Sonny – Osteosarcoma:
Sonny is a 15-month-old American Staffy, diagnosed with osteosarcoma (bone cancer) of the proximal tibia of his right hind leg. This is, sadly, a common condition in many older, large breed dogs, but is rare in young large breed dogs. Almost all dogs with this condition are euthanised due to the pain from the condition, not because of the symptoms associated with the spread of the cancer.
Limb-removal can solve the pain problem, because it provides the dog to be pain-free post-surgery, and it does not have to be an expensive undertaking. Sonny’s amputation cost just $1,000, not a small sum, but far more affordable than the approximate $3,000-$4,000 if the procedure had been undertaken at a specialist centre. Most of these osteosarcoma cases will live pain-free for 3-6 months post-surgery without any further treatment.
Adding chemotherapy to this can often achieve 6-12 months life-extension post-amputation, and sometimes even longer. Chemotherapy also doesn’t have to be an expensive exercise and Sonny is currently undergoing doxorubicin chemotherapy every 3 weeks for approximately $265 each time. These visits are not onerous and can be as little as one hour each time, with the owners usually being present during these treatments to further support their best friend.
Check out these videos below of Sonny a few weeks after surgery:
Cassie & Charlie –Anal Gland Adenocarcinoma:
Cassie and Charlie have both overcome anal gland adenocarcinoma, which is a cancer of the anal gland. Unfortunately, it is often diagnosed late as the caner of this gland tends to grow into the pelvic area rather than out through the skin, making it very easy to miss. By the time of diagnosis, this cancer has often spread to the sub-lumbar lymph nodes – those lying beneath the back muscles in the abdomen.
As these lymph nodes enlarge from multiplying tumour cells, they often start to apply pressure to organs passing through the pelvic canal, so the first signs of this condition are sometimes straining secondary to having trouble passing stools due to pressure on the colon. Read about our brave patients with this cancer below:
Cassie, a 10.5-year-old German Shepherd, was presented for straining and her condition was that bad that her bladder and colon were both obstructed by multiple, very enlarged, sub-lumbar lymph nodes. Six of the 6-8cm x 4-6cm masses where removed (as shown above). This, along with the removal of the primary anal gland tumour in the same surgery, was achieved for $1,450….a fraction of the cost of referral and many, many of these cases are now referred rather than treated through primary care veterinary hospitals.
Charlie, a 9.5-year-old Cavoodle, was also presented for straining. He had sub-lumbar lymph node removal and removal of the primary anal gland tumour in September 2017, at a cost of $1,280. He has had five cycles of doxorubicin chemotherapy, at a cost of approximately $230 each time. It has been five months since his original surgery and at present, shows no signs of recurrence of the cancer, either locally or in the sub-lumbar area. Of note though, his coat colour, as a result of chemotherapy, reverted to his puppy colour of brown, whereas for most of his adult life he had been white!
Lola, Fifi, Rusty & Milly – ACL Tears
Lola, Fifi, Rusty & Milly all experienced tears in their anterior cruciate ligament. Our solution: Modified Marquet Procedure (MMP), which is a very reliable and rapid method of restabilising unstable stifles following ACL tears. The use of a titanium foam wedge, keeps the tibia in its normal position relative to the femur, and re-establishes normal stifle movement, and does not involve entry into the joint.
The titanium wedge is a block of titanium foam rather than just a solid implant, which leads to rapid ingrowth of bone into the wedge, with permanent stability of the surgery site achieved in just 3-4 weeks.
This procedure only takes around 30 minutes surgery time, yet allows rapid return to full function in the vast majority of cases over as little as 10-12 weeks, with many dogs being 80-90% normal within just 4 weeks after surgery. The best part – we do this for only $1,200-$1,300!
We have performed some 15 of these in the past 3 months. If you would like more information or know someone with a dog that may benefit from this, please feel free to contact the hospital or email me at firstname.lastname@example.org.
Lola (seen in the video below) was our first ever patient to have her ACL repaired via our MMP procedure. She received the treatment for a torn anterior cruciate ligament of her right hind stifle, via the MMP technique where a titanium wedge was inserted into the tibial crest. It was a huge success and you can from the video just 13 weeks after her surgery how well Lola recovered. She is now able to free run/play again without restriction.
Fifi is a 4-year-old desexed male Maltese Terrier, who presented lame to us and was diagnosed with a torn anterior cruciate ligament of the left hind stifle (knee). Fifi had his left hind stifle stabilised using the MMP method of ACL stabilisation, which took only 30 minutes and he was in and out in a day.
Here is an outline of Fifi’s MMP procedure:
You can also see videos of two other patients of our MMP procedure – Rusty (left) and Milly (right) – merely weeks after their surgery.
Misty – Meibomian Tumour
Tumours of the Meibomian glands in eyelids are common in older dogs and start as small bumps at the margin of the upper and lower eyelids. Many of these stay small (2-3mm) and do not continue to grow further, so there is never any rush to have these removed.
Some of these tumours even rub/rest on the eye itself, but if they remain small, they do not appear to cause any irritation. Occasionally, the tumours become “active”, as I prefer to describe it to clients, and they start to become larger. Once evidence of enlargement is seen, then they will only continue to grow until removed.
These tumours are easily removed using a “V” wedge excision of the affected eyelid. We can cut close to these tumours as they do not require large margins, thus preserving most of the eyelid. Most of these require removal of around 1/8th to ¼ of the affected eyelid, but even up to a 1/3rd of the eyelid can be removed without noticing that surgery has been performed once healed.
Very fine sutures, such as 6/0 prolene, are used to close the surgery site/re-oppose the eyelid margins. Placement of the first suture at the eyelid margin is very important. If this is located perfectly, then it is often hard to tell that the affected eyelid did indeed have surgery once healed.
These surgeries are often referred to eye specialists and usually cost $1,500 or more as a result. We perform these surgeries frequently. whey take only around 15-20mins surgery time and cost as little $500-$650, depending on whether pre-anaesthetic blood are chosen or not.
The accompanying below of Misty show a Meibomian gland tumour, and unusually, a “stye” on the affected eyelid follicle beside it as well, which we removed with the same “V” wedge. The cost of the surgery in the photos was only $510 and the follow-up is simply sutured removal two weeks after surgery, which we do not charge for.
Zelda – End-of-Life Care
From pet owners Mark and Vanessa Greatorex:
“On behalf of myself and Vanessa, I would like to extend a very sincere thank you to your team for the way you looked after our beautiful Zelda during the final months of her life.
Zelda was challenged throughout her life with adversity through illness, but the fact that she actually looked forward to her regular trips to the vet speaks volumes about how well she was looked after there.
From our point of view, it was wonderful to finally find a vet surgery where the welfare of the animal was given priority over the size of the medical bill. Although it’s a long way from Mount Dandenong to Clayton, it was a drive we were prepared to make as often as necessary, as we always felt that Zelda was being given the best care and attention possible.
Losing Zelda has left an incredible hole in our lives and our boy Reinhardt (Rennie) misses his little sister terribly. Although we know we’ll never be able to replace a dog as unique as Zelda, we’ve promised Rennie that one day soon he’ll have a new companion to play with, and when that time comes we will make sure that we bring our new puppy to you for all of her medical needs.”
Jasmine, Mylo, Mack, Puddy & Tye – ACL Repairs
At the South Eastern Animal Hospital, since we started offering the MMP method of stabilisation of canine stifles post ACL (anterior cruciate ligament) tears in Dec ’17, we have now performed 38 of these procedures.
The Modified Marquet Procedure has been shown to produce equivalent results to the current considered gold-standard method called the TPLO (tibial plateau levelling osteotomy). Research has shown there is no difference between results achieved by 12 weeks post either surgery, but in fact many of those that have stifle stabilisation via MMP show more rapid return to function. This inherently produces some challenges in trying to keep the dogs quiet/rested until 4 weeks post-surgery (walking on lead is quite ok from day one), as many of these dogs want to start running again by as early as 2-3 weeks after surgery. However, this is far too early as the bone has not fully grown into the implant at this stage. From 4 weeks through to 10 weeks post-surgery, we seek to increase their lead walks from 10mins to up to 30mins at a time and by 10 weeks, we seek to begin off lead activity with the aim to return to full freedom by 12 weeks post-surgery. This is a remarkably short period of time given that it is such a significant injury.
The five videos below demonstrate the range of dogs that the procedure can be performed on and the speed at which they return to being near normal post-surgery.
- “Jasmine” 6.5yo, 17kg English staffy, 4 weeks post-surgery
- “Mack” 8.5yo, 31kg American staffy, 10 weeks post-surgery
- “Mylo” 2.5yo, 30kg Labrador, 6 weeks post-surgery
- “Puddy” 3yo, 43kg Dogue de Bordeaux, 4 weeks post-surgery
- “Tye” 6yo, 8kg Jack Russell Terrier, 6 weeks post-surgery
Another significant point is that we only charge between $1,200 and $1,400 for this procedure, much less than any other procedure performed at other hospitals (~$2,000 – $2,500) and far far less than the TPLO procedure performed at specialist centres (~$4,800). So far we have effectively saved these 38 clients a cumulative total of between $35,000 and $130,000, an enormous amount, along with seeing their best friend rapidly return to normal after such a significant injury.
Finally, as mentioned previously, there is NO surgical method of stifle stabilisation post ACL tear that prevents arthritis long term. Surgery markedly slows the onset of arthritis and leads to a far more rapid return to full function, but does not stop arthritis. We are heavy users of pentosanpolysulphate (eg. Zydax, Catrophen, Pentosan 100) post-surgery. If we look after the health of the cartilage post-surgery, then the dogs do not get arthritis long term. Arthritis only occurs because of excessive cartilage wear and exposure of bony surfaces. It is this bone on bone contact that leads to joint inflammation/pain and new bone growth in an attempt to fuse the joint to stop the pain. We advise the use of pentosanpolysulphate as a four weekly course of injections at least every 6 months to look after the health of the cartilage long term.
Casey – Lower Jaw Symphyseal Separation
Casey, an 18mo desexed male Burmese cat, was presented Friday afternoon after escaping from the house and being bitten on the head by a dog. Casey had bruising to the top of his head, and generalised inflammation to the head and face. The exam also revealed a separated symphysis of his low jaw. These injuries are common where a cat is hit on the head as rotational forces applied to the head/jaw lead to separation of the lower jaw at this point. X-rays revealed no other damage to head/jaw/face structures. He was placed onto IV fluids, given a long-acting antibiotic, NSAID anti-inflammatory injection, opioid (buprenorphine) injection and an opioid (fentanyl) patch applied to his foreleg. His breathing was stable, and he appeared to have suffered no chest or abdominal injuries. He was placed into hospital care and allowed to rest overnight.
Casey in hospital Saturday morning, prior to surgery. The accompanying photos show Casey much brighter and happier the next morning. Casey was anaesthetised with O2/Isoflurane by mask, intubated, then placed onto O2/Isoflurane gas maintenance. 20” needles were placed through the skin either side of the lower canines to act as guides for the wire.
20” needles in place acting as wire guides. Wire is then placed around the lower canines to hold the lower jaw symphysis together to allow healing to occur. The wire is tied beneath the jaw, after removal of the needle wire guides. The wire tie is often left outside of the skin, whereas I prefer to cut the skin, allowing the wire to be buried beneath the skin during this healing period so the wire does not get caught on bedding or other material. The wire is usually left in place for 6-8 weeks.
The result after the wire is tied and buried beneath lower jaw skin.
The normal alignment of lower jaw post wire placement
After surgery, recovering in hospital.
This procedure is quick and easy to perform and very effective. The whole account for the time in hospital, fluid therapy, anaesthetic, surgery and medication cost just $710. Veterinary care does not have to be expensive and we try very hard to keep these costs within reach of more owners. Treated at an emergency centre then referred to a specialist centre, would have lead to an account of $3,000-$4,000 or more. While these centres provide fantastic care, these costs are often incredibly onerous for most owners. We regularly take enquiries from all over Victoria, where clients are looking for a possible alternative to very expensive quotes.
Raven – Modified Marquet Procedure (MMP)
“Raven”, a 3yo Golden Retriever, is the 43rd case we have treated for a torn ACL (anterior cruciate ligament) using the MMP method, since beginning to offer this method of repair from Dec 2017. The accompanying photos provide a visual collage of the procedure. This procedure takes only around 30mins and leads to most dog’s being 80-90% sound in as little as 4-weeks post-surgery and the majority of dog’s free running again by just 12 weeks after surgery. There is no limitation to the size of the dog that this can be performed on. We have performed this procedure in dog’s as small as Pomeranian’s and Maltese Terriers, right through to very large dogs such as Great Danes and Mastiffs.
Skin incision over the inside (medial) surface of the stifle
The saw guide is positioned over the medial stifle and held in place with locating pins and a hole drilled over the proximal tibia at the end of the tibial crest.
The drill bit is left in place to hold the saw guide in position.
The tibial crest is then cut with a sagittal saw, via the saw guide.
The saw guide has been removed, and bone holding forceps are attached to the tibial crest to assist in distracting the tibial crest, to allow for location of the titanium wedge.
Placement of the titanium wedge with wedge inserter.
A stainless-steel bone pin is then placed through the tibial crest, continuing through a pre-drilled hole in the titanium wedge, into the tibia. This helps stabilise the wedge/keep it in place, during healing.
A guide is then used to accurately drill holes for the titanium staple. The staple keeps the pressure required against the tibial crest during healing. This allows time for the unique feature of this method to occur, i.e. bone actually grows into the wedge, thus forming a very strong permanent union with the bone.
The staple is placed into the pre-drilled holes.
The staple is then tapped into place, forming a very secure/strong grip on the tibial crest to hold it in place.
This shows the completed procedure with the wedge, staple and pin in place.
This shows the closure of the tissues over the implants.
The skin is then closed.
“Raven” in surgery nearing the end of the procedure.
The surgery provides a very rapid return to normal function in the majority of dogs, yet takes only around 30mins to perform. We currently perform this for approx. $1,250 to $1,400, depending on the size of the dog and the medication requirements, though we have heard of quotes as high as $3,500 for this same procedure. The procedure has been shown to produce equivalent results to the TPLO method commonly performed by veterinary orthopaedic specialists for around $4,000-$5,500.
The video below shows “Phoebe”, a 12yo Pomeranian, just 4 weeks after stabilisation of a right hind anterior cruciate ligament (ACL) tear, via the MMP method, at suture removal.