Joshua’s story: taking pain seriously

Joshua, a sweet 3 year old Beagle, had been seen by 3 different family vets to find the source of his pain.

His owner described bizarre signs: trouble wagging and lifting his tail; difficulty urinating and defecating.

Joshua would occasionally chew at his back leg. “Because he was in pain” his owner thought. But nobody would take her seriously.

Overall, the condition seemed to get worse with time, despite several medication trials.

Beagles are prone to slipped discs, but Joshua did not fit the picture. His neurological exam was totally normal except for pain in the lower spine.

That’s when I met Joshua. His physical exam was normal, except that he had mild and consistent pain in his lower spine. Stretching his tail over his back would also cause pain. There were no other significant findings.

I wanted to take Joshua’s pain seriously, so I had a heart-to-heart with his owner. There was clearly something wrong with Joshua. An MRI was the next logical step… and a big leap of faith. His owner consented to it.

The MRI report described that young Joshua (again, a 3 year old) had a mass, most likely a tumor, in his lower spine (between lumbar vertebrae L5 and L6). Even worse, the tumor seemed to be attached to his spinal cord.

Because she really wanted to help her dog, Joshua’s owner elected surgery. We found exactly what the MRI report had described.

The tumor, which was almost 1 inch in length, could not be completely removed.

WARNING: THE NEXT PICTURE IS GRAPHIC !!!

Therefore, we carefully took 3 biopsies of the mass, which in effect, decreased the size of the tumor by two thirds. So we “debulked”‘ the mass, i.e. we removed the bulk of it.

Removing more tumor would have put Joshua’s ability to walk in serious jeopardy.

Spinal surgery is very delicate, so we typically expect worsening of the signs initially. Miraculously, just a few hours after surgery, Joshua stood up and walked! He went home a couple of days after surgery.

One week after surgery, the biopsy came back: Joshua had a bizarre type of cancer called chondrosarcoma, which is an aggressive cancer of cartilage. Luckily, it was slow-growing, or “low grade.”

Two weeks after surgery, Joshua came back to the clinic for staple removal.

His owner was thrilled by his progress, since he had no sign of pain anymore. He was now able to lift and wag his tail. His neurological exam was completely normal. The only concern was occasional fecal incontinence, which we are trying to control with a special diet.

Beyond surgery, there is no good treatment for a “low-grade” chondrosarcoma of the spinal cord. Neither chemotherapy nor radiation therapy is a good option. However, Joshua might benefit from low doses of cortisone.

As your pet’s best advocate, you need to keep pushing until you get the answers you and our pets deserve. If you are not satisfied with the answers you’re getting, you owe it to them to ask more questions, to demand better answers, and, if needed, to be referred to a specialist.

As I always say, “pain is not acceptable.” We have multiple ways to decrease pain, which may or may not involve medications.

Joshua is a perfect example of this philosophy: his owner kept pushing until she found somebody who took her seriously.

This may seem to be a sad story, and it certainly is in a way. But Joshua’s owner and I would rather look at the glass half full: he is currently pain-free and happy, and his owner enjoys her pain-free dog… one day at a time.

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

What is a TRUE emergency?

When should you rush to your family vet? When should you go to the emergency clinic? When is it safe to wait until the next day?

Here is a list of 13 true emergencies that require immediate vet care, day or night, week day or week end*.

  1. Severe bleeding or bleeding that doesn’t stop within 5 minutes.
  2. Choking, difficulty breathing or nonstop coughing and gagging.
  3. Bleeding from nose, mouth or rectum; coughing up blood; blood in urine.
  4. Inability to urinate or defecate, or obvious pain or straining while eliminating.
  5. Injuries to an eye.
  6. Your pet ate or drank something poisonous (antifreeze, xylitol, chocolate, rat poison etc.).
  7. Seizures and/or staggering and/or paralysis.
  8. Fractured bones or severe lameness.
  9. Obvious signs of pain or extreme anxiety.
  10. Heat stress or heatstroke.
  11. Severe vomiting or diarrhea – more than two episodes in a 24-hour period, or either of these combined with obvious illness or any of the other problems listed here.
  12. Refusal to drink for 24 hours or more.
  13. Unconsciousness.

The bottom line is that ANY concern about your pet’s health warrants, at a minimum, a call to your family vet.

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

* This list was compiled by the American Veterinary Medical Association.

Will Weez need an amputation?

Weez, a cute 12 year old Cockapoo, had a swelling under her left armpit (aka the axilla).

 

No signs were present otherwise: she was eating, drinking and acting normally.

Since the swelling continued to grow, her owner wisely went to see his family vet. She diagnosed a mass of unknown origin.

The vet (again, wisely), recommended surgery to remove it and biopsy it.

The suspicion, based on experience, the location of the mass and its fast growth, suggested that it was likely a cancerous mass (soft tissue sarcoma, nerve sheath tumor, lymphoma etc.). In addition, there was a chance that it involved some important nerves in the armpit (aka the brachial plexus).

Since those nerves cannot be sacrificed, we discussed a small possibility of amputation.

A physical exam and blood work confirmed than Weez was a good candidate for anesthesia.

To my relief, my own exam revealed that there was no need to sacrifice the leg!

So we removed the mass uneventfully, and it as sent to the lab for analysis.

Weez recovered smoothly from anesthesia and surgery, and went home.

Her activity had to be restricted and she had to wear a cone (E-collar) around her beck for 3 weeks. She was also given oral antibiotics and pain medications.

One week later, the results of the biopsy were shocking – in a fantastic way!

Amazingly, the mass was benign! It is called a fibroma, which is a non-cancerous tumor, and very unusual in that location.

There is still a small risk that the tumor can come back, so I asked Weez’s owner to monitor the area by feeling it monthly.

Weez’s owner was ecstatic. He wrote: “Cannot be any happier and blessed to have had Dr. Zeltzman operate on our girl. He was able to remove a tumor and save her leg from being amputated.”

This story reminds me that board-certified cancer specialists (oncologists) and surgeons have 2 similar sayings:

* The 3 deadliest words in the English language are “Just watch it” and

* The 5 deadliest words in the English language are “Keep an eye on it.”

What we mean by that is size doesn’t matter when it comes to masses.

A tiny mass the size of a grain of rice can be cancer.

Bottom line: even though this mass was luckily benign, it is important to remove masses as soon as possible. Have your family vet check your cat or your dog as soon as you notice any lump or bump, so that they can guide you through the next steps.

So please don’t procrastinate. Removing a mass when it’s small is less invasive, less costly, and gives much better chances for a cure.

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

Khloe’s story: shocking findings nobody expected

Khloe was a 2 month old adorable golden retriever puppy, with a soft look in her eyes.

When her owners purchased her, they thought they were bringing home a happy and healthy puppy.

But as soon as Khloe’s family brought her home, they noticed that something was not right. She was not playful. She was quiet and reserved.

What they saw was a terrified, sick, and painful puppy.

An owner’s touch is supposed to comfort a small puppy. But how can that be when the smallest contact causes severe pain?

In a matter of 3 days, Khloe began having fits of screaming and jaw chattering. The smallest touch anywhere on her body caused her terrible pain. Her front legs were weak.

Khloe’s case was perplexing. Figuring out where the pain was coming from was almost impossible. It seemed that her whole body was affected.

The owner had noticed a small scratch on the skin of the head, sustained after a brief fight between Khloe and their other dog.  It didn’t look like much and was already healing.

To help with the pain, I placed her on pain medications, and created a neck brace for her. It was difficult to tell, but it seemed that her pain might be stemming from her neck or her head.

Once Khloe was stable, she was transported to get an MRI of her head and neck.

When the MRI report arrived, we were shocked.

Khloe had several skull fractures, with severe changes in her brain, including encephalitis (irritation of the brain) and too much fluid. It was suspected to be due to an infection, most likely caused by the dog bite.

In addition, a brain abscess was suspected.

Suspected abscess

She had a mild displacement (hernia) of the back of her brain, called the cerebellum. And she had a severe syringomyelia extending caudally to the 8th thoracic vertebra (ie the middle of the chest).

Syringomyelia is a condition that is due to fluid-filled cavities in the spinal cord, usually in the neck. This disease is most often found in Cavalier King Charles Spaniels.

So what we suspected was that a brief fight was in fact violent enough that it caused skulls fractures, and in turn a serious infection of the brain.

Based on these findings, Khloe was immediately started on medications. Two antibiotics were chosen to treat the infection. Two pain killers were also prescribed. One of them is called gabapentin, which is often used to control syringomyelia.

Three weeks later, Khloe was doing great and was finally behaving like a 3 month old puppy should!

It is difficult to tell at this point whether the syringomyelia will be a life-long issue or not. For now, Khloe’s owners are taking it one day at a time. They are thrilled that their pup has beaten the odds.

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

Sparky receives the gift of life

It’s lar par season!!!

As the weather gets warmer, I will see more and more dogs suffering from laryngeal paralysis.

This reminds me of a recent patient with lar par, Sparky, an 11 year old Labrador. He was suffocating and was diagnosed with laryngeal paralysis. This is a serious and stressful condition where the larynx (voice box) doesn’t allow enough oxygen to flow into the lungs.

His condition had been getting worse for about a year, then it suddenly got dramatically worse. When he arrived at Barton Heights Veterinary Hospital (www.bartonheights.com) in Stroudsburg, PA, Sparky had to be placed on oxygen. He was given tranquilizers to decrease the stress of suffocating.

Then something unusual happened. Because he was still struggling, he had to be placed under general anesthesia so that more oxygen could be delivered through a tube placed down the throat and into the windpipe.

This bought time until I was able to drive to the hospital and perform emergency surgery. The goal of surgery is to open up the larynx with permanent sutures (tie back surgery).

Despite a stressful start, Sparky’s surgery and recovery were uneventful.


And that was exactly 2 years ago,

His owner updated us after a year: “Sparky is still with us. We celebrated his one year anniversary last night with some vanilla ice cream. He has lost a lot of his muscle in his back end, but is still ambulatory and it hasn’t stopped him from trying to chase deer in the meadow (though he doesn’t get too far) or climbing up on the furniture (even though he has a comfy bed on the floor).”

How does his owner feel about doing the surgery on a senior dog (11 years of age), in spite of how severe his situation was a year ago?

“It really is miraculous! We are extremely happy – beyond words, really – that Sparky had the surgery and survived the ordeal. If he had lived only a week, or a month after surgery, we would not have regretted his having it, but the fact that he is here a year later certainly underscores why he should have had it. We are so grateful to you for the gift of his life!

You can watch a quick video of Sparky here: https://youtu.be/fy7dWlAVqnM

So Sparky is breathing well. Yet “He has lost a lot of his muscle in his back end.”

It is possible that he has another nerve condition, related to lar par, that leads to progressive weakness in the back end (visit http://www.cvm.msu.edu/scs/research-initiatives/golpp/living-with-golpp for more info).

Sadly, there is no treatment. Well, besides doing the opposite of what most dogs wants to do: these dogs should not be moping around all day. They should be taken on slow, steady leash walks to keep the muscles as strong as possible.

Few pet owners are as dedicated as Sparky’s owner. She wasn’t about to give up on him without a fight, and the reward is a happy, breathing, deer-chasing Labrador!

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