Pictures and stories of the patients for the week of December 7 through 11 follow. At the end of the month, we'll repost the weekly winners. The Patient of the Month will receive a gift package from Azzore Veterinary Specialists with treats for both pet and owner. So, if one of these babies is yours, be sure to cast your vote and have your friends and family vote for them as well! Your pet just may win the Patient of the Month prize from Azzore.
First up is Abby. Abby is a 11 1/2 year old, 63 lb Black Lab mix. Abby was sent to us by Dr. Jayasundera after her family had her looked at for left rear limb lameness which had lasted for a month. Dr. Jay identified a left cranial cruciate ligament injury, and sent Abby to Dr. Dew for treatment. At her examination, Dr. Dew confirmed the diagnosis and Abby was admitted to our surgery center for surgery.
TREATMENT:
The procedure Dr. Dew used to correct Abby's injury is a Tibial Tuberosity Advancement. Abby looks a little worried, but she has nothing to fear. Dr. Dew has performed thousands of these procedures. In fact, cruciate ligament rupture is the most common orthopedic injury in dogs of all breeds and sizes. Abby will have to be exercise restricted to only leash activity for the next 12 weeks to give her bones time to heal. But, after that, she should be back out on the trail chasing rabbits again!
Pepper is a 5 year old, 15 lb Dachshund. He was brought in to see us after acute onset of rear limb paresis (partial paralysis) two weeks prior. Conservative treatment had resulted in no improvement in his condition, so Dr. Nall sent Pepper to Azzore for treatment. Pepper was admitted for further diagnostics.
TREATMENT:
A myelogram was performed to determine the extent and location of Pepper's injury. In this diagnostic procedure, iohexol (a dye) is injected into the spinal canal and xrays taken. This contrast medium allows Dr. Dew to spot disc pathology and/or degenerative changes of the spine. The myelogram indicated a problem with the disc over T12-13 and suggested a lesion on the left. A hemiliminectomy was performed during which a large amount of chronic disc material was removed. Pepper has a long road of physical therapy ahead of him, but with proper medical management, he has a good chance of regaining mobility over the next six months.
Cleo is a 9 year old, 73 lb Yellow Lab who usually lives in Montana, but she's here in Arkansas with her dad. Cleo first suffered acute onset of right rear limb lameness several months ago which has recently become worse. Dr. Harmon suggested Cleo be seen by a board certified surgeon, so she was brought to Azzore for an exam. Dr. Dew confirmed the suspected diagnosis of cruciate ligament injury, and Cleo was admitted for surgery.
TREATMENT:
Cleo underwent Tibial Tuberosity Advancement surgery, a procedure utilizing implants developed by Kyon in Switzerland. In this procedure, Cleo's knee was biomechanically altered by moving the tibial tuberosity and stabilizing it with a permanent titanium implant system. Cleo will need to be rechecked in 2 weeks, and then again in 12 weeks post surgery to have x-rays taken to make sure everything has healed before going back to normal activity.
Buddy is a 6 year old, 14 lb Rat Terrier who came to us non-weight bearing on his right hind limb. The poor guy had gotten himself hung up in a fence. His veterinarian, Dr. Bell, identified transverse fractures of metatarsals II-V.
TREATMENT:
Unfortunately, when Buddy's bandage was removed, his foot was cold to the touch. Dr. Dew found no vascular activity present. After discussion with Buddy's dad, Dr. Dew proceeded with a mid-femur amputation of Buddy's right rear leg. Buddy came through surgery just fine, and was already figuring out how to balance and get around on three legs by the time he was released the next day. If everything has healed fine in a couple of weeks of leash restriction, Buddy should be good to go back to normal activity again.
CASE HISTORY:
Tippy is a 6 year old, 51 lb black lab mix. Dr. Self sent Tippy to us for a history of left rear lameness. Tippy's radiographs were suggestive of non-displaced lateral condylar fracture of his humerus.
TREATMENT:
During surgery, Dr. Dew determined that there was no fracture, but there was a large free osteophyte present on the lateral aspect of the olecranon fossa. The osteophyte was removed and a new procedure performed: bioscaffold implant. This medical device provides a structural matrix for local repair cells, such as stem cells or fibroblasts, to attach and heal tissue and is eventually resorbed by the infiltrating cells. Tippy is our second bioscaffold patient. In case studies using this new technique, (and in our own experience) owners report a marked improvement within seven days of implantation and continued improvement thereafter. We are excited to be able to offer this new medical technique for our clients and their patients.
Konor is a 7 month old, 40 lb mixed breed dog. Konor's veterinarian, Dr. Durham, has diagnosed coxofemoral hyperlaxity. Lately, Konor has been consistently lame on the left rear. Xrays taken last month demonstrate bilateral poor acetabular congruity, subluxation with less than 15% femoral head coverage. The plan is to assess Konor's angle luxation/reduction under anesthesia to see if he would be a candidate for TPO. If not, then we will do a total hip replacement.
TREATMENT:
While under anesthesia, Konor's left hip was luxated, but Dr. Dew was unable to reduce and achieve ortolani. Konor's family wants to go ahead with a total hip replacement. In a Total Hip Replacement, both the femur (ball) and the acetabulum (socket) of the hip joint are replaced with implants. As is typical with orthopedic procedures, Konor will need to be exercise restricted with no off-leash activity for 12 weeks while he recovers.
Zandra is a 1 year, 3 month, 14 lb, Miniature Schnauzer. Dr. Southerland, her veterinarian, sent her to us because of intermittent rear limb lameness. While she experiences lameness on both sides (bilateral), the right appears to be worse than the left. During her exam with Dr. Dew, she demonstrated grade II-III Medial Patella Luxation (MPL - sometimes referred to as "trick knee") on the right, and grade II on the left. With MPL, the knee cap rides on the inside of the knee. This is a pretty common problem in small breed dogs. And in about 1/2 of the cases, both knees are affected.
TREATMENT:
Dr. Dew performed bilateral (both sides) Tibial Tuberosity Transposition to improve the alignment of the patella mechanism in Zandra's knees. In some cases, trochlear groove has to be reconstructed with block recession trochleoplasty or may even require corrective osteotomies of the femur or tibia in extreme cases. But, Zandra's trochlear grooves were sufficient to allow Dr. Dew to stabilize her patellas with pins. Zandra may be a bit unsteady for a few days since she had both legs operated on, but after about 8 weeks of exercise restriction, if her x-rays show that she's healed, she'll be able to work her way back to normal activity.
Precious is a 3 year old, 21 1/2 lb Terrier mix. Precious has sustained an injury to her right carpus when she was a puppy. She continued to get around on her leg, but when she came to us she had full thickness exposure of the cranial aspect of the radius, loss of all extensor tendons and 3X6cm area of granulation tissue. Dr. Dew felt there were three options for treatment. 1) Arthrodesis which would require multiple procedures with an unknown prognosis; 2) Partial amputation which could be a multiple stage process, but with high likelihood of successful soft tissue closure; or 3) Forequarter amputation which would be single stage procedure with lowest complication rate.
TREATMENT:
Precious's family decided to go ahead with a partial amputation, allowing her to keep most of the length of the limb for balance, and still have a high probability of success. Dr. Dew amputated the digits/metacarpals of the right forelimb, and then transposed the carpal pad over the distal radius. If healing progresses, this should in a limb that looks almost normal, just a couple of inches shorter than the other leg. Shortly after Precious recovered from anesthesia, she was up on her feet testing out her new leg in the treatment area.
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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!
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