POTW June 21st thru June 25th, 2010

Our Patient of the Week for last week's voting contest was:

Willie with 308 votes!

Who will be our winner for this week's voting contest?  Vote now!

PATIENT SUMMARY:
Brianna is a 12# 1yr 7mo Terrier Mix belonging to Dr. Carolyn McCutcheon at Park Avenue Animal Hospital. She had Bilateral grade III MPL. Dr. McCutcheon wished to pursue bilateral correction.
TREATMENT:
Dr. Dew used a medial approach with medial release. He stabilized the patellas with divergent pins. He was unable to luxate post correction. Brianna’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 SUMMARY:
Dobber is a Jack Russell Terrier. He is 12 yrs old and weighs 20#. He was referred to us by Dr. Michael Thames at Labahn Veterinary Hospital. With progressive seizure activity in the AM, Dr. Thames identified low blood glucose consistent with pancreatic tumor. Dr. Dew discussed option of insulin/glucose ratio. Dobber’s owner opted for exploratory surgery and tumor excision if possible.
TREATMENT:
Dr. Dew used a ventral celiotomy approach. There was a 2.5cm mass at the head of the pancreas. It did not involve pancreatic body, but appeared to originate from satellite tissue in the omentum. The caudate lobe of the liver immediately adjacent to the mass is thickened and nodular. Dr. Dew excised the pancreatic mass and caudate liver lobe. All tissues were submitted to lab for histopathology. Dobber’s prognosis is good for healing, the long term prognosis will be dictated by response to surgery and final pathologic diagnosis.

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: 9x19mm 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.

PATIENT SUMMARY:
Bentley is a 3mo 3.3# Yorkie. He was referred to us by Dr. Heath Stump of Russellville Animal Clinic. Bentley jumped from his owner’s arms and was then acutely lame on right forelimb. Dr. Stump identified transverse fractures of metacarpals II-V. Dr. Dew discussed open reduction and IM wire stabilization of 2 or more fractures, with a good prognosis for healing and return to function. Bentley’s mommy consented for surgery.
TREATMENT:
Dr. Dew used a cranial approach for the stabilization. He used 0.035 wire to stabilize all metacarpal fractures. Bentley’s prognosis good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

PATIENT SUMMARY:
Elle is a Weimaraner. She weights 75# and is 2yrs old. She was referred to us by Dr. Martin Reed of North Shelby Animal Hospital. Elle had a previous diagnosis of left CCL injury, and her owner had her transported to our facility for a Left TTA (tibial tuberosity advancement).
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. Hardware from Kyon consisted of: 9x19mm basket, 6 hole plate & fork, and 4 titanium screws. Elle’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.

PATIENT SUMMARY:
Lucky is a Lab. He is approximately 1.5yrs old and weighs 50#. He was referred to us by Dr. Marilyn Baeyens of North Hills Animal Clinic. Found on the banks of a river in South Arkansas, Lucky had left fore lameness. Dr. Baeyens identified Left elbow luxation (craniolateral). On radiograph, the joint surfaces appeared normal, with no osseous changes to suggest that open reduction can not be completed. Dr. Dew discuss open reduction, need for exercise restriction and P/T, progression of arthritis. Surgery is agreed upon.
TREATMENT:
Dr. Dew used a lateral approach with olecranon osteotomy. The luxation was chronic as evidenced by changes in ulna and degree of fibrosis. The joint was temporarily stabilized with 0.064 wire, and the olecranon with elbow was stabilized with extension 5/64 IM pin and 18 gauge tension band. Reduction was adequate with some inherent stability. ROM smooth but greatly reduced post-surgically. Lucky’s prognosis is good for normal osseous and soft tissue healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. Physcial therapy will be required to maximize joint function.

PATIENT SUMMARY:
Tommy is a Golden mix. He weighs 54# and is 7 mo old. He was referred to us by Dr. Darrell Riffel at Countryside Animal Hospital. He was possibly HBC 2-3 weeks prior to our visit. Dr. Riffel identified a left acetabular fracture. Dr. Dew discussed articular fractures and open reduction, with a good prognosis for healing and function if exercise restrictions are followed. Tommy’s owner decided to proceed with surgery.
TREATMENT:
Dr. Dew used a lateral approach with trochanteric osteotomy. Due to soft callus fractures being difficult to reduce, he still observed good joint surface reduction and hardware placement. Hardware used to stabilize the fractures were as follows: 4-hole, 6.5mm acetabular plate, 4-2.7mm screws. The trochanter was stabilized with 7/64 pin and 0.062 wire, and 18 gauge tension band. Tommy’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. The progression of arthritis will occur but should remain sub-clinical.

PATIENT SUMMARY:
Saur is an 8yr old 50# Pit Bull Mix referred to us by Dr. Mia Winters of Oak View Animal Clinic. Saur had acute onset of right rear lameness, and Dr. Winters identified a CCL injury. Upon examintation, Dr. Dew found there was positive anterior drawer consistent with CCL rupture. The owners decided on TTA (tibial tuberosity advancement) surgery.
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. Kyon hardware used as follows: 9x19mm basket, 5 hole plate & fork, and 4 titanium screws. Saur’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.

PATIENT SUMMARY:
Bandit is a 59# 1yr old Labrador Retriever. Dr. Ronnie Roberson of Treasure Hill Pet Hospital referred him to us. Bandit was struggling to rise and was lame after activity. Dr. Roberson identified poor joint congruity in both hips and pain on hip extension. Upon examination, Dr. Dew observed discomfort demonstrated on hyperextension of both hips. The radiographs showed joint incongruity, with very minimal osteophyte formation on left greater trochanter. Bandit was a good candidate for a bilateral TPO (triple pelvic osteotomy). He suggested completing the left first and then the right in 4-6 weeks. His owner wished to proceed with a left TPO.
TREATMENT:
Dr. Dew used a ventral to pubis/lateral to ilium approach for Bandit’s surgery. He split the pubic symphysis, ilial osteotomies, and stabilized the ilial osteotomies with 35 degree Rooks plates and combination of 3.5 and 4.5mm screws. Bandit’s prognosis is good for normal bone healing, improved function and decreased progression of arthritis. Exercise restriction, nursing care and physical therapy instructions must be followed to maximize the prognosis for uncomplicated healing.

PATIENT SUMMARY:
Speck is a 2.9# 5mo old Yorkie.  His referring veterinarians and parents are Drs. Scott and Laura Koenig.  Speck presented to the Koenig's for dyspnea, and Dr. Scott identified pneumonia in left middle lung lobes.  Since that time Speck has struggled with episodic dyspnea and cyanosis.  Radiographs demonstrated left middle lung changes, and increased perihilar density consistent with lymph node enlargement.  Dr. Dew discussed bronchoscopy with BAL. Dr. Koenig wished to proceed.
TREATMENT:
Dr. Dew used an oral approach for Speck's bronchoscopy.  There were no significant changes in oropharynx, and the arytenoid function and soft palate appeared normal.  Cervical tracheal contour & size were normal, mucosa hyperemic, in thorax trachea collapses in trilobed pattern (peritracheal lymph nodes?).  There was a moderate amount of mucous from left mainstem bronchus, with mainstem bronchi collapse on inspiration. With 2 - 3ml aliquots flushed, there was good debris retrieved submitted to AR-State lab for cytology and C&S.  Speck's prognosis is good for recovery from the procedure, the long term prognosis will be dictated by Speck's response to medical therapy.