Advanced Procedures
at the
Range Animal Hospital
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| Advanced Medicine | Orthopedic Surgery |
| Advanced Dentistry | Neurosurgery |
| Large Animal Medicine & Surgery | Soft Tissue Surgery |
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Endoscopy
Electrocardiography
Intraoperative Frozen Section Diagnosis
Endoscopic Biopsy
Contrast Radiography
Advanced Intravenous Therapy
Whole blood and plasma transfusions
Endoscopic Foreign Body Removal
Chemotherapy
Oxygen Therapy
Simple Fracture Repair
Complex Fracture Repair
Pelvic Procedures
Stifle Reconstruction
Fore Limb Procedures
Bone Grafts
Non-Union / Delayed Union
Surgical Disk Disease
Skull Fractures
Abdominal Techniques
Cardio-Respiratory Techniques
Surgery of the Perineum
Surgery
Medicine
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Our Thoughts on these Procedures
Anterior Cruciate Ligament and menisceal injuries
These should be operated on as soon as it is established that the
knee will not restabilize. My protocol is to Anesthetize the
animal and palpate for drawer movement. They are graded 1 to 4.
Four's are operated on immediately. Three's and two's and one's
are given Bute or Rimadyl for 7 days, rested, and repalpated in 14
days, again under anesthesia. If drawer movement improves to zero
or 1, we monitor for lameness and operate only if the lameness
persists for 3 more weeks. If the drawer movement remains at two
or more they are operated on immediately. I strongly believe that
an unstable knee will cause irreparable harm in 5-6 weeks, and the
greater the instability the faster and more severe the harm. I
have operated on too many knees that were neglected, for even short
periods of time, with less than perfect results. Early operations
uniformly result in good results.
Chronically painful cervical disk patients should have a myelogram
to absolutely establish the diagnosis and then be fenestrated.
This is highly successful.
Acute cervical disk disease with neurologic losses, but are still
ambulatory, should be treated medically. Surgery is indicated if
5-7 days of treatment is not giving improvement. Remember, EXTREME
REST is the cornerstone of medical treatment. Along with that I
give Bute or Rimadyl and Dexamethasone in a decreasing dosage.
Acute disease with partial but profound paralysis, i.e. not
ambulatory should have a myelogram and fenestration as soon as
possible. Start dexamethasone in high doses and give pain killers
as needed.
Acute disease with complete paralysis need an immediate myelogram
and fenestration or hemilaminectomy. Begin dexamethasone at high
doses and provide pain relief.
Acute disease with minimal neurologic losses should be treated
medically.
Acute disease with partial paralysis should be treated medically
and monitored closely. Slow return to function is a strong
indication for surgery.
Acute disease with profound paralysis is an indication for an
immediate myelogram and hemilaminectomy. Complete paralysis only
makes this recommendation stronger. Many doctors would argue that
some dogs with some function can be treated successfully with
medical care. My experience is that a more rapid surgical
intervention greatly improves the outcome. We all know that in
severe disk disease, waiting only closes and locks doors. Early
intervention results in a much better success, and delayed
intervention GREATLY reduces the surgical outcome if medical care
was ineffective. When I do a hemilaminectomy, I also fenestrate
all of the neighboring disks that are in the surgical field
(usually 2-3 above and below). This is a very effective preventive
for future disease.
Call with details, fees vary greatly from an uncomplicated
unilateral ileal fracture to bilateral fractures with acetabular
involvement or sacroiliac luxation.
This is can be a very rewarding procedure with dramatic results.
Some are not so good. The client must be informed and motivated.
These cases need to be very carefully selected and in the right
circumstances can be very successful. Again, the client must be
informed and motivated.
This is a good salvage operation for severe arthritis in a dog that
did not receive proper care for an ACL injury. It is best done in
a young dog with severe unilateral disease.
I do the toggle procedure which is very successful, technically
simple, cost effective, and minimally invasive. These dogs usually
go home walking on all four's the following day. This is assuming
that there is no dysplasia.
As a general rule I both move the tibial tubercle and deepen the
patellar groove. Very often by doing only the poorest side, the
not so bad side will be OK for the rest of the dog's life. This is
a highly rewarding procedure.
This is a good method of obtaining a high quality specimen of a
nasal mass with out being technically difficult or or aggressively
invasive.
These cases also require careful selection. The trans-oral nasal
biopsy may be a better place to start.
This is another example of a disease process that responds best to
early surgical intervention. Many dogs in the early stages of this
disease will have an occasional impaction and do all right on fecal
softeners, but when this is no longer working, surgery is now more
difficult and the results not nearly as good. These dogs should be
operated on as soon as the problem is identified.
This is also a very rewarding procedure on a tom cat that has
plugged up for the second time despite medical treatment. It is
also a good procedure for families that are not reliable about
dietary treatment. On a young cat it is likely more cost effective
than a lifetime of prescription food.
The classic tooth requiring restoration is a slab fracture of the
carnassial tooth of the dog. Many also require root canal therapy
as a result of an open pulp chamber. If the fracture extends below
the gum line, the pocket created will pack with food and result in
rapid tooth loss. It is important to lift a gingival flap and to
restore the buccal bulge to prevent this. If that is not possible,
gingivectomy is in order. We do not do restorations on cat neck
lesions. The more cats that I radiograph, the more I see that
these lesions, while they look small, have resulted in major damage
to the tooth structure. I do not believe this is a valuable
procedure in the cat.
We believe that a root canal is reasonable on the canine teeth and
the major grinding molars. If many of these teeth are missing,
then it may be reasonable to salvage some of the other teeth with
this procedure. Age and general health is also a major factor. We
do not do root canals on 18 year old dogs with leaky hearts and
marginal kidneys. Most root canals can be done as one procedure,
but an occasional one will require two. We do composite
restorations with the primary goal of returning function, not
anatomy to the crown. In the last six months our practice has seen 8
dogs that we recommended root canal therapy for. They are more
common than I thought.
Many complex and severe maxillary fractures respond very nicely to fixation with an oral brace made of surgical wire and acrylic. This is a minimally invasive procedure, and is very cost effective. Often the need of endodontics for the teeth that are vascularly compramized is the greater cost. While there is some owner aftercare, it is not difficult.
Mandibular symphysis fractures are simarilly treated with wires and acrylic. Other mandibular fractures are treated with a varity of techiques, but most are not difficult.
Reconstructive surgery of the Equine Patient
We have found that most clients are pleased to invest the time and
money for an all out Cosmetic Reconstruction of their horse after
it has been "busted up." Our fees are typically much less than the
value lost by an inadequate reconstruction. Lets face it, a $5000
show horse with an ugly scar running down its leg is not worth
$5000. Unfortunately veterinary schools did not do the best job in
teaching cosmetic reconstructive surgery. We have made the effort
to learn what they did not teach.
Modified Forssell's Procedure for the Cribbing Horse
It involves cutting some of the muscles and nerves of the ventral neck and the removal of some muscle tissue. In almost all cases it does not result in any cosmetic problems. We have done this procedure a few times, all with wildly successful results. We all will agree that cribbing is a horrible vice.
| About our Hospital. | Meet our Staff. | Routine Procedures. |
| Policies & Procedures. | Advanced Care. | All about Referals. |
| How do I get There? | Give us your Comments! |
Revised 5-2-02