Thursday, December 26, 2013

Back in the Game

                        It was only a routine play to the sideline. But when it was over, the player sat quietly on the grass, with a “help me” facial expression both acknowledging that something bad had happened, and disbelief that it did.

                        The fans were shocked, silenced by the sudden end of so much promise,  followed by that horrible feeling of what might have been.

                        Am I describing the play that took out Cleveland quarterback, Brian Hoyer, and all the hope he represented for long suffering Browns fans? Oh, my goodness, no! This was far worse than that. The player injured didn’t even play football. She played “ballie”, and although she had the same injury as Brian Hoyer, a torn ACL, she wasn’t a human. She was a dog. And not just any dog. The player hurt was our beloved Welsh Corgi, Betsy Louise. Moreover, in that instant her parents went from being veterinarians to owners of a broken pet, with all the concern and anxiety their clients might experience when faced with a similar situation.

                        What should we do? Surgery or medical management? We don’t do knee surgery in our practice, but we have treated several dogs, big and little, successfully with anti-inflammatory drugs, glucosamine-chondroitin sulfate medications, exercise restriction, and time. Betsy, however, was a special case. She was only two years old, and without question, the most athletic dog we’ve ever had.

                        Although our two Border Collies literally run circles around her when it comes to herding sheep and ducks, and Betsy does try, fetching the Kong ball is her specialty, and obsession. With her short legs and lightning reflexes, she makes the Border Collies look like the team that always plays, and loses to, the Harlem Globetrotters.

                        The knee or stifle joint, which connects the long femur bone to the shorter tibia and fibula bones of the lower leg, is one of the most complex joints in the body, subject to stress with each step taken; the stress exacerbated when running, jumping, and twisting is thrown into the mix. This is probably what got Betsy into trouble.

                        The joint is held together by two pairs of ligaments, which are fibrous bands of tissue, that link bone to bone. The medial and lateral collateral ligaments are located on the inside and outside surface of the joint. The anterior or cranial cruciate ligament and the posterior or caudal cruciate ligament hold the joint together from within.

                        If the anterior cruciate ligament is torn, as in Betsy’s case, the tibia is allowed to move forward unconstrained, which destabilizes the joint and can lead to further damage to the other ligaments as well as arthritis.

                        Betsy’s mother, Bonnie, consulted with two surgeons. One preferred a procedure known as Tibial Plateau Leveling Osteotomy [TPLO]. In this surgery part of the tibia is cut and rotated. It is more invasive, more complicated and thus more expensive. For larger dogs, though, it may be necessary. The other surgeon routinely performs the Lateral Imbrication technique, which involves tightening the lateral joint tissues with sutures. For smaller dogs like Betsy, this usually works fine, and is the route we decided to take.

                        As surgery day drew near, however, we were filled with additional nervous-owner questions. Were we doing the right thing? Would the operation be a success? And, of course, the whole idea of putting Betsy’s life in someone else’s hands, even when we knew he was perfectly capable, was another small mountain to climb.

                        The patient was to be dropped off at the animal hospital around noon. Bonnie made a list of Betsy’s likes and dislikes. Included was that Betsy liked to have someone’s fingers placed inside her ears, I guess for an internal massage. She also liked to have her chest rubbed, but not her belly. I did not know that. And please, if they could trim her nails real short while she was sleeping, as Betsy has never been keen about nail-trims. I knew Betsy liked to play by her own rules, but I didn’t realize there was an actual list. I appreciated the doctor and his technicians for the kindness and patience shown to me, the list, and Princess Betsy Louise.

                        Her surgery and recovery went well, and although she was pretty gimpy for the first few days, the sparkle soon returned to her eyes. With each passing day she becomes more like the Betsy Louise of old. Hopefully, in about three months, if her rehabilitation continues to go well, she can begin to think about getting back in the game.

Author:  Dr. John Jones

Tuesday, December 17, 2013

Making Your Pet’s Christmas Merry and Bright

                        Stuart is a much loved, bow-tie-wearing Goldendoodle.  At just five months of age, he was the recipient of most of Angela’s Secret Pal presents at our recent hospital Christmas party.  The more “Stuart gifts” Angela unwrapped, the larger the grin on her face grew.  Witnessing Angela’s joy inspired me to share some thoughts about every pet’s Christmas list. 
                        Stuart’s gifts were both delightful and appropriate: a Christmas collar to match his favorite bow-tie, a seasonal bandanna, and a Santa/Mickey Mouse hat. I truly believe we love our pets because in many ways they are a reflection of us.  As a health-conscious veterinary technician who graduated at the top of her class, Angela takes great pride in assuring that “Stu” always looks good.  And, she is giving him one of the greatest gifts of all, obedience classes. 
                        Besides the gifts of attire and training, toys and treats probably top every pet owner’s shopping list.  As a veterinarian, unfortunately I am usually on the side of the “Don’ts” for pet Christmas presents.  The gifts that make me cringe most are all items that go into pets’ mouths.  For dogs, these include hard vinyl toys (Nylabones), rawhide chews, antlers, cow hooves, pig ears, and pressed bones. For cats, the “No-No” list includes any toy with small pieces or long strings.
                        The problem with the canine “Don’ts” are the fractured teeth associated with these chew toys that are just too hard.  Veterinarians see many fractured teeth. The history for these pets usually includes that the dog is an aggressive chewer whose owner has great difficulty finding toys the dog cannot destroy and ingest.
                        My suggestion for these “extreme chewers” is Kong toys, with the black Kong (“Extreme Kong”) being the most durable.  Kong toys are made of very tough rubber and are available in multiple shapes and sizes.  If a pet swallows chunks from a Kong, the pieces are likely to be small and will pass through the pet’s digestive tract.  By stuffing your dog’s Kong toy with low fat canned food or peanut butter mixed with treats then freezing it overnight, you can create an enjoyable, enduring, healthy, dental treat.
                        For fans of rawhide treats for pets, I have a precautionary word.  I once had the misfortune of seeing a Pekingese that had died en-route to our hospital as his owner rushed him in to see us.  The cause of his sudden death was a chunk of rawhide lodged in the back of his all too crowded throat.  His owner was inconsolable.   Inevitably, rawhide will get swallowed, intentionally or accidentally, then either obstruct or grind its way through your pet’s intestinal tract.  Please don’t give your pet rawhide chews!
                        Also, changing your pet’s food or treats during the holidays may result in an “astronomical-gastronomical event” that will not “deck the halls” nicely, if you know what I mean.  Instead, consider filling your pet’s stocking with tried and true treats. And, please do not share your holiday dinner with your four-legged friends!
                        For my feline patients, the “Don’ts” include Christmas toys with strings, such as fishing pole toys.  These are great “chase toys” when humans are on the other end of the pole controlling the game, but NOT when they are left unattended.  Cats commonly swallow linear items like thread, yarn, and string while in pursuit of whatever is attached to them. Eat, drink and be merry, but please don’t give your cat the gift of emergency intestinal surgery!
                        The best holiday cat toys may already be in your home and include gift bags and boxes to play in, and bows to bat around.  Since many house kitties are often overindulged with too much food and not enough exercise, consider “puzzle balls (Egg-cersizer)” to make your cat “work” for its food and treats.
                        If your pet family is mixed like mine and includes both cats and dogs, be mindful, too, of small cat toys that dogs will seek, chew, then swallow. Nothing ruins the reason for the season like an expensive emergency foreign body retrieval surgery.
                        Like all of us, pets crave the gift of your time more than anything else. Instead of spending that embarrassing amount of your slush budget on toys and food for Fido and Fuzzy, choose to spend time interacting with your pet, or homeless pets if you are currently “pet-free.”  Celebrate the human-animal bond during the holidays and all year round by walking, playing with, or training your pet.  Then, ask yourself who really received the gift. 
                        Happy Holidays from the two and four-legged residents of Welshire Farm!
Author:  Dr. Bonnie Jones