Our Archives: Surgery

Most people have, at some point, met a pet with only three legs. The reasons for amputating animals' limbs are as wide and varied as the reasons in humans.

Some pets develop tumours such as osteosarcomas, which sit in the bone and spread round the body. These can be painful and even when the tumour might have already spread, amputation may be the safest way to ensure future comfort. Other pets break their limbs and while most fractures can now be repaired, sometimes this is incredibly fiddly with a high risk of failure.

What is a lump?

A lump is a swelling or growth that can appear on or under your pet’s skin. Finding a lump on your pet can be a worrying time but try not to panic – not all lumps are nasty. Lumps and bumps are more common in older pets but they can be found in younger animals too. Swellings or growths can simply be caused by a bruise or even an abscess so is not always a cause of concern. Whilst some dogs can develop cancerous growths please remember that there are many treatment options available. If caught early most cancers are treatable; just keep an eye on your pet for any new lumps and get them checked by your vet as soon as you notice them. 

Cruciate ligaments are structures within your dog’s stifle (knee) that help support the joint during weight-bearing. If a cruciate ligament snaps or is injured, this can lead to a painful and unstable joint. This will cause your dog to limp or not be able to put weight on the affected limb at all, often causing them to hop on one back leg. This can be very worrying but rest assured your vet will be able to discuss all the treatment options available to your dog. Most dogs will return to full physical health with appropriate treatment. Keep reading to find out more about the cruciate ligaments. Read how they can become damaged and which surgery may be best to treat ruptured cruciate ligaments in your dog.

What is ‘ex-lap’?

So your vet tells you, “your pet needs an ex-lap”. Many thoughts go through your mind. What is an ex-lap? What does this mean for my pet exactly? 

‘Ex-lap’ is short for exploratory laparotomy. It simply means an operation, where a vet opens your pet’s abdomen (belly) to explore its contents. Organs such as the stomach, kidneys, intestines, liver and bladder are found in the abdomen. An ex-lap might be needed for many reasons, including: to repair a damaged organ; remove stones from the bladder; or to take samples of a tumour to aid diagnosis. 

Question from: Sheree Lu My 10 year old dog has a lump around the size between a 10-cent/20-cent (Australian) coin. It's round, soft to touch and when I touch it, it didn't seem to cause him any discomfort or pain. It's located on one of his hind flanks, on his thigh-ish area. Like if he sits down, the lump would be on the ground but it's not near his anus. I'm not sure if I should take him to the vet..? Answer by Shanika Winters Online vet Hi Sheree and thanks for your question, with any lump you find on your pet I would advise that you take your dog to be seen by your vet.  I will try and explain in my answer some of the possible causes for the lump and how it can be monitored, treated or removed. Why has my dog got a small soft lump? A small soft lump can be caused by an infection, reaction to a parasite/foreign body, swelling in response to an injury/allergy, a tumour or a combination of these. Infection tends to lead to an area of reddened/hot (inflamed) skin, which may then swell up as it fills with fluid/puss.  An infected lump would usually appear over a few days, may be painful to the touch and might burst followed by crusting over.  An infected lump may be due to a skin infection, where a parasite has bitten, where a foreign body (e.g. a grass seed or thorn) has entered or is trying to exit or maybe on top of an existing lump. Reactions to a parasite/foreign body will also lead to inflamed skin but can occur over a much longer time scale of days to weeks.  A common parasite that can lead to development of a lump like reaction is a tick.  On some occasions the lump that you see is actually the tick still attached to your pet’s skin, it could also be the reaction to a tick bite that looks like a small lump on your dog’s skin.  Tick bite reactions are more likely to lead to a firm lump (granuloma).  Common foreign bodies that can cause a reactive lump in your pet’s skin include grass seeds and thorns.  A reaction to a foreign body may also be infected and/or painful.  Grass seeds and thorns are easy to come across on walks, depending on what season it is and where you tend to walk your dog. Allergy or injury can cause a lump to develop quite soon after encountering e.g. a stinging nettle or having a tumble.  Allergic lumps can be single or multiple and can come down themselves in time, but the concern with an allergic reaction is if it affects the airways or circulation then this becomes an emergency situation requiring urgent veterinary attention.  A lump which occurs after an injury such as falling over or bumping into something at high speed is something an owner can usually link to the incident occurring. Tumours are abnormal growths that come about due to a mutation (change) in your pets cells causing unregulated growth and multiplication of cells.  Tumours can be benign (not cancerous) or malignant (cancerous and likely to grow/spread).  The time scale of tumour development varies from slow growth to very fast and there are some tumours (mast cell tumours) that can vary in size due to the release of Histamine (reactive body chemical). Should I take my dog to the vet? Definitely take your dog to the vet if you find a lump, the urgency with which you need an appointment will depend on how long the lump has been present, how well your dog is and if the lump is changing. Your vet will ask you a lot of questions such as: How your dog is in general, eating, drinking and toileting? How long has the lump been present? Has the lump changed in shape, size, colour or texture? Is the lump causing your dog any pain or affecting its normal bodily functions? Your vet will also ask about any changes in diet, environment, medications and general routine. The answers to all these questions combined with a full clinical examination will help your vet to work out what the lump could be and what steps should be taken. What happens next? In some cases your vet may send your pet home with medication such as antibiotics if the lump is thought to be an area of infection, or pain relief if it is thought to be a reaction to an injury. If the lump is thought not to be harmful then your vet may ask you to monitor its size, shape, colour and texture on a weekly basis and return for a check-up should there be any significant changes such as the lump doubling in size or changing colour. If however your vet is still unsure as to what has caused the lump then further tests may be advise, from a fine needle aspirate through to an excisional biopsy with or without x-rays. Fine needle aspirate is when a needle is inserted into the lump (usually done in an awake pet) and some tissue sucked out into a syringe, this tissue can then be put onto a microscope slide or into a bottle of liquid to enable analysis to try and work out what the lump is. Biopsy is when a small piece or the entire lump is cut out (usually under a general anaesthetic) and is then sent for analysis to try and work out what the lump is.  If your vet finds other lumps or enlarged lymph nodes which may be related to the original lump then samples may need to be taken from these too. X-rays of the affected area, chest and abdomen (tummy) may be performed to show how deep the lump goes and whether it has spread to other areas such as the lungs or liver.  The reason why the chest and abdomen are x-rayed is that these are common sites for the spread of malignant growths due to their very good circulation. If the lump turns out to be cancerous then even after cutting out the lump your pet may need further therapy such as chemotherapy to treat/prevent the lump spreading or re-growing. I hope that my answer helps to explain the importance of having a lump checked out by your vet, hopefully your dog’s lump is nothing sinister and your vet can confirm this. But due to the many possible causes of a lump it is always safer to get your dog looked at by your vet and then make a joint decision as how best to proceed. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.

Question from Carol Fogerty Hi my vet says my poodle cross Pom ,may have cushings disease whot is this please Answer from Shanika Winters MRCVS, Online Vet Hi Carol and thank you for asking about Cushing’s disease (HAC hyperadrenocorticism) which is a condition where the body makes too much of the steroid cortisol which can result in a variety of symptoms.  HAC is most common in middle aged to older dogs but does also affect cats, horses, hamsters and ferrets. There are three different types of HAC: Pituitary dependant HAC (PDHAC) is the most common type and this is when a tumour of  the pituitary gland in the brain is making too much of a hormone called adrenocotricotrophic hormone (ACTH)  this causes the adrenal glands to make too much cortisol. Adrenal dependant HAC (ADHAC) is less common, this is when a tumour of the adrenal glands causes too much cortisol to be produced. Iatrogenic HAC (IHAC) is when very high doses of steroid given as medication lead to symptoms of HAC. What are the signs of HAC? If your pet is showing some of the following signs then your vet may suspect HAC: Increased drinking (PD polydypsia), increased urinating (PU polyuria), increased appetite (PP polyphagia), a large rounded low slung abdomen ( tummy), muscle weakness, hair loss on both sides (bilateral symmetrical alopecia), hard areas under the skin due to deposits of the mineral calcium (calcinosis cutis) and dark spots on the skin due to blocked keratin (hair protein) filled hair follicles  (comedones). How do we test for HAC? There are several blood tests, urine tests and diagnostic imaging tests than can be done to try and make a diagnosis of HAC:

Routine blood tests in cases of HAC may show up increased levels of liver enzymes, increased cholesterol, increased blood glucose (blood sugar) and also changes to the white blood cell numbers.

Routine urine tests may show an increase in glucose, white blood cells and protein.

More specific tests for HAC include:

Urine creatinine: cortisol ratio, here a urine sample collected from your pet is sent to a laboratory for analysis, abnormal results are found in cases of HAC but can also suggest diabetes, liver disease or womb infection (pyometra).

ACTH stimulation test, this is a set of blood tests in which a blood sample is taken from your pet, an injection of artificial ACTH is given into a vein (blood vessel) and 1-2 hours later another blood sample is collected. The laboratory results are abnormal in approximately 80% of dogs with HAC, this test is also often used to monitor dogs on treatment for HAC.

Plasma cortisol level, this is a blood test which directly measure the level of cortisol in the blood , the blood sample has to be treated very carefully and sent to the lab quickly so as to get an accurate result.

Ultrasound scan of the abdomen can be used to check the size of the adrenal glands (found next to the kidneys), look for a tumour and assess the other abdominal organs. IN PDHAC the adrenal glands are usually normal size or slightly enlarged with ADHAC the adrenal glands are usually different sizes, the large irregular gland being the one with the tumour.

Low and High dose dexamethasone suppression test (LDDST & HDDST) are blood tests where the effect of artificial steroid on the adrenal glands is measured, the results can sometimes help tell apart PDHAC form ADHAC.

Magnetic resonance imaging (MRI) scans and computed tomography (CT) scans can be performed at referral centres to help in the diagnosis of HAC and also tell which type it is.

How is HAC treated? Trilostane is a tablet with blocks a step in the production of cortisol in your pet’s adrenal glands therefore decreasing the amount of cortisol in your pet’s body. Mitotane is another tablet which works by destroying the parts of the adrenal glands that produce cortisol. Surgery to remove the actual tumours can be performed usually at referral centres. Trilostane and mitotane are the most commonly used treatments for HAC, they are effective on both PDHAC and ADHAC and your pet should have regular blood tests to monitor that the dose given is correct for your pet. Too much medication for HAC can lead to symptoms of Addison’s disease (Hypoadrenocorticism) where there is not enough cortisol which includes dehydration, depression, diarrhoea and lethargy (weakness). I hope that my answer has given you some useful information about HAC, the exact test done on your pet will need to be discussed with your vet. The aim of treating your pet is to reduce the signs of HAC to improve your pet’s quality of life and is best achieved by working closely with your vet. Shanika Winters MRCVS (online vet)