WSAVA, Hill’s 2017 Announce ‘Next Generation’ Veterinary Award Winner

wsava logoJudges praise commitment to raising standards of veterinary care in the Balkans

TOPEKA, Kan. (21 July 2017) – Dr. Luba Gancheva, a Bulgarian veterinarian who now lives and works in Romania, has been named by the World Small Animal Veterinary Association (WSAVA) and Hill’s Pet Nutrition as the winner of the 2017 ‘Next Generation’ Veterinary Award.  The award acknowledges the work of a veterinarian who graduated within the past ten years and who has contributed significantly to the betterment of companion animals, the veterinary profession and society at large.

 

“Millennial vets carry the future of the profession with them,” said Dr. Jolle Kirpensteijn, ‎Chief Professional Relations Officer at Hill’s Pet Nutrition.  “Luba has demonstrated a strong commitment to improving the experiences and education of early-career veterinarians. She has also taken positive steps to connect these next-generation professionals with ones who are already established in the field.”

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Dr Luba Gancheva

Dr. Gancheva will be presented with her award at the WSAVA World Congress 2017, which takes place Sept. 25-28 in Copenhagen, Denmark.  She will also give a lecture entitled: ‘A high professional level of veterinary medicine is offered in the Balkans.  True or false?’

The Balkan Peninsula extends from Central Europe to the Mediterranean Sea and includes the countries of Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Montenegro, Romania, Serbia, Slovenia and the European part of Turkey.

Dr. Gancheva graduated from the Faculty of Veterinary Medicine of the University of Forestry in Sofia, Bulgaria, in 2010, and began working in a small animal practice in the city. She demonstrated her commitment to continuing education and received a Master of Science in Infectious Diseases from Triaka University in Bulgaria.  She now lives in Bucharest, Romania, and works at the Cabinet Filip Veterinarul animal hospital.

 

Her PhD thesis, entitled ‘Clinical Manifestation of Brucellosis in Dogs, caused by Brucella Canis,’ was based on a study she conducted on the incidence of this disease in the Balkans.  As a result of her thesis, Dr. Gancheva was invited to speak at two congresses in the Balkans, where she realized how enthusiastic her colleagues in the region were to continue their professional development.

 

In 2015, she launched an online veterinary journal called ‘Vets on the Balkans,’ with the goal of helping regional veterinarians work more collaboratively and share their experience and knowledge.  The journal has presented more than 90 cases and has developed a strong readership. It has also built partnerships with many of the key companion animal veterinary associations in the region.

Building on this success, Dr. Gancheva in 2016 launched an initiative called ‘Learn and Travel with Vets in The Balkans’.  The program enables veterinarians to increase their knowledge and experience by working in clinics in nearby countries. The first placements were made earlier this year, and they were supported through sponsorships and donations from 12 participating practices in Bulgaria, Turkey, Romania, Belgium, Italy and Croatia.

Dr Käthi Brunner, Chair of the WSAVA’s Leadership and Nomination Committee, said: “Tackling the inequality of education and resources available to veterinarians depending on where in the world they are working is one of the key challenges facing the profession.  Dr. Gancheva has taken some very practical steps to support the development of the profession in the Balkans, both through launching the journal and through the new ‘Learn and Travel’ scheme.  We congratulate her and hope that both of these initiatives continue to prove successful.  She is a great example of a Next Generation veterinarian who is showing a very personal commitment to raising standards of veterinary care.”

 

As the winner of the 2017 ‘Next Generation’ Veterinary Award, Dr. Gancheva will receive a monetary gift, an engraved plaque and a WSAVA certificate.

 

Dr. Gancheva said: “I would like to express my gratitude for the Award. It is the biggest honour of my life and I am excited to be part of WSAVA World Congress this year.  During my lecture, I will present clinical reports from my journal from each country in the Balkans to show that, while we may have economic difficulties, our passion for knowledge and love for animals give us strength.  When you cure an animal, you change the world for someone, so veterinarians change the world. Thank you WSAVA!”

 

Hill’s will fund Dr. Gancheva’s attendance at the 2017 WSAVA World Congress so that she can accept her award.

 

Candidates for the WSAVA, Hill’s Next Generation Award can come from any country and must meet the following criteria:

  • Graduated within the past 10 years
  • Active in continuing education
  • Have a strong record in community service
  • Working to bridge the gap between their generation and others

 

The WSAVA’s 101 member and affiliate associations represent more than 200,000 individual veterinarians from around the globe.  They work together to advance the health and welfare of companion animals.  Hill’s is the WSAVA’s most long-standing and significant industry partner.

 

Candidates for the 2018 Next Generation Award can nominate themselves by sending an email to yourwsava@wsava.org by Jan. 1, 2018. They should include a letter of intent, a CV and at least one reference letter. Further information can be found at www.wsava.org.

 

 

About Hill’s Pet Nutrition

 

Founded more than 75 years ago with an unwavering commitment to pet nutrition, Hill’s mission is to help enrich and lengthen the special relationships between people and their pets.  The right nutrition, combined with the devotion of veterinary professionals can transform the lives of pets; and healthier and happier pets can transform the lives of pet parents.  Hill’s is dedicated to pioneering research and ground-breaking nutrition for dogs and cats based on a scientific understanding of their specific needs.  HILL’s® Prescription Diet® therapeutic pet foods. HILL’s® Science Diet® and HILL’s® Ideal Balance™ wellness pet foods are sold through veterinarians and pet speciality retailers worldwide.  For more information about Hill’s, our products and our nutritional philosophy, visit us at HillsPet.com, HillsVet.com for Facebook, keywords “Hill’s Pet Nutrition.”

Fibrosarcoma in rabbit

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Dr Spas Spasov

Dr Spas Spasov

United veterinary Clinic Varna, Bulgaria

 

Fibrosarcoma in rabbits are malignancy rapidly grow soft tissues tumor. Can affect cats dogs and rabbits . The couse of fibrosarcoma in rabbit also can be a viral infection (polyomavirus, malignant rabbit fibroma virus)

Clinical case

Case description
Rabbit, female , entire , 5 years old was evaluated because of sings of anorexia and apathy .
History
The owners reported  that a week ago the rabbit progressively stops  eating. The last two days it didn’t eat at all. Тhe rabbit has regularly deworming and vaccination.
The rabbit eats hay and rabbit granules only and lives in an apartment and  never go outside, there are no others animals in the apartment.

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Clinical manifestations
Anorexia, cachexia, apathy, unilateral uveitis, normal temperature (38.5).
Clinical examination revealed all of the body (back, neck, abdomen and all the legs) nodules, which are not painful, mobile, not tempered and pigmented .The size of the nodules was variable from 1 to 5 centimeters.
Some nodules were ulcerated and bleeding, and still painless. Such formations are not observed in the nose and the ears, and the front part of the head.
Diagnostic approach:
We did not find any abnormalities on the X-ray examination of the chest and abdomen. A nodule was surgically removed by cutting.
Symptomatic therapy was appointed until the results of the histopathological examination:
Metoclopramide-0,5mg / kg
Ranitidine-4 mg / kg
Simethicone-65mg / rabbit
Meloxicam-1mg / kg
Enrofloxacin, 10 mg / kg
Intravenous infusion Hartman 4ml / kg / hour.
So designated therapy lasted about 10 days pending the results of pathological examination The condition of the animal slightly improved, which is expressed in phrases in appearance of appetite. The animal took small amounts of food.

Diagnosis:

Fibrosarcoma
The prognosis for this type of tumors is garded to poor. Because of poor condition of the patient and the prognosis owners decided to euthanased the rabbit.

” A neoplasia in left midbrain in dog”

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Dr Dimitar Ivanov

Dr Dimitar Ivanov,
Veterinary surgeon, Neurology specialist
Dobro hrumvane veterinary clinics
Sofia, Bulgaria

 

 

 

Case report

Dog, Bleki, toy terrier, M, 5 yo.

Came in the clinic on 11.04.2017 with left circle movements, menace deficit on the left and no reaction when stimulating the nasal mucosa.  On the right, spinal reflexes are decreased and there are no conscious proprioception.

Doubt for brainstem problem.

Differential diaggnosis:

V – vascular – it’s with peracute onset

I – inflamatory – it’s possible but no changes in blood sample

T – toxic – The dog did not take any medication, fed the same food and was not seen taking unusual things, but it’s not unpossible

A – anomalous – тhe dog is 5 years old and it is unlikely that there will be any manifestation of these diseases

M – metabolic – there is no other clinical signs or any changes in blood samples.

I – idiopathic – there is no seizures and vestibular signs

N – neoplastic – it’s more possible

D- degenerative – the dog is too young for cognitive dysfunction and too old for other degenerative diseases.

We made MRI on 12.04. and found a lesion in the left mesencephalon.

dhs dhs1 dhs2

 

 

 

 

 

 

 

 

 

 

The final diagnosis is neoplasia in left midbrain.

 

We started to prepare for surgery.

The antibiotic preoperative was Ceftriaxone 30 mg/kg i.v., Manitol 1 g/kg i.v. and Methylprednosolone 20 mg i.v.

The surgery was on 22.04.2017 and we made a left craniotomy and displacement of the temporal lobe dorsolaterally until the lesion was reached.

Bleki preoperative video:

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Pic 1

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Pic 2

The skull was open and we enlarged the hole with Kerrison rongeur (pic 1 and 2)

 

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Pic 3

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Pic 4

We aspirated the brain liquor and very slowly reverse the left temporal lobe.( Pic 3 and 4)

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Pic 5

When we found the lesion we punctured the cyst formation and drew the liquid contents.( pic 5)

 

 

 

 

 

 

 

 

 

 

The reason to do this surgery was to try to reduce the pressure in the tissue and to improve the dog’s condition.

After surgery we continued the antibiotics in the same dose and methylprednisolone in the same dose for three days. After then the dose was reduce to 2 mg /kg.  After few days the methylprednisolone was change with prednisolone and started to reduce the dose.

Until the methylprednisolone is reduced, the patient is better every day, improves motor activity, appetite, but fails to maintain a constant temperature. A corneal ulcer of the left eye appears – I guess the cause is a trauma to the left oculomotor nerve and reduced lacrimation.

On 28.04. we included one more antibiotic – amoxicillin with clavulonic acid.

On 29.04. the prednisolone was reduced to 0,5 mg/kg, the dog was with anisocoria (myosis on the right eye and mydriasis on the left). On 30.04. the circle movements on left started again.

We tried to find Lomustine for chimiotherapy but we couldn’t and increased the dose of the prednisolone to 2 mg/kg

 

Bleki 22 days after surgery:

 

 

Bleki 23 days after surgery

The dog is good, he walk normally but when he stops, he start to make circle movement on the left.

 

Open heart surgery for a left atrial mass extraction during cardio-pulmonary bypass (CPB) in a 9 yoa Labrador dog

ranko

Dr Ranko Georgiev

Ranko Georgiev1, Stoyan Nikolov2, Nadezhda Petrova3

Georgi Ignatov4, MD Thoracic Surgery

1,2,3 DVM, Central Veterinary Clinic, Sofia, Bulgaria

4 MD, City Clinic Cardiovascular Center, Sofia, Bulgaria

1rankoge@gmail.com

 

Introduction:

 

Open heart surgery during a cardiopulmonary bypass is the only effective approach for some diseases that require an access to the heart chambers or the great vessels; even when a temporary inflow occlusion is chosen as an alternative, only a very few “time restricted” procedures could be done on a beating heart. However, when considering an open heart surgery, the high risk of intra- and post- procedure complications often outweighs the benefits. In veterinary medicine the financial weight of such a procedure is also a limiting factor.

We would like to share a case where a temporary sinus arrest was induced during a cardiopulmonary bypass and a huge mass was successfully extracted from the left atrium of a dog with an open heart approach.

 

Case presentation:

 

Artur 1

This is the patient just before the surgery

Arthur is a 9 year old MC Labrador, trained like a guide dog for a blind person, admitted because of increasingly frequent exercise intolerance episodes during the past few months. Furthermore, the last week the patient was very weak and experienced several syncopal episodes. On a clinical presentation with the referring vet а tachycardia and dyspnea were noted and the patient was referred to us for a Cardiology consult.

On physical examination, the dog weighted 25 kg, with a history of a rapid body mass loss for the last couple of months. His “normal” weight has always been around 32 kg according to the owners. The body condition was poor (score 2/5) and the dog had a grade II/VI left sided apical soft diastolic heart murmur. Lung auscultation was unremarkable, but the respiratory rate (RR) was more than 50 breaths per minute.Artur VD

Artur LLR

 

 

 

 

 

 

 

 

 

 

The X-rays of the chest were highly suggestive for e left sided congestive heart failure and showed mild generalized cardiomegaly with a VHS of 11.5 with enlarged left atrium and left ventricle. The pulmonary veins were slightly larger than the pulmonary arteries; the lung parenchyma with diffuse interstitial pattern in the area of the hilus. The patient was already on Furosemide in a low dose – 2mg/kg twice a day for the last two weeks with no improvement of the clinical signs.

 

 

A transthoracic echocardiography was done with the patient in lateral recumbence through the right and left parasternal windows. A huge echogenic mass with irregular shape was observed in the area of the left atrium – attached to the intra atrial septum and prolapsing through the mitral valve during diastole towards the left ventricle. The mass was creating almost full diastolic obstruction of the valve, allowing only a tiny fraction of the blood in.Artur_Ochi_na_4_lapi_20161116113435_1139400 Artur_Ochi_na_4_lapi_20161116113435_1140250 Artur_Ochi_na_4_lapi_20161116113435_1147090 Artur_Ochi_na_4_lapi_20161116113435_1837270 Artur_Ochi_na_4_lapi_20161116113435_1837510

Complete blood count, electrolytes and biochemical profile were normal. During the abdominal US study no further abnormalities were noted and no more masses found. On the ambulatory ECG a normal sinus rhythm was recorded with multiple atrial premature complexes. The blood pressure was normal. A hemo-culture and a urine culture were obtained and came back negative for a bacterial growth. The bleeding time and the Pt/APtT were normal.

A diagnosis of an intra atrial mass with clinical signs of a progressing left sided congestive heart failure was made and a surgery was discussed. Because of the location of the mass no surgical or interventional approach was possible without the aid of a cardiopulmonary bypass (CPB) and cardioplegia. All the risks and possible complications were discussed with the owner and a decision for such a surgery was made. The team for the surgery was from a veterinary surgeon, human cardiovascular surgeon, cardiovascular perfusionist, veterinary and human anesthetists, and nurses. The procedure was done in Central Vet Clinic, Sofia on 3rd of December 2016.

 

 

 

Artur 3

The heart-lung machine with 4 pumps – one main pump for the oxygenator and the blood, two for collecting the surgical field blood and one for the cardioplegique solution; the model is Sorin 5 with a pediatric small volume oxygenator

Our anesthesia protocol with this patient started routinely for the procedure of a thoracic surgery – premedication with Midazolam and Buprenorphine, induction with Etomidate, intubation and maintenance with Isoflurane. Additionally we put a bladder catheter for urine production measurement, central venous catheter, an intra-arterial catheter for a direct blood pressure measurement and tree peripheral intra-venous catheters. Many more drugs were used during the anesthesia and the long post-operative recovery period like Nitroglycerin, Atracurium, Protamine, Amantadine, Pyracetam, Efedrin, Dopamine, Methylprednisolone, Fraxiparin, Clopidogrel, antibiotics, etc.)

Artur 2

The busy surgical field – left lateral thoracotomy through the 5th intercostal space; visible are the venous, the arterial and the cardioplegique cannulae

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the surgical ward during the procedure – a total of 10 people were simultaneously engaged in the procedure

Artur 5

the surgical ward during the procedure – a total of 10 people were simultaneously engaged in the procedure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Artur 6

he extracted mass from the left atrium – Neurofibrosarcoma with size 8/6/4 cm

The surgical approach was through the left fifth intercostal space with a standard lateral thoracotomy. Additionally the left carotid artery was approached and prepared in case it is needed for the CPB blood return. The pericardium was excised and the left atrium, the big vessels and the left ventricle visualized. Then three cannulas were put – the one collecting the venous blood inside the right atrium (through the right atrium auricle), the one returning the oxygenated blood from the CPB machine into the ascending aorta and one small cardioplegique cannula into the aortic root over the coronary arteries. Then a bolus of Heparin was injected iv in a dose of 800UI/kg and 5 minutes later the patient was switched to the heart-lung machine (Sorin 5 and a pediatric oxygenator with 360 ml prime). Then we started a controlled cooling of the patient using a chiller, connected to the CPB machine. When the target body temperature of 28o C was reached the ascending aorta was cross clamped and a 600 ml of cooled to 4o C crystalloid cardioplegique infusion rich in potassium was infused through the coronary cannula producing complete heart arrest. We stopped the active ventilation of the lungs and the patient became fully dependent of the heart-lung machine. The heart was open through a 5 cm cut into the left atrial wall starting from the auricle tip. The mass was directly visualized and excised. It was connected to the intra atrial septum with a relatively small neck. We removed it without creating an ASD. The air from the heart was evacuated and the surgical cut closed with a 5-0 Polypropylene suture in a continuous way. The mass was a solid and well defined structure with irregular shape and was admitted for histology. The size was 8/6/4 cm.

We started a slow rewarming of the patient with a target body temperature of 38o C. Two epicardial electrodes were embedded and connected with an external pacemaker. Once closed and warmed, the heart was gently massaged manually for a couple of minutes and then hit with a direct pediatric defibrillator. We used 5 to 20J of energy shocks and got a slow and then faster rhythm after the 9th try. The external pacemaker was switched on and put on a 100 bpm rate for the next 12 hours. The surgical closure was uncomplicated and no significant bleeding was noted. The patient received slowly iv Protamin (1mg/100IU Heparin) as a Heparin antidote and the heart-lung machine was gradually restricted and then switched off. Two chest drains were put and connected to a sterile active suction. The total machine time was 130 min, the sinus arrest time – 22 min, total surgery time – close to 5 hours. Immediately after the CPB machine was stopped a hemotransfusion with two units of fresh blood was done.

Artur 10

the first 12 hours post the procedure Artur was kept on a Propofol CRI and with an external pacemaker set at a minimum of 100 bpm rate

Artur 9

the first 12 hours post the procedure Artur was kept on a Propofol CRI and with an external pacemaker set at a minimum of 100 bpm rate

Comments:

 

Arthur recovered from the general anesthesia slowly over the next 12 hours, but he was unable to stand on his feet for additional 5 days. The electrolyte levels, liver and kidney values were monitored almost every hour for the first 2 days and then three to five times a day; our main concern was the potassium blood level and we tried to maintain it stable at all times. The urine production was also constantly monitored and tailored to be in the normal range – with diuretics and blood pressure control drugs. From all the possible complications after a CPB we saw only a transient neurological signs attributed to some degree of brain injury – interpreted after the neurological exam as left sided forebrain lesion – ischemic or hemorrhagic. Arthur recovered completely both physically and mentally for the next two weeks with a lot of supportive care and physiotherapy. On discharge from the clinic he was able again to do all the things a blind person guide dog is trained to do. The histology report was made in a referral laboratory in Germany – Laboklin, and after the immunohistochemistry stain came back as a Neurofibrosarcoma.ran 2 ran 3

 

 

 

 

 

 

Artur 11

Artur reacted very well when in children company and we use this to stimulate his mental state (the authors’ youngest daughter)

Conclusions:

 

Artur 12

two weeks after the surgery with the owner

CPB is a routine everyday procedure in the human hospitals, usually carrying a good to excellent prognosis and very low mortality rate. On the other hand in the veterinary medicine field is still an exotic and very risky one. Although very demanding both for the clinical team and the patient himself, the cardiopulmonary bypass is the only option for cardiac diseases requiring an open heart surgery. We believe that a close relationship between a human medicine cardio surgical team and a small animal hospital team could make this type of procedures safer and better recognized.

We have done regular monthly rechecks on the patient with echocardiography and X-rays since then and now six months later Arthur is doing great, no drugs or any supportive therapy needed. He gained back his usual weight and is working like a guide dog every day.

 

1st Bulgarian Dermatology Congress , organised by BAVD

14612382_553114001550481_6070253379668782534_oFirst Congress of Bulgarian Association of Veterinary Dermatology held in 27-28th of April, 2017 at city of Plovdiv, Bulgaria. There were more then 120 veterinarians from Bulgaria, Macedonia, Romania, Greece and Cyprus.

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Dr. Emmanuel Bensignor and Dr. Sebastian Viaud, who impressed the audience with the way information was provided, but also the way all the scientific information was presented so to be useful in every-day-practice. They   discussed which one is the best elimination diet, which medicine is effective in the control of canine atopic dermatitis and how to use them appropriately? How to do Desensibilisation therapy? How to perform biopsy from unusual places? How to recognize vasculite lesion and how to deal with it?18209350_640038969524650_2972147177502418052_o

Vets on The Balkans support BAVD submit one free ticket for 4th Latin American Congress of Veterinary Dermatology to be held in
Merida, Mexico from 13th to 16th of June 2018  and one free ticket for 4th Romanian Dermatology Congress , October, 2017. Their members are presenting clinical reports and the best one will win. All of the cases will be posted in the journal Vets on The Balkans.

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Dr Ana Maria Boncea, Vetderm Therapy in Bucharest, Romania

 

“I would like to thank you one more time for this opportunity. It was great event!! Congratulations for everything! See you soon!!”

 

Dr Daniela Bajenaru, Tazy Vet Veterinary Clinic in Bucharest, Romania

 

“Dear Luba, the 1st Bulgarian Veterinary Dermatology Congress was excellent, the lecturers gave us a lot of useful information and the organization was great!”

 

Dr Adriana Cosma, Conforvet on Bucharest, Romania.

 

“ Hi Luba! I wanted to tell you that we thank you for everything…we had wonderful time. We liked very much the BAVD Congress and the city of Plovdiv!”

 

 

The team of Vets on The Balkans congratulated BAVD for the high professional level of organizing and the brilliant scientific program.

Learn and Travel……. stories from the vets! Dr Daniela Bajenaru at Central Vet Clinic in Sofia

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Dr Daniela Bajenaru and Dr Ivelina Valcheva

Dr Daniela Bajenaru, working in vet clinic Tazy-vet in Bucharest, Romania with the sponsorship of Pamas Trading SRL have done her externship at Cenral Vet Clinic in Sofia, Bulgaria. Let’s her tell us about it :

                   My wonderful experience in Sofia at the Central Vet Clinic

It all started with a simple decision to try my luck at a contest organized by the Vets on The Balkans, that was a first step in a wonderful walk. Dr. Luba Gancheva told me about this possibility of externship at the Central Vet Clinic in Sofia, and I said why not, we always have something to learn from those around us.
At the Central Vet Clinic I met only welcoming and beautiful people. The management is at a very high level, they are very well organized. I admired very much their way of dealing with the hospitalized patients and their X-ray techniques.There the doctors, besides their great experience, have all the necessary equipment to establish a quick diagnosis of certainty.
On my first day I remember that I was very impressed by the large number of patients who walk into the clinic, I think they were around 150. They always manage this with a lot of professionalism.16 5 3
The surgery rooms are very rarely free. I think that the most difficult cases from Sofia (and not only) come to them.
Because my greatest passion in the veterinary field is dermatology, my time spent in the Central Vet Clinic has been allocated , for the most part of it, in the dermatology department with Dr. Iveline Vacheva. For her I have only wonderful words. I see in her a very dedicated doctor, with many ambitions. I had the opportunity to see a lot of interesting cases, one of them was about a young cat with degenerative mucinotic mural folliculitis. I know that this affection is quite rare…so, great job Dr. Iveline!7111 2
My days were my own to plan and fill. I had a little time to visit also Sofia. I took a walk on the Witashe Mountains, I climbed up to the Boulder slopes, called ” stone rivers” or “morains” in Bulgarian and in some English language guidebooks.
It was a great experience for me, I left with a lot of practical ideas for home. I will definitely come back again in Sofia to the Central Vet Clinic!8 9

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Thanks to the all team for all the goodwill they have shown, they always answered to my questions.
Thank you Dr. Ranko Georgiev for all the kindness, for sure in the future you will do more then that for the Central Vet Clinic!
Thank you Vet on The Balkans, Dr. Luba Gancheva, Pamas Traiding and Tazy-vet, because you made this possible!12814393_1673705086236432_1339900710371625092_n

Craniomandibular osteopathy

8months old, American bully, Female

 

History: pain, jaw swelling.

 

Findings: Periosteal new bone formation, palisading type, affecting the mandible bilateral.

The tympanic bullae and temporomandibular joints are not affected.

 

Diagnostic:  Craniomandibular osteopathy.

rx rx1 rx2

Discussion: Craniomandibular osteopathy is a non-neoplastic, proliferative  bone disease that affects primarily the mandible, tympanic bullae, frontal bone and occasionally long bones in dogs of about three to eight months.

The proliferation of new bone of the head and jaws decreases as the endochondral ossification of the long bones slows after 7 to 8 months of age.

Learn and Travel…..stories from vets!

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Dr Constantin Ifteme

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externship

In March 2017, Dr Nadejda Tsureva, working at Veterinary Clinic ” Dobro Hrumvane” in city of Sofia, Bulgaria, has done her externship at Centru de Endoscopie si Chirurgie Minim Invasiva Veterinara with Dr Constantin Ifteme in city of Bucharest, Romania.endo3endo6

What is the opinion of Dr Nadejda Tsureva:

“Dear colleagues and friends,

I want to thank you for the opportunity of spending some precious time in Centru de endoscopie si chirurgie digestiva veterinara in Romania. Thanks a lot to Vets on the Balkans and the Vet team of the endoscopic center.
I had the chance of meeting new friends and family. Had the chance of learning from great professionals and great people. Working with love for the animals is really important and when combined with knowledge and great skills that is how “magic” is happening. I am really pleased to know that there are more people of that special “breed”.
Thank you all for the knowledge and the smiles you shared with me.
Hope to see you again.
To my Romanian family with love.
d-r Nadezhda Tsureva
We would like to express our gratitude to Dr Constantin Ifteme and brilliant team for everything. We are proud to have you on The Balkans , such a high level of professionalism and big heart!endo4 endo2 endo5

Rupture of the atrial septum in dog with degenerative mitral valve disease

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Dr Todor Kalinov

Dr Todor Kalinov

ZaraVet- city of Plovdiv, Bulgaria

Introduction

Degenerative mitral valve disease (DMVD) is the most common cardiologic disorder in canine population. It has been estimated to account for 75% to 80% of canine cardiac disease1. It is common in small breed dogs, but also can be encountered in large breeds like german shepherd and other . The disease characterizes with thickening and enlarging of the mitral leaflets, elongation of chrdae tendineae and mitral regurgitation. Histopathologic  features are expansion of extracellular matrix with glycosaminoglycans and proteoglycans; valvular interstitial cell alteration; and attenuation or loss of the collagen-laden fibrosa layer2. Because of the mitral regurgitation the usual course of this disorder represents volume overloud of the left atrium and left ventricle , eccentric hypertrophy of the left ventricle , dilation of the left atrium ,and  left sided congestive heart failure . Increased pressure in left atrium and pulmonary veins leads to pulmonary edema . Often complication is so called passive pulmonary hypertension , consequence of increased pressure in pulmonary veins. Really rare complication is left atrial rupture .

 

Case presentation

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Fig. 1

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Fig.2

Richka is 12 years old mixed breed dog with history of DMVD , threated only with enalapril . She was admitted in our clinic for cardiologic examination, because recently increasing in coughing and exercise intolerance. During the examination she was tachypneic , normal mucous membrane color , alert and responsive .She had increased heart rate. Auscultation revealed right and left apex systolic heart murmurs. The abdomen was swollen with palpable fluid thrill. We have made echocardiographic examination, with the patient on left and right lateral recumbency, with all parasternal views according to the accepted standards. We found eccentric hypertrophy of the left and right ventricles, left and right atrial dilation, thickening and prolapse of the mitral valve. Doppler examination shows mitral and tricuspid regurgitation with pressure gradient of 162 mmHg and 62 mmHg respectively (figures 1,2,3) . Abdominal echography revealed ascites. So we diagnosed degenerative mitral valve disease with secondary pulmonary hypertension. We prescribed following: pimobendan – 0.25 mg/kg/bid , furozemid – 4.0 mg/kg/bid , spironolactone – 1.0 mg/kg bid enalapril – 0.5 mg/kg/bid , sildenafil – 1.0 mg/kg/tid.

Week later on control examination Richka was better, ascites resolved , mitral and tricuspid regurgitation was with gradient 125 mmHg and 43 mmHg respectively. So we decreased the dose of furosemide to 2.0 mg/kg/bid, and the other drugs were continued with the same doses.

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fig 8

Fig 8

Several months later the owners noticed again swelling of the abdomen and the dog collapsed after exercise. When they came in the clinic Richka was tachypneic with cyanotic mucous membrane. On auscultation we have found 5/6 systolic murmur on the right haemithorax with palpable precordial thrill. Electrocardiography revealed sinus tachycardia – 156 bpm , with premature supraventricular and multifocal ventricular complexes (fig 4). We have made roentgenography in right lateral (fig 5) and dorsoventral (fig 6) position. There was generalized cardiomegaly with dilation of the pulmonary vessels. On echocardiographic examination we have found eccentric hypertrophy of the left and right ventricles, paradoxical motion of the ventricular septum (fig 7), mitral and tricuspid regurgitation with gradient – 118 mmHg and 42 mmHg respectively. Abdominal ultrasonography showed ascites with no collapse of the caudal vena cava with respiration (fig 8). Despite the medications and lower then before pulmonary pressure in this dog the signs of right heart failure were predominant. Because of that and the palpable precordial thrill on the right side we suggested right to left intracardiac shunt. The presence of ventricular septal rupture is less possible, so we decide to search for rupture of the atrial septum. On the right parasternal 4 chambers view modified for better visualization of the right and left atrium with atrial septum, we have found rupture of the septum in the region of the fossa ovalis with left to right shunt.

 

 

 

Video 1 and 2 are same loops with and without colour Doppler demonstrating the defect and shunt of the blood. In this region very often because of the echo dropout on 2d image can be seen a hole in the atrial septum. To be sure that this is a real defect we decided to make a bubble contrast study. We injected 10 ml of agitated saline in v.cephalica antebrachii thru i.v. catheter.  When there is right to left shunt the microbubbles are seen in left atrim, left ventricle or arterial circulation – usually the abdominal aorta. But in left to right shunt the goal of the bubble study is to notice contrast washout during right atrium passing of the bubbles. Video 3 and 4 show right parasternal short axis view of the base of the heart with cranial vena cava. We can see the entrance of the contrast and the following washout like a flame because of the left to right shunting of the blood.

 

 

In this situation sildenafil makes the pulmonary pressure lower and facilitate the shunt from high pressure left atrium to low pressure right atrium. So we decided to use pulmonary hypertension properly and make the dose of sildenafil lower – 1 mg/kg/24 h. with presumption that higher right ventricle and right atrium pressure will make the amount of the shunt lower. 72 hours after this change the ascites resolves and the condition of the dog became better. On the time of the written of the article Richka is about half year on this medications with sildenafil once per day and no changes in other medications and the only clinical sign is exercise intolerance.

 Discussion

Rupture of the atrial septum is really rare complication of mitral valve disease. Most commonly the rupture occurs in caudal weaker part of atrial wall. In a study of Buchanan JW from 30 dogs only in 4 was found rupture of the interatrial septum with signs of right heart failure3. In another study from the same investigator from 50 dogs 7 have acquired ASD4. The еtiology for rupture of the left atrium is uncleаr , but probably is related with the high pressure in the left and right atrium and the so called jet lesions from the mitral and tricuspid regurgitation. Usually the mitral regurgitation jet is toward lateral wall of the left atrium like in this case (video 5). Tricuspid regurgitation jet was directed to interatrial septum so probably contributed to rupture of the septum. The thin fossa ovalis is weak and suitable place for this kind of lesions. In human medicin rupture of the septum is reported after blunt chest trauma , most often accompanied with rupture of the tricuspid valves 5,6. The proposed reason is that compressivе force occurred during isovolumic contractiоn with maximally dilated ventricles and closed atrioventricular valves5. In humans  right ventriсle is right behind the sternum , and this predispоse it to injury. In those cаses when there is rupture of the tricuspid valve and massive regurgitation , the increased pressure in right atrium leads to rupture of the septum and right to left shunt. In canine patients with degenerative mitral valve disease after the rupture of caudal atrial wall and following haemopericardium the clinical signs are collapse and sudden death. After rupture of the atrial septum the predominant signs are of right heart failure. In this case the right atrium and ventricle serves as a low pressure “sink” for severely dilated left atrium.

There are several publications about echocardiographic diagnosis of acquired atrial septal defect and rupture of the atrial septum with haemopericardium3,4. The bubble contrast study has been validated in veterinary echocardiography for diagnosis of congenital and acquired intra and extra cardiac defect and shunt7,8. In this case we have demonstrated the usefulness of so called contras washout – result of bubbles free blood entering contrast rich compartment.

In conclusion in any dog with degenerative mitral valve disease and predominated signs of right heart failure we have to look echocardiographically for atrial septal rupture. More we scan , more we find , and more we learn.

 

Learn and Travel……. stories from the vets!

learn and travelLast month started for the first time our project ” LEARN AND TRAVEL WITH VETS ON THE BALKANS”. Dr Andrey Ginchev from Bulgaria, working in Blue Cross veterinary clinic in city of Sofia, and Dr Cristian Badulescu, main vet and owner of Blue Point Vet veterinary clinic in city of Bucharest, Romania have done their externship at Clinica Veterinara Lago Maggiore – Dr Lugi Venco , Dr Luca Formaggini and Dr Mariangela De Franco. Both of them have stayed 2 weeks. I think is better they to speak about the adveture.

Dr Andrey Ginchev:

I have so many good things to say about this externship. Firstly, it was the best experience of my life! The doctors  are amazing,especially Dr Luca Formaginni and Doctor Luigi Venco –  the best doctors I ‘ve ever seen in my life.17309856_1747923415519034_2303429150324906549_n 17342975_1747923572185685_5866766753935364961_n

The team was very well organized,very welcoming and really friendly with me. I met a lot of people from Italy and had great time with them. I became more flexible to changes, more ambitious and more sociable. My desire to travel is increased. Also this practise  helps me to gain my confidence in my own abilities,so now I am more self – confident in my work.I improved my English language and also I learned a little bit Italian…,Grazie and Thank you!!!I hope to see my  Italian friends again.

17362812_1747331025578273_7316356212028963391_n

Dr Andrey Ginchev with the team of the clinic

I´m so thankful for this experience, Thank you very much for this opportunity that you gave to me!17352518_1843303222609950_1508220180873091218_n


Dr Cristian Badulescu :

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Dr Cristian Badulescu with the team of the clinic

Before I go to Lago Maggiore Clinic, I looked on the internet to see what’s going on there. I saw them with equipment high-technology facilities. I saw that they are capable and do surgical maneuvers excellent and it’s a veterinary clinic with a very good reputation. I can therefore expect to find here and a little superciliousness, or even some superiority. But it was not so! I found wonderful people, full of positive energy. Highly trained people who know exactly what they do. But what I liked most is modesty and their openness to sharing information. They do not want to hide anything. If you know what questions to put, you get all the information you need. 17522631_1751933485118027_6444855593354748323_n 17498712_1751933001784742_8726199192797128569_nI had the honor to talk to Luca Formaggini, Luigi Venco and Giorgio Romanelli. They are true celebrities in the world of veterinary medicine in Italy. I talked a lot about a lot. The impression to me of all is that all are governed by modesty and good will. So, I thank you Vets on the Balkans for this oportunity to meet great people! Great job! Bright future!17626459_1751932908451418_3868390825708698876_n 17554387_1751934088451300_4726607108209581561_n

And of course the opinion of Dr Luigi Venco:

It ‘s Always a great experience to meet and work with enthusiastic and motivated people like Dr. Andrey Ginchev and Dr Cristian Badulescu. Exchanging knowledge and experiences and find to be friends at the end. Thanks Andrey and Cristian! Thank you Vet on the Balkans!
 Vets on The Balkans
The team of Vets on The Balkans would like to express their gratitude to ALL THE VETS included in the project! THANK YOU Clinica Veterinara Lago Maggiore – Dr Lugi Venco , Dr Luca Formaggini and Dr Mariangela De Franco for the opportunity! In fact, You are Vets on The Balkans, we are just the technical part.
Thank you as well to our sponsors Pamas Trading SRL , Romania and Bayer , Romania. Because of you Vets on The Balkans is alive.