Category Archives: Case Studies

Ramsey’s successful cancer treatment

Animals get cancer, too. Ramsey, a 13-yr.-old male Goldendoodle was diagnosed with lymphoma in November of 2021.  After staging of his aggressive cancer, he was placed on an extensive chemotherapy protocol.  Without treatment he was not likely to survive more than a month or two.

Ramsey underwent a 25 week long course of therapy, he handled his many treatments very well!  Despite a few side effects, Ramsey never lost his spirit or zest for life.  Animals are incredibly resilient to the side effects of chemotherapy.   We use the same chemotherapy drugs that are used in people; however, they seem to have fewer or less severe side effects.  Ramsey successfully completed his treatment, which allowed him precious time with his family. 

Different types of cancer have different treatment options, most are quite simple and short courses.  Some cancers respond to simple medications, some respond to surgery; while others respond best to surgery and medications.  Each patient with cancer needs a thorough assessment of their health and disease.  Then a thorough discussion of options and potential outcomes is necessary so that the pet’s family can make the best decisions possible.  At SJVC we have a lot experience with treating cancer and have even helped complete treatments for patients that have been referred to us from specialty centers and even Colorado State University Veterinary Teaching Hospital.  We have the ability and desire to help animals suffering from cancer. Animals are incredibly resilient and their positive attitude is a wonderful trait.  We recognize their amazing attributes and want to help them live the best life possible.

What is gastropexy and why should I care?

Gastropexy is a surgical procedure used to prevent an emergency condition called “GDV” or “bloat”.  This is when a dog’s stomach twists and occludes the esophagus and causes the stomach to develop severe distension.  The swollen stomach will affect the ability to breath, limit the blood supply getting back to the heart and the blood supply to the stomach and even the spleen.  This is a life-threatening condition which requires immediate surgical intervention to have a chance to survive.  Emergency surgical and extensive medical care are required to save a patient with GDV patient; thus, it is quite expensive.

Large and giant breed dogs are the most common victims of this condition.  Predisposing factors, include: being deep chested, thin body condition, “sensitive stomach” dogs and those that tend to be a bit anxious.  The condition appears to have a genetic component, if relatives to your dog have had this condition then your dog is at a much greater risk.  Over the years, many assumptions have been made about eating or drinking and then becoming active right away causing GDV to happen.  There is almost no evidence that timing of eating or drinking causes this condition.

Prevention is the best option! Let us help you assess your dog’s risks and determine if a gastropexy could be indicated for your companion.  This procedure can be performed at most any time, we typically encourage having it done at the time of neutering or spay; however, it can be done any time after 6 months of age.  Gastropexy can be performed by a traditional surgery technique or by a laparoscopic assisted technique. The procedure is greater than 99% successful at preventing GDV, with much less risk and expense than emergency surgery.

Anesthesia: What happens and why?

Considering having your beloved companion anesthetized can create many different worries and second thoughts in most people. This is very understandable. Many people may have heard a story of someone’s pet dying while under anesthesia for a routine procedure. Many of those cases happened a long time ago, thankfully, and modern anesthetic techniques have drastically improved patient safety.

At SJVC, we are very proud of our anesthetic safety record which we have earned through careful consideration of every patient. Our team is diligent, uses constant monitoring, and performs rapid intervention when needed.

The most common reasons a pet needs to undergo anesthesia include:

  • Dental Hygiene Procedure
  • Sterilization (spay or neuter)
  • Mass removal or tissue biopsy
  • Trauma (orthopedic fracture, laceration, etc)
  • Exploratory abdominal surgery
  • Other varieties of exploratory procedures and treatments

Anesthesia is an amazingly wonderful tool that allows us to perform life-saving and health improving procedures on a daily basis. Anesthesia can be broken down into 2 main categories: 1) Sedation and 2) General Anesthesia. These are both performed with the animal’s health, comfort and safety as our primary consideration.

Sedation is a very common practice to allow us to investigate and treat an animal more invasively than they would tolerate while awake. This is typically achieved by giving the animal either an intravenous or intramuscular injection of a combination of anesthetic agents that can be reversed after the procedure is complete. The animal is asleep and feels no pain but is still able to control their airway and blink.

General Anesthesia is required for more invasive, more stimulating or longer procedures. This involves 3 phases of anesthetic agents being administered to slowly calm the animal, maintain good cardiovascular function, provide pain control, and keep them asleep very safely for as long as we need to complete their procedure.

For general anesthesia we first perform a thorough physical exam on every patient.

Second we analyze pre-anesthetic lab work including a complete blood cell count (CBC), serum chemistry panel, and urinalysis to ensure all of your pet’s organs are functioning normally.

If the patient’s physical exam and laboratory test results demonstrate a healthy animal, we proceed with the 1st phase of anesthesia which is typically a subcutaneous injection of a combination of 3 drugs intended to sedate, provide pain control and regulate cardiovascular function. Once this takes full effect (usually 20-30 minutes) the patient receives an intravenous catheter and is given supplemental oxygen.

This allows the 2nd phase of anesthesia where the patient is anesthetized with an IV injection of typically 1 or 2 anesthetic agents. Once they are sound asleep, a breathing tube is placed to allow us to deliver oxygen and an anesthetic gas. This is the 3rd phase of anesthesia and is used to keep the patient asleep for the duration of the procedure.

Anesthetic support and monitoring are critical to the success of the anesthetic experience. This vigilance is the primary reason anesthesia is safer today than ever before in history.

A typical anesthetized patient receives IV fluids throughout the entire procedure to support optimal blood pressure and maintain ideal tissue perfusion.

Each patient also has eye lubricant applied to keep their eyes from drying out and is kept comfortable and warm with a warm water blanket, hot towels, warm rice socks and an IV fluid warmer.

Throughout the procedure we constantly monitor several aspects of the patient’s cardiovascular and pulmonary function. This typically includes ECG, Blood Pressure, Pulse-ox (blood oxygen saturation), Temperature, Respiratory Rate, CO2 expiration, Inhaled Oxygen level and anesthetic gas level.

If a procedure is expected to be painful, we provide additional pain control measures whenever possible to lower the amount of anesthetic required. This typically would include topical anesthesia (eyes), local anesthesia (laceration), regional nerve blocks (dental/ oral surgery), epidural anesthesia (orthopedic surgeries), and intra-operative pain medication such as anti-inflammatories, lidocaine drips, opioid drips and pain patches.

Anesthesia is a serious endeavor and should be treated as such. However, a well-planned drug protocol, pre-anesthetic health assessment and diligent monitoring help to make anesthesia very safe. Avoiding a life improving procedure out of fear of anesthesia is not necessary. If you have any concerns about your pet’s safety during an upcoming anesthesia, our well-trained staff is happy to answer any questions and listen to any concerns to ensure you are completely comfortable before proceeding. Our entire purpose is to improve the life of your companion, together with you.

Happy Trails!!

Bonnie’s Teeth

This is “Bonnie”, the world’s sweetest 6-yr-old S/F Chocolate Labrador Retriever. Bonnie was presented to us for a COHAT. We immediately noticed something unusual about her teeth.

This is what we saw...

There is obvious discoloration of the teeth, but oddly enough, all of these teeth were determined to be perfectly healthy! There was tartar accumulation above and below the gum-line, and moderate gingivitis in addition to small areas of gingival hyperplasia (gum tissue overgrowth), and numerous areas of wear but the color of the teeth in this case is not an indicator of tooth disease.

This appearance was most likely caused by this dog receiving a tetracycline antibiotic (as would be prescribed for an upper respiratory infection) as a young puppy while the adult teeth were forming. The chemical nature of tetracycline antibiotics makes them bind to calcium in the body. As the hard tissue of a tooth (made of calcium) is forming, the antibiotic is incorporated into the tooth structure permanently discoloring it.

Generally, we use tooth color as one of many factors to evaluate the health of a tooth. We cannot rely on this factor in this patient so annual x-rays are ideal to be able to detect any developing disease within the tooth.

Miller’s Teeth

Meet “Miller”. He is a very sweet, 2 yr 7mo old Neutered Male Terrier mix who came to see us for bad breath and visible tartar. He was rescued by his current owner a few months ago so nothing is known about his dental history.

Upon presentation “Miller” had pre-anesthetic lab work and a physical exam which were both unremarkable. Besides his poor dental hygiene “Miller” appears to be in very good health. After we anesthetized him and placed a breathing tube we began is dental exam.

You can see from the photo that he has large tartar deposits and moderate gingivitis around all of his teeth with more advanced periodontal disease on his top back teeth and top k9 teeth. Radiographs confirmed that “Miller” had several teeth in end-stage periodontal disease as expected based on the visual exam. But the reason “Miller” made our list of interesting cases is because of what we didn’t expect.

The following radiograph of the right mandible shows a tooth deformity known as convergent roots. There is no structural problem with the roots converging, but this particular deformity is often accompanied by abnormal creases in the tooth known as enamel or dentin invagination and these teeth have a high rate of endodontic infection.

You can barely make out black halos around the root tips of this tooth making us very suspicious of endodontic disease.

Looking closer as seen in the next radiograph we could also see what appears to be a large crease extending from the outside of the tooth into the pulp chamber between the roots (red arrow). In a normal tooth we only expect there to be 1 port of entry into the pulp chamber, located at the tip of each root (yellow arrows).

This condition, known as “dens invaginatus” is usually present on both right and left sides, which was the case with “Miller”. The next radiograph is from the left mandible showing the same pathology but in a more advanced state.

Both of these teeth were surgically removed and the left tooth is shown on cut surface in the photo below.

Miller is so much happier now without his abscessed teeth and this is another example of why we radiograph every tooth every time we do a dental hygiene procedure. Without doing so we would have left this sweet boy with 2 painful throbbing jaw abscesses.

No More Antlers!

This is a very sweet adult neutered male yellow Labrador retriever that came to see us for a swollen right face of several weeks duration. He was still eating normally and seemed happy despite the draining wound on his face.

Upon examining his teeth, we noticed the following wear/ fractures to his top right and top left carnassial teeth.

Both teeth are worn and have fractures but neither tooth is broken into the pulp. The gingiva around the top right tooth is more inflamed than the left side and there is also more enamel missing. The brown spot visible in the middle of the tooth is called a pulp scar. This is where the pulp used to be and has receded over time due to the wear on the tooth.

Fractured teeth are extremely common in dogs and most of the time have no significant consequences. Occasionally these teeth can become infected by bacterial invasion directly through the exposed dentin (the layer under the enamel) which is very porous. This is what the top right tooth associated with the facial swelling looked like on x-ray:

If you look closely, you might be able to make out dark areas around the root tips:

These are tooth root abscesses, and these are the source of the infection draining from the face. This tooth was removed, the tooth sockets were curetted, and he was given antibiotics and anti-inflammatory medication. The swelling resolved rapidly, and he is now even happier than before.

This case was selected for a write-up because it represents something we see very commonly. Antlers and other inappropriate items are being market and sold as “healthy for teeth” and well-intending owners are giving these to their dogs with the best intentions. Unfortunately, these claims of improving dental health couldn’t be further from the truth.

One dental specialist recommends not to give your dog anything to chew on unless you can bend it with your hands. This means no antlers, bones or even plastic bones.

Dante’s Tongue and Teeth

Dante is a 3 ½ yr old intact male Great Pyranees that came to us for a dental hygiene procedure due to difficulty eating. Pre-anesthetic labwork and examination were unremarkable so we proceeded with his anesthetic induction. When Dante was having his breathing tube placed the technician immediately noticed something very wrong. His tongue was unable to be extended past his incisors.

We then noticed an abnormal fibrous attachment tethering the tongue.

This attachment has been present since Dante was born and we were all very surprised that he’s made it this far in life with this condition. Often times this abnormality would be expected to interfere with nursing and result in failure to thrive or even death as a puppy.

Dante has “ankyloglossia”, also known as being “tongue tied”. Although quite common in human newborns this condition is thought to be quite rare in dogs and to our knowledge has only previously been reported in Anatolian Shepherds where it is a known genetic condition.

The treatment is a fairly simple surgical release of the abnormal attachment but has life improving benefits that are immense. Dante is a heavily haired stock dog that lives outdoors (as a full time livestock guard dog) in Western Colorado where the daytime temperatures in the summer routinely reach the 90’s. Up until now Dante has been unable to pant normally to cool off, as well as not being able to drink efficiently. Below is a photo of Dante’s tongue after the release.

As a side note, Dante also had another known genetic dental anomaly which was corrected at the time of this procedure. Dante developed more maxillary incisors than he should have. This led to displacement of the normal teeth and a resultant malocclusion.

Dante is so much happier now and this just goes to show how valuable a thorough dental exam can be!

Luna’s teeth

Luna is a very sweet 1 ½ year old spayed female Labrador. She was presented for a routine wellness exam and was noticed to have a “chipped” tooth.

Fractured teeth are the #1 most common dental pathology we see in young large dogs. These “chipped” teeth are often brushed off as insignificant but can harbor significant disease. Luna’s owner is a wonderful owner and promptly brought her in for assessment of this tooth. The following is the dental x-ray of this tooth obtained a week later during a COHAT (comprehensive oral health assessment and treatment).

This tooth has a crown fracture with pulp exposure, also known as a “complicated crown fracture”. When this happens and the internal chamber of the tooth is exposed to the contaminated environment of the mouth, the pulp gets heavily infected within 24-48 hours and undergoes septic pulp necrosis (death from infection) over perhaps 2 months. This is very painful as it is happening.

This large dark circle demarcated by red arrows is pocket of infection (periapical abscess) in the facial bone as a result of this process. There are only 2 options to treat this condition, 1) tooth extraction, or 2) root canal therapy. The tooth was extracted in this case since this tooth is not of high value.

This is another example of how a routine wellness exam resulted in a dramatic improvement in this dog’s quality of life!

Klaus’s teeth

Klaus is a 6½-year-old neutered male Wirehaired Pointing Griffon. He is the goofiest dog on earth and is Dr. Green’s personal dog and best buddy. This is a series of dental radiographs taken over a period of 1½ years showing the progression of tooth resorption.

The first sign of tooth resorption was noticed during a routine COHAT (comprehensive oral health assessment and treatment) over 1 ½ years ago.

Tooth resorption is a painful and progressive disease with no realistic long-term treatment other than tooth extraction. In early stages with the resorptive lesions well below the gumline, it is not known to be painful and the process can move quickly or very slowly. For several reasons, this tooth was not extracted and we decided to just monitor the tooth annually with dental radiographs under anesthesia.

Like all veterinarians working on their own animals, I repeated the radiographs 18 months later rather than 12 months later. The reason for the delay is that all of his teeth looked very clean still and his gums were pink and very healthy. But, Klaus was noticed to consistently avoid chewing on this side of his mouth when he got is daily dental rawhide chew. The following was observed at the follow up COHAT:

As you can see, the original resorptive area has progressed deeper into the tooth root (green arrows). Additionally, a portion of tooth root near the apex (root tip) has been almost completely resorbed and is now a substance similar to bone (yellow circle). Most importantly, resorption is approaching the crown (red arrow) and this is when the tooth will become painful. The decision was made to extract the tooth.

2 months later when Klaus was brought back for the extraction, the following radiograph was taken immediately before extraction showing even more progression.

Some of the changes may be caused by a slightly different angle of projection when the radiograph was taken, but these changes are clearly happening quite rapidly.

To extract the tooth, Klaus was placed under general anesthesia with IV fluid administration and full anesthetic monitoring including ECG, blood pressure, pulse-ox and temperature. A breathing tube was placed and his throat was packed with soft gauze to help prevent fluids and debris from irritating his airway.

A regional nerve block was performed with traditional numbing agents (bupivacaine and lidocaine) as well as a narcotic agent called buprenorphine. Adding this micro dose of narcotic to the nerve block may in some cases provide pain control for up to 4 days. This tooth was extracted surgically and very delicately as well as taking post-extraction radiographs to ensure all remnants were removed. Very small absorbable sutures were then placed to close the extraction site and ensure a healthy collar of gingiva remained around the surrounding teeth. He was prescribed anti-inflammatory medication and placed on a soft diet for 14 days and the area healed very nicely.

He already seems to be happier and is chewing on this side of his mouth again. This case is a great example of 3 things:

  1. A significant, painful dental disease can be occurring below the gum line even with teeth that appear to be very healthy.
  2. All teeth should be radiographed every time an animal has a dental hygiene procedure. There is no such thing as performing dental x-rays “as needed”.
  3. The potential dental pain an animal may be experiencing in silence cannot be overestimated. Dogs almost never accurately show their pain and discomfort with dental pain or even most other types of pain. This is why we generally operate on the assumption that if it can cause pain, it is causing pain.

Happy trails!

Oscar’s Braces

Oscar is the world’s sweetest 8-month-old, neutered male Cavalier King Charles Spaniel. He was presented to us because the owner noticed his baby teeth did not fall out like they should have. The following picture is what his teeth looked like upon presentation.

Oscar has failed to shed his deciduous k9 teeth. Under normal circumstances, the root of the tooth is resorbed, and the crown is exfoliated, then the adult tooth erupts into its place. If this process fails, the baby tooth remains in place leaving the adult tooth no place to go as it erupts. As a result, the adult tooth is displaced into an abnormal position. In this case (which is typical of nearly all cases) the adult k9 tooth has been displaced forward.

Oscar now has 2 major dental problems: 1) His adult k9 teeth are interfering (hitting each other) causing significant tooth wear and pressure and causing his mandible to be pushed to the left when he closes his mouth.

Because of this, when Oscar closes his mouth his lower right k9 tooth has to rest to the inside of the top right k9 tooth. This is causing a traumatic pocket in the soft tissue of his palate which is painful.

Here’s one more look with his mouth closed.

Here is the dental radiograph of the area:

The entire root of the baby tooth is still present which is why the tooth didn’t fall out.

The 2nd problem that Oscar now has is the certain rapid development of periodontal disease due to the crowding of the baby tooth and adult tooth.

For these reasons, we very delicately and surgically removed the entire baby tooth and decided to use active orthodontic force to move the adult tooth back into its normal position.

After 2 weeks, Oscar came back to have his braces removed and this is the result:

Here is a before photo just to compare: