Patient of the Week for March 18-22, 2013

Posted by azzore | Azzore Review | Monday 1 April 2013 10:24 pm
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Patient Of The Week

for the week of March 18th – 22nd, 2013 

Graham wins Patient Of The Week !

Graham POTW

Graham

is a Golden Retriever, who was originally referred to us by Dr House at Rodney Parham Animal Clinic. Dr. Dew did a CT Scan and nasal tumor removal on Graham in February 2012. Graham has enjoyed the past year with his family and housemate, Chip, with no symptoms, though we knew the tumor would come back at some point. Graham returned to Azzore because his symptoms indicated his tumor had grown back. Dr. Dew performed a CT Scan to confirm. Looking forward to the day we can offer a permanent cure.

Total Elbow Replacement

Posted by azzore | Azzore Review | Monday 11 February 2013 10:31 am
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Total Elbow Replacement

using the TATE elbow system by BioMedtrix

 

Dr. Randy Acker came in to assist Dr. Dew with two total elbow replacement surgeries on February 2, 2013. Total Elbow Replacements are relatively new to veterinary orthopedics, being developed a little over 10 years ago. Read more about the TATE Elbow system here.

Dr. Acker developed the TATE total elbow system, named after his own dog Tate, a yellow lab suffering from severe elbow dysplasia. Dr. Acker sought many forms of treatment for Tate, none of which proved to be very helpful. You can read more about his development here.

There are only 3 veterinary surgeons in the United States who perform the total elbow replacement surgery using the TATE system: Dr. Acker the developer; our very own Dr. Dew; and another board certified surgeon and academician Dr. Dejardin at the College of Veterinary Medicine, Michigan State University.

 

Our first case study  “Dixon”, a 5 year old female spayed mix breed weighing 69 pounds, first came to see Dr. Dew in November 2012 to discuss total elbow replacement. “Dixon” suffered from bilateral forelimb lameness, severe osteoarthritis in both elbows, restricted range of motion, and muscle atrophy. Her owner believed the right forelimb to be more problematic than the left. Dixon then came back in December to be sized for her implant. (For pictures, x-rays and surgery reports for Dixon go here)

Due to Dixon’s severe osteoarthritis, her surgery took much longer than originally anticipated and, as you will see, was not as clean as York’s surgery. From prep to recovery, total time was 5 hours.

 

“York”, our second case study, initially came in April 2012 for a consult with Dr. Dew to discuss what the options were for elbow dysplasia. “York” had demonstrated right fore lameness for months. Radiographs demonstrated significant osteoarthritis in the right elbow. Neurologic exam and orthopedic exams did not demonstrate any other problems in the right fore. The options discussed with York’s owners included regenerative medicine, total elbow replacement and medial compartment resurfacing.  (For pictures, x-rays and surgery reports for York go here)

 

“York’s” surgery was much cleaner and only took 3.5 hours from prep to recovery.

 

Both Dixon and York were seen 3 days post surgery. The incisions were healing as expected. “Dixon” was placing as much if not more weight on the right fore than prior to surgery. “York” was willing to place the limb. Both owners were reminded about the need for exercise restriction and a slow incremental increase in on-leash activity.

 

 

Joint Replacement

Posted by azzore | Azzore Review | Wednesday 23 January 2013 9:18 am
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Interesting article in the NY Times about Joint Replacement in dogs.

 

http://www.nytimes.com/2011/01/17/sports/17dogs.html?pagewanted=all&_r=0

 

Joint Replacements Keep Dogs in the Running

Suzy Allman for The New York Times

Kathleen Dooley’s pug, Lily, ran an obstacle course at the Port Chester Obedience Training Club in White Plains

By VINCENT M. MALLOZZI

In November 2006, Dr. Melvyn Pond performed total hip-replacement surgery on a patient who had been hobbled from years of exercise and competition.

Kathleen Dooley’s pug, Lily, underwent hip replacement surgery shortly after beginning her agility-course training.

Now the patient is competing again — on all fours.

“She’s doing very well,” Pond said of Lily, a 9-year-old pug who participates in agility contests. “For her to be able to run, jump and climb again is pretty exciting news.”

Pond, who is based in New Haven, is among a handful of veterinarians who have been replacing hips, elbows and knees in dogs like Lily, allowing them to prolong their competitive careers.

Joint replacement has helped larger working dogs return to hunting, aiding the blind and assisting in search-and-rescue missions and other police activities, not to mention relieving the pain of beloved pets. Although hip-replacement surgery for bigger dogs has been performed since the mid-1970s, micro-hip replacement for cats and dogs weighing 6 to 30 pounds began in the last five years.

“I was totally shocked to see that Lily was walking so well almost immediately after the surgery,” said her owner, Kathleen Dooley of Washington Heights. “She is happiest when she is training and competing. It keeps her mentally and physically fit.”

That sentiment is familiar to Dr. Pamela Schwartz, who specializes in soft tissue and orthopedic surgery at the Animal Medical Center in Manhattan.

“Many people treat their dogs as if they were their own children,” she said. “So when it comes to the health of their dogs, owners are more inclined than ever before to seek out specialized care.”

According to the American Pet Products Association, based in Greenwich, Conn., spending in the industry — including food, supplies, veterinary care, live animal purchases and services like grooming and boarding — grew by 5.4 percent to more than $45.5 billion in 2009 from $43.2 billion the year before, with no declines in any category from 2007.

The average cost of replacement surgery is about $5,000, not including any physical therapy that may follow.

Lily, who weighs 18 pounds, is one of about 200 dogs around the world who have had a micro-hip replacement since the product was licensed in 2005, by BioMedtrix, a company in Boonton, N.J., that designs, develops and manufactures veterinary orthopedic implants and the surgical tools used in such procedures. The primary materials used in the prosthetics — titanium and cobalt-chromium-molybdenum alloys — are the same as those for humans.

“While the short-term results have been very good,” Pond said, “I think there aren’t many other veterinarians doing these types of surgeries because they seem to be hanging back, waiting on the long-term results.”

Indeed, six months after Lily’s replacement surgery, she still limped occasionally. Pond found a gap between the artificial socket and the bone, so he recemented the socket into place in May 2007. Lily has had no problems since.

“This is a relatively new science,” said Dr. William D. Liska, a veterinary orthopedic surgeon based in Houston who performed the first micro-hip replacement there in April 2005 on a Shetland sheepdog named Champ.

Two months later, Liska made an international house call in Helsinki, Finland, to perform the first knee replacement on a Karelian bear dog named Jere, a national moose hunting champion, as part of clinical trials for the prosthetics. Total knee replacements became available for all dogs in 2007.

Since then, about 120 dogs have had the operation. Among Liska’s 1,500 surgical patients over the years are a black Labrador retriever from Rome, a yellow Labrador from Mexico and a Lhasa apso from Japan.

“I don’t think the general public is very aware of these surgical procedures,” he said. “When they find out, they are wowed by it and pleasantly surprised.”

Three years ago, Liska replaced a hip on a 7-year-old Australian shepherd named Zydeco, whose career as a champion Frisbee dog was in jeopardy.

“She did this particular trick during competitions where she caught a Frisbee and rolled over on her back,” said Mark McNitt of Houston, who owns Zydeco. “Suddenly, she wasn’t able to do that anymore, and over time, I noticed she started limping and I realized she was in pain.”

Six months after the operation, Zydeco was working out again in her backyard. Shortly thereafter, she was back on the Frisbee circuit. In August, Zydeco and McNitt finished 12th among 69 teams at the Colorado Canine Challenge in Denver.

“I don’t know what we would have done if this surgery wasn’t available,” McNitt said. “She’s just tearing it up now, no more pain, and she will probably be competing for another three or four years.”

Pond said that, unlike humans, most athletic dogs who had joint-replacement surgery could return to top-level competition.

“As long as these dogs are not involved in a contact sport, they should be fine,” he said. “Bo Jackson had hip-replacement surgery and could not return to football, but Tom Watson was able to return because golf does not have the same physical demands.”

Total elbow replacements for dogs weighing 50 to 80 pounds began in the late 1980s, but only since a minimally invasive procedure was developed in 2008 has it become a generally accepted method of treating severe disease in the joint. Since then, 90 dogs worldwide have had total elbow replacements, the first performed by Dr. Randall L. Acker in 2007 on a black Labrador from Boise, Idaho, named Otis.

Acker, who is based in Sun Valley, Idaho, was inspired by his yellow Labrador, Tate, who suffered greatly from elbow tendinitis before dying of cancer in 2003. He worked with Greg Van Der Meulen, a biomedical engineer, to create a cementless total elbow prosthesis. Now known as the Tate Elbow, it was eventually licensed by BioMedtrix.

“I didn’t want to see any more dogs going through what Tate went through,” Acker said. “More and more people who consider their dogs to be a part of their families are now opting for this surgery, and they are willing to pay for it.”

“It’s well worth it,” said Dr. Jim Sabshin, a neurosurgeon from New Haven. Five years ago, Liska performed a double hip replacement on his 7-year-old Labrador retriever, Leia.

“She was having trouble hunting, swimming and walking up stairs, just sort of bunny-hopping around, which is a sign of hip dysplasia,” Sabshin said. “I thought I had two really bad options: letting her live with the pain or having to put her down. She’s now running around like a normal dog. You could never tell she has artificial hips.”

The same could be said for Lily, who was gnawing on a bone at home a few hours before a recent training session at the Port Chester Obedience Training Club in White Plains. An inch-long scar on her left hip was the only sign of her operation.

“My local veterinarian said Lily would never again be able to do agility exercises,” Dooley said, watching Lily scoot around her apartment. “But my husband and I kept searching for help. We never gave up.

“Just look at her now.”

 

For more information on Total Hip replacement click here. or for Total Elbow Replacement here.

Spinal Regeneration Study

Posted by azzore | Azzore Review | Friday 30 November 2012 12:49 pm
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Interesting report by Fergus Walsh, the medical correspondent for BBC News, on spinal regeneration helping paralyzed dogs walk again.

 

 

Nose cell transplant enables paralyzed dogs to walk

Jasper the dachshund walking again.

 

Scientists have reversed paralysis in dogs after injecting them with cells grown from the lining of their nose.

The pets had all suffered spinal injuries which prevented them from using their back legs. The Cambridge University team is cautiously optimistic the technique could eventually have a role in the treatment of human patients. The study is the first to test the transplant in “real-life” injuries rather than laboratory animals.

Olfactory ensheathing cells

The only part of the body where nerve fibres continue to grow in adults is the olfactory system.

Found at the back of the nasal cavity, olfactory ensheathing cells (OEC) surround the receptor neurons that both enable us to smell and convey these signals to the brain.

The nerve cells need constant replacement which is promoted by the OECs.

For decades scientists have thought OECs might be useful in spinal cord repair. Initial trials using OECs in humans have suggested the procedure is safe.

In the study, funded by the Medical Research Council and published in the neurology journal Brain, the dogs had olfactory ensheathing cells from the lining of their nose removed.

These were grown and expanded for several weeks in the laboratory.

 

Treadmill

Of 34 pet dogs on the proof of concept trial, 23 had the cells transplanted into the injury site – the rest were injected with a neutral fluid.

Many of the dogs that received the transplant showed considerable improvement and were able to walk on a treadmill with the support of a harness.

None of the control group regained use of its back legs.

The research was a collaboration between the MRC’s Regenerative Medicine Centre and Cambridge University’s Veterinary School.

Professor Robin Franklin, a regeneration biologist at the Wellcome Trust-MRC Stem Cell Institute and report co-author, said: “Our findings are extremely exciting because they show for the first time that transplanting these types of cells into a severely damaged spinal cord can bring about significant improvement.

“We’re confident that the technique might be able to restore at least a small amount of movement in human patients with spinal cord injuries but that’s a long way from saying they might be able to regain all lost function.”

Prof Franklin said the procedure might be used alongside drug treatments to promote nerve fibre regeneration and bioengineering to substitute damaged neural networks.

 

Partial repair

The researchers say the transplanted cells regenerated nerve fibers across the damaged region of the spinal cord. This enabled the dogs to regain the use of their back legs and coordinate movement with their front limbs.

The new nerve connections did not occur over the long distances required to connect the brain to the spinal cord. The MRC scientists say in humans this would be vital for spinal injury patients who had lost sexual function and bowel and bladder control.

Prof Geoffrey Raisman, chair of Neural Regeneration at University College London, who discovered olfactory ensheathing cells in 1985 said: “This is not a cure for spinal cord injury in humans – that could still be a long way off. But this is the most encouraging advance for some years and is a significant step on the road towards it.”

He said the clinical benefits were still limited: “This procedure has enabled an injured dog to step with its hind legs, but the much harder range of higher functions lost in spinal cord injury – hand function, bladder function, temperature regulation, for example – are yet more complicated and still a long way away.”

Jasper, a 10-year-old dachshund, is one of the dogs which took part in the trial.

His owner May Hay told me: “Before the treatment we used to have to wheel Jasper round on a trolley because his back legs were useless. Now he whizzes around the house and garden and is able to keep up with the other dogs. It’s wonderful.”

Jasper can be seen in the video at the top of the page before and after his treatment.

 

from BBC News online

ID Chip

Posted by azzore | Azzore Review | Monday 1 October 2012 5:43 pm
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Chip

 

ID Chip #1

is an 8 year old Labrador Retriever mix who came to us with rear limb lameness and a recurring infection after a previous surgery at another clinic. Dr. Ward at Ward Veterinary Clinic referred Chip and his family to Dr. Dew. Dr. Dew explored the draining tract, submitted tissue for histology and retrieved suture material for culture and sensitivity, The prognosis is good for resolution of infection. The stability of the stifle will determine if a TTA procedure will be beneficial in the future.

While Chip was here, his family asked if we could also do some DNA testing on Chip, since everyone always asks them what breed he is and they just don’t know. Knowing your dog’s breed can sometimes be beneficial when it comes to issues such as training and health problems.

DNA was collected and sent in for testing. We should have the results sometime between October 15th and 22nd. In the meantime, we thought it would be fun to see what our readers think. So, for a chance to win an Azzore Prize Pack, comment with your best guess and help us ID Chip.

 



 

Managing Corneal Ulcers

Posted by azzore | Azzore Review | Tuesday 12 June 2012 1:25 pm
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Managing Corneal Ulcers

if an ulcer doesn’t heal in 5-7 days after routine therapy, refer to an animal eye specialist. Time is of the essence.

 

Routine therapy for corneal ulcers will normally consist of a broad spectrum antibiotic and atropine. If the ulcer is not beginning to heal within 5 to 7 days, it is time to refer to a specialist.

There are several complicating factors depending on the type or severity of the ulcer, and more aggressive medical therapy, even surgical therapy, may need to be pursued.

 

Types of Corneal Ulcers:

  1. Secondary, anatomic
  2. Traumatic
  3. Bacterial
  4. Fungal
  5. Herpetic
 

Ranges in Severity of Corneal Ulcers:

  1. Superficial
  2. Mid-Stromal
  3. Deep
  4. Full-Thickness
 

Complicating Factors:

Brachiocephalic Breeds
(smooshed faces – i.e., Shih Tzu, Lhasa Apso, Pekingese, Pugs, etc.)
Eyelid Disease – Entropion, Distichia
 
Dry Eye (KCS)
 
Bacterial Infections
Melting
Fungal
 
Viral (herpes) Infections
Eosinophilic Keratitis
Sequestrum
 
Indolent Ulcer
 
Descemetocele
Iris Prolapse
 
Endothelial Dystrophy
 
Endothelial Degeneration
 
Laceration/Foreign Body
 
 
 

 

Types of Therapy:

  1. Routine Medical Therapy – for superficial, non-complicated ulcers (either bacterial or traumatic)
  2. Aggressive Medical Therapy – for mid-stromal, deep, melting and/or bacterial ulcers
  3. Specific Medical Therapy – based on ulcer type
  4. Surgical Therapy – medically non-responsive, rapidly progressing ulcers; infected: deep, full thickness ulcers
  5. Specific Type Surgical Treatment – for indolent ulcers, sequestrum, corneal degeneration, and endothilial dystrophy
 
 
 

 

Cataracts – Before and After

Posted by azzore | Azzore Review | Tuesday 12 April 2011 10:28 am
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Cataracts

before and after surgery

 

Wendy, an 11 year old shih tzu, before cataract surgery:

 

and now here she is after her cataract surgery:

 

- – - – - – - – - – - – - – -

 

 Buddy, an 11 year old toy fox terrier,
experienced bilateral cataracts:

 

and here he is after his cataract surgery:

Cataracts

Posted by azzore | Azzore Review | Thursday 24 March 2011 12:31 pm
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Cataracts

Vision is restored in 90-95% of patients after cataract surgery.

 

Cataracts in Dogs

Dr. Hodgson recently treated two patients for cataracts on the same day.
Over the next several weeks, we’ll follow their progress
from their initial exams, to surgery, to the follow up appointments.

 

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Meanwhile, test your knowledge about Cataracts with the following True or False Quiz.

1.  I should wait to have my dog’s cataracts treated until his vision is compromised.

2.  I should wait to have my diabetic dog’s cataracts treated until his diabetes is controlled/regulated.

3.  Cataracts are a disease of old age.

4.  All cataract patients have an artificial lens surgically implanted.

5.  The average age of a cataract patient is 12-13 years old.

 

 

Wondering how you did? Find out here:  cataract quiz answers.

 

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What is a cataract?

A cataract is a change in the clear protein of the lens. Normally, the lens is transparent and clear, allowing the image that the eye is focused on to be clearly projected onto the retina. When the lens proteins change or are damaged, the lens becomes cloudy or opaque. The opaque area, or cataract, distorts the image projected onto the retina which results in a slightly blurred image. As the cataract progresses more and more of the lens is affected, which distorts the image further until vision problems occur.

Most dogs with diabetes develop cataracts within 6 to 12 months due to biochemical changes in the lens caused by elevated blood glucose levels.  Diabetic cataracts progress quickly causing blindness.  Surgical removal of the cataract restores vision and improves quality of life.  Removal of the cataract by phacoemulsification surgery is still the only present method of improving or restoring vision in a patient with cataracts.

(For more about Cataracts and Cataract Surgery click here.)

Laryngeal Paralysis: Post-Op

Posted by azzore | Azzore Review | Monday 12 July 2010 12:23 pm
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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.

A long acting antibiotic was given as an injection.
Rechecks:
“Marcie” should be rechecked in 13 days by Dr. Dew. If at anytime during the healing process you wish to have Dr. Dew recheck “Marcie”, please call 479-964-4300 to schedule a recheck appointment.
Exercise Restriction:
“Marcie” should be restricted to leash activity for one month.  ”Marcie”  should be restricted to short leash walks in the cool of the morning and evening.  At no time should she be left unattended in the yard or in a vehicle.  ”Marcie” will be intolerant of hot, humid conditions for the remainder of her life.
Other Information:
Use of a harness rather than a collar, permanently, would help prevent stress on the neck.

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!

Laryngeal Paralysis Surgery

Posted by azzore | Azzore Review | Saturday 15 May 2010 1:36 pm
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The surgery – Arytenoid Tie-Back

Laryngeal Paralysis Part Three

 

Marcie in recovery following laryngeal tieback sugeryMarcie’s mom brought her to our Russellville surgery center on May 5th. Marcie underwent arytenoid tieback on the left side. Typically, only one side needs to be operated on, as a unilateral tieback procedure will provide sufficient increase in the airway for comfortable breathing.

Marcie did well during surgery, and has a good prognosis for an uncomplicated recovery and improved quality of life.

With this procedure, there is a significant chance of airway edema for the first 24 hours, so we recommended that Marcie be watched at a 24-hour facility.

Dogs with an arytenoid tie-back will experience an occasional bout of aspiration pneumonia.  Symptoms to watch for are lethargy and not eating. Marcie’s mom is cautioned to take her to her regular veterinarian if this occurs for chest x-rays. If that is the cause, a round of antibiotics should take care of the problem.

After surgery, Marcie looks and sounds much better!

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