g107-dr-paul-hodges-vet

Esophageal Foreign Bodies

Wed, 11 Mar 2026 05:24:55 GMT

In their never ending quest to amaze pet owners and veterinarians, dogs (and sometimes cats) are always demonstrating how many things they consider "edible". While food products such as bones and corn cobs can be understood, less tempting items such as underpants, toys, stuffed animals, shoes and jewelry tend to make us scratch our heads. Most of these items will make their way down the esophagus into the stomach, and occasionally will pass through their digestive system without any major problems. However, quite often these items will become lodged somewhere and require treatment to be removed (eg: endoscopy to pull it out of the stomach or general surgery if further into the small intestine). On rare occasions a foreign object will become lodged in the esophagus and cause the pet great discomfort. Over the past while I have been asked to remove a few esophageal foreign bodies and these are never pleasant or easy to do. Objects that become lodged in the esophagus are typically larger and more firm in nature, making it harder for the pet to swallow down to the stomach. Once the object becomes stuck it can be difficult to dislodge and swift treatment is the best chance for preventing more serious secondary trauma. In particular, animals with esophageal foreign bodies are at a risk of pressure ulcerations forming in the esophagus (where the foreign material is tightly wedged). The esophagus is not able to distend like a stomach would and pressure sores (ulcers) can start to form fairly quickly. Should the foreign material be successfully removed, the esophagus begins to repair itself and scar tissue can form. If a large amount of scar tissue forms in an area there is a risk of stricture (shrinking down or narrowing of the opening in the esophagus). In extreme cases these strictures can cause the esophagus to become so narrow that food cannot get through. When this happens the process for opening that narrowed spot back up can be time consuming, uncomfortable for the pet, and expensive.

In many cases, signs of an esophageal foreign body can be difficulty swallowing, repeated swallowing motions despite not currently eating anything, drooling, regurgitation when trying to eat, and even difficulty breathing if the object is putting pressure on the trachea (airway).

BOTTOM LINE: If you think your pet has an object stuck in their throat, don't wait! The sooner you can get to a veterinarian to investigate the better.

Case #1: 5 year old small breed dog that was eating a dental chew and swallowed a large piece that became lodged in the esophagus. She was not experiencing any respiratory issues and was stable, so the esophagoscopy was performed later that day.

The foreign object was removed leaving a mild to moderate amount of inflammation to the tissue (seen as small red depressions on the lower left image. This little girl made a full recovery.

Case #2: 10 year old small breed dog with history of regurgitation for a number of days prior to presentation to his veterinarian. Radiographs showed a large amount of foreign material in the esophagus and esophagoscopy was performed to attempt to remove the obstruction. During an extremely difficult procedure we removed multiple pieces of a small plastic toy combined with a large amount of hair.

The esophagus was extremely ulcerated and we were concerned about a secondary stricture formation.

Despite aggressive therapy a severe stricture did form and ultimately humane euthanasia was elected. While unfortunate, this serves to demonstrate the importance of recognizing a problem and treating it as quickly as possible.

Wellness Testing - Why does my vet keep recommending it?

Wed, 11 Mar 2026 05:20:32 GMT

At some point or another the chances are that your veterinarian has recommended running "wellness" bloodwork on your pet during a visit. While many people appreciate the benefit of wellness testing, there is still some confusion as to what it is and why we (as veterinarians) recommend it. Quite often, the question we're asked is "why run bloodwork, he's acting completely normally"? To fully appreciate why we recommend additional bloodwork on seemingly "normal" pets it's important to understand the thinking behind these recommendations. Many veterinarians (myself included) strive to practice preventive medicine. Preventive medicine is the approach that it's better to prevent a problem in our patients, than react to and treat an already existing (and often more serious) problem down the road. In order to take this proactive approach, we're often looking for signs of impending disease which can sometimes be subtle or require monitoring for change over time. It makes sense that preventing problems is better than trying to play "catch-up" once a disease is in full swing. This isn't to say that all diseases can be addressed this way, but it's good practice to try to prevent illness when we can. Sometimes we can identify potential future problems during our physical examinations - a good example of this would be the prevention of dental disease while examining the mouth. However, the physical exam is just one of the tools we use to assess overall health and sometimes additional testing is needed to identify potential problems. This is especially important because our patients cannot talk to us and tell us how they're feeling. Wellness bloodwork is an example of a tool we use to assess overall health and consists of a comprehensive screen for many diseases. Wellness bloodwork generally consists of a CBC and Biochemical Profile:

CBC: evaluation of red and white blood cells - looks for signs of anemia, clotting disorders and infection (to name a few)

Biochemical Profile: evaluation of body organs such as liver, kidneys, pancreas. Is also used to screen for diseases such as Diabetes Mellitus, Cushings Disease, Thyroid Disease and others.

Recently I was involved in a case that perfectly illustrates how helpful wellness blood testing can be in identifying a potential problem, and initiating therapy in a dog that was showing no signs of disease at all:

A colleague recently called me in to perform laparoscopic liver biopsies on a 7 year old male neutered Standard Poodle. 2 months prior his owner had brought him in for a general annual exam and wellness bloodwork was performed during this appointment. Clinically the dog was acting completely normal and the owner had no health concerns at all, however the bloodwork came back showing some mild to moderately elevated liver values on the biochemical profile. This can sometimes be a normal fluctuation or minor recent liver insult, so the veterinarian recommended monitoring him at home and rechecking the liver values in about 4-6 weeks time. At the recheck examination, the dog was still behaving normally but the liver values had continued to increase so the decision was made to investigate further with laparoscopic liver biopsies. On laparoscopy, the liver appeared smaller than normal, quite nodular, and there were signs of fibrosis (or scarring). Multiple biopsy samples were taken and sent to the lab for interpretation, with concerns about hepatitis or cancer being the underlying cause.

Luckily, the results confirmed that cancer was not present, but did report generalized nodular growth and scarring throughout (suggestive of a slow chronic disease process but not specific).

While this particular disease may not be 100% curable, specific treatments were started to slow down the progression of disease. By catching something early, this veterinarian will now be able to offer therapies that will provide a higher quality of life for a longer period of time. By contrast, if this problem had been identified later due to the dog becoming clinically ill there would have been very little that could have been done to help him (i.e. the damage is already done and he is suffering from liver failure).

Remember: Wellness bloodwork often allows us to identify issues early and prevent smaller problems from becoming big ones!

Esophageal Regurgitation Under GA IS REAL!

Wed, 11 Mar 2026 05:17:38 GMT

It's happened to all of us - we're in the middle of a surgery and our technician tells us that the patient is regurgitating. While we continue to operate, our techs quickly clean out the mouth and double check to ensure the endotracheal cuff is snug. Now what? There are a variety of ways to address an obvious regurgitation including use of gastroprotectants (sulcrate, famotidine, omeprazole, etc.) as well as a post-operative lavage to attempt to neutralize the corrosive effects of the acidic material. In most cases, these patients recover well and do not develop severe esophagitis with complications. HOWEVER.......what if the regurgitation does unnoticed because it only made it into the distal esophagus and not all the way to the mouth? How common is this and how would we even know it happened? I'm here to tell you that subclinical esophageal regurgitation under general anesthetic does happen.....and probably more than you think.

Under normal conditions, the lower esophageal sphincter (LES) helps contain stomach material within the stomach and prevents it from entering the esophagus. The lining of the stomach is able to withstand the corrosive effects of stomach acid (and digestive enzymes) while it helps break up food, however the lining of the esophagus is more susceptible to damage from these same irritants. Under general anesthetic the LES can become relaxed, thereby allowing flow of stomach material back into the esophagus. In an awake patient this backflow might be quickly swallowed again and no long standing effects would be seen, however when this same patient is under a general anesthetic this regurgitated material sits in prolonged contact with the sensitive lining of the esophagus. Prolonged contact with stomach acid and digestive enzymes can cause damage ranging from minor inflammation and swelling, to deep ulceration of tissue and subsequent scarring. Not only is this painful for the patient, but can also occasionally lead to esophageal stricture (scarring down and narrowing of the esophagus). Esophageal stricture can obstruct the lumen of the esophagus making eating extremely difficult - a point highlighted by a difficult case I saw recently:

A 10 year old male neutered medium breed dog had undergone surgery approximately 2 weeks prior for a splenic mass. A splenectomy was performed and the dog seemed to recover without incident. Initially the dog was eating, albeit much more slowly and a smaller amount than usual - both of which were attributed to the serious surgery he had just undergone. As his recovery progressed the owner noted that he continued to eat very slowly and would vomit if he ate more than just a little bit of food at a time. After about 10 days it seemed to be worse and he would bring food back up shortly after eating (if not immediately after). The attending veterinarian became worried about a possible subclinical gastroesophageal regurgitation while under the previous general anesthetic and called me to perform an evaluation. I performed an esophagoscopy and immediately confirmed an esophageal stricture just anterior to the opening of the stomach (image 1). I was able to pass my scope through the stricture and evaluate the distal esophagus which showed marked ulceration and inflammation confirming a severe esophagitis (images 2 & 3). Gastroscopy was normal and as the scope was being retracted it was noted that the esophageal stricture had torn a small amount (presumably from the scope) making the lumen much more open.

The dog recovered from the anesthetic and was immediately put on medication for esophagitis. Balloon dilation was discussed as a possible treatment for the stricture, however the small tear had made the lumen larger and the owner and referring vet elected to treat the esophagitis and monitor for stricture recurrence (which is quite common). 10 days later the clinical signs had worsened so I repeated the esophagoscopy. Stricture recurrence was confirmed and this time I could not pass my scope through (image 4) although the level of esophagitis was greatly reduced. Referral for dilation was discussed again but the owner declined.

While cases like this unfortunately do happen, it's worth considering some measures that can be taken to try to prevent situations like this. At present, some veterinarians have considered using things like anti-emetics (metoclopramide, Cerenia) to try to keep lower esophageal sphincter tone tighter during GA. It is unclear how helpful this is, but it's worth considering due to the low risk of side effects in using medications like this. This may be especially true when performing a surgery that is longer or involving the digestive tract. Some surgeons will tip the table so that the head is slightly elevated, although this is not always feasible. Generally speaking, close observation in the 24 hours following surgery is essential as subtle signs of esophageal irritation may be picked up including: excessive lip licking, hypersalivation, dysphagia (difficulty swallowing), or painful swallowing. If any or these signs are noted, it is worth instituting treatment for presumed esophagitis - if started earlier, treatment may prevent damage from progressing to stricture. Most medications used in the treatment of esophagitis (gastroprotectants/Sulcrate, H2 receptor blockers +/- proton pump inhibitors) are well tolerated and safe and could be started sooner rather than later in suspect cases.

Intestinal Biopsy II - Case Examples

Wed, 11 Mar 2026 05:11:49 GMT

In my last post I discussed the options available when collecting intestinal biopsy samples. While both flexible endoscopic samples and laparoscopic assisted intestinal biopsy have their benefits, it really does come down to individual expectations and suspicion of disease(s). In this post, I thought I would summarize 2 cases that I participated in during a visit to a local hospital. I think it is important to remember that both rigid and flexible endoscopic samples would have been appropriate procedures for both of these procedures; however, we used a case-based approach to determine what we considered the best option.

CASE #1

"Jolene" is a 9 year old, female spayed Schnauzer with a chronic history of diarrhea and weight loss with intermittent vomiting. Previous diagnostics had not helped isolate a cause, nor had symptomatic treatment and multiple diet changes. As the disease progressed and Jolene continued to lose weight, her regular veterinarian became concerned about the possibility of Inflammatory Bowel Disease (IBD) or Intestinal Lymphoma (a form of cancer). Jolene's regular vet recommended intestinal biopsy and we discussed the best approach to take. In this case, we elected to perform upper and lower GI endoscopy (flexible) and collect biopsy samples from all areas of the GI tract (stomach, duodenum, jejunum, ileum, and colon). Multiple samples were collected throughout and sent to the lab for interpretation. A diagnosis of Inflammatory Bowel Disease was made based on these samples and appropriate therapy was initiated. Today Jolene is doing much better, has gained some weight back, and her diarrhea is largely under control.

In Jolene's case, we were collecting samples from all areas of the GI tract, so flexible endoscopy made sense as full thickness biopsies of the colon are not generally recommended. The preparation required prior to a colonoscopy was reasonable and allowed us to biopsy the colon as well as the ileum (most distal portion of the small intestine).

CASE #2

"Rex" is a 12 year old, male neutered Domestic Shorthair Cat with a history of vomiting and weight loss. As with Case #1, previous diagnostics had not isolated the potential cause. Previous diagnostics included bloodwork and urinalysis, radiographs, and an abdominal ultrasound. The ultrasound report indicated areas of thickening in the small intestine with a normal stomach. The 2 primary rule outs at this point were Inflammatory Bowel Disease (IBD) or Intestinal Lymphoma (cancer). Rex's regular veterinarian recommended intestinal biopsy and we discussed the best approach to take. In contrast to Case #1, we did not feel that biopsies of the colon were going to be especially helpful and agreed that good quality small intestinal biopsies were ideal. For Rex we elected to perform laparoscopic assisted full thickness intestinal biopsies and collected samples from the proximal duodenum along to the distal ileum. These samples were sent to the lab and unfortunately a diagnosis of Intestinal Lymphoma was made. Rex was started on supportive care as the owners elected not to proceed with chemotherapy.

To better appreciate why this approach was made, it should be noted that the only way to collect samples of the ileum using flexible endoscopy is via colonoscopy. The flexible scope, while quite long, is not long enough to travel to the ileum all the way from the mouth. Therefore, a colonoscopy must be performed to biopsy the ileum. Current literature suggests that the ileum is the most ideal location to collect intestinal biopsy samples from if trying to differentiate IBD from Lymphoma. While we could have collected our samples using flexible endoscopy here, it would have required additional time and preparation (for the colonoscopy).

As I mentioned initially, it would have been reasonable to perform either type of minimally invasive procedure for each of these cases. However, by using a case-based approach we were able to select the least invasive option that allowed a diagnosis to be made and more targeted treatments to be initiated.

Intestinal Biopsy - The Ongoing Discussion

Wed, 11 Mar 2026 04:57:03 GMT

When it comes to discussing intestinal biopsies, the same question seems to be asked over and over again: "Do I need full thickness or partial thickness biopsies to get a diagnosis"? While working in general practice I asked this question of many Pathologists and Internists. The answer was as variable as the personalities the question was being posed to. At times the opinion would be that full thickness biopsies were really the only way to confidently differentiate between diseases that can look similar (think Inflammatory Bowel Disease vs. Lymphoma). Just as quickly as that seemed to be "gospel", the opinions would change and partial thickness biopsies were now the best (and least invasive) option. So the question remains - what's better? While it is important to remember that I am a general practitioner and not a specialist, I feel it is still valid for me to present the most logical approach I take when veterinarians call me asking for biopsies.

First of all, I think it is important to appreciate that obtaining biopsy samples (in general) is best done in the least invasive way possible. A faster, less painful recovery is obviously better for the animal in question, but will also help the pet owner more readily accept the treatment recommendations. When a veterinarian calls me asking for intestinal biopsies, I explain the 2 methods I can use to help:

Flexible endoscopy involves passing a long flexible scope along the gastrointestinal tract in order to visualize from within. This scope can be passed through the mouth, down the throat and into the stomach and first part of the small intestine. Conversely, it can also be passed into the colon and up through the large intestine and (in some cases) into the last portion of the small intestine. When performing flexible endoscopy the biopsy samples are collected with a long biopsy forceps that is passed through the scope. These samples are called "partial thickness" because they only sample the innermost layers of the wall of the intestine.
Rigid endoscopy: By contrast, "full thickness" biopsies can be collected by taking samples that demonstrate all of the layers of the intestinal wall. In order to collect these samples in a minimally invasive way, a small incision is made into the abdomen and laparoscopy is performed. The intestine is grasped and brought through a small incision to allow sample collection and sutures (stitches) to be placed into the intestine to repair the defect left after the biopsy. In the past, collecting full thickness biopsies would require a larger abdominal incision and many pet owners were hesitant to put their per through this. With the use of laparoscopy, the abdominal incision is much smaller allowing for faster recovery.

So Which Is Better?

A general agreement seems to be that both full thickness and partial thickness biopsies are useful in diagnosing the majority of gastrointestinal diseases found in dogs and cats. The quality of the biopsy samples has (and always will be) the most important aspect of achieving a reliable diagnosis. However, in my opinion the decision to perform full thickness vs. partial thickness biopsies varies depending on the animal and the suspected disease. If a full representation of the small intestine is required (or wanted by the veterinarian), it can often make more sense to collect full thickness biopsies via laparoscopy. Flexible endoscopy is no doubt less invasive in comparison, but is also limited in how far into the small intestine the scope can be passed (thereby providing no guarantee of jejunum samples). In order to obtain samples from the Ileum (last segment of the small intestine) a colonoscopy must be performed (due to the extraordinary length of the small intestine). While this is certainly possible, it can be difficult to access all areas of the small intestine in smaller dogs and some cats. In addition, colonoscopy requires considerable patient preparation before performing the procedure (cleaning out the colon, etc.).

BOTTOM LINE

When performed using minimally invasive techniques, both full thickness and partial thickness biopsies can be extremely helpful in obtaining a diagnosis. The choice between technique is best tailored to the individual patient and expectations and/or requirements of the clinician responsible for the case. Understanding the pros and cons of each approach can help ensure that our patients receive the care they need with the least amount of discomfort possible.

I am always happy to discuss potential cases with veterinarians to help determine the best approach. Please feel free to contact me.

Which Spay is Best?

Wed, 11 Mar 2026 04:43:55 GMT

Recently I have had a number of inquiries from veterinarians (and clients) about the type of laparoscopic spay I perform. In general, there are 2 accepted techniques for performing a "spay": ovariohysterectomy (OVH) and ovariectomy (OVE). In an OVH both ovaries as well as the uterus are removed. By comparison, only the ovaries are removed during an OVE. The question is: which technique is better and why perform one over the other? The answer tends to stem from which technique a veterinarian was taught during their education. Generally speaking, veterinary colleges in North America have traditionally taught OVH, while colleges in Europe teach OVE. In recent years a decent amount of research has been done trying to determine if one technique has any advantages over the other. In short, both techniques seem to be equivalent from a medical standpoint. Comparisons of pain scores and recovery times showed no statistically significant difference between OVH and OVE using open (or traditional) technique. Laparoscopic spays show a very significant decrease in pain scores and recovery times when compared to traditional open surgery. However, when OVH and OVE were both performed laparoscopically they were deemed to be equivalent. With respect to future disease (mammary and uterine disease specifically), there was also no difference detected between the two procedures. In other words, there is no increased risk of mammary cancer, uterine cancer, or uterine infection if only the ovaries are removed. This makes sense because the ovaries are responsible for hormone production (primarily) and they are removed in both procedures. Conversely, I have been asked if I perform "tube tying" or a procedure where I remove only a piece of the ovarian horns and leave the ovaries in place (to prevent pregnancy only). I have not found any research suggesting this is a reasonable approach, and would have concerns with respect to future disease because the ovaries would still be present and producing hormone.

Bottom Line: Both OVH and OVE are excellent techniques for spaying dogs and cats, and the technique chosen is based on the individual surgeons experience and comfort level. There is no appreciable difference between the two procedures with respect to effectiveness, pain levels, or recovery time. Personally I tend to perform laparoscopic OVH because I went to veterinary college in Canada, but have performed laparoscopic OVE if a client or veterinarian requests that procedure.