left my mind for all the time I was off work. I kept thinking: ‘I wonder how he is going. I hope he pulled through.

‘Tenzing’ is one of the most remarkable dogs I have ever met. His will to live and conquer his illness was beyond belief.

He was admitted afterhours by my colleague Dr. Bruce for collapse. He had pale gums and required an immediate blood transfusion. The next morning I had to operate on him immediately to stop the bleeding. He had a ruptured splenic tumour. These tumours can be benign (don’t spread) or metastatic (ones that spread). When I opened his abdomen up, I was greeted with so much blood. It was pretty challenging trying to visualise all the vessels that I needed to ligate to safely remove his spleen. Brace yourselves, below is a photo of his x-spleen:

Unfortunately it did not end there.

‘Tenzing’ had lost so much blood during the surgery and so he needed another blood transfusion.

You can always get away with giving a dog the first blood transfusion without cross matching. However, in theory, should you need to give another transfusion in very close proximity to the first, you must always cross match to prevent a reaction. The reality of the situation was I did not have much choice in the matter. We did not have the gear to cross match and ‘Tenzing’ was in dire need for more blood. I simply had to take a leap of faith and give him a second blind blood transfusion and hope for the best.

Thankfully it paid off and he did not have a transfusion reaction! He was stable but still not eating when I took time off work. It was just crazy to see how great he looked 2 weeks after his massive surgery. He needed two holders to restrain him while we took his sutures out!

So I know what you are all thinking? My god, how will I know if my dog has a tumour in his/her spleen? What can I do to check and so forth…

Splenic tumours are common in middle to geriatric aged canines.

What happens is a tumour (benign or metastatic) starts to grow in the spleen and it may occasionally cause small bleeds. The subtle symptoms owners usually pick up on in the early stage of the disease process are that their dogs have suddenly gotten very quiet, are hesitant to jump up and seem generally uncomfortable. Sometimes a veterinarian can palpate an enlarged spleen during a health check and will recommend further workup (x-rays + ultrasound) to confirm the diagnosis. It is obviously far better prognosis to remove the spleen before it ruptures and leads to a massive bleed.

The tricky thing is the early symptoms of splenic disease are similar to arthritis. The crucial details to pay attention to are how quickly these pooches suddenly slow down and not want to jump up. Arthritis is usually a commulative process and so patients rarely present to us for suddenly getting stiff! Most patients guard their abdomen and make it very difficult for vets to palpate the enlarged spleen.

We often diagnose splenic tumours when they have ruptured and the patient’s life is hanging in the balance.

This brings me to the importance of blood testing middle-aged to geriatric patients. We can easily pick up on an anaemia and if the patient is guarding its abdomen, we can take radiographs to rule in/out an enlarged spleen.

I could keep going on and on about this but I think it is enough details for now. Fire away any questions you may have.

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It may seem like such a rhetoric for many people to hear veterinarians recommend desexing their pets.

In all honesty, I am surprised that so many people out there still do not desex their bitches even though they do not intend to breed from them. Why do we recommend desexing your bitch? We simply want to ensure your dog does not develop ‘pyometra‘ which is pus in the uterus or bring in unwanted puppies to the world.

Pyometra can present in two ways: open versus closed. In open pyometra, the cervix is still open and there is pus oozing out of your dog’s vulva which she will constantly be licking and that may or may not prompt you to get her checked out by a vet. As for closed pyometra, the cervix is closed and so no drainage is present and the uterus consequently distends with pus and then ruptures. Both open and closed pyometra are life threatening conditions and usually occur soon after your dog has had a season.

We can not tell which dog is going to develop pyometra.

However, a dog that has had several seasons is at higher risk of developing pyometra.

The only signs that owners seem to notice is that their dog is very thirsty (drinking lots) and appears lethargic. Some owners come home to discover their dog is dead.

I am hoping that the case I am going to talk about will really hone in on the importance of desexing your female dogs. It is crucial to note that I also strongly recommend desexing male dogs too but this won’t be the subject of my article today.

We got called at 4.30 p.m. last Friday regarding ‘Gemma’, a 10-year-old Golden Retriever that had suddenly fallen ill. We were half an hour away from closing the clinic but she had to be seen. On examination, ‘Gemma’ looked so depressed and had a very high temperature. She was guarding her abdomen and would not allow us to fully palpate it. We admitted her for full workup and hospitalization.

X-rays of her abdomen showed a suspect pus filled uterus.

The owner informed us that he believes she is desexed and so pyometra is unlikely. We started her on iv fluids and antibiotics.

The next morning, I did not see any improvement and felt like she had deteriorated in spite of the aggressive supportive therapy. ‘Gemma’ had an absolutely horrible smell to her. I noticed she had a swollen vagina and was still very concerned about pyometra.  She did not have a desexing tattoo in her ear which even made me more suspicious. I repeated her blood work and found she had developed an anaemia overnight. I called the owner immediately and strongly recommended an exploratory laparotomy to determine what is going on in her abdomen. The owners gave me the okay to go ahead with afterhours emergency surgery.

I was going into surgery not knowing exactly what to expect. My gut instinct told me she had pyometra (pus in the uterus)  but a ruptured tumour or an abscess of some sort were some of my other considerations.  As soon as I opened her abdomen, I was flooded with heaps of creamy free abdominal fluid (pus).

My heart sank because I instantly knew that her uterus had ruptured.

There was so much pus in her abdomen and that made her prognosis very guarded. She was bound to develop a peritonitis (infection of her abdominal cavity). I tracked her very distended uterus and started doing the tedious job of desexing her. It was quite an intense process because the uterus was so friable and there was so much contamination and I was working in a very un-sterile field.

Gemma’s pus filled uterus (referred to as ‘pyometra’)

Working very hard to remove this friable and distended uterus.

Resected uterus with pus oozing out of it.

I flushed her abdomen thoroughly but she was still bound to have pockets of pus within her abdominal cavity. She recovered well from her anaesthetic. I monitored her very closely as I was concerned about post operative bleeding and/or infection.

The next day, she seemed much brighter but was still not interested in eating.

I repeated her bloods and they showed a very high white cell count (indicating infection). I increased her antibiotic cover and had her on a triple antibiotic therapy to cover against all types of bugs. She was still very tender in her abdomen. I did not expect her to bounce back at that stage as I had only operated on her the night before.

Her whole family came to visit her that day. According to her owners, she usually inhales her food and so they were shattered to see her rejecting her favourite treats. However, ‘Gemma’ managed to put on a brave face for her family and even mustered enough energy to wag her big beautiful tail for them. They looked into her eyes and could tell she was in a world of pain and simply miserable.

It really saddened me to see the anguish her family felt at seeing her. One of them cried so much because he could not believe how she was not bouncing all over the place. I knew she was a very much-loved dog and they would have desexed her as a young dog had they known they could have avoided this situation. They did not intentionally mean to neglect her.

They returned home with a heavy heart because they knew that ’Gemma’ was not out of the woods yet.

On Monday, she seemed brighter but was still not interested in eating. The rest of her vitals were good. Blood tests were still indicating a very high infection. We repeated her full bloods to ensure that the rest of her organs were still viable and thankfully her results were absolutely normal. I started to warn the owners that I may need to go back in for repeat surgery to flush her abdomen again and address the underlying peritonitis.

On Tuesday, ‘Gemma’ finally started showing a slight interest in eating. She even started hopping on her favourite cushion that her family had brought in.

Her blood results showed that her white cell count was getting lower indicating response to treatment. We were ecstatic to see those results and decided to send her home on very close monitoring. We held off on surgery because we believed that the antibiotics are finally doing their work. We sent her home with a huge pile of medications. I have kept in touch with her mom and she informs me ‘Gemma’ is showing small improvements each day. She is due for a revisit next week. I am crossing my fingers for my beautiful ‘Gemma’. She has fought very hard to conquer this battle and I sincerely believe she will triumphantly survive.

For all those pet owners that have bitches that are not desexed and are not being bred,  I say: ‘Why are you risking your dog’s life?

Your dog will not always be as lucky as ‘Gemma’?

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What is important is that I am back now and I am buzzing with interesting and exquisite cases that I can’t wait to share with you…

The gorgeous cross puppy below is a rehomed RSPCA that I had to castrate on Monday. He is obviously quite zonked with my premedication in this photo.

I mean really, is it only Wednesday!?! It feels like friday or more importantly I can not wait until it is friday. It has been a very big week already.

I started monday with a big BANG. I had to operate on Travis, a 5-year-old golden retriever, that presented to us 4 days before for being blocked up. The poor fellow had a very distended bladder and was unable to urinate and was grunting when we admitted him as an emergency case. We proceeded with a light anaesthetic to allow us to pass a urinary catheter and also confirmed that he had bladder & urethral stones. Unfortunately he was too unwell to operate on the next day. We thus gave him aggressive supportive care over the weekend and he was scheduled  for his big surgery on Monday.

You can read all the books in the world to mentally prepare yourself for a surgery but when it comes down to it, you are never fully prepared.

You just can never account for all that you are about to see until you are elbow deep in there! As soon as I opened Travis’s abdomen, I was greeted with lots of free abdominal fluid which I had not expected. It baffled me and got me worked up because it meant there was a possibility that Travis had a ruptured bladder or ureter. We obviously can attempt to repair torn bladders depending on their severity. However, when it gets into the finer things like ureter or urethral ruptures, that is beyond the scope of a mixed veterinarian. It became my mission to determine the source of all that fluid and in all honesty, I never got a concrete answer.

Travis had an intact bladder but it was very thickened & inflamed. I confirmed an intact urethra and did a cystotomy (cut into the bladder) and removed all the bladder stones & flushed the urethral stones too. It all went according to plan but the mystery of the abdominal fluid still haunts me. Thankfully, Travis has made an excellent recovery so far and is scheduled to go home tomorrow.

We can only hope that the mystery of the abdominal fluid will never creep up on us again…

Below is a picture of him demanding some more food even though he has been successfully extorting the nurses with his pitiful and adorable face all day!

Then yesterday, I had another massive surgery on a very special patient of mine. It was on Katie, a 10 year old JRT, that has been losing weight and not responding to our medical treatments over the past few months. We had done the full work up and come up with no answers and so we had to proceed with an exploratory laparotomy (abdominal investigation). This is like a surgical safari to try to determine a cause for her symptoms: liver/splenic tumour, foreign body obstruction, tumour or so forth.

We discovered a very inflamed & possibly obstructed loop of bowel and decided to resect the affected gut.

We sent the tissue away for histopathology. Katie is one tough cookie and made a good recovery. We were praying her results would not come back confirming tumour/cancer. Unfortunately she was diagnosed with lymphoma today. She is doing pretty well considering her challenging circumstances and we have decided to let her enjoy some serious pampering and good palliative care at home in her numbered days on this planet. It is very sad that we can not fix her but at least we now have some answers and are not grasping at straws of hope. This is a picture of us together the morning of her scheduled surgery!

Today, it did not feel like Wednesday because I have done almost a week’s worth of work already!

I was just running around catching up on my phone calls & looking after all my hospital cases, namely Travis, Katie and Echo. Echo is a 5-year-old female JRT that is my colleague’s case. The poor possum was run over 2 days ago and her injuries included a fractured femoral head + fibulae on the same leg. Her surgery was completed by my colleague today. She is recovering so well and is such a sweet and stoic pooch!

I am hoping for a more quiet rest of the week…

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Just got back from an afterhours emergency call and it is almost 1 a.m., my patient is stable and has gone home but I will be readmitting her for full workup tomorrow morning!

Now back to my heartbreaking case of today. Two days ago, we admitted ‘Boss’, a lovely 10-year-old male desexed labrador, who presented to my colleague afterhours for excessive panting and a distended abdomen. He was xrayed and bloat/abdominal mass were ruled out but he had a fever and seemed quite painful. He was started on aggressive supportive treatment which included iv fluids and pain relief and antibiotics.

I arrived the next morning to see this adorable and morbidly overweight labrador panting away in his cage. He looked dreadful because he could not get comfortable and appeared quite distressed. We reassessed him and proceeded with further workup. We collected bloods and they indicated he was anaemic and had a severe infection. We have access to an excellent ultrasound machine but we are not ultrasonographers by any means and often use the ultrasound just to see if anything obvious pops up. We have been able to diagnose suspect liver or splenic tumours known as haemangiosarcomas based on ultrasound that were later confirmed during surgery!

In his case, the ultrasound was not very specific but we definitely saw a few abnormalities in the abdomen but they were very challenging to characterise.

We were concerned he had free abdominal fluid and collected a sample and sent it off to the pathologist for interpretation. We were suspicious of a ruptured liver/splenic tumour or peritonitis (infection of the abdominal cavity secondary to many possible causes).

We loaded up ‘Boss’ with heaps of palliative care while awaiting his abdominal fluid results. He seemed more settled but was not very interested in eating. That was very alarming, he would eat a few bits of chicken but then seemed more tucked up afterwards. I mean what labrador in their right mind would say no to food, right? But even though he was not feeling well, whenever you spoke to him or patted him or took him out of his cage to examine him, he would wag his precious tail. It was like he was putting on a strong face just to please us!

Ah labradors, such loving pooches, you just want to cuddle them all day!

His results came back and indicated there was pus in his abdominal cavity. The next step was an exploratory laparotomy (surgically exploring his abdominal cavity) to determine the source of the pus/infection and try to mend it if possible. Unfortunately, we discovered he had a very aggressive pancreatic tumour and so his owners opted for us to euthanize him while he was still under anaesthetic. It was a very peaceful parting and he is finally free of pain and wagging his tail at full pace!

I just really love Labradors and their dedication to wag their tails at all cost. All they care about is making you happy.

I am so sorry we could not save you ‘Boss’ and your lovely wagging tail…

I instantly called her back and she had a caesarean to do and the nurse on call was too far away.

Everyone feels terribly guilty calling me in on my day off because I never fail to oblige. I keep insisting they should not feel bad because I will not be hesitating to drag them out when I ever need them. I am very fortunate that all the support I offer is mostly reciprocated.

This poor red heeler had already had nine healthy puppies without any problems but then continued to contract for four consecutive hours without any progress.

Alana decided to x-ray her to determine how many puppies are still due to come out and she found ONE LUCKY LAST and he/she was far from being engaged in the pelvic canal. That was the green light to proceed with the caesarean.

She already knew that the puppy is most likely dead.

A whelping bitch should be producing one puppy every 20-30 minutes and she can take up to 1.5 hours to rest between pups. However, she should not be contracting during that resting period. If you notice greenish vaginal discharge coming out of your whelping dog after so many contractions and no puppy is presenting, that should set off some serious alarm bells! It can indicate that there is early placental separation and so the puppy is in major strife as he/she can not breathe. You should never breed a dog if your are not well-informed about the whole process from beginning to end.

You must familiarize yourself with the bitch’s nesting behaviour indicating an impending labour to the whole whelping process and the aftercare involved too. You must be prepared to take your dog to a vet if she is struggling to have a normal birth. Caesareans are major surgeries and cost a great deal of money and 50% occur afterhours and so that will add lots of $$$ to the bill. You have to be prepared to pay up and take full responsibility of your dog.

You risk not only losing the puppies but also your bitch if you withhold veterinary attention.

Back to the caesarean section I got called into, I played anaesthetist and unfortunately as we expected, the pending puppy was dead. He was also twice the size of the rest of his litter mates which can explain why he got stuck. Mom made an excellent recovery and we sent her on her merry way with all her squeaky healthy puppies. She has a very hectic 6-8 weeks ahead of her.

Below is a picture of mom recovering from her anaesthetic. Puppies are not really considerate at that age and all they seek is to latch on and get a decent feed. Poor mom!

Then mom was more awake and getting antsy about me getting close to pups and taking too many pictures. That is an excellent sign!

In her case, we were not worried about her not connecting with her pups because she had delivered them naturally.

However, when puppies are delivered via a caesarean section, you often worry because the bitch may reject them and so the owners need to be overseeing her care and helping her connect with her babies.

When you see this puppy’s face, it really cheers you up and reinforces why you do what you do as a vet no matter how late it is or how run down you are or even if it is indeed your day off!

I wonder how many people can vouch that they are just as dedicated in their own careers…

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Latte is owned by one of our staff members and so we regularly see him. We noticed he had an abnormal hindlimb gait from the first time we met him. He was so tiny at that stage and would only just fit into the palm of your hand so we did not get too fixated on working him up. His owner hoped he would grow out of the skipping as his bones developed.

Unfortunately, while he still seemed comfortable and happy and was running around like a mad pup, he started collapsing more frequently on his affected leg.

I often find that people assume a skipping gait can be normal or unique to their dog. The tricky part is that dogs and animals in general are so stoic. They do not show any subtle signs of discomfort. They wait until the pain levels reach an excruciatingly high level and they can not mask it anymore. That may be due to their survival instinct that gives them an urge to hide any weakness. While a mild case of flu may leave a person feeling crippled, I have seen dogs attemtping to walk on broken leg. Please pay attention to the subtle signs of discomfort that your pet may be displaying! If your pet has an abnormal gait, get it checked out by your vet before it gets more serious and difficult to cure or treat.

I actually once went out of my way to chat to some random owner walking her dog in Sydney that had a very prominent skipping gait. I could not bear to watch him anymore because I knew how uncomfortable he was. His owner was baffled yet so happy to discuss the skipping issue with me and said she had taken him to her local vet. Her dog had been worked up but the xrays taken were of his back not his knees. She was told they could not identify the problem and she should not worry about it. I strongly recommended she seek another vet’s opinion because his potential knee problems may have been missed! And oh I did that while I was walking back to my hotel after attending a conference.

You would think I would have better things to do than stalk random pet owners on the streets.

Dogs don’t talk and vets aren’t psychic so it is possible for us to localise the pain to a wrong location. I never feel offended if a client wants a second opinion especially if I am managing a case and feel like I’m not getting results. I simply welcome a second opinion and always get my colleagues involved. Another set of fresh vet eyes may help crack the case!

Back to Latte, we finally decided we really needed to work him up and so he got examined by 3 different vets (me included) and we thought he had a very abnormally positioned patella preventing him to freely move his knee joint. We xrayed his knees and confirmed the diagnosis of grade IV medially luxated patella. This condition is very common in toy dog breeds and is heritable. We usually grade luxated patellas from I to IV; Grade I not requiring surgery up to IV being the worst and most severe one requiring surgical repair.

We referred ‘Latte’ to Dr. Kuntz (a vet specialist) for surgical repair because he was only 3 months old at the time and we preferred the expert handling his case.

Check out Latte bolting around the vet clinic BEFORE HIS SURGERY:

He has made a fabulous recovery and is currently still on strict rest and is bustling with so much pent up energy.

His mom is letting him swim in the bath as part of his physiotherapy exercises. There is a 30% chance of recurrence of his patellar luxation but we are all crossing our fingers! We can’t wait to see him running full blast without skipping or collapsing on one of his back legs.

He loves coming into the vet clinic and is usually busting with excitement to see everyone especially me because I have brain washed him with heaps of liver treats.

About a month and a half ago, I was called out afterhours to examine him as he was just hit by a car.

His poor dad witnessed the whole thing. They brought him straight in and he snapped at me and his own parents during the consult for the first time ever. He was in shock and in a lot of pain. We could see a gash around his neck but he would not allow me to fully examine the extent of the wound. He was stable otherwise. I gave him pain relief and admitted him to the hospital for close monitoring and reassessment the next day.

The next morning, he was more comfortable but appeared very stiff in his neck. I was starting to get concerned about his cervical spine.

I proceeded with a full anaesthetic and only then did I realise how stoic this poor pooch was.

He had a very extensive skin flap. I had not expected the wound to be so huge. The pictures below clearly illustrate the extent of his wounds.

You can easily appreciate that it was quite a job getting that laceration stitched up. Chris (my nurse) did an awesome job at scrubbing and preparing his wounds for surgery. The length of the wound was about 35-45 cm and over his neck & shoulders. This is what it looked like after I repaired it surgically.

I was very concerned about the high potential for wound break. .

Unfortunately, my concerns were verified one week later.

Bruno developed a seroma (hard tissue swelling on the right side of his neck) which was very painful and required repeat surgery to put a drain in it.

Bruno is pretty blessed not to have been killed or even paralysed from his accident. He was obviously run over at high speed. Thankfully, he made an awesome recovery after that. This would not have been possible without his very dedicated and amazing owners. They followed our home care instructions so thoroughly and did an excellent job at cleaning his wounds and medicating him and bringing him back every couple of days for reassessment. It is so rewarding to work with such great clients that were so down to earth and reliable and worked with us as a team to help Bruno get back on track!

He came in for a revisit today and I was very happy to see that his wound is healing very nicely and has very little to go.

It was quite a challenge taking a photograph of him today because he was too full of spice.  The pictures of his initial injuries were good because they were taken while he was under anaesthetic. This is what his wounds look like now.

Bruno brought his sister with him today to introduce her to the whole concept of liver treats at our practice! They had a blast and ate lots of treats.

It was just so great to see Bruno back to his very happy hyperactive self!

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AFTER

The story of ‘Brandy‘ began when she was brought into me by the rangers afterhours one friday afternoon. They had been trying to track her down for a month. Many concerned citizens had been calling them about her whenever she was spotted dragging her hindlegs behind her.

The firt time I looked at Brandy, I saw her beautiful face and her body that looked like a pile of bones.

I then noticed that one of her hindlegs had an open fracture and the other had the hock joint completely exposed. She looked like an absolute mess. The rangers handed her to me and said: ‘You’re the vet. Please do what you think is best for her as she is a stray dog’. That meant I had the authority to put her down on humane grounds if I felt her injuries were beyond repair.

I took a deep breathe and started to thoroughly examine her wounds. She was so brave and did not once attempt to lash out at me even though she was in a world of pain. I decided to give her palliative care overnight and xray her in the morning. I gave her an epidural as pain relief, cleaned her wounds, bandaged her legs and started her on iv fluids. I also fed her and, needless to say,  she swallowed her food in a heartbeat.

The next morning, I opened her cage and she blew me away. She just jumped out and started walking on her two frontlimbs without any hestitation or balance issues. Her backlegs did not touch the ground for one second. She had developed a completely new way to walk and it was so admirable.

At that moment, I knew I could never give up on her and I hoped that she had no spinal damage.

Check out her footage below:

..

We then had to sedate her to get appropriate xrays as it required us to stretch her out. The xrays confirmed a fracture in the obvious leg with bones sticking out but also ruled out any other fractures. That was a huge relief. We then thoroughly cleaned all her wounds and rebandaged both her legs.

We could not operate on her until we got consent from her owners or until she was officially declared an unclaimed stray.

The next morning, a lady came in and informed us that she had owned Brandy for only 24 hours. Brandy had escaped her property that had very high fencing one week ago and consequently incured her injuries. She was her 5th owner and that was the only background history she was given. All this lady knew was that Brandy was the most beautiful natured dog she had ever met. When she called Brandy’s previous owners to warn them that she may well be on her way back to them, she was outraged with what they told her. They chose to only  tell her then that Brandy hated being left alone. She could not afford paying for any of the surgeries required and so we requested she surrender Brandy to us. At that stage, we had no real indication if any surgeries would be succesful in saving one or both of Brandy‘s hindlegs.

My bosses had witnessed the way Brandy walked and immediately understood why we had to give this dog a chance.

Bruce proceeded with plating her open fracture and it took him 4 hours of very labour intensive surgery.

It was a very challenging task to replace the bones into their normal position.

After one week, Brandy had attached herself to me and would start whimpering whenever I had to leave her at the clinic after work. At that stage, I decided to take her home and start the rehabilitation process. When I first took her home, my dogs were not so welcoming; they chose to pretend she did not exist but they eventually came around. I could not leave her at home either because she would ‘kick up a stink’ and my husband could not console her. She simply wanted to be with me all the time. This meant she would come into work with me every morning and go home with me every night.

During her first week with me, I noticed that inspite of me pumping her with lots of food, it was going straight out of her. She would produce piles and piles of horse poo. Her body was not absorbing a single nutrient because of how malnourished she was. Bruce recommended I add a few supplements like enzyplex (pancreatic enzymes) to her diet that aid in digestion and that worked a treat.

Her first few bandage changes filled us with hope because both wounds seemed to be healing very nicely.

But disaster struck after 10 days.

Brandy started looking really sad and miserable and was very hesitant to put any weight on her plated leg. Upon examining her plated leg, we noticed the skin sloughing off and she had no feeling in it. That leg was not viable and had to come off. That posed a huge dilemma for us at that stage because her other back leg was far from stable. The whole hock joint was exposed dorsally and so all the ligaments and tendons supporting that joint were also gone. If we amputated her backleg, it meant she would put all the pressure on the other leg which could prevent its healing. If we couldn’t save one of her backlegs, that posed a serious ethical predicament for us.

We had no choice but to press on and amputate the plated leg. Shockingly, she recovered really well from the surgery and was actually much brighter after losing the dud leg. She was still used walking on her frontlegs so she did not put too much pressure on her backleg. We regularly applied Manuka honey and Jelonet on her exposed hock followed by a very robust supportive bandage (Robert Jones bandage). We would be changing her dressings and bandage every 2-3 days. It took about 3-4 months for her wound to completely heal. However, she was still very hesitant to use that hindleg at that stage. I started to take her out with my dogs for regular short walks.

She would use her back leg every 3rd or 4th stride for couple of steps then carry it the rest of the way. I resorted to using pulse therapy of antiinflammatories  incase there was an underlying painful stimulus.

That seemed to help and she started to gain confidence in using her leg more and more each day.

At that stage, Brandy was part of my family. She had fallen in love with my husband and my dogs. Unfortunatley she had also developed the habbit of chasing Shepo amidst his high jumps and I was mortified he would land on her frail little hindleg one day and that would be the end of her.

Whenever I used to throw the ball around for my dogs, I would keep Brandy indoors to prevent any injuries. One day she snuck out and there she was sprinting across the backyard taunting Shepo while he chased after the ball.

In that moment, I felt so truimphant, happy and relieved that I never gave up on this beautiful survivor.

So I set out to find her a new suitable home and I did not have to go very far. She was adopted by one of our staff member’s moms. She clicked with her two new whippet mates and adapted to a life full of pampering. I was banned from seeing her for the first few months because she was pretty unsettled the first couple of days of moving into her new home.
When we eventually met, it was an absolutely brilliant reunion because Brandy was psyched to see me yet very obviously besotted with her new owner.

Ah Brandy, the thought of her always makes me smile.

Every animal teaches me something and she taught me never to give up hope.

Erin (her mom is the proud owner of brandy now) was kind enough to send me recent footage of Brandy running around on her three legs. Enjoy.

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