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Cranial Cruciate Ligament Part 2 - Repair

There are three different surgical techniques commonly used to repair ruptured Cranial Cruciate Ligaments. The Extracapsular Repair, TPLO and TTA. Your veterinarian can advise you on which would be the best procedure for your pet.

Extracapsular Repair
In this procedure a strong nylon line is placed to hold the stifle in place. The suture will eventually break, but by that time the dog has formed scar tissue enough to hold the knee in place without the extra support of the line. During the surgery the knee joint is opened and inspected and the torn cruiciate ligament removed. After the procedure your dog will require at least 12 to 16 weeks of restricted exercise and rehabilitation. This procedure is typically considered in small to medium sized dogs or geriatric/older patients.

TPLO (Tibial Plateau Leveling Osteotomy)
In this procedure the biomechanics of the joint are changed. The knee joint is again opened and the damaged meniscus and cruciate ligament inspected and removed as needed. Then a section of the tibia bone is cut and rotated to change the angle of the joint and create greater stabilization. Special metal hardware is placed to hold everything in place. Typically these dogs are toe-touching by 10 days post surgery, but again restricted activity and rehabilitation exercises are required for12 to 16 weeks. Most patients are back to normal activity 6 months after surgery. This procedure is typically considered in young, very active and large breed dogs.

TTA (Tibial Tuberosity Advancement)
Similar to the TPLO, in this surgery the tibial crest where the patellar ligament attaches is cut and repositioned using titanium implants and bone grafts to stabilize the new angle. The recovery is similar to that of the TPLO and it is also recommended for young, large and very active dogs. Which of these two surgeries is better? Whichever one your surgeon is more comfortable performing. Studies have shown that the results at one year post-operative seem to be the same regardless of which procedure is performed.
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Allergic Skin Disease

Dr Richelle Kendall

Is your pet always scratching and chewing at his skin? Does he have brown staining on his feet from constantly licking and chewing between his toes? Does he suffer from recurring ear infections?

As an owner, there are few things more frustrating than living with a pet who is constantly chewing and licking at his fur, scratching at his ears, pulling out his fur, sometimes even causing damage to his skin and coat. As a veterinarian, these are some of our most challenging cases because unfortunately, there are rarely quick and easy solutions to this problem.

What are the most common causes of chronic or recurring itchiness in pets? Well, external parasites, for one – we are all well aware of the serious flea problem in our area! – but we also see patients that are infected with lice, mites (including demodectic and sarcoptic mange), and ringworm (dermatophytosis). The other major cause of chronic itchiness is – you guessed it – allergic skin disease.

What is allergic skin disease? Allergy is a state of hypersensitivity in which exposure to a harmless substance known as an allergen induces the body’s immune system to “overreact.”  People with allergies typically experience watery, itchy eyes, runny nose and sneezing. Cats and dogs more typically experience the effects of allergies as skin disease.

Allergies in pets come in three main types – flea allergy dermatitis, food allergy, and atopy (environmental allergy). Unfortunately, the clinical signs are often very similar, and pets can suffer from more than one type of allergy at the same time. Add to that, the fact that most pets also present with secondary bacterial and/or fungal (yeast) skin infections, and it all adds up to one very itchy pet – and one huge diagnostic challenge for your veterinarian.

Did you know that some pets are allergic to flea saliva? For these pets, even a single bite from a flea can cause a severe inflammatory reaction. The itchiness is usually most severe around the tail base and lumbar back. Flea allergy dermatitis the actually the most common type of allergy in our patients, which is why we recommend year-round flea prevention for all itchy pets. If flea allergy dermatitis is the cause of the pet's itchiness, only 100% flea control will stop his symptoms. And if food allergy and/or atopy are the cause, we certainly don't want fleas to be making the problem worse.

 

Food allergy is hypersensitivity to a component of the diet.  The allergen usually is a major protein or carbohydrate ingredient (such as beef, chicken, pork, corn, wheat, or soy), though minor ingredients (such as preservatives or dyes) are also potential allergens. Itchiness is typically worse on the "ears, feet and rears". To diagnose a food allergy, we will likely recommend an elimination diet trial. Often, when we see an itchy pet, owners have already tried switching the diet, often more than once, to see if the itchiness resolves. But a true elimination diet trial is a bit more tricky – first, we must select a diet which is not likely to contain the offending allergen(s), taking into account which ingredients the pet has eaten before. Second, the diet should consist of properly balanced home cooked meals, or a veterinary therapeutic diet. Why? Well, there is some question as to how "hypoallergenic" many pet store formulations really are: in a recent study examining a number of pet store foods labelled as "venison only", all the diets were also found to contain soy, poultry and/or beef protein, though these ingredients were not listed on the label. Third, here's the hard part for many owners! – during the diet trial, the pet should be fed only the prescribed diet – no treats, no table scraps, no flavored medications – for a minimum of 12 weeks, to see if the diet results in less itchiness for the pet. Lastly, to confirm a diagnosis of food allergy, once the signs resolve, we perform a "challenge" by feeding the former diet to see if the pet's itchiness recurs. In practice, we rarely complete the challenge part of the trial because once we find a diet that reduces the pet's itching, owners rarely want to switch the food, even temporarily (and who can blame them?).

Atopy, or environmental allergy, is hypersensitivity to a variety of substances, such as pollen, weeds, grasses and trees, as well as house dust mites and mold spores. Pets with atopy are typically itchiest on the face, abdomen, armpits and/or front legs. Symptoms may be seasonal (similar to "hay fever" in people) or year-round. Unlike food allergy, there are reliable tests available to diagnosis atopy, including blood tests, which we can send directly to the lab, or intradermal skin testing, which involves referral to a veterinary dermatologist. The results of one or more of these tests helps us compile a list of substances which the pet is allergic to. We can then design immunotherapy (ie. an "allergy vaccine"), made up specifically for the pet, which is given by the owner, by injection every 7-14 days, usually for the life of the pet. Just recently, oral immunotherapy has become available, which eliminates the need to give injections to your pet, but instead is given by mouth, usually daily. Both the injectable and the oral form of immunotherapy have been shown to decrease itchiness in approximately 70% of patients. Other treatments for atopy include topical or oral steroids, anti-histamines, fatty acid supplements, and frequent bathing to remove allergens from the skin. We also have veterinary therapeutic diets available which work by improving the skin barrier against allergens.

Treatment for allergic skin disease usually involves a cooperative relationship between owner and veterinarian. Successful treatment may involve a combination of approaches – for example, for a dog with food allergy and a secondary yeast infection, treatment recommendations might include ointment to treat the ears, an elimination diet trial, and/or oral medications to help control itchiness. Though allergic skin disease can be frustrating to manage, pursuing treatment is certainly worthwhile, as there is much we can do to improve your pet's quality of life.