Surgery Patient of the Month – October – Pelvic and Left Ileum Fracture

A fewdays post op
Ginger is an exceptionally sweet 9-year-old Havanese who was presented to the West Hills Emergency Service after falling out of a van window, landing on a sewer grate, and possibly being hit by a car.  Ginger’s owners did not witness her accident, but brought her in for evaluation once they saw she could not bear weight on her right hind limb.

Our emergency veterinarian, Dr. LeBars, noted that Ginger had significant bruising and swelling of both of her hind limbs and along the underside of her belly.

Radiographs (x-rays) showed multiple fractures along both sides of Ginger’s pelvis (see picture 1). The x-rays also showed Ginger had air/gas trapped underneath the skin of her broken pelvis. This is called subcutaneous emphysema.

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The air/gas could have been introduced from “outside to inside” (air from the environment becoming trapped in a wound secondary to the trauma), or from “inside to outside” (gas leaking from an ruptured internal organ that passes through a tear in the body wall–the layers of muscle and tissue that separate the abdominal contents from the skin). The latter scenario represents a critical emergency and can be life-threatening.

Once she was stabilized, our board certified veterinary surgeon Dr. Hirshenson, evaluated Ginger. He recommended a CT scan of her abdomen and pelvis to better delineate the extent of her fractures and to further examine the cause of the air/gas seen on the radiographs.

The CT scan revealed multiple pelvic fractures including a left ileal-wing fracture and bilateral ischial and pubic fractures). Fortunately, Ginger’s body wall was found to be intact, eliminating an internal cause of the air/gas seen under her skin.

Despite her multiple fractures, restoration of the structural support of her pelvis required repairing only the left ilial wing with a plate and screws (see picture 2). With the help and dedication of the staff at West Hills (and Ginger’s owners) she progressively gained strength and at the time of discharge was able to walk comfortably on her own!

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Nearing 2 months post-surgery, we are glad to report that Ginger is back to her happy, playful self and is getting stronger every day.  With the diligent care provided to her at home, Ginger is on the path towards a full recovery!

Surgery Patient of the Month – July – Typhlectomy, Intussusception and Septic Abdomen

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We wanted to share with everyone a very touching story about Rosie.

Rosie, a beautiful 1 year old mix breed, was presented to West Hills Animal Hospital on referral from her primary veterinarian for continued care of persistent diarrhea and loss of appetite. Rosie was initially evaluated 2 days prior to presentation by her primary veterinarian, where blood work revealed a low white blood cell count and low protein, and fecal examination was negative. She was treated supportively with fluids and antibiotics; however clinical signs persisted, leading to referral to West Hills. Prior to this episode Rosie had been an otherwise healthy dog.

Upon arrival at West Hills, Rosie was admitted to the hospital for additional diagnostics and intensive supportive care by one of our primary care veterinarians, Dr. Lancer. Radiographs (x-rays) did not reveal an obvious cause for her signs. The following day an abdominal ultrasound of the abdomen was performed, which also did not pinpoint an exact cause of the clinical signs, but showed evidence of dilation of her intestinal tract with fluid and ileus, which is a lack of movement of material within the digestive tract. Rosie was continued on supportive care, but her signs progressed to include nausea as well as continued diarrhea, and she was very lethargic. Repeat blood work was consistent with sepsis, a systemic wide infection that was not responding to supportive care. Following consultation with Dr. Ries and Dr. Hirshenson, our board certified veterinary surgeon, Rosie’s owners elected to pursue an abdominal exploratory surgery.

In surgery, 2 small perforations were found in the cecum which is a small section of the intestinal tract that connects the small intestine to the large intestine. This, caused intestinal contents to leak into Rosie’s abdomen. The affected portion of her intestinal tract was removed. Dr. HIrshenson suspected that the perforations developed secondary to an intussusception. This is a condition where a loop of intestines slides inside another loop, causing inflammation, and in some cases, necrosis of the intestinal tract. The condition typically occurs in young dogs and in some cases can be life threatening. In Rosie’s case, the leakage of intestinal contents into the abdomen was causing a severe systemic infection, along with severe pancreatitis (inflammation of the pancreas) and secondary changes to her heart and liver.

Rosie required intensive monitoring and supportive care following surgery including two plasma transfusions, medication to help support her heart contractility and blood pressure, and a feeding tube to provide nutrition. Each day she showed slight improvement and exactly one week following admittance to the hospital (5 days following surgery) Rosie began eating small amounts on her own. Four days later (a total of 11 days in hospital) Rosie was discharged!

Over the following 2 weeks at home Rosie continued to regain strength and put on weight and rechecks of her blood work showed continued improvement. Through the hard work of the entire West Hills staff, the dedication of Rosie’s family, and of course the determination of Rosie herself, she is back at home where she belongs running through trails!

Surgery Patient of the Month – August – Limb Sparing and Amputation for Osteosarcoma

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Scooby is our Surgery Patient for the month of August!

Meet Scooby, the gentle giant! Scooby, a 7-year-old Great Dane, initially was presented to West Hills Animal Hospital in mid-January for right forelimb lameness. Radiographs were obtained, revealing a lesion in his radius, concerning for a primary bone tumor. A week later Scooby was evaluated by the surgery service and a biopsy of the bone was performed to obtain a definitive diagnosis. Results showed osteosarcoma, the most common type of primary bone cancer, seen in dogs.

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The recommended therapy following diagnosis of osteosarcoma is amputation of the affected limb followed by chemotherapy. Amputation serves to control the disease locally, as well as relieve the patient from the source of pain. An alternative option is a procedure called a “limb-spare,” where the affected portion of bone is removed and replaced with an implant and a large metal plate. Unfortunately, limb-spare surgery carries the risk of many possible post-operative complications compared to amputation surgery. 

Scooby’s owners elected to pursue the “limb spare” surgery and additional testing confirmed that he was an ideal candidate for this procedure. Surgery was performed by Dr. Hirshenson, our board certified surgeon, who is one of a small number of veterinarians in the world trained in this complicated procedure. He then started chemotherapy as previously recommended.
Unfortunately Scooby experienced some of the more common complications associated with limb-spare surgery including an infection associated with his metallic surgical implants, requiring long-term administration of antibiotics, and ringworm, a fungal infection, along his skin. These setbacks caused several delays in his planned chemotherapy treatments. However, Scooby handled all the vet visits with his typical patience and gentle demeanor.

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Unfortunately, in July (5 months after the initial “limb spare” surgery), Scooby‘s lameness returned and radiographs showed tumor growth in the ulna (the bone next to the previously affected radius). Given the discomfort this lesion was causing, an amputation of Scooby’s right forelimb was recommended. He underwent this surgery the following day and in typical “Scooby fashion”, never looked back!

Now, Scooby is hopping around on 3 legs and continues to be admired by all who know him. He is still undergoing chemotherapy, but is taking everything in stride and is comfortable and happy. Scooby holds a special place in our hearts here at West Hills and he continues to impress us all!

Surgery Patient of the Month – September – Laryngeal Paralysis

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Angel is our Surgery Patient for the month of September!

Angel, a lovely 13 year old chocolate Labrador, was initially presented to the West Hills Animal Hospital surgery service in November 2014 with a primary complaint of increased respiratory effort when active and slight change to the sound of her bark. Based on Angel’s age, breed, and clinical signs, Dr. Hirshenson discussed concerns about a condition called laryngeal paralysis.
As Angel’s signs were fairly mild at the time, a conservative management plan was created, including ensuring she was kept in a cool environment and not allowed to overheat. Angel did well at home through the winter, but re-presented to the surgery service in April 2015 for worsening signs, including several episodes of collapsing with activity.

Laryngeal paralysis (“Lar Par”) is typically seen in older dogs. Labrador retrievers are more frequently affected; though any breed could develop this condition. Laryngeal paralysis results from degenerative loss of neurologic function to the muscles responsible for opening the larynx, the part of the airway located at the back of the throat. When the larynx fails to open, air cannot pass normally from the mouth or nose into the lungs.

Owners of dogs with laryngeal paralysis frequently note their dogs showing signs of exercise intolerance, increased panting and occasionally a change to the sound of their bark. Dogs can still breathe with this condition, but exercise, heat and inflammation can rapidly exacerbate their signs, making it difficult for them to breathe.

In extreme cases, pets collapse from lack of oxygen! It is unclear exactly why dogs develop laryngeal paralysis, but evidence supports the theory it is part of a systemic neurologic degeneration that occurs as dogs age.

Patients with mild clinical signs can often be managed conservatively, where owners must keep their pets in cooler environments (i.e. air conditioned houses and cars) and not allowing them to become too excited. For severely affected dogs, like Angel, surgery is recommended.
The recommended procedure is called an arytenoid lateralization or “tie-back”, and entails making an incision into the neck and suturing one side of the arytenoid cartilage in a fixed position to widen the airway opening. The procedure works well, but carries a moderate risk of a complication called aspiration pneumonia. Angel’s signs were severe enough she required surgery to maintain a good quality of life.

Angel had surgery and recovered with flying colors! Following recovery, her breathing was quieter and she was more relaxed. She was able to sleep through the night without respiratory difficulty and can now go on longer walks and enjoy the yard without effort, even in the dog days of summer!

24hr Veterinary Care – An Animal Hospital Always Open

For over 30 years, West Hills Animal Hospital has provided 24 hour nursing care for your pets 365 days a year.  We always believed in being available for our patients 24 hours a day and never sent our clients to a strange emergency clinic.  What many people don’t realize is that to this day we are one of less than a handful of general practices on Long Island to provide 24 hour care.  That’s correct; when your friends’ pets are hospitalized elsewhere chances are they are left alone with nobody caring for them all night long.  Ask your friends to call their current animal hospital at 11:00 pm and ask to talk to the nurse or doctor who is at the facility caring for their pets.  The likelihood is they will get an answering machine or an answering service.  Don’t you owe it to them to let them know that your practice, West Hills Animal Hospital & Emergency Center is there with doctors and nurses around the clock to provide complete and comprehensive critical care for their pets when they most need it?  We think that’s what friends are for!

And because we value our relationship, please always know that as a preferred client at West Hills Animal Hospital & Emergency Center you never have to pay an additional emergency fee even at 2:00 am.  It is our way of saying thank you for entrusting us with the care of your precious pet and family member.

Internet Pharmacies

In our fast paced, convenience driven society, on-line shopping has become the norm. However, as many consumers have unfortunately found out, the Internet is not always your friend.  Just as there are disreputable “brick and mortar” businesses, the same applies to on-line “stores”.  This also holds true when it comes to pet medications.  In fact, even the FDA has warned consumers of the potential perils of some on-line pet pharmacies.  For example, you may not know that manufacturer’s warranties are “null and void” when pet medications are purchased from places other than your veterinarian.  Furthermore manufacturer rebates are not honored either.  For over a decade we at West Hills Animal Hospital & Emergency Center have offered our clients a convenient, very competitively priced, e-Pharmacy where they can get their medications online from the doctors they trust and still retain the manufacturer’s warrantees and rebates.  Visit us at www.whahzoo.com and go to our e-Pharmacy.

Stem Cell Therapy in Pets at West Hills Animal Hospital & Emergency Center

West Hills Animal Hospital and Emergency Center is now offering Stem Cell Therapy!

Stem Cell Therapy is a part of the growing field of regenerative medicine, in which medical therapy aids in the repair, replacement or restoration of damaged and diseased tissues.  While much controversy has erupted regarding the use of embryonic stem cells in people, stem cell therapy available to our veterinary patients is not met with the same ethical considerations, as the cells are derived from the same patient in whom we are treating.

Stem cells are unique in that they are considered multipotent, meaning once injected they have the ability to differentiate and develop into various types of tissue depending on their environment and be used to treat a variety of conditions. Using a concentrated sample of the pet’s own stem cell cells (autologous) derived from their own fatty tissue, these stem cells can help treat degenerative diseases such as osteoarthritis, cartilage defects and ligament or tendon injuries.  These cells have been shown to not only help in the repair and regeneration of new tissue, but also provide a role in promoting anti-inflammatory pathways. While stem cell therapy is not indicated for every patient, published research in the human and veterinary literature suggest promising results.

If you have questions about the use of stem cells, or believe your pet may benefit from this treatment ask your veterinarian for more information or referral to our surgeon Dr. Marc Hirshenson, DVM, DACVS-SA by calling 631-351-6116.

Cats and How to Alleviate Stress Going to the Veterinarian!

Every cat owner has been in this situation… your cat gets sick or needs a wellness exam, but you hesitate to make a veterinary appointment because of the stress to you and your cat.  Your cat runs as soon as the carrier comes out of the closet, she wails and drools in the car ride and then she growls and hisses at the veterinarian.  Not a pleasant experience!

Recently, the American Association of Feline Practitioners (AAFP) and International Society of Feline Medicine (ISFM) published guidelines to help ease feline stress during veterinary visits.  Contained within these guidelines, there are a number of tips offered to pet owners that can help make the veterinary visit more palatable to your cat.

First, rehearse visits to the veterinarian. These rehearsals help to desensitize your cat to the carrier and car trip.  You can start gradually by introducing your cat to the carrier, using positive reinforcement to promote desirable behaviors. An example of this technique is to put treats in the carrier so your cat associates being in the carrier with something good.  Move on to short car trips, then to longer car trips.  You can even bring your cat into the veterinary clinic without taking her out of the carrier and then, when she seems comfortable, take her out of the carrier without being seen by the veterinarian.  The more you practice the experience, the easier it will become.  Just call your veterinary clinic ahead of time so they will be prepared.

When making the trip to the clinic, it is helpful to bring a blanket or towel that your cat is familiar with.  Start exposing her to the fabric several weeks before the appointment by putting it on her favorite sleeping spot in the house.  Place the towel or blanket in the carrier when you go for the appointment.  Your cat can even use it as a way of hiding during the appointment, which the veterinarian can work around to complete a physical exam.

Once in the veterinary clinic, notify or remind the staff that your cat is easily upset.  It is important not to become outwardly stressed yourself during the exam, and try to avoid making any loud noises, whispers (which sound like a hiss to the cat) or sudden movements.

If you don’t have one already, purchase a cat carrier with quick-release latches so the top of the carrier can be easily detached.  Your cat can remain in the bottom of the carrier, with the scented blanket or towel during the exam.  You will find this approach much easier than having to fight and pull your cat out of the carrier for her exam!

An easier visit will allow you to concentrate on your cat’s health rather than on her anxiety.  This small investment of time will make veterinary visits more palatable for you, your cat and your veterinarian.   And remember, if none of these methods work, we can always come to you and make a house call to treat your pet in the comfort of your own home!

Sincerely,

Jeremy Lancer, BVSc

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