Unexpected delays with Macy's spey
Little Macy, having been fasted the night before, thought she was getting desexed at the end of August, but on admission Dr Tania noted her deciduous (baby) teeth were still present and the adult ones only just starting to show themselves.
At the time of desexing, it is often a great opportunity to extract baby teeth that aren’t already naturally falling out. However, prematurely removing baby teeth in cases where the adult teeth have not erupted sufficiently can be damaging, as the adult teeth are guided into position by the baby teeth. Thus it was decided to postpone Macy’s spey for a further 3 weeks.
Three weeks later and noted to be a bit quieter than normal but fasted once more, Macy returned to the clinic to see Dr Tania, who was excited about finally getting to do Macy’s procedure. But little did she know it would be delayed once more! Macy’s owner had elected to have pre-anaesthetic blood test performed on the morning of the spey. We highly recommend conducting this test for any animal undergoing an anaesthetic because not all disorders will be evident on the vet’s physical examination that is performed during the pre-surgical check.
There are two main reasons for doing the pre-anaesthetic blood test. The first reason being it allows us to evaluate internal organ function (e.g. liver and kidney) and gauge an understanding of systemic health, thereby enabling us to make alterations to our general anaesthetic protocol (e.g. which drugs to use) to generate the safest anaesthetic protocol possible. The second reason is that if in the future Macy became unwell, her blood test would serves as an excellent reference to assess what is ‘normal’ for her and as a helpful comparison.
On the morning of her spey, Macy’s blood test yielded some concerning results. In particular the levels of some important enzymes, which indicate liver health, were abnormal. The blood concentration of ALT was through the roof at 650 (the normal range is 5 to 80)! Another indicator of liver stress, AST, was also elevated. This increased our concern for Macy’s ability to cope with the general anaesthesia that was required for an otherwise routine surgical procedure. Therefore her spey was postponed for a second time. Dr Tania wondered if she would ever get to spey Macy…
Various harmful events, such as bacterial infections, can cause liver damage and subsequent elevations in liver enzymes. Sometimes the liver dysfunction is a result of anatomical abnomalies that the animal was born with or acquired. Macy was prescribed antibiotics for a week to determine if a bacterial infection was causing inflammation of the liver, and returned to the clinic for repeat blood tests. When these showed that there had been no improvement, bacterial infection was ruled out.
The next step recommended by our vets to determine Macy’s underlying health issue was to perform a test known as a Bile Acid Tolerance Test (BATT). A BATT involves taking blood samples on a fasted patient to check their baseline gastrointestinal enzymes, then feeding a moderately fatty food to stimulate the release of bile, which emulsifies and assists with the digestion of fat. Normally the vast majority of bile and fats are absorbed in the small intestine and pass to the liver via a blood vessel called the portal vein, where they are stored and processed. Sometimes animals are born with an abnormal vein that redirects blood away from the liver, known as a portosystemic shunt (PSS). In these animals, bile acids will be abnormally high after a fatty meal because the liver has not received them for storage and processing. A BATT on Macy showed abnormal results which made us very concerned she may have a PSS. These are more common in breeds like Macy (Schnauzers) and can cause clinical signs such as weight loss/ failure to thrive, lethargy, urinary problems (e.g. inflammation of the bladder or an obstruction in the urinary tract) and neurological signs such as head pressing, circling or disorientation.
Macy was referred to Advanced Vet Care for specialists diagnostic tests. Diagnostic imaging confirmed our suspicion of a PSS and Macy underwent surgery to correct this condition and also to be speyed at the same time. Macy has been doing brilliantly since surgery and is as happy as ever, with all the energy of a healthy pup. Dr Tania was right, she never would have the chance to spey Macy!