Grandpa Charlie has successful heart surgery

Charlie, a roughly 12 year old Yorkie, just wasn’t himself. His appetite was poor. His breathing was faster than normal.

His owner recalls: “Charlie lives to eat so I knew something was wrong when I couldn’t even tempt him to eat tuna!”

Blood work was fairly normal except for high sugar levels – nothing new since Charlie was a known diabetic.

Chest X-rays showed an enlarged heart.

An ultrasound showed fluid around the heart. It also was suspicious for a tumor on the heart.

This is a pretty classic case of pericardial effusion.

What does that mean exactly?

The heart is covered by a sac called the peri-cardium (latin for “around the heart”). Its job is to protect and lubricate the heart, and to keep it in place within the chest.

Because this kind of tumor is fragile and very rich in blood vessels, it doesn’t take much for it to bleed.

Since the tumor is located inside the sac – the pericardium – blood builds up inside of it.

And because the sac can only expand so much, the fluid build-up eventually puts pressure on the heart.

Think of it as a bad headache or a migraine. The brain can only swell so much because of the skull around it.

This explained that Charlie didn’t feel well (poor appetite) and was out of breath.

Not only was the heart feeling squeezed, but the lungs had less room to expand.

The best solution is surgery, to relieve the pressure.

Anesthesia in a 12 year old diabetic dog with a sick heart is not exactly the safest thing to do.

I went over the pros and cons of surgery with Charlie’s owner.

Who on earth chooses surgery in such an old, sick little dog?

There was no doubt in his owner’s mind that it was the right thing to do.

She believes: “Once you take on the commitment of owning an animal, they become part of your family. (Despite) the bleak prognosis, we can’t willingly say goodbye to our beloved pet. (…) Even though he may only live a year (or less) or two years more, we feel we must do all we can to prolong his life.”

And she very kindly shared: “Honestly, I felt very reassured by your discussions with me prior to surgery. You clearly laid out postop care. I felt calm the day of surgery knowing Charlie was in good hands.”

Equipped with such positive vibes, and despite the risks, we took Charlie to surgery.

After an incision on the left side of his chest, between two ribs, a large section of the pericardium was removed.

ASSUMING YOU HAVE THE STOMACH FOR IT, you can watch the short video below.

As my wonderful nurses can attest, watching a beating heart is one of the coolest things we see, but I understand it is certainly not for everybody!

https://bit.ly/3Q2sM0o

Before removal of the pericardium, the heartbeat is typically harder to see, because the heart is surrounded by the pericardium and lots of blood. In this video, that is not really the case, because a lot of the blood inside the sac had been removed with a needle to provide relief to Charlie.

After removal of the pericardium, a surgery called a peri-cardectomy, the heartbeat is easier to see, because there is nothing restricting it anymore.

We then needed a way to remove free air from the chest. This is done with a device called a chest tube. You can see a glimpse of it at the end of the video, on the left side of Charlie’s body. It only stays in place for a short time after surgery, and can be removed once there is no more air and not too much fluid left to remove.

After the chest tube was secured, the rest of the chest was stitched up.

Then it was time to transition from the OR to ICU.

Little Grandpa Charlie recovered from surgery and anesthesia very smoothly.

In fact, minutes after coming out of the OR, he looked surprisingly good and comfortable. I was so impressed, that I took a video of him (see link above). Of course, he’s in a daze because he went through a lot and he was high on doggy morphine, but he still looked amazing so soon after surgery!

This is a great testament to the wonderful anesthesia nurse who took care of Charlie. Anesthesia is always a bit more challenging when we do open chest surgery, especially in a patient with a compromised heart.

Even more encouraging, Charlie ate dinner the evening of surgery, for the first time in days!

Who eats a few hours after open chest surgery?!

The chest tube was removed the very next day.

After a few days on heavy duty pain medications and lots of TLC, he was able to safely go home.

His owner remembers: “I didn’t see Charlie for several days after surgery. When Charlie did come home, he had the cone on, but he seemed to almost be his old self. He didn’t seem like he was in pain (we gave pain meds anyway!). He ate and drank fine. When going potty, he was eager to do more, wanting to get back to his walks – though we said not yet!”

Charlie is very lucky his owner didn’t procrastinate and trusted her guts based on what were after all (seemingly) very minor signs.

Remember, all there was is a decreased appetite and faster breathing, that’s it!

She recalls: “I just had a bad feeling and knew things weren’t good. He just wasn’t acting like himself and I worried he was in pain.”

It’s only been 2 months since surgery, but so far Charlie is doing great.

His owner writes: “Charlie is doing marvelously well! He is eating, drinking and has a happy demeanor. He seems comfy and happy! Overall, the experience went very well and all of our fears have been alleviated. We have our energetic Yorkshire Terrier back!

And her final words of wisdom:

“The day will come when we won’t have a choice anymore and we will have to say goodbye. But for now, and thanks also to you, that day is not today. Some beings and their life/memories with us are more important than $!”

If you would like to learn more about how your pet can have safe surgery and anesthesia, contact us through www.DrPhilZeltzman.com

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

When is it time to say goodbye?

Nobody likes to talk about it. Once we realize that our pets are, after all, not immortal, we may hope that they will just “go” in their sleep. Well, that almost never happens. Most of the time, we have to help them. Euthanasia is a very personal, heart-breaking, grueling decision. Let’s go over 16 common concerns and questions.

An old greyhound on a couch

1. What is euthanasia?

According to the American Heritage Science Dictionary, euthanasia is “the act of painlessly ending the life of an animal who has a terminal illness or incurable condition, as by giving a lethal drug”.

I would say that euthanasia, or “putting a pet to sleep”, is the humane way to end a pet’s life with dignity when their quality of life is no longer acceptable. Euthanasia should not be a convenience when a pet becomes, well, an inconvenience.

2. When is euthanasia appropriate?

It’s all about quality-of-life. A quality-of-life scale helps you assess various criteria such as pain level, appetite, hygiene, happiness, mobility etc.

You can Google “quality of life scale HHHHHMM” to find a great example.

Basically, are there more good days or bad days? The challenge is that you need to try to look at the situation from your pet’s standpoint – not yours.

This is often difficult, because it is a very emotional situation that tends to make you lose your objectivity. In other words, if the same situation happened to your best friend’s pet, you probably would know exactly what to do. But because you are dealing with your own pet and your own emotions, you cannot see the situation as objectively. Sometimes, denial makes things even worse…

3. When will I know it’s time?

Some people say “You’ll know in your heart when it’s time.”

I’m not so sure it that’s easy. Sometimes, you just don’t know. Again, you are so emotionally close to the situation, that you often can’t reason with a clear mind. Therefore, some pet lovers just don’t know when it’s time.

It is a vet’s job and ethical responsibility to make the owner aware of the situation. It is however not a vet’s job to make the decision for a pet’s owner. So asking “What would you do if it were your pet” is usually not a fair question: it’s a very personal decision.

The vet’s job is to explain the facts, describe the medical situation, and present options. Only you can (and should) make the final decision.

An older cat sitting on a blanket outside

4. How is euthanasia performed?

Each vet has his or her own protocol, so the description below is only one way to do things. Let’s try to forget emotions for a minute, and let’s try to focus on the scientific or medical aspect of euthanasia, so that you know what to expect.

An IV catheter is placed. Most veterinarians will give a sedative or tranquilizer IV first, to relax the patient, or even make them sleepy. Then, the euthanasia drug – an overdose of barbiturates – is given IV. This is a pain free, almost instant procedure. The heart and lungs stop. And it’s over. I think most pet owners are surprised how quickly euthanasia happens. It’s over in less than a second…

You may then want to spend some time alone with your pet to say goodbye.

Although not exactly glamorous, it is important to mention a few things that may or may not happen during euthanasia. For example, your pet may or may not have one last deep breath (called an agonal breath). Eyes typically don’t close. This is not Hollywood.

There may be noises or vocalizations, or muscle spasms, or urination, or defecation, as the body relaxes. These are just possible, physiological, medical things that can happen and may be traumatizing if you are not prepared or warned.

Regardless, euthanasia is a quick, smooth & painless process.

5. What do I do at the animal hospital?

An experienced team will guide you through the different steps. Here are two important suggestions:

. Ask if you can take care of all the paperwork and financial stuff BEFORE proceeding with the euthanasia. The last thing you want to do is stand at the front desk after the euthanasia, in tears, in the middle of a full waiting room. A good receptionist should spontaneously suggest this option.

. Have a friend or family member drive for you if you think you will have difficulty driving safely after it’s all over. Now is not the time to get teary-eyed and get into an accident!

6. Should I be present?

This is one of the most difficult questions to answer. There is no right or wrong answer. There are several options.

You can say goodbye, leave the room, and let the doctor proceed. You may or may not want to visit afterwards. Or you can be present, start to finish.

Here is a testimonial from a friend and former client in Cincinnati, OH:

“My daughter and son-in-law had to euthanize Banshee, their Bernese mountain dog. They had had his leg amputated, but the cancer progressed. In the end, they had to put him to sleep. It is always sad to lose a pet. He was one of the sweetest dogs I’ve ever known, and even in his illness, he kept his sweet disposition.

My son-in-law and daughter were both with him at the end. That is something I would encourage pet owners to do. It is a comfort to see how peacefully your pet can go, and for me their loyalty demands your presence. I recognize that some people may not be able to do it.”

7. A very special situation

In our surgical practice, there is another situation. We are occasionally faced with an incurable condition during a surgery. I will then call the owner on the phone during the surgery, discuss the situation, and if we both agree, humanely euthanize the patient “on the table.” In this situation, the patient goes from anesthesia to euthanasia with no awareness and no pain whatsoever.

Here is a testimonial from a client who had to make such a decision. Their cat Jackie needed surgery to remove a fibrosarcoma – a cancerous tumor – from the skin of her belly. It turned out that the tumor invaded multiple structures, including half of her diaphragm (the muscle that separates the chest and the belly). The cancer was inoperable.

The owner writes: “I was faced with a very difficult decision.

My kitty Jackie was on the operating table when I received a call from Dr. Zeltzman, telling me that the tumor she had was so extensive that he did not feel he could remove it all. Compassionately, he gave me my options:

#1 – He could wake her up from surgery and let her live out what would be the rest of her life. The tumor however would eventually cause her significant pain.

#2 – Put her to sleep now while she was still under anesthesia. He told me I could think about it for a bit and call him back with my decision.
I tried my husband at work, but was unable to reach him. I kept thinking about Jackie and that she was so young, only 7 years old. I thought about how she came to be my kitty. (…) She was my side-kick.
With Jackie still on the table, I called Dr. Zeltzman back. He talked me through my options, not making the decision for me, but helping me make the right decision. After my conversation with him, I decided to have Jackie put to sleep then, while still under anesthesia. My deciding thought: I did not want Jackie to suffer.
It has been two months since that day. I miss her so very much! The hardest part for me was that I did not get to say goodbye to her. But in my heart, I know I made the painful but right decision for Jackie. I take great comfort in that.”

A cat with its eyes closed

8. What happens with the remains?

There are several options. Some people elect to bury their pet. This may be illegal where you live, so it is important to check. It you can’t, there are memorial gardens and cemeteries for pets throughout the country.

Most owners elect cremation. You then have 2 options: you may get ashes back, or not. Some people save the ashes.

Here is what a pet owner wrote after receiving her pet’s ashes. Cookie, a 1 year old female Boston terrier, had abdominal surgery that revealed a terrible condition called intestinal volvulus: 90% of her small intestine had twisted onto itself, which is deadly.

The owners were called during the surgery, and reluctantly elected the only reasonable choice: euthanasia. Later, they write:

“Cookie’s ashes now sit on our mantle in the beautiful box with her name on it. (…) Cookie has come home in style.”

Other pet owners sprinkle the ashes somewhere, such as the pet’s favorite place in the back yard. Again, this is a very personal decision.

9. What happens during the grieving process?

For most clients, losing a pet is like losing a family member, so the grieving process should not be taken lightly.

Typically, people who do not own pets don’t understand how sad a grieving pet owner may feel. This may be a good time to avoid such people, for example at work…

10. Where can you get support?

Support is crucial to get over a pet’s loss. It can require finding a friendly ear: a friend, a family member, a receptionist or a nurse you developed a good relationship with, or your family vet.

If you have other pets, they can also provide a support system, as you will need to redirect your attention to their needs. Actually, your other pet(s) will “feel” that their buddy is missing, and they will feel your sorrow. Now is the time to provide some extra TLC. They may become lethargic or have a poor appetite.

Your other pets may actually help you grieve, so you can actually help each other.

There are also some websites where you can share your feelings.

If you are completely overwhelmed, or you feel that you are grieving for an unusually long time, you may need counseling. This is now available through several vet schools and of course through a private counselor.

An older dog in the outdoors

11. What can I do to get through this?

Here are a few things you can do to help you heal.

. Allow yourself to cry. It’s okay – really.

. Put your pet’s belongings (water bowl, food bowl, bed, leash and collar or harness, toys etc.) in a big box and store it away for the time being.

. Talk about it.

. Write in a journal. Nobody has to know.

. Depending on your artistic talents, you could draw a picture of your pet, write a poem, create a scrapbook with memorabilia and pictures…

. Create a memorial in your garden or on your balcony.

12. How else can I get closure?

Another vastly personal topic. Although it is difficult to believe it at the time of euthanasia, time heals all wounds. Eventually, you will get over your sorrow.

Getting closure requires going through the flow of the various stages of grieving.

You can write a letter, like the one above about Jackie the kitty. After writing it, she said: “I still miss her, but I think writing this text has helped.”

Getting your pet’s ashes and “taking care of them” may also help with closure, as this typically happens after a week or so.

13. When should I get a new pet?

Most people recommend waiting until you achieve complete closure before getting a new pet. Adopting a new pet too soon may lead to bad decisions that you might regret, which is not fair to the new pet (or you and your family).

14. What do I tell my kids?

This is another very complicated topic. I would rather direct you to web sites (mentioned below) that explain things very well depending on the age of the child. You just don’t explain things to a 3 year old the same way as you would a 13 year old. There a re many things to be aware of. For example, it may be inappropriate to say that your pet “went to sleep” or was “put to sleep” and will never come back, as this may traumatize a child at bed time for years. After all, their buddy is never going to wake up…

16. How can I help my grieving elderly parents?

Again, a touchy topic… Sometimes, a pet is the last link an elderly person has to the world. If a grandma or grandpa cannot walk Fluffy in the neighborhood, a whole part of their social interactions may vanish all of a sudden.

I hope this helps you understand the process of euthanasia. In a sense, euthanasia is an act of love. You will rarely see it that way the day you lose your pet. But after your grieving period, I hope you will understand that you made the right decision.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What you need to know about broken bones

We repair a surprisingly large number of fractured bones (aka broken bones).

A dog looking out the car window

They can happen at any age. We’ve surgically treated a 3 week old pup and a 23 year old kitty.

Virtually any bone in the body can sustain a fracture: skull, vertebrae, legs, pelvis, tail, ribs… no bone is spared!

Just in the past 3 weeks, we’ve had:

. 3 dogs who jumped out of the car window

. 1 dog who jumped off the couch

. 1 dog who was attacked by another one.

. 1 dog who was hit by a car.

And that’s just in 3 weeks!

This blog was written to:

. inform you about how fractures happen.

. tell you how they are commonly repaired.

. help you prevent them.

How do bone fractures happen?

Here are the top 10 reasons (in no particular order):

Falls

Cancer

Gunshot

Hit by car

Fights/Bites

Malformation

Jaw – Bad teeth

Bone deterioration

Fatigue (repeated trauma)

Various traumas (slipping on ice…)

A dog laying on the couch

How do we repair bone fractures?

There are multiple types of fractures and multiple ways to repair them. Let’s go over the most common ways.

But wait, not all fractures need surgery.

Some will simply heal with rest, time and pain medication.

Occasionally, healing can be attempted with a splint – a type of bandage reinforced with a molded piece of plastic (I am not too fond of casts…).

The challenge is to know which fractures can predictably heal with a splint.

For example, fractures of the forearm (radius & ulna) and shin bone (tibia & fibula) in small dogs don’t heal well with a splint, and most need surgery. This is a common misconception.

Many fractures require surgery.

There are 2 main ways to fix a fracture:

. with internal fixation, where no implant can be seen outside the skin.

. with external fixation, meaning that the implants are visible from the outside. This is called an external fixator.

  • Plates and screws

The most common type of repair involves a bone plate and some screws. A plate is a flat stainless steel bar with holes, designed to keep the pieces of bone together while the fracture heals. The plate is attached to the bone with stainless steel screws.

Plates have different shapes, thicknesses, widths and lengths. The number of screw holes varies accordingly.

So a Yorkie with a forearm (radius) fracture may need a small 6-hole plate, and a Lab with a complicated thigh bone (femur) fracture may need a big 12-hole plate.

Therefore, a surgery practice must stock a variety of plates, since we need to be prepared to help a kitten as well as a Great Dane.

A broken limb repaired with pins and plates
This 10 year old cat’s femur (thigh bone) fracture was repaired with a plate, 12 screws, several wires & a pin.
  • Wires

To help reconstruct a bone that is in several pieces, we sometimes need the help of stainless steel wire (“cerclage wire”).

Some wire is placed around pieces of bone, and the ends are twisted, like a twisty-tie on your bread.

  • Pins

Pins look like knitting needles. They come in various lengths and sizes.

They are used to connect one piece of bone to another. Pins are used in very specific cases, either to reinforce a plate and screw repair (see above), or as the main repair (see below).

Pins in the bone
This 5 month old cat’s femur (thighbone) fracture was repaired with 2 pins.

Again, all the implants described above are used under the skin, so they are used for “internal fixation.” Once the surgeon is done, the skin is sutured, and you can’t see anything stick out. These implants are typically designed to stay in forever. Only if they cause problem would we remove them.

  • External fixators

In some cases, such as bad gunshot wounds, we prefer using “external fixation.”

There are different types of external fixators, but here is the concept: several pins are placed through the skin, into the broken pieces of bone.

Then a big metal bar, or some other device, is used to connect all the pins. By keeping the pins together, we indirectly keep the pieces of bone aligned, which helps them heal.

To avoid infection, the holes in the skin must be cleaned regularly, e.g. with hydrogen peroxide.

Because it is external to the skin, the fixator must be removed after the fracture is healed. This is typically a quick procedure under heavy sedation or brief anesthesia.

An external fixator
This German shepherd’s radius & ulna (forearm) fracture was repaired with an external fixator because of open wounds created by a gunshot.

How can you prevent bone fractures?

As always, prevention is the best medicine. Not every fracture can be prevented. Accidents do happen.

Some dogs sustain a fracture while playing in the back yard. Some cats get a fracture while playing indoors. As sad as it is, that is nobody’s fault and simply cannot be avoided.

Many could have been prevented. Several easy ways come to mind:

– Keep your dog on a leash when outdoors to decrease the risk of getting into a fight or being hit by a car.

– Keep cats indoors.

– Keep dogs inside a fenced-in yard.

– Don’t let small dogs jump from your arms or furniture. They can get very common fractures of the forearm or the elbow.

– Never let your car windows open to allow your dog to enjoy the wind and the smells. Remember, we saw 3 dogs who jumped from a car window in the past 3 weeks. All 3 owners swore that they had done it multiple times and they had never jumped before. Which is true… until they did.

Fractures can be painful both to the patient and the owner’s finances. Luckily, most fractures can be repaired and most pets can ultimately lead a normal, happy, comfortable life.

A dog looking out the car

Postop care:

Depending on the fracture, the type of repair and the pet, you might need:

. very strict confinement, on ground zero, in a large crate or a small room, most often for 2 months.

. weekly splint changes if needed.

. regular X-rays to assess healing of the bone.

. pain medications and antibiotics.

. short leash walks for elimination only (for dogs).

. rehab once the bone has healed, to transition to normal life.

Then they can go back to their interrupted agenda: the squirrel herder, the keeper of the couch, the bird chaser, the flower bed destroyer or the overall ruler of the back yard.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

How Yoda lost his tail

Yoda was a healthy 4 year old French Bulldog with one ongoing, itchy, painful, smelly issue…

Yoda, a French bulldog

 

He had frequent skin infections around his crooked little tail.

As in many Bulldog type dogs, Yoda had a “screw tail,” also called “corkscrew tail,” “ingrown tail,” or tail fold dermatitis.”

The problem with this condition is not the tail itself, but the issues the malformation creates. The malformed tail creates skin folds that become infected.

The skin folds are not exposed to air and they create a moist, dark, warm environment – heaven for all kinds of nasty bacteria.

The tail problem

Mild cases of screw tail can be treated medically or conservatively with proper hygiene & daily cleaning.

Unfortunately, despite Yoda’s family vet’s and his owner’ best efforts, nothing helped.

This is a classic, vicious cycle with no end in sight. Antibiotics didn’t work. Antiseptics didn’t work. Pet wipes didn’t work.

Most of the clients I see for this problem are frustrated after months to years of unsuccessful treatments and impressive veterinary bills.

So what’s the solution?

The only permanent solution is to remove the “screw tail.”

The goal of surgery is to remove the malformed part of the tail and the entire infected skin fold.

The end result: no more dark, moist, warm environment for bacteria to thrive in.

This is a fairly technical and sometimes challenging procedure, which is often performed by a board-certified surgeon.

There are a few risks to be aware of:

. Patients with a flat face (brachycephalic breeds) have a higher risk during anesthesia, so an experienced anesthesia nurse is critical.

. We have to work in a filthy area, both because of the infection in the tail fold and because of the proximity of the anus. We certainly scrub the skin as thoroughly as possible, but there is always a mild risk of infection.

. There is a delicate balance between removing too much skin and not enough. Not enough skin leaves infection behind, so there is potential for complications. Too much skin taken away can lead to difficulty stitching up the skin nicely.

. Fecal incontinence is a complication that is often mentioned, but that is a low risk in the hands of an experienced surgeon.

. After surgery, some patients drag or scoot their hind end, which can result in damage to the incision and poor healing.

The outcome is typically very good with proper postop care.

Yoda did great during his procedure. He recovered smoothly from anesthesia and surgery.

Yoda's healing incision

After 3 weeks of TLC, his owner reported that Yoda was doing well at home.

A healing incision

No more smell, no more itching, no more scooting, no more soreness.

Just pure Bulldog happiness, and a happy, wiggly behind.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What caused Kona to lose a kidney?

Kona, a female Lab, was only 1 year old, yet she had had several bladder infections.

Kona, a 1 year old Black Labrador Retriever

Rather than keeping her on repeated antibiotics, her family vet looked into the situation and discovered that Kona had an extra fold over her vulva.

This common (and under-diagnosed) condition is called a “redundant vulvar fold,” “vulvar fold dermatitis,” “recessed vulva” or “hooded vulva” (see below a picture in another patient, a 6 year old Newfie, where the vulva is barely visible).

Redundant vulvar fold

The treatment is a reconstructive surgery called vulvoplasty or episioplasty. The goal is to remove the extra skin.

The main challenge is to remove just the right amount. Not too little, and not too much.

Kona’s pet owner wisely chose to have her spayed under the same anesthesia. Her vet asked me to look into the possibility of a malformation of her urinary system called an ectopic ureter. The ureter is the tiny tube between the kidney and the bladder.

It was a possibility because Kona was constantly leaking urine, i.e. she was incontinent.

During surgery, we removed the extra skin fold, spayed her, found no ectopic ureter… but found another condition.

She had a hydro-ureter, i.e. a ureter that was huge, about 5 times bigger than on the other side. This required removing it, and sacrificing the kidney on the same side – of course after calling the owner in the middle of surgery to request permission to do so.

Surgery was uneventful, and Kona recovered smoothly from anesthesia.

Here is a (warning, graphic) picture of the kidney and the enlarged ureter (hydro-ureter) in another patient, a 6 year old Malamute.

A removed kidney and ureter

Three weeks later, her owner EB writes:

“Kona is doing well. I have not noticed any leaking and when she urinates, it is a steady stream. Her incision looks great and she is her spunky self.”

Obviously, this is an unusual situation, but a good reminder to keep an open mind when a patient has an unusual situation, like leaking urine constantly.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!