Case of the Month

Greg Fryzek

by Dr. Abigail Roeters

Greg

Greg

Let me introduce you to a little golden retriever puppy named Greg. Greg originally presented to our clinic for a routine puppy physical exam after being adopted by his owners from a breeder in Wisconsin.

On his first physical exam Greg had very significant ear infections in both ears with lots of smelly discharge, redness and inflammation. I also noted that he had some crusting along the bridge of his nose, under his chin and that his lymph nodes located just behind his jaw (submandibular lymph nodes) seemed to be a bit larger than normal. I had discussed with the owners that the enlarged lymph nodes could be due to the severity of the ear infections he was experiencing but that they needed to keep a close eye on him because of his enlarged lymph nodes. When puppy’s lymph nodes are swollen in that location we get concerned about Juvenile Cellulitis also known as “Puppy Strangles”.

What is Juvenile Cellulitis you ask? This is a disease that is usually specific to puppies 3 weeks to 4 months old, but can rarely occur in older pets. Unfortunately there has not been a specific cause identified but it is speculated to arise from dysregulation  of the immune system. It causes facial swelling, severe skin inflammation and crusting as well as enlarged lymph nodes. It is very common within 24 hours of the lymph nodes being enlarged that puppies will develop pustules that will rupture and become crusted specifically on the face and ears.  Skin biopsies can give a definitive diagnosis but commonly these specific clinical signs being noted as well as response to medical treatment can yield a positive diagnosis. The core of treatment is using immunosuppressive doses of steroids and treating secondary bacterial infections with oral antibiotics, medicated shampoos and topical ointments and sprays. Regular rechecks are important to track progress and determine if any changes to treatment plans need to be made.

Back to Greg! At Greg’s first visit we cleaned out his ears with an ear cleaner and started him on a topical ear drop to start treating his ear infections. I also dispensed an oral antibiotic to help clear up the crusting and scabbing that was noted on his muzzle (nose). I pointed out to the owners all the locations on Greg’s body where his lymph nodes that can be felt so that they would be able to monitor at home. If they were noticing that his lymph nodes were getting larger or that his ear infection or skin infection were getting worse they needed to call and recheck sooner than 1 week.

Unfortunately the next day the owners noted that Greg’s ears looked worse and saw more discharge in his ears. They also noted that the crusting and scabbing on his face got dramatically worse over night so they called to have Greg re-evaluated. When Greg was evaluated that day his ear infections had gotten significantly worse, the muzzle of his nose was extremely swollen with pustules and discharge and his submandibular lymph nodes had gotten significantly larger. At this point he was diagnosed with suspected puppy strangles and an immunosuppressive dose of steroids (Prednisone) was started to help Greg.

Greg came in for weekly rechecks to track his improvement. Each week he seemed to be doing better and better. After 2 weeks his ear infections were healed and the skin infection on his nose had improved but was not completely healed. We continued Greg on his oral antibiotics but started slowly decreasing his dose of steroids. Since Greg was doing so great we started pushing his rechecks to every 2 weeks. Greg continued to improve and so his steroids were decreased at each vet visit.

GregFinally after 5 weeks we were comfortable in Greg’s improvement that he was able to receive his first set of puppy vaccines. We held off vaccinating Greg while treating his puppy strangles for two reasons: 1. a patient with puppy strangles immune system is compromised 2. Greg was on steroids to suppress his immune system therefore this could make the vaccines we give less effective as well as this could compromise his immune system even more.

Greg is doing fantastic at this time and has made a complete recovery. His owners were amazing in staying diligent and were very involved in his treatment plan. It took about 6 weeks to get Greg off of steroids and all other medications and back to his handsome self.  He is now a happy healthy puppy!

Greg is now a social media sensation and can be found at Greg_thegolden on Instagram.  His progress has been remarkable.

Osiris

By Dr. Melissa Conrad

OsirisOsiris, a 3 year old Sphynx (an exotic hairless cat), was presented to Mill Creek Animal Clinic for not feeling well for a couple days. Osiris had several episodes of vomiting over the past weekend with small pieces of cloth appreciated within the vomit. Mom had been working on her Halloween costume (yes, there are people in the world who can still sew), and she thought the material looked like he had gotten into her supplies. Osiris, while a very good boy, did have a bad habit of eating things he shouldn’t. Osirus was acting tired at home and was unwilling to drink water.On physical exam it quickly became evident that Osiris was deteriorating quickly and emergency medical intervention was initiated. He was severely dehydrated and his blood sugar was very low. An intravenous (IV) catheter was placed and Osiris was given fluids supplemented with dextrose to help increase his blood sugar. We also started warming measures to help Osiris regulate his body temperature. With his IV fluids and warming blanket, Osiris started to perk up a little bit while he was in hospital.

OsirisAlthough Osiris was pretty out of it, we could tell he was very painful on abdominal palpation (feeling around his belly) and since he had a history of eating foreign objects, we elected to proceed with an abdominal ultrasound. An ultrasound is an imaging technique that uses sound waves to allow us to see the internal organs as well as look inside the gastrointestinal (GI) tract. Since Osiris’s condition was so guarded, we did not want to pursue surgical intervention unless we were sure of what was happening. Osiris’s ultrasound revealed that he had a large amount of foreign material in his small intestine that was causing an obstruction. Osiris’s foreign body was especially dangerous in that it was a linear foreign body. A linear foreign body is usually a long piece of cloth-like material that gets stuck in the intestinal tract. As the intestines try to push the string-like material through, the intestines become bunched on one another and the foreign body actually starts to cut through the intestinal wall.Given this ultrasound finding, we had no choice but to take Osiris into surgery to remove the foreign body from his intestinal tract. Ideally we would have liked Osiris’s condition to be more stable before such a big surgery, but to wait would mean increasing chances of septic peritonitis, and if this happened, we would lose him for sure. During surgery, a large amount of foreign material was felt in the beginning of the small intestines. Three enterotomies (incisions into the GI tract) were made to remove about 1.5 feet of a black cloth material. We had to enter the intestine, cut the piece of material and pull out a section only if it came easily. It was important not to pull, since this could cut through the intestine like a knife. Osiris made it through surgery despite his blood sugar and body temperature continuing to fluctuate.Since Osiris was so sick, he was transferred to a 24 hour emergency hospital for continued care overnight. Osiris stayed at the emergency care center for several days on IV fluids with glucose support, IV antibiotics and pain medications. Once his blood sugar stabilized and he was re-hydrated, Osiris was discharged to be supervised under the watchful eye of his loving family.

OsirisWith any surgery where you have to cut into the intestinal tract, there is always concern that the intestines can dehisce (start to leak) following the surgical correction. Even if the initial surgery goes well, it is crucial to monitor the patient closely for the 3-5 days after surgery. Luckily, Osiris’s intestinal sites healed appropriately with no leakage.Osiris continued to improve following surgery and he now remains at home with his family. We saw the handsome guy for his suture removal and he is back to his loving, energetic behavior! Overall, we couldn’t be happier with the amazing progress this patient has made!

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.