Golden Retriever Uveitis, Max's Rare Bird.

This is Max

There are a few diseases that I only get to see once in every blue moon. They are those elusive veterinary diseases listed in the tiny paragraphs at the end of the chapter of your text book. A veterinary student, like an ornithologist, focuses on the “common birds” learning about their specific traits knowing full well that we will see them, and therefore, we need to recognize and feel comfortable and confident in treating them, but secretly we are hoping to encounter those “less commonly seen birds.” We hope and pray that somewhere along our travels we will finally get to see that magical mysterious rare bird that lives at the end of the vet school books. 

When Max walked in last Tuesday (2/18/14) I finally got the chance to log his disease in my record book.

Max as his full on welcoming self

Max as he looked on his initial exam on 2/18/14. 

Max walked into the clinic with his mom and brother on a Tuesday night. A shy, smiling face, with a timid wag, but a welcome expression. He is the typical Golden Retriever, quiet, sweet, gentle, un-foreboding, and willing to meet a new friend if you are quiet, calm, and unassuming. Even with his gentle expression he sat at his parents feet almost unable to open his eyes.

For a veterinarian observation of your patient before they enter the exam room, when they are calmest and least likely to feel, or act like a patient, is the best time to gather your information. Free from the influences of their parents perception, the hidden masked epinephrine hidden clues, and the biased thoughts of the veterinarian that preceded you. Just watch without anyone knowing you are, let your eyes read the small subtle clues and remember that you can diagnose a patient about 90% of the time with just your senses and an open educated mind.

I was fairly certain of Max’s dilemma, disease, and treatment needs just by secretly watching him in the reception area. 

When we entered the exam room his mom gave me Max’s history. He was a middle aged, happy, healthy boy. He had a previous eye ulcer that had healed well almost a year ago, but this morning he was quiet, panting, and squinting his eyes. He had no history of trauma, illness, or exposure to toxins that might have injured his eyes. He just sat and squinted his eyes as if the brightness of the pearly gates were shining upon him beckoning him to come home.

After a thorough exam revealed no abnormalities to any other body system I took a good long look in his eyes. When you have a patient who will not open their eyes it is usually because they are painful to do so. A few drops of a short acting anesthetic in each eye will relieve their pain for just long enough for you to be able to check the eyes. Of particular concern were; his ocular pressures because glaucoma (increase in intra-ocular, or inside the globe of your eye) can be very painful and present with a patient who squints because when your eye hurts you keep it closed. These were checked with the Tonopen (a device to check the pressures in the eye) and were normal after checking both eyes several times.  I was also concerned about damage to the corneas (normal on examination) and the appearance of the sclera which can indicate blood pressure and disease. Max’s eye exam was quick. He was very reluctant to be a patient eye patient and I had to gather the information I needed quickly. It took four people to hold Max, his head, and each eye open. When you need excessive force there is something wrong and you need to re-think both your strategy and your end goal. Excessive force will lead you to a bigger problem then you started with. We needed four people to keep an eye open for about four minutes. The results were more normal than abnormal but there was no denying a painful, irritated eye, and a tiny hint of “flare” in the anterior chamber.

My poor puppy Jekyll, always the one who has to be the demo dog.
Jekyll demonstrating the Tonopen use.
Such a good boy!

“Flare” is seen when tiny pieces of protein float inside the eye. The eye is separated into a front (anterior) and back (posterior) chamber by the lens.  It can be seen with a slit lamp that sends a narrow beam of light into the anterior chamber. A normal anterior chamber is clear and allows the light to pass clearly and smoothly to the lens. When there is abnormal stuff in the anterior chamber the light gets murky and irregular.

So, Max had a diagnosis. Max had uveitis, or inflammation of the anterior chamber. I presumed the rest of his diagnosis. He is my elusive (third case in ten years) Golden Retriever Uveitis. 

Lesson Learned; Always go immediately to your vet if your dog or cat is squinting. Squinting indicates pain! Eye problems can become huge disasters that could jeopardize your pets vision very quickly. But, the flip side is that in many cases eye problems can be cured very quickly too, ONCE the problem is DIAGNOSED AND a TREATMENT PLAN is started.

This is Max at his follow up appointment on February 23, 2014

Golden Retrievers can get a specific type of uveitis called "pigmentary uveitis." In this disease Golden Retrievers disperse pigment in their anterior chamber. 

Cross section of the eye

 "The iris becomes darker and thickened and clumps of pigment can be seen on both the lens capsule and corneal endothelium (inside layer of the clear corneal covering of the eye.) Aqueous flare, posterior synechia, cataract, and glaucoma may also occur. Any relation between the presence of uveal cysts, pigmentary uveitis, and glaucoma is unproven." From Slatter's Ophthalmology Text.

I spoke to Max's mom about the treatment plan and my concerns about Max's eyes.

I put max on a topical steroid with very specific instructions to monitor his eyes very closely. I also discussed my concerns with both Max's eyes and the drug I was recommending for his treatment. I wanted her to use the lowest effective dose of the eye ointment and to begin tapering the medication as soon as possible. If she had any questions or concerns about his eyes I wanted her to stop treating them and return immediately. Steroids, whether taken orally or put in your eye are both absorbed systemically and can cause both short term and long term detrimental side effects. 

Max returned five days later. His eyes were wide open, comfortable and he was smiling from ear to ear. He was clearly much more comfortable and much happier. His mom had started to taper his eye steroid and was going to remain vigilant on any future flare ups or recurrence of his eye issues.

We will monitor him closely for glaucoma, uveitis recurrence, and hope that we never see either again..I will remain ever observant for the other tiny paragraph birds in the hopes that I spy another "snowy owl" among the millions of starlings...

If you have a pet related question, or just an adorable pet photo to share you can find me on Pawbly.com, or at the clinic, Jarrettsville Vet, or even on Twitter @FreePetAdvice.

Related articles;

The Eye, Timing Matters.

Eyelid Masses, Surgery To Remove Them.

Crying Blood, Enucleation Surgery

Cherry Eye Surgery

Anatomy of the Eye, It's Like a Beach Ball and an Ice Cream Sandwich

Wordless Wednesday, February 26, 2014

This little guy was the subject of intense excitement when he made the mistake of flying around our house early one morning. If we had had the time to get out the video camera we would have had some laughable footage as two adults try to corral four cats who thought that they had hit the lottery and an old dog who is stuck in the middle of the mayhem and oblivious to know what to do about it.
Everyone got out safely, and remarkably unscathed. But if you are the husband of a veterinarian it is hard to be the hero. When he asked me if "I needed his help to catch the bat?" I know I shot him a "are you crazy?" look back. I'm the one vaccinated against rabies and I'm the one who can safely, gently catch a critter without anyone getting injured.

This is Beau.
His family is having a difficult time now and
I just wanted to say that"they are in my thoughts and prayers."

Savannah got herself some new all terrain running shoes this week.
Look out she can motor now!

Bella, she make look little at 3-1/2 pounds but she thinks that she is fierce!

Abigail, who can be coaxed into saying hello IF you have a treat..
She is so scruffy and frizzy that you just have to smile!

Magpie, who hunts my feet in the bathroom..

Max, the subject for tomorrow's blog, came on for a re-check.

Sophie

and her sister Bella

Nothing makes me smile bigger than a dog who comes in with a muzzle..

But leaves as a friend.
This is Gracie

Stormy.
Who was mis-labeled as a "bite risk" because
she bit someone who touched her while she slept in the shelter.
She is deaf, (as are almost ALL white cats with TWO blue eyes),
and she reacted as most deaf pets due to a fearful stimuli.
As pets loose their hearing, or sight, it is important to wake them up with a stomp on the floor,
or a gentle jostle of their bed and not touching them.
They react as if they were being attacked (and really how can they know the difference?) and attack back. Wouldn't you do the same?

Smile!

Monday's surgeries;
three sphinx kitten neuters, which ALWAYS takes us ten times longer than it should
because we can't stop kissing and cuddling them!

waking up.

Because of Monday's short surgery schedule I got home early to spend some quality time with my critters.
They love sitting in the sun..only tough part is sharing.

Magpie gives Charlie a kiss..
I don't think he was too flattered.

Wren

Charlie

Wren and Magpie listen intently as a woodpecker (outside thank goodness!)
tries to hide a seed in the logs of our kitchen.

Hope everyone had a good week! Spring is coming, I think?

If you have a pet question you can find me at the clinic, Jarrettsville Vet, or on Pawbly.com, or even Twitter @FreePetAdvice.

I will be traveling around Harford County and Baltimore spreading the word about Pawbly. If you would like me to visit your business, or if you would like me to send you our promotional package with flyers and brochures explaining what we are all about please contact me at krista@pawbly.com.

Rio's Mysterious Bump? What is a Histiocytoma?

December 1, 2013

Nothing beats getting to know multiple generations of a family. As hard as it is so say goodbye to one pet when it passes away, it is pure joy to meet the next new addition to the family. Sadly, of all of the clients that I see I would estimate that only about 50 percent of them adopt another dog after their only dog has passed away. Especially if that family is an older retired couple. But that is a topic for a blog anther day…

For those clients that do adopt another dog I love to see the joy a new life, so full of new energy, curiosity, and the proverbial “I forgot how much work a puppy was!” 

At Jarrettsville Vet's
Pets With Santa

This is Rio. He is a Belgian Shepherd. He may look rather ominous, but he is rather small and lithe under his long luxurious coat and serious face. His ears stand straight up and did so at a very early age, (for the German Shepherds this can be a long and somewhat frustrating task that keeps us guessing as to when and if they really will ever stay up?). Rio was adopted as an early Christmas present to his parents from each other. 

He arrived off the plane as a tiny bundle of ebony fur complete with Santa hat. He, like every puppy that enters a home after the departure of a pet who has passed away from old age and disease, seemed like (and was) a bolt and jolt of lightning. Their previous decade of caring for a well-trained, sedate, courteous adult dog became a life that quickly required baby proofing the home, the trials and tribulations of housebreaking (always made significantly more difficult when attempted in the middle of a record awful winter), the in home gymnastics and calisthenics when it’s too cold and snowy outside to burn off steam, and teething. For a retired couple I answer a lot of questions, but most of them include a few affirmations that “yes, this is normal puppy behavior.” Followed quickly by the sworn testimony of the pleadings that their last dog was “never this wild,, high strung,,, hard to train,, crazy,, loud,, mouthy,, bite-y,, playful,, hungry,, etc. etc.. 

December 12, 2013

Yawning,
January 2, 2104

Excited to see me!

Practicing my puppy manners,
January 16, 2104

AAAHHH chew!
January 2, 2014

Rio was always a very smart, rambunctious, and happy puppy. He was housebroken in a few weeks and continues to grow exactly on schedule with an excellent daily regimen of excellent diet, exercise plan, and good puppy manners training. I saw him exactly on schedule for every needed check-up, vaccination, and miscellaneous puppy question. But at his 3 month old puppy exam his parents mentioned to me that they were concerned about a bump on his nose. 

January 22, 2014

Sure enough he had a rather ugly red round raspberry looking bump on his nose.

January 28, 2104

Understanding bumps and being able to categorize them by sight takes years. You see “lumps and bumps” can come from too many things that can resemble each other, and come from various etiologies. Some are benign cosmetic bumps, and some are potentially life threatening tumors that need to be addressed quickly. So when it comes to trying to figure out which is which is where your vet is an invaluable resource.

Lesson Learned: Pay attention to bumps, lumps, and skin abnormalities immediately by asking your vet about them! Also, follow their recommendations for diagnosing and treating them. If they feel a biopsy, aspiration, or medical treatment plan is indicated I encourage you to listen, AND, follow up with all recommended re-checks.

Of course, his parents were worried about the following:

1.      ‘Was it a dangerous bump? (We use the word lesion).

2.      Could it be treated so it would go away soon? (It is after all ugly).

3.      Was there something we could put on it to keep it from bleeding, or rupturing, or getting infected?

4.      What caused it?

5.      Will he get more?

Here were my answers:

1.  I did not believe that it was a dangerous bump because; a.  He is soo young. b.  It came up so quickly. c. It wasn’t bothering him at all. d.  I thought I knew what it was. 
2. Treatment relies on diagnosis in many cases. It is far safer, and more effective to treat a lesion IF we know what it is. And, his is on his nose, and anything that you put there will be immediately licked off, so I would have to give him a medication that is effective AND safe to ingest. (Boy does that limit your options!)
3.  A bump or lesion will rupture and bleed when it gets too big for the overlying skin to keep closed. The only way to avoid this is to have it removed or treat it so that it shrinks before this happens. Infection occurs with an open draining wound, OR a mass that is beneath the skin. We don’t commonly see infection with masses that are from the skin.
4. What caused it can be explained when the lesion is diagnosed. 
5. Same answer as number 4.

All of this leads me to giving you some hints about what I suspected Rio’s bump was.

Rio’s clues were;

1.      Age on onset, 3 months.

2.      Character of lesion; spontaneous eruption and regression.

3.      Size and shape, small round, raised, erythematous (red) singular.

4.      Non-painful.

5.      Area of body affected.

1/28/14

January 28, 2014

 Here is what we did.

I explained to Rio’s parents that like every diagnosis in medicine the only definitive way to correctly diagnose a lump or bump was to remove (or take a sample) of tissue and examine it at the microscopic level. Without doing this we were making a presumptive diagnosis. Sometimes we skip this step based on cost to run the confirmatory pathology tests, time constraints of patient health (say for example a bleeding intra-abdominal mass that needs to be removed immediately so the patient doesn’t bleed to death while we wait for a pathology report), a response to treatment that indicates a diagnosis, or even a good educated guess on your veterinarians part. But definitive diagnosis should always be made by a biopsy, guessing, whether well-educated or not, is still guessing. Rio’s lesion was about a quarter of an inch, or about a half of a centimeter, and right beside his nose. This left either removing it with surgery, or trying to get an impression smear with a glass slide. Now Rio is a bouncy boy who prefers to be lunging at your face to kiss you then be expected to hold still. He is also about three months old. We decided to take my presumptive guess as a diagnosis and IF the lesion worsened or grew we would remove it for biopsy at the time of his neuter, which we could do early if needed.

January 30, 2104

January 30, 2014

 My presumptive diagnosis was that Rio had a histiocytoma. “A histiocytoma is a common but benign tumor affecting the skin. Their cause is unknown but believed to be a consequence of proliferative or reactive hyperplastic Langerhans cells (these type of cells overpopulate without known cause) but are not truly considered neoplastic (cancerous). They are most commonly seen in young dogs under age 2. They are usually solitary and found on the head, ears, and limbs. They are usually less than 3 cm in diameter, firm, dome, or button shaped, well circumscribed, dermal in location, and frequently ulcerated. They are fast growing but benign. Diagnosis is based on cytological examination.” (Edited from Muller & Kirk's Small Animal Dermatology, 6th edition).

February 8, 2014

February 8, 2014

 Our plan was to monitor the lesion closely and come in for weekly re-checks (or send me a photo and give a brief update via phone or email).

February 13, 2014

 It has been a little over 8 weeks and the bump is gone. A small hairless area remains but I expect this to fill in normally over the next few weeks. I also expect that there will never be even the tiniest hint that the bump was ever there at all by then.

February 18, 2014

February 18, 2014

If you have any lump, bump, or any thing in between,pet question, you can find me and a whole bunch of other helpful people at Pawbly.com. We are the best place to share information, exchange pet photos, meet people with similar pet interests, and join the pet social network to help pets around the world!

Or you can find me on Twitter @FreePetAdvice, or at the veterinary clinic, Jarrettsville Vet, in Jarrettsville Maryland.

Thanks for visiting! Now go kiss your pet!

This blog is dedicated to Abby..who left little Rio with some amazing shoes to fill and a lifetime of love, smiles, and joyful memories to those who miss her.