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

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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. 615121_366369290105799_850257174_oAfter 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.1981850_10152450903586373_3129797009924029363_n

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.1378157_531105503639201_913611203_n

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. 966212_10152044458571373_4002784005965675672_oIf 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.

Through the scope balloon dilatation of post-traumatic esophageal stricture in dog – case report

 

Author Emil Ofner

Emil Ofner DVM, Only sky’s the limit

Emil Ofner DVM, Veterinary Clinic More

Authors : Emil Ofner, DVM
Davor Crnogaća, DVM
Ivica Ukić, DVM
Silvijo Tarasić, Eng; OLYMPUS d.o.o. Zagreb

Small Animal Veterinary Clinic More, Šibenik, Croatia
Key words : esophageal stricture, balloon dilatation, regurgitation

Abstract :

Many diseases can cause esophageal stricture formation. Strictures in dogs are most frequently caused by foreign objects trapped in esophagus. The easiest way to diagnose and treat esophageal strictures is with flexible gastroscopes. Although there are lots of ways to dilate stricture, through the scope method, using esophageal balloon catheter is simple and safe method enabling direct visualisation of whole procedure.

Introduction :

Table 1

table 1

Post-traumatic esophageal strictures in small animals are relatively rare problems. Most common cause of post – traumatic esophageal strictures is foreign body entrapment in the esophagus. Also, post – traumatic endoluminal strictures can be caused by caustic material ingestion or as a complication of esophageal surgery. In all of these situations damage of esophageal wall layers causes local inflammation with production of fibrous connective tissue. Local fibrosis or scar formation causes reduction of esophageal diameter thus causing stricture. Common symptoms of esophageal strictures are : regurgitation, salivation, dysphagia and ptyalism. Treatment is usually dilatation with balloon catheters or different types of cylindrical tubes called bogies (Table 1).

Case presentation :

Picture 1

Picture 1. Olympus BE – 6 esophageal balloon catheter and hand held saline pump

Female, 9 years old West Highland White Terrier was brought to our clinic because of chronic regurgitation that lasted for four weeks. Prior to this, dog ingested bones and vomited them after five days. She could drink water and take liquid food. Solid food was regurgitated immediately after ingestion. Rectal temperature was normal but she lost 0.84 kg of body weight. Complete blood count and biochemistry values were normal. Radiographic examination didn’t reveal any cause of regurgitation. At this point we decided to do a flexible endoscopy examination of esophagus, which revealed 4 mm diameter stricture in distal part of thoracic esophagus.

Management and Outcome :

Picture 2

Picture 2. Esophageal stricture

Picture 3

Picture 3. Through the scope method of introducing balloon catheter into stricture

Dog was put under general anesthesia and intubated. Olympus GIF Q10 flexible gastroscope with 2.8 mm working channel was introduced into esophagus. After this, Olympus SWIFT balloon catheter (model BE – 6 ) was introduced through the working channel into the stricture ( through the scope method ). To generate force for stricture dilatation, catheter was expanded using saline and hand held Swift pump, two times for duration of two minutes. Steroid ( tramcinolone 40 mg / ml ) diluted with saline 1 : 2 was injected submucosally in three places around the stricture ( Pictures 1 to 5 ). After procedure, we prescribed omeprazole ( 1 mg / kg PO q24h ) for 7 days. After three weeks whole procedure was repeated. On next check-up dog regained normal body weight and was eating solid food without any problems.

Discussion :

Picture 4

Picture 4. Expanding balloon catheter with saline

Picture 5

Picture 5. Triamcinolone application

From a biomechanical perspective, all types of dilators ( balloons and bougies ) generate two types of forces on esophageal wall, radial stretch force which is responsible for dilatation and unwanted longitudinal shear force which can cause esophageal perforation ( Table 1 ).
Through the scope balloon dilatation of esophageal strictures is an easy and relatively safe procedure. Stricture dilatation occurs because saline filled balloon transfers radial stretch force on esophageal wall. Complications like esophageal preforation rarely occur when using balloon catheters because of low longitudinal shear force. Mean shear force of balloon catheters is 1,44 N. Low shear force of balloon catheters is associated with significantly lower risk for perforation.
When using other types of dilators like bougies, in theory perforations are more likely to occur because of strong radial and shear forces.Bougies involve passing long rigid instrument ( rigid cylindrical tube ) through the stricture blindly or by endoscopic guidance. Advancing bougie through stricture generates radial force which causes dilatation of stricture, but it also generates strong shear force which can cause perforation. Mean shear force when using bougies is 16,92 N for Maloney type and 6,92 N for Savary – Gilliard bougie.
Steroid injection prior or after dilatation improves outcome because it’s decreasing scar formation and need for repeated dilatations. Most cases will need repeated procedure in three weeks. If the dog is eating normally after 3-4 weeks it probably wont need new dilatation procedure.
After procedure, anti-acids are prescribed to reduce potentially negative effect of gastric acid on new scar formation. Use of proton pump inhibitors like omeprazole is recommended because of better effect than H2 receptor antagonists ( ranitidine, famotidine ).

Acknowledgments :

We are thankful to Mr. Silvijo Tarasić and Olympus d.o.o. Zagreb who provided technical expertise that greatly assisted us in implementing new technology improvements in our practice.

References :
1. Adamama-Moraitou KK, Rallis TS, Prassinos NN, Galatos AD. Benign esophageal stricture in the dog and cat: A retrospective study of 20 cases. Can J Vet Res. 2002 Jan;66(1):55-9.
2. Leib MS, Dinnel H, Ward DL, Reimer ME, Towell TL, Monroe WE. Endoscopic balloon dilation of benign esophageal strictures in dogs and cats. J Vet Intern Med. 2001 Nov-Dec;15(6):547-52.
3. Harai BH, Johnson SE, Sherding RG. Endoscopically guided balloon dilatation of benign esophageal strictures in 6 cats and 7 dogs. J Vet Intern Med. 1995 Sep-Oct;9(5):332-5.
4. McLean GK, LeVeen RF. Shear stress in the performance of esophageal dilation: comparison of balloon dilation and bougienage Radiology. 1989 Sep;172(3 Pt 2):983-6.
5. ASGE Technology Committee, Siddiqui UD, Banerjee S, Barth B, Chauhan SS, Gottlieb KT, Konda V, Maple JT, Murad FM, Pfau PR, Pleskow DK, Tokar JL, Wang A, Rodriguez SA. Tools for endoscopic stricture dilation. Gastrointest Endosc. 2013 Sep;78(3):391-404. doi: 10.1016/j.gie.2013.04.170.