Lakeland Veterinary Imaging

553 Lake Drive Road
Edgerton, WI 53534

(608)630-0469

lakelandvetimaging.com


Chronic Nasal Disease - My dog is sneezing blood.

 -- 10/02/2015

Diagnosing nasal disease in dogs and cats.


Most of us sneeze once or twice on most days.  We know there are certain environmental conditions that can promote benign excessive sneezing and we try to avoid these if possible.   Things are similar for our pets who are constantly exploring their world by enthusiastically sniffing everything.  It is common for them to inhale dust and debris as they explore and this material is typically expelled by a sneeze or two.  The canine and feline nose are uniquely designed to be very sensitive sensory organs and a very effective filters at once.  

Clinical signs of nasal disease include excessive sneezing and nasal discharge that could be clear, mucoid, purulent (pus) or bloody.  In some cases, nasal discharge is intermittent, perhaps only observed during or after a sneezing episode.  In other cases, the discharge occurs continuously even when the pet is not sneezing.  

In advanced cases of nasal disease, there may be facial swelling or changes in the position of the eye that indicate an expansile swelling is originating from the nasal cavity.   In most cases, these advanced clinical signs represent an aggressive tumor or serious fungal infection of the nasal sinus.  

The nasal cavity is a very difficult place to examine.  It is almost completely surrounded by bone with very natural points of entry at the nostrils and above the soft palate.  This means there is no easy way to investigate nasal disease when it becomes necessary to do this.  


^^  This is a normal radiograph of a dog's skull and nose.

Classic nasal disease workups typically begin with empirical medical therapy that may include antibiotics, antihistamines or corticosteroid drugs.  These medications may be used singly or in combinations to determine if there is a positive clinical response in the patient.  A positive response often tells the veterinarian something about the cause of nasal disease in general, but typically cannot provide a specific diagnosis.  Of course in some cases, clinical signs can completely resolve using empirical therapy and everyone is happy.  

In other cases, nasal disease responds partially, temporarily, or not at all to empirical therapy.  These patients suffer from chronic nasal disease that may be due to chronic severe infections (bacterial and/or fungal), presence of nasal foreign bodies, or nasal cancer.  


^^ The dog on the left had nasal discharge and snzeezing, but had normal skull radiographs.  
The dog on the right also had nasal discharge and sneezing, but has very abnormal skull radiographs (likely cancer in the nose).

Advanced nasal diagnostics traditionally begin with radiographs to visualize structures of the skull - especially the sino-nasal region.  But high quality diagnostic radiographs are often difficult to obtain.  The patient must be heavily sedated or anesthetized to obtain this special study.  Positioning of the patient must be precise and the radiographs can be confusing to interpret for even the most experienced veterinarians.  

At Lakeland Veterinary Imaging, we believe that chronic nasal disease represents a classic indication for CT imaging.  We recommend CT be performed in lieu of radiographs as it provides much more diagnostic information than radiographs for only a small increase in cost to the pet owner.  The three dimensional imaging obtained in CT examination provides precise localization of any lesions and determines the most likely cause of nasal disease prior to additional diagnostic testing.


^^ This dog had sneezing and nasal discharge for months.  The CT scan showed no evidence of cancer, but a biopsy was collected and this patient was diagnosed with inflammation of the nose (rhinitis).

In most cases, CT examination is followed by nasal biopsy.  This biopsy procedure can be performed using lesion location data obtained on CT images.  In some cases (especially with small focal lesions), the biopsy requires guidance of an endoscope.  During this procedure, swab samples are typically obtained to culture for infectious organisms.  


If your pet has clinical signs of chronic nasal disease and has responded inadequately to empirical medical therapy, call or email the imaging professionals at Lakeland Veterinary Imaging.  We would be happy to advise you whether advanced diagnostic imaging is indicated and can provide an estimate of fees for the procedures we believe are necessary to diagnose the problem.  We want to help you get an answer so that appropriate therapy can begin for the patient.  In cases requiring complicated treatment or monitoring, we can also help you select an area specialist to provide this treatment.
-- Dan Heder

I just found out my pet has a heart murmur ... What should I do?

 -- 08/27/2015

Cardiac ultrasound (echocardiography) in dogs and cats.

Veterinary cardiologists estimate that approximately 10% of dogs and cats have some form of heart disease.  In some cases, cardiac disease can remain stable and the patient asymptomatic (no obvious signs of heart disease) for many years.  In other cases, the pet may develop significant symptoms very rapidly ... heart failure is a life threatening illness, but effective treatment is available.  


^^ This is a drawing of the heart, and how blood flows through the heart.  Dogs and cats have 4-chambered hearts that pump blood from the body through the heart to the lungs to pick up oxygen.  The oxygenated blood is then pumped from the lungs through the heart to the rest of the body to deliver oxygen to muscle, other organs, and the brain.  Murmurs can originate from the valves (aortic, pulmonic, mitral, or tricuspid) or from abnormal heart muscle (too thin or too thick).


Early symptoms of heart disease include cardiac murmurs, irregular heart rhythms and intolerance to normal activity.  This is why, every year, your regular veterinarian listens to your pets' heart and lungs.  As the problem progresses, difficult breathing and cough are often noted.  Unfortunately, some feline patients with severe heart disease can appear essentially normal at home until the moment they enter a cardiac crisis and become very ill.  

The care team at Lakeland Veterinary Imaging has the expertise to diagnose, treat and effectively monitor your pet with cardiac disease.  We can also work with your family veterinarian to develop a rational approach that is best for each situation.   



^^ This is called a "4-chamber view" of the heart on echocardiogram (this is a normal dog heart). 
The right side of the heart is on the top of the image, the left side is on the bottom.  The right and left ventricles are on image left, and the right and left atria are on the image right.  
(see the first blog image for a diagram)  


Emergency treatment of cardiac crisis is costly and emotional for pet owners and very uncomfortable for the pet.  Our goal is a treatment and monitoring strategy to dramatically decrease the risk of cardiac crisis.  In many cases this will require medication, but not all patients require medication in early stages of heart disease.  When appropriate, we will tailor a program combining recheck office visits with simple to perform observations you can record at home.   There is even smart phone software (http://www.alivecorvet.com/) to make recording this data easier for you and more rapidly available to the veterinary care team.  



^^ An example of an AliveCor ECG trace from a patient with a normal heart rate and rhythm.


Veterinary patients who suffer from acute cardiac crisis or severe late-stage heart disease may experience a significantly increased risk of complication due to anesthesia.  These patients are generally not recommended for elective procedures (dental cleaning/extractions, spays, neuters) that require anesthesia.  

On the other hand, many cardiac patients have a murmur with stable disease and little to no structural cardiac change. These stable patients have no significantly increased risk of anesthesia.  At Lakeland Veterinary Imaging we believe they should not be denied procedures that are required to preserve oral health or general comfort.  



^^ This patient has a leaky mitral valve (valvular insufficiency/mitral regurgitation).  
This leaky valve caused a murmur in this patient that was heard on a regular annual physical examination by the regular veterinarian.  Echocardiogram allowed us to determine if this dog could have anesthesia for a dental cleaning safely.


The key is accurate cardiac diagnosis and assessment which, in turn, requires experience and an advanced set of diagnostic tools.  Lakeland Veterinary Imaging brings 25 years of advanced imaging and cardiac medicine experience to your pet's care team.  

The veterinarians at Lakeland Veterinary Imaging want you to know ... your pet's newly diagnosed cardiac murmur will not necessarily prevent delivery of important general health care .... Even if that care requires sedation or anesthesia.  An echocardiogram can tell you many more details about what exactly is causing your pet's heart murmur.  
-- Dan Heder

My pet is urinating out of the litterbox/in the house... help!

 -- 07/30/2015

Using ultrasound in recurrent lower urinary tract disease.

Chronic or recurrent urinary disease is one of the most commonly treated problems in any small animal veterinary clinic.  This frustrating problem can affect cats or dogs of almost any age, but most often occurs at middle age or beyond.  Lower urinary disease can be uncomfortable for the pet and is of great concern for pet owners especially when nothing seems to help eliminate the problem.

Clinical signs of lower urinary disease can arise due to infections, stones or mineral sediment in the bladder, and tumors of the urinary system.  These clinical signs include straining or pain during urination, increased frequency and urine accidents in the house.  In many cases, there will be an abnormal amount of blood in the urine of affected pets, but there is not always enough blood for pet owners to visually confirm its presence.   

^^ This is a bladder with crystal sediment that was found on urinalysis.  Occasionally crystals in the urine can mean that there is a urinary bladder stone present.  That is why veterinarians usually investigate for urinary bladder stones when crystals are present in the urine.

In many veterinary clinics, first occurrence of these clinical signs is typically treated with antibiotic and/or anti-inflammatory medication.  Urinalysis is generally recommended to guide therapy decisions, but many affected animals have very empty bladders when they get to the vet's office and cannot be tested prior to prescribing therapy. 

Uncomplicated bladder infections respond rapidly to empirical therapy.  Clinical signs are usually resolved within a day or two of starting the prescribed medication.  In most cases, the problem does not return.

In chronic lower urinary patients, clinical signs of urinary disease return within days or weeks of completing therapy or perhaps never fully resolve even during the treatment.  For these chronic cases, diagnostic imaging is appropriate. 

While regular radiographs can sometimes identify bladder or kidney stones, they generally do not tell us much about the degree of inflammation in these organs and cannot determine if there is a urinary obstruction.  Special contrast X-ray procedures could be considered to fully investigate lower urinary disease, but these procedures may require anesthesia, can be very time consuming and are expensive.  In patients with chronic or recurrent signs of lower urinary disease, Lakeland Veterinary Imaging strongly recommends ultrasound examination of the urinary system.   

^^ This patient had urinary bladder stones (see green arrows pointing out the two stones where they collect with gravity) that could not be seen on radiographs.

With ultrasound, we are able to examine the kidneys, the ureters (connecting tubes from kidneys to bladder), the bladder itself and associated structures such as prostate gland and lymph nodes in the area.  Ultrasound gives us a real-time multidimensional picture of the urinary tract so we can pinpoint even the most subtle structural lesion responsible for chronic symptoms.  

In most patients, the reason for a chronic urinary problem is efficiently identified on ultrasound in a matter of minutes without anesthetize get the patient.  Bladder stones, tumors, or prostate disease are rapidly diagnosed so that additional diagnostic tests or definitive treatment can be prescribed.   

^^ This patient has a benign urinary bladder mass called a urinary mucosal polyp.  We had to collect a sample of this mass to find out if this mass was benign or malignant cancer.  These benign tumors often form after intense bladder inflammation and can cause blood in the urine.

Ultrasound is valuable in cases even when the urinary system is structurally normal because it offers a means to collect a clean urine sample from the patient with a syringe (a procedure called (cystocentesis).  Collection of urine by this method provides the best sample on which to perform culture (to determine the type of bacteria causing infection) and sensitivity testing (to determine the best antibiotic choice).  By performing a urine culture and sensitivity, we often discover a bacterial infection is resistant to drugs that were previously used in therapy and can provide a more appropriate medication in those cases.  

If your pet suffers from a chronic undiagnosed urinary condition, you can call or email Lakeland Veterinary Imaging to discuss the problem and determine if an ultrasound imaging procedure is an appropriate diagnostic test.  
-- Dan Heder

Welcome to our blog!

 -- 07/22/2015




Welcome everyone to the new blog for Lakeland Veterinary Imaging!  


For those of you who don’t know us, we are a team of veterinarians and veterinary technicians in Wisconsin specializing in advanced veterinary diagnostic imaging.  We perform outpatient computed tomography scans (CT scans), mobile ultrasound, mobile echocardiography (heart ultrasound), and radiology (x-ray) consultations for veterinary hospitals and their patients across the entire state!   Lakeland Veterinary Imaging LLC was formed in 2010 by Dr. Dan Heder to provide veterinarians with a convenient, affordable, and high-quality service to eliminate the barriers to advanced diagnostic imaging.   Today, it’s not only Dr. Dan Heder that you may see in your regular veterinarian’s office, but also his daughter Dr. Brianne Heder.


We hope to use this blog as a source of information about ultrasound, x-rays, and CT scans and their use in veterinary medicine for pet owners and veterinarians alike.  To learn more about the team, and the services we provide, check out our website:  www.lakelandvetimaging.com.  

-- Dan Heder