Creature Comforts

Ok, I’ll admit it – I’m a huge Harry Potter fan. Anyone who knows anything about Harry Potter knows about the horrible, forbidden “cruciatus curse,” which causes the intended victim to writhe in excruciating, agonizing pain.

I know of a real-life injury that can cause a similar terrible pain – a torn anterior cruciate ligament. It’s a condition that can occur in anyone with knees. For most, this injury is a traumatic one, and is the result of a tremendous external force on the knee.

Football players typically sustain cruciate ligament injuries when hit in the knee by another player. Cats usually acquire cruciate ligament injuries when hit by a car, as they generally avoid being tackled by football players. Interestingly, cruciate ligament injuries can occur spontaneously in dogs. The reason for this apparently has to do with the way the canine stifle (knee) is put together.

There are two cruciate ligaments in the knee: the anterior (or cranial) and the posterior (or caudal). These ligaments cross within the knee joint, hence the name, “cruciate.”

The positioning of these ligaments provides stability to the knee joint, preventing the femur and the tibia/fibula from sliding on each other.

A classic test for an anterior cruciate ligament injury in dogs is “cranial drawer sign,” which checks for instability and abnormal sliding motion within the knee joint.

The most common scenario for dogs injuring their cruciate ligament is one that I have witnessed myself.

One summer, while my parents entrusted their dog, Norman, to my care, I sort-of … broke him. It was an accident! I thought I’d be nice and throw the Kong for him outside in the yard. As is my usual experience, no good deed goes unpunished.

Norman, a big, silly labrador of the chocolate variety, was enraptured by the mere thought of playing fetch, even when faced with my pathetic, weak-armed throws. Norman, always optimistic, did not judge the thrower of the Kong.

Norman was in love with the Kong and would follow it over a cliff, if necessary. No, this story does not take place near a cliff. It takes place on a glorious, sunny day on a wide-open, flat lawn.

As I hurled the Kong as far as I could (which, sadly, wasn’t very far at all) I watched as Norman took off in an all-out sprint.

There’s nothing like watching a retriever doing his thing. And then, I watched in horror as his left knee did a funny sort of bend, and he let out a yelp. He ran back with the Kong in his mouth, using only his other three legs.

Grief has five stages: denial, anger, bargaining, depression and acceptance. I believe my exact words at that moment were, “NO! This is not happening! Norman, you jerk – why’d you have to do this on MY watch? C’mon, you can put it down, look, it doesn’t hurt that bad, how about for a treat? I think I’m gonna cry. Well, I guess I’d better call Mom and Dad.” (The naughty words from this passage have been edited out.)

I was pretty sure my parents were going to kill me. FYI: Hallmark doesn’t make a card for, “Sorry I broke your dog.” I had to make up for it by doing Norman’s surgery myself.

There are some risk factors for dogs unexpectedly rupturing (tearing) their anterior cruciate ligaments, such as having a family history of this injury, obesity, and being out-of-shape, but that doesn’t mean it can’t occur in dogs with no apparent risk factors. It can happen in any age, breed, sex or size of dog.

I am freshly reminded of this since I spent several hours last Wednesday night at a continuing education meeting on this very topic.

Anterior cruciate ligament rupture happens to be THE most common injury to the canine knee joint, so many surgical techniques have been developed through the years. Interestingly, even after many scientific studies, not one technique stands out as “the best,” though opinions can become heated amongst surgeons on the topic. The good news is that most techniques work pretty well. And yes, surgical correction is the best treatment for this condition.

Sherman, my sister’s chocolate lab, tore his anterior cruciate ligament when he was just 2-years old. I was no where near him when it happened, thank goodness. As it turns out, the injury occurred during a play session with Westley, my parents’ then 3-year-old golden retriever.

I’m not sure, but I don’t think either dog was wearing protective pads or helmets. Not that it would have mattered, anyway.

A dog like Sherman that manages to tear his anterior cruciate ligament simply running in the yard, is apt to do it again on the opposite side – and the chances of that happening are as high as 70 percent while he’s favoring his already sore leg.

And guess what – Sherman did just that about a year after his left knee was repaired. It’s the cruciate curse – bummer.

The “drawer sign” test can be difficult to do in an awake patient in pain, so, many times we sedate the dog and perform radiographs (x-ray pictures) to check more carefully.

Although torn ligaments are difficult to detect on a radiograph, x-rays can help rule out other possibilities, like tiny fractures, arthritis and cancer. When dealing with a dog suddenly refusing to bear weight on a hind leg, it pays to be thorough. The anterior cruciate ligament in dogs is a fan-shaped structure, and even when only partially torn, can cause great discomfort to the dog without a detectable “drawer sign.” Sherman was one of these cases.

Even when fully anesthetized, Sherman’s stifle was stable and did not exhibit “drawer sign.” However, following the laws of probability, as well as what my Dad refers to as my professional acumen, I decided to surgically explore his knee anyway.

Sherman’s cruciate ligament was torn, but not all the way through – it was hanging on by about two threads. Fortunately for Sherman, the injury was very recent and very little arthritis had developed in the injured joint.

Although surgically invading a joint is guaranteed to induce inflammation and begin arthritic changes, with the proper stabilizing technique, medicines and post-surgical physical therapy exercises, most dogs have minimal discomfort.

That being said, contact sports are strictly forbidden once the dog has undergone surgery. I suggested to my sister that Sherman take up golf.

Seriously, swimming is an ideal sport for a dog like Sherman.

Unfortunately, unless Sherman joined the Y, I seriously doubt he’s been swimming much while living in Buffalo, N.Y.

So, instead, it’s long walks on the leash, which Sherman does enjoy.

Suffice it to say that although Sherman’s Frisbee dog career never got started, it never will.

Mostly, that’s because Sherman has never learned to catch anything in his mouth, and although he will chase a frisbee, he tends to then eat it, which is universally frowned upon in the frisbee-ing community.

And if you’re ever lucky enough to watch a true frisbee dog in action, please don’t even jokingly refer to the cruciate curse. Not funny.

Daverio is a veterinarian at Williamsport West Veterinary Hospital.

Creature Comforts

“What do you mean, ‘They’re on their way?’ ” I asked, forcing my eyes open, now sitting bolt upright in bed. It was still black as night outside.

“She was very upset,” the answering service operator said, “She and her husband are on their way to the hospital with the dog. They’ll be there in two minutes. She said she thought the dog was having a heart attack.”

“A what?” I said as I began dragging on some jeans.

“Heart attack.”

Having no more information than this, and having no way to call the owners who were presumably already waiting in the parking lot of the veterinary hospital, I finished dressing and made my way to work, about two hours before the place was to open.

Unable to communicate some important information, like how long it would take me to get there, I was hoping the owners would not have had heart attacks themselves while waiting for me to arrive. Thank goodness for them I lived relatively close. Thank goodness the dog had not required any first aid, as there was no way for me to instruct them, being incommunicado. I was worried about the atypically irrational behavior of these owners.

When I arrived, I found the dog to be panting heavily, but in no significant distress. The owners were distraught, but otherwise apparently in good health. Sans heart attacks, all around.


The history of this mysterious case was as follows: LuLu the pug, just two years old, was perfectly fine the night before – ate dinner, drank water, did her business outside and went to bed – as usual.

But, when the owners woke the next morning, LuLu was panting heavily, pacing, and was looking very uncomfortable.

She was intermittently whining. She didn’t eat her breakfast, which for LuLu was alarming, as she had never missed a meal in her whole two years. She was not vomiting; she went outside to urinate and defecate, both seeming normal.

LuLu was undoubtedly uncomfortable – I recognized a problem right away: Her belly was very big, and she “splinted” or winced, holding her abdominal muscles very tightly when I palpated her there. Her belly wasn’t rock hard, but it was definitely distended with what seemed to be gas. I admitted her for tests, but was able to assure the owners that LuLu was not having a heart attack, which seemed to put them at ease.

After assuring her owners over the phone that LuLu’s heart was fine and her blood tests were normal I said, “LuLu’s abdomen seems to be the source of her discomfort, and the radiographs show that the stomach and the entire length of her intestine are distended with gas.

Did LuLu eat anything out of the ordinary?”

“No, she just ate her own food,” Mrs. replied. “We don’t give her food from the table. And she didn’t eat anything at all this morning.”

“Does she chew on toys or objects that she may have swallowed?” I asked.

“No, she didn’t even chew stuff as a puppy,” she said.

Hmmm. Nothing is easy.

I hung up, feeling deflated, as I was sure this was a clear case of dietary indiscretion.

Nonetheless, I was on a mission to treat my patient, who badly needed to be deflated, too. So to speak.

No, I didn’t stick a pin in her and watch her sail backwards all around the room like a balloon. That only works in cartoons. However, a similar technique can be used in a dire emergency (minus the sailing around the room) which I’ll get to in a moment. For LuLu, “the doctor said Mylanta.” Worked like a charm, and relatively quickly. Within an hour of being more or less forced to swallow the chalky medicine, LuLu was wagging her curly tail wildly and looked much happier. Success.

So, back to that dire emergency I just mentioned. LuLu was bloated – stem to stern, and getting the gas distension under control was very important, before it led to a much more serious condition in which the stomach becomes so bloated, it begins to twist on its own axis. This condition is called GDV: Gastric dilatation and volvulus, but is commonly known as “bloat” or “twisted stomach.” Suffice it to say that if this condition develops, the situation has suddenly become very, very bad.

The typical M.O. of a dog with GDV is as such: Large breed dog eats a big bowl of food really fast, perhaps more than a bowl, chugs a whole bunch of water, and runs around like a maniac.

Within an hour, the dog looks as if it wants to die, retches as if to vomit, but can’t, and the owners invariably describe a rock hard belly, getting larger before their eyes. Many of these dogs are collapsed by the time the owners make the call.

This situation is dire, and many of these patients die before treatments can be begun.

GDV is diagnosed via telltale signs on physical examination and abdominal radiographs. The first and foremost treatment is the aggressive administration of IV fluids and an attempt to relieve the gas distention, usually by passing a tube into the stomach through the mouth.

Many GDV patients are so debilitated, sedation is not often required. If a tube cannot be placed, but the abdomen is becoming very distended, the dog’s breathing may become affected, among other problems, and a trocarization may be performed.

This technique actually does involve the aforementioned ‘sticking a pin in a balloon,’ in a manner of speaking.

The doctor will use a large gauge hypodermic needle to pierce the bloated stomach right through the dog’s body wall, allowing it to deflate some. While this is a quick fix, it does not resolve the problem, and poses the potential for stomach contents to leak from the hole made with the needle – a necessary risk in some cases.

The current thoughts on GDV are that most, if not all cases require surgery to correct the twist, which often involves the spleen along with the stomach.

A gastropexy is then performed to “tack” the stomach to the body wall with sutures to prevent the stomach from twisting again.

The sad reality is that many of these patients have long-term complications following GDV, even after surgery is performed successfully.

Although it is uncommon, small breed dogs can be victims of GDV – the smallest I’ve seen was a Maltese. Cats do not get GDV, but they can become bloated.

Fortunately for LuLu, she was just bloated but not twisted. Later that day, I got a call from her owner.

“I was wrong,” LuLu’s owner said. “She did eat something unusual.” I couldn’t wait to hear this. I was hoping it wasn’t something inedible.

“My son had a Valentine’s Day party at school yesterday,” she said, “and he left his backpack open on the couch.

He didn’t notice until this afternoon that there was an entire box – a BIG box – of JuJu-Hearts, you know, like jelly candies, all gone.

LuLu ate the whole box, probably last night. Do you think that’s what did this?”

Relieved and feeling somewhat vindicated, I said, “Yes.” Another case solved: LuLu’s JuJu-Heart Attack.

Daverio is a veterinarian at Williamsport West Veterinary Hospital.