Speedy is an 8 month old domestic short hair cat that presented on emergency to Dr. Rice. Her owner found her with extensive wounds to her abdomen (almost complete deglovement) and very weak when she got home from work — on presentation she was in critical condition and minimally responsive. She was stabilized and started on antibiotics that night in preparation for more extensive evaluation the next day.
The following day Speedy was re-evaluated where it was found she was very neurologic – she could not stand and was very stiff on one side of her body, but she was stable otherwise so she was put under anesthesia to more thoroughly explore and clean/debride her wounds. While cleaning her wounds and evaluating the damage it became clear there was a hole in her abdomen within the wounds, but the omentum (the fatty part that holds all the intestines together) had sealed it well enough that even on radiographs the night before there was no air in the abdomen like you would expect with an abdominal puncture.
The abdominal hole was fixed and her wounds appropriately treated. She stayed with us for 5 days for wound management, physical therapy, and laser therapy to improve her movement and help with healing of her wounds prior to going home. Some of her wounds were left to heal on their own, but 3 weeks later Speedy was running around the house again true to her name. She was a very lucky kitty and definitely a fighter to get through such a traumatic event!
Katie is a 10 year old beagle that presented for a sudden enlargement in her inguinal region. On exam it was not painful, but it was increasing in size so we opted to do surgery to explore this area as a hernia was on the list of differentials. During surgery we found something we had never seen before…her uterus had herniated through the body wall! Her incision was extended into the abdomen where we pulled the uterus back into the abdomen and spayed her prior to closing both incisions and the hernia site.
Older dog with a mysterious problem –
‘RAFE’ is a 13 yr old Bull Mastiff/mixed breed dog. Rafe was presented to MMVS for occasional vomiting and ‘ADR’, ‘ain’t doin right’ a couple times within a 4 month period. Rafe lives on a farm and likes to eat/chew on lots of things he shouldn’t, so he was treated symptomatically and each time he seemed to return to his normal, happy-go-lucky self. Blood work was also performed at the second visit, with no significant abnormalities seen. When these signs recurred a third time, we performed some more thorough diagnostics to see if there could be an underlying cause for the repeated episodes of malaise, poor appetite, and vomiting.
To start off working up a case of ‘ADR’ in a dog, we got blood samples to repeat the complete blood count (CBC) and a basic chemistry panel. The CBC measures several parameters of the red and white blood cells levels, and platelets. It basically evaluates function of the bone marrow and tells us if the bone marrow is meeting the needs of the patient. The results of the CBC were fairly normal; two of the white blood cell types were a bit out of range, but not seriously at this time. Rate’s RBC parameters were normal, so no anemia was present; his platelet count was also normal.
The chemistry panel was mostly normal as well, however, there were 3 changes that were alarmingly out of range. His total calcium, protein and globulin levels were all quite elevated. His protein was almost 11 mg/dl; it should be less than 8.2, and his calcium was almost 15 mg/dl; it should be less than 12. Globulins are types of proteins; many are the immunoglobulins we call antibodies. Protein and globulin levels can increase with inflammation or infection and with significant dehydration. The latter was not present, so we then needed to look for a cause of inflammation or infection. We did not find focus of infection anywhere based on our physical examination, so we started to look for a source of inflammation. In dogs, the combination of a hyperproteinemia, hyperglobulinemia, and hypercalcemia can be associated with some types of cancer, especially lymphoma, plasma cell myeloma, and anal sac adenocarcinoma. The cancer cells produce a protein that causes resorption of bone; this increases calcium levels in the blood. So, unfortunately, we started looking for a tumor somewhere.
For the next step, we ultrasounded the abdomen (Dr. Sjoberg actually) and took radiographs of the chest and abdomen. No abnormalities were found on the radiographs, but there were some very unusual areas in the spleen seen with the ultrasound. Ultrasound sends sound waves through tissue. The sound waves bounce back and are collected by the machine and converted to images. The ultrasound images produced are specific to the organ or type of tissue examined. When more sound is reflected (denser tissue), the image has more white present, less dense tissue varies from gray to black. For example, urine is black, but the bladder wall is white. Most of the time, cancer shows up like an irregular area that is ‘HYPER-echoic’ with ultrasound – it’s pattern is different from the normal tissue and it looks ‘whiter’ as this tissue reflects more sound than the normal tissue. However, in this case, we found something different – there were many areas in Rafe’s spleen that were actually HYPO-echoic – they were less white than the surrounding tissue. In fact it looked like scattered islands of pale tissue in a sea of normal tissue. Although this is an unusual finding, the spleen can have areas where white blood cells collect and produce antibodies, but these are rarely seen on ultrasound. This function was greatly exaggerated in Rafe’s spleen, suggesting that these were areas where abnormal cells were located, producing the extra globulins. So, what to do next?
Took a day and got some information on diagnosis of plasma cell myeloma. Then we got Rafe back to the clinic and performed a couple fine needle aspirates (FNAs; Dr. Rice, actually) of the spleen. These are small samples of the splenic tissue that can be spread on a slide and sent to a pathologist for evaluation. We also took blood and urine samples to determine what kind of globulins were present.
The FNA of the spleen showed evidence of a sarcoma, with collections of a single type of round cells; the pathologist felt these were likely plasma cells. The blood and urine samples both had very high levels of a single type of beta-globulin; this evidence supported the diagnosis of plasma cell myeloma (PCM). This is a cancer of plasma cells, a specialized type of lymphocyte whose primary job is to produce antibodies -> globulins.
So, we had a diagnosis, now how to treat – PCM is usually treated with steroids and a drug called melphalan. Both work to suppress the immune system, decreasing the number of plasma cells, and/or decreasing the production of globulin by the cells. We actually started Rafe on predisone (a steroid) while waiting for the last results because he was actually getting a bit worse, not eating well at all, very lethargic, and he was becoming anemic. When these results returned, a source of the melphalan was obtained and Rafe is currently on maintenance doses of both drugs. The steroids actually made him feel a lot better very quickly. A recent recheck of his blood work showed that Rafe’s protein levels are down to normal levels and his anemia is resolved. He is feeling much better – back to going on trips to the lake and romps through the woods with his owners. Although we are not likely to be able to stop this disease completely, with Rafe’s very dedicated owners, we are striving to help him enjoy life as long as possible. So far, it’s working – Rafe’s back at the lake, on his boat, snoozing in the sun!
Oscar and Groot
These boys are 6 month old bucklings that presented separately on the same day for “screaming their lungs out” and acting painful when they tried to urinate according to the owner. On presentation, they were dribbling urine, but were unable to create a full stream and ultrasound revealed a very distended bladder. The most common thing to cause this problem in male goats is urolithiasis (urinary stones that get stuck and block the flow within the urethra). The first step in any goat urolithiasis case is to snip the urethral process (“the pizzle”), which is a small amount of tissue on the end of the penis that has a sharp turn with a narrow hole because this is the most common place stones get stuck due to the anatomy. Stones could be palpated in both bucklings in that area so when we removed the process they were able urinate normally and felt much better.
There are cases where they have stones stuck in other places in the urethra because a goats’ penis is in the shape of an “S” so its best to implement management practices that do not predispose them to stones such as the following:
-Feed as little grain as possible – goats do much better on just roughage (hay/grass) and grains tend to change things in the body that lead to formation of stones
-Do not castrate until males are 6 months old to allow their urethra to mature to full size.
Two Socks, a 13 year old female spayed cat, presented to our clinic for lethargy and weight loss after being gone for a few days. During the initial exam, she appeared normal except for a yellow tint on the white part of her eyes and inside her ears. After a series of blood work, it was determined that she was suffering from hepatic lipidosis, commonly known as fatty liver disease. Attempts to medicate her and feed a prescription diet for liver disease were unsuccessful and her appetite completely diminished. Lack of eating put more strain on the liver and her condition was worsening. To be able to give Two Socks a chance to turn things around we had to get her to eat so a feeding tube was placed and small amounts of watered down canned food was passed through the tube (gradually increasing the amount). Once she was stable and nibbling on bits of tuna and chicken, she was discharged back to her owners. Their commitment and diligence to her feeding tube treatment was the turning point for Two Socks. Her appetite increased and she began eating more solid foods and started gaining weight. As her liver values improved, it was time to pull the feeding tube. In fact, it was Two Socks herself that initiated the tube removal, and her concerned owner successfully finished it with our guidance – she is one of our favorite success stories!
La Vikina is a 5Y racing quarter horse mare that presented to MMVS in May 2019 for coughingheavily and having occasional clear nasal discharge in addition to having very little appetite – this from a mare who tries to steal her neighbor’s food! The owner had already tried soaking her hay and wetting her stall to prevent dust from stirring up, but she was still coughing consistently without relief.
On examination she was bright, alert, and responsive. She had an overall normal exam except for the coughing and crackles that were heard in her lungs. Dr. Rice used the ultrasound to look at her lungs, which showed areas of consolidation (fluid and abnormal lung tissue) throughout her lungs on both sides—she had a severe pneumonia!
Her bloodwork supported her diagnosis as she had a high white blood cell count and her fibrinogen was increased (this usually increases when the body is trying to fight something).
She was treated with 2 different antibiotics over 2 months’ time with rechecks along the way. After she was improving at a steady rate we started her on a slowly increasing exercise routine to build her back up to her previously normal work load and mid-July she received a clean bill of health and performed well under saddle.
Just about a month after she was cleared she entered her first race since before she got sick and won by 5 strides! We are very happy to see her healthy and back out on the track!