It’s just a broken tooth…

This dog came to see us for what was thought to have  possibly been a broken tooth.  In this case, the dog was aggressive (in conjunction to being in severe pain) and did not allow for a non-sedated oral exam, even with the owner trying to hold the lip up.   Under sedation, it was found that there were 2 upper incisors that were hanging on by the gums with no actual attachment to the jaw (teeth were then removed) and that her maxillary bone (upper jaw bone) was fractured and was able to be moved easily with any pressure.  The hard palate (the firm part of the roof of your mouth) of the left side was also torn away from the teeth.  The only way to stabilize the fracture properly was to produce wire stabilization, like braces.  In this case, the only way to do so was to drill behind each canine tooth and run a surgical steel wire through  and around the canines and incisors allowing strong stabilization.

The photos below are after 5 weeks of intraosseous wire stabilization and Antibiotics to prevent bone infection from exposure to the environment and wire placement.  At the time of removal, there was no movement of the maxilla occurring with gentle force.

Below is the X-ray that was taken prior to wire removal to monitor bone healing, 5 weeks post initial injury and wire placement.  You can see the wire (yellow arrows) that was drilled into the bone (behind the canine teeth) that runs around the front of the affected teeth and bone (like braces in humans).  Red Arrow: the front part of the maxilla is not completely healed and stabilized, but the Neon green arrow shows new bone growth with the hard palate, allowing for stabilization of bone.

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(Before intubation with endotracheal tube: Yellow arrow – absorbable suture to hold gums and lips together where it was torn  apart;  Blue arrow – steel wire for jaw stabilization (bone was showing originally in this area)

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(Below is another view once intubated with an endotracheal tube.  The yellow arrows point to the stabilization wire once cut on the hard palate (most left) and untwisted in the front of the arcade (most right) and where it runs around the canine (slightly covered by gingiva).  This is just prior to the wire being removed manually.

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In this case, she likely got her front teeth caught in a fence or area she tried to pull away and fractured her teeth and maxilla.  She’s doing great now and eating without any movement of bone or any pain!! YAY!

 

Non-weight bearing on front limb

This dog came to me on emergency for suddenly not wanting to bear any weight on a front limb.  The owner was un-aware if she had been hit by a car, shot, or some other injury that may have happened.  Upon arrival she would not place her left front limb on the ground at any time.  It also appeared to point more lateral (outward) from the elbow down.  There was no pain response of flexion or extension of the shoulder.   Prior to any flexion/extension of the elbow.  There was abnormal bony protuberances on the medial (inside) of the elbow joint.

Below is the first radiograph that was taken with the dog laying on her side (lateral view) with the injured leg down with the other leg moved out of view.  I was looking for fractures, luxation/subluxations,  and other bony injuries.  Upon inspection, the elbow joint (red arrow) space appears slightly enlarged but not other abnormalities were seen on this view.

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I highly recommended taking another radiograph with a different view to see bones and joints at a different angle.  The owner was cautious, but decided to do so.  the radiograph below  called an AP (anterior to posterior) or DP (dorsal-palmar) that shoots from front to back of the limb.

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Purple arrow:  Shoulder joint (humerus and scapula); Blue arrow: Ulna/radius; Green arrow: Humerus

This radiograph shows that the elbow joint is luxated (dislocated).  The humerus is moved toward the body and the radius/ulna are moved away from the body.  It is likely because of the severity of the luxation, that the stabilizers (tendons/ligaments) are torn.  This dog was sedated heavily and the elbow was replaced, but in this case the joint would re-luxate as soon and the leg was extended.  Normally, luxations are treated via spica splint (straight leg with splint for stability), surgery, or amputation.  If the luxation is severe, like this case, it is likely that even with splinting, that the elbow will likely re-luxate once removed. In that case, surgery or leg amputation are the best options for treatment.

NOTE:  This case shows the IMPORTANCE of taking several different radiographic views for appropriate diagnosis and correction.  You may not see a problem in one view but another may give you an answer!!

 

PUS WHERE?!

Pyometra is an infection of the uterus that can happen in any species of animal.  The uterus becomes filled with pus, blood, and mucoid material.   The cervix can either be open, allowing some* drainage, or closed.   Many times it occurs following a normal heat cycle and signs can begin to show within a couple weeks following.  In either case, this is an EMERGENCY and the animal needs to be taken to surgery and have a spay procedure completed immediately to remove the infected uterus.  In the case of the “Closed” pyometra, with no immediate* medical attention, the uterus will fill up with material so much that it will rupture into the abdomen and cause severe sickness and death.   This can also happen with the “Open” form even with some drainage through the cervix.  There is no way to remove the infection without removal of the uterus via surgery.  In either case, animals are very lethargic, febrile, anorexic, vomiting, and many other clinical signs.   Blood work (Complete Blood Count) will show a very high white blood cell count, indicating an infection.  It may also show dehydration and anemia depending on severity and length of sickness.   This is one of the very important reasons to spay your pets at a young age!!  Due to the large amount of fluids, antibiotics, emergency status, surgery, and hospitalization, this situation is an expensive*, dangerous, and meticulous procedure.

The picture below is an ultrasound of the abdomen showing a thickened, fluid filled uterus (red arrow) just adjacent to a full bladder (green arrow).  This is a confirmation of the diagnosis, because there is no other internal organ the would be in this position, and have this anatomy, in an intact female.

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The picture below (CAUTION: may be graphic to some) is during the Spay surgical procedure.  Please note how FULL the uterus is of the infectious material.  In this case shown, it was even the “Open” form.  This dog was given large amounts of antibiotics and IV fluids, then immediately rushed to surgery.

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Odontoma

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This oral benign tumor that is effecting the dental structure is known as an Odontoma.  This was an incidental finding during a routine spay procedure and it affected teeth on both sides of the upper arcade in this specific case.  The arrows above show the abnormal growth of the teeth because of the tumor.  This dog was likely born with this malformation (aka congenital malformation) because she is only 6 months of age.  The bone structure of the jaw may be affected so the dental procedure of removing these teeth and tumor would need to be completed at a dental specialty center with specialized equipment and dental radiography.

 

 

Coccidiosis Infection

 

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This is a microscopic view from a fecal float that has Coccidia (Isospora species) oocysts present.   Coccidia is host specific and can not infect other species of animals.  Clinical signs for coccidiosis is watery-to-mucoid, possibly blood tinged, diarrhea.  It is most commonly seen in puppies and kittens and it may cause weakness if chronic and/or severe.  Animals are infected via the environment that has been contaminated.  They can carry it within their intestinal tract and may not show clinical signs until stressed.  Medications are available for treatment for the animals affected.  If dehydrated, fluid treatment may also need to be given.

 

 

 

 

Blister Beetle Poisoning

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These are Blister Beetles (three striped species).  They are mainly found in contaminated alfalfa hay or other alfalfa based products.  The actual toxin that effects mainly horses (also: cattle, goats, dogs, cats, and sheep) is Cantharidin.  It can be a mild toxicity to being fatal, and only a small amount of beetle consumption is needed (4-6 grams can be fatal).   The clinical signs seen in horses that have consumed Cantharidin range from lethargy/depression to shock and death, but most clinical signs seen are related to the GI tract and Kidneys.  The most frequent signs seen are lethargy, anorexia, colic, frequent small drinks/dunking nose in water, frequent urination (may contain blood), dark and congested gums.  Other less common signs include: oral erosions, bloody diarrhea,  stiff gait, laminitis, shock, and death.  If a horse ingests a large amount of this toxin, they may go into shock and death within hours of consumption.  Treatment is needed in all cases.  Hay fields need to be scanned, as well as entire bails of hay (1 flake in entire bail may be affected) in endemic areas.

 

More mites!?

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This is a microscopic view from a skin scraping of Demodex mites (cigar shaped with stubbed feet) that live on the skin within the hair follicles of dogs.  Common signs include patchy to diffuse hair loss (because the mites damage the follicle), itching (from probable skin infection), and reddening of the skin.  Common areas affected are around the eyes, axillary (armpit), feet, and flank.  It can be patchy spots or diffuse covering of the body.  It is mostly seen in juvenile animals, but less commonly can  affect adult animals.  It is NOT communicable to humans or other animals.  It is known to be genetically associated, so affected animals should be spayed/neutered and not used as breeding animals.  There are several options for treatment available, depending on the breed and needs of the dog affected.  Some animals may even need to use medications for life to control clinical signs, if initially severely effected.

Fungus Where?!

This 2-3 year old neutered male cat has a history of weight loss, lethargy, and a decrease in appetite.  He is Feline Leukemia virus and Infectious Anemia virus negative.  His blood work shows severe anemia (very low red blood cells), slightly low white blood cells.  He has lost a significant amount of weight over a 3 week time period.   X-rays  of his chest and his lungs show a typical pattern for a fungal lung infection in cats, which is typically an uncommon sickness.  The  Arrows point to examples of the abnormal “blotchy” pattern in the x-rays below (Lateral view on top and the VD/ laying on their back view).  A bird shot pellet is also found in this x-ray, but is insignificant at this time.

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A fine-needle aspirate of the lungs is then completed under anesthesia to confirm the diagnosis of Histoplasmosis.  The sample is stained and viewed under the microscope.  The arrows point to the actual fungal buds present(circles with halos) surrounded by the three purple stained white blood cells, which confirms the diagnosis.

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Histoplasma is found within dirt in the environment from feces of waterfowl.  The infection in cats shows as a respiratory illness.  It is very expensive (~$300/month), long-term (~6 months), with a guarded prognosis.  It cannot be transmitted directly to other animals or humans from the infected cat.  This cat is currently being treated and continuing to eat!

Hookworm eggs

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These are eggs from the intestinal parasites commonly known as “Hookworms” under the microscope.  There are two common species between cats and dogs known as Ancylostoma and Uncinaria.  They cause weight loss, dull hair coat, pot belly appearance, bloody stool, and vomiting.  Pets can pick up these intestinal parasites via the environment.  Children and the immunosuppressed are susceptible to this parasite and it causing “cutaneous larval migrans” (not an intestinal infestation) by walking around barefoot in the contaminated environment.  The larvae travel to the skin and live there and can cause serious infections!!!  Protect your children AND dogs/cats, de-worm your pets every 30 days!!!!

Calcium Oxalate Bladder Stone

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This is an ultrasound examination of the bladder of a dog that has had chronic urinary tract infections that currently has blood in the urine once again.  Ultrasound showed a very bright round stone.  A bladder stone will cause the black shadow below it, like in this ultrasound.  The urinary stones, in cats and dogs, cause chronic irritation with the increase in likelihood of infections and  urine blockage (emergency!).   Certain stones can be dissolved with prescription diets (Struvite), but this stone (Calcium oxalate), had to be removed via surgery (cystotomy) due to its composition.  The only way to distinguish the type of stone is via microscopy prior to surgery.  Dogs that have urinary stones and crystals need to be kept solely on prescription urinary diets for life to prevent this from occurring again.  The picture below, with a quarter for size comparison, shows the stone that was removed.

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Can you imagine this stone rolling around in your bladder!? OUCH!

A snapshot into fun and interesting cases within the veterinary field

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