Published in the Summer 2015 North Carolina State University College of Veterinary Medicine Magazine
By Whitney L.J. Howell
The Veterinary Hospital at NC State University is major referral center for veterinarians from throughout the Southeast. Board certified specialists annually diagnose and treat more than 27,000 patients who are often seriously ill and require the best that veterinary medicine offers. The patient case load also allows for instruction of the next generation of veterinarians and the opportunity for clinical trials that advance animal health and well-being.
Henry, a Hanovarian horse, was fast. Galloping was always one of his favorite things. Charging down a trail at speed, he never missed an opportunity to let loose with a playful buck. Until one day, he started to hurt. Initially, Henry tried to ignore the pain to keep running in the field and competing in Hunter/ Jumper shows with his owner. As time passed, the pain grew. He stopped running, and almost any exercise in the field or the show ring caused discomfort. No matter what he did, he couldn’t shake the problem, and his doctors were stumped.
The puzzle pieces finally started to come together when Henry’s owners, the Thompsons, brought him to North Carolina State University’s College of Veterinary Medicine. Despite his uncertain future as a show horse, the Thompsons wanted him to receive the best care possible.
“Henry has a great personality—he just loves people,” says Julia Thompson. “He’s the sweetest thing, like the son I never had. Seeing Henry in so much pain was very distressing for my daughter because no one could figure out what was wrong with him. She was very attached to him.”
As a horse with undiagnosed head-shaking, Henry needed a veterinarian experienced with difficult-to-solve cases and a clinic with advanced technologies and varied expertise unavailable elsewhere.
Initially, his owners and primary care veterinarian speculated Henry’s head-shaking appeared because he wasn’t accustomed to the gnats in his new environment. Bred in arid New Mexico, he’d never encountered the insects so common in humid Charleston, South Carolina. But when the behavior continued to the point where he couldn’t hold a bit, everyone searched for another reason.
Head-shaking in horses isn’t uncommon, according to Callie Fogle, clinical associate professor of equine surgery at NC State’s Veterinary Hospital. It’s thought to be similar to the severe headaches and uncomfortable tingling sensations experienced by humans with trigeminal neuralgia. The pain and tingling in the head of the horse, however, manifests itself through headshaking, particularly during physical exertion. It can be extremely debilitating.
“This can be a really terrible thing in a horse,” says Dr. Fogle. “Some can’t eat, they can’t function, and most horses can’t be ridden because of the bobbing and shaking of their head the whole time. Some cases can be so uncomfortable for them to live normally.”
Fogle discovered Henry’s problem during a preliminary conversation with his trainer. When she opened Henry’s mouth, she saw it—a mass invading his lower right jaw, pushing his teeth out of alignment.
“His trainer was shocked,” Fogle says. “She’s very thorough and attentive, and even she hadn’t seen this. That’s how quickly this tumor had grown, and she was convinced that was the source of Henry’s head-shaking.”
Fogle wasn’t convinced because head-shaking root causes can be elusive and a mandibular, or lower jaw, problem causing head shaking hadn’t been described before. Quick X-rays revealed an abnormal growth of new bone in Henry’s jaw, radiating from its center like a sunburst. Tests of a small sample of the growth revealed that it was aggressive cancer, and the pathologist classified it as a tumor of dental origin. The tests also revealed another significant problem—Henry also had a bacterial infection in his jaw.
But the team needed more information. They did a short-acting nerve block of the jaw and took Henry out for exercise, to ensure the mass was the problem spot. With this area of his jaw desensitized, Henry was able to hold a bit and had no head-shaking. Tumor-induced pain was most likely the culprit behind the head-shaking, which meant to treat Henry’s head-shaking, she’d have to remove a significant portion of the rostral, or front portion, of his mandible.
“In a horse, that’s not something to be taken lightly because they need their teeth for grazing and grasping things,” says Fogle. “It affects them. We had to make sure we took enough of the jaw to get the entire tumor, but no more than absolutely necessary.”
To get a better idea of the tumor’s exact location and size, they anesthetized Henry and performed a CT scan with 3D reconstruction images, an advanced imaging procedure not available in the majority of equine veterinary clinics.
Fogle removed the whole right side of Henry’s rostral mandible, including his canine and all incisor teeth on that side. She was able to preserve enough of his jaw bone, though, so that he didn’t need a prosthetic device or any stabilizing metal implants. Henry was also given antibiotics to treat the bacterial infection within his jaw.
Now, more than a year-and-a-half after surgery, Henry’s back to his old activities and doing well according to the Thompsons. “He’s like Prince Charming—still a loving, wonderful and kind spirit, full of personality,” she said. “He’s doing much better and his demeanor never changed. He just exudes charm.”
Buster: Pulmonic Stenosis
Initially, Lisa Bass from Greenville, South Carolina, wasn’t keen that her son brought Buster home from college. Her house was already crowded with a 13-year-old Labrador Retriever and an 18-year-old Schnauzer. She couldn’t see where a 12-week-old Bernese Mountain Dog puppy— a toddler-sized dog—would fit. But after one summer, Buster won her over.
“We fell in love with him,” says Bass. “He makes you smile. He’s such a little cut-up. When he looks at you, it’s not with the eyes of a dog, but a person. He’s constantly playful—he’s the light of our lives.”
That’s why Bass was so surprised when her veterinarian heard a heart murmur during Buster’s one-year check-up. After an echocardiogram (a cardiac ultrasound exam), Buster’s diagnosis was clear. He had pulmonic stenosis—a congenital defect of the valve between the heart’s right ventricle and the main artery that carries blood to the lungs (pulmonary artery). This defect thickens and narrows the valve, forcing the heart to work harder to pump blood across it. Dogs with severe pulmonic stenosis often live shorter than normal lives, and they can develop heart failure or arrhythmias at a relatively young age.
Even through Buster was not showing clinical signs of his heart defect, he had a poor prognosis for a normal life. Buster’s pulmonic stenosis was severe, causing a pressure difference between the right ventricle and pulmonary artery of over 100mmHg (there is normally no difference). The best option, Bass’s veterinarian said, was an interventional procedure called balloon valvuloplasty, and he referred Buster to the Hannah Heart Center of the Veterinary Hospital at NC State University’s College of Veterinary Medicine— the only veterinary heart center in North or South Carolina that performs the procedure.
Balloon valvuloplasty is a minimally invasive procedure that is done under general anesthesia in the cardiac catheterization laboratory. A catheter is introduced through a needle stick in either the jugular vein in the neck or the femoral vein in the groin. Under fluoroscopic (x-ray) guidance, a high pressure balloon is carefully placed across the defective valve. Once positioned, the balloon is inflated to expand the valve area, relieving the obstruction to blood flow across the valve. At NC State, the procedure is permanently effective in returning the valve to nearnormal function more than 90% of the time.
Buster’s outcome, according to Dr. Teresa DeFrancesco, section chief for cardiology, dermatology, and oncology at the Veterinary Hospital, was outstanding.
Buster’s peak pressure gradient fell to 44mmHg.
“Buster now has only mild residual stenosis, and his lifespan should no longer be significantly shortened by his heart defect. He still has a heart murmur, but we’ve gone from a severely affected dog to one mildly affected.”
The Bass family sees no change in Buster’s behavior— and that’s just what they wanted.
“From our perspective, Buster has stayed the same,” says Bass. “He never gave us any indication that he was sick, and now that he’s back home and being Buster, you’d never know he’d been sick. It’s amazing that his energy level is the same. He lights up a room with his expressions. If I had to do it all over again, there’s no question I’d bring Buster to N.C. State.”
Buster, who probably would have died as a young adult, now has the potential for a normal lifespan thanks to his veterinarian who detected the problem during his annual checkup.
“Sometimes when dogs are older, the affected tissues are tougher, and more difficult to dilate,” says DeFrancesco. “This means our ability to help may be reduced. We like to see patients with this defect as soon as possible. Puppies presenting with loud murmurs (grade 3/6 and above) should be evaluated by a veterinary cardiologist as soon as possible.”
Alice: Diagnosed with Uterine Cancer
It’s said there’s often one hen to rule the roost.
In the case of Alec Bergin, a 13-year-old boy from Moore County, that hen is Alice, a rare breed Phoenix chicken. Ever since Alice joined the Bergin family with three other Phoenix hens, Alec has hand-fed her treats and watched her assume a leading-lady role, hatching and mothering her share of 12 chicks.
“This is Alec’s own flock, and he takes care of them,” says Jennifer Bergin, Alec’s mother. “He’s responsible for feeding and watering them. He goes outside and spends 20 minutes every day just watching them to make sure they’re acting normally. If anything’s wrong, he can catch it early on.”
And that’s exactly what Alec did one evening. Instead of running for her treat like normal, Alice stayed on her nest. She only half-heartedly pecked at the niblet, and after looking her over, Alec and his mother noticed her distended belly and discovered her back end was covered in feces. Their first assumption: she couldn’t lay her eggs.
Taking Alice to the community veterinarian wasn’t an option— chickens aren’t everyday pets. To get this family hen the proper care, Bergin brought her to the NC State Veterinary Hospital and put her in Jeff Applegate’s hands.
“When Alice came in, she was very lethargic and exhibited the distended belly or coelom so we started with a physical exam, completed blood work, and proceeded to complete an emergency ultrasound in concert with the Radiology Service,” says Dr. Applegate, a clinical veterinarian specializing in companion exotic animal medicine.
“The ultrasound revealed significant fluid and abnormal tissue in and around the reproductive tract,” Applegate continues. “There shouldn’t have been any free fluid in her belly. Of the more routine birds that we treat as pets, the abdomen or more appropriately referred to as a coelom can be described as a central column or organs like the heart, liver, and intestines, with the remaining space occupied by the surrounding air sacs and lungs.”
Reproductive disease is common in chickens, and it’s analogous to uterine disease in humans and other mammals. The ultrasound showed Alice had free coelomic fluid and abnormal tissue in her oviduct, the tunnel in which an egg forms and by which it leaves the hen’s body. The diagnosis was oviductal adenocarcinoma—Alice had uterine cancer. The treatment: a salpingohysterectomy, the avian equivalent to spay.
Once the Bergins green-lighted surgery, understanding Alice would never again lay eggs, Applegate assembled a team from the Exotic Animal Medicine Service to combine their skills during Alice’s operation. Pooling talents from multiple specialties is a benefit the NC State University Veterinary Hospital offers patients according to Applegate. In cases like this, many collaborating hospital services may include specialists from emergency and critical care, radiology, anesthesia, and surgery.
The surgery—an invasive procedure with the surgeons removing Alice’s diseased oviduct through a small L-shaped incision behind her left leg—was a success with few complications and a moderate amount of bleeding. After two weeks recuperating in the Bergin’s master bathroom, Alice moved back outside and assumed her leadership position.
“She’s living with friends and doesn’t look any different from the other hens,” Bergin says. “She’s a valued member of our family as much as the cats and dogs are.”
To read the story at its original location: https://drive.google.com/file/d/0BwTq5NcNMuyjamNwVzJaSlhZNFU/view
