What is Facial Nerve Paralysis

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					                                                                   COMPANION
                       COMPANION is a publication for the Sunshine State’s
                   veterinary community from BluePearl Veterinary Partners.




                                                                                               2011
      If you would like to receive COMPANION via email instead of by mail,
               please email Alicia Valle at alicia.valle@bluepearlvet.com.




                                                                                                Summer
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                                    Medical Director: Erick Mears, DVM, DACVIM
                                   Practice Manager: Stacey Weider, CVPM, PHR




     MEDICAL DIRECTOR’S COLUMN

    SOON YOU WILL NOTICE BluePearl signage appear on the
                                                                                             What is Facial Nerve Paralysis?
    exterior of our Florida hospitals. As we founded BluePearl
                                                                                             THE FACIAL NERVE (CRANIAL NERVE VII) is responsible
    right here in Florida, we are excited about our new name!
                                                                                             for providing motor function to the muscles of the
              The question we hear most often is, “What does
                                                                                             face, lips, eyelids and ears. Loss of facial nerve
    ‘blue pearl’ mean?”
                                                                                             function results in decreased movement of these
              In the vernacular, “blue pearl” means different
                                                                                             regions. Owners typically notice a drooping of the
    things to different people. You might know a blue pearl if …
                                                                                             side of the face and the pet dropping food or water
    … you’re a meditation devotee striving to achieve your most
                                                                                             from the affected side of the mouth or tearing from
       transcended self, which yoga practitioners describe as a
       “blue pearl” experience.                                                              the eye that is affected.
    … you’ve admired rare bluish pearls on an elegant necklace                                          Causes for the loss of facial nerve function
       and a pair of earrings.                                                               include trauma to the head, neoplasia involving the
    … you’re a devotee of the techno-music duo, Blue Pearl.                                  brain or middle ear, and otitis interna/media.
             But none of those is us.                                                        Hypothyroidism and Cushing’s Disease have also
                                                                                             been associated with the condition, however, their         Dogs with facial nerve paralysis will not blink when the medial
               We are BluePearl Veterinary Partners, a group of                                                                                         corner of the eye and cornea are tapped with a finger.
    veterinary specialty and emergency hospitals in nine states.                             relationship with the loss of nerve function remains
    There are more than 200 specialists and emergency                                        unexplained.
    veterinarians – and nearly 800 veterinary technicians,                                              Idiopathic dysfunction is the most common cause for facial nerve paralysis. Idiopathic facial
    assistants and support staff — who work together toward a                                nerve paralysis is typically acute in onset and can be either unilateral or bilateral. It is not uncommon for
    common goal: partnering with the primary care                                            one side of the face to be affected before the other. Cocker spaniels, and in our experience, golden
    veterinarians in our local communities to provide advanced                               retrievers, are the most common breeds affected with the idiopathic form of the disease. Facial nerve
    patient care and outstanding customer service.                                           function loss may be transient or permanent depending on its cause.
               Being a part of a family of hospitals with broad                                                                                      When examining a dog with facial nerve paralysis, get
    resources and talents allows us to strengthen and improve                                                                              a good history from the pet owner, checking for recent trauma,
                                                                                             Get a good history from the
    each of our individual hospitals. We take pride in the fact                                                                            ear disease, evidence for progressive signs or concurrent
    that each hospital is led by a team of local veterinarians                               pet owner, checking for                       illnesses, and the presence of other neurologic signs or pain.
    and professionals who know our veterinary community best.                                recent trauma, ear disease,                   A thorough neurologic exam, and evaluation of the ear on the
               While we do not think of ourselves in terms of                                evidence for progressive                      affected side, is warranted. When performing a neurologic
    yoga, jewelry or music, the fact is, we strive for perfection as                                                                       exam, you will find the menace response, palpebral reflex, lip
    much as a yoga master, a jewelry maker and a musician do.
                                                                                             signs or concurrent illnesses, reaction and ear twitch response to be severely diminished or
    We enjoy working with you and your patients, and we look                                 and the presence of other                     absent on the affected side. Note that sensation is intact in
    forward to continuing to improve and expand our clinical                                 neurologic signs or pain.                     these individuals and corneal reflex ark is completed by
    offerings and educational programs, which are enhanced                                                                                 retracting the globe, not by blinking. Advanced diagnostic
    because we are a BluePearl Veterinary Partners hospital.                                 imaging is frequently required to find the source of the dysfunction or to diagnose idiopathic facial nerve
                                                                                             paralysis by ruling out other causes. In cats, in the absence of trauma, further diagnostic evaluation is
                                                                                             always warranted as they rarely get the idiopathic form of the disease.
                                                                                                       Neurologist Mike Kimura says, “Advanced imaging modalities such as MRI can be invaluable in
                                                                                             getting to an accurate diagnosis. Many times, I have been humbled when the presumptive diagnosis is
    Erick Mears, DVM                                                                         proven off-base through an advanced imaging study.”
    Diplomate, ACVIM (SAIM)                                                                            The treatment of facial nerve paralysis is directed at its underlying cause. Treatment in patients
    Medical Director                                                                         with idiopathic disease is typically unrewarding. Corticosteroids are unlikely to be beneficial unless tissue
                                                                                             inflammation is responsible for the nerve damage. Lateral tarsorrhaphy can be performed in patients with
        Learn more about BluePearl Veterinary Partners at                                    severe corneal/conjunctival irritation from exposure to keratitis.
                       bluepearlvet.com!

Sign up to get COMPANION by email by contacting Alicia Valle at
alicia.valle@bluepearlvet.com. We promise to use your email solely
                                                                                                                             Come hear Dr. Mike Kimura and Dr. Sonja Olson discuss
to send our newsletter and professional notifications. Would you
                                                                                                                             seizure management on June 30. Check out the CE schedule
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BluePearl Veterinary Partners is recognized as                              Tampa                        Brandon                        Clearwater            Sarasota                   The Villages
Florida Veterinary Specialists in these locations:                          3000 Busch Lake Blvd.        607 Lumsden Professional Ct.   4525 Ulmerton Rd.     7517 South Tamiami Trail   748 Village Campus Circle
                                                                            Tampa FL 33614               Brandon FL 33511               Clearwater FL 33762   Sarasota FL 34231          The Villages FL 32162
                                                                            813.933.8944                 813.571.3303                   727. 572.0132         813.933.8944               813.933.8944
SNIFF…
…Get to know BluePearl’s veterinarians

Nicole Salas, DVM
                                                                                                      It’s in the Mix:
                                                                                                      Pharmaceutical Compounding
Meet Dr. Nicole Salas, who joined Florida
Veterinary Specialists — now renamed BluePearl                                                        YOU MAY THINK THAT THE COMPOUNDING of
Veterinary Partners — in 2010 after completing a                                                      medications is a relatively new process,
small animal surgery residency at the Veterinary
                                                                                                      but it is not.
Specialty & Emergency Center in Langhorne, Penn. Nicole Salas, DVM
                                                                                                                 Compounding drugs by mixing
Before embarking on residency training, she              Surgical Services
                                                                                                      and reformulating to fit the unique
completed a small animal surgery internship at
Affiliated Veterinary Specialists in Maitland, Fla., and a rotating                                   requirements of the patient is most
internship at Fifth Avenue Veterinary Specialists in New York City.                                   frequently requested due to the owner’s
A graduate of St. George’s University School of Veterinary Medicine in the                            inability to administer a medication
West Indies, Dr. Salas spent her clinical year at North Carolina State                                orally. Compounding is also performed to
University. She graduated with a B.S. from Cornell University.                                        resize a medication meant for human
When not hard at work at one of BluePearl’s Florida locations, Dr. Salas                              consumption or to produce a medication
enjoys time with her family, friends and two pets: her cat, Clarence, and                             that is not commercially available.
mini-dachshund, Henry. When not chillin’ on the couch, you might find                                            From the 1800s to the mid-
her at the beach, kickboxing, or cycling.                                                             1900s, compounding by pharmacists was
                                                                                                      common practice. Many of the                    Compounding under strict regulations
WAS THERE A COLLEGE TEACHER WHO CHANGED YOUR LIFE?                                                    ingredients used were natural herbs and recipes came out of books or were based
When I was in undergrad, a professor told me that I would never become a                              on folklore. As the efficacy of new formulations was scientifically confirmed, older
veterinarian and that I needed to change my major. I was so heartbroken
                                                                                                      recipes and homemade concoctions were replaced. For economic reasons,
that I cried for nearly two weeks. Then I sat up one night and asked myself,
                                                                                                      compounded medications individually formulated by pharmacists were soon
“Who is he to tell me what I am going to become?” I worked hard to get to
                                                                                                      replaced by the mass production of suspensions, tablets, creams, and capsules. In
where I am now. Throughout undergrad, I worked three jobs, and I made it
all the way to Grenada for vet school and through two internships and a                               the 20th century, greater government regulation of the industry further reduced the
residency. I couldn’t be happier!                                                                     practice of compounding.
                                                                                                                 The Animal Medicinal Drug Use Clarification Act of 1994 allows
WHAT WOULD YOU BE DOING TODAY OR WHAT WOULD YOU LIKE TO BE DOING                                      compounding for the veterinary field, permitting veterinarians to prescribe extra-
TODAY IF YOU COULD NOT HAVE BEEN A VETERINARIAN?                                                      label uses of animal and human drugs for their patients.
The only other job I really considered was being a pediatrician, but being a                                     Using compounded medications is not without risk. The efficacy of the
veterinarian was what I planned to be my entire life, so I couldn’t imagine                           finished product can depend on the purity of the ingredients and the quality of the
it any other way.                                                                                     production. Active ingredients may not be compatible with the carrier in which it is
                                                                                                      mixed causing it to become inactive. The active ingredient and/or carrier may not be
WHAT THREE WORDS WOULD YOUR HIGH SCHOOL MATH TEACHER USE TO                                           effectively absorbed by the method prescribed for its administration. The desired
DESCRIBE YOU?                                                                                         concentration of the active ingredient may not be added correctly to the
Social-butterfly, determined, and busy. I was in a lot of clubs, president of                         compounded product. Finally, studies assessing the efficacy of many compounded
my senior class, and I played sports throughout the year. Other than                                  formulations and recipes are lacking.
studying, I was either playing sports or working at my part time job.                                            Therefore, it is important that you have confidence in the compounding
                                                                                                      pharmacy with which you are working. You want to use a pharmacy that specializes
IF YOU KNEW THEN WHAT YOU KNOW NOW, WHAT WOULD YOU DO DIFFERENTLY?                                    in compounding and is willing to research the efficacy of the medications it is
I would have studied harder and worked less, but that would have left me
                                                                                                      producing. At BluePearl, we use Stokes Pharmacy (800.754.5222) for the
with more student loans!
                                                                                                      compounding of many of our medications.

HOW DO YOU UNWIND AT THE END OF THE DAY? WHAT KEEPS YOU UP AT NIGHT?
I love to go home after a long day at work and just sit down on the couch
with my husband and watch tv. I know that sounds boring, but I love that
it’s thoughtless. When I have a complicated case or a patient who’s not
recovering as I expect, I toss and turn, thinking about what more could be
done or what I could have done differently.
                                                                                                      An end around the liver
OUTSIDE OF VETERINARY MEDICINE, WHAT DO YOU CONSIDER YOURSELF TO BE AN                                A PORTOSYSTEMIC SHUNT (PSS) IS AN ABERRANT VESSEL or vessels that shunts blood
EXPERT AT?                                                                                            from the portal vascular system to the systemic vascular system. This causes blood
I do know a lot about fitness and nutrition. I used to teach cardio kickboxing                        flowing from the GI tract, pancreas, and spleen to bypass the liver where it would
and I have taken courses to be certified in kickboxing and floor exercises.                           normally be “processed.” The liver never has the opportunity to remove toxins
                                                                                                      absorbed by the GI tract, release anabolic hormones into the circulation in response
WHAT IS IN YOUR REFRIGERATOR RIGHT NOW?
                                                                                                      to portal constituents, or process nutrients such as fatty acids and proteins for
We recently had a BBQ, so our fridge is full of left over grilling stuff.
                                                                                                      efficient use by the body. Growth and development of the organs of the body are
Normally it just has water and condiments in it — we’re not great at
                                                                                                      frequently compromised.
cooking at home. I definitely need to cook more.
                                                                                                                Most congenital shunts are the result of a single aberrant vessel.
WHAT IS THE LAST MOVIE YOU SAW THAT YOU ENJOYED?                                                      Extrahepatic shunts are more common in small breeds of dog whereas intrahepatic
“Limitless.” I enjoy most movies and I love going to the movies. Before we                            shunts are more common in large breed dogs. The condition is hereditary in
moved to Florida, we used to go every weekend!                                                        Yorkshire terriers and, probably, Irish wolfhounds. It is presumed to be hereditary in
                                                                                                      other breeds. Portosystemic shunts have also been reported in cats.
WHO WOULD YOU LIKE TO TRADE PLACES WITH FOR A WEEK?                                                             Portosystemic shunts are most commonly diagnosed in young animals,
I would love to switch roles with someone famous — no one in particular                               although they have been found in animals as old as 10 years of age. Clinical signs
— just for a week. Who wouldn’t love to have a personal trainer,                                      may be subtle. Intermittent gastrointestinal upset, lethargy, stunted growth, pica, or
nutritionist and someone to help you pick out fashionable clothes?                                    neurologic signs such as circling, head pressing or seizures may be seen. In many
                                                                                                      patients the first abnormality noted may be a slower than expected recovery from
                                                                                                      anesthesia. Dysuria (from urate bladder stones) or even mild elevations in the liver



        Services                               Acupuncture
                                               Felicity Talbot DVM, CVA
                                                                             Cardiology
                                                                             Alan Spier DVM, PhD, DACVIM
                                                                             Nicole Piscitelli DVM
                                                                                                             Critical Care
                                                                                                             John Gicking DVM, DACVECC
                                                                                                             Miryam Reems DVM, DACVECC
                                                                                                                                           Dermatology
                                                                                                                                           Michael Canfield DVM
                                                                                                                                           Heather Willis-Goulet DVM, DACVD
                                                                                                                                                                              Emergency Medicine
                                                                                                                                                                              Kate Brammer DVM
                                                                                                                                                                              Dee Ann Dugger DVM
                                               Avian & Exotic Medicine       Sarah Silverman DVM             Terry Corona DVM              Nadine Znajda DVM                  Colleen Elligott DVM
                                               Teresa Lightfoot DVM, DABVP                                   Juliet Gladden DVM                                               Sonja Olson DVM
                                               Jonathan Rubinstein DVM                                       Jacqueline Nobles DVM                                            Allison Shreve DVM
                                                                                                                                                                              Steve Tutela DVM
                                                                                                                                                                              Marie Yakubik VMD
Xylitol: A not-so-sweet sweetener
XYLITOL APPEARS TO BE EVERYWHERE THESE DAYS. It has become popular as a sugar                                    You can find Xylitol in chewing gum, baking products,
substitute for human consumption. You can find it in chewing gum, baking
                                                                                                                 sugar free candy and weight loss food items.
products, sugar free candy and weight loss food items. The reason for xylitol’s
popularity is that it is just
as sweet as sucrose but
lacks sucrose’s caloric
content and insulin
stimulating effects.
Xylitol is naturally found
in the fibers of many
fruits and vegetables. It
is presently produced for
mass consumption by
hydrogenation of xylose which has been extracted from wood and corn sources.
           Xylitol first became popular in the 1800s when it was determined it could
be used as a sweetener for people with diabetes mellitus. More recently xylitol has                                       The immediate treatment for xylitol ingestion, similar to other toxicities,
been shown to have significant dental benefits.                                                                  should include the induction of emesis followed by the administration of activated
           Studies have shown xylitol to inhibit streptococcus bacteria proliferation in                         charcoal. Unfortunately xylitol is absorbed very rapidly after ingestion.
the mouth thereby slowing plaque formation and tooth decay. By alkalinizing the
saliva, xylitol also potentiates the deposition of calcium and phosphate salts into                              • The ingestion of a subtoxic dose of xylitol warrants observation and monitoring of
dental enamel. It has consequently been gaining use in such products as                                            the dog for 24 hours.
toothpaste, chewing gum, and mouthwashes. Other studies have suggested that                                      • If a toxic dose of 0.1 – 0.5 g/kg is ingested, in-hospital observation and
xylitol may be useful for inhibiting osteoporosis and the development of infections.                               monitoring of glucose and liver values should be performed. In patients with
In one study, cats who drank water supplemented with xylitol demonstrated reduced                                  significant hypoglycemia, intravenous fluids supplemented with glucose should
dental plaque and calculus formation.                                                                              be administered until normal glucose concentrations can be maintained without
           Xylitol does not appear to be toxic to humans or cats. This is not the case                             supplementation.
in dogs where it appears to excessively stimulate insulin release. Severe                                        • For toxic dose > 0.5 g/kg, at least 72 hours of intravenous fluid therapy, frequent
hypoglycemia can develop as early as 30 minutes after ingestion or as late as 12                                   monitoring of glucose and liver values, and the prophylactic administration of
hours later, potentially leading to depression and seizures. The exact toxic dose for                              hepatoprotectants such as s-adenosylmethionine and N-acetylcysteine are
dogs has not been determined. Clinical signs of hypoglycemia have been reported in                                 suggested.
dogs ingesting >0.1 g/kg.
           Recent reports also indicate that xylitol can cause liver necrosis in dogs.                                     When in doubt about the quantity of xylitol ingested, aggressive treatment
Hypoglycemia is not a prerequisite for liver damage to occur. Signs of liver failure                             should be considered as a precaution. Additional treatments will depend on the
could include loss of appetite, bleeding, and gastrointestinal upset. Most dogs will                             patient’s clinical signs and lab results. Prolonged treatments will be required in
demonstrate signs within 72 hours of xylitol ingestion. The toxic dose for potential                             patients with significant liver damage. The prognosis would be at best guarded in
liver failure has been reported to be >0.5 g/kg. The mechanism for liver necrosis                                these patients.
remains undetermined.




                                                                                                                 Radiographs often show a small liver but otherwise are unremarkable. In our
                                                                                                                 experience, ultrasound examination of the abdomen has been very sensitive (80-
                                                                                                                 92% sensitivity) for identifying PSS’s. Ultrasound has also proven useful for
                                                                                                                 identifying other hepatic diseases, concurrent intra-abdominal abnormalities, and
                                                                                                                 urate bladder stones. Urate bladder stones will not typically appear on routine
                                                                                                                 radiographs. Other imaging methods used to confirm the presence of a PSS include
                                                                                                                 portal scintigraphy (the visualization of portal vascularity via radioactive dye
                                                                                                                 injected into the spleen), CT scanning, and mesenteric portography (the
                                                                                                                 intraoperative injection of radiopaque dye into a portal vessel for radiographic
Ameroid rings placed around the shunting               Ultrasound demonstrating an irregular tortuous            viewing). In some patients, an exploratory surgery will be performed based on the
vessel slowly squeeze the vessel obstructing           shunt vessel
blood flow.                                                                                                      patient’s signalment, clinical signs, and blood work alone.
                                                                                                                           Surgery is the treatment of choice for a single PSS. Attenuation of the
                                                                                                                 shunting vessel, utilizing an ameroid ring or cellophane band placed around the
values on routine blood work in clinically normal dogs are reasons to consider the                               shunting vessel, or insertion of intravascular coils into the vessel, is the preferred
possible presence of a PSS.                                                                                      method of surgical treatment. The goal is to slowly decrease the volume of blood
          Bile acid testing should be considered in any patient with clinical signs or                           flowing through the shunt vessel over time. Complete and immediate ligation of the
blood work abnormalities compatible with a PSS. An excessively high post-prandial                                shunting vessel is no longer recommended due to complications of portal
bile acid value (usually greater than 100 mg/dl) should prompt a search for a PSS.                               hypertension, i.e. excessive backpressure within the portal circulation. Patients
          Imaging is typically performed to confirm the presence of a PSS.                                                                                                        Continued on next page.



Internal Medicine                 Neurology                            Ophthalmology                    Rehabilitation                   Surgery
Anthony Ishak DVM, DACVIM         Michael Kimura DVM, DACVIM           Tammy Miller Michau DVM, DACVO   Felicity Talbot DVM, CVA         Helga Bleyaert VMD, DACVS
Brian Luria DVM, DACVIM                                                Michele Stengard DVM, DACVO                                       Michael Reems DVM, DACVS
Erick Mears DVM, DACVIM           Oncology                                                                                               Cory Pinel DVM
Melanie Otte DVM, DACVIM          Virginia Coyle DVM                   Radiology & Diagnostic Imaging                                    Nicole Salas DVM
Cathy Meeks DVM                   Curtis Kane DVM                      Wendy Gwin DVM, DACVR                                             Natasha Stanke DVM
                                                                       Val Sadler DVM, DACVR
Soft Tissue Sarcomas: An Exercise in Frustration
TUMORS CAN ARISE FROM A NUMBER OF DIFFERENT TISSUES within the submucosa. Many of             opportunity to achieve a surgical cure is frequently limited by the ability of the surgeon
these tumors exhibit similar biological behavior. Consequently, pathologists will             to remove all the microscopic tendrils. The tendency for these tumors to develop on the
frequently group them under the term soft tissue sarcoma. Examples of soft tissue             limbs or over the thoracic wall and vertebral column makes wide surgical excision
sarcomas include hemangiopericytomas, neurofibromas, peripheral nerve sheath                  around these tumors difficult. If wide surgical margins are not obtained, regrowth of the
tumors, and fibrosarcomas.                                                                    tumor is almost certain. The median survival time for dogs treated with surgery alone in
           Soft tissue sarcomas are typically classified as low, intermediate, or high        one report was less than 1.5 years.
grade. These histopathologically defined categories are based on the appearance of the                   When surgical excision of the soft tissue sarcoma is not complete, ancillary
most aggressive-looking portion of the tumor. The goal of this classification system is to    therapy should be pursued as soon as healing has occurred. Most tumors will show
predict the local behavior and metastatic risk of the tumor. Most soft tissue sarcomas        regrowth within months. Once the tumor starts to regrow it becomes more difficult to
are classified as low grade. High grade tumors are uncommon.                                  treat. Therefore if the pet owner wishes to resolve the condition without removing the
           All grades of soft tissue sarcomas are locally invasive sending microscopic        pet’s leg, subsequent radiation therapy is recommended. Studies have demonstrated
tendrils from the main tumor out into the surrounding tissues. This can make it quite         that radiation therapy, when administered after debulking of visible disease, will
difficult for these tumors to be completely surgically excised. With the exception of high    prevent regrowth of soft tissue sarcomas in up to 85% of patients for at least 5 years.
grade tumors most soft tissue sarcomas will not metastasize. The metastatic rate for          In most cases, this represents a cure.
soft tissue sarcomas as a group approximates 10%. By contrast, high grade soft tissue                    The best time to treat a soft tissue sarcoma is when it is small or immediately
sarcomas have a 50% chance for metastasis.                                                    after it has been removed. Don’t wait for it to regrow. Should you have a patient with a
           Surgery is the preferred treatment for soft tissue sarcomas. However the           suspected soft tissue sarcoma, give us a call to discuss treatment options.



2011 Upcoming CE & Events
DATE:      TIME: TYPE:      TOPIC/SPEAKER:                                                                                                                LOCATION:                 CE:
Jun 4      2pm     Tech     Urinalysis 101 / Jamie Blanchet CVT, VTS (SAIM)                                                                               BluePearl Clearwater      1 hr
Jun 25     7pm     Tech     Urinalysis 101 / Jamie Blanchet CVT, VTS (SAIM)                                                                               BluePearl Brandon         1 hr
Jun 30     7pm     Doctor   Critical Care Lecture Series: Seizure Management / Mike Kimura DVM, ACVIM (Neurology) & Sonja Olson DVM                       BluePearl Tampa           2 hr
Jul 12     7pm     Doctor   Cruciate Disease – How to Diagnose & Treat / Mike Reems DVM, ACVS                                                             BluePearl Clearwater      2 hr
Jul 14     7pm     Doctor   New Classifications of Canine Heart Disease / Alan Spier DVM, ACVIM (Cardio)                                                  BluePearl Brandon         1 hr
Jul 16     2pm     Tech     Hemacytology – Preperation & Evaluation / Chastity Knopp CVT                                                                  BluePearl Tampa           1 hr
Jul 28     7pm     Doctor   Critical Care Lecture Series: General Toxicology / John Gicking DVM, ACVECC & Juliet Gladden DVM                              BluePearl Tampa           2 hr
Aug 9      7pm     Doctor   New Classifications of Canine Heart Disease / Alan Spier DVM, ACVIM (Cardio)                                                  BluePearl Clearwater      1 hr
Aug 10     7pm     Doctor   Canine Liver Disease – How to Diagnose & Treat / Melanie Otte DVM, ACVIM                                                      BluePearl Brandon         1 hr
Aug 25     7pm     Doctor   Critical Care Lecture Series: Does the Yellow Patient Need Surgery / Erick Mears DVM, ACVIM & Mike Reems DVM, ACVS            BluePearl Tampa           2 hr



An end around the liver                             Continued from page 3.

with extrahepatic shunts typically do well with shunt attenuation; 80 -85% of patients          disease due to concurrent portal vein hypoplasia.
achieving a successful outcome. By contrast, intrahepatic shunts can be difficult to                      Another congenital condition characterized by the microvascular shunting of
reach and have a success rate of generally 50%. Cats also do not do as well following           blood within the liver, either in conjunction with macroscopic shunts or as a primary
shunt attenuation.                                                                              entity, can mimic a PSS. This abnormality was initially called hepatic microvascular
          Unfortunately, attenuation of the shunting vessels is not without potential           dysplasia (HMD). More recently this condition has been termed portal atresia. Since there
sequella. Acute hemorrhage, DIC, hypotension, ascites, hypoglycemia and seizures have           is no shunt vessel to attenuate, medical management is the only treatment option.
all been described. Long term complications may also develop after surgery including                      Please don’t hesitate to give us a call if you are suspicious for the presence of a
chronic portal hypertension, inadequate attenuation of the shunt, and progressive liver         PSS in one of your patients.


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              3000 Busch Lake Blvd.
              Tampa, FL 33614




BluePearl’s newsletters are produced for the Sunshine State’s veterinary community with support from Your Partners in Education: Abbott Animal Health, Antech
Diagnostics, Boehringer Ingelheim, Hill’s Pet Nutrition, Novartis Animal Health, Pfizer Animal Health, Stokes Pharmacy, Virbac Animal Health, Webster Veterinary

				
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