Tuesday, August 30, 2011

Meet Matilda

By Beth Guerra, DVM
During my first week at ACCES, a stray bedraggled poodle came in through the ER. She had been found roaming the streets injured and a Good Samaritan contacted Seattle Animal Control to pick her up. She was initially assessed at another animal hospital before being transferred to our clinic to treat her injuries. She had no microchip or other identification, and after 3 days no owner had been found.
I was on a receiving shift when she came through the door. She was dirty, covered in fleas, and had bandages on both forelimbs. She was extremely shy and not making eye contact. The left forelimb had a degloving wound over the paw and wrist, but when I unwrapped the right forelimb, I was in for a shock. The limb was hanging at an odd angle, indicating a fracture, and the tissue was missing right down to the bone. The area was covered in dirt and fur. Although she was obviously in great pain, she tolerated an exam with no protests.
It must be said that I have a thing for small dogs, especially poodles. Our childhood dog growing up was a poodle, as was the dog my mom had before she married my dad. I already had one dog, a yorkie mix that I rescued from a shelter in Chicago, but my fiancé and I had just discussed getting a second dog to keep him company. We were planning on visiting the local shelter, and then this poodle landed in my lap.
That first day, we gave her some pain medications, antibiotics, and started her on IV fluids. X-rays confirmed that the limb was shattered and the joint was a mess. Extensive surgery would be needed to fix the limb. I got her set up in the ICU for the night, but after I left, I couldn’t stop thinking about her. I am quite an impulsive person, and I knew she would be our second dog.
The next day, I came in to find a technician sitting in her cage trying to hand feed her some kibble. She saw me and gave a wag of her tail, just a rhythmic thumping of the very end. The tech seemed surprised as she had given no other show of emotion so far. I immediately decided her name would be Matilda (I have no idea where it came from) and called Seattle Animal Control to inform them I would adopt her and assume responsibility for her medical care. I consulted with our surgeon about the wounds that day. There were two options; fuse the joint and repair the missing skin with a graft, or amputate the limb. For me, the decision was an easy one.
Three days after her right forelimb was amputated, I was brushing my teeth after a swing shift and she was following me around the house. It was 3am and I had no lights on. I heard a jingle and a series of thumps, and looked around to find she had descended a flight of stairs to chase after our cats. Then she came right back up the stairs without hesitating.
Since then, Matilda has been unstoppable. She jumps onto the bed with much more ease than our 4 legged dog. She goes for two mile runs without tiring. She uses her remaining forelimb to scratch at the door, or my leg, or whack our other dog on the head. We even have sweaters with one sleeve removed to accommodate her new form. When we are on walks, people often ask what happened to her leg. We make up stories that she was in a skiing accident or victim of a shark attack while surfing. People are surprised that she gets around so well, given that approximately 70% of a dog’s weight is carried on the forelimbs. She has adapted to life as a 3 legged canine. I realize that not everyone would make the same decision, but I do use Matilda as an example for my clients who may be faced with the same difficult decision.
If you are faced with having to decide whether an amputation will be the best decision for your pet, there is also a really useful website -

Wednesday, August 17, 2011

An Unlikely but Deadly Hazard-Vitamin D

By Beth Davidow, DVM DACVECC
The benefits of Vitamin D have been much in the news. Vitamin D is that funny vitamin that is produced in your skin after exposure to the sun, specifically ultraviolet B light.  Vitamin D from your skin is converted to the hormone calcitriol which regulates the calcium and phosphorus balance in your body.  Lack of Vitamin D can lead to rickets in children, a problem where the bones become overly brittle, don’t grow normally or deform. Lack of vitamin D is also a risk factor for osteoporosis in adults.  These diseases are why milk is supplemented with Vitamin D. 
Vitamin D’s recent newsworthiness has come from observational studies that have suggested that low Vitamin D may increase the risk of certain neurologic diseases such as multiple sclerosis, Alzheimer’s, and Parkinson’s.  In addition, low vitamin D levels may be a risk factor for some cancers and peripheral artery disease. Increased daily intake levels were recently recommended by the Institutes of Health leading many people, especially in locales with low sunlight, to start taking Vitamin D supplements
            Although a certain amount of a vitamin will improve your health, too much can lead to toxicity.  Daisy Mae, a 5yr female Basset hound cross, found her owner’s very concentrated liquid vitamin D supplement and drank the content of the bottle.  Daily recommended Vitamin D is about 600 IU for a child.  Daisy Mae drank about 1.2 million IU!  While normal Vitamin D will maintain the right amount of calcium and phosphorus for normal bone growth and strength, toxic levels of Vitamin D can lead to calcification of tissues other than bone.  In addition, the increased calcium and phosphorus in the blood can lead to acute insults to the kidney and possibly renal failure.
            The ASPCA National Animal Poison Center was consulted as soon as Daisy Mae presented to ACCES and they recommended aggressive treatment to try to prevent calcification of her tissues.  Daisy Mae was made to vomit and then given activated charcoal to try to bind up any of the vitamin D still left in her intestinal tract.  She was also given an intravenous lipid infusion.  This is a newer treatment for toxins that are fat soluble to try to pull the toxin out of the tissues.  She was also placed on IV fluids to try to flush any accumulating calcium out of her kidneys.
            However, after 24 hours, Daisy Mae’s calcium and phosphorus had both risen to higher than normal levels.  We then started furosemide, a medication to make her urinate more and to increase the calcium being excreted and a steroid.  The calcium and phosphorus stayed high so we then gave a medication called pamidronate.
            Despite all these treatments, Daisy Mae’s calcium and phosphorus remained stubbornly high for 10 days in ICU!  Finally, levels fell back to normal. Luckily, Daisy Mae never felt sick and the treatments were able to protect her from any adverse effects on her kidneys.
            Animals can get a similar toxicity from a Vitamin D type ointment called Calcipotriene, marked as Dovonex®, which is used to treat psoriasis.  Even as little as 1.25 teaspoons can cause problems in a dog.           
The lesson from Daisy Mae is to remember that even supplements and vitamins can be dangerous.  If your pet gets into a medication or supplement, contact your veterinarian, your local emergency veterinarian, or the ASPCA National Animal Poison Center as soon as possible.  Without treatment in this case, permanent renal damage could have occurred. Luckily, Daisy Mae is now home and doing great.

Monday, August 1, 2011

Saving Lives: ACCES & The Seattle Humane Society Team up to give Tully a second chance at life

Recently, ACCES had the opportunity to work with the Seattle Humane Society to help a critically ill young dog. Tully, an approximately 2 year old, female Chihuahua was soon to be euthanized in an animal shelter in Los Angeles when the Seattle Humane Society agreed to care for her and find her a home. Tully arrived at the shelter in Bellevue emaciated, covered in fleas, and pregnant. Over the course of her first days in Seattle, Tully started having a hard time breathing until on the afternoon of Tuesday, June 14, it was clear that Tully’s condition was deteriorating. Hopeful that cause of Tully’s increased respiratory rate and effort was a fixable condition, the Humane Society referred Tully to ACCES for further diagnostic tests and care.
Tully was admitted by an emergency clinician, Dr. Julie March, and immediately radiographs were taken of Tully’s chest. The radiographs were diagnostic of a diaphragmatic hernia. The diaphragm is a musculotendinous partition that separates the chest from the abdomen. Loss of this separation allows the abdominal organs to enter the chest cavity and interfere with the lung’s ability to fill expand and ventilate normally.
The diaphragm is made up of a muscular portion that attaches to the ribs on both sides and a central tendinous region. The aorta, vena cava and other veins, esophagus, and lymphatic system pass through openings in the diaphragm. Hernias can be either congenital, in which one or both muscular portions of the diaphragm fails to develop or fails to fuse centrally, or traumatic, in which injury to the diaphragm can cause a tear in normally developed diaphragm. This is a common sequelae after dogs and cats get hit by cars.
Treatment of this condition requires surgery to repair or reconstruct the diaphragm. Complications can arise when the abdominal organs have been present in the thoracic cavity and have adhered to structures within the chest or to the chest wall. Or in congenital diaphragmatic hernias when abdominal organs develop within the chest and may not mechanically be reduced into the abdomen even with surgery.

Tully’s condition was complicated by the fact that she was pregnant. The puppies had mineralized skeletons but whether or not they were near term was yet unknown.  A decision was made to take Tully to emergency surgery to relieve the lung compression and repair the diaphragm. Since Tully was pregnant, it was also decided to perform a cesarian section to try to save the puppies since they would be unlikely to survive a long anesthetic procedure.
Tully was quickly anesthetized and taken to surgery.  Four puppies were retrieved and resuscitation of the puppies was initiated. Tully’s entire gastrointestinal tract, spleen, omentum and the majority of her liver had been pushed into her chest through a very large hole in the right side of her diaphragm. Her abdominal organs were replaced into her abdomen and closer inspection revealed the hernia to likely have been congenital.  It was necessary to also approach the diaphragm from her chest to get adequate access for repair. By advancing the diaphragm and part of the abdomimal wall forward and towards the left side, it was possible to close the hole in Tully’s diaphragm.
Tully had a rough recovery from anesthesia and struggled to reinflate her lungs and breath normally. She was treated with oxygen therapy overnight and by morning was breathing more comfortably. Unfortunately, Tully’s puppies did not survive. After several days of further supportive care, Tully returned to the Seattle Humane Society where she was put into foster care. Tully appears to be adapting well to her new home. We hope she finds a fantastic new family soon.

Tully is now waiting for her forever home in foster care.

Tully, fully recovered, is happy and healthy.