Noodle, a 5 year old Labrador Retriever was referred to Northwest Veterinary Specialists (NWVS) from his primary vet due to a persistent cough, that did not resolve even following a course of antibiotic treatment. Although Noodle was still a typically happy Labrador who always wanted to play, the cough began to take its toll and Noodle was beginning to feel its tiring effects. Noodle came to NWS for a consultation with one of our internal medicine clinicians, Karen Crawford. On physical exam there was noticeable effort in how Noodle was breathing and when Karen listened to his lungs, there were notable abnormal sounds. Noodles cough was described as harsh sounding, deep within his lungs, which worsened with exercise.
Following consultation, it was unquestionable that Noodle required a Computerised Tomography (CT) scan. A cannula was placed for easy drug administration and blood samples were taken to check his liver and kidney function. A CT scanner works in a similar way to an X-ray machine, but coupled with a computer, it rotates around the patient to create cross sectional images of the selected part of the body, in this case, Noodle’s chest. The computer then reconstructs the images to create a 3D image, which we hoped would help diagnose why Noodle had a cough. In order to perform the scan, Noodle had to have a general anaesthetic (GA). In his case the risks were higher than any elective procedure due to his impaired breathing ability. Every pet that undergoes GA at NWS is monitored closely by one of our Registered Veterinary Nurses (RVN) from the start, right through to the recovery period and supervised by our specialist anaesthetists. During GAs our RVNs remain in direct contact with the anaesthetist overseeing the case to ensure that the best possible care is provided. The standard monitoring used during GA is capnography, pulse oximetry, blood pressure monitoring, ECG and temperature. In Noodle’s case particular focus was given to the first two monitoring aids as they show how the lungs are ventilating and getting oxygen into the blood stream, both of which were within the normal ranges.
The CT images were analysed by one of our Radiologists Annette Kerins and after close examination she discovered a large foreign body (FB) in one of the right lung lobes, with a surrounding area of pneumonia. We were positive that this was the cause of Noodles cough, so further investigation and treatment was essential. A common way of retrieving FB’s within the airway is with a bronchoscope (a camera into the lungs via the mouth) but in Noodle’s case this did not seem feasible because the FB was too deep and seemed to be wedged within the bronchus. Therefore we concluded that it could not be reached, and even if we could, we would most likely damage the bronchial wall during our attempts.
In such cases the medical and soft tissue teams join together to work out the best approach for the patient. Following much debate and due to the location of the FB, it was agreed that the most likely way of retrieving the FB was with surgery. Further discussions outlining the positives and negatives took place and both teams decided the best approach would be to perform a lung lobectomy (removal of the entire lung lobe which housed the FB).
Noodle was transported to the surgical preparation room, an area connecting to the surgical suites where patients are clipped and scrubbed before surgery. A lung lobectomy can be a rather painful surgery, so pain relief was a priority for Noodle at this stage. To begin with, Noodle received a schedule 2 opioid, the strongest class of pain relief available for our patients. Once his fur was clipped and skin scrubbed, Noodle then received two types of local anaesthetic techniques from our specialist anaesthetist, Elizabeth Leece. This reduces and potentially blocks pain sensation, not only during surgery but also during the first couple of hours following surgery.
Noodle went to surgery with soft tissue specialist Rachel Burrow. During the surgery, Rachel opened the chest cavity (thoracotomy), and Noodle was place on mechanical ventilation to breathe for him as the surrounding pressure that helps him breathe was lost. After 2 hours of intense surgery the lung lobe was removed successfully. A chest drain was placed to avoid any air or fluid accumulating in the chest which may have impaired Noodle’s ability to breathe following surgery. The chest was sutured and once surgery was complete Noodle was transported to the recovery area to wake up in a warm, quiet environment. Once Noodle was recovered, our attention turned to the lung lobe. Careful dissection reveal a large ear of wheat, measuring 5.6CM, which Noodle must have inhaled when running through a field. This would have gradually tracked deeper in the lung, pretty amazing.
Whilst hospitalised overnight, hourly observations took place focusing on Noodle’s respiratory rate and effort. Noodle remained hospitalised for 5 days under the care of our Inpatient Care Team who frequently monitored his respiratory function. Following plenty of TLC and medication, Noodle was discharged, happy (as always) and cough free.
Following his check-up appointments, Noodle has continued to improve and is now back to full health.
This case report was written by Ana Mota an Intern at NWS.