Vets on the Balkans - an online journal for veterinarians from the Balkans - Vets on the Balkans

CASE 2 – Nutritional secondary hyperparathyroidism

March 28, 2016 Leave a Comment

History:

difficulty walking, abnormal conformation Technique: X-ray Findings: There is a generalized reduction in radiopacity of bones (diffuse osteopenia). The cortices of bones are thinned. Coarse trabeculation visible especially in the pelvis. Folding fracture seen in the left scapula. Excessive curvature of the spine. The vertebral body of L4 its shorter and the sacrum has an abnormal curvature, which means folding fractures at this levels. Abnormal alignment of the sternum.

Diagnostic:

Nutritional secondary hyperparathyroidism

Discussion:

Nutritional secondary hyperparathyroidism is seen in young growing animals, particularly kittens, fed a high-meat diet which is low in calcium and high in phosphorus.

Ehlers-Danlos syndrome (EDS) in cat

March 25, 2016 Leave a Comment

Dr Iva Nikolova

Veterinary Clinic Dobro Hrumvane

Sofia, Bulgaria

Introduction

Cutaneous asthenia has also been called Ehlers-Danlos syndrome (EDS), Dermal fragility syndrome, Dominant collagen dysplasia and Dermatosparaxis. EDS is a group of inherited connective tissue diseases ,characterized by defects in collagen production. This results in a variety of clinical signs including loose, hyperextensible, fragile skin, joint laxity and other connective tissue dysfunctions. Clinical signs include fragile skin from the time of birth, wounds that heal with thin scars, delayed wound healing, pendulous skin, hematoma and hygroma formation.

The case:

Lucko, 7-month-old shorthair male mix breed cat, was represented to the clinic with uveitis, alopecia and multiple skin ulcerative wounds, located in the regions of the dorsum, thorax and head. He was treated for few months with antibiotics, ointments and corticosteroids with no success. The skin of the cat was extremely extensible and very fragile. It was very easy for the skin to be torn but with no bleeding at all. The cat had to be handle with gentle touch and care.

The diagnostic work-up included a complete blood count, blood serum biochemistry panel and urinalysis to rule out any internal disease associated with these skin lesions. CBC showed mild leucocytosis (white blood cell count: 19.5 x 10^9, reference range: 5.0 x 10^9 –18.9 x 10^9). In biochemistry analisys the changes were CK – 225 U/L (reference range: 17.00 – 150.20 U/L) and LDH – 427 U/L (reference range: 35.10 – 224.90 U/L).

The rapid test of Feline Immunodeficiency Virus and Feline Leukemia Virus (IDEX FIV/FeLV) were found to be negative. Feline Herpes Virus PCR – negative. Dermafyt KRUUSE test – negative. Microbiology of skin lesions – negative. The low-dose dexamethasone suppression test – negative for Cushing disease.

During the long-lasting treatment all the wounds healed well and Lucko was sent home. Few days later he was brought again with new skin lacerations.

Punch biopsy of the skin was performed together with dr Rares Capitan and sent for histological investigation in Romania. The histopathologic findings were compatible with Feline Cutaneous Asthenia.

Discussion:

Feline Cutaneous Asthenia is a rare, inherited disorder of collagen production in cats. There is no cure, but consistent management can allow affected cats to have long life. Owners should be trained to handle the affected cat with gentleness and to avoid traumas.

Pacemaker implantation (PMI) as treatment for AVB III and very slow ventricular escape rhythm in a geriatric canine patient

March 22, 2016 Leave a Comment

Dr Ranko Georgiev

Ranko Georgiev¹, Hristina Shukerova², Nadezhda Petrova³

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

Introduction:

Pacemaker implantation is the most effective treatment for ‘syncope and severe exercise intolerance’ – related arrhythmias; however when searching for the best clinical decision for some older dogs, the risk of anesthesia often outweighs the benefits. We would like to share a case where the old age was not a problem.

Case presentation:

Larry was a 17-year old MI mix breed dog admitted because of increasingly frequent exercise intolerance episodes during the past few months. Furthermore, the last week the patient was very week, unable to stand on his feet and with a depressed overall clinical status. On a clinical presentation with the referring vet а bradycardia was noted and the patient referred to us for a Cardiology consult.

During auscultation, a slow regular rhythm was detected with heart rate of 20 bpm classified as ventricular escape rhythm during the normal ECG. A 24hour Holter monitor revealed complete AV block (AVB III) throughout the study with an average rate of 31 bpm, occasional VE beats with some pairs, triplets and short runs; no pauses greater than 5 sec were noted. The slowest heart rate detected was 20 bpm.

Complete blood count and biochemical profile were normal. Radiography and echocardiography revealed generalized cardiomegaly, with mild-to-moderate mitral and tricuspid regurgitation and decreased contractility. During the abdominal FAST study a small amount of free fluid was noted – defined as a transudate on diagnostic abdominocenthesis. Lari_20150811163929_1640560

A diagnosis of complete AV block with clinical signs of right sided congestive heart failure was made and pacemaker implantation was decided. A VVI, bipolar, passive lead was fluoroscopically placed, under anesthesia, through the right jugular vein into the right ventricle, where it was successfully lodged.Lari_20150814181226_1819550 The lead was connected to a generator, which was later fixed in the subcutaneous tissue dorsally to the cervical vertebrae. A temporary pacemaker was used when the dog developed asystole during the procedure. Recovery from the surgery was uneventful, with the pacemaker capturing normally. The pacing rate was set to 100 bpm. The system used was a ‘St Jude’ one.

Our anesthesia protocol with this patient was routine for the procedure of a PMI – premedication with Midazolam and Buprenorphine, induction with Etomidate, intubation and maintenance with Isoflurane. The post procedure treatment was only with Cefazolin iv for the next few days.

The use of a temporary lead and/or an external pacemaker is highly advisable in patients who are depended on their escape rhythm.

Comments:

Even though Larry recovered from the general anesthesia normally he was unable to stand on his feet for additional 5 days. He was bright, alert and responsive, with good appetite and normal consciousness, but with an impaired proprioception. We attributed this to the long period with severe bradycardia (HR of 20 bpm) and potential vasoconstriction/reperfusion complications. There is some data in the human medicine literature concerning PMI in old people with preexisting severe bradycardia, who reported pain in the extremities post the procedure.

Other factors such as chronic joint and spinal diseases could have been the cause of the slow recovery as well. The myoglobin levels were not checked prior to the PMI unfortunately.

Conclusions:

Pacemaker implantation may be warranted even in older dogs with ‘syncope and severe exercise intolerance’ – related arrhythmias.

7 months post the procedure Larry is still doing great; in this period he underwent two additional major surgeries for a prostate abscess – with no anesthesia complications.

Cardiology

March 21, 2016 Leave a Comment

Coming soon…

Sharing is Caring ?

March 13, 2016 Leave a Comment

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Dr Ates Barut with 3 beautiful romanian vets in Petcode Veterinary Clinic

What means the words “work ethic “?
I am sure, everyone has different answer. It depends, first you are employee or manager or owner of veterinary clinic.
If you are employee, for sure, you think about your relationship with your colleagues in the clinic, where you are working. May be you have “problems” with some of them. But it is so normal. Veterinarians on the Balkans, and not only, work a lot of hours. When we spend a lot of time with someone is so normal to have different points of view, because we are different people and we cannot be the same.
If you are manager or owner of veterinary clinic, you think about you colleagues, who are owners as well and they are your “competition”. It is again the same situation- “different people, different concepts”.
Veterinarians are more passionate, more ambitious, more powerful part of the humanity. Sometimes they are so purposeful in this, to be the most professional, to be the best. And we all forget that we all are at first people. We all have our own battles, our own fears, emotions problems, which are outside veterinary world. So, we all go to work every day with our “luggage”.
If we try to see with “the eyes” of the other, if we help and support each other , we all will live in better veterinary world.

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Dr Robert Carst with the brilliant team of Blue Cross Veterinary Clinic

We are really proud and happy to announce that it happens on the Balkans. Dr Anca Cucos, Dr Bianca Bofan and Dr Gina Girdan, all of them PhD students in Veterinary Faculty in Bucharest, Romania, they are doing their internship at PetCode Veterinary Clinic in Ankara, Turkey. We would like to express our gratitude to the owner and main veterinarian Dr Ates Barut for the hospitability and for his “sharing” of knowledge and experience. Other veterinarian from Bucharest, Romania , Dr Robert Carst from Speedvet Veterinary Clinic starts his internship of Orthopaedy in Blue Cross Veterinary Clinic in Sofia, Bulgaria. We would like to express our gratitude to the owner Dr Borislav Georgiev and the whole brilliant team for everything!
You guys show us what means the words “SHARING IS CARING”
Lets be better people!

OUR PARTNERS

March 11, 2016 Leave a Comment

Associations , we are in contact:

EEVC( East European Conference)

AMVAC Romanian Small Animal Association

TSAVA Turkish Small Animal Assocaition

CSAS Croatian Small Animal Section

SASAP Serbian Association of Small Animal Practicioners

SRDV Romanian Society of Veterinary Dermatology

SRMF Romanian Society of Feline Medicine

RoVECCS Romanian veterinary and critical care association

Romanian Association of Ophthalmology

SAVAB Belgium Small Animal Association

Hemopet Blood Bank

ASMVT Veterinary Students association from Timisoara

SRVO Romanian Society of Veterinary Orthopeady

Clinic which we are in contact:

Bulgaria:

Central Vet Clinic

Blue cross

Nova

Dobro Hrumvane

OVK Varna

Saint Antim veterinary center

Itavet

Vet Medical Assistance

Provet Plovdiv

Julyvet

Light vet

Dianavet Varna

Albeitar Ruse

Romania

Bluevets

Speedvet

Regatul Animalelor

Falconvet

Vet Center Otopeni

Hemopet

Vet Medical Center

Sarmivet

Dr Nicolae Valentin

Trivet

Robert and Oana Popa veterinary Clinic

Radiologie4vet

Histovet

Serbia

Veterinary Practice Novak – Denis and Nikoleta Novak

Ivavet- Dr Ivan Jevtic

Tommy VeterinaryClinic -Dr Goran Tomisic

Dr Ivan Rakic

Dr Eugen Sefer

Turkey

Petcode – Ankara, Dr Ates Barut

PatiSev Veterinary Clinic- Dr Gizem Taktak
Ares Veterinary Clinic , Istanbul
Tilia Veterinary Clinic Istanbul
Cat Hospital Ankara
Anipoli Veterinary Clinic Istanbul
HappyPets Veterinary Clinic Mugla

Croatia

Kreszinger Veterinary Clinic – Dr Lea Kreszinger

Veterinary Clinic More – Dr Emil Ofner

Veterinary Clinic Vevita- Dr Ana-Maria Bljaic

Italy

” Citta di Pavia ” Veterinary Clinic

2nd Edition of Emergency and Critical Care Congress 16-19th March , 2016 in Bucharest , Romania ! Meeting with the president of the romanian emergency association Dr Adrian Iurcenco!

March 10, 2016 Leave a Comment

What and who are RoVECCS?

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Dr Adrian Iurcenco , president of RoVECCS

Roveccs started with the idea that united we ca do more for our field of interes, veterinary emergencies and intesive care. Only working toghether a community can have progress. Eastern Europe has so much to recuperate in relearning about this concept, putting our differences aside and be united by our common needs and goals. Most of us will be colleagues for life.

The goals of the association?

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1st congress of RoVECCS

For a balkan vet it is so much more difficult to keep up with what’s new. Trips to other parts of Europe are quite expensive for us and not too many are in english. So we decided to create our own local congreses and courses (cheaper) with internarional lecturers and also promote “local” specialists that are unknown to their vet community.

3. Future plans?

Continue our annual congress at the highest level possible and (hopefully this year) start a series of multiple day seminars for small groups of 30 to 50 vets, that can give a deeper insight into emergency medicine and not only.

4. Who is Adrian Iurcenco?

Dr Adrian Iurcenco

Dr Adrian Iurcenco

That is almost philosophical and what I have been asking myself for a while .
I grew up in communist Bucharest, waiting in line for food and ice cream and barefoot in the hills and woods of Romanian countryside; later, in the refugee campus and schools of Holland. Finished my vet studies back in Bucharest and some more advanced vet studies arround Europe.
Now I own an emergency veterinary clinic with an ambulance service (Speedvet), two akitas with which I hike the Romanian mountains sometimes and (in my free time) I preside Roveccs.

5. What do you think about the level of veterinary medicine on the Balkans?

I think that the level in rural parts of the countries is much lower than in the cities, compared to the rest of Europe and that needs to be changed. I also think that Eastern vets are doing much more efforts to be competitive than their Western colleagues and even though we are still far behind, the progress is faster than what they had so far.
The key is to keep going to scientific events and be passionate about their preffered subjects. Passion is what we have plenty of, just needs to be smartly directed in veterinary science .
Go to congreses and seminars and apply the science in your daily practices!

6. What do you think about Vets on the Balkans?

Plenty of space to grow, great future if you keep up the good work. You unite our need for a healty veterinary community, where we can be confortable among colleagues, learn new things and know what else is going on in our “neighbourhood”

Demodex injai associated with Anaplasma spp and epiteliotrophic lymphoma in a 9 year old male Akita

February 24, 2016 Leave a Comment

Case report

Dr Alberto M Cordero

A. MARTIN CORDERO
vetderm25@gmail.com

*VETDERM: Dermatologia Veterinaria Especializada, Guadalajara, Mexico
Assistant professor Department of Veterinary Medicine, Centro Universitario de Ciencias Biologicas y Agropecuarias, University of Guadalajara; Guadalajara, Jalisco, Mexico

A male non neutered 9 year-old Akita was presented with alopecic focal crusty lesions on rear and front limbs. Hemorrhagic lesions were observed on the front limb and history of tick infestation was provided by the owner. Ulcerative and nodular lesions were present on the right lateral aspect of the face. Skin scraping revealed presence of Demodex injai. . ELISA rapid testing IDEXX 4DX was performed to confirm tick borne disease revealing positivity to Anaplasma spp. Skin biopsies were taken from the face and abdomen revealing large atypical lymphocytes with epitheliotrophism consistent with epitheliotrophic lymphoma. The patient was presented one month later with pleural effusion, euthanasia was performed.

A male non-neutered 9 year old Akita was presented with history of focal crusty lesions. Due to his geographic origin from the North of Mexico close to the border with the United States and comments from the owner about tick infestation an ELISA SNAP 4dx plus test (Idexx) was performed.

SNAP test was positive to Anaplasma spp.

CBC showed no abnormalities.

Cutaneous lesions observed include, crusty and erythematous lesions in the abdominal regions, crusts, erosion and ulceration in the muzzle and petechial and ecchymosis in the front left limb.

A deep skin scraping was performed revealing the presence of long body Demodex compatible with Demodex injai.

Treatment with weekly Doramectin at 0.5mg/kg was started in conjunction with Doxycycline at 10mg/kg per day.

After 5 weeks of treatment owner reported depression and decrease of food ingestion, also, the appearance of new lesions in the muzzle region. Physical examination show nodular and plaque erythematous formations in the face and ventral region.

Cytology by fine needle aspiration was performed revealing atypical lymphocites characterized by cluster aggrupation, anisocytosis, and prominent nucleoli.

Three biopsies were taken using a 6mm punch biopsy and sent to dermatopathological examination. Results of the biopsy showed large atypical lymphocytes with epitheliotrophism consistent with epitheliotrophic lymphoma.

2 weeks later the patient was presented with pleural effusion and respiratory distress. Euthanasia was performed by owner request.

Conclusions

Demodectic mange may appear in a juvenile or adult onset presentation, as well as generalized or localized form. Patients with adult presentation should be screened in search for underlying conditions. In most cases underlying conditions will not be found. In order to control the disease, primary cause should be treated and corrected1.

Correct approach to dermatological conditions include a well-detailed clinical history and diagnostic test according to lesions found. We should be aware of perform all the diagnostic dermatological test we need, du to the fact, there are several dermatosis associated with secondary factors or associated conditions.

1.- Mueller, R. S., Bensignor, E., Ferrer, L., Holm, B., Lemarie, S., Paradis, M., & Shipstone, M. A. (2012). Treatment of demodicosis in dogs: 2011 clinical practice guidelines. Veterinary Dermatology, 23(2), 86–e21

Imaging – Case 1

February 16, 2016 Leave a Comment

10 years old Golden Retriever

History: chronic right inner ear infection

Technique: X-ray, MRI

Findings:

X-rays: There is thickening and destruction of the right tympanic bullae.
There is marked swelling of the soft tissues of the right aural region. The external ear canal is obliterated and there is calcification of its inner end.
MRI: There is a well-demarcated, expansile mass in the right tympanic bulla, with remodeling and destruction of the right tympanic bone. The right petrous temporal bone and the right inner ear are unclear indicating erosion from the mass. The right external ear canal is not visible. The muscles and tissues on the right side appear markedly hyperintense and there is a fluid filled cavity approximately 6 x 4.4 x 1.9 cm that appears to continue cranially and communicate with right tympanic bulla. This cavity extends from the level of the tympanic bulla and caudally up to the level of the C2 vertebra. The right mandibular salivary gland appears displaced medially from the cavitary lesion.

Conclusion:

mass in the right tympanic bulla is consistent with cholesteatoma. Erosion of the right petrous temporal lobe and possible involvement of the inner ear is visible.
Cystic lesion may reflect abcess or haematoma.

Discussion:

Cholesteatoma, a destructive and expanding growth, in the middle ear and/or mastoid process, is a relatively rare cause of otitis media in dogs.
Cholesteatoma are epidermoid cysts lined by a pluristratified keratinizing epithelium containing keratin debris and is characterized by independent and progressive growth, causing destruction of adjacent tissue, especially bone.

Who is Dr Stefan Savov and why he left his country Bulgaria?

February 15, 2016 Leave a Comment

Stefan Savov, DVM, MRCVS

Who is Dr Stefan Savov?

It is quite hard to answer that question.
Firstly, I`m just a normal person who enjoys life and learning. I think life is extremely beautiful.
Secondly, I am a veterinary surgeon. I definitely like animals. What I mostly enjoy about my job is when the pet is healed and is back to its normal behaviour, happily waging its tail – priceless. Currently I am doing general internship in Willows referrals close to Birmingham UK. It is a very busy program with rotations by different disciplines like Orthopaedics, Ophthalmology, Internal medicine, Oncology, Neurology, Image diagnostics, etc. The hospital is amazing and the team is very friendly.

2.How many times you live abroad?

I have been abroad many times.
My first time abroad was in Italy in 2008 for 4 months. There I did internship program in one emergency clinic in Pavia – close to Milan. After that for short periods of time I have been in France, England and twice in Israel. In 2012 I went back to Italy where I worked for 8 months for the same clinic as before. After that I did more focused internship in Ophthalmology in a referral clinic close to Bologna. Then I moved to the UK where I started to work as sole charge vet in first opinion practice close to London. In general I have spent quite a long time abroad.

3.Why you left your country?

That is a very complicated question – I think the main reason was because I managed to achieve quite a lot here in Bulgaria in my field but I still felt that I need more and more things to learn. Unfortunately this couldn’t be done in Bulgaria. One thing lead to another and I packed my luggage and documents and I started to travel. I am happy to say that I was very well accepted everywhere and that over a short period of time I realised how much more I can study. This is the reason that I am doing my third internship program.

4. Differences between vetеrinary medicine on the Balkans and West Europe?

In my opinion there aren`t many differences. In Bulgaria there are several places where the level of Veterinary medicine is very high. One of the main differences, of course, is the money. Veterinary medicine is a really expensive job. More than 90% of the medical procedures are really underestimated but sadly that is the economic reality. Of course, that reflects on how Bulgarian clients spend for their pets. In UK there is a really well developed insurance system for pets. This allows the owners to use the services of specialists and, if necessary, really expensive investigations, and treatment plans to be performed. I think this is the main difference.

5.Do you think to turn back in your country?

Bulgaria is always in my heart and mind. I really cannot answer when I will be back but it could happen sooner or later. If I stay to work abroad I am sure that I will continue to come back as a speaker for workshops, seminars and congresses. I want to give all this knowledge that I am collecting to my colleagues. This is one of the best ways for our profession to go ahead in the eastern countries.

6. What do you think about Vets on The Balkans?

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