Archives for July 2012

Tibial Plateau Leveling Osteotomy (TPLO)

“TPLO” stands for tibial plateau leveling osteotomy – one of several techniques available for treating injury to the cranial cruciate ligament in dogs (equivalent to the “anterior cruciate ligament” of humans) which is found in the knee. This ligament is one of 2 cruciate ligaments which lie within the ‘knee’ joint (stifle), attaching the femur (thigh bone) to the tibia (calf bone) providing stabilization. The stifle is a complex joint, relying on a variety of anatomical structures in order to function normally (and pain-free).

Dogs, especially larger breeds, often injure the cranial cruciate ligament (CCL) resulting in an unstable ‘knee’, resulting in pain. You may notice a slight limp which worsens with exercise, reluctance to exercise or jump, or sudden lameness following activity. Your pet may sit with the limb splayed out to the side. Injury to the cranial cruciate ligament can be a slow process, or occur suddenly; even partial tear of this ligament can cause pain and instability but a complete rupture often causes unwillingness to stand on that leg.

Will this happen to my dog? Conformation of canines and the angle of the joint puts excess strain on this ligament, often causing slow degradation over time. Some breeds are more susceptible than others. Although injury to the cranial cruciate ligament can occur in any breed, sex or age of dog, several factors such as obesity significantly increase the risk. There is no way to prevent this injury from occurring; however exercise helps to keep weight down and muscle strength up, possibly decreasing likelihood of injuries, illness and osteoarthritis.

How will my veterinarian diagnose this condition? Your veterinarian can make a presumptive diagnosis of a damaged CCL based on palpating (feeling) the knee as well as testing its stability. The tibia and femur which form the “stifle”, or knee, are normally stable, allowing flexion and extension; however when the CCL is damaged, the femur is free to move forward in relationship to the tibia, demonstrating “cranial drawer” motion, a strong indicator of a damaged CCL.

Radiographs (x-rays) are also a valuable diagnostic tool to confirm that there aren’t additional problems present causing your pet’s clinical signs. Although soft tissues such as ligaments are not visible on x-rays, other changes to the joint may be seen following injury to the stifle such as joint effusion, fracture or arthritis.

Does the surgery cure my dog of a ruptured CCL? There is no cure for injury or rupture of the CCL. The goal in treatment of TPLO surgery is stabilization of the stifle and pain control to keep your pet comfortable. There are many surgical options which attempt to stabilize this joint, including the TPLO, TTA (tibial tuberosity advancement), extracapsular and intracapsular techniques – some of which attempt to mimic the action of the no longer functioning CCL. Which technique will work best for you and your pet is determined by your veterinarian based on body weight, breed, activity, and other factors.

Medical treatment involves controlling the pain with anti-inflammatories such as non-steroidal anti-inflammatories (NSAID’s) and opioid-like medications such as tramadol.

What will happen to my dog’s condition should I decide no to surgery? Although the canine stifle is difficult to stabilize by using a cast, splint or bandage, over time the body will attempt to stabilize the injured knee by production of scar tissue in and around the joint. Arthritis will also develop over time. To delay these changes such as degenerative joint disease, the joint should be treated as soon as possible after the injury if determined to be the best course of action by you and your veterinarian.

What happens after surgery? The recovery process following the TPLO is crucial, involving 2-3 months of restricted activity. Physical therapy can be of benefit to maintain strength and expedite recovery during this time. X-rays are taken at the end of the recovery period to ensure adequate bone healing before removing those exercise restrictions. Most dogs return to the same or similar level of activity prior to the injury; however, as with any surgery, there are risks, including infection, implant rejection/failure, bone fracture, etc.

If you think your pet may have an injury or possibly a CCL injury, please give us a call as soon as possible to discuss your and your pet’s options for care at Encina Veterinary Hospital with Board Certified Veterinary Surgeon, Dr. Carl Koehler: (925) 937-5000

Cindi Hillemeyer, DVM

Don’t Pass the Fleas, PLEASE!

Fleas and ticks! Those pesky critters that love to feed on our beloved pets. Spring and summer is the time for play dates in the park, a hike on a mountain, or a stroll along the trail. These are favorite areas for fleas and ticks to live. They are hiding in the grass, behind the wood log, and on the dog or cat that just passed by to said hello. These culprits are everywhere and can cause itchy skin and other diseases including paralysis. Disease is the number one reason why veterinarians recommend flea and tick preventative medication every month.

Flea and tick preventative medications are important monthly. These medications are either given topically on the skin, in between the shoulder blades, or taken as a pill by mouth. It is recommended for pet owners to purchase these types of products from local veterinarians to ensure the product ingredient accuracy. The manufacturer has guaranteed and approved that the product sold at your veterinarian is safe to use and will not to cause harm to your pets. The products that are sold are up to date for flea resistant type medications. It may also be the most current research on the market. Your veterinarian will give you specific recommendations for products based on the lifestyle of your pet/s. You are given the proper information regarding warnings, side effects, or contraindications if your pet is on other medications.

You may question: why can’t I buy the flea and tick products that are sold in stores or even online? In today’s economy, online pricing may be very appealing to clients. The convenience of at-home shopping also gives online suppliers an edge. There may be flea and tick preventative medications that your veterinarian does not carry which you may prefer.
Although these previous points seem fantastic, there are many risks behind shopping online (see what the FDA has to say about it here). The most important risk is product ingredient and supplier guarantee (did you know that if your pet becomes ill after taking a medication purchased from an online pharmacy or general store, the maker of the medication will not pay for your pet’s treatment? If you purchase your medication through a veterinarian however, the manufacturer will stand behind their drug and pay for any adverse effects it may have on your pet).

Fleas and ticks do not discriminate. If you have a multi-pet household and one of the pets have fleas, it is imperative to treat all the pets for fleas. Common sense will tell us that exposure to fleas and ticks is the number one cause for an infestation to occur. Therefore, indoor cats are less likely than outdoor cats to become burdened with an infestation.
There are some diseases that are associated with fleas and ticks. Quite commonly, flea allergy dermatitis (FAD). Dogs and cats are allergic to the saliva of the flea not the actual fleas themselves crawling on their skin.

As soon as the flea bites, the allergic response can begin. Ticks, on the other hand, are vectors for disease. The most common ticks in the East Bay area are American dog tick, Pacific coast tick, Western black leg tick.

Trifexis is our current recommendation for oral preventative medication that treats fleas, intestinal parasites, and heartworm. This is an excellent option for dogs that love to swim or sneak a lap around the pool right after the topical medication is administered. Intestinal parasites are a cause for spread of human disease. For flea and tick preventative topically, our current recommendation is Parastar plus. Revolution is currently our recommended as the topical medication that treats fleas, intestinal parasites, heartworm, and ear mites. The current recommendation for only flea and tick preventative in cats is Easy Spot topical. Trifexis and Revolution medications are recommended because they not only prevent external parasites but internal parasites as well.

Christine Fabregas DVM

Cancer in Pets 101

Encina Veterinary Hospital’s board certified veterinary oncologist, Dr. Stephen Atwater, has taken some time to answer some questions that many pet owners may have regarding cancer in their pets.

Why did you decide to specialize in oncology and how rewarding is it to you?
I had the opportunity to be part of a world renowned oncology program at Colorado State University. It was such an honor to be a part of that program which has helped to develop treatments for cancer in people. Practicing veterinary oncology is extremely rewarding. I get the opportunity to work with very dedicated owners to help extend their pet’s lives providing owners and their pets additional good quality time together.

What are some common options for treatment when a pet is diagnosed with cancer (including holistic/diet)?
The common types of treatments of cancer in animals include surgery, chemotherapy and radiation therapy.
Holistic treatments exist as well, but are largely unproven in their benefit. Diet recommendations include feeding a high fat, good quality protein, low carbohydrate diet. Supplementing diets with omega 3 fatty acids and amino acids such as glutamine and arginine are also recommended. Although in theory this is advised, the true beneficial effects of diet are uncertain.

What are some types of cancers you commonly see and treat?
The most common tumors that I see and treat include lymphoma, mast cell tumors, hemangiosarcomas, bone cancer and soft tissue sarcomas.

How is cancer typically treated at Encina Veterinary Hospital?
Surgery, chemotherapy and radiation are the most common treatments for cancer in pets.

Are the chemotherapy drugs used on pets the same as the ones used on humans?
Most of the drugs used to treat cancer in animals are the same drugs that are used to treat cancer in people.

When a human undergoes chemotherapy, they seem to suffer a lot (nausea, lethargic, etc); do our pets suffer this same way when they undergo treatments?
Animals that receive chemotherapy typically tolerate the treatments well. In veterinary medicine, we appreciate that owner’s primary goal in treating their pets is to maintain a good quality of life. If that was not the case, most owners in their right mind would elect to discontinue treatment. As a result, doses of chemotherapy in dogs and cats are designed such that most animals will tolerate the treatment without significant side effects. If side effects do occur, we are quick to address them with medication to control the signs and potential adjustments with future doses to avoid additional side effects.

Can a pet ever be cured of cancer?
There are many types of cancers in animals. Some forms of cancer in animals can be cured with treatment. This is particularly the case with tumors that develop as localized forms of cancer such as soft tissue sarcomas. Many types of cancers that are localized can be cured with wide surgical excision.

Like humans, pets have remission periods. How long do these periods typically last in pets?
Some animals have cancers that are very resistant to treatment and the animal never goes into remission. Others can be cured of their cancer and are in remission for the rest of their lives. Based on the type of cancer and extent of the disease, remission times can vary greatly. It is based on this information that a prognosis can often be provided to owners on what the expectations for their pet is with respect to the likelihood of a response to treatment and for how long.

Does Encina Veterinary Hospital offer clinical trials of cancer treatments?
We do not do clinical trials very often at Encina Veterinary Hospital, but have done some in the past.

Tell us a brief success/happy story of a patient of yours who stands out in your memory.
Maggie is a Shih Tzu that was diagnosed with lymphoma and was treated with a course of chemotherapy. She relapsed about a year after she completed her first treatment and received another course of the same treatment. She never had recurrence of her cancer after the second round of chemotherapy and survived over 10 years from diagnosis of her lymphoma and had to be put down due to non-cancer related causes.

If you would like to schedule an appointment with Encina Veterinary Hospital/East Bay Veterinary Specialists and Emergency’s Board Certified Veterinary Oncologist, Dr. Stephen Atwater, please give us a call at: (925) 937-5000

Dog Bite Prevention Tips by Veterinary Behaviorist, Dr. Meredith Stepita

1. Dogs that behave as though they are shy, may actually be fearful and scared. They are most likely to become aggressive when they cannot escape or feel trapped in a situation, so avoid cornering the dog or overwhelming them by trying to pet them or be near them.

2. Listen to the dog: Dogs have a normal progression of aggression starting with barking, then growling, snarling, snapping and finally biting. If a dog is showing one of the early signs of aggression then remove them or yourself from the situation so that they do not feel the need to escalate to biting. Also, look for other stress signals such as a furrowed brow, muzzle licking, yawning, moving in slow motion, hypervigilance, panting, not accepting treats, etc.

3. So that your dog does not grow up to be a dog who bites, it’s important you socialize your dog starting as a puppy (less than 16 weeks of age) to inoculate them against fear, defensiveness and aggression later in life. Although socialization must occur throughout life for maintenance of social relationships, at less than 16 weeks of age puppies are in their sensitive period of socialization in which they are more likely to overcome mild fears and habituate to people, other animals, noises, objects, etc. Remember not to socialize puppies in places frequented by dogs of unknown vaccination or disease status such as dog parks or pet stores.

If you would like to schedule a private consultation with Dr. Meredith Stepita to discuss your pet’s behavior, please give us a call: (925) 937-5000

Meredith Steptita DVM, Dipl. ACVB