POTW May 24th thru May 28th, 2010

Our winner for last week's POTW Poll was Lola!

Yay, Lola!

This week's candidates are below:

PATIENT SUMMARY:
Maddie is a Labrador Retriever. She is 8.5 yrs old and weighs 92#. Her referring veterinarian is Dr. Jon Southerland with Kiehl Avenue Animal Clinic. She presented to Dr. Southerland with Bilateral rear limb lameness, and he identified Bilateral CCL rupture. Upon examination by Dr. Dew, there was positive anterior drawer and medial buttress consistent with Bilateral CCL rupture. He discussed TTA (tibial tuberosity advancement) and EFS (external fascial strip) procedures with Maddie’s owner, and she decided to proceed with Bilateral TTA surgeries.

TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. Kyon hardware used was as follows: 12x22mm basket, 6 hole plate & fork, and 4 titanium cortical screws. A cancellous bone graft was placed to promote bone healing. Maddie’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. With having both legs corrected at once, "Maddie" will benefit from the use of the Help ‘Em Up Harness when rising and walking for the next 1-14 days.

PATIENT SUMMARY:
Apple Blossom is a Miniature Dachschund weighing 10#, and is 5 yrs old. She was referred to us by Dr. Marty Nall of West Oaks Animal Hospital. Apple had neck pain and cervical splinting for previous 3 weeks. There had been limited response to steroids and restricted activity. Upon examination by Dr. Dew, her neck was guarded, and she had muscle tremors, but was able to walk on all 4 limbs. Dr. Dew discussed cervical IVDD, myelogram and if required ventral slot decompression. Her owner was given a good prognosis for resolution of discomfort over 3-4 weeks post-op.
TREATMENT:
Cerebrospinal centesis: 2ml of clear CSF was collected from the cisterna magna.
Myelogram: Using a lumber injection consisting of 4ml of iohexol, column thinning and elevation at C2-3 were observed with a slight deviation of the spinal cord to the right at C2-3.
Ventral Slot: Dr. Dew used a ventral approach at C2-3 vertebrae. He observed a large amount of acute and fibrous disc material, and it was removed. Apple Blossom’s prognosis is good for healing and improved comfort. 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 and pain resolution 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:
Spencer is a Jack Russell Terrier. He is 5yrs old and weighs 25#. He was referred to us by Dr. Brian Barron at Shackleford Road Veterinary Clinic. Spencer had an acute onset of rear limb paresis 3 days previous, and historically had voluntary motor movement in tail the day before meeting with Dr. Dew. At presentation, he exhibited grade IV-V rear limb myelopathy, deep pain was present in right rear but absent in left. Panniculus evident at T10. Dr. Dew discussed the severity of clinical signs, the likelihood of IVDD, and gave 80% prognosis for neurologic improvement with surgical intervention if cord swollen over less that 4 vertebra. Spencer’s owner wished to proceed with myelogram and will consider surgery if indicated.
TREATMENT:
Myelogram: Using lumber injection 2-4ml aliquots iohexol, column thinning from T12-L1 was observed. There was a slight deviation of the spinal cord to the left at T12-13. On the lateral view, the cord was compressed from the dorsal aspect at T12-13. Dr. Dew called and discussed the findings with Spencer’s owner. Surgery would be beneficial, but due to cord swelling prognosis was guarded until improvement is noted, he wished to proceed with surgery.
Hemilaminectomy:
Dr. Dew used a right approach at T12-13. He observed the spinal cord ventrally compressed. A large amount of disc material and a clot was removed dorsally and laterally, with the cord swollen. Spencer’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 6 months. Nursing care, physical therapy and exercise restriction all play critical roles in avoiding complications and aiding recovery.