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Introducing Harley, this week's Critical Care Case Study: ![]()
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Harley is a 5-year-old, male neutered German Shepherd who presented to Pacific Northwest Pet ER & Specialty Center's Critical Care Service with a fast-progressing hind limb weakness, incontinence, and coughing. He started having a short, choppy, hind limb gait with progressing weakness that would require him to rest after 2-4 steps and had a minimal to weakened palpebral reflex. Within one week his neurologic dysfunction was so poor that he was unable to empty his bladder and was dribbling urine despite having a large, distended bladder. He was also unwilling to eat and drink. Chest radiographs were performed and showed megaesophagus. He received a challenge dose ![]()
of neostigmine which improved his gate within minutes, confirming a diagnosis of generalized myasthenia gravis. ![]()
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In Harley's case, this is an acquired disease where his immune system made antibodies against certain receptors at his neuromuscular junction. These antibodies cause decreased activity of neurotransmitters leading to severe muscle weakness. Human patients in myasthenic crisis are treated with either total plasma exchange (TPE) or IVIg, with the former considered most effective. TPE is a therapy that removes the plasma, which contains these immune mediated antibodies, and replaces it with plasma donations and other fluids. This is considered a short-term therapy to remove antibodies, decreasing progression of disease as the medical therapies start working. This can be a lifesaving therapy in many autoimmune diseases. ![]()
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Harley received two TPE therapy sessions with our critical care team and started oral therapies for his disease. After his second treatment he had an improved gait and was able to walk increased distances without growing too weak. After the second therapy, he was able to urinate on his own and keep food and water down, despite his enlarged esophagus. Harley continues to improve at home with long term management from the neurology team. ![]()
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We are thankful we could be part of Harley’s recovery and look forward to seeing his progress. ![]()
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To learn more about our Critical Care service please visit: www.pacificnwvets.com/service/critical-care/
Thanksgiving is almost here! While we’re excited for the delicious feast, it’s important to understand which foods are toxic for pets. ![]()
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Keep your cats and dogs away from:![]()
🦃 Stuffing – as it may contain onions or garlic![]()
🦃 Ham and other Pork – can cause pancreatitis, upset stomach or diarrhea ![]()
🦃 Turkey - Dogs should only have a little bit of meat, no skin or seasoning.![]()
🦃 Turkey Bones – splinters may cause indigestion or bowel obstruction ![]()
🦃 Mashed Potatoes – may have been prepared with butter and milk ![]()
🦃 Salads with Grapes/Raisins – can cause kidney failure ![]()
🦃 Chocolate Desserts – toxic to both cats and dogs If your pet does ingest any of these foods![]()
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If you suspect your pet eats something toxic this holiday call Pacific Northwest Pet Emergency and Specialty Center at (360) 635-5302 we are OPEN on Thanksgiving Day.
Here at Pacific Northwest Pet Emergency and Specialty, we are proud of the work our team does every day! ![]()
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Meet Lady May, a 1.5yr F/S mixed breed canine. She was adopted at six months of age and had severe incontinence for 8 months prior to presenting to Pacific Northwest Pet ER & Specialty’s internal medicine department. She had urine-stained fur and was leaking urine throughout her examination. ![]()
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Our ultrasonographer was able to identify a change that was suspicious for an ectopic ureter, which is when a ureter drains somewhere outside of the bladder. Lady May had an active urinary tract infection, so we started by treating her with a course of antibiotics. She later returned to have a cystoscopy and fluoroscopic excretory ureterogram which confirmed the suspected ectopic ureter and identified the ureter as intramural. Its intramural diagnosis, meaning it tunneled through bladder tissue before exiting in an abnormal location, allowed Dr. Sutter and the internal medicine team to laser the lesion to a more appropriate exit point inside the bladder. ![]()
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One week later, Lady May had about an 80% improvement in her incontinence, only leaking small amounts of urine at night. With the addition of medication to tighten her lower urethral sphincter, she has become continent for the first time in her life.![]()
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To learn more about our internal medicine department: www.pacificnwvets.com/service/internal-medicine/
