The Medical Work-Up
“Amelia” Hunter is a lovely, tiny wee Yorkshire Terrier, who has been born with an unusual and potentially serious problem. This problem took a bit of tracking down…..
Amelia was about 8 months old when the problems started. She was bright and lively, a loving dog and the apple of Mrs. Hunter’s eye, but had always been on the small side. She had recently been licking her lips a lot, and looking in her little mouth showed that she had not lost her baby teeth. Rather than this, the adult teeth had come in behind them, leaving her with a complete double set of nashers! It seemed sensible to schedule her for a routine dental procedure to remove the baby teeth and leave enough space for the adult dentition to come in, particularly if it was bothering her, so informed consent was given she was duly booked in for an anaesthetic and the operation. As is routine, she was starved overnight prior to her surgery.
That day she was admitted as planned, but a few hours later Elaine Hawley, our vet nurse noticed that she had started to behave oddly in her kennel. This was during a routine ward round, and before she had received any medication, but she was staggering and looking like she was drunk. Because Elaine had been observant, the team swung into action, a blood was drawn and it revealed that Amelia was suffering from dangerously low blood sugar, which was quickly addressed using dextrose gels and food. Her surgery was cancelled, her owner informed, and thankfully she made a quick and full recovery. The question was why had she taken such an extreme reaction to a commonplace situation like an overnight fast?
Given that prior to this episode she had NO symptoms at all, out initial assumption was that she was just so tiny she did not have enough reserves to support herself. Although this simple answer was the most likely, thankfully Mrs Hunter gave permission for a further work-up, and basic biochemistry bloods showed some subtle abnormalities. Not enough to be conclusive, but enough to raise a question mark over her liver. After more discussion, Amelia was re-admitted a few days later for liver function testing. Still symptom free, the bloods showed that her liver really wasn’t working well at all, at which point she was referred to the Glasgow Vet School on suspicion of a portosystemic shunt…. a blood vessel that bypasses the liver shortly after a dog is born and prevents it from developing properly.
The specialists at the Vet School performed ultrasound scans and further tests, and this life threatening and life limiting abnormality was confirmed. After a period of intense medication and diet to support what liver she had, Amelia underwent surgery to close this bypassing blood vessel. Fortunately, the surgery has been a great success, and she is able to come off her drugs, and has a hope of a long, happy and full life. This would not have been possible if her condition had not been found so quickly. It is also now becoming apparent that her littermate, Alfie, may have the same condition. Now we just have to sort him out and deal with Amelia’s retained baby teeth!
THESE CASE REPORTS REFLECT REAL ANIMALS AND EVENTS IN THE PRACTICE. PERMISSION WAS GAINED FROM THE OWNERS INVOLVED TO USE THE DETAILS OF THEIR ANIMAL’S CARE PRIOR TO PUBLICATION; HOWEVER I HAVE ALTERED THE NAMES AND SOME OTHER DETAILS TO MAINTAIN CONFIDENTIALITY.