Case studies


We thought we'd highlight some interesting cases that show our approach using 'modern medicine with traditional values'. We hope they give an insight into what Tweed House Vets can offer your pet at its time of most need. Any questions are welcome. Contact us for more information.

PORTOSYSTEMIC SHUNT in a Miniature schnauzer

A male miniature Schnauzer presented to us with problems urinating. Our vet, Elisabeth, admitted him and discovered that he had multiple large bladder stones. A cystotomy (operation to cut into the bladder) was performed and the srtones removed. The dog recovered very well. The stones were sent to the University of Minnesota where they underwent quantitative analysis. The results revealed that these stones were Urate stones.

Urate stones sometimes form in dogs; Schnauzers being a common breed for this to happen; if a Portosystemic Shunt (PSS) is present. These shunts are usually present at birth and are abnormal blood vessels that shunt blood from the intestinal circulation (Portal veins) straight into the vena cava, thereby bypassing the liver. This means the liver never gets its chance to metabolise the digested components within the blood and this has major metabolic consequences in the body. In this dog's case it meant it started producing crystals in the urine. In more sever cases and over time dogs can go on to develop other signs such as anorexia, vomiting and fits.

In this case the owner elected to have surgery performed to close off the PSS. With the help of Roger Wilkinson, of Ultrasound4Pets, the shunt was identified by Doppler ultrasound. Roger performed the surgery to place and ameroid constrictor around the vessel. These constrictors slowly constrict the vessel over time so that the problem can be slowly rectified. This avoids the risk of blood backing up in the intestines too quickly (increase portal blood pressure). The dog recovered well from surgery and went home the same day. 

A case of insulinoma in a west highland white terrier.

This case highlights the multi-disciplined approach that we had to follow to gain a diagnosis and successful management of the condition. 

Poppy is a nine year old female Westie and her owner originally brought her to see our vet Phil in January. She had been having small fits when she was excited or had been exercising. There are many causes of fits in dogs, with epilepsy being the most common, but Phil thought it was unusual for a dog of Poppy's age to suddenly develop epilepsy. He obtained blood samples and sent them to a specialist veterinary lab (which happens to be just round the corner from our Yeadon surgery, so the blood sample could be analysed very quickly!). The lab picked up that Poppy had a very low blood glucose level. As Poppy is not a diabetic and was not showing signs of poisoning, Phil used his medical expertise to suspect that Poppy may have an insulinoma. The lab was then asked to perform a very specialist test to check Poppy's insulin levels and it was discovered that her insulin levels were much higher than normal. This was highly suggestive of an insulinoma, a tumour of the B-cells in the pancreas that produce insulin. If insulin levels are too high, the blood glucose level falls and when blood glucose drops too low it can cause fits. 

Insulinomas are not very common in dogs and the condition only gets a small mention in most veterinary textbooks, so we were quite surprised to diagnose this condition. Insulinomas can spread to other parts of the body so it was very important that we made sure Poppy's tumour hadn't spread to her lymph nodes or liver. We called upon a specialist Ultrasonographer to come into the practice and obtain very detailed ultrasound scans of Poppy's abdomen. He discovered that the tumour sat in the left arm of the pancreas, and fortunately there were no signs of spread elsewhere. 

We discussed surgery with Poppy's owner and a couple of weeks later she came in to have the tumour removed. You can see the tumour on the pictures, surrounded by normal pancreatic tissue. We had to remove some normal pancreas to make sure we had successfully cleared all of the tumour cells. Poppy recovered from the surgery well, but 24 hours later she started to drink lots and was a little sickly. These were signs of pancreatitis, an inevitable side effect of the surgery (but only temporary). The excessive drinking was caused by a rebound diabetes. When the tumour is removed it takes a while for the normal B cells that remain to recover function as they had been relying on the tumour to provide all of Poppy's insulin. We had to give Poppy insulin for a few days after the surgery until her own reserves recovered. She also needed to be hospitalised on fluids, pain relief and anti-sickness drugs. 

A week on and Poppy was a lot better and back to normal. She has had her stitches removed and we will now intermittently monitor her to check that there is no recurrence of the condition. We would like to thank Roger Wilkinson of Ultrasound4Pets for supplying such an excellent diagnostic service and for the use of his images in this report.


Cruciate ligament disease is the most common cause of hindlimb lameness in the dog. When the ligament ruptures it causes instability of the stifle (knee). The image below shows stabilisation of the stifle using a technique called Tibial Tuberosity Advancement (TTA). We are proud to offer TTA at Tweed House Vets. This specific technique uses a titanium implant developed by Orthomed (TM), which provides support for new bone to grow into it, resulting a very stable TTA. 

Colonic prolapse in a puppy

This was a very interesting, but extremely nerve wracking case for our vets one evening. A little 10 week old puppy was brought by her owners one evening and it is clear from the picture below that she had a big problem. She had been straining to pass faeces that afternoon and eventually she strained so hard that she managed to prolapse her rectum and colon right the way back to her small intestine. We had to stabilise her with pain relief and fluid therapy for the shock and then anaesthetise her to perform a laparotomy (opening into the abdomen) to enable us to retract the prolapsed intestine and put things back in the right place. This was very delicate surgery as the bowel was extremely fragile by that point. We also had to 'plicate' (fold against itself) the small intestine and perform a colopexy (attach the colon to the abdominal wall) to prevent a recurrence. We are happy to report that this pup made a full recovery. The prolapse had occurred as the pup had suffered a telescoping of its bowel called an intussusception. 

Hypoglycaemia (low blood sugar) in a miniature chihuahua. 

A small dog came into our surgery collapsed and in a coma following an episode of vomiting and diarrhoea. Her owner feared the worst. The little dog was immediately rushed into our prep room and placed on intravenous fluids whilst blood was taken to run on our in-house biochemistry and haematology analyser. Within two minutes we were able to determine that the dog had an extremely low blood sugar level and an infection of the gastrointestinal system. Intravenous glucose and antibiotics were given immediately to increase blood sugar levels and treat the infection. The dog came out of its coma within ten minutes and we were able to discharge it 48 hours later. 

These cases shows how important it is to have access to on site laboratory facilities for immediate results.

heart failure in a hyperthroid cat

A female cat came into us in severe respiratory distress. Xrays revealed fluid build up around the lungs (pleural effusion). Blood tests were run immediately and we were able to determine that the fluid build up was as a result of heart failure due to an over-active thyroid gland. A pleural effusion usually carries a poor prognosis, but the rapid discovery of an over active thyroid gland allowed us to make the decision to drain the fluid from the chest and begin anti-thyroid medication. The over active thyroid glands were removed a few weeks later and the cat made a full recovery.

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