POTW Candidates Dec 21 thru 25, 2009

Patient of the Week Candidates

for the week of December 21st thru 25th, 2009

 

PATIENT SUMMARY:


First up:  Amber a 14 year old, 12.9 lb, female spayed Shih Tzu.  Amber was brought to us after an acute onset of rear limb paresis.
She had been treated at the animal emergency clinic in North Little Rock over the weekend. Her veterinarian, Dr. Peck of Doubletree Veterinary Clinic, referred her to Azzore for further treatment. When she arrived, she was diagnosed with Grade IV rear limb paresis.

TREATMENT:
Cerebrospinal centesis: Spinal fluid to be sent to the lab was collected before injection of the contrast medium.
Myelogram: The picture above is a nice xray of Amber’s spine taken during the myelogram. Multiple sights of cord elevation and column thinning were identified due to what appears to be chronic disc disease.  Column is absent over T11-12 with suggestion of lesion on left side. Amber’s prognosis is guarded, but her family wants us to proceed with a hemilaminectomy.
Hemilaminectomy:  Chronic disc material was removed from T11-13.

So, how is Amber now? Mom reports that she’s up and walking and they will be here for a recheck appointment this Thursday!

PATIENT SUMMARY:
Our next surgery of the day was Spot, a 9 month old, 60 lb mixed breed mutt — and I say that with the utmost affection, because he’s my own mixed breed mutt!  Spot was, unfortunately, hit by a car when I took the dogs out for their morning walk. He suffered a comminuted supracondylar fracture of the left humerus, bilateral sacroiliac luxation, a broken tail and a bunch of road rash.

TREATMENT:
Dr. Dew found a couple of small, unusable fragments, but was able to adequately reduce the fracture with pins, wires and an external acrylic side bar. He also stitched up a nasty laceration to Spot’s left stifle. Now comes the fun part: keeping this 9 month old galute exercise restricted for 12 weeks while his leg heals!

PATIENT SUMMARY:
It was a day for emergency surgeries! We suddenly felt like a trauma center. Next up was Rocky, a 10 year old, 80 pound lab mix with a very sweet disposition and a very nasty fracture after being kicked by a horse over the weekend.  Dr. Rohlman of Brown Animal Hospital identified a comminuted humeral fracture and sent Rocky to Dr. Dew for treatment. Rocky’s radiographs demonstrated a mid-diaphyseal fracture with butterfly/segmental fragment and several small comminutions.

TREATMENT:
During surgery Dr. Dew found several small comminutions that couldn’t be utilized in fixation, but was able to get good alignment and hardware placement (pins, wire and an acrylic side bar). You can see the acrylic sidebar in this post-surgery xray. I know it looks odd to have a “gap” between the bone, but this fills in with new bone growth during the 12-week recovery period.  Again, time and exercise restrictions are the key to recovery. These humeral fractures are difficult to repair. But, with proper aftercare, Rocky should recover and be able to get around fine.

PATIENT SUMMARY:
Next we have Hoot, a 2 year, 9 month old, 45 pound Blue Heeler.  Hoot suffered some sort of unknown trauma which resulted in, believe it or not, yet another humeral fracture — this time a comminuted distal diaphyseal fracture of the right humerus.

TREATMENT:
Dr. Dew’s used a mini lateral approach on this one for alignment purposes. Pins were placed and stabilized with a 1″ acrylic side bar. Hoot has an excellent chance of good recovery as long as exercise restrictions are carefully followed. That means no off-leash activity, and no running, jumping or playing for the next three months.  These implants are designed to maximize the opportunity for successful bone healing and return to function. BUT, they aren’t as strong as normal bone and tissue.  So, until the bone has healed, exercise restriction is mandatory to prevent catastrophic failure of the fixation hardware.

PATIENT SUMMARY:
Our next patient, Lizzie, 6 year old, 3.4 lb, Yorkshire Terrier had to be different!  Lizzie was referred to us by her veterinarian, Dr. Chris Merritt of Merritt Animal Clinic.  An unknown trauma has resulted in a fracture of the distal metaphysis of the right femur.  I think Dr. Dew was glad it wasn’t another humeral fracture!

TREATMENT:
Dr. Dew used a lateral approach with lateral arthrotomy to reduce Lizzie’s fracture. The fracture was stabilized using pins and wires.  Post-op x-rays showed good alignment and hardware placement. Lizzie’s prognosis for a full recovery is excellent as long as her post-op instructions are carefully followed.  We’ll take xrays of Lizzie’s leg in about 8 weeks to see how she’s healing.

PATIENT SUMMARY:
Our next surgery was on Spot, a 9 month old, 60 lb mixed breed mutt.  If you’re thinking this sounds familiar, it should. Yes, two days later the Spotted One had to undergo a second surgery. He not only suffered a humeral fracture when he was hit by a car, but also bi-lateral sacroiliac luxation. Because his first surgery took so long (he was under anesthesia for four hours), Dr. Dew put off the SI reduction for another day.

TREATMENT:
Dr. Dew used a lateral approach on the right. Usually in a hit by car with SI luxation, there is a pelvic fracture involved. But, because his pelvic bones were intact, it was a little trickier to get everything back into place. Spot was in surgery for another two hours in the OR.

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So, there you have it. Another Dew Week in Review. Vote for your favorite Patient of the Week, and be sure to have your friends and family vote too!  (In case you’re wondering, Spot isn’t eligible since he’s a employee pet.)

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