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The surgery department at San Francisco Veterinary Specialists ran the numbers and compiled a listing of the 10 most common surgeries performed at the specialty hospital, as of June 2009.

Clicking on the name of a procedure below will link to corresponding educational material, including background conditions, procedure overviews and photos, on either the American College of Veterinary Surgeons (ACVS) website or the Veterinary Information Network’s VeterinaryPartner.com client education website.

1. TPLO – Tibial Plateau Leveling Osteotomy (For Cranial Cruciate Ligament (CCL) Rupture)
2. Extracapsular Suture (For Cranial Cruciate Ligament (CCL) Rupture)
3. Gastrotomy or Enterotomy for Foreign Body Removal
4. Fractures (Plates, Screws, ESF Placement)
5. Patella Luxation (Knee Cap) Repairs
6. Splenectomy (Spleen Removal)
7. Gastropexy (Surgery to Prevent Bloat)
8. Liver Shunts
9. Laminectomy/Fenestrations/Ventral Slots (For Disc Disease)
10. Anal Sacculectomy or Perianal Mass Removal

(Note that this list is probably quite different than that of a general veterinarian’s office. SFVS is a multi-specialty referral hospital; general vets often refer their patients to us for particular procedures. For example, you won’t see spays or neuters on this SFVS list. List updated June 2009.)

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When she was 7 months old, Olive, a Portuguese Water Dog, went into a coma during her spay surgery. She was transferred to an all-night veterinary hospital, where her guardian, Hannah, wondered what could have happened – why her healthy young dog of only a few months would go into a coma during a routine surgery like spaying. Olive’s blood work revealed a problem with her enzyme levels: Olive’s liver was not functioning properly. But, after receiving fluids and care from the hospital, Olive finally came out of her coma at 5 o’clock the next morning. Thrilled that Olive was conscious, Hannah took her home to the family to recuperate. A couple of weeks passed, and with Olive on antibiotics all seemed well. Then, Olive became very lethargic. She stopped eating her food and was constantly drinking water. Hannah noticed that she was growing, but not very quickly. Olive also had started bumping into things. After a trip to the veterinarian, Hannah learned that Olive’s enzyme levels were still off. This fact, followed by copious online research about Olive’s other behaviors, led Hannah to believe that Olive had an intrahepatic shunt.

What Is a Liver Shunt?

One of the liver’s primary functions is to remove toxins from the blood. A liver shunt is an abnormal blood vessel that allows blood to bypass the liver instead of passing through it. Shunts can either be within the liver (called intrahepatic) or outside the liver (extrahepatic). They can be congenital (present at birth) or acquired secondary to chronic liver disease.

Olive

Olive

In fetuses, a shunt is always present, so that the mother’s liver can do the work of cleaning the blood of toxins – as the fetus’s liver does not yet work. Usually the shunt closes soon after birth and the newborn’s liver takes over, filtering out toxins from the blood flow.

Sometimes, however, the shunt does not close properly, and a congenital shunt is formed, allowing unfiltered, contaminated blood to reach general circulation without being filtered through the liver. Toxins can build up in the bloodstream or kidneys. In addition, under normal circumstances, food is broken down or digested in the intestines and then absorbed into the portal bloodstream, which is carried through the liver. When a shunt is present, this flow is diverted; therefore, the pet lacks the necessary materials to help him grow and to give him a ready energy source.

While extrahepatic shunts are more commonly seen in small-breed dogs such as the Yorkshire Terrier, Havanese or Maltese Terrier, intrahepatic shunts occur more frequently in large-breed dogs. They are often reported in Labrador Retrievers, Irish Wolfhounds, Australian Shepherds, Australian Cattle Dogs, Samoyeds and Old English Sheepdogs. The incidence of shunts in the general dog population is 0.18 percent; it is a 36 times higher incidence in Yorkshire Terriers.

Clinical Signs

Shunts can be seen at any age, although congenital shunts are usually diagnosed before the pet is 1 or 2. Some common clinical signs of a shunt include the following:

  • Intermittent anorexia
  • Abnormal behavior after eating
  • Neurologic dysfunction such as head-pressing, circling, pacing or unresponsiveness
  • Episodes of apparent blindness
  • Excessive salivation
  • Pica (eating foreign material)
  • Seizures
  • Poor weight gain
  • Small stature, stunted growth, poor muscle development
  • Excessive sleeping, lethargy
  • Excessive water consumption, excessive urination
  • Straining to urinate due to bladder stone formation
  • Poor recovery after surgery

Through her research, Hannah identified and reached out to specialists with expertise in shunts, and eventually connected with Margo Mehl, DVM, Diplomate, American College of Veterinary Surgeons.

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image via Greyhounds Only, Inc.

image via Greyhounds Only, Inc.

The San Francisco Chronicle’s Ask the Vet column features SFVS dermatologist Helen Power today, answering a reader’s question about a greyhound with troubling red patches on her skin. The question:

The skin between and above my greyhound’s paw pads is red and now she has a red patch on her belly. Her vet prescribed Panalog (an ointment used to treat skin and ear infections or inflammation), but he didn’t make a diagnosis and the ointment hasn’t helped. These red patches are obviously bothering her because she’s licking the area. What could this be?

The answer: Allergy may be troubling dog

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In today’s Ask the Vet column, which runs every Wednesday and Saturday in the San Francisco Chronicle, SFVS animal behavior expert Sophia Yin, DVM, answers a reader’s question about a dog who has lost her love for car rides. The question:

Every morning, I take my two dogs for a drive in the car when I go to the coffee shop. They’ve always loved going, but all of a sudden, one of my dogs is afraid to get in the car. As soon as she sees me with the keys, she runs away. Nothing bad has happened in or near the car to hurt or frighten her, so I don’t understand this sudden fear. What could be causing this?

Read Dr. Yin’s answer: Getting rid of dog’s fear of the car

Last week was National Dog Bite Prevention Week – dog bites are considered to be a public health problem that is easily prevented. According to the CDC, “4.5 million Americans are bitten by dogs each year, and one in five dog bites results in injuries that require medical attention.” Yikes!

image from www.askdryin.com

image from www.askdryin.com

SFVS animal behaviorist Sophia Yin, DVM, recently spoke with PEOPLE Pets about this issue, answering such questions as “When a dog bite happens, who’s usually to blame: the person or the dog?” and “What advice do you have for behaving around unfamiliar dogs?”

An excerpt:

Do you have tips for preventing dog bites?
Set rules and boundaries, especially with children. The dog should have personal space, like a safe spot to be away from the kids. Have rules: If the dog is laying down resting, don’t bug him, but if you call him and he comes, you can play. That way you’re not pushing him to do something he doesn’t want to do.

Have a carrier or kennel the dog likes to rest in, and make a rule that you can’t bug the dog when he’s in his crate. Don’t go in with him, and don’t be outside making funny faces at the dog. And don’t bother the dog when he’s sleeping, chewing on a bone or eating his meal.

When kids do the things they love to do – like scream, run around, wrestle or play rough with a dog – they turn themselves into a human squeaky toy. The dog learns it’s fun to get out of control with them, even nip them like they would with their toys. This behavior teaches the dog to be overly excited, and allows him to play rough and in an unsafe manner. That’s not okay. Arousal and aggression are on the same continuum – if the dog gets too excited he could bite out of excitement.

Every time you’re playing with the dog and you’re getting him excited, you have to recognize if he has an “off switch,” meaning he’ll calm down on his own if you tell him in a normal voice to sit down and be still. If he doesn’t, it’s probably not safe to get him too worked up, and maybe he shouldn’t be playing that way, because the behavior will only lead to rough-housing and, eventually, a potential dog bite.

Check out the full article – Ouch! Dog-Bite Prevention Tips to Sink Your Teeth Into – for some more helpful tips.

Also, the CDC has a podcast where you can listen and learn about steps to prevent dog bites. (4:05 seconds)

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San Francisco Veterinary Specialists partners with the animal adoption centers at Pets Unlimited and The San Francisco SPCA to care for shelter pets in need of specialty treatment; the hospital donated nearly $100,000 in care in 2008.

e_sherman

photo by beth sherman

San Francisco, Calif., May 21, 2009 – Thanks to a unique partnership with San Francisco Veterinary Specialists (SFVS), Pets Unlimited and The San Francisco SPCA are able to provide homeless animals with the specialty care they often need. For instance, Sid the Shelter Cat, whose current address is the Pets Unlimited adoption center, was down on his luck and had an unfortunate run-in with a car – leaving him with multiple pelvic fractures, a hind leg fracture and a severely injured tail. Utilizing designated charity funds, SFVS – Pets Unlimited’s specialty referral partner – performed Sid’s surgery at no cost to Pets Unlimited (or Sid).

SFVS works closely with The San Francisco SPCA in a similar partnership. Tillie, a lively border collie mix, arrived at Maddie’s Adoption Center with a congenital defect of her back legs. SFVS specialists performed extensive corrective surgery to reposition her luxating patellas and realign her femurs.

Each month, SFVS donates a pre-determined amount of charity care to the two non-profits and their special-needs shelter pets. In addition, SFVS provides discounted care to rescue groups across the Bay Area, such as Guide Dogs for the Blind (Marin), Rocket Dog Rescue and Grateful Dog Rescue.

“For the past four years, we’ve been working closely with the two largest non-profit animal rescue groups in the city – Pets Unlimited and The San Francisco SPCA – along with other organizations, to help provide critical specialty services where needed most. As the only multi-specialty referral hospital in the city, we’re proud to extend our services when Pets Unlimited or The SF/SPCA calls on us,” said Craig H. Maretzki, VMD, MS, DACVIM, medical director at SFVS. “These partnerships are a ‘win-win.’ We are able to give back to the community in a meaningful, effective way, and the neediest dogs and cats get second, or third, chances.”

In 2008, SFVS donated nearly $100,000 in charity care and discounted services. SFVS does not offer discounted or pro-bono care to individual pet owners; instead, the hospital works solely with its organizational partners to identify and  care for the pets they refer.

“We have primarily been using SFVS’s charity funds for specialty surgery cases. This partnership with SFVS greatly expands our ability to deal with critical-needs cases like Sid, where we need to access specialty care outside of Pets Unlimited,” noted Thomas Mason, DVM, director of veterinary services at Pets Unlimited.

“The relationship between SFVS and The SF/SPCA has been instrumental in not only saving the lives of many dogs and cats who need specialty surgical care, but also dramatically improving the quality of their lives,” said Jan McHugh-Smith, president of The San Francisco SPCA.

Oh, and Sid? He’s doing great, according to his friends at Pets Unlimited. He’s on his way to finding a permanent home – and doesn’t seem to mind his little “Boxer” tail at all. And Tillie? She found a loving home and is now able to do what border collies do best – run!

For more information on Pets Unlimited, visit www.petsunlimited.org. The SF/SPCA is online at www.sfspca.org.

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We’re exploring the world of online video here at SFVS! Our first clip is an interview with Diana Bowen, DVM, MS, DACVIM, one of four Board-certified veterinary internists at SFVS.

Learn a little more about Dr. Bowen and what led her to veterinary medicine, as well as more about our hospital.

Stay tuned for more!

x_vid_Staff_Bowen

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Only 15 percent of U.S. animal hospitals are accredited by the American Animal Hospital Association; AAHA standards are recognized around the world as the benchmark for quality care in veterinary medicine.

San Francisco, Calif., May 11, 2009 – San Francisco Veterinary Specialists (SFVS), the first and only multi-specialty referral hospital in San Francisco, has received accreditation following a comprehensive evaluation by the American Animal Hospital Association (AAHA). The evaluation includes a quality assessment review of the hospital’s facility, medical equipment, practice methods and pet health care management.  AAHA_Referral_tag_right

Only 15 percent of all small animal veterinary practices in the United States have achieved accreditation by the AAHA. In order to maintain accredited status, SFVS must continue to be evaluated regularly by the association’s consultants.

“SFVS belongs to a select group of practices that are committed to meeting the highest
standards in veterinary medicine,” said John Tait, DVM, AAHA president. “AAHA hospitals pass a stringent evaluation of over 900 standards covering patient care, client service and medical protocols. By attaining accreditation, SFVS is demonstrating its dedication to offering the best care to its patients and clients.”

“SFVS is proud to be an accredited member of the AAHA. Our accreditation demonstrates our commitment to the highest standards of veterinary care. AAHA standards are recognized around the world as the benchmark for quality care in veterinary medicine,” added Craig H. Maretzki, VMD, MS, DACVIM, medical director at SFVS. SFVS is one of the only AAHA-accredited multi-specialty hospitals in the Bay Area.

Established in 1933, the AAHA is the only organization that accredits veterinary practices throughout the United States and Canada for dedication to high standards of veterinary care. Approximately 3,000 AAHA-accredited practices pass regular reviews of AAHA’s stringent accreditation standards. For pet care information or referral to an AAHA-accredited practice, visit www.healthypet.com.

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Dr. Drourr + Playdoe

Dr. Drourr + Playdoe

The May 2009 issue of Fetch the Paper includes an article by SFVS’s Lori Drourr, DVM. A recent addition to the SFVS medical team, Dr. Drourr completed her cardiology residency training at Texas A&M University and brings to SFVS a strong foundation in the management and care of congenital and acquired cardiac disease. Her Fetch article, titled “Heart Health Going to the Dogs,” covers the basics of canine heart disease, reviews treatment options, and offers suggestions for keeping your pup heart-healthy.

An excerpt:

When it comes to heart disease and your pet, regular visits to your veterinarian can make all the difference. During an examination, a veterinarian may detect signs pointing to heart disease, such as an irregular heart rhythm or a heart murmur. Early detection is key to learning about longterm prognosis and management. If your dog is a breed that is more likely to have heart problems, your veterinarian may refer you to a veterinary cardiologist for breed screening at an early age.

Read the full article: Heart Health Going to the Dogs (PDF)

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Continuing our medical staff spotlight series, SFVS’s Philip Watt, BVSc, MACVSc, FACVS gives us a glimpse of what life is like as a veterinary surgeon.

1. When did you know you wanted to be a veterinarian?

Dr. Watt at Work

Dr. Watt at Work

Apparently even as a small child it was the only thing I wanted to do. When I was in high school I debated between human and veterinary medicine and you can see how that turned out.

2. How long have you been at SFVS?

I started in August 2004, so coming up five years soon.

3. What are a few of the most common surgeries you perform at SFVS?

There are a wide range of surgeries that I perform, but certainly cruciate ligament repair is one of the most common procedures.  The other common stifle procedure I do is little dogs with dislocating patellas. With two oncologists on board the surgery department sees a lot of tumor removals and some of these require skin flaps or grafts. Last surgery we did seven procedures and all with the exception of a skin tumor removal were knee procedures.

4. I know the tightrope procedure has lots of buzz around it right now. What kind of results are you seeing?

I am finding that not all dogs are candidates for this procedure. The results can be excellent in lean medium-sized dogs.  Although they now make a smaller implant for dog under 15 lbs., this size dog does well with a simpler procedure (extracapsular repair). My preference remains a TPLO for large breed dogs although I have had excellent results in some of those dogs as well.  I warn owners that not all dogs will have a great result.

5. If there’s an emergency, are you “on call” like human surgeons?

As a surgeon you are often on call. For four years I was on call pretty much seven days a week. Now with Dr. Mehl here I am on call Monday to Thursday and every second weekend, so substantially better but it does make getting away difficult.

6. What’s the best part of being a veterinary surgeon?

There are a lot of good things about being a vet and a surgeon in particular. For the things that we think of as part of our job such as care for the animals and clients I still love being a vet. With surgery you do have an opportunity to make things better quickly such as with an intestinal foreign body or fracture. That appeals to my personality.

7. Do you have any free time? If so, what do you enjoy doing away from the hospital?

I do have some free time nowadays. I do like running and still manage to get to the gym at 6 during the week. I eat out once or twice a week and as everyone knows I love my wine. I haven’t had much of chance at gardening for the last six months but have been known to spend the entire weekend there, and now with spring here will be doing some of that in the new house.

8. Any pets of your own?

I have inherited from SFVS one dog and two cats. Ty is a lab pit bull cross (unless someone asks if he is a pit bull); Max is a Savannah (an interesting personality and I have the scars to prove it); Elliot is a slightly brain dead DSH. They all get on pretty well.

Thanks, Dr. Watt!

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