News


Archive for the ‘News’ Category

Hiatal Hernia

by admin on November 5th, 2019

Category: News, Tags:

What is a Hiatal Hernia?
A hiatal hernia is the abnormal movement of part of the stomach from its normal position in the abdomen into the chest.

The diaphragm is a sheet of muscle which separates the chest and abdomen. The oesophagus (food pipe) and major blood vessels and nerves pass through the diaphragm via small openings within the muscle. During the development of a puppy, these openings may be excessively large, allowing organs which should remain in the abdomen to pass into the chest. The stomach can become permanently displaced but more commonly slides back and forth between the abdomen and the chest.

What breeds are affected?
English Bulldogs are the breed most commonly seen with this condition in the UK. Brachycephalic dogs (those with a shortened nose such as English Bulldogs, French Bulldogs and Pugs) are at an increased risk of displacement of the stomach into the chest as the negative pressures within the chest created by their abnormal airway, act to ‘suck’ the stomach through the opening in the diaphragm.

What are the symptoms?
Dogs with hiatal hernia frequently vomit or regurgitate (passive reflux of stomach contents) due to the abnormal position of the stomach. These signs most commonly occur during peak exercise or when the dog becomes excited. Reflux of acidic stomach contents into the oesophagus results in inflammation (reflux oesophagitis) which can trigger a self-perpetuating cycle of regurgitation causing further inflammation.

Other symptoms which may be observed include excessive salivation, poor appetite and weight loss. Vomiting and/or regurgitation of stomach contents can result in inhalation of this material and the development of secondary pneumonia. In this scenario symptoms such as a cough, nasal discharge and breathing difficulties will be observed.

How is the diagnosis made?
Hiatal hernia is most commonly diagnosed via fluoroscopy (a moving x-ray study). Whilst the dog is eating, a continuous run of X-rays are taken which allows the swallowing process and position of the stomach to be closely observed. Typical findings consistent with a diagnosis of hiatal hernia are food entering the stomach and then passing back up the oesophagus (reflux) along with movement of the stomach back and forth across the diaphragm.

As the stomach typically slides back and forth from a normal to abnormal position, there is the possibility that the imaging study documents a normal stomach position. This does not exclude the diagnosis of hiatal hernia as the most likely explanation for a normal stomach position is that the stomach has not been ‘captured’ in an abnormal position at the time of the imaging study. If this scenario arises, a presumptive diagnosis of hiatal hernia may be made based on the breed of the dog and the symptoms.

What treatment options are available?
The management of hiatal hernia can be broadly divided into medical and surgical options.

Medical management consists of the use of medication to reduce inflammation within the oesophagus (antacids) and aid motility of the gastrointestinal tract. Medication often reduces the severity and frequency of the symptoms but is unlikely to eliminate them completely due to the persistently abnormal position of the stomach.

Surgical correction is often indicated to resolve the clinical problems. In some patients surgical correction of the upper airway problems, as seen in Brachycephalic dogs, eliminates the problems. In other patients the surgery will consist of reducing the size of the overly large opening in the diaphragm and stitching the oesophagus and stomach permanently in a normal position. This technique prevents movement of the stomach into the chest.

What is the outlook (prognosis) for my dog?
The prognosis following surgery is good. The aim is to eliminate the symptoms (regurgitation and vomiting) completely. Rarely, dogs may continue to regurgitate and/or vomit after surgery although with a markedly reduced frequency compared to before surgery. If this is the case, these mild symptoms can usually be controlled with the use of medication.

Hiatal Hernia

No Comments »


Canine Flank Alopecia

by admin on October 1st, 2019

Category: News, Tags:

What is canine flank alopecia?
Canine flank alopecia is a localised, often cyclic, disease of the hair follicles resulting in hair loss over the flanks of affected dogs. It is also known by the names cyclic flank alopecia, recurrent flank alopecia and seasonal flank alopecia, but these terms are not always accurate as the condition can appear at various times of the year, vary in duration, be continuous or be sporadic in nature.

What causes flank alopecia?
The cause of this condition is not known. However, as hair loss often occurs at times of the year when day length is at its shortest, light exposure may be involved. The mechanisms by which this might occur are not understood at present.

What are the clinical signs?
Canine flank alopecia occurs in dogs with ages ranging from 1 year to 11 years, although most cases develop between 3 and 6 years. This condition is seen more commonly in breeds such as Boxers, Airedale terriers, English Bulldogs and Schnauzers.

The condition causes areas of non-itchy hair loss over the flanks of affected dogs (Figure 1). The skin at the affected sites usually appears normal, although it often becomes very dark with pigmentation, and hair re-growth of a different colour sometimes occurs. Surrounding hair and skin is usually normal. Canine flank alopecia can occur on both sides of the dog or be limited to one side, and hair loss can also occur over the base of the back (Figure 2). The disease in some dogs is cyclic, with hair loss occurring at the same time each year and hair re-growth occurring in the times between. In other dogs, hair loss is more permanent, and no re-growth is seen following the initial loss. Some dogs are reported as only having one cycle of hair loss and re-growth in their lives.

How is it diagnosed?
The diagnosis of canine flank alopecia can often be made based on the clinical findings, since the lesions are so striking. Some hormonal diseases of dogs can present with non-itchy hair loss, so blood and urine tests may be warranted if there is a concern about these diseases.
Additionally, biopsies of affected skin can be taken which are then sent off for analysis at a laboratory. Biopsies can be supportive of a diagnosis of canine flank alopecia.

What are the treatments available?
Canine flank alopecia is a cosmetic disease. As dogs remain healthy, with many re-growing their hair eventually, a decision not to treat the affected dog is often taken.
If treatment is requested, melatonin is generally considered the treatment of choice as it is relatively safe and inexpensive. It is difficult to judge the response to medication though due to the high rate of spontaneous hair re-growth.

What is the outlook/prognosis?
The prognosis for this cosmetic disease is good, with dogs remaining systemically healthy despite unpredictable hair growth. The prognosis for full and normal hair re-growth at affected sites is also often good, but the disease is highly variable.

Seasonal_flank_alopecia

No Comments »


Nasal Disease

by admin on September 2nd, 2019

Category: News, Tags:

What diseases can affect the inside of the nose?

There are several different types of problem that can affect the nasal cavity of dogs and cats. The most common conditions in dogs include inflammation of the nasal cavity (rhinitis) and nasal tumours (cancer). Rhinitis in dogs can be due to a number of problems including allergy (called lymphoplasmacytic rhinitis), fungal infection (most commonly a fungus called Aspergillus) and foreign bodies (such as grass blades). In cats fungal disease is rare, whilst polyps (benign outgrowths of tissue) in the nose/ throat, rhinitis of unknown cause and tumours are more common. Bacterial infection can occur as a consequence of the underlying disease but does not cause nasal disease by itself.

What are the signs of nasal disease?

  • Sneezing
  • Snorting
  • Nasal discharge
  • Nose bleeds
  • Nasal pain
  • Nasal ulceration or loss of pigment around the nostrils
  • Reverse sneezing (this can look like spasms of choking or difficulty breathing and can be quite disturbing to see but is not a life threatening problem)

How is nasal disease diagnosed?
Bloods tests may be performed as part of an initial investigation, looking at general organ health prior to performing an anaesthetic or other tests. Sometimes blood tests are performed to look at how well the patient’s blood is clotting in patients with nose bleeds. Most commonly X-rays or a CT scan of the nasal cavity are performed under general anaesthesia and a procedure called rhinoscopy is carried out, in which an endoscope camera is inserted up the nose or used to look at the back of the throat.

Nasal X-rays may show damage to the small bones in the nose and they may reveal the presence of fluid or tumours. X-rays can sometimes look normal even when nasal disease is present, however.

A CT scan is a much more effective and sensitive way of detecting disease in the nose and will not uncommonly reveal abnormalities that haven’t shown up on an X-ray. A CT scan will also help to define the extent of any damage or the location of a tumour.

Rhinoscopy (passing a small camera inside the nose) is performed to look for abnormalities including fungal infection, tumours, and foreign bodies and to help take a tissue biopsy from the nose to send for analysis.

How is nasal disease treated?
The treatment for nasal disease depends upon its underlying cause and severity. Sometimes medication in the form of tablets is prescribed; anti-fungal solution must be put into the nose or the sinuses to treat the fungal infection Aspergillus, whilst either radiation therapy or chemotherapy may be required for the treatment of nasal tumours.

What is the long term outlook (prognosis)?
The long term outlook depends upon the underlying disease. Patients usually recover well from removal of a foreign body. Allergic rhinitis is not a life-threatening problem, but treatment is generally aimed at controlling rather than curing the problem and some patients may not respond as well as would be hoped. Aspergillus can respond well to therapy, but the condition may be recurrent and difficult to cure in some patients.
More specific advice and guidance about treatment of nasal disease for individual patients can be given once the diagnosis has been made and detailed information has been obtained from the diagnostic work-up.

Dog Boxer (1)

No Comments »


Spinal Fractures

by admin on August 1st, 2019

Category: News, Tags:

Spinal Fractures
Fractures (breaks) of the spine occur when dogs and cats are involved in road traffic accidents or suffer other major trauma such as a fall or running into a patio door. Spinal fractures are often associated with varying degrees of injury to the spinal cord (the bundle of nerves inside the vertebrae) and, therefore, nerve damage. Although many animals may be paralysed as a result of the fracture, they will often recover, provided that they retain the ability to feel pain and that they are managed appropriately. Some cases can be treated medically, but it is often necessary to consider surgery to stabilise a fractured spine.

What is involved in a spinal fracture?
In a spinal fracture, the bones (vertebrae) of the spine break (fracture) or come apart from each other (dislocate or luxate). Fracture of the spine usually occurs as a result of a significant injury, such as being hit by a car, although occasionally the bones in the spine may fracture with minimal, if any, trauma because they are already weakened by a condition such as a tumour (referred to as a ‘pathological fracture’).

When the vertebrae of the spine fracture or dislocate (luxate) the associated vertebral displacement often injures the nerves of the spinal cord. The concussion and compression of the spinal nerves affects nerve function, and the signs that develop may vary from only mild weakness through to paralysis (inability to voluntarily move the limbs). Severely affected patients may become incontinent and lose the ability to feel pain in their limbs and tail.

How are spinal fractures diagnosed?
Physical examination of the patient by the specialist may enable detection of instability of the spine or abnormal alignment of the spine. Importantly, examination also enables assessment of the severity of any associated spinal cord injury – in particular, whether or not the patient can still feel pain.

X-rays (radiographs) are often obtained to look for evidence of fracture (or luxation) of the vertebrae and are generally sufficient to make a diagnosis in the majority of cases. Occasionally a more advanced imaging technique is preferred, to provide additional detail of the spine. CT scanning is particularly good at looking at the bony detail of fractures which may not be apparent on normal X-rays. MRI scanning is not so good at detecting damage to bones of the spine, but it is excellent for assessing any damage to the spinal cord.

How are spinal fractures managed?
Spinal fractures (and luxations) are often emergencies because of the associated spinal cord injury and risk of further damage. As a result, they need to be treated with the minimum of delay. Affected dogs and cats are often in significant pain, and care should be taken to avoid the handler being bitten or scratched. Patients should be moved with great caution in case the spine (vertebral column) is unstable, as further movement may aggravate the injury and any nerve damage. Strapping the patient to a rigid board may be helpful in some cases.

Some fractures of the spine may be treated conservatively without the need for surgery. This is particularly appropriate in patients with relatively stable vertebrae and minimal spinal cord injury. Conversely, dogs and cats with unstable fractured spines, those with significant spinal cord injuries and those in severe pain are often best treated surgically. Surgery aims to re-align and stabilise the affected vertebrae. The procedure most often involves placing screws or pins in the bones on either side of the fracture (or luxation) and securing them with either a plate or cement.

What is the outlook (prognosis) in patients with spinal fractures?
The outlook in dogs and cats with spinal fracture is primarily dependent on the severity of the spinal cord injury and how the patient is treated. Provided the ability to feel pain in the limbs and tail is maintained and the patient is managed appropriately, the outlook is generally good. Recovery may take a number of weeks (or even months in severely affected cases) and supportive care, including physiotherapy/hydrotherapy exercises, may be necessary. In contrast, patients with spinal fractures that can no longer feel pain are very unlikely to recover, no matter how they are treated, since the spinal cord injury is generally severe and irreversible.

 SPINE LUXATION

No Comments »


Pancreatitis in Dogs

by admin on July 3rd, 2019

Category: News, Tags:

What is pancreatitis?
The pancreas is an organ in the abdomen (tummy) which is responsible for releasing enzymes (types of proteins) to digest food. The pancreas also releases important hormones (such as insulin) into the bloodstream. Pancreatitis occurs when the pancreas becomes inflamed (tender and swollen). In most cases pancreatitis occurs for no apparent underlying reason, although sometimes it can have a particular cause (such as scavenging food). Pancreatitis most commonly affects middle aged to older dogs, but in addition, dogs of certain breeds (e.g. Cocker Spaniels and Terrier breeds) are more prone to developing the condition.

What are the signs of pancreatitis?
Pancreatitis can cause a variety of symptoms, ranging from relatively mild signs (e.g. a reduced appetite) to very severe illness (e.g. multiple organ failure). The most common symptoms of pancreatitis include lethargy, loss of appetite, vomiting, abdominal pain (highlighted by restlessness and discomfort) and diarrhoea.

How is pancreatitis diagnosed?
The possibility that a dog may be suffering from pancreatitis is generally suspected on the basis of the history (i.e. loss of appetite, vomiting, etc) and the finding of abdominal pain on examination by the veterinary surgeon. Because many other diseases can cause these symptoms, both blood tests and an ultrasound scan of the abdomen are necessary to rule out other conditions and to reach a diagnosis of pancreatitis. Although routine blood tests can lead to a suspicion of pancreatitis, a specific blood test (called ‘canine pancreatic lipase’) needs to be performed to more fully support the diagnosis. An ultrasound scan is very important in making a diagnosis of pancreatitis. In addition, an ultrasound scan can also reveal some potential complications associated with pancreatitis (e.g. blockage of the bile duct from the liver as it runs through the pancreas).

How is pancreatitis treated?
There is no specific cure for pancreatitis, but fortunately most dogs recover with appropriate supportive treatment. Supportive measures include giving an intravenous drip (to provide the body with necessary fluid and salts) and the use of medications which combat nausea and pain. Most dogs with pancreatitis need to be hospitalised to provide treatment and to undertake necessary monitoring, but patients can sometimes be managed with medication at home if the signs are not particularly severe. At the other extreme, dogs that are very severely affected by pancreatitis need to be given intensive care.

One of the most important aspects of treating pancreatitis is to ensure that the patient receives sufficient appropriate nutrition while the condition is brought under control. This can be very difficult, because pancreatitis causes a loss of appetite. In this situation it may be necessary to place a feeding tube which is passed into the stomach, and through which nutrition can be provided. If a dog with pancreatitis is not eating and will not tolerate a feeding tube (e.g. due to vomiting), intravenous feeding (using a drip to supply specially formulated nutrients straight into the bloodstream) may be necessary.

What is the outcome in pancreatitis?
It may be necessary for dogs with pancreatitis to be hospitalised for several days, but fortunately most patients with the condition go on to make a complete recovery, provided that appropriate veterinary and nursing care is provided. In some instances, dogs can suffer repeated bouts of the condition (called ‘chronic pancreatitis’) and this may require long term management with dietary manipulation and other approaches which the specialist will discuss with you in detail, as required.

 

Pancreatitis

No Comments »


Inflammatory Bowel Disease (IBD)

by admin on June 6th, 2019

Category: News, Tags:

What is IBD?
IBD is a disease that causes inflammation in any part of the digestive tract (stomach and/or intestines and/or colon i.e. large bowel). Some breeds of dog, such as Soft Coated Wheaten Terriers have a genetic predisposition to this disease. In other breeds of dogs and cats it can be triggered by a parasite or food intolerance. More commonly no specific underlying cause is found and the disease is thought to be caused by an over-activity of the body’s immune system (which normally fights off infections) to ‘foreign’ proteins (such as food) that are eaten, resulting in inflammation.

What are the signs of IBD?

  • Weight loss
  • Vomiting
  • Diarrhoea
  • Increased or decreased appetite
  • Blood or mucus in the faeces

How is IBD diagnosed?
IBD is diagnosed by a combination of tests, as several other diseases can cause similar signs. Blood tests are often performed to rule out other underlying diseases such as liver or kidney disease, and faecal examination is performed to look for any parasites. Cats with IBD can have low vitamin B12 levels therefore vitamin B12 is measured in all cats.

As foreign body obstructions, or sometimes tumours, can cause weight loss and vomiting, X-rays or ultrasound scans are usually performed to rule out these problems.

Finally, the ultimate diagnosis of IBD is made by taking biopsies from the stomach, intestine or colon. Usually this is performed under a general anaesthetic using a flexible endoscope camera, of which we have several different sizes to suit different sizes of patient. This is not an invasive procedure and most pets recover very quickly and will go home within 24 hours.

How is IBD treated?
Many dogs and cats will improve following a dietary trial. Often this involves prescribing a new diet that is hypoallergenic (i.e. unlikely to cause a reaction) or contains a protein source that your pet has not eaten before (such as venison or salmon). This is fed for 1 to 2 months and it is very important that no other food, treats or tit-bits are given. Some pets won’t respond to one diet but will respond to an alternative diet.

Pets that don’t respond to diet alone may be prescribed certain antibiotics.

Dogs and cats that are severely affected or that don’t respond to the treatments mentioned above will be prescribed steroids. A high dose is prescribed initially and this is decreased every few weeks for several months. Sometimes in pets that don’t tolerate steroids or don’t respond to steroids alone, other drugs which suppress the immune system are prescribed.

What is the long term outlook? (prognosis)?
IBD has a broad spectrum of severity, ranging from mild vomiting and diarrhoea to severe weight loss and fluid build up in the abdomen. It is not generally a life-threatening disease but can be in severely affected patients. It is not a curable disease, therefore the aim of treatment is to minimise the frequency of vomiting and diarrhoea: it is rare to be able to stop the clinical signs altogether. Keeping a diary of how often the signs are happening can be helpful to us in establishing the success of treatment. Most dogs and cats are able to live a good quality of life following a diagnosis of IBD.

Dog Boxer

No Comments »


Arthrodesis

by admin on April 30th, 2019

Category: News, Tags:

What is arthrodesis?
Arthrodesis means the surgical fusion of a joint. In other words, the bones forming the joint are permanently joined together so that there is no movement in this part of the limb. Arthrodesis is a salvage procedure that is generally only performed when there are no other options to save the function of the joint.

What joints can be arthrodesed (fused)?
The shoulder, elbow, carpal (wrist), stifle (knee), hock (ankle) and digit (toe) joints can be arthrodesed. The main joint that cannot be fused is the hip joint. This is generally not a problem since the hip joint can be replaced with an artificial one. Elbow and knee replacements are also possible alternatives to arthrodesis of these joints.

Reasons for performing an arthrodesis
The principle indications for arthrodesis are:

  • osteoarthritis that is causing chronic pain and cannot be managed medically
  • joint instability that cannot be treated by other means
  • fractures involving the joint surface that cannot be repaired
  • infection involving the joint that fails to respond to antibiotics
  • tumours in or around joints
  • muscle/tendon rupture that cannot be managed directly

What does arthrodesis involve?
There are a number of important steps when fusing a joint:

  • the surface of the joint (known as the articular cartilage) must be removed to enable bony fusion.
  • a bone graft should be placed into the spaces between the bones to promote fusion. This may be an autograft (from the patient), an allograft (from a donor) or a combination of both.
  • the bones forming the joint to be arthrodesed must be rigidly stabilised to maximise the possibility of bony fusion. This is most commonly achieved with one or two plates that are secured to the bones under the skin. Occasionally an external skeletal fixator (a metal framework) is employed, where the bones are stabilised with pins that penetrate the skin and are attached to bars on the outside of the limb.
  • exercise must be restricted until there is radiographic (X-ray) evidence that the bones have fused. This often takes eight to 12 weeks.

Risks and complications
The majority of arthrodesis operations are uneventful and are not associated with complications, however, these are major procedures and thus the following complications are possible:

  • loosening or breakage of implants (plates, screws, pins) may occur if the joint fails to fuse in sufficient time. Implant failure can result in joint instability and necessitate further surgery.
  • wound problems, such as breakdown and infection, are primarily associated with arthrodesis of the carpal (wrist) and hock (ankle) joints. Wound management within the first few weeks of surgery is of vital importance to minimise this risk. Dressings are often applied to the limb to minimise swelling and prevent the patient interfering with the wound.
  • fracture of bones adjacent to the fused joint may occur due to the abnormal forces that result following arthrodesis surgery.

How good is limb function following arthrodesis surgery?
Limb function after arthrodesis surgery is primarily dependent on which joint is fused. It is good following carpal (wrist) and hock (ankle) arthrodesis and fair following shoulder arthrodesis. Fusion of the elbow or stifle (knee) joint significantly compromises limb function. Dogs and cats generally have to swing the limb outwardly (circumduct) when walking in order to prevent the toes dragging on the ground.

Conclusion
In those patients where arthrodesis is indicated, the vast majority benefit from surgery. Fusion of a joint is undoubtedly a major undertaking, and these procedures are commonly performed by specialist orthopedic surgeons. We will be pleased to give as much help and support as possible if you decide to give your pet the opportunity of arthrodesis surgery.

Carpal arthrodesis

No Comments »


Special Offer – May 2019

by admin on April 30th, 2019

Category: News, Tags:

May Feline Hypertension month

No Comments »


Corneal Sequestrum

by admin on April 2nd, 2019

Category: News, Tags:

What is the cornea?
The cornea is the clear window of the eye. It is a very delicate structure which is less than a millimetre thick. In order to be transparent, the cornea has no blood vessels. This makes the cornea vulnerable to injury and infection, and results in a slow healing response to deep wounds.

What is a corneal sequestrum?
A corneal sequestrum is a part of the cornea which has died off and which is then rejected by the remaining healthy cornea. Most sequestra (as more than one sequestrum is known) affect the centre of the cornea. Corneal sequestra are usually pigmented in different shades of brown and may vary in appearance from subtle bronze staining to very obvious dark plaques. In some patients, blood vessels grow into the cornea in response to the sequestrum and a reddish rim may surround the pigmented plaque. In many affected patients, their tears will also be darkly pigmented and brown to black discharge may crust on the eyelids.

Is a corneal sequestrum a problem for affected cats?
Overall, the answer to this question is yes. In their very early stages, corneal sequestra will not cause pain or visual impairment but with time corneal ulceration (wounding) develops, and patients will show intermittent signs of eye pain such as blinking, squinting, weeping and light-shyness. Occasionally patients will show signs of a sequestrum only after several episodes of apparently spontaneous corneal ulceration.
Corneal sequestra can become infected, and this may lead to loss of the eye in the absence of rapid treatment.

What causes a corneal sequestrum?
Chronic injury has been identified as a possible cause of sequestrum formation and especially abnormalities of the eyelids such as inward turning of the eyelids and eyelashes. However, even today, it is not known why the majority of patients develop corneal sequestra. Many theories have been investigated and herpesvirus (one of the cat flu viruses) has been identified as a possible cause in crossbred (domestic short haired) cats. However, most corneal sequestra are seen in purebred cats such as Persians and British Short Hair cats. It is possible that the special shape of the faces of these patients is associated with the problem. They generally have big bulging eyes which often have a poor blinking response. Herpesvirus does not generally appear to be related to sequestrum developments in purebred cats. Abnormalities of the tear film such as a poor quality or quantity of tears are also considered to be involved in some cases.

What treatment options are available if my cat has a corneal sequestrum?
There are three major treatment options available:

  • Conservative treatment with antibiotic and lubricating ointments to reduce irritation and prevent infection until the eye has shed the sequestrum by itself.
  • Surgical excision of the sequestrum and placement of a soft contact bandage lens.
  • Surgical excision of the sequestrum followed by a grafting procedure to provide support for the affected area of cornea and to reduce the risk of the sequestrum coming back.

In general, it is unlikely that continued conservative treatment will be recommended, as this is usually associated with prolonged periods of eye pain for the patient. Furthermore, ongoing monitoring and veterinary care will be required to try and reduce the risk of infection or rupture (bursting) of the cornea. This is a risk as the sequestrum may spread deeper. The cost advantage of not proceeding with surgery usually does not outweigh the prolonged care and discomfort for patients suffering a sequestrum, and the result of surgery may be less good with later intervention.
In our experience, surgical removal of the corneal sequestrum under the operating microscope is the treatment of choice. Given the depth of the lesion and the risk of retention of some pigment in the cornea after surgery, an additional grafting procedure may well be recommended.
Grafting procedures involve the placement of a piece of conjunctiva (the lining of the white of the eye) or other tissue into the wound following excision of the sequestrum. Grafts are usually stitched into place and will lead to a partial impairment of corneal transparency. However, the eye should still retain useful vision.

What does surgery for sequestrum removal involve?
Removal of corneal sequestra is carried out under general anaesthesia with the help of the operating microscope. The area around the eye is clipped. During the anaesthetic, the patient’s heart rate, blood pressure and blood oxygen concentration are monitored and a fluid infusion is given intravenously to maintain good blood circulation. Once the sequestrum has been removed, the surgeon will usually either place a contact lens or place a graft (see previously mentioned). Following the surgery, the operated eye is likely to be slightly sore and many cats will only partially open it for a few days.

What aftercare will be required?
Post-operatively, the patient needs to wear an Elizabethan collar to prevent damage to the wound by rubbing or scratching. Gentle cleaning of the operated eye with wet cotton wool twice daily is recommended.
An antibiotic ointment is generally applied to the eye for approximately ten days post-operatively. A short course of antibiotic tablets and painkillers may also be given after surgery. The use of false tears or other lubricant preparations may be recommended long-term in some cases, usually to be applied once or twice daily.

How successful is surgery for removal of a corneal sequestrum?
Surgical removal of corneal sequestra is a very successful surgery in uncomplicated cases.

The main risks of the procedure are wound infection and loosening of the graft. On occasion, a second procedure may be required to achieve a satisfactory result. Fortunately, the loss of an eye due to complications or progression of the disease after surgical sequestrum removal is very rare.
Surgery for sequestrum removal and placement of a graft aims at reducing the risk of sequestrum recurrence but cannot guarantee that the same eye will never be affected with another sequestrum.

Can my own veterinary surgeon remove the corneal sequestrum?
Removal of a corneal sequestrum is a procedure that requires a skilled and experienced micro-surgeon, equipment for magnification and illumination, and fine surgical instruments that will not damage the delicate tissues of the eye. For this reason most general practitioners will recommend referral to an ophthalmic specialist for treatment of this condition.

Do I have to return to the eye specialist for the aftercare?
After an eye has developed a serious disease which has required a major procedure, it is best to have its progress checked by the specialist. The number of revisits will depend upon the severity of the problem and the post-operative progress. In many cases only two or three re-visits will be required. In more complex cases there may be a need to continue with further check-ups from time to time.

Is my cat’s other eye at risk?
Unfortunately, the other eye is also at risk of sequestrum formation and must be carefully monitored for this reason. At the moment no treatment is known that will reliably prevent sequestrum formation, but the use of ocular lubricants may be helpful in providing some degree of additional corneal protection.

Corneal sequestrum

 

No Comments »


Cancer in cats and dogs: Surgical therapy

by admin on March 4th, 2019

Category: News, Tags:

The role of surgery in the management of the patient with cancer

Surgery is commonly used in the management of solid tumours (i.e. tumours that are ‘lumps’ rather than tumours such as leukaemia that are not just in one place) in dogs and cats.

Surgery may have a number of roles to play in the management of cancer:

  • Surgery for diagnosis (biopsy)
  • Surgery for prevention of cancer, i.e. removal of abnormal tissue before it becomes cancerous (e.g. pre-malignant change such as polyps), or removal of other tissue (e.g. testicles or ovaries) to prevent hormone-dependent cancer
  • Definitive curative-intent surgery, i.e. surgery designed to remove all of the tumour and cure the patient of that tumour
  • Cytoreductive surgery, i.e. surgery designed to remove most of the tumour and leave only microscopic deposits of tumour cells so that additional therapy (e.g. radiotherapy or chemotherapy) will be more effective
  • Palliative surgery, i.e. surgery designed to improve the patient’s quality of life without necessarily extending the duration of life

The role of biopsy before surgical treatment
We need to understand what the role of surgery in any patient is before the operation is performed, so that it is as clear as possible what benefit the patient is likely to receive. This will generally require that a biopsy is obtained prior to other surgery, to identify the nature of the tumour. We will discuss these issues and the results of the biopsy with owners at each stage.
However, a biopsy may not be performed in the following circumstances, which are occasionally encountered:

  • If the results of the biopsy would not change the plan for treatment, i.e. the treatment is the same regardless of the nature of the tumour
  • If the results of the biopsy would not change the owner’s willingness to treat, i.e. if a particular treatment would be chosen, whatever the tumour is
  • If the biopsy procedure is as invasive or difficult as surgical excision, i.e. to avoid two major surgical procedures

However, if we do not have information provided by a biopsy, we may be faced with an increased risk that the entire tumour is not subsequently removed and that a cure is not obtained.

Types of surgery

Curative-intent surgery
Curative-intent surgery (surgery designed to remove all of the tumour and cure the patient) represents the best option for many tumours, but it is only appropriate for a tumour or tumours in one location, with no evidence of spread. Surgery cures more patients of their tumour than any other treatment (e.g. radiotherapy, chemotherapy) and consideration is always given to surgery if it is possible.
The advantages of surgical management of cancer are:

  • It provides an immediate cure (in appropriate circumstances)
  • It does not cause cancer (as radiotherapy and chemotherapy might do)
  • It has no toxic side effects
  • It does not suppress the immune response
  • It is effective for large masses, whereas radiotherapy or chemotherapy are not

Surgery may be combined with other types of treatment including chemotherapy and radiotherapy. Generally these additional therapies are used post-operatively, once the amount of tumour in the body has been reduced to as low a level as possible, to delay or prevent return or spread of the tumour. However, in some cases, these other treatments may be used before surgery to make the surgical procedure simpler or more likely to be successful.

When considering surgery for the management of cancer, the following principles should be borne in mind:

  • A diagnosis should be established to help plan the surgical procedure
  • Diagnostic imaging (X-rays, CT scan) should often be used to assess the extent of the tumour and improve our ability to plan the surgical procedure
  • Surgery should be performed early in the course of the disease when the tumour is small, rather than allowing it to grow larger
  • The first surgical procedure for any particular tumour has the best chance of success. If the tumour recurs after one surgery has been performed, it is difficult to know where the tumour now extends to
  • Surgery for cure involves removing the tumour and a margin of normal tissue in 3 dimensions

It is important to realise that while curative intent surgery has a good chance of curing the patient of that tumour, the pet may develop additional new tumours in the future.

Cytoreductive surgery
Cytoreductive surgery involves the removal of all the tumour that can be seen with the naked eye, but accepts that microscopic deposits of tumour cells will be left behind and the patient will not be cured with surgery. However, reducing the number of tumour cells in the body increases the effectiveness of post-operative radiotherapy or chemotherapy, as these two types of treatment are less effective when dealing with a large mass.

This therapy will probably not produce a cure, but will often provide long-term local control, i.e. will prevent the mass from regrowing for as long as possible and will delay the signs of ill-health due to the tumour for as long as possible. Cytoreductive surgery generally involves a more minor procedure than surgery for cure and the recovery time after surgery is therefore generally shorter.

Palliative surgery
Palliative surgery is designed to remove a tumour that is causing signs of illness, while accepting, as for cytoreductive surgery, that this will not cure the patient. This surgery may be performed for tumours that are causing pain and discomfort or that are infected or ulcerated. Often this is a more effective form of pain relief than painkilling drugs alone. Usually, the simplest type of palliative surgery that will provide an improvement in the animal’s health is chosen, to maximise the benefit of this surgery, avoid a long recovery time and minimise post-operative complications.

Other considerations prior to surgery
For more radical surgery and, in particular, surgery that alters the appearance of the pet, e.g. surgery of the head and neck or amputation of a limb, pet owners understandably often have two concerns:

  • How will surgery alter the cosmetic appearance of my pet?
  • How will surgery affect the ability of my pet to lead a normal, happy life i.e. to function normally?

These questions are usually asked in that order. On reflection, we would probably all regard normal function to be more important than a normal appearance. However, the physical appearance of a pet is still an important factor in decision-making. This decision may sometimes be made easier if the pet is otherwise well and if radical surgery offers the potential for a cure, and if without therapy the tumour will likely lead to the pet being put to sleep.

Wound healing may be delayed or impaired in patients with cancer and a wound infection may be more common. This is as a result of the adverse effects that the tumour has on the body, and the effects of the therapy itself.

Surgical margins and types of surgery
If we are using surgery to attempt a cure, we will aim to remove the entire tumour along with a margin of normal tissue, to do all we can to ensure that all the tumour is removed. This margin of normal tissue is not exact and is our best guess at how far the tumour has invaded into the adjacent tissue.

Around the tumour, these margins are normally measured in centimetres, with more invasive tumours having wider margins (e.g. 3cm) than less invasive tumours (e.g. 1cm). Below the tumour, these margins are either measured in a similar way, or a natural barrier to tumour invasion is chosen, so that the tumour is removed with this barrier intact, as though removing the tumour in an “envelope” of normal tissue. A benign tumour may be removed with very narrow margins. In some locations, adequate margins of excision cannot be achieved while still preserving the function of the affected body part and a cure may not be achievable.

Cytoreductive surgery and palliative surgery procedures will generally remove the tumour with a narrow margin of tissue, as a cure is not anticipated.

Wound reconstruction
All surgical procedures for the management of cancer involve two steps:

  • Removal of the tumour
  • Reconstruction of the wound

Often, removal of the tumour is relatively straightforward, whereas reconstruction of the wound can take longer and be more of a challenge. The ability to close the wound in some way after surgery may dictate whether the tumour is considered operable. Normally several options are considered for closure of the wound in the planning stage, so that we have the best chance possible to provide a good outcome.

Post-operative pain management (analgesia)
We cannot discuss surgical management of cancer without discussing post-operative pain control (analgesia). Before embarking on any surgery we have to be sure that we can provide adequate analgesia for all our patients, irrespective of the underlying disease and the surgical procedure performed. It is also important to realise that for certain tumours, surgically removing the tumour is an effective means of providing pain relief, and as a result some patients are more comfortable in the immediate post-operative period than they were before surgery.

We aim to use analgesia drugs before there is any pain or discomfort (pre-emptive analgesia) in our patients and to use a combination of analgesic agents of different types that work in different ways and act at different sites in the body. As a result, our patients will often receive an aspirin-like drug (a non-steroidal anti-inflammatory drug: NSAID), a morphine-like drug (an opiate) and a local anaesthetic, as well as other types of drug.

Post-operative care
Patients will normally be kept in the hospital after surgery until the nursing care and analgesia that they need is relatively minor and can be provided by the owner at home. Instructions for post-operative care may comprise:

  • Examination of the wound daily for any evidence of inflammation
  • Administration of drugs, e.g. analgesia, antibiotics
  • Exercise restriction until the surgical site has healed sufficiently
  • Methods to prevent the patient licking or scratching at the surgical site.

Assessment of the tumour specimen and monitoring of the patient
Once the tumour is removed, it will normally be sent to the laboratory for assessment, even if a biopsy was obtained beforehand, as a larger sample can often provide additional information. Examination of the tumour specimen post-operatively may provide the following information:

  • Confirmation of the type of tumour. In certain tumours, particularly those with various cell types in it, a small sample (such as that obtained at biopsy) may not be representative of the actual type of tumour
  • Identification of the tumour grade, if this could not be assessed pre-operatively
  • Evaluation of the local lymph nodes (glands) if these were not accessible before surgery, but could be sampled at surgery
  • Assessment of the tumour margins as to whether all the tumour has been removed. This helps to predict the likelihood of tumour recurrence at the surgical site
  • Identification of invasion of the blood vessels and lymph vessels by tumour cells. This helps to predict the likelihood of distant tumour spread elsewhere in the body

Our aim at every stage is to make sure that owners of pets undergoing surgical treatment for cancer are fully informed and understand what is being recommended and why. We will discuss possible complications and the likely costs involved ahead of time, and we will only undertake surgery with an owner’s fully informed consent and understanding.

Cancer in dogs and cats (1)

No Comments »