Download Referral Report Lake Country Veterinary Specialist

Lake Country Veterinary Specialist Hospital
10564 Powley Court - Unit A, Winfield, BC V4V 1V5
PHONE (250) 766-6699
FAX (250) 766-6693
E-MAIL [email protected] www.lakecountryvet.ca
Mark E.H. Smith BSc, DVM, MVSc, Diplomate, American College of Veterinary Surgeons
Referral Report
Date: January 18/13
Owner - Name: Mike Bjerstedt
Patient – Name: Duncan
Sig: 2 y MN English Mastiff
Referring Hospital: Crescent Falls Veterinary Hospital
Doctor: Kristina Ringness DVM
Weight: 35 kg
History: Please see previous reports. Duncan has had bilateral elbow FCP surgery and
bilateral TPLO’s. I saw him Dec 17/12 for increased RH lameness; at that time he was BAR
with normal appetite; he had historically had an incisional infection in that TPLO site. His owner
had heard popping during ambulation suggestive of meniscal pathology. I could not induce
popping Dec 17. He had advanced but incomplete osteotomy healing and so we planned to
explore his right knee mid January.
On presentation, his owner reported that he now had loud popping from his left knee, which
was causing worse lameness than the right. He was becoming depressed and moderately
inappetant.
Physical Examination:
Depressed; severe lameness LH with loud popping; mod lameness RH; R TPLO incisional
area slightly swollen. Given his degree of lameness, we elected to reexplore both joints.
Operative Report:
Pain Control
Narcotic pain relief injections were given throughout surgery; no preop antibiotics until culture
samples collected, then cefazolin and enrofloxacin were given.
Surgical Procedure:
Left Stifle:
- Arthrotomy and incision over implant; all tissues grossly healthy; macerated tear of entire
caudal half of medial meniscus; large amount of torn meniscal tissue excised; joint
cartilage healthy in appearance. A moderate amount of bone had grown over the bone
plate; removed with rongeurs; site cultured and sent to IDEXX; bone smoothed; fascia 0
PDS SCP; SQ 2-0 PDS SCP; subcuticular 3-0 Monocryl; tissue glue, polysporin,
bioclusive and tensor bandage applied overnight.
Right Stifle:
- arthrotomy and incision over implant; severe infection with purulent fluid around implant
and in screw holes as screws removed; the joint was septic with large volumes of
fibrinous debris in recesses of joint capsule; approximately 30 minutes spent flushing
joint and retrieving debris; culture submitted. Bone was then smoothed, unhealthy
tissue sharply excised around plate. Due to severity of infection; wound was left open
over distal 2 cm of arthrotomy and entire area over plate (approx 15 cm); arthrotomy
closed prox with 0 PDS SCP; SQ 2-0 PDS and skin stapled. The wound was packed
with adaptic and lap sponges and a tie over bandage applied; The entire leg was
wrapped; the LH was wrapped with a tensor bdg.
Post Operative Care:
- Hydromorphone intravenous CRI x 48 hours for pain control.
- IV Fluids
- Cefazolin TID
- Enrofloxacin TID.
Daily Bandage Changes x 3 days:
- Duncan was sedated daily and the open wound was lavaged with 500 ml sterile saline;
sterile gloves instruments and red rubber feeding tube used to flush within stifle joint;
adaptic/tie-over bdg replaced; the wound rapidly improved in drain character, which
diminished by the 3rd change.
- Thurs Jan 17/13: Duncan was BAR by this point, eating and going out for walks with
assistance; He was reanesthetised and taken back to the OR for wound closure. The wound
was flushed with sterile saline at which point healthy granulation tissue was visible; the deep
muscle was apposed with 2-0 Monocryl SCP and and same material for SQ; skin stapled;
polysporin/Adaptic and tensor bdg applied.
Home Care Instructions for Owner
Care of Operated Limb:
1. Take care with your pet around children- the operative sites are uncomfortable.
2. Cleanse the incisions only as needed, with the soap & moistened gauze provided.
- dab don’t rub/wipe as this delays healing.
3. Check the incision daily for increasing discharge or swelling, suggestive of infection.
ACTIVITY:
- Leash walks only, in the yard, several times daily x 4 weeks.
- Gradually resume normal activity over the following 2 weeks.
MEDICATIONS & SUPPLIES:
a: Cephalexin – antibiotic. Give 1000 mg orally every 8 hours x 14 days. Once
bacterial culture results are in, an appropriate antibiotic should be used for an
additional 2 weeks.
Next dose is due:
b: Meloxicam – non-steroidal anti-inflammatory pain killer. Give ¾ tablet orally
ONCE daily for 7 days, then every 2-3 days, as needed, for stiffness.
Stomach ulceration is a rare side effect of this class of drug. Discontinue if
vomiting, black stool (digested blood) or loss of appetite is observed – stop
the drug & call your veterinarian.
DO NOT GIVE ASPIRIN WHILE USING THIS CLASS OF DRUG.
Next dose is due:
c: Glucosamine & Omega-3 Fatty acids – These supplements can reduce joint
inflammation. Give as directed by your veterinarian on an ongoing basis.
*** Please dispense 1 bottle Allerg-3 as Omega 3 Supplement***
d: Percocet – oral narcotic/Tylenol pain killer. Give 1 tablet every 8 hours x 3 days
then every 12 hours x 3 days, for pain.
Next dose is due:
e: Chlorhexidene antibacterial soap. Small bottle, Ziploc with gauze sponges.
f: E-collar should remain on at ALL times x 7 days.
REEXAMINATIONS:
1.
PLEASE CALL US IN 5-7 DAYS FOR BACTERIAL CULTURE RESULTS.
2.
10-14 days – inspection of surgery site. Please book with one of our Tri-Lake
Animal Hospital doctors. They will send me an update.
3.
1 month - please book another progress check of Duncan’s function with my
surgery colleague, Dr Bhandal.
PROGNOSIS: Good. Left hind function should be very good; Right hind function should also
be good provided infection is completely resolved. Monitor for any signs of worsening
lameness.
Mike – Duncan has been very challenging to manage and I (and I am sure, Duncan!)
appreciate your great attitude and perseverance in seeing his recovery through to the end.
Please contact Cara with any questions, or email me directly at [email protected].
Good luck and I’ll be in touch soon with culture results.
Kind Regards,
Mark Smith DVM, DACVS