Your Patient of the Week candidates for the week of April 12th - 16th:

Last week's POTW winner was Sophie with 8 votes.  Congrats, Sophie!

Lets see if we can get it going with this week's Patient of the Week poll.  Vote Here~~~~>>>

CASE STUDY:

Max is a 122# 5yr old Golden Retriever. He was referred to us by Dr. Greg Hartman with Hartman Animal Hospital. Max has had Left rear lameness for the past 4-5 months which gets worse after activity. He had improved on Previcox. Dr. Hartman's radiographs were not suggestive of hip dysplasia as a cause. There was Left stifle thickening and medial buttress suggestive of partial CCL tear, but no pain on hock manipulation or hip extension. Max exhibited delayed proprioception with normal foot placement, and no pain on dorsal spinal palpation. Dr. Dew discussed EFS (external fascial strip) and TTA (tibial tuberosity advancement) augmentation, and also suggested prior to surgery some survey lumbar films to rule out discospondylitis. The owners wished to pursue radiographs and a TTA if recommended.
TREATMENT:
Diagnostics: The radiographs of Max’s lumbar spine were normal; he had very minor degenerative joint disease in his hips. The changes in his Left stifle were consistent with partial CCL tear.
Dr. Dew used a medial approach with medial arthrotomy. The Kyon hardware used to stabilize Max’s stifle were a 12x22 basket, 6 hole plate & fork, and 4 titanium screws. His prognosis 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.

CASE STUDY:
Mercy is a 5# 2yr old Chihuahua. Her RDVM is now Dr. Carondelet Nollner with Greene Animal Hospital. She was a rescue baby who was HBC 10 days previous to appointment with us. She was diagnosed with a Right femur fracture, and also received an OHE (spay).
TREATMENT:
Dr. Dew used a ventral to abdomen approach for Mercy’s OHE. He then used a lateral approach to repair her fracture. To stabilize her fracture, he used a single IM 5/64 pin and 2 –f 5/64 threaded transcortial pins as well as a 5/8 sidebar. Mercy’s prognosis is for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

CASE STUDY:
Sophie is a Bichon Frise and Shih Tzu cross. She is 3yrs and 3mo old and weighs 11#. She was referred to us by Dr. J. Gregg Melancon with West Fork Veterinary Clinic. Sophie had jumped from moving vehicle and had acute onset non-weight bearing lameness right rear. She was treated treated at AEC, and her radiographs demonstrated a right coxofemoral luxation as well as a distal femoral fracture. Upon exam by Dr. Dew, she was BAR and able to support weight on her left rear limb. The degenerative changes in her acetabulum and femoral head suggest chronic subluxation. Dr. Dew discussed open reduction of the femoral fracture and FHO (femoral head osteotomy) on the right. Her owner decided to proceed with surgery.
TREATMENT:
Dr. Dew used a medial to stifle approach for her femur fracture repair and a lateral to hip approach for her FHO. Hardware used in these surgeries were 0.062 wires. Sophie’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. Physical therapy will need to be completed to maintain the range of motion in both the stifle and hips.

CASE STUDY:
Bella is a 3yr old Pug who weighs 15.2#. She was referred to us by Dr. Shane Parker of Parker Animal Clinic. She has had a history of difficulty breathing, sleep apnea and exercise intolerance. Medical therapy has allowed her to function on a limited basis. Upon exam by Dr. Dew, she exhibited stenotic nares and stridor consistent with elongated soft palate. He discussed brachycephalic upper airway syndrome, and the benefits and risks of surgical correction. Her owner decided to proceed with rhinoplasty, soft palate reduction and excision of saccules if required.
TREATMENT:
Dr. Dew used a lateral approach for the stenotic nares and an oral approach for elongated soft palate. He significantly improved Bella’s nasal opening, and her soft palate was reduced to the level of tonsilar crypts. There was significant redundant tissue dorsal to soft palate, and the saccules were normal. Her prognosis is good for healing and significant improvement in airway function. It would not be unusual for Bella to have some blood tinged saliva or nasal discharge for the next 3-5 days. Airway sounds should be significantly reduced but will remain raspy and louder than a dog with a normal length nose. Some coughing when eating or drinking for then next 7-10 days is to be expected.

CASE STUDY:
Valentina is a 2yr old 22# Pug. Her referring veterinarian was Dr. Randy Ashley of Briarwood Animal Hospital. She has had a chronic history of exercise intolerance, snoring and coughing. She was partially responsive to medical therapy, but has been crate confined for the past 2 weeks previous. Upon examination by Dr. Dew she was BAR. The stenotic nares were evident, and her stridor was consistent with an elongated soft palate. Dr. Dew discussed brachycephalic upper airway syndrome, correction and prognosis. Her owner wished to proceed with rhinoplasty, soft palate reduction and saccule excision if required.
TREATMENT:
Dr. Dew used a lateral approach for the stenotic nares and an oral approach for elongated soft palate. He significantly improved Valentina’s nasal appeture, and her soft palate was reduced to the level of tonsilar crypts. There was significant redundant tissue dorsal to soft palate, and the saccules were normal. Valentina’s prognosis is good for healing and significant improvement in airway function. It would not be unusual for her to have some blood tinged saliva or nasal discharge for the next 3-5 days. Airway sounds should be significantly reduced but will remain raspy and louder than a dog with a normal length nose. Some coughing when eating or drinking for then next 7-10 days is to be expected.

Your Patient of the Week Candidates for April 5th through April 9th:

J.R. wins Patient of the Week for last week with 103 votes.

Way to go, J.R.!

Who will be the next POTW??

Your candidates for the week of March 29 through April 2nd:

The winner for last week's Patient of the Week vote was Lola with 71 votes.

Congratulations LOLA!

Above is Lola playing with her ball.

Who will be next?  Vote Here ~~~~>>>

CASE STUDY:
J.R. is an 8yr old 23# Jack Russell Terrier referred to us by Dr. Blair Willman of North Hills Animal Clinic. 2 weeks previous, he became acutely lame on his left rear after chasing an opossum. Dr. Willman identified a CCL injury. Upon exam by Dr. Dew, J.R. is weight –bearing , but lame He discussed the EFS (external fascial strip) procedure, recovery and prognosis. J.R.’s owners decided to proceed with surgery.
TREATMENT:
Dr. Dew used a lateral approach with lateral arthrotomy. He observed that the meniscus was intact. He performed the fascial surgery and used a medial buttress suture #1-maxo, advanced biceps, lavaged, and closed the site. J.R.’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.

CASE STUDY:
Duke is a Doberman; he weighs 112# and is 3yrs old. He was referred to us by Dr. Beth Stropes at Crossover Veterinary Clinic. 6 months ago, Duke became acutely lame on right rear, had a suture/anchor technique completed, revised for osteophytes and cold laser therapy. However; he never returned to to more than toe-touching use. Last month he became acutely lame on left rear and began to use his right rear. Dr. Stropes had identified a left CCL rupture. Upon Dr. Dew’s exam, Duke was lame in both rear limbs and was placing more weight on right than left. Both stifles were thickened and there was + anterior drawer on left, but Dr. Dew was not able to assess the right while Duke was awake. He discussed TTA (Tibial Tuberosity Advancement), recovery and prognosis for unilateral and bilateral surgery. He also suggested assessing the right stifle while under anesthesia, if significant drawer is present then proceed with bilateral TTA. Duke’s owner wished to proceed with the above plan.
TREATMENT:
Dr. Dew did identify CCL rupture on the Right while Duke was under anesthesia. He used a medial with medial arthrotomy-left, medial with lateral arthrotomy-right. All of Duke’s previous implanted hardware was explanted. The Kyon hardware used in Duke’s corrective surger were a 12x25 basket on the Left, a 12x28 basket on the Right, 7 hole plate & fork combo on both Left and Right as well as 4 titanium screws in each side. Cancellous graft placed to promote bone growth. Duke’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. Due to having both knees corrected simultaneously, Duke may require some assistance rising and walking for the next 3-14 days, the harness (Help ‘Em Up Harness) should be helpful for this care.

CASE STUDY:
Amy is a 10yr old 64.8# Bassett Hound. Her RDVM, Dr. Kim Miller of Chenal Valley Animal Hospital referred her to us because she had identified a mass at 7 O'clock in the wall of the rectum. Upon Dr. Dew’s examination, the mass was 2cm in diameter and firmly affixed to rectal wall with no ulceration noted. Dr. Dew discussed the likelihood of an anal gland tumor, and suggested local excision with good prognosis for recovery and continence. Her owner wished to proceed with surgery today and asked that any suspicious sub-Q masses be aspirated for cytology.
TREATMENT:
Dr. Dew used a caudolateral-left approach to remove Amy’s mass. It was 2cm in diameter, irregular is circumference, and firmly adhered to rectal wall. There was no evidence of deep involvement, and it was contained within pseudocapsule. The mass was excised and submitted for histologic assessment. A Fine Needle Aspirate was also performed on Left cervical area, right thoracic area, and sternal area. All slides were also submitted to the Arkansas State Lab. Amy’s prognosis is good for healing; the long term prognosis will be more clearly defined by the histology results.

CASE STUDY:
Mellee is a 38# 6yr and 4mo Cocker Spaniel. She came to us from Dr. Leath Harper of Village Pet Hospital for a Lateral Condylar fracture of the Left Humerus, caused by running through a ditch. Dr. Dew discussed an open reduction, the prognosis and restrictions, and Mellee’s owner decided to proceed with surgical stabilization.
TREATMENT:
Dr. Dew used an anconeal myotomy approach for Mellee’s surgery. The fracture was stabilized using a 2.7mm transcondylar screw placed in lag fashion, along with a 0.062 antirotational wire. Her prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

CASE STUDY:
Reese’s is a Mix Breed who is 66# and 3yrs old. Dr. Todd Kollasch referred her to us for a previous diagnosis of Bilateral Medial Patellar Luxation, and her owners decided on Tibial Tuberosity Transposition surgery for correction.
TREATMENT:
Dr. Dew used a medial approach with medial release. The tibial tuberosity were stabilized with divergent pins, 5/64 in size. Reese’s prognosis is 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. Due to having bilateral correction today, Reese’s may require some assistance rising and walking for the next 3-10 days.

CASE STUDY:
Chopper is an 80# 2yr old English Bulldog. He was referred to us by Dr. Joe Rohlman with Rohlman Animal Hospital. Chopper had rear limb dysfunction, and had unilateral lameness recently until it progressed into bilateral to the point that he no longer attempted to stand. Radiographs demonstrated bilateral degenerative changes consistent with dysplasia/chondrodystrophic anatomy. Bilateral cranial drawer and medial buttress is present. Dr. Dew discussed mechanical issues with CCL rupture and pain due to hip dysplasia. He suggested bilateral TTA surgery, and his owners wished to proceed.
TREATMENT:
Dr. Dew used a medial approach with medial with medial arthrotomy. Kyon implants consist of 9x19 mm baskets on both sides, 4 hole plate & fork combination for both left and right, as well as 4 titanium screws in each side. A cancellous bone graft was used to promote bone growth and healing. Chopper’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. Due to having both legs corrected simultaneously, Chopper may require some assistance rising and walking for the next 1-14 days. This can be done with a harness or by placing a towel under his abdomen.

CASE STUDY:
Zoe is a Pomeranian. She is 1yr and 7mo old and weighs 3.8#. Her referring veterinarian is Dr. Alan Thompson of Farmington Veterinary Clinic. Zoe had previous bilateral MPL correction in Feb 2009, and has done well since that time and is participating in agility. The left patella continued to luxate when the limb is relaxed and this may be limiting her ability to compete. Upon Dr. Dew’s exam, he notes a grade II MPL which stayed reduced with normal muscle tension. He discussed a revision surgery with good prognosis for return to athletic function. Her owner decided to proceed.
TREATMENT:
Dr. Dew used a medial approach with medial release for Zoe’s revision. Post-surgically, Dr. Dew observed trochleoplasty of adequate depth and well healed, also, he was unable to luxate post correction. Zoe’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.

CASE STUDY:
Lucy is an 80# 8mo old Lab. She was referred to us by Dr. William Pitchford of Pitchford Animal Clinc. She fell off of a 4-wheeler and became acutely non-weight bearing on her left rear. Dr. Pitchford identified a Salter Type IV fracture of the distal femur. Dr. Dew discussed an open reduction and IM pin stabilization. Her owners wished to proceed with surgery.
TREATMENT:
Dr. Dew used a lateral approach for Lucy’s fracture repair. Her femur was stabilized using 2 size 7/64 divergent pins. Her prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

CASE STUDY:
Dusty is a Mix Breed 10yr 8mo old and weighs 24#. This baby was referred to us also by Dr. William Pitchford of Pitchford Animal Clinic. Dusty had previously undergone a Right EFS (external fascial strip) surgery on his Left cruciate ligament, and had come back to our office because he was acutely lame on his Right rear limb. Dr. Pitchford identified a Right CCL Rupture. His owners opt for surgery for correction.
TREATMENT:
Dr. Dew used a lateral approach with lateral arthrotomy for Dusty’s Right EFS. He used #0 size suture for medial buttress, advanced biceps, lavaged, and closed his incision. Dusty’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.

Patient of the Week candidates for March 22 through March 26:

Last week was a close one for awhile, but Belle ended up POTW with 48 votes, Congratulations!  The week of the 22nd through the 26th was a short week, but the babies in question are below. 

Vote to the right, to the right ~~~>>

CASE STUDY:

Lola is an English Bulldog.  She weighs 10# and is 2mo old.  Dr. Bob Mills with North Arkansas Veterinary Clinic referred her to us for Upper Airway issues.  Dr. Mills identified stenotic nares and elongated soft palate.  Lola had previously responded well to steroid and antibiotic therapy.   Upon Dr. Dew's examination, she exhibited moderate stridor at rest, and her nares collapsed. Radiographs demonstrate mildly hypoplastic trachea.  Dr. Dew discussed hypoplastic trachea, stenotic nares and elongated soft palate with her owner.  He decided to proceed with nares revision and soft palate reduction.

TREATMENT:
Dr. Dew used an oral approach for Lola's surgery.  Her soft palate was reduced to the level of tonsilar crypts, and on her nares he performed wedge reduction naroplasty.  Lola's prognosis is good for recovery from the procedure, uncomplicated healing and improved respiratory function.  Exercise restriction will help facilitate an uncomplicated recovery.

CASE STUDY:
Duncan is a 42# 7yr old West Highland White Terrier.  Dr. Scott Hollensworth of Springhill Animal Clinic sent him to us for a hemi maxillectomy.  Radiographs taken previously did not demonstrate any evidence of pulmonary metastasis.  Osteolysis/osteoproductive changes were noted on maxilla and rostral zygomatic arch.  Duncan's owners wished proceed with partial hemi maxillectomy.
TREATMENT:
Dr. Dew used an intra-oral approach for this surgery.  The tumor tissue extended full thickness through hard palate and lateral maxilla, and there were periosteal changes on the zygomatic arch.  Tumor tissue also extends to medial canthus.  The tumor was excised en block with 1mm margins obtained at ventral border of eye and medial canthus; otherwise 3-10mm margins soft tissue and bone.  The maxillectomy was from the canine root to the rostral border of the zygomatic arch.  All tissue was submitted for histologic assessment to the Arkansas State lab.  Duncan's prognosis is good for soft tissue healing from the sugery.  Due to the aggressive nature of the tumor, size, and location there is little doubt that recurrence will be seen.  However Duncan should be much more comfortable during this time.

CASE STUDY:
Ginger is an 11# 3yr old Dachschund.  Dr. Susan Belt at Benton Veterinary Hospital is her referring veterinarian.  Six weeks previous, Ginger had an acute onset of left rear paresis, and responded well to prednisone and rest.  3-4 days previous to referral to Dr. Dew, she exhibited bilateral rear limb weakness.  Prednisone was re-instituted with no response, and her ambulatory function continued to decline.  Upon examination by Dr. Dew, she was unable to move her back limbs at all.  She is at Grade V rear limb paresis, panniculus localizes lesion to T9.  Dr. Dew discussed the severity of Ginger's clinical presentation.  Surgery would be of benefit to decompress the cord, prognosis for improvement 30-65%.  Her owner decided to proceed with myelogram and hemilaminectomy.
TREATMENT:
Myelogram:  Dr. Dew administered 2 lumber injections, each of 2.5ml iohexol, and loss of columns at T11-12 and T8-9 were observed.  He then called and discussed these findings with Ginger's owner.  It was advised that surgery would be beneficial, but due to multiple lesions and clinical signs, prognosis is poor to guarded for return of ambulation until improvement is noted, she wishes to proceed with hemilaminectomy.
Hemilaminectomy:  Dr. Dew used a Left dorsolateral approach.  He observed cord swelling and chronic disc protrusions at each site.  There was also a loss of epidural fat in the affected areas.  Disc material was removed, the canals explored.  Ginger'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.

CASE STUDY:
Cosmo is a Brussells Griffon.  He is 4yrs and 3mo old and weighs 24#.  Dr. Allison Patchell of Patchell Veterinary Clinic referred him to us with a history of recurrent urethral calculi, and at the time of his exam was only able to dribble urine.  Dr. Dew discussed a scrotal urethrostomy, cystotomy and stone analysis, recovery and prognosis.  Cosmo's owners wished to proceed with surgery.
TREATMENT:
Dr. Dew used a ventral celiotomy approach for Cosmo's surgery.  He observed that the stones were spiculated, urethra adequate lumen at level of urethrostomy.  The urethrostomy was at 1.5cm in length, Dr. Dew lavaged the bladder and urethra, and submitted the stones for analysis to the Arkansas State Lab.  Cosmo's prognosis is good for healing and recovery from the surgical procedure.  Cosmo should have a significantly easier time urinating as a result of the surgery.  Uncomplicated healing will be facilitated with exercise restriction and the use of the e-collar.

 

CASE STUDY:
Chugalug is a 137# 1yr old St. Bernard.  Dr. Claire Kelly at Edwards Veterinary Clinic referred him to us for a hygroma on right elbow.  It had been drained repeatedly but still recurs.  Upon examination, it is a fluid filled mass over the right calcaneous,a nd is 6cm in diameter.  Dr. Dew explained the nature of hygromas in young dogs, suggested surgical excision and closure of joint capsule.  His owner decieded to proceed with removal.
TREATMENT:
Dr. Dew used a lateral approach for Chugalug's surgery.  Also identified a defect in his joint capsule.  The hygroma capsule was excised and the joint capsule defect was closed.  The prognosis for Chug is good for normal soft tissue healing.  Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

Who will be Patient of the week for week 3/15 through 3/19??

OUR WINNER FOR LAST WEEK'S VOTE WAS, DRUM ROLL PLEASE........LOUIE!! WITH 931 VOTES!!!!!

CASE HISTORY:
Belle is a Bernese Mountain Dog and is 2yrs and 6mos old.  She weighs 60#.  Dr. Kristy of Austin Osage Veterinary Clinic is her referring physician.  Back in July of 2008, Belle had a THR.  Between then and now, she has had a previous diagnosis of a loose acetabular cup.  She now has come in for a Total Hip Replacement revison.  Dr. Dew discussed prognosis and recovery.  Belle's owners decide to proceed with surgery.
TREATMENT:  Dr. Dew observed moderate wear debris associated with loose cup and cup screw.  After he implanted a new cup and proceeded to replace the femoral head, a loose femoral component was identified.  Following conversations with Dr. Tepic of Switzerland, Dr. Dew elected to explant all components.  There appeared to be no crepitus post implant removal and calcar reduction.  Dr. Dew discovered also from his conversations that most femoral stem loosening has been associated with low grade osteomyelitis.  Cultures were sent to Arkansas State Lab for further examination.  Dr. Dew noted adequate femoral neck resection and soft tissue interposition between femur and acetabulum  Belle's prognosis is good for healing and resolution of the arthritic pain.  Physical therapy will play a critical role in assuring that she has a good return of post-operative function.

CASE HISTORY:
Poo is a 7yr old, 10# Poodle sent to us by Dr. Heath Stump of Russellville Animal Clinic.  She had been HBC several weeks ago.  The left hock had been splinted, but had not stabilized.  Dr. Dew discussed primary ligament repair and splint augmentation or stabilization of avulsion fragment.  Her owner wished to proceed with surgery.
TREATMENT:
Dr. Dew used a medial approach for Poo's medial collateral ligament reconstruction in her right hock.  Radiographs suggested medial collateral disruption, but no fractures were noted.  Good stability was achieved by debriding the ligament/joint capsule attachments, and also by drilling a 0.045 hole through medial malleolus and placing multiple SI 2-0 maxon sutures in differing orientations, whereby good stability was achieved.  Poo's prognosis is good for normal soft tissue healing.  Exercise restrictions and bandage care instructions must be followed to maximize the prognosis for uncomplicated healing.

CASE HISTORY:
Diesel is a 1.5yr old 85# Labrador referred to us by Dr. James Hoffman with Westside Veterinary Clinic.  He was HBC 4 days previous, and Dr. Hoffman had identified a sagittal fracture of the olecranon that involved the aconeous and articular surface.  Dr. Dew discussed internal fixation with lag screws, and gave a good prognosis for return to hunting function.  His owner wished to proceed with stabilization.
TREATMENT:
Dr. Dew used a lateral approach with anconeal myotomy for this procedure.  He observed good reduction and compression of fragments.  He stabilized the fracture with two 2.7mm screws placed in lag fashion.  Post-surgically, good reduction and hardware placement was noted.  Diesel's prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. Diesel's leg has been repaired using a combination of wires and/or pins. These implants have been designed to maximize the opportunity for successful bone healing and return to function. HOWEVER, they are initially not as strong as normal bone or tissue! Therefore, exercise restriction is mandatory to prevent catastrophic failure of the fixation hardware.

CASE HISTORY:
Dixie is a Labrador who is 6yrs old and weighs 67.9#.  She came to us from Dr. Sandra Reynolds with Little Rock Veterinary Clinic.  Dixie became acutely lame on the Right Rear 3-4 days previous.  Dr. Reynolds identified a right CCL, and upon examination there was + anterior drawer consistent with that diagnosis. The owners have had experience with the TTA (tibial tuberosity advancement) procedure, as Dr. Dew had previously operated on one of their other family members, and had no further questions. 
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy.  The Kyon implants used for the Tibial Tuberosity Advancement were a 9x19mm basket, 6 hole plate & fork, and 4 titanium screws.  Good hardware placement was observed;  tibial plateau was perpendicular to straight patellar ligament.  Dixie'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.

CASE HISTORY:
Haley is a 10 yr and 6mo old, 113# Golden Retriever.  She was referred to us by Dr. Scott Hollensworth of Springhill Animal Clinic.  Her owner had noted a soft tissue tumor on the caudal aspect of the left mandible.  The mass is 2x1.5cm on the buccal side of the 4th premolar.  Dr. Dew discussed resection with margins including partial mandibulectomy.  Haley's owner wished to proceed with surgery.  Presurgical radiographs did not demonstrate any evidence of pulmonary metastasis.
TREATMENT:
Dr. Dew used an oral approach to excise Haley's tumor and perform her left partial mandibulectomy.  The removed segment includes the last premolar and 2 molars.  There was no evidence of tumor at bone or soft tissue margins.  The removed tissue was submitted to Akansas State lab.  Haley's prognosis is good for healing; the biopsy results will help define the expected outcome

CASE HISTORY:
Coletrane is a Dachschund weighing 12.4# and is 4yrs old.  He was referred to us by Dr. Mark Sharp of South County Animal Hospital.  Coletrane had had previous rear limb weakness treated conservatively and resolved.  However; 48 hours prior to presentation to us, Coletrane became weak bilaterally, and was unable to support weight.  He was given tramadol, buprenorphine and robaxin at Dr. Sharp's clinic.  Upon examination by Dr. Dew, he had Grade IV paresis in his left hind limb, and Grade V in the right.  Dr. Sharp's radiographs were suggestive of T11-12 disc rupture.  Dr. Dew discussed the confounding clinical signs that may have been drug influenced.  Coletrane's owner decided to proceed with myelogram and hemilaminectomy surgery.
TREATMENT:
Myelogram:  Coletrane was given a lumber injection of 4ml iohexol.  This allowed Dr. Dew to view the loss of all columns throughout T12, with column attenuation greater on the right side.  T11-2 rupture, left sided lesion.
Hemilaminectomy:  Dr. Dew used a left dorsolateral approch.  There was a large amount of acute and fibrous disc material removed ventral to the spinal cord, decompression extended to level of normal epidural fat.  Cord appeared normal.  The disrupted disc material from T-11 through T-12 was removed.  Coletrane's prognosis is good for healing and guarded for 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.