An Introduction to Pet-specific Care

ackermanWritten by Lowell Ackerman, DVM, DACVD, MBA, MPA, CVA, MRCVS

Author: Dr. Lowell Ackerman is a veterinary consultant, lecturer and author. He is editor-in-chief for “Five-Minute Veterinary Practice Management Consult,” and he lectures globally on medicine and management topics.

 

[© Lowell Ackerman 2019. No part of this material may be reproduced or copied in any manner without express written consent of author. Some of this material has been abstracted from Five-Minute Veterinary Practice Management Consult, 3rd Edition]

 

For veterinary medicine to provide real value to pet owners and real financial success for veterinarians, there is a need to focus on being proactive, appreciating risk factors, closing compliance gaps and managing through evidence-based guidelines. This is the essence of personalized medicine and an opportunity that veterinarians should embrace.

I define pet-specific care as veterinary care tailored to individual pets based on their risk of disease and their likely response to intervention. It could also be regarded as the right care, for the right pet, at the right time. This is a common sentiment in medicine, and it is known by a variety of other names, including lifelong care, client-centric care, personalized medicine, precision medicine and genomic medicine. At its core, pet-specific care focuses on prevention, early detection and evidence-based management using a pet’s individual risk factors and circumstances to determine the best course of action.

The Situation

All veterinarians intend to practice the highest quality of veterinary medicine possible, but this is not always the case. For example:

  • Animals continue to contract infectious diseases even when highly effective vaccines exist.
  • Animals get parasites despite the widespread acceptance that all pets should have year-round parasite control.
  • Diagnoses are often not made until a pet has overt clinical signs of an illness.
  • Genetic predispositions are not always considered for each pet in a proactive manner.
  • Even well-understood chronic diseases like atopic dermatitis and osteoarthritis are sometimes treated with on-again, off-again regimens despite the lifelong timeline.

Imagine the difference to the health of patients and to the bottom line if we ensured that preventive care was provided to all pets in the practice, that we embraced an early-detection model for disease surveillance based on risk rather than waiting for pets to get sick, and that we tailored treatment to patients on the basis of consistent guidelines rather than by relying on individual expertise to dictate how patients are managed.

Most veterinary practices are aware of the importance of prevention, but inconsistencies between doctors in the same practice, a failure to address compliance gaps, and not standardizing hospital-wide recommendations mean too many pets are not receiving optimal care. Practices lose the compensation that would be associated with such care.

Currently, many pet owners only appreciate the need to see a veterinarian for vaccination, routine care or serious illness. This failure to grasp the true value of pet-specific care can adversely affect the health of pets and the financial health of veterinary practices.

Be Pre-Emptive

The area with the most need for improvement is early detection. Veterinary health care teams are very good at working up patients with clinical problems (such as polyuria/polydipsia), confirming a diagnosis and instituting treatment. However, a goal of pet-specific care is to identify problems when they are subclinical and the pet still appears well and when the most options are often available for management or prevention.

So, for example, our human physician counterparts would not be as satisfied with diagnosing diabetes mellitus in a patient; the preferred goal would be to identify the pre-diabetic patient and then manage the condition so that it might never evolve into clinical diabetes. For us to achieve the same level of care, we need to embrace early detection and not wait for animals to be clinically ill before we start routine screenings and intervention.

A comprehensive history, physical examination and appropriate periodic diagnostic screenings are the key components of early detection. Diagnostic screenings might include genotypic testing (e.g., DNA) and phenotypic testing (e.g., laboratory findings or imaging) for heritable or otherwise predictable medical issues.

Early detection is easiest if we first take the time to appreciate risk. Some animals are going to be at higher risk for specific conditions than others, based on genetics, family history, breed predisposition, lifestyle, exposure and other factors. Doesn’t it make sense to screen pets at risk for a variety of conditions proactively rather than waiting until the conditions become problematic?

The earliest screening is typically genotypic testing, which can be done as early as 1 day of age but for practical purposes is usually done at around 12 weeks (and after pet health insurance is in full effect, for pet owners who desire this form of risk management). With recent advances it is now possible to cost-effectively screen for dozens of genetic diseases with a single panel. Such panels include things like von Willebrand disease, progressive retinal atrophy, cardiomyopathy, degenerative myelopathy, MDR1 and cystinuria. A variety of laboratories, such as Orivet, Canine Health Check, Embark and Mars, provide comprehensive panels. However, the goal of such testing is not necessarily to identify problems, but to provide most pet owners with peace of mind that there are not underlying monogenic diseases that need to be addressed. This is the purpose of neonatal screening in human hospitals – to identify the rare individual with genetic errors, but to provide comfort to the majority of parents that worrisome disorders were not found in such screenings.

Genotypic testing is new and exciting, but it won’t uncover all risks, so phenotypic testing is needed for many conditions, including diabetes mellitus and orthopedic disorders, based on a pet’s individual risk factors. While genotypic testing can be done early in life since DNA does not change as a pet ages, phenotypic testing, such as blood work, urinalysis and radiographic studies, is usually performed at ages and intervals that vary with the breed and condition being detected.

Diagnostic screenings can provide baseline values and facilitate long-term monitoring to establish trends that might help to identify subclinical disease. Without early detection and management, many of these conditions can lead to a significant decrease in a pet’s quality of life.

Shared Standards of Care

The final aspect of pet-specific care is evidence-based management. Hospitals should endeavor to codify best practices that are common to all veterinarians in a practice and based on the most current guidelines available. These standards need to be periodically reviewed and updated as new evidence becomes available.

Clients want veterinarians to provide health guidelines in accordance with their pets’ actual needs, so adopting and implementing guidelines, protocols and evidence-based care pathways allows the veterinary practice team to satisfy this desire while simultaneously better meeting practice revenue objectives. A suitable starting point is to consider thorough assessments or questionnaires to determine which risk factors might influence the decision-making process, using the information to establish prevention protocols and early-detection opportunities, and then monitoring pets throughout their lives, modifying action plans as needed.

Early therapeutic intervention has been shown to offer the best chance of successful long-term management of many conditions. Clearly distinguishing between curing a medical condition and long-term control is important when discussing the benefits of intervention and disease management with pet owners.

The Bottom Line

It doesn’t take much imagination to see that personalized medicine allows for the delivery of better medicine. With improved prevention, early detection and evidence-based treatment and monitoring, as well as closing compliance gaps, there are many more opportunities for revenue generation just by providing better medicine. In fact, the American Animal Hospital Association has suggested a significant increase in revenue is possible over the life of a pet just by providing the level of care that most veterinarians already acknowledge is needed.

When will you incorporate pet-specific care into your practice?

Author: Dr. Lowell Ackerman is a veterinary consultant, lecturer and author. He is editor-in-chief for “Five-Minute Veterinary Practice Management Consult,” and he lectures globally on medicine and management topics.

LEARN AND TRAVEL….. NEW STORY! Dr Matei Alexandru at Central Vet clinic in Bulgaria

46520505_355142141909610_6510054373484134400_nDr Matei Alexandru from 3vet Original Project Clinic in Bucharest, Romania has done his externship at Central Vet Clinic in Sofia, Bulgaria. What he said about it:

 

Central  Veterinary  Clinc – Sofia – October /November 2018

To go to certain places you need friends, and sometimes you will find friends simply by hitting them in while you’re going through life. A rumor, a link and a helping hand at the right time if you know how to accept them will open your world. Luba, I met her through a rumor, my colleague Stefan made my connection and my helping hand came from Pamas Trading .12814393_1673705086236432_1339900710371625092_n And I accepted the challenge but a bit different from what was initially planned.

At first I was asked what I liked and I answered –  Soft tissues surgery… when I got there I was asked again – What do you like? And I answered – ALL and I had the opportunity to see ALL at the clinic in Sofia .

I saw a waiting room full of people that was held by three receptionists. I went to three meeting rooms on a long hallway leading to the triage / urgent reception area, and in one corner a lab with all of a dedicated man surrounded by books. I went back through two ultrasound halls and stopped in a radilogy room used to its maximum value.46504093_1954656381506155_1879230126814658560_n 46506316_504219466756165_6529017598988779520_n 46507462_343922266187577_8073384407227957248_n 46507771_738542649840914_4496201851145814016_n 46508584_2175589452709070_1243322865311285248_n 46513483_369877663752364_467199421403103232_n 46514154_1186951701472334_2597444006979829760_n 46514502_259039121427825_8745223588467965952_n

Many surgeons can be operated at once and I have enjoyed the idea and the fact that each surgeon has an anesthesiologist who will do his job very well, the surgeon being strictly focused on the surgical side. I have attended and participated in routine and to more complicated operations (new or older fractures remedies, chronic cases without hope of resolution). Through the hard work of dedicated people ,animals with no hope of healing, resumed their lives, and I have learned new things.

In the clinic everywhere is always a line. A line on which doctors walks and split  the chaos of order. I tested my own skin because I tended to go into the surgery  without a mask … it was a good lesson.

I saw smile, confidence and knowledge and felt the strength of a team. I have received the required information without retention, I have debated cases and I was involved in a differential diagnosis … I have seen desperately recovered cases but also the last breaths of patients for whom nothing could be done.46518652_2331664727053218_7447802504802205696_n 46519168_502253150292970_4750675781510758400_n

I have known dedicated doctors only for overnight patients focused on continuous monitoring, I have communicated with specilalists on exotic animal ,cardiology, ophthalmology, internal medicine, reproduction, neurochirurgia, orthopedics, dermatology, endoscopy, oncology … and I was pleasantly impressed of their level of knowledge and the fact that they want to share whit their colleagues the informations without asking for anything in return.I have been invited into their world for a short time to be witness at high-quality veterinary business build on trust and respect. Thank you Ranko Georgiev for accepting me in your house.46485905_349823095794080_9038427446554132480_n

Purina Institute Announced as WSAVA’s First Diamond Partner

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The recently launched Purina Institute has become the World Small Animal Veterinary Association’s (WSAVA’s) first Diamond Partner. Its support will underpin the running of some of the WSAVA’s key clinical committees and initiatives. These include:

  • The Global Nutrition Committee (GNC), which produces research and resources to help the veterinary healthcare team and owners to understand the importance of nutrition in companion animal health
  • The Animal Wellness and Welfare Committee (AWWC), which promotes advances in companion animal wellness and welfare around the world. It will publish its Global Guidelines on Companion Animal Welfare at this year’s WSAVA World Congress
  • The Hereditary Disease Committee (HDC), which raises awareness and understanding of hereditary disease and genetic predispositions in dogs and cats
  • WSAVA One Health Committee, (OHC), which works to highlight the importance of the small companion animal-human interface on the global One Health agenda.Purina pic

The Purina Institute is also a Global Partner for WSAVA One Care, a pioneering initiative to motivate veterinary associations in countries where companion animal practice is still emerging to raise standards of care.

Serving as the global voice of Purina’s science and its more than 500 scientists and pet care experts, the Purina Institute aims to put nutrition at the forefront of pet health discussions.

The Institute will connect the most innovative minds in pet health by facilitating knowledge exchange and collaboration with veterinary and scientific thought leaders around the world. As a champion of nutrition, the Purina Institute will share the company’s latest scientific breakthroughs and will provide objective, fact-based information sourced from the wider scientific community on current trending topics across pet and human nutrition.

Commenting, Dr Jane Armstrong, External Relations Director for the Purina Institute, said: “We have supported the WSAVA for many years and, as its mission aligns closely with that of the Purina Institute, we felt it was the right time to step up and build an even stronger relationship.”

“The Committees we support align with the Purina Institute’s focus.  Purina has long been a pioneer in advancing the science of pet health, so we look forward to the opportunity to participate in global nutrition conversations through the GNC. Additionally, our research on the human-animal bond reflects our commitment to making lives richer for pets and the people who love them. This is a key driver for our interest in the AWWC.”

“We are particularly excited by One Care as it supports the development of companion animal medicine around the world.  The Purina Institute embraces its goals, especially the development of regional leadership to enable veterinary organizations to support individual practitioners.”

She added: “The WSAVA is the largest and most important global community of companion animal veterinarians. The team at the Purina Institute look forward to working closely with it on initiatives that advance the missions of both organizations.”

Dr Shane Ryan, Incoming WSAVA President, said: “The work carried out by our Committees is helping to transform companion animal medicine around the world but it would not be possible without the help we receive from our industry partners.  On behalf of all of our 200,000 members, I would like to thank the Purina Institute for its most generous support and we look forward to working with the team in the months ahead.”

Diamond Partnership is the premier level available under the WSAVA’s recently launched Partnership Program.

BRAIN TUMORS- 3 CLINICAL REPORTS

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DR SVETOSLAV PENCHEV

United Veterinary Clinic

Varna, Bulgaria

CLINICAL CASE 1

Old Dogs with sudden onset of seizures

 

The 1st clinical case is about 13 years old, castrated Belgian shepherd with acute onset of cluster seizures. Before 5 years the dog was operated ( total mastectomy and ovariohysterectomy) , because of mammary gland tumor.  Another vet made the blood analysis and there is no change in laboratory results. Contrast MRI study  was performed.

MRI findings:1 2 3 4

There are two, oval shaped, T1 hypo- and T2 hyperintense,  intraaxial mass lesion with cystic component. One is in right piriform lobe and another one is in the left olfactory bulb/ frontal lobe. The masses nonuniformly enhances following contrast administration, with more intense enhancement peripherally.  Mass effect with mild brain edema surrounding the lesions is present.5 6

 

Thoracic x-ray show :7

Multifocal nodules with soft tissue opacity in lung parenchyma

The reason of seizures are  metastatic brain tumors in  the right piriform lobe and in the left olfactory bulb and there are multifocal metastatic nodules in the lungs. Although the dog was operated ,  the primary mammary gland tumor is the reason of this condition

There is no feedback with the owner about dog`s condition.

 

CLINICAL CASE 2 8

Next case is about a 9 years, female, not castrated Labrador retriever with acute onset of cluster seizures. The dog present  proprioceptive deficit on the right fore and hind limb. There is no history of previous seizures.  By abdominal palpation mammary gland mass was find.

There is no change in the blood analysis.

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MRI findings:

There is   oval shaped T1, T2 mixed intensity mass in the parietal part of left cerebral hemisphere with surrounding brain edema. Mass margins are well defined on T2. Peripherally enhancing following contrast administration is present with mass effect and midline shift to the right

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Thoracic x-ray show multiple oval shaped masses with soft tissue opacity

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In this case we have the same condition. The metastatic lung and brain disease are due the primary mammary gland tumor.

The dog`s owner prefer to euthanized the dog, because the seizures getting longer and stronger.

 

 

 

 

 

 

CLINICAL CASE 3

The last case is about a 9 years, not castrated, female Jack Russell terrier with depressed mental status from a month and acute onset of seizures. The dog reacted with hypersensitivity in right cranial nerves, proprioceptive deficit in left fore and hind limb and proprioceptive ataxia. MRI contrast study was performed. MRI findings:    17 18 19 20

 

 

There is a one, irregularly shaped, T1 hypo and T2- mixed intensity intraaxial mass involving the right midbrain. The mass intensely, but nonuniformly, enhances following contrastadministration. There is a mass effect and surrounding brain edema.

In this case there is no history of neoplastic disease. This midbrain mass has a characteristic of primary tumor and It is the cause of the seizures.   Every dog after 5 years of age, who presented with a new onset of seizures should be suspected for a brain tumor. The most common indication for brain tumor in dogs are seizures, especially seizures that began for the first time in a dog older than five years of age. Other signs suggestive for a brain tumor include abnormal behavior, vision problems, circling motions, uncoordinated movements and  lethargy.

 

THE ABDOMEN IS ALWAYS A MAGIC BOX

41768527_2349628575051886_8602568388625039360_nDr Giulia Nadasan

Vet Point Vest

Arad,Romania

 

Patient: Ellie

Species: canine

Breed: mix German Shepherd

Age: 9 years

 

Anamnesis: the dog and it’s owner are very close to our vet practice, they ask for anual hematology and biochemistry exams, abdominal ultrasounds  x-rays just for prevention. In the 19th of September 2018 the owner called beacause her dog was not being herself, she was not eating for 24 h and she thinks the dog is in pain.

 

Clinical findings: when the dog got to our practice she was lethargic, with pale mucose membranes, tahicardic, dispneic and with an enlarged abodomen.

 

Blood samples were taken and the results were:

-mild anemia 4130000 mm3

-hemoglobine 9,9 g/dL

-hematocrit 27,2 %

-severe trombocitopenia 52.000 /mm3

-leucocitosis 22510/mm3

-limfopenia 8%

-extended clotting time

-TCR >2 sec

-CPK increased 955 U/L

-ASAT 289 U/L

-ALAT 70 U/L

-Ureea 124 mg/dL

 

We performed and ultrasound and there was free fluid in the abdomen and after the paracentesis we removed aprox. 300 ml of blood from the abdomen. We suspected an abdominal hemorrage.

 

Diferential diagnosis:

  • Intoxication with anticoagulant raticides
  • Trauma
  • Internal bleeding: organ hemorrage
  • Hemangiosarcoma

 

After a few hours of i.v fluids (aprox 2000 ml NaCl 0,9%) to reestablish blood volemia we decided to do a laparatomy.

Thoracid X-rays were free for pulmonary metastasis. At the ecocardiography the heart was free of any mass in the right atrium.

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** Note that we did not made that incision, this is how the spleen looked like

Splenomegaly with ruptured spleen was our main concern, we did a splenectomy and removed aprox 4L of free blood from the abdomen. The splenectomy was made with sutures and the attached omentum was removed in bloc. A thorough abdominal lavage was made and the instruments were changed to minimize the risk of metastatic seeding.

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*After surgery

A sample of the spleen was sent to the histopathology lab. That night we performed a blood transfusion from a 60 kg Tossa Inu.

 

 

 

 

 

 

 

 

 

The next morning the dog was feeling great, she ate normal, she waig her tail and everything was great.

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*next day after surgery

 

After too weeks our suspected diagnosis was confirmed: Spleen’s red pulp hiperplasia and splenic haemangiosarcoma. The staging could be: T1 (primary site tumor), N1(regional lymph node involvement: mesenteric lymphadenitis 2 weeks after surgery), N0( no evidence of distant metastatis: clear lungs, heart, liver at ultrasound).

 

Final diagnosis: Visceral Hemangiosarcoma stage II

 

I also tested cardiac canine troponin I (a marker with high specificity for cardiac injury) at PraxisLab in Budapest to check for miocardial metastatic modifications but the result was normal ( <0,25) .

 

Treatment: it has been 2 months since the surgery and splenectomy was the treatment of choice at that time.

She received ONCOSUPORT (RX) and a shot of 3 ml of Theranekron (Tarantula cubensis extract) every 5 days.

We finally found Doxorubicine and we started the treatment with the following protocol:

-Doxorubicine 30 mg/m2 = 16 mg/38 kg every 2 weeks for 5 treatments. It does have a cardiotoxic effect but if the dog lives long enough I will continue as much as I can.

-Maropitant (Cerenia) 1mg/kg 2-3 days after chemotherapy.

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*2 months after splenectomy

Other drugs that can be used with a antiangiogenic effects are : Masivet, Thalidomide, Palladia.

 

The prognosis with dogs with haemangiosarcoma treated with splenectomy only is really poor, 2-3 months surviving time after surgery. Even with chemiotherapy the surviving time of 12 months is only 10%. Median survival time with spelectomy and doxorubicine is 132 days.

Indolent corneal ulcer

Indolent corneal ulcer

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Dr Iuliana Ionascu

Iuliana Ionascu 

Faculty of Veterinary Medicine Bucharest

 

The fluorescein test is very important in diagnosis of corneal diseases. Is our best friend that accurately describes the size and the depth of the corneal lesions. If the fluorescein test is positive exclude primarily a foreign body (from the conjunctival fornix  or from the internal surface of the third eyelid) and then examine using the loupe, the edges of corneal lesion. If is an area of loose of the epithelium at the periphery of the lesion, looking like an “opened book (Figure 1, Figure 2 and Figure 5) your patient has indolent corneal ulcer.

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Figure 1 – Indolent corneal ulcer

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Figure 2 – Vascularized indolent

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Figure 3 – Debridement of the indolent corneal ulcer using cotton-tipped applicators

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Figure 4 – Debridement of the indolent corneal ulcer using Alger Brush®

The first step in the treatment of indolent corneal ulcer is the debridement of the denude epithelium using a cotton-tipped applicators (Figure 2), scalpel blade or Alger Brush® (Figure 3). Local anesthesia of the cornea using Benoxi® will allow you to perform debridement.

Using cotton-tipped applicators, the loose epithelium is removed using gentle lateral and circular movements. Debridement using a surgical blade is easily performed doing lateral movements, holding the blade’s sharpen edge perpendicular on the corneal surface.

The burr of the Alger Brush® device is faced towards the edges of the corneal ulcer and debridement is performed in a circular movement, following the limit between the ulcer and the healthy cornea. The small burr of the device quickly removes the epithelium so that the surgeon’s hand is laid on the periorbital area for support, to avoid accidents. Throughout debridement the corneal surface is flushed continuously using saline.

After performing the debridement of the indolent ulcer, the lesion is significantly bigger than the initial one (Figure 6), and in some cases, the anterior epithelium is completely removed.

The fluorescein test is used to reveal the size of the lesion after debridement in order to choose a therapeutic approach:

  • medical treatment – corneal healer eye drops and gels
  • therapeutic contact lens and eye drops (Figure 7)
  • VetShield® colagen contact lens and tarsorrhaphy
  • only tarsorrhaphy
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Figure 5 – Indolent corneal ulcer before debridement

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Figure 6 – Indolent corneal ulcer after debridement

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Figure 7 – One day therapeutical contact lens applied after debridement of the indolent corneal ulcer

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Figure 8 – The previous case 5 days after local treatment (notice the lesion is smaller)

Indolent corneal ulcer after debridement can be healed ad integrum (Figure 8) in 5-10 days or, in some cases, we need to perform many debridements. That’s why rechecks should be performed each 5 days after debridement and fluorescein test and reexamination with the loupe is mandatory.

Surgical removal of the luxated lens including the capsule (intracapsular lens extraction) in a bear

Belica_surgery118Dr Maria Savova

Veterinary Clinic NOVA

Sofia, Bulgaria

 

Violeta is a 37y.old brown bear form Belitsa Dancing bears park, Bulgaria.

She was suddenly blinded and had an urgent eye check.The ophthalmological examination revealed increased pressure (40mmHg) and displaced lens in the left eye.The cornea was mildly opaque and the lens was with senile cataract. No PLR. The retina was also degenerated resulting in marked tapetal hyper reflexivity.Belica_surgery30 Belica_surgery40

Lens subluxation (posterior) is partial detachment of the lens form the ciliary body, due to breakdown or weakness of the zonules.

We preformed surgical removal of the luxated lens including the capsule (intracapsular lens extraction).

In the “open sky” approach, the superior cornea was incised 120 – 160 degrees using a cornea knife. The lens and its capsule were removed together in one piece through the incision.Belica_surgery93 Belica_surgery100 Belica_surgery110

Hydrodissection was employed for the removal of lens. We left the eye without artificial lens (aphakic).

During the removal of the lens, prolapsed vitreous was determined and we removed it with scissors in the anterior chamber.

Following the irrigation of the anterior chamber, corneal incisions were closed by separate sutures using 8/0 polyglactine.

For the postoperative care, we applied systemic antibiotics for the first five days.Belica_surgery121 Belica_surgery126

7 days after surgery, the eye is calm; there is no secretion or swelling.

 

Now the bear is in preparation for hibernation and her eye will be examined in the spring.

Meningocele and meningoencephalocele in a dog

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Dr Svetoslav Penchev

United Veterinary Clinic

Varna, Bulgaria

 

8 mounts ,female dog with congenital meningocele and hydrocephalus . The dog is with normal behavior and without neurological deficits.1113

Meningocele and meningoencephalocele of the skull are congenital deformities. These deformities, which are observed as cyst-like swellings in the median part of the skull cap, occur very rarely. The intracranial material protrudes through a spontaneous cavity, such as the anterior fontanelle , and they are classified as encephalocele, meningocele, or meningoencephalocele according to the cranial bifida.111 1122

LEARN AND TRAVEL…..New story!

44621748_2183879854956768_4110182779130478592_nDr Jelena Micic has done he externship in Central Vet Clinic in Sofia Bulgaria. Let her share with us:

“Thanks to Vets on the Balkans and Luba Gancheva, I had a chance to spend time from 14th do 22nd October this year at a great Central Veterinary Clinic in Sofia, Bulgaria.

The clinic is amazing, with everything that you think you might need for veterinary medicine. Great place, which has stationary, x-ray, two amazing ultrasound machines, great laboratory, operating rooms, 24h service etc. and above all, experts in all fields of veterinary medicine, team that is not only made of great doctors but great people. First of all, I would like to thanks Dr Ranko Georgiev, who is amazing cardiologist with huge experience and unselfish of giving his knowledge to others. Open to all my questions and willing to answer all of them and explain everything from echocardiography, cardiology, x-ray and also abdominal ultrasound. As I started to write about cardiology, I had chance to meet Dr Marin Buchkov, a young doctor, who works alongside Dr Georgiev and probably is a future of Bulgarian cardiology. Now, about abdominal ultrasound that I am professionally interested in, I have to thanks Dr Miroslav Genov, expert in reproduction and Dr Kaloyan Voichev, who had patience for all of my questions and luckily I will attend at least one of his ultrasound workshops in the future. 44702825_443237652867945_6189133321910353920_n

Also, I saw some interesting cases in ophthalmology thanks to Dr Janica Dencheva. Interesting part of my externship was meeting Dr Gergana Georgieva and Dr Melinda De Mul, who are interested in exotic animals. Even I don’t have so much contact with these kind of pets, they explained me a lot of cases and give chance to see, for example, an ultrasound exams and x-rays of exotic. Also I had chance to see and learn from Dr Yordan Stoyanov, Dr Nadia Mihalopoulou and Dr Yordan Yordanov. Special thanks to (of course also great doctors) Dr Tome Peychinovski, dermatologist and ultrasonographer and Dr Iva Dimitrievska, who spend her free day for tour of Sofia with me , and gave me that privilege to meet their family and spend the beautiful day with them. 44797808_534785090279383_5473703989302263808_n

There wasn’t just work. We also spend very pleasant night out with delicious food, drink and talks, speaking in Bulgarian, Macedonian, Serbian and English. Contacts that I made during this stay at the clinic are, hopefully, something that will last for a long time. I was really lucky to have opportunity for this externship, thanks once again to Dr Luba Gancheva and great invention, Vets on the Balkans.”24246_103549239687374_288378_nlearn and travel

LEARN AND TRAVEL- Bulgarian vet in Belgium

Presentation3 Dr Anna Mircheva from United Veterinary Clinic has done her externship in Belgium with Dr Ann Criel.

She is telling us more about it:

“I had the great opportunity to spent the last week of September at Dierenartsen praktijk in Kermt, Belgium with the amazing Dr Ann Criel and her team.

The clinic is well structured and very good equipped. From the beginning I was greeted with smiles, open hearts and good clinical discussions.

Every morning began with some good coffee, discussion of the daily schedule and treatment of the hospitalized animals. Then we continued with the assigned operations and examinations.

Due to my interest of soft tissue surgery Dr Ann invite me in the operation room and I assist her from the first to the last operation. Without hesitation she answered to all of my questions, she explains every step of the operations, and she allowed me to do a lot of things by myself. She is the kind of doctor that you can learn a lot from, because she has the experience and the patience.Presentation2

Almost every day we had some great lunches – with Dr Ann’s family, team members and friends. I tried some delicious Belgian dishes in the company of amazing people.  Everyone that I met was really nice, smiling and intelligent – it was a pleasure to met all of them.

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I want to thank Dr Ann because she opened her practice, her home and heart for me. Thanks to her team and family and of course one big Thank you to Vets on the Balkans- it was an amazing week.

Vets on The Balkans express our gratitude to our sponsor of the program for Bulgaria BLUE SKY COMMERCE! All is possible because of them.23316272_180060419216123_164154967085808895_n