The one in which Panda gets spayed

Momma has a strict rule at our house: "No babies." So last week, she told me it was time to "fix me," so I did not have babies. I did not think I needed to be fixed. I thought I was perfect, just the way I was. But after all, I am the baby of this house, and I do not want any other babies to come along and be more specialer than me, so I agreed to this "fixing" thing.
First, they put me in a cage at The Work. I am not usually in these metal cages. I usually have my own room at The Work, with my toys and bowls and things. This cage is different. I thought maybe I should worry, but somehow, I was so tired, I could not keep my eyes open, let alone worry about anything.
"Katie, I feel really funny. Please hold me close - this room is spinning."
They put a little stick in my arm and then I went from a little bit sleepy to all the way asleep, and after that, I do not remember much, but Momma and Katie took lots of pictures, and this is what they said was next.
They opened up my mouth. I have a really big mouth, and I am proud of it. Look how big my mouth is!
They put this tube in my mouth and all the way into my breathing tube. I did not feel the tube, and I do not remember it, but Momma says it is real, real important to have this tube in when you are asleep, especially if you have a smooshie face like me.
I do not think this is a very nice picture of me, and I do not like it that Momma put it in the blog.They scrubbed my tummy, to make it all clean. I have a bath every week, and I wash my hands and face every day myself, so I did not think I was very dirty, but they told me I had to be extra-special clean for the fixing.

They took me into the room with the bright lights and the table that moves up and down. I see this room every day, and I know that they take sleepy dogs and cats in here all the time and they are all OK, so I knew I would be, too.

They put me on my back on the special table, and underneath me was a blanket with warm water running through it that helped keep me warm. This is very important when you are very little, because being cold makes it harder to wake up later.
They put a thing around my ankle to give me Blood Pressure and tied my arms down so I would not roll around. Then Momma put on some really ugly clothes and covered me all up with a blue thing. You cannot even see me, but I am there, under the blue thing. Kate is checking to make sure I am still there.
Please do not laugh at Momma in her ugly clothes that do not match. She does not have any "fashion sense."OK, now we are all ready to go.
The next pictures might make some of you feel icky, but I think it is pretty neat to see what my insides look like. If some of you have girl dogs, you might like to see my insides, too, so you know what happened to your dogs during the fixing. It is OK - you can look.

Besides, I really like Momma's hands. Her hands are the best part of her. She can do lots of special things with her hands, like the fixing, so you should watch. (I will let Momma 'splain what she is doing.)

first incision, through the skin

second incision, abdominal wall

using a spay hook to find the uterus

exteriorizing uterus

tugging on uterus to exteriorize ovary

pointing out ovary

triple clamp technique

cut between clamps

ligating ovarian pedicle

double ligatures for safety

both ovaries ligated

pointing out cervix

ligating uterine body

complete ovariohysterectomy
(removal of ovaries and uterus)

closing abdominal layer

closing skin layer

surgery finished

Kate thought she would be funny with me while I was asleep. Momma says she hopes the doctors and nurses who do the fixing to people do not make fun of them when they are asleep.

The black clip on my tongue is to see that I have enough oxygen in my blood. It does not pinch or hurt. I am not sure what oxygen is, but I am glad that I had enough.

This picture is when I was starting to wake up, but I could not swallow yet. Momma says it is important to leave the breathing tube in smooshie faced dogs until they are able to swallow, so that they do not choke. I think I remember this part, but maybe I just dreamed it.
It is good to have a friend with you when you wake up from the fixing. I am glad that Momma thought to bring my pink pig that day, and that they gave it to me. It made waking up nicer.
But, it is even better to be held and carried around when you are so sleepy, like Amanda did for me. It felt so good, I went back to sleep on her shoulder.
And so, now I am home and everything is all right, really. Momma gives me a little pill in my dinner every night, which is supposed to help with the belly pain, even though I do not have any belly pain. I tell her I am a big dog, and strong and brave, but she just smiles and gives me the belly pain pill anyway.
The only bad part is Momma says "Cage rest and leash walk only" for at least a week, and I want to run and jump on things and play with Holly and torture the cats and she says "No." Do you know how long a week is? Because I do not and I think it must be a really long time.

Can I gross you out? version 2.0

Same warning as before: Look away if you have a low tolerance for ick.

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Still with me? OK, then, take a look at this dirty, infected laceration on the neck of a 9 year old Pug. Any idea what caused it?After sedating Miss Pugg (name changed to comply with HYPPA laws) we began shaving the wound to inspect it more closely. This is the underside of the neck, but the line goes all the way around the sideand across the back, completely encircling the poor dog's neck.In the past, the culprit would have been a rubber band, applied maliciously or perhaps innocently. Today, we have a new foe:Yep, "Silly Bandz," a rubber band updated for the 2010's, but just as tight and constricting as the original version. The family's small boy thought it was a good idea to put this modern day torture device around the dog's neck. (And then, the family went on vacation, leaving the dog at home.)

This wound is at least a week old. The poor dog has had a rubber band around her neck for seven or more days. Do me a favor: Put a tight rubber band around your wrist for 15 minutes, and tell me how it feels. Now, imagine how this dog felt for the past 168 hours. It makes me disgusted.

We scrubbed the wound with an antiseptic solution, then flushed it with sterile saline.
In a perfect world, the dog would have been anesthetized for me to trim and debride the wound edges and suture it closed for primary healing. Unfortunately, the owner was unable (or unwilling) to make the financial commitment for appropriate therapy. Instead, I gave her antibiotics and pain meds, and I am hoping that Nature will help me out with good second intention healing.

Look at this brave old girl. Against all odds, she was gentle and sweet and cooperative throughout the whole treatment. Dog lovers out there, send up a prayer for Miss Pugg tonight.

Update, Aug. 25: Here's the wound 5 days later. Granulation tissue is filling in the defect and Miss Pugg is recovering nicely. Thank goodness for Mother Nature and second intention healing!

What's Your Diagnosis?

My bimonthly JAVMA (Journal of the American Veterinary Association) has a regular feature called "What's Your Diagnosis?" (Or, as my sister always called it, "Exhibit Your Symptoms.") Each month, one or more X-ray pictures are printed, and the reader is given a brief synopsis of the case and invited to make a diagnosis. It always makes my day if I can guess it correctly.

Today, I present to you a real life "What's your diagnosis" from a case I saw this afternoon. Here's the history: An elderly woman fell last evening while carrying her 9 week old kitten. Both lady and kitten appeared to be unhurt at the time. Today, however, the kitty had a very swollen neck. Fearing the kitten's neck was broken, the son brought him in to my office at about 1:30pm.

The kitten was obviously distressed, breathing with increased effort, and his gums were cyanotic (bluish in color) indicating a lack of oxygen. He was walking OK, but seemed to tired easily. His neurological reflexes were normal, so I was reassured that his spine was not damaged.

However, his neck was very puffy, and this swelling extended along his back and chest, right down to the kitty equivalent of a waist.

Here's the lateral view X-ray. It's has been a while since we have done this; do you remember how to read an X-ray? Bones are white, air is black, and soft tissues (organs, blood, etc.) are shades of gray. The kitten is lying on his side. His head is on our left, his tail to our right.

[Click on any photo to enlarge.]

Here's a slightly closer view. What do you think?
Go ahead, take your time. I'll wait.

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Give up? That's OK, this is a toughie. It may comfort you to know that this is only the second time I have seen this problem, and the first time I have seen it caused by a fall.

Check out this labeled version of the first film. The skin is lifted away from the underlying tissues, and all those black spaces are collections of air under the skin. The technical term is subcutaneous emphysema. I have indicated several of the pockets of air with red *.
The kitten has a tracheal rupture. Every time he breathes in, some air goes into the lung, but some also escapes through the tear in the trachea and ends up under the skin. Because of the one-way valve effect, when he breathes out, the air is trapped there and slowly accumulates.

You can diagnose this on a physical exam, by the crackling, popping feeling you get when you run your finger tips over the skin and press in slightly.

Although this is a bad injury, believe it or not, mild cases of tracheal rupture can be treated with conservative medical management. However, let's look at that X-ray again.In this closer image, we are focusing our attention on the chest cavity. Anything about this picture bother anybody?

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Let's look at the labeled version. The kitten's heart should be in contact with his sternum (breastbone.) Instead, it is elevated, lifted up by an accumulation of air in the chest cavity. One lung is all black, filled with air, while the other is much smaller and gray in color. That lung has collapsed.
Not only does he have a ruptured trachea, he also has a pneumothorax. Now, his prognosis for survival has taken a big step backwards. If we were to attempt treatment, he would need a chest tube to evacuate the air, a tracheoscopy (using a small diameter endoscope to look down his trachea) to attempt to find the rupture, and a surgical specialist to try to find and repair the damage, if possible.

But wait! Kitty's story is not over. When the owner woke to find her kitten in distress, she tried to help him by crushing up a 200mg ibuprofen tablet and mixing an unknown quantity of the powder into some milk. As we all know from Toxicology Tuesday, Non-Steroidal AntiInflammatory Drugs (NSAIDs) like ibuprofen are deadly poisons for cats.

Now, we have a ruptured trachea, pneumothorax, and potential ibuprofen toxicity. Oh, and did I mention that the clients don't have any money? I suppose you can guess the final outcome of this case.

In my job, as in my life, I try to find the good in everything. This case was tragic and very sad, but I was able to turn it into a teaching opportunity for the hospital staff and you, my gentle readers.

Let's see if I can gross you out

[If you have a sensitive stomach,

you might want to skip today's post.]

A client brought in a new-found kitten today with a sore on its neck. I was excited before I even saw the patient, because a sore on the neck of a kitten in summer usually means one of my favorite summer time conditions: Cuterebra!

But, I am getting ahead of myself. Let's go back to the beginning and that moist, icky sore on the neck of an 8 week old kitten.

Is it an abscess? A bite wound? No, it's not.

Look closely at the hole. See the little white thing sticking out, with a dark ring in the center?Here, I'll point it out to you.

A close-up (Forgive the fuzzy focus - I was using the little point and shoot belonging to the office, not my Canon Rebel.)

What could it be?

It is a spiracle, the breathing apparatus of a warble, the larval form of the Cuterebra fly, which is a member of the botfly family. Similar botflies include the ox warble that causes "grubby back" in cattle, the stomach bot in horses, and the nasal bot of sheep.

Cuterebra primarily infest rabbits, although cats, and occasionally dogs, may be victims. The female fly lays its eggs on plants along paths frequented by rabbits. When the rabbit passes by, the eggs hatch instantly and the larvae crawl onto the host's fur. They enter the body through natural openings, (nose, mouth, anus, etc.) and migrate under the skin. They usually end up in the neck area, although I have found them on other body parts.

The larva cuts a breathing port through the host's skin and attaches its spiracles. These respiratory openings, it should be noted, are at the butt end of the grub, not the head end like you might expect. Not pertinent to treatment, just a fun factoid I like to share.

The developing organism sets up a strong inflammatory reaction in the rabbit or cat, leading to moist, painful wounds like we see here. A warble wound may resemble a standard cat bite abscess but for one thing: if you observe the opening carefully, you can see the movement of the larva at the breathing port.

That's where I come in. Rather than allowing the warble to finish its life cycle, enlarge its breathing port and drop to the ground to complete its metamorphosis to an adult fly, I swoop in to remove the little bugger. Just a small nick to enlarge the hole, and I can grasp the butt of the warble and slowly, carefully extract it.

(Please excuse the Band-Aid. A slip with a dental elevator earlier in the day gouged my thumb.)

TA-DAH! Victory!

Here's an even better shot, complete with a centimeter ruler for scale.

Astute readers will note that the warble itself sustained an injury during the extraction process. This is the first warble I have ruptured during removal, and luckily, it happened after that part of the larva was out of the kitten's body. If a warble is ruptured under the skin, it could set up an anaphylactoid reaction that might prove fatal. For that reason, warbles should not be casually squeezed out of the hole, but removed delicately.

After the minor surgery, we cleaned up the kitty's neck and gave her an antibiotic injection. The wound is not sutured, but allowed to close on its own. Once healed, in 7 to 10 days, she'll be as good as new.

Update, Aug. 2:

Three days after warble removal, look how much better the wound looks.Even the kitty is happy about the outcome.