FELINE PLASMA CELL PODODERMATITIS

okan 2

Dr Okan Kahraman

Case Presentation

 

Vet.Okan KAHRAMAN Greenpet Veterinary Clinic     İstanbul/Turkey

 

 

 

Signalament and History

. 3month unvaccinated female cat

. The cat licking the affected foot pads also smelling bad at foot pads sometimes lamess were observed

 

 

Pysical Examination

.All foot pads were affected

.Swollen,soft,ulcerated/erosions (also contaminated with bacteria )

.and some of them were paintful while pysical examination espacially whish one has ulcerated

.vital signs were completly well

okan 1

Picture 1

.photos (include each foot pads) ( Picure 1)

 

Laboratory results

. Just Leucocystosis other parameters were okay. FIV And FelV test was (-)

Differential Diagnosis.Plasma Cell Pododermatitis.FIV ,FelV.Autoimmune Dermatoses (pemhigus complex,lupus eryt.).Neoplasia

 

Diagnosis and Treatment.

Feline plasma cell pododermatitis .

prednisolon 1mg/kg X 2 PO (3 day ) after 3.

Day 4mg/kg Metilprednisolon asetat

S.c.cefovesin (convenia ) 8mg/kg S.C.

clindamycin 15mg/kg X 2 PO (5 day ) .

 

okan 3

Picture 2

After 10 days later Photos( Picture 2)

FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

index

Dr Adriana Moise

CASE PRESENTATION

  1. MOISE ADRIANA

TAZY-VET, BUCHAREST

 

SIGNALMENT AND HISTORY

  • FEMALE CAT , 2 YEARS OLD WAS PRESENTED FOR A CLINICAL EXAMINATION WITH HYPERSALIVATION , HALITOSIS, LACK OF APPETITE FOR PROCESSED DRY FOOD

CLINICAL FINDINGS

-THE CAT HAD NORMOTHERMIA AND A NORMAL BODY WEIGHT

-AT PHYSICAL EXAMINATION SHE PRESENTED ULCERATIVE LESIONS IN ORAL CAVITY, LOCALISED ON GINGIVAL MUCOSA, INFLAMATION ON PALATOGLOSSAL FOLDS AND PHARYNGEAL WALLS

-EDEMA WAS PRESENTED AND LOCAL LYMPHNODES WERE REACTIVE TOO

der2

photo 1

der3

photo 2

LESIONS WERE PRESENTED BILATERAL ( photo 1,2)

DIFFERENTIAL DIAGNOSTIC

-FELINE LYMPHOPLASMACYTIC GINGIVITIS-STOMATITIS COMPLEX

-FELINE CALICIVIRUS INFECTION

-FELINE HERPESVIRUS INFECTION

-FeLV-FIV

-FELINE EOSINOFILIC SINDROME

-NEOPLASIA

FURTHER INVESTIGATIONS

-FELINE CALICIVIRUS Ac –NEGATIVE

-FELINE IMMUNODEFICIENCY – FIV Ac-ELISA –NEGATIVE

-FELINE LEUCHEMIA –FELV Ag-ELISA – NEGATIVE

-THE CORONAVIRUS Ac TITRE – INCREASE

-CITOLOGY FROM IMPRESSION SMEAR – INCREASE NUMBER OF BACTERIA AND NUMEROUS ACTIVE INFLAMATORY CELLS

BLOOD TEST (BIOCHEMISTRY)  WAS NORMAL

-HEMATOLOGY REVEALS LYMPHOCYTOSIS

-CYTOLOGY AND HYSTOPATOLOGIC EXAM CONFIRMED THE DIAGNOSTIC – FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

 

DIAGNOSTIC

FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

TREATMENT

UNTIL WE GOT THE RESULTS THE OWNER BEGINS TO TREAT THE CAT WITH

-STOMODINE GEL TWISE A DAY, 14 DAYS

-CEFA CURE 20MG/KG/DAY, 10 DAYS

-SYNBIOTIC D-C 1CPS/DAY, 10 DAYS

-K9 IMMUNE SUPPORT CAT

 

-AFTER 10 DAYS OF TREATMENT THE INFLAMATION BEGAN TO REDUCE BUT THE ULCERS DO NOT HAVE THE TENDANCE OF HEALING

AFTER WE GOT THE DIAGNOSTIC THE CAT GETS THE FURTHER TREATMENT

-PREDNISON 2MG/KG/DAY, 5 DAYS; THEN 1MG/KG/DAY , 5 DAYS FOLLOWEDBY EVERY OTHER DAY

-STOMODINE GEL TWICE A DAY LOCAL

-HONNEY WITH PROPOLIS LOCAL

WHEN SHE CAME FOR THE EVALUATION AFTER 5 DAYS OF TREATMENT WE SAW THAT THE LESIONS HAD A TENDANCE TO REDUCE, BUT AFTER ANOTHER 5 DAYS THE LESIONS WERE EXACTLY THE SAME AS THE BEGINNING

-WE DECIDED TO INTRODUCE CYCLOSPORINE IN THE TREATMENT

-CYCLOSPORIN 7MG/KG/DAY

derder1

-THE CAT IS PERMANENTLY MONITORIZED ; HLG IS MADE EVERY 2 WEEKS

-AFTER 2 WEEKS OF TREATMENT THE LOCAL INFLAMATION BEGINS TO REDUCE

-AFTER 1 MONTH OF TREATMENT THE LESIONS FROM ONE SIDE WERE HEALD

-THE CAT IS STILL UNDER TREATMENT

-THERE IS NO SIGN OF SECOND EFFECTS OF CYCLOSPORINE

 

Bacterial species isolated from cats with lower urinary tract infection and their susceptibilities to cefovecin

16712035_1830518720555067_8623029219772829783_n

Dr Banu Dokuzeylül

Banu Dokuzeylül1, Beren Başaran Kahraman2, Alper Bayrakal1, Belgi Diren Siğirci2, Baran Çelik2, Serkan Ikiz2,
Abdullah Kayar1* and M Erman OR1

Abstract

Background: The aim of this study was to determine the bacterial species recovered from 61 cats with lower
urinary tract infection (LUTI), and their susceptibility to cefovecin in vitro.
Results: The clinical signs and final clinical diagnosis for cats with confirmed LUTI were also reported. After physical
examination of the cats, urine samples including ≥5-6 leucocytes in microscopic evaluation were cultured using
bacteriological techniques. The isolates were identified by conventional microbiological methods and tested for
in vitro susceptibility using the Kirby-Bauer disc diffusion method recommended by the Clinical Laboratory Standards
Institute. Bacterial growth was observed in 16 of 61 urine samples. Antimicrobial susceptibility tests showed that 13 of
16 (81%) isolates were susceptible to cefovecin. The most frequently isolated bacterium from cats with signs of lower
urinary tract infection, was Escherichia coli.
Conclusion: Cefovecin was found to be effective in cats with LUTI. Because cefovecin is a new antimicrobial agent in
veterinary medicine, there are only few studies about urine culture of cats with LUTI. It is the first study on in vitro
activity of cefovecin against bacterial isolates from cats with lower urinary infections in Istanbul, Turkey.
Keywords: Cat, Urinary tract infection, Urine culture, Antimicrobial susceptibility, Cefovecin

 

Background
Lower urinary tract infections (LUTI) are rarely seen in cats, dogs and human beings. Various lower urinary tract
disorders can predispose to opportunistic infections as a complication of the underlying disease or its treatment,
while bacteria can be the initial cause [1]. Urine culture is the gold standard used to confirm the diagnosis of urinary tract infection (UTI). The urine sample used for this purpose should be obtained by cystocentesis to avoid bacterial contamination from the lower urogenital tract flora [2]. In urinary tract infections of cats and dogs, the most
commonly isolated bacterial species were reported as Escherichia coli, Proteus spp., Staphylococcus spp. and Streptococcus spp., although the prevalence of the various species varied considerably [3,4]. Cephalosporins belong to the beta-lactam group of antibiotics and they are originally derived by hydrolysis from the natural compound of Cephalosporin C. This class is bactericidal and acts by inhibiting the synthesis of the peptidoglycan
layer of the bacterial cell wall through binding to the penicillin binding protein (PBP) [5]. Cefovecin sodium [Convenia®; Pfizer Animal Health; USA] is a newly developed, semi-synthetic, extended-spectrum injectable third-generation cephalosporin administered at 8 mg/kg subcutaneously (SC) for the treatment of
UTI and skin and soft tissue infections in dogs and cats and it has been approved for subcutaneous (SC)
injections in cats since 2006 in EU and 2008 in USA [4,6-9].Third generation cephalosporins are generally less active
than members of the first or second generation formulations against gram-positive organisms (e.g., Streptococcus
spp. or Staphylococcus spp.) [5]. Stegemann et al. [4]have reported that cefovecin showed good activity
against Gram-negative organisms isolated from dogs and cats, including Escherichia coli, Pasteurella multocida,
Klebsiella spp. (including K. pneumonia), Enterobacter spp. and anaerobic-growing pathogens Fusobacterium spp.,
Bacteriodes spp., Prevotella oralis. However it was not effective against most Pseudomonas aeruginosa isolates.
The aim of this study was to determine the bacterial species recovered from cats with LUTI, and their susceptibility
to cefovecin in vitro. The clinical signs and final clinical diagnosis for cats with confirmed LUTI
were also reported.

Methods
Samples
In this study, 90 cats with one or more urinary clinical signs such as stranguria, haematuria, pollakiuria, inappropriate urination, excessive licking of the genital area and frequent and/or prolonged attempts to urinate were physically examined at the Department of Internal Medicine,Faculty of Veterinary Medicine, Istanbul University and
their anamnesis was gathered. Complete Blood Count(CBC), blood serum biochemistry (Serum glucose, blood
urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and urine analyseswere performed in all patients. Twenty-nine cats were excluded from the study because antimicrobial treatment had already commenced in private veterinary clinics prior to our physical examination. Sixty-one cats with no antimicrobial treatment and including ≥5-6 leucocytes in urine microscopic examination were included in the study.The examination focussed on the presence of pyuria (≥5 white blood cells/high magnification (40x objective; highpower field, (hpf)) which were indicator of LUTI. The cats in the sample group were from different breeds: mixed (n:38), Persian (n:11), Siamese (n:5), Turkish Van (n:3), Turkish Angora (n:4). Forty-one cats were male, 20 catswere female. Five of the cats were one year old or younger, 38 between 2–7 years old and 18 were 8 years old or older. Samples of 5 ml of urine were collected by ultrasoundguided cystocentesis. Cats were restrained in lateral recumbency, the caudal abdomen area was cleaned with alcohol then the needle was inserted. Urine samples
for culture and antimicrobial susceptibility tests were sent to the laboratory within 1 hour, stored in cooling
boxes.Medical imaging Abdominal radiography and ultrasonography were also performed to diagnose underlying urinary diseases/disorders of the cats. Abdominal ultrasonography was performed using a 3.75-MHz convex transducer (Schimadzu 350-A,Shimadzu Corporation, Kyoto, Japan).

Culture
The samples were sent for bacteriological examination to the Laboratory of the Microbiology Department of
Istanbul University, Faculty of Veterinary Medicine. Urine samples were inoculated onto nutrient agar supplemented with 7% sheep blood (blood agar) and MacConkey agar plates. While the MacConkey agar plates were incubated aerobically, the blood agar plates were incubated under aerobic and microaerobic conditions at 37°C for 7 days.The colonies were examined macroscopically and then microscopically using Gram staining. Biochemical identification was performed by conventional methods and all the isolates were confirmed with API systems (BioMérieux, SA, Marcy I’Etolie, France) [10,11]. A bacterial count of more than 103 cfu/ml was considered diagnostic of UTI [9]. Cultures with no growth after 7 days were interpreted as negative.

Antimicrobial susceptibility tests

The antibiotic susceptibility tests were performed according to the Kirby-Bauer method recommended by
the Clinical Laboratory Standards Institute (CLSI) to select the optimal antimicrobial agent for treatment [12].
The zone of inhibition around the disk (30 μg cefovecin) was measured. The inhibition zone of ≥ 23 mm was considered as susceptible, while 20–22 mm as intermediate and ≤ 19 mm as resistant [6,12].banu

Statistical analyses
The results were analysed with the SPSS 13.0 programme. The Chi-squared test was used for the comparisons of
gender groups and age groups with respect to bacterial growth. Differences were considered significant at
p < 0.05.

Results
Clinical signs
The most common presenting clinical signs of bacterial lower urinary tract infection in cats were pollakiuria (n = 41)
followed by stranguria and haematuria, respectively. Clinical disorders associated with lower urinary tract signs
Disorders and the number of cats involved are given in Table 1. Sixteen culture-positive cats were diagnosed
with the following conditions: urethral plaque (n:4), feline idiopathic cystitis (n:1), haemorrhagic cystitis
(n:2), bladder stones (n:1), acute renal failure (n:3), chronic renal failure (n:2), diabetes mellitus (n:1), other diseases
(n:2). The final diagnosis was reached following anamnesis, physical examination, blood and urine analysis, medical
imaging and urine culture.banu1

Complete Blood Count (CBC) and blood serum biochemistry
All the animals in the study were found to be within the normal range of CBC parameters. At the same time,
leucocytosis was not observed in 16 culture-positive cats. Biochemical blood serum values (Serum glucose, blood
urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase) were determined for every patient.
In our study, these parameters were found not to be significant.
Medical imaging
Blood clot formation was seen in the urinary bladder in cats diagnosed with haemorrhagic cystitis. The echogenicity of the clots was variable (hypo- to hyper-) and the bladder wall was thickened. Bladder stones were seen hyperechoic
and distal shadows were detected. The bladder wall was also thickened in cats diagnosed with renal failure and cystitis. No abnormal findings were seen in cats with urethritis.The sonographic appearance of transitional cell carcinoma was irregular, its shape was irregular and the echogenicity seemed non-homogenous. The ultrasonographic findings are compatible with our diagnosis.
Urine analysis microscopic evaluation
Leucocyte numbers detected by urine microscopic evaluation are summarized in Table 2. Bacterial growth was observed in 16 of 61 (26.2%) cats urine samples with a leucocyte count ≥ 5–6 leucocytes
(Figure 1). All the isolates were pure cultures.

Bacterial growth and susceptibility testing

Bacterial growth was observed in 5 of 20 (25%) urine samples of female cats and in 11 of 41 (26.8%) samples of male cats (p > 0.05). Three in five cats (60%) with bacterial LUTI were 1 year old or younger, 9/38 (23.6%) 2–7 years old and 4/18 (22.2%) 8 years old or older (p > 0.05). In this study, no significant difference was found between female and male cats with bacterial LUTI (p = 0.879). The differences among age groups were also not significant
(p = 0.200). Antimicrobial susceptibility tests results showed that 13 of 16 (81%) isolates were susceptible to cefovecin. E. avium and S. epidermidis isolates were resistant and Arcanobacterium renale isolate was intermediate.banu2

Discussion and Conclusions

Incorrect therapy of urinary tract disease, overuse and misuse of antimicrobials can have negative effects on patient
health (e.g. failure to resolve infections), the allocation of resources (e.g. need for repeated or prolonged
treatment), and public health (e.g. antimicrobial resistance) and may raise regulatory concerns (e.g. antimicrobial use)[13]. The antimicrobial activity of cefovecin is similar to that of other cephalosporin antibiotics, which share low
toxicity and good activity against many Gram-positive and Gram-negative aerobic bacteria [6]. Bacterial urinary tract infections (UTIs) in cats are relatively rare [14]. Studies of cats with clinical signs of lower urinary tract disease (dysuria, stranguria, pollakiuria) have consistently shown that the overall prevalence of positive bacterial urine cultures is <3% [2,15]. Some studies have reported much higher prevalence rates (15–43%) in cats that have their urinary tract defence mechanisms compromised by the effects of other diseases and/or by the treatment [2]. In this study, bacterial growth was observed in 26.2% of cats’ urine samples with ≥ 5–6 leucocytes. Our findings confirm to a
large extent to the results reported by Weese et al. [15]. Bacteriuria is generally seen in older cats [16]. In our
study, the percentage of young cats (≤1 years old) was highest. Most of the younger cats in our sample group
spent time both indoor and outdoor. They generally hunted and usually drank water from flower bowls and
ponds. These risk factors and their close contact with stray cats, may have contributed to the high prevalence
of urinary problems in this age group compared to indoor and older cats. Urine analyses were shown to be a useful indicator for UTIs. The most commonly isolated bacteria of cats with urinary tract infections were reported to be Escherichia coli, Enterococcus spp., Staphylococcus spp. and Streptococcus spp. [4,6,9]. Our results support these findings.
Proper and timely diagnosis is critical for the treatment of lower urinary tract infections as well as for the
selection of appropriate antimicrobials and drugs. Cefovecin has been specifically developed for the animal
practice as a long-acting third-generation cephalosporin with duration of action of 14 days. Stegemann et al. [4]
reported that cefovecin exhibited a broad activity against a range of Gram-negative pathogens and was not active
in vitro against P. aeruginosa. Wernick and Müntener [5] have reported that cefovecin showed no bactericidal
activity against Enterococcus spp. but it is active against Arcanobacterium renale. Our results (81% of isolates
susceptible to cefovecin) are in agreement with these findings. However, E. avium isolate was found to be resistant,
and Arcanobacterium renale isolate to be of intermediate susceptible to cefovecin. Stegemann et al. [4] reported that cefovecin was not appreciably active against Enterococcus spp., although in this study E. faecalis
isolates were found to be susceptible in vitro. While literature suggests good activity of cefovecin against coagulasenegative staphylococci, in this study S. epidermidis isolate
was resistant to cefovecin [4,8]. It is known that antimicrobials are the cornerstone of LUTI therapy. Despite the high cost of cefovecin in Turkey, its effectiveness and usefulness have been discussed in this study. Cefovecin is one of the antimicrobial agents that can be used in lower urinary tract infections and it is easy to administer a single injection.

Scabies incognito in dog

stef artStroe Marina- Ștefania

6-th year student at FMVB, Faculty of Veterinary Medicine of Bucharest

Rottweiler dog, 1 year old, male, intact develop intense pruritus, mild erythema, crusts and less-hairy skin on the phalanges, hocks; no other cutaneous lesion than this diffuse erythema.

  • Other differentials (demodicosis, dermatophytosis, contact dermatitis, Malassezia dermatitis, hipersensitivity).
  • Pinnal-pedal reflex: rubbing of the ear margin and may obtain a scratch reflex.
  • The pinnal-pedal reflex in this case was positive
  • Microscopy

Superficial skin scraping: negative but false-negative results are commnon because mites are extremely difficult to find.

derm3

Macroconidia Alternaria alternata

derm2

Eggs/ova mites

Deep skin scraping: negative (for Demodex).

derm4

Malassezia spp.

Scotch test: detection of eggs/ova mites Sarcoptidae like, derm5 derm6Malassezia 8/OIF, bacterial cocci, macroconidia Alternaria alternata.

Serology (ELISA): detection of IgG antibodies against Sarcoptes. This is highly specific and sensitive test but false-negative results can occur. In this case the test was negative.

 

Diagnosis: “Scabies incognito”

 

Treatment and prognosis

  • Topical treatment applied to the entire body two times per week, 4-6 weeks. Bathing with a shampoo that contain chlorhexidine and antifungal (ketoconazole) – KetoHexidine shampoo 1%ketoconazole, 2%chlorhexidine.
  • Omega 3 and Omega 6 fatty acid supplements, which reduce inflammation and itching – Megaderm >10 kg, 1 dose/day, 1-2 months.
    • Systemic treatment with Ivermectin: 300-400 mcg/kg po or sc, once weekly for weeks. I use this scheme for 5 administration.
    • Recheck: progress, hair regrowth, decrease of the lesions.
    • The prognosis is good. S. scabiei is a highly contagious to other animals and to humans.

 

 

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

daniDr Daniela Bajenaru

Tazyvet veterinary clinic

Bucharest, Romania

 

Singalment and hystory

 

Bella, presented on 12/13/2016

10 year old, female, Labrador retriever

5 month history of polydipsia, polyuria, polyphagia and pruritus

 

Physical examination

 

Abdominal enlargement

Palpable hepatomegaly

Thin, hypotonic skin, easy bruising

Phlebectasias

Erythema

Calcinosis cutis over the dorsal neck, thorax and rump

Bacterial pyoderma

 

 

 

6 1 unnamed7

 

 

 

8 9 4 10

Investigations

Ultrasound

Urinalysis

Coagulation time

Serum chemistry panel

Trichogram, scoch test

Bacteriological examination

ACTH stimulation test

 

Laboratory results

Ultrasound- hepatomegaly

Urinalysis – low specific gravity (1.005)

Coagulation time – 5’

Serum chemistry panel: GPT -361,  ALP>1980, CHOL- 215, CREA -0,587, UREA -25,2

Trichogram/ scoch test – no significant findings

Bacteriological ex. – Staphylococcus aureus  (++++)

Basal cortisol level  > 10 µg

ACTH stimulation test – cortisol= 29,4 µg/dl

Diagnosis

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

SUSPICION: PITUITARY DEPENDENT

 

Treatment

TRILOSTANE -120 mg once daily

Amoxicillin with clavulanic acid -12,5 mg/kg/12h, 30 days

Probiotics

Topical: – moisturizing and desinfectant shampoo, once weekly

– antiseptic, anti inflammatory and healing gel, once daily

EFA supplements

Diet: low fat

EVOLUTION

After 3 days of topical treatment

15

After 3 days

Basal cortisol level      > 10 µg/dl

13

After first bathing

 

 

Bella1

21

After 7 weeks basal cortisol – 5,3 µg/dl

22

After 7 weeks basal cortisol – 5,3 µg/dl

Bella3

The evolution to be continued ….

How to start up an exotic animal department in your private clinic

ama

Dr Ama Groza Mrcvs

If you have already realised that providing high quality veterinary medicine services to exotic pets can increase your turnover and enhance clientele then let me congratulate you! This article will give you an easy step-by-step guide to follow in order to make the best of your new venture.

Have you wondered why so few vets are seeing exotics? Some frequent explanations include:

  • Most vets get little training in caring for exotic pets and as a consequence they get stressed when having to see an exotic pet. Many clinicians will refuse to see them unless it’s a first aid situation and the ones that do, probably won’t generate sufficient income to cover their time.
  • If surgical intervention is required, the price for the time spent with an exotic animal, a rabbit for example, is almost half that compared with the same time spent caring for a dog or a cat.

It is no surprise that exotic animal medicine is not high on the preference list of any sensible practice owner. But this is because you’ve been doing it all wrong!

These steps will guide you in starting up a successful exotic animal department in your clinic.

 

  1. Don’t cut corners, practice good quality medicine

The slogan “Gold standard practice” is unfortunately overused these days. Many practices advertise gold standard protocols, however these apply to dog and cat patients only. When it comes to seeing an exotic pet, basic investigations like a simple blood sample or a faecal test are often not even offered to owners and this is where the clinic is losing money and clients.

Through having your staff trained and consequently confident in carrying out specific procedures on exotic pets this will not be the case.

Protocols for different alignments should be in place for exotic animals as well as for small mammals to secure the best care for all pets. Having protocols in place will facilitate a fast treatment set-up at the best standard, easily followed even by inexperienced vets when there’s no support around.

There are a wealth of specialised procedures to be carried out on exotics and trained veterinarians and/or nurses will be able to offer all this to customers, generating more income for the practice.

Encouraging best care practice will stimulate your staff to keep up to date with their training; practice high standard procedures and good outcomes will not stay unnoticed for long. As a consequence more owners will register with your practice. Your staff will be delighted to be at the top of their job taking pride in what they do.

 

  1. Train your staff

Having your staff trained into caring for exotic animals their procedures can be fast, successful and stress free. Because major differences exist between exotic and small mammals, one must have specialised training in order to be able to look after exotics.

Knowledge and confidence is what you need in your team. Offering a generous list of fairly priced specialised procedures will generate more work for the practice and can only be an asset comparing with your competitors (I will return to this later in this article).

Naturally, trained staff will exude confidence and gain owners trust. Consequently, owners will be more likely to agree to more high risk or specialised procedures which they might otherwise hesitate upon; again, thus increasing your revenue.

Practices with trained staff to care for exotics are scarce, so letting your customers know what your team can do and what their level of training is, will not only serve to retain existing clients but will also attract new customers to the practice, and these new customers will often have more than one pet. And who doesn’t like a growing client base?!

 

  1. Charge a fair price for your services

Establishing a fair price is the key factor in setting up your business for failure or success.

Firstly, it is important to understand that there is no relation between the purchase price of a pet and the costs for its medical treatment.

Some people will adopt stray dogs and request for expensive laparoscopic rather than traditional neutering. No surgeon would hesitate to give them an accurate estimate. However when contemplating performing a tortoise spay, most surgeons will doubt the owners’ willingness to accept the surgery as a first option because of the costs involved. However, this is only our assumption!

pic 1

I always try and explain before an estimate that the medicines and consumables we use are the same price for all pets. My practice overheads are the same regardless of whether I work with dogs or parrots so why should my work time be priced up differently?

Set your pricing to charge fairly for your time, your assistants’ time, the materials used and not least for your skill.

Pricing all  materials used (like catheters, swabs, gloves etc.) separately will show owners how much the consumables cost, otherwise owners have no idea how much an urinary catheter is and not giving them a detailed bill can lead to confusion. Pricing of the consultation fee should cover time spent with the client and overhead costs such as rent, electricity, water etc. Pricing for the individual procedures carried out (like “placing an IV catheter” or” blood collection”) must cover your salary costs and the cost of ongoing training. The message here is that all costs should be factored in rather than just absorbed.

To your advantage is the fact that few veterinary surgeries offer good quality medicine for unusual pets. If you are clearly the best at it, you have little competition. There is nothing inherently wrong with being expensive but you should not forget that this approach requires continuous training and investment in equipment.

My experience has shown that owners shopping around for price rarely become good, loyal clients. They will always be difficult to convince to agree to investigations and will be likely to complain more if things don’t work out immediately (this is natural, because they can’t afford to spend more money for further tests if needed). The question is not whether you need these clients, but whether you can afford them. Charitable care organisations might be more appropriate for financially challenged clients.

pic 22

This is a baby Russian tortoise (Agrionemys horsfieldii ), has a lifespan of 75 years

Customers shopping for quality and excellence in veterinary care will be yours for life and will pay fairly for your services because they understand and appreciate your approach. Make this group your target clientele and your efforts will pay off.

 

pic 2

This is a replica cake of a Russian tortoise (Agrionemys horsfieldii ), it survived for 1 day”

  1. Facilities

Working with exotic pets requires that some adjustments to the hospital facilities and dispensary are made. Exotic pets are escape artists, easily stressed and some of them are poikilothermic, will need special hospitalisation facilities like a vivarium or even an incubator. With a modest budget you’ll be able to adjust your clinic to their needs (to keep costs down you can consider buying vivariums, loupes or surgical instruments second hand).

Most medication used is similar to that for small mammals, however, be aware that dosage is not, so be careful and make sure to consult your exotic medicine library.

pic 3

My favourite books which I have always at hand

ARAV.ORG, AAV.ORG  , AEMV.ORG are prestigious, reliable sources of information, so do invest in membership to this organisations. This will give you access to updated care sheets, up to date research data, specific event information and most important, a lot of colleagues to get in touch with in case you need advice on your cases.

 

  1. Advertise

There’s not much gain, except of course personal gain, in being very good at your job if nobody knows about it. In order to keep the business going one should make sure existing and prospective clients know about the range of services the clinic is offering.

You could periodically inform clients about any new equipment purchased and about what training your staff has undertaken. This will not only act as a “refresher” on what your service offering is but will also spread by word of mouth. You may be surprised to find how much impact the users of specialised forums have when a new exotic pet owner is looking for a knowledgeable vet. Make sure your name appears there, next to a good review of course.

Always remember to keep your colleagues informed about your services. Referral cases are a good source of income and a great way of practicing your specialist skills. Organizing open days and continual professional development courses will keep you on the radar of colleagues and clients alike, they should know that you exist and are doing well.

An unusual pet can easily become a news subject and this can get you free advertising. Don’t be shy, let the world know about your successful cases, consider local newspapers, TV and radio as well as social media.

  1. Stay at the top

Don’t ever stop learning.

Exotic animal medicine is developing fast, trends are changing and new protocols are being elaborated at an incredible speed. Refresh your library (very important: change your Carpenter’s Exotic Formulary with any new edition) periodically.

Re-evaluate your protocols every year, attend refresher courses, learn new surgical procedures, and stay updated. When you are the best you can be, you have no competition other than yourself.

Enjoy your success!

16603144_264440650646201_7165809784550866666_n

Next event of Dr Ama Groza, soon in Bucharest, Romania!

 

Resection of a chest wall mass- surgical technique and peri-operative analgesia

12959354_10153530931267960_1853416198_o-200x300

Dr Vladislav Zlatinov

Corresponding authors :

Dr. Vladislav Zlatinov, Dr. Aglika Yordanova (Clinical pathologist), Dr. Nadejda Petrova (Anaesthetist)

 

Central Veterinary Clinic

Chavdar Mutafov str, 25 B, Sofia, Bulgaria

 

Introduction

 

Rib tumors are uncommon in small animals. Osteosarcoma (OSA) is the most common (73%). Other types include chondrosarcoma (CSA), fibrosarcoma (FSA), hemangiosarcoma (HSA).

Rib tumors tend to occur in large breed dogs and the usual location is in the costo-chondral junction. Radiographic changes include lysis, sclerosis, or a mixture of lytic and blastic patterns. Intra-thoracic invasion of adjacent pericardium and lung lobes is relatively common, so CT scans are recommended to determine the location and extent of the tumor, planning of the surgical resection, and clinical staging for pulmonary metastasis1.

 

Chest wall resection is recommended treatment for the rib tumors 2. The surgical approach is the identical to intercostal thoracotomy, but caudal and cranial margins include a minimum of one intercostal space and rib, while ventral and dorsal margins should be a minimum of 2 cm from the tumor.  Because of the large defect present, a need for autogenous and/or prosthetic reconstruction techniques is often necessary. Autogenous reconstruction techniques include the latissimus dorsi and external abdominal oblique muscles, and diaphragmatic advancement following resection of caudal rib tumors 3. Prosthetic reconstruction with non-absorbable polypropylene mesh, alone or in combination with autogenous techniques, is recommended for large defects. Autogenous reconstruction is preferred in humans because of a high complication rate associated with prosthetic mesh, such as infection and herniation. These complications are rarely reported in dogs following chest wall reconstruction with prosthetic mesh. Up to six ribs can be resected without affecting respiratory function in dogs 4.

Thoracic surgery in small animals is considered a painful procedure, resulting in alterations in pulmonary function and respiratory mechanics. Appropriate analgesic protocol may improve outcomes. Systemic administration of opioids and NSAIDs, intercostal and intrapleural blocks, and epidural analgesia are among the most common options for pain management after thoracic surgery in small animals 5.

 

 

Case report

 

A 10 years old male pitbull dog, weighting 24 kg was presented to us. The owners had been to three veterinary consultations before, the chief complaint being lameness at the right front limb. The cause was suggested to be a “lump” on the right thoracic wall. Based on an X- rays study and clinical examination, so far the owners were discouraged to pursue the further surgical treatment, because the procedure was supposed to be too aggressive and painful. The dog was prescribed palliative NSAIDs therapy.

 

 

Clinical examination

 

Fig1

Fig.1

We did a thorough clinical exam, revealing normal behaviour, good over-all body condition; signs of multiple joint arthritic diseases were found- elbows and stifles decreased ROM and capsules thickening. On the right cranio- ventral thoracic wall we found protruding, egg- size oval mass, widely and firmly connected to the rib cage (Fig.1).

 

 

 

Diagnostics

 

Radiograph of the right elbow revealed advanced elbow arthritic changes.

Fig 2

Fig.2

Additionally, orthogonal thoracic radiographs (+ oblique one) were done, demonstrating large infiltrating mass, with heterogenous lytic and proliferative mineralised pattern, originating at the costo-chondral junction of the 4-th rib (Fig.2).

 

 

 

 

 

unnamed

Fig.3

A fine needle aspiration was done and evaluated (Fig.3).

The pathologist remarks:

“Clusters of  fusiform mesenchymal cells, with obvious signs of malignancy- pleomorphism, increased anisokaryosis and anisocytsosis, basophilia, multinucleated cells . Occasional osteoclasts, macrophages and neutrophils were noted. No osteoid/chondroid was found in the examined material. The tumor was classified as malignant mesenchymal– fibrosarcoma, chondrosarcoma or osteosarcoma.”

 

 

Fig4

Fig.4

A computer tomographic study was accomplished and the mass’s margins investigated carefully. A mineralised tumor centre (from the distal third of the 4-th rib) was found; also soft tissue aggressive expansion in the neighbour intercostal spaces -3-th and 5-th. Typically for the chest wall masses, there was an eccentric growth- the 2/3 of the mass volume protruding into the throracic cavity, extruding the pulmonary parenchyma and contacting the heart on the right side. No lung metastases were noticed on the scans (Fig.4, video 1).

 

Complete blood work was done and found normal. Including normal Alkaline Phosphatase level, considered favorable prognostic factor.

 

After a discussion with the owner, a decision for surgical resection was made.

 

 

Anesthetic protocol

 

Premedication with Medetomidine and Butorphanol was used, followed by Propofol induction. The maintenance was sustained by Isoflurane and Ketamin drop in the fluid sack.

 

Peri-operative analgesia, Anesthetists remarks

 

fig 5

Fig.5

fig 6

Fig.6

The thoracic wall resection is considered very painful procedure, so a corresponding analgesic strategy was built and applied. A continuous post operative segmental epidural analgesia application was provided. T13—L1 epidural puncture (by Tuohy needle), was done and an epidural set catheter (B. Braun) was inserted till the 5-th thoracic vertebra(Fig.5-6). The catheter was safely attached and maintained for 48 h post op, during the patient’s stay in the clinic. The agent delivered through, was Levobupivacain (0,5 %), one 1ml every 4 hours, including pre op.

 

 

After the mass removal, a soaker catheter was sutured at the ribs resection edges; another one was applied between the skin and muscle flap, covering the defect. Both catheters were connected to an elastomeric pump (B. Braun), delivering locally 5 ml/h of 1% Lidocain for 96h (including outpatient period) post operatively.

 

The rationale behind additional soaker catheters was to suppress maximally the nociception transfer, including the sensation through the non- blocked cervical spinal nerves. Also we contemplated- removal of epidural catheter at the time of discharge, but leaving the delivery pump, providing residual local analgesia.

 

Cimicoxib (Cimalgex) was prescribed for 10 days post op. No opioids were used in the recovery period.

 

 

 

Surgical protocol (surgeon remarks)

 

Fig7

Fig.7

Fig 8

Fig 8

Fig 9

Fig 9

fig10

Fig10

After macroscopic mapping and drawing, a rectangular shaped, full thickness (skin, muscle, ribs and pleura) en bloc excision was done (Fig.7).  This included partial ostectomy of 3-th, 4-th and 5-th ribs. Caudal intercostal thoracotomy was performed first, permitting evaluation of the intrathoracic extent of the tumor. Special attention was applied at the proximal approach to ligate safely the three intercostal arteries and veins. No visceral lung pleural or pericardium adhesion were noticed. Careful electrocautery haemostasis was done at the muscles’ cut edges.  The removed mass was macroscopically evaluated for “clean” margins, and a reconstruction of the large defect was preceded (Fig.8). A double (folded) polypropylene mesh (SURGIPRO®TYCO) was sutured to the wound edges, using simple interrupted pattern (3-0 PDS material). A latissimus dorsi muscle flap was advanced to cover and “seal” the defect (Fig.9). The air content was evacuated with aspirator on the final closure; no chest drain was left in the thorax. Two soaker catheters were applied in the wound; the skin was closed by double pedicle advanced flap technique and simple interrupted pattern (Fig.10).

 

 

 

 

Post operative care and follow up

 

 

 

Fig 11

Fig. 11

The dog’s chest was loosely bandaged; the elastomeric pump and epidural catheter were securely fixed to the body(Fig.11). I.v. antibiotics and fluid support was continued for 24 hours post op.

Provided very effective local analgesia- the dog revealed excellent comfort immediately after the surgery (video 2,3,4). We paid special attention to any pain signs- excessive vocalization, hyper-excitement, panting, tachycardia, behavior abnormalities, etc. No such were present and the patient started eating the next day after surgery; it was discharged 48 after the procedure. No ambulation deficits were seen with the Levobupivacain application. The elastomeric pump was removed on the 4-th day. Mild to moderate serosanguineous discharges from the wound were present for 10 days after the surgery.

On the 14 days recheck the wound was healed and the sutures were removed; the patient showed excellent clinical recovery (Fig.12).

 

 

 

 

Discussion

 

 

The surgical excision is considered the first treatment of choice for malignant rib tumors, but a question about the long term prognosis and rationale behind an aggressive surgery could be raised. As mentioned above, the most common rib tumors are osteosarcomas (OS)  and chondrosarcomas(CS). They have quite different prognosis- OS is rarely cured, whereas CS could be cured with surgery alone. Dogs with osteosarcoma that have elevation of the Alkaline phosphatase level have a much lower median survival times 6. Chemotherapy significantly increases the survival of dogs with rib OS- from a few months to about 9.5 months. Roughly survival time is increased 4 times with chemotherapy + radical resection, compared to surgery alone. Chondrosarcomas have a very good chance to be cured with surgery alone with median survival times exceeding 3 years. The other common type -fibrosarcoma and hemangiosarcoma have intermediate metastatic potential between the other two. Survival times ranging from 120-450 days with chest wall resection alone 7.

 

Dealing with motivated owners, a patient in good general health, with normal AP, and need for moderately large rib case resection size, we found good indications for tumor removal without preliminary histological verification. We suggested acceptable life expectancy in the worst tumor type scenario (the option for chemotherapy was available). While respecting previous vets’ opinions, we took into consideration the stated in the literature fact that dogs tolerate removal of a large portion of the rib cage very well.

 

Despite all this encouraging decision making facts, we would have fought ethical issues in a scenario we weren’t able to provide sufficient peri-operative analgesia of the patient. Except the ethical side, the pain associated with thoracoectomies may have potentially lethal consequence for the patient cardiopulmonary status after surgery. A thoracoectomy requires a very painful excision, involving multiple muscle layers, rib resection, and continuous motion as the patient breathes. Sub-optimal management of pain has major respiratory consequences. Inspiration is limited by pain, which leads to reflex contraction of expiratory muscles, and consecutively to diaphragmatic dysfunction (decreased functional residual capacity and atelectasis, hypoxemia).Treatment of acute post-thoracotomy pain is particularly important not only to keep the patient comfortable but also to minimize pulmonary complications 8.

 

In the veterinary literature there are suggestion for various types of analgesia provided after thoracotomies-  intercostal blocks, intrapleural lidocaine, incisional pain soaker catheters9; systemic agents as NSAIDs, opioids, NMDA antagonists (ketamine),etc. There is plenty of space for objective evidence based studies, proving the best analgesic protocol, yet.

In the presented case we applied sophisticated but uncommon noxious stimulus blockage strategy. The thoracic epidural catheter insertion is technically demanding procedure but it is very powerful tool for both intra and post operative pain control 10. Even more, it allows even preemptive pain blockage. So-called preemptive analgesia is intended to prevent the establishment of central sensitization caused by surgery induced injuries. Evidence from basic research has indicated that analgesic drugs are more effective if administered before, rather than after, a noxious stimulus.  Human studies report that the area of post-thoracotomy pain is more discrete and largely restricted to the site of surgery. Hence, any benefit of preemptive epidural analgesia is, theoretically, more apparent in thoracic surgery than in abdominal surgery.

 

It is interesting if the present tumor or the arthritic elbow lesions caused the primary clinical sign- front right leg lameness. Lameness of the forelimb had been described with costal tumors, located within the first four ribs 11. Possible mechanism is pain translation to the nerves to the limb, mechanical interference with movement or invasion into the muscles of the forelimb. After the surgical excision the owners reported lameness disappearance, supporting the tumor as the real cause.

 

 

CONCLUSIONS

 

Excision of malignant chest wall masses could be very successful. It is feasible to achieve clean cut margins; large residual wall defects could be managed with combined reconstruction techniques. Never mind the aggressive character of the procedure, an excellent patient comfort should be achieved with a combination of thoracic epidural and local wound nerve nociception blockage, as in this case.

 

 

Comments:

 

Just before the submission of this case report the histopathology result was received. It concluded:

 

Mass, originating from spindeloid to pleomorphic cells, highly cellular. The cells were round, organized in bundles and solid formations. There was moderate to marked anisokaryosis and anisocytsosis; mitotic figures frequently present, multifocally there is osetoid production.

 

Diagnosis: Malignant pleomorphic neoplasia, suspicious for osteosarcoma.

 

Long term prognosis:

 

In the case, no local recurrence is expected because of the wide margins excision. Generally the median survival time (MST) for dogs with rib OSA is 90-120 days with surgery alone and 240-290 days with surgery and adjunctive chemotherapy, and death is caused by distant metastases.  Age, weight, sex, number of ribs resected, tumor volume, and total medication dose do not influence survival disease-free interval 12.

 

A chemotherapy protocol is already being contemplated:

Carboplatin 300mg/sq.m.; 4 treatments q 21 days (Withrow and MacEwen Small Animal Clinical Oncology,2007)

 

 

If available, the long term result and the survival time of the patient will be followed and shared through the journal.

Tibial nerve peripheral nerve sheath tumor in dog

 

 

  1. Loncar, DVM1

    10698593_10203534440535771_1510276061084451082_n-238x300

    Dr Zoran Loncar

  2. Hadzic, DVM2

M.Dragomirov, DVM2

1,2 Department of Orthopedic Surgery and Neurology, Veterinary Clinic Novak, Belgrade, Serbia

 

INTRODUCTION

 

An 8,5 years old miniature schnauzer dog was presented at the clinic with finding of right hind limb monoparesis and grade 1 lameness. CT diagnostic study was done but it was suggested that there was no visible lesions. MRI study shoved a lesion consistent with PNST. The dog was treated surgically and the tumor was excised completely with large margins. The dog recovered completely. The purpose of the article is to suggest that a lesion consisted with PNST distal to the stifle an elbow can be treated with large margins and very good motility of the limb afterwards. This type of pathology can be often missed with orthopedic conditions.

CASE HISTORY

 

A 10 kg BW, 8,5 years old miniature schnauzer was presented at the clinic with owners complain of lameness on right hind limb for last five months.

At previous vet the dog was submitted to complete orthopedic, radiography and CT study with no diagnosis after the diagnostic workout. The dog was treated with 20 days of NSAID therapy (carprofen 2mg/kg BID 10 days and the dosage was reduced by half for the next 10 days). There was no improvement so the dog was treated with prednisolone for 20 days SID with again very little improvement.

The dog doesn’t have any important data in medical history.

At the presentation in our clinic:

During the walk dog showed grade one lameness.

zoran 2

CT STUDY , Fig 1 and 2

At the clinical examination the dog showed normal proprioception but reduced withdraw reflex on right hind limb.  During palpation region of gastrocnemius muscle was markedly painful. The rest of nurology and orthopedic examination was in within normal limits.

CT Study

Figure 1. and 2.

zoran 3

MRI SYUDY Fig 3

zoran 4

MRY STUDY- Fig 4

There is a focal dilation of a vascular structure, presumably a vein, caudal to the medial aspect of the right stifle. The vascular dilation/aneurism has a maximal diameter of 7.7 mm and extends over a distance of approximately 4 cm. Contrast filling of the dilated area is heterogeneous with some areas lacking contrast filling. The affected vessel is an anastomosis/branch between the caudal branches of the saphenous vein and the caudal proximal femoral vein.

MRI study:

Figure 3. T1+contrast: On the right limb at the level of tibial nerve there is a lesion with heterogeneous contrast intake in long contact with blood vessel. The lesion is 3 cm long in diameter.

Figure 4. T1+contrast: Lesion at the level of tibial nerve in close contact with saphenous vein and the caudal proximal femoral vein. Heterogeneous contrast intake.

 

zoran 1

Figure 5. Surgical field

The surgical approach was made from medial side at the level of proximal part of gastrocnemius muscle. The careful identification of blood supplies and nerve structure was needed. The healthy proximal and distal part of the nerve was identified and the excision with 3 cm margins has been done.

The dog was treated post operatively with antibiotics for 7 days (cephalexin 15mg/kg BID), fentanyl patch for 3 days, carprofen 2 mg/kg BID for 7 days, gabapentin since 3th day 20 days 10mg/kg TID.

Neurological exam has been done after 1,3,6 and 12 months. The only abnormal finding 6 and 12 months post op was longer ground phase during walk and reduced withdraw reflex.

 

DISCUSSION:

 

Tibial nerve is in charged for the motor function of caudal aspect of tibia and fibula. Deficit in function shows clinical signs that look similar to orthopedic conditions. Ground phase is longer, calcaneus drops distally more than in contralateral limb. Sometimes we can see plantigrade stance. Orthopedic conditions similar to these in term of signs are pathology of Achill’s tendon and tarsus and metatarsus.

PNST if at the distal part of peripheral nerves can be treated with good outcome. The reasons are fewer functions that lead in less of dysfunction of the limb, and good surgical margins.  If PNST is localized at plexus or nerve root, 78% of dogs are going to be euthanized. The prognosis depends on localization and histopathology grading.

 

CONCLUSION

 

This article shows how close sometimes can be neurology and orthopedic clinical findings. Even if advanced imaging is available the cruciate information is localization of the lesion during the clinical examination. Further a right interpretation of images is necessary to define the lesion. PNST is an important differential diagnosis in investigation of distal extremities dysfunctions.

 

WHO ARE Vets on The Balkans? Veterinarians speak…..

10334323_1650417485231859_7490271749546982451_nLUIGI VENCO, DVM , SCPA, Dipl EVPC, Pavia, Italy

 

It ‘s a wonderful Journal.  Open source. Clinical cases and tips useful for the reader. Not just a display of vanity for the authors. Congratulations to the editors for strong expended effort

 

ROMANIA

 

Dr Constantin Ifteme – Center of Veterinary Endoscopy and Minimum Invasive Surgery

 

Vets on the Balkans it is more than a promoting platform of all successful projects from the veterinary medicine in the Balkans region.  It can be compared with the Olympics of the veterinarians from this geographical area, with major involvement in training and continuous learning of the veterinary community.

 

 

Dr Iuliana Ionascu, DVM , PhD, member ESVO

 

Vets on the Balkans is the meeting point of the specialists, the friends and of the people who have the joy of sharing their experience in areas of interest in veterinary medicine.Vets on the Balkans helped us by placing us in direct contact with specialists and taught us how to work together. The first step is done. The next step is one that I want from the bottom of my heart:  to write therapeutic guides together.So, Vets on the Balkans, my dream has to be your accomplishment in the years to come.I love you for what you created. Good luck on your wonderful journey!

 

 Dr Alexandru Diaconescu, DVM, PhD, Senior Lecturer

 

I think it’s a great idea! All the vets in the Balkans area can learn from each other’s experience, we can share opinions, interesting clinical cases, etc.

I wish you good luck!

 

Dr Rares Capitan , DVM, resident ECVD

I think is a good interesting idea. I really hope that this project will  continue for a long time and collect many vets as want to share their experience. So the whole community from the Balkans will progress in a good way.

 

Dr Ana Maria Boncea, DVM, resident ECVD

“Vets on the Balkans” is like a fresh air for all the vet’s from every place…Is an open door for sharing your experience, upgrading your knowledge and enjoy the vet’s life spectaculy. Let’s share together all beautiful insides of our job!

 BULGARIA

Dr Vladislav Zlatinov – Central Vet Clinic in Sofia, Bulgaria

 It is so great to have such a professional forum, connecting Balkans (and not only) vets! I literally see people from different countries in the region, getting to know each other because of your journal.  The “Vets on The Balkans” deserve all the compliments for your great positive initiative and work!

 

Dr Stefan Savov- Ditton  Reach Veterinary Surgery, England

 The journal is a really brilliant idea. I read all the articles. I find some really good examples there. It has proved that veterinarians on Balkans are no worse than the colleagues in the western countries. I wish you more and more interesting cases shared on the pages of the journal and lots of luck.

 

 

Dr Mila Bobadova ( Veterinary Clinic “ Dobro Hrumvane”  in Sofia, Bulgaria)

 We needed that kind of journal at Balkans, a connection spot and an open source. It brings veterinary medicine to a new level, but most of all it helps all the vets from Balkans to get to know each other. For that I am very thankful and I am sure it will make a difference.

 

Dr Svetlina Aleksandrova ( Veterinary Clinic “Light Vet” in Sandanski, Bulgaria)

 Vets on the Balkans is great new way for communication and learning. The reality is that we can not know everything for any condition. The learning process continue until the end of our lives. I love the case reports – a lot of photos and good explications. The Learn and Travel initiative will make a lot of collegues better in their prefered section of veterinary medecine. Please, dr Gancheva, continue to do what you do in the best way – connect!

 

Dr Liliya Mihailova ( Veterinary Clinic “ United Veterinary Clinic “ in Varna, Bulgaria )

 According to me ” Vets on the Balkans “o is one of the greatest way for many veterinarians to communicate and share knowledge and experience. Because is a new and modern way to connect veterinarians not only from countries of Balkan peninsula but also from countries all over the world. Moreover It provides the latest scientific information about news in veterinary medicine and useful personal professional experience.

 

Dr Spas Spasov  ( Veterinary Clinic “ United Veterinary Clinic “ in Varna, Bulgaria )

 I want to extend my greetings to the great work you do with the magazine. It is very interesting and useful. I wish to become more known. I wish to be ever visited. I think the idea to united vets on the Balkans is realized.

 

 

Dr Vanya Stoyanova – Veterinary Clinic Provet in Plovdiv, Bulgaria

 Useful  veterinary journal,creative realized idea.
Like to read the letters ,interesting posts ,new information for me and classified my level where I am on the market with the Balkan colleagues .Receive information for future symposiums,Conferences and Webinars. Thank You  Luba Gancheva & Co
Wish you continue enjoying with your fantastic work!!!

 

 Dr Dimitar Djambazov Veterinary Clinic Sofia in Sofia, Bulgaria

 Vets on the Balkans is a unique in its respective category as a journal who strives to connect the countries on the Balkans- a highly diverse and interesting set of countries.

The journal provides easy-to-reach and concise practical knowledge as well as the opportunity for interviews, presentations and step-by-step guidelines for management of specific problems.

From where I stand as a practitioner the case reports are by far my favorite method of acquiring new information in the veterinary field. That is of course after one has a strong basic knowledge on a given subject.

And here’s where the next indispensible role of “Vets on the Balkans” becomes evident. The journal not only acts as a mean of learning and developing oneself as a veterinary professional with blog posts but also serves as a connecting point between the countries and veterinarians in the region, as to promote and organize practical sessions, continuing education projects and various externships. This is indispensible help, strongly appreciated by many and luckily gaining more and more popularity among animal caregivers on the Balkans.
The effort invested in the journal by its creator and her collaborators is immense and undoubtedly greatly acknowledged as we all know how hard it can be to sustain such a project, be a practicing veterinarian at the same time and have a life from time to time as well.

As a young and still lacking a certain amount of experience, vet, I appreciate the Vets on the Balkans journal as a source of CPD, but also as a opportunity to reach and connect to our neighbors on the Balkans.

 

 

CROATIA
 Dr Emil Ofner – Veterinary Clinic More in Sibenik, Croatia

 Task for every journal is to have a good impact factor on its readers. Vets on the Balkans journal doesn’t do just that, but it also successfully ties up vets from different Balkan countries and others. It is the first of its kind in the Balkans and for sure it will facilitate further development of the veterinary profession. Hopefully it will become a great online tool for improvements of veterinary skills and knowledge.

 Dr Mario Kreszinger – Veterinary Clinic Kreszinger in Zagreb, Croatia

 It very useful easy approachable source of informations we need in everyday Jobs routine.

 

Dr Nikola Bunevski– Veterinary Clinic Kreszinger in Zagreb, Croatia

 Sharing is caring. Every information is priceless. We are working near each other we have similar problems and questions, it will be better for each of us if we share those questions and problems to one another, we will come to answers faster and painless. Vets on the Balkans can serve that purpose.Thank you for having me.

 

 

SERBIA

 Dr Zoran Loncar- Veterinary Clinic Novak in Belgrade, Serbia

 Vets on the Balkan is refreshment and result of people with good energy and wish to improve our region. We live in small countries and if we cooperate together we have better chance to improve ourselves.

 

Dr Nikoleta Novak- Veterinary Clinic Novak in Belgrade, Serbia

I read the interview you had with our colleague Nikola Bunevski, and I think he said it perfectly; “Sharing is caring. Vets on the Balkans can serve that purpose””Vets on Balkans” is really a great idea and I do wish you all the best on this exciting and high-minded mission.

 

SLOVENIA

 Dr Marko Novak- Klinika Loka in the city Škofja Loka in Slovenia

 I came across VTB when I was scrolling down the facebook and I saw these interesting articles from guys doing great job. I think it is one of those starters that help people to become better at what they do.

 

TURKEY

 Banu Dokuzeylul, DVM, PhD ,Department of Internal Medicine

Faculty of Veterinary Medicine

Istanbul University, Istanbul, Turkey

 I like reading. One day I found myself reading a case from Vets on The Balkans Online Journal. This subject was one of my interesting areas in veterinary medicine. With this article, I couldn’t imagine a good collaboration and friendship start. With Dr. Luba Gancheva’s support, I was invited to seminar in Bucharest. As I see until today, the journal improves day by day. Instead of giving important information, this journal combines the colleagues on the Balkans. If you want to be a part of a great friendship and have a vulnerable data, you must start to read the journal as fast as you can.10334323_1650417485231859_7490271749546982451_n