Your POTW candidates for the week of February 1st through February 5th:

Last week's winner was Callie with 60 votes. WAY TO GO!!!  Remember, the Pet of the Week with the most votes wins an awesome Azzore Pet of the Month Prize Package! Cast your new votes here:~~~~>>>

CASE STUDY:

Tough is a Bulldog at  73# and 6yr sent to us by Dr. Paul Jenkins from Vilonia Animal Hospital.  He had a Left TTA procedure done by Dr. Dew in 2005.  Tough had been doing well on his Left TTA,
but was now lame on the Right.  Dr. Jenkins identified a CCL and MPL condition in the right stifle.  Dr. Dew discussed the use of the TTA procedure to correct both conditions simultaneously.

TREATMENT:
Dr. Dew used a medial approach for Tough's surgery.  Hardware used in his TTA surgery consisted of a 9x22mm basket, 4 hole plate and fork combination, and 4 titanium screws from Kyon.  A bone graft was used to promote healthy healing underneath the cage.  The MPL was also corrected during the tibial tuberosity advancement surgery.  Post-surgical x-rays showed good hardware placement, and tibial plateau was perpendicular to a straight patellar ligament.  Tough'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:

Brody is a Labrador Retriever.  He is 6.5 yrs old and weighs 85#.  He was sent to us by Dr. Craig Boyd of Boyd Veterinary Clinic.  Dr. Boyd has identified a right CCL injury.  Dr. Dew observed and palpated a positive anterior drawer consistent with CCL rupture.  Discuss TTA (tibial tuberosity advancement) procedure, recovery and prognosis.

TREATMENT:
Dr. Dew also used a medial approach for Brody's CCL rupture surgery.  Kyon hardware used for the TTA in this case were 12x22mm basket, 6 hole plate & fork, and 4 titanium screws.  A bone graft was also placed to promote healthy bone growth.  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:
Kenai is a 60# 9month old Golden, and is sent to us by Dr. Brad Lyon at Animal Medical Clinic.  Brody has shown chronic right fore lameness which worsens after activity.  Dr. Lyon suspected shoulder OCD (osteochondrosis dissecans) but has been unable to confirm this by radiograph (x-ray).  Dr. Dew performed an exam and radiographs were taken.  An externally rotated radiograph demonstrated changes consistent with OCD, right shoulder.
TREATMENT:
Dr. Dew used a deltoid split approach.  He observed a linear flap with dimensions of 0.5x1.5cm.  The flap was removed and the defect edges were debrided.  Kenai's prognosis is good for resolution of lameness.  Exercise restriction for 3 weeks will decrease the likelihood of seroma formation.

CASE STUDY:
Kiwi is a Yorkie who is 11# at 3yrs of age.  Dr. Kristie Austin of Osage Veterinary Clinic sent her to us.  He had a 1-week history of rear limb paresis, and has been responsive to steroids; however paresis has worsened with each episode.  Dr. Dew observed upon examination Grade IV rear limb myelopathy.  There was deep pain present bilaterally, but it was reduced.
TREATMENT:
Dr. Dew used a dorsolateral approach to the Left T12-T13 Vertebrae.
Cerebrospinal centesis:  There was 2ml of clear CSF (cerebrospinal fluid) collected from cisterna magna.
Myelogram:  Dr. Dew injected 3ml iohexol.  He observed column thinning and elevation from T12-13, with a slight deviation of the spinal cord to the right.
Hemilaminectomy:  There was a large amount of acute disc material removed ventral to the cord.  Dr. Dew explored the spinal canal, used lavage for cleaning and applied a free fat graft for healing.  Kiwi'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:
Archie is Bull Terrier.  He is 2yrs old and weighs 45#.  Dr. Bob Hale of Briarwood Animal Hospital has referred and transferred him to us.  Archie had been hit by a car.  He suffered an oblique fracture of the proximal 1/3 of the left tibia.  Dr. Hale stabilized with IM pin and cerclage. Fixation failure noted. During bandage removal at Dr. Hale's office, they noted significant dermal and muscle damage both medial and lateral.  Upon Dr. Dew's examination, he was concerned with extensor function.  We confirmed vascular viability by a nail clip.  He called Dr. Hale and discussed his findings.  Offering 75-80% prognosis for obtaining a functional limb with ESF (external stabilization fixator) and soft tissue care as well as a skin graft, the owner's wish to save limb rather than amputate.

TREATMENT:

Dr. Dew approached the fractured limb through the existing wounds.  He observed moderate dermis and muscle devitalization on craniolateral and medial aspects of the limb. More concerned with extensor function, he contacted Dr. Hale.  They decide to proceed with limb salvage.  Good reduction and hardware placement of 4 enhanced thread pins, 3 large, 1 medium, 2-7/64 smooth pins, and  2- 1" acrylic bars for type II fixator, after extracting and culturing remnants of existing IM pin and removing existing suture.  Archie's prognosis is good for delayed osseous healing. The healing process for both soft tissues and bone will be extended, bandage and dressing care will be critical to facilitate healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

CASE STUDY:
Kelly is a Labrador Retriever who is 9yrs and 7mo old and weighs 85#.  Dr. Michael Thames with Labahn Veterinary Clinic has referred her to us.  Kelly has had Left fore lameness which has progressed to non-weight bearing since a past exam with Dr. Dew.  There was no evidence of scapulohumeral or distal radius pain, but Dr. Dew suggested radiographs of the proximal humerus and distal radius to rule out changes suggestive of tumor.  He also discussed Total Elbow Replacement (TER) procedure and post operative care with the owners, they decided to proceed with TER.
TREATMENT:
Dr. Dew used a medal to medial epichondylar osteotomy approach for Kelly's TER surgery.  Dr. Dew visualized her ulnar nerve and protected it during the surgery.  He used a medial epicondylar osteotomy-chevron, prepared the mill for implant bed, trial implant was positioned, 21mm prosthetic implant was seated in the prepared bed.  Kelly's epicondyle was stabilized with hardware, including screws placed in lag fashion.  Post surgically, range of motion was assessed and it was good.  Kelly has an excellent prognosis for an uncomplicated recovery and pain free left elbow function. The success rate in clinical cases is reported to be 80%-85%. Possible complications include infection (early or late), luxation, fracture or aseptic loosening. The majority of complications occur in the first 8-12 weeks after surgery. Many of the early complications (luxation and fracture) can be greatly decreased with exercise restriction and nursing care. If infection is present, a decrease in appetite or limb use will be noted in the first 1-3 post-operative weeks.

CASE STUDY:
Pudden is a 4yr old 13.3# Dachshund, and was sent to us by Dr. Dr Todd Kollasch of Green Animal Hospital.  There was an acute onset of rear limb paresis the day before being referred to Dr. Dew.  Upon exam with Dr. Dew, he noted grade IV rear limb paresis.  He discussed IVDD, myelogram and surgery, with 85% prognosis for return to ambulatory ability over next 6 months, bladder management and P/T would be required.
TREATMENT: 
Myelogram: Dr. Dew injected 3ml iohexol. He observed column thinning and elevation from T10-13, with a slight deviation of the spinal cord to the left throughout.  Surgery would be beneficial, but due to cord swelling the prognosis is guarded until improvement is noted.
Hemilaminectomy: There was a large amount of acute disc material removed from T12-10, ventral. Dr. Dew explored the spinal canal, used lavage for cleaning and applied a free fat graft for healing.  Pudden'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.