That's a Mouth Full!

This week one of my tiniest, sweetest little patients was diagnosed with a problem that is quite a mouth full to pronounce: crycopharyngeal achalasia. Whew! It made me think back-WAY back-to my first medical terminology class. I took it as an undergraduate student at Cal Poly in San Luis Obispo. I liked it because it wasn't a course where you had to memorize lists and lists of those mile-long, foreign words. Instead, we were taught how to break down those words in their prefixes, suffixes, roots and parts-dissecting them if you will- and this way found we actually knew the meaning of most of those daunting words, even if we had never heard each one before.

We started with the basic terms we learned in our anatomy classes, words describing parts of the body, organs, etc. Derm refers to the skin, osteo to bone, cerebral to the brain, cephal is the head, coreo is the pupil of the eye, and cardio the heart. Cysto refers to a bladder, renal or nephro to the kidneys and hepatic to the liver. Chol refers to bile or the gall bladder. Ovo refers to the ovaries while orch refers to the testes. I wasn't amused when we learned that the root for uterus was "hystero" because females were considered "hysterical" by their doctors. Wonderful. Metra can also refer to the uterus.

We then learned the prefixes that describe these organs or conditions. "A-" can simply mean without or not. "Neo-" is new or recent. "Bi-" means two or double. "Iso-" means equal or alike. "Endo-" means within. "Pyo-" refers to purulence or pus.

Suffixes might further describe or quantify conditions or situations. "-algia" refers to pain or a painful situation. "-itis" refers to inflammation. "-osis" simply refers to "the disease or condition of." "-lith" refers to a calculus or stone. "-otomy" means to surgically cut into while "-ectomy" means to surgically remove and "-ostomy" means to crate a permanent hole in. "-oma" usually refers to a benign tumor while "sarcoma" refers to their malignant counterparts.

So, let's try out your new skills in medical terminology. Break down the big words into their smaller, more familiar parts and see what you come up with. You will be surprised how easy (and even how fun) it can be!

1) Dermatitis
2) Nephrectomy
3) Pyometra
4) Endocardiosis
5) Cholecystolith
6) Ovariohysterectomy
7) Osteosarcoma
8) Acholiosis
9) Tracheostomy
10) Isocoria

Ok, here are the answers-I'm sure you got all of them right!

1) Derm-skin + itis-inflammation = inflammation of the skin
2) Nephro-kidney + ectomy- surgically remove = to surgically remove the kidney
3) Pyo -pus + metra- uterus = pus in the uterus or a uterine infection
4) Endo-within + card-heart + osis-condition or pathology of = disease inside the heart, actually refers to a disease of the heart valves (which are inside the heart-see how this works?)
5) Chol-bile/gall + cysto-bladder + lith-stone = gall bladder stones
6) Ovario-ovaries + hyster-uterus + ectomy = removal of the uterus and ovaries-in dogs or cats, we call this a spay surgery.
7) Osteo-bone + sarcoma-malignant tumor = bone cancer
8) This one looks hard, but just break it down...a-with out + chol-bile + osis-condition of = the condition of not being able to produce bile.
9) Trache-refers to the trachea + ostomy-to create a permanent hole in = creation of an opening into the trachea.
10) Iso-the same + coria-refering to the pupils of the eye = having pupils that are the same size.

Look at that! I knew you could do it. See? Doctors really aren't all that smart. Using big words just makes them sound that way, and now you know the secret behind doing that, too. And it doesn't even give you cephalgia (a headache) to use those big words, too.

Peace,
DrReneigh

No Puppies for Heike

Heiki wasn't feeling quite herself. Normally vivacious, full of life and energy, the first day we saw this wonderful Coton de Tulear, she was a little down. She was fortunate to be owned by a very observant lady who noticed early on when something wasn't quite right and brought her in for an exam. She noticed that her appetite was off the past two days or so, and most significantly, Heike had some clear, shiny discharge from her vulva which she kept trying to lick clean. Her temperature was a bit elevated, too. Heiki's owner also happened to be her breeder-and was very knowledgeable that these symptoms could be signs of trouble with the reproductive tract. She told me that Heike had been bred 3 weeks earlier.

By far, most breedings of dogs happen with no problems at all. But the process isn't exactly sterile, and bacteria can get introduced into the reproductive tract of the female dog during mating. They will migrate up through the cervix, which is relaxed during estrus instead of being closed tightly as it is during the rest of a dog's cycle. The bacteria then start to reproduce in the uterus, creating an infection here we call a pyometra-literally "pus in the uterus."

We can see two types of "pyos," open and closed. These descriptions refer to the cervix, and tell us if the infection is trapped or contained in the uterus creating a life-threatening "balloon" of infected material or if the bacteria and pus is able to drain or leak out of the uterus through the cervix. Both are incredibly serious problems for any dog, much less a breeding female.

Now, the discharge coming from Heike's reproductive tract at this point didn't look like pus-it was clear with no blood or other cells in it at this point. We decided to do an ultrasound exam of her uterus and see just what was going on in there. We shaved some of her glorious long white hair from her abdomen and very quickly confirmed that Heike was, indeed, pregnant. This certainly made our treatment decision more difficult-if it was at all safe to do so, we would like to be able to continue the pregnancy. Since we suspected the discharge could be normal or could be early signs of the pyometra infection we were concerned about, we talked at length with Heike's owner. Another possibility was that the pregnancy was trying to resorb or abort for some reason. We trusted that Heike had the type of owner who could carefully monitor her condition, give medication as directed and watch for the changes we discussed. If Heike stopped eating or started vomiting we wanted her right back in. If her temperature increased, or if the vulvar discharge turned milky or creamy we needed to recheck her. Many dogs with pyometra will start to drink water excessively, so we wanted to watch for this, too. Since we knew she was pregnant, monitoring for a distended abdomen wasn't going to be very helpful. But if she became painful in her belly, that would be a bad sign. We gave Heike a prescription of an antibiotic we felt would be effective for an infection in the uterus but would also be safe for developing puppies, gave her some fluids under the skin to help her hydration and slight fever, and sent her home.

Heike's owner was diligent in medicating her and giving her fluids, orally and subcutaneously. She monitored her vital signs as we asked, and Heike did pretty well for about a week. About that time her temperature actually decreased to below normal and she stopped having any vulvar discharge. We had her come in to reevaluate, and did some blood work and another ultrasound exam. The blood work showed a significant elevation of her white blood cells, a tell-tale sign of infection in the body despite the week-long antibiotic treatment. The ultrasound exam showed that the pregnancy was not progressing as expected. In fact, while we could see the individual vesicles of amniotic fluids, no evidence of feti were found in those vesicles. The uterus itself was very large and fluid filled. With no vulvar discharge seen now, we diagnosed a closed pyometra.

As mentioned before, a closed pyometra is a life-threatening condition. As the uterus fills with pus, the wall of the organ becomes stretched thin and attacked from within by the bacteria, weakening the tissues and making rupture of the organ very possible. The only treatment is an emergency removal of the uterus, hopefully before any rupture or leakage of any amount occurs. We rearranged our schedule and got her right into surgery. It was a good thing we didn't wait.















Normally a thin band of tissue, sometimes even difficult to find among all the intestines and other abdominal contents, Heike's uterus was huge, bulging up right under the incision I made in her abdominal wall. I exteriorized it carefully, revealing the "balloons" we saw on the ultrasound exam.
While thinning in some areas and obviously very diseased tissue, there were thankfully no obvious tears, ruptures or leaking areas. Gentle handling was essential to keep that from happening. I wanted to remove the entire pus-filled uterus, along with both ovaries and the supporting tissues without spilling the contents into the surgical site. Unlike in a human female where the uterus has a simple body, (just fine for a single fetus) the uterus in a dog consists of two "horns," much better suited to accommodate the numerous developing puppies or litter. You can see Heike's diseased uterus kind of looked like big sausages-very abnormal.

We were able to remove both of Heike's uterine horns and ovaries without obvious pus contamination of the abdomen, but we flushed out her abdomen with warmed, sterile saline as a precaution, explored the rest of her abdominal organs briefly and found no other problems, and closed her incision. After we removed the diseased organ from her body, we opened it up and found that, sure enough, it was filled with a huge volume of a nasty, strawberry milkshake colored liquid that anyone could tell wasn't normal. The entire surgery was less than 30 minutes, but without it, this sweet little dog would certainly have died from that infection.

It is tempting to treat these dogs like those we have spayed-just a "routine" procedure, especially when they do as well as Heike did. But that would be a mistake, and could have resulted in a decline in her condition later. There was nothing routine about needing to rush to surgery right away. Heike had no time for adequate preparation before surgery, such as fasting, and she was only started on her IV fluids minutes before I made the incision into her abdomen. That uterus was hardly normal, and her blood work showed an obvious affect on her entire body from sepsis or pronounced infection. Her lower than normal body temperature was a sign that her body could no longer handle things on its own and might be facing impending shock. Heike was placed on a different, more powerful antibiotic, one we couldn't use earlier when we had a potential pregnancy to consider. She had aggressive IV fluid therapy and her nurses got her body temperature back up to normal-and kept it there. Her surgical pain was managed well with narcotics before and after surgery, as well as a non-steroidal anti-inflammatory medication. She was also sent home with an appetite stimulant, as getting her to eat right away would be very important to her healing process.

Heike was fortunate that her owner knew the signs of pyometra and how serious it could be. Even if an owner didn't know about this disease specifically, just knowing the "normals" for your pet, his or her normal habits, appetite, activity level, etc. really goes a long way to helping know when something just isn't right. It is the veterinary team's job to then try and figure out why that is-working as a team, we got Heike all fixed up, sent her home to her owner and when we later rechecked her, found that she was the happy, healthy dog she had always been.

But even happy and healthy isn't enough if you are a female dog living with a breeder-and you don't happen to have a uterus! Heike needed to find a new home, and that she did. She actually got to make a plane trip across the country, and now lives with another sweet "cotton" dog, MC. Heike is now known as Olivia-and she couldn't be happier! Her new owner opened her home and heart to this sweet little girl. We are glad that everything has worked out so well for everyone. Good luck, sweet Olivia!

Peace,
DrReneigh

Lucy is #100!!

Lucy was normally a feisty and trouble-making tortiose shell kitten. Well, yesterday she had the trouble-maker part down pat. Her feisty personality was toned way down, though. She had vomited the day before, a piece of what looked like gift-wrapping ribbon. And there was blood in the vomitus. If that had been all, and she had gone back to eating and tormenting her brother and all, well, that would have been that. But Lucy's mom just had a feeling about her, and I have learned never to dismiss a mother's intuition. She brought her in first thing in the morning-and I am glad she did. Lucy's usual glossy hair coat was oily and rough-she wasn't grooming herself. Her gums were tacky and dry-she was dehydrated. And when I palpated or felt her abdomen, she became very tense and painful-different from the normal-"don't do that, I don't like it" reaction most cats will give me. It might be a subtle difference, but like her mom, I knew it when I saw it.

Because of her history of vomiting up what looked like ribbon, we decided to take some radiographs of her abdomen right away. Now, for most patients with a little vomiting or gi upset, I don't usually jump right to x-rays. They are expensive, and by far most pets are going to get better with a little tender loving care, maybe a fast, some fluids, bland food, etc. But remember her mother's intuition? And remember her painful abdomen? And remember she vomited blood and ribbon? Those symptoms all added up to trouble-and I wanted to be ahead of the game with Lucy's diagnosis. I'm glad we took the pictures.

Lucy's radiographs showed a whole lot of "stuff" in her stomach-lots of very distinct lines all packed together-nothing readily identifiable. Her owner said she hadn't been fed since the night before, (and she didn't know if she ate then or not-she does have another kitten in the household.) Lucy hadn't had any breakfast, so she shouldn't have had anything in her stomach at that time. Since I couldn't identify just what it was, but knew it shouldn't be there, and because that meant a pretty big next step-surgery-I wanted a second opinion on the films.

We have all of our x-rays read by a board certified radiologist-I learn a lot from him and it is a lot of comfort to have that second set of eyes when I'm just not sure of what I'm seeing. Our local veterinary reference laboratory provides a courier service for the films themselves, (I haven't made the 70+ thousand dollar investment in a digital system yet...) picking them up and delivering them to the radiologist's office where he interprets the films, faxes us a copy of his results, and sends the films back via the same courier service. This is a very handy and speedy service, but still takes a day or two at best. We can occasionally arrange for "stat" pick up and delivery of films, but there is a considerable extra fee involved, and still some delay. Since I was worried about the liklihood of imminent surgery for little Lucy, I asked her owner to hand carry the films to the radiologist's office herself, saving the fee and resulting in much faster results. Lucy stayed with us, and so did George, her big brother-more for moral support for HIM. He couldn't bear being seperated from her!

All this worked out very well. In about an hour the radiologist gave me a call and concurred: the radiograph findings suggested we should do a "peek and shriek" surgery. In proper medical terms, an exploratory laparotomy. I like "peek and shriek" just fine. They are usually quick and we usually find some pretty impressive things to "shriek" about in these surgeries-and Lucy's was no exception.

We called Lucy's mom and told her what she was already suspecting-Lucy would be going to surgery right away. We called a few other owners to rearrange the schedule-those with "routine" appointments for things like vaccinations had no problem resceduling for another day. Others with ill pets, just not as critical, got moved to a little later-all knew that if it were their pet needing the emergency attention, they would be first in line. That's just how we do things here, and everyone is usually very understanding.

I have to mention here how very lucky Lucy is to be owned by such good humans. Not only did they recognize her signs of illness and bring her right in, they also accepted the responsibility and need to care for her, making big sacrifices during this holiday season so they could provide the care she required. We all know that isn't the case with all of our animal friends, especially in these difficult economic times. Hurray for Lucy's humans!!!

Schedules were rearranged, the staff swallowed some pizza I got for their lunch and off we went to surgery. Lucy did great, and so did her team. She was anesthetized and prepped for surgery, and I was in the surgery room with her in record time. It didn't take long to find her problem. Her stomach was the size of my fist, (That's pretty darned big for a 9 pound cat!) and although outwardly it looked just fine (no signs of perforations or necrosis, thank goodness) it was rock hard. I ran through the rest of the gastrointestinal tract and found it was completely empty-whatever was in the stomach had prevented anything from entering her intestines for quite some time.

After ensuring that the stomach was the sole problem area, I performed a gastrotomy-an incison into the stomach wall.
The contents were pretty impressive-wads of what appeared to be plastic strips and elastic bands-hair bands and maybe even a small bungee cord. And yes, there were many pieces of colorful ribbons, too. Lucy had been collecting these goodies for quite some time.

We saved all these treasures to show her owners-after all, they were paying good money for retrieving them! Hopefully they would be able to identify them-and then be able to "Lucy-proof" their home a little better than they thought they were. Her incisions were closed up, Lucy was given some good pain medication, and she was tucked into her recovery kennel, nice and toasty warm. She was a bit slow to wake up, but there was no rush. We monitored her carefully, and by the end of the day, she was doing just fine. She even ate a couple fingers full of food! We set up some nurse checks and I put my web cam on her so I could monitor remotely. She got a little over heated with all the heat lamps, heated kennel and heated rice bags, so those were removed during the night, but otherwise, everything went smoothly. Lucy had another dose of pain medication this morning, and soon after she began eating like a pig! She wouldn't let poor George any where near the food dishes. She must have been starving for actual real food-hair bands don't have much nutritional value.

Lucy's owners came this morning to pick up her and her brother-the house must have been awfully quiet without those two last night. We went over her care instructions-I don't usually consider gastrotomy patients "out of the woods" until about 10 days or so post-op. That would give the stomach incision plenty of time to heal and digestion to start up again. If any leakages were to occur, infection would become obvious during this time. All in all, I was quite pleased with how she did, and expect her to recover just fine. Now it is up to her humans to keep her away from those darn enticing stringy things. My own cat, Stella, has an addiction to curly ribbon-she can just smell a package wrapped with the stuff when it enters the house and is immediately drawn to it, chewing frantically unless I intervene. It is weird just how much certain cats love to chew on things like this-ribbon, string, yarn, tinsel, dental floss, and yes, hair ties. If you don't know what your cat's predilection is for these things, don't take a chance! Keep them in drawers or cabinets or in covered bins. Surgery is no fun for any one. (Well, I actually DO like these types of surgeries :) "A chance to cut is a chance to cure." In Lucy's case this adage is particularly true.


Wow! Lucy's story makes 100 blog entries! That is quite a milestone, especially since I took the last 3 months or so off. I hope you have had some fun reading about the various patients that have come and gone in our busy little hospital-maybe were grossed out by a few stories, laughed at some, shed a tear or two at others. I tried to always add a little "educational" aspect to most of my blogs-hopefully teaching fellow pet lovers some new things about their friends, reminding you of situations to be aware of or just exposing you to an aspect of veterinary medicine that you might never have considered before. Some veterinarians are called upon to do some pretty amazing things-from realigning the broken bones in the leg of a puppy accidentally stepped on by the playing children, to stuffing the intestines of a "broken" spider back in his body and super-gluing him closed. Some of us who enjoy surgery might get to repair a torn ACL on a rambunctious lab or pull hair ties out of a kittens packed stomach. We occasionally get to diagnose rare or exotic illnesses, and the outcomes may not be good-but hopefully we learn from them, too. With all this knowledge and technology at our hands, we still have a "few" limitations. (Ha ha! I wish it were ONLY a few!) But I was referring in this instance to a limitation I have often wished we didn't have-we still aren't capable of installing zippers into the bellies of patients who repeatedly eat things they shouldn't eat.

Peace,
DrReneigh

A Big Dog With a Big Problem

Kodi was a BIG dog-a gorgeous 120-pound Malamute- who had a very big problem-his kidneys weren't working like they should. For him, this meant the waste products of every day metabolism that build up in the bloodstream just kept rising, unable to be filtered by those failing kidneys. Now, Kodi wasn't an old dog as you would have expected. Older patients get things like organ failures-they just wear out after years and years of use. Sometimes they get cancer in those organs. This just wasn't the case for Kodi-he was only 4 years old. As we attempted to treat Kodi for the obvious problems resulting from his kidneys not working, we also had to go on a hunt for possible causes of their failure-or we might not be able to stop it from happening again.

Since kidneys are a filtering organ, anything that travels in the blood stream and accumulates in the kidneys could potentially casue those organs problems. Drugs like non-steroidal anti-inflammatory medications can do this, especially ibuprofen, a drug really meant for human, NOT canine use. Other medications humans routinely take could have renal toxicity problems in dogs, but Kodi's owners were fairly certain he didn't have access to anything like that. They hadn't given him anything as some people do, "just to make them feel better" before resorting to a veterinary visit. We couldn't think of any plants or yard products/chemicals he could have eaten, and they hadn't changed their anti-freeze in their cars recently. Anti-freeze is a well known kidney toxin.

There are, of course, primary diseases of the kidneys themselves-infections like pyelonephritis which can develop from bacteria that travels up the urinary tract from the bladder to the kidneys when a pet has a bladder infection, often unnoticed by owners. The blood work we did on Kodi did not indicate any infection in his body right then, but it was still a slight possibility.

Leptospirosis is a bacterial disease that can affect the kidneys of dogs, as well as humans. Wild critters such as possums, racoons and rats can be the carriers, spreading the organism through their infected urine. The disease can be serious for both humans and animals. In people, the symptoms are often like the flu, but sometimes leptospirosis can develop into a more severe, life-threatening illness with infections in the kidney, liver, brain, lung, and heart. Because we had put many of the other possibilities for Kodi's kidney problems lower on the differential or "rule-out" list, leptospirosis worked its way higher up the list. Testing for the disease is done via a blood sample, but results often take 10 days to get back. Since the treatment for the leptospirosis bacteria itself is done with antibiotics, we decided to start Kodi on these right away rather than wait for the test results to come in.

Leptospirosis is one of the "big" diseases we usually vaccinate at-risk dogs for every year, but unfortunately the vaccine does not provide 100% protection. This is because there are many strains (types) of this bacteria, and the vaccine does not provide immunity against all strains. It is important to get your pet vaccinated again even if it gets leptospirosis because it can still get infected with a different strain of leptospirosis. Kodi was vaccinated each year for 4 different strains of lepto, but his test came back positive for another strain, one for which a vaccine is not available. It was a good thing we had started him on antibiotics when we did. when we got the test results back, we also started his house mate, Kiona, on a prophylactic course of antibiotics. She wasn't showing any symptoms of the disease, and we certainly wanted to keep it that way.

As mentioned, treatment for the leptospirosis bacterial infection is antibiotics, specifically those in the penicillin family. These will arrest the on-going infection, but dogs can remain carriers of the disease unless a second antibiotic from the tetracycline family is used, often for 6 weeks, to break that carrier state. Kodi was initially put on injectable ampicillin since he was so nauseated and anorectic from the kidney disease that resulted from the infection. And this was the big problem: we had a handle on the disease and could get it treated, no problem. But the damage it had already done to Kodi's kidneys was severe-he was hospitalized multiple times, once for 4 days in a row for 24 hour a day IV fluid therapy in a attempt to diurese his blood and get those kidneys working again. It never worked. His owners were terrific. They did everything we asked of them, bringing him in for testing, for hospitalization and treatment despite the considerable time they had to take off work and expenses they incurred. He spent a lot of time with us and in the emergency hospital when we weren't available.

We really expected such a young, big, strong, dog to turn the corner any time and make a full recovery, but it was not to be. Kodi's initial bloodwork showed just how poorly the kidneys were doing, and his first retesting of their values showed good improvement. Kodi was given very aggressive care, including those antibiotics, fluids, anti-vomiting medications, prescription renal diets to require less work on the kidneys while providing good nutrition for healing, antacids, appetite stimulants, phosphate binders (phosphorus levels go sky-high in kidney failure patients, making these patients very weak and wobbly, and Kodi was no exception)-you name a drug in our pharmacy and he probably was on it at one time or another! Subsequent testing showed no changes in those kidney values, and his phosphorus levels worsened, making him even weaker. His owners were reaching their limits of what they wanted to put him through, and frankly, what they could afford to spend. When Kodi finally became painful-his kidneys evidently swollen and tender-he was crying out as only a 120-pound Malamute can-his loving owners made the choice to end his suffering and said goodbye. It was a terrible tradgedy-his owners did everything right, loved him, fed him right, provided him with good preventive health care-and it just wasn't enough. They unselfishly did the right thing for him that weekend, as hard as it was on everyone involved.

Kiona is still symptom-free, and we fully expect her to stay that way. We had a little scare when one of out veterinary technicians became ill this week and made sure to alert her physician about her exposure to leptospirosis. In fact, we were required to report Kodi's case to the state veterinarian, that's how serious this disease is.

Definitely get your pet vaccinated for leptospirosis (the "L" part of a typical DHLPP vaccine) if he or she is at risk, and do your best to control the rodent/small animal population to minimize their urine in your pet's environment. Leptospirosis is out there, but is not a very common disease, thank goodness. If your pet has been confirmed by your veterinarian as having leptospirosis, don't despair. Early, aggressive treatment usually brings about good results. Kodi's case was rare and tragic.

Peace,
DrReneigh

Making Herself Right at Home

So, the picture is a little blurry, but that is because little miss Raena was moving pretty darned fast. That big silver disc she is on is actually her exercise wheel, a pretty great design, considering most of the ones you usually see for rodents are made of open wire, and an open wire wheel caused Raena a huge problem a few years ago. She got hung up in it somehow (she wasn't telling exactly what happened) and broke her tiny little leg. We tried to fix it, but rodents aren't known for being the best patients when it comes to injuries like that, and Raena the chinchilla was no exception. Chewing at wounds and suture lines, and not understanding the meaning of "rest" or "taking it easy" until the bone could heal meant numerous complications, and she ended up having her left hind leg amputated. Not that you would ever know that today. She may have a goofy little swing to her gait, but when she gets going on her nice solid wheel, she looks like a pro! And boy, is she fast! We had her out in the living room the other night just to see her scamper around. When it was time to put her to bed-ha! it was crazy trying to catch that slippery little varmint! It really does my heart good to see how lively she is-don't even dare consider this girl "handicapped." A 3-legged chinchilla is just the most natural thing in the world, at least it is in a vet's home!

My husband Michael and I lost our first chinchilla, Edgar, last year. He was over 15 years old-quite a distinguished old man, and such a wonderful little pet. I don't think we realized just how much we had missed him until we learned that Raena's owner was asking about finding her another home. My hospital manager, Cori, had owned one of Raena's babies at one time, and she would have made a great home for her. But she has a very happy chinchilla already, and she didn't want to risk upsetting the balance of his life by adding another critter right now. I jumped at the chance to add Raena to our little family, and she came home with me last Friday.

You would think she would take some getting used to her new situation, needing some time to figure things out and all but, no, not Raena. She never missed a beat, jumping out of her travel carrier right onto her exercise wheel and going for a short run right when she arrived. Then she hopped over to the side of the cage and took a raisin from Michael-he was thrilled! It was one of Edgar's favorite treats, and now you can be sure she will be spoiled rotten by her new "dad." Raena wasn't even phased by the cats who came running over to see who was taking occupancy of the great big cage in the living room-they were pretty perturbed it wasn't for them! Anyway, Raena didn't even bat an eye at those natural predators, or maybe she was batting her eyes, winking and flirting, more like teasing those cats who are easily 6 or 7 times her weight!

Chinchillas are members of the rodent family, actually closely related to porcupines if you can believe that!, but also related to guinea pigs.

Yes, chinchillas were originally bred in captivity for their pelts-it IS wonderfully luxurious and beautiful, but it seems to me it would take an awful lot of those little guys to make a single coat! Current fur colors we see include white, silver, beige, and black. The chinchillas who were lucky enough to have lower quality fur were sold as pets, although some were used as research animals. That is how I got my first chinchilla, Edgar-he was losing all of the fur on his body, not exactly what they wanted in the fur-coat business, thank goodness! He was a wiley little dude-he grew a gorgeous thick silver coat after he came to live at our home and was no longer at risk of being made into a coat.

Chinchillas originated in the barren, mountainous regions of Peru, Bolivia, Chile and Argentina-particularly in the high altitude Andes mountains. The first known chinchilla ranch was founded in Chile in 1874 in Vallenar by John Murry, an English member of the famous scientific expedition "Challenger." In February 1923 an American mining engineer, Mathias Chapman, brought the chins to North America. He was in charge of several mines in the Andes and that is where he was introduced to the chinchilla. He took an immediate liking to the little guys and hoped that he could take a few of them home to California as pets. The export of chinchillas was illegal, however, he eventually persuaded the authorities to permit him to take eleven chins with him back to the States. Eight male and three female Chinchilla Lanigeras. He brought them down from the mountains and arranged passage on a Japanese freighter. And the story goes, (although this is almost certainly apocryphal) that all the chins in North America are descended from Chapman's.

In general, chinchillas are very friendly and clean little pets, and compared to most pet rodents, have very little odor. They can be quite shy and high-strung and therefore easily frightened, so they aren't the best pets for small children. It can be difficult to house multiple chinchillas in one cage, even in larger cages, especially if you have a more aggressive female chinchilla. Breeders and pelters have an interesting arrangement for their habitats to avoid "disagreements." They will create polygamous colonies with one male having access to five or so females maintained in separate cages. The male has a tunnel along the back of the females' cages which enables him to enter any cage at will. The females cannot pass through the tunnel because they are fitted with light-weight collars that are just a little wider than the cage opening.

Chinchillas are best housed in large, wire-meshed cages for proper ventilation, with or without a solid floor. They need some sort of enclosed nesting box to sleep in. They tend to be nocturnal creatures, spending a lot of time running around, eating and playing while YOU are sleeping-so be sure to oil that squeaky exercise wheel! Wood cages aren't a good idea because chinchillas are constant chewers, and pretty quickly your nice wooden cage will be a pile of saw dust! Ideal environmental temperatures are around 60 to 75 degrees F.

Raena has been fed a very good, balanced diet-but that isn't the case for a lot of the pet chinchillas we see. In fact, improper nutrition and/or husbandry (housing and care) are the most common causes of health problems in our little rodent and other small pets. She gets a pelletted chinchilla diet, although not all pet stores or feed stores will carry this. Using a standard rabbit or guinea pig ration is OK temporarily. Chinchillas like Raena are really cute when they eat, tending to pick up each pellet with their little hands, but they can be pretty messy, too, throwing a lot of pellets around the cage, so there can be quite a lot of waste. Raena has been pretty neat about her eating habits so far.

Grass hay is an important part of a chinchilla's diet as it adds fiber, important for proper digestion and teeth wearing (chinchilla's teeth grow constantly through their lives so need to be monitored for problems associated with overgrowth.) Hay also just gives these little guys something to do. Bored chinchillas often start to "barber" or chew on themselves, and many become bald as Edgar almost did. Alfalfa hay has the wrong calcium/phosphorus ratio for proper chinchilla nutrition, so should be avoided. Any hay fed to them should be clean with no evidence of mold, insects, or wild rodent contamination.

I mentioned earlier that Raena loved the raisin that Michael gave her. Dried fruit and nuts are great treats for chinchillas-and these little guys really do look like they are just relishing those treats! Fresh veggies are great, too, but all these treats should only be about 10% of the total diet. Because of their original habitat, dry, barren mountainous regions, chinchillas aren't used to taking in lots of fluids like what is found in fresh produce. They will likely drink much less water if they are offered these fresh treats, but their urine output should remain about the same. Be sure to monitor this for any changes or problems. Raena has a wonderful plastic corner box which she uses as a litter box. I just take that out and rinse it out every other day or so-it really cuts down on the need for an over-all bedding change in her cage. Pretty cool, huh?

One unique part of chinchilla husbandry is the need to offer them a dust bath a couple of times a week. Raena LOVES hers! She takes her dust bath in a little plastic box, big enough for her to twist and turn and spin all around, covering herself from head to tail with the lightly colored powder. When she is done all you can see are her two little eyes peeking out of all that powdered fur. The dust is actually a finely ground volcanic ash, and it serves to keep that wondeful fur clean, oil free and over all well groomed. I think it is just plain fun for them to spin around in the bath! Here's a good You-tube video of a chinchilla enjoying his bath:
Chinchilla Dust Bath
I don't leave the bath in the main cage all the time or it gets used as a litter box...and then it isn't much good as a grooming aid.

Raena is a pretty tame chinchilla, but she still doesn't like being handled all that much. In general, chinchillas are usually easy to handle and rarely bite (although any little critter can if agitated enough.) More likely, they might just urinate when they are annoyed about being held-so watch out! You also have to be gentle when handling chinchillas due to the possibility of 'fur slip." This is a sudden shedding of the hair coat in a patchy way that occurs when it is grasped or handled roughly. I haven't ever seen this happen-and I hope I don't! Doesn't 'fur slip' sound awful? As with any animal, just be gentle but firm when holding or restraining a chinchilla to avoid injuries to you or them.

The average life span for a pet chinchilla is 8 to 10 years, but there have been reports of some reaching 18 years! Raena is 6 years old right now, so she should have a good long life ahead of her-I sure hope so! She has already brought a lot of joy to our home, and I am so very grateful to her first owners for letting us adopt her into our family. I have been playing around with how her name is spelled, and even if we should keep her name as it is since it is so darned close to my own. I found several different definitions for her name, including "queen," "pure," and "song." We'll see how things work out. For now, our "pure little song queen" is working her way into our hearts....it isn't taking long to accomplish that!

Peace,
DrReneigh

What More, Verbal Dog?

Regular readers of this blog (and anyone who knows me AT ALL) know all about Verbal. She has been my constant companion since she joined my life over 11 years ago, an adorable, 4-week old yellow puppy. This tiny, broken thing was presented to the hospital where I was then working by a supposed "breeder." I use the word loosely-what kind of breeder would cross a Golden Retriever with a Yellow Lab, and do absolutely no pre-breeding health or temperament testing on the parent dogs? As much as I love this dog of mine, I have had numerous times called her "my genetic disaster," referring to her terrible hip and elbow dysplasia, her numerous bouts with cancer (yes, debatable whether genetically linked or not) and her, at times, questionable temperament.

Anyway, this little puppy had been attacked by her daddy dog-evidently she got too close to his food dish and he mauled her. 4 weeks old and he broke her jaw and ripped her tongue off. The "breeder" brought her in to be euthanized-they couldn't justify putting any money into this one puppy when they had 8 others at home, and it was pretty obvious how they felt about spending money on veterinary care.

Well, I would have euthanized the dog that did this to the pup in a heart beat-what would stop him from turning on a child someday? But there was no way I could end the life of this innocent little ball of joy, wagging her tail despite the terrible pain she had to be in. My husband and I had just happened to purchase our first home literally one month prior to meeting this wayward puppy, and we knew that adding a dog was in our future.....Can you see the big word "sucker" tatooed across my forehead? Well, there's worse things, for sure. We had the owner sign over the rights to the puppy, and we did surgery to fix her up right then.

Her lower jaw was broken, so we placed a pin through the length of it. Her tongue was reattached, and we could only cross our fingers and pray that it would be functional after such a dramatic injury. To this day, she has a huge scar on the back of her tongue, and when she yawns, her tongue curls up, almost touching her right ear. I doubt it has much feeling on that side, so accounts for even more dribbling than usual after drinking water (but what labrador anywhere drinks neatly???) It isn't perfect, but at least she has a tongue, and that goofy sideways grin gives her even more character than the usual smiling, happy water dog that she is.

4 weeks is awfully young to wean a puppy from its momma, but this just wasn't a normal situation. We did our best choosing some pain medication for her, but were limited due to her age. It didn't seem to matter, though. She was up and eating that first night after surgery, and was carrying a frisbee that was bigger than her later that week. Eating and carrying something, Frisbee, tennis ball, stick-SOMETHING-have been THE themes of her life ever since! She was our first (and so far only) dog in the family, but not the first pet. Flake was our "top dog," even though she happened to be a Maine Coon cat. She was bigger than the puppy at the time, and even though not exactly thrilled with the new addition, handled her just fine. The curious puppy couldn't help bouncing up to the giant cat asking her to play, and came away more times than not with a swat on the nose but hardly humbled at all. To this day, Verbal goes up to the various kitties in her life a bit cautiously, fully expecting to get whacked, but unable to resist-she just loves them so much!

Since I brought this broken little thing home kind of unexpectedly, I thought it would be best if I let Michael name her. We had just seen a great movie, "The Usual Suspects," one of Michael's favorites, and the main character, played by Kevin Spacey, actually had two names. "Keyser Soze" just didn't seem like a good name for a little girl puppy, so "Verbal" it was. We kind of thought it would be a joke, too, since how could a puppy whose tongue was ripped off and jaw was broken be very talkative? Ha! The joke was on us! Verbal more than lived up to her name, and very few people who meet her know the source of her name-they just assume it is because of how darned much she likes to talk.

Since she had no trouble eating, she began growing like a weed. It was only two weeks before we realized that pin in her jaw would have to be removed. I took her to work, anesthetized her, and pulled the pin, but during her recovery, Verbal's heart stopped! I went into emergency doctor mode, performing CPR, injecting epinephrine into her heart, and sure enough, that plucky little puppy came back to us. I got the job of reviving her done-then went and puked my guts out. Being mom and doctor at the same time is really hard to cope with, but it was good to know that I could automatically go into emergency mode when needed-and deal with the emotions of the situation later. Verbal actually suffered hypoxia during her cardiac arrest. The lack of oxygen to her brain resulted in her being very wobbly and unsteady when walking for a few days-and scariest of all, she was actually blind for a day! Of course, we didn't know it would only be 24 hours, and it was a horrible time when we didn't know what was going to happen to her. Michael was adamant-we were NOT getting a seeing eye dog for our puppy! Thankfully, she regained her sight the next day, and gradually got more steady on her feet. An anesthesiologist I consulted with thought her blood glucose might have been too low during her procedure, resulting in the hypoxia. While adult or even older puppies can be safely fasted prior to anesthesia, it just isn't safe to do so in these neonates or very young puppies for just this reason. This was just one of so many things Verbal has since taught me about medical issues that I would be able to use for my future patients. I know she came into my life for a reason, making me a better veterinarian, despite what people say about how lucky she has been to have me (a vet) for her owner. She has given me far more in my life than I could ever have given her.

After that anesthesia fiasco, I swore I would make her suck it up and just stand there for her spay. Not really, but I sure was holding my breath during that surgery when she was about 6 months old. I think the anesthesiologist was right about that low blood sugar as a neonate-she has never had anesthetic complications again-and she has had a LOT of surgeries in her life.

Verbal was only about 2 months old when I began noticing how she ran with both of her hind legs kind-of "rabbit-hopping" together. Normal dogs have hind legs that move independently of each other; this rabbit-hopping gait was indicative of pain, discomfort, or at least some limitation of movement in her coxofemoral (hip) joints. We took some radiographs of her hips and found out that she had a terrible case of hip dysplasia. I probably blogged about it before, but where there should be nice deep sockets or cups, Verbal's hips had flat plates. There was no where for the round heads or balls of the femurs to fit. Her right side was much worse than the left, and unfortunately, surgery was in her very near future. I took her x-rays and visited a surgeon I respected and trusted. He told me that the "usual" surgery to repair hips in such a young dog, a TPLO or triple pelvic osteotomy (breaking the hip in three places and plating them together in alignment for the femoral heads to seat better) just wouldn't work because of her particular anatomy. We would have to wait and do at lest one if not two total hip replacements. Since these surgeries can't be done on growing dogs, and since she was already showing signs of pain, we decided to do an FHO or femoral head osteotomy on her right hip. This involved removing the ball and neck of the bone so it would no longer cause bone-to-bone contact and therefore no more pain. Read the blog on 3/24/09 about Quik and his screening for hip dysplasia for more info.

Her hip surgery went well, and so did her spay, thank goodness. She was pretty much pain free-and she went everywhere with me. I was so lucky! I had a small mobile (house and farm call) practice at the time, so she hopped in and out of the truck, waited patiently while I doctored any sick animals, and looked forward to getting on the way again. Well, there are a few things she isn't so "patient" and good about. When she sees cows, for example, she just has to let them know who's boss. She doesn't do this for any other animals, unless a dog is obviously challenging her, jumping up and growling at "her" car-then it is only natural that Verbal gives them a piece of her mind. She also loves to "attack" the scrubbers and brushes when we go through automatic car washes. I really don't think she is afraid or anything-I think it is a big game and she is just having fun. But boy! Those windows get all steamed up and drool-y by the time we are driving out the other side. Nice and clean on the outside-pretty much a disaster on the inside. Oh well, simple joys in life....

I said she went everywhere with me-she really did. When I was doing some relief work, working for other veterinarians at their hospitals or clinics when they were taking vacations or going out of town for some reason, Verbal would always come with me, even when we had to stay in motels. In fact, we became "regulars" at one motel. Verbal and I stayed in the same room on the top (3rd) floor. She would often wake up before I really needed to and wanted to go outside to do her business. I REALLY didn't want to get dressed just to do that and then come back to go to bed again, especially on those cold, rainy, wintery days. I would just open the door, Verbal would run down the three flights of stairs, run to the back of the motel, pee really quickly, and come running right back up to our room. What a good girl!

So, I mentioned that the FHO surgery went well and she had no pain in that hip. This was so evident that she put most of the weight on her hind legs on that leg, and subsequently, one day, playing Frisbee (of course) came down from way too high of a jump and blew out her anterior cruciate ligament (ACL) I've blogged often about ACL injuries-Verbal's was no different-except for the fact that she had surgery on her blown knee 3 times! It now has severe degenerative joint disease, an "end-stage knee" according to the orthopedists, and she will always have pain there. We manage it the best we can using multi-modal analgesia (again, a frequent blog topic) and of course, no more high flying Frisbee games. And now at her age, a couple of tosses and chewing some of the cheap Frisbees to shreds is just fine by her!

Swimming is such good exercise for bodies, human and animal, as it allows working muscle without too much stress on the joints. Now, our hospital is in a community called Lake Stevens-and yes, there is a nice lake here. But do you think we could find a place to swim anywhere on that lake? There are "no dogs allowed" on the public beaches, and I just didn't have any friends who owned property with beach access. I was reprimanded by a "lake cop" one day while walking Verbal on an empty beach; we were standing by some HUMAN'S discarded dirty diaper. I mean, gross. We always carried baggies for "accidents," but there is just no reasoning for some things. I decided to write a short letter to the editor of the Lake Stevens Journal, our local little paper, asking if anyone would be able to offer their yard access to my gimpy yellow dog who needed swimming for physical therapy. The response was just amazing! We have a terrific community of pet lovers, that is for sure! I got over 30 responses offering Verbal a place to come swim any time she'd like. I can't help but wonder how many I would have received if I had asked for a place to swim for myself-a gimpy HUMAN! Another story there....One wonderful lady named Jo actually called me the day BEFORE the paper was released. I was really surprised by this until I learned that she worked part time for the Journal, stuffing inserts in it before delivery the day before release each week. Jo lives alone, her husband had died and her children had moved away. She has a very cute home and a secluded back yard right on the water. Jo offered it up to Verbal and me any time we wanted to come over....She is so sweet, Verbal just adores her, and the little steps going down into the water are perfect for my gimpy old lady. She goes crazy when we are driving up to Jo's house-she can smell the water and it just makes her day! We never stay very long, and I always have to make sure I hose her off really well after the swim. Lots of duck poo and other fun things growing in the water usually give my disaster dog a lovely case of pyoderma (skin infection) if I fail to do that. I never knew a dog could wag her tail while swimming and retrieving. I wish I could take her to the lake every day-such a simple thing makes her so darned happy. It's the least I should do for her.

So, life went on pretty fine for Verbal, normal aging stuff, an occasional lipoma (fatty lump) but nothing too awful. Then came a day when I noticed she was chewing at one of those apparent lipomas on her elbow-she just wouldn't leave it alone. I was constantly telling her to stop it-anyone with an itchy dog knows the lip smacking sound-it can drive you crazy! Then the light goes off in my head-duh! That is what I have clients monitor lumps and bumps for....does the pet "care" it is there? Licking and chewing at a lump is a tell-tale sign that we should remove it, or at least biopsy the thing. Verbal had quite a few lumps at this point, and needed a bit of some dental work, so we went ahead and removed it and sent that elbow lump in to the lab for analysis. Wouldn't you know it? It wasn't just a lipoma, it was cancerous. In fact, it was a type of cancer, hemangiopericytoma, that is very aggressive where it occurs, so much so that the oncologists recommended amputating her leg to control the disease. Ugh.

I already mentioned her terrible hips and the blown apart knee; amputating a front leg would have just been cruel. So, removal of the mass and follow up radiation therapy at the tumor site was the best treatment choice for my Verbal.

I can't remember if I have blogged about radiation therapy in pets yet. If not, I'll go into more detail some other time-it is pretty fascinating! But suffice it to say that Verbal had her treatments-15 of them!-and was cancer-free for 3 years-pretty awesome! Then another tumor popped up at a different site on the side of her chest-totally unrelated to the first one. My girl is just a tumor factory. This one was able to be removed with a very radical surgical procedure, cutting wide and deep margins around it and having those margins evaluated for sneaky little cancer cells. The margins were deemed "clean" by the pathologist, and now, 1 year later, there is still no evidence of regrowth of that tumor, thank goodness. I watch her like a hawk, of course, and every lump or bump she gets is tested with an FNA (fine needle aspirate) while I hold my breath and pray.

Last week we did Verbal's yearly blood panel. I certainly had been noticing her change in eating and drinking habits over the last year-she has been ravenous! She practically takes your fingers off when you give her a treat, and, as gimpy as she is, has been finding ways to get up on the table and counters to scarf up food (especially the cat food) left there. She would drain her water bowl dry on a regular basis, and even raid the toilet for more water. These were behaviors she had never done when she was younger, and I was oblivious, attributing them to being a bad old lady dog, losing her manners or something. Well, the bloodwork showed that she has a very specific reason for these changed behaviors- Verbal has hyperadrenocorticism, or Cushing's Disease. Dang! What more does this sweet thing need to deal with???

I'll blog specifically about Cushing's later on, but basically it is an endocrine (hormonal) disease, caused by too much cortisol in the body. It can occur for various reasons-Verbal's is caused by a tumor on her pituitary gland triggering her adrenal glands to produce too much of this hormone. Cortisol mimics stress in the body, and we all know how much havoc stress can play on our bodies. I guess it is good because we have an answer to why Verbal is behaving the way she is, and can now go about the process of getting her treated for it. As with so many diseases, Cushing's cannot be cured; it will be a condition we have to manage for the rest of her life. Monitoring that treatment is particularly important because over-treatment can be very dangerous; hypoadrenocorticism or LOW amounts of cortisol in the body is Addison's Disease and can result in weakness, collapse, shock or even death.

Whew! That was some blogging I did there, huh? Can you tell Verbal is a "subject" I feel passionate about??? I love that dog, and was just talking the other day with my friend, Valerie, about this very thing. Some times we are lucky enough to have one special dog in our lives, our "heart dog," the love of our life-however you refer to the relationship, if you are fortunate enough to experience it, you just know what I am refering to. This new diagnosis of Cushing's Disease is awful, but we will fight it as we have every other battle in her life. She hasn't stopped wagging her tail, smiling, and just generally goofing around. I saw her upside down, rolling back and forth in the newly cut lawn on Sunday, just reveling in the feel and smells and all. You make what you will of life, and Verbal sure has made hers full and happy, despite all the challenges along the way. Yep, she has taught me so very, very much. I love you, Verbal dog.
Peace,
DrReneigh

Max Can't Catch His Breath

Max is normally a goofy, joyous Labrador, (are there any other kind?) always so happy to visit us for whatever reason-vaccines, ear infections, even getting neutered-you name it. He was always jumping and wiggly and just full of energy. But last week when he came in, things were markedly different for poor Max. He was struggling with something we all take for granted-Max couldn't breathe! Well, not without extreme effort on his part, any ways. He was panting, extending his neck, and just couldn't get comfortable. His owner reported that he couldn't lie down for any period of time and therefore hadn't slept in days. She and her family had actually been gone the week prior and Max had been looked after by a friend during that time. That friend noticed the problem developing towards the end of his stay, but couldn't pinpoint exactly when it started and couldn't tell us what might have triggered it. We were concerned that this could actually become a life-threatening issue, so we worked to get to the bottom of just what was causing the condition known medically as "dyspnea"-literally abnormal breaths.

Max didn't want to leave his owner's side, but we worked gently with him and encouraged him to allow us to work with him. Usually treats would have been welcome, but Max didn't want anything to do with food-it was all he could do just to get air in and out of his body. We had to figure out if this was because of an obstruction in his throat or airway, an infection in his lungs such as pneumonia, or if the dyspnea was secondary to some other condition. Pain and fear often cause our patients to stress so badly as to cause panting when we see them, but Max was having these breathing difficulties at home, too, where presumably he wasn't stressed. Pain was still possible, so we set out to find a possible source of that.

Max's blood work was perfectly normal-surprising since he hadn't eaten in so long. I expected at least some electrolyte abnormalities, but even they were just fine. We did find, though, that whenever we worked with him, Max became cyanotic-his tongue and gums became a distinctly blue or purple color due to the lack of oxygen traveling through those tissues, a very scary finding. We placed a mask over his nose and delivered oxygen to him-he didn't like the smell of that very much, but he evidently liked how it made him feel and he stopped resisting the mask pretty quickly when he realized it meant he could actually breathe with it around.

Next we put Max on the x-ray table and got some radiographs of his chest. It was difficult to get good films because he just couldn't lie in the positions required for very long at all. His blue tongue and distressed/panicked demeanor had us rush the process, but the diagnosis became evident despite the less than ideal positioning. Max had developed a pneumothorax.

Pneumothorax is free air in the space in the chest outside and around the lungs. It may result from trauma to the chest as when ribs become broken when animals are hit by a car, for example. We also see pnemothorax in patients who develop excessive pressure on their lungs, therby overinflating the lungs and rupturing the little alveoli or air sacs of the lungs. Underlying lung disease (asthma, chronic obstructive pulmonary disease, etc.) can also cause pneumothorax, again because the alveoli are damaged and air leaks out of them into the thorax. In some cases, we never do find out the cause of the pneumothorax-that is very frustrating because then we don't know if this will be something that will reoccur (and therefore how we might prevent it.) The problem with pneumothorax is that the air surrounding the lungs doesn’t allow the lungs to inflate normally, so dogs and cats with this condition can have difficulty breathing (the dyspnea we saw in Max), increased respiratory rate, exercise intolerance, chest pain, cyanosis, collapsed lungs, etc. If only a tiny bit of air gets inside the chest cavity, it can be resorbed and the pet can heal without medical help. If there is a lot of air in the chest cavity, however, it must be removed medically. If severe cases are left untreated, or it is progressive as happens with big holes in the chest, the pneumothorax can be fatal.

Max's chest was FULL of air-this was a pretty severe case of pneumothorax, but it did not appear to be progressing rapidly. If it had, he likely wouldn't have still been alive. We searched teh x-rays to find a cause for the free air in his chest cavity. There were no obvious broken bones or other evidence of trauma. We certainly would have hoped his dog-sitters would have told us if he had been hit by a car or had experienced some other massive trauma or had been exposed to any toxins or the like. His blood work hadn't indicated any raging infections as a possible cause, and we didn't see this on the radiographs, either. We were facing an unknown cause of his condition, but at least we knew how to help him. We had to take the air surrounding his lungs out of his chest, and we could do this with a long needle and a great big syringe. Some patients require the palcement of an indwelling valved chest tube, allowing for the continued evacuation of the free air while the patient's body heals from whatever condition caused the air leakage or production in the first place. My biggest concern was that after evacuating Max's chest of all that free air, what would prevent it from coming right back? We just would have to wait and see and hope that it was a one time thing and that his otherwise young and healthy body would be able to heal.

The process of inserting a needle into the chest in order to aspirate and remove the free air is called thoracocentesis. It is important that anytime you insert a needle into the chest cavity that you don't inadvertantly introduce bacteria into it, so we did a surgical prep of Max's skin over his rib cage on both sides of his chest. This involved clipping the hair off and scrubbing the skin with an antimicrobial solution. We inserted a needle into his chest, attached some tubing and a syringe, and pulled some air off his chest-and continued to do this over and over and over for well over an hour. we finally got negative pressure on the syringe after almost 10,000 mls of free air was drawn off the left side of his chest and another 1000 mls was taken off his right side. I suspect the two sides were communicating with each other and the "little" extra taken off the second side was just found in a pocket there, but regardless, it was an impressive volume-over 2 1/2 gallons of air where it shouldn't have been!

It was pretty darned cool to watch Max during his thoracocentesis procedure. Initially, it was very difficult for him to sit still for us; there just wasn't any position where he was comfortable and he became cyanotic very frequently from stuggling/panicking. He required oxygen by the face mask, but we had to just keep forging ahead. As more and more air was removed, Max became visibly more comfortable. At first, we noticed he was simply breathing through his nose; he was no longer open-mouthed breathing or panting. Then he became more and more relaxed to the point he rested his head in his nurse's lap, sighing deeply, and even shutting his eyes a bit. He was exhausted, the poor thing, and relieving the air gave him the freedom to stop struggling and just rest. We all felt so good for him.

We never did find out the cause of Max's pneumothorax, but he was lucky. We sent him home and over night and through the next day, there was no evidence that the pneumothorax was returning. We never did have to place a chest tube, but we did put him on some antibiotics and some antiinflammatory medications. We had Max come in that next day and we listened to his chest, but you could just tell by looking at his face and reading his demeanor that he was back to his happy, rested self-no longer preoccupied with where his next breath was going to come from. His owners were please and very relieved, and it looked like they were able to finally get some sleep, too. Breathing is a good thing.

Peace,
DrReneigh