Wednesday, September 24, 2014

It Takes a Village

When Hillary Rodham Clinton wrote “It Takes A Village” more than a decade ago, she was describing the collective efforts needed to help our planet’s children. This concept of a multifaceted community to treat our animal friends has become especially relevant to the veterinary community.

At VCA VRA we have always stayed ahead of the technological curve and when this is enhanced with the vast collective experience of our village, winning treatment approaches occur every single day.

Let us examine a case in point. Logan, an eight year old male neutered Cane Corso began having seizures and was referred for a consultation with our neurologist, Dr. Steinberg.  Dr. Steinberg explained to Logan’s owners that although Idiopathic Epilepsy (seizures of no known cause) was possible, other more serious conditions may be the cause of Logan’s seizures.   He recommended advance diagnostics consisting of an MRI to help make an accurate diagnosis.  Logan’s owners decided to pursue a MRI and it was performed that same day.  Sadly a large right-sided brain tumor was discovered.

Figure 1 (top) shows an image of Logan’s brain looking down on the brain from the top of Logan’s head and Figure 2 (bottom) shows Logan’s brain looking straight down his nose. In both views the tumor is outlined by a ring of contrast.

Based on the MRI findings, Dr. Steinberg suspected a Glioma, one of the more aggressive brain tumors seen in dogs.  To make matters worse, shortly after the MRI, while Logan’s owners were considering treatment options, Logan sustained a cranial cruciate ligament (CCL) rupture in his right knee (similar to the human ACL).  Despite these challenges and with the collective expertise of our team, this story has a happy ending.

Although, most surgeons would consider Logan’s tumor inoperable, Dr. Steinberg and his team have extensive experience in performing this type of delicate surgery.
Dr. Steinberg has probably successfully removed more brain tumors than anyone, having performed his first brain tumor removal in 1984.  As a result of his immense experience, Dr. Steinberg is asked to lecture world wide and has been flown to Germany and Hawaii to perform this life-saving surgery.  As an instructor at the famed Canine Rehabilitation Institute in Wellington, Florida, he continually updates his lecture series to share his and his team’s experiences as they discover improved rehabilitative therapy techniques to reduce recovery time and improve function for post-operative brain surgery patients. Most recently, Dr. Steinberg was asked to present these lectures at veterinary conferences in Bologna, Italy and Seattle, Washington.

Based on Dr. Steinberg’s vast first-hand knowledge, he counseled Logan’s owners on the expectations and potential complications of the proposed surgery. 

Logan’s owners had plenty to think about while they were considering treatment options for Logan’s brain tumor.  Unfortunately, Logan presented to our emergency service just days after his MRI with his CCL injury.  This injury makes the stifle (knee) unstable causing discomfort and lameness.  Fortunately, our surgeons have extensive experience in both the surgical and non-surgical management of CCL injuries.  Our lead orthopedic surgeon, Dr. Snakard discussed with Logan’s owners the options for managing Logan’s knee injury.  They decided to pursue non-surgical management for the knee and proceed with the life-saving brain surgery.  Non-surgical management of CCL injuries typically consist of a brace and rehabilitation therapy.  Our rehabilitation team, led by Ms. Renee Mills, CCRP, has had great success with this protocol for all sizes of dogs so Logan’s large size (more than 100 pounds) was not a concern.  Our rehabilitation team made a cast of Logan’s injured limb and sent it to Canine Orthotics & Prosthetics, located in Canada, who made a custom brace for Logan (Figure 3--below).

With the knee injury addressed, we proceeded with Logan’s brain surgery.  Brain surgery of this kind is very different than what is experienced under the same circumstances in man. Dr. Steinberg’s goal is to make a wide excision and leave no tumor behind. Having hundreds of brain surgeries behind him, Dr. Steinberg knows where the pitfalls are and what compromises can be made. In addition, having rotated with a Sacramento Human Neurosurgical Group in California and recently spending time with the Northwest Neurosurgical Group in Chicago, he has experienced first-hand the variations in choices that face the veterinary neurosurgeon vs the human neurosurgeon.

Logan’s surgery was a success!  After surgery, Logan recovered in our Critical Care Unit where he could be closely monitored (Figure 4--above). Although, he was weak on the left side of his body and his head turned towards the right constantly, our experience told us these symptoms would improve. We also believe immediate therapy with our rehabilitation team hastens recovery and can make recovery more complete. What does that all mean…..Logan gets to swim in our rehab pool (Video 1).

At the same time we were performing therapy for Logan’s brain tumor recovery, we also performed rehabilitation for his injured knee. With therapy we have achieved significant  improvement in Logan’s strength and limb use (Video 2).

The biopsy of the brain tumor came back as an Oligodendroglioma, a generally “nasty’ neoplasm. We have followed a large number of these dogs and have seen many of them go for years without recurrence. There are no guarantees and we will follow Logan’s progress but are pleased with his recovery thus far.  Logan’s brain surgery was July 15th of 2014. His owners report he is already completely back to his normal self and they plan to meet with Dr. Snakard to discuss potential surgical management of his knee injury.

At VCA VRA we have the team, compassion and experience that will determine the best treatment options for your precious pet. We have the village!


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