Case Studies

PSOM in Cavalier King Charles Spaniels

Mar 1, 2013

PSOM in Cavalier King Charles Spaniels

Primary Secretory Otitis Media (PSOM) in Cavalier King Charles Spaniels & Treatment Presentation: Primary Secretory Otitis Media (PSOM) is an important differential diagnosis in Cavalier King Charles Spaniels with signs of pain involving the head and neck, and possible neurological signs as well. This breed can also have a Caudal occipital malformation syndrome (COMS), which also presents with similar clinical signs. Caudal occipital malformation syndrome (COMS) is a congenital malformation of the caudal occipital region of the skull, leading to overcrowding of the caudal fossa and compression of the cervicomedullary junction at the level of the foramen magnum. Diagnostics: Diagnosis of PSOM can made by examination of the tympanic membrane and middle ear with the OtoPet-USA Video Vetscope. A bulging, but intact, tympanic membrane is found in most cases. While patients are under general anesthesia, a myringotomy is performed and a highly viscous mucus plug is found filling the middle ear. This condition is also referred to as “glue ear.” Treatment consists of removing the mucus plug via a myringotomy and flushing the middle ear. The myringotomy can be performed with visualization using the OtoPet-USA Video Vetscope. The ear can be flushed using the OtoPet-USA Earigator. An MRI is needed to diagnose COMS. Treatment: The Video Vetscope is used to visualize the tympanic membrane. The Video vetscope probe is inserted into the horizontal ear canal and is used as a working channel to perform the myringotomy. A myringotomy is performed at the 5:00 (left ear) or 7:00 position (right ear) in the ventral portion of the pars tensa at the ventral most portion of the attachment of the eardrum to the annulus. In an already diseased eardrum, a myringotomy may be performed by applying pressure to a tomcat catheter and perforating the eardrum. If the eardrum is thickened or hard to perforate, the end of a 5 Fr. polypropylene catheter is cut at a 45 degree angle so that there is a point at the tip. Long, thin spinal needles are more expensive, but may also be used for myringotomy. The tip is then directed to the puncture site and is pushed through the eardrum to remove mucous from the middle ear. Using these locations for myringotomy prevents disruption of the blood supply to the eardrum and does not disrupt sound transmission from the malleus to the cochlea. Once the myringotomy is performed, the mucous plug should be suctioned from the same perforation site using a 5 Fr. catheter and a 3 cc syringe. Finally, irrigation and suction of the bulla can be done using the OtoPet-USA Earigator (link here). In most dogs, small myringotomy incisions completely heal within a month. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Diagnois and Treatment of an Eosinophilic Plaque

Mar 1, 2013

Diagnois and Treatment of an Eosinophilic Plaque

A 7-year-old female spayed Domestic Shorthair was presented to a veterinarian for a pruritic skin lesion of several weeks duration located on her right inner thigh. She was a mostly indoor cat with no other pets in the home, and not on flea control. The veterinarian used the OtoPet-USA Video Otoscope full image lens to take a picture of this raised, thickened and erythematous lesion. This picture was printed for the veterinarian’s records and for the client. Eosinophilic plaques typically look like raised, thickened, raw areas of skin, and are usually located on the belly, inner thigh, anal, or throat areas. Cats with these lesions are commonly extremely itchy. The veterinarian made a slide by pressing it against the lesion and then looking under the microscope for eosinophils, which were present, thus confirming this condition. In most cases, eosinophilic plaques respond to cortisone-type medications. Typically an injection of a long-acting corticosteroid (such as Depo-Medrol) is given and most lesions resolve with one or two injections. This cat was given an injection of both Convenia and Depo-Medrol, both of which were repeated at 2 and 4 weeks, respectively. The cat was also placed on flea control. The lesion was resolved with this treatment. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Cytology Pictures

Mar 1, 2013

Cytology Pictures

As demonstrated in previous case studies, the VetScope system can be used in daily practice to aid in the diagnosis and treatment of our patients. Here are pictures of both a hookworm and whipworm egg. Both eggs were found by doing in-hospital fecal flotations on stool samples. Pictures of the eggs were taken using the OtoPet-USA VetScope and the microscope attachment. Specific directions on how to take a microscope picture are below. The hookworm egg was isolated from a stool sample of a young puppy during a routine fecal examination. The puppy was treated with a 3-day course of Fenbendazole, and the same deworming was repeated 3 weeks later. The whipworm egg was isolated from a stool sample of a young dog that was having chronic diarrhea. A fecal performed 2 weeks prior had been negative. Note the characteristic double plug appearance of this egg. This dog was treated with a 3-day course of Fenbendazole, and the same deworming was repeated at 3 weeks and 3 months. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Lymph Node Cytology Photo

Mar 1, 2013

Lymph Node Cytology Photo

To the right is a picture of a microscope image of a reactive lymph node on a dog. This picture was taken using the OtoPet-USA VetScope and the microscope attachment. Specific directions on how to take a microscope picture are below. A fine needle aspirate was taken from an enlarged submandibular lymph node on a dog that had severe dental disease. The slide was prepared, allowed to dry and then stained using the diff-quick method. A mixed inflammatory population of cells that includes mostly lymphocytes, in addition to neutrophils and macrophages are observed on this slide. (Cytology images can be sent via e-mail from the Vet-Dock software to a specialist if consultation is needed). The dog had a dental under general anesthesia with multiple extractions. He was sent home on Rimadyl and Clindamycin, and upon re-check 1 month later the lymph node was no longer enlarged. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Use of the Earigator in Cleaning

Mar 1, 2013

Use of the Earigator in Cleaning

This is an example of an ear that benefited from a thorough cleaning using the OtoPet-USA Earigator. View a picture of the thick ceruminous discharge within this dog’s ear canal that was taken using the OtoPet-USA Video Otoscope here. The OtoPet-USA Earigator may be used for lavage and suction of the ear canal to remove exudate and cerumen. Cleaning of the ear canal is an important component in the management of ear disease. Cleaning allows the removal of exudate and cerumen, allowing the visualization of the ear canal and the tympanic membrane, as well as contact of medication if needed. In this case, the patient was placed under general anesthetia, which is required for a through otic flushing. An endotracheal tube was placed and the patient was positioned in lateral recumbancy. The ear canal was visualized using the Video Otoscope. If needed, samples for cytology, culture and sensitivity should be collected and imaging studies should be performed prior to flushing the ear canal. The type of discharge in the ear directs the selection of an appropriate initial flush. If the discharge is waxy, a cleaner with good ceruminolytic properties should be used. If the discharge is mucoid and purulent, an aqueous cleaner is preferable. Copious flushing of the ear canal with a warmed aqueous flush should be performed after the initial flush to remove any residual ear cleanser and minimize any irritation from the cleanser. Flushingn also helps to remove the debris. A ceruminolytic cleanser was initially instilled into this ear to break up the thick cerumen. This was followed by a warm aqueous flush using the OtoPet-USA Earigator. Directions on how to use the Earigator are below. Finally, the ear was evaluated again with the Video Otoscope to ensure it was clean. Alligator forceps inserted through the OtoPet-USA Video Otoscope probe may be used to remove any excess debris if needed as well. Most of the debris was removed with the Earigator in this case but residual pieces required removal with forceps. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Diagnosis & Treatment of an Aural Polyp Using Video Otoscopy

Mar 1, 2013

Diagnosis & Treatment of an Aural Polyp Using Video Otoscopy

A cat presented for pawing and scratching at his ear for several weeks duration. The OtoPet-USA Video VetScope was used to perform an otoscopic exam and this picture of the cat’s aural polyp was taken and documented for records. The cat was placed under general anesthesia and the polyp was again visualized using the OtoPet-USA Video VetScope. Once visualized, forceps were used with video guidance to grasp and extract the polyp using the traction and avulsion method, which will be discussed below. This cat was sent home on topical steroids to help prevent re-growth, and oral antibiotics – as secondary bacterial infections are commonly associated with aural polyps. Aural polyps may be found in a cat’s ear when they have clinical signs that include head shaking, pawing or scratching at the ear, nystagmus, head tilt, otic exudate, ataxia and Horner’s syndrome. They may also be found in a non-clinical cat’s routine exam using an otoscope. Polyps are benign, fleshy masses that may be found in the nose, nasopharynx, middle ear, and/or external ear canal. The exact cause of polyps is unknown. Upon examination of the ear canal using an otoscope, an aural polyp appears as a smooth, pink mass. They may also appear red or white, or be covered in blood or mucous. The tympanic membrane may appear discolored or distorted if the polyp is located in the middle ear. If a polyp is suspected in the middle ear, then open-mouth skull radiographs may be taken and can show increased density within one of the bulla and in the horizontal ear canal. To the left is a radiograph of a bulla showing some opacity that is consistent with a polyp in the right middle ear. This radiograph was copied using the OtoPet-USA Video VetScope full image lens. Aural polyps may be removed by steady traction and twisting of the polyp with forceps while that cat is under anesthesia and while using videoscopy. The stalk of the polyp should be removed as well. Curved forceps are inserted into the ear canal, and the mass is grasped and extracted with traction. Polyps that are more fibrous or difficult to reach may require a ventral bulla osteotomy for removal. A ventral bulla osteotomy for removal of aural polyps has a much lower recurrence rate than the traction and avulsion technique. After removal, oral antibiotics should also be given based on bulla cultures, and oral anti-inflammatory doses of steroids should be given for several weeks to reduce the incidence of re-growth. Topical high dose steroids and antibiotics may be used as well. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Diagnosis & Treatment of Distichiasis

Mar 1, 2013

Ocular problems can be easily captured and treated using the OtoPet-USA Video Vetscope. Here is a video of a patient with distichiasis, which was recorded and treated using the OtoPet-USA Video Vetscope. The Video Vetscope allowed for magnification and easy diagnosis of the distichia, as well as a chance for the client to visualize the problem. In this case, the patient presented for chronic redness and squinting in the left eye. After a negative fluoroscein stain and a normal schirmer tear test, the Video Vetscope probe was used to evaluate the eye and the distichia were found. You can appreciate multiple distichia located on the upper left palpebral margin on the video. Distichiasis is a condition in which extra hairs grow out of the eyelash area or palpebral margin. Untreated distichiasis can cause corneal ulcers, chronic eye and eyelid pain and excessive tearing. Signs of distichiasis may include increased blinking, extra tears and squinting. There are several treatment options for distichia. Cryosurgery freezes the lid margin at the places where there are extra hairs. Surgery, electrolysis and laser treatment can also be performed to remove the hairs permanently. All of these procedures destroy the hair follicles, preventing hair re-growth. In this case, the patient was placed under general anesthesia and the distichia were treated using laser. An 0.8mm x 180mm stainless steel CO2 laser waveguide was placed through the working channel of the Video Vetscope probe. The Video Vetscope probe and laser were then placed over each eyelash to be removed so that it was highly magnified on the Video Vetscope monitor. The laser was lined up perpendicular to the leading edge of the eyelid with the beam aimed directly into the growth of the hair as it emerged from the eyelid. Using a single 500 millisecond pulse at about 5 watts of energy, the hair follicle was lasered, liquefying the hair and destroying the hair follicle. All of the distichia in the video were removed using this technique. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Otic Tumor Diagnosis & Treatment

Mar 1, 2013

Otic Tumor Diagnosis & Treatment

A 2 year-old male castrated mixed breed dog presented for scratching his left ear and shaking his head for 1 week duration. During physical examination, the OtoPet-USA Video VetScope was used to evaluate both ears. The VetScope probe was inserted into the both ears and a mass along with a hyperemic ear canal was visualized in the left ear. The owner was able to see the mass on the screen and a picture was taken for the records.  Otic neoplasia is uncommon in dogs. Benign tumors of the ear include inflammatory polyps, histiocytomas, papillomas, basal cell tumors, ceruminous gland adenomas, plasma cell tumors, and sebaceous gland adenomas. The most common malignant tumors of the ear in dogs are squamous cell carcinoma, ceruminous gland adenocarcinoma, and undifferentiated carcinoma. Melanoma, mast cell tumor, fibrosarcoma, squamous cell carcinoma, spindle cell tumors and lymphoma are less common tumors that may be found in dogs ears. Otitis may be a predisposing factor to the development of otic tumors. Chronic otitis can cause hyperplasia of the ear canal, which may eventually induce dysplastic changes. Tumors of the ear canal can also predispose an animal to otitis. Cytology was performed during the exam and 1+ cocci was found. Surgical excision is the treatment of choice for most otic tumors. The patient was sent home on a topical antibacterial and steroid otic medication. A surgical excision and biopsy under general anesthesia was scheduled. One week later, the patient was placed under general anesthesia and the mass was debulked and removed using video visualization and alligator forceps inserted through the OtoPet-USA Video VetScope probe. The tissue was sent for histopathology. The patient was sent home on Rimadyl. The otitis was resolved as evidenced by cytology at the time of removal. The biopsy results came back as a papilloma. In mild cases of papillomas, observation without treatment is appropriate, as they may spontaneously resolve over 6-10 weeks in most cases. However, removal may be recommend if it is occluding the ear canal or causing a problem such as irritation in this case. In addition, it is hypothesized that crushing and removal may help to stimulate an immune response. In older dogs, papillomas may indicate immunosuppression and full blood work and a physical examination are both indicated. Azithromycin can be helpful to speed regression in some cases. Following the surgical removal, the owners elected to monitor for reoccurrence of the growth. In the case of regrowth, a more radical surgery would be considered if the growth again occluded the ear canal. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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