Oncology - Hickory Veterinary Hospital

Tel: 610-828-3054
Fax: 610-828-8465
Pennsylvania Veterinary Specialty
and Emergency Associates
Newsletter for
our referring
Veterinarians
Hickory Veterinary Hospital
Meet
Lighthouse
An Article by
Melissa McGrath
pg2
Hickory Veterinary Hospital
2303 Hickory Road
Plymouth Meeting, PA 19462
ISSUE: VOLUME1
Melissa McGrath, DVM
Number 1
Oncology
Open 24 Hours 7
Days a week all year
News & Events
Mast Cell Tumors
Online prescription refill request
at www.hickoryvet.com
click on “pharmacy”
Vet News
Spring 2014
MRI
IS HERE!!
Medical Boarding for Cats, Dog,
and Exotics
The Pennsylvania Veterinary Specialty and
Emergency Associates at Hickory Veterinary
Hospital continues to have 24 hour medical
boarding. We have doctors and technicians on
staff to take care of our medical boarders during
their stay at our hospital. We also offer 24 hour
emergency services, medical boarding and
boarding exotics pets all year round and during
the holidays.
The mast cell tumor is the most common skin tumor in dogs and the second most
common skin tumor in cats. They can present in a wide variety of ways and can be
initially misdiagnosed as a benign lesion. We recommend a fine needle aspirate and
cytology be performed as an initial diagnostic step for any new mass. Once cytology
confirms a mast cell tumor, a biopsy of the tumor is the next appropriate step. This surgery
usually requires an experienced surgeon so that the best chance of getting clean margins
occurs. The current recommended for removal of mast cells is 2 cm around the tumor and
one fascia plane deep. The goal of the biopsy is to determine the grade of the tumor. Mast
cell tumors can have a variable histologic appearance and this can make it difficult to give
the appropriate grade. Currently most pathologists are
grading tumors with both the
older, Patnaik grading system,
as well as the newer, 2-tier
histologic grading system,
developed by M. Kiupel et al
(Vet Path, 2009). Even with
the development of the newer
grading system there are still
some tumors that are given a
low grade but are biologically
more aggressive and behave
as a high grade tumor.
Therefore, once the biopsy is
performed the oncologist will recommend that a mast cell tumor (MCT) panel be
performed. This panel is a new way to further evaluate the tumor. A MCT panel includes
evaluation of cell proliferation (Ki-67, AgNOR), c-Kit PCR to detect internal tandem
duplication (ITD) mutations of exon 11 and exon 8, and KIT immunohistochemistry to
analyze the expression of the tyrosine kinase receptor.
Running the full panel can help give a better understanding of the how this tumor may
behave and assist in determining the best treatment plan for your patient. For example,
MCT with ITD mutation on exon 11 are seen in 20-30% of MCT and are more aggressive
but are also responsive to our tyrosine kinase inhibitors (TKI), like Toceranib, whereas
other tumors may not be as responsive to TKI’s and therefore traditional
chemotherapy may be recommended. Our oncologists review the mast cell tumor panel
and then assist the client in determining the best treatment plan for the patient.
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Our oncology department is available to answer any questions you may have about the
MCT panel or any other oncology related concern you may have.
The PVSEA Hickory Veterinary Hospital
now scheduling MRI services.
Now Offering Laparoscopic Surgeries
Nancy Brown has been recognized by
ACVS as a Founding Fellow, Surgical
Oncology award
Contents
Mast Cell Tumors ………….. Page 1
Meet Lighthouse ………….. Page 2
Welcome: …………………….. Page 3
Michael Kowaleski, DVM,DACVS
Louis DelGiudice, DVM, DACVECC
Laparoscopic Surgery ……Page 3
Referral Coordinators:
Kathleen Smith,
Melissa Prendergast
Stephanie Baron
Fees:
Specialty consult fee $140.00 - $225.00
ER visit $120.00 - $140.00 plus diagnostics
Website: www.hickoryvet.com
E-mail: [email protected]
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Meet Lighthouse
Surgery
Nancy Brown, VMD, DipACVS,
DipACVIM-Oncology Founding
Fellow, Surgical Oncology
Stephanie Dobbins, DVM
Melissa McGrath DVM – Resident
Total Hip Replacement
Stephanie Dobbins, DVM
Michael Kowaleski, DVM, DipACVS
Oncology
Nancy Brown, MA, VMD,
Dip ACVS, DipACVIM-Oncology
Founding Fellow, Surgical Oncology
Amy Koterbay, BVMS
Cardiology
Cecelia Helenski, MS,DVM
Rehabilitaion
Michelle Rupp, VMD, CCRT
Gina Chambers, DVM, CCRT
Ophthalmology
Seth Koch, VMD, DipACVOCritical
Critical Care & Emergency Medicine
Louis DelGiudice, DVM, DipACVECC
Ashley Boucek, VMD
Matthew Turner, DVM, MSc
Ersin Ulke, VMD
Neurology
William J. Kay, DVM, DipACVIM, DABVP
Dermatology
Kevin Byrne, DVM, MA, DipACVD
Ultrasound
Jennifer Reetz, DVM, DipACVIM, DACVR
Allison Clemens, DVM
Primary Care
Allison Clemens, DVM
Debra Eisenstein, VMD, Ph.D
Gina Chambers, DVM, CCRT
Ann Mitchell, VMD
Interns
Anna Bierwiaczonek, DVM
Nancy Callori, VMD
Jessica Wilbourne, BVetMed, MRCVS
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“Lighthouse” Slaughter, a 5 year old female spayed German Shepherd mixed breed canine, presented to Pennsylvania Veterinary Specialty and Emergency Associates at Hickory Veterinary Hospital on
February 9, 2013 after falling through the floor at a construction site. On presentation, “Lighthouse” was
non-ambulatory, paraparetic, and painful on palpitation of the dorsal lumbar spine. Her neurological
exam revealed absent conscious proprioception in the spine pelvic limbs, diminished sensation in the
pelvic limbs, deep pain present, normal to hyper-reflexive withdrawal reflexes, and rigidity of the thoracic
limbs.
A chemistry panel revealed a moderately elevated, and ALT (371U/L,normal 10-100U/L) and
moderate hypokalemia (2.9mmol/L, normal3.5-5.8mmol/L). A complete blood count was within normal
limits. Spinal radiographs performed as giving 1.6mg Hydromorphone IV (0.7mg/kg) revealed a step-up
lesion and narrowing of the L2-L3 intervertebral disc space, with dorsal luxation of the third lumbar vertebra. Urinary bladder calculi were also detected on the radiographs.
On February 11th, “Lighthouse” was placed under general anesthesia and a CT study with contrast was performed, the CT revealed a laterally
displaced fracture of the left pedicle of L3 with a
small osseous fragment arising from the left lamina of L3 was present within the spinal canal dorsally over L3. A slight step was detected between
L2-L3, but no obvious subluxation of the facet
joints was observed. A non-displaced fracture,
arising from the mid-aspect of the cranial endplate
of T1 extending caudodorsally through the dorsal
aspect of the cranial-mid vertebral body of T1,
was also detected. A fracture through the left
lamina/pedicle that was minimally displaced and a non-displaced fracture through the left transverse process at the junction with the vertebral body was also present. No compression of the spinal cord was present at this time.
“Lighthouse” was transferred to surgery to repair the subluxation, A fracture of the
left L2-L3 dorsal facet was detected with the
right dorsal anticular facet remaining intact. A
left hemilaminectomy was performed that revealed hemorrhage and an osseous fragment
within the dorsal spinal canal, which was removed. A 6-hole 2.7mm dynamic compression
plate was applied on the left vertebral bodies,
with 3 screws in the body of L2-L3. A second 4-hole dynamic compression
plate was applied on the right side of the vertebral bodies, with 2 screws in L2
and one in L3. Good stability was achieved with fixation, and a fat was graft was
placed over the hemilaminectomy site. “Lighthouse” recovered well from surgery, and was maintained with orthoplast dorsal spinal bracc from her cervical spine to the tail base, in
order to support her fracture repair and provide support to the non/minimally displaced fracture of T1.
“Lighthouse” had intensive post-operative care with monitoring of her urine output, pain medications,
antibiotics, and rehabilitation multiple times per day. Rehabilitation included passive range of motion,
standing exercises, brushing of the quadriceps/hamstrings/gastrocnemius muscles, laser therapy, message,
and electrical stimulation.
Three days post-operatively, “Lighthouse” and regained strength in the left pelvic limb and was
discharged to her owner on March 1st. She spent a total of 20 days in the hospital. To date “Lighthouse”
is doing very well. She moved back to New York City with her owner, and is walking on her own with
no additional support. She continues to have mild spinal ataxia in the pelvic limbs, but overall her longterm prognosis is very good.
Pennsylvania Veterinary Specialty and Emergency Associates
Hickory Veterinary Hospital
Welcomes Orthopedic Surgeon Dr. Michael Kowaleski and Critical Care and Emergency Medicine Specialist Dr. Louis DelGiudice
Louis DelGiudice, DVM, DipACVECC
Louis A DelGiudice, DVM, DACVECC is originally from Brooklyn, NY and moved to Pennsylvania during
high school. He obtained his bachelor’s in Small Animal Science at Delaware Valley College in Doylestown, PA
and then his DVM from Purdue University in Indiana. Dr. DelGiudice practiced for a couple of years and then decided to complete a residency in emergency and critical care medicine in Los Angeles, CA. He became a boarded
diplomat by the American College of Veterinary Emergency and Critical Care in 2009 and was actively involved in
training fourth year veterinary students, interns, and residents in emergency and critical care.
Dr. DelGiudice is a member of the American Veterinary Medical Association, the Veterinary Emergency and
Critical Care Society, as well as the human Society of Critical Care Medicine. He serves on several committees for
the American College of Veterinary Emergency and Critical Care.
Dr. DelGiudice has just recently returned to Pennsylvania and joined Pennsylvania Veterinary Specialty and Emergency Associates at Hickory Veterinary Hospital. He has extensive training in thoracic and abdominal ultrasonography as well as emergency surgery. He also has a special interest in trauma, respiratory emergencies, and coagulation abnormalities. Dr. DelGiudice will serve as department head for the emergency and critical care service and
will oversee all cases seen through the department.
H ICKORY V ETERINARY H OSPITAL
IS
H APPY
TO
A NNOUNCE V ISITING O RTHOPEDIC S URGEONS
Dr. Timothy McCarthy, DVM, PhD,
DACVS (Surgery)
Michael Kowaleski, DVM, DipACVS
Dr. Kowaleski received his
Bachelor of Science from the University of
Massachusetts at Amherst (1989); DVM at
Tufts University (1993) and surgical residency from Tufts University/Angell Memorial Hospital (2002). Dr. Kowaleski
was an assistant professor, then associate
professor, of orthopedic surgery at The
Ohio State University.
Areas of expertise:
• Total Hip Replacement • Joint replacement • Arthroscopy •
Stifle (knee) surgery • Corrective Osteotomy
Dr. McCarthy received his undergraduate
degree at Oregon State University and his
DVM from Colorado State University for
Veterinary School in 1969. After two years in
practice he returned to Colorado State University for six years of advanced training in
veterinary surgery leading to board certification by the American College of Veterinary
Surgeons in 1978 and a PhD in Veterinary
Surgery in 1981. Dr McCarthy then spent
three years practicing as a small animal surgeon in California before moving to Portland
in 1981, where he was the first board certified surgeon in private practice in
Oregon. In 1985 he started the Surgical Specialty Clinic for Animals where
endoscopy developed into the main focus of the practice and the primary
expertise of Dr. McCarthy.
Areas of expertise:
• Transurethral Cystoscopy • Rhinoscopy • Otoscopy
•
Arthroscopy • Transabdominal Nephroscopy
Hickory Veterinary Hospital is proud to offer a new and exciting service, laparoscopic surgery!
Laparoscopic surgery, has gained huge popularity as a minimally invasive surgery in the world of human medicine and this
technique has now moved over into veterinary world. Laparoscopy is
done by making a very small incision and inserting a laparoscope or camera in to the abdominal cavity. The abdomen is then filled up with carbon dioxide (a safe, absorbable gas) to easily see all the organs in the
abdomen. The images are magnified and viewed on a monitor during the
surgery while the surgical procedure is being preformed. This service
will be available for ovariohysterectomy, biopsy, gastropexy, and to aid in diagnosing complex problems.
Laparoscopic surgery comes with many benefits including, but not limited to, less pain, shorter recovery time and smaller incisions. Patients rarely
need an Elizabethan collar post surgery as the incisions are smaller and can often be closed with absorbable suture material.
In addition to Laparoscopic surgery, Hickory also offers “state of the art” cystoscopy for female dogs and cats. This procedure
allows for removal of urinary bladder stones, biopsy of the bladder and evaluation of the bladder wall.
Endoscopy is also available for non- invasive removal of foreign bodies and biopsies of the stomach, intestinal tract and colon. If you are interested in
any of the above procedures for your patients, please do not hesitate to call 610-828-3054!
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