ACCES teams up with the Seattle Humane Society to give Tully a second chance at life!
Recently, ACCES had the opportunity to work with the Seattle Humane Society to help a critically ill young dog. Tully, an approximately 2 year old, female Chihuahua was soon to be euthanized in an animal shelter in Los Angeles when the Seattle Humane Society agreed to care for her and find her a home. Tully arrived at the shelter in Bellevue emaciated, covered in fleas, and pregnant. Over the course of her first days in Seattle, Tully started having a hard time breathing until on the afternoon of Tuesday, June 14, it was clear that Tully’s condition was deteriorating. Hopeful that cause of Tully’s increased respiratory rate and effort was a fixable condition, the Humane Society referred Tully to ACCES for further diagnostic tests and care.
Tully was admitted by an emergency clinician, Dr. Julie March, and immediately radiographs were taken of Tully’s chest. The radiographs were diagnostic of a diaphragmatic hernia. The diaphragm is a musculotendinous partition that separates the chest from the abdomen. Loss of this separation allows the abdominal organs to enter the chest cavity and interfere with the lung’s ability to fill expand and ventilate normally.
The diaphragm is made up of a muscular portion that attaches to the ribs on both sides and a central tendinous region. The aorta, vena cava and other veins, esophagus, and lymphatic system pass through openings in the diaphragm. Hernias can be either congenital, in which one or both muscular portions of the diaphragm fails to develop or fails to fuse centrally, or traumatic, in which injury to the diaphragm can cause a tear in normally developed diaphragm. This is a common sequelae after dogs and cats get hit by cars.
Treatment of this condition requires surgery to repair or reconstruct the diaphragm. Complications can arise when the abdominal organs have been present in the thoracic cavity and have adhered to structures within the chest or to the chest wall. Or in congenital diaphragmatic hernias when abdominal organs develop within the chest and may not mechanically be reduced into the abdomen even with surgery.
Tully’s condition was complicated by the fact that she was pregnant. The puppies had mineralized skeletons but whether or not they were near term was yet unknown. A decision was made to take Tully to emergency surgery to relieve the lung compression and repair the diaphragm. Since Tully was pregnant, it was also decided to perform a cesarian section to try to save the puppies since they would be unlikely to survive a long anesthetic procedure.
Tully was quickly anesthetized and taken to surgery. Four puppies were retrieved and resuscitation of the puppies was initiated. Tully’s entire gastrointestinal tract, spleen, omentum and the majority of her liver had been pushed into her chest through a very large hole in the right side of her diaphragm. Her abdominal organs were replaced into her abdomen and closer inspection revealed the hernia to likely have been congenital. It was necessary to also approach the diaphragm from her chest to get adequate access for repair. By advancing the diaphragm and part of the abdomimal wall forward and towards the left side, it was possible to close the hole in Tully’s diaphragm.
Tully had a rough recovery from anesthesia and struggled to reinflate her lungs and breath normally. She was treated with oxygen therapy overnight and by morning was breathing more comfortably. Unfortunately, Tully’s puppies did not survive. After several days of further supportive care, Tully returned to the Seattle Humane Society where she was put into foster care. Tully appears to be adapting well to her new home. We hope she finds a fantastic new family soon. 
Sasha Gets a New Chance at Life
It was a typical drizzly and chilly February day when Mr. Rodgers saw his newly adopted greyhound companion Sasha hit by a careening car. Mr. Rodgers rushed to Sasha’s side to find him weak and dazed, fighting for each breath.
Sasha was immediately taken to the Eastlake Veterinary hospital. His gums were grey as he labored to breathe. A quick radiograph revealed bleeding and bruised lungs. Sasha had a tear in his lungs that released his breaths into his chest cavity. Once in his chest cavity, the inhaled air could not escape, threatening Sasha’s life. The veterinarian worked quickly to remove the air and blood from his chest - with a needle and syringe he drew blood and air out, liters of air. But even as the veterinarian drew air out, Sasha breathed more in, compressing his lungs so they couldn’t inflate. Sasha was critical and needed 24 hour intensive care; he was transferred to Animal Critical Care and Emergency Services (ACCES).
Dr. Wassink and the ACCES team were ready for Sasha when he arrived. They quickly went to work and started him on oxygen support, while placing an IV catheter and checking his vital signs. Dr. Wassink knew Sasha was going to need chest tubes to remove the accumulating air and fluid. The big dog was sedated; tubes were swiftly placed between his ribs and into the air and blood-filled chest cavity. As the air and blood were suctioned off, Sasha was able to inflate his lungs and breathe. There was a sigh of relief and smiles around the emergency room as everyone saw Sasha begin to take bigger and bigger breaths until he was breathing easier.
However, the relief was short-lived as Sasha continued to bleed into his chest. He now needed a blood transfusion. Dr. Wassink consulted with the ACCES Critical Care Specialist, Dr. Davidow, and they decided the best way to help Sasha was to auto-transfuse him. They would collect the blood from his chest to further help his breathing, and then give the blood back to him as a blood transfusion. The ACCES staff collected the blood and carefully transfused it back into him through his IV catheter. The auto-transfusion helped to stabilize Sasha that afternoon. 
Through the afternoon and night Sasha remained critical. He stayed in ACCES’s ICU on oxygen support, while continuous suction was applied to his chest tubes to remove the excess air and blood, and he was constantly monitored by the ICU nurses and veterinarians. By the next morning Sasha was more comfortable, but he still needed intensive care. He was still anemic from bleeding into his chest cavity and was given a second blood transfusion, this time from an ACCES Blood Bank community donor. Sasha was maintained on pain medication and watched closely.
Over the next 24 hours, Sasha’s lung tear started to seal, and less air could be removed from his chest cavity. The continuous suction was disconnected. His pain medication and sedation were gradually weaned down. He started eating and drinking on his own, and began walking outside. Two and a half days after his accident, Sasha was breathing well enough on his own that his chest tubes were removed. Today this big beautiful boy is home, enjoying life with his loving adopted family.
ACCES Renton's First Patient Ever Doing Well At Home
Bijou Rathbun presented to ACCES Renton during our very first day. He is an 11 year old Sheltie that had been vomiting for the past few days. He was becoming less interested in food. He was evaluated by his regular veterinarian the day before and responded somewhat to supportive care and a bland diet. The next day, he had stopped eating and was vomiting water. He was evaluated on emergency and found to be slightly dehydrated with some abdominal pain. X-rays were taken and our radiologist was concerned about a gastrointestinal foreign body. Our internist was in the building that day and performed a quick abdominal ultrasound and was able to visualize the foreign object in the intestines. After several hours of IV fluids, emesis control, and pain medications, he was taken to surgery, where a 2 inch piece of carrot was removed from the small intestine. Bijou made a full recovery and was discharged the following day. He continues to do well at home and is honored to be ACCES Renton’s first patient!
Here's what Bijou's owner had to say about ACCES:
Bijou has made a full recovery since he had his surgery on Easter weekend. He is energetic, happy, and barking at the fisherman on the lake in his backyard! We are so grateful for the wonderful care he received from the team at ACCES, especially from his surgeon. We are so happy to have him healthy again.
A Complicated Case Turns Out Well
Solstice is a young female cat (11 months) who was brought in to our hospital after unknown trauma. She was very quiet, painful, unable to walk and vomiting. After radiographs, an ultrasound and blood work, she was diagnosed with a ruptured bladder and an injured left hind limb.
Solstice was treated for shock and her vital signs were stabilized before being taken to emergency surgery a few hours later to assess and repair her ruptured bladder.
There were two places where the bladder was torn, one at the tip and one at the junction between the bladder and the urethra (the tube that urine exits through to reach the outside of the body). The tip of the bladder was repaired, however the urethra was stretched and torn and could not be repaired. A urinary catheter was placed with the hope that the urethra would heal on its own over time, or that the urethra would be surgically repairable in the future. The injured left limb was placed in a small cast.
The urinary catheter was left in place for several days; however, when it was removed Solstice had severe difficulty urinating because of scarring of the urethra. She was taken to surgery a second time where a portion of her small intestine was used to create a graft to open up the area of scarring.
Solstice did very well and is urinating normally. She is also walking well on her left hind limb out of her cast.
Here's what Solstice's owner had to say about ACCES:
Special thanks goes to Dr. Davidow who compassionately explained in lay terms the condition she was in and her chances for survival and patiently answered all of my many questions. I was very grateful to be provided a private room to visit with Solstice and was accommodated with food, blankets or whatever we needed. The staff was also happy to show me where she was housed, in a quite spacious kennel, with soft bedding and constant supervision. I know she was often given affection and held on numerous laps in their care and I do so thank them for their compassion during her stay at the hospital.