Your Patient of the Week candidates for Week 3/1 through 3/5

The winner of last week's poll was Olive with 45 votes.  Awesome, Olive!  Have a picture of your pet getting his/her prize pack in the mail?  Email it to info [at] azzore.com and we'll add it to the photo album on our website: You've Got Mail!


CASE HISTORY:

Gracie is a Mix Breed at 57# and 2yr 4mo. Her referring veterinarian is Dr Tammy Smith of Animal Medical Clinic. Gracie had been to us before for Bilateral Cruciate surgery, now she had presented with Bilateral Luxating patellas.


TREATMENT:
Dr. Dew used a medial approach on both of Gracie's tibial tuberosity transposition surgeries on both knees. Her prognosis is good for maintained reduction of patellas and improved ambulatory function.
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CASE HISTORY:

Keke is a 4# 1yr and 2mo Pomeranian. She was referred to us by Dr Michael Whatley with The Pet Clinic. She had a Left radius/ulna fracture. Distal diaphysis had been previously stabilized with IM wires, but this has resulted in a non-union of the fracture. Dr Dew discussed fracture debridement, bone graft and plate stabilization.
TREATMENT:
Dr Dew used a craniomedial approach for the fracture repair. He observed poor bone quality distal fragment. He used hardware to stabilize the fracture consisting of a 3mm plate with 5 - 1.5mm screws. Kayla's prognosis is fair for uncomplicated osseous healing. Exercise restrictions and bandage care instructions must be followed to maximize the prognosis for uncomplicated healing.
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CASE HISTORY:

Coco is a 23# 15yr old Rat Terrier sent to us by Dr Hartford Hamilton of Pleasant Valley Veterinary Clinic. She was sent to us for mass excision of right caudal 2 mammary glands.
TREATMENT:
Dr Dew used a ventral approach to remove the mass. It infiltrated the medial thigh muscles, abdominal wall muscles, and also filled her pelvic inlet. Dr Dew as able to debulk 90% of mass. Coco's prognosis is fair for uncomplicated soft tissue healing and improved comfort and function. The interval for which improvement can be expected is impossible to predict, a great outcome would be 4-6 months for comfortable function at home. Samples were sent to the state lab for further testing.
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CASE HISTORY:

Charlie is a Westie that weighs 12# and is 7mo old. Dr Kenneth Shaddox with Chestnut Small Animal Clinic referred him to us. On routine pre-op chemistry panel, Dr. Shaddox recognized hepatic abnormalities; the bile acid assay submitted returned results consistent with PSS (portosystemic shunt). Dr Dew discussed PSS medical and surgical therapy, associated prognosis and benefits. Charlie's owners decided to proceed with surgery.
TREATMENT:
Dr Dew used a ventral celiotomy approach to repair the shunt vessel. Charlie's liver mass appeared normal. The shunt vessel consisted of gastric and splenic veins; it joins to form 1 short shunt vessel into vena cava. A cellophane constrictor (3 ligaclips) were placed to correct the shunt vessel. 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.
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CASE HISTORY:

Sally is an 89# 2yr 11mo old Labrador Retriever Mix. Dr Marilyn Baeyens with North Hills Animal Clinic is her referring veterinarian. A previous diagnosis of bilateral hip dysplasia R & L, and left tarsal OCD. Over the past 16 months, Sally's right rear limb function has continued to deteriorate. Upon Dr Dew's exam, the right stifle has medial buttress and positive anterior drawer consistent with CCL rupture. Although Sally had been coming to the clinic for a right THR(Total Hip Replacement), the TTA procedure was discussed and recommended to be completed first. Bioscaffold implantation of the hips, right stifle and left hock was recommended and discussed. After discussion, Sally's dad decided to go with the TTA and bioscaffold procedures.
TREATMENT:
For Sally's TTA (tibial tuberosity advancement) surgery on her right knee, Dr Dew used a medial approach with medial arthrotomy. He placed Kyon implants consisting of a 12x22mm basket, 6 hole plate & fork combination, and 4 titanium screws. The BioScaffold procedure included 0.5ml of BioScaffold being implanted into both of Sally's coxofemoral (hip) joints, her right stifle (knee) and left hock (ankle). 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. 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. The bioscaffold implantation should provide significant pain relief and improved joint function for greater than 12 months time.
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CASE HISTORY:

Oliver is a Powderpuff Chinese Crested weighing 21# and is 2yrs old. He was sent to us by Dr Kristy Austin of Osage Veterinary Clinic. Oliver was HBC the previous week, and Dr Austin had identified a right mid-diaphyseal, compound, comminuted femoral fracture with moderate/severe soft tissue injury to the medial aspect of the thigh. Dr Dew discussed the use of a composite ESF for both soft tissue and orthopedic support. The owners wished to proceed with stabilization utilizing the ESF.
TREATMENT:
Dr Dew used a medial approach through Oliver's open would. There was significant loss of medial bone and soft tissue components of stifle joint, medial femoral condyle appeared ground off by 1/3. There was loss of the medial trochlear ridge, but the articular surface of condyle present. Also, 1/3 of tibial tuberosity was lost, but the medial collateral stayed present. Dr Dew placed 2 - 20 guage cerclages on distal fragment to protect fissures. He used a retrograde 7/64 IM pin, and reduced fracture. He advanced IM pin distally, placed 1 - 3/32 enhanced thread pin distally, and 1-5/64 smooth transcortical pin proximal. Dr Dew then tied all 3 pins together with 1" acrylic bar for stabilization. Oliver's prognosis is good for normal osseous healing. Due to the severe bone and soft tissue loss that involves the stifle, the long term stifle function is difficult to predict. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.
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CASE HISTORY:

Molly is a 13 wk old 6# Miniature Pinscher. She was sent to us by Dr Lesley Holidy of Arkansas Animal Care Clinic. Molly had a history of urinary incontinence and constant urine leakage. According to her owner, Molly will posture and produce urine but continuously has urine discharge. Dr Dew discussed ectopic ureters, diagnosis, treatment and prognosis for improvement but not always curative and often requires medical therapy. Molly's owner wished to proceed with IVP and surgery if indicated.
TREATMENT:
Dr Dew used a ventral celiotomy and cystotomy approach for the surgery. He observed that both ureters were enlarged, and identified ureters. The ureters ligate as they fuse with bladder serosa. Dr Dew transplanted with drop in technique and stabilized with 4-0 dexon SI sutures. Molly's prognosis is good for healing and successful ureter transplantation. The prognosis for normal urinary/bladder function is guarded/fair although significant improvement should be noted. Medical therapy may be a useful addition to the therapy.
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CASE HISTORY:

Kloe is a 3# 9mo old Yorkie. Dr Lynn Life of New Hope Animal Hospital referred her to us. Two weeks previous, Kloe had fallen off the bed and became acutely lame on the left rear. Dr. Life had identified a left capital physeal fracture. Dr Dew discussed articular nature of fracture and growth plate involvement. He suggested an open reduction and divergent wire stabilization. Her owner agreed.
TREATMENT:
Dr Dew used a craniolateral approach for Kloe's surgery. He reduced the capital physis, and stabilized with 2 - 0.045 wires and 1 - 0.035 wire. Her prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.
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CASE HISTORY:

Nash is a Lab at 100# and is 9yrs old. He is sent to us by Dr Jon Southerland of Kiehl Avenue Animal Clinic. Nash had a Right TTA by Dr Dew back in 2007. He is doing well on the right, but had now become acutely lame on the left rear. Positive anterior drawer and medial buttress indicate a cruciate injury. His owner was educated concerning the TTA procedure and wished to proceed with the Left TTA (tibial tuberosity advancement).
TREATMENT:
Dr Dew used a medial with medial arthrotomy approach. He used Kyon implants: 12x22mm basket, 6 hole plate & fork, and 4 titanium screws. 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.
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CASE HISTORY:

Patch is a Mix Breed. He is 6yr 3mo old and weighs 85#. Dr Kristen Westhoff with Rose Animal Clinic is his referring veterinarian. Patch had a Right TTA back in 2007, and has now been referred to us for a Left Cruciate rupture. His owners agreed on the same surgery as his Right, which is the tibial tuberosity advancement.
TREATMENT:
Dr Dew used a medial with medial arthrotomy approach for Patch's TTA. He used a 12x22mm basket, 6 hole plate & fork combination, and 4 titanium screws. His prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). These implants and the TTA technique 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.  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.