Rookie's Foreign Body

Rookie waking up from anesthesia.

Rookie is a 2-year-old male domestic shorthair cat who was recently admitted to CUVS. Rookie's owner noticed a couple things that spurred her to bring Rookie in: he had started acting differently and dry heaving occasionally without bringing anything up. He was eating and drinking less than normal and his bowel movements were infrequent. As an indoor cat, Rookie normally doesn't get into much trouble (besides finding hair ties on the floor and batting them around). However, his owner also noticed a lump that had formed under Rookie's jawline, and at that point she decided to bring Rookie to CUVS.

Close-up view (inset) of the end of the needle (with black thread) embedded in Rookie's throat. Click to enlarge image.

Rookie was seen by emergency veterinarian Dr. Michael McCann, DVM, who performed a physical exam and found that Rookie had an elevated temperature, and that the composition of the submandibular mass was abnormal. Palpation of the mass revealed the suspected presence of a hard object within the swelling. Together, Dr. McCann and Dr. Melissa McDaniel, DVM, MPH, performed an exam of Rookie's mouth and throat. A sharp metal object was seen protruding from the right ventral oropharyngeal region, just caudal to the back of the tongue (behind the tongue, protruding from the bottom right side of the wall of the throat).

Two radiographic views showing the location of the foreign body.

Dr. McCann ordered two radiographs of the neck and head. A linear metal object of uniform thickness from end to end was visualized adjacent to the mandible. Rookie was then intubated and prepared for surgery to remove the foreign object. A hemostat was clamped onto the foreign object from within the oropharynx to prevent accidental loss of the object into the mouth upon removal. An incision was made in the skin just over the top of the mandible, not only to easily remove the foreign object, but to allow the wound to drain afterward. The incision revealed the foreign object to be a sewing needle with a few millimeters of thread still attached. The needle and thread were removed, along with some purulent debris (commonly called pus). The wound was cultured and sent out to the lab for analysis, and it was thoroughly irrigated with sterile saline.  The surgery went very well and Rookie recovered uneventfully.  Rookie spent the night at CUVS to continue to receive supportive care, pain medication and antibiotics. The next morning he was discharged back into the care of his observant and concerned owner with more antibiotics and pain medication. 

Close-up of the needle and thread removed from Rookie's throat.

While the above case sounds fairly simple and uneventful, it should be noted that this particular cat was very lucky: lucky to have an attentive owner, lucky to be seen quickly at a high-tech animal hospital, and lucky that he did not sustain more serious injuries from ingesting the needle. This is a great reminder to all of us: cats and dogs frequently play with and explore objects with their mouths. This is a natural behavior that can lead to big trouble if they find something dangerous. We should all take the time to pick up and put away anything potentially harmful to our pets so we can keep them safe.

April 10th Pet Health Education Sessions: CPCR and First Aid for Your Pet

Cornell University Veterinary Specialists is proud to provide pet health educational sessions for owners, starting with our first session:


Sunday, April 10, 2-3:30 PM
CPCR and First Aid for Your Pet, led by Debbie Glynn, BS, LVT

Do you know what to do if your pet has been hit by a car, suffers from heat stroke or gets stung by a bee? This class is designed to teach you the basics of first aid and Cardiopulmonary Cerebral Resuscitation (CPCR formerly known as CPR) for your pet. You will learn everything from at-home splints/bandages to chest compressions so that you can be the first responder for your pet.

If you are interested in attending any of these classes or learning more about our pet health educational sessions, please call us at 203-595-2777 or email us at info@cuvs.org. Space is limited and reservations are required for attendance. All classes are held at CUVS. Please check back often for session updates.

Zolty's Heart Surgery at CUVS

Zolty is an amazingly sweet 9-year-old Golden Retriever who was born on Valentine's Day in 2002. Zolty's owners recently noticed an acute onset of extreme weakness, prompting them to take Zolty to see Dr. Nolan Zeide, their regular vet at Bull's Head Pet Hospital. After a thorough examination, Dr. Zeide found that Zolty suffered from pericardial effusion and a condition called cardiac tamponade. In layman's terms, pericardial effusion is the accumulation of excess fluid around the heart. Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up between the heart and the outer covering of the heart. Dr. Zeide referred Zolty to Cornell University Veterinary Specialists for further evaluation and treatment.

When Zolty arrived at CUVS, he was extremely weak with a fast heart rate and weak pulses. His heart sounds were barely audible with a stethoscope. One of the first diagnostic tests run on Zolty at CUVS was an echocardiogram, which confirmed Dr. Zeide's findings of pericardial effusion and cardiac tamponade. Additionally, a mass was located on the right side of Zolty's heart.

In order to alleviate the stress created by fluid buildup on the outside of Zolty's heart, criticalist Dr. Sergi Serrano, LV, DVM, DECC performed an ultrasound-guided pericardiocentesis. In other words, Dr. Serrano used ultrasound as a means of guidance to insert a needle into the sac surrounding Zolty's heart and remove the excess fluid that was trapped there. After Dr. Serrano removed 100mls of fluid, Zolty's tampanade resolved on its own and his heartrate returned to normal. While this remarkable turnaround sounds exciting, it was simply a temporary fix for the symptoms associated with a larger problem: the mass on Zolty's heart. It should be noted that Zolty still had arrhythmias, or abnormal electrical patterns within his heart, and that the fluid would have continued to fill up within the outer covering surrounding Zolty's heart if no further action was taken.

After a consultation with Dr. Serrano, Zolty's owners decided that they wanted to have the mass removed from Zolty's heart. A second consultation with Dr. Mandi Kleman, DVM, DACVIM (Cardiology) involved more detailed and extensive analysis of Zolty’s heart and the mass. Using echocardiogram, Dr. Kleman found that the pumping function of Zolty's heart was moderately depressed. Additionally, she described the location, size, and appearance of the mass within the edge of the right atrium. Based on these findings, she suspected to be a malignant type of cancer called hemangiosarcoma.

Zolty's large run allowed him to stretch out and relax post-surgery.

After the values of a full blood test were found to be favorable, and no metastatic disease was discovered on abdominal ultrasound, Dr. Alon Kramer, DVM , DACVS scrubbed in to perform Zolty's heart surgery. Zolty’s surgery involved a thoracotomy (open chest surgery) to allow exposure, and careful excision of his heart’s right atrial mass. Dr. Kramer also removed part of Zolty’s pericardial sac (the outer covering of the heart) to prevent any future fluid accumulation. The surgery went very well, despite being a technically difficult procedure. Zolty recovered recovered uneventfully and was comfortable in our ICU shortly afterwards. After the surgery, the mass was sent out to the lab for a histopathology and analysis.

Zolty relaxes in his run in ICU while we monitor his heart functions post-surgery.

Zolty stayed in the ICU for four days after surgery for close monitoring and pain and arrhythmia management, during which time he successfully won over every single employee that participated in his care.

Zolty and critical care technician Stephanie Phillips, BA, AAS, LVT

After his stay in ICU was over, Zolty was discharged to his owners with a Holter Monitor, which is an ambulatory device that measures heart rate and rhythm for 24 hours. The beauty of these devices is that they can be worn by the patient while resting in the comfort of their home. The dog can relax while the Holter monitor acts like a portable ECG, recording information about the heart that can be downloaded later for analysis. Heart rhythm abnormalities can vary from hour to hour, so without a portable device like the Holter monitor, the animal could experience abnormalities while away from the animal clinic that would otherwise be missed by the doctor. Zolty stayed at home resting for 24 hours while wearing the Holter monitor, and then he was brought back to CUVS to have the monitor removed. The data was then downloaded and analyzed. We were all pleased to find that the Holter monitor showed no evidence of concerning arrhythmias post-surgery.

The histopathology report on the heart mass did reveal cells consistent with hemangiosarcoma, confirming Dr. Serrano and Dr. Kleman’s pre-surgical suspicions. Hemangiosarcoma is a form of malignant cancer. Zolty is currently being seen by CUVS oncologist Dr. Edwin Brodsky, DVM, DACVIM (Oncology) who has begun treating him with chemotherapy. Chemotherapy does not usually make animals feel ill like it can do to humans. The use of chemotherapy in animals is not meant to absolutely cure the cancer; rather, it is a way to prolong a good quality of life. As such, we are very happy that we were able to give this wonderful dog more time with his owners. Zolty is an amazing animal who deserves to live a comfortable life, and we all feel blessed to be able to help with that.

Inside Cornell: Cutting Balloon Valvuloplasty for Subaortic Stenosis

Our own Dr. Mandi Kleman, DVM, DACVIM (Cardiology) and Dr. Susan Hackner, BVSc, MRCVS, DACVIM (Internal Medicine), DACVECC (and CMO of Cornell University Veterinary Specialists) participated in the most recent Inside Cornell event in New York City. Dr. Kleman discussed treating subaortic stenosis (SAS) in pets utilizing novel balloon valvuloplasty with cutting balloons and high-pressure balloons. The video can also be viewed on Cornell's website, and the Inside Cornell event is discussed on the CU in the City blog.

Scottie's Pacemaker Implantation at CUVS

Scottie is a very special male 7-year-old Pembroke Welsh Corgi who has previously enjoyed Championships in multiple US and Canadian dog shows. He has also received titles for herding ducks and sheep. Unfortunately, Scottie's owner, Mari Carroll, noticed over the past few weeks that he had become exercise intolerant and less interested in playing with the other dogs in the household. Scottie was brought to his regular vet for an exam. While at the vet's office, he suffered four fainting episodes (syncope). The results of an electrocardiogram (ECG) were cause for concern and Scottie's veterinarian immediately referred him to the Emergency and Critical Care service of Cornell University Veterinary Specialists (CUVS) for a consultation with cardiologist Dr. Mandi Kleman, DVM, DACVIM (Cardiology).

Upon arriving at CUVS, Scottie experienced another episode of fainting and collapse, and he was immediately brought into the Emergency service for stabilization under the care of Dr. Sergi Serrano, LV, DVM, DACVECC. A repeat ECG showed complete heart block. After discussing all of the options with the owners, Dr. Serrano admitted Scottie for a diagnostic workup with the intention of Dr. Kleman implanting a pacemaker.

Scottie's initial diagnostic workup included bloodwork, a urinalysis and an echocardiogram. Due to the additional findings during Scottie's physical exam, an abdominal ultrasound was performed by CUVS board certified internist Dr. Forman DVM, DACVIM (Internal Medicine) prior to pacemaker implantation.

Dr. Kleman implanting Scottie's pacemaker.

At this point,  Scottie was a good candidate for emergency pacemaker implantation, and Dr. Kleman was prepared for the procedure. The 75-minute implantation procedure went smoothly and Scottie was kept overnight for post-surgical monitoring. The next day, Dr. Kleman performed a chest x-ray, another ECG, and programmed the pacemaker to optimize the settings. Programming the pacemaker, as well as periodic evaluations of the pacemaker's function, can be achieved with no sedation and absolutely no discomfort for the animal. Scottie laid down on a bed in ICU and enjoyed a head scratching (care of our technicians) as Dr. Kleman programmed the pacemaker with her laptop computer and a remote control. 

 

Scottie's x-ray (radiograph) taken the day after surgery showing the pacemaker's location.

It should be noted that the total amount of time that elapsed between Scottie's arrival at CUVS and the end of Dr. Kleman's pacemaker implantation procedure was only about 7 hours- a testament to the speed, accuracy and flexibility that is only possible at a state-of-the-art animal hospital such as CUVS.

Dr. Kleman, DVM, DACVIM (Cardiology) and Nicole VanSant, BS, LVT, VTS (ECC) examine Scottie the day after his pacemaker implantation.

“Pacemaker implantation in dogs and cats is not uncommon. Hundreds of pacemakers are implanted in the U.S. each year by veterinary cardiologists,” says Dr. Kleman. “Pacemaker implantation in dogs and cats is also not as expensive as one might think.” The cost of the procedure is comparable to an orthopedic surgery on a dog’s knee or back. Additionally, the procedure is minimally invasive, with the pacemaker implanted through a superficial vein.

Scottie, bright, alert and happy the day after his pacemaker implantation.

The patient recovers from the procedure with instant clinical improvement. The heart rate is restored to normal and the heart can provide enough oxygen-rich blood to the pet's body. The rechecks are not difficult for the pet or the owner. It can be expected that the typical pacemaker only needs to be programmed two to three times in the first year, and once per year after that.

 Please click on the image above to see an enlarged version.

We were thrilled that we could provide the necessary care to another dog with complete heart block. Scottie was a remarkable patient and our affection for him was trumped only by the joy on Mari's face as he was discharged from CUVS the following day.

 Dr. Kleman, DVM, DACVIM (Cardiology) Nicole VanSant, BS, LVT, VTS (ECC), Scottie & Scottie's mom Mari at discharge.

 Nicole, Dr. Kleman, Scottie & Scottie's mom Mari at discharge.

To learn more about pacemakers, click here.

Sherman Gets a Pacemaker at CUVS

Sherman Tank is an 8-year-old, 66-pound male bulldog who was brought into CUVS in need of help. Sherman needed a pacemaker. Sherman’s owners brought him to their family veterinarian for an exam after noticing that sometimes he lacked his usual energy and was reluctant to climb stairs. Sherman’s veterinarian performed an electrocardiogram (diagnostic tool that measures the electrical activity of the heart) and found that Sherman had 3^rd degree atrioventricular block with a ventricular escape rhythm. In layman’s terms, this diagnosis means the normal electrical impulse which stimulates the heart to contract is blocked. Fortunately, the muscular portion of the heart has a back-up system which allows it to continue to beat in the absence of a normal electrical impulse. Unfortunately, this back-up system often fails over time, despite various medical therapies.  Previous veterinary studies have shown that dogs such as Sherman may experience episodes of collapse or even pass away suddenly at home. Sherman was then referred by his family veterinarian to Cornell University Veterinary Specialists to see our cardiologist, Dr. Mandi Kleman, for an evaluation for a pacemaker.

Upon examining Sherman, Dr. Kleman found Sherman to be bradycardic (possessing a heart rate that is too slow), consistent with his previous exam. In preparation for potential pacemaker implantation, she obtained a repeat ECG, an echocardiogram (an ultrasound of the heart), bloodwork, and a urinalysis. The ECG confirmed the continued presence of the 3^rd degree AV block and the echocardiogram showed mild volume overload of the left heart. After discussing the plan at length with the owners, Dr. Kleman scheduled a pacemaker implantation procedure for the following day.

Dr. Kleman surgically implanting Sherman's pacemaker

Sherman stayed at CUVS overnight for monitoring and at noon the following day, Dr. Kleman prepared and scrubbed for the surgery. During a short 90-minute procedure, Dr. Kleman implanted a Medtronic pacemaker device into Sherman’s heart via two small incisions in his neck.  The surgery was a complete success with no complications. The pacemaker was ideally working to control Sherman’s electrical heart rhythm. Sherman recovered in ICU overnight with attentive pain management and monitoring. 

 

Dr. Kleman evaluating Sherman's pacemaker with ECG the next day.

Dr. Kleman programming Sherman's pacemaker the next day.

The morning after the procedure, the pacemaker was functioning properly, Sherman was energetic, and he ate a can of dog food for breakfast. That day, Dr. Kleman performed a chest x-ray, another ECG, and programmed the pacemaker to optimize the settings.  To program the pacemaker, Dr. Kleman uses a specialized computer to evaluate the pacemaker’s function and if necessary, to adjust the settings of the pacemaker. Sherman was prescribed oral antibiotics and a mild tranquilizer to keep him calm and to allow him to heal properly. He was discharged to his owners at 4PM that day with a normal heart rate and a short little wagging tail.

Sherman at discharge with Dr. Kleman,DVM, DACVIM (Cardiology), Carrie Maskley BS, CVT, Sherman and his owners

–      Dr. Mandi Kleman, DVM, DACVIM (Cardiology)
–      Stephanie Phillips, BA, A.A.S, LVT                       

Learn more about pacemakers by clicking here.

Human pain relievers are toxic to dogs and cats

This past week we saw a couple cases of ibuprofen toxicity in dogs- one was an intentional dosing of the dog by the owner, and the other was a case of the dog finding the bottle of pills and ingesting them. While these are two very different situations, the end result is the same: two very sick animals. Cats and dogs that ingest ibuprofen (the active ingredient in Advil), acetaminophen (Tylenol) or aspirin experience a wide range of negative effects such as severe vomiting, gastric ulcers, kidney failure, liver failure and, if the animal is not treated medically, death.

The dog we treated that accidentally ingested the ibuprofen pills arrived at CUVS comatose, with constricted pupils. She was unresponsive but trembling. Our team sprang into action by administering fluids and the appropriate drugs, placing a nasogastric tube, suctioning her stomach and giving her charcoal and gastroprotectants. Her blood values were closely monitored overnight and by the morning she was awake and aware, although she did stay in the intensive care unit for three more days. Despite the severity of this case, both dog and owner are very lucky: the attentive owner figured out something was wrong and rushed his dog to the vet. This quick thinking saved the dog's life.

The case described above provides two valuable lessons for pet owners:

#1: Make absolutely sure that all of your pills at home are locked away securely.

#2: Do not give any pills to your dog or cat without seeing your vet first.

We all know that dogs like to jump up and see what's on the counter or table, and cats have a truly remarkable ability to jump onto the highest shelves. A bottle of pills left out on a flat surface is a tempting target for both dogs and cats.

If you feel like your pet is in pain, always bring her in to see your vet. The vet will advise you on the proper care for whatever is causing the pain, and you can be certain that the prescription he writes for you will be safe.

Here is the rule of thumb we'd like you remember: dogs and cats cannot take the same pain relieving pills as humans.