Veterinary

GDV
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GDV

Ava

Gastric Dilatation and Volvulus (GDV)

Gastric dilatation and volvulus is commonly called GDV and even more commonly referred to as bloat. The term bloat is somewhat of a misnomer because that really only describes half of the issue. This condition occurs when the stomach both dilates (fills with gas and/or fluid) and rotates on its axis. Unfortunately, we never know which happens first the rotation or the dilation. Regardless, surgery is necessary in order to correct the issue and prevent recurrence, we will describe the procedure below.

This condition most commonly occurs in the large/giant breed dogs and deep chested breeds. It is rarely seen in small and medium size breed dogs. The most common breeds are the Great Dane, Mastiff, etc – you get the picture. Surprisingly, in addition to the larger breed dogs, we also see it in Standard Poodles more frequently. There are a lot of theories out there as to why this may occurs. Some common thoughts range from frequency and size of meals, exercising after meals, elevation and height of bowls, etc. We also see an increase in GDV incidence in dogs that have other types of gastrointestinal disease, such as inflammatory bowel disease.  Stressful environments such as pets being hospitalized, boarding, storms, etc. can increase the risk of this issue too. As a practicing surgeon, I can’t tell you how many times, dogs that present with a GDV are coming from a referring veterinary hospital, boarding facility, the pet-sitter, etc; so it is a real problem. A lot is done to avoid some of these situations to try to prevent this from occurring, the most definitive way to avoid this is to have a prophylactic gastropexy performed either by your veterinary or veterinary surgeon. I will address these techniques later on in the series, and we will spend some time on it, because this can be performed very easily by minimally invasive techniques.

Clinical Signs

Some of the most common signs an owner will see include the attempt to vomit, which is termed non-productive retching. This occurs due to the junction of the lower esophagus and stomach being rotated >180 degrees in effect kinking this area. Other signs are signs of discomfort such as listlessness and the inability to get comfortable. Also, many times you will notice enlargement of the abdomen. In cases that have been going on for some time (even a few hours) you can see dogs that are unable to get up and/or not responsive to stimuli.

As described above, this condition can progress rapidly and be fatal, so immediate veterinary care is a must. This condition not only directly affects the stomach and gastrointestinal system, but also affects the cardiovascular system (compression of the vena cava and return flow to the heart) which places these patients in shock and can propagate various inflammation and coagulation cascades that can also cause death. The spleen can also become affected due to its close proximity ad shared blood supply from the stomach. As the stomach rotates these splenic vessels can become torn.

Diagnosis

An experienced veterinarian will be able to quickly diagnose this condition, based on signalment (breed), clinical signs, and physical examination. Radiographs (X-rays) generally leave little doubt, as there are “tell-tale” signs seen on x-rays. Blood work will also be performed to assess values such as red blood cell concentration, electrolyte abnormalities, lactate, etc all factors that will be used to guide initial stabilization and treatment prior to surgery. Once diagnosed, surgery is required. If surgery is not feasible (patient is not able to be stabilized, owner unable to move forward with surgery, etc), humane euthanasia will be likely recommended.

This is a right lateral abdominal x-ray. Note the large, dilated stomach and evidence of the duodenum (intestine) just above the stomach and below the spinal column.

This is a right lateral abdominal x-ray. Note the large, dilated stomach and evidence of the duodenum (intestine) just above the stomach and below the spinal column.

Treatment

As one may assume anesthesia is more risky in a sick animal, but is needed for this problem. Unfortunately, there is no conservative/ non-surgical approach that has been shown to work. After immediate stabilization of the patient, surgery is indicated.

The surgical goals are to decompress the stomach, place the stomach in the correct position, and attach the stomach to the body wall – to drastically decrease the chance of this happening again. The last part of the procedure is called a gastropexy, dogs that do not have this performed, are at high risk for this to happen in the future.

Other things that need to be evaluated while in the abdomen are the stomach – there are times where necrotic (dying) segments of the stomach must be removed. Unfortunately, there are times where gastric (stomach) necrosis is so profound or is affecting a non-resectable location of the stomach when humane euthanasia may be recommended. Thorough evaluation of the spleen is necessary and a splenectomy may need to be performed. After these organs are evaluated, the rest of the abdomen is evaluated.

Post-operative care is also very important, since many cases are not completely straight forward. Close monitoring, aggressive fluid therapy and appropriate management is necessary for a successful outcome. More recent reports show an 80-85% survival rate (with straight forward cases), which is much higher than previously thought. The more damage done (gastric death, spleen involvement, etc), the worse the outlook. Again, a quick response and aggressive management is what is needed.

Prevention

While there are many different views about how to decrease the chance of a GDV occurring, the most successful way is to have a prophylactic gastropexy performed. A gastropexy is a procedure that attaches the pyloric antrum segment of the stomach to the body wall. While this does not prevent dilation of the stomach, it does prevent the deadly rotation of the stomach.

When is the best time to have this performed? I recommend this procedure be performed at 6 months or older. This timing of the procedure coincides with spaying and neutering of your pet, both procedures can be performed at the same sitting. This procedure is especially easy in female dogs that are being spayed, since the abdomen is already open.

Recently, we have the advantage of doing this procedure and the spay procedure via laparoscopy. Laparoscopy is a minimally invasive procedure in which small incisions (0.5-1.0 cm) are made in the abdomen and the organs are visualized on a screen with cameras and surgery is done with small instruments through these incisions. The laparoscopic gastropexy is typically a very fast and effective procedure and is commonly combined with a laparoscopic ovariohysterectomy (spay). Contact your veterinarian for details about this procedure or a referral to a veterinary surgeon who can perform this procedure.

New Total Hip Replacement Video
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New Total Hip Replacement Video

Take a look at our new Total Hip Replacement (THR) video. This happy dog is a recent (last fall) recipient of a total hip replacement at AVS Orange Park. As you can see, he is a very happy boy and much happier now that he is feeling better!! Please contact us with questions or if you feel that your dog may benefit from a THR.

Total Hip Replacement video

What’s Your New Year’s Resolve??
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What’s Your New Year’s Resolve??

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Ah New Year’s day! The day the gyms are packed with high aspirations, the day that we “turn over a new leaf”, start dieting, develop new relationships, try to find love, etc. We have been at this juncture last year and every January 1st before; many times we were met with the same outcome – disappointment. Not that our “resolutions” weren’t admirable, but we were never quite able to carry them out for a week, month, or let alone a whole year.

I hope this is not the normal New Year’s Day post. As we embark on a new year, we do have a clean slate and can start fresh. While we can restart on any day of the year, January 1st has become the day to reset. I hope everyone can do things differently and better in 2016. This can range from improvement to our health, personal relationships, business relationships, and more. Let’s make our New Year’s resolution one in which we follow out our new found goals! While a common definition of a New Year’s resolution is “a tradition in which a person makes a promise to do an act of self-improvement or something nice”. Wouldn’t it be better if we took a different approach and made goals for the new year and use our “resolve” to accomplish the goal.

A recent definition of the word resolve is “firm determination to do something”. Wow that is powerful, it almost sounds like we WILL accomplish that goal if we show resolve! When making goals we not only need to define what it is we want to achieve, but we need to define the “why we want to achieve it” and the “how we are going to achieve our goal”. The why and the how will fuel and power our resolve. If we never define these important components of our goals, they become mere resolutions and dreams – they are admirable and lofty, but there is no power behind them!

When choosing goals for the new year (or at any part of the year), remember to chose goals that are reachable, defined, and are dependent on you and your actions. I also want world peace, but I also realize there are many factors that go into that dream. Another thought is to WRITE down your goal(s)! Unfortunately, this is a lost art – writing in a journal or notebook. This can be one of the most inexpensive tools, yet one of the most effective tools we can employ. The ability to see our goals in writing can make an immense impact on us and be a constant reminder. Lastly, share your goals with someone you trust and someone that can provide encouragement. Accountability is an essential tool that can power your resolve. For some this may be a spouse, significant other, employer, colleague, parent, etc., whomever this is for you, this can make or break success. You may be thinking that this is a lot of work and you would be correct, reaching goals requires dedication and discipline.

Throughout this new year, let’s continue to make new goals and power them with resolve to follow them out to completion. Remember as we enter a new year, we can put last year behind us, with all the doubts, concerns, and failures – DON’T dwell on the past! Make goals that will better your life and the lives of those around you, both on a personal level and in your business life!

Remember these 4 points:

  1. Write down your goal
  2. Define your why
  3. Define your how
  4. Tell someone

Happy New Year and attack this year with RESOLVE!!!

  • Kevin Benjamino DVM, DACVS
    • Copyright January 1, 2016
Generosity in the Workplace
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Generosity in the Workplace

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Jelly of the Month

Christmas Vacation – Jelly of the Month Club

Do you ever feel like Clark Griswold or do you sometimes feel like Clark’s boss Frank Shirley?

While we may not be in the same situation as Clark and Frank, generosity in the workplace can go a long way. In Christmas Vacation, Clark was dependent on his boss’ generosity and Frank had no idea how his generosity affected others – until he was abducted by Eddie and stood in Clark’s shoes.

Generosity can take many different forms. It is not just about doling out financial rewards at the “end of the year” office party, generosity can be manifested all year round. Merriam-Webster defines generosity as “the quality of being kind, understanding, and not selfish”. The word “quality” means that this is something that becomes part of who we are, not who we are during the holiday season.

Also, they use three words to describe this quality: kindness, understanding, and unselfish. This means that it is not just about giving tangible items, while this may be one part. It can be giving of one’s time and knowledge to both staff members and clients/patients. Taking the extra time to train staff members to excel in their field. Providing a means (CE lectures, etc) to improve your staff’s knowledge base. Generosity can also be extended beyond your staff and current clients and infiltrate into the community. Does your business sponsor events in the community?

While one of the key principles of generosity is not expecting a return, no one can deny the way generosity permeates into the culture of an organization as the leadership team acts from this spirit of generosity. Expect others in your team to emulate this quality and it may even become infectious within your organization.

As the current year ends and a new year begins, think of different ways you can display generosity to both your staff and clients. I would propose that generosity should be more like the “jelly of the month club”, as spoken by Eddie: “Clark, that’s the gift that keeps giving the whole year”.

-Kevin Benjamino DVM, DACVS

Copyright 2015

The Importance of Direct Communication
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The Importance of Direct Communication

Jacksonville Beach

Now before I get started, I will say that this is a topic that I personally struggle with on a daily basis (ask my wife). The more technology advances the more difficult it becomes to have direct, meaningful communication. Maybe it isn’t more difficult, but the alternative of indirect communication becomes easier and easier. I was walking on the beach recently (where the photo above came from) and saw a couple enjoying the sunrise and the waves. On a closer look (no I am not acting as the creepier version of Rob Lowe on the DirectTV ads) both were fully absorbed in their online life on their cell phones. Maybe they were “liking” that video of a singing and dancing cat, who wouldn’t?! It baffled me to think of coming to the beach for a breathtaking sunrise, only to be checking out Facebook; to each their own.

The real question is how often do we find ourselves, like the beach goers, exchanging quality time that could be spent building a relationship with a loved one, co-worker, or client with increasing our online presence? I am not saying that our online presence is to be ignored, it is a great tool that can help build relationships and improve our marketplace visibility. What I am saying is to be careful that we are not exchanging real relationship building opportunities for our mobile devices. Think of this way, Jon Acuff writes in “Do Over” about being present and gives the following scenario (albeit paraphrased): Each of us have been on the receiving or the giving end of the following scenario, you are in the middle of a conversation and either you or the other party pulls out their phone and scrolls through the contents. Who knows what they are doing, probably checking the weather or “liking” a post from a friend, but whatever it is, they have effectively put you on “pause”. Without speaking a word they have said “hang on a minute, because this is more important than what we are currently discussing”. This scenario happens on a daily basis and I am just as guilty of it as the next person.

The applications can be made to ones personal life, however I will let you formulate your own “real life” examples – I never pretend to be a psychologist. What are the professional correlations? Think of your business relationships (staff and clients) as you would your personal relationships for a minute, both demand time and nurturing or at some point when you look up from your computer or mobile device, they may be gone as well as an opportunity. Remember, the art of personal communication cannot not be captured in a text, email, or hitting “like” on social media; it requires time, attentiveness, and work for both parties involved. So much can be gained by a person’s facial expression and body language that gets missed with the indirect communication described above. In your professional life, try devoting more time to one-on-one direct communication, it WILL payoff!

Kevin Benjamino DVM, DACVS
Copyright @ 2015

Seeing the Forest Through the Trees
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Seeing the Forest Through the Trees

Bainbridge Island

One of my main reasons for starting this blog was to reach people who may be in need, in distress due to the current condition of their pet, or just plain curious about different disease mechanisms. I tried to address multiple surgical conditions in the dog and cat, because I am a surgeon and try to approach things in a calculated, methodical nature. My overall goal is to help people and pets.

I never in a million years thought I would be writing articles and/or blogs (some may wish I didn’t). I do want to thank the following that I do have to this website. Writing and grammar, not arguably I’m sure, have never been my strong suit. If you wondered if I was a little off, you probably could have guessed – I am LEFT handed. Yes folks, I follow in the footsteps of some famous people: Michelangelo, Ty Cobb, and the list goes on. You would have thought that being left handed would have made me right brained and lean towards, the arts, writing, etc, however I don’t and I am sure my high school English/grammar teacher would have a visceral, gut wrenching response to my writings (I am trying extra hard to paint a picture, just for her).

While I will continue writing posts about disease processes and various cases that are seen through the hospitals at Affiliated Veterinary Specialists, I would like to change focus from time to time, addressing topics that may surpass the practice of veterinary medicine and deviate into the emotional, communication, and management world. How many times have we found ourselves immersed in situations where we have been overwhelmed either with the medical condition of our pet or the declining medical condition of a loved one and thought “if only my doctor would listen to me, to my questions, and concerns”? At times we may feel like the tree falling in the middle of a dense forest – never heard or noticed. At times, we may be the doctor who is trying their best to communicate the gravity of a medical condition to a client or patient and don’t know how to chose our words properly or are rushed by the overbooked schedule we allow. It is not that there is fault to be given, but is there a better way, can we teach ourselves to be a more articulate, caring professional? Can we manage our time better to be a more caring and compassionate professional; for that matter can we maximize our time both at work and at home? How many times do we feel drained emotionally when we come home and don’t have enough compassion for the ones who are supposed to matter most to us? What is the bigger picture, can we “make out the forest through the trees”?

Obviously, there are a lot of topics to discuss and with time and diligence we will cover the big topics. I will try to pull from my own life lessons and the life lessons of others, both professionally and personally (and I will try to make them short and light if possible). As a professional, there are times I do my job well and there are certainly times that I could have communicated differently or acted differently for a more desired outcome. I do expect that some of my future topics will leave me open and vulnerable. I am always open to constructive criticism. For me this altered direction is about self improvement as well – ask my wife how well I separate work and home life, on second thought don’t.

I will leave with this one thought (OK it will be a long thought, I am long-winded). I remember vividly January 1, 2000 sitting in the packed waiting room of a hospital emergency room, while my grandfather was being admitted for congestive heart failure. Being twenty-one years old and that it was New Year’s Day, this wasn’t exactly what I had in mind to say the least. I would have rather been home watching bowl games and celebrating the new year with my friends and family, however I learned a very important lesson that I have taken with me since that lonely day. It was just me in the waiting room filled with people waiting their turn, some in more serious condition than others (many nursing their New Year’s Eve hangover). I can remember the scene like it was yesterday: an elderly man in a wheelchair came up to me and we exchanged the normal small talk and discussing the football games that were being played that day. He asked me where I went to school and what my plans were after school. My answer was well rehearsed, since I knew that I wanted to be a veterinarian from a very early age. I told him my current status of having applied to various veterinary schools when he abruptly stopped me and gave me this word of advice: “No matter what you do, if you are able to help people and animals ALWAYS treat that opportunity as a blessing and a privilege”. It was obvious that he had his run in with the medical profession and I am sure he had both positive and negative experiences. He was right, I was blessed, I had my veterinary school interview at Ohio State University (where I would eventually attend) the day before my grandfather passed away – it was his dream that I go to veterinary school. That man, whom I do not know his name and can barely remember his face, touched a young man that day and it is my goal to impact others in a similar way.

Kevin Benjamino, DVM, DACVS

Copyright 2015

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Meet Faith!!!

Meet Faith!!!

Meet Faith!!!

Faith is an adult, mixed breed dog that came to Affiliated Veterinary Specialists – Orange Park from a local rescue group (SAFE Pet Rescue) in the Jacksonville, FL area. She was found and brought to a local shelter and had sustained multiple injuries. We suspect that her injuries were most likely caused by being hit by a car. Unfortunately, her injuries are chronic in nature, probably about 4 weeks old and she has learned how to scoot around and pull herself with her front end.

Left tibia/fibula fracture

Left tibia/fibula fracture

Right hip luxation

Right hip luxation

Her major injuries are a right hip luxation and left tibia/fibula fracture. She has normal neurologic function in the hind legs, however she has no support in the back legs……..until surgery. In addition to her orthopedic issues, she also is heartworm disease positive. The decision was made to address the orthopedic conditions in order to get her mobile and then focus on the heartworm disease. The heartworm disease always makes anesthesia more complicated, but with the proper precautions, she did great. Due to the chronicity of the hip luxation, a femoral head ostectomy was performed and the left tibia/fibula fracture was repaired.

Right femoral head ostectomy

Tibia/fibula fracture repair

Just two days after surgery she is starting to stand on her own and take some steps forward. She is very sweet and has determination. She will make a great addition to someone’s home when she recovered. It is exciting to know that she has been given a well deserved second chance. Please go to the SAFE Pet Rescue website:  http://www.safe-pet-rescue-fl.com or following them on Facebook: SAFE Pet Rescue to learn more about Faith and other adoptable dogs!!

Faith

Faith says “Hello”

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Pet Rehabilitation

Check out the new page on http://www.drbenjamino.com

Pet Rehabilitation.

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Top 5 List for a Safer Holiday Season

Happy Halloween!!!

As Halloween and the upcoming holidays are rapidly approaching, we are often wrapped up in family gathering, parties, and other activities and forget about the well being of our beloved pets. I tried compiling a short list to help keep our pets healthy and out of trouble this holiday season. This should ensure that everyone has a happy holiday season and may save you and your pet from needing emergency trips to veterinarian or emergency clinic.

1. Keep candy away from pets, in particular chocolate and candies made with xylitol and other sweeteners. While these taste good, they can have very harmful effects on your pet, ranging from liver failure, seizures, and as severe as death. If you suspect your pet has consumed any of these, seek veterinary care immediately.

2. Keep a close on the whereabouts of your pets. With all the excitement and increased visitors during this time, make sure your pets are accounted for and haven’t run off. Missing pets and subsequent trauma, such as being hit by a vehicle is an all to common occurrence during this time. Make sure your pets are in a safe place when company is over.

3. Keep pets out of the garbage and from grabbing food off the table. Bones and fatty meats can cause illness in our pets, especially dogs. Bones can cause a lot of irritation and in some cases puncture the gastrointestinal tracts. Fatty foods are not good for our pets and can cause pancreatitis and other gastrointestinal issues. Pancreatitis can range in severity and needs to be treated by your veterinarian.

4. Keep cords and electrical wiring away from your pets. Both cats and dogs can find wires enticing. Electrocution injury can be very severe and cause death in some cases. If you believe your pet to have be electrocuted, have them evaluated by your veterinarian immediately.

5. Keep easily ingestible objects away from your pets. Objects that can be easily swallowed can cause gastrointestinal irritation and obstruction. Some objects that can become obstructive are clothes, small toys, tinsel, etc. Gastrointestinal obstructions demand immediate veterinary care. There are times when the object can pass, but most of the time your pet will need surgery to relieve the obstruction, Surgery can range from a single incision in the stomach to removal of a segment of intestine. In extreme cases this condition can be fatal.

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October 2014 Case of the Month

October’s case of the month is an interesting one. Lucky is a young chihuahua mix that came to us with SEVERE injuries. He was attacked by a neighborhood dog about 7 days before presenting to us and was in very bad shape. His initial wounds were managed, but unfortunately infection still set in and the majority of his cervical (neck) skin started to die and needed to be removed. Not only was the infection causing a problem locally, but we had signs of it being spread systemically (through his blood stream). He needed both surgical care and care by a criticalist(board certified in Emergency and Critical Care) in order for him to have a fighting chance. Below is a picture of what he looked like when he was admitted into the hospital.

This was Lucky as he was admitted to the hospital.

This was Lucky as he was admitted to the hospital.

You can make out the extensive injuries on the photo above. He was fortunate to be alive! Whenever we get a case like this (unfortunately it happens more frequently than we like), we am always realistic with the owners, because there is a chance that their pet will not survive. Also, these cases are not quick cases, Lucky was hospitalized for 2-3 weeks and wasn’t fully healed for about 6 weeks. Our first objective is to get the systemic infection under control and get him strong enough to be able to handle surgery. While the criticalist was working on the systemic infection, we were concentrating on the neck wound.

The first phase wounds go through is the debridement phase, which is where the body gets rid of necrotic (dead) tissue and the size of the wound is established. The next phase to follow is the granulation phase. The granulation phase is very important in a large wound like this, this is when the body begins to infiltrate the wound with healthy tissue and more importantly capillary vessels, which bring blood flow. For this wound, I choose to use a wound dressing called BurnStat (Ubuntu) which is a dressing that can be used through multiple phases. It is an organic clay substrate that does an excellent job of removing toxins and necrotic tissue while promoting granulation tissue formation.

Debridement phase

Debridement phase

Applying BurnStat as the primary wound dressing

Applying BurnStat as the primary wound dressing

Following this type of bandaging, the diseased tissue begins to be replaced with more healthy, red granulation tissue. The final product, before being able to close the wound, needs to be completely covered with granulation tissue in order to increase the chance of the new skin being accepted.

Complete coverage by granulation tissue.

Complete coverage by granulation tissue.

You can see how the surface is covered with healthy looking tissue and no presence of dying tissue visible. By this time Lucky amazingly over came his battle with the widespread infection and overall was doing very well. He was making a remarkable recovery.

Our next dilemma was “how do we cover the exposed tissue”? In cases like this, we have a few options, which is beyond the scope of this post. I choose to use an advancement flap (skin freed up from a nearby location that is moved over the wound), which made the most sense due to the elasticity of the skin in this area. Below is his wound following surgery.

Advancement flap

Advancement flap

Following surgery we also utilized laser therapy to help promote uptake of the skin flap. This is Lucky in his referee uniform (it is close to Halloween) receiving his laser therapy.

Post-advancement flap therapy

Post-advancement flap therapy

Here is the finished product for Lucky!!! He overcame a lot of obstacles along the way!!

This is about 6 weeks after Lucky presented.

This is about 6 weeks after Lucky presented.