Cases of the Week

Cases of the Week

Cases of the Week

Cases of the Week

Stevie

Case #44 – Stevie​​​​​​​
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Meet Stevie! He is an adult male Labrador who happens to be a high-level competition dog. He presented to Capital Veterinary Specialists for a left pelvic limb lameness that started after a trial. Dr. Drygas and team evaluated Stevie and diagnosed him with a torn sartorius and rectus femorus muscle in his left cranial thigh. This is a rare and possibly career ending injury. The CVS team used an MRI to see exactly where the muscle was injured prior to surgery so they could plan their repair. A muscle reconstruction/reattachment was performed and Stevie did great! He went through 4 weeks of canine rehab and is doing amazing! We are all encouraged and expect a return to the competition life for Stevie! Go Stevie! Go!!!

MRI image
MRI image
Intraoperative torn muscle #1
Intraoperative torn muscle #1
Intraoperative torn muscle #2
Intraoperative torn muscle #2
Muscle repair
Muscle repair
Stevie after surgery
Stevie after 4 weeks
Cracker

Case #43 – Cracker​​​​​​​
Cracker presented to the CVS Internal medicine department for regurgitation and chronic reflux. After a work up that included imaging and blood work she was treated outpatient with antacids and anti-emetics and instructed to follow up in one week. Cracker did not improve and her condition actually worsened. At that time Dr. Sofia Morales, decided to confirm her suspicion that Cracker had an esophageal stricture (a narrowing in the esophagus that is induced by esophageal ulceration) that was not allowing her to swallow her food and causing constant discomfort and regurgitation. This condition can be caused by acid reflux or esophageal foreign bodies and can be treated by dilating the esophagus open with a balloon that goes through an endoscope. The procedure is typically repeated a few times for success. Cracker was found to have not one but two esophageal strictures each of which were approximately 8mm. This means anything she ate larger than 8mm (which is almost everything) could not pass through her esophagus, causing further reflux and regurgitation.

Cracker

Cracker has undergone two balloon dilation procedures thus far and has done very well. Her strictures are now approximately 1.5cm (normal canine diameter for an esophagus is 3-4cm). Cracker was eating a liquid diet and is now able to eat small little pieces of canned dog food. She loves her dog food!

Cracker is scheduled to have an additional procedure next week to determine if further dilation is needed. We expect Cracker to continue to do very well and enjoy dog food for the rest of her life. Much thanks to Cracker and her family for trusting us and allowing us to help her. She is such a sweetheart!

Endo image #1
Endo image #2
Endo image #3
Endo image #4
Endo image #5
Endo image #6
Cash

Case #42 – Cash​​​​​​​
Meet Cash! He is a 3 month old English Bulldog that presented to Capital Veterinary Specialists for not being able to control his bowel movements – fecal and urinary incontinence. Basically, he would walk around the house dribbling urine and leaking poop all day. No fun! His owners also noticed a weird dimple of his lower back area – see image below. Dr. Drygas and the Cap Vet team assessed Cash and determined that he had neurological deficits causing his urinary and excrement issues. The team started with spinal radiography and noted an abnormal defect in his spine at the level of his sacrum (this is the junction between the dogs lower back and tail) – see image with red arrow. Cash had an abnormal sacrum and it failed to form normally on top. With this info, the team’s next step was to perform a CT. The CT identified not only the abnormal sacral body but also a cyst in his spinal canal and a fibrous connection between the spinal tissue and the skin which is what was causing the dimple on his back. Dr. Drygas and team took Cash to surgery to remove the abnormal tissue and reconstruct his sacrum (intraoperative picture of tract tissue). Cash made an AMAZING recovery and just one week after surgery he was able to control his urination and defecation! We are so happy for Cash and his owners!

Image of dimple
CT image
Image of abnormal tissue
Rex (Elhew G Force)

Case #41 – Rex (Elhew G Force)​​​​​​​
Meet Rex (aka Elhew G Force)! He is a young adult English Pointer and is a champion field trial dog who competes all across the United States. Rex presented to the surgical department for a history of left front limb lameness after heavy activity and competition. Dr. Jehn examined Rex and determined the lameness was related to shoulder pain. Radiographs of the joint were taken but were normal and a soft tissue injury was then strongly suspected. The next step in the diagnostic plan for Dr. Jehn was to perform an MRI (Magnetic Resonance Imaging) on Rex’s shoulder to look closely at the soft tissue structures around the joint (see pic). MRI examination was performed under a short anesthesia and the cause of the lameness was identified – Rex had injured his biceps tendon and his glenohumeral ligament (a medial shoulder support structure that can be damaged with heavy activity or trauma). The white area in the T1 weighted MRI image indicates inflammation. The good news for Rex was that the injury did not require surgery. Instead, Dr. Jehn and Erin O’Connell, PT/CCRT (our rehabilitation specialist), initiated a rehabilitation program and cleared Rex for competition in the upcoming National Trial! Great job Rex and we hope you bring home the first place prize!

Radiograph
MRI image
EL

Case #40 – El
Meet El! She is a young, spayed, domestic short-haired female feline. El presented to Capital Veterinary Specialists for evaluation of loss of balance, weakness, and a severe head tilt. El was depressed, not eating, and unable to stand or walk. Dr. Carl Jehn and the team evaluated her and determined the problem with El was neurological in nature and was isolated to her brain. A contrast enhanced CT (computed tomography) of her brain was performed and an infection in her middle ear with evidence of infection spreading into the brain (red arrow, attached image) was identified. Dr. Jehn and the surgery team took her to surgery to perform a ventral bulla osteotomy – a procedure where a hole is made in the bone surrounding the middle ear and infection or cancer can be removed. After surgery, aggressive antibiotic therapy was instituted and El is now back to normal! She is a wonderful little patient and we are so happy she is feeling better. You go El!

CT image of El’s brain
Phil

Case #39 – Phil​​​​​​​
Meet Phil! Phil is a 7-month old German Shepherd puppy who presented last week for consultation regarding a left elbow fracture. Phil’s injury, called a T-Y humeral fracture, was very serious and required surgical repair to restore function to the limb. An advanced technique was used that placed multiple pins in addition to a fixation bolt (see x-rays). Phil’s surgery went very well and he is expected to make a complete recovery. Great going Phil!

Pre-op x-ray
Post-op x-ray
Beretta

Case #38 – Beretta
Meet Beretta! Beretta is is a three month old, female English Cocker spaniel that presented to Capital Veterinary Specialists for evaluation of a heart murmur. Dr. Sorrentino evaluated her and performed an echocardiogram (heart ultrasound) to determine that the cause of the murmur was a birth defect in her heart. Beretta had a patent ductus arteriosus – a vessel in the heart that normally closed at birth and if it stays open causes heart failure and early death. The only therapy for this type of defect is to close off the vessel. This procedure can be done with open chest surgery or minimally invasive catheter procedures, but due to the size and shape of Beretta’s abnormal vessel, surgery was her only option. Dr. Drygas, Dr. Carl and the surgery team performed a patent ductus arteriosus vessel ligation (see intraoperative video of beating heart and black sutures prior to closing vessel). The vessel was successfully closed off and Beretta made an excellent recovery. Just two weeks after surgery, Beretta is back to playing and training for her work in the field! Way to go Beretta!

Ductus Arteriosus Vessel Ligation
Brynna

Case #37 – Brynna​​​​​​​
Meet Brynna! Brynna presented to the surgery department of Capital Veterinary Specialists for a problem with her back left leg. She had been limping on the limb for several months and was no longer able to conduct her agility training. Dr Drygas and the surgery team evaluated Brynna and identified a very rare but treatable injury. Brynna had luxated (popped out of place) her long digital extensor tendon (the tendon in the back leg that extends the digits of the toes). This injury resulted in an instability that was painful and irritating every time she bent her knee. The surgery team operated on Brynna and stabilized the loose tendon (see pre-fixation intraoperative video) with a bone plate and screws (see post-fixation video). Radiographically implants can be seen on the outside of the tibia. Just 2 weeks after surgery, Brynna is back to running and jumping and is ready to resume her agility training! Great job Brynna!

Brynna​​​​​​​ Radiograph #1
Brynna​​​​​​​ Radiograph #2
Pre-fixation
Post-fixation
Brynna’s recovered gait
Case #36 – Jake

Case #36 – Jake​​​​​​​​​​​​​​
Meet Jake! Jake is a 10 year old Dachshund owned by a local veterinarian. He presented with an acute onset of lethargy, diarrhea and difficulty breathing. Radiographs of his chest showed a large tumor behind his heart. Jake had a CT scan and was later taken to surgery to remove his tumor. Dr. Neihaus performed a median sternotomy to remove a large tumor of his accessory lung lobe. The tumor was adhered to his vena cava, diaphragm and adjacent lung lobe but was able to be successfully dissected out and removed. Tumors of the accessory lung lobe are extremely rare and can be difficult to diagnose and remove. Jake recovered very well and was discharged two days after surgery. Two weeks after surgery, his stitches were removed and Jake was feeling great!

Jake's Radiograph
Removed tumor
Bernie

Case #35 – Bernie
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Meet Bernie! Bernie is a 7 year old Boxer that presented to Dr. Walker for an acute onset of weakness, panting, and an enlarged heart. An echocardiogram showed a tumor on the base of his heart and pericardial effusion compressing his heart. Pericardiocentesis was performed to temporarily relieve the compressive effect of the pericardial effusion. Heart based tumors in dogs (chemodectomas) are very slow growing and most dogs die from the secondary pericardial effusion. It has been shown that dogs that have a portion of the pericardium (heart sac) removed survive significantly longer than dogs without surgery (2-5 years vs. 42 days). Traditionally, pericardectomy has been performed through an open lateral thoracotomy. In Bernie’s case, Dr. Neihaus was able to perform the pericardectomy thoracoscopically, which allowed for excellent visualization and three very small incisions. This minimally invasive procedure allows for a quicker recovery with less pain and a lower risk of complications. Two weeks after surgery, Bernie’s sutures were removed and he was reported to be back to normal!

Thoracoscopic pericardectomy
Crackhead

Case #34 – Crackhead​​​​​​​
Meet Crackhead! He is an adult English pointer, working plantation dog. He presented to Capital Veterinary Specialists for severe neck pain and weakness in all of his limbs. Dr Drygas and the team evaluated him and determined he had a cervical spine lesion. A CT exam of his spine was performed and a ruptured intervertebral disc was identified compressing his spine (see green arrow in radiograph). The team took Crackhead to surgery to decompress his spine and remove the offending disc material – a procedure also known as a ventral slot. Just 3 weeks later crackhead was pain free and back to work! We are so happy for his full recovery (see video)!!

Crackhead’s Radiograph
Crackhead’s Radiograph
Crackhead
Doc

Case #33 – Doc​​​​​​​
Meet Doc! He is an adult Labrador that came to Capital Veterinary Specialists with an ACL tear. This a very common injury in dogs so the treatment isn’t the interesting part of this case. The reason Doc is unique is the way he got through his recovery. Doc recovered from surgery with the help of a therapy bunny! That’s right, Doc’s parents got him a baby bunny to keep him company while he recovered! The bunny’s name is Frank and he helps with rest and recovery and even with ice therapy! Frank lays on Doc during his cold compression therapy sessions! Way to go Doc and Frank!

Doc and Frank 1
Doc and Frank 1
Doc and Frank 2
Doc and Frank 2
Ilean

Case #32 – Ilean​​​​​​​
Meet Ilean! She is a one year old female Great Dane pup that came to Capital Veterinary Specialists for elective surgery. Ilean and her mom drove from Jacksonville to Tallahassee for a minimally invasive laparoscopic spay and gastropexy. This is a newer procedure where the surgeon uses small incisions and a surgical camera to operate on the patient, remove the reproductive organs, and pexy or suture the stomach in place. The gastropexy is a very important procedure for large breed, deep chested dogs (e.g. Great Danes, Golden Retrievers, Labrador Retrievers, and Rottweilers) to prevent future episodes of gastric dilatation and volvulus (a life threatening disease where the stomach twists on itself and can rupture). Using minimally invasive surgical techniques we decrease postoperative pain and speed recovery in our animal patients. Great job Ilean!

Laparoscopy #1
Radiograph 1
Laparoscopy #2
Radiograph 2 (myelography)
 Jackson

Case #31 – Jackson
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Meet Jackson. He is an adult male Beagle dog that presented to Capital Veterinary Specialists for neck pain and a stiff forelimb gait. On examination, Jackson was very very pained by any manipulation of his head or neck and would cry out randomly during the day. The surgical team determined that Jackson had a herniated cervical intervertebral disc that was causing compression on his cervical spinal cord and nerve roots thus resulting in his severely painful episodes. The team confirmed this with a myelogram (advanced diagnostic imaging where radiopaque material is injected around the spinal cord to outline any areas of compression). A compressive lesion was identified at C2-C3 (red arrow) and Jackson was taken to surgery. Dr. Goring and Dr. Drygas performed a ventral slot and removed the herniated disc material. Just 7 days after surgery Jackson was feeling amazing and even jumping as he played! He is pain free and will make a full recovery!

Radiograph 1
Radiograph 1
Radiograph 2 (myelography)
Radiograph 2 (myelography)
Winston

Case #30 – Winston​​​​​​​
Meet Winston! He is an adult basset hound that presented to Capital Veterinary Specialists surgery department for pelvic limb paralysis – he simply couldn’t walk. The team determined that he had a ruptured intervertebral disc that was compressing his spinal cord and causing the paralysis. After conducting advanced imaging of his back – myelography (see arrow pointing to area of spinal cord compression) – the team determined he had a spinal compression at L3-L4. Dr Drygas and the surgical staff took Winston to surgery to decompress the area and remove the herniated disc material. Just 4 weeks after surgery Winston is back in action and wanting to run, jump, and play again (and maybe fly – look at those ears!!)! Great Job Winston!

Pre-operative gait
Post-operative gait
Tom

Case #29 – Tom​​​​​​​
Meet Tom! He is a 4 year old male Plott Hound. He is a working dog on a plantation and a big game sporting dog. He fractured his humerus while working in the field – he was actually bitten by a Georgia Black Bear. The bear caused severe fractures to the humerus and open wounds along the affected limb. He was lucky he survived the accident with his limb still attached. Dr. Drygas, Dr. Goring, and the surgery team operated on Tom’s limb and used a plate and rod to repair the break. Tom stayed at Capital Veterinary Specialists for his recovery and is healing very well. In 6 weeks, Tom will be fully healed and back to work! Great Job Tom!

Chancey

Case #28 – Chancey
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Meet Chancey! She is a 6 month old, English Cocker Spaniel who presented to Capital Veterinary Specialists after sustaining a fracture to her left front limb. Chancey was in training to become a plantation working dog when she injured herself and required immediate medical attention. Chancey had fractured her left humerus at the level of the elbow joint and the humerus was in three pieces. This is a very tough fracture as it involves the articular cartilage. The CVS surgerical team used a medially applied bone plate with screws and a laterally applied compression screw and wire to rebuild her humerus and elbow. Four weeks after surgery, Chancey is back to her normal self – wanting to run, jump and play. Chancey is doing great and will resume training in the next 4 weeks. Great Job Chancey!

 Daisy​​​​​​​

Case #27 – Daisy​​​​​​​
Meet Dakota (Catahoula mix breed female) and Tater (Boston terrier male). They are our Tag Team Case of the Week! Both three month old puppies presented to Capital Veterinary Specialists on the same day with the SAME fracture in the SAME front left forelimb. The fracture is common in young growing dogs and involves the articular surface of the distal humerus (in the elbow joint). They are tough fractures to fix as you have to align the articular surface perfectly to prevent the development of arthritic changes in the future. Both pups received a transcondylar screw and a wire to reduce and hold the fractures in place while they heal. The hard part is going to be keeping these two energetic puppies rested for the next 8 weeks while they heal! Keep calm Dakota and Tater! CVS wants to see both of you healthy and playing again soon!

Dakota & Tater

Case#26 - Dakota & Tater
Meet Dakota (Catahoula mix breed female) and Tater (Boston terrier male). They are our Tag Team Case of the Week! Both three month old puppies presented to Capital Veterinary Specialists on the same day with the SAME fracture in the SAME front left forelimb. The fracture is common in young growing dogs and involves the articular surface of the distal humerus (in the elbow joint). They are tough fractures to fix as you have to align the articular surface perfectly to prevent the development of arthritic changes in the future. Both pups received a transcondylar screw and a wire to reduce and hold the fractures in place while they heal. The hard part is going to be keeping these two energetic puppies rested for the next 8 weeks while they heal! Keep calm Dakota and Tater! CVS wants to see both of you healthy and playing again soon!

Justice

Case #25 – Justice​​​​​​​
Meet Justice. He is a 12 year old yellow Labrador that presented to Dr. Drygas and Walker for a left sided oral mass. He had a history of abnormal left mandibular growth that had been going on for years with a recent onset of a large intraoral soft tissue mass affecting his ability to eat (see pic #1). Dr. Walker performed a CT evaluation on Justice (see 3-D reconstruction images), to characterize the bone changes in his jaw. After evaluation, Dr. Drygas took Justice to surgery to remove the oral mass. The bone changes seen are benign changes in his mandible but unfortunately, the soft tissue mass was determined to be a Fibrosarcoma. Justice has healed from surgery and is beginning chemotherapy. We are very happy to see Justice back to eating and drinking normally and we know he will do amazing in his chemotherapy sessions.

Leelo

Case #24 – Leelo​​​​​​​
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Meet Leelo! He is a 1 year old, shepherd mix breed who came to Capital Veterinary Specialists for evaluation of forelimb lameness. Dr. Drygas and the surgery team evaluated Leelo and determined that the cause of the pain and lameness was his elbow joints (see radiograph). Leelo was suffering from a disease known as fragmented medial coronoid processes (see http://www.vcahospitals.com/main/pet-health-information/article/animal-health/fragmented-coronoid-process-or-fcp-in-dogs/1012 for information). This disease causes a portion of the bone in the elbow to not form properly and results in pain and elbow arthritis. Dr. Drygas, with the help of Jason and Kate, took Leelo to minimally invasive surgery by using an arthroscope to remove the abnormal fragments in Leelo’s elbow joints (see video and pic of bone fragment after removal). Leelo recovered from surgery well and is on the road to a full recovery. Way to go Leelo!

Spot

Case #23 – Spot
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Meet Spot. He is a 1.5 year old, male, mix breed canine that was hit by a car in his front driveway. Unfortunately, Spot suffered two fractures – his humerus bone (front right limb) and his femur bone (right pelvic limb)! With two limbs fractured, he could not stand or walk on his own. Due to the severity of the injuries, a local animal charity group reached out to Spot’s mom and offered to help finance the surgery and Capital Veterinary Specialists matched the charity’s contribution in order to make the surgery be affordable for Spot’s mom. Spot’s veterinarian stabilized him and sent him to CVS for surgical therapy. It took Dr. Drygas and the surgery team two long surgery sessions to fix Spot – his front limb was mended during the first surgery and his back limb during the second. Spot was already trying to walk on his newly repaired limbs the day after his surgery! Great job Spot!

And a special thanks to the St. Francis Ministry for Animals for their care and generosity to help fund both of Spot’s surgeries.

Pre Op Radiographs
Post Op Radiographs
Hudson

Case #22 – Hudson​​​​​​​
Meet Hudson! He is a 13 year old flat-coated retriever who presented to Capital Veterinary Specialists for severe respiratory difficulty. After evaluation and a full diagnostic work up, the team determined that Hudson had a disease called laryngeal paralysis – a disease that causes a slow degeneration of the nerves that control the opening of the larynx during breathing. The disease is progressive. It starts by causing the inability to open the larynx when trying to breath and ultimately can be fatal or result in repeat episodes of heat stroke or collapse. Dr. Drygas and the team took Hudson to surgery and performed a left arytenoid lateralization (also known as a “tie back”). This surgery permanently opens the left side of the larynx and allows for improved air flow and breathing. Unfortunately there is a risk of aspiration pneumonia following surgery so we will have to watch Hudson closely over the next weeks. He left the hospital the day after surgery doing great and breathing better than he had in a long long time.

Bella

Case #21 – Bella​​​​​​​
Meet Bella! She is an adult female spayed Labrador who injured her left forelimb several months ago in a car accident and nearly lost her leg. After an intense wound therapy regimen by her primary care veterinarian, Thomasville Animal Hospital, she presented to Dr. Drygas for therapy options related to the persistent limping. The limp was due to the severe instability in her wrist joint that was secondary to the car accident. Dr. Drygas and Randy Williams of Williams Orthotics and Prosthetics fitted her with a custom carpal brace and Bella is back to running, jumping, and playing – Great Job Bella!

Sam

Case #20 – Sam​​​​​​​
Meet Sam. He is an adult male American Bulldog who was rescued by his owners several years ago when they found him hit by a car on the side of the road. He sustained a femur fracture as well as a nerve injury to his right front limb. The femur fracture healed with surgical intervention but the neurological injury to the forelimb (partial brachial plexus avulsion) progressed over time.

Orthotic
Radiograph 2

The injury resulted in a severe contraction of the forelimb at the level of the carpus (wrist joint in a dog) and prevented Sam from using the limb (see image of flexed carpus). Dr. Drygas and the surgery team evaluated Sam and determined that despite the severe contraction of the muscle, his nerve function had improved enough to bear weight on the limb. Sam was taken to surgery and a complete tendon release with reconstruction was performed to straighten the carpus out (see image of straight carpus). He was treated with splint therapy for 2 weeks until a custom orthotic was made specifically for Sam (see image of orthotic). After a few orthotic adjustments Sam is doing great and is using the limb better than ever. We are so happy to see Sam using the limb after years of non-weightbearing lameness!

Flexed carpus
Flexed carpus
Straight carpus
Straight carpus
Jeb

Case #19 – Jeb
Meet Jeb. He is an 8 year old, male springer spaniel who injured himself while working in the woods with his owners three months ago. For the last three months Jeb has had a severe right forelimb lameness that failed to improve with rest and pain management. He presented to Dr Drygas for evaluation and, if necessary, surgical intervention. Dr Drygas determined that Jeb had injured his right shoulder joint and had severe medial instability in the joint – i.e. Jeb tore his medial collateral ligament (similar to a rotator cuff in people). Dr Drygas teamed up with world famous veterinary orthopedic surgeon Dr Jimi Cook and visiting academic surgeon Dr Stan Kim to repair Jeb’s shoulder. Dr Cook recently pioneered a cutting edge shoulder surgery and brought that technology and technique here to Capital Veterinary Specialists! Doctors Drygas, Cook, and Kim used minimally invasive techniques (arthroscopy and custom implants) to rebuild the medial compartment of Jeb’s shoulder. The surgery went very well and we are expecting Jeb to make a full recovery over the next 12 weeks. It was an amazing opportunity for this 8 year old working dog and for the community here in Tallahassee to benefit from Dr Cook’s expertise and state-of-the-art surgical technique.

Arthoscopy image
Arthoscopy image
Radiograph 1
Radiograph 1
Radiograph 2
Radiograph 2
Jeb’s leg
Jeb’s leg
Doctors at work 1
Doctors at work 1
Doctors at work 2
Doctors at work 2
Maggie

Case #18 – Maggie
Meet Maggie, she is an 8 month old female, spayed bulldog that presented to Capital Veterinary Specialists for investigation of head tremors and possible seizure activity. Dr. Walker and Dr. Drygas evaluated Maggie and determined that she had normal mentation and no neurological deficits. Her orthopedic, physical, and neurological examinations were all normal as well. Based on her age and the type of tremors she was displaying the top differentials for her condition were: a) idiopathic head tremors, b) congenital brain deformity, c) cancer or d) hydrocephalus. After discussing the case with Maggie’s owners, we elected to take Maggie to MRI and image her brain and cervical spinal cord (see images). There was a very mild increase in the fluid in Maggie’s brain but no other abnormalities. This condition is known as mild hydrocephalus or ventriculomegaly. Medical treatment was instituted and the head tremors have resolved! Maggie continues to do well and we are all very pleased with her recovery!

MRI 1
MRI 1
MRI 2
MRI 2
Ruger

Case #16 – Ruger
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Meet Ruger! He is a four month old male French Bulldog pup rescued by his current owner after being diagnosed with a heart defect and secondary megaesophagus – an abnormal vessel from his heart. The megaesophagus enlarged his esophagus which, in turn, caused it to constrict and prevented him from eating food normally. Dr. Drygas and Dr. Goring took Rugar to surgery and performed an open chest procedure to repair the defect. Ruger is making a very fast recovery and should be able to swallow food normally very soon. We can’t wait to see him 100% recovered!

Open chest surgery
Radiograph 1 – Before therapy
Saidie

Case #15 – Sadie
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Meet Sadie, a 7 year old spayed female lab/retriever mix. Sadie presented for the investigation of three weeks tenesmus (straining to defecate). Physical examination showed a left sided mass in the anal gland (sac). Cytological examination showed an anal sac adenocarcinoma (cancer of the anal glands). Ultrasound and radiographic studies showed the cancer had spread to the local iliac lymph nodes and the lungs (see radiograph 1). Notice the large pulmonary (lung) nodules sometimes known as ‘cannonballs.’ The extent of the cancer had eliminated surgery as a viable, single treatment (surgery is useful for contained or localized disease). The treatment options included traditional chemotherapy (high dose, long dose interval cytotoxic drugs) and metronomic therapy (low dose, oral therapy administered continuously at home). A metronomic protocol was selected. Metronomic therapy interferes with cancer growth by (1) inhibiting angiogenesis (hijacking of the body’s blood vessels supply nutrition), (2) inhibiting cancer cell division and growth, and (3) promoting cancer cell death. After 1 month of metronomic therapy Sadie’s chest films looked markedly improved (see radiograph 2). Notice the dramatic decrease in the size of the pulmonary nodules and in some cases replacement by a poorly defined interstitial pattern (ill-defined ling densities). We hope to see Sadie’s cancer in full remission in the near future as she continues to respond positively to her treatment.

Radiograph 1 – Before therapy
Radiograph 1 – Before therapy
Radiograph 2 – After therapy
Radiograph 2 – After therapy
Pumpkin

Case #14 – Boone
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Meet Boone! Boone is a 14 week old Labrador puppy that presented to Dr. Drygas and Dr. Walker after being hit by a car. Boone sustained an open fracture to his back left limb that involved the tibia and fibula (the bones below the knee joint similar to a persons shin bone). After Boone was stabilized and his open wounds treated, Dr. Drygas took him to surgery to fix his fractured tibia. A bone plate with 6 screws was applied to the inside of the fractured tibia and the open wounds were cleaned and closed. Boone has been making a GREAT recovery and will be running again very soon!

Pre Op Lateral Radiograph
Pre Op Lateral Radiograph
Pre Op Lateral Radiograph
Post Op Lateral Radiograph
Post Op Ap Radiograph
Post Op Lateral Radiograph
Pumpkin

Case #13 - Pumpkin
Meet Pumpkin. She is a 5 year old, female spayed Dingo mix breed. Pumpkin was presented to Capital Veterinary Specialists for evaluation of a back right pelvic limb lameness. Dr. Drygas and the surgery team evaluated Pumpkin and determined she was limping due to a torn cranial cruciate ligament (a structure similar to a persons ACL in the knee joint). Dr. Drygas and team took Pumpkin to surgery and performed a tibial plateau leveling osteotomy (TPLO) to correct the lameness and stabilize her stifle joint (see post operative radiograph with TPLO plate). For more information on TPLO procedures follow the link to: https://www.acvs.org/small-animal/cranial-cruciate-ligament-disease.The two videos below show Pumpkin’s progress. The bottom left video shows Pumpkin after 2 weeks and the bottom right video shows her progress after 4 weeks. As you can see, Pumpkin is doing great 4 weeks after surgery! She has 2 more months of recovery and then will be back to running, jumping, and playing off leash!

Pumpkin’s pre-surgical radiograph
Pumpkin’s pre-surgical radiograph
Pumpkin’s post-surgical radiograph
2 weeks after surgery
4 weeks after surgery
Dinah

Case #12 – Dinah​​​​​​​
Meet Dinah. She is an adult, female, spayed, Basset hound that was presented to Capital veterinary Specialists for paralysis of her back legs. Dr Drygas and Dr Walker performed a Myelogram (i.e. a contrast study to outline the spinal cord and evaluate it for compression) and determined the cause for Dinah’s paralysis was due to a ruptured inter-vertebral disc at the level of her first and second lumbar vertebral bodies (see the radiograph picture with the white arrow pointing to the compressive lesion). Dinah was taken to surgery where spinal decompression was performed including the removal of the herniated disc material. Dinah made an excellent recovery and was back up and walking again at 2 weeks. After just 4 weeks, she was walking almost normally (see video)! We expect Dinah to make a complete recovery over the next 2 months.

Radiograph
Dinah’s Radiograph
Dinah’s Radiograph
Maggie

Case #11 – Maggie​​​​​​​
Meet Maggie. She is a 9 year old German shepherd dog who was presented for surgical evaluation of a chronic, partial Achilles tendon injury. The Achilles tendon attaches several muscles to the heel bone and controls the extension of the hock (ankle) joint. The radiograph with the arrow points to thickening and degenerative changes of Achilles tendon insertion. Because the injury was only a partial tear and Maggie was still using the limb well with only mild lameness, Dr. Drygas elected to treat Maggie conservatively without surgery. Dr. Drygas worked closely with Randy WIlliams, co owner of Williams Orthotics and Prosthetics, to construct a supportive orthotic brace for Maggie. The brace will help support Maggie while she walks and runs to prevent further injury to the tendon that would otherwise require major reconstructive surgery. We are so excited to see Maggie doing well and are all watching her progress closely!

Radiograph
Radiograph
Brace
Brace
Closeup of brace on Maggie
Closeup of brace on Maggie
Oscar

Case #10 – Oscar
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Oscar is a 9 year old, male Golden retriever who was presented to us by Dr. Greshake for evaluation of a chest mass. The mass was identified on thoracic radiographs taken by Dr. Greshake after Oscar came to him for coughing and intermittent regurgitation. The mass was very large and located in the mediastinal space – the space between his lungs and in front of the heart. Dr. Walker evaluated Oscar and performed an ultrasound-guided aspirates of the mass to obtain a diagnosis. Unfortunately the cytology came back inconclusive and was either a thymoma or a lymphoma. Oscars parents wanted to give him every possible chance for survival and elected to have the mass surgically removed. Prior to surgery Dr. Walker and Dr. Drygas had Oscar’s chest examined with computed tomography (CT). This exam identified a massive 15 cm x 8cm x 10 cm mass in his cranial mediastinum that was compressing his left lungs and pushing his heart to the right (see images 1, 2, and 3). Dr. Drygas and Dr. Goring took Oscar to surgery and performed a median sternotomy to remove the mass (see image 4 showing Oscar’s open chest and identifies the mass and the normal right lung lobe). After the removal of the mass, the left lung lobe expanded normally and Oscar was able to breath more normally (see image 5 to view Oscar’s open chest after the removal procedure). His sternotomy was closed with orthopedic wire and a chest tube was placed (see image 6 showing a radiograph of the tube and wires in Oscar’s sternum). Oscar made a fast recovery and was sent home 2 days later. The mass biopsy was evaluated and determined to be high grade lymphoma. Oscar will begin chemotherapy with Dr. Walker in a few days and we are very optimistic of his long term survival and quality of life.

Image 1 – CT #1
Image 1 – CT #1
Image 2 – CT #2
Image 2 – CT #2
Image 3 – CT #3
Image 3 – CT #3
Image 4 – Open Chest #1
Image 4 – Open Chest #1
Image 5 – Open Chest #2
Image 5 – Open Chest #2
Image 6 – Radiograph
Image 6 – Radiograph

Case #9 – Tanner​​​​​​​
Meet Tanner, a 2 year old male castrated Rhodesian Ridgeback mix breed dog. He came to Capital Veterinary Specialists for a very unique problem – a dermoid sinus. A dermoid sinus is a birth defect that results from abnormal separation of skin tissue and neural tissue (spinal cord) during embryological development. This condition results in a tubular structure that extends from the skin (see picture of Tanner’s neck) down into soft tissue on dorsal midline. It is a congenital and heritable condition in the Rhodesian Ridgeback and can cause recurrent infections and even serious neurological infections if the defect communicates with the spinal cord. Tanner had three sinuses that converged into one and penetrated all the way down to the back of his second cervical vertebra (see radiograph picture). They were causing Tanner to have recurrent swelling and skin infections that were painful and bothersome. Tanner was taken to surgery where Dr. Drygas and the surgical staff removed the sinus (see intra-operative picture and dissected tract pictures) and repaired Tanner’s neck. He is making a great recovery and we are so happy to see him back in good health and ready to play again.

Tanner's neck
Tanner's neck
Neck Radiograph
Radiograph (red = vertebra of sinus origin, white = sinus opened on neck)
Intra-operative tract
Intra-operative tract
Dissected trace with hair and infection #1
Dissected trace with hair and infection #1
Dissected trace with hair and infection #2
Dissected trace with hair and infection #2

Case #8 – Winston
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Meet Winston, he is a 1 year old male standard poodle. His primary care veterinarian diagnosed him with bilateral retained abdominal cryptorchid testicles – hes testicle never moved into his scrotum and stayed in his belly instead. When this condition happens, the testicles are at risk for twisting and becoming cancerous. Furthermore, such a condition can be difficult to diagnosis. We took Winston to surgery, but performed a minimally invasive procedure, called laparoscopy, to remove his testicles. Laparoscopy allowed us to make only 2 small 1 cm incisions and remove both abdominal testicles. Because Winston is a deep chested breed, we also performed a laparoscopically assisted gastropexy at the same time (tacking the stomach to the body wall to prevent twisting and bloat). Winston did great and was feeling so good he went home the same day of surgery!

Right testicle grasped with forceps
Right testicle grasped with forceps
Stomach grasped prior to pexy to abdominal wall
Stomach grasped prior to pexy to abdominal wall

Case #7 – Samantha
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Samantha is a 13 year old spayed female that was presented for the investigation of acute onset blindness. This had occurred 3 days before her visit with Capital Veterinary Specialists. Physical examination showed both pupils were dilated and unresponsive to light. Both retinas had detached from the ‘back’ of the eye. Samantha’s blood pressure was markedly elevated (210 mmHg; normal < 150 mmHg) and this was treated with antihypertensive medication (amlodipine and enalapril). One week later her vision has returned and her retinas have re-attached to the ‘back’ of her eyes. Her blood pressure is 160 mmHg.Cats and dogs usually develop hypertension secondarily to other diseases. In people primary or essential hypertension is much more common, because we live for about seven decades while cats and dogs live one to one and a half. Samantha has mild to moderate (Stage II out of IV) chronic kidney disease that caused her elevated blood pressure. This is being managed with a kidney diet (protein and sodium restriction).

Samantha
Samantha
Retinal detachment
Retinal Detachment

Case #6 – Molly​​​​​​​
Molly, a 10 year old female spayed, was presented for the investigation of anemia (packed red blood cell volume: PCV 15%; normal > 35%). Hematology showed NO young red blood cells (reticulocytes) in circulation suggesting a bone marrow problem. Our initial plan included a blood transfusion and bone marrow analysis. This study showed Molly’s immune system was destroying metarubricytes (a red blood cell precursor) and a diagnosis of central immune mediated hemolytic anemia was made. Molly was treated with drugs to suppress her immune system (prednisone and cyclosporine). Follow up blood testing showed Molly was beginning to produce red blood cells (reticulocyte count increased from 20,000/uL to 59,000/uL). Later that same week Molly became depressed and was nauseated. Her PCV fell to 13% and testing determined she had a very low platelet count (platelets are cell fragments that help blood to clot) and was bleeding into her gastrointestinal tract. A combination of an immune mediated destruction of red blood cells and platelets is called Evan’s Syndrome. Therapy was intensified and Molly received another blood transfusion and intravenous immune globulins to abrogate her inappropriate immune response. Since those treatments Molly has done very well. Her platelet count has increased to ½ normal; 80,000/uL (up from 1/20 normal) and she is making red blood cells (reticulocyte count 210,000/uL). Everyone at Capital Veterinary Specialists and Molly’s family is ecstatic!

RBC precursors in Molly’s bone marrow
RBC precursors in Molly’s bone marrow
Macrophages engulfing Molly’s rubricytes
Macrophages engulfing Molly’s rubricytes

Case #5 – Dutchess​​​​​​​
Meet Dutchess. She is a 5 year old Poodle mix breed that came to Capital Veterinary Specialists for evaluation of suspected bladder and kidney stones. Dutchess was experiencing episodes of fever, pain, and blood in her urine. Dr. Drygas and Dr. Walker evaluated Dutchess with radiographs (see preoperative images) and an abdominal ultrasound. These diagnostic tests confirmed the presence of a left ureter stone (i.e. a stone present in the tube that drains urine from the kidney to the bladder) and multiple bladder stones. Dutchess was feeling sick because the stone in her left ureter was blocking the flow of urine and causing a back-pressure that dilated her ureter and kidney. Dutchess was stabilized and then taken to surgery during which the bladder stones and ureter stone were removed. One day after surgery, Dutchess was doing great and was sent home with her owners. The next step is to send the stones in for evaluation to determine their type(s). The classification of the stones is a critical step in prescribing the best preventative care for Dutchess. Dutchess is a sweet girl and we are all happy to see her on the road to recovery.

Preoperative lateral radiograph
Preoperative lateral radiograph
Preoperative ventrodorsal radiograph
Postoperative lateral radiograph (no stones!)
Hydronephrotic kidney ultrasound
Hydronephrotic kidney ultrasound
Hydroureter kidney ultrasound
Preoperative ventrodorsal radiograph

Case #4 – Missy​​​​​​​
Missy, a 14 year old, female domestic medium-hair cat was presented to Capital Veterinary Specialists for the investigation of regurgitation for a two week duration. Missy had a large ‘hairball’ retrieved from her throat and proximal esophagus four weeks prior. At this time, our primary differential cause for her clinical signs was an esophageal stricture. This diagnosis was confirmed by a scoping procedure called esophagoscopy. A mature stricture (scar tissue) was seen 2 to 2 ½ inches from the ‘top’ of her esophagus. This scar tissue had narrowed down the esophagus so only water could pass to her stomach. This stricture was dilated with a ‘balloon’ until the 9.8 mm diameter endoscope could be passed. This technique was repeated on two separate occasions about a week apart. This is because the bodies reaction is to heal and re-scar. To date, Missy’s esophagus is still not normal, but she has only regurgitated once in the last week and has gained 20% of her original body weight. She appears to be on her way to a successful recovery!

Missy’s esophageal stricture
Balloon dilation
Post procedure examination

Case #3 – Gypsy​​​​​​​
Meet Gypsy, a three month old female Chinese crested puppy. She was referred to Capital Veterinary Specialists from her primary care veterinarian Dr. Gillespie for a suspected congenital heart defect. Gypsy was evaluated by Dr. Walker and Dr. Drygas and diagnosed with a persistent right aortic arch. This condition is a defect in the major vessels of the heart and results in an external compression of the esophagus at the level of the heart base. The defect is a ligamentous band of tissue that prevents food from passing normally down the esophagus. Dr. Walker performed esophagoscopy (video of the inside of the esophagus) to confirm the diagnosis and Dr. Drygas took Gypsy to surgery. A thoracotomy was performed and the abnormal tissue transected. This procedure removed the external compression and allowed food to pass down her esophagus normally. Gypsy will have a 4 week recovery after which we expect her to return completely back to normal!

Gypsy’s Radiograph

Case #2 – Tobie
Meet Tobie. He is an 8 year old, male terrier who came into CVS as an emergency. Tobie was presented for being paraplegic (paralyzed in his back two limbs) and had been down for two days. After examining Tobie, Dr. Drygas, Dr. Potter, and Dr. Walker determined Tobie had a ruptured disc in his lumbar spine. Advanced imaging was performed (myelography – a procedure where special dye is injected into the spinal canal and used to outline the spinal cord) and a disc compression was identified. Tobie was taken to emergency surgery and a hemilaminectomy was performed. The disc material was removed from the spinal canal and the spinal cord returned to its normal position. We were all pleased to see Tobie walking at his 2 week recheck exam! He is still very early in his recovery but we anticipate a full return of function!

Side View
Top View
Case#1 Bobo

Allow us to introduce Bobo. He is a 3-month old Bulldog that sustained fractures in his right leg (the proximal tibia and fibula to be specific) while playing with his house mate. Bobo was taken to surgery where he received a bone plate with 6 screws to stabilize his fractured tibia (the fibula will heal on its own). Once the bone plate was in place, Dr. Drygas sutured the wound and bandaged Bobo’s leg to start the 2-month recovery process. Bobo left Capital Veterinary Specialists a little sore but in good spirits. We look forward to seeing him again for his one week recheck exam!

Before
After