Pink teeth in a 10 months old Cane Corso

 

30595139_1823183557733595_5657871534119714816_nDr Elena Carmen Nenciulescu

Bucharest, Romania

 

 

 

Hera, a 10 months old female Cane Corso, was presented on the 15th of October 2018 for a dental consultation. She had pink teeth, a strong halitosis, „wasn’t eating like she used to” and showed signs of pain (didn’t let anyone touch her mouth or look at her teeth).

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Crown fracture with pulp exposure 304 and 404

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Image 1 – Abnomal density of the cortical bone

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Image 3 – X-ray of the rostral maxilla

 

 

 

 

 

 

 

 

 

 

 

 

 

X-rays showed a very large pulp cavity in all teeth, very thin dentin and enamel, crown fracture with pulp exposure in 304 and 404 (Image 2), but also an abnomal density of the cortical bone in the mandible (Image 1) . The owner reported that the deciduous teeth were pink too.

 

 

 

 

 

 

 

 

 

 

 

 

The dog previosly had 2 surgeries in both elbows in another clinic (bilateral elbow dysplasia). Hera is also blind with both eyes (there is no vascularization in the eyes).

Antibiotics (amoxicillin with clavulanic acid 20 mg/kg/12 h) and analgesia (meloxicam 0.1 mg/kg/day) were immediately started and the patient was scheduled for a dental procedure a week later.  CBC and routine biochemistry were normal.

The dental examination under aneshesia revealed 6 crown fractures with pulp exposure (109, 110, 209, 210, 304, 404). We extracted these teeth and tried to seal  with the remaining ones. The dental extractions were very difficult, but the healing was good (as you can see in the images from the second dental procedure).

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Image 4 – Complicated fracture 304

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Image 5-404 pulpar granuloma and 404 extraction

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Image 6- 404 pulpar granuloma and 404 extraction

At this first dental procedure (Images 4 – 11), we took a blood sample to see what were the vitamine D3, calcium and parathoyroid hormone levels. When results came, we found out that Hera had hypoparathyroidism (PTH level was 1.2 pg/ml, almost 16 times lower then the physiologic range) and recomanded a thyroid ultrasound, which is not availiable unfortunately.

Also Vitamine B12 was low, so the patient recieved treatment for that too.

 

 

 

 

 

 

 

 

After the first procedure, the recovery was fast, the dog started to eat the next day, but only very soft food.

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Image 8- Clinical view of the right maxilla

oznor

image 9-Clinical view of the right maxilla

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Image 10 – Clinical view of the right mandible

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Image 11 – Clinical view of the left maxilla

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

image 12

Image 12 – Clinical view of the right maxilla and mandible – tooth wear of all teeth is more pronounced

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Image 13 – Clinical view of the lower incisors that are even „pinker” then the first time

The second dental procedure (Images 12 – 16) together with  the ovariohysterectomy took place on the 23rd of February 2019, when we performed extractions of 208 and 209 retained roots and full 405 was extracted for histopathological examination (that will be performed at Histovet by Dr. Teodoru Soare). The recovery was even better than the first one. Hera received clindamycin 11 mg/kg/day, 7 days and meloxicam 0.1 mg/kg/day, 4 days. Unfortunatelly, because a second set of radiographs were not available for this dental intervention.

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Image 14 – Closer look of the right maxilla

image 15

Image 15 – Left upper premolars

image 16

Image 16 – Left maxilla and mandible

 

 

 

 

 

 

 

 

 

 

 

The dental pathology of this patient might be a very rare congenital dental condition called „shell teeth”, in which teeth have large pulp chambers and insufficient coronal dentin. The treatment of this dental disease is full mouth extractions, but given the very high level of difficulty of the extractions, we chose to extract only the fractured teeth. It may be a consequence of a congenital hypoparathyroidism, which would also explain the other pathological signs (blindness, bilateral elbow dysplasia).

Hera is a very interesting case with high didactic value. She remains supervised for evaluation of her clinical evolution.

Both interventions took place at QincyVet and were performed together with Dr. Raluca Zvorasteanu.

Broncholithiasis in cats

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Dr Svetoslav Penchev

Unites Veterinary Clinic

Varna, Bulgaria

 

 

 

 

 

 

3 years old male, not castrated British shorthair cat with history of tetraparesis was referred to the clinic for Computed Tomography. Mineral-attenuating endobronchial lesions were detected in Thorax as accidental finings in spinal CT. The finding is specific for broncholitiasis.

CT  :

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CT features: Multifocal mineral-attenuating endobronchial lesions in cranial and middle right and cranial left lung lobe are present. There is mild generalized thickening of the bronchial walls and consolidation of right middle lung lob with regional bronchiectasis

 

 

 

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X-rays

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X-ray features: Multiple mineral opacity nodules with irregular margins are present within left and right cranial and right middle lung lobe. The largest of which lies within the right middle lung lobe and interstitial patter in this region is present.

 

 

 

Broncholithiasis is very rare condition in cats and is defined as the presence of calcified or ossified material within the bronchial lumen. Only four cases of broncholithiasis in cats have been reported in the veterinary literature. Normal this condition is associated with lower airway inflammation, but in this case the owner does not report for respiratory problems. Broncholithiasis is an uncommon condition, which should be considered as a differential diagnosis for cats with chronic respiratory disease. Affected cats may develop broncholithiasis secondary to a diffuse inflammatory lower airway disease with mineralisation of secretions in the airways.

 

 

 

 

 

 

Vet Business Academy, an amazing association, open to give us the knowledge and help us to make our life better

24909813_388955481530328_7583228791966007145_nWe are really happy that more and more veterinarians are aware of the needing, to improve our knowledge in a field that is really far of our medical way of thinking, because if we are aware or not, we are managers of our own business. So, we should be open and to start learning how to improve this field.

 

And we are lucky because we have the sources and the people who can teach us.

One of these opportunities is Vet Business Academy, an amazing association, open to give us the knowledge and help us to make our life better.

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Dr Cristian Marinescu-the president of Vet Business Academy

VET BUSINESS ACADEMY

  1. What is our desire?

 

  • Create a vet business community and provide access to business education.
  • Provide knowledge and increase vets’ competencies in areas like:
    • People management, Communication, Marketing-merchandising, Financial knowledge.

 

  • Improve vet the efficiency of vet clinics by providing better services to clients and improving internal processes.

 

 

  • Training and workshops to improve vet competencies in business areas.

 

  • Vet consultancy in the business field.

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Why us and why now?

 

  • Practical experience in vet clinic management

 

  • Experience in vet industry , local and international.

 

  • Experience in fields like: marketing, communication, planning, business administration and people management.

 

  • Good relationship with KOLs, Universities and local authorities.

 

  • Knowledge of vet legislation and experience in the prediction of future vet business trends.

 

  • Coaching, Leadership, Critical thinking.

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OUTCOME

  • Become more than a Vet clinic
    • Provide a consultative relationship model
    • Build effective TEAM
    • Become preferred Vet Clinic for Vets & Pet-Owner’s
    • Differentiate in a crowded market

 

In 2018 the association has organized plenty of events in Romania.

  • Workshops : Communication , People Management, Merchandising , Financial intelligence
  • Class – “Mastering Public Speaking”
  • Management presentations on AMVAC Congress –Dr.Lowell Ackerman
  • Provide the management string in different vet events

vba 4

 

If we realize or not, we are part of the economically world, we sale service and together with our love to the animals and our professional, we are responsible about our employers, for their financial comfort and work environment. So, it is time to start learning to be good in this as well

Learn and Travel-Dr Renata Jelic from Serbia in Central Vet Clinic in Sofia, Bulgaria

 

53835429_2559867640708543_1925608025490456576_nDr Renata Jelic from Serbia has done her externship in Central Vet Clinic in Sofia, Bulgaria

learn and travel

 

 

 

 

Lets see what she said about it:

 

“I would like to start by thanking Dr. Luba Gancheva and Vets on The Balkans for giving me a wonderful opportunity to spend a week in one of the best veterinary clinic on the Balkans. received_625044874599015Together with my colleague I was warmly welcomed by Dr. Ranko Georgiev, the head of Central Veterinary Clinic in Sofia, a great expert and an exceptional man who provided accommodation for us and, more importantly, gave us free access to all parts of his clinic. And what a clinic it is. It spreads on three levels, all well organized and fully equip, in order to provide the best possible comfort and care for pet patients. Dr. Georgiev when out of his way to make sure that I used my time efficiently, constantly encouraging me to ask and participate. His help is immeasurable. Central Veterinary Clinic is the best vet clinic I ever had a chance to be a part of, even for a short while. One week is certainly not enough to experience and learn all that the great and professional staff was willing to teach me, but the knowledge and experience gained will sure help me improve as a veterinarian. One vet that I would like to give a special thanks to is Dr. Hristina Shukerova,received_555494404860695 received_2472585622815978 a person I spend most time with. She was always there for all my questions, she answered them professionally but with a touch of human emotion which made me fell as a part of the group, as a part of their team. As Dr. Shukerova’s field of expertise is cardiology, a field I wish to specialize in, she was able to help me greatly improve my knowledge in this area of veterinary practice. I will conclude this short look back on my week spent at Central Veterinarian Clinic in Sofia by sending my love and lots of smiles to all the staff working in this clinic, with a special big “Thank you” to Dr. Ranko Georgiev, Luba Gancheva and Vets on The Balkans for making this externship possible.”received_398377974256240 received_445330466039904

We would like to express our gratitude to Dr Ranko Georgiev and the whole team of Central Vet clinic for make this possible!

 

Rare case of Feline Progressive Histiocytic Disease (FPH) – A case report

41768527_2349628575051886_8602568388625039360_nDr Giulia Nadasan

Vet Point Vest

Arad, Romania

This is the story of Chucky, a senior 9 year old european male neutered cat. He used to live in an outdoor environment. His medical history is very long, since he was young he had different pathologies from infectious diseases, chronic urolithiasis ended with urethrostomy and a femur fracture osteosintesis.

Chucky was a well monitored patient with all his dewormings and vaccinations on time.

Chucky was presented for a clinical consult because the owner noticed something on his skin. On the first clinical presentation I found two skin lesions (papules) about 0.5 cm diameter non ulcerated on the dorsal thorax, well circumscribed that made my think of piogranulomatosis pioderma. I started a treatment with amoxicillin + clavulanic acid and asked them to come back after 7 days. At the second consult, Chucky looked exactly like in the pictures, he was suffering of a generalized nodular ulcerated dermatitis.54515532_560264067813760_3040561606883803136_n

A skin biopsy was made the next day and the sample was sent to the histopathology lab.

 

Pathology findings : the superficial and profound dermis are infiltrated with neutrophils, macrophages, histyocitic mesenchymal cells with atypical mitosis and eosinophils and also areas of necrosis and hemorrhage (histovet.ro) = piogranulomatosis pioderma with histiocytic neoplastic component

 

DIAGNOSIS : Progressive non-epiteliotropic feline histiocytic disease

 

 

Biological facts:

Histiocytes are mesenchymal cells derived from the bone marrow as stem cells. They either become macrophages or dendritic cells (antigen presenting cells APC). Dendritic cells can be also divided into Langerhan cells, interstitial dendritic cells or interdigitating dendritic cells.

Using immunophenotyping methods the histyocites were found expressing CD1a, CD1c, CD18 and MHC class 2 molecules used specific for dendritic cells and not Langerhan cells.

 

Epidemiology:

Feline Progressive Histiocytic disease is a benign skin neoplasia in humans and dogs but it is extremely rare in cats. In a 2006 study conducted by Affolter and Moore (VetPathol.43(5)646-55) it is said that except some case reports this disease has not been characterized in cats. They analysed the cases of 30 cats with FPH and summarized that there is no breed or age predilection, that females are more prone on developing this disease and that it is a fatal one with no successful treatment options.

 

Clinical findings in Chucky :54416663_265039581075898_1025659308638994432_n 55575966_692832224465879_5135189188315971584_n

  • Multiple papules with red margins, non-pruritic on the body especially on the dorsal and lateral thorax
  • Ulcerated nodules on the head and ears also non-pruritic
  • Periauricular alopecia with hyperpigmentationPrognosis:

    FPH is a slowly progressive skin neoplasia that does not cause any pain but will spread behind the skin in the terminal stage. Median surviving time is 13.5 months.

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    Treatment:

    It is considered only paliative. At the time of my diagnosis I started treatment with Prednisone at a 2mg/kg/24 h but there was no evidence of improvement. Lomustine (CCNU) is an antineoplastic drug that is used for the dog’s histiocytic disease and may be used in the cat as well at a dosage of 40-60 mg/m2 every 3-6 weeks.

    According to the book Small Animal Clinical Oncology (2012) the skin lesions do not appear to respond to corticosteroid therapy and effective medical treatment as not yet been described.

     

    What happened to Chucky: Chucky was brought for humanly euthanasia after 2 months after the diagnosis because of dyspnea and anorexia. I suspect pulmonary metastasis was present at that time but the owner refused necropsy.

     

     

     

     

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.

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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

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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

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

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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

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Skin cytology- Lots of corneocytes, rare cocci.

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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.

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Trichogram- Almost all hair follicles were covered in waxy material

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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

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DEMI AFTER 7 DAYS OF TREATMENT

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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

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DEMI AFTER 1 MONTH OF TREATMENT

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DEMI AFTER 1 MONTH OF TREATMENT

 

 

 

 

 

 

 

 

DEMI AFTER 2 MONTHS OF TREATMENT

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DEMI AFTER 2 MONTHS OF TREATMENT

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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