Canine Cruciate Ligament Surgery

Canine Cruciate Ligament Injury

Canine Cruciate Ligament Injury (CCLI) is the leading cause of pelvic limb lameness in dogs. Although tearing of this ligament can occur as a result of an athletic injury, a significant number of patients suffer from degeneration of the ligament that leads to failure with minimal trauma. The primary cause of this degeneration is unknown but is likely the result of several factors including genetics and conformation. Veterinary surgeons and researchers are constantly studying potential contributing factors to CCLI and exploring surgical techniques that may improve long term function.

Diagnosis

The diagnosis of CCLI can be challenging for general practice veterinarians and veterinary surgeons alike. The combination of training, experience and collaborative approach of the surgical specialists at Veterinary Specialty Hospital ensures an accurate diagnosis of CCLI despite the various clinical presentations. For complex cases, advanced diagnostic imaging techniques including magnetic resonance imaging (MRI), computed tomography (CT) or diagnostic arthroscopy are available in-house to help differentiate CCLI from other injuries of the stifle joint (knee). In the vast majority of clinical cases, the orthopedic exam and radiographic findings are sufficient to make a diagnosis of cruciate injury.

Treatment

The board certified surgeons at the Veterinary Specialty Hospital are trained in several surgical techniques for repair of CCLI in dogs including: (1) Lateral Suture, (2) Tibial Plateau Leveling Osteotomy, and (3) Tibial Tuberosity Advancement. In general, surgical repair either involves the implantation of prosthesis to mimic the function of the cruciate ligament or alteration to the stifle joint geometry to eliminate the need for the cruciate ligament. Your surgeon will consider several factors when making recommendations for surgical intervention for your pet. These include age, weight, activity, body confirmation, limb confirmation and concurrent illness or disease. While all of the surgical techniques utilized at the Veterinary Specialty Hospital have a high likelihood of restoring pain-free function to the limb, each procedure may offer specific advantages for your dog.

(1) Lateral Suture The Lateral Suture technique (lateral fabellotibial prosthesis) was developed in the early 1960s and was once considered the “gold standard” for cruciate repair in dogs. The procedure involves the placement of prosthesis (generally a synthetic, heavy gauge suture material) in a plane parallel to the cruciate ligament. When placed correctly, this suture helps restore stability to the stifle joint (knee) by preventing the tibia from sliding forward with respect to the femur. The technique also prevents excessive internal rotation of the tibia. The scar tissue that forms around the implant further provides joint stability.

(2) Tibial Plateau Leveling Osteotomy The Tibial Plateau Leveling Osteotomy (TPLO) is a novel technique that changes the weight bearing surface of the tibia (the tibial plateau). The weight bearing surface is altered by creating a controlled fracture (osteotomy) and rotating the tibial plateau to a more neutral or level position. A bone plate and screws stabilize the osteotomy until healing is complete. Altering the weight bearing surface of this joint eliminates the need for the cruciate ligament. Research has shown this surgical technique to slow and potentially halt the progression of arthritis.

(3) Tibial Tuberosity Advancement The Tibial Tuberosity Advancement (TTA) is a technique developed in Switzerland between 2002-2004. Like the TPLO, this technique involves the creation of a controlled fracture (osteotomy) to alter the geometry of the stifle joint to restore stability. This procedure also utilizes surgical implants to stabilize the osteotomy until bone healing is complete. This technique has the potential advantage of avoiding the weight bearing surface of the bone that may potentially result in a more rapid return to normal function.

Prognosis

In general, the prognosis for the return to pain-free function following surgery is very high. Following an initial 2-3 week period of extreme exercise restriction, a gradual increase in controlled activity is permitted. Your surgeon will review specific recommendations regarding postoperative rehabilitation during the initial consultation and follow-up visits. Postoperative physical rehabilitation, in some cases, can maximize the positive outcome and shorten the rehabilitation period. Fortunately, the majority of dogs do not require additional physical therapy beyond leash controlled activity at home. Potential complications exist for any orthopedic surgery and include infection, implant failure and incision complications. An experienced surgeon and appropriate postoperative care significantly decrease the risk and negative effects of these complications.

Sliding Humeral Osteotomy

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A new Treatment for Elbow Dysplasia in Dogs

Elbow dysplasia and the secondary arthritis are the most common causes of foreleg lameness in dogs. Fragmented coronoid process (FCP) is the most common form of elbow dysplasia in dogs. In this disease, a fragment of bone and cartilage of one of the bones of the elbow joint (ulna) is broken off. More important, the rest of the joint may be normal or there may be additional cartilage damage, including severe full-thickness cartilage loss. Damage to the cartilage in dogs with elbow dysplasia is called Medial Compartment Disease because it commonly results in severe erosion of the cartilage of the medial aspect of the joint.

Diagnosis of FCP and Medial Compartment disease (MCD)

Diagnosis of FCP and MCP can be challenging. The diagnosis is initially based on a careful orthopedic examination. X-rays (radiology) are of limited use in the diagnosis of FCP. The FCP fragment and damage to the cartilage cannot be seen on x-rays. We recommend arthroscopy for the diagnosis of FCP and MCD because it allows early and accurate diagnosis and treatment

Dogs with Medial Compartment Disease usually require more continuous medical treatment of osteoarthritis and owners should consider additional surgical treatment options.

Advanced surgical treatments of Medial Compartment Disease include Sliding Humeral Osteotomy (SHO) and total elbow replacement.

Total elbow replacement may be indicated when the cartilage is severely damaged throughout the elbow joint. Numerous total elbow replacements have been designed over that last 15 years and to date none has been proven to be safe and effective enough for routine use.

Sliding Humeral Osteotomy

Sliding Humeral Osteotomy (SHO) was developed in the Orthopedic Research Laboratory of the University of Californita by Dr Schulz. This procedure is based on similar procedures that are performed on people for arthritis of the knee. The procedure realigns the limb to shift the forces off of the area of cartilage damage and back on to healthy cartilage. This relieves the pain of grinding of bone on bone and gives the damaged joint an opportunity to heal.

The sliding humeral osteotomy procedure is the result of almost 10 years of laboratory research. These studies have demonstrated that the sliding humeral osteotomy significantly decreases joint pressure in the medial side of the elbow joint.

Clinical results

Over the last 3 years the SHO procedure has been performed in over 70 dogs. Careful clinical studies have been performed to evaluate the efficacy of this procedure. The majority of dogs undergoing SHO have decreased lameness by 12 weeks postoperatively with many dogs having no visible lameness at a 26 week evaluation. The owner satisfaction rate following SHO has been nearly unanimous.

SHO surgeons

Surgeons performing the SHO procedure are all highly experienced orthopedic veterinary surgeons. They have completed a course covering the theory, indications, and application of the SHO technique.

Radiation Therapy for Dogs and Cats

Cancer is one of the most common causes of sickness and death in pets, just as it is in people. Many people consider pets as family members and want to provide the same care they would their own children. Therapies once limited to human cancer patients, including chemotherapy and radiation, are now available for our companion animals.

Cancer treatment conjures images of illness and severe side effects, things that no one wants for their pet. Fortunately, our animal friends have fewer complications and a negative impact on quality of life is unlikely. Animals usually gain all the benefits from treatment with few of the downsides.

Radiotherapy is used for many different cancers. It commonly applied when a tumor is removed and there is residual microscopic disease. Many cancers can be treated with radiation alone; even short courses of radiation can alleviate pain and slow disease progression.

Radiation is usually given in multiple doses over a few weeks. A typical treatment might involve a total of 16 doses given once daily for three weeks. Such therapy is “definitive” treatment and is used when long term control or cure is possible. When pain control and comfort are the goals, we can use “palliative” therapy. This involves fewer doses, usually with several days between treatments. Both approaches are well-tolerated and can provide superior survival times while maintaining good quality of life.

Some patients may benefit from a very precise form of therapy known as CyberKnife®. This can deliver a definitive dose in just 1-3 treatments. There is no single best treatment; that decision depends on many factors, including the type of cancer, its location, and the family’s goals for their pet.

Radiotherapy is a flexible treatment that is useful for many cancers: as means of achieving cure, preserving quality of life, and providing comfort when nothing else can be done.  Radiotherapy is not appropriate for all patients but it is becoming more commonplace for animal patients and is a major tool in our fight against cancer.

Ever wonder what your cat or dog sees?

Although it is difficult to know for sure, there are actually many clues that can help us piece together how dogs and cats view the world.  The most significant difference in our eyes compared to our pets is in the structure of the retina. The retina is a layer of tissue at the back of the eye that is responsible for transforming light entering the eye into electric signals that are then sent to the brain for vision processing.

The cells that make up the retina have been carefully examined and results have given us some interesting insight into the lives of our furry friends.  For example, the human retina is structured to pick up a rainbow of colors and allows us to appreciate intricate detail. Dog and cat retinas are structured more for detecting the slightest movement and operating in low light conditions.  These differences are a reflection of the way our ancestors hunted and survived in the wild.

Color vision:

Dogs do have some degree of color vision.  However, they do not experience the wide range of colors appreciated by humans, other primates and birds.  Based on the composition of their retinal cells, it is thought that dogs most likely see ‘colors’ with a palette made up of different shades of blue and yellow.  Objects that we would view as red or green are seen as varying shades of gray.  Cats also have the capacity for limited color vision.  Based on the cells in their retinas, cat color vision may actually be a bit better compared to dogs.  Despite this lack of a complete color palette, pets are able to detect subtle difference in shades of gray that would be indistinguishable to their owners.  They also rely on their highly developed senses of hearing and smell to navigate and differentiate between objects.

Night vision:

Enhanced night vision is due to special adaptive features of our pets’ eyes.  One of these is a structure called the tapetum lucidum.  This is a layer of reflective tissue at the back of the eye that results in the ‘eye shine’ you may have observed in a photograph or in the beam of a flashlight at night.  The tapetum causes light to be reflected internally within the eye, allowing more efficient use of small amounts of light.  Also, synapses in their retinas are arranged so that very little light is required to form an image.  However, there is a trade-off.  These same features that allow for better night vision result in worsened visual acuity, producing a more ‘grainy’ image with poorer detail compared to humans.

LMU and Ethos Veterinary Health Collaborate on Research, Simulation, and Technology

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WOBURN, Mass.–(BUSINESS WIRE)–Lincoln Memorial University (LMU) and Ethos Veterinary Health (Ethos) have entered into a unique collaborative relationship to advance their shared commitment to improve the profession through innovation in education. The relationship aims to transform learning in the veterinary community by leveraging Ethos’ unique commitment to learning and development and its online learning platform, VetBloom, and the strength of LMU’s pioneering educational model.

The multi-faceted partnership will allow for:

  • shared research on educational outcomes
  • advancing the use of simulations in clinical education
  • new ways of incorporating technology into training and continuous development

One component of the relationship consists of Ethos clinicians conducting virtual, case-based rounds with LMU students, providing them this type of learning very early in their education. “These rounds allow the LMU students to gain proficiency in clinical reasoning through case discussions,” said Linda Fineman, DVM, DACVIM (Oncology), Vice President of Learning and Development at Ethos. “At the same time, having the opportunity to give back to the next generation of veterinarians is rewarding for our clinicians.”

The partnership will capitalize on LMU’s educational expertise. LMU has a vast amount of experience and research building patient models through LMU’s Center for Innovation in Veterinary Education and Technology (CIVET). VetBloom currently has a unique anesthesia simulation and one area of mutual interest is in creating additional online simulations to expand their offerings. LMU and VetBloom share a goal of reaching underserved communities. Whether through VetBloom’s international reach, or LMU’s mission to serve the extensive Appalachian community, both organizations are focused on bringing advanced educational opportunities wherever they are needed.

“We’re very excited about this collaboration,” said John Weale, DVM, MS, Associate Dean, Clinical Relations and Outreach at LMU. “Not only does this benefit the teams at LMU and Ethos, but also the veterinary community at large.”

“This partnership is a living manifestation of our mutual commitment to advance veterinary learning by leveraging robust partnerships, rich technology, and succinct learning outcomes. It is, indeed, the future of education,” said Vice President and Dean of LMU-CVM, Dr. Jason Johnson.

The relationship promises to be fertile ground for ongoing exploration, and expansion of innovative programs.

About Lincoln Memorial University

Lincoln Memorial University is a non-profit, private, values-based learning community dedicated to providing educational experiences in the liberal arts and professional studies. The LMU-College of Veterinary Medicine is located on LMU’s main campus in Harrogate, Tennessee, with additional academic facilities in nearby Lee County, Virginia. LMU-CVM is an integral part of the University’s medical programs and provides real-world, community-based education in a collaborative learning environment. For more information visit vetmed.LMUnet.edu.

About Ethos Veterinary Health

Ethos is a veterinary health company with locations across the U.S. providing advanced medical care for pets. Our approach includes a focus on transformative science, continuous learning and growth for team members, and collaboration. For more information visit ethosvet.com.

Seizures and Idiopathic Epilepsy

WHAT IS A SEIZURE?

The word seizure, convulsion, attack, or fit describes a sudden abnormal electrical event in the brain that temporarily interrupts normal brain function. Chaotic electrical activity replaces the normal electrical signals coming from the brain cells and results in the abnormal function we observe in the animals.

There are many different diseases known to cause seizures in animals. Anything that can change the function of the neuron within the brain may produce a seizure. Your veterinarian or veterinary neurologist determines the cause of the seizures through a complete physical and neurological examination plus appropriate diagnostic testing.

WHAT CAUSES A SEIZURE?

The cause of seizures is usually classified into two categories; extra-cranial (causes outside of the brain) and intra-cranial (causes inside of the brain). Metabolic disorders and toxicities are the two main causes of extra-cranial seizures. Metabolic disorders include hypoxia (low oxygen), hypoglycemia (low blood sugar), hepatoencephalopathy (liver malfunction that allows toxins to build up), hyperlipoproteinemia (specific syndrome primarily seen in schnauzers), electrolyte imbalances (calcium, sodium, and potassium), and hyperthermia/heat stroke.

Toxic causes of seizures include lead (uncommon), organophosphates, ethylene glycol (anti-freeze), rodenticides, snail bait, some plants, moldy food, chocolate and xylitol. Extra-cranial causes are usually diagnosed with laboratory tests and history of toxin exposure or ingestion.

Intra-cranial disorders that cause seizures include congenital malformations (hydrocephalus, lissencephaly), degenerative diseases (storage diseases), immune-inflammatory diseases, infectious agents (e.g. viral and fungal), cancer (brain tumors), severe trauma, and vascular disorders (strokes). Intra-cranial causes are usually diagnosed by MRI of the brain and analysis of cerebrospinal fluid.

THE THREE PHASES OF SEIZURES

Most seizures occur in three stages. The first part of the seizure, called the ‘aura’ often is not noticed. Owners who have dealt with seizures in their epileptic pets are often aware of certain changes in their pets’ behavior prior to a seizure. The pet often shows signs of apprehension, restlessness, nervousness, or salivation. Some pets can become clingy while others may withdraw.

The second stage is the ‘ictus’. The ictus usually lasts for 1-3 minutes. It often seems longer to an owner. During the seizure, the animal usually collapses on its side and has a series of violent muscle contractions that cause the body to be rigid and the legs to paddle. Loss of consciousness, salivation, involuntary urination and defecation may also occur in more severe seizures. A less common form of milder seizures occurs without loss of consciousness with the animal developing stiffness, uncontrolled trembling and attempting to crawl or move to the owner. There is no standard type of seizure and other variants do occur.

The period immediately following the seizure is the post-ictal phase. It usually lasts less than an hour but may last many hours or even days. Some pets are confused, disoriented, restless and temporarily blind during this period. They are usually tired, but typically want to eat and drink.

IS THERE A CURE FOR AN EPILEPTIC ANIMAL?

There is no cure for idiopathic epilepsy. Seizures can be controlled with anticonvulsant drugs in most cases. Unfortunately there are a small number of epileptic dogs in which the seizures can not be controlled. The purpose of treatment is to decrease the frequency, duration and severity of the seizures. Generally 1 seizure per month is considered good control. Treatment is started with one anticonvulsant, but several drugs or a combination of drugs may be needed before a successful treatment is found.

It can take months to get the seizures under control. The amount of medication is adjusted depending on frequency of seizures, therapeutic blood levels of the anticonvulsant medication, and changes in body weight. Keeping in close communication with your veterinarian or veterinary neurologist is necessary in getting the seizures under control.

IMPACT ON QUALITY OF LIFE

Despite all our efforts, some seizure disorders are impossible to control. Trying to balance the number of seizures with the side effects of medication can be difficult. Rarely, patients may require so many medications that their quality of life is compromised. If this happens, veterinarians and clients will need to decide what is in the best interest of the individual patient.

WHAT SHOULD YOU DO IF YOUR DOG OR CAT HAS A SEIZURE?

Seizures are very frightening and scary to pet owners, especially when it is the first seizure. Owners should take certain steps during a seizure to prevent injury not only to themselves but also to their pets. Keep in mind that dogs and cats do not experience pain during a seizure, or even remember it, as they are unconscious during the event.

• Ensure your pet is on the floor away from objects (corners of coffee tables). Do not allow the pet to fall off furniture or down stairs.

• To prevent choking, make sure that collars or leashes do not get caught on protruding objects.

• Keep your hands away from the mouth! Animals are unconscious during typical seizures. They have no control over their mouth and jaw muscles and may bite anything put in their mouth.

• Dogs can not swallow their tongues despite what you may have heard. Do not attempt to restrain the dog or pull the tongue during a seizure.

• Please be aware that some pets will vocalize, salivate, urinate or defecate during a seizure. Their limbs may become rigid and they may paddle. These actions are involuntary.

• Most seizures last 1-3 minutes and are not life threatening. If the pet has repeated seizures and fails to regain consciousness between the seizures, or if a single seizure lasts longer than 5 minutes, it is in status epilepticus. This is an emergency and your pet needs to be seen by a veterinarian immediately. If your veterinarian is closed, you should go to the nearest emergency hospital. You can pull your pet onto a blanket and then lift the blanket to get them in the car for transport.

IDIOPATHIC EPILEPSY

Idiopathic epilepsy is diagnosed when the precise cause of the nerve cell malfunction can not be found. This diagnosis is made once all other causes have been eliminated with the correct diagnostic tests since there is no test for idiopathic epilepsy itself. Studies have shown idiopathic epilepsy is probably an inherited problem in certain breeds of dogs such as the Beagle, Dachshund, German Shepherd, Keeshond, and Belgian Tervuren. Idiopathic epilepsy occurs in almost all breeds of dogs, although it has not been proven to be inherited in all breeds. Certain breeds of dogs have a high incidence of seizure disorders but do not have a proven genetic basis yet. These breeds include the Boxer, Cocker Spaniel, Collie, Golden Retriever, Irish Setter, Labrador Retriever, Miniature Schnauzer, Poodle, Saint Bernard, Siberian Husky and Wire Fox Terrier. Idiopathic epilepsy is seen in cats, although it is not as common.

WHAT IF IT IS NOT IDIOPATHIC EPILEPSY?

Your veterinarian will perform a physical and neurological exam and run the appropriate diagnostic tests to evaluate the cause of the seizures. Your veterinarian may refer you to a veterinary neurologist for additional testing and treatment. Tests that may be recommended include a CBC (complete blood count), chemistry profile (blood test), urinalysis, x-rays of the chest and/or abdomen, blood pressure, abdominal ultrasound, certain infectious disease titers (specific blood tests), CSF analysis (cerebrospinal fluid analysis), and advanced imaging with MRI as the gold standard.

Seizures and Brain Disease

WHAT IS A SEIZURE?

The word seizure, convulsion, attack, or fit describes a sudden abnormal electrical event in the brain that temporarily interrupts normal brain function. Chaotic electrical activity replaces the normal electrical signals coming from the brain cells.

There are many different diseases known to cause seizures in animals. Anything that can change the function of the neuron within the brain may produce a seizure. Your veterinarian or veterinary neurologist determines the cause of the seizures through a complete physical and neurological examination plus appropriate diagnostic testing.

WHAT CAUSES A SEIZURE?

The cause of seizures is usually classified into two categories; extra-cranial and intra-cranial. Extra-cranial causes come from outside the brain but affect the brain through the action of toxins or metabolic dysfunction. Toxin exposure is an uncommon cause for seizures but should be carefully considered. Ingestion of some plants, moldy foods, chocolate, an artificial sweetener called xylitol, drugs (including inadvertent ingestion of human medications), heavy metals (i.e. lead), pesticides (i.e. snail bait) and some chemical agents (i.e. antifreeze) can all lead to seizures. Routine blood work is needed to look for metabolic causes of seizures such as low blood sugar, electrolyte abnormalities, hypoxia, hyperlipidemia and liver or kidney problems.

Intra-cranial disorders that cause seizures include congenital malformations (hydrocephalus, lissencephaly), degenerative diseases (storage diseases), immune-inflammatory diseases, infectious agents (viral and fungal), cancer (brain tumors), severe trauma, and vascular disorders (strokes). Intra-cranial causes are usually diagnosed by brain imaging and analysis of cerebrospinal fluid.

An MRI is necessary to look inside the brain and cerebrospinal fluid collection, a CSF tap, is necessary to evaluate for infections, inflammatory diseases, and some kinds of cancer (such as lymphoma). Pets that are five and older are at a higher risk for cancer. Prior to pursuing more advanced testing such as an MRI and CSF tap, chest x-rays +/- abdominal ultrasound should be considered to screen for cancer. If cancer is found on these screening tests, pursuing costly anesthetic procedures may not be desirable.

SEIZURE TYPES

Generalized Seizures

This is the most common type of seizure. It is characterized by falling over, loss of consciousness, and/or stiff limbs followed by paddling movements, +/- jaw chomping, drooling, urination and defecation.

Partial/focal Seizures

These seizures are sometimes called psychomotor seizures. They are variable in appearance and can be characterized by anything from simple facial twitching or staring off into space, to complex behaviors like suddenly running around or biting at imaginary flies.

Cluster Seizures

This is when either of the above types of seizures happens repeatedly (2 or more times) in a 24-hour period.

The post-ictal phase can last from minutes to days. This is the period of time after a seizure has occurred when your pet is still not acting normal but is not actively seizing. It is often characterized by disorientation, poor balance, and pacing. Some animals become very thirsty, hungry or vomit. They can also become aggressive. Do not interact with your pet if he/she becomes aggressive. If he/she is not him/herself, they can harm people and other pets during this period.

THE THREE PHASES OF SEIZURES

Most seizures occur in three stages. The first part of the seizure, called the ‘aura’ often is not noticed. Owners who have dealt with seizures in their epileptic pets are often aware of certain changes in their pets’ behavior prior to a seizure. The pet often shows signs of apprehension, restlessness, nervousness, or salivation. Some can be clingy while others may act aloof.

The second stage is the ‘ictus’. The ictus usually lasts for 1-3 minutes. It often seems longer to an owner. During the seizure, the animal usually collapses on its side and has a series of violent muscle contractions that cause the body to be rigid and the legs to paddle. Loss of consciousness, salivation, involuntary urination and defecation may also occur in more severe seizures. A less common form of milder seizures occurs without loss of consciousness with the animal developing stiffness, uncontrolled trembling and attempting to crawl or move to the owner. There is no standard type of seizure and other variants do occur.

The period immediately following the seizure is the ‘post-ictal’ phase. It usually lasts less than an hour but may last many hours or as long as 1-2 days. Some pets are confused, disoriented, restless and temporarily blind during this period. They are usually tired, but typically want to eat and drink.

WHAT SHOULD YOU DO IF YOUR DOG OR CAT HAS A SEIZURE?

Seizures are very frightening and scary to pet owners, especially when it is the first seizure. Owners should take certain steps during a seizure to prevent injury not only to themselves but also to their pets. Keep in mind that dogs and cats do not experience pain during a seizure, or even remember it, as they are unconscious during the event.

• Ensure your pet is on the floor away from objects (corners of coffee tables). Do not allow the pet to fall off furniture or down stairs.

• To prevent choking, make sure that collars or leashes do not get caught on protruding objects.

• Keep your hands away from the mouth! Animals are unconscious during typical seizures. They have no control over their mouth and jaw muscles and may bite anything put in their mouth.

• Dogs can not swallow their tongues despite what you may have heard. Do not attempt to restrain the dog or pull the tongue during a seizure.

• Some pets will vocalize, salivate, urinate or defecate during a seizure. Their limbs may become rigid and they may paddle. These actions are involuntary.

• Most seizures last 1-3 minutes and are not life threatening. If the pet has repeated seizures and fails to regain consciousness between the seizures, or if a single seizure lasts longer than 5 minutes, it is in status epilepticus. This is an emergency and your pet needs to be seen by a veterinarian immediately. If your veterinarian is closed, you should go to the nearest emergency hospital. You can pull your pet onto a blanket and then lift the blanket to get them in the car for transport.

DIAGNOSING THE CAUSE OF SEIZURES

Your veterinarian will perform a physical and neurological exam and run the appropriate diagnostic tests to evaluate the cause of the seizures. Your veterinarian may refer you to a veterinary neurologist for additional testing and treatment. Tests that may be recommended include a CBC (complete blood count), chemistry profile (blood test), urinalysis, x-rays of the chest and/or abdomen, blood pressure, abdominal ultrasound, certain infectious disease titers (specific blood tests), CSF (cerebrospinal fluid) analysis, and MRI (magnetic resonance imaging).

Imaging of the brain is very important in diagnosing the underlying cause of seizures. Magnetic resonance imaging (MRI) is the gold standard to evaluate the brain. A computed tomography (CT) scan is no longer the recommended imaging test for the brain now that MRI is available. At VSH, the neurologists are intimately involved in performing and interpreting the MRI.

TREATMENT OF COMMON BRAIN DISEASES

Once the specific type of brain disease is diagnosed, appropriate therapy can be recommended. Treatment for brain tumors can include radiation therapy, surgery, anti-seizure medication, steroids and diuretics. Treatment for inflammatory-immune brain disease can include a combination of medications; these can include steroids, Imuran, Cytosar, cyclosporine and leflunomide. Treatment of vascular disorders (strokes) primarily includes time and supportive care. Treatment of infectious diseases is dependent upon identification of the specific organism.

Shoulder OCD

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Osteochondrosis of the shoulder joint is a common cause of lameness in dogs. Fortunately the outcome with surgical treatment is generally excellent when arthroscopy is performed early in life.

What is OCD of the shoulder?

OCD (osteochondrosis dessicans) is probably the leading cause of osteoarthritis of the shoulder joint. Shoulder OCD occurs when a piece of cartilage separates from the underlying bone. Pain is due to inflammation of the joint and exposure of nerves in the bone under the cartilage flap.
Shoulder OCD in dogs has been demonstrated to be a genetic disease and cannot be caused by diet or exercise although excessive exercise in a dog with untreated shoulder OCD may make the lameness more severe.
OCD of the shoulder is usually found in young dogs ranging from 6 months to 2 years of age.
The clinical sign of shoulder OCD is lameness of one or both forelegs. Dogs with shoulder OCD may have trouble getting up and often have some muscle loss and pain when the joint is moved.

How is Shoulder OCD Diagnosed?

The diagnosis of shoulder OCD is usually straight­forward because most lesions are easy to see on radiographs (x-rays) of the shoulder joint. The normal curve of the joint surface is interrupted by a flat area representing the abnormal cartilage.

How is Shoulder OCD Treated?

Treatment of shoulder OCD should be strongly considered by dog owners because surgical removal of the flap almost always results in elimination of the lameness whereas nonsurgical management often results in continued limping and may result in severe osteoarthritis later in life.
Removing the cartilage flap lets the underlying bone heal, stops the irritation of the joint, and keeps the flap from moving into another part of the joint where it might cause other problems. We strongly recommend using arthroscopy to re­move the flap to avoid large incisions and for a faster recovery.

Are there complications?

Complications with arthroscopic treatment for shoulder OCD are very rare (less than 2 percent). The most common complication is swelling of the shoulder that resolves in several days. Anesthetic complications, infection, or nerve damage are very uncommon.

What is the outcome of treatment?

The outcome with arthroscopic treatment of shoulder OCD is generally excellent with complete resolution of lameness over several months following surgery. Physical therapy can accelerate the recovery. In most cases there is little residual arthritis which may be apparent after very heavy exercise or as the dog becomes much older.

Arthroscopic Surgery at Peak

Arthroscopy at Peak Veterinary Referral Center is performed by a highly experienced and caring team who prioritize your pets welfare. Dr Schulz has been performing arthroscopy for over 15 years and is an author of the only textbook on small animal arthroscopy. In many cases surgery may be performed the same day as your initial appointment and because ar­throscopy is minimally invasive, many patients may go home the same day.
Dr Schulz served as chief of surgery at the University of California and has published over 60 manuscripts in canine orthopedics. He is an author of several books including Small Animal Surgery, Small Animal Arthroscopy, and the Pet Lovers Guide to Joint Problems and Osteoarthritis.

At Peak we understand the importance of your pet to your lives. Our philosophy is to educate owners and help them make the best decisions for their pet and their family.

Osteosarcoma

If your dog has been diagnosed with a bone lesion most likely caused by a type of bone cancer.
An option for confirming diagnosis of this condition is ultrasound-guided fine needle aspirates of the lesion (as opposed to surgical biopsy for histologic diagnosis).  This technique will provide an accurate diagnosis in 75 – 90% of patients, enabling the patient’s family to feel most comfortable when moving forward with treatment decisions.  However, it is reasonable to proceed with amputation based on x-ray appearance alone, based on high likelihood of osteosarcoma as the cause of the bone lesion.  Prior to radiation therapy or limb spare surgery, a cytologic or histologic diagnosis is recommended.

Other causes of destructive bone lesions are infection (fungal or bacterial) and other types of cancer, though these are rare.  Fungal disease of the bone is difficult to treat; we expect a favorable outcome in approximately 50% of bone fungal cases treated medically.  The treatment can be ongoing for months and some cases ultimately require an amputation to cure the patient due to difficulty of eradicating the fungal disease from the bone even when treating with chronic, appropriate anti-fungal medication.

Other tumors of the bone are far less common and are associated with variable prognoses depending on tumor type; some better than osteosarcoma (fibrosarcoma), some less favorable (hemangiosarcoma).

If your dog has been diagnosed with osteosarcoma. 

Prognosis for osteosarcoma:  Without treatment, most families elect euthanasia relatively soon after diagnosis due to pain that cannot be adequately controlled with medication.

Treatment Options

Surgery:

Amputation: Reported median survival following amputation alone (without chemotherapy) is 4-5 months, with 10% survival expected at one year.  Following a combination of treatment with amputation and chemotherapy, median survival is close to a year with 10-20% of patients surviving to 2+ years.  Patient survival is typically limited by metastatic spread of the tumor to the lungs.  With appropriate patient selection, most dogs fare very well following amputation.

Limb spare:  The limb spare surgical procedure is an attractive treatment if amputation is not an option (such as for patients with advanced hip or stifle disease) and the tumor is located in the lower forelimb.  The advantage of the limb spare procedure is a comfortable, functional limb following surgical healing, and the disadvantages are the potential for infection, implant failure, and local tumor recurrence that sometimes occur.  Survival time expectations following limb spare surgery + chemotherapy is similar to amputation + chemotherapy.

Chemotherapy:

In combination with the pain relief treatment option chosen, chemotherapy is generally administered as an intravenous dose of carboplatin administered once every 3 weeks for 6 doses, starting approximately 1 week post-surgery or in combination with radiation therapy.  Carboplatin is generally well-tolerated; please refer to chemotherapy handouts for more information regarding possible chemotherapy side effects.

Radiation therapy:

Is very effective at providing pain relief when surgical management is not an option.  As few as two treatments are capable of complete or partial pain relief that typically lasts for several months.  This treatment is non-painful and causes no immediate side effects other than hair loss in the therapy site.  Typical survival times for dogs treated successfully with radiation therapy are 4-7 months.  Quality of life during this time is generally very good and dogs can remain active and comfortable.

Pamidronate (bisphosphonate therapy):

This is a medication that has been used in the past to treat osteoporosis, and is an anti-bone cancer drug that has been recently evaluated for treatment of canine osteosarcoma patients when amputation is not an option.  Pamidronate has been most often combined with radiation therapy but several anecdotal reports exist for patients treated with only pamidronate that have had significant pain relief for several months.  This drug is given IV once monthly for several months.

Prior to initiation of therapy, radiographs or a computed tomography (CT) scan of the chest cavity are recommended (for general health evaluation and cancer staging), along with a blood panel and urinalysis for general health evaluation.  A nuclear bone scan is available on-site (we are one of the few veterinary hospitals in Southern California that have this diagnostic procedure available in-hospital).  The bone scan is used to identify other bone lesions in the body that may represent other sites of cancer.  These bone lesions have been identified in up to 25% of dogs with osteosarcoma at the time of initial diagnosis.  As an alternative, a whole body CT scan or x-rays can provide a rapid and accurate means of evaluation of general health and for visible metastasis of osteosarcoma.

Osteosarcoma is a painful, aggressive disease.  Rest assured, your health care team at the Veterinary Specialty Hospital is equipped with the expertise and compassion to assist you with decision-making and help your dog achieve a comfortable life and improved survival if diagnosed with this condition.

 

 

Hemangiosarcoma

Hemangiosarcoma (HSA) is a type of cancer that develops from the cells that normally create blood vessels (endothelial cells). The cause of hemangiosarcoma in most cases is unknown. However, we do know that sunlight can cause this cancer on the belly skin, inner thighs, eyelids, and eyelid membranes (conjunctiva) of patients with pale/pink skin and thin fur who live in very sunny climates.

Hemangiosarcoma is more common in dogs than any other species and affects mostly middleaged to older animals. Some breeds, such as German Shepherds, Golden Retrievers, and Labrador Retrievers are more susceptible than other breeds to develop non-cutaneous HSA.

Signs & Symptoms

In dogs and cats, the most common primary sites of this cancer are spleen, liver, heart, and skin. However, it can develop anywhere in the body.

Symptoms of this cancer are variable and dependent on location in the body. In the skin, a red to purple colored superficial bump may be noted; this bump may bruise or bleed. Under the skin, a soft or firm swelling that may feel like a benign fatty tumor may be palpable. Symptoms for tumors that develop internally may be any combination of the following: unexplained weight loss, bulging belly, decreased exercise/ stamina, lethargy/sleeping more, decreased appetite, increased panting, pale gums, weakness, cough, and collapse.

Diagnosis

Typically, this cancer is diagnosed based on a biopsy that is reviewed by a veterinary pathology specialist. It is a cancer that is very difficult to diagnose using fine needle aspiration cytology. Abdominal ultrasound, x-rays, CT scan and surgery are all tools that are used to provide information about the extent of the disease in the patient’s body. There is not currently a perfect blood screening test for HSA, though one has been developed and investigators are working on refinement of our understanding of how to use such a test.

Treatment & Aftercare

Surgery is typically the ideal first treatment for HSA. For some types of HSA, it may be the only treatment option that is necessary. However, for many types of HSA, further treatment after surgery is often necessary because of potential for spread to other sites in the body (metastasis). Chemotherapy is often recommended following surgery for the following sites: liver, spleen, beneath the skin/in the muscle (subcutaneous/intramuscular), and bone. Chemotherapy is usually recommended as the primary therapy for HSA of the heart as surgery in this location is very difficult to perform. Radiation therapy is sometimes used if surgery is unable to remove the tumor in it’s entirety from external surfaces (skin/eyelids, “incomplete margins”).

If hemangiosarcoma is diagnosed in your dog or cat, it is ideal to consult with an experienced veterinary professional, such as a board-certified oncologist. When such an individual recommends a personalized treatment plan, quality-of-life (QoL) is expected to remain optimal because these veterinarians know how to create an ideal plan and gather a team of veterinary specialists who are experienced in managing cancer patients and only have your pet’s best interest in mind. This team might include a surgeon, radiation oncologist, radiologist, internal medicine specialist, etc.

Prognosis

Prognosis depends on the site on the body that is affected and is quite variable:

  • Sunlight-induced, superficial, skin hemangiosarcoma are often cured following surgery, though other skin sites in the same patient may become affected by new cancer lesions that occur entirely independent of the first location. It is recommended for families with pets diagnosed with sunlight-induced skin cancer of any kind to practice future sun avoidance for the affected pet.
  • In contrast, it is rare when patients with spleen HSA are cured following surgery to remove the spleen as tumors that arise in that site are usually associated with metastasis (spread of tumor cells from primary site via the blood stream to new locations such as lung). This metastasis occurs even if there is no evidence of secondary tumor sites at the time of surgery. The average survival prognosis for patients with spleen HSA following surgery alone is approximately 2 months, with only 10% survival at 1 year. The average survival for dogs with spleen HSA treated with surgery and chemotherapy is improved at 6-8 months, and patients typically experience an excellent QoL during with treatment.
  • The prognosis for other sites of hemangiosarcoma is quite variable. Consultation with a specialist who is board certified by the American College of Veterinary Internal Medicine (such as veterinary oncologists) can help you better understand your pet’s individual prognosis if he or she is diagnosed with hemangiosarcoma.

The only means of prevention of this disease in the skin and eyelids is to avoid sun exposure in dogs with thin/fair hair and pale/pink skin (white pit bulls, white boxers, whippets, etc.). There is no known preventive method for other types of hemangiosarcoma.