Week of February 15th through 19th Patient of the Week Candidates:

In last week's vote, Bosco won with 127 votes!  Who will be the next Azzore Veterinary Specialists Patient of the Week? 
Vote Here~~>>>

CASE HISTORY:
Brie is a Lab Mix at 53# and 1yr old.  Dr. Beth Stropes with Crossover Vet Clinic sent her to us last year for a Right Total Hip Replacement.  Brie is doing great on her right hip, and had now come for a Left THR.

TREATMENT:
Dr. Dew used a craniolateral approach for this surgery.  He used Kyon hardware of 26mm cup, small femoral stem, 25mm stem screw, medium neck.  He observed good implant seating with no tendency to luxate post reduction through stressed ROM. Greater trochanter adequately stabilized.  Brie has an excellent prognosis for recovery and lifetime pain free function with her hip replacement.


CASE HISTORY:
Sparkle is a Yorkie/Bichone Frise who weighs 7.3# and is 1yr and 2mo old. Dr. Jerry Bridges at Banfield Pet Hospital sent her to us with a history of ataxia which got worse after eating.  Dr. Bridges had completed chemistry and bile acid assay, and findings were consistent with portosystemic shunt.  Dr. Dew discussed the Shunt surgery with Promise's owner, and she agreed to surgery and additional ovariohysterectomy (spay) if possible.
TREATMENT:
Dr. Dew used a ventral celiotomy approach for the shunt surgery.  He identified and dissected the shunt vessel, and placed a 5mm ameroid ring.  ovariohysterectomy (OHE) was completed.  The prognosis for an uncomplicated recovery after shunt surgery is fair. Hospitalization with fluid support may be needed for 4-5 days. The accumulation of abdominal fluid (ascites) and some abdominal discomfort may be noted. The long term prognosis will be dictated by the liver's response to an increased blood supply. The prognosis for significant long-term improvement in liver function is good.

CASE HISTORY:

Prissy is a 53# 4yr old Pointer.  She was sent to us by Dr. Wayne Wolfenkoehler with All Pets Animal Hospital for acute onset of right rear lameness.  Dr. Wolfenkoehler had identified a right CCL rupture. She was recommended for a TTA (Tibial Tuberosity Advancement) surgery.

TREATMENT:
Dr. Dew used a medial with medial arthrotomy approach to place the Kyon implants as follows:  9x19mm basket, 5 hole plate & fork, and 4 titanium screws.  The 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 HISTORY:

Humper is a 4yr old 8# Chihuahua referred to us by Dr. John Davis of Davis Veterinary Clinic.  It was suspected that Humper was HBC over the weekend. When he was found, he had rear limb paresis and according to Dr. Davis he had a  Schiff/Sherington posture (characterized by thoracic limb extension and inability to move the pelvic limbs normally).  He suspected a high cervical fracture.  Upon exam by Dr. Dew, Humper was in a neck wrap, sitting upright, with deep pain present in both rear limbs, good withdrawal reflex in rear, fore limbs held in extension, and cranial nerves were normal.  Sub-Q emphysema and dermal abrasions were present over lumbar spine.  The presented radiographs were inconclusive.  Dr. Dew discussed spinal fractures and could offer 70% prognosis for positive neurologic improvement if spine can be stabilized.  He suggested anesthesia, radiographs and myelogram if indicated to assess spinal cord. Owner wished to proceed.
TREATMENT:
Cerebrospinal centesis:  2ml of clear CSF was collected from cisterna magna.
Myelogram:   Lumber injection 3ml iohexol, observed column thinning from T12-L2, slight deviation of cord to right at T13.  Dr. Dew called and discussed findings with owner.  Suspect traumatic disc rupture surgery will be beneficial, but due to traumatic nature of injury prognosis is guarded until improvement is noted, he wishes to proceed with hemilaminectomy.
Hemilaminectomy:  Disc material was removed from T12-L1
Humper's prognosis is good for healing and fair 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.


CASE HISTORY:
Jake is a Bassett who weighs 54# and is 10yrs old.  Dr. Carolyn McCutcheon Park at Avenue Animal Hospital is his referring veterinarian.  Jak has had significant tumor regrowth.  It has recurred circumferential around the right tibia/stifle.  There has been soft tissue enlargement in the area of the right gluteal's, a pedunculated 3cm diameter haired mass is evident at the ventral rectal/tail junction, a large mass consistent with lipoma is immediately caudal to the right scapula, and a 4cm diameter sub-Q mass is present on the sternum.  Jake's owner wished to pursue debulking of stifle mass and resection of tail base mass.
TREATMENT:
Dr. Dew used the following approaches for Jake's tumors:  cranial to stifle/tibia, elliptical incisions including dermis on tail and sternum.  There was no deep extension noted on sternum or tail.  The mass on the stifle/tibia was extremely invasive.  There were no discernible margins, and the normal tissue visible was absent.  The prognosis is good for soft tissue healing, regrowth on the right rear is absolute, and other prognosis will be determined after biopsy results are returned.

CASE HISTORY:
Promise is a 22# 8yr old Pek/Pom.  She was sent to us by Dr. Jennifer Limbaugh with Parkway Village Animal Hospital.  With a history of stranguria, Dr. Limbaugh has identified a urethral calculi lodged at the os penis.  Dr. Dew discussed retropulsion and cystotomy or scrotal urethrostomy.  The owners decide to proceed with scrotal urethrostomy and stone analysis.
TREATMENT:
Dr. Dew used a ventral approach to remove a single large stone, and multiple small stones.  They were retrieved and submitted to the Arkansas State Lab.  Promise's prognosis is good for healing and reduced propensity for urethral blockage due to calculi.  Stone analysis will give direction for medical therapy to reduce stone formation.

CASE HISTORY:

Sara is a 32# 7yr old Cocker Spaniel.  She was sent to us by Dr. Hartford Hamilton of Pleasant Valley Veterinary Clinic previously for Bilateral TECA procedure.  Her owner reports that Sara has not been feeling well lately, and has noted an ulcerative area at apex of right TECA incision; 4mm in diameter.  She also mentions that she has developed a generalized dermatitis.  Dr. Dew suggested exploring her ear for possible fistula.
TREATMENT:
Our staff induced anesthesia, and Sara was examined by Dr. Dew.  The severity of her dermal changes was noted, described as ulcerative/necrotizing dermatitis, most severe at lip margins and toe webs of front feet.  There were bilateral submandibular masses noted, and Dr. Dew suspected lymph nodes.  He called Sara's owner and discussed this with her.  He suggesed dermal biopsies and FNA of submandibular masses; she wished to proceed.  Sara's prognosis is good for recovery from the surgical procedure.  Her long term prognosis is guarded until a definitive diagnosis of her skin disease is obtained and a positive response to treatment is noted.

CASE HISTORY:
Elli is a German Shepherd at 107#  and almost 4 yrs old.  Dr. Amanda Barnett with All Animal Health Center is her veterinarian.  Dr. Dew had previously performed a biceps tenotomy on Elli, and she had improved considerably post procedure.  2 weeks ago after running outside she became acutely lame, and the lameness has not improved.  Upon exam, she was non-weight bearing lame on right forelimb.  Elli was extremely painful on manipulation of her shoulder.  Dr. Dew suggested repeat radiographs to determine if degenerative changes have progressed.  Radiographs demonstrate proliferative and osteolytic changes in the proximal aspect of the glenoid and intertubercular groove.  Dr. Dew called and discussed these findings with Elli's owners and they decided to proceed with removal/biopsy of degenerative bone understanding that any improvement may not provide durable.
TREATMENT:
During the surgery, Dr. Dew observed a large amount of abnormal bone present at proximal aspect of supra glenoid tubercle and intertubercular groove.  He was unable to define healthy/degenerative border of glenoid.  He explored the proximal glenoid, removed abnormal bony fragments.  He stabilized the greater tubercle with divergent 5/64 pins and the acromion with a 20 guage tension band.  Dr. Dew states in dictation, "I would anticipate that immediate improvement would be noted, I am concerned that the improvement noted may not be durable. The biopsy results my help delineate the disease process and direct further treatment."