Case of the Month

Spike

Spike came to visit mid-summer for being a little down in the dumps and for a possible eye infection, as his left eye was red and squinty. He had a low grade fever, and it was clear his left eye was very uncomfortable. The pressure in his eye did not indicate glaucoma, but his vision was questionable and the back of the eye was not visible with an ophthalmoscope.
There was no history of trauma, and his blood work was pretty uneventful. His right eye looked normal at this visit.We collected a urine sample to test for a disease called blastomycosis. Unfortunately, this test takes 3-7 days to get the results and we were concerned that Spike’s eye problem was progressing quickly. Eyes are amazing things. There are so many things that work together to make vision happen! The eye can heal pretty quickly, but it can also go downhill just as quickly. For that reason, we sent Spike for a visit with a veterinary ophthalmologist (yes veterinary medicine has many specialty fields….these veterinarians have gone through an additional 3-4 years of intense education to earn their specialty degrees).The ophthalmologist agreed that the biggest concern was blastomycosis, so aggressive treatment was initiated that day. Thank goodness we did, since by the next day, Spike began showing symptoms in his right eye as well. A few days later, the test came back positive for blastomycosis, and we were already a couple days ahead of the game….our treatment plan was on course.

WHAT IS BLASTOMYCOSIS?

Blastomycosis is a disease in animals and people caused by the fungus Blastomyces dermatitidis. This fungal organism is present in most of the US, but more prevalent in areas along the Mississippi, Ohio, and Missouri river valleys….so pretty much everywhere in the Midwest. The fungal spores are present in soil rich in organic matter like decaying wood or animal waste, along with a moist soil. Most of the cases at Mill Creek Animal Clinic are linked to dogs spending time in the woods of Wisconsin. Retrievers and hunting dogs are more at risk…they have their noses to the ground A LOT! Excavated sites are risky, since there is overturning of the soil that allows the fungal organism to be at the surface.Blasto can affect several different areas of the body, but the most common sites are the lungs (from breathing the spores in), and then the spores go out to the rest of the body. The blasto fungus like the eyes, as 20-50% of dogs with blastomycosis have eye lesions and these can quickly lead to blindness. Blastomycosis can cause skin, bone, muscle and brain infections. Unfortunately, Blasto can progress VERY quickly. Blasto is treatable with antifungal medication. However, there are many cases that the disease is too advanced by the time we see the pet, and the medication can’t kick in quick enough to save the dogDogs with suspected cases of blastomycosis need a thorough workup to arrive at the diagnosis as quickly as possible. A full blood workup, chest x-rays and complete physical exam are essential. The urine test is the best confirmation test, and is currently done at a lab in Tennessee.

BACK TO SPIKE!

Spike responded quickly to the medication. His chest x-rays showed no sign of blasto lesions in his lungs, so it appeared that his disease was limited to his eyes. The disease had progressed too far in his left eye, and unfortunately, he most likely will not regain vision in that eye. His right eye improved immensely, and we are optimistic that he will retain vision in that eye. He will be given antifungal medication for at least 6 months, and we will be re-testing him periodically to make sure there is no recrudescence.

HOW DID SPIKE GET THIS HORRIBLE DISEASE?

Spike had not been traveling to any other areas, so we know that he was exposed to the fungus here in the Chicagoland area. His family had just put in a new patio in their back yard, so we suspect that the overturned dirt led to his exposure. The human members of the family will be discussing blastomycosis with their physician to watch for any signs that they may have the disease. It is highly unlikely for humans to catch blasto from an infected dog, but they can inhale the spores the same way the dogs can. To be safe, we caution people to practice good hygiene (wash hands before touching your eyes or mouth) after handling a dog with blasto, especially if they have open draining skin lesions.Spike continues to do well, and although he is blind in one eye, he is a success and will live a good quality life for years to come. If you suspect your pet might have blastomycosis, schedule an appointment with your veterinarian as soon as possible!

by Dr. Abigail Roeters

LemonMany of you have met our honorary receptionist Lemon who spends most of her days lounging behind the receptionist desk and accepting treats as payment. As some of you may know there is a reason behind her name and here is her story.

Lemon was presented to my previous clinic as a neglect case from the local police department when she was about 12 weeks old. Her right hind leg was extremely swollen, warm to the touch and had green discharge draining from a hole on the inside of her leg. She also had a grade 5/6 heart left-sided heart murmur. Radiographs were taken and revealed she had multiple fractures of her right femur that of which she had not received any medical care. Radiographs of her chest revealed an extremely enlarged heart.

LemonInitially medical management with pain medications, antibiotics as well as laser therapy treatments were started to clear up her infection and decrease the inflammation. The police department had proceeded with legal actions towards her previous owners and so Lemon lived in the clinic for a few weeks while these proceedings were taking place. This was the time that I and everyone who had met her fell in love with her. Her previous owners ended up relinquishing her to our clinic as they could not afford to treat her medically. By the time she was relinquished I had fallen in love with her and decided to adopt her.

Seeing as she had a high grade heart murmur and enlarged heart on radiographs, I pursued a consult with a cardiologist to determine the severity of her heart condition. The cardiologist performed an echocardiogram (ultrasound of the heart) which revealed that Lemon had severe aortic and pulmonic stenosis (narrowing) of her heart. This is a congenital heart condition (birth defect). Unfortunately the prognosis for this condition was not the news I wanted to hear. Approximately 85% of dogs with her condition usually pass away within the first 2 years of life due to an arrhythmia (abnormal beating pattern) of the heart.

After speaking with the cardiologist about Lemon’s fracture, it was decided that amputation would give her the best chance at living a life pain free. Precautions were taken in her anesthetic choices since she was at a higher risk of complication due to her heart condition. Luckily her leg amputation procedure went smoothly and she was also spayed at the same time.

Since her amputation Lemon has been living her best life. Lemon’s long term prognosis with her heart condition is not a good one, but I am focusing on giving her the best life I can for as long as I can. At this point Lemon seems to living life to the fullest and getting spoiled rotten by everyone she meets. She may be a lemon, but when life gives you lemons….it could be the best thing that ever happened to you!Lemon

Dr. Melissa Conrad

Madison

Madison, a six year old Labrador Retriever, was presented after her owner noticed a bump on Madison’s left eyelid. The bump had been present for a few months, but Madison recently started rubbing her face on the carpeting and pawing at her eye. The bump on Madison’s left upper eyelid margin was a small, pale, hairless, well defined nodule noted to be touching the cornea (transparent layer forming the front of the eye).

A fluorescein eye stain was performed to evaluate if the eyelid tumor was causing a corneal ulcer (damage to the outermost cell layers of the cornea). Madison had stain uptake which indicated that the cornea was ulcerated by the constant rubbing of the tumor on the eye surface.

Given that the mass was causing Madison discomfort, the owner elected surgical removal of the mass. Madison’s eyelid was clipped of all hair and the surgical site was scrubbed with betadine solution to help prevent infection. A pie shaped wedge incision was made around Madison’s eyelid tumor and the mass was removed. The incision was closed with tiny sutures, taking great care to perfectly align the edges of the eyelid (Madison insisted on perfect cosmetic closure so she could continue her super-model career). We submitted the mass for histopathology to make sure we got all of the mass, and to identify what kind of tumor it was. This allowed us to make recommendations for any further treatment that might be needed.

Madison’s eyelid tumor was determined to be a Meibomian Gland Tumor which is a non-cancerous tumor of the eyelid margin. The Meibomian Gland’s function in the body is to secrete sebum (oil) onto the cornea to help form the tear film and prevent corneal dryness. Meibomian Gland Tumors are the most common eyelid tumor in dogs and occur frequently in older animals. If the entire tumor is removed during surgery, the tumor will not grow back in that area (although some dogs will develop other tumors on the eyelids).

Madison did wonderfully through her surgery and she recovered at home under her owner’s loving care. Madison had to wear an Elizabeth Collar (Yes, the cone of shame) for her recovery period to prevent her from rubbing at her eyelid stitches. There is often a lot of resistance to this, but it’s very important since one good swipe can rip out the sutures in this very sensitive site. She was prescribed anti-inflammatory eye drops to help with inflammation at the surgical site and provide pain relief. Madison was also prescribed antibiotic eye drops to help prevent a bacterial infection at the corneal ulcer site. At the two week recheck appointment after surgery, Madison’s eyelid had fully healed and the corneal ulcer had fully resolved. Madison is now back to work as a super-model and you can expect to see her on the fanciest Chicago runways.