The Dog with the Titanium Bone

This entry is article 1 of 6 in the April 2013 issue

By Genevieve Rajewski

Tyson

Tyson, a seven-year-old Rottweiler, received limb sparing surgery at the Tufts University Cummings School of Veterinary Medicine after developing osteosarcoma, a bone tumor, on his left foreleg.

Photo by Alonso Nichols, Tufts Photo

Tyson could win an award for stoicism. Osteosarcoma, a common bone cancer so painful that medication doesn’t provide much relief, had invaded the 7-year-old Rottweiler’s left foreleg.

“Tyson used to love to go for walks, but slowly, he stopped going out,” recalls his owner, Rachna Khanna of South Glastonbury, Conn. “One day, we noticed he was limping. we thought maybe he had twisted something and took him to the vet to get an X-ray. That’s when they found a lump and the cancer in his limb.”

Amputation is the accepted treatment for this aggressive cancer. Dogs do not experience the same psychological trauma that people do after losing a limb, and most can race around happily enough on three legs. But amputation challenges dogs that already have mobility issues caused by severe arthritis or neurological disease, for example. And such heavyset giant breeds as St. Bernards,Newfoundlands, Great Pyrenees and Mastiffs often struggle after losing a forelimb because dogs bear most of their weight on their front legs.

Tyson had ligament tears in each  knee, and Khanna and her husband hoped to save his leg to avoid even more stress on his already-unstable joints.

Their research into alternatives led them to the Cummings School’s Foster Hospital for Small Animals, one of three veterinary hospitals in the country that offer a novel limb-sparing surgery for dogs. Earlier this year, Tufts orthopedic surgeon Michael Kowaleski, operated on Tyson, removing the cancerous bone and replacing it with a custom titanium implant. The procedure can be more successful than a bone implant or graft because there is a lower risk of infection, and dogs regain mobility quickly.

Tyson is once again going on walks and playing with his two younger canine housemates. “He still has a bit of limp,” says Khanna. “But he’s healthy and looking good, and we are so happy the cancer is gone.”

This story originally appeared in the Winter 2013 issue of the Tufts Veterinary Magazine.

Hermione

This entry is article 2 of 6 in the April 2013 issue
Hermione

Hermione on a follow-up visit gets a welcome ear scratch from Emergency/Critical Care Resident Dr. Yuki Tse after having her one leg bandage (down from all four) changed.

Hermione arrived in the Tufts veterinary emergency room on Thanksgiving evening after having been in a house fire that had destroyed her home and tragically claimed the life of the other cat in the household, Luna. Hermione had burns covering the bottoms of all four feet, her tail, the tips of her ears, and the skin on her nose and cheeks. She also had a cough secondary to smoke inhalation. Hermione was hospitalized in the intensive care unit and treated aggressively for her injuries.

Dr. Amanda Abelson, a Small Animal Emergency and Critical Care Specialist at Tufts, and one of the doctor’s overseeing Hermione’s care remembers that while in the hospital, it could be difficult to examine Hermione because when you went to see her, she would roll on her back for belly rubs and purr and purr. “I remember thinking to myself, here is this wonderful cat, she smells of smoke, she has terrible burns, she has been through a fire, she is away from her family, and yet she is always so happy for human company.” That is pretty rare for any cat in the hospital, let alone a cat that has survived a fire.

After a few days of hospitalization, Hermione was well enough to go home, however her burn injuries still required daily care. The difficult thing about burns is that it can be very hard to tell how severe the injury really is. You need to give the body a chance to heal on its own, and while you do that, you give it the tools it needs, like pain medications, good nutrition and hydration, and you protect the injured areas from further damage and infection with protective bandages.

“With Hermione, the burns on her feet were quite extensive, and we just couldn’t tell if she was going to be able to heal, or how long it would take for her feet to recover. I spoke with her owner and said it might be a bit of a rollercoaster ride while we wait for Hermione to heal, one day we might say things look really good, and the next we might say, we are not sure we can save her feet. But I told the family, if they were willing to give it a try we would do our best to save her feet.”

The other complicated thing about burn injuries that makes them unique is that often a family has been devastated by a fire and they have lost everything, making finances very complicated. In Hermione’s case, we were fortunate that a client of the small animal hospital heard about Hermione and her family, and asked to give anonymous financial assistance, taking some of the burden off of the family.

Given the seriousness of Hermione’s burns, and the anticipated duration of her recovery, a team of doctors was assembled to manage her case. This would assure that even though there were different doctors seeing Hermione, everyone would be working together and communicating on Hermione and her treatment. The team consisted of 7 critical care doctors, two surgeons and a dermatologist. The team was spear headed by 3rd year critical care resident Dr. Yuki Tse who organized Hermione’s visits to the hospital and kept individual team members up to date on Hermione’s status. Photographs were taken of Hermione’s feet so that members of the team could monitor her progress and these were emailed daily to the team members.

The team elected to treat Hermione’s feet conservatively with protective bandages. In the beginning non-pasteurized honey was put on the soles of her feet under the bandages. Honey has healing and antibacterial properties and is gaining popularity in the treatment burn wounds in people. The bandages were changed daily for the first two weeks but progressed to every other day bandage changes and then every third day. Hermione also had to have her tail amputated due to the severity of the burns along it. After two and a half months of bandages, Hermione’s feet have healed and she is doing very well at home.

Foster Hospital for Small Animals

A Very Thirsty Guinea Pig

This entry is article 3 of 6 in the April 2013 issue

Jennifer Graham, head of the Cummings School’s zoological companion animal medicine department, responds to a reader’s question about her parched guinea pig.

Q: Could my guinea pig be diabetic? He drinks 32 ounces of water a day and soaks his cage within a few days. If he is, is there any way to treat it?

A: That certainly is an excessive amount of water consumption for a guinea pig and may be an indicator of underlying disease, including kidney problems, dental issues and metabolic disorders such as diabetes.

I urge you to visit a veterinarian familiar with this species to have your pet undergo a thorough physical examination. your veterinarian will take a blood sample to check your guinea pig’s blood glucose levels and look for signs of infection or organ dysfunction.Further testing, including X-rays, may be needed to rule out urinary tract stones.

Diabetes mellitus is not particularly common in guinea pigs, but it has been reported. The good news is that the disease can be temporary, and insulin therapy is usually not necessary. A low-fat, high-fiber diet is most important in treating–and preventing–diabetes.

Until your guinea pig is seen by a veterinarian, pay close attention to what he is eating. Guinea pigs should always have access to high-quality grass hay, such as timothy, and water. Alfalfa hay and pellets shouldn’t be fed to adult guinea pigs, because they contain excessive amounts of calcium and can predispose these animals to obesity and bladder stones. Unfortunately, many diets commonly sold at pet stores contain alfalfa as well as seeds or dried fruit, which are also not appropriate foods for a guinea pig.


Please email your questions for “Ask the Vet” to Genevieve Rajewski, Editor, Tufts Veterinary Magazine at genevieve.rajewski@tufts.edu

This story originally appeared in the Winter 2013 issue of the Tufts Veterinary Magazine.

A Message from the Medical Director

This entry is article 4 of 6 in the April 2013 issue

A Message from the Medical Director: Welcome to our first client newsletter. At the Foster Hospital for Small Animals, we believe that a compassionate, team-based approach creates the best care for your pet.  By working with you and your referring veterinarian, our staff of board-certified specialists, certified veterinary technicians, residents, interns, passionate veterinary students and dedicated support staff develop treatment plans considering your goals for your pet.   We are animal lovers and understand how stressful it is to have a sick pet. In this bimonthly newsletter we will keep you posted on happenings at the hospital and also share a few helpful pet care tips.

Meeting your pet care needs is important to us. We recently conducted a client survey to find out how we are doing. We were pleased to learn that most people feel:

  • Our health care team treats your animal with the utmost compassion and care.
  • Our veterinary staff is top notch when it comes to being friendly and courteous.
  • Our doctors answer your questions well and explain things clearly.

You also told us about things we can do better, including:

  • Improve the speed and convenience of the checkout.  In response, we have added staff and adjusted procedures to allow for a quicker exit. We also have established a team between the veterinary staff and pharmacy departments to evaluate the checkout process on an ongoing basis.
  • Start appointments on time. We know your time is valuable, and we are working to ensure we are being realistic in spacing appointments so our doctors can spend the necessary time to collaborate with other specialists regarding your pet.

As with human health care, scheduling can be a challenge because emergencies arise at the hospital every day. We work hard to prevent these confounding issues from impacting you, but sometimes we need to adjust your pet’s appointment day or time.  We will do our best to communicate with you about these occurrences. We are designing a more robust website to help us communicate clearly about scheduling and expectations for your appointments. You can find information about what to expect during your visit, client rights and responsibilities, and interesting things to do in the Grafton area while you wait for your pet.

On behalf of all the caring professionals at Foster Hospital for Small Animals, I encourage you to speak directly with us about your concerns and needs for your pet. We strive to provide expert medical care for your pet and high-quality service to all our clients.  We care about your experience. Please contact our Client Service team at 508-839-5395.

Sincerely

Rentko signature-clean

Virginia Rentko VMD, DACVIM
Medical Director

Meet the FHSA Orthopedic Surgery Team

This entry is article 5 of 6 in the April 2013 issue

When a dog starts limping or has an abnormal gait, it’s natural to worry. If he’s limping, he’s in pain, and if he limps for more than a few days, it’s likely to result in the early stages of arthritis (inflamed joints). For dogs, arthritis is rapidly progressive, so if there’s persistent lameness for more than a couple weeks’ duration—even in young dogs, who can have arthritis too—it should be investigated by a veterinary specialist.

At Tufts Foster Hospital, we see trauma cases admitted through the emergency service and outpatient appointments. Let’s focus on outpatient appointments. Outpatient appointments most often begin with a referral from a primary veterinarian. We review your dog’s medical history and previous radiographs (X-rays); perform a complete gait evaluation, physical exam, and orthopedic exam; and keep your primary care veterinarian in the loop with written reports, updates, and other timely communication. When you bring your dog in, we’ll investigate causes for his poorly fitting or unstable joint. It could be a number of reasons: elbow dysplasia (commonly seen in labs and golden retrievers, even in very young dogs), which can usually be treated by arthroscopy in a minimally invasive manner; cranial cruciate ligament disease, usually treated with surgical stabilization; or hip dysplasia (widely known as a disorder in large- and giant-breed dogs, but it can occur in smaller dogs as well), treated medically and sometimes with total hip replacement, a surgery that we routinely perform. We work closely with other specialties at Tufts Foster Hospital, such as diagnostic imaging, to determine what’s ailing your dog and how we can help. By collaborating and using the expertise of our team of veterinary specialists, we improve the accuracy of our diagnostic and surgical procedures. The strength of the “Tufts bench”—its people and technology—ensures your pet receives the best care possible. For example, if your dog has a crooked leg, we can use a state-of-the-art CAT scan with 3D reconstruction of the bone to accurately measure the deformity. In the past, this would be accomplished with a series of two-dimensional radiographs (X-rays) that had to be interpreted together to get a three-dimensional sense of the deformity within the bone and to plan the surgery. Now, we can scan the normal and abnormal leg in one procedure. It takes less time and it’s more accurate. Many of these 3D reconstruction techniques were pioneered here at Tufts.

We’ll discuss all the benefits, risks, and details of possible treatment plans with you thoroughly and decide as a care team on the best course of action for your family. Your pet’s health and well-being is our top priority. We dedicate our lives to healing animals and advancing veterinary care to help make a difference in the lives of all species. We are driven to provide you with the most up-to-date and honest information available. You have our genuine and compassionate advice.

If surgery is the best plan for your companion animal, you’ll have the opportunity to meet beforehand with an anesthesiologist to determine which pain management method is best for your dog, and you’ll meet post-op with our trained technical staff as well. Tufts is unique in that we have board-certified anesthesia specialists in our hospital every day, so you can be assured your dog is getting the very best care before, during, and after surgery.

Tufts orthopedic surgeons are exposed to a robust case load. In fact, we are routinely called up to work on challenging and complex problems. Whether your dog has a rare orthopedic issue, or a more common ailment, we have the expertise to diagnose and treat the problem with the latest equipment, the experience to perform the surgery, and the knowledge that comes from working in a research-driven, world-class medical institution.

Our diagnostic and treatment approach is a team process that includes you, your primary veterinarian, and Tufts specialists. Your role in your pet’s care is important. Our goal is to make sure your dog is completely comfortable and home as soon as possible in a pain-free way. Our veterinary specialists and staff are more than happy to assist there as well.

If your dog is limping, it’s important to see a veterinarian. Learn more about what to expect at your orthopedic surgery appointment here.