At Lida Vets we often work closely with charities to help those animals most in need. During the bank holiday weekend in August, we were called to assist one of these cases. Katie was a lovely young female cat, collected by the RSPCA from owners who could not afford to help her through illness. Sadly, Katie had too many litters of kittens in a short life – a shocking reality in any unneutered cat. She had developed a severe case of mastitis, an infection of her mammary tissue. This gave Katie a temperature, systemic infection, and caused a large portion of her mammary tissue to become detached from her body and die away. This left us with a nasty wound with pus to manage and heal.
At first the task seemed daunting, as the damage was so severe. Step by step we were able to help. Pain-relieving and antibiotic drugs were administered, Katie was stabilized before undergoing a general anaesthetic to remove the worst affected tissue. This left Katie with much missing skin, so a body bandage with special wet to dry dressing was used to protect the area and to remove the remaining infection. Dressings were changed daily at first, then every 2 days. 10 days later, we were thrilled to find that Katie was ready for her second and final surgery. Under general anaesthetic, we were able to spay Katie to prevent her from having further kittens. Then the skin around the wound was prepared and gradually the wound was reduced in size before finally being closed.
We can report that Katie has found a lovely new home and looks forward to a new life. Without the dedication of the RSPCA and their close work with Lida Vets, Katie would not have survived.
The Case of a Non-healing wound.
In the field of surgery, there are some wounds that are tricky to heal. There are many reasons why a wound will not knit back together, including underlying skin disease, size of the wound and tension over the incision, infection, over activity and many more. This case is that of a beautiful boxer dog on whom we found an aggressive tumour. The tumour was a Mast Cell Tumour, requiring a large amount of skin to be taken to ensure the disease was completely eradicated.
Unfortunately, despite best efforts, too much tension over the wound led to the original stitches failing and the wound re-opening. So we had to think laterally to come up with some ways to dress the wound. Due to the position on the leg, we couldn’t just apply a bandage!
We managed the wound as an open wound, changing dressings every few days. We used different dressing materials to help draw out infection, and create fresh new granulation tissue which would eventually help us close the wound.
The pictures below show the wound starting to granulate and create fresh healthy tissue.
After several weeks of dressing, we created a new flap of skin by finding some spare from the back of the leg. We were able to drag this across to help close over much of the wound surface. Even with this great success, a small area still remained open But with further dressing, the wound healed completely!
5th March 2015 11:00 - On a damp morning of Lettuce (Name altered) arrived at the surgery with a worried owner. Lettuce is nearly thirteen years old, one of those tiny Jack Russell Terriers which are immediately lovable. She had lost her right eye previously. Now the left side of her face was swollen and asymetrical, to be precise the entire left lip and cheek was thick and hard though painless and about five times bigger than normal!!.
The kind of things that can cause such a swelling (differential diagnoses) vary from infections e.g. a massive abscess from a bite or a foreign body (FB) (very common) all the way to a rapidly expanding cancerous growth (rare).
11th March 10:16 - Worryingly, week on antibiotic and antiinflammatory did seemed not to have any effect, the swollen cheek became even more humongous. Something odd was going on..
Lettuce underwent surgery to obtain a full thickness biopsy from the lip. It was sent to the pathology lab where, using analytical techniques of histopathology and immunohistochemistry the cells would reveal their secret. X-rays did not show any FB or lesions in the rest of her body.
15th March 16:39 - Days spent waiting for results. Letttuce is now on antibiotic again because of secondary infection and the swollen lip is getting worse with skin and mucosa inside of her mouth breaking up.
16th March 09:32 - The grim news - this is a malignant T-cell lymphoma localised to the lip. Chasing the lab for immune cell markers results. Lettuce is referred to a specialist oncology unit where treatment begins using Vincristine and Prednisolone chemotherapy combination.
20th March 16:29 - The report from the specialists does not bode well.Th cancer had not responded and the face is getting worse
24th March 09:46 - Stalemate. Lettuce has been released home on tablets but the massive cheek is getting worse and encroaching on her one remaining eye. The lack of response to chemo means she may have to be put to sleep. Urgent phone calls are made to several specailists. Suggestions are discussed with the owners. A shortlist of potentially helpful chemotherapy drugs is drawn.
30th March 15:29 - Lettuce is a really brave little dog. still eating inspite of the massive mass of her left face. There is nothing left to lose - ee decide to try Lomustine, a drug which would allow Lettuce to be at home during the treatment.
01st April 12 noon - Good news! the tumour has begun to shrink and Lettuce is in good spirits.
07st April 10.29 Lettuce still making good progress. We add antibiotics and steroids to ease infection and inflammation respectively.
13 April 13.15 Sudden eye trouble! Lettuce appears to be blind in her one remaining eye within the last 24 hours: colliding with objects and disoriented. Lettuce had one eye removed due to a detached retina over a year ago and the prospect of the same fate being visited on the left eye is troubling.Dr David Williams, the specialist ophthalmologist is called to examine her. It appears that old eye problems have resurfaced on both corneal, pupillar and retinal levels. She cannot see and we attempt treatment with atropine and Remend. Has the eye been invaded by the cancer cells? is the problem related to the cancer treatment?
21 April 14.33 - Lettuce undergoes an ultrasound examination of the eye. A possible retinal detachment is detected. Things do not look promising. Worries prevail but we persevere with treatment and hope. It is time for the next dose of Lomustine - How would she cope? Another blood test is run and she is declared in fine fettle, eye notwithstanding. The new dose is administered and off she goes home
27 April 10:20 - Emergency. Lettuce suddenly became lifeless and lethargic with a high temperature. We commence intensive iv fluids and iv medication. The chemotherapy has wiped out her entire immune defences. It is a known adverse reaction to chemo but the owner has reacted swiftly. Hand wringing for a few hours but she begins to get better.
28 April 09.17 - Lettuce is improving and is eating. Her temperature is dropping as treatment continues.
29 April 14:21 - she is much brighter already and can go home
05 May 10.46 - Lettuce is so well!! The eye issues have miraculously resolved. She is well,phew.
12 May 16.30 - How good is that!
Josh replied and a discussion ensued on how to diagnose the condition as quickly as possible. Whether it is best to proceed with a fine needle aspirate (FNA) to draw cells from the lump and associated lymph node or to biopsy, removing a representative full thickness wedge from the lump. Another option is to remove the whole lump with wide margins.
The owner is now mulling over the choice and we will proceed as soon as a decisiion ismade
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