Dr. David Crouch attends prestigious orthopaedic surgery conference

Dr. David T. Crouch recently attended the Veterinary Arthrology Advancement Association (VA3) meeting in Naples, FL. The meeting is hosted annually by Arthrex, Inc. This elite group of 45 orthopedic veterinary surgeons from around the world come together to discuss and refine the latest surgical techniques

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More specifically, the course featured advance arthrosopic approaches to many orthopaedic problems affecting small animals. They also discussed and gave examples of new implants and data sharing in order to improve outcomes in veterinary orthopaedics. All who attended had to be at the advance level in arthroscopy.

Continuing education is always important no matter what profession you are in. At Western Carolina Veterinary Surgery, we take this seriously. It is very important to us that we are up-to-date with the latest and greatest breakthroughs. The more we can fine tune our skills, the better service we will be able to provide you and your pet.

Dr. Crouch pilots sick Boxer dog to safety.

Lilly is a white boxer mix from Rome, GA, who had a litter of puppies, but they all died. She was quite sick and heartworm positive. She successfully recovered from the heartworm treatment, and is now a 50-lb healthy, sweet adult who has found her "furever" home thanks to Dorothy Peters of Carolina Boxer Rescue (Graham, NC).

With the help of another pilot, Mr. Bob Hite, Lilly arrived at the Asheville airport on the morning of June 16, 2011. Dr. David Crouch and his son Mark flew Lilly to Burlington, NC. They were greeted by Dorothy Peters and Doug Allison who will be her foster parents.

Dr. Crouch and Western Carolina Veterinary Surgery are proud supporters of Pilot N Paws.

www.pilotsnpaws.org

Dr. Crouch Attends Conference In Aspen, Colorado

Dr. Crouch recently attended the Veterinary Orthopedic Society Conference in Aspen, Colorado. The purpose of the Veterinary Orthopedic Society's annual conference is to present a forum where individuals involved in the area of orthopedics can meet to discuss or exchange ideas pertaining to the advancement of the field and improvement of patient care. Veterinarians from over 30 countries worldwide were in attendance. Dr. Crouch is thrilled to have had the opportunity to attend this prestigious conference. Staying on the forefront of 21^st century science helps to provide the very best care for our beloved veterinary patients.

Causes and Signs of Osteochondrosis

Osteochondrosis (OCD) occurs commonly in the shoulders of immature, large and giant-breed dogs. The lesion appears on the caudal surface of the humeral head (Figure 1). Although your dog may be lame in only one leg, this condition is often present in the opposite leg. This condition results in a cartilage flap found on the humeral head. In some cases, the resulting defect occupies half of the area of the humeral head. The cartilage flap may completely detach from the underlying bone and become lodged in the back of the joint pouch.

Causes
The causes of OCD considered to be multifactorial with input from management, genetic and nutritional interactions in young growing dogs.

Incidence and Prevalence
Large and giant-breed dogs are commonly affected. Males are more commonly affected than females.

Signs and Symptoms
Clinical signs often develop when the dog is between 4 and 8 months of age. Dogs usually show a lameness of one forelimb. In many cases, there is a gradual onset of lameness that improves after rest and worsens after exercise.

Risk Factors
Risk factors for OCD include age, gender, breed (genetic), rapid growth, and nutrient excesses, primarily calcium excesses. The hereditary nature is suggested because of high frequency of occurrence within certain breeds of dogs and within certain bloodlines. Males are more commonly affected than females.

When to Seek Veterinary Advice
If your young large breed dog is persistently lame in a forelimb, especially after exercise, you should have a physical exam performed. If the dog is painful on palpation of the shoulder, usually during shoulder extension and flexion, then radiographs of the shoulder should be made to evaluate for OCD.

Please contact Western Carolina Veterinary Surgery for further information.
828.684.0019

- Information provided by American College of Veterinary Surgery.

Pain Behaviors - What To Look Out For

As time goes by our pets settle into a routine of their own. New and somewhat odd behaviors need to be not only noticed, but for the benefit of your pet, addressed in a timely manner. Some new behaviors are harmless and developed out of preference while others are developed from pain. Take a look below at the examples the American College of Veterinary Surgery gives for possible causes of pain and signals of distress

Causes for pain may be:

• Physical trauma, such as falling down or being hit by something.
• Internal organ problems, such as intestinal upset or kidney blockage.
• Surgical procedures, such as abdominal surgery or bone surgery.
• Brain or spine problems, such as a slipped disc, pinched nerve or headache.
• Degenerative changes, such as arthritis and cartilage damage.

Our reaction to pain is seen as “pain behavior”. A child cries when he breaks his arm. A woman holds her head and squints her eyes when having a migraine headache. A man winces when he stands up on his bad knee. To an observer, these behaviors display pain in action. In the veterinary medical setting, we use these pain behaviors, common to each different species but unique in each different patient, to grade the pain experience.

Many owners are surprised to learn that their pet may be experiencing pain, since some pain behaviors are not seen in people. Common pain behaviors are:

• Crying and/or whining (dogs)
• Growling and/or purring (cats)
• Hiding (cats and dogs)
• Not grooming (cats)
• Squinting (cats)
• Glassy-eyed, vacant look (dogs)
• Hunched up body (cats and dogs)
• Restlessness and changing positions a lot (dogs)
• Not moving from one spot (cats)
• Irritable or aggressive (cats and dogs)
• No appetite (cats and dogs)
• Shaking and trembling (dogs)
• Protecting the hurting body part (cats and dogs)

For more information on pain and the management of pain, visit the American College of Veterinary Surgery. This excellent resource will lend you great information on many pet owner concerns.

www.WCVS.org
www.ACVS.org

Financial Aid

Our pets are more then just four legged animals, they are family. Below is an article provided by In Memory Of Magic , also known as IMOM, a charity whos mission statement is "Helping people help pets". This article features an option for emergency financial aid for crisis situations concerning your pets.

Financial Assistance From IMOM
http://www.imom.org/fa/index.htm

"Due to the current economic crisis and decline in donations, IMOM presently accepts applications for life threatening emergencies only. Life threatening emergencies are defined as follows:

A life threatening emergency exists when it has been confirmed in writing by a veterinarian that your pet will die or have to be humanely euthanized if care is not provided within ten days from the date of diagnosis.

You are understandably under stress and want to get through this process as quickly as possible. Everyone who volunteers for IMOM is well aware of that. We will always do our best to help you help your pet if you qualify. Unfortunately, it's not as easy as simply exchanging a few emails and IMOM sending a check to your veterinarian.

You need to take a deep breath and try to relax as much as you can. Following the steps as we have them outlined is not nearly as daunting as it looks.

There are no shortcuts. As you read through the step-by-step instructions please keep in mind that IMOM is a federally registered charity. We have to justify every penny we spend to the IRS, our donors and grantors. In order to do that we need to have complete files on each and every case.

If you follow our step-by-step instructions, making sure to send the proper documents, our financial aid committee can usually have an answer for you in less than two hours after receiving your application -- sometimes less. However, please keep in mind that sometimes we sleep or take breaks to :)

The bottom line is this -- we've been doing this since 1998 and we know what works. All of our volunteers know exactly what is needed to get your pet the care they need, if you qualify. We are here and ready to do our jobs but we are helpless if you don't do your part.

The reality

As much as IMOM would like to help everyone who comes to us, it is simply not possible. We are working with very limited funds and an overabundance of requests for help.

IMOM presently accepts applications for life threatening emergencies only. Life threatening emergencies are defined below:

• A life threatening emergency exists when it has been confirmed in writing by a veterinarian that your pet will die or have to be humanely euthanized if care is not provided within ten days from the date of diagnosis.

Click on "Financial Aid" then "Step 1" in the menu on the left side of this page to get started.

PS...

If you feel like it's just too much to read and too many documents to provide, you should know that since 1998 IMOM has help more than 1800 pets and paid out more than 1.5 million dollars to veterinarians nation wide. Our system works so that we are able to comply with the IRS and to help you help your pet."

Tracheal Collapse

Tracheal collapse is a chronic, progressive disease of the trachea, or windpipe. The trachea is a flexible tube and, similar to a vacuum cleaner hose, it has small rings of cartilage that help keep the airway open when the dog is breathing, moving, or coughing. The rings of cartilage are C-shaped, with the open part of the C facing upward. Between the two ends of the C is a long band of tissue- the dorsal membrane- that runs the length of the airway. In some dogs, the C-shaped cartilage becomes weak and begins to flatten out. Initially it becomes U shaped but, as the dorsal membrane stretches, the cartilage rings get flatter and flatter until the trachea collapses (Figure 1). The collapse can extend all the way into the bronchi- the tubes that feed air into the lungs, resulting in severe airway compromise in the animal. Figure 1. Diagram of tracheal collapse. Tracheal collapse is graded mild (Grade 1 = 25% collapse) to severe (Grade 4 =100% collapse). The trachea in dogs most often collapses at the thoracic inlet (green arrows) where the trachea bends to enter the chest. Initially dogs may present with a harsh dry cough that sounds like a goose honking. Coughing may occur when the dog is picked up or if someone pulls on its collar, since either may put pressure on the airway. As the disease progresses, the dogs may develop exercise intolerance or even turn blue with excitement. The strain of breathing may cause secondary heart disease. Some dogs may also have laryngeal paralysis along with tracheal collapse; the cartilages at the entrance to the windpipe will not open properly and the dogs will develop a wheezy noise when they breathe inward. Small breed dogs are most commonly affected with the disease, particularly Yorkshire terriers, Pomeranians, poodles, and Chihuahuas. Affected dogs are often middle aged or older, though it can be seen in some young dogs as well. Dogs that are overweight or that live in household with smokers may be more at risk or at least more likely to show clinical signs. Medical management includes weight loss, cough suppressants, antispasmodics or bronchodilators to reduce airway spasms, and sedation to reduce coughing and anxiety. Some dogs may require heavy doses of sedation to break the coughing cycle, since coughing will irritate the airway and lead to more coughing. Additionally dogs should be kept away from smoke and other environmental pollution (coughing may be even stimulated by smoke or other irritants brought in on clothing and hair). Dogs with infections are treated with antibiotics. Medical management may work for up to 70% of dogs, particularly those that have mild collapse. Some animals do not respond to medical management, however, and require surgical or interventional treatment. Collapse of the trachea in the neck or thoracic inlet- the front part of the chest where the trachea bends- is treated by surgical placement of plastic rings (Figure 6, 7) or spirals around the outside of the trachea. If the collapse is deep within the chest, it can sometimes be corrected by placing a stent- a spring like device- inside of the airway to hold the trachea open (Figure 8). Most dogs that receive stents will require ring placement in the neck or thoracic inlet region as well. Medical management is continued after the surgery, and most dogs are placed on a course of steroids to reduce swelling and irritation from the ring or stent placement. Owners must continue to keep their dogs thin and avoid exposing them to smoke or other airway pollutants. Also, they should use a harness that is specially made to fit low on the chest so that no pressure is put on the neck area when the dog is being walked. In winter months, a humidifier may help relieve irritation from dry, heated air. At this time there is no known prevention for tracheal collapse, although reducing weight or exposure to airway irritants such as smoke may help. About 70% of dogs that are treated with medical management alone will show some improvement. About 20% of dogs that undergo tracheal ring placement will require a tracheostomy- a temporary or permanent breathing hole in the neck. About 75% of dogs improve after surgical placement of rings. Dogs that are older than 6 years of age or that have laryngeal or bronchial disease have more complications and a poorer long-term outcome. Of dogs that receive stents, 95% are immediately improved and 90% are markedly improved at the time of recheck. Control of coughing is important for a good outcome, and dogs with bronchial collapse (and therefore continued coughing) are much more likely to have problems after stent or ring placement. This information on Tracheal Collapse and much more can be found on the American College of Veterinary Surgery's website! acvs.org

Patellar luxation

The patella, or knee cap, is a small bone buried in the tendon of the extensor muscles (the quadriceps muscles) of the thigh. The patella normally rides in a femoral groove within the stifle. The patellar tendon attaches on the tibial crest, a bony prominence located on the tibia, just below the knee. The quadriceps muscle, the patella and its tendon form the “extensor mechanism” and are normally well-aligned with each other. Patellar luxation is a condition where the knee cap rides outside the femoral groove when the stifle is flexed. It can be further characterized as medial or lateral, depending on whether the knee cap rides on the inner or on the outer aspect of the stifle.

Patellar luxation is one of the most common congenital anomalies in dogs, diagnosed in 7% of puppies. The condition affects primarily small dogs, especially breeds such as Boston terrier, Chihuahua, Pomeranian, miniature poodle and Yorkshire terrier. The incidence in large breed dogs has been on the rise over the past ten years, and breeds such as Chinese shar pei, flat-coated retriever, Akita and Great Pyrenees are now considered predisposed to this disease. Patellar luxation affects both knees in 50% of all cases, resulting in discomfort and loss of function.

Patellar luxation occasionally results from a traumatic injury to the knee, causing sudden non-weight-bearing lameness of the limb. It may also develop subsequent to cranial cruciate deficiency in dogs that will typically have a chronic history of lameness. However, the cause remains unclear in the majority of dogs. Congenital patellar luxation is no longer considered an isolated disease of the knee, but rather a component/consequence of a complex skeletal anomaly affecting the overall alignment of the limb, including:

• Abnormal conformation of the hip joint, such as hip dysplasia
• Malformation of the femur, with angulation and torsion
• Malformation of the tibia
• Deviation of the tibial crest, the bony prominence onto which the patella tendon attaches below the knee
• Tightness/atrophy of the quadriceps muscles, acting as a bowstring
• A patellar ligament that may be too long

You should seek veterinary surgical advice if you have any concern about the gait of your pet or if your primary veterinarian advises you to do so. The severity of patellar luxation has been graded on a scale of 0 to 4, based on orthopedic examination of the knee. Surgical treatment is typically considered in grades 2 and over:

Grade I	Knee cap can be manipulated out of its groove, but returns to its normal position spontaneously
Grade II	Knee cap rides out of its groove occasionally and can be replaced in the groove by manipulation
Grade III	Knee cap rides out of its groove most of the time but can be replaced in the groove via manipulation
Grade IV	Knee cap rides out of its groove all the time and cannot be replaced inside the groove

Thank you American College of Veterinary Surgery for making this information available for all who are interested!

Brachycephalic Syndrome

The American College of Veterinary Surgery has done a fantastic job at describing the Brachycephalic Syndrom. To put it simply, this syndrome deals with short nosed breeds of animals and their difficulty breathing due to the shape of their head, muzzle, and throat.

The signs and symptoms listed below is just a clip of ACVS's article.

"Dogs with elongated soft palates generally have a history of noisy breathing, especially upon inspiration (breathing inward). Some dogs will retch or gag, especially while swallowing. Exercise intolerance, cyanosis (blue tongue and gums from lack of oxygen), and occasional collapse are common, especially following over-activity, excitement, or excessive heat or humidity. Many dogs with elongated soft palates prefer to sleep on their backs. This is probably because this position allows the soft palate tissue to fall away from the larynx. The signs associated with stenotic nares and everted laryngeal saccules are similar."

Image on left is a stenotic which is malformed nostrils that are narrow or collapse inward during inhalation, making it difficult for the dog to breathe through its nose. Image on the right is a normal nose.

To see detailed photos and find out more on what happens during the physical exam, the treatment options, and the recovery period, visit their website by clicking here.

http://wcvs.org/

Signs, Test, & Treatment Options For Bone Tumors

When our pets feel ill or are facing serious health situations, it can be very stressful for the owner. We feel that the more information you know about what your pet is going through, the better you may help them and be prepared.

The four primary bone tumors are osteosarcoma, chondrosarcoma, fibrosarcoma, and hemangiosarcoma. 95% of bone tumors found in pets is osteosarcoma.

Signs & Symptoms

• Lameness and swelling of the affected bone.
• Generalized weakness.
• A swelling or mass is the first sign of a tumor, particularly the skull, jaw, and ribs.
• Respiratory difficulties with rib tumors.

Diagnostic Test

• Physical and orthopedic examination.
  
• Blood tests (complete blood count and serum biochemistry).
  
• Radiographs of the affected bone, chest radiographs.
• Computed tomography (CT) scans.
  
• Bone scan are recommended for dogs with a suspected primary bone tumor.

PHOTO: A whole-body bone scan of a dog with a tumor in the prostate. The bone scan shows multiple bright white areas, indicating of wide spread metastasis to bone.


Treatment Options

• Pain-killing drugs are usually effective initially, although stronger analgesic drugs or drug combinations may be required as the tumor progresses.
  
• Radiation therapy usually once weekly radiation for 3 to 4 weeks or once monthly.
• Surgery, the affected limb can be amputated if the bone tumor is very painful or fractured.

The vast majority of dogs will adapt very well after limb amputation, even if arthritic in other joints, overweight, or a large dog breed.

The photograph of the dog to the left was taken 6 months after a hind limb amputation for osteosarcoma.

This information was taken from the American College of Veterinary Surgery. More on bone tumors may be found in their article to pet owners by clicking here.

We hope you found this information helpful. If you have any questions, you may reach us at our office by calling 828.684.0019.

Hip Dysplasia Signs, Causes, and Treatments

One of the services we offer at Western Carolina Veterinary Surgery is help for Hip Dysplasia. We would like to highlight a great reference for hip dysplasia found on the American College of Veterinary Surgery website.

CANINE HIP DYSPLASIA Overview Canine Hip Dysplasia is a condition which begins in immature dogs with instability or a loose fit of the hip joint. The hip joint laxity is responsible for early clinical signs and joint changes. The abnormal motion of the hip stretches the fibrous joint capsule and ligament connecting the head of the femur to the pelvis, producing pain and lameness. The acetabulum (the hip socket) is easily deformed by continual movement of the femoral head. Causes Causes of hip dysplasia are considered to be multifactorial; including both hereditary and environmental factors. Rapid weight gain and growth through excessive nutritional intake may encourage the development of hip dysplasia. Mild repeated trauma causing synovial (joint lining) inflammation may also be important. Incidence and Prevalence The incidence of hip dysplasia is greatest in large breed dogs. Two populations of animals show clinical signs of lameness: (1) patients 5 to 10 months of age, and (2) patients with chronic degenerative joint disease. Signs and Symptoms The clinical signs of hip dysplasia are lameness, reluctance to rise or jump, shifting the weight to the forelimbs, loss of muscle mass on the rear limbs, and pain when the hips are manipulated. Dogs may show clinical signs at any stage of development of the disease, although many dogs with hip dysplasia do not show overt clinical signs. Some dogs are painful at 6 to 8 months of age but recover as they mature. As the osteoarthritis progresses with age, some dogs may show clinical signs similar to people with arthritis such as lameness after unaccustomed exercise, lameness after prolonged confinement, and worse problems if they are overweight. Risk Factors Risk factors for CHD include breed (genetic), rapid growth and nutrient excesses. When to Seek Veterinary Advice Some veterinarians recommend radiographing the hips at 6 months of age to help identify dogs with hip dysplasia early enough to perform a triple pelvic osteotomy. For many dogs, the owners seek veterinary surgery advice when the dog has been consistently lame, and has not responded to medical therapy. Many of the surgical treatments for hip dysplasia are performed by surgical specialists. Treatment Options Treatment depends on the dog’s age and degree of discomfort, physical and radiographic findings, and owner’s expectations and finances. Conservative and surgical options are available for juvenile and mature animals with hip pain secondary to hip dysplasia. Most immature animals are best treated with conservative or medical management. Although early surgical intervention with juvenile pubic symphysiodesis or triple pelvic osteotomy may increase the prognosis for long-term acceptable clinical function, approximately 75% of young patients treated conservatively return to acceptable clinical function with maturity. The remaining 25 % require further medical or surgical management at some point in life. In puppies less than 20 weeks of age, juvenile pubic symphysiodesis (JPS), a technique for stopping the growth of the pubis (part of the pelvis) may be performed to alter the growth of the pelvis and increase the degree of coverage of the acetabulum over the femoral head. Most puppies of this age do not show clinical signs of hip dysplasia, so diagnosis depends upon use of a screening technique for documenting hip laxity, such as Penn Hip, to determine which animals may be candidates for the procedure. Although specific criteria for application of JPS have not been developed, puppies under 20 weeks of age that have palpable and radiographic evidence of laxity on a hip distracted view can be considered for the procedure. Immature dogs (less than one year) with loose fitting hips, but no arthritic changes can be treated with a pelvic osteotomy (also sometimes called a triple pelvic osteotomy). This procedure involves cutting the pelvic bone in three places and rotating it to stabilize the hip joint and in many cases slow the progression of osteoarthritis.

More information and photos on Canine Hip Dysplasia may be found on the ACVS website.
Click here to view the report.