Sep 24 2015

Follow Dr. Mandel’s Morning Appointments

I hope to present a morning of appointments and surgeries to represent a glimpse into a typical day in the life of this veterinarian. It’s always intense, always challenging and demonstrates why I love my job so much even after 25 years.

First thing in the morning, I like to come in, grab a cup of coffee and go back to my office to catch up on mail, messages and look up lab work from the previous day’s appointments. This rarely happens as we usually have emergencies meeting us in the parking lot or calling first thing. Cool, that’s why I am here! Today is no different. Early to arrive and meet me first thing is a young dog who jumped out of an open car window with the added problem that the car was moving at the time. She was referred here because of our reputation for excellent orthopedic care. She landed on her knee and just absolutely crushed her kneecap. We looked at the films provided by the referring clinic and put together a plan for repairing the leg. It’s not going to be easy since the knee is such an important joint for weight bearing and the patella connects to the largest muscles in the body. They will be pulling on the fracture site constantly and fractures require absolutely no motion to successfully heal. Plus, the dog is going to want to flex his knee and, did I mention he’s a puppy.

Fractured patella being cleaned prior to surgery.

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The knee was cleaned and prepared for surgery. The patella, being in so many pieces, could not be simply pinned or wired together so we improvised by combining nylon implant material and gathering the pieces together in a tension device we use for large dogs in ligament surgery. It worked!. The dog was placed in a cast post operatively and we will see down the road how things go. I am guardedly optimistic.

My first actual appointment is an older ferret who has stopped eating, seems lethargic and has a swollen belly. After careful examination, the spleen is found to be greatly engorged and the ferret is definitely depressed and dehydrated. Radiographs were taken which confirmed our suspicions so a fine needle aspirate was performed to look at the cells in the spleen. Our concern is that the ferret has lymphoma, an unfortunately common ailment in ferrets older than six years of age.

Stained splenic aspirate showing lymphoma in a ferret.

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The aspirate confirms our suspicions and we discussed the treatment options for the patient. The patient was given medications and supportive treatments and improved over the day. We sent her home with additional medications and, so far at least, the ferret continues to improve and is eating.

My next appointment is a dog who was born with a severe deformity to the knee. Instead of being in the middle of the femur, it’s locked on the inside of the leg. The dog is middle aged and having never had the use of it’s leg, his muscles are atrophied and contracted. We have already fixed the kneecap defect but the dog still cannot extend his leg. Our goal is to loosen the contracted muscles surgically and then brace the leg in extension. Presently, the leg will not extend more than 10%.

Affected knee before surgery, showing maximal extension, less than 10% of normal.

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After our procedure, the leg is able to extend 85%. Not perfect but much better than it was. Months of therapy will follow but, if we can save the leg from being amputated, it will all be worth it.

My last appointment, another referral, was for a dog who had developed stones in his bladder. Some of the stones had tried to leave on their own through the dog’s urine but got stuck. Male dogs have an actual bone in their penis and it’s a great place to hang out if you are a stone. Unfortunately, there is no escape. The guys cannot move back or move forward. If a dog can no longer urinate around the stones, they can die within 48 hours from toxemia or bladder rupture. Oh, and it’s as extremely painful as one might imagine. We first went into the bladder surgically and removed all of the large stones. We then created a new opening for the urethra under the tail so he can resume normal urinations and never have to worry about a life threatening blockage. The stones were sent out to be analyzed in order for us to formulate a diet plan for this guy to prevent new stones from being created and the dog was also given antibiotics as chronic urinary tract infections are the most common cause for bladder stones in dogs.

The ellipse shows a cluster of large stones in this dogs bladder. The red arrow points to the location of an additional cluster of stones in a single file along the urethra at the level of the dogs “os penis” or penis bone.

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I had one other appointment scheduled which was a dental cleaning. It’s best to keep the teeth clean of tartar and before the disease gets to the point where teeth are loose and really stinky and infected. This was a large dog which usually means we will have a good situation. Small dogs, because their teeth are all crowded in a little mouth, have very rapid, progressive dental disease whereas large dogs, having proportional teeth for their jaw size, usually develop tartar but far less gum and root disease. That’s the case here.

The teeth cleaned up beautifully and the dog went home with fresh breath and a happy owner.

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Ahhh, the morning went along pretty well. Not all good news because of the ferret but at least she is responding to treatment. We can’t always eliminate the problem but we can hopefully eliminate the suffering that goes with it. Now, I run home to lunch and some precious moments with my little girl, Lexi, and I immerse myself into the world of a two year old until it’s time to do it again for the afternoon. Let me know if you like these posts, I will continue to do them. Otherwise, I’ll just post pics of dogs eating ice cream cones or iguanas wearing tuxedo vests, whatever the clients want me to do.

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Take care, Dr. Will Mandel

Lifelearn Admin | Blog

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