ARH wins the National Practice of Excellence Award

De cember 2013
Treatin g yo ur p et s a s t h e memb ers o f o ur f a mi ly
ARH wins the National
Practice of Excellence Award
The Australian Veterinary Association
Practice Management (AVAPM) Practices
of Excellences Award recognises veterinary
practices that provide outstanding service to
their clients, acknowledges excellence and
encourages veterinary practices Australia
wide to improve their overall practice
management.
AVAPM and Hill’s are proud to announce
the Animal Referral Hospital is this year’s
Small Animal Practice winner, says AVAPM
Executive Officer, Mark Fraser.
Tall
I S S UE #11
“With an outstanding offering of entries, the ARH stood out with their
attention to detail and superior client service. Well done to the team at the
ARH,” says Mr Fraser.
ARH General Manager Troy James and hospital co-director and surgeon
Dr Sarah Goldsmid travelled to the AVA Conference in Cairns last month
to collect the award.
“It’s really exciting for the ARH to win this prestigious award,” says Mr James. “We received an excellent rating of
90.6 per cent! This shows we are on the right track with what we are trying to do with our customer service.
”Since relocating to Homebush from Strathfield in 2010, the ARH has gone through a large expansion of staff and
services and invested in a lot of training. Currently, the ARH employs 120 people.
“We’ve spent a lot of time sourcing the right staff from human
specialists backgrounds, making sure they are trained, and I
think that reflects on the service they provide,” says Mr James.
Take a look at the reception area, you’ll see thank you cards
and a constant stream of flowers and cakes to show how much
clients appreciate the quality and genuine care the ARH staff
provides to their ‘best friends’.
“We also have a feedback book at the front desk, which has
been received very well. We also get emails and messages on
Facebook, which is wonder ful,” he says. “I think we’ve got some
excellent specialists and support staff, which makes a business,
and we are very fortunate.”
DE CE MBER TAI LS
P.1 Practice of Excellence Award
P.4 MRI Quiz (cont.)
P.2 Trusting Your Instincts
P.5
Welcome Sandra Nguyen
P.3
MRI Quiz
P.6 New Equipment at the ARH
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DECEMBER TAILS
P.1 Bone Marrow Transplantation
P.2 Bone Marrow Transplantation
P.3Focus on Medicine
New Medicine Specialists
Mechanical Ventilation in Dogs
P.4Focus on Medicine (cont.)
Black Snake Envenomation in Dogs
P.5
ARH Baulkham Hills
Clinical Study
P.6 Pfizer Clinical Training Wing
The Oesophageal Foreign Body That Wasn’t
[email protected]
www.arhvets.com
A case of trusting your instincts – “Seti” a 7yo MN Kelpie
By Dr Ingrid Goodman (Medicine Intern)
Seti presented to the Animal Referral Hospital Emergency and Critical Care Service
for assessment of acute onset of reluctance to settle, hypersalivation and lip-smacking.
Seti, being an epileptic managed with phenobarbitone therapy for some years, was
always ravenous and had the night prior to presentation eaten a beef rib bone with
gusto. His clinical signs had developed soon after ingestion of the bone and had
not resolved, hence his presentation. At the time of examination, Seti was showing
clinical signs consistent with oesophageal disease and an oesophageal foreign body
was high on the list of differential diagnoses. Thoracic radiographs per formed by
one of our emergency clinicians and surgery intern, Dr James Brown, confirmed
the suspicion of an oesophageal foreign body. Haematology and biochemistry were
per formed prior to an anaesthetic and were unremarkable. Seti was referred to Dr
John Angles of our internal medicine service and the foreign body was removed
with ease. In fact, the bone was removed too easily, and at the time of the procedure
Dr Angles was suspicious that there may have been an underlying pathology of the
oesophagus that predisposed to the bone becoming lodged, as the bone was only
small, and not irregular in size and should really have passed through to the stomach.
Oesophagoscopy following removal of the bone was unremarkable.
Seti
Seti recovered well and was discharged the day after his procedure, but returned two days later having not eaten since his
discharge and was noted to be markedly dyspnoeic. Thoracic radiographs at that time showed a large volume pleural effusion.
The pleural effusion was drained with ultrasound-guidance by Dr Katherine Briscoe, another of our internal medicine specialists,
and post-drainage radiographs revealed evidence of aspiration pneumonia and a widening of the caudal mediastinum. Pleural
fluid analysis revealed a pyothorax and Acinetobacter spp. and Pseudomonas aeuruginosa were cultured. The cause of the
pleural effusion at that time was puzzling – did we have a parapneumonic spread from aspiration pneumonia, or was this a
case of a per foration of the oesophagus? And what was the cause of the caudal mediastinal widening – oesophageal dilation or
paraoesophageal mass? Could this have been the underlying cause of the foreign body obstruction?
In order to further investigate these possibilities, Seti
was again anaesthetized and oesophagoscopy per formed
to ensure no evidence of a megaoesophagus or foreign
body within the oesophagus. At that time, clear external
compression of the oesophagus was visible. A CT was
per formed of the thorax and all became clear – Seti had a
large paraoesophageal abscess present caudal to the heart
causing marked compression of the oesophagus. The cause
of her pleural effusion was likely secondary to trauma to
the oesophagus which also resulted in the development of
the paraoesophageal abscess.
Seti’s dedicated owners elected to pursue treatment
and Seti had surgery per formed by Drs David Simpson
(Specialist surgeon) and Arana Parslow (Second Year
Surgery Resident). The paraoesophageal abscess was
drained and the wall of the lesion resected to prevent
further fluid accumulation, and analysis of the fluid from
the abscess was similar to that of the pleural effusion.
A thoracic drain was placed to facilitate flushing and
drainage of the thoracic cavity for management of
the pyothorax. The most likely cause of Seti’s disease
considered to be previous oesophageal trauma (likely from
bone ingestion) resulting in the abscess formation and
pyothorax.
Over subsequent days, Seti made a dramatic recovery and
8 days after his second admission to the hospital he was
discharged. Seti has continued to do well after discharge
and is now returned to his normal activities... but he will
never be fed a bone again! Seti’s owners are extremely
grateful for all the care that Seti received and are so
pleased he has returned to his normal happy self.
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Radiograph
Imaging Ser vices at the ARH
[email protected]
www.arhvets.com
High Field at the Animal Referral Hospital
Since it was commissioned in early 2012 the high field MRI unit at Animal Referral Hospital Homebush has been used extensively
in the diagnosis of a wide range of clinical problems. Finding the cause of the previously elusive lameness case, discovering the
cause of neurological disease and planning for major oncological resections are but a few of the areas that we have made great
advances. More accurate diagnoses lead to better treatment outcomes. If you want to discuss any case that you think might benefit
from either CT or MRI please contact David Simpson ([email protected]) or Sarah Goldsmid ([email protected]) at
the Animal Referral Hospital on 9758 8666.
MRI Quiz
See if you can match the following MRI images with the right diagnoses.
a)Spinal meningioma of the lumbar spine of a Golden retriever treated by hemilaminectomy, durotomy and surgical excision.
b)Squamous cell carcinoma on the rostral nasal septum of a Labrador retriever treated by surgical excision of the septal mass
lesion with clean margins.
c)T2 weighted, STIR and proton density weighted images of a soft tissue mass adjacent to the caudal proximal humeral
metaphysis with associated bone oedema. Diagnosed as a soft tissue sarcoma.
d)
F acial abscess tracking back to an infected mandibular tooth root treated by tooth extraction antibiotic therapy and abscess drainage.
e) P
roton density weighted, STIR and T2 weighted images of a subcutaneous myxosarcoma dorsal to the pelvis in a terrier dog treated
by surgical excision and metronomic antiangiogenic chemotherapy.
f)Post contrast T1 weighted sagital and coronal views of a dog with a neuroblastoma of the olfactory lobe of a Malamute treated by
surgical excision with follow-up radiation therapy.
g)Discospondylitis of the L7-S1 intervertebral disc in a terrier treated effectively with antibiotic therapy.
h) T2 weighted images of a normal dog brain.
i)T2 weighted images of a myxoma of the temporomandibular joint with mucin accumulation in the retrobulbar region or a 14 year
old Staffordshire Bull terrier.
j)Infiltrative lipoma deep to the flexor retinaculum of the carpus causing associated with an accessory carpal bone fracture in a
crossbred Rottweiler treated by surgical excision of the lipoma and lag screw fixation of the accessory carpal bone.
k)Chronic discospondylitis of C7-T1 with vertebral subluxation and chronic stenosis of the spinal canal in a 3 year-old Chow Chow.
l)An intervertebral disc extrusion at C2-C3 in the neck of a boxer treated by a ventral slot decompression.
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[email protected]
www.arhvets.com
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Dr. Sandra Nguyen joins ARH
[email protected]
www.arhvets.com
A THIRD Board Certified Oncologist makes ARH the largest
veterinar y oncology group in the Southern Hemisphere!!
We are delighted to welcome Dr. Sandra Nguyen (nee Barnard), BVSc,
Diplomate ACVIM (Oncology) to the Animal Referral Hospital.
A native of Sydney and 2004 graduate of the University of Sydney, Sandra
previously worked as a staff veterinarian at Gladesville Veterinary Hospital.
During this time Sandra won a research prize at the Australian College of
Veterinary Scientists (now the ANZCVS) for her work in using samarium
therapy in palliation of dogs with bone tumours.
Sandra completed a residency in Medical Oncology at Cornell University
in 2010 and while there won the Veterinary Resident Award for dedication
to veterinary student training and service to patients and clients. She
achieved Diplomate status of the American College of Veterinary Internal
Medicine in Oncology in 2010. For the past 2 ½ years has been an Assistant
Professor in Oncology and Hematology at The Ohio State University. In the
last 3 months, she has been acting Department Chair of the Department of
Clinical Sciences at The Ohio State University.
Sandra and Bella
Sandra has authored and co-authored 6 peer-reviewed publications in
the veterinary scientific literature including a very recent Veterinary
Cooperative Oncology Group (VCOG) Consensus Document on which she
was lead author, and 2 textbook chapters. She has presented her research
and published abstracts and proceedings at both the Australian College
of Veterinary Scientists (now the ANZCVS) College Science Week and the
Veterinary Cancer Society Annual Conference. At The Ohio State University
Sandra has participated in 13 clinical trials involving innovative new
treatments for pets with cancer.
Sandra has also undergone special training in communication, and she is particularly interested in end of life care for pets with
cancer and the impact that communication surrounding euthanasia has on pet owners’ grief.
Sandra will be joining our two existing Oncologists, Drs. Angela Frimberger, VMD, Diplomate ACVIM (Oncology), and Tony
Moore, MVSc, Diplomate ACVIM (Oncology) as well as Catherine Tran (oncology registrar) and Tanja Richardson and Alex
Grimley (oncology nurses). With this addition, the ARH’s Oncology service will become the largest group in Australia and
elsewhere in the Southern Hemisphere; and will comprise 3 of only 5 veterinarians in Australia who have undergone the
rigorous training program that leads to Board Certification in Oncology in the US (Diplomates of the ACVIM). We will now
be able to offer Oncology with fully qualified specialists offering the very highest level of expertise, 5 days per week and every
other Saturday. This will greatly strengthen the existing Oncology service and further complement the other specialty services
available at the ARH.
Bone Marrow Transplants
Don’t forget bone marrow transplantation now being offered by the Oncology
Service. This therapy doubles the cure rate for dogs with lymphoma (increased
from 15% to 30%), without increasing clinical side effects compared to standard
therapy. Dogs must have normal marrow cytology before starting chemotherapy.
Also – starting July 1 the Oncology service will also be offering investigational
bone marrow transplantation services for osteosarcoma, mast cell tumours,
mammary carcinoma, nasal carcinoma, and urinary tract transitional carcinoma
in dogs; and cats with mammary carcinoma.
PA GE 5
[email protected]
www.arhvets.com
H O M E B U S H
+61 2 9758 8666
250 Parramatta Road, Homebush NSW 2140 Australia
B A U L KH AM H I LLS
+61 2 9639 7744
19 Old Northern Rd, Baulkham Hills NSW 2153 Australia
Strontium-90 Radiation Therapy
The Animal Referral Hospital is delighted to announce the availability of Strontium-90 radiation for dogs, cats and horses.
Strontium-90 therapy can be useful in managing superficial cancers, as well as some inflammatory conditions. Strontium 90 involves
the use of a radioactive probe to apply large single doses of radiation to superficial tumors. These probes were first developed to
treat ocular lesions in people, but they have been found to be useful in treating a number of tumors in dogs and cats.
FACTS ABOUT STRONTIUM-90 Radiation Therapy
• A
strontium-90 probe has a radioactive source at the end of a rod which gives off low energy beta radiation. The probe can be
used with a single application to treat small tumors or multiple overlapping treatments can be used to treat larger areas.
• T he radiation from a Strontium-90 probe only penetrates a few millimeters in the patient. This allows for a large dose of
radiation to be applied to the skin or mucosa without affecting the deeper tissues. Most patients treated with Strontium-90
radiation develop an ulceration of the skin in the area, which forms a scab and heals over about 4 weeks. These side effects
rarely bother the patient.
• T he shallow depth of penetration of the radiation allows for treatment of small tumors in areas that are typically difficult to
treat such as tumors of the cornea, sclera or eyelids.
• Treatment usually is per formed in a single treatment that typically takes about 6 minutes. This means that patients need to be
under anesthesia for a short period of time, minimizing the risk of potential complications.
• I n an article in the Journal of the American Veterinary Medical Association dermal mast cell tumors in cats treated using
Strontium-90 were controlled 98 percent of the time. Many of the cats treated in this study had multiple tumors treated in a
short treatment time.
For additional information on the treatment of tumors using the Strontium-90 probe, please contact Dr. Sandra Nguyen on
(02) 9758 8666 or via email at [email protected]
BEFORE
AFTER
Answer Key MRI Quiz:
a)1
g)7
b)4
h)3
c)6
i)10
d)2
j)8
e)12
k)9
f)5
l)11
New equipment at the Animal Referral Hospital
At ARH Homebush we are now equipped with a Nellcor Puritan Bennett 840 ventilator.
This is a top-of-the line ventilator found in human hospitals. It has many features that allow adjustment of
ventilation parameters to achieve optimum patient-ventilator synchrony.
Scenarios where ventilation may benefit your patients include, but are not limited to:
• Respiratory failure secondary to neurologic disease
• Severe pulmonary disease
oTick paralysis oBronchopneumonia
o Intracranial disease o Acute lung injury/acute respiratory
o High cervical spinal cord disease distress syndrome
o Snake evenomation o Congestive heart failure
At ARH Homebush our Medicine specialists are available to supervise management of ventilator cases around
the clock. Our physiotherapists can also contribute to the care of these patients to optimise the chances of a
successful outcome. We can also transport unstable patients from your clinic to our in our purpose-equipped
van. Please do not hesitate to contact us at ARH should you have any questions regarding mechanical
ventilation for any of your patients.
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