POTW Candidates Dec 28 thru 31, 2009

Patient of the Week Candidates

for the week of December 28th thru 31st, 2010

 

PATIENT SUMMARY:

Maggie 11 year, 16 1/2 lb Dachshund was referred to us by her veterinarian, Dr. Rob Rucker of Waymack Animal Hospital. She suffered acute onset of rear limb paresis two days prior to her visit. 
Her owner had noticed that she had been reluctant to jump up for about 4 or 5 weeks. At her examination, she exhibited grade IV rear limb paresis.  It looks like the problem is around L1 in her spinal column. Dr. Dew discussed IVDD (invertebral disc disease), tumor and GME (Granulomatous Meningoencephalitis), and recommended cerebrospinal centesis, myelogram and surgery if indicated. 
TREATMENT:
Cerebrospinal centesis: 2ml of clear fluid was collected for lab analysis.
Myelogram: Dr. Dew injected 3ml iohexol (contract medium). X-rays showed a loss of contrast over T13-L1 with a slight deviation of cord to right at T13-L1. Also noted was an old but non compressive lesion at L2-3 on left.  Maggie’s owner gave the green light for going ahead with surgery.
Hemilaminectomy: Using a right dorsolateral approach to T13-L1, Dr. Dew removed a large amount of acute disc material. With time, medical management, and physical therapy, Maggie has an 85-90% chance of recovering her ability to walk over the next 6 months.

PATIENT SUMMARY:
Meet Elli, a 3 year, 10 month, 107 lb, German Shepherd. Elli underwent right biceps tenotomy in 2007.  Several months ago she began to experience off and on lameness on her right front leg, but responsded to restricted activitity and NSAIDs.  The last time she came up lame, her veterinarian, Dr. Barnett from All Animal Health Center took x-rays of her shoulder. When she discovered several mineralized densities in the biceps groove, she referred Elli to Dr. Dew for further treatment. At her examination, Elli was weight bearing with no lameness evident. (You’d be amazed how often this happens!) But, she consistently exhibited painful response to deep palpation of the biceps groove. Elli could either be managed with medical therapy, or undergo surgery to remove the osteophytes. Her owner wants Dr. Dew to take additional x-rays and perform surgery if indicated.

TREATMENT:
X-rays showed osteolytic/osteoproliferative changes in the glenoid area and mineralized densities in the biceps groove.  Dr. Dew suggests biopsy, culture and debridement. Elli’s owner give him the go ahead to proceed. Elli’s joint was cultured, a biopsy of the joint capsule taken, and the mineralized densities removed. All samples are being submitted to the lab for further analysis. 
Special Update: At Elli’s 2-week checkup, she is walking well on her front leg, and her mom feels she’s much more comfortable.

PATIENT SUMMARY:

Next up was Graham, a 6 yr, 77 lb, Golden Retriever. We first met Graham in May of 2009, and performed a multilobular tumor removal in June of 2009. He had been doing really well for the past 6 months. Then, the week in December, he bumped his maxilla and his owner noticed some drainage from the surgical area. Graham’s veterinarian Dr. House of Rodney Parham Animal Clinic identified a draining tract. He took x-rays of Graham which indicated that the tumor had come back and sent Graham and his family to Dr. Dew for treatment. Graham’s family gave Dr. Dew the green light to proceed with a second excision.
TREATMENT:
Dr. Dew used a ventral approach for the oral tumor revision.  The 3cm mass was similar in consistency to the previous excision, and was intimately assocaited with the zygomatic arch. A 2cm soft tissue mass was also removed from the paralumbar fossa. This mass appears to be consistent with lipoma. (Lab analysis showed that to be the case.).  Regrowth of the oral mass is expected, but the time frame is difficult to predict.

PATIENT SUMMARY:
Rounding out our busy Monday is Sheba, a 5 yr old, 80 lb, Golden Retriever.  Sheba was referred to Dr. Dew when she suffered acute onset of left rear lameness after jumping.  Dr. Wolfenkoehler of All Pets Animal Hospital identified a left cranial cruciate ligament (CCL) rupture. During her exam with Dr. Dew, anterior drawer is consistent with a full CCL rupture. After discussing both the external fascial strip (EFS) and tibial tuberosity advancement (TTA) procecures with Sheba’s owner, he gives Dr. Dew a thumbs up to proceed with a left TTA.

TREATMENT:
Dr. Dew uses a medial approach with medial arthrotomy. He found Sheba’s meniscus intact. Bone graft material was harvested from the distal femur, tibial tuberosity osteotomy was advanced and stabilized with Kyon implants. Post surgery x-rays show good hardware placement. Now that the “easy” part is over, Sheba’s owner will have the hard job — making sure she stays exercise restricted for 12 weeks while her bone heals! With proper restriction, Sheba should be as good as new in a few months (although she’ll feel like she is much sooner!). 

PATIENT SUMMARY:
Our next patient, Lola, 4 yr, 60 lb, Boxer was referred to Azzore by her veterinarian, Dr. Paul Seminara of Green Mountain Animal Hospital .  Lola had experienced left rear lameness for several months. Dr. Seminara identified a left cranial cruciate ligament (CCL) injury. During her exam, Lola was weight bearing, but anterior drawer consistent with a partial CCL rupture. After discussing CCL rupture, external fascial strip (EFS), tibial tuberosity advancement (TTA), recovery and prognosis, Lola’s family asks Dr. Dew to proceed with a left TTA today.

TREATMENT:
Dr. Dew uses a medial approach with medial arthrotomy.  Lola’s meniscus is torn, and requires a partial menescectomy. The tibia is osteotomized using a special saw, and then stabilized with titanium implants. The bone graft material is placed to speed up the healing process.   Lola came through surgery well, and should be back to normal after 12 weeks of exercise restriction and time to heal.

PATIENT SUMMARY:
Mr. Vegas was one of our transport patients from the Memphis Animal Emergency Center.  This 11 year old, 95 lb Black Lab was referred to us by Dr. John C. Stevens of the Animal Hospital in Memphis. Dr. Stevens identified a right axillary soft tissue mass (8x12cm) and a right thoracic wall soft tissue mass (4x6cm). Both are associated with deeper tissue and partially fixed. The owner wants Dr. Dew to transport Mr. Vegas from Memphis to our surgery center in Russellville, AR for treatment.

TREATMENT:
Dr. Dew used medial approach to the axilla, and a lateral approach to the thorax. Both masses appear to be lipomas.  Both are infiltrative involving muscle, vasculature and nerves. These were submitted to the lab for further analysis. While there is a possibility of recurrence, it’s pretty small.  So, Mr. Vegas should be “high rolling” it again in style after 3 weeks of exercise restriction.
 
PATIENT SUMMARY:
Our next patient, Bailey, hitched a ride with the transport van from Little Rock. Bailey is a 12 year old, 51 lb, English Bull Dog.  Bailey’s veterinarian, Dr. Bob Hale of Briarwood Animal Hospital identified a right cranial cruciate ligament (CCL) injury after Bailey was brought to him for chronic right rear lameness.  Bailey’s mom wants Dr. Dew to proceed with a tibial tuberosity advancement (TTA).
TREATMENT:
Dr. Dew used a medial with medial arthrotomy. He found that Bailey’s meniscus was torn, and required a partial meniscectomy.  Graft material was harvested from the distal femur and placed after the tibial tuberosity osteotomy had been advanced and stabilized with titanium implants. Bailey came through surgery with flying colors! Now comes the tough part — keeping this beautiful “bully” exercise restricted during the 12-week healing process. While this surgical technique and implants are designed to maximize the opportunity for successful bone healing and return to function, they are not as strong as normal bone or tissue until completely healed. So, Bailey will be restricted to leash activity for the next three months.
PATIENT SUMMARY:
Also referred by Dr. Bob Hale was Freddy, an 11 year old, 16 lb, Papillon who, by the way, obviously can’t take a bad photo! Freddy also hopped on the transport van headed for our Russellville surgery center.  He suffered from a history of chronic rear limb ataxia and back pain which had progressed to grade IV rear limb paresis on right, and grade II on left.  Freddy’s mom asked Dr. Dew to bring Freddy to Russellville for further dianostics and surgery if indicated.
TREATMENT:
Cerebrospinal centesis: 2ml of clear fluid was collected from a lumbar puncture for possible analysis. This is taken before the myelogram, so that we have untainted fluid to submit to the lab if nothing operable shows up in the x-rays.
Myelogram: lumber injection of 3ml iohexol and x-rays showed an interruption of contrast column at T12-13. In addition, Freddy has several fused vertebra and sites of cord lateralization.  Because of the multiple issues found, Freddy is given a guarded prognosis for recovery, but since surgery will give him the best opportunity for improvement, mom asks Dr. Dew to proceed.
Hemilaminectomy: using a right dorsolateral approach at T12-13, Dr. Dew discovers bony proliferation with is causing compression. He removes the proliferative bone and soft tissue material.  Now only time will tell. Even in the best of cases, a patient will temporarily experience worse neurologic function that before a myelogram and surgery. This usually resolves to the pre-operative state in 3-10 days. But, the nervous system is very slow to heal. Following this procedure, gradual improvement can be expected for up to 5 months.

Special Update: Freddy was in for his two week recheck today and is already walking! Way to go, Freddy!  Now, mom, remember to keep him leash restricted. No jumping on or off of furniture. But, so far, so good. Freddy seems to be recovering very well.

PATIENT SUMMAR:
Next up is Sonny, an 8 month, 10.8 lb, Maltese/Shih Tzu mix. This poor little guy was hit by a car.  His veterinarian, Dr. Theresa Durham of All For Pets identified a comminuted T fracture of the right humeral condyle. After Dr. Dew talked to his owners about an open reduction stabilization, recovery, prognosis and the likelihood of Sonny developing osteoarthritis, they ask Dr. Dew to proceed with surgery.

TREATMENT:
If Dr. Dew needed any practice on humeral fracture repair, he has certainly gotten it these last couple of weeks!  Dr. Dew uses a lateral approach. The condyle was fractured through at an angle, and several small comminutions of articular surface make complete reduction impossible. But, Dr. Dew is able to achieve adequate joint surface alignment, range of motion and hardware placement. The fracture and olecranon are stabilized with wire and tension band.  As always, exercise restriction and physical therapy will play a big role in Sonny’s recovery. We’ll take x-rays 8 weeks post surgery to see how he’s healing.

PATIENT SUMMARY:
Finishing up our week is another transport patient from Tennessee.  Jack, 3 yr old, 85 lb, Siberian Husky Mix suffered from chronic, intermittent right rear lameness.  He was referred to us by his veterinarian, Dr. Shannon McGee from Collierville Animal Clinic after being dianosed with a right cranial cruciate ligament (CCL) injury.  After discussion of tibial tuberosity advancement (TTA) and external fascial strip (EFS), his family elects to have Jack transported to our Russellville surgery center for a right TTA.

TREATMENT:
Dr. Dew used a medial with medial arthrotomy approach. Jack’s meniscus was intact. The tibital tuberosity osteotomy was advanced and stabilized with a 12x22mm basket, 6 hole plate and fork and 4 titanium screws.  Dr. Dew has literally performed thousands of TTAs on dogs in the last several years.  This procedures provides patients with an excellent chance of recovering function and decreasing the 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 for Jack.


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!

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