11 MONTH OLD MAX SUFFERS A RARE TESTICULAR TORSION

Normally lively and full of beans, a very subdued Max came in to 387 Vets because he was showing obvious signs of abdominal pain. He had also vomited several times and was refusing to eat. When he didn’t respond to initial treatment and we couldn’t find any abnormalities on x- rays or in blood tests, we performed exploratory surgery to investigate the source of the pain.

We already knew that Max had a retained testicle (he only had one testicle in his scrotum) but during surgery, we were very surprised to find that it had twisted round on itself (torsed), thus causing Max’s condition.  Testicular torsion is so uncommon, it was the first time Hamish had seen a case in over 14 years of practice.

Can a twisted testis be left in situ?

Unfortunately the answer is no. As well as being 14 times more likely to become cancerous, retained testicles are also much more likely to suffer from torsion – the twisting of the testicle around on its venous vasculature (or blood supply cord) and as in Max’s case, this causes immense physical distress. Twisting of the venous vessels prevents blood from leaving the testicle, though blood can still enter because of high arterial pressure. As a result, the testis becomes heavily engorged, bruised and very painful. In fact, the pain can be so intense it can elicit a state of shock or collapse.  It was important for Hamish to remove Max’s irreparably damaged testis to avoid any further discomfort.

The photographs above show the swollen, blood-filled testicle during surgery, and afterwards, alongside a normal testicle.

After gentle recuperation, we’re delighted to report Max is now fully recovered and back to his bouncy self!

Pippin, a seven year old bichon frise, is our pet of the month for January 2012.  He came to us as he had been having difficulty using his back right leg. On examination, it was clear he had ruptured his cranial cruciate ligament – one of the knee’s two stabilising ligaments. Pippin was doubly unlucky though, as while he was coming to terms with coping on three legs, he ruptured the same ligament in his other back leg – within just three weeks of damaging the first! Poor Pippin could barely get about at all.

What causes cruciate damage?

Cranial cruciate ligament injury in dogs is not uncommon. In young dogs it is usually caused by a traumatic episode, for example, landing badly when jumping or twisting the knee awkwardly, similar to sporting injuries in humans. In middle aged to older dogs, however,  it can be caused simply by general wear and tear. Complete rupture of the ligament leads to considerable joint instability in dogs, whilst partial tearing or stretching of the ligament can cause a lot of pain. Many dogs that suffer with one cruciate ligament injury go on to have problems with the other, but it is very unusual to totally rupture both in quick succession like Pippin.

What happened to Pippin?

Pippin didn’t have an accident or fall but merely suffered from ligament ‘fatigue’. Both his ligaments completely snapped, leaving him unable to manoeuvre or support himself on his back legs. We operated on his weakest leg using a titanium implant and orthopaedic fiberwire® system. This immediately restored joint stability and rapidly allowed him to use the leg again. He is recovering extremely well and is once again a happy, mobile dog!

Now that building works are complete, we are reintroducing Pet of the Month as an ongoing feature in the waiting room and online.  Look out for these great stories of 387 Vets’ pet heroes and heroines!

Fred is our Pet of the Month for December 2012. A domestic short-haired black and white cat, he was brought in to us with a nasty bite on his foot.  He was given antibiotics to reduce the swelling, but after several days, he started to develop ulcerated lesions on his body, lost his appetite and was generally very under the weather.  On carrying out blood and skin tests, we were able to confirm that Fred had contracted the feline cowpox virus, an incredibly rare infection in cats and only seen by Hamish twice in his fourteen years in practice.

How did Fred catch the pox?

Unlike chicken pox in humans, Fred’s virus is not easily spread. The cowpox virus, an uncommon skin condition which can affect any part of the body, is most likely to be contracted by cats who are avid hunters and come into contact with or are bitten by small prey.  Cattle suffer from the virus, but other known carriers are the bank vole, the field vole and the wood mouse, and cases of cats with the pox rise significantly between July and November when there are lots of rodents about.

Cattle, rodents and the domestic cat are not the only species to contract the virus.  As well as cases reported in cheetahs and occasionally humans, cases have also been diagnosed in dogs, a foal and even an elephant!

Treatment and recovery

After initial infection, it can take between 10 days and several weeks for sores approximately 1cm in diameter to appear. These crust over and disappear as the infection resolves itself, generally after six to eight weeks though some residual scarring may remain.  As with chicken pox, no medical intervention is necessary unless there is a secondary infection or a complication, although some cats who lose their appetite may need intravenous fluid therapy. Generally cats, like Fred, make a full recovery and carry on with the rest of their nine lives intact!

Spice is a little dog with a big spirit! At less than 3kg (6.5lb) in weight she has a fine frame that does not match her enthusiasm to jump about adventurously. Unfortunately, one day she jumped off too high a level and when she landed the radius and ulna in the forearm of her front left leg broke.

Thankfully the fracture was relatively clean and uncomplicated which allowed us to repair the bone using a plate, with three screws into the bone on either side of the break. The plate is contoured to fit the bone (radius) and then pre-stressed – which means that the plate is slight over-bent so that it applies compression to the fracture. The screws must pass through both sides of the bone (so that they do not slip or work loose) but must not interfere with the other bone in the leg (the ulna). The ulna did not require any fixation because it was naturally re-aligned by repairing the radius.

Fixing fractures with plates is a preferred option when applicable because they produce a rigid repair with a rapid return to use of the leg and no external casts, frames or pins that could irritate. Plates are usually left in place once the fracture has healed.

Max was rushed to the surgery by his worried owners having been hit by a car. He was in considerable pain and shock so he immediately received intravenous pain relief and fluids. Once Max was stable we were able to radiograph his injuries, revealing a nasty compound (many pieces) fracture of his femur (thigh bone), with less serious fractures of his pelvis.

Because of the multiple pieces of bone involved in the fracture the repair combined an intramedullary pin (pin down the middle of the bone) ‘tied in’ to an external fixator (external frame) to give a strong and rigid support to the fracture pieces to allow healing. The most important aspect in achieving a successful fracture repair in these cases is to preserve the blood supply to all the individual pieces of bone, rather than achieving perfect re-alignment of the bone shaft. Max’s fracture healed very well and we removed the pin and frame 6 weeks later.

Luckily Max had received a microchip 2 weeks before his accident and the microchips that we use (Tracer Advance®) entitle owners to an automatic 4 weeks of free insurance from Pet Plan™. The owners were relieved to discover that their bill was therefore covered and now appreciate the importance of pet insurance!

For more information about pet insurance please ask us for advice.

Sage had an intestinal foreign body but was a patient with a difference! He had swallowed some rope which was too thick and bulky to pass through his guts. This resulted in a complete gut obstruction leading to repeated vomiting and a loss of appetite, which would over a few days have been fatal.

Having established that Sage needed surgery to remove his obstruction we were presented with the dilemma of his blood clotting problem. Like many other Doberman Pinschers, Sage suffers from von Willebrand’s disease – this is a lack of a particular factor required for efficient blood clotting. Operating on dogs with this disease can lead to fatal intra-operative bleeding. Thankfully we were able to order fresh frozen plasma from the Pet Blood Bank* and administer this to Sage prior to his surgery, providing him with the necessary clotting factor. His surgery went uneventfully.

However, there was a further twist to this case. As you can see from the radiograph below Sage’s stomach had dilated to a huge size at the time of surgery making stomach torsion (where the stomach dilates and twists – another commonly fatal problem) a high risk. Doberman Pinschers, like many other deep-chest dogs (eg Great Danes and Setters) are at risk of stomach torsion. Hence we attached Sage’s stomach to the abdominal lining (called a gastropexy, using a strong ‘belt-loop’ technique) as part of his surgery to prevent the stomach from twisting and causing a torsion.

Sage recovered well from his surgery and is back to leading a normal, healthy life. Hopefully he will not include rope amongst his culinary favourites anymore!

*The Pet Blood Bank is a not for profit charity which provides a national canine blood bank. For more information about this charity or to find out how your dog can donate blood please visit www.petbloodbankuk.org

Merlin was brought to the surgery because he was losing his appetite, had had some diarrhoea, was vomiting occasionally and was very weak. During examination an abdominal mass was discovered. Blood tests confirmed that his organs and body systems were still working well. An x-ray confirmed the presence and position of the mass in his abdomen and allowed assessment of the other internal organs.

At exploratory surgery, under general anaesthetic, the mass was found to be a large, cancerous testicle which was removed. His other testicle was also found within the abdomen and removed. With no clear evidence of the cancer having spread, Merlin recovered well and returned home to his owners the following day.

Dogs’ testicles should descend into the scrotal sac when they are young puppies. Testicles that do not descend by adulthood are said to be ‘retained’ and carry a high chance of becoming cancerous (statistically retained testicles are 14 times more likely to develop cancer). Therefore we strongly advise that all retained testicles are removed surgically at a young age.

Becky was brought to the surgery because she had lost her appetite and was very subdued and weak. She had blood tests which showed a high white blood cell count, consistent with an infection. Becky then developed a purulent (pus) discharge from her vulva which indicated an infection in her uterus (womb), known as pyometra (literally meaning pus in the womb). Becky had deteriorated rapidly and required an urgent ovariohysterectomy (surgery to remove her womb and ovaries).

Becky had the necessary surgery that night, after evening consultations had finished, and was kept in overnight on a drip. She recovered from her surgery extremely well and went home the following day, having already regained her appetite.

Pyometra is a potentially fatal, common condition of middle-aged to older bitches that have not been spayed (neutered). It is one of the reasons that we recommend spaying non-breeding bitches at a young age.

Tilly came home on a Friday evening unable to stand on her right hind leg and in obvious pain. Her owners phoned our emergency service and Tilly was admitted to the surgery that same evening for necessary treatment. It was apparent that Tilly had been hit by a car. Her condition was stabilised over night before x-rays were taken the following morning.

The x-rays showed that she had dislocated her right hip and had also fractured the right hand side of her pelvis. The severity and complicated nature of the injury made hip replacement and pelvic repair unsuitable, and after discussion with the owners, it was decided that Tilly would receive surgery known as an excision arthroplasty.

In this procedure the ball head of the affected hip is removed – this prevents the top of the thigh bone rubbing on the pelvis which allows the cat to quickly regain function of its leg and removes long term pain.

Tilly’s surgery went well and she recovered smoothly from her anaesthetic. She was hospitalised for a further night to keep her comfortable and to allow us to give her strong painkillers through the night time.

Tilly is doing extremely well following her surgery and is regaining use of her leg rapidly. However, she has definitely lost one of her nine lives!