Lewis Hamilton’s Race to Recovery

“Lewis Hamilton” a 5 month male Maine Coon cat was referred to Northwest Veterinary Specialists from his primary care practice for further investigations into regurgitating his food after eating.

Lewis came to see one of our Soft Tissue Surgery Specialists Rachel Burrow. On his examination Lewis was very well in himself, in good body condition and very active, as to be expected with his young age.

His referring veterinary practice had taken some general radiographs (x-rays) of his chest and also performed a barium swallow radiographic study where a contrast material is given orally highlighting the oesophagus.

This procedure demonstrated Lewis had a dilation in his oesophagus in front of his heart which is commonly known as a megaoesophagus.

The suspected diagnosis for Lewis was a Persistent Right Aortic Arch but this needed to be confirmed via a Computed Tomography (CT) Scan first.

Lewis was admitted to the hospital the same day and an intravenous cannula was placed and blood samples were taken to check Lewis’s liver and kidney function prior to his anaesthetic procedure.

To perform a CT scan of Lewis’s chest cavity, a full general anaesthetic was required and this was not without risks. Due to Lewis’s history of regurgitating, he had an increased risk that he may regurgitate food material from his oesophagus and aspirate some of this material into his lungs which could result in pneumonia. He was also at risk of hypoglycaemia (low blood sugar) due to his young age. Both of these complications can potentially be fatal if unnoticed.

Luckily here at Northwest Veterinary Specialists we have a team of specialist Veterinary Anaesthetists that work closely with our Registered Veterinary Nurses (RVN) to provide “gold standard” care to all of our patients.

The CT images were analysed and confirmed the suspected diagnosis of Persistent Right Aortic 4th Arch, and after a discussion between Lewis’s owner and Rachel Burrow, it was decided that Lewis would be taken to theatre the following day for open chest surgery (thoracotomy) to correct the problem.

A Persistent Right Aortic Arch is a developmental abnormality that occurs due to abnormal blood vessel development  in the foetus. This results in a blood vessel  encircling the oesophagus (and sometimes the trachea too) near the heart and compresses these structures resulting in difficulty of passage of  food through the obstruction into the stomach. In some cases breathing difficulties can be seen but this was luckily not seen in Lewis’s case.

The following morning Lewis was taken upstairs to our theatre suites and placed in a warm ward area while our team of surgical nurses and veterinary anaesthetists prepared for his procedure and general anaesthetic.

A thoracotomy (opening into the chest via surgery) is a painful procedure so a pain plan was discussed and implemented to provide sufficient pain control before, during and after the surgery ensuring Lewis remained as comfortable as possible. Lewis received a schedule 2 opioid (one of the strongest available for small animals in the UK) along with a sedative. He also received a local anaesthetic agent that was infiltrated around the surgery site before Rachel Burrow began his surgery. Lewis was placed on a mechanical ventilator to breathe for him during the operation and was carefully monitored throughout.

Rachel Burrow opened the chest wall and began the hour long procedure of dissecting away the left ligament arteriosum (the abnormal vessel) from the oesophagus. A tube was then placed into the oesophagus and slowly passed down to ensure there was sufficient dilation for food to pass through with ease.

Once the surgery was completed and Lewis’s chest was closed, a drain was placed into the chest cavity near the surgical site for drainage of any air or fluid build-up and to instil further pain relief agents to ensure a comfortable recovery for Lewis. He was then transferred into our recovery ward for further monitoring of his breathing and blood glucose along with regular assessments of his pain levels.

Lewis was exceptionally comfortable after his operation and was back to playing with one of his toys just 3 hours later! The drain in his chest was removed and he was discharged from the hospital 2 days later with guidelines for Lewis to be fed small amounts of soft food often.

Lewis returned to us 8 weeks later looking exceptionally well. He had grown in height and weight and is no longer having any problems with eating or with regurgitation. Rachel carried out a fluoroscopy examination to determine if he had any remaining problems with his oesophagus. This procedure involves feeding Lewis a barium (contrast) coated meal whilst at the same time, taking a live images similar to an X-ray using a special piece of highly technical equipment called fluoroscopy. The images were then assessed by Rachel, which highlighted the food moving through his oesophagus as expected. Lewis had this procedure performed whilst he was conscious and he was able to go home a couple of hours later and has now been completely discharged from the hospital. This is great news for Lewis and his family and a successful and interesting case for us all here at Northwest Veterinary Specialists!

This case report was written by Michelle Moran RVN.


Noodle – Something to get off my chest!

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.

A tale of two hernias

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RJ came to Northwest Surgeons when he was just over two months old. Since RJ was born his owner had noticed that he seemed to breathe faster than his sister: he had also had one episode of more severe difficulty breathing. Although he ate regularly, he seemed to be always hungry and wasn’t growing as fast as his sister.

RJ’s investigation

RJ’s vet took some x-rays of his chest and suspected he might have a diaphragmatic hernia (a hole in the muscle sheet dividing the chest from the abdomen) so he was referred for specialist investigation.

The most common type of diaphragmatic hernia in puppies and kittens is a peritoneopericardial diaphragmatic hernia, where the abdominal cavity which contains the liver, spleen, intestines, bladder etc. communicates with the pericardium (the fibrous bag surrounding the heart) because the middle part of the diaphragm doesn’t form properly and organs can slip through the hole. When you x-ray an animal with this type of hernia the pericardium appears enlarged and the organs in the hernia obscure the normal outline of the diaphragm towards the bottom of the chest.

The specialist findings

When we examined RJ and looked at his x-rays we agreed that a hernia was the most likely explanation for his signs. The appearance of the x-rays was slightly unusual, however, because along with the enlargement of the pericardium (labelled A on the x-ray below) and loss of the outline of the diaphragm (labelled B on the x-ray below) the area at the top of RJ’s chest close to the diaphragm was abnormal as well (labelled C on the x-ray below). This area also appeared to have an organ protruding into it, which shouldn’t happen with this type of hernia.rj-thorax-right-lateral-labelled

To try to get more information about what was going on we did an ultrasound scan of RJ’s chest. This confirmed that he had a peritoneopericardial hernia and also that the second abnormal area on the x-ray was caused by part of his stomach lying inside his chest. However, because RJ was so tiny it wasn’t clear on the scan how the stomach had got into the chest. Although we could have done further tests like a CT scan to get additional information, after discussion with RJ’s owner we decided to proceed with surgery to fix the peritoneopericardial hernia and investigate what was going on with the stomach at the same time.

A big surgery for a small hole

At surgery we found that RJ had an extremely unusual combination of problems: he did have a peritoneopericardial hernia involving his liver and had a hiatal hernia as well. Hiatal hernias occur when the opening in the diaphragm thrspecialist surgeonough which the oesophagus (tube from the mouth to the stomach) passes is too wide, allowing the stomach to slide forwards into the chest. While we see hiatal hernias fairly often in dogs they are rare in cats and extremely rare in as young a cat as RJ. We were able to bring both the stomach and liver back into the abdomen where they belong and then repair both hernias. The peritoneopericardial hernia was relatively straightforward to fix by stitching the gap in the diaphragm closed. The hiatal hernia was more complicated, needing a combination of 3 techniques to close it (placing some stitches to narrow the opening in the diaphragm, stitching the oesophagus to the diaphragm to stop it slipping forwards and stitching the stomach to the inside of the muscle of the abdominal wall to prevent it from sliding forwards into the chest). A diagram of this is shown in the picture below.

RJ recovered well after the surgery and went home two days later, once we were happy with his progress and felt that he would be comfortable at home. He has done very well since surgery and is eating larger meals, feeling less hungry and growing much better. His breathing has settled down too!

What is a mast cell tumour?

Mast cell tumours are the most common skin tumours in the dog accounting for over 20% of all malignant skin tumours. Mainly they occur in older dogs, with an average age from 7 to 9 years old although sometimes dogs under a year of age can also be affected. There is no sex predisposition but among various breeds the Boxer is one of the most frequently affected, followed by the Labrador, Golden Retriever, Sharpei and Weimaraner.

These tumours appear as an isolated mass of various sizes, generally like a firm nodule raging from few millimitres to several centimetres, the skin overlying it can be alopecic or eritematous or in few cases even ulcerated. Ulceration is often a sign of more aggressive behaviour.

Palpation of these masses can sometimes cause a release of histamine, a molecule contained within the granules that characterise the cells of this type of tumour and this could potentially cause signs such as swelling or redness.

Location of these masses varies from the trunk, in most of the cases, followed by hind limbs and in fewer occasions the head. You can see pictures of a variety of locations here.

These tumours can spread, therefore the regional lymph nodes should be examined as well as the spleen and liver.

Various substances are produced by these tumours and vomiting or blood in the faeces may be seen. Moreover any wound resulting from a surgical excision of a mast cell tumour should be strictly monitored as risk of wound breakdown is a common sequela.

The diagnosis is made by clinical appearance together with cytological and/or histological findings. Samples are routinely sent for laboratory analysis. Cytology often carried out by a fine needle aspiration can be as high as 90% diagnostic, although this tool does not tell us the grade of malignancy, for which histology is required.

The most common system of grading a mast cell tumour divides them into three classes, Grade I, with a benign behaviour, grade II called intermediate grade, that could potentially behave as grade I or as grade III, and grade III malignant. Despite all, any mast cell tumour should be considered as a potential malignancy as the rate of recurrence post surgery is high.

Complete excision is curative and the treatment of choice for grade I mast cell tumours, with at least two centimetre margins of excision around the perimeter of the mass. If the margins are not clear following surgery a revision surgery is required, or if not possible a follow up with radiotherapy should be provided to decrease the chances of recurrence.

Chemotherapy is also an option and there are various protocols available but are mainly referred to the more malignant ones, and mainly for the grade three mast cell tumours.

Our specialist soft tissue surgeons are highly experienced in dealing with mast cell tumours in dogs. For the best for your pet, ask your vet to refer you to Northwest Surgeons.

Sally – urinary incontinence

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Sally, a much loved family pet, developed the condition of urinary incontinence at 4 years of age in 2006. The incontinent episodes would occur mainly at night after Sally had been lying down but could also occur intermittently during the day time.

A thorough diagnostic investigation was performed incorporating urine analysis, ultrasonography and radiography with the use of contrast dye to highlight the anatomy of her bladder and associated structures. The tests revealed that Sally had an elongated bladder outline and the bladder neck was located within the pelvis rather than the more normal position of being in the abdomen. This is a common cause of incontinence in bitches referred to as acquired urethral sphincter mechanism incompetence  (AUSMI). This condition means that the bladder neck / urethral tone is no longer capable of restraining the urine collecting in the bladder and subsequently, urine leaks out in an uncontrolled manner, often whilst the dog is lying down.

Initial medical treatment with Propalin ( phenylpropanolamine) was successful, but soon there was evidence of incontinent episodes again. Another oestrogen medication called Incurin was trialled but again Sally experienced episodes of urine leakage. The combination of these two medications was given but still, there was minimal improvement.

In 2008, the next sensible step was to consider surgery and a urethropexy procedure was performed. This aim of this surgery is to fix the urethra in a more forward / abdominal position and hence increase the muscular tone of the urethra and bladder neck, hopefully giving urinary continence or at least reducing the level of incontinence. Sally was completely free of urinary accidents for 7 days, but sadly the incontinence returned after a sudden, unexpected episode of exertion. Disruption of the fixation sutures was suspected, so a second urethropexy was performed. There was some initial improvement but again despite a restricted exercise regime post operatively, the urinary accidents returned to the same frequency as prior to the surgeries.
Sally’s veterinarian at Village Vets worked tirelessly to research other medical options for Sally, but a year later in 2009, further referral was sought. At this time, one of the only other options was to consider a different surgical procedure called a Colposuspension, which aims to achieve similar goals to the urethropexy surgery but utilising the redundant vaginal tissue. Sally did very well for 7 days, no urinary accidents then day by day the wet beds started to occur again – the incontinence had returned.
More medication was trialled – this time imipramine followed by Enurace (ephedrine) – there was some improvement. But was there anything else that could be done……..
From  January 2010, Northwest surgeons were able to offer the treatment of urethral collagen injections by a specialised endoscope. The collagen blebs are injected directly into the urethra without the need for a surgical approach. The aim of the collagen is to act as a bulking agent around the urethra and cause some resistance to urine outflow, hence resolving or at least improving the episodes of urinary incontinence. The patients have a short anaesthesia, a pain free recovery and once they have demonstrated a good urinary flow after the procedure, they are ready for home. Sally is the first patient at Northwest Surgeons to receive urethral collagen injections for urinary incontinence. It is early days for Sally, but nearing 3 months after the collagen delivery with no additional medication, the urinary accidents are infrequent giving a more manageable situation for her caring , devoted owners.

Our thanks to veterinary surgeon Alan Humphreys of Village Vets, Woolton, Liverpool for referring Sally to Northwest Surgeons.

Beth – Hide and See!

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Beth was a 3 year old cocker spaniel who had suffered with bilateral droopy eyelids, chronic watery eyes (epiphora), distichia (eye lashes growing inwards) and conjunctivitis since she was 11 months old. She had been treated with various topical eye medications and false tears but still Beth remained uncomfortable with droopy eyelids causing irritation to her eyes and ocular discharge.

Beth had undergone bilateral upper entropion surgery in September 2011 at her own vets with the aim of stopping her eyelids scrolling in. This gave some relief but did not fully resolve the problem.

When Beth first presented at Northwest Surgeons, she was bright and alert but with obvious ptosis (drooping) of the upper eyelids causing a scrolling over (entropion) of the upper eyelids and bilateral ocular discharge. Her eyes were barely visible under the excessive amount of skin.

Beth’s problems were exacerbated when she was sleeping. With her facial muscles relaxed, this caused  her skin to droop more and the eyelashes of her upper eyelids to tuck into her lower lids.

On examination Beth had an excess amount of skin over her temporal region which drooped down causing the eyelids to cover her eyes. Her right eye was affected more than her left but both eyelids covered 1/3 of her corneas.

To correct Beth’s facial droop, she required facial lift surgery to try to significantly lift the heavy overhang of skin on her brow and improve her ability to see and reduce the corneal irritation from the eyelashes.

Beth underwent a general anaesthetic and facial surgery to remove an ellipse of skin from over her temporal region in order to lift her eyelids. The skin was resected from the medial canthal region to the nuchal crest.

Beth recovered well from the surgery and the following day there was already a slight improvement to the facial droop. She was bright and alert and was discharged from the hospital 2 days after the surgery.

Beth’s case was a challenging one but the outcome gave a dramatic improvement for Beth. By the 14th day post operatively she no longer had corneal irritation and ocular discharge. Beth is bright and wide eyed and she can now see the world instead of just the inside of her eye lids.

Taz’s toiletting troubles

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Taz was 10 years of age when he presented to Northwest Surgeons in 2011 with difficulty in urinating (dysuria). As a younger cat, 8 years previously, Taz had experienced a blockage of his urethra, the tube going from the bladder to the outside. The blockage had been due to crystal / stone formations (uroliths). The stones lodged in the urethra had been flushed back towards the bladder and retrieved surgically (cystostomy).

A special formulated diet can be used to reduce further crystal formation and dissolve existing small crystals in the urine. Despite eating this diet following the recovery from the cystostomy, Taz started to experience episodes of straining to urinate (stranguria) in 2011. Taz’s owner had also noted that for many years that Taz never urinated with a good stream of urine, just a thin, dripping stream.

When Taz presented to the soft tissue surgery service at Northwest Surgeons, he was quite relaxed despite his discomfort in the inability to properly pass urine. Taz is a lovely natured cat and allowed a full examination. Taz was quite a large feline weighing over 8kg when we first saw him in consultation. We are pleased to say that since being treated for his uncomfortable urinary problem at Northwest Surgeons, that Taz has been feeling more energetic and has lost 300g in one month.

To investigate Taz’s urinary problem abdominal ultrasound was performed under sedation. The ultrasound revealed a thickened bladder wall affecting the entire surface area – a sign that this was a long term problem. There was also an obvious amount of sediment and sand in the bladder. An ultrasound guided cystocentesis (sterile urine sample collected by a needle into the bladder) was performed and the sample submitted for bacterial culture and microscopic analysis.

Plain lateral abdominal radiographs were taken under general anaesthetic which revealed two uroliths (stones) present in the penile urethra, one of which was very large. A retrograde study was also performed. This involves injecting air and water soluble contrast liquid into the bladder via a urethral catheter to obtain a clear outline of the bladder and urethra. This confirmed there were no other strictures present in the urethra.

Given Taz’s history and the fact that he had two uroliths lodged in his urethra, the surgery of choice for Taz was a perineal urethrostomy. The aim of this surgery is to remove the penile urethra which is a narrow tube in order to prevent stones becoming lodged. A new aperture, a much wider opening to the urethra is then created surgically. This allows any debris/crystals/stones to pass without obstructing the urethra and also enables a good flow of urine to be voided.

The surgery was successful and Taz recovered well. The surgery has given Taz long lasting relief from his obstructed urethra! He can now urinate good volumes and good streams of urine comfortably.

For Taz, the ongoing treatment was very important. Dietary support is vital and so he was to continue being fed RCW Urinary support (moderate calorie) which he had previously eaten well. This diet will help produce moderately acidic urine, control the content of minerals in the urine and help increase the amount of urine produced. In addition to the diet Taz was also prescribed Cystaid tablets which are a GAG (Glycosaminoglycan) supplement. These aim to restore the protective mucosal/GAG layer (thin layer of mucous) within the bladder wall and decrease permeability. As Taz had previously suffered with stranguria (straining to urinate) and his bladder was very inflamed, this was an important supplement for him. Taz’s urine analysis results confirmed a urinary tract infection was present. Taz was prescribed a course of potentiated amoxicillin antibiotics to treat this infection. Follow up ultrasound guided cystocentesis samples for bacterial culture will ensure the infection is under control.

Taz returned to the hospital 10 days post surgery. He had been urinating well, passing good volumes of urine. The owners were happy with his progress. Taz had lost weight too and was now a very happy cat, purring loudly!!

Urinary tract problems are one of the common conditions seen by our soft tissue surgery team.

Daisy – Life threatening injuries

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Daisy was only a one and half year old cat when she was hit by a car. She received emergency treatments from her local veterinary surgery and was then referred immediately to Northwest Surgeons. Daisy had incurred multiple injuries. She had fractured her pelvis and ruptured both her body wall and bladder – urine was leaking into the abdomen and seeping into her muscles, fat and the skin of her tummy region. Left unchecked this would lead to a painful death for her.  Rupture of Daisy’s bladder was confirmed by injection of a water soluble contrast agent into her urethra via a urinary catheter.  The contrast dye, which shows up white on xray was seen leaking into the surrounding tissues.

The bladder and pelvis were repaired surgically, but there was already some evidence that the fat and skin infused abnormally with urine would start to die away as a result of the damage caused by the urine leakage. Approximately 10 days after surgery, a clear line of demarcation had formed between the normal skin of the belly and the dead and dying skin and fat. The latter was removed, leaving a very large open wound – the entire surface area of Daisy’s belly region was no longer present. The large wound was managed by tie-over dressings which allow a number of dressing products to be applied to a wound and tied underneath surgical swabs – in a parcel-like effect. This enabled Daisy to walk around without having her entire body wrapped beneath dressings whilst the body slowly started to fill in the wound cavity.

Six weeks later, the wound had progressively healed but had reached a static point and we had to use a skin grafting technique to fill the remaining wound bed. Daisy’s progress was hampered by a number of clinical set-backs resulting from the horrific nature of her original injuries. She developed acute kidney failure and became critically ill.  As a result of her weakened state, the skin graft failed and the wound bed became infected with a resistant bacterium that took advantage of her debilitation. At Northwest Surgeons, the importance of infection control is taken very seriously and it was the routine monitoring that takes place as part of our infection control procedures that detected this problem early.   Daisy was moved immediately into our isolation facility and strictly barrier nursed to prevent contamination of other patients and staff. Within two weeks of appropriate treatment and topical silver preparations (which have activity against bacteria), the infection was quickly controlled. However, the open wound took a number of combined medical treatments before it would support further wound healing. In total, Daisy stayed over 3 months in isolation, but she remained a bright, active and happy cat despite her continued isolation status for infection control. This was largely because part of Daisy’s treatment incorporated designated playtimes which she adored.  She also became expert and mischievous in buster collar avoidance skills!
Three and a half months later, the wound bed was again ready for surgery and this time, much to everyone’s relief, the flank fold skin flap healed 100%.  Finally, 6 months after beginning her emergency treatment at Northwest Surgeons, Daisy went home to her devoted owner and we are delighted to report that she now leads an active and normal life style.


Megan – Breathing Easy

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As a typically boisterous Great Dane, Megan enjoyed good health in her first year of life. Soon after this she quickly developed severe breathing difficulties which left her unable to exercise normally and fighting for breath even when she was resting. Her local vet carried out X-rays which revealed an abnormal accumulation of air outside her lungs, within her chest cavity. Known as a pneumothorax, it meant that no matter how hard Megan drew breath she wasn’t able to expand her lungs enough to get the oxygen her body needed.

The vet administered emergency treatment with oxygen and also placed drains in Megan’s chest to remove the air surrounding her lungs, which allowed her to breathe more easily and removed the immediate danger.

The x-rays also showed an abnormal balloon-like structure on the left side of her chest cavity – this is called a bulla and is a collection of air that can suddenly burst to the surface, causing air to leak out of the lungs and into the chest. This was probably the source of Megan’s problems and would not resolve by itself, so Megan was referred to Northwest Surgeons for further investigations and treatment.

Our results showed that this structure had collapsed, meaning the only option was to remove the damaged part of her lung to seal the leak. With her breathing carefully and expertly controlled by our anaesthetist, I was able to dissect the lung away from Megan’s heart and her chest wall without damaging these vital structures. Her post-operative recovery was good and after only 48 hours her chest drains were removed.

The diseased part of her lung had been sent away for analysis in our laboratories, and the pathologist diagnosed lung necrosis, inflammation and the presence of a fungal infection. A four-week course of anti-fungal medication helped Megan continue to make progress, regaining her boisterous nature and enthusiastic manner.