Pet Health Library 2018-07-27T10:38:17+00:00

A Library Built For You

Orthopedics
Soft Tissue Surgery
Acupuncture
Dental Care
Oncology
Dermatology

Orthopedics

Tibial Plateau Leveling Osteotomy (TPLO)

dog running on the grass
  • There are two cruciate ligaments which cross inside the knee joint: the anterior (cranial) cruciate and the posterior (caudal) cruciate.
  • The anterior cruciate stabilizes the knee by preventing the tibia from slipping forward and out from under the femur.
  • There are two collateral ligaments that stabilize the knee in a side-to-side direction.
  • There are two c-shaped cartilage structures (meniscus) that cushion and stabilize the knee by fitting between the femur and tibia.

Anterior (Cranial) Cruciate Ligament Rupture

  • ACL rupture is the most common orthopedic condition that we treat. The cause is unknown, but conformation of the limbs and genetics may play a role.
  • All breeds of dogs, cats and ferrets can be affected, butsome breeds such as Labrador Retrievers, Rottweiler, and Mastiffs are more predisposed.
  • Ligament rupture is usually the result of a gradual process, not due to a single traumatic injury.
  • Symptoms may begin after sudden stopping, twisting, or over extension of the knee during exercise.
  • Many animals have a predisposing factor like age-related ligament degeneration, pre-existing inflammation, anatomical abnormalities or abnormal slope of the plateau of the tibia bone.
  • About 33-50% of dogs that have an abnormal cruciate ligament (ACL) will develop a partial or full rupture of the opposite ACL.

How do I know if my pet has this injury?

  • Limping is usually the first symptom noticed at home, often after exercise.
  • Stiffness and/or very mild lameness are early signs.
  • Swelling inside the joint is common, but is usually not externally visible.
  • A medial buttress is swelling on the inside of the knee (facing the other knee); this indicates arthritis is developing from chronic irritation.

How do we diagnose an ACL injury?

  • The doctor will perform a physical exam and check for ‘drawer motion’ and pain in the knee. If the ACL has torn, the doctor may be able to slide the knee joint like a drawer; a normal knee does not slide in this way. There are other physical manipulations of the knee that can be done to aid in the diagnosis of ligament injuries.
  • X-rays may be taken to look for excessive fluid build-up in the joint, signs of arthritis or any other problems that may be affecting the knee.

Is there anything that can be done to fix an ACL injury?

It is unusual for lameness to resolve without surgery, especially in large breeds. We use one of two surgical procedures to correct this problem:
  • TPLO surgery
  • Extracapsular

Tibial Plateau Leveling Osteotomy (TPLO) Wagon Model Used to Explain Instability of the Knee Joint

  • The tibial plateau of a dog’s knee (stifle) is sloped.
  • Understanding the importance of the tibial slope when the cranial cruciate ligament is torn is somewhat difficult. We therefore present a model of a wagon on a hill, which is tied to a fence post.
  • The slope of the hill represents the tibial plateau, the wagon represents the femur bone, and the cable represents the cranial cruciate ligament.
  • If the cable is torn, the wagon will roll down the hill (see fig below). Likewise, when cranial cruciate ligament is torn the femur bone will slide down the slope of the tibial plateau.
  • When surface that the wagon is placed on is level and weight is put in the wagon, it does not to roll backward (see fig below).
  • In the dog, the tibial plateau leveling osteotomy levels the slope of the tibial plateau so that the femur no longer slides down the plateau. Thus a dynamically stable joint is created even when no cruciate ligament is present.

TPLO Surgery

TPLO is a type of knee surgery designed for pets who have injured their ACL (anterior cruciate ligament). The bone of the tibia is cut and then rotated to an angle that prevents the bones of the knee joint from slipping. Bone plates are screwed in place to hold the bone while it heals. During surgery, the knee joint is inspected, and damaged meniscus and bone spurs are removed via a small incision into the joint or arthroscopically. The cruciate ligament remnants may be debrided depending on the degree of damage.
  • Up to 90% of patients become fully weight-bearing (normal or near normal function) after TPLO surgery.

How does TPLO compare to other techniques?

  • Slower progression of degenerative joint disease as compared to other methods of repair.
  • Better range of motion of the joint.
  • Return to athletic or working activity (no lameness after heavy activity in most patients).

What are the risks of TPLO surgery?

  • Any time a surgery is performed, there is always the possibility of anesthesia complications, but these are minimized by our high experienced and skilledstaff.
  • Difficulty restricting activity after surgery (especially in the first 2 months)which can cause poor healing due to straining of the patellar ligament, breakage of plates or screws, or loosening of the screws.
  • Poor healing of the bone can also be caused by steroid use (usually for allergies) or some illnesses such as diabetes.
  • Fracture of tibial plateau or shifting of the position of the bone (from falling or too much activity) which can require additional surgery.
  • Infection at the surgery site, (minimized by sterile surgical techniques, antibiotic use, and prevention of licking of the incision after surgery).
  • If meniscal cartilage was not damaged at the time of surgery, it may become damaged at a later date requiring a second surgery.
  • Improvement may be reduced if your pet has arthritis or advanced degenerative joint disease before surgery.
  • Improvement may be reduced if your pet had a previous surgery of an alternate technique on the knee.

Arthritis and ACL Injury

  • Unfortunately we cannot stop or reverse the arthritis and degeneration of the joint, but surgery can help to slow its progression.
  • If your pet has arthritis in any joint, you may notice stiffness in the morning, lameness after heavy exercise or during weather changes.
  • We recommend that you help your pet by keeping them at ahealthy weight, maintaining a regular amount of mild exercise, and giving ahigh quality glucosamine and chondroitin product.

Post-Operative Instructions for TPLO ACL Repair

For eight to twelve weeks following surgery, a strict confinement regimen is required. Please follow these instructions closely. If you have any problems or questions not answered here then please call us at 761-7063.
  • Your pet needs to be kept inside on carpeted surfaces. He/She can wander around a small room at a slow walk as long as it is not constant. Running, jumping, bounding, playing, etc., are not allowed.
  • Bruising and swelling is expected at and below the incision over the next several days. He/She will likely be reluctant to use the operated leg for the next 7 or so days.
  • WHe/She must be on a leash at all times when outside for fresh air and going to the bathroom. The “sling” is to be used for support for approximately the first two weeks after surgery.
  • When not under your direct supervision, your pet is to be confined in a small room or crate with no access to furniture (elevated beds, couches, etc…)

General Information:

  • Playing with other animals is not allowed during confinement. If there are other pets in your household, you will need to keep them separated.
  • During confinement, your pet’s food intake needs to be reduced to help prevent weight gain. For most dogs, a 10-15% reduction in food intake is needed during the recovery process. Water consumption should remain normal.
  • The first two weeks following surgery you will need to monitor your pet’s incisions. Licking or chewing can cause infection or sutures to loosen. If you notice that he/she has started licking, you will need to take steps to discourage him/her from doing so by utilizing the e-collar provided.
  • It takes a minimum of eight to 10 weeks for bones to heal.
  • One of the most difficult aspects of confinement is that the animals will frequently feel better long before they are healed. At this point your pet will start being more careless of the operated limb and is then more likely to be overactive and injure him/her’s self. Until the bone is healed, you must adhere strictly to the confinement guidelines and not allow your pet to do more.
  • Sedatives (acepromazine) may be required to help alleviate your pet’s anxiety or control hyperactivity.
  • If at any time during your pet’s recovery and healing, if he/she does anything that causes him/her to cry out or give a sharp yelp, contact us as soon as possible.
  • Medications have been dispensed to treat pain and help prevent post-operative infection. Follow the directions on the medication label. Discontinue the medication if your pet vomits, refuses to eat or experiences diarrhea. He/she should also be placed on a joint support medication containing glucosamine and chondroitin (Cosequin ). Please ask our staff about the amount your pet should take.
  • Your pet may not defecate for several days after the surgery. This is due to the pain medication that was administered. If he/she does not defecate within three days of being home or there is straining to defecate, please notify us.
  • Recheck appointments are necessary at the following times.
  • 12-14 days for staple removal.
  • 6 weeks for limb usage and x-ray evaluation.
  • 11-12 weeks for x-ray evaluation of bony healing.
Please schedule these appointments with our front desk.

Physical Therapy for TPLO/ACL Repair

  • Increased blood flow to the affected area
  • Prevention of joint contraction
  • Prevention or decrease in muscle atrophy
  • Faster return of use of the affected limb
We recommend the following methods of physical therapy for your pet. Please ask one of the staff members to demonstrate any technique you are not familiar with. Do not hesitate to call us with any questions.
  • Cold Packs – apply during the first 72 hours after surgery; for approximately 3-5 minutes or as tolerated; to minimize post-operative swelling and pain. Never apply the cold pack directly to the skin as it could result in tissue damage. It is recommended that the cold pack (frozen bag of peas or corn) be wrapped in a towel and then applied to the area two to three times a day.
  • Heat application – Apply moist heat to the incision area beginning on day 4 after surgery. This will help increase blood flow to the area and relax tense muscles. Heat application should be applied 2 to 3 times a day for a period of 3-5 minutes. We recommend using a warm washcloth as the heat source. Continue warm compresses for 3 days.
  • Massage – the main objective of massage is to improve blood and lymphatic flow to the area, thereby increasing available nutrients to an area and promoting removal of waste products and fluid. Massage also aids muscle relaxation. With massage the muscles are grasped between the thumb and index finger and gently elevated. The tissues are then compressed alternately between the fingers of one hand and the heel of the other hand. Massage should be firm enough to cause muscle contraction but gentle enough to avoid causing pain. Begin massaging the lowest part of the leg first and work toward the top of the leg. Massage should be performed twice daily for 5 minutes. This may begin 10 days after surgery.
  • Benefits of physical therapy include:Passive Range Of Motion (PROM). This is very important in the prevention of tissue adhesions, promotion of normal joint dynamics, enhancement of blood and lymphatic flow, and in preventing muscle and joint contracture. Range of motion exercises can begin after the staples/sutures are removed (12-14 days). Hands on instruction by one of our staff members will be provided to you before PROM therapy is attempted at home.
  • Exercise – specific instructions regarding exercise will be covered on your pet’s take home instructions. It is very important to follow these instructions regarding restricted activity to ensure the success of the surgery.

TPLO Rehabilitation Protocol

The first eight weeks are critical to bone healing. Therefore, activity must be kept to a minimum and under strict control to avoid overstressing the bone and joint. No running, jumping, sprinting, or ascending/descending stairs is allowed during this period Short, leash walks are encouraged during the first eight weeks. This activity will increase muscle stimulation and improve range of motion. Walks are to be done on a short leash and at a very slow pace. Use of extended leads is discouraged. Walks may begin 10 days after surgery. At 10 days from surgery, begin with 5 minute walks twice daily. At two weeks, this may be increased to 10 minute walks and at three weeks, 15-20 minutes twice daily. After eight weeks and a follow-up x-ray that demonstrates sufficient bone healing, you may increase your pet's activity. Your pet may now begin to go up and down stairs slowly. No off-leash activity is allowed until the bone has completely healed which is normally evident on the x-ray at ten to twelve weeks. The basic rehabilitation theme is a slow, gradual return to activity. The thigh muscles will still be weak even after the bone has healed. It often takes 3-6 months after surgery for the muscles to regain their pre-injury strength.

Frequently Asked Questions About TPLO

Does my pet have to spend the night in the hospital? Orthopedic surgery patients are kept overnight for several reasons. Epidural anesthesia is given to keep your pet comfortable, but makes them unable to walk without assistance. Your pet will also continue to receive IV antibiotics and pain medication. Can a TPLO be performed on an animal when an older technique has failed? Improvement is expected but may not be as dramatic on a knee that has had a previous surgery of an alternate technique. Will my dog experience pain in the postoperative period? We takepain controlvery seriously. Your pet will receive pain medication before surgery, epidural anesthesia during the procedure and continue on IV pain medication throughout the evening of surgery. Pain medication will be sent home as well. How long does it take for healing? Patients followspecific post-operative physical therapyrestricting activity to give the bone time to heal. Controlled exercise is usually started in 6-12 weeks. 4 months after surgery most exercise restrictions are lifted. By 6 months, working, hunting and agility dogs are cleared for full activity.

Extracapsular Repair

Running magyar dog

Anatomy of the knee

  • There are two cruciate ligaments which cross inside the knee joint: the anterior (cranial) cruciate and the posterior (caudal) cruciate.
  • The anterior cruciate stabilizes the knee by preventing the tibia from slipping forward and out from under the femur.
  • There are two collateral ligaments that stabilize the knee in a side-to-side direction.
  • There are two c-shaped cartilage structures (meniscus) that cushion and stabilize the knee by fitting between the femur and tibia.

Anterior (Cranial) Cruciate Ligament Rupture

  • ACL rupture is the most common orthopedic condition that we treat. The cause is unknown, but conformation of the limbs and genetics may play a role.
  • All breeds of dogs, cats and ferrets can be affected, but some breeds such as Labrador Retrievers, Rottweiler, and Mastiffs are more predisposed.
  • Ligament rupture is usually the result of a gradual process, not due to a single traumatic injury.
  • Symptoms may begin after sudden stopping, twisting, or over extension of the knee during exercise.
  • Many animals have a predisposing factor like age-related ligament degeneration, pre-existing inflammation, anatomical abnormalities or abnormal slope of the plateau of the tibia bone.
  • About 33-50% of dogs that have an abnormal cruciate ligament (ACL) will develop a partial or full rupture of the opposite ACL.

How do we diagnose an ACL injury?

  • The doctor will perform a physical exam and check for ‘drawer motion’ and pain in the knee. If the ACL has torn, the doctor may be able to slide the knee joint like a drawer; a normal knee does not slide in this way. There are other physical manipulations of the knee that can be done to aid in the diagnosis of ligament injuries.
  • X-rays may be taken to look for excessive fluid build-up in the joint, signs of arthritis or any other problems that may be affecting the knee.

Is there anything that can be done to fix an ACL injury?

It is unusual for lameness to resolve without surgery, especially in large breeds. We use one of two surgical procedures to correct this problem:
  • TPLO surgery
  • Extracapsular

Extracapsular Repair Extracapsular Surgery

  • The knee joint is first inspected via a small incision (arthrotomy) or insertion of a camera (arthroscopy). The torn remnants of the ACL are removed and the meniscal (diagram) structures are examined. If the meniscus is torn, the damaged portion is removed.
  • A strong, non-absorbable suture (nylon band) is passed around a small bone on the back of the knee and then placed through a small hole made in the front of the tibia bone. The suture is then tightened which serves to prevent drawer motion, effectively taking over the job of the torn cruciate ligament.
  • Over time, scar tissue will form around the suture which helps to stabilize the joint.
  • This technique is most commonly used in small dogs and cats.
  • About 85% of patients show a significant improvement after surgery and are able to resume pre-injury activities.

Risks and Complications

  • Anesthesia complications can occur, but these are minimized by our high quality surgical facility.
  • The nylon band can break or loosen from its attachment behind the knee. This most often occurs when pets are too active during the early healing period (4-6 weeks from surgery).
  • Infection at the surgical site. This is minimized by proper sterile technique, peri-operative antibiotic usage, and prevention of licking of the incision.
  • If meniscal cartilage was not damaged at the time of surgery, there is a small chance that it may become damaged at a later date requiring a second surgery.

Arthritis and ACL Injury

  • Unfortunately we cannot stop or reverse the arthritis and degeneration of the joint, but surgery can help to slow its progression.
  • If your pet has arthritis in any joint, you may notice stiffness in the morning, lameness after heavy exercise or during weather changes.
  • We recommend that you help your pet by keeping them at a healthy weight, maintaining a regular amount of mild exercise, and giving a high quality glucosamine and chondroitin product.

Home-care Instructions for Extracapsular ACL Repair

  • Keep the rest restricted from excessive activity for the next 6 week. No running, jumping or rough play with other pets during this time. No unsupervised time outside for the first 6 weeks.
  • Utilize the E-collar or inflatable collar to prevent licking and/or chewing of the incision.
  • Applying a cold pack to the XXXX knee (5-10 minutes daily) will help to reduce inflamation.
  • Short, slow, leashed walks (5 minutes) twice daily.
  • Medications have been dispensed. Please follow the directions
  • Recheck appointments are nexessary at the following times:
a) 10-14 days for a suture removal. b) 4 weeks for limb usage evaluation. c) 6 weeks for limb usage evaluation. A rehabilitation protocol has been attached for specific

Physical Therapy for Extracapsular ACL Repair

What are the benefits of physical therapy?

Benefits include:
  • Increased blood flow to the affected area.
  • Prevention of joint contraction
  • Prevention or decrease in muscle atrophy
  • Faster return of use of the affected limb.

What does physical therapy involve?

We recommend a combination of actions as follows:
  • Cold packs will minimize post-operative swelling and pain. Never apply the cold pack directly to the skin as it could result in cell damage. For the first 72 hours after surgery, the cold pack should be wrapped in a towel and then applied to the area 2-3 times a day for 5 to 10 minutes each time.
  • Moist heat application will help increase blood flow to the area and relax tense muscles. We recommend using a clean washcloth moistened with warm water – starting 72 hours after surgery, heat should be applied 2-3 times a day for a period of10 to 20 minutes each time.
  • Massage will improve blood and lymphatic flow to the area, which increases available nutrients to an area and promotes waste products and fluid removal. Massage also aids muscle relaxation. The muscles are grasped between the thumb and index finger and gently elevated. The tissues are then compressed alternately between the fingers of one hand and the heel of the other hand. Massage should be firm. Perform for 5 to 10 minutes every day.
  • Passive Range of Motion (PROM) is very important in the prevention of tissue adhesions, promotion of normal joint movement, enhancement of blood and lymphatic flow, and prevention of muscle and joint contracture. Usually, this mode of therapy may be started after sutures are removed. Hands-on instruction by one of our staff members will be given to you before PROM therapy is attempted at home.
  • Exercise. Specific instructions regarding exercise will be covered on your pet’s take home instructions, depending on the type of surgery they had. It is very important to follow these instructions regarding restricted activity to ensure the success of the surgery.

Extracapsular Surgery Rehabilitation Protocol

Short, leash walks are encouraged during the first six weeks. This activity will increase muscle stimulation and improve range of motion. Walks are to be done on a short leash and at a very slow pace. Use of extended leads is discouraged. Week One:
  • Begin with 5-10 minute walks three times daily, followed by an ice-pack (package of frozen peas wrapped in a towel) on knee for 5-10 minutes.
  • Massage the thight muscles for 5-10 minutes daily.
  • Flex and extend the knee 10-20 times twice daily.
Weeks Two and Three:
  • Increase walks to 10-20 minutes three times daily, followed by an ice-pack (package of frozen peas wrapped in a towel) on knee for 5-10 minutes if swelling is still present.
  • Continue massage the thight muscles for 5-10 minutes daily.
  • Flex and extend the knee 10-20 times twice daily.
Weeks Four and Five:
  • Leash walks may be increased to 20-30 minutes two to three times daily. While walking, gently nudge your dog sideways.>
  • Sit/stand 10 repetitions three times daily.
  • Figure 8 walks or circling to the left and right 10 times daily.
  • If your dog is doing well, “dance” with him/her. Hold up the front legs to encourage walking on the hind legs.
  • If your dog is not putting weight on the operated leg, the rehabilitation specialist will give you suggestions.
Weeks Six through Eight:
  • Leash walks 30-40 minutes two to three times daily, including inclines, hills, and ramps.
  • He/she may now begin to go up and down stairs slowly.
  • Tug-of-war.
The basic rehabilitation theme is a slow, gradual return to activity. The thigh muscles will still be weak even after the bone has healed. It often takes 3-6 months after surgery for the muscles to regain their pre-injury strength.

Frequently Asked Questions About Extracapsular Repairs

Does my pet have to spend the night in the hospital? Orthopedic surgery patients are kept overnight for several reasons. Epidural anesthesia is given to keep your pet comfortable, but makes them unable to walk without assistance. Your pet will also continue to receive IV antibiotics and pain medication. What can I expect after surgery?
  • 24 hours after surgery most dogs will be non-weight bearing to toe touching when walking.
  • 5 to 7 days post op — most patients will be bearing some weight on the limb.
  • 2 weeks post op — a moderate of amount of weight bearing is expected.
  • 6-8 weeks — mild lameness may be present.
  • Partial tear patients tend to recover more quickly.
Will my dog experience pain in the postoperative period? We take pain control very seriously. Your pet will receive pain medication before surgery, epidural anesthesia during the procedure and continue on IV pain medication throughout the evening of surgery. Pain medication will be sent home as well.

Medial Patellar Luxation

Close-up of a white maltese dog running on green grass background

What is medial patellar luxation?

  •  The patella (kneecap) normally rides in a groove called the trochlea at the end of the femur bone (Figure 1). When the patella luxates or moves out of the groove, the knee joint cannot flex properly (Figure 2).
  •  Patellar luxation is usually caused by a conformational abnormality at the level of the hip joint and results in abnormal forces that act on the kneecap causing it to ride outside the groove. In young animals, the groove becomes very shallow and the attachment of the patellar ligament is often malpositioned on the tibia (shin bone). The kneecap most often luxates to the inner aspect of the knee joint and is called medial patellar luxation.
Clinical Signs:
  •  Lameness/Pain
  •  Intermittent skipping
  •  Stiffness of the affected leg
  •  Combination of the above
Surgery:
  •  In most cases, a series of three to four surgical steps are taken to properly align the patella.
  •  If the groove is shallow or misshapen, it is surgically deepened to allow the patella to sit deeper within the femur. Replacement cartilage (fiibrocartilage) will gradually fill in the recontoured portion of bone (Figure 3).
  •  The attachment of the patellar ligament to the tibial crest is often surgically repositioned to the side opposite the luxation. It is then secured in place with one or two metal pins (Figure 4).
  •  The joint capsule and surrounding muscle along the side of the patella are often stretched during a luxation. These tissues are sutured or tightened on the opposite the side of the luxation to provide additional support and prevent abnormal movement of the patella.
  •  Occasionally, the joint capsule on the side of the luxation is ‘released’ to reduce tension.
Recovery:
  •  Pets are often beginning to touch the toes to the ground by 10-14 days. Some take a bit longer depending upon the severity of the luxation.
  •  Most pets are using the operated limb well by 6-8 weeks.
Prognosis:
  •  Approximately 90% of our patients will return to normal function of the limb.
  •  Surgery is designed to address the luxating patella, but cannot reverse arthritic changes that are already present in the knee joint. Patients with arthritic knees may have some stiffness after rest or may become lame after heavy exercise.
  •  Some patients with a severe luxation are at risk for reluxating after surgery. Fortunately, this is not common for most pets.
Potential Complications:
  •  Anesthetic related complications can occur with any procedure. Close monitoring of our patients throughout the surgery and recovery period minimizes these complications.
  •  As with any surgical procedure, infection is always a concern. Keeping the surgical site clean and preventing pets from licking the incision is of paramount importance.
  •  Occasionally, the pin(s) used to secure the transposed portion of the shin bone can shift or back out. Once the bone is healed (at approximately 8 weeks), the pin(s) is no longer needed and are removed if they migrate.
  •  A fluid swelling (seroma) may occur over the pins.
  •  Excessive activity during the first 6-8 weeks can result in a breakdown of the repair requiring additional surgery.

Post-operative Instructions MPL (Medial Patellar Luxation)

1.  Keep your pet restricted from excessive activity for the next 6 weeks.  No running, jumping or rough play with other pets during this time.  No unsupervised time outside for the first 6 weeks. 2. Utilize the E-collar or inflatable collar to prevent licking and/or chewing of the incision. 3.  Applying a cold pack to the knee (5-10 minutes daily) will help to reduce inflammation. 4.  Short, slow, leashed walks (5 minutes) twice daily are encouraged. 5.  Medications have been dispensed.  Please follow label directions. 6.  Recheck appointments are necessary at the following times: a) 10-14 days for suture removal. b) 4 weeks for limb usage evaluation. c) 6 weeks for limb usage evaluation. A rehabilitation protocol has been attached for specific exercises at certain points along his/her recovery. Please call if you have any questions or concerns. (303)761-7063.  

Post Operative Rehabilitation Protocol for Patella Subluxation Surgery

Week 1:
  • Ice pack over operated knee for 5 minutes 2 times per day for 3 days, especially after exercise. (package of frozen peas or corn wrapped in a damp towel).  Apply a warm compress to the incision for 5 minutes twice daily beginning on day 4 after surgery.  Continue warm comrpesses for 3 days.
  •  Massage the thigh muscles for 5 minutes daily.
  •  Slow leash walks (5 minutes) 2 times per day.  No stair climbing is allowed.
Weeks 2 & 3:
  •  Begin range of motion exercises (flexion and extension) and ice if swelling is present.  Our staff will show you how to perform these exercises.
  • Slow leashed walks (10 minutes) 2 times/day on flat, nonslippery surfaces.
  • Continue massage.
Weeks 4 & 5:
  • Slow leash walks 15-20 minutes two to three times per day on flat surfaces..
  • Sit/stand 10 repetitions 2 times per day
  • While walking with your dog, gently nudge him/her sideways.
  • Figure 8 walks or circling to left and right 10 times.
  • If your pet is doing well, “dance” with him/her.  Hold up the front legs to encourage him/her to walk on the hind legs.
Weeks 6, 7 & 8:
  •  Leash walk 30-40 minutes, including inclines, hills, ramps.
  • Stair walks slowly 5 flights twice a day.
  •  Tug-of-war.
Weeks 9 & 10:
  • Faster walks on leash 30-40 minutes.
  • Runs on leash straight only, no turns.
Weeks 11 & 12:
  • Turns on leash at a run.
  • Gradual return to full activity at the end of 12 weeks.
  •  Avoid extreme activity such as chasing a ball or playing Frisbee to reduce the chances of further injury.

Fractures

Funny red cat flying in the air in autumn
Dogs and cats suffer broken bones in much the same way as humans. Drs. Willer and Glawe have extensive clinical experience repairing fractures; from simple to very complicated. Our new state of the art operating room enables us to perform orthopedic surgeries in an optimal environment to ensure your pet gets the best care.

How do we determine if a bone is fractured?

In nearly all cases, pets will not bear any weight on the fractured leg. Swelling and pain are often present and pets resent palpation of the injured leg. X-rays are performed to determine which bone is broken, the extent of the fracture, and optimal surgical treatment.

How are broken bones repaired in animals?

While there are situations when broken bones can be ‘set’ and splinted or casted, surgery is required for a majority of fractures. This entails placing the pet under general anesthesia and making an incision over the fractured bone. The segments are then anatomically aligned and secured by means of one or more of the following methods:
  • Internal fixation  (Click here to see Image) using a bone plate. A stainless steel medical grade bone plate is placed against the fracture bone and secured using bone screws.
  • Pin and cerclage wire. (Click here to see Image) A large pin is placed inside the cavity of the bone and surgical wire is wrapped around the bone to secure the loose fragments.
  • External fixator. (Click here to see Image) Sterile pins are placed from outside the skin and directed into the bone. The ends of the pins are then anchored with a connecting bar.
  • Combinations of the above. Occasionally various combinations of the above modalities are needed to properly secure broken bones.
Which methods are used depends upon the surgeon’s experience and understanding of the mechanics and biology of bone healing and what repair will result in the best outcome for your pet.

How long does it take for broken bones to heal?

In most instances bones will heal in eight to twelve weeks. However, this is very dependent upon the type of fracture, the age of the animal, and the degree of activity restriction during the healing period. X-rays are generally performed every four to six weeks after surgery until the fracture is healed.

What is required in the post-operative period to allow bones to heal properly?

Proper care of the incision is imperative in the early post-operative period. The use an inflatable or Elizabethan (E) collar is necessary to prevent licking and contamination of the surgical wound. Placement of a cold compress (frozen bag of peas or corn) can be placed on the incision twice daily for 3-5 minutes for the first three days after surgery. This will help reduce swelling and inflammation. It is extremely important that pets be restricted from running, jumping, stairs, and rough play during healing. Excessive activity will delay or jeopardize proper bone healing. Dogs often need to be confined to a pen or small room to prevent excessive movement. They will need to be leashed when outside to urinate and defecate. Cats may need to be crate confined if they are inclined to jump or become too active. Once the fracture is healed pets are permitted to gradually resume their normal activity.

Does the implant need to be removed once the fracture is healed?

Most of the implanted (bone plates, screws, pins, and wires) materials do not need to be removed. However, situations do exist when the implants need to be surgically removed. This includes infection, adverse reaction or pain from the implant, and migration or movement of the implanted material. External fixators are completely removed once the bone is healed.

Elbow Dysplasia

Adorable Cute Female Of Bernese Mountain Dog Standing In The Park
Elbow dysplasia is a term used to describe generalized osteoarthritis of the elbow joint caused by non-traumatic developmental abnormalities.  Four common manifestations of elbow dysplasia include: fragmented medial coronoid process (FMCP), osteochondritis dissecans (OCD) of the medial aspect of the humeral condyle, ununited anconeal process (UAP), and articular cartilage anomaly or incongruence between the humerus, radius , and ulna.  See illustration.  The International Elbow Working Group in 1993 agreed that elbow arthrosis caused by one of these four conditions is the manifestation of inherited canine elbow dysplasia.  Elbow dysplasia is a common inherited condition seen in Labrador Retrievers and Bernese Mountain Dogs, but can be seen in most breeds.  This disease is bilateral (both elbows) in approximately 35% of affected dogs.  

What are the clinical signs seen with this condition?
Affected dogs are often lame or have an abnormal gait.  The onset of lameness is usually between 4-6 months of age however, clinical signs may not be obvious until much older (1-2 years of age).  In some cases, we see late onset FMCP perhaps secondary to chronic increased stress in the medial compartment of the joint and/or traumatic insult to an otherwise abnormal joint.  Delayed presentation of lameness may also manifest in middle-aged or older patients as arthritis progresses.

 How do we diagnose these problems?
The diagnosis of elbow dysplasia is primarily based on clinical signs and radiographic evaluation of the elbow joint. Specific developmental abnormalities such as UAP and OCD of the elbow joint are often fairly apparent on standard x-ray projections. 

The diagnosis of FMCP however, can be somewhat more elusive. Orthopedic examination findings (pain over the inner aspect of the elbow joint), x-ray changes in the elbow joint, and exclusion of other orthopedic conditions are tools that aid in the diagnosis. Standard x-rays often do not confirm the presence of FMCP, but rather provide information about the general congruency of the elbow joint and highlight changes around the joint that support the diagnosis of FMCP. It is recommended that x-rays be performed on both elbows due to the high incidence of bilateral disease.Confirmation of FMCP is made either with a CT scan or with arthroscopy/surgery.

What are the treatment options?
Each patient is unique based on the age of diagnosis, the severity of the osteoarthritis, and the specific problem(s) affecting the elbow joint.  

There is some degree of variability amongst surgeons as to the preferred surgical approach based on the nature of the problem. Most agree that the joint should be surgically explored (mini surgical approach or arthroscopy) preferably before severe osteoarthritis develops.  

In the case of FMCP, debridement (removal) of the loose fragment(s) and /or performing a sub-total coronoidectomy is the cornerstone of surgical treatment.  This may be combined with a surgical release of the lower attachment of the biceps tendon; biceps ulnar release procedure (BURP). 

Early anecdotal evidence suggests this technique may relieve ongoing pressure over the inner (medial) aspect of the elbow.

Newer surgical treatments are being developed to address end-stage osteoarthritis of elbow joints.   

These patients have substantial cartilage loss that is irreversible.  Sliding humeral osteotomy (SHO) and ulnar osteotomies (bone cuts) can transfer forces to the lateral or outer part of the elbow joint thereby alleviating stress on the medial or inner compartment. 

Complete and partial elbow replacements, stem cell therapy and platelet rich plasma (PRP) injections are also being researched and developed.

Expectations with Surgery
The success of surgery largely depends upon the extent of arthritis and cartilage damage that is already present as well as the degree of incongruency (improper fit) of the elbow joint.  

Most dogs, if operated early enough, are significantly improved in their lameness within the first 8-10 weeks after surgery.  However, some dogs don’t show considerable improvement for 3-4 months after surgery. 

There is also a subset of dogs that continue to show lameness despite the successful removal of loose fragments.  For these patients, consideration is given to the above mentioned load-transfer surgeries.   The sooner surgery is performed to address elbow dysplasia the more likely dogs are to improve in their mobility and pain.

Osteoarthritis, with or without surgery, often progresses in the affected elbow joint(s).The aim of surgery is to remove the source of pain and slow the advancement of arthritis.
  • Exercise restrictions are necessary for the first 6 weeks after surgery to allow for replacement cartilage to properly fill-in the defect created by the loose fragment of bone.
  • Keeping your dog at an optimal weight and maintaining him/her on a high quality dog-specific  joint supplement (Cosequin or Dasuquin) is important in improving overall joint health.
Physical therapy/rehabilitation/hydrotherapy, acupuncture, cold laser therapy, Adequan injections and traditional anti-inflammatory and pain relief medications are often considered for patients that continue to display lameness.

Soft Tissue Surgery

Laparoscopic Assisted Prophylactic Gastropexy

cute puppy among the grass and flowers
This procedure is performed to prevent gastric dilatation and volvulus (GDV) which is commonly known as bloat.

Bloat is a life threatening condition in which the stomach fills with air then twists thus causing severe disturbances in the animals’ circulatory system. Although any breed of dog can develop GDV, it classically affects deep chested dogs such as Great Danes, Doberman Pinschers, Mastiffs and the setter breeds.

Our hospital performs laparoscopic assisted stomach tacking (gastropexy) to permanently anchor the stomach to the abdominal muscle. The stomach is thus prevented from twisting should it become filled with excessive air or gas. This newer technique involves making small incisions into the abdominal cavity which allows for the placement of a fiberoptic camera. The stomach is then grasped and delivered through an incision in the abdominal wall. The outer lining of the stomach is then sutured to the abdominal muscle. This procedure is often performed when dogs are spayed or neutered, but can be done at any time after the pet reaches 6 months of age. It is particularly recommended in dogs that have a family history of bloat.

Gastrointestinal Obstruction

The domestic multi-colored kitten sits on a floor.
How do we determine if a pet has a GI obstruction?

An x-ray of the abdomen is often one of the first tests performed.While is often one of the first tests performed.  While some objects such as rocks and metal will show up on an x-ray, many do not (cloth and various toys).  The doctor will examine the x-ray for characteristic patterns that suggest an obstruction is present.  If the x-ray is not entirely convincing of an obstruction, yet the pet continues to experience sickness, then an abdominal ultrasound is performed by one of our radiologists or internal medicine specialists.  This test is often conclusive in determining whether a pet needs to be taken to surgery.


What type of surgery is performed if my pet is obstructed?
If foreign objects are lodged in the stomach they may be retrieved with a flexible endoscope (camera) thus sparing the pet from undergoing an exploratory surgery. 

If it cannot be retrieved with the endoscope, then surgery is necessary.  This entails making an incision into the abdominal cavity and palpating the entire gastrointestinal tract as well as examining the abdominal organs.  Once the obstruction is identified, an incision is made in the wall of the stomach or small intestine and the object is retrieved. 

If the blood supply of the bowel is severely compromised, the diseased intestine needs to be removed and healthy bowel is spliced together using sutures or staples.  This is called a resection and anastamosis. 

Once all of the foreign material is removed, the bowel is sutured and the abdomen is thoroughly rinsed using a warm sterile fluid.  The abdominal cavity is then closed using sutures and the pet is awakened from anesthesia.

What is the recovery period for a pet that has had GI surgery?
There are several factors that determine the recovery period following surgery.   

Issues such as how sick the pet was prior to surgery, the extent of damage from the ingested foreign object, the presence of a bowel perforation, possible placement of a feeding tube and the nature of the surgery influence how long the pet will need to be hospitalized.  In instances when the obstruction is identified early in the course of sickness and the bowel is reasonably healthy, then usually one night in the hospital is necessary.  The attending doctor will formulate a treatment plan which often includes intravenous fluid and antibiotic therapy, pain medication, and withholding food and water for a specific time to reduce the workload on the bowel. Very sick pets and/or those with a severely compromised bowel may need to spend two to seven plus (at least 2) days in the hospital. 

It is important to recognize that surgical treatment is not a guarantee of success in all GI obstruction patients.  Fortunately, most pets recover uneventfully from this condition.    

Once pets are back at home restricted activity is recommended  for  two weeks and an Elizabethan collar and/or T-shirt is placed to prevent licking of the incision.

The sooner we can examine a pet that is suspected to have a GI obstruction, the higher the likelihood that surgery will be successful.  If your pet has not eaten for 24 hours and is vomiting or acting lethargic please call the hospital at (303) 761-7063.   A physical examination by one of our veterinarians is important to rule out this potentially fatal problem.

Bladder Stones

Adult dalmatian enjoying the English spring sun on the hillside field
Bladder stones, or calculi, are mineral accumulations that form in the urinary bladder as a result of alterations in an animal’s metabolism of various diets. They can also occur from chronic urinary tract infections. There are many different types of stones, although calcium oxalate and struvite are the most common. Several breeds of dogs including, Bichon Frises, Miniature Schnauzers, and Dalmations are at increased risk of developing bladder stones.



How do I know if my pet has a bladder stone?

Surprisingly, some pets do not exhibit symptoms until the bladder stones are large and/or numerous (See x-ray image).  Typical signs include straining to urinate, increased frequency of urination with relatively small volume, and licking of either the penis or vagina.   Some pets will become obstructed from the dislodging of the stone into the urethra (see diagram). 

In this instance, the pet will not be able to produce urine during voiding.  Lack of urine production, especially if the pet is straining, should be taken very seriously.

How are bladder stones diagnosed?

Many stones are visible on standard x-rays.  However, those that are not obvious on x-rays are visualized with an ultrasound of the urinary tract.  Occasionally, a dye enhanced x-ray study of the urinary tract is used to further investigate the presence of bladder stones.  A urine culture is often performed if a urinary tract infection is suspected to be the cause of the stone (struvite) or as a coexisting problem.

How are bladder stones treated? 

Surgery is needed in a vast majority of cases. Occasionally, prescription diets along with antibiotic medications are used to dissolve struvite stones. Lithotripsy is a shock wave treatment routinely used in human medicine to dissolve kidney and ureteral stones.  While this technology is available in veterinary medicine, few institutions in the U.S. are equipped to provide this form of treatment on animals.



We use two different surgical approaches in the removal of bladder stones.  In both situations, the pets are placed under general anesthesia.  The standard or ‘open’ approach is when an incision is made into the caudal or lower third of the abdominal cavity.  Then, an incision is made into the urinary bladder, the stones are retrieved, and the lower urinary tract is copiously flushed with sterile fluid. 

The bladder and abdominal cavity incisions are sutured and a post-operative x-ray is taken to ensure all of the stones have been removed. The pet is then awakened from anesthesia. The stones are sent to an outside laboratory to determine their mineral composition. The second type of surgery employs a laparoscopic camera that is introduced into the urinary bladder through small incisions.  The stones are then visualized and removed. The incisions are closed in a manner similar to that described above.

In some instances, the bladder stones travel out of the bladder and become lodged in the urethra (see picture and x-ray). This is a particular problem in male cats and dogs. In these instances, emergency treatment is needed to flush the stones back into the bladder to relieve the obstruction. Occasionally, the stones are so firmly lodged that they will not readily pass into the bladder. 

In this case, emergency surgery (urethrotomy) is needed whereby an incision is made into the urethra and the stones are removed. The urethral incision is then either closed with fine gauge suture or allowed to heal on its own.

What is involved in the recovery period following bladder surgery?

Pets are given pain medicine before surgery begins, immediately after surgery, and generally for several days after surgery. The pets usually spend one night in the hospital so that pain medication can be administered and their urination habits can be monitored. Running, jumping, and rough play are prohibited for the first 10-14 days after surgery. Short, leashed walks may begin a couple of days after surgery.  Pets are kept from licking or chewing their incisions by using either an inflatable or Elizabethan (E)-collar.

How do I prevent my pet from forming more stones in the future?

Once the stone type is identified, a specific and exclusive diet is generally recommended to help prevent new stones from forming.  The diets are generally prescription only, but occasionally tailored, homemade diets can be used as well.  One of the most important parts of preventing stones is by providing moisture to the diet which produces dilute urine.  Dilute urine (less yellow in color) has less of the mineral components which are the precursors to stones.  Moisture is provided by either using exclusively canned food and/or adding liberal amount of water to dry diets. Human food and over the counter treats other than the type used in the specified diet are generally not allowed as they can predispose the pet to stone formation.

We recommend a routine urinalysis to look for crystals which are the precursors to stones. The urine pH is also a very important parameter in assessing the effectiveness of the specified diet. A repeat urine culture may be suggested to determine if an infection is present. This information helps us determine if the pet is receiving an adequate, moist diet.  Some pets will form bladder stones despite following proper dietary recommendations.  

In these instances, medications and supplements can be added to change the constituents of the urine.

Laryngeal Paralysis

Labrador retriever puppy catches funny laughing treat
Laryngeal paralysis is a common cause of upper airway obstruction in older, large breed dogs.It occurs when the larynx (voice box) fails to adequately open when the animal is taking a breath.  Laryngeal paralysis results in progressive exercise intolerance, increased respiratory effort and sounds, coughing, gagging, and voice changes.  There are several causes of laryngeal paralysis, but it is most commonly referred to as idiopathic in which a known cause is not identified.  Known causes of laryngeal paralysis include damage to the nerve that supplies the voice box (recurrent laryngeal) from trauma, polyneuropathy (nerve disorders) secondary to hypothyroidism or immune mediated disease, and masses or tumors in the larynx.  Recent reports suggest that laryngeal paralysis is part of a broader and more generalized neurologic disorder that includes muscular weakness. 

How is this diagnosed?
A thorough physical examination including palpation of the neck region and a neurologic evaluation provide necessary information regarding the overall health of the patient.  A comprehensive blood test, urine analysis, and chest x-rays are performed to identify other causes of airway problems as well as the presence of concurrent medical conditions. 

X-rays may reveal the presence of lung changes, dilation of the esophagus and heart enlargement which may exclude dogs as surgical candidates.  Laryngeal paralysis is confirmed with the pet placed under a light plane of anesthesia which allows visualization of the opening and closing of the larynx.  Pets with laryngeal paralysis are not able to effectively open their larynx during inspiration. 

Once the diagnosis is confirmed pets are often taken directly to surgery to correct the problem.

How is laryngeal paralysis treated?
The goal of treating laryngeal paralysis is to alleviate signs of upper airway obstruction while minimizing complications thus allowing the patient to breathe more comfortably and return to an age-appropriate level of activity.  This goal can be achieved through a variety of surgical methods (laryngoplasty).  These include partial arytenoidectomy (removal of a portion of the airway opening), ventriculochordectomy (remove the focal folds), modified castellated laryngofissure (widening the larynx) and arytenoid lateralization or “tie-back”.  Most surgeons prefer the “tie-back” surgery to address laryngeal paralysis. 

Arytenoid lateralization or “tie-back”
This surgery is designed to permanently pull open one side of the larynx thus improving air flow.  See illustrations.  It is a technically demanding surgery in which two non-absorbable sutures are placed within very specific cartilage structures on one side of the voice box (usually the left) to abduct or open the airway diameter.



Are all patients with laryngeal paralysis candidates for surgery?
No. Pets that are not good candidates for surgery include those with existing lower airway (lung) problems such as pneumonia, megaesophagus (dilated and dysfunctional esophagus), and conditions that produce difficulty with eating and swallowing (dysphagia).

What is the prognosis with surgery?
Most pets experience a dramatic improvement in their breathing immediately following surgery.  Some dogs will experience a change in their bark, as if they had been debarked.  This is due to the wider opening of the airway. Some may also experience a soft cough or ‘clearing of the throat’, especially after eating and drinking.

Because laryngeal paralysis can be linked to other neuromuscular conditions, we advise owners to observe for signs related to the progression of generalized neuromuscular weakness.

A very careful post-operative home program must be followed to reduce complications.  One of the greatest concerns following tie-back surgery is aspiration pneumonia. Some reports estimate that up to 20-30% of post-operative patients may experience aspiration pneumonia. This is a very serious and potentially life threatening complication. The larger airway opening presents a greater risk for pets to unintentionally inhale food particles during eating. This is why it is imperative to change the manner in which pets are fed following “tie-back”surgery. 

We recommend feeding moistened food in the form of meatballs for the first four weeks following surgery; no dry food. Moistened food is preferred because dry food crumbles and has a greater chance of entering the airway. Food is to be fed at ground level. Water intake is to be kept normal, at ground level.  Additionally, we ask that pets be placed in a chest harness during leash walking rather than in a collar to avoid further neck trauma. Swimming post-operatively is also discouraged as it is easy for dogs to inadvertently inhale water.

Our experience with surgical repair of laryngeal paralysis has been overwhelmingly positive.  Our clients are often surprised at how much energy their pets have following surgery.

Acupuncture for your pet

Acupuncture

Animal acupuncture
Acupuncture has been proven to increase endorphins (the body’s natural analgesia and pain relievers), boost the immune system, increase blood circulation to the areas needed, relieve muscle spasms, and stimulate nerves. Many animals become relaxed or will even sleep during the treatment session.

What is acupuncture?

  • Acupuncture is the insertion of fine needles into specific points on the body to correlate with a desired healing effect.
There are different acupuncture techniques: Manual or dry needling is the most common, where needles are inserted for 10-30 minutes. Electropuncture is the process of hooking electrodes to some of the inserted needles to pass low levels of electrical energy through acupuncture points. This is not painful and produces a mild tingling sensation under the skin. Other techniques include aquapuncture, where small amounts of saline or vitamins are injected into a site or moxibustion which involves warming the needle.


How does acupuncture work?

  • On average, 65-85% of animals will show moderate to marked improvement with treatments.
Acupuncture has been proven to increase endorphins (the body’s natural analgesia and pain relievers), boost the immune system, increase blood circulation to the areas needed, relieve muscle spasms, and stimulate nerves. According to Traditional Chinese Medicine, disease is the result of an imbalance of energy in the body. Specific acupuncture points will help redirect the body’s energy (chi) back into harmony. In western medical terms, acupuncture assists the body by causing physiologic changes

What are some of the uses of acupuncture?


Acupuncture can have an effect on a variety of illnesses. It is often used in conjunction with Western medicine and surgical treatment. The most common conditions where veterinary acupuncture is used include:

  • Musculoskeletal disorders (arthritis, back pain).
  • Neurological disorders
  • Gastrointestinal disorders
  • Respiratory disorders


Is acupuncture painful?

  • Many animals become relaxed or will even sleep during treatment sessions.
Most pets are very tolerant of the needles. Because acupuncture needles are much smaller than needles used for vaccinations and injections, needle insertion is usually painless. It is important for owners to relax during treatments because pets are very sensitive to their owner’s anxieties.

How long do acupuncture treatments last, and how often are they needed?





  • The length and frequency of treatments depends on the problem and condition of your pet.
Effectiveness of acupuncture will vary depending on the disease and the individual pet. Initially we recommend 4-6 treatments about one week apart. If the problem is acute (occurring suddenly), such as back pain, we may not need to do any follow-up visit. If the disease is chronic, such as arthritis, treatments may be needed for 1-4 months. We are usually able to see improvement by the 4th or 5th treatment.

Are all veterinarans qualified to do acupuncture?


  • No, acupuncture is not usually part of veterinary school training.
A vet who wants to become certfied in acupuncture takes a 5-month course after vet school. After this course, certification is completed by passing written and practical exams, writing a scientific paper, and completing externship hours.

Oral Healthcare

The Importance of Dentistry

beautiful cute cat licking his paw on stylish bed with funny emotions on background of room

Why should I brush my pet’s teeth?

Plaque is continually forming on your pet’s teeth. Plaque is an accumulation of bacteria that forms at the gum line. When plaque is not removed daily with tooth brushing, calculus then forms irritating the gums further and causing infection. This infection then spreads under the gum line causing destruction of the attachments that hold the teeth in place. In addition to creating loose teeth, infection under the gum line can spread to the kidney, liver and heart. Daily removal of plaque is the key to an effective oral hygiene program.

How often does my pet need to have its teeth cleaned by the veterinarian?



It depends on the degree of plaque and tartar accumulation. You can perform regular oral exams on your pet. If you see an accumulation of yellow or brown material at the area where the tooth meets the gum line or if the gum line appears red above the tooth, it is time for a professional teeth cleaning.

Can I just remove the calculus myself with my fingernail or dental scaler?


Removing the calculus from the visible part of the tooth does not treat the problem that is occurring below the gum line. It is the plaque and calculus build up under the gum line that causes periodontal disease.

Do you have to use anesthetics to clean my pet’s teeth?


Anesthesia is necessary when performing teeth cleaning. Anesthesia provides six important functions:
  1. Immobilization in order to clean below the gum line
  2. Pain control
  3. Placement of an endo-tracheal tube to prevent calculus and other debris from entering the respiratory system and to maintain an airway
  4. Thorough evaluation of tooth roots with dental x-rays
  5. Evaluation of pocket depths around each tooth
  6. Ability to treat or extract diseased teeth


What is involved in a routine teeth cleaning at your hospital?

  1. A physical exam is performed prior to placing your pet under anesthesia.
  2. Preoperative blood work is performed and evaluated.
  3. An intravenous catheter is placed to give fluids and any necessary drugs during the procedure.
  4. Your pet is placed under a general anesthetic and their heart rate, heart rhythm (ECG), blood pressure, body temperature and SpO2 (percentage of oxygen saturation in blood) are monitored during the entire procedure by a certified veterinary technician. Your pet is also placed under a forced air warming blanket.
  5. Your pet’s teeth are then hand scaled and ultrasonically cleaned above and below the gum line.
  6. Radiographs of your pet’s teeth are then taken.
  7. Your pet’s teeth are then charted and pocket depths are measured for each tooth.
  8. Your pet’s teeth are then polished to remove small scratches on the surface of the tooth.
  9. A veterinarian then evaluates the radiographs and performs an oral exam. Checking for fractured teeth, discolored teeth, wear patterns of the teeth and oral cancer.
  10. Your pet is then recovered from the anesthesia by a veterinary technician.

What if you find loose teeth or an infected tooth?

Teeth that are loose have bone loss that has occurred underneath the gum line. If the bone loss is greater than 50% we would extract the tooth. Bone loss less than 50% can be treated by root planning and application of an antibiotic material to try to get the gum to adhere back to the tooth.

If a tooth is found to have a root tip infection — surgical extraction is our only option.

If a tooth is fractured but the pulp cavity is not exposed, the tooth can be sealed.

If a tooth is fractured and the pulp cavity is exposed but the root itself looks fine, there are two options, extract the tooth or perform a root canal.

We employ a board certified veterinary dentist to perform specialized endodontic procedures.

What is involved with extractions and what is the cost?

It is difficult to give an exact estimate for extractions. The cost is dependent upon the time it takes to extract the tooth and the number of teeth extracted. If your pet needs an extraction, a local anesthetic will be instilled, a gingival flap will be made, and the bone surrounding the roots will be removed. The tooth will then be split and elevated out of the socket. This method helps prevent excessive trauma to the jaw during the extraction. The flap is then sutured closed to prevent food from accumulating in the socket and improve patient comfort.

What is periodontal disease?

Teeth are anchored in periodontal tissues consisting of gingival (gums), ligaments, cementum and supporting bone. Periodontal disease starts with the formation of plaque. Plaque starts forming within twelve hours after a thorough dental cleaning. When plaque is not removed, mineral salts in the saliva hasten the formation of hard calculus. Calculus, covered with bacteria, is irritating to the gums. By-products of bacteria destroy the tooth support structures, causing pain and periodontal disease. More than 85% of dogs and cats over the age of four years have periodontal disease.

Periodontal disease can be graded in four stages. The first two stages are classified as gingivitis and the last two as periodontitis. Thorough dental cleaning followed by home care, can usually reverse the first two stages. If the first two stages are left untreated, periodontitis can result. Periodontal disease occurs when there is bone loss in addition to gingival inflammation and infection. Once bone loss has occurred, more involved therapy than teeth cleaning is needed. Factors to be considered before periodontal surgery are: do you have a cooperative patient, is the tooth treatable, and a which procedure would best benefit the tooth and patient.

The owner of a dog or cat with periodontal disease needs to be committed to saving the animal’s teeth. This commitment includes daily brushing to remove plaque. Frequent veterinary dental examinations are also required, therefore expense should be considered.

The patient must also be a willing partner. If a dog or cat will not allow home care, it is wiser to extract a tooth rather than letting the pet suffer with dental pain.

Oncology

Common Cancer Types

Lymphoma
Hemangiosarcoma
Hemangiosarcoma-Cutaneous Form
Osteosarcoma
Soft Tissue Sarcoma
Mast Cell Tumor
Urinary Bladder Neoplasia
Feline Gastrointestinal Lymphoma

Cancer Treatments

Chemotherapy
Angiogenesis Inhibiting Therapy
Young American Cocker Spaniel scratching

Dermatology

How to give allergy injections
Understanding food allergies and diet
Allergy treatment in dogs