METROPOLITAN VETERINARY ASSOCIATES P roviding emergency care & specialized veterinary services

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A n e w l e t t e r f o r r e f e r r i n g veterinarian SPRING 2010 METROPOLITAN VETERINARY ASSOCIATES P roviding emergency care & pecialized veterinary ervice INSID E: p2-3 Focu on Canine Cranial

Veterinary Aociate & Emergency Service i a veterinary group that provide referral veterinary ervice.

ophthalmology, radiology (including CT and MRI) and urgery.

1 A n e w l e t t e r f o r r e f e r r i n g veterinarian SPRING 2010 METROPOLITAN VETERINARY ASSOCIATES P roviding emergency care & pecialized veterinary ervice INSID E: p2-3 Focu on Canine Cranial Cruciate Ligament Dieae p4 Pet Lo Support Group p4 Monthly Lecture Serie Inert Meet our Surgeon Inert Vet Imaging Partner WELCOME TO the third edition of our newletter Etablihed in 1986, Metropolitan Veterinary Aociate & Emergency Service i a veterinary group that provide referral veterinary ervice. We concentrate on pecialty and emergency cae, allowing u to dedicate high-level care to the following dicipline: behavior, cardiology, dentitry, dermatology, emergency, internal medicine, neurology, ophthalmology, radiology (including CT and MRI) and urgery. In order to maintain a high level of patient care, MVA moved into a newly renovated 18,000 quare foot facility with tate-of-the-art diagnotic and therapeutic equipment in If you haven t been able to viit our practice, we hope you can join u at one of the upcoming hopital lecture mentioned on page 4. Pleae enjoy thi newletter and let u know of any topic of interet you d like to ee explored in future edition. We ve made it eaier to contact u. Catch u 24 HOURS A DAY at 610/666/1050! (our primary phone number) DID YOU KNOW?

FOCUS ON CANINE CRANIAL CRUCIATE LIGAMENT DISEASE Behavior Laurie Bergman, VMD, ACVB Cardiology Micheal Miller. MS, VMD, ABVP Ria Roland, DVM, ACVIM (Cardiology) Dentitry Paul Orini, DVM, ACVS.

2 FOCUS ON CANINE CRANIAL CRUCIATE LIGAMENT DISEASE Behavior Laurie Bergman, VMD, ACVB Cardiology Micheal Miller. MS, VMD, ABVP Ria Roland, DVM, ACVIM (Cardiology) Dentitry Paul Orini, DVM, ACVS.AVDC Dermatology Karen B.Farver, DVM, ACVD Emergency Service Jame Buckman, VMD, PhD Jaon Chamberlin, VMD Francizek von Ee, VMD, ABVP Owen Fink, DVM Mary F. Heckcher, VMD Jennifer McGough, VMD Maria Suvannavejh, VMD Julie Banyacki, CVT, VTS (ECC) Practice Manager Internal Medicine Jame F. Dougherty, MS, VMD John DeBiaio, DVM, ACVIM Damon B Rodriguez. DVM, ACVIM Neurology Jerry W. Northington, DVM Ophthalmology Stephen L. Gro, VMD, AVCO Radiology Robert C. McLear, VMD, ACVR Surgery Lori W. Cabell, DVM, ACVS A. Jon Nanno, DVM Jacqui Nile, BVetMed, SAS, ACVS Catherine Popovitch, DVM, ACVS Timothy M. Schwab, VMD, Reident Cranial cruciate dieae i the mot common caue of lamene in the dog and i the mot frequently encountered orthopedic injury in veterinary medicine. Over the pat 40 year, numerou technique have been developed to overcome the intability created by the ruptured cranial cruciate ligament (CCL) and the ubequent oteoarthriti that develop. However, no perfect procedure ha been created that work in every animal or that halt the development of degenerative joint dieae over time. Pathogenei of cruciate dieae i multi-factorial and include trauma, abnormal tifle biomechanic, a well a biological factor. A recent review of caue of CCL rupture in the April 2010 iue of Veterinary Surgery ugget that only a mall percentage of animal with CCL rupture are a a reult of a ingle traumatic epiode. In fact, abnormal tifle biomechanic and biological change within the joint both play ignificant role in the deterioration of the CCL and ultimate rupture of the ligament. Current thought ha focued on the conformation of the proximal apect of the tibia (i.e. exceive tibial plateau angle and patellar tendon-tibial plateau angle) a primary underlying caue for cruciate ligament rupture, but there ha been no definitive evidence that thee change ignificantly increae the rik for cruciate dieae. Other have uggeted that there i a dyfunction of the paive and active tifle tabilizer (ligament, menici, joint capule, mucular upport), that metabolic/endocrine caue, or the inflammatory cacade perpetuate ligament deterioration. It eem clear that cruciate ligament dieae i caued by contribution of each of the aforementioned caue. With tifle incongruency, repetitive trauma, mucle weakne, and abnormal biology the inflammatory cacade i activated intra-articularly, perpetuating the deterioration of the cruciate ligament fiber, eventually cauing a complete tear. Numerou procedure have been developed over the year to addre cruciate ligament deficiency in companion animal, each with their own ubet of benefit, rik, and ucceful outcome. However, the goal of each of thee procedure remain the ame- to return tability to the tifle and to return the pet to a pain-free, active lifetyle. When evaluating urgical option to tabilize a cruciate deficient tifle, all of thee factor mut be conidered in order to attempt to elect the ideal urgical technique for each individual patient. Currently at Metropolitan Veterinary Aociate, we offer our client two different technique for the treatment of cruciate ligament rupture, 1) the lateral fabellar uture (LS) and 2) the tibial plateau leveling oteotomy (TPLO). The lateral fabellar uture technique i an extra-articular tabilization that remove cranial drawer of the tibia by placing nylon acro the joint in a poition that mimic the orientation of the cranial

3 cruciate ligament. The TPLO tabilize the tifle by rotating the tibial plateau to approximately 6 degree relative to the weightbearing axi. Thi change cranial tibial thrut into caudal tibial thrut and thi i counteracted by the caudal cruciate ligament. Both procedure are reported to have an 85%-90% good to excellent prognoi for full return to function with few complication, however, heated debate continue at all veterinary urgery conference a to which i the bet procedure to perform. In the literature, there ha been no evidencebaed proof of the uperiority of one procedure over the other. A comparion of the hort- and long-term function and development of oteoarthriti in dog having either TPLO or LS wa publihed in the February 2010 Veterinary Surgery. Thi tudy revealed there wa no ignificant difference in ground reaction force or development of oteoarthriti in dog receiving either urgical technique. However, thee animal alo received pot-operative phyical therapy. Owner are alo advied to maintain their dog at an ideal body weight and conider tarting their pet on a glucoamine/ chondroitin joint upplement if they have not already done o. Regardle of the urgical technique ued, mot animal are able to return to normal pre-operative activity level around 12 week pot-operatively. Dog that till have a degree of reidual lamene at 12 week pot-operatively often continue to improve for 6-8 month pot-operatively. Due to the ubequent development of oteoarthriti, many dog will require the tactical ue of non-teroidal anti-inflammatory drug (NSAID ) if they have period of mild lamene or tiffne, particularly aociated with heavier than normal activity level or cold, damp weather. When evaluating animal with cruciate ligament dieae at Metropolitan Veterinary Aociate, we evaluate each animal a an individual, taking into account conformation, breed, activity level, and biological factor. Our goal i alway to addre abnormal biology and biomechanic, decreae pain, retore function, and low the progreion of degenerative joint dieae. Pre-operative radiograph are evaluated cloely to determine if one procedure would produce better long-term outcome over another. We find it important to educate owner on each procedure and work with them to decide on the bet urgical option for their pet. Other factor taken into conideration when chooing a urgical technique include the weight and temperament of the dog, it expected activity level, owner finance and the preence or abence of cruciate ligament dieae in the contra-lateral tifle. It i import to remind owner that even if their dog i currently ound in the other tifle, they have a 40-50% chance that their dog will develop cruciate ligament rupture in the other tifle within 1-2 year of the firt ide becoming clinical. Pot-operatively, animal are monitored cloely and recommendation are made to help them achieve a full recovery. We have found that pot-operative phyical therapy play an important role in rapid recovery, improved weight bearing, and full range of motion and each client i encouraged to have their pet participate in a program near them. Pot-operative radiograph of a giant breed dog after tibial plateau leveling oteotomy (TPLO).

DO YOU WANT TO GO GREEN? Have thi newletter electronically ent to you by contacting Stacey Connell at 610/666/1050 or email to connell@metro-vet.

beloved four-legged family member ha paed. For that reaon, Metropolitan provide a pet lo upport group to help grieving owner in need.

Pleae contact u at 610/666/1050 if you would like to have Pet Lo Support Group brochure mailed to your office.

4 DO YOU WANT TO GO GREEN? Have thi newletter electronically ent to you by contacting Stacey Connell at 610/666/1050 or to METROPOLITAN VETERINARY ASSOCIATES 2626 Van Buren Avenue Norritown, PA PET LOSS SUPPORT GROUP Many of our employee have experienced and undertand the depth of lo one experience when a beloved four-legged family member ha paed. For that reaon, Metropolitan provide a pet lo upport group to help grieving owner in need. Our pet group i deigned to provide grieving pet parent with a afe, confidential environment to hare their feeling with other who have experienced pet lo. Pleae contact u at 610/666/1050 if you would like to have Pet Lo Support Group brochure mailed to your office. Client are able to viit our webite to find meeting date and time, general information and recommendation on obtaining help outide of the group etting. Pet Lo Support Group meeting held monthly for your client (and are free of charge). Pleae contact u at for more information or for brochure FOR OUR MONTHLY HOSPITAL LECTURES PRESENTER/TOPIC To get a lit of topic and peaker pleae viit our webite in the for referring veterinarian ection UPCOMING DATES/TIMES 6/17/10/6pm 7/15/10/6pm 8/12/10/6pm 9/16/10/6pm 10/14/10/6pm ALL LECTURES WILL BE HELD AT METROPOLITAN Dinner provided :: Space i limited Stacey Connell at 610/666/1050 or connell@metro-vet.com SAVE THE DATE 10/28/10 CE FOR VETERINARIANS More detail to come! RSVP The meeting are held once a month onite at Metropolitan and are free of charge for your client (all family member are invited to attend). The group i led by Dr. Cari Thomon and co-led by pychiatrit Dr. Carol Tavani. JOIN US tel 610/666/1050 fax 610/666/1199 webite

SAFE MRI & HIGH QUALITY IMAGES ADJACENT TO METROPOLITAN VETERINARY ASSOCIATE S BUILDING FINALLY, A SAFE NON-INVASIVE DIAGNOSTIC TOOL AT

2) How can I help my owner obtain all the information they need?

control difficultie Seizure Head tilt Neurological ymptom Hind limb hypermetria Oncology iue Hind limb weakne Brain tumor ANSWER: DIAGNOSE

Reult: Severe pinal cord compreion, level L1/L2, L2/L3, caued by intervertebral dic herniation.

and patient. OUR RESULTS 7-Year-old Golden Retriever with left ided naal bleeding over the pat two month.

5 SAFE MRI & HIGH QUALITY IMAGES ADJACENT TO METROPOLITAN VETERINARY ASSOCIATE S BUILDING FINALLY, A SAFE NON-INVASIVE DIAGNOSTIC TOOL AT YOUR DOORSTEP THAT CAN ANSWER THESE QUESTIONS: 1) How can I obtain quality information to make good clinical deciion? 2) How can I help my owner obtain all the information they need? 3) How can I enhance my practice when dealing with patient that arrive with: Ataxia Parei Cervical pain Tetraparei Lamene Trauma Urinary control difficultie Seizure Head tilt Neurological ymptom Hind limb hypermetria Oncology iue Hind limb weakne Brain tumor ANSWER: DIAGNOSE WITH MRI AT VET IMAGING PARTNERS 9-Year-old German Shepherd with hitory of worening neurological ymptom. Reult: Severe pinal cord compreion, level L1/L2, L2/L3, caued by intervertebral dic herniation. COME MEET OUR DOCTORS to chedule your patient MRI or to ANESTHESIA: CALL US TODAY peak with our taff about how we can erve your practice and patient. OUR RESULTS 7-Year-old Golden Retriever with left ided naal bleeding over the pat two month. Reult: A left ided naal cavity ma extending through the choana and lightly through to the right of midline within the naal pharynx. Radiotherapy treatment wa planned. Sandra Perkowki, VMD, PhD, Dipl ACVA RADIOLOGY: Alexia McKnight, DVM, DACVR, McKnight Inight Robert C. McLear, VMD, DACVR, PetRad CONTACT 877 DOG SCAN (877/364/7226)

MEET OUR SURGEONS LORI W. CABELL DVM, ACVS Dr. Cabell completed her veterinary degree in 1988 from the Univerity of Tenneee.

Cabell joined the taff of Metropolitan Veterinary Aociate in 1997 and completed her board certification in urgery in 1998.

Nanno wa awarded a cholarhip to attend Aritotle Univerity School of Veterinary Medicine in Salonica, Greece.

Nanno then completed an internhip in medicine and urgery in 1987 and a reidency in urgery in 1990 at the Univerity of Pennylvania.

Nanno joined Metropolitan Veterinary Aociate in 1993. He perform all apect of urgery with a pecial interet in orthopedic and neurological urgery a well a oft tiue procedure.

She pent three year in private veterinary practice and then completed a three year urgical reidency at Liverpool Univerity in the UK.

6 MEET OUR SURGEONS LORI W. CABELL DVM, ACVS Dr. Cabell completed her veterinary degree in 1988 from the Univerity of Tenneee. She purued a rotating internhip and urgical reidency at the Univerity of Pennylvania from 1991 to Dr. Cabell joined the taff of Metropolitan Veterinary Aociate in 1997 and completed her board certification in urgery in Her urgical interet lie with general orthopedic, neurologic, and oft tiue urgery. A. JON NANNOS DVM After earning hi bachelor degree from Drexel Univerity in Philadelphia, Pennylvania in 1979, Dr. Nanno wa awarded a cholarhip to attend Aritotle Univerity School of Veterinary Medicine in Salonica, Greece. He graduated in 1984 and returned to Philadelphia to complete clinical rotation at the Univerity of Pennylvania School of Veterinary Medicine in Dr. Nanno then completed an internhip in medicine and urgery in 1987 and a reidency in urgery in 1990 at the Univerity of Pennylvania. From 1990 to 1993 he intructed veterinary tudent in urgery at the Veterinary Teaching Hopital of the Univerity of Pennylvania a a faculty orthopedic urgeon and lecturer. Dr. Nanno joined Metropolitan Veterinary Aociate in He perform all apect of urgery with a pecial interet in orthopedic and neurological urgery a well a oft tiue procedure. JACQUI NILES BVETMed, SAS, ACVS Dr. Nile obtained her veterinary degree from the Royal Veterinary College, London, England in She pent three year in private veterinary practice and then completed a three year urgical reidency at Liverpool Univerity in the UK. She then croed the Atlantic to complete a further three year of advanced urgical training at The Ohio State Univerity and became board certified in urgery in She wa a faculty urgeon at Purdue Univerity and taught veterinary tudent for three and a half year prior to working in private pecialty practice in Indiana. She joined Metropolitan Veterinary Aociate in January Her urgical interet include TPLO for the management of cranial cruciate ligament rupture in dog and all type of oft tiue urgery, epecially portoytemic hunt, thoracic urgery and oncologic urgery. CATHERINE POPOVITCH DVM, ACVS, ECVS Dr. Catherine Popovitch joined Metropolitan Veterinary Aociate in She completed her undergraduate degree in cience at the Univerity of Guelph and received her DVM degree from Ontario Veterinary College in Following veterinary chool, Dr. Popovitch completed an internhip in mall animal medicine and urgery in 1990 and a reidency in mall animal urgery in 1993, both at the Univerity of Pennylvania School of Veterinary Medicine. Following the reidency Dr. Popovitch wa an intructor in Small Animal Surgery at the Veterinary Teaching Hopital of the Univerity of Pennylvania School of Veterinary Medicine before developing a provide conulting practice in mall animal urgery. While pecializing in all apect of mall animal urgery, Dr. Popovitch ha pecial interet in orthopedic urgery, fracture repair, and angular limb deformitie. TIMOTHY M. SCHWAB VMD, Reident Dr. Schwab i a reident in mall animal urgery at Metropolitan Veterinary Aociate with pecial interet in orthopedic, portoytemic hunt, and minimally invaive urgery. He i a graduate of the Univerity of Pennylvania Veterinary School in Dr. Schwab completed a rotating mall animal urgery and medicine internhip at Florida Veterinary Specialit in He attended Denion Univerity and graduated in 1998 with a major in environmental tudie concentrating in marine biology. CALL US 24 HOURS A DAY :: 610/666/1050 VISIT US AT TODAY METROPOLITAN VETERINARY ASSOCIATES

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