Magenta was able to eat kale normally again after her treatment.

We have had many guinea pigs over the years but none has ever chirped and squealed like our youngest one, Magenta.

Our family delights in her constant greetings, day or night, when she hears my voice, we enter the room or open the refrigerator door.

The day her squeals suddenly stopped, I knew something was wrong.

I had also noticed her food intake had been slowing down over the previous days but thought perhaps since she was still young, just under a year of age, this was due to her having reached adult size.

When I checked her cage the next morning I was met with silence and I found she had not eaten her hay from the night before. She didn’t come to greet me and showed no interest in the fresh piece of kale I offered.

I immediately called Dr. Jonathan Mitelman at VETSToronto at the Kingston Road Animal Hospital. Dr. Mitelman has taken care of several of our family rabbits and guinea pigs (properly known as cavies) and has educated me well in their care and health concerns.

These little guys need to have constant food going through their gut to keep their systems functioning well and when they stop eating a check-up is in order as soon as possible.

Magenta’s weight was taken (850g), but we were not certain if she had lost any as the previous number had been taken months prior while our pig was still a baby. I said she felt more “boney” that her usual plump shape.

The physical exam showed muscle atrophy but she did not resent abdominal palpation. Radiographs were normal. Her incisor teeth appeared slightly overgrown and Dr. Mitelman was not able to assess the molars.

Dental overgrowth was likely secondary to something else that was causing and/or resulting in gastro-intestinal pain.

For example, there is ileus (a stall in GI gut movement), or dysbiosis (disequilibrium of the gut bacterial flora), thereby permitting dental elongation, and thus inability to eat properly and provide the gut with necessary fibre.

As guinea pigs are hind gut fermentors (as is a horse), when food does not move properly through the system, that system begins to cease functioning. A painful gut means the guinea pig stops eating.

When the hay is not chewed, the teeth are not ground down adequately and become overgrown. Sometimes the source is difficult to define so it becomes a cycle with undetermined origin but requiring immediate intervention.

We needed to hand feed Magenta with Critical Care for Herbivores from Oxbow, a complete diet supplement, in order to provide her with required calories and restore her gut to normal function.

This would also replenish her fluids as maintaining hydration was essential. In addition, she was prescribed antibiotics and a motility stimulant. We added more Vitamin C by way of a tablet crushed into her feedings.

As guinea pigs require Vitamin C, we needed to ensure a deficiency was not contributing to her condition.

Guinea pigs, like humans, have systems that do not produce Vitamin C and require dietary supplements. The hay that is the bulk of the Guinea pig’s diet contains very little Vitamin C.

Problems of this deficiency, called ascorbutus, or scurvy, include but are not limited to lameness, lack of appetite, and dental pain. If there is a slight deficiency, they may not show any recognizable signs, but the immune system might be compromised and have decreased ability to fight off illness.

Magenta accepted the Critical Care very well. But it did not stimulate her to eat on her own. Her stool output declined significantly, as did her fluid intake.

We brought her back for a follow-up exam. Her weight had dropped to 820g. Her tongue appeared “entrapped” between her lower molars limiting the free movement of the tongue around the visible incisors or tearing teeth.

Magenta was admitted to the hospital and blood work was done. This revealed hepatic lipidosis, or fatty liver disease. Despite the quick medical intervention, her body had already begun starving itself.

Dr. Mitelman did intra-oral radiographs to assess and inspect her teeth and mouth. This required anesthesia.

Possible causes could be dental spurs, tooth root abscess, a foreign body lodged in her tongue, or lingual inflammation/ulcer/trauma.

Her teeth did not appear out of the limits of normal but her incisors had slight obliqueness indicating uneven wear. Dr. Mitelman rasped Magenta’s molars and trimmed her incisor’s slightly.

He attempted an ultrasound to search for abnormalities and did not detect ovarian cysts, but gas present in her gut impeded visualization of most abdominal structures.

Dr. Karen Regan, of Animal Hospital of High Park, was called in for an on-site consultation and examination of Magenta. She recommended regular re-checks of Magenta’s mouth for suspected dental irregularities and increasing the amount of supplemental Critical Care to encourage weight gain.

Our goal was to achieve a minimum 100g increase in her weight.

At home, Magenta appeared to want to eat, but was unable to prehend the kale with her tongue. She actually worked out how to stuff parcels of veggies into her mouth with her fore paws, indicating she was hungry.

It took some weeks, but Magenta began eating on her own and was weaned off her supplemental Critical Care.

We continue to do monthly dental and weight rechecks. She has been slowly gaining weight and now registers 920g.

Our home is once again filled with Magenta’s cheerful chirps and squeals.

Lessons learned:

1. Guinea Pigs need regular veterinary check ups and care. A base weight is beneficial. A palpable back bone and spine (you can feel the bones) require an immediate consult.

2. As prey animals, guinea pigs go silent when they have pain. If they stop eating or have loose or clumped stool, consult a veterinarian ASAP. Prolonged anorexia can be fatal.

3. Prolonged growth of a guinea pig’s molars will eventually stretch their TMJ (the temporomandibular joint or “jaw joint”), resulting in weakening of muscles and inability for adequate mastication (chewing) of ingesta.

4. Proper nutrition is essential to a cavy’s health and longevity. Ask your veterinarian for guidance in this area to ensure you have a balanced diet for your guinea pigs.

Billy's serious paw infection brought him to VETSToronto as an emergency. He fully recovered.

When Diva, a pug, was having trouble breathing, her owners rushed her to VETSToronto. She was suffering an acute allergic reaction and needed emergency treatment.

Cohen, a standard poodle, swallowed a stone. His owner saw him do this and immediately took the dog to their regular clinic. Radiographs revealed the rock’s location and the owner was advised of the treatment options.

The veterinarian referred the case to VETSToronto where the surgeons were able to remove the foreign body via endoscope.

These are the types of cases Dr. Morris Samson had in mind three years ago when he and his partner, Dr. Jonathan Mitelman, opened VETS (Veterinary Emergency Trauma Service), housed within the existing Kingston Road Animal Hospital.

It allows doctors to provide 24-hour veterinary care in one neighbourhood location.

When Dr. Samson opened the doors to the hospital 25 years ago, he vowed to listen to, and grow with, the surrounding community. Dr. Mitelman joined the practice in 2002 (he became a partner in 2005), sharing that commitment to embrace the ever-changing veterinary world.

Some things do not change, however. Pets can become ill or suffer injuries on holidays or outside of regular office hours. In some cases, just the time traveled to obtain medical intervention can affect the pet’s outcome.

Prior to VETSToronto’s arrival, the nearest emergency hospital was over 10 kilometres, or a 20 minute drive, from their Kingston Road location.

Many different cases find their way to VETSToronto. Some are clients of the regular day clinic, others are referrals from other veterinarians. There are also cases where pets become very ill or suffer trauma and the owners come as emergency walk in-clients.

Here are some more:

Lucy, a boxer, was struck by a fast-moving bicycle while walking near the waterfront with family members. Not close to home and unfamiliar with the area, a local resident directed them to VETSToronto where they rushed the injured dog.

Surgery was performed to repair the dog’s fractured leg.

Bubble’s pet sitter knew the cat was very sick and recognized he needed to be seen as soon as possible. Bubble’s owners were away and their regular clinic was not open. The pet sitter brought him to VETSToronto.

On presentation, the cat, suffering from chronic kidney disease, was moribund, laterally recumbent and dehydrated. Treated and returned back to the referring clinic, Bubble is doing well with ongoing fluid management.

Emma, a standard poodle, was retching, prancing and her belly was swelling. These are signs of Gastric Dilatation Volvulus (GDV or bloat), a life-threatening condition that requires immediate medical intervention.

Her owners brought her to VETSToronto where Dr. Mitelman performed the middle of the night corrective surgery.

At times when the pet is in the palliative stages or is gravely ill, having the clinic open 24 hours can make a difference.

When clients have made the decision for euthanasia for their pet, they can either spend time at the clinic with their pet or they can take the animal home, knowing they can bring it back at any time of the day or night. No travelling to an unfamiliar environment.

Drs. Mitelman and Samson see the 24-hour emergency and after-hours hospital as an opportunity to provide pets and their people with what they feel is a full circle of care.

For regular clients, after-hours doctors have access to all of the patient records, pets are coming to familiar surroundings and Drs. Samson and Mitelman oversee cases, ensuring continuity of care.

Clients who are referred by other veterinarians, or come in as emergency cases, are assessed, stabilized and treated. As soon as medically feasible the pets are sent back to their regular clinic for continued care.

Follow up with both owners and referring veterinarians is done and patient records are sent to the home clinic.

Opening 24/7 has allowed the doctors to grow in other ways than just extended office hours.

There are upgrades of techniques and technologies. There have been additions of on-site staff and connections made with external consultants. Increased cases involving exotics (birds, rodents, rabbits, amphibians) come to the hospital.

Lessons Learned

1. Here is a list to help you know when a trip to the ER is needed: Seizures, breathing difficulties, inability to walk, collapse, unrelenting vomiting or diarrhea, trauma (car accident, falls, cuts etc.), toxic or foreign body ingestion, straining to urinate, bloat or choking. When in doubt, ask.

2. Emergencies can happen outside of regular clinic hours. Locate your closest vet emergency hospital and investigate it ahead of time. Post the phone number in an easily accessible location. Prepare as best you can for the unexpected.

3. If you have an exotic pet, find an emergency clinic that will see and treat your pet.

4. Kingston Road Animal Hospital/VETSToronto is a full-service facility offering emergency and after-hours care, referral services, critical care and overnight patient monitoring. The hospital offers on-site ultrasonography, endoscopy and laser surgery.

Visit www.vetstoronto.com for a full listing of services.

Dr. Jonathan Mitelman answered questions from Centennial College journalism students at a recent visit.

There is more to a veterinarian’s day than administering annual vaccines, prescribing flea medications and offering a friendly pat on your pet’s head.

A recent trip to Centennial College, where Dr. Jonathan Mitelman of VETSToronto was interviewed by journalism students, confirmed a need for community outreach and education.

The students who interviewed Dr. Mitelman asked pointed questions and the common thread brought the conversation back to pet owners. Not surprising when the health and happiness of the pet really relies heavily on the owners’ participation in their pets’ veterinary care.

Dr. Mitelman acknowledged the connection between the pets and their people is of the utmost importance and a key factor in the veterinarian-pet-client relationship. Although experience is a good teacher, each case before him must be treated on an individual basis.

He sees his role as being to treat the pets through educating, informing, and supporting their owners.

It is not uncommon for pet owners to miss signs of illness. Animals can be stoic and often do not show when they have pain.

It is the veterinarian’s role to help spread the message that regular physical examinations and preventative care are essential to overall well being, just as is the case with humans.

Some symptoms pet owners often miss include a refusal to eat or decreased appetite, increase in water consumption, changes in urination and defecation patterns and personality or temperament differences.

Any of these should be reported to your veterinarian for further investigation.

Another question concerned my own dog Billy, whose story we have told on Twitter via @DawgBlogger (http://www.littleurl.net/6cd1a7). This led the conversation in two directions.

First, they were interested in the participation by VETSToronto on various social media platforms and, second, why vets and owners are so persistent in the search for answers and treatments in challenging medical cases, such as Billy’s.

Dr. Mitelman explained that the conversation on-line through various social media platforms has allowed us to not only share our cases (Billy and others) and medical and educational material, but has allowed us to hear from veterinarians and pet owners who may have similar stories to tell.

We hope our message of encouraging open dialogue with their own veterinarians has helped owners to feel more comfortable with the process.

As for the dedication of pet owners, one can never under estimate the lengths people will go to care for their much-loved pets. A veterinarian will guide and support. Open lines of communication always bode well for the pet.

Also on the students’ minds was the difficult question of breaking bad news about a pet’s health or potential negative medical outcomes to the owners.

Dr. Mitelman said owners need to know the facts and the available options for treatment. Diagnostic tests, consults with specialists, possible medications or procedures, on-line research are all openly discussed with the owners so that they will feel well-informed and comfortable with their choices.

He stressed that news must always be delivered with compassion and respect.

Not unexpected was the question of costs of veterinary care. The students wanted to know what happens if an owner simply cannot afford diagnostics and treatments for their pets?

Dr. Mitelman explained he and his staff will take each case on an individual basis and try to explore available avenues. He encourages owners to ask about options before ruling out medical care and treatments based solely on a cost.

The students asked Dr. Mitelman what his overall message to pet owners would be. He stressed that pets, just like people, need regular check ups, proper nutrition, and preventative care to lead the best lives possible.

And the veterinarian-pet-owner relationship is key to people sharing long and happy lives with their much loved family pets.

We would like to thank Ellin Bessner, Journalism Professor at Centennial College for inviting Dr. Mitelman to be interviewed by her journalism class.

LESSONS LEARNED

1. Veterinarians need to help spread the word about animal health care. Spend time with your clients and take advantage of opportunities to share with the community.

2. Social media allows veterinarians to be active and participate in the on-line conversation.

3. Encourage dialogue. Whether you are the veterinarian or the pet’s owner, open lines of communication make for a better veterinarian-pet-owner relationship.

Sydney was out for a Sunday stroll when trouble began.

For about two weeks, Sydney, a five year old Artesian Bassett Hound, was intermittently crying out when her owners touched her body or stroked her head.

One day, while out for her walk, the 56-pound dog stopped suddenly, refusing to go any further and having to be carried home. She needed to be assessed by a veterinarian as soon as possible.

It was a Sunday afternoon and the family was new to the area and without a regular veterinary clinic.

On a friend’s recommendation, Sydney’s owners brought her to VETSToronto at the Kingston Road Animal Hospital, a local emergency veterinary hospital open 24/7/365.

Dr. Jagdish Verma was the doctor on duty that day.

On presentation, he found Sydney’s belly was tense and her abdomen sensitive to the touch. Her head tilted to the right and her back was hunched.

She displayed hind limb ataxia. In other words, her reflexes were slow and she moved with a drunken gait. Sydney lacked strength in her hind end and her back limbs were sliding laterally.

The middle of her back was very warm to the touch from inflammation.

WATCH NOW: Dr. Mitelman takes Sydney for a walk

Dr. Verma admitted Sydney to the hospital. Radiographs were taken and blood work was done. Antibiotics were administered due to suspected inner ear infection (possible cause of the head tilt).

The following morning, Dr. Jonathan Mitelman reviewed the test results and examined Sydney, finding X rays that showed multiple mineralized disc spaces from T10-L2.

This indicated there was chronic desiccation of the nucleus pulposus leading to insufficient function and cushioning of the discs. This all pointed to Intervertebral Disc Disease (IVDD), chronic in nature with an acute presentation.

Visible blood in the dog’s urine prompted urinalysis and cultures to be done at that time. The lab work showed sugar in Sydney’s urine despite a normal blood glucose level.

These conflicting results were unexpected and needed further investigation.

Sydney’s owners were contacted for more information and they revealed that the dog had recently had a urinary tract infection (UTI), antibiotics had been given, but no follow up done.

Dr. Mitelman showed them that Sydney had excessive perivulvar skin as a predisposing factor for urine/moisture retention and ascending infection.

The owners also mentioned that chicken jerky treats from China were part of her diet. Although there are no supporting conclusive studies at this time, there is concern that some dogs might develop acquired Fanconi-like syndrome from eating this product.

Fanconi Syndrome is a congenital disorder, very specific, found in the Basenji breed.

But Fanconi-like Syndrome has the same pathology, but not genetic error, rather acquired through toxic means. This condition injures tubules in the kidneys leading to sugar and protein leakage, sometimes resulting in kidney failure.

Dr. Mitelman performed an ultrasound to inspect the abdomen and look for evidence of kidney damage. Everything was normal. Blood and urine was tested again.

The conclusion was the glucosuria (sugar in urine) without hyperglycemia (high blood sugar) was attributed to an antibiotic given on admission to the hospital.

Consultation and supporting documentation showed a metabolic product from the antibiotics caused a false positive sugar reaction in the urine. A day later, Sydney’s urinalysis results were normal once again.

MRI called for

A consult was done with neurologist Linda Shell regarding the IVDD, and whether an MRI would be recommended at this time. Dr. Shell advised that an MRI allows you to know exactly what you are dealing with.

Sydney’s owners opted for conservative treatment, including crate rest with medication (metacam, gabapentin and anti-oxidants).

Two weeks later, having seen no improvement to Sydney’s condition, her owners took her to the Ontario Veterinary College at the University of Guelph where they saw a neurologist and an MRI was done.

This revealed a disc herniation at T12-13 on the right side causing spinal cord compression.

The following week Sydney had surgery. A hemilaminectomy was performed at T12-13 on the right side, extruded disc material was identified and removed, allowing for decompression of the spinal cord.

Two days later, Sydney was discharged with analgesics, instructions for rest and recommendations for physiotherapy.

Sydney is making progress, recovering well and following her physiotherapy plan. Recently her owner commented that he was pleased with the choices that were made regarding Sydney’s care as “he couldn’t imagine life without her.”

Lessons learned:

1. If you notice pain reaction in your dog, changes in gait, head tilting or a hunched back you should take your pet in to see a veterinarian as soon as possible. When dealing with IVDD, time matters.

2. Radiographs may indicate mineralization but an MRI will give an accurate account of the discs. This information will assist the doctor when presenting options for treatment.

3. Are there risks to an MRI? In rare cases, the patient can be clinically worse as the anesthesia allows the dog to be relaxed and stretched on the back. This change in alignment could cause more disc material to extrude if something is jostled.

And what about the ultrasound? It was not performed under anesthesia. Careful handling of the dog reduces any risk of further injury. And knowing the results of the ultrasound to verify kidney function was essential.

4. It is important to know the location of the nearest veterinary emergency hospital. If you are new to an area you should research this in advance of an emergency or illness.

VETSToronto at the Kingston Road Animal Hospital has a doctor on site around the clock.

For more details, view our website at: www.vetstoronto.com.

Cohen's rock called for some slick surgery

Many dog owners will tell you their beloved companions will eat just about anything. This story about Cohen, a seven month old standard poodle, illustrates this point.

Cohen’s owner actually saw his puppy eat the stone. He knew that immediate medical attention was required so he took him to his regular veterinarian, Dr. Ronnie Pusong, at Banks Animal Hospital.

The radiographs taken there showed a large foreign body in Cohen’s stomach. It needed to be removed as soon as possible. Dr. Pusong recommended there were two options: exploratory surgery or the less invasive method via endoscope.

Cohen’s owner opted for endoscopy and a referral was made to VETSToronto at the Kingston Road Animal Hospital where Dr. Morris Samson and Dr. Jonathan Mitelman took over the case.

Additional radiographs were taken to verify the exact location of the rock as foreign objects in the body tend to change position.

The plan was to anesthetize the dog and use the endoscope and a variety of instruments to lure the big stone out of the stomach via Cohen’s mouth.

But Dr. Samson and Dr. Mitelman were faced with some challenges.

The rock was too large to get the loop snare around it. It was also too slippery for the pronged graspers to maintain their hold. Just like the claw game at the arcade, the doctors thought they had it but the prize, in this case the stone, slipped out.

The doctors were able to get the instrument behind the rock and snared it up to the esophagus.

But there was a hitch. From the oropharyngeal cavity to the cervical esophagus there is a bend in the road, even with the neck extended to minimize the angle and an upper esoph sphincter.

It is doubly difficult to pull an object through a nonlinear junction. The doctors almost had it, and then it slipped out.

At this point, Dr. Samson and Dr. Mitelman thought they might have to rely on the alternative method of removal. They could push the stone back into the stomach and retrieve it surgically via laparotomy and gastrotomy.

Cohen is normally poetry in motion.

But they still had options. They managed to get two instruments in the esophagus at the same time – one the scope for viewing, and the second a 24-inch laparoscopic tissue crushing device called Dorsey Intestinal Forceps that was used as a pair of alligator jaws.

The size of the dog and the tract accommodated both.

After several attempts they managed to grip the rock in just the right way.

It was out.

And it was very large at approximately 1.5 x 1.5 x 3 inches. It is amazing that what goes down so quickly doesn’t come out so easily.

Any foreign material that big risks scraping the esophagus, and that can lead to discomfort and inflammation, and subsequently poor motility (often reversible) and reflux.

It was necessary to place Cohen on preventative medications including sucralfate (coats and fills in gouges if present), losec (an antacid) and cisapride (a prokinetic that ensures the stomach empties). All of these medications are used to prevent acid reflux in the esophagus.

Cohen will have his post procedure follow up visits at VETSToronto and return to Banks Animal Hospital for his regular veterinary needs.

Lessons learned:

1. Dogs will chew and swallow things they shouldn’t. It happens even when supervised. It happens right before your eyes.

The key is quick intervention. The foreign object has all sorts of places to lodge itself inside the dog’s body. Best to seek veterinary help immediately and find out your options as soon as possible.

2. Know the location of your nearest veterinary emergency hospital. Sometimes your pet needs emergency care outside of your regular clinic’s hours. VETSToronto at the Kingston Road Animal Hospital is open 24/7/365, with on-site endoscopy and a doctor on the premises around the clock.

For more information view our website: www.vetstoronto.com.

Billy lies on the operating table as Dr. Jonathan Mitelman does an intra-oral radiograph.

Let’s start with a question: How often should you brush your dog’s teeth?

The answer might surprise you. It certainly took me aback.

It is recommended that you brush your pet’s teeth EVERY DAY. There is sticky matrix being formed, etching and latching bacteria. The next day a fresh coat of sticky film appears. Without cleaning this continues.

If you were to miss brushing your teeth at night, how would your mouth feel in the morning? The process is the same for your dog and cat.

February is Pet Dental Health Month and it brings the issues concerning our animals’ dental needs to the forefront. Reminders from the vet clinic, articles in the local press, maybe a free toothbrush and sample toothpaste come our way.

But in reality, our pets’ dental routines and care should be a priority all year round.

Recently my nine year old dachshund, Billy, had a dental emergency. When I was giving him his twice-weekly teeth cleaning (I thought it was often enough, I was wrong), I noticed blood emanating from one side.

A whirlwind event spanning 24 hours ensued. I reported the bleeding to Dr. Jonathan Mitelman, at VETSToronto. He examined a very painful Billy and assessed what looked like a cracked tooth with pulp and nerves exposed.

The next day an oral exam under anesthesia was done where intra-oral radiographs confirmed the cracked tooth and showed two damaged incisors.

Dr. Mitelman performed dental surgery and removed the three problem teeth.

Then he cleaned and polished Billy’s teeth, which actually had very little plaque.

He was also able to assess Billy’s whole mouth, note the worn-down teeth and those with pulp exposed. Billy is a powerful and aggressive chewer, the cause of both of these dental conditions.

We were able to bring home a much more comfortable, pain-free Billy, and we now know what the condition of the dog’s mouth is and what we need to monitor for future oral concerns.

What do owners need to know about their pet’s dental care? The most important point to acknowledge is the necessity for preventative care and medical attention when an oral health issue arises.

Terms to become familiar with are: periodontal disease (inflammation of the teeth’s supporting structures), endodontics (acute tooth fracture) and gingivitis (inflammation of the gums).

All of these conditions can lead to infections and introduce bacteria into other parts of the body.

One needs to know proper home care routines, what healthy gums and teeth look like, and how to do regular mouth inspections. Bad breath smells, red, sore, bleeding or swollen gums, broken or damaged teeth all should be promptly reported to your veterinarian.

Lessons learned

1. Ask your veterinarian to show you how to inspect your pet’s mouth and brush the teeth. Make a plan on how you can work together to ensure your pet’s dental heath needs are addressed.

2. Pets hide their pain. They will continue to eat and even chew their toys when they have dental pain. On closer inspection you might note your dog is only chewing bones on one side of the mouth.

3. Good products to assist with oral care are enzymatic pastes to help with plaque breakdown, oral cleansing/disinfecting solutions, dental specific chews for cats and dogs and dental formula kibbles.

4. Intra oral radiographs can show your veterinarian what is happening beneath the surface. Discuss an individualized plan for your pet.

5. VETS Toronto at the Kingston Road Animal Hospital is a full-service emergency hospital open 24/7/365. Medical attention for dental emergencies is available around the clock. Our doctors would be happy to discuss your pet’s ongoing dental care.

For more information on dental health, here’s a great site run by Dr. Fraser Hale.

Dr. Jonathan Mitelman speaks to the graduating students at the Ontario Veterinary College in Guelph.

Dr. Jonathan Mitelman, of VETS Toronto at the Kingston Road Animal Hospital, himself a graduate of the Ontario Veterinary College in 2002, lectured to the up-and-coming graduating class on “What should I know as emerging veterinary school graduate?”

Although many topics were covered during his hour-long, lunch time presentation, the question on everyone’s mind concerned mentorship.

The new doctors are interested in finding a clinic or work situation with a supervisor or hospital owner that is not only willing to teach and instruct, but be a “mentor” to them.

Dr. Mitelman describes a mentor as someone who cares about the outcome. This will influence the quality of teaching, interaction, comprehension and this individual will use feedback to modify interactions. The pairing will be nurturing and reflective.

It is possible to start out as a teacher and instructor but with time develop into a mentor. The pair works together and the new grad will not feel left on their own, but supported, challenged and encouraged to grow.

The truth is new graduates will enter the veterinary workplace as both a doctor and a student. Their new employer will be making a considerable investment in this individual. Both new grad and employer must feel there is compatibility in needs and expectations.

The question of how one approaches this vital part of the job search process was asked of Dr. Mitelman. He suggests being straightforward during the investigative stages and interview itself. The new grad should express the hope to find a mentor and the desire to be taught and guided by this person.

The new grad should gauge the response accordingly. The age of the prospective mentor should not necessarily be the determining factor. Rather maturity, mindfulness, awareness, recognition of skills and patience are all to be considered.

A mentor is one who was likely mentored.

Dr. Mitelman himself has been on both sides of this. As a new grad he researched many hospitals and interviewed at many clinics. He knew the fit was right with Dr. Morris Samson, founder of the Kingston Road Animal Hospital.

He was hired at the clinic upon completion of his DVM and has worked there since.

With Dr. Samson as his mentor he achieved partnership in the clinic in 2005 and together they have grown the business and responded to the needs of the ever-changing veterinary community.

Now in a position of recruiting and hiring doctors for his 24-hour emergency hospital and day clinic, Dr. Mitelman has some additional words of advice to new grads.

He stresses the need for them to enter the interview process with a sense of humility, acknowledging that one does not know everything when coming straight out of vet school. Learning from one’s mistakes is part of the process.

And he feels gratitude goes a long way. Thank the new boss for the opportunity and investment of time and commitment and show a desire to contribute to the team.

Finally, will the connection or bond with the new mentor be immediate? In some cases it might be, but more often it will be realized with trust and over time.

VETS Toronto at the Kingston Road Animal Hospital has been operating in the same Toronto location for over 25 years. It is a full-service veterinary emergency hospital offering a regular day clinic and after hours, critical care and referral services. If you wish to contact Dr. Mitelman, he can be reached at 416 690-0625. Please visit the hospital’s website at www.vetstoronto.com

Dr. Mitelman with Tessa, who is doing well after her spleen surgery.

When Tessa, a five year old German Shepherd, showed signs of decreased appetite her owner thought it might be as a result of candy wrappers the dog had eaten a couple of weeks earlier.

As the dog’s condition continued to worsen and weight loss was becoming apparent, Tessa’s owner sought emergency medical attention for her at VETSToronto at the Kingston Road Animal Hospital.

Her owner had been reading about ultrasound on the clinic’s Internet blogs, and came in to discuss possible treatment options.

When Dr. Jonathan Mitelman performed a physical examination he found Tessa to be at least 10 pounds underweight, cachexic (weakened, emaciated body condition), boney, and presenting with a pendulous abdomen with a large mass in her belly.

Recent blood work done at a previous clinic showed anemia and low protein, but no specific cause. Dr. Mitelman advised further diagnostics were necessary at this time in order to determine the cause of the dog’s declining health.

Radiographs showed a large abdominal mass displacing the stomach craniad (toward the front) and intestines caudad (toward the back). The presence of free fluid distorted the abdomen. However, the chest looked fine.

An abdominal tap was done revealing pink translucent (serosanguinous) fluid.

Blood work was repeated and the results showed the anemia was worsening, but regenerative. This was a sign that the body recognized the problem at least five days earlier and was attempting to rectify the anemia.

Dr. Mitelman performed an ultrasound. He found a very large homogenous spleen taking up a lot more space than it should be, without blood flow in and out through the normal pathways (splenic artery and veins). There was no transcapsular venous blood flow.

The spleen was obviously abnormal. Was it a tumour? Was it twisted? Or was the spleen just dead? Whatever the case, why did this happen and was this curable?

Dr. Mitelman explained surgery was the only option, the pathologic spleen had to be removed. Although the hope was that a splenectomy would be curative there was still a possibility that cancer may be hiding somewhere within.

Tessa’s skin and abdominal wall were incised with a surgical laser. Dr. Mitelman was greeted by the abdominal organs bathed in a large volume of bloody fluid.

The huge necrotic spleen had rotated 360 degrees or more on its axis and was encased in an omental wrap, which surrounds the inflamed tissue and provides nourishment. The splenic vein and artery had twisted, preventing blood from entering and exiting the organ, leaving a vital organ dead inside.

Moreover, the splenic artery was as tough as wire. The normally delicate tissue could not be cut with a sharp scalpel. It even sparked with the laser. Oversized orthopedic wire cutters were actually used to do the job.

All of the abnormal tissue was removed. Tessa did well with the surgery and the recovery was unremarkable. Tessa went home two days later, bouncing as though nothing had happened.

Did the candy wrappers play a role? In this case, they did not. Her declining health was caused by a combination of a torsed and necrotic spleen, venous thrombosis, and osseous metaplasia of the splenic artery.

What this means is the large, dead, engorged with blood, filtering organ twisted on itself. The venous blood outflow was blocked, and arterial blood inflow was cut off. In addition, there was boney matrix growing in the splenic artery.

Her anemia resulted from blood leakage into the abdominal cavity. Weight loss was associated with insufficient calories and marked inflammation.

VETSToronto monitored Tessa’s progress for the two weeks after her life-saving surgery. She has since returned to Black’s Toronto Veterinary Hospital for further follow up and regular veterinary care.

Lessons learned:

1. It is always wise to have your pet checked by a veterinarian if you notice changes to appetite and sudden weight loss.

2. A pet owner should explore all treatment options available in order to make well-informed decisions. Veterinarians are open to consults and referrals, don’t be afraid to suggest and discuss this with your pet’s doctors.

3. Diagnostics are essential to determine the root of a pet’s illness. Sometimes what is assumed to be obvious, in this case some ingested candy wrappers, might be unrelated to the actual cause.

4. VETSToronto at the Kingston Road Animal Hospital is open 24/7/365. Know the location of your nearest veterinary emergency hospital. There are times when pets need treatment outside of your regular clinic’s hours. Minutes can count in emergency situations.

Nickle had two heads removed from his femurs. He's doing just fine.

A sudden onset of non weight-bearing lameness of Nickle’s right hind leg prompted the cat’s owner to take him for assessment at the Brimley-Lawrence Animal Clinic.

She explained to veterinarian Dr. Chari Paneeru that the 20-month-old Domestic Shorthair climbed bookcases and likely was hurt from a fall.

Dr. Paneeru examined the cat, viewed the radiographs and consulted via telephone with Dr. Jonathan Mitelman at VETSToronto at the Kingston Road Animal Hospital.

Nickle was in pain and Dr. Paneeru advised the owner that VETSToronto was a 24-hour emergency hospital where the cat could be stabilized and monitored overnight.

Upon arrival at VETSToronto, a thorough history was taken, revealing that Nickle had some previous lameness in the left hind leg. The examination showed the 12 pound cat to have good body condition.

In addition to the non weight-bearing right hind leg, the right hip was painful and had palpable crepitus (crunching sound). There was bilateral patellar luxation (kneecaps able to pop out of the groove).

This was a developmental issue but likely not contributing to the current presentation.

The radiographs showed a fracture of the right femoral neck with displacement (the femur was broken between the head and neck, with both parts separated).

There was also a line of radiolucency at the femoral neck of the left femur. The growth plate was not fused, therefore had a weak spot in the head and neck connection that was visible.

This explained the bilateral nature of Nickle’s lameness. A fall from the bookcase was not the cause. Faults in the growth plates of each hip left him with a weak point. Any jump or fall would stress the weak point in the bone, causing it to shear and fracture.

Dr. Mitelman consulted and verified his findings with a local orthopedic specialist and online with a surgeon through VIN (Veterinary Information Network). He discussed available options with Nickle’s owner.

These fractures are not amenable to repair reduction of fracture segments since there is little bone with which to anchor, and poor blood supply.

What was required was a femoral head osteotomy (FHO) or excision. In other words the head of the femur is removed, and the surface is smoothed allowing for a non-rubbing and not painful joint.

Cats do quite well with this procedure. Hip replacements are not typically done as they do so well with FHO’s.

But both hips needed to be done. Should the surgeries be staggered so the right one was done immediately, the left one in six week’s time? Or should both hips be done at the same time?

The cat would not be mobile for about two weeks. There would be some pain but experience shows that cats tolerate that well. Attempts to avoid additional hospitalization and anesthesia were noted.

It was important to present all options and discuss this openly with the owner. The consensus was FHO’s would be performed on both left and right hip joints concurrently.

There was excessive pre-existing scar tissue as a result of the growth plate weakness.

While immobile, a urinary catheter was put in place to keep Nickle comfortable.

Although wobbly, the cat was up and walking within six days. At the two week post-op check Nickle was walking well. He has returned to Dr. Chari at Brimley-Lawrence Animal Clinic for his follow up care.

Lessons learned:

1. Cats are rarely lame without a good reason. It is always wise to check it out.

2. A weakness in the growth plate such as this can sometimes be chronic, but more often will be a sudden surprise.

3. It is always good to explore and discuss your options when faced with medical decisions. Consultations with specialists can help both the primary veterinarian and the pet owner with understanding the medical condition and the treatment plan.

Galway lost her brave fight with cancer.

Galway’s owners noticed that their normally active, four-year-old Bernese Mountain Dog was not herself.

For about three-to-four days her behaviour had changed, she was showing reluctance to sit properly at her food bowl, she didn’t come to the door and had difficulty ascending the stairs.

Normally together with the family’s other dog, both full of mischief, she now was not as interested in their usual playful antics.

Galway’s concerned owners brought her to VETSToronto at the Kingston Road Animal Hospital, where Dr. Jonathan Mitelman and Dr. Morris Samson were responsible for the case.

Dr. Mitelman performed a physical exam, assessed the hips, spine and stifles. There was mild hip dysplasia present along with steep tibial plateaus, but no significant arthritis or cruciate instability.

Otherwise, Galway presented as frisky and happy. The situation would be monitored and follow up to be done.

On the next visit, the owners said Galway was still “not quite right”. The situation seemed to be quickly worsening.

She was still responsive and bright, but not her bouncy self. She had begun gagging randomly, even when she was not at her food dish and lagging behind on her walks.

There was a decreased appetite, but that was coupled with weight gain. On touch, Galway’s backbone felt more boney than usual. When Dr. Mitelman assessed the belly to be heavier and fuller than normal he recommended an immediate ultrasound.

The ultrasound showed abdominal fluid that was tapped and the blood removed. There were multiple, variable-sized, non-homogenous spherical masses throughout the abdomen that were everywhere and attached to everything.

Galway’s blood work had been almost entirely normal except for evidence of new red blood cell regeneration. She wasn’t even anemic. Blood tests, unfortunately, can appear normal in the face of cancers.

At this point the doctors and owners were faced with a number of what if scenarios.

Should a biopsy be done to get concrete evidence (risking complications such as uncontrolled bleeding)?

Should an exploratory surgery be done with the hope and intention of debulking the tumours (again risking complications, post-op problems etc)?

Should they forego any procedures and do euthanasia without pathology evidence?

Every decision was a difficult and painful one to make.

Galway’s owners opted to take her home with pain medications. Despite all of this, she still had bursts of normal activity. Did she even know she was sick? Everyone wanted to make the most of their remaining time together.

Sadly, the situation worsened overnight and an at-home euthanasia was done the next day, Galway surrounded by those she loved.

The pathology revealed a form of cancer called a myxosarcoma, one so aggressive and pleomorphic that it was not possible to identify the tissue of origin. This explained her rapid decline near the end.

Lessons learned:

1. Some animals mask their illnesses so easily. Owners know their pets best. Any changes that are concerning should be discussed with the veterinarians.

2. Pet owners often are faced with some difficult decisions. It is wise to explore all of your options. Medicine will guide you.

3. Does a post mortem assist with closure? That is all so personal. Some might see the results confirmation that they made the best decisions for their pets.

4. It is hard to lose a companion, regardless of how long they have been on this earth.

Please have a look at our euthanasia blog for more information.