RE: Lilly’s Post-Operative Status

Dr. Kalis,


Be aware


From: Dr. Russell Kalis
Sent: Wednesday, September 02, 2009 18:14
Subject: RE: Lilly’s Post-Operative Status


Mr. Royall,


continues to do well with no arrhythmias, retching or vomiting. However, her
blood work does show changes that we suspected due to her not wanting to eat
(low albumin) and having her spleen removed (low platelets). Also, her thyroid
level is low which can be falsely lowered when an animal is sick, along
with her having a history of hypothyroidism. We will continue to offer her food
tonight and will most likely want to keep her another evening should she not
start eating by tomorrow morning. Again, clinically she is looking very well,
but now we just need her to start eating. She will be maintained on IV fluids
throughout the night. An update will be sent tomorrow late morning/early afternoon.


for now,



From: Scott Royall []
Sent: Wed 9/2/2009 2:15 PM
To: Dr. Russell Kalis
Subject: RE: Lilly’s Post-Operative Status

Good news is


From: Dr. Russell Kalis
Sent: Wednesday, September 02, 2009 08:23
Subject: RE: Lilly’s Post-Operative Status


Mr. Royall,


is doing very well this morning. No arrhythmias were noted throughout the
night/morning. We will offer a small amount of water and food this morning.
Should she keep the water and food down without vomiting, we will start to
switch her medications from IV to oral. A blood sample has been submitted this
morning in order to evaluate her organ values and platelets. If she continues
to do well by tomorrow, she may be able to go home tomorrow afternoon. I will
give you another update (status and bloodwork) today in the late afternoon/early




From: Scott Royall []
Sent: Tue 9/1/2009 4:49 PM
To: Dr. Russell Kalis
Cc: ‘Marsha Anderson’; Mom
Subject: RE: Lilly’s Post-Operative Status

Soloxine is
fine, 0.6 mg.


From: Dr. Russell Kalis
Sent: Tuesday, September 01, 2009 16:42
Subject: Lilly’s Post-Operative Status




surgery and general anesthesia went very well.


Gastric Dilatation-Volvulus (GDV), often referred to as
"bloat" or gastric torsion, is a serious condition caused by abnormal
dilatation and twisting of the stomach. The condition is initiated by abnormal
accumulation of air, fluid or foam in the stomach (gastric dilatation).
Bloating of the stomach is often related to swallowed air, although food and
fluid also can be present. Bloat can occur with or without volvulus, or
twisting, such is the case with Lilly. As the stomach enlarges, it may rotate
90 degrees to 360 degrees, twisting between its fixed attachments at the
esophagus (food tube) and at the duodenum in the upper intestine.

Volvulus completely obstructed Lilly’s ability to empty her stomach. The
twist also prevented belching/vomiting which prevented her from being able to
relieve the air and other stomach contents. In fact, a hallmark symptom of
torsion is nonproductive attempts at vomiting. The bloated stomach obstructs
the return of blood from the veins in the abdomen which can lead to low blood
pressure, obstructive shock and associated complications.

The combination of bloating and torsion greatly reduces the blood supply to the
stomach (gastric ischemia) and this can lead to necrosis (death) of the stomach
wall. Shock and lack of blood supply to abdominal organs break down the
integrity of the gastrointestinal tract lining and permit toxins and bacteria
to enter the blood stream. Abnormal blood clotting – disseminated
intravascular coagulation (DIC) – may develop. The spleen can be damaged
or begin to bleed because it is attached to the stomach by a membrane, and it
becomes twisted and rotated abnormally as the stomach turns. Heart function is
compromised due to lack of venous blood return. Irregular heart rhythms often
develop such as ventricular tachycardia.


cardiac arrhythmias were noted at any point prior to or during the surgery. Due
to decreased perfusion and viability of the spleen, Dr. Liska removed the
sleen. In addition, the stomach was derotated and sutured to the abdominal wall
in order to help prevent the stomach from rotating on itself in the future. We
will continue to monitor Lilly throughout the night and will give another
update tomorrow late morning/early afternoon.


noted that Lilly is currently taking thyroid medications. Please let us know
what which medication (Soloxine?) dose (?) and frequency (twice daily?) she has
been receiving in order for us to continue that medication tomorrow morning.



Russell Kalis


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