DERMATOLOGY
• Allergies
Is your cat hacking and coughing? Does your dog scratch until he’s raw? Do your pet’s eyes look watery? Most of us would attribute these symptoms to hairballs, fleas and infection but another more common culprit could be the cause. Pets, just like people, can suffer from allergies. Symptoms, causes and treatments are remarkably similar for our footed friends. The types of allergies are contact (brought on by skin contact with an allergen), inhalant (caused by breathing in allergens), ingested (allergies to food and oral drugs) and sub-dermal (less common, caused by the injection of medication).
• Causes:
Contact allergens are most commonly caused by your pet’s contact with plants, especially oily ones which will cling to the animal’s fur, carpet, carpet fresheners, newsprint, household cleaners and plain old dust. Symptoms of contact allergies include rashes, changes in skin color and sores especially in the chin, underarm, stomach and ears. These are the areas that receive the most contact with the allergy-causing substance.
Ingested allergens are most commonly found in the food your pet eats. Surprisingly, it is not the color or preservatives that cause the majority of reactions; instead it is the meat, grain or dairy products that are used in the food. This category also includes a reaction to medication given by mouth and those brought on by your pet nibbling on plants. Food allergies take anywhere from seven to ten years to manifest; it is not an instantaneous reaction.
Inhalant allergens are most commonly caused by pollens, molds, dust, tobacco smoke, fragrances, even something as commonplace as kitty litter. In felines, symptoms include coughing or “hacking”, watery eyes, sneezing, congestion and sniffling. These symptoms are often misdiagnosed as a respiratory tract or eye infection. Diagnosis of inhalant allergies is also accomplished with a skin patch test.
The last category of allergens is the sub-dermal allergen. These are relatively uncommon, and are usually caused by the injection of a medication under the skin. The reaction will subside as the medication is absorbed into the system. A severe reaction can be treated with antihistamines.
• Treatments:
Treatment for contact allergens may involve removing houseplants from the pet’s vicinity, limiting the animal’s exposure to grass, keeping them away from carpeted areas, even changing their food and water dishes to metal or glass containers. If this doesn’t stop the reaction, your pet may require treatment with steroid-based drugs. Unfortunately such treatments are not always effective, so the best treatment is to isolate the cause of the reaction and make sure your pet has no (or limited) contact with it.
Treatments for ingested allergens usually starts with implementing a bland, hypoallergenic diet. It’s possible to buy hypoallergenic food at many pet supply stores. Giving your pet distilled water to drink is also a good idea because the minerals and chemicals in tap water can cause a reaction.
Treating inhaled allergies will usually include bronchi dilators, steroids and an antibiotic if an infection is present. Dogs, on the other hand, usually react with skin problems, characterized by scratching, chewing at their skin and repeated licking of their paws. Treatments include removal of the irritants, antihistamines, corticosteroids and immunotherapy.
Sub-dermal allergens can be treated with an antihistamine.
• Prevention:
By taking the same precautions that you would use for an allergic human, you can prevent or minimize allergic reactions in your pets. First and foremost, isolate the cause of the reaction, remove it from the pet’s vicinity and talk to your vet about appropriate treatment.
• EAR INFECTIONS:
Ear infections (otitis) are a relatively common and bothersome problem for pets. Most of the time they are short-term and can be easily treated and cured. However, in some cases they can become chronic and recurrent. In these circumstances, a more complete investigation into the cause and longer-term treatment plans are required.
• Causes of Acute and Chronic Otitis:
Causes of acute otitis include foreign objects such as plant material, allergies, parasites and water in the ears from swimming or bathing. Allergies, hormonal diseases, tumors, immune mediated diseases or incomplete/inadequate treatment of an acute infection can cause chronic and recurrent otitis. The underlying problem changes the environment in the ear allowing the development of bacterial and yeast infection. Allergies are by far the most common cause of chronic ear infections. Besides treating the infection component, the underlying allergy must be addressed or else the infection will continue to recur.
• Treatments:
In many acute otitis cases with no major underlying problem, a 2-3 week treatment course with a topical drop or ointment placed into the ear canal may be all that is necessary to clear the infection. When there has been a chronic infection, simple ear drops and ointments are usually inadequate to clear the infection. The ear canal has undergone many changes that make it difficult for topical therapy to be effective. They include swelling, glandular enlargement and a buildup of scar tissue. In these cases systemic medications (i.e. oral pills and capsules) will be necessary to treat the infection, underlying cause and correct the secondary changes. Antibiotics are used for bacterial infections and antifungals for yeast infections. Glucocorticoids such as prednisone or dexamethasone are often included to reduce the amount of inflammation in the ear. Therapy may be required for many weeks to get the ear canals back to normal.
• Prevention:
The key to healthy ears is to keep them clean. Check your pet’s ears weekly. A slight amount of waxy buildup may be present in normal ears. If your pet swims a lot, has pendulous ears or a history of ear disease; routine cleaning (often once to three times per week) is recommended. Treat any underlying condition that predisposes your pet to ear problems. Remember if your pet is showing severe discomfort, the ears have a bad smell or the ear canals look very abnormal, do not delay in contacting your veterinarian. If your pet has a ruptured or weakened eardrum, some ear cleansers and medications could do more harm than good.
• HYPERTHYROIDISM:
Hyperthyroidism occurs when too much thyroid hormone is created and released from the thyroid glands. The reason the gland secretes more hormones is because the gland enlarges and becomes over active. Generally, this is from benign (non-cancerous) growth. Although not cancer, this overactive thyroid gland tissue can cause life-threatening problems. It is very rare in dogs, but is actually quite common in cats. In fact, it is the second most common disease that we see in cats over 10 years old (kidney disease is the most common.)
• Symptoms:
Generally, the signs of the disease are directly related to the function of the thyroid hormone excess. It is rare that you will notice a thyroid mass at home. The classic signs of hyperthyroidism are weight loss, increased appetite and hyperactivity/restlessness. Behavioral changes are a very common cause of why the cat or dog was brought to the office. Some other signs include diarrhea, patchy hair loss, matted fur/unkempt coat, excessive grooming, increased thirst/urination, vomiting, aggression, anorexia and dehydration.
• Treatments:
There are 3 treatments for this disease: Surgery, medication and radioactive iodine.
• Surgery:
This is the most invasive treatment, is quite costly and carries a high rate of recurrence. It can also cause another hormonal disease called hypoparathyroidism if both thyroid glands are removed. Given all of that, it is not a recommended treatment unless (1) you can’t give medication or (2) you don’t live near a facility that can give the radioactive iodine.
• Medication:
Anti-thyroid medication (methimazole) does not cure hyperthyroidism. They block the ability to form functional thyroid hormone. This medication is both short-term and long-term and is relatively inexpensive.
• Radioactive Iodine:
This is often the most successful means of treatment for hyperthyroidism in cats. Radioactive Iodine (I131) is given via a simple injection. It damages the thyroid hormone producing cells without damaging the surrounding tissues. Unfortunately our hospital does not offer this treatment, but there are several facilities close by that do upon referral.
• Prevention:
This disease cannot be prevented, but the earlier the detection, the more likely a good outcome for both dogs and cats. Annual examination includes a palpation of the thyroid gland areas. Annual lab work for both dogs and more importantly cats include a T4 test that might find subclinical hyperthyroidism. Knowledge of the symptoms and examination if they occur are also vital for early detection.
• HYPOTHYROIDISM:
Hypothyroidism is the clinical condition caused by a deficiency of the thyroid hormone. The thyroid hormones are produced by the thyroid glands, which are located in the neck on either side of the trachea. Thyroid hormones are critically involved with the metabolism of most of the organs in the body. A deficiency results in a decreased metabolic rate, which may cause a wide variety of symptoms. Hypothyroidism generally affects middle-aged to older animals.
• Symptoms:
Symptoms will vary from dog to dog and can affect multiple organ systems and usually have a gradual onset. The most common signs are lethargy, mental depression, exercise intolerance, weight gain, hair loss of the tail, dry/oily skin, darkening of the skin, slow heart rate and seizures.
• Treatments:
Dogs with hypothyroidism are easily treated with synthetic thyroid hormone supplement (i.e. l-thyroxine, T4) usually administered once to twice daily. Once the proper dosage has been established, yearly blood checks are recommended to insure continued adequate supplementation. Improvement of clinical signs can occur within one week of initiating therapy for mentation or take several months for hair regrowth. Lifelong thyroid supplementation is required for all dogs with a confirmed diagnosis of hypothyroidism.
• Prevention:
Hypothyroidism, like hyperthyroidism, is a disease that cannot be prevented. Annual examinations and lab work are the best ways to stay in touch with your pet’s overall health.
• EMERGENCY AND CRITICAL CARE
• ALLERGIC REACTIONS:
Common causes of allergic reactions include bee stings, vaccination and spider bites. In many cases, we may never know what your pet has been exposed to that has caused signs of hives, swelling of the face, itchiness and sometimes vomiting and/or diarrhea. Severe forms of allergic reactions are known as anaphylaxis and cause difficulty breathing, weakness, low blood pressure and collapsing. If your pet is showing any of these severe abnormal signs, bring them to the closest veterinary hospital immediately.
If your pet has had an allergic reaction to a vaccination, your veterinarian may elect not to vaccinate anymore or may pre-treat with an antihistamine before any further vaccinations are administered. Make sure that you remind any new veterinarian that your pet has had a vaccine reaction in the past, to help avoid ongoing problems.
• PARVOVIRUS:
Canine parvovirus is the most common serious infectious disease of dogs in the United States. Canine parvovirus causes ulcerative enteritis and diarrhea in susceptible dogs. This diarrhea can be bloody and life threatening. The parvovirus has mutated several times since 1980. The most common strain today is CPV-2B. Parvovirus is an extremely tough and resistant bug. The virus lives for long periods of time on floors, food containers and other household objects.
• Symptoms:
Parvovirus disease is remarkable in that symptoms can vary from none to all to a fatal disease. Four factors govern the severity of the disease: age at exposure, the size of the virus dose, the presence of maternal antibodies and the breed of the dog involved. Dogs receive transient maternal antibodies from their mothers through their first milk or colostrum. This antibody gives the puppy resistance to the disease. Puppies that are housed in a parvo-filled environment rarely break with the disease until they reach 14-20 weeks of age. At that time their mother’s immunity no longer protects them and they may die of the disease. Dogs over six months of age develop natural resistance to the effects of parvovirus. Many of these dogs show only transient diarrhea. The most common form of parvovirus infection is a sudden (acute) inflammation of the small intestine or enteritis. This is characterized by depression, vomiting, diarrhea and profound dehydration.
• Treatments:
Treatment of parvovirus is directed at correcting the life-threatening dehydration that accompanies the diarrhea with intravenous fluids. Once the initial dehydration is corrected, maintenance fluids can also be given subcutaneously. Many of the younger dogs have hookworm infestations that make the parvovirus disease more severe. As soon as these dogs can hold down liquids, they are wormed with pyrantel pamoate. Dogs and puppies that begin to accept small portions of food invariably are on the road to recovery.
• Prevention:
Recovered dogs are probably immune for life. Because of the strong immunity that follows infection, carrier dogs do not exist. Many excellent brands of vaccine are on the market. Most contain living, attenuated (weakened) parvovirus. All products are safe and produce good immunity when the last injection is given at 16 weeks of age. When a vaccine fails it is usually because it was given to a puppy before enough passive maternal antibodies were gone from its blood stream. Parvovirus is still a major threat to dogs in the United States and a common cause of mortality in puppies. Due to the resistance of the virus to antiseptics, heat and drying, it is impossible for a kennel to be 100% safe from this disease. No matter what puppy vaccination schedule is used, there will be a window of susceptibility when puppies are at risk of disease if exposure occurs. Rapid veterinary care can save many infected dogs, but some will die from the disease despite excellent care.
• HEMORRHAGIC GASTROENTERITIS:
Hemorrhagic gastroenteritis (HGE) is a common cause of bloody vomiting and diarrhea in dogs. The exact cause of HGE is unknown, although bacteria such as Clostridium perfringens and immune reactions have been implicated to play a causative role in some cases. HGE can affect all dogs, but is more common in some small breeds, such as miniature schnauzers, dachshunds, miniature poodles and Yorkshire terriers.
• Symptoms:
Diagnosis of HGE is largely based on clinical signs of bloody vomiting and diarrhea, bloodwork that demonstrates hemoncentration with elevated hematocrit, as well as normal to decreased plasma total protein concentration. Your experienced veterinarian will recommend bloodwork, x-rays of the abdomen and fecal examination to rule out other caused of bloody vomit and diarrhea.
• Treatments:
The gold standard of treatment is to administer intravenous fluids, antibiotics and antinausea medications. Most dogs usually will require monitoring in the hospital for one to several days until it is able to hold down food and water without vomiting. During hospitalization, it may become necessary to monitor coagulation tests and EKG if abnormalities develop. Some animals may require plasma or albumin transfusions to help replenish the protein that is lost in the diarrhea. After your pet returns home, it will be necessary to administer antibiotics and a bland diet for several days to a week. You can purchase a bland diet from us or can cook a bland diet for you pet. Feed the diet for 2-3 days then gradually re-introduce their regular diet over a period of 24-48 hours. Watch your pet carefully for signs of vomiting, diarrhea, weakness, lethargy or difficulty breathing. If your pet shows any of these abnormal signs, please contact Pet Menders Animal Hospital immediately.
How to Prepare a Bland Diet for Your Dog:
Boil hamburger or chicken in boiling water until cooked through. Place the meat in a strainer and rinse the excess fat away. Boil white or brown rice until thoroughly cooked. Mix 2/3 meat with 1/3 rice and feed an amount as directed by your veterinarian. You can add several tablespoons of low-fat cottage cheese to the mixture for taste.
• TRAUMA:
Your pet has just been hit by a moving vehicle. Although injuries may not be apparent at this moment, it is very important for your pet to be monitored closely for the next 24-48 hours. Internal bleeding, severe bruising or collapse of the lungs or a ruptured urinary or gall bladder can be present and can cause life-threatening illness if not recognized and treated promptly.
• Treatments:
When your pet goes home, injuries that occurred at the time of the accidents may not become apparent for days to weeks after the event. Your animal should be kept indoors and allowed outside only on a leash for the next 7 days or until your veterinarian says that restricted activity is no longer necessary. Excessive play, running and jumping are not allowed even if your pet looks completely normal.
Monitor your animal’s gum and tongue color. Make sure that it stays nice and pink. Pale pink, purplish or gray discoloration to the gums or tongue can occur with anemia or breathing problems. Make sure that your animal is urinating and defecating normally. Monitor your pet’s appetite. Watch for vomiting, diarrhea, decreased appetite, difficulty breathing, lethargy, weakness or collapse. If your pet has any of these abnormal signs, please contact a veterinarian immediately.
Getting hit by a car is a traumatic event for both you and your pet. With the proper diagnostics and treatment, many animals can survive and lead healthy lives. Please don’t hesitate to contact us with any questions, problems or concerns.
• ENDOCRINE
• DIABETES:
Diabetes mellitus is a chronic endocrine disorder that occurs in dogs and cats. It is characterized by high blood sugar (hyperglycemia) and results when the pancreas is unable to produce enough insulin to meet the animal’s requirements.
Insulin is a hormone which is needed to transport glucose (blood sugar) as well as certain amino acids and minerals through the blood to energy-producing cells. When a lack of insulin occurs, glucose cannot move into the cells and the glucose level in the blood rises to abnormally high levels.
• Symptoms:
An animal with diabetes mellitus will exhibit some or all of the following symptoms: weakness, increased thirst, frequent urination, rapid weight loss, depression and abdominal pain. An animal may also show signs of either increased hunger or lack of appetite. In some animals, the sudden development of blindness due to cataract formation may indicate diabetes.
• Treatments:
Treatment requires a commitment of time and management from you, the owner. There is no cure for diabetes mellitus, but, as with humans, it can be controlled with insulin injections, diet and exercise management. With such therapy, your pet can lead a happy, comfortable life.
Once your pet has been diagnosed with diabetes mellitus, its specific insulin requirements need to be determined. As each pet’s insulin needs are unique and often vary from day to day, your pet may need to be hospitalized for 2-4 days in order to determine its specific needs. This is accomplished by your veterinarian giving the pet an insulin injection and testing the blood sugar levels at regular intervals throughout the day. These results are used to determine your pet’s initial insulin requirements. Your veterinarian may indicate these on a Glucose Curve Chart. Because your pet’s insulin needs may change once it returns home, due to changes in diet, exercise and certain environmental stresses, periodic re-evaluation over the next two weeks is recommended until satisfactory control is achieved. Once control is achieved, further evaluation should be completed every 2-4 months.
• Causes:
Diabetes mellitus in dogs and cats is caused by damage to the pancreas. Predisposing factors are: obesity, genetic predisposition, poor diet, hormonal abnormalities, stress and drugs. The sex of the animal can also be a predisposing factor. In dogs, females are affected twice as often as males and in cats, diabetes is more prevalent in males.
USEFUL WEB SITES
www.animaldiabetes.com
www.petdiabetes.org
www.caninediabetes.org
www.petdiabetes.com
www.felinediabetes.com
www.petdiabetes.net
• ORTHOPEDICS
• CHRONIC HIP DYSPLASIA (CHD) OPTIONS:
(1) Conservative:
• Weight reduction – “thin is good”
– Limit feeding has a profound positive effect on expression of CHD*
– 83% of dogs with CHD that are permitted to get overweight develop osteoarthritis (OA).*
– ONLY 50% of dogs with CHD that are kept LEAN develop OA.
– Lean dogs live 1.8 years longer.*
– Keeping dogs lean does not change the genes of dogs predisposed to CHD; however, leanness has been shown to delay or prevent the expression of radiographic signs of CHD.*
*Gail Smith, VMD, PhD, University of Pennsylvania, “Influence of diet and age on subjective hip score & OA” Veterinary Orthopedic Society abstract 2002
• NSAIDs – Nonsteroidal Anti-inflammatory Drugs (Rimadyl, Deramaxx,
Metacam, Zuprin, Etogesic, Aspirin)
• NEUTRACEUTICALS – Glucosamine, Chondroitin Sulfate, MSM supplements
• MODERATE activity; PHYSICAL THERAPY; MASSAGE; ACUPUNCTURE
• UNDERSTANDING limitations
(2) Juvenile Pubic Symphysiodesis (JPS):
• A productive procedure involving surgical fusion of the pubic symphysis that results in dynamic outward rotation of the acetabulii during continued normal growth of the pelvis.
• If successful, dorsal acetabular femoral head coverage and femoral head seating is improved similar to a TPO.
• Requires early recognition and surgical intervention by the age of 3 to 5 months for maximal benefit.
(3) Triple Pelvic Osteotomy (TPO):
• A proactive and preventative procedure.
• Surgical osteotomy of the affected hemipelvis with outward rotation by 20-30 degrees to achieve improved dorsal acetabular coverage and femoral head seating (the ball fits better into the socket).
• Maintains “normal” anatomy. Limits or prevents progression of hip osteoarthritis.
• “Window” of opportunity is typically after 6 and before 12 months of age.
(4) Excision Arthroplasty (Femoral Head Ostectomy-FHO):
• A versatile option for many different situations and types of patients.
• Surgical excision of the femoral head and neck with soft tissue interposition to create a “false joint”.
• Good surgical technique combined with postoperative physical therapy and rehabilitation can result in excellent outcome and function.
• STIFLE (KNEE) INJURIES:
• CCL injury:
The most common orthopedic injury and cause for rear limb lameness in dogs is damage to the Cranial Cruciate Ligament (CCL) of the knee. In people this ligament is called the anterior cruciate ligament, frequently referred to as the ACL. The CCL is the primary stabilizing ligament within the knee. Dogs can injure this ligament in a variety of ways. All shapes, sizes, and ages of dogs can suffer this injury. Damage to the CCL, either partial or complete rupture, results in progressive lameness, development of osteoarthritis, osteophyte (bone spur) production, and meniscal (cartilage) damage. A recent survey of veterinarians and board certified veterinary surgeons placed the economic impact of CCL disease at approximately $1.2 billion nation wide.
• Biomechanics:
Why is this injury so common? No scientific study has documented a definite cause. Many factors are important: excess body weight, repeated explosive activity (i.e. jumping to catch a ball), prolonged inactivity or lack of conditioning (i.e. the “couch potato” dog), bone conformation, genetics or inheritance, and simple bad luck. The knee joint of dogs and human are constructed in a similar manner with nearly identical ligament and cartilage structures. The biomechanics of the knee joint, however, differ slightly between dog and human. Dogs walk on their toes, with their heel elevated off the ground and their knee bent forward. The knee is basically a big hinge joint, allowing flexion and extension (bending and straightening) with some internal rotation. As a dog walks, weight is transferred through the hip and down the femur, then across the actual surface of the joint (the tibial plateau), into the tibia, the foot, and ultimately the ground. The CCL maintains the integrity of the joint and resists the force of the femur sliding backwards along the tibial plateau.
• Partial vs. Complete Tear:
The Cranial Cruciate Ligament is composed of thousands of strands or fibers of tissue. Its construction is very similar to that of a cable which is also composed of many, many strands of material (usually steel). Dogs can sustain either a partial or complete injury to this ligament. A partial injury results in tearing of some of the fibers. A complete rupture results in tearing of all the fibers. A frayed cable, in which some of the strands of steel have broken, will still work but it is weakened and will ultimately fail. Similarly, a partially injured CCL will still support the knee; however, it is weak, does not support the knee completely, and will ultimately fail. Dogs that have a partial CCL injury will have intermittent lameness and early, mild development of arthritis. Partial CCL injuries always progress to complete CCL injuries.
• Symptoms:
Any type of injury to the CCL results in rear limb lameness. Partial tears may result in subtle, chronic, intermittent lameness that can be very frustrating to diagnose. These types of tears may only cause the dog problems during times of heavy activity. Rest and anti-inflammatory medication may resolve the lameness until the next time the dog is very active. These symptoms may be present for months until a diagnosis is made or the partial tear progresses to a complete tear. When a complete tear occurs, the knee is very unstable and painful. Many dogs will carry the affected leg or just touch the toes to the ground. Complete tears can result as a slow progression of a partial tear or as sudden, catastrophic failure of the ligament. Rest and anti-inflammatory medication are usually ineffective at resolving lameness associated with complete CCL tears.
• Diagnosis:
Cranial cruciate ligament injury is diagnosed with a good physical exam and detailed x-rays of the knee. Typical physical exam findings include swelling or thickness around the knee and instability (positive cranial drawer) of the knee with stress. Dogs that have suffered a meniscal tear in addition to the CCL injury may also have a distinct “pop” or “click” with flexion of the knee. The meniscal cartilages serve as cushions between the femur and the tibia and also help to stabilize the knee. X-rays usually show excess fluid (effusion) in the joint and early osteoarthritis or bone spur production in more chronic cases. Sedation may be required to allow for more thorough evaluation and testing of the knee for instability. In some cases of subtle, partial CCL injuries, arthroscopic evaluation is needed to confirm the diagnosis.
• Surgical stabilization:
Once the CCL has been damaged, either a partial or complete tear, surgical stabilization is the recommended treatment. In humans with ACL injuries, the damaged ligament is actually replaced using other ligament tissues (i.e. patellar tendon). Although we have tried this technique in dogs, results have been inconsistent, unpredictable and unreliable. Currently we are recommending one of two different techniques that stabilize the knee but make no attempt to replace the damaged ligament: ExtraCapsular Suture (ECS) and Tibial Plateau Leveling Osteotomy (TPLO). These techniques vary in several ways: patient selection, recovery, rehab requirements, short-term outcome, long-term outcome and expense. Your surgeon will discuss these procedures with you in detail so that you can make an informed decision regarding which technique is best suited for your pet. In the future, additional techniques may become available and prove effective in treating this injury. Non-operative management, or conservative treatment of CCL injuries, is very ineffective and results in a joint that is chronically unstable, arthritic and painful.
• Prognosis:
CCL injuries are very debilitating and the prognosis following stabilization of the knee is dependent upon many factors: surgical technique used, experience and abilities of the surgeon, patient body condition score (BCS), patient fitness, owner compliance, rehabilitation/physical therapy, ancillary medications and ancillary therapies employed (massage, acupuncture). With respect to the ECS technique, the results tend to be much more unpredictable, some dogs (especially smaller dogs and cats) do well, while others recover poorly. Without question, the ECS technique requires a significantly greater amount of post-operative rehabilitation and physical therapy to achieve a reasonable outcome. Even with extensive rehab, the ECS technique always results in greater arthritis development with greater loss in range of motion (flexibility) as compared to the TPLO procedure.
• TPLO Surgery:
The Tibial Plateau Leveling Osteotomy procedure stabilizes the knee by neutralizing tibial thrust, not by replacing the injured CCL. The bone below the tibial plateau is cut with a circular saw blade and rotated to level the tibial plateau slope thus eliminating tibial thrust. The other ligaments in the knee remain unchanged and help to further stabilize the joint. Injuries to the meniscus are treated by removing any damaged portions of this structure.
Dogs under 100 lbs: $ 3300.00
Dogs over 100 lbs: $ 3400.00
• Post-operative care:
Most dogs feel better immediately following the TPLO procedure and will start to use the operated leg within the first 24 to 48 hours after surgery. Healing of the bone and soft tissues usually takes 8 weeks. Strict confinement is required during this period. Complete healing is confirmed with x-rays, at which time a rehabilitation program is established. Most dogs return to full activity by 3 to 4 months, and to athletic competition (running, swimming, field trial, hunt testing, agility, etc.) by 6 to 9 months post-operatively.
• ELBOW DYSPLASIA=ABNORMAL TISSUE DEVELOPMENT:
Elbow Dysplasia, regardless of degree of severity, always results in the development of progressive osteoarthritis in the affected joint(s). Dogs typically carry 60% of their body weight on their front limbs; therefore, any condition that affects the front limbs (i.e. elbow dysplasia) is serious and can be very crippling. Treatment recommendations for ED are dependent upon various factors, including the age at which the condition is diagnosed and the degree to which the dog is symptomatic. No single treatment modality has been shown to completely arrest the progression of osteoarthritis. However, it is acknowledged by the “International Elbow Working Group” and board certified surgeons across the country, that early recognition and early surgical intervention offer the best hope for limiting progression of the osteoarthritis that will otherwise develop. The most accurate way to diagnose ED is with x-rays and CT or CAT scan technology. State-of-the art surgical intervention at this time involves joint evaluation and treatment via arthroscopy. The use of arthroscopy provides a minimally invasive means by which to visually evaluate the joint, record and document the degree of cartilage damage, remove coronoid bone/cartilage fragments (chips) and smooth, rough, irregular or incongruent joint surfaces. The loose fragments of bone and cartilage found within an elbow joint affected by dysplasia are not only a manifestation of the disease, but also an accelerant to the development of osteoarthritis. Keep in mind the analogy that ED is like a shoe that is too tight; it still works but it hurts to walk in, and there are pressure points present that can cause blistering. Now, place a pebble in the “too tight” of a shoe analogy, and you can imagine how that might increase the discomfort of the shoe as well as increase additional injury to the foot – as in the pebble digging into the tissue of the foot. This is similar to what is going on in an elbow joint affected by dysplasia: the joint does not fit together well, pressure points are present which result in fragmentation and erosion of the articular cartilage, and loose or fragmented pieces of cartilage and/or bone are present that increase the discomfort within the joint and worsen the arthritis. Early removal of loose fragments and smoothing of rough joint surfaces makes the joint more comfortable and removes one propagating cause of arthritis; however, it does not change the underlying fact that the joint still does not fit together perfectly. Additional treatment recommendations include long-term management for osteoarthritis such as: weight reduction, moderation in activity, anti-inflammatory medications (NSAIDs), cartilage protective agents (nutraceuticals), disease modifying osteoarthritis drugs (DMOADs), Eastern Medicine techniques (acupuncture) and specific diets for joint disease that have higher levels of omega fatty acids.
Following arthroscopy treatment in which dead, damaged, devitalized, fissured or fragmented articular cartilage is removed, a six-week period of rest is advised to allow for proper healing. Arthroscopic treatments such as microfracture and/or abrasion chondroplasty, result in release of stem cells from underlying bone marrow to replace the damaged cartilage. These stem cells form in the blood clot or scab on the injured areas in the joint where the damaged cartilage was removed. Over time, the stem cell blood clot transforms into new cartilage. Controlled activity and avoidance of trauma to the joint during this period of restoration is critical to insure that the stem cell blood clot is not knocked loose from the healing joint surface.
• GENERAL
• Bandage/Splint Home Care:
Bandages and Splints are applied for a variety of reasons and indications. Proper home care is critical to a successful outcome with their use. Listed below are a few simple recommendations for taking care of your pet when they have a bandage or splint – please read these recommendations.
1. Keep bandage/splint DRY at all times.
2. Use a plastic bag, saline bag or a similar device to protect the bandage/splint when your pet goes outside.
3. Leave the bandage/splint covered ONLY while your pet is outside. Remove the bag when your pet comes back inside.
4. DO NOT leave your pet outside for prolonged periods of time with recovered bandage/splint.
5. IF the bandage/splint gets LIGHTLY wet – dry it with a hair blow dryer.
6. IF the bandage/splint gets MORE than lightly wet, bring your pet in at once to have the bandage/splint changed.
7. IF
a) your pet starts to chew at the bandage/splint.
b) you notice a foul odor, or any change in odor coming from the splint.
c) your pet stops using the foot with the bandage/splint on it.
—->Please call AT ONCE to schedule an appointment to have the bandage/splint evaluated/changed (303) 494-0840.
8. Check with your doctor about when you should schedule an
appointment for a bandage/splint change.
9. If you have any questions at any time concerning your pet or the bandage/splint-please call at once (303) 494-0840.
• Osteoarthritis:
Osteoarthritis (OA) is the most common form of arthritis affecting companion animals. In the United States with an approximate dog population of 44 million, published data indicate that as many as one in five or 20% of the adult dogs suffer from some degree of OA. Cats frequently suffer from OA as well. Osteoarthritis is a degenerative process, sometimes referred to as “degenerative joint disease” (DJD), and is exhibited by progressive destruction or loss of the cartilage surface in the affected joint(s).
Osteoarthritis typically develops as a consequence of: development disorders, articular trauma or acquired orthopedic conditions. Other causes for arthritis include immune-mediated and infectious processes. Osteoarthritis develops slowly and progressively. Once the process has been set in motion, it is difficult to arrest and impossible to reverse. As the environment of the joint changes with the development of OA, alterations occur in the basic properties of the articular cartilage. As these changes occur and progress, the cartilage is no longer able to provide pain-free movement in the affected joint(s). Patients with OA thus typically develop stiff and painful joints.
• Diagnosis:
Diagnosis of OA begins with a thorough patient history and physical exam. Owners often report a specific lameness or distinct behavioral change. Earlier symptoms may be more subtle. Physical exam findings typically include: muscle atrophy (wasting) in the area of the affected joint, joint stiffness (loss in range of motion) and tenderness with manipulation, increased joint fluid (effusion) and increased thickness or swelling (periarticular fibrosis) around the affected joint. Currently, radiographs (x-rays) constitute the primary method of definitive diagnosis. Radiographic changes, however, occur later in the disease process and do not necessarily correlate with symptoms. As we say, “dogs do not walk on their x-rays.” This implies that patients with significant OA, as noted on x-rays, may have significant joint pain. Whereas patients with minimal OA, as documented on x-rays, may have significant joint pain. Furthermore, x-rays may document that a patient has OA in more than one joint of a lame leg (i.e. hip and knee) again stressing the importance of a thorough exam to determine which joint(s) is/are painful and responsible for the lameness.
• Treatments:
Treatment of OA depends to a large degree on what stage the disease process is in at the time of initial diagnosis. In every case however, a multi-modality and/or multi-agent therapy is advised. Ideally, medications for OA would relieve pain and inflammation, retard on-going joint degradation and promote joint tissue healing. No single ideal medication exists for OA treatment. A typical multi-modality approach to treatment OA involves the following: weight reduction, an exercise program, anti-inflammatory agents, chondroprotective agents (nutraceuticals and DMOADs), narcotic analgesics, ancillary modalities and surgical intervention (if indicated).
• Preoperative Instructions:
Things to do and remember before your pet’s surgery.
1. Pre-surgical blood work
• Prior to any type of general anesthesia and/or surgical procedure, we require a complete health profile and blood screen to evaluate your pet’s immune system and organ function
• These tests are done to help identify and pre-existing condition that might otherwise result in a complication during anesthesia or surgery
• We advise that this lab work be done one to two weeks prior to your pet’s surgery but no more than 4 weeks before the procedure
• If we did not draw a blood sample (for these tests) from your pet at the time of your initial consultation, please stop by our hospital (prior to your pet’s procedure) or see your regular veterinarian to have a blood sample taken so the tests can be completed
2. Diet adjustment
• Most pets will require a reduction in caloric intake following their procedure to avoid unnecessary weight gain which can complicate or delay the rehabilitation process
• We often advise beginning your pet’s “diet” prior to the surgical procedure
3. Confinement preparation
• Most surgical procedures require a period of confinement and rehabilitation following the procedure to insure the best outcome; therefore, it is often helpful to prepare a confinement area for your pet prior to bringing them home from the surgery
• Along these lines, it may be helpful to begin “crate training” your pet prior to their surgical procedure
4. Morning of surgery
• NO breakfast
• No food after midnight the previous evening
• Water is fine in the morning and overnight
• If your pet is taking medication, please make sure they get their morning meds (even if you have to give their meds with a small food treat) or we can dispense the meds here before surgery
• EXCEPTION: if your pet is receiving aspirin to help control inflammation prior to surgery, please STOP this medication at least 7 days before the procedure
• Please bring your pet to the hospital by 8:00 to 8:30am the day of surgery
• Postoperative Instructions:
The patient should be confined for the first 6 to 8 weeks following surgery.
1. Three activities are allowed:
• The patient can be in the house under the immediate control of the owner on a carpeted surface without playing.
• The patient is to be in a traveling kennel while unattended.
• The patient is to be under the direct supervision of the owner and on a leash while outside for bathroom duties.
• No prolonged walks are allowed. These restrictions are imposed during the bone healing process to secure the anticipated surgical results. No free activities are allowed until after healing has occurred and is confirmed by x-rays.
2. Normal food and water consumption can resume the day following surgery. During the 6 to 8 week confinement period it is recommended that the patient be kept on half (50%) of their normal portion of food to prevent excessive weight gain which could hinder rehabilitation.
3. Inflammation is usually the worst during the first 2 to 3 days following surgery. If there is a time when the patient is acutely sore or hurts, please contact us immediately. Sharp yelps or cries and change in usage of a limb are indications of potential problems.
4. Discourage the patient from licking at their incision. Licking leads to chewing and the patient may remove sutures or create a wound infection by doing so. Bandages and splints should be kept clean and dry. Any odors or persistent licking and chewing are indications of a possible problem. When in doubt call us or your veterinarian to schedule an evaluation ASAP.
5. Please schedule an appointment for 10 to 14 days post-operatively for evaluation of soft tissue healing. X-rays are usually taken 6 to 8 weeks following surgery to evaluate bone healing (x-rays may be advised at 4 week intervals depending on the case and the procedure done). After bone healing is confirmed by x-rays, a more active rehabilitation process will be outlined and initiated.
• Passive Range of Motion (PROM):
1. Passive Range of Motion (PROM) is used to help post-surgical patients recover following surgery on a joint: hip, knee, ankle, shoulder, elbow, etc.
2. The intent of this physical therapy (PT) exercise is to re-establish and/or maintain movement in the operated joint.
3. PROM is accomplished by flexing and extending – bending and straightening – the operated joint and/or region with slow, rhythmic movements. The flexing and extending movements should be repeated 10 to 15 times in a row during each PT session. Three to five PT sessions a day during the rehabilitation phase of recovery are indicated.
4. During PROM, the operated joint should be flexed and extended to its maximum degree as dictated by the patient’s comfort level. A minor degree of discomfort is anticipated during the initial PT sessions. PROM should be pushed to the level of minor patient discomfort. Pushing PROM beyond this point is harmful to the patient and the healing and is not advised. A compress of chipped ice, ice cubes or other ice pack (a bag of frozen peas work the best) helps to reduce swelling and should be applied following each PROM PT session for 3 to 5 minutes. Apply the compress directly over the surgical wound or operated joint. Most patients tolerate the cold compress well during the initial recovery period and PT sessions (initial 2 to 4 days postoperatively). Patients frequently become agitated with the cold after this point and it can be stopped.
5. PROM is most effective and important for postoperative recovery during the initial 10 to 14 days following surgery. After this time, PROM PT sessions can be tapered to once a day or stopped completely depending on the situation and individual patient recovery.
6. Inflammation is usually the worst during the first 2 to 3 days following surgery. If there is a time when the patient is acutely sore or hurts please contact us or your regular veterinarian. Sharp yelps or cries and change in usage of a limb are indications of potential problems.
• Sling Supported Walking:
Sling Supported Walking is a means by which to assist your pet (the patient) during rehabilitation following various orthopedic or neurologic surgical procedures or injuries.
The idea behind sling walking is to support and protect the rear and rear limbs (back legs) of your pet. You do not want to lift the rear end off the ground, but rather provide enough support so that your pet feels some weight on their rear legs and feet, and MOST IMPORTANTLY does not slip or fall while ambulating. Depending upon the injury, or surgery, you may be asked to do nothing more with the sling then use it to help slow your pet down and prevent slipping. In more complicated or severe injuries, or post-op surgery situations, the sling will be very useful in helping your pet to get up, move around and even perform bathroom duties.
• Strengthening Exercises:
The exercises listed below are intended to help your pet develop strength, weight bearing and balance in their operated limb(s) during the post-operative period. Because our canine companions are talented athletes and very adaptive, they usually have no problem walking on three legs; therefore, we often have to “re-educate” them on how to use their injured or operated leg.
• “Cookies” to the opposite (contralateral) hip. Hold a treat or special snack (cookie) to the opposite hip area, this will encourage the patient to turn their head and neck to that side and thus shift weight to the operated side.
• “Weight Shifts” front to rear. Gently lift the opposite forelimb off the ground therefore shifting weight to the opposite rear limb and facilitating increased weight bearing.
• Backward walking for increased joint sense, hip/stifle extension and strengthening.
• “Step-overs” to increase flexion/extension pattern.
• Practice “Sit to Stands” with foot tucked under buttocks in a “normal” manner (takes the place of passive range of motion).
• “Incline Stands” place front paws on small uphill incline or step, about a 30-degree incline. Hold for 5-10 counts; then take feet off step. This exercise shifts weight to the rear limbs.
• “Side Shifts” gently push patient from side to side at the hips, then push patient opposite shoulder to opposite hip.
• “Counter-irritants” place a small marble, pebble, bottle cap or syringe cap between the pads of a foot in a non-operated leg and tape this object in place (sometimes just a piece of tape around the foot works well). Then take your pet for a directed 5-10 minute walk on a leash. The counter-irritant between the pad on a good foot will promote weight shifting to the operated leg. Remove the irritant immediately after the walk.
• Front Leg Wheel Barrow
• Rear Leg Wheel Barrow-“Dancing”
• PAIN MANAGEMENT
• How to Tell if Your Cat is in Pain:
Cats often disguise the fact they are in pain. That may be because in the wild, cats that appear sick or injured are vulnerable to predators.
Cat pain can be caused by such things as arthritis, dental problems, urinary tract infections, bone disease and cancer. Pain is also common following a surgical procedure.
You are in the best position to look for the subtle changes in behavior that may indicate your cat is suffering. It’s important to stay alert, because the sooner your cat’s pain is diagnosed and treated, the sooner he or she can heal and resume a normal, happy life.
• Vocalizing:
Meowing, purring, hissing, growling
• Daily Habits:
Withdraws from social interaction, decreased appetite, changes in sleeping or drinking, fails to use the litter box, urinates frequently, won’t groom or grooms less, looks unkempt, sleeps more
• Self-Mutilation:
Licking, biting, scratching a particular part of its body
• Activity Level:
Restless, reluctant to move, has difficulty getting up from a laying position; repetitively gets up and lies down, trembles or shakes, limps, can’t leap as high, seeks more affection, avoids being petted or handled, hides
• Posture:
Generally lays with feet underneath, arches back or tucks in abdomen
• Facial Expression:
Grimaces, furrowed brow, vacant stare, glazed, wide-eyed or looks sleepy, enlarged pupils, flattened ears, pants when at rest
• Self-Protection:
Protects a part of its body, doesn’t put weight on a limb, doesn’t want to be
held or picked up
• Aggressive: (especially a previously friendly cat)
Acts out of character, growls, hisses, bites, pins ears back
Never administer pain medications to a pet without consulting with your veterinarian. Many human pain relievers, such as ibuprofen or acetaminophen, are poisonous and can be fatal to cats.
Whenever you have a question or concern about your cat’s health, please call us! (303) 494-0840
• How to Tell if Your Dog is in Pain
Dogs feel pain for many of the same reasons as humans: infections, dental problems, arthritis, bone disease and cancer. They also feel discomfort following surgical procedures.
Unfortunately, unlike humans, they are unable to speak to us about when and where they hurt.
• Vocalizing:
Whining, howling, whimpering, yelping, groaning, grunting
• Daily Habits:
Decreased appetite, withdraws from social interaction, changes in sleeping or drinking, lapses in housetraining, sleeps more
• Self-Mutilation:
Licking, biting, scratching a particular part of its body
• Activity Level:
Restless, reluctant to move, difficulty getting up from a laying position, repetitively gets up and lies down, trembling, circling or lying very still, seeks more affection than usual
• Facial Expression:
Grimaces, vacant stare, glazed, wide-eyed or looks sleepy, enlarged pupils, flattened ears, pants excessively when at rest
• Grooming:
Coat lacks normal shine, hair stands up in places
• Self-Protection:
Protects a body part, doesn’t put weight on a limb, limps, doesn’t want to be held or picked up, hides
• Aggressive: (especially a previously friendly dog)
Acts out of character, growls, hisses, bites, pins ears back, a normally aggressive dog may act quiet, docile
• Posture:
Hunched, with hindquarters raised and front end down on the ground, lays on its side
As with cats, never administer pain medication without consulting your veterinarian. After diagnosing the problem, your veterinarian will explain the benefits, risks and costs associated with various treatment options. That way, you and your veterinarian can choose the approach that best meets the needs of you and your dog.