Dr. Phil Zeltzman’s Blog

Kona, a female Lab, was only 1 year old, yet she had had several bladder infections.

Rather than keeping her on repeated antibiotics, her family vet looked into the situation and discovered that Kona had an extra fold over her vulva.

This common (and under-diagnosed) condition is called a “redundant vulvar fold,” “vulvar fold dermatitis,” “recessed vulva” or “hooded vulva” (see below a picture in another patient, a 6 year old Newfie, where the vulva is barely visible).

The treatment is a reconstructive surgery called vulvoplasty or episioplasty. The goal is to remove the extra skin.

The main challenge is to remove just the right amount. Not too little, and not too much.

Kona’s pet owner wisely chose to have her spayed under the same anesthesia. Her vet asked me to look into the possibility of a malformation of her urinary system called an ectopic ureter. The ureter is the tiny tube between the kidney and the bladder.

It was a possibility because Kona was constantly leaking urine, i.e. she was incontinent.

During surgery, we removed the extra skin fold, spayed her, found no ectopic ureter… but found another condition.

She had a hydro-ureter, i.e. a ureter that was huge, about 5 times bigger than on the other side. This required removing it, and sacrificing the kidney on the same side – of course after calling the owner in the middle of surgery to request permission to do so.

Surgery was uneventful, and Kona recovered smoothly from anesthesia.

Here is a (warning, graphic) picture of the kidney and the enlarged ureter (hydro-ureter) in another patient, a 6 year old Malamute.

Three weeks later, her owner EB writes:

“Kona is doing well. I have not noticed any leaking and when she urinates, it is a steady stream. Her incision looks great and she is her spunky self.”

Obviously, this is an unusual situation, but a good reminder to keep an open mind when a patient has an unusual situation, like leaking urine constantly.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

Xena, a beautiful 6 month old female German shepherd, was ready to be spayed. Benefits include eliminating the risk of mammary (breast) cancer and preventing a deadly infection of the uterus called pyometra.

In addition, Xena’s family vet discussed the benefit of performing a prophylactic gastropexy.

A what?

A gastropexy is a simple surgery performed to prevent twisting of the stomach – sadly sometimes called bloat – or more appropriately Gastric Dilatation Volvulus (GDV), stomach torsion or flipped stomach.

Prophylactic means that it’s an elective or preventive surgery performed before the stomach ever has a chance to twist.

The success rate of this simple surgery is very high. It is critical to understand that the dog can still bloat, ie the stomach fills up with air. This still means that they would need emergency treatment to deflate the stomach. But it’s a much safer place to be in, since the stomach should not twist on itself.

It is a potentially life-saving procedure that should be considered in Great Danes (the #1 breed for this disease), German shepherds, Dobies, Weimies, Labs and several other large dog breeds with a “deep chest.”

After Xena’s owner had a friend who lost her Great Dane because of a twisted stomach, she wisely chose the added surgery as recommended.

During the gastropexy, the stomach is tacked or stitched to the inside of the belly. This simple procedure prevents the twisting of the stomach.

Then a standard spay was performed.

I’ve performed many of these life-saving surgeries at the time of a spay or neuter. Occasionally, it is done in an older dog who is already spayed or neutered – which is still a great idea.

Xena recovered well after 4 weeks of restricted activity, pain medications and antibiotics.

And now, her family’s mind is at ease, knowing that they did all they could to help Xena live a long, healthy and hopefully GDV-free life.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

A LOOK BACK AT 2021…

The beginning of a new year is a great time to reflect on past accomplishments. For me, as a surgeon, it includes thinking of all the patients we helped and which surgeries we performed the most.

This can give you an idea of which surgeries pets are most likely to need…

So here were our top 10 surgeries in 2021.

1. ACL SURGERY

It never fails.

ACL surgery remains the most common surgery we perform, mostly in dogs (and less so in cats).

We have different procedures in our toolbox depending on the patient.

. TPLO (Tibial Plateau Leveling Osteotomy) is THE most common surgery we perform, by far.

. The “traditional” technique with heavy nylon sutures can be used in well-selected dogs (and occasionally in cats).

. The TWO (Tibial Wedge Osteotomy) has come in handy a few times this year in dogs who had implants that prevented doing a TPLO, or who had extremely steep angle at the top of their shin bone.

. TTA (Tibial Tuberosity Advancement).

One size doesn’t fit all here. We don’t see every problem as a nail, and we don’t only have one hammer.

2. Mass removal

We’ve removed masses in and under the skin, in the chest, in the bone (legs, toes, jaws)…

Thankfully, not all tumors are cancerous, and we’ve removed many benign masses.

3. Belly surgery

Belly surgery or “exploratory laparotomy” allowed us to:

. remove foreign objects from the stomach

. remove body parts (gallbladder, spleen, adrenal gland)

. take biopsies

. remove bladder stones, etc.

You can read about bladder stone surgery here:

Matilda and the amazing bladder stones

Some cats had their colon removed because of a serious condition called megacolon. This is the only definitive solution when cats are so severely constipated, that the colon has become a painful giant bag of dehydrated poop. At that stage, medications are a waste of time and money.

Procrastinating to move on with surgery invariably leads to a much worse anesthesia candidate. These cats may go from otherwise healthy to skinny and unhealthy. Not to mention the fact that they suffer from untreatable constipation.

We also performed a number of prophylactic gastropexies, a preventive procedure designed to present stomach twisting in dogs at risk for “bloat.” This life-saving procedure should be considered in Great Danes (the #1 breed for this disease), German shepherds, Labs and several other large dog breeds.

4. Joint dislocations

We’ve mostly treated joint dislocations in the hip and the knee. Some pets had trauma, others were born that way (congenital dislocation).

The most common one is the kneecap dislocation. The kneecap slides out of the groove where it is supposed to live, at the bottom of the thigh bone (or femur). It is common in dogs, and we’ve treated a few cats with that condition last year.

5. Fractures

We’ve fixed fractures in just about every bone this year, mostly the forearm (radius), the shin bone (tibia) and the thigh bone (femur), as well as some toes, the jaw and the arm (humerus).

To fix these broken bones, we’ve used plates and screws, pins, or a device called an external fixator.

Causes of broken bones mostly included jumping, falling or being hit by a car.

6. TECA

Total Ear Canal Ablation (TECA) is the only definitive treatment for dogs (most often Cockers) and cats who have never-ending ear infections. They lead to pain, head shyness and sometimes aggressiveness.

Unfortunately, most of these pets are treated with medications for years, which can’t even go down into the ear canal because it has become so swollen.

We occasionally perform a TECA in pets who had a tumor in the ear.

TECA is an invasive procedure, with possible complications, yet it fortunately works very well in the majority of patients.

7. FHO

FHO (Femoral Head Ostectomy) is used to treat hip dislocations or hip dysplasia.

The “ball” of the hip (femoral head) is removed during surgery.

FHO is also done in pets with a hip fracture or deterioration of the bone (e.g. Legg Perthes disease in small dogs).

8. Laryngeal paralysis

Dogs, mostly Labs, can have a condition that paralyzes their larynx, a.k.a. voice box, and causes them to suffocate. It’s an incredibly stressful condition. Fortunately, surgery (a “tie back”) allows them to have a wider airway, which typically works very well. These patients quickly go from suffocating to being able to breathe comfortably.

You can read about the amazing story of Mae Mae here:

https://www.drphilzeltzman.com/blog/from-florida-to-pennsylvania-mae-mae-the-lab-gets-a-new-lease-on-life-after-tie-back-surgery-for-laryngeal-paralysis/

9. Brachycephalic syndrome

This condition is seen in dogs (and rarely cats) with a flat face, which caused snoring and difficulty breathing: Bulldogs, pugs, Boston terriers, Persian cats etc.

It typically involves 4 conditions:

. The most visible part are stenotic nares (aka tiny nostrils) which prevents getting enough oxygen. Surgery involved making them wider, aka “a nose job” or a rhinoplasty.

. An elongated soft palate. The tip of the roof of the mouth is so long, that it covers the entrance of the windpipe. When it vibrates, it causes snoring. We can shorten it during surgery.

. Saccules are fleshy structures at the beginning of the windpipe. Over time, the saccules can pop out into the airway – and further block the flow of oxygen. We can remove them during surgery.

. A tiny windpipe, which we can’t do anything about.

You can read more about this surgery done on Kasper here:

https://www.drphilzeltzman.com/blog/guess-who-had-a-nose-job-today/

10. Reconstructive surgery

We did multiple surgeries that required reconstructing a body part:

. Cleft palate (or roof of the mouth), which you can read more about here:

https://www.drphilzeltzman.com/blog/squirrel-gets-a-new-lease-on-life-after-cleft-palate-surgery/

. Male cats who could not pee (P/U or perineal urethrostomy).

. A dog’s penis which had a (benign) tumor.

. Hernias, which are a condition where an organ ends up where it shouldn’t be.

Remembering some of the surgeries we’ve performed in 2021 is also an opportunity to give credit to the wonderful vets, nurses, and pet owners who have been caring for them.

Until next time,

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free certified

www.DrPhilZeltzman.com

“I beg you for help.”

Such was the subject line of the email.

In the email, a pet owner explained:

“My dog Ninja, a 6 year old Siberian Husky, just had a CAT scan, then surgery to drain a cyst in his enlarged prostate” (17 cm long – about 7 inches).

“Because of the pressure on the colon and the bladder, Ninja couldn’t defecate or urinate!”

“His bladder has been so over-stretched, that it couldn’t contract and now Ninja still can’t urinate. A urinary catheter was placed temporarily… and the only option the surgeon gave us was euthanasia!”

“I don’t want to put him down. He is eating, drinking and (now) pooping. He acts normal but can’t pee. Please help me, I am very desperate.”

Desperate times call for desperate measures.

Ninja had a condition similar to unfortunate older gentlemen who struggle to pee because of an enlarged prostate. It is a frustrating & painful situation. But in a dog, it can be life-threatening.

There is a better solution than euthanasia. I suggested a surgery that involves placing a special tube in the bladder and allows draining the bladder on demand.

It’s certainly not for every pet owner, but Ninja’s owners were exactly the right people for the challenge: dedicated, attentive, and totally in tune with their dog. They had done their homework and found out about this option by reading my blog about Madeline, who had the same surgery for a different problem (a bladder tumor).

How Madeline got a new lease on life

Chapter 1

Time was of the essence, so we quickly scheduled surgery at Brodheadvsille Vet Clinic.

Ninja had a “cystostomy” surgery, where a tube was placed to drain the bladder through an opening in the skin.

In addition, Ninja was neutered. After that necessary step, male hormones would decrease and cause the prostate to shrink. That would reduce the pressure on the urethra and allow Ninja to urinate.

Chapter 2

Everything went according to plan for about a month… until Ninja accidentally stepped on the tube.

The logical next step was to replace the life-saving drain. Unfortunately, preop bloodwork showed some concerning changes. Ninja’s immune system was attacking his own red blood cells (hemolytic anemia) and platelets (thrombocytopenia). This double condition is called Evans’ syndrome.

So we changed plans. Since it was too risky to perform surgery with such low numbers of red blood cells and platelets, we placed a traditional urinary catheter to allow Ninja to urinate.

We were able to do this thanks to the generosity of another practice owner near Allentown, PA.

The catheter had to be changed frequently to lower the risk of bladder infection (UTI).

His faithful owners would drain the bladder multiple times a day to allow it to stay small. Remember, the bladder was so over-stretched, that it couldn’t contract anymore…

Chapter 3

At that point, Ninja was referred to a board-certified internist (a medicine specialist) to manage his Evans syndrome.

Meanwhile, Ninja still couldn’t pee!

To make matters worse, an ultrasound showed that the prostate now had an abscess. Again, euthanasia was recommended.

Again, his owner called me to see if there were any other options.

After reaching out to multiple specialists, we found one willing to help. My amazing nurse and I suggested a completely crazy plan:

. An ICU specialist at a specialty hospital in NJ accepted to let us use the key to our problem: a special transfusion with platelets to help with clotting.

. We would drain the abscess at another practice in NJ, and place a new cystostomy tube to allow Ninja to pee.

. We would recover Ninja under the supervision the ICU specialist.

Amazingly, Ninja’s owners decided to go with surgery, about 2 months after the first one.

The procedure was uneventful, and after 2 days in ICU, Ninja went home.

Then came weeks and months of amazing dedication from Ninja’s owners.

Long story short, Ninja progressively got better and stronger.

Then out of the blue, to everybody’s surprise, he started to pee on his own!

After agonizing over the right time to remove the tube, we eventually did, once we were convinced that Ninja was emptying his bladder on his own sufficiently to survive.

Now you understand why Ninja was such a technical and mostly ethical dilemma for me.

When should a surgeon stop helping?

When should a pet owner stop hoping?

When should a pet to cross the rainbow bridge?

Why did I choose Ninja’s story…

… over so many other amazing pet stories I was fortunate to play a part in in 2021?

Because of the number of people who played a role in Ninja’s survival.

In the middle of the COVID crisis, it was an absolutely astonishing display of generosity, love and care, by multiple vets and nurses.

Across half a dozen practices.

And across 2 States (PA & NJ).

(trust me, I gave you the short version!!!)

Everybody rallied behind Ninja, led by his loving owners.

And the result is one happy, playful, fluffy Husky, whose only wish is to be comfortable, to be able to pee, and to return his owners’ love.

Ninja’s owner created an amazing video summary.

It’s a story about the love of a family pet.

A story about the power of dedication.

A story about not taking no for an answer.

You can watch it here: https://vm.tiktok.com/ZMRatj6Co/

Fair warning: it’s a tiny bit emotional…

What’s the moral of the story?

1. Neutering early in life decreases or eliminates the chances of having prostate issues in male dogs. There are many other good reasons, which you can read about here:

https://www.drphilzeltzman.com/blog/top-10-reasons-to-neuter-your-pet/

2. You are your pet’s best advocate. If something makes no sense to you, don’t give up. Sadly, there is not a solution or a cure for every condition. But at least, you should explore your options.

Don’t take no for an answer. Get a second opinion.

This is exactly what Madeline’s and Ninja’s owners did. They didn’t take no for an answer, and they saved their dogs’ lives.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

I recently had the unique opportunity to fix a 2 month old coyote baby!

One of my referral clinics is heavily involved in wildlife rehab.

Mama coyote had been hit and killed by a car.

Her two orphans were eventually found.

One pup, promptly named Lukas, had sustained a fracture of the right humerus, the bone in the arm, which required surgery.

Preop blood work showed that he was healthy enough to undergo anesthesia.

There were 3 main risks to be aware of:

. Surgery is challenging because of puppies’ bones are soft, so they don’t hold screws very well.

. Pediatric patients who undergo anesthesia are at risk for hypoglycemia (low blood sugar), hypothermia (low temperature) and hypotension (low blood pressure).

. It’s much tougher to rehab a wild animal than a tamed house pet.

Fully understanding the risks, we put baby Lukas under anesthesia.

What we couldn’t know before doing surgery, since scar tissue is not visible on X-rays, is how old the fracture was. It turns out that it had been a while. And that makes sense: by the time the terrified pup was found, rescued, assessed, transferred to the vet clinic, and then transferred to my care, it had been many days.

Another proof that the fracture was old is that his range of motion was very poor, even under full anesthesia (my exam notes said “Poor range of motion preop: cannot flex elbow beyond 45 degrees”).

My surgery report said “TONS of scar tissue… very difficult to recognize the anatomy of the bone.”

So we did what we could: stabilize the fracture the best we could, since lining up the bone was not possible. The result is not pretty on X-rays, but functional…

A stainless steel plate and 8 screws were placed.

Fortunately, Lukas recovered smoothly from anesthesia.

Despite the above challenges, the benefit of being young is that bones heal very quickly.

The next challenge was to allow Lukas to heal, confined in a small area, fed a healthy diet, while doing physical therapy so his elbow wouldn’t get too stiff.

All of that, while handling him as little as possible. It is very detrimental to overhandle wildlife, especially pediatrics, due to the risk of human imprinting.

Imprinting refers to a critical time in young animals when they form attachments and develop their identity. So they need to “imprint” onto their mother, or their siblings, or their buddies, not humans.

To avoid this risk, Lukas was eventually transferred to a rescue association.

Once fully healed based on 6 week X-rays, Lukas was reunited with his brother. They were kept at the rescue until they were 6 months old. Then they were released together, to live their coyote lives…

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com