To Pexy or Not To Pexy?

Right lateral abdominal radiograph taken of Cole shortly after arrival at the Huronia Veterinary Emergency Clinic.

On Easter Sunday, right around dinner time, Cole had an episode of "mild to moderate" gas distension of his stomach. A state of silent panic started inside me as soon as I saw this image. The DVM on duty was not overly concerned about it, but erred on the side of caution and recommended to keep Cole for observation and treatment if necessary. There was no torsion of his stomach, and the gas resolved on its own with only minimal treatment. Upon discharge, it was recommended that I discuss a prophylactic gastropexy with my regular DVM, although the ER vet would not necessarily recommend this himself.

This is where the dilemma begins.... There is much controversy right now in the veterinary community about whether preventative gastropexies should be performed. Some pet owners of high risk breeds are opting to have this procedure done while the pet is in for his / her spay or neuter. Cole's situation is a little bit different, as he has now had an episode of gas build up in his stomach, the precursor to bloat and GDV. Because I own one of the "high risk" breeds, I am always on high alert when it comes to GDV. Arlo's littermate, Mika, had a full blown GDV not long ago while in my care. I caught it immediately, and I knew what was going on. I got her in to my vet right away, and she was rushed into surgery. She survived with no complications. Not all do.

Based on Cole's history and the recent research I have done, I am leaning really heavily towards having the gastropexy done. There are many good reasons in my mind to have this procedure done now. He will be stable when he goes in for surgery rather than in a life threatening state of health. Post-op complications will likely be far less than if he'd had the procedure done post GDV. There is always a risk with any surgery. The risk would be far, far greater if I decided to "wait and see". Dogs that bloat once almost always will bloat again. It is usually just a matter of time... If Cole develops a GDV and I am not here to catch it right away, the outcome could be devastating. That is simply a risk I do not want to take.

ShowStopper Success Story

For a few years now, Cole has suffered from seasonal itchy skin and usually gets a few hot spots in the summer months. These were previously managed the usual way... clip the hair, keep the area clean and dry, and keep the dog's mouth away from the hot spot using an Elizabethan collar if necessary. The bacteria in the mouth do not belong on the skin, and can make any skin condition worse. Cole would usually spend a few weeks of every summer wearing an Elizabethan collar. I experimented with different diets, and with Cole also suffering from SIBO, I had to be careful when trying out a new food. I found a diet that agreed with his digestive system, and also did not produce any itching - for most of the year he was comfortable. However, come summer and the hot humid weather that is so typical of Ontario, he would always suffer from hot spots.

On the advice of Richard from ANR-Specialties, I decided to give the ShowStopper supplement a try for Cole. This supplement is not specifically marketed for relief of hot spots, however he was aware that the product had provided relief for many dogs suffering from hot spots and itchy skin. With the alternative for Cole likely being a need for antibiotics +/- some steroid therapy to control his itching / hot spots, I decided that we had nothing to loose trying this supplement. Richard did warn me that the cost may be a factor, as the supplement is not cheap. This did not deter me. I thought that if the supplement did in fact work, and Cole was able to live E-collar and itch free, then it would be well worth the price. I also liked the idea that perhaps his itching could be managed drug-free.

Being from a scientific, western medicine, veterinary background, I would have been very skeptical to try something like this in the past. I have learned though over the years, that sometimes you just have to give things a try... as long as there is no potential to cause harm, then trying things that have not been "scientifically proven" may just prove to be worth your while. Such was the case with the ShowStopper. I didn't expect to see any improvement in Cole's skin for at least a month. Well, within 2 weeks of starting the supplement, Cole was no longer itchy and his hot spots had healed and was living without his E-collar. If I didn't see it for myself I never would have believed it. On the advice of Richard, once we saw relief, we decreased his dose of the supplement to the lowest effective dose. It does not have any claim like this on the label, it was simply Richard's advice from past experience. Although Cole's labeled dose is 3 scoops per day, and up to 6 scoops per day, Cole is easily maintained on 2 scoops per day. And he loves the taste. The one down side to this supplement is weight gain. It is so high in fat, that Cole quickly gained weight. And, with him not being able to exercise properly because of his ongoing SLO, he bulked up in no time. I had to experiment with the portions of his food, as he is also on an energy dense food. As a young dog, we had tremendous trouble trying to keep weight on him. So, we quickly stabilized his energy intake, and although he is still a bit heavy, he is doing well.

The biggest improvement I saw with Cole would be with his skin and his coat. He was no longer itchy and his coat was beautiful, shiny, and better than it has ever been. This product also significantly reduces shedding. Once again, if I hadn't seen it with my own eyes, I never, ever would've believed that claim. There are so many products out there that claim to reduce shedding..... I thought they were all just marketing claims..... after all, many dogs have a double coat... Dogs SHED!!!! Especially Cole. He has a very typical GSD coat, heavy, double coat, with a lot of undercoat, and he was always a heavy sheddder even though he is a house dog and never really develops a true winter coat. Well, it is like a dramatic transformation.... he barely sheds at all now. Even when I brush him, the hair that comes out is negligible, unlike before when I could get mounds and mounds of undercoat out of him, enough to seemingly make another GSD. Those of you with shepherds who have coats like that will know exactly what I am talking about. It's so unbelievable, that I won't truly believe it until spring comes. This is when the shedding is usually the heaviest. I'll be sure to report back at that time. In the meantime, I plan to keep Cole on this supplement indefinitely, and although it is a bit pricey, I feel it is well worth it.


Below, Cole with his new, shiny coat.

The Last Nail Hath Cometh Off...

This is the very last nail of Cole's to come off. He is now free to do whatever he wants, with nothing holding him back. Only time will tell what will become of the new nails that have yet to grow back. So far, the few that are growing back are all deformed, but do not seem to be causing him any discomfort.

See my earlier post here for the full story.

The Horrors of SLO - Symmetrical Lupoid Onychodystrophy

Cole...

Symmetrical Lupoid Onychodystrophy (SLO) is a disease affecting the nails on a dog's paws, which causes complete loss of the nails (Onychomadesis). I had not heard of this condition before, which is why I was unaware of what was really going on with Cole when his first nail lifted off back in April of this year. It was a warm April afternoon, just before the easter weekend, when the nail on the most lateral toe on his right hind foot lifted off. This was the result of a traumatic injury; he was running around in the yard, ran too close to my husband, clipped his shoe with his left hind foot, screamed and when we investigated, we saw a nail that had been ripped off right to the nail bed, quick exposed underneath. The nail was not loose enough to pull off (we tried), so I took Cole with me to work the next morning, and with the help of some topical anesthetic cream, the nail was sucessfully pulled off without the need for a sedative. I really thought nothing of this at the time. Since I've been working in the veterinary field for 14 years, I have seen many nail trauma injuries where the nail must be pulled off. We bandaged his foot for a couple of days, and waited for it to heal.

Not long after this initial incident, perhaps a couple of weeks, another nail lifted off right to the nail bed. This time I could not confidently say that a trauma had taken place. Shortly thereafter, a third nail lifted. Just picture the hood of a car lifting up, intact, and then staying up in the lifted position; this is exactly what was happening to Cole's nails. The entire nail, intact, would detach from the quick, and lift up, staying attached at the nail bed. Upon closer inspection, nothing else out of the ordinary was apparent.... no swelling, no infection, no oozing, no abnormal appearance of the nail or surrounding tissue, just a nail that lifted up, leaving the quick exposed and the dog in significant discomfort. None of these nails that detached in this way were loose enough to be pulled off. The only option was heavy sedation or general anesthetic, or wait for them to fall off. After the 3rd nail lifted, I began asking questions to my veterinary friends and colleges... One DVM had heard of this, and had treated a few dogs, all them GSDs or GSD mixes. Others had heard of it, but were not familiar with it, and others simply had not heard of it. I decided to put a post on my favourite GSD online forum. I would never recommend this in place of veterinary advice. But I do like these forums, as there is so much traffic on there, you are almost certain to get a response from someone who has either had a dog with a similar condition, or from someone who knows someone who had a dog with the condition. This then sets the ball in motion for you to get more info, what you were after in the first place. Also, having dogs with rare medical conditions myself, I find it very comforting to communicate with others who are actually living with and managing these dogs as part of their daily lives. This is invaluable to me. In short order, I got a response from a couple of members who referred me to some links on SLO, including a yahoo group dedicated to the disease. I also had the added benefit of having a friend who was just finishing vet school, who did some research on VIN for me. Being an RVT, I don't really have access to the GOOD part of VIN. After some reading and some discussion, we are pretty certain that Cole has SLO. The only way to a definitive diagnosis is through ampuation of P3 of one of the afftected nails, something that is not actually recommended.

Cole had to suspend all activity, including his much loved agility career, which was just starting to take off. He could not run, play, go for walks, or even play fetch, his absolute favourite activity. I did try a few times to keep his agility lessons up, but even if he was having a good week with no nails that were lifted at the time, often just the activity alone would be enough to cause one or two more to become lifted off. The nails that were lifted but still attached were the most painful periods for him. Once the nails finally fell off (anywhere from 7 to 10 days typically), he was so much more comfortable. I also found that if he did little or no activity, thus significantly decreasing the chances of the nails lifting off due to trauma, that the nails took much longer to actually lift off away from the quick. This meant that by the time they actually did lift off, the quick was already blackened and somewhat hardened, and less painful for him. The nails that were lifted prematurely from trauma (such as from playing fetch), left a very tender, pink, raw, painful quick exposed. Also, because they were lifting off over a period of months (he has one nail left to come off as this is written - remember it started in April), putting him under sedation or GA everytime a nail lifted to have it pulled off was not practical or a good idea.

I am trying conservative treatment for him first, as there is some evidence that some people have had success with this. If this does not help, there is the option of him going on long term medications that have been reported to have some success.

At this time, Cole seems confortable, and pain free. He has lost all 18 of his nails, except for one, which will be gone soon. Some of the nails appear to be growing back, albiet deformed. I will have to closely monitor the nails that are growing back, and keep them as short as possible. Soon he will be able to continue on in agility again, which will make him really happy.

I did not get any photos of the nails that were lifted off prematurely due to trauma, thus exposing the quick when it was red and raw.

Below is a lateral view of the left front paw. I am holding digit # 3, of which you can clearly see the entire intact nail has lifted away from the soft tissue underneath, yet still remains attached to the nail bed (Onycholysis). The quick has turned black, and has started to dry out.


Below is the same toe, from a head-on view. Digits 2 - 5 are all visible here. Digit #2 has already had the nail fall off, digits 4 & 5 still have the nails attached.


Below is a lateral view of the left hind paw. Digit #5 is clearly visible with the nail detached from the quick, completely lifted off, yet still attached at the nail bed. These nails are slightly movable, but cause considerable pain when touched.



Below is the same digit as the above photo, but looking at the toe from a head-on position.


Below is a medial view of digit #2 of the right hind paw. The nail has fallen off, and the underlying soft tissue has turned black and dried up. The nail is in the process of growing in, but it is deformed (Onychodystrophy).



Again, a medial view of the right hind paw. Here digits 2 -5 are visible. I am holding back some of the hair, and the new nails growing in that are deformed (Onychodystrophy) are seen here, especially on digits 2 & 3.

Below is a medial view of the left front paw with Cole in a sitting position. Here we see digits 2 & 3, with #2 missing the nail completely and a dried up quick, and another view of #3. Here it is easy to see what position the nail is in when the dog is weight bearing.



This is a lateral view of the right hind paw. I am holding digit #5. This was the very first nail to come off, as the result of the trauma described above in April. Here we can see a new nail growing in, but it is deformed (Onychodystrophy), and not really attached to the underlying tissues.

Dorsal view of the right front paw. Digits 2 - 5 are visible here. All the nails have come off. There is regrowth of nails, especially # 3 & 4, but they are deformed.



Lateral view of left hind paw with Cole standing. Digit 5 is seen here with the nail lifted up while Cole is weight bearing.

Lateral view of left front paw with Cole sitting. Digits 4 & 5 still have the nails in a normal position, yet they have become detached from the underlying tissue, and it is only a matter of time before they lift up. This is another view of digit 3's lifted nail, alongside the 2 that are still in normal position. It was much harder for Cole to walk without pain when nails on his front paws were in the lifted position, as opposed to the hind paws.


Palmar view of left front paw. Digit 3 is visible with its lifted nail. Digits 4 & 5 still have their nails in a normal position, but they have detached from the underlying tissue (Onycholysis). They appear as a loose sheath covering the quick.

Glossary of Terms:
Onychodystrophy - malformation of the nail
Onycholysis - loosening or separation of the nail from its bed
Onychomadesis - complete loss of the nails

Links:

Yahoo SLO Group - http://groups.yahoo.com/group/SLOdogs/join.
Brief description of SLO, plus has a great link to a published study from the UK - http://www.bloodaxe.com/SLO.html