Cat’s Tooth resorption case

pict 2Dr Yavor Stoyanov,

Veterinary clinic Bomed

Sofia, Bulgaria

A 6-year-old, neutered male domestic shorthair cat

was presented for dental cleaning due to “bed smell breath”.

No vaccinations history, irregular anthelmintic treatment.

No earlier dental care.

History of cystitis four years ago.

 

Clinical exam:

The cat was in good physical condition.

Normal temperature, auscultation, palpation.

 

Facial Exam:

Normal facial and eyes symmetry, no nose or eyes discharges.

No compression discomfort, no swollen regions, lymph nodes – normal, lips with black pigmented zones.

 

Conscious Oral exam:

The cat was cooperative.

Normal maxillomandibular joint mobility, without pain.

Normal buccal mucous membranes.  Lingual, sub lingual, caudal mouth space and  roof of the mouth was normal.

Moderate gingivitis, gingival recessions, missing all upper right premolars (106,107,108), left upper first premolar (206), first and third left mandibular premolars (307,308).

All canine teeth were with root exposure.

Many mobility teeth: 207,208,308,403, with root exposure and visual

root resorption and attachment loss.

Plaque index 2.

 

CBC, Biochemistry was in normal limits, except high globulins level.

 

Dental X-Ray was unavailable.

 

Oral exam and treatment under general anesthesia:

Missing all upper right premolars (106,107,108), left upper first premolar (206), first and third left mandibular premolars (307,308).

Moderate  gingivitis (gingival index 2).

Gingival and alveolar recessions.

No periodontal pockets. Stage 3 furcation (307, 308, 309, 208)

All canine teeth were with root exposure due to tooth extrusion.

Mobility teeth: 207(M3), 208(M2), 308(M3), 303(M3), 309(M3), 403(M3), with root exposure, visual root resorption and attachment loss.

1

Pic.1. Dental chart

Diagnosis:

 

Idiopathic Tooth Resorption

 

Treatment plan:

Multi teeth simple extraction

 

Treatment procedure:

Preoperative analgesia: Rheumocam

General anesthesia

Chlorhexidine Rinse 0.12% solution

Simple extraction with elevator and extraction forceps.

In this case because of severe attachment loss I just needed to section only one premolar.2

3

Postoperative treatment:

 

Rheumocam    24h/3 days

Stomorgil        24h/8 days

Stomodine      12h/14 days

 

Further treatment:

 

Dental and oral prophylaxis with Stomodine,

Regular examination every 3 months.

 

Discussion:

There are many theories about the etiology of Tooth resorption in domestic cats but main cause is still unknown.

Depends of the source, about 25–75% of domestic cats are affected.

There is an increasing prevalence of Tooth resorption as cats get older, with the first teeth becoming affected usually at four to six years of age.

Gender and neutering were not found to affect the prevalence of disease.

Cat owners may report halitosis, ptyalism, head shaking, dropping food

while eating, reluctance to eat hard food, excessive tongue movements,

repetitive lower jaw motions while eating, drinking or grooming,

sneezing, dysphagia, dehydration, anorexia, weight loss, and lethargy.

Clinical findings are various degrees of gingival inflammation, missing

or mobile teeth, gingival hyperplasia or recession, tooth extrusion, tooth

tissue destruction and others.

Earlier and most accurate diagnosis is made by dental X-Ray because

first changes are subgingival.

Depending on changes there are few classification based on severity

(stages 1–5) and radiographic appearance of the resorption (types 1–3).

Tooth resorption can develop with cementation and ankyloses or with

attachment loss and mobility of teeth. In case of attachment loss extraction

is easier.

 

Conclusion:

Tooth resorption is the most common progressive disease affecting the

dental tissues in domestic cats.

In every regular cat exam (with or without oral or dental abnormality)

Tooth resorption should be routinely suspected.

Choice of treatment – extraction of all affected teeth.

 

CONGENITAL FOLLICULAR PARAKERATOSIS IN A STRAY DOG

48260278_10156282671250432_7554491919091367936_nDVM Diana Anghelescu

Hemopet Clinic

Congenital follicular parakeratosis is a  hereditary disorder affecting females, which suggests a X-linked mode of inheritance, the particular aspect of the condition is not affecting the skin of the nose and footpads unlike other seborrheic disorders.

More about this particular condition can be found in Small Animal Dermatology 7th Edition.

 

 

 

THIS IS DEMInnn

This particular case seemed interesting as it occurs very rarely and even more so there are few cases when owners are willing to do everything they can to keep them in good shape.

Female stray dog presents to our clinic in gravely  bad shape, with serious skin scaling , waxy material clumping together most of her coat, runny eyes and greasy smell.

Comes from a litter of 3 puppies, her other brothers being already twice her weight, with normal skin condition

 

 

Name: Demi

Age: 2 months

Sex: Female, Mixed breed

 

Waxy material concentrated mostly on the edges of the pinnae and on her neck

pic 2pic 3

 

 

 

 

 

 

 

 

Waxy material covering most of her body, creating clumps of hair, general aspect of  a dirty dog

pic 4 pic 5

 

 

 

 

 

 

 

 

 

 

Due to the severity of her condition, several tests have been performed to exclude potential affections:

-Skin scraping

-Trichogram

-Citology examination

-CDV test

-Otoscopic examination

-Bloodwork

-Giardia Test

-Coproparasitological exam

 

*CDV test – negative

*Otoscopic examination: Billateral ceruminous otitis, with buildup waxy hair follicles inside the ear canal

*Skin scrapings: Negative for ectoparasites

*Cytology from different sites of  affected skin – keratinocyes, corneocytes accompanied with malassesia, no other signs of inflamation present

*Cytology from ears-  copious amounts of ceruminous debris, flourishing with malassesia

*Cytology of the conjunctiva- chains of cocci, macrophages and neutrofiles

*Trichogram revealed normal hair structure, mostly in telogen phase, but embedded in a dense brown waxy material.

*Giardia test- negative

*Moderate Toxocara infestation

pic 6

Skin cytology- Lots of corneocytes, rare cocci.

pic 7

Otic cytology- Almost 90% Mallassezia levures

After ruling out most of the possible diagnostics, Demi was reexamined closely looking for particularities.

 

-It turned out that the keratosis was affecting especially the external areas of the pinnae, the ventral side of the neck, the entire back and along the limbs and in a smaller part the abdomen.

 

-It was peculiar  that the skin on her nose was normal, as well as her footpads, which led me into thinking about this possible condition, that could only be 100% proved with a skin biopsy.

pic 16

Trichogram- Almost all hair follicles were covered in waxy material

pic 15

Trichogram- Almost all hair follicles were covered in waxy material

 

-Unfortunately the owner who rescued her did not agree with the biopsy so I had to move onto the therapy without knowing  100%, but shortly after I was sure that this was it.

TREATMENT

-Demi remained at the clinic for 2 months, giving us time to use proper treatment such as:

-Frequent bathing (2-3x/week) with Benzoyl peroxide followed by mixed shamoo (ketohexidine) and a conditioner

-High quality protein diet based on salmon

-Daily Omega 3 and 6 oral suppliments and weekly spot ons.

-Daily Vitamin complex with high ammount of vitamin A and E

-The otitis externa was treated with Clorexyderm oto and Surolan 2x/daily for 14 days

-The conjunctivits was resolved with cloramfenicol drops and daily cleansing of the ocular area – the hyperkeratosis also affected her eyelashes, constantly irritating the eyes, I had to remove each affected lash.

-She received deworming pills and sarolaner to control the endo and ectoparasites.

 

DEMI AFTER 7 DAYS OF TREATMENT

pic 9

DEMI AFTER 7 DAYS OF TREATMENT

pic 10

DEMI AFTER 7 DAYS OF TREATMENT

 

 

 

 

 

 

 

 

 

DEMI AFTER 14 DAYS OF TREATMENT

14 days 2

DEMI AFTER 14 DAYS OF TREATMENT

14 days

DEMI AFTER 14 DAYS OF TREATMENT

 

 

 

 

 

 

 

 

DEMI AFTER 1 MONTH OF TREATMENT

pic 11

DEMI AFTER 1 MONTH OF TREATMENT

pic 12

DEMI AFTER 1 MONTH OF TREATMENT

 

 

 

 

 

 

 

 

DEMI AFTER 2 MONTHS OF TREATMENT

pic 13

DEMI AFTER 2 MONTHS OF TREATMENT

pic 14

DEMI AFTER 2 MONTHS OF TREATMENT

 

 

 

 

 

 

 

 

CONCLUSIONS

As you can see, her condition can be kept under control especially if the owner understands that it’s a lifetime condition and she will require special treatment for the rest of her life

 

She had a brief period of time when I decided to see how long it takes until new keratin materials starts to form if I stop the treatment and it only took 6 days for the most affected areas to relapse.

 

It’s a rare condition, I was especially glad to be able to care for her and to see that there are people willing to do everything needed to keep her in good shape

 

I’m pretty sure most of these dogs don’t survive long if in the wild, or are discarded by breeders if not, let’s say Demi was lucky enough to be rescued at such a young age.

 

 

 

 

Main topic: “A new approach to radial nerve palsy in cats”. Clinical Case Series Report

380533_338242309525656_1915103081_nby the Orthopedic department of “Dobro hrumvane!”veterinary clinics,

Sofia city, Bulgaria

  1. Introduction

The radial nerve palsy is a pathology that is rarely seen in dogs, in comparison to cats, where it is more commonly seen, especially in young stray cats. The most commonly observed clinical picture in such patients includes paralysis of the antebrachial portion of the limb, the carpus, the manus and fingers. According to our personal observations, in about 25% of these patients the elbow’s neuro-muscular apparatus is also involved, in a different degree.

The patients demonstrate an external rotation of the antebrachial area in relation to the portion of the limb above the elbow.

The carpus and manus possess an additional and permanent external rotation in relation to the antebrachium, which causes the patients to use the rostral portion of the their carpus for stepping and weight bearing, which in turn inducts the formation of a chronical traumatic inflammatory proliferative granuloma in this area. For about a 25-45 days period, an impossible to overcome carpal hyperfelexion develops, to the point where the joint can no longer be returned to its physiological position, due to the shortening of the flexor muscle-tendon apparatus (see video 1 with cat Sonia 39 days after the trauma at https://youtu.be/SZoXfp8tMJ0 ).

A few therapeutic approaches are being advised for this pathologic condition worldwide: total limb amputation; stem cell therapy (with still controversial results); standard pancarpal arthrodesis (note that very often it is very difficult to execute procedure in the state of this disease and is almost always accompanied by a nonsatisfactory limb function end result).

None of the upper mentioned approaches for treatment of radial nerve palsy in cats, while trying to avoid limb amputation, was producing satisfying results in the patients with this problem, operated by our team. This is the reason we decided to test and implement a new “Dobro hrumvane modified pancarpal arthrodesis” procedure for the operative treatment of feline radial nerve palsy.

  1. Report patients base

 

Up to this moment, this modified by our team procedure has been done in 111 patients. In the first 11 patients we tried different but very similar to each other versions of the modification, and after patient 12 up to patient 111 (meaning exactly 100 patients) we were performing always one same version of the technique.

In 87 of these patients a follow-up postoperative monitoring for over one year has been performed (in 9 of them an approximately 5 year follow up was achieved, in 33 patients the follow up period was approximately 4 years etc.), in 11 patients the follow up period was between 4 months and one year and in 2 patients the follow up period was less than 4 months. In four of the operated patients, pre- or postoperative clinically relevant paralysis of the elbow region was also observed. As was mentioned earlier, 25% of feline radial nerve palsy patients demonstrate this (according to our observations in 23% of the patients it is already observed in the preoperative period and in other 2%, it develops a few weeks after the surgical intervention, with the reasons for that still being unclear). It should be noted that the majority of owners of patients with elbow area involvement preferred amputation over the experimental procedure.

 

 

  1. Surgical technique

 

The standard pancarpal arthrodesis general guidelines are being followed, but with the following modifications:

  • Straight 11̊ inclination non locking hybrid pancarpal arthrodesis plate has been used  (produced by Medimetal or Mikromed, delivered by VetWest). The plate contouring should be modified before the surgery and the inclination should become 21-22̊. Twisting of the distal portion of the plate internally in relation to the proximal portion of the plate is not recommended! For the fixation to the metacarpus 1.5 mm non locking screws were used (produced by Mikromed, delivered by VetWest) and for the fixation to the radius 2.0 mm non locking screws were used (produced by Mikromed, delivered by VetWest);
  • The proximal (os carpi radiale et ulnare) and distal carpal bones are being completely removed, this being done with extreme caution not the traumatize the adjacent magistral structures (especially blood vessels), which are located on the palmar surface;
  • The proximal ends of the metacarpal bones are being separated from one another;
  • The fixation of the plate to the dorsal surface of the third metacarpal bone is achieved the same way as in the standard technique, using 1.5 mm thick and 6 mm long screws, but the fixation to the radius is not applied on its dorsal, but on its medial/mediocaudal edge/surface, using 2.0 mm screws. The screw hole on the plate which is intended for os carpi radiale (note that this bone is actually removed  in the modified technique) is used for an additional 2.0 mm screw, placed in the distal radius. In other words, the whole metacarpal portion of the limb is being internally rotated around 85-95° (for the purpose of that an almost full blunt and careful separation of all soft tissues, including the magistral vessels and nerves in the distance between the carpus and the middle portion of the metacarpal bones, should be performed). After plating of the third metacarpal plate with four 1.5 mm non locking screws in neutral position the third metacarpal bone is being compressed to the radial distal This compression is easily achieved with the first screw, placed in the radius (not dorsal but medial/mediocaudal radial edge/surface – see below Xray picture Standard) thanks to the DC wholes of the plate types mentioned upper above. This screw is being inserted in the second 2.0 mm screw whole in distal to proximal direction, meaning the third plate hole in relation to the whole plate in proximal to distal direction. After that, 4 neutrally (not in  compression mode) placed screws are applied to radial bone in the following order: the most distal hole, the most proximal hole, the second hole in proximal to distal direction, the third hole in proximal to distal direction. It is recommended that at least two of the screws in the distal radius engage the distal ulna too, so the distal portions of the two bones could eventually be pulled together – the screws could be numbers one and two or four and five from proximal to distal, this possibility could be estimated only intraoperativelly;
    pic1

    POST-OP STANDARD X-RAY PICTURE AFTER PANCARPAL ARTHRODESIS “DOBRO HRUMVANE”

    • With this technique it is easy and recommendable to use a significant amount of autograft material – recommendable due to the large gap that is being created. This autograft is readily available, considering the amount of bone that is being removed in the previous stages of the surgical technique;
    • The final stage of the surgery includes almost full blunt separation of the skin from the underlying soft tissues in the designated area, along with skin plastic traction modification, which is intended to place the fifth finger in a more medio-cranial position. The skin sutures and respectively the skin incision should be placed in a position that is not exactly above the plate (eventually they plate and incision could be placed in a cross manner, but should not be on top of each other for their whole lenght). It is not necessary to perform tenodesis of the digital extensors or excision of some skin on the dorsal carpal area in orther to pull the fingers in extension. It shoud be noted that the upper mentioned skin traction used to “pull” the fifth finger in a more dorsal and medial direction (meaning that the fifth finger is placed adjasent to the dorsolateral, not solely lateral, surface of the fourth finger, under subtle tension that will not allow overlapping of the fifth finger) is extremely important because in some of the first patients, which underwent the still not perfected procedure, weeks to months after the surgery pressure necrosis developped in the fifth finger, which required further revison plastic surgeries.
    • In patients that have a very wild temper and where it is not possible to achieve two week long cage rest, postoperative splint could be placed. If this is done, additional amount of cotton could be used to help achieve the upper mentioned mediocranial position of the fifth metacarpus and finger;
    • NEO K-9 clinical formula is prescribed for a month and a two week long cage rest is done in more calm patients.

     

     

    1. C) Results – the last 100 cats (No 12 … No 111 made with identical technique) :

     

    C1) 96 patients that did not have (according to our clinical opinion) involvement of the elbow region pre- or postoperatively:

    – 95 patients with good limb geometry in stance and during walking, active involvement of the limb during walks and playing, owners completely content with the results 4 months up to 5 years after the surgery. 89 of these 95 patients had no postoperative complicatioons; 2 patients developed moderate postoperative infection that was easily treated; 2 patients demonstrated delayed healing of the surgical incision in the area above the plate (it took more than 5 weeks in both patients); 2 patients had delayed bone union, that took around 5 months to be completed;

    – 1 patient demonstrated unsatisfactory to this point level of weigt bearing and limb usage during walk and play. It is understandable that the owner of this patient is not completely content with the results, but is unfortunately refusing implant removal and further diagnostic procedures;

    – No cases with implant loosening, intra- or postoperative fracture, postoperative necrosis etc.;

     

    C2) 4 patients with clinically relevant pre- or postoperative involvement and paralysis of the motor unit of the elbow joint:

     

    1 patient without preoperative elbow problem, developed such around a month after the surgical intervetion and the problem was accompanied by the development of an additional low grade external rotation of the antebrachium in relation to the limb portion above the elbow. The main problem was presented by progressive loss of support of the ebow joint in extension during stance, which lead to the inability of the limb to support the body during weight bearing. The problem was resolved after a two week long active rehabilitation and machine physiotherapy and application of a light splint, which is suporrting (but not blocking) the elbow.

     

    – 1 patient (cat named Trun) with preoperative paralysis of the elbow joint, but accompanied by almost complete ankylosis of the elbow joint (only 15% of the normal range of motion was preserved, especially the extension was blocked) – see below the post-op pictures of cat Trun

    pic 2

    cat Trun

    pic 3

    cat Trun

    Although there was a serious accompanying problem, months after the surgery the owners are completely satisfied with the result. The patient is using the limb with no limitations during play, almost no limitations while running and with some limitations while walking – that last limitation is probably due to the constant flexed position of the elbow, which is exceeding the normal flexion angle of an elbow joint during walk, thus the animal is placing the shoulder of the affected limb under the level of the shoulder of the unaffected limb, during weight bearing (see video with cat Trun approx 3 months post-op at https://youtu.be/N9scMppZeyo ). The owners do not report signs of pain. Even though it is not right to make conclusions only on the basis of a single patient, this case gives us hope that patients with radial nerve palsy in combination with complete or partial elbow joint ankylosis have the chance to avoid amputation of the limb.

     

    – 1 patient with partial preoperative paralysis of the elbow joint which became more severe (around  50%) month after the surgery: the bones in the arthrodesis region achieved complete healing, but the elbow joint loses support during weight bearing,  thus the animal is placing the shoulder of the affected limb under the level of the shoulder of the unaffected limb, during weight bearing. Due to this the ptient is weight bearing the limb not on its pads, but rather on the carpal palmar angle surface. Because of that a chronic nonhealing skin lesion developed in this area over the time, which is intermitently bleeding. Up to this point, the owners are content with the result and do not wish to start rehabilitation or agree to a revision surgery, but for our team this result is unsatisfactory and it requires additional surgical and/or physiotrepautical intervention;

     

    – 1 patient (Doxy) wtihout preoperative involvement and paralysis of the elbow, which developed a progressive clinically relevant paralysis of the elbow a few weeks after surgery. This led not only to loss of support of the elbow joint during weight bearing, but also to constant progressing additional rotation of the antebrachium in relation to the humeral area.

    pic 4

    X-RAY PICTURES DOXY

    pic 6

    X-RAY PICTURES DOXY

    This rotation made the patient bear weight on the lateral surface of the carpal angle, developing a skin lesion there. This postoperative elbow joint paralysis did not resolve after a rehabilitation course. In order to correct the problem an elbow arthrodesis was performed, but not in a standard way. A “double-modified” elbow arthrodesis was performed: the boomerang plate produced by Mikromed and supplied by VetWest was placed on the lateral surface instead of the medial. Also, the antebrachial region was rotated 18 degrees internally, in relation to the humerus. We recommend very torough preoperative preparation: the execution of the technique is quite challenging, because the compression must be maintained and in the same time the “locking” of the anconeal process in the humeral fossa must be overcome, along with the congruency of the other ulnar structures and their corresponding radial structures – see below post-op X-ray pictures of cat Doxy after the second surgery, the elbow modified arthrodesis:

    It can be seen that the plating is on the lateral surface of the radius distally and on the laterocranial surface of the humerus proximally.

    Only a few hours after the surgery, the patient demonstrated excellent, pain free limb usage, with very good limb geometry and lack of difference in the level of the two shoulder joints during weight bearing. In the following days the patient started using the limb for playing too. At this point, 3-4 months after surgery, the patient is demonstrating completely satifying results (see video with cat Doxy approx 4 months post-op at https://youtu.be/X_rFEgrZink ). There are no signs of malunion, infection or other types of complications. The muscle mass in the shoulder area of the operated limb is similar to that of the non operated limb. Even if it is based just on one patient, the result of this case gives us some hope for surgical resolution for patients with modified or standard carpal arthrodesis, which have an acompanying or later develop severe elbow pathology of nonakylotic kind, as we know that the combination of carpal and elbow arthrodesis is not recommended in the known sources. For this patient especially we have an additional recommendation:

    1) The first recommendation that is applied to all 111 operated patients – considering that it is a patient with a paralysed limb it should live on a non- smooth surface (but also not on an abrasive one). On a slippery surface patients with Dobro hrumvane arthrodesis step with mild slipping which combined with the lack of sensitivity could cause in longer period skin lesion (see Video 2 with cat Zhivka approx 5 weeks post-op at https://youtu.be/hKKjmO9yWdI ).

    2) Additional recommendation especially for Doxy: the patient has two joints that underwent arthodesis, which means that a stress point is being created between the two plates, which in turn creates a significant risk for further fractures. This risk is further amplified by the fact that the arthrodesis procedures are reducing the shock absorbing function of the joints. Considering all of the mentioned above, the patient should live in an enviornment that lacks the risk of creation of serious vertical vector forces (such as jumping to or from high places). It should be noted that Doxy did exactly that, many times after surgery and no problem occured, but it is still highly not recommended.

     

    1. Conclusion

     

    The 100 clinical cases, with patients that underwent a similar modified pancarpal Dobro hrumvane arthrodesis procedure for the treatment of feline radial nerve palsy demonstrate a constant and satisfying result with very good return to function of the limb, pain free, with no discomfort. No following complications, including long-term ones are being observed and there is a very high level of owner satisfaction. We recommend this surgical technique and we would be glad to recieve feedback afer the completion of the procedure, either in the algorithm recommended by us, or with any additional modifications.

    pic 7

    Hari

    Even when the rotation of the metacarpal area in comparison to the antebrachial area is not 85-95 degrees the patients use the leg and the owners are satisfied but the leg geometry is in our opinion not good looking. Cat number 11, the last before the standartized 100 patients chain, named Hari is such a case, the rotation was 78-80 %, the operation was made approximately 5 years ago. As you can see at the videos made 4 years post-op the patient uses the left operated leg even during acrobatic jumping (see below picture Hari)

    and active playing (see video Hari 4 years after surgery at https://youtu.be/SfhzUtLr9ig ).

    1. E) Post scriptum

    A few years ago we presented the technique and its results, based on a few dozens of cases, on a VOG\BAVOT event. Ever since, a few colleagues from the Balkan region have sent us feedback with very encouraging results, after using the technique. One of them was our inconsolable friend, colleague and inspirator, D-r V. Vasilev, whose memmory and collosal contribution to the development of the veterinary meidicine in Bulgaria we would like to honor in the end of this report.

     

     

              Sofia                                      The Orthopedic department of

       March 2019                            “Dobro hrumvane!” veterinary clinics

     

Feline chronic gingivostomatitis (FCGS): Case report

IMG_3022Stefani Sabrodin,

6th year veterinary student from Estonian University of Life Sciences

Animal data:

  • Donskoy cat
  • 6 years 10 months old
  • Spayed
  • Weight 3,66kg

Anamnesis morbi:

Owners came to visit, because of halitosis and cats’ loss of appetite. Cat has also lost some weight in previous months. Cat lives mostly inside and was not vaccinated for any diseases over 2 years.

Clinical examination:

Gingiva was very red, inflammatory and gums were bleeding when the mouth was opened. Opening a mouth was painful for the cat and ulcers on the tongue were visualised (Figure1). Cat had also a lot of calculus and she was hypersalivating. Due to the fact that cat was not vaccinated, a FeLv/FIV snap test was done, and it was negative. Also hematology and biochemistry were evaluated. In biochemistry liver and kidney values were mostly within normal limits (WNL) Only UREA was a bit low (4,5mmol/L) but it might be due to the starvation. Electrolytes were also controlled and they were WNL. In hematology only mild leukocytosis was seen.

04 02 03

 

 

 

 

 

 

 

 

 

Treatment:

After the first visit, a dental appointment was planned. The cat got one subcutaneous injection of cefovencin (Convenia) 8mg/kg and went home with oral meloxicam 0,05mg/kg for 3 days. She came to tooth removal surgery in seven days. A cat was sedated with dexmedetomidine, butorphanol, and ketamine intramuscularly. TIVA with propofol was used during surgery. Cat got 5ml/kg/h of Ringer-Lactate during the procedure and free flow oxygen was given. Buprenorphine (0,01 mg/kg) intramuscularly and meloxicam (0,3 mg/kg) subcutaneously were given for analgesia and lidocaine was used for nerve blocks. Dental radiographs were made pre-and postoperatively (Figures 2). Figure 3 shows how important are dental radiographs. 301 was broken during the extractions but it was unclear if remnant got out or not. An x-ray was made and the root was visualised. Then the root remnant was removed and a new x-ray was taken.05 08 07 06

During the procedure, clinical picture (gingivitis II-III in all dens, 204 had gingival pocket of 2mm. 404 had gingival hyperplasia and also pocket of 2mm) and full mouth radiographs were evaluated. All teeth except canines were extracted. A cat went home with oral meloxicam (0,05 mg/kg) for 5 days. A new checkup was in 7 days. Figure 5 shows that gingiva is not so inflamed anymore. Cat started eating with a good appetite already the next day after the extractions.

 

 

 

09

This picture shows how much we actually need radiographs. 301 was broken during the extractions but we were not sure if we got the remnant out or not. We made an x-ray and saw the root. Then we removed root remnant but unfortunately I have no pictures of the last x-ray, but it was clean.

 

Figure 2. (a) 409 has a tooth resorption (TR). (b) 309 is missing. (c) and (d) are made after extractions.

Figure 4. was made right after the extractions.

Background

Feline chronic gingivostomatitis (FCGS) is a common syndrome, but its’ aeitology is unclear. FCGS causes inflammation and proliferation for the gingiva and oral mucosa. Inflammation can be mild to severe and it worsens with time. Mucosal ulcers are commonly seen in cats with FCGS. Ulcers are the most commonly on gingiva, tongue, buccal mucosa, lips, palatoglossal folds, and the lateral pharyngeal walls.

Aetiology is unclear, but it might be due to bacteria (usually from plaque Pasteurella spp↑, Prevotella spp↑), viruses or immune-mediated. Feline calicivirus (FCV), feline herpesvirus (FHV-1), feline immunodeficy virus (FIV), feline leukemia virus (FeLV), feline coronavirus (FeCoV) may cause FCGS.

The most obvious clinical changes are bilateral focal or diffuse chronic gingival and oral mucosal inflammation, ulcers and hyperplasia. Cats with FCGS has halitosis, dysphagia, ptyalism, bloody saliva, anorexia, and bleeding gingiva. Caudal part of the oral cavity is also with lesions. There is no sex, age or breed predilection.

For diagnostics, laboratory examinations are mandatory. Complete blood count (CBC), biochemistry (glucose and kidney values) and serological assays (FeLV/FIV) should be done.

Since the aetiology of the disease is unclear then treatment is empirical. In some cases, conservative treatment may help. Administration of antibiotics (amoxicillin/clavulanate, clindamycin, metronidazole), corticosteroids (not a good choice, because of side effects) , megestrol acetate (was used widely in the past, but now it’s not recommended due to the side effect), sodium salicylate, gold salts, lactoferrin (in mild cases, inflammation and salivation↓), interferon (poor results without extractions), professional tooth cleaning 3-4 times per year, chlorhexidine mouth rinses (usually not tolerated by cats for a long time) and teeth cleaning have been reported. The best cure is still full-mouth extractions.10

References

Holmstrom, S.E. Veterinary Dentistry: A Team Approach, 2nd edition. Elsevier 2012, 10:228- 230

Niemiec, B.A. Small Animal Dental, Oral & Maxillofacial Disease: A Colour Handbook. Manson Publishing 2012. 6:176-181

Correl C., Nind, F. Saunders Solutions in Veterinary Practice: Small Animal Dentistry. Saunders 2008. 12-15:79-97

Gorrel, C. Veterinary Dentistry for the General Practitioner 2nd Edition. Saunders, 2013

Tutt,C., Deeprose, J.& D.A. Crossley. BSAVA Manual of Canine and Feline Dentistry, 3rd edition. BSAVA. 2007.8:137-144

Alveoloplasty and correction of the symphysiolysis.

33923857_1331071137036756_1657367049904586752_nDr Vanya Stoyanova

Provet clinic , Plovdiv, Bulgaria

 

 

Aprilcho’s story takes place in the centre of Plovdiv, Bulgaria. The kitten is a victim of a car accident. Our colleague

Nina is the only one, who noticed the helpless cat , squirming on the street with painful convulsions. Nina picked him

up and brought him to the clinic. IMG-c876b25da24befa64f282c01eb7608bd-VHe was in a very bad condition – shock, prostration, severe head trauma with

neurologic symptoms, acute mouth bleeding, and convulsions. It was visible that he had maxillofacial trauma and a

mandibular symphysiolysis.

IMG-949d5241944ddd5fec26de1315bc28f8-V IMG-b0ab8099e22425bf3aa308c098ca5f89-V

First we did shock therapy so we could stabilize the patient. After we had the shock under control, we performed the oral surgery.

The upper premolars and molars had to be extracted, then alveoloplasty and correction of the symphysiolysis.

 

We’ve inserted an esophagostomy tube, so we could deliver enteral nutrition during the recovery period.

The recovery was long, due to the vestibular syndrome. He had pus expulsion from the left nostril and forehead

edema. We gave him antibiotics (Synulox) , Nootropil (piracetam) diluted with Glucose per os, and he received for

  1. 6 weeks enteral feeding with *Recovery* Liquid (Royal Canine).

The Cat is happy adopted in Germanykitty

New opportunity! Learn and Travel with Dr Ana Nemec!

49539480_10156980124763851_4018716318076239872_nSuch a honor to have Ana Nemec, DVM, PhD, Dipl. AVDC, Dipl. EVDC at our project LEARN AND TRAVEL with Vets on The Balkans.
More about Dr Ana Nemec: https://www.ananemec.si/en/about-me/
We would like to express our gratitude as well to The University of Ljubliana, Faculty of Veterinary Medicine in Slovenia for the opporunity! https://www.vf.uni-lj.si/

who recognizes the need to educate students but also vets in veterinary dentistry!

Because of the huge interest about our new opportunity and limitated places, we decide to make a game! So in that way to choose who will attend the program with Dr Ana Nemec!
Send your clinical case and you can be the vet who will spend one week with such a teacher
We are waiting for you at gancheva.vet@gmal.com till 30 of April!
So your case should not be high level of knowledge and something specific. Can be regular case, avaible in you everyday practice. We would like to see only you are passionate about veterinary dentistry!learn and travel

Success to all of you!

Wound management part 1: the healing process and recognition of wound healing stages

51559132_952390804967417_8511078558653743104_nFlorin Delureanu

DVM, MRCVS

Romania

 

Section A

The physiology of the healing process

The most largest organ of the body is the skin. The skin acts like a barrier between the body and environement. Composed by 3 layers (epidermis, dermis, subcutis) and associated adnexa, the skin is a complex organ with many functions and properties: thermoregulation, motion and shape, environmental protection, storage (vitamins, electrolytes, fat, etc.), immunoregulation, sensory perception, secretion, excretion, etc.

Following trauma, the skin is the first organ to undergo changes. A wound represent a disruption in the continuity on anatomical structure with deterioration of the physiological function. There are several criteria for wound classification:

–                by the time that has passed since wound production: acute or chronic;

–                by the thickness of the skin layer that has been injured: full-thickness or partial thickness;

–                by the degree of contamination:

·                clean wounds – made under aseptic conditions (surgical wounds), in which it does not penetrate into the chest cavity, gastrointestinal, genitourinary tract;

·               clean contaminated wounds – in which the respiratory, gastrointestinal, or                            genitourinary tract is entered with minimal contamination;

·               contaminated wounds – wounds with a major break in sterile technique, open traumatic wounds less than 4-6 hours old with inflammatory process without purulent discharges;

·               infected wounds – traumatic wounds with purulent discharges or perforated viscera, more than 6 hours old.

 

After trauma, when the patient shows up in the clinic, it must be stabilized initially. If haemmorage is present, the wounds need to be bandaged with sterile gauze to stop bleeding, and emergency treatment should be initiated according to the patient’s needs. If it is not an emergency and the patient comes to the clinic with an older wound, after obtaining the complete anamnesis and examining the wound, formation of an initial plan of treatment is necessary. Thereby, depending on the type of wound, the approach differs. Four types of wound closure are described:

–                 primary closure, called also healing by first intention represents immediate closure of a fresh wound. This category includes recent traumatic wounds and surgical wounds.

  • delayed primary closure is indicated when the injured tissue have questionable viability or infection is suspected. The closure is delayed 3-5 days in which time the wound is assessed with proper dressings. Also delay closure offers time for proper drainage and the inflammation will decrease. Approximately 5 days after wounding fibroplasia, cytokines and macrophages will protect the wound against infection and closure can be performed. This type of closure is done before granulation tissue formation.

–                 secondary closure is performed after granulation tissue formation. Usually 5-10 days after injury; this type of closure is indicated when necrotic tissue persists and need to be debride many times, when inflammation is prolonged or when signs of infection are still present

.-                healing by second intention represents healing by granulation, contraction and re-epitelisation. This method is applicable for next types of wounds:

·                    moderate to large wounds in young animals that are located on trunk. Kittens and puppies have a fast rate of healing;

·                    wounds located in areas where the closure may create a “tourniquet effect“ (commonly on distal limbs). In this situation the circulation is compromised

;·                    infected wounds and those who presents questionable tissue viability;

·                    wounds that are closed under tension and dehiscence will occur.

How do wounds heal?

Tissue continuity is restored by the healing process. This biologic process begin immediately after injury or incision. Wound healing is a complex process that comprise three phases: inflammation and debridement, proliferation (repair), maturation and remodeling. All these three stages overlap and have a different duration.

Ø              Inflammatory and debridement phase.

After wounding, to avoid exsanguination hemostasis occur. Following the breakdown of blood vessels, endotheline is produced and along with other mediators (serotonin, bradykinin, catecholamines, histamine, prostaglandins) cause contraction of muscle within the vessel walls and hemorage is stopped by vasoconstriction. After 5-10 minutes, vasodilation occur. An increased blood flow to the wound bed and extravasated fluid in the wound will be present. Subsequent vasodilation, leukocyte migration starts (neutrophils and monocytes). At this point the wound will have the classic aspect of inflammation: swelling, elevated local temperature, erythema, pain. In early inflammatory phase the neutrophils predominate and in late inflammatory phase they decrease and monocytes predominate.

The main cells: –endothelial cells: neoangiogenesis-provides oxygen and nutrients to the tissue;

macrophages and neutrophils: debridement, phagocytosis of bacteria

and other pathogens.

 

  • Proliferative (repair) phase. About 4-6 days later, after wound debridement, the wound enters in repair phase. This stage lasts from day 5 until day 20 but can be longer and depends on many factors: wound size, location, age, health, etc. Four stages are included in the proliferative phase: angiogenesis, fibroplasia, contraction and epitelisation. The aspect of the wound will change in this phase from red to pink and the quantity of exudate will decrease. This phase is predominated by macrophages, fibroblasts, endothelial and epithelial cells. Due to platelet-derived groth factor (PDGF) and transforming growth factor (TGF-β), fibroblasts migrate in the wound from surrounding tissue. As a response to PDGF
    type III collagen is synthesized by fibroblasts. After 7-14 days, TGF-β increase synthesis of type I collagen. Collagen afford strength to connective tissue. There are more than 20 types of collagen. Type I collagen is present in unwounded dermins in 80% and type III collagen in 20%. Finally, due to TGF-β1, fibroblasts are transformed into myofibroblasts and wound contraction begin. Contraction increases with a speed of approximately 0.6 to 0.8 mm/day. As a response to epidermal growth factor (EGF) and TGF-α proliferation of epithelial cells begin. Epitelisation continue until complete epidermal thickness. The growth rate of the granulation tissue is 0.4 – 1mm/ day. The granulation tissue is very fragile in consistency and act as a barrier to infection.
  • Maturation and remodeling phase. In the last phase of wound healing remodelling and strengthening of collagen take place. Care must be taken at the beginning of this phase because the scar tissue new formed is very thin and fragile and need few weeks until will gain a proper strength. Due to a changing in collagen type (only 10% of type III collagen present in the scar tissue) rigidity rise and the matrix becomes more stiff. Though, the final scar tissue will not achieve the elasticity and strength of a normal tissue. The maximum strength will be approximately 70 % – 80%. Usually this phase starts 3 weeks after wounding and continue until 1 year.

Figure 1. Illustration of approximate time of wound healing stages. Inflammatory phase last between 0-6 days,

52115600_1963395883709645_7962708292625498112_n

Fig 1

repair phase 4-25 days and maturation and remodelling phase 21 days to months. Overlapping of healing stages is represented by the green triangles.

 

51536172_382363025646642_7845768621056851968_n

Fig 2

  Figure 2. Illustration of cell distribution in the time of healing;

 

Conditions that delay or impede wound healing

 

Factors who are involved in this process are grouped into several categories:¨             Host factors: hypoproteinemia (malnutrition); age (wounds in elderly patients have a longer healing time compared to young patients); internal organ disfunctions (Cushing Syndrome- excess circulation of glucocorticoids, liver diseases – clotting factor deficiencies, diabetes mellitus, uraemia, hypothyroidism), obesity, immune disfunction, viral diseases (FeLV/FIV), cancer, coagulopathies, self trauma;¨             External factors: infection, foreign bodies (environmental – grass awns, soil; surgical  metal plates, drains), radiation therapy, long surgical time and hypoperfusion;¨             Medication: chemotherapy, glucocorticoids, NSAID, anticoagulants, cytotoxic solution used for lavage; ¨             Mechanical factors: motion, tension, pressure (from bandage).

 

 

Section B

 

In which stage of healing we are?

In order to choose an appropriate treatment method (closure or dressing) it is necessary to recognize the phases of wound healing. Some specific aspects should be considered: macroscopic appearance (infection, contamination, blood, inflammation), time elapsed from wound appearance, amount of exudate, wound size, tissue viability, wound margins. This section will illustrate wound details in different phases of healing.

Figure 3. Ventral view of abdomen of a cat during     Figure 4. Approximate 1 hour old wound located on

spay, midline approach; This is a surgical clean        the left front leg, between digit IV and digit V. Small

wound.                                                                                amount of  unclotted blood and early inflammation

51544716_292749861353945_6836055190253076480_n

Fig 3

51549863_2104152773006043_8753717663684886528_n

Fig 4

 

 

 

 

 

 

 

 

 

 

 

 

Figure 5. (a)Lateral view of digit V of  left hind in a 6 years old paraplegic female dog. Healthy

granulation tissue is present 9 days post dressings treatment. Mild exudate was present following the

removal of the bandage . (b)The same pacient 18 days after wounding; a nearby photograph was made to highlight the presence of epithelisation present at the wound edge (black arrows). The white color at the

center of the wound represents the reflection of the camera light. (c) Maturation phase- complete

epithelisation present in day 44 post dressing treatment.

51800949_234522520832342_3353788615388823552_n

Fig 5

51617023_2173831566010944_4981136923385921536_n

Fig 5

51503030_346822929264552_8289757970472894464_n

Fig 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 6. Dorsal view of the right paw of the hind limb in a cat;

51489305_2177554915616450_8814354617560203264_n

Fig 6

The deglowing wound shows necrotic tissue, foreign materials devitalised tissue and mild exudate; High local tempreture was present on palpation. The infected wound was debride surgically, treated with dressings and later a full thickness mesh graft was applied. The cat disappeared from home for 2 weeks.

 

 

Figure 7. Left latera view of a 4 years old male Yorkshire beign bitten by a dog; Second intention healing

from the beginning until the end was chosen. Granulation tissue is in the middle followed by epithelisation

51573064_655797781507474_8977494285964279808_n

Fig 7

and obvious wound contraction after 4 weeks of treatment with dressings.

 

 

Demodicosis with secondary pioderma and fungal infection (dermatophytosis).

31218656_1929341830411951_7466975273171288064_nDr Daiana Debreczeni

Veterinaru clinic VitalVet

Oradea, Romania.

 

Information about the patient:

Name: Lala

Sex: Female

Age:10 months

Species: Canis familiaris

Breed: Mix

Medical history

The dog had been treated for 14 days at another veterinary clinic for allergy with steroidal non-inflammatory drugs and antibiotics (amoxicillin and clavulanic acid).On presentation at our clinic the owner complained about the fact that the dog was pruritic and had the lesions presented in the pictures shown below.

IMG_0997 IMG_0998

 

 

 

 

 

 

 

 

IMG_0988 IMG_0994 IMG_0987

Diagnostic tests:

Skin citology, Gram stain: Gram positive, rod shaped cocci (Staphylococcus spp.);

Wood lamp examination: positive;

Trichogram: swollen, frayed hair with irregular outline; cortex and medulla structure – abnormal;

Deep skin scraping: positive for Demodex.

 

 

Diagnostic: Demodicosis with secondary pioderma and fungal infection (dermatophytosis).

 

Treatment:

 

– Simparica (sarolaner)  1x/month, repeat until 3 consecutive negativ skin scrapings;

  • Marbofloxacin, 21 days;
  • Bathing with therapeutic shampoo (ketokonazol, clorhexidine formulation) every 3 days;
  • Every 3rd bath another therapeutic shampoo was used (benzoyl peroxide);
  • Dermoscent Pyo spot-on, 1x/week, 4 weeks;
  • FortiFlora probiotics.

Topical gel with onion extract and heparin;

Follow up after 1 month:

IMG_1146 IMG_1153 IMG_1154 IMG_1155

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After 3 months from the initial consultation:

 

48370418_299299174033893_6871986109262331904_n 48392732_266569077305066_4483729918953259008_n 48376231_563513447463071_1721448816659398656_n 48408389_284540192407843_6492582261840412672_n

What will make your job easier and what you need to come to work with pleasure?

50286153_10218983474407136_3258501475982114816_n We had a question on our Facebook Page and we would like to share some of the answers ( We will skip the names, so people will be more comfortable):

  1. Hi Luba,
    I have followed your journal for a long time, and I sincerely enjoy your success. Hope there are more people like you, radiant and dedicated to your profession.
    Your question, “What would make your work easier and what do you need to work with pleasure?” I would answer so …
    Our profession is wonderful, our patients too, but we also work with people. For this reason, my answer is exactly the same … people. In my opinion, working atmosphere, our colleagues, our attitude towards each other is very important. Our work is tense and responsible and our day would be lighter if there are more smiles, jokes and teas, mutual help and respect among colleagues.
    I will be glad if I can contribute at least a little bit, in order to be more creative, fruitful and happy at my workplace.
  2. Regarding this issue I think we should look from 2 points of view. From my opinion going to work has always been a pleasure in the last 10 years because passion was my motivation but with the passing of time I understood it is the most important to work in an environment that makes you feel at home because all of us spend more time at work than at home with our families. So the work team need to be united and lead by a leader that work side by side with his employees and motivates each of the members by having a nice attitude and giving money reward when needed.On another hand this job would be perfect if the people’s culture regarding the PET industry will grow somehow in a way more responsible, to give more respect to the medical team, to stop treating us like garbage, to stop asking Dr.Google and to be more aware of what means raising a dog or a cat but that will only happen in another world.

    In conclusion I think passion and hard work are the success key in this field.

  3. I would do it more easily if I didn’t waste my energy on unnecessary things, if I had the understanding and appreciation of my colleagues, encouraging of my mentor, if we stop complaining for things that are difficult to solve or things that don’t work and see all like challenges, replace with the appreciation of things that work, complain but with a good optimist conclusion, make a effort to have good mood and positive energy maybe we can inspire all the team 
  4. The team is most important and the attitude to owners!
  5. THE TEAM!
  6. The team is very important! And a boss who trusts you.

50516709_2262407440699524_3020977303338352640_n

So, veterinarians from The Balkans are searching a team, good envoirment for work. Noone spoke about payment, schedule and so on.

I would like to ask every single vet to think with heart and see what we all can do, to work in a good envoirment, to trust more our colleagues and just to be kind. I would like to ask all the leaders to think how they can improve the good envoirment in their own clinic, how to create a TEAM , not just couple of vets in one place. As a vets, we would not see our colleagues as a competition, we should see them as a help and support. We are the first once who should respect our job between us and then to expect this from the owners

 

 

with love

Luba Gancheva

Learn and Travel- New Story

20181207_125741Dr Cristian Badineci from Bucharest Romania, with the kindly support of Pamas Trading has done his internship in Central Vet Clinic in Sofia, Bulgaria. Let him tell us more about it:

 

I had the chance to attend a one-week internship in December 2018 at the Central Vet Clinic in Sofia. I recently heard of the Vets on The Balkans project from colleagues sharing the same passion: Cardiology. Thus, with the help of organizers Luba Gancheva and Pamas Trading 12814393_1673705086236432_1339900710371625092_nI managed to come to Bulgaria to meet wonderful people.

The clinic is located in an area with green spaces, next to a zoo. I had a warm welcome and attention from Dr. Ranko Georgiev, who presented his colleagues and the tour of the clinic. It has a reception hall, a corridor to the large workroom. On the right corridor there are 3 consulting rooms, and on the left 3 imaging rooms. One for radiology and two for ultrasound. Also on the ground floor there are 2 surgical halls. In the basement there are the admissions stations, the meeting room.During my time here, I attended various cases of general medicine, emergency and surgery, but most of the time I spent in the cardiology department with Dr Marin Buckov, Dr Hristina Shukerova and Dr Ranko Georgiev. I have remarked their dedication to this discipline as well as vast experience in cardiology. They participated in numerous workshops and international congresses. I have witnessed many cases, both common like PS and AS, DCM, MVD, HCM, and distinguished, such as a Labrador with Cor Triatriatum Dextrum, a Jack Russell with Revers PDA. cor triatriatum dextrum24246_103549239687374_288378_nAs far as cardiology is concerned, in the clinic can be made specialized consultations and any kind of interventions for solving cardiac diseases in dog, cat and exotic animals. Performing the necessary investigations in a timely manner, Those in critical situation are interned, stabilized and monitored. There are always staff checking out the clinical signs and administering the medication.During my time at the clinic I was impressed by the qualities of this team. I have met respect and common sense both towards people, animals and love for medicine. I witnessed an emergency in which a small dog was sprouted by a wild boar and had an open chest wound and internal haemorrhage. He arrived in hypovolemic shock. They quickly organized a mini intervention team and stabilized the puppy in 30 minutes. 5 people quickly took clinical signs, performed intubation, artificial respiration, 2-member venous approach, restored volley, stopped bleeding. In 15 minutes the surgery room was ready, and the surgery team performed the closing of torax. The next morning, this dog was barking and eating like nothing happened.I was impressed by a doctor who received a chinchilla with kidney failure. The animal was in critical condition since receiving had serious prognosis and died, but this doctor did not stop for 2 hours trying to save it.After this experience I can hardly wait to get back in our practice and apply the new working methods learned here. I attach some pictures of Dr. Ranko‘s interesting cardiology cases to which I have attended. I am very greatfull for this experience.

 

Vets on The Balkans express their gratitude to Centra Vet Clinic and Dr Ranko Georgiev for being part of Learn and Travel and as well to Pamas Trading for the strongly support as always!