Contact

Please feel free to contact me via this website. You can leave me a private message via WordPress or through my professional Facebook page at Kevin Benjamino DVM,DACVS. Contact me with questions or comments. Also, I can be reached for lecturing engagements as well.

24 thoughts on “Contact

  1. I have just read your article in relation to cruciate ligament injury in dogs. My Staffordshire Bull Terrier has suspected ruptures to both hind legs ligaments. I am trying to get information as to who the best surgeon would be on the Gold Coast or Brisbane and also try to get information as to the latest technology in treating this issue. I have heard that procedures can be done via Arthroscopy and that there is a new system of replacing the ligament with tissue rather than the more invasive treatments currently used. Any help would be greatly appreciated.

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  2. Thank you for the comment and question Kristen! I hope that you found some of the information on this site useful as you go through this tough time with your pup. I have certainly seen bilateral (both) cranial cruciate ligament (ACL) ruptures fairly frequently and in the Staffordshire Terriers. The way I approach these injuries may be a little different than some, however I will generally try to stage the procedures by about 6-8 weeks doing the more affected side first and then addressing the second side once we are confident that the pet is recovering well. I will do both at the same time, if the pet is extremely debilitated. Performing surgery on both knees at the same time, while shortening the recovery period, also increases risk of complications which in the early recovery period could be catastrophic.

    As for the techniques used for stabilization of the stifle joint (my opinion), I tend to perform the osteotomy procedures and arthroscopy to evaluate the joint. I have never been convinced about the intra-articular stabilization techniques of replacing the ligament as a sole method of repair. While the canine knee resembles the human knee, there are very different forces on the ACL ligament in the dog when compared to you or I and at this point only the osteotomy procedures address this force adequately (again in my opinion) where the ligament replacement techniques seem to have a much higher rate of failure.

    How I generally approach these cases would be to perform a stifle (knee) arthroscopy and then immediately (on conformation of the ligament tear) perform a tibial plateau leveling osteotomy (TPLO). My opinion is that evaluation of the joint is crucial, to both evaluate the cranial cruciate ligament(ACL) and the other structures of the joint (more importantly the menisci) In dogs with a complete ACL tear, we will commonly see a medial (inside) meniscal tear which needs to be addressed by removal (debridement). Arthroscopy allows us to do all the joint work in a minimally invasive way and tends to speed recovery versus an open arthrotomy (larger incision into the joint) techniques. Immediately after the arthroscopy, I will make a small incision over the proximal (top) tibia and perform the tibial plateau leveling osteotomy (TPLO) procedure in order to alleviate the forces that were on the ACL.

    I hope my answers help, if any other questions arise please feel free to ask! As for recommendations regarding surgeons in your area, I am not familiar with anyone in Brisbane, etc. I do have some contacts in Australia that I will try to touch base with and let you know. I would be happy to help at Affiliated Veterinary Specialists, but we are a little far from you in Florida.

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  3. What a great blog, Dr. B. Very informative. Could you do an article on Gallbladder Mucoceles? We have a dog (Min-Pin) on the Cushing’s Yahoo list who was diagnosed with this and the IMS is suggesting the Cushing’s should be treated first. Makes me more than a little nervous to hear this!
    Sandy – Jacksonville Sheltie Rescue

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  4. Hi Sandy, I will definitely work on a gallbladder mucocele article – I’ll try to include some images (not too graphic) and diagrams. Also, I will try to contact you over the next few days to go over your specific case. I hope all is well.

    -Kevin

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  5. Hi Dr. Benjamino, my 6 month old mini dachshund has confirmed bilateral Pes Varus and I am looking to find a surgeon who can operate using the new locking plate system so my pup doesn’t have the external fixator pins in both back legs. Can you recommend somebody on the east coast?
    Thank you kindly,
    Sam

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  6. Hi Sam, thank you for reaching out. I am sorry about your little puppy. I understand the various feelings that go along with thought of surgery on any member of the family. What area of the east coast are you looking for and how far are you willing to travel? The surgeon community is relatively small. I’ll try my best to help.

    Best regards,
    Kevin Benjamino

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  7. Hi Dr. Benjamino,
    With regards to Tido (esophageal fb), being rawhide and not a sharp bone etc..could that have been attempted to be removed via gastrotomy (either gently pushing it from esophagus into stomach/pulling into the stomach) or was it just too big? I understand you chose the best option for Tido and obviously he is doing great, just wondering if there is a specific finding on your workup that made you decide the surgical procedure you did do? Do you have radiographs you could share? Or is any esophageal fb that doesn’t make it into the stomach (past the reach of an endoscope) an automatic thoracotomy/esophagotomy for a surgeon? Most of our clients decline referral…it’s so sad when they have something like this that they present with.
    Thanks for sharing your cases!

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  8. Thank you so much for your response. I agree whole heartedly with everything you mentioned. As a surgeon, I view going into the esophagus (either cervical or thoracic) as a LAST resort. I am very fortunate to work with some very skilled internist who do a lot of endoscopy. Tido originally went to them and they tried both removal of the rawhide and as a second option, they tried to push it into the stomach, but it wouldn’t budge. It had been there for a few days (amazingly) and was well embedded into the esophageal mucosa. I would say that >95% of these types of cases never see me as a surgeon, however this was a rare case. I hope this helps. I do have some radiographs and I will look through them and try to post one along with the story. If I remember correctly, the rawhide didn’t stand out too much. I hope this answers your questions, if not let me know.

    Kevin

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  9. Hello Doctor. Our 6 mo old mini dachshund, wirehaired, has a right hind bowed leg. The other hind leg is perfect. We are in a situation where one vet says he thinks surgery should be done immediately with a dx of Pes Varus. Two other vets say wait because the GROWTH PLATES are still open. She is in no pain, no limping etc. How do we know who to believe? This is so stressful on my husband and I who are disabled vets and right now the vet insurance won’t pay for anything on this leg. BUT, if it was needed we would figure something out. But the problem is who is right? Also, hours of researching the internet leaves us blank on what happens during the probably 8 weeks of recuperation for the surgery. would she have to be caged? etc. Thank you for any guidance… we are at a loss.

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  10. Hi there, I hope this finds you otherwise well. I am sorry to hear about your little one. So oddly enough, I saw a very similar case last week – 6 mo Dachshund for right pes varus and a patella luxation (knee cap moving over). Just like your little one, the left leg is normal. That being said, I will give you the same advice I gave them. Overall, surgery will be needed to correct the growth issue, as it will NOT correct over time. The surgery required is what is called an (medial) opening wedge osteotomy of the distal tibia and either a plate and screws are used to hold the bone together while the bone heals or a ring external fixator. Both methods works well, what determines which is used is surgeon’s preference and bone size.

    Recovery is usually 6-10 weeks (I am giving broad time frames, not knowing your kiddo) and a bandage potentially. The best way to ensure that she won’t be too active during recovery is to utilize a crate and possible sedation especially while you are not directly watching her. She cannot be running and jumping while the bone is healing. Too much activity and force can cause break down of the implants before the bone is healed, which would require more surgery (not what we want).

    The outcome for this procedure is typically very good. Why we recommend surgery is not just for the appearance of the leg, but also so we get normal weight bearing to the hock (ankle) and stifle (knee) joint. If left alone, the likelihood of arthritis and further issues is higher.

    The timing of this procedure, in my opinion, is important. I told my recent client that I would like for the tibial growth plates to be closed, which will occur at 8-10 months of age. I instructed them to recheck with me in 2 months (at 8 months of age) and we will take x-rays to look at the growth plates. We know we will damage and close the growth plates with surgery if they are open at the time of surgery, so I opt to wait. We are not waiting a long time, just 2-4 months until the growth plates close. If we were to wait a year or so, we don’t know what type of arthritis could develop and surgery may not be as successful.

    If you haven’t met with a board-certified (ACVS) veterinary surgeon, I would highly recommend it, as they will be the best to perform the surgery and guide you through the process. I am in Northeast Florida so I may or may not be of help – but I would be happy to see you.

    I hope this helps, let me know if further questions develop.

    Sincerely,
    Kevin Benjamino

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  11. Thank you we just wish we were closer to you. We live in Lecanto over by Crystal River, Fl.
    Our vet here thought surgery should be done right now and that did not make sense to us. A second opinion was hold off as surgery may never be needed and that didn’t make sense to us either. YOUR opinion however makes perfect sense. Our vet said he would do a referall to the University of Florida Small Animal Hospital but not sure we could afford it. But will we I guess make an appt with them. My husband and I are both disabled vets and since we lost our other little doxie several months ago (tumors on the liver) this is beyond stressful. Can’t even picture this 2 month recovery though. She is an active wonderful puppy and this is so devasting. But, your opinion has helped us understand everything so we thank you so very much for your help.
    Thank you so very much!!

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  12. I am sorry to hear about your other doxie – that is sad. Luckily, what your little puppy has is not life threatening. It sounds like the University of Florida may be your closest option. There are referral hospitals in Tampa, which may or may not be closer. I believe that UF does good work. As for experimenting, a case like hers would likely be done either by a resident under clinician/professor supervision/guidance or by the clinician him/her-self not a student or intern. I know some of the staff, but not all. My personal preference of surgeons for this type of case would probably be Dr. Dan Lewis. He is very experienced and has been there awhile.

    Another option would be the company that I work with (Affiliated Veterinary Specialist) does have an office in Gainesville too. Dr. Eric Herman works there and he is comfortable which pes varus deformities (I asked him since our last conversation). I am always up front – he is not boarded but is residency trained (at the same institution that I trained at). What it means to not be boarded in this case, is he has not sat for his board examination. He does quality work and I trust him, but I want you to feel comfortable with whomever is performing surgery on your little girl – that is the most important thing. Let me know how I can help – I wish my office were closer.

    In answer to your question about arthritis, one of the goals with surgery is to restore normal weight and pressure through the joint which should decrease the arthritis seen. Without surgery we are much more apt to see progression of arthritis.

    I hope this help! Have a great weekend!

    Kevin

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  13. Thank you again. You are an angel sent from Dachshund Heaven LOL We will try and call the UF Small Animal to ask about Dr. Dan Lewis (our appt with UF is on Sept 14) I know this is imposing but you have helped us beyond what you can imagine. Is there a way to send you via e mail her xray? (just one) Thank you

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  14. Dr Benjamino Not sure if you got our last report which explained the doctor you recommended at UF is not available until the end of Sept. We wanted to know if you knew the other doctors we listed or if you would consider seeing our Sasha . If you did not get the note please let us knowl Sorry to be a bother thank you

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  15. Hi there!

    I apologize about my delay – it has been a long few days – you are NOT a bother. Unfortunately, I do not know the other doctors you listed. My instinct would say Dr. Lewis would be the most experienced at UF. Dr. Stan Kim is good also, however he is largely doing research now. I think it would be fine to wait until Sept. 26th for Dr. Lewis.

    As for me seeing her, I would be more than happy to see you and her. If you would like to go that route, around her 8 month birthday would probably be best, because we will be close to growth plates being closed by then. I will do my best to answer all your questions. Generally, they will need to spend one night with us (night directly after surgery) and this is mostly for pain management. Some owner that are coming from a distance will hospitalize them the night of the consult for surgery the next day (if this is something you are considering, let our front desk know when you are scheduling a consultation and then they can make sure they schedule for both the consult and then a tentative surgery slot the next day). We do have 24 hour care.

    As for rechecks, I think we may have a couple options. I am fine for the majority of bandage changes, rechecks to be done with your vet, as long as he/she is comfortable with managing the post-op care. I am more than happy to guide. Another option may be to do rechecks with our Gainesville office – I will have to ask Dr. Herman if he is OK with that plan, I don’t think that would be an issue. There will be a bandage on for 4-6 weeks, meaning that we will have weekly bandage changes. If there is a recheck that I would like to she he for it would be the 8 week recheck when we take x-rays. If x-rays are taken with me (AVS) there will not be an additional charge (the same with the bandage changes), however if your vet did some of the rechecks I would expect there to some charges.

    As for charges the initial consultation will be $135, I will ballpark surgery around $3000-3500 which includes the surgery, overnight care, and medications to go home, however I’m not at the office know for sure. Again, the follow-up exam and x-rays will not have a charge.

    I hope this helps! Have a great weekend!

    Kevin

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  16. HI Again Dr. Kevin…. We are the folks over in Lecanto with the small mini dachshund with “pes varus” or the angular limb disorder. We wanted to know… have you done this type of surgery before? And how the outcomes were… thank you so much

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  17. Hi there! How are you? I certainly do remember you. I remember that you had an appointment with Dr. Lewis, how did that go? I’ve not toured UF’s facility, however I here it is impressive.

    I have done surgical correction for pes varus in both the dachshund and other breed types, however the dachshunds (most common) have the challenge of a very small limb. I feel that they they have a very good prognosis (outlook) following surgery and the post-operative recovery. In addition to the pes varus deformities, I tend to do the majority of the other angular limb deformities at AVS. The nice thing about the pes varus deformity is that the correction is typically in one plane (2 maximum) versus some of the other deformities I see, it is fairly straight forward.

    Please feel free to ask me other questions you may have. i try to be as open and honest as I can be. I hope all is going well! Talk to you soon!

    Best Regards,
    Kevin

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  18. Forgot to ask Dr. Kevin when you did the surgery for pes varus did you use the plate method, or the outer rings, pins etc? thans

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  19. Is it OK to use your email that pops up under the comments (not visual to the public) ending in the gmail.com? It would be easier for me. You will get an email from AVSpethospitals.com.

    Thanks,
    Kevin

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  20. Dear Dr. Benjamin.
    Here in Taylors, South Carolina, we don’t have a large population of specialists for dogs. I am so happy to see you will actually look at this and I welcome your educated opinion. I have been to the emergency clinic, 2 regular vets, and a homeopathic vet. (1)

    I am facing something between “wait and see” and removal of a front right foreleg.

    Bailey, my 3 year old lab/redbone coonhound was hit by a fast moving truck on June 26. I took him immediately to the Emergency clinic at 7pm. They took xrays and said he had no broken bones but the only “curious” thing they found was this anomaly on his humerus. They said it was probably an old injury because “the edges were smooth”. It looked to my 68 year old brain like a bone chip that had dislocated. . They sent him home with abrasions, contusions, and crying out in pain. They have him a pain shot and I was sent withn Carprofen 75mg.

    result: two days later he quit crying all night and took to the couch. will not set his foot down. falls on his face.

    Then I went to an Orthopedic Specialist Vet of a very ripe age because i was sure his knowledge would be helpful. I was surprised when he couldn’t open the digital xrays on his computer. (I sent them to him later but his opinion didn’t change.) Based on his general exam, he sent me home with Tramadol 50mg and Prednisone 10mg.

    result: No improvement in his holding his leg up. Add to that the side effects of Prednisone.
    (I gave him the prescribed dosage and reduction) He drank gallons of water, and urinated every hour and ate like three dogs. And now five weeks later he is still doing this.

    He seems actually depressed. Doesn’t try to run away. doesn’t sleep in my room. JUst does the basics. No sense of play. In fact, he has gotten more aggressive with other animals.

    Took him to Dr Fowler, a homeopathic vet. She is well versed in Chinese medicine, acupressure, herbs, etc. She gave him acupuncture, an “adjustment’ done with a sort of electric hammer, and reported, by feeling him, that he had some liver issues. She sent me with Drenamin, and two mixtures – one containing “Arnica 1 m” and the other called “homotox 4 detox, tra,neur,rh”

    There is no pool for dogs around here but I think it would do him good to move that leg because of the atrophy in his leg.

    If possible, I will enclose the xrays that were taken, and a video of him trying to walk. If I can’t attach them here, I hope you will send me an email address that will take a large attachment.

    Thank you for any and all advice. The suggestion of losing his leg breaks my heart although I know they adjust well. But how long should i “wait and see” while something else being done in a timely manner may make the difference in his future. He is my beautiful best friend.

    Thank you for all you do.

    Terri Cash
    864.616.7677

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  21. Hi Terri,

    I am so sorry to hear about Bailey and his injury. Hang in there! Do you know what the diagnosis was? Was there substantial neurologic injury, like a brachial plexus avulsion? This is where the axillary/brachial nerves (nerves that come out of the “arm pit” area and go down to the leg) get pulled and tethered from their origin near the spinal cord. Is he dragging the leg? Is there feeling to the leg? I apologize for the multiple questions. I was unable to get the X-rays, do you have a better way to send them? I am happy to take a look at them and try to direct you better. I can’t give specific recommendations without seeing Bailey, however I can let you know what I see (or don’t see) and guide you.

    Hang in there!
    Kevin Benjamino

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