"Tiny Tim" Turned "Hercules"



God bless us, everyone!

A figurative “Tiny Tim” of the feline persuasion presented to Dr. Kate Fitzwater, DACVS, and our Surgery Department on Halloween.  Hercules (his real name) was just six weeks old, smaller than his litter mates, and had a condition called bilateral carpal varus.  Put in simple terms, both his front limbs turned inward.  Try as he might, this little fellow just could not keep up and was doomed to life long problems. 

Hercules is also a polydactyl cat, which means he has extra toes that make his paws look like mittens! This is an inherited trait in cats.  People often refer to them as "Mitten Cats" or “Hemingway Cats”, named after the famous author who adored and protected them.  Many decedents of Hemingway's first polydactyl cat still occupy his estate in Key West Florida.    



Radiographs before
treatment

To give Hercules a chance for a normal life, he was placed in bilateral forelimb splint bandages for 4 weeks to straighten his deformed legs.  These were changed weekly to accommodate his growth and make sure he didn’t form any sores.  The bandages did not seem to bother him and all.  Karen, his owner, reported that with his “boxing gloves”, aka bandages, he started standing up to the big cats and boxing them in the face!



Karen and Hercules

At the end of 4 weeks, the bandages were removed.  Now, in this festive holiday season, Hercules has lived up to his name; he is walking well and playing with the big guys.  He will continue to become stronger on his forelimbs and should grow normally without any foreseen complications.  And, just as any proud polydactyl cat would do, he happily shows off his mittens to everyone he meets!   .

Unlicensed Veterinarian + Untrue Accusations = Slanted News

By:  Matthew Lemmons, DVM, DAVDC

You may have seen a recent story on ABC’s 20/20 reporting veterinarians upsell their clients with unneeded services.  The former veterinarian claiming this stated in particular that dentistry is equivalent to McDonald’s asking if you want fries with your order.  He seems to mean that dentistry is just a side item your pet does not need.  This is simply a horrible analogy.  Preventative dental care is important to our pet’s health, just as it is with our own health.  Prevention of periodontal disease can save our pets from having to undergo dental extractions which is more painful and requires longer anesthesia periods than preventative cleanings.

20/20 set up an “investigation” to see if they could catch veterinarians making medical recommendations that the pet did not need to simply make money.  In the investigation a pit bull named “Honey” was determined to be healthy by a veterinarian hired by 20/20.  “Honey” was then taken to several veterinarians to be examined.  One veterinarian stated “Honey” had dental tartar or calculus and recommend a dental cleaning.  The report spun her recommendations to sound as if she was pushing for a service that “Honey” didn’t need and that was potentially harmful to her health.  I applaud the veterinarian who made the recommendation.  Not only did “Honey” have calculus, but she had gingivitis, worn or fractured canine teeth, and an oral tumor that needed a biopsy.  “Honey’s” owner should be happy this veterinarian was observant and proactive in recommending preventative treatment.

The coup de gras of the story was the part of their interview with Dr. Marty Becker that ABC chose to air.  Watching the interview, it seems that Dr. Becker would not recommend dental cleanings for pets unless there was already disease present because of the risk of anesthesia.  Dr. Becker has since said this comment was taken out of context.  His point was that he would not anesthetize an unhealthy animal for preventative care.  He also reports that he was interviewed for two hours and only this small portion was used.

It is unfortunate that an individual who is no longer licensed to practice was given such a large stage to air his agenda (which includes selling books and DVDs on the subject).  It is also sad that a respected veterinarian’s comments were twisted to sensationalize a story.  We advise that pet owners have a trusted veterinarian whose advice they can rely on.  The vast majority of veterinarians have the best interest of their patients, and not profit, in mind.   

The Great Greta - On the 'Wheels' of Love

The old saying, "A picture paints a thousand words", could not be more true here, only it is video that tells this story.  Greta received her wheelchair during her latest rehabilitation session and surprised everyone with her instant liking to this new form of mobility. 

Once she figured out what this new contraption was supposed to do, it was full speed ahead...literally!  There was no doubt that Greta was on a roll as she explored her new-found freedom.  The hospital filled with cheers and smiles, including one from Greta, as she made her rounds.

Technology and Dogs Make W-A-L-K-I-N-G Fun!

By:  Karen Hull, DVM

Veterinary Physical Rehabilitation

Fall in Indiana is a great time of year.  The leaves are beautiful, the air is crisp…what better time to make your dog happy and get some exercise at the same time?   Now there is an app available to make walking your dog both fun and informative.  

MapMyDogWalk by Subaru is a free app available for both Android and iOS.  MapMyDogWalk tracks and maps your dog walking route.  It keeps track of things like duration, speed, distance, pace, elevation, and calories burned (for you) in real-time.   The app uses the built-in GPS technology of your device to create your route on an interactive map which you can save.  I have used the app both on neighborhood streets and on paths in Ft. Benjamin Harrison.    The app does a good job of mapping both.   An additional feature is geo-tagging photo capability, which allows you to take pictures along your walk and automatically upload them with your saved route.

When you save your dog walk, the app automatically syncs with your training log on MapMyFitness.com (also free).   There, your routes and statistics are saved.  There is a multitude of ways to view your statistics.  If you are so inclined, you can earn “Achievements” by joining a challenge or by creating your own personal goal.

MapMyDogWalk is among a suite of fitness tracking apps, and as such, it can keep track of more than just dog walks.  The app can log other types of workouts, log food, and you can share your routes with friends.  Dog specific features are drop markers for things such as water sources and poop bag dispensers, as well as videos of dogs driving a Subaru!

Exercise is beneficial for our dogs, just as it is for us.  Some dogs have mobility limitations, but if your dog is able, you can mix it up on your walks.   Incorporate hills or weaves, and vary surfaces and speeds for a bit of a workout.   MapMyDog walk will keep track of your elevation changes and pace.   

If you are motivated by statistics, then this app will do well to motivate you.  If making your dog’s day is motivation enough to take him or her for a W-A-L-K, then this app will provide a fun way to log your exercise.  In any case, this is a great time of year to get outside with the best walking companions ever and enjoy the Fall!

The Great Greta - Continued

Greta continues rehabilitation.  Her family reports that she can wag her tail again, ever so slightly, which means a lot since she was always very expressive with her wagging.   To the left is a picture of Greta during one of her land exercises and below a video of one of Greta’s sessions in the underwater treadmill. 

 

 

 

Along with her exercises, Greta receives laser therapy and acupuncture.  She is being fitted here for a wheel chair and getting the proper fit is vital to the success of its use.  Greta truly has a great attitude and it is a joy to work with her, and her family!

Is General Anesthesia Really Necessary for Dental Cleanings?

By:  Matthew Lemmons, DVM, DAVDC

The American Animal Hospital Association (AAHA) recently made a requirement that all of its member hospitals only perform dental cleanings under general anesthesia with an endotracheal tube in place, AAHA Dental Guidelines.  This decision has come under fire from groups who perform dental cleanings without anesthesia.  Fairly, we should look at each side’s concerns.

The groups who perform dental cleanings without general anesthesia argue that their trained staff can safely and completely clean the teeth without general anesthesia.  They also correctly state that there is an inherent risk whenever general anesthesia is performed.  Some of these groups only recommend non-anesthetic dental cleanings (NADs) in between complete cleanings under general anesthesia as preventative maintenance.  Some believe general anesthesia is only required if there is a need for extractions or other involved treatments.

Those who believe general anesthesia is required state that scaling of all the teeth surfaces and cleaning below the gum line is not possible when a patient is awake.  Additionally complete diagnostics including periodontal probing and dental x-rays cannot be adequately performed in an awake patient.   One group taking this stance is the American Veterinary Dental College, who are the only group of veterinary dental specialists recognized by the American Veterinary Medical Association.  The College’s position can be found here, Dental Scaling Without Anesthesia.

I believe that some of the groups supporting NAD do have the pet’s best intention in mind.  Their thought is that the risk of an adverse reaction under general anesthesia is too high to justify an anesthetized cleaning.  I agree that if general anesthesia is not properly performed, the risk of a problem occurring is high.  However if the right precautions are made, the risk of an event under general anesthesia is minuscule in a healthy pet.

Adequate dental care can not be provided on an awake patient in the vast majority of cases.  Most of the patients I see have some degree of gum recession and bone loss which requires more than simple scaling and polishing.  As well, a number of patients I see who have had a recent anesthetized dental cleaning have large amounts of dental tartar left behind.  If dental tartar is left behind in some anesthetized patients, how can it be completely removed in an awake, uncooperative patient?

In conclusion, adequate dental scaling and polishing does require balanced and monitored general anesthesia.  It is my opinion that cleaning teeth without general anesthesia is simply cosmetic and not therapeutic.  It is a disservice to the pet and client.

 

 

The Great Greta

Remember The Great Gatsby, a legendary novel about the Roaring 20’s full of glamor and the romance of noble deeds?  Well, today we share the tale of The Great Greta, a Terrier who followed a young man home one day and worked her way into a community’s heart.

 

The name, Greta, means “Pearl” and just like a pearl, Greta dazzles everyone she meets.   So, when Greta suffered a debilitating back injury, her family did not have to think twice about getting help for her.  Greta underwent back surgery with Dr. Rebecca Ball, DACVS, and has begun a series of physical rehabilitation treatments with Dr. Karen Hull and Dr. Kelly Fisher, CCRP.   

Greta enjoys a picnic lunch with
Technicians, Stephanie and Kim

Along with the support of her family and medical team at Circle City Veterinary Specialty & Emergency Hospital, Greta has developed a significant fan base because she has accompanied one of her favorite people, her dad, Ben, on his travels around town. Her glittering personality charmed the masses and get well wishes flow in as word of her injury spreads.   On October 23, the Tomlinson Tap Room will host a Tap Takeover & Fundraiser for Greta with the Fountain Square Brewing Company donating one of their favorite brews and affectionately renaming it, “Puppy Pilsner”. 

Grandma Cathy with Greta
during a rehabilitation session

Take a few minutes to meet Greta and make a toast on her behalf.  Her sparkle remains in spite of her circumstance and we will bring you back to her story as her rehabilitation continues.   



When Your Pet Needs Surgery - Anesthetic Monitoring

By Rebecca Ball, DVM, MS, DACVS-SA

Whenever a pet has to undergo a surgical procedure, owners are often very concerned about how their pet will handle anesthesia and if it is safe.  Unfortunately, some patients do not have a surgery that they need because of this fear.  Although there are always risks associated with anesthesia, there are things we do to help keep your pet as safe as possible during any operation and to minimize these risks. 


The Surgivet Advisor Monitor
 apexx-equipment.com

At Circle City Veterinary Specialty & Emergency Hospital, all patients are continuously monitored during surgery and anesthesia by both a special monitor and a person who is always with the patient during the entire procedure, recording vital signs and monitoring  progress.   Our surgical monitor records the patient’s heart rate, respiratory rate, continuous ECG, end tidal carbon dioxide level, blood pressure, and SpO2.

The heart rate tells us how fast your pet’s heart is beating.  The ECG tells us about the electrical activity of the heart.  A normal ECG is pictured below. 

 



 

Certain diseases can cause heart arrhythmias to occur and an ECG will alert the Doctor to any problems.  An ECG of a dog that developed an arrhythmia is pictured below. 



 

The respiratory rate tells us how fast your pet is breathing.  The end tidal carbon dioxide level tells us how well they are ventilating their lungs.  If a pet is breathing too rapidly and shallow during anesthesia, the end tidal carbon dioxide level will be low.  If they are not breathing deeply enough, their end tidal carbon dioxide level will be high.  The end tidal carbon dioxide is reported as both a number as well as a graph that gives us additional information about their breathing.  A graph of a normal patient is pictured below.

 

Your pet’s blood pressure is as important as your blood pressure.  Often, during anesthesia, the blood pressure will be low.  It is important to know this as low blood pressure can have negative effects on the kidneys and brain.  Low blood pressure can be treated with fluids and medications during surgery if needed.

The SpO2 level refers to the percentage of oxygenated hemoglobin present in the patient’s blood.  Hemoglobin is part of the red blood cell that carries oxygen from the lungs to the tissues.  A low value alerts us to the possibility that the patient may not be breathing enough or that there may be something wrong with the lungs causing the pet to be not getting enough oxygen.

If you have any concerns about anesthesia, please feel free to contact us. 

Oh Those Broken Bones

By Kate Fitzwater, DVM, MS, DACVS

Summer brings nice weather for all of us, including our four legged friends who like to run and play outside too. Unfortunately both dogs and cats can run out in front of cars or get into other trouble that may result in a broken bone. Long bone fractures are one of the most common orthopedic problems we see at Circle City Veterinary Specialty Hospital.   The most common bones to be fractured include the radius/ulna in the forelimb and the femur (seen here) or tibia/fibula in the hindlimb.

There are several variables of bone fractures that may make prognosis better or worse. If the joint is involved in the fracture, then osteoarthritis of that joint is highly likely after surgery, even if it is stabilized. Young animals can fracture through their growth plates, which may cause deformities as they heal. Also the bone may come through the skin, which is termed an “open” fracture and has a higher risk of infection than one where the fractured bone ends are contained within the muscle and skin. Young animals typically heal faster than older animals, which is great, unless the fracture is not identified until several weeks after the fracture occurs and the bone heals in an abnormal location.

Fractures can be fixed by multiple methods and one repair doesn’t work for all fractures. The most common repair is by plate and screws.  The following pictures show the repair of the fracture above using this method.   To add stability and help prevent bending forces, a pin was also added down the center of the bone. Animals can keep plate and screws for their entire life if they don’t develop an infection or loosening of the implants.

 

Another unique repair is called an external fixator, which places most of the hardware outside the leg, as seen in this picture. When the fracture heals, the fixator is removed, which also removes all the implants. This type of repair is excellent for open fractures that are infected so the implants can be removed and will not harbor that infection. The downside to this method is the cleaning of the pin tracts and weekly checks of the fixator to make sure it stays tight.

 

Most orthopedic implants are stainless steel, but titanium is also used. Other types of implants include: interlocking nails, pins, screws, or pins and wire combination.  Most fractures heal within 8-12 weeks. If animals are less than 1 year of age, fractures can heal within 4-6 weeks. Rehabilitation in an underwater treadmill in the early period after surgery is recommended.   This type of therapy encourages use of the operated limb so the patient can maintain range of motin and muscle mass without having to bear as much weight.  

 

What Can My Dog Chew?

By: Matthew Lemmons, DVM, DAVDC



Metal Crown to Repair Fracture

When you go to the pets stores, there are dozens of choices for dog chews, some even claiming to help clean teeth.  However there are choices which can be harmful to your dog’s teeth.  We need to realize that our dog’s teeth are no stronger than our own teeth and their bite pressure is as much as two and a half times our own.  So one may deduce that anything that could break our teeth, could break our pets’ teeth.  Bones, hooves, antlers and hard plastic toys are all common culprits when broken teeth are noted.  These teeth then need to be treated, often by root canal therapy or extraction.  Therefore our basic rule of thumb for appropriate chews for dogs is “If you think it is too hard to chew yourself, it’s too hard for your dog to chew”.  Toys and treats which are more appropriate are durable rubber toys like Kongs, rawhides, many dental chews and stuffed toys.  It goes without saying that pets should always be monitored while chewing to assure they are not eating large pieces of a toy which may become stuck in the stomach or intestines.

There are many dental chews and diets which are clinically proven to help keep the teeth clean.  These products have the Veterinary Oral Health Council seal of approval and can be found at vohc.org.  These products include Hill’s T/D, Greenies and Tartar Shield treats.  These provide a healthy alternative to hard toys which may harm your pet. 

 In conclusion, if you are looking for a treat to add to your dog’s regimen to keep his teeth clean, look for clinically proven choices found on vohc.org.  By all means avoid anything which may harm your dog’s teeth.  Remember, if it is too hard for you to chew, it’s too hard for your dog to chew.

 

Are Mixed Breed Dogs Really More Healthy?

By:  Scott Owens, DVM, MS, DACVIM

The assumption has long been held that the best way to avoid many inheritable diseases in dogs is to adopt a mixed breed dog, or a mutt.  While many of the well known inheritable diseases have been linked to specific breeds of dogs, no study has ever set out to show the lack of these diseases in mixed breed dogs, until now. 

A group of veterinary researchers from the University of California, Davis set out to investigate how frequently many of the commonly seen inheritable diseases would occur in mixed breed dogs as compared to pure bred dogs.  In contrast to many veterinary studies with very small numbers of dogs, this study analyzed 27,254 dogs with 24 various diseases that are known to be inheritable.  Some of the more common internal medicine diseases evaluated included Cushing’s disease, hypothyroidism, liver shunts, and Addison’s disease.  Other well known conditions included many congenital heart defects, various types of cancer including lymphoma and mast cell tumor, and multiple orthopedic conditions including hip and elbow dysplasia, as well as cruciate ligament tear. 

As was to be expected, 10 of the diseases were seen more commonly in pure bred dogs, including hypothyroidism, dilated cardiomyopathy, and cataracts.  Somewhat surprisingly, however, 13 of the 24 diseases that were evaluated did not show any bias towards pure bred dogs compared to dog of mixed breeding.  This means that there is no significant difference in risk of contracting one of these diseases for a mixed breed dog compared to a purebred.  This group of diseases included Cushing’s disease, Addison’s disease, hip dysplasia, and multiple types of cancer.  Cranial cruciate ligament rupture, a very common orthopedic condition, was actually seen significantly more often in mixed breed dogs. 

Inherited diseases are, by definition, associated with some degree of genetic mutation.  Since we know that all breeds of dogs originated from a common ancestral pool, and genetic diversification and breed selection / separation has only occurred in the more recent past, it stands to reason that diseases caused by genetic mutations long ago should not be found in any higher proportion in pure bred versus mixed breed dogs.  Genetic mutations that have occurred much later in the diversification process, for example causing hypothyroidism, likely will affect a smaller subset of dogs making pure bred dogs more at risk.  This may be better conceptualized using a family tree image.  The common ancestors may be grouped together in the “trunk” of the tree, and any mutation occurring in this area is likely to affect all branches.  A mutation that occurs on an isolated branch, or in the case of dogs after the selection process of specific breeds, is only likely to affect those specific breeds, and not the rest of the tree.

So how does this impact you when it is time to pick out a new companion?  There are many positive attributes to bringing home both mixed breed dogs available at the local shelter and pure bred dogs from a reputable breeder.  Deciding on what kind of dog to bring home should be a well thought out process, weighing all of the positives and negatives of the breed(s) involved.  The conclusion of this study should in no way detract from adopting a mixed breed shelter dog; it should just be one more puzzle piece to help make the most informed decision.  

Bellumori TP, Famula TR, Bannasch DL et al.  Prevalence of inherited disorders among mixed-breed and purebred dogs: 27,254 cases (1995–2010).  J Am Vet Med Assoc  2013; 242: 1549-1555. 

Clinical Trial Results in New Treatment

By: Terry L. Grieshaber, DVM, DACVD

Golden Retriever with Atopic dermatitis

On June 21 – 22, 2013, I attended a first-to-know meeting sponsored by Zoetis for its launch of Apoquel (oclacitinib). Oclacitinib is a Janus Kinase inhibitor which inhibits the function of many pruritogenic and pro-inflammatory cytokines. This drug was developed for the treatment of Atopic dermatitis in the dog. While I do not feel that oclacitinib should be used as a first line treatment for Atopic dermatitis, it is another option for treating this sometimes devastating disease. Oclacitinib will likely be available after January 1, 2014.

Circle City Veterinary Specialty & Emergency Hospital has been involved in conducting clinical trials to determine the effectiveness of oclacitinib for the past several years. My team and I are proud that we were able to contribute in even a small way to bringing this drug to market. Developing new treatment modalities is not a small undertaking and requires a true team. I thank those veterinarians who referred cases for these clinical trials and those clients (and patients) who chose to participate. Watch our e-mail newsletters and website for further updates.

Note: An additional and completely separate clinical trail for Atopic dermatitis is currently being conducted in our Dermatology Department where patients may still be enrolled. If you would like more information on this 2013 study, click here or contact our Dermatology Department.

 

TTA vs TPLO - Similar until there are complications

By: Kate Fitzwater, DVM, MS, DACVS

Cranial cruciate ligament rupture is the most common orthopedic injury in dogs. There are multiple surgical procedures that can be done to treat this disease, but two of the most popular “osteotomy” (cut in the bone) procedures are the TPLO (tibial plateau leveling osteotomy) and TTA (tibial tuberosity advancement).

Both procedures can provide excellent outcomes and both have their potential complications. Infection can occur with any surgical procedure, but with orthopedic surgeries that involve implants, the risk is higher. That is why prior to an elective orthopedic procedure, the skin is evaluated for infection and antibiotics are used during the procedure and postoperatively to lessen this risk. If a dog licks or chews at the incision, this is highly likely to result in an infection in the immediate postoperative period.  Late infections are also a potential possibility as well, because urinary tract, skin, oral, or ear infections can spread to the site of an implant or area of inflammation (osteoarthritis). If the site of an orthopedic surgery becomes infected, the implants have to be removed to clear that infection completely. This is because the stainless steel implants do not have a blood supply and the bacteria stay on the implant in a “biofilm”. The implants can be removed as long as the bone has healed.

 

When we are dealing with removal of TPLO or TTA implants, the level of difficulty and invasiveness is dramatically different between the two procedures. Below are radiographs of each procedure showing the metal implants. The TTA implants involve a cage (square) that acts as a spacer, and during healing bone grows into this cage. There is also a fork plate and screws that hold the osteotomy in place. When removing TTA implants, the fork plate and screws easily can be removed, but the cage must be “cut” out of the bone, leaving a large defect that has a high risk of fracture. This surgery to remove the cage that is encased in bone is invasive and difficult. The TPLO, on the other hand, doesn’t have a cage and only has a plate and screws, which can easily be removed because the bone doesn’t grow into them.

  TTA radiographs showing cage,
fork plate/screws             

 TTA radiographs showing cage,
fork plate/screws             



TPLO radiographs showing
plate/screws 

TPLO radiographs showing
plate/screws

 

 

 

 

 

 

 

 

 

 

 

 

 

So, when discussing the surgical options for a cranial cruciate ligament rupture, all the potential complications need to be discussed and the risks weighed. Infection risk is low at 7.4% (Gallagher AD et al. Implant removal rate from infection after TPLO in dogs. Vet Surg. 2012), but if it is your dog that needs the implants removed, the process is less complicated to have had a TPLO over the TTA!