Category Archives: Veterinary Specialists

Surgery Patient of the Month- June- Portosystemic Shunt (PSS)

Nacho with his mommyCongratulations to Nacho for being our June Surgery Patient of the Month!

You would never know by looking at him, but Nacho was recently diagnosed with a life-threatening condition for which he showed no signs whatsoever! When Nacho turned one, his owners wished to have him neutered. He was an active and happy pup, and as expected, his exam was completely normal. As part of routine diagnostics done prior to any surgical procedure here at West Hills, Nacho had blood work performed. Results showed a single value related to liver health was slightly elevated. You might argue that a slight elevation of a sole value on a blood panel is likely insignificant, but at West Hills we are committed to practicing the highest standard of care for our pets. Therefore, Nacho’s veterinarian, Dr. Sikalas, recommended further testing to ensure it was safe for him to undergo anesthesia and surgery.

An additional blood test (called bile acids) was performed and Nacho’s results returned abnormal. When this occurs in a young small breed dog, a likely possibility is a congenital abnormality associated with the liver called a portosystemic shunt (PSS). In dogs and cats, blood carrying toxins, such as ammonia, from the digestive tract is first transported to the liver through the portal vein. The liver removes all the harmful substances before returning the detoxified blood to the general circulation. Nacho on Halloween!

In pets with a PSS, there are one or more abnormal vessels that bypass the liver, allowing those harmful substances to the rest of the body before detoxification occurs. Pets with this condition often times suffer from a smaller liver with impaired function, and can have stunted growth or abnormal neurologic behavior, particularly after eating. They may also have problems metabolizing medications, especially anesthetic drugs, and this can be fatal for some pets.

Surgery is frequently recommended for dogs with PSS and consists of an abdominal exploration to identify the abnormal “shunting” vessel and a procedure to redirect blood flow back to the liver. Nacho underwent surgery with our ACVS Board Certified Veterinary Surgeon, Dr. Marc Hirshenson, who identified an abnormal vessel consistent with a PSS. Dr. Hirshenson placed a small device called an occluder on the vessel. This allows for gradual closure of the vessel and redirection of blood flow to the liver.

Nacho handled surgery like a champ and recovered without any complications. At home, Nacho continues to thrive. More importantly, his most recent bloodwork showed normal liver values! Congratulations Nacho!

Minimally Invasive Surgery for Pets

Minimally Invasive Surgery (MIS) involves the techniques of using sophisticated surgical instruments with cameras and often, flexible fiberoptic instruments in order to accomplish procedures that have traditionally involved more invasive surgical procedures or “going under the knife”.  While MIS is not a substitute for all surgical procedures there is many that can now be performed using MIS techniques.  In human medicine we are all familiar with laparoscopic surgery, endoscopic procedures, and arthroscopy.  Thanks to technological advances these are now becoming more available in veterinary medicine.  The advantages of MIS are less extensive surgical cuts with decreased associated pain and discomfort and a resultant more rapid post-operative recovery.

At West Hills Animal Hospital & Emergency Center, our board certified surgeon, Dr. Marc Hirshenson is now able to offer MIS thanks to the investment in our state of the art Karl Storz Endoscopic and Laparoscopic equipment.  Procedures such as stomach and esophageal foreign body retrieval, stomach and intestinal biopsies, liver biopsies, cystoscopy to evaluate urethral and bladder disorders, arthroscopy, and bronchoscopy are now all within our realm.  In fact, the most common procedure we do, spaying, can now be done laparoscopically in addition to performing a gastropexy (tacking the stomach to the body wall) to help avoid bloat (GDV) in large breed dogs.

Talk to your veterinarian to see if MIS is appropriate for your dog or cat.

 

The Age of Veterinary Specialization

The Age of Specialization 

It should come as no surprise that, with today’s specialized services being the norm in everything from your hairdresser to your attorney, the profession of veterinary medicine has fundamentally changed as well.  In bygone days, your local veterinarian took care of all of your pets’ needs from birth through old age.  However, the past 10-15 years has witnessed the dawn of a new era – The Age of Specialization.

While your primary veterinarian will always remain the doctor you may lean on most for guidance, with the extraordinarily advanced care now available, it is no longer feasible for that doctor to be able to always provide what’s best for your pet.  It is essential for every pet owner to be aware that there are indeed specialists in virtually every discipline that we have come to expect in human medicine, e.g. surgeons, cardiologists, dermatologists, oncologists, ophthalmologists, etc.  In order to be considered a specialist in veterinary medicine, one must have completed a formal internship and a residency in a specific discipline and pass a certifying exam of clinical proficiency along with any number of other requirements as dictated by the various specialty boards.  The veterinarian would then be considered Board Certified and therefore recognized as a Diplomate in their respective area.  If the doctors are not Board Certified, then he/she may not represent themselves as specialists.

The list of specialty services seems endless, ranging from advanced orthopedic surgeries and arthroscopic surgeries, to laparoscopic or minimally invasive surgery, to complex cardiac diagnostics, to cataract surgeries, to chemotherapy and radiation therapy offered by oncologists, etc.  If you’ve heard of it being done in human medicine, it is now likely to be available in veterinarian medicine.

What will distinguish one general practitioner from the next will not only remain the care and compassion they provide to you and your pet, but their ability to recognize their limitations and their willingness to recommend specialists who may be able to provide a needed level of care that they can’t.   If your pet’s veterinarian does not approach the subject when your pet is having serious, more difficult, or lingering problems then it is up to you to be your pet’s advocate.  The same applies to hospitalization for your pet.  You must make sure that if your pet is being hospitalized for medical or surgical care that there is indeed a staff of nurses and doctors taking care of your pet 24 hours a day.   Don’t assume, ask!!!

Specialists will distinguish themselves not only by their abilities and the hospitals they work in, but by giving you and your pet the same tenderness and compassion that your family’s veterinarian and their staff provides.  You have choices and they do not have to be prohibitively expensive either.

At West Hills Animal Hospital & Emergency Center we have doctors and nurses working 24 hours a day, seven days a week for emergencies as well as routine care.  Additionally we have added a board-certified Surgeon offering laparoscopic and other minimally invasive surgery in addition to advanced soft tissue and orthopedic surgeries, and Cardiologists to our staff.  As always, if you ever have any pet questions that I can assist you with, don’t hesitate to reach out to me.

Sincerely,

Alan M. Coren, DVM