Monthly Archives: November, 2012

A Case Demonstrating the Importance of MRI in Veterinary Neurology

 

As a veterinary neurologist and neurosurgeon in Charleston, SC I see many patients with paralysis and spinal disease. Obviously, the most common questions are, “What’s causing this?” and “What can we do to fix it?”. There are many ways to image the spine, including a plain x-ray, a myelogram, a CT scan, and MRI. Which imaging technique to choose is a discussion I have daily and is made on a case by case basis. These techniques have an increasing degree of diagnostic benefit, but unfortunately, the ability to get a more accurate and complete diagnosis also comes with a greater cost. When evaluating these cases it is important to choose testing that allows us to come to an accurate diagnosis but at the same time minimizing anesthetic risk and cost. Although MRI requires anesthesia and costs more than a plain x-ray, it is vastly more sensitive and helpful in achieving a diagnosis than a plain x-ray is. Last week I saw a case that demonstrated the importance of MRI as a diagnostic test.

Lola is a 1 ½ year old Miniature Schnauzer. Four or five days prior to my evaluation here she was at the dog park and was standing next to her owner when she suddenly developed a very rapidly progressive inability to walk in all four limbs. Plain x-rays were taken of her neck and demonstrated a condition called atlantoaxial subluxation (a dislocation/instability of the first two neck bones). An x-ray of this is provided:

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Based upon the exam findings and the history, this diagnosis was a little unusual and I was concerned another condition may be responsible for the signs. The treatment of the atlantoaxial instability is a surgery to fuse the two neck bones together. Since I was suspicious there was something else going on with Lola I did not want to rush in to doing this surgery based upon the x-rays alone and we performed an MRI. The MRI (provided below) demonstrated evidence of a fibrocartilaginous embolism (aka spinal cord stroke) as the primary cause of Lola’s weakness, and the atlantoaxial instability was an incidental finding and she was likely born with this condition.

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In this case the MRI may have been more expensive than the plain x-ray, however, without it Lola would have been subjected to an unnecessary surgery and the additional cost associated with that procedure as well. I have seen many cases in which my treatment recommendations have drastically changed after performing an MRI and I feel that it is a very important test that may actually save pet owners money and prevent unnecessary procedures in the long term treatment of our patients.

Lola has been recovering and improving each day without any need for surgery. Below is a link to her video on my Facebook page if you would like to see her getting around without any need for support. https://www.facebook.com/photo.php?v=423915624345755

 

 

Should I induce vomiting at home when my pet ingests a toxin?

By: Carrie Davis, DVM – Mt. Pleasant Emergency

Should I induce vomiting at home when my pet ingests a toxin?

I do NOT recommend it for four main reasons:

1. Owners may misinterpret the ingredients and induce vomiting of a potentially hazardous substance.  With many substances, vomiting is contraindicated!

2. There is a risk of causing aspiration pneumonia.  Your pet should be assessed for ability to protect the airway prior to vomiting.

3. There is a risk of an object getting lodged in the esophagus on the way back up, which causes a serious emergency. 

4. We induce vomiting in the hospital by an IV injection.  This is much more pleasant for your pet than forcing nasty tasting hydrogen peroxide down his or her mouth.  Further, peroxide can cause serious HARM if given inappropriate dosages!  It is actually toxic and should be used with caution.

Please check with a veterinarian or animal poison control before you treat for any toxin ingestion.

 

 

New advances in veterinary medicine help patients with wobblers syndrome

My vet says its probably a condition called wobbler syndrome, that it will continue to worsen until he cannot walk at all, and that there is no good way to reverse this. My whole family is heartbroken. What are your thoughts?

A: Your veterinarian is probably correct about the diagnosis. “Wobbler” is a basket term that actually describes five different conditions affecting the neck portion of the spine. There are several possible causes here, and a full diagnostic evaluation would be required to confirm the cause, appropriate treatment and prognosis.

Given Rolf’s age and breed, it is likely that his specific condition is disc-associated wobbler syndrome (DAWS). While there are many factors that play a part in the development of this disease, degeneration of the intervertebral disc and increased motion of the spine contribute to the compression and resultant injury to the spinal cord. Think of the bones that make up the spine as a row of train cars. They are linked together by the discs that sit between them. With DAWS, this linkage is loose, so every time Rolf moves his neck, the vertebrae (bones) bump against the spinal cord. This may be at only one site or at multiple sites. The disc gets fatter and bulges up against the cord. Over time, the accumulated damage and pressure is debilitating. Sadly, your veterinarian also is correct in that this condition likely will continue to worsen and is often, ultimately, fatal.

Treatment for DAWS includes both medical and surgical options. Treatment methods are controversial. While rest and drugs that decrease inflammation may be helpful, many times surgery is required. The method of surgery chosen is determined by the type of disease present and the choice of the treating veterinarian. The success rate for surgery of DAWS in dogs is 80 percent, and about 25 percent will develop additional lesions after surgery.

Traditionally, surgery has focused on fusing and immobilizing the spine at the affected site by pulling the vertebrae at the affected sites apart (distraction) so as to allow the disc to flatten out and then to fuse the vertebrae together to eliminate any motion. This is a procedure we have been performing at our hospital for many years with good results. As mentioned above, up to 20 percent to 25 percent of dogs may have additional sites become affected after surgically stabilizing the original site.

This is called adjacent segment disease or a domino lesion. When two vertebrae are fused together, it creates one long vertebra.

In a patient who is prone to instability, this longer vertebra places more stress on the adjacent sites and may create another site of instability.

Research is continuing to find more consistent and reliable methods or repair, and some exciting new developments are upon us.

Recently, our neurologist/neurosurgeon, Dr. Peter Brofman, performed with Dr. Filippo Adamo the latest advancement in surgical treatment of DAWS. Adamo has pioneered a technique called artificial disc arthroplasty.

This surgical procedure distracts the vertebrae and disc space as previous techniques have done; however, instead of fusing the vertebrae together and immobilizing them, the distraction is maintained by implanting an artificial disc made of titanium.

This artificial disc allows for the normal motion to occur at the disc space, hopefully avoiding complications such as a domino lesion. As specialists, we strive to remain on the cutting edge of veterinary medicine to ensure we can provide our clients and their pets the most advanced and compassionate care possible.

This procedure is new in veterinary medicine and is being evaluated to see if it is more successful than the traditionally used surgical techniques. So far, results are promising.

If you would like to see pictures of the surgery, please see Brofman’s Facebook page at http://www.facebook.com/drpeterbrofman and click on his photo album section. Feel free to contact him with any questions on his Facebook page or by e-mail at peterbrofman@gmail.com

“Is Pet Insurance a good investment?”

This is one of the questions recently presented to me by a client.  My initial thought was “Probably not”. But I decided to do a little research so I would be better prepared the next time this question came up.  

I have been working as a veterinary technician for over 10 years and pet insurance has been around since the 1980’s; but it seems more recently people are getting interested in buying it for their pets. Maybe this is due to more financial strains of families in this day and age, or, maybe its due to more families considering their pets a four-legged family member instead of just a dog or cat, or maybe is a little of both. For whatever reason I have noticed more client bringing in their pets along with their insurance forms.   

I have never worked in “Human” medicine; but I am sure the large insurance companies that cover medical care have representatives that go around teaching health care professionals about how their company works, what they cover, how they decide what a “pre-existing condition” is, etc. It does not appear to be this way in veterinary medicine. Maybe this will change over the next few years; but as of right now it seems the best way to decide if this is a good investment it to do some “down and dirty” research.  

After a long day spent reading articles from news resources, consumer spending groups and the pet insurances sites themselves, here are some thoughts I have put together.

If you enroll your pet in the right policy, it can be an asset to the health care of that pet and have a significant impact on the bill that results from a visit in an emergency situation, or a treatment that is needed by a specialist. Which in turn is an asset to the family. Anyone who has been in a stressful situation with a pet knows its hard enough to make any decisions, but is compounded exponentially when finances have to be discussed.

Some people can’t afford the treatment so they ask us to euthanize their pet. It’s very sad for the owners and veterinary team alike; but unfortunately not uncommon. The guilt that many people feel that comes along with making that decision could be avoided if some of these people had acquired pet insurance before the pets illness or emergency. They might have been able to move forward with treatments for their pets; and even if these treatments were not life saving the grief would be lessened on an owner who knows they were able to try without the financial burden in their forethought.

On the flip side of the coin; you may end up investing in insurance that you may never need. If you have a very healthy pet, simply putting away the money you would spend on pet insurance premium every month would be enough to pay for your pets yearly health care.   

Buying pet insurance is both an economic and an emotional decision that needs to be based on your families financial situation and what you’re willing to pay for peace of mind. 

So… my new and improved answer to a client who asks me “Is pet insurance worth it?” I can now say:  

If you are concerned there may come a time when you don’t have the money to cover an emergency medical situation or an illness that may require a lengthy stay in a veterinary hospital that could cost thousands of dollars, I think you should consider pet insurance. You’ll get the lowest price if you buy when your pet is young and you won’t have to worry about navigating the sea of pre-existing conditions and age related conditions that an insurance company may choose not to cover.

Remember, insurance is designed to cover you from a catastrophic financial burden, so choosing the highest deductible you can reasonably afford will help bring down monthly premiums while giving you the peace of mind that made you decide to look into getting your pet insurance in the first place.  

The bottom line: If you buy pet insurance and don’t use it, consider yourself lucky. But with pets living longer these days, and with medical advancements in veterinary medicine giving you more treatments options for your pet, your chances of using the policy are greater than ever.   

And one last thing to remember is that, from what I have researched and dealt with, pet insurance companies do not pay the veterinarian directly. The owner is responsible for paying the bill out of pocket and the owner then files a claim to the insurance company. If the claim is approved the owner is reimbursed, either partially or fully depending on the policies limits.

Animal Obesity: A Big Deal By: Dr. Nora Schmidt Veterinary Specialty Care Emergency Doctor

We’ve all sat down to eat a snack, only to realize that we have a set of large eyes focused on our every move.  We’ve all seen those expressive furry eyebrows, desperately begging for a little taste of whatever we’re eating.  And most of us have given in and shared a little morsel or two.  Our pets will often eat their own meal and then tell us they’re still starving and need more. Many of us give in, over and over again.  We all want to give our beloved pets everything they want to keep them happy and many people believe that food equals love.  But the sad truth is: overfeeding can greatly shorten our pet’s lives and cause unnecessary suffering.  Obesity has become the most common health problem diagnosed in animals.
Did you know that obese animals usually die many years before their healthy counterparts?
There has been a lot of research conducted on obesity in animals, and the results are astounding.  Animals that are at a healthy weight live 1.7 times longer than obese animals – that’s almost twice as long!
That means that by keeping our animals at their optimum weight, we get to enjoy many more years of happiness together.  And I think we all agree that the benefits of more years together greatly outweigh the stress of the sad, begging looks we get from our pets.  I assure you, they’re not starving.  As a pug owner myself, I witness forlorn, “hungry” looks every day.  But keeping my dogs healthy is my job as their human mom because they can’t make these decisions for themselves.
Over the years, I have seen many animals brought into the emergency clinic for obesity-related problems.  The list of these problems is a long one:
  • Carrying extra weight stresses our pet’s heart, lungs and joints on a daily basis, often leading to life-threatening complications.
  • Weight gain of even a pound in a tiny or small-breed dog can cause a weakened trachea (the airway between the nose and lungs) to collapse completely, causing intense coughing and extreme difficulty breathing.
  • Overweight male cats are more likely to experience episodes of urethral blockage (urine accumulates in the bladder with no way out of the body), resulting in an emergency situation that often requires surgery.
  • Diabetes and often-fatal fat deposition in the liver are much more likely in obese cats.
  • And then, of course, there is the long list of orthopedic problems ranging from cruciate injury (tearing of knee ligaments) to early onset of severe arthritis.  Many people have to make the painful decision to euthanize their beloved pet due to unrelenting arthritic pain that would have been much milder and later in onset if their pet had stayed at a healthy weight.
  • Finally, there is another very big risk we take when we allow our pets to gain too much weight – anesthesia.  We all try to avoid having our animals put under anesthesia for procedures.  And although there are some surgeries that are recommended but still optional, there are emergencies that occur unexpectedly in which surgery is required to keep an animal alive.  Obese animals have a much higher anesthetic risk, making them less likely to survive anesthesia.
 The good news in all of this?  Obesity is a completely avoidable and treatable disease!
How many opportunities do we get in life to prevent a lot of suffering in our furry kids?  All pets should all be examined by a veterinarian every six to twelve months, even if we see no obvious health problems.  If your pet is carrying extra pounds, your vet can determine an ideal weight, exercise regimen, type of food and portion size. There are also some metabolic diseases like thyroid or adrenal gland disease that can cause abnormal weight gain, despite food restriction.  Your veterinarian can test for these diseases if he/she suspects them based on clinical examination and your valuable input.  If underlying medical conditions are ruled out and your pet isn’t losing any weight, despite exercise and diet revisions, there is a weight loss medication that can be used in dogs.  Unfortunately, no such medication has been approved for use in cats yet.
Are you ready to find your pet’s waistline again?  Once you’ve designed a weight-loss regimen with your veterinarian, stay the course.  Be strong when those eyebrows and sad eyes try to work their magic on you.
Instead, think of all those extra years of fun together that you have ahead of you!