Patient of the Week Candidates

for the week of July 19th thru 23rd, 2010

Review the patient summaries below
then vote for your favorite patient.
The patient with the most votes wins the “Patient of the Week” title.

PATIENT SUMMARY:
Drake is a 4mo old 40# Italian Mastiff (cutest, largest puppy to pass through our doors in a long time! I mean a 40# puppy with paws larger than my sweet Ruby’s hands. . . and that puppy fur – so silky. Can’t wait for this “little” guy to come back for his recheck!)

Dr. Howard Foggo of Benton Veterinary Hospital is his referring veterinarian. Drake jumped from a pickup window (he was a bit rambunctious even with the CCL injury – that’s cranial cruciate ligament, just like the “ACL” in our knees) , and began exhibiting acute right rear lameness (wouldn’t you!).

Dr. Dew discussed doing radiographs to check for avulsion and then EFS (external fascial strip) stabilization (a procedure that Dr. Dew co-created!). Since Drake is still growing (and will more than likely triple in size), having hardware placed in his knee would not be a good idea.

TREATMENT:
Surgery went off without a hitch, but required several stiches. The hardest part will now be keeping this guy activity restricted! But his mama bought him a new crate and he should be good to go! See you in two weeks for your recheck Drake.

(more…)

Patient of the Week

June 28th thru July 2nd, 2010 

and the winner,
with 10 votes, is. . . . 

PATIENT SUMMARY:
Gretchen is a 101.6# 6.5yr old Anatolian Shepherd. Her referring veterinarian is Dr. Brian Barron of Shackleford Road Veterinary Clinic. Dr Barron diagnosed a spindle cell tumor of the rostral right hemi-mandible. Dr. Dew discussed partial mandibulectomy, probability of limited ability to obtain wide margins, as well as the likelihood of recurrence and options for revision surgery in the future. Gretchen’s owner was well-educated concerning oral tumors and wishes to proceed with excision and histopathologic assessment.
TREATMENT:
Gretchen’s oral exam demonstrated the tumor crossing the symphysis. Dr. Dew called and discussed converting to a bilateral mandibulectomy; her owner decided to proceed with bilateral rostral mandibulectomy. Radiographs demonstrated limited bone involvement and no evidence of pulmonary metastasis. Dr. Dew used an oral and ventral approach for the mandibulectomies. He observed 1cm margins of bone and soft tissue, with no gross evidence of tumor at the margins. On the right, M1-2 and Left PM2-3, with roots removed. Dr. Dew shaped the bone ends with a burr, and all tissue removed was sent to AR-State lab. Gretchen’s prognosis is good for soft tissue healing, the likelihood of recurrence and the likely disease free interval will be better determined after a definitive diagnosis is obtained and margins are assessed.

Congratulations Gretchen!

Patient of the Month

June 2010

and the winner,
with 401 votes, is. . . .

PATIENT SUMMARY:
Jack is a 62.8# 7yr 3mo old Beagle. He was referred to us by Dr. Sharon Stone of St. Francis Veterinary Clinic. Jack had an acute onset of left rear lameness, and Dr. Stone identified a left CCL injury and referred to us for a Left TTA (tibial tuberosity advancement).

TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. Hardware from Kyon used were as follows: 9×19mm basket, 4 hole plate & fork, and 4 titanium screws. Jack’s prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). Nursing care, physical therapy, exercise restriction and the use of Glycoflex will play critical roles in an uncomplicated recovery and optimization of long term function. With the TTA procedure, it is not uncommon to see some bruising and edema around the hock (ankle) and on the inside of the leg below the incision. These changes are not painful and will resolve without treatment in 3-10 days.

Congratulations Jack!

Azzore’s Tomato Wars – Episode Three

What’s happening to Pam’s tomato plants?

Back to the Zoo

This time to fix a Cheetah!

Moonfire was destined to make the news! Read the “Cheetah Roams Airplane after Escape From Cage” Story here to find out more. Recently  Moonfire was up to something. . . maybe another escape attempt. . . or maybe just a really fun play session at the Zoo. . . who knows, but we do know that she broke her foot!

but Dr. Dew came to her rescue!

Patient of the Week

June 28th thru July 2nd, 2010

and the winner,
with 215 votes, is. . . .

PATIENT SUMMARY:
Schultz is a 2yr old 20# Dachschund. His veterinarian is Dr. Joe Rohlman of Rohlman Animal Hospital. Schultz had an acute onset of rear limb weakness on the previous Sunday, with the left being significantly worse than the right. Treated with steroids, his owner has seen some improvement. Upon examination by Dr. Dew, he shows Grade III rear limb paresis, and the panniculus changes character at L2. Dr. Dew discussed myelogram, and hemilaminectomy surgery if indicated. The owners wished to proceed with diagnostic examinations and surgery if indicated.
TREATMENT:
Cerebrospinal centesis: 2ml of clear CSF was collected from the cisterna magna.
Myelogram: Using a lumber 3ml injection of iohexol, column thinning from L2-L5 was apparent, with a slight deviation of cord to the right at L4-5. Surgery would be beneficial, but due to cord swelling prognosis is guarded until improvement is noted.
Hemilaminectomy: Dr. Dew used a dorsolateral approach at L4-5. A large amount of organized clot and acute disc material was removed, and the cord returned to its normal position. Schultz’s prognosis is good for healing and improved neurologic function. A transient worsening of neurologic function can be noted after a myelogram and surgery. This condition will usually resolve to the pre-operative state in 3-10 days. The nervous system is very slow to heal. Improvement can be expected for up to 5 months. Nursing care, physical therapy and exercise restriction all play critical roles in avoiding complications and aiding recovery.

Congratulations Schultz!

Patient of the Week Candidates

for the week of July 12th thru 16th, 2010

Review the patient summaries below
then vote for your favorite patient.
The patient with the most votes wins the “Patient of the Week” title. 

PATIENT SUMMARY:
Gretchen is a 101.6# 6.5yr old Anatolian Shepherd. Her referring veterinarian is Dr. Brian Barron of Shackleford Road Veterinary Clinic. Dr Barron diagnosed a spindle cell tumor of the rostral right hemi-mandible. Dr. Dew discussed partial mandibulectomy, probability of limited ability to obtain wide margins, as well as the likelihood of recurrence and options for revision surgery in the future. Gretchen’s owner was well-educated concerning oral tumors and wishes to proceed with excision and histopathologic assessment.
TREATMENT:
Gretchen’s oral exam demonstrated the tumor crossing the symphysis. Dr. Dew called and discussed converting to a bilateral mandibulectomy; her owner decided to proceed with bilateral rostral mandibulectomy. Radiographs demonstrated limited bone involvement and no evidence of pulmonary metastasis. Dr. Dew used an oral and ventral approach for the mandibulectomies. He observed 1cm margins of bone and soft tissue, with no gross evidence of tumor at the margins. On the right, M1-2 and Left PM2-3, with roots removed. Dr. Dew shaped the bone ends with a burr, and all tissue removed was sent to AR-State lab. Gretchen’s prognosis is good for soft tissue healing, the likelihood of recurrence and the likely disease free interval will be better determined after a definitive diagnosis is obtained and margins are assessed.

(more…)

Azzore’s Tomato Wars – Episode Two

Pam Seeks Expert Advice

Patient of the Week

June 21st thru 25th, 2010

and the winner,
with 401 votes, is. . . .

PATIENT SUMMARY:
Jack is a 62.8# 7yr 3mo old Beagle. He was referred to us by Dr. Sharon Stone of St. Francis Veterinary Clinic. Jack had an acute onset of left rear lameness, and Dr. Stone identified a left CCL injury and referred to us for a Left TTA (tibial tuberosity advancement).

TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. Hardware from Kyon used were as follows: 9×19mm basket, 4 hole plate & fork, and 4 titanium screws. Jack’s prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). Nursing care, physical therapy, exercise restriction and the use of Glycoflex will play critical roles in an uncomplicated recovery and optimization of long term function. With the TTA procedure, it is not uncommon to see some bruising and edema around the hock (ankle) and on the inside of the leg below the incision. These changes are not painful and will resolve without treatment in 3-10 days.

Congratulations Jack!

Laryngeal Paralysis

Post-operative

So, what happened with Marcie after surgery?

Marcie was given a good prognosis for uncomplicated recovery and improved quality of life — in other words, she could look forward to being able to breathe more easily than before surgery.

The first 24 hours after surgery have the highest risk. There is a chance of swelling in the airway (edema), so Dr. Dew recommended that Marcie be watched at a 24-hour facility. during this time period.

One of the possible complications following arytenoid tie-back is aspiration pneumonia — in layman’s terms, this is an infection caused when saliva is inhaled into the lungs.

Symptoms of aspiration pneumonia include lethargy and loss of appetite. Untreated, this is a potentially fatal condition. Aspiration pneumonia can be diagnosed with chest x-rays and antibiotics will generally clear it up.

Marcie was sent home with a five day supply of Prednisone to reduce swelling and was given a long-acting antibiotic injection. We prefer injections over capsules that have to be given orally whenever we perform a surgery that involves the oral or respiratory system.

Marcie will come back to see Dr. Dew for a recheck in a couple of weeks to make sure that she is healing as expected.

What lifestyle changes will Marcie have to make?

For one month post-surgery, Marcie will need to be exercise restricted. This means no off-leash activity (in other words, Marcie will be on one end of the leash, and her people will be holding the other end!). In fact, we actually recommend a harness in place of a leash.

Marcie will need to be restricted to short leash walks in the cool of the morning and evening during this time.

At no time should she be left unattended in the yard or in a vehicle. (Of course, NO pet should be left unattended in a vehicle!)

Marcie will be intolerant of hot, humid conditions for the remainder of her life, but with minor adjustments to her daily routine, she should do just fine!