POTW 5/17/10 through 5/21/10

Lucy won last week's contest with 20 votes.

Congrats, Lucy!

Below are the candidates for this week:

PATIENT SUMMARY:

Buddy is a Mix Breed at 34#, and is 8yrs old. His referring veterinarian was Dr. Tena Spencer with Arkansas Animal Care Clinic. Buddy chased a fish hook and got it! Dr. Stump identified a treble hook lodged in the proximal esophagus, and had treated with IV fluids and sedation through the weekend. Dr. Dew discussed the need to surgically remove the hook, the complications of possible infection, as well as dehiscence or stricture in 20% of cases. His owner wished to proceed with surgical removal.

Radiographs showed the exact location of the hook.

TREATMENT:

Dr. Dew used a ventral approach to reach the location of the treble hook. He observed that 2 of the 3 barbs would need to be pushed through as they were embedded. He cut the “free” barb, and then pushed the other 2 through into the lumen and clipped them. The hook was then removed. Buddy’s prognosis is fair for uncomplicated healing.

PATIENT SUMMARY:

Charlie is a German Shepherd Mix. He is 2yrs old and weighs 124#. His referring veterinarian was Dr. Jo Cochran of Park Avenue Animal Hospital. Charlie had been lame on his right rear limb for the previous 6 weeks. Dr. Cochran diagnosed a Right CCL rupture. Upon examination by Dr. Dew, there was anterior drawer consistent with complete CCL rupture. He discussed TTA (tibial tuberosity advancement) and EFS (external fascial strip) procedure, recovery and prognosis. His owner decided to proceed with Right TTA and utilize transport service to Russellville.

TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. A cancellous graft was harvested from the distal femur. Kyon implants used for the TTA surgery were: 12x25mm basket, 7 hole plate & fork, and 4 titanium screws. He then lavaged, placed graft, and imbricated joint capsule. Charlie’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:
Lady is a Mix Breed. She is 5-1/2 years old and weighs 22.4#. Her referring veterinarian is Dr. Anne Brenneke of St. Francis Veterinary Clinic. Lady had an acute onset of rear limb paresis on the previous Sunday. She was treated by Dr. Brenneke with NSAID's and steroids for the past 4 days with no improvement. Upon examination, Dr. Dew observed Grade V rear limb paresis, UMN, with panniculus evident at L1-2. He discussed the severity of Lady’s clinical signs, and gave 20-40% prognosis for neuorlogic improvement over 6 months time if the cord is swollen over less than 4 vertebra. Lady’s owner understood the prognosis and nursing care required and wished to proceed with myelogram and surgery if indicated.
TREATMENT:
Cerebrospinal centesis: Dr. Dew obtained 2ml clear CSF from cisterna magna.
Myelogram: Using a lumber injection of 3-4ml of iohexol, he observed column thinning from L1-T11, with deviation of cord to the left at T12-13-L1. He advised Lady’s owner that surgery would be beneficial, but due to cord swelling the prognosis is guarded until improvement is noted.
Hemilaminectomy: Dr. Dew used a dorsolateral approach to L1-T13-T12-T11. A large amount of disc material was removed. A clot was removed ventral, lateral and dorsal to cord. It appeared that both T12-13 and T11-12 were involved acutely. Lady’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.

PATIENT SUMMARY:
Shay is a 159.3# 5yr 11mo old Irish Wolfhound. He was referred to us by Dr. Sara Jennen of Pine Street Animal Clinic.  Over the previous 3 months, Shay had lost 20lbs, exhibited exercise intolerance, inappetitence, and lethargy. With CBC pancytopenia, he was non-responsive to antibiotic therapy. Upon examination by Dr. Dew, Shay was afebrile, pupils dilated and non-responsive to light, but blink reflex was intact. The left suprascapular lymphnode was prominent. His heart rate and MM color was abnormal as listed above. Dr. Dew discussed the possibility of cancer, due to pancytopenia. He recommended, CBC/Chemistry panel, a bone marrow aspirate, a lymph node FNA (fine needle aspirate), and chest and abdominal films. His owner wished to proceed with the aforementioned plan.
TREATMENT:
Dr. Dew obtained 8 slides of bone marrow from the left humerus. He obtained a lymph node aspirate, prescapular, of 4 slides. The radiographs demonstrated that the thorax was normal, but the abdomen, spleen, and liver were slightly enlarged. The FNA of the spleen produced 6 slides for study. All cytology was sent to AR state lab. Shay’s prognosis is good for recovery from procedures; the long term prognosis will be determined after a diagnosis is made and treatment plan formulated.

PATIENT SUMMARY:
Taz is a Yorkie. He is 10 yrs old and weighs 8#. His referring veterinarian is Dr. Heath Stump of Russellville Animal Clinic. Taz had an acute onset of right rear lameness the previous week. Dr. Stump identified a Right CCL injury. Upon examination by Dr. Dew, there was positive anterior drawer to the right stifle, and Grade III MPL (medial patellar luxation) left stifle. He discussed TTA (tibial tuberosity advancement) and EFS (external fascial strip), with and without patella correction by TTT (tibial tuberosity transposition) on the Left. Taz’s owner decided to proceed with a right EFS and left TTT correction.
TREATMENT:
Dr. Dew used a lateral approach with lateral arthrotomy on the Right stifle for the EFS procedure. He used 2-0-maxon medial buttress suture to stabilize the fascia. He then used a medial approach with lateral arthrotomy for the Left stifle for the TTT procedure. Taz’s prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). Due to having surgery on both knees simultaneously, Taz may require some assistance rising and walking for the next 1-10 days. 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:
Lola is a Boxer, and she weighs 70.9# and is 4yr and 5mo old. Dr. Paul Seminara of Green Mountain Animal Hospital is her referring veterinarian. Lola came to us in December of 2009 for a Left TTA, and had been doing very well on it. She had now been diagnosed with a Right CCL (cranial cruciate ligament).
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. A cancellous graft was harvested from distal femur. Kyon implants used for the TTA surgery were: 9X19mm basket, 5 hole plate & fork, and 4 titanium screws. Lola’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:
Angel is a Basenji. She is 10 yrs old and weighs 22.5#. Dr. Bob Hale of Briarwood Animal Clinic referred her to us. Angel had an acute onset rear limb weakness 3 days previous. She has shown no response to medical treatment. Upon exam by Dr. Dew, she shows signs of grade III transverse myelopathy, UMN rear limbs, with deep pain intact. There were panniculus changes at the T/L (thoracic/lumbar) junction. He discussed IVDD (intervertebral disc disease) and tumor as the most likely etiologies. He suggested cerebrospinal centesis, myelogram, and then hemilaminectomy if indicated. If the problem is a single disc, then there would be an 85-90% prognosis for return to ambulation within 6 months. Angel’s owner wished to proceed with diagnostics and surgery.
TREATMENT:
Cerebrospinal centesis: Dr. Dew extracted 1ml clear CSF collected from the cisterna magna.
Myelogram: Using a lumber injection of 4ml iohexol, he observed column thinning from T12-L1, with a slight deviation of the cord to the right at T12-13. Also, there was elevation and loss of ventral columns T12-13 and T13-L1.
Hemilaminectomy: Dr. Dew used a dorsolateral approach at left T11-L2. There was moderate disc bulging with significant cord compression at T12-13 and T13-L1. A small amount of acute disc material and an organized clot were removed at T13-L1. Large amount of fibrous disc material were removed from both sites. Angel’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.