Olive's Story

Meet Olive! 

Olive is a female neutered Whippet, who was one year and two months old at the time of her injury. 

Olive presented to the practice in December 2017 with a history of running into a tree while out walking with another dog that day. Following an examination by the veterinary surgeon, Olive was bright, alert but non weight bearing on the right hind. There was very little extension of the right hip and the veterinary surgeon was suspicious of a hip dislocation. Olive was admitted for radiographs that day which confirmed a dislocated hip with femoral head fracture.

A radiograph of Olives pelvis, showing that her right hip is dislocated and the femoral head is fractured 

The following day Olive underwent surgery to perform a femoral head and neck excision (FHNE) to remove the femoral head and communitions. She was discharged later that day with post-operative instructions of strict rest and some physiotherapy exercises for the next 10 days, with a view to start hydrotherapy after 10 days. 

Olive at home, recovering from her surgery.

Olive was seen at 3 and 10 days post op by one of our registered veterinary nurses. She was making good progress, using the limb when walking and allowing good flexion and extension of the hip. Olive’s owners were instructed to increase her land exercise, add in some more physiotherapy exercises and her first hydrotherapy session was booked.

At the first hydrotherapy session in January 2018 Olives muscle mass on the hind limbs was measured. 

• Right – 27cm • Left – 30cm 

This indicated that Olive had been weigh bearing more through the left leg than the right. This was to be expected following surgery with the idea been that the more she used the affected limb the more muscle mass would increase and once weight bearing was symmetrical through the hind limbs muscle mass would be even. 

Olive during one of her hydrotherapy sessions.

Olive had hydrotherapy twice weekly for the next few weeks. She took a little time to get use to the water in the treadmill but after much encouragement from her owners and the rehabilitation team she was making slow progress. Poor extension of the right hind had been noted throughout the hydrotherapy sessions and by session 8, 14 weeks later this had not really improved. 

The rehabilitation team were concerned about scar tissue or possible osteophytes with Olive still being young. Practice partner and veterinary surgeon Caroline Richards examined Olive and advised to book her in for further radiographs to recheck the pelvis. Radiographs revealed a bone spur on the femur and revision surgery was carried out to remove this. As before Olive was sent home with post-operative instructions of rest for 1 week then short lead walks and physiotherapy exercises following this. Olive revisited to see orthopaedic surgeon Peter Richards 2 weeks after surgery and was making good progress. 

A radiograph showing the bone spur that had formed following Olives first surgery.

She restarted her hydrotherapy sessions in April following a short break of just land based exercises. We measured her muscle mass again following her revision surgery.

• Right – 29cm • Left – 31cm 

Since January a 2cm increase in right muscle mass had been noted, indicating that Olive was more comfortable and more confident at using the limb. The owners continued hydrotherapy weekly to correct the muscle deficit. Olive is now back to off lead exercise and is leading a happy and normal life. 

Olive was a lovely patient and the team at Barnsley Vet4Pets enjoyed working closely with Olive and her owners to get her back to full fitness. 

Olive is now enjoying a happy and normal life following her surgery and rehabilitation!

Christmas Toxins - Why 'Only One' Mince Pie is Too Many...

 Why is 'only one' mince pie too many for our furry family members? 

Many of us this Christmas will spend a lot of time with friends and family enjoying the festivities. Naturally, we want to share this time with our pets (after all they are part of the family!). Although it appears as though we are spoiling them by giving them some of the treats that we enjoy safely, it can actually be a big danger for our pets to ingest some of the classic things we enjoy at Christmas time. 

In some toxins even a tiny amount can be enough to cause harm to our pets. The kidneys are often affected by toxin ingestion, as they as responsible for the breakdown and excretion of waste products from the body. Many pets will appear clinically well immediately after eating the toxin, and will become unwell at a later time. However, this unfortunately can mean that the damage has already been done, causing a lasting negative effect on the kidneys. Time is of the essence when treating a case of toxicity!

Below are some of the most common Christmas toxins...

Mince Pies/Raisins/Christmas Pudding - grapes and raisins are very common at Christmas time - they are present in puddings and desserts, as well as on many cheeseboards. Even one raisin or grape can cause permanent damage to the kidneys and make pets very poorly.

Nuts - some nuts, such as the Macadamia nut are toxic to pets. They can cause muscle tremors, vomiting and hyperthermia soon after ingestion. All nuts are high in fat, so it is best to avoid feeding any type of nuts to your pet. 

Onions/Garlic - all types of onion and garlic are toxic to pets, and can cause kidney damage even if only a small amount is ingested. Be mindful of feeding your pet anything that could potentially contain any onions or garlic (such as gravy or stuffing).

Chocolate/Xylitol - a favourite treat at Christmas, chocolate contains theobromine which is toxic. Theobromine is found in higher concentrations in dark chocolate, although it is still found in milk varieties. It can affect the central nervous system and heart as well as the kidneys, and severe cases can result in seizures. 

Bones - we don't advise giving any bones to pets as there is a big risk of splintering and perforation. This is particularly important with cooked bones as they are much more brittle after cooking. They can also get stuck after being ingested and become a choking hazard. 

Tinsel/Baubles/Fairy Lights - Christmas decorations can break, shatter and/or splinter very easily. This can result in cuts on the paws if stepped on, and blockages or perforations if ingested. Make sure you keep decorations and Christmas trees out of reach, and use pet friendly materials where possible. Salt dough should be avoided, as it can cause sodium levels to rise dangerously high if ingested. 

Poinsettia/Mistletoe/Potpourri - all of these Christmas plants are mildly toxic and can cause vomiting, diarrhoea and excessive salivation. 

If your pet ingests anything listed above, please get in touch with the practice as soon as possible. The sooner treatment is started, the better the outcome will be, and long term side effects will be less likely. The treatment plan will vary depending on the type of toxin and amount ingested. We are open 24 hours a day, 7 days a week even throughout the Christmas period to care for your pets!

Merry Christmas and Happy New Year from the team at Barnsley Vets4Pets!

What is a Registered Veterinary Nurse?

What is a Veterinary Nurse? 

Here at Barnsley Vets4Pets we have a team of 13 qualified nurses and 3 student nurses. As a team we work hard to maintain high standards - we must be doing something right as we have just been given a Clinical Excellence award! 

Every year the month of May celebrates Veterinary Nurses by raising awareness of the amazing job they do in practice. Many people aren't aware of how much our job role actually involves, so here are some of the main bits...

Reception - we answer the phone, book appointments, check people in on arrival and help if reception is particularly busy. A lot of the time you won't realise it, but a Veterinary Nurse can be one of the first faces you see when you come through our doors!

Anaesthesia - we monitor anaesthetics, and make sure your pets are kept stable throughout. We are trained to recognise emergencies whilst the vet is busy performing surgery on your pet. Although we have some machinery that helps us, the most important equipment is us - using our eyes and ears we are able to carefully monitor your pet from induction right through to recovery.

Consultations - we run nurse consultations every day and see a wide variety of appointments. They can range from second vaccinations to post-operative checks and nail clipping. We have our own reception and waiting area with a viewing window into our Hydrotherapy suite. 

We are lucky enough to have our very own waiting area & reception!

Physiotherapy/Hydrotherapy - here at Barnsley Vets4Pets we are lucky enough to have a team of nurses who are physiotherapists and hydrotherapists. After orthopaedic procedures we see pets on a weekly basis and demonstrate physiotherapy techniques, check surgical wounds, and guide you and your pet through the rehabilitation process. We can also offer hydrotherapy in our aquatic treadmill to further support them in their rehabilitation. Our rehab team consists of eight nurses; Tanya, Chelsea, Rachel, Charlotte, Emily, Mandy, Alex and Reann.

Gorgeous Charlie working in our aquatic treadmill!

Surgery - sometimes we are required to assist the vets in more complicated surgeries. One surgery that we commonly assist in is a Laparoscopic spay - this a is similar to 'key-hole surgery' in humans. This involves the use of a rigid endoscope, light and camera. Using this method we can carry out a less invasive surgery when compared to the traditional 'open' surgical method.

Inpatient Care - when patients are unwell and require hospitalisation the majority of their care is provided by a Veterinary Nurse (always under the direction of a Vet!). We regularly carry out vital sign checks, administer medications and give your pets the TLC they need when they are staying with us. 

Weight Clinics - Georgina, one of our qualified Veterinary Nurses runs weight clinics here at Barnsley. Over a period of time Georgina helps owners to get pets to their ideal body-weight safely. She can work out daily requirements in calories, and tailor make weight loss programmes for each individual pet.

Just a few of our Registered and Student Veterinary
Nurses! 

Laboratory Work - taking and testing blood samples is something that we do on a daily basis. This can tell us how a patient's organs are functioning, as well as assess the response to certain types of treatment. The list is endless! Laboratory work is not just blood samples - we also test urine and examine things such as mites under microscopes - interesting stuff!

Behaviour - qualified Veterinary Nurse Reann offers one-on-one extended behaviour appointments, as well as running puppy training classes every Tuesday evening in the Healthcare Centre at the practice. Reann is our go to for all things behaviour!

Dental Hygiene - our head nurse Claire has a particular interest in this subject and has done an advanced dentistry course. As nurses we are able to scale and polish teeth, but are not able to carry out extractions. After pets have had dental treatment under anaesthesia we can advise clients on oral hygiene for their pet (brushing, dry diets). We also discuss oral hygiene at our puppy checks, as prevention is the best form of treatment! 

These are just a few of the things we do every day as a Veterinary Nurse! The list could go on forever as we have such a varied job role, especially as we work in such a busy Hospital. We even have our own dedicated night-nurse team (Keeley, Charlotte and Lauren) who provided emergency and out of hours care to your pets! 

To find out a little more about our Veterinary Nurse team click on the link below... 

Meet the Veterinary Nurse Team @ Barnsley!

Our VN Awareness Banner proudly up in the nurse reception area!

You may have spotted our very own Dr Caroline Richards on your TV screens, she’s the star of the current Vets4Pets TV adverts promoting £49 BSIL being shown right across the UK. We’re really excited and proud of Caroline.

We managed to grab some time with the already very busy Caroline to chat to her about her experience filming the advert and why she feels so passionately about the Best Start in Life plan.

How did you get selected to star in the TV advert?

I’ve been a partner with my husband Dr Peter Richards for last 16 years since we set up Vets4Pets Barnsley. The support office team reached out to me a few months ago to see if I’d be interested. I was quite nervous but the first step was just a test day so I was keen to experience something new! It turned out that they felt I did a good job on camera and I was so pleased when I heard they’d like me to shoot the full TV advert.

You did a great job! How did you remember all your lines?

I was really nervous but the team were all really good. I did have lines to learn but overall I’m passionate about the brand, my business and the Best Start in Life health plan so it felt very natural to talk about the plan. I love working with pets of all ages but spending the day with some lovely puppies and kittens certainly kept any nerves at bay.

There are some gorgeous pets in the advert, can you tell us anymore about them?

The golden retriever puppy in the advert is called Maggie and the kitten was called Bear. They were really well behaved and had their owners on hand all day with lots of breaks, good food and play time.

Were there any pet bloopers on the day!?

There were a few pets there on the day and a couple of the puppies just didn’t want to sit still. There were plenty of bloopers of playful puppies. 

Tell us why you feel so passionate about Best Start in Life as a health plan

There is so much to think about when getting a new puppy or kitten and the Best Start in Life plan includes everything your pet needs to grow up happy and healthy! I love this plan as not only do I love meeting puppies and kittens, its great to know that the puppy and kitten have had their first vaccination, 3 months flea and worm treatment and have been micro chipped making them ready for the world! 

How are you dealing with your new fame locally!

Its lovely to be recognised by people when I'm walking the dog or taking my children to school. I feel very proud to be recognised by people as a vet, its a huge part of my life and I'm very passionate about what I do. 

Click on the below link to see Caroline in action! 

 

Watch the TV Advert

Hydrotherapy Case Study - Tilly

This post has being written by Chelsea, one of our Hydrotherapy & Physiotherapy nurses.  Chelsea has a Level 3 Certificate in Canine Hydrotherapy as well as a Degree in Veterinary Nursing.  She talks us through Tilly's case from presentation, diagnosis, surgical treatment and rehabilitation. 

Patient Details;

Name -  Tilly

Breed - Patterdale Terrier

Age - 9 years & 2 months

Presentation - Tilly was first seen at the practice after falling and twisting her left stifle (knee).  The vet examined Tilly and suspected she could have either pulled a muscle or it could be something more serious like a cruciate rupture.  The vet also found that Tilly had a medial patella luxation (MLP) - this is where the knee cap slips out of place  towards the inside of the leg.  The MLP is not a consequence of the injury Tilly sustained but it certainly complicated her case.  Initially Tilly was prescribed some non-steroidal anti-inflammatory (NSAID's) to go home and rest, if she had pulled a muscle she should quickly feel better however it was planned that if Tilly didn't improve within a few days we would book her in for a sedation and radiographs (x-rays) to investigate further.  

Diagnosis - After a couple of days of rest and relaxation along side the NSAID's Tilly was still painful and so x-rays were taken of her left and right stifle and her hips to give the vet a full picture of Tilly's hindlimbs.  When Tilly was sedated the vet also performed a full joint evaluation of all her joints in her hindlimbs - this is very painful and so can only be done fully when patients are under anaesthetic.  The joint evaluation and radiographs confirmed Tilly's diagnosis.  She had ruptured her cranial cruciate ligament and also had an MLP, both of which would require surgery.

The cranial cruciate ligament is inside the stifle joint and its job is to stabilise the stifle during weight bearing onto the joint.  It prevents the tibia from moving forward relative to the femur.

 

Diagram showing ruptured cruciate ligament

An MLP occurs when the patella (knee cap) slips out of the groove it should sit in.  This can be really painful and dogs will often lift their leg when walking until it slips back into place and they carry on as normal - despite being very painful dogs do seem to be able to ignore it enough to hide it from owners.  Sometimes it dislocates and cannot go back in to the groove.

Diagram showing MLP

Both of these conditions can be fixed during one surgery via a range of different techniques which reduces how often Tilly would need to have an anaesthetic.  

Surgery - Tilly was booked in for surgery where the vet performed a procedure called a lateral suture which is where a very strong material is placed where the ligament should be to mimic the action of the criciate ligament and allow stability until the body produces long term scar tissue around the joint. 

Simplified diagram of where the suture material is placed

To correct Tilly's MLP the vet performed two techniques, one was a sulcoplasty which is where th groove in the patella is moved out of the groove it sits in so that using an electric saw a wedge can be cut to remove the groove, the bottom of that wedge is then filed down, turned 180° then replaced.  This results in the groove being much deeper than before meaning that when the patella is placed back in its correct place it can no longer dislocate from the groove.  

The second technique was a retinacular imbrication which involves the soft tissue around outside aspect of the stifle joint is tightened - in a sense it gives the joint a 'tight hug' to keep everything where it should be.

Post operative care - After recovering from her surgery Tilly and her owners had a discharge appointment with Chelsea so that her tailored physiotherapy regime could be planned and everything her owners needed to do at home could be demonstrated.  Her regime included thermotherapy, massage and passive range of movement techniques.  Tilly needed to continue her NSAID's medications to help with post op pain and inflammation.  3 and 10 day post op appointments were arranged with the phyiotherapy team to ensure Tilly and her owners were doing well.  Being a 24hour hospital really helps in these cases as owners can contact us any time of day if they have questions or concerns... caring for a patient like Tilly isn't easy and we're lucky to have 24hour contact available. 

10 days post op - At this point TIlly's surgical wound was fully healed which meant that her rehabilitation could be pushed on to the next step which meant Tilly could start her hydrotherapy treatment.  

Hydrotherapy - We have an underwater treadmill that offers partial weigh bearing exercise in a controlled environment.  Patient's benefit from the support and buoyancy of the water and so can begin to use the affect limb/joints to their full potential without the pain associated with full weight bearing.  Having the tank vs a pool also means that the hydrotherapy nurse can alter the depth of the water and which alters how patients move in the water... initially the water will be higher and as the patient improves the depth is dropped to increase weight bearing and range of movement required from the joint.  The speed of the treadmill can also be adjusted as well as working flat, incline or decline.  

Tilly's recovery - Tilly had hydrotherapy alongside her physiotherapy at home for six weeks and throughout showed vast improvement, with her owner really noticing the difference.  Clinically Tilly started weight bearing on her leg and her range of movement improved throughout each session.  Tilly's muscle mass was regularly measured - naturally this reduced in the lead up to surgery due to the long standing MLP meaning she naturally put more of her weight through her non-affected leg and more so after surgery when initially she hardly used the leg (this is normal post op which is why physiotherapy is so important to regain normal use).  Tilly's muscle mass was rebuilt indicating fantastic recovery results and she now has regular rechecks with the physio team to ensure she continues to improve. 

Tilly in our hydrotherapy treadmill

And again

Indications for hydrotherapy - 

There are lots of different reasons that our patients use the hydrotherapy unit including;

• Reducing pain & inflammation
• Arthritis
• Hipy & elbow dysplasia
• Obesity
• Muscle wastage
• Cardiovascular fitness
• Neurological conditions
• Spinal conditions
• Pre & post operative rehabilitaion

Cases like Tilly's really show how much time and effort is involved in getting patients back on their feet and how each team member really plays a huge part in that process from a patients owner calling to book the initial appointment, a vet consult to determine the problem and its cause, surgeons to perform the surgery and work with the nursing team and owners to provide the important after care needed. 

We would like to say a huge thank you to Tilly and her owner for letting us share her story.   

Bladder Stone - What's the big fuss?!

Hi everyone

so this post is going to be about bladder stones, this is relevant for any species from dogs, cats and even guinea pigs.  For this post we will focus on dogs and cats. We'll talk about what they are, how they develop, symptoms and how to deal with them... enjoy!!!

Lets start with what they are and how they develop;

Bladder stones are the accumulation of microscopic mineral crystals that are present in the urine, that along with a mucus like substance produced by the bladder build up and stick to each other growing and growing over time.  The correct name for bladder stones are uroliths. 

Different uroliths develop in urine of differing PH levels, some favour acidic conditions and other alkaline. 

The most common crystals found in dogs are;

- Struvite uroliths (magnesium ammonium phosphate or MAP)

- Urate uroliths 

- Cystine uroliths

- Calcium oxalate uroliths

If left untreated they will eventually reach a size that is visible to the naked eye and some to the size of say the stone in a plum!!! Some of you may remember this picture from one of our "What is it Wednesday's" of some bladder stones that were surgically removed from a dogs bladder.

So why are they so dangerous? 

There are many answers to this question but the main reasons are as follows;

1. These stones are rough and hard and they move freely around in the bladder, this scratches and traumatises the lining of the bladder which causes bleeding, inflammation and pain.

2. These can also get lodged in the urethra (the tube that carries urine from the bladder to the outside world). This not only causes pain and trauma but can actually block the urethra meaning that it is impossible for the patient to pass urine either at all or only be able to pass small amounts.

What do you think happens when the bladder is unable to empty? 

The kidneys continue to produce urine and the bladder continues to fill meaning that in extreme cases it cannot take anymore urine, to the point that the bladder bursts like a water balloon. I'm sure you can imagine that repairing a ruptured bladder is not an easy task and the risk of infection is very high.  Unfortunately if the bladder does rupture there is a high chance it will prove fatal for the patient.

If the bladder doesn't burst you still have urine backing all the way up the urinary tract, right back to the kidneys which can cause the kidneys to fail further adding to the patients complications.

What causes bladder stones... 

The pH level of a substance tells us how acidic or alkaline it is and depending on these conditions we either have a normal or abnormal environment. When the environment is normal we don't get the development of these crystals (but be aware of calcium oxalate crystals).  When it's abnormal it creates the perfect development site for them.

Some crystals only develop in acidic urine and others in alkaline,  for example calcium oxalate loves an acidic urine but they can also develop in neutral urine!!!, whereas triple phosphate AKA struvite crystals adore an alkaline urine.  There are other crystals too including; cystine, ammonium urate (Dalmations are prone to these), uric acid, calcium phosphate and calcium carbonate but the two most common we see in our practice are struvite and calcium oxalate. 

Diagnosis -

When we perform a urine analysis we also perform a 'dipstick' which indicates the presence of; glucose, bilirubin, ketones, blood, protein, pH, uroliths and leucocytes. We then check how concentrated it is using an instrument called a refractometer - this gives us an idea of how well the kidneys are functioning.  Again you may remember this picture from another What is it Wednesday...

Refractometer view

Once all this is done the vet will review the results and based on these as well as the patients clinical exam or symptoms described by the owner we will decide if a urine sediment should be examined under the microscope.

To perform a urine sediment we take a small sample of urine and spin it down in the centrifuge at a speed of 1500rpm for 5 minutes. The result is a separation between the urine at the top of the sample and the sediment at the bottom. We take a sample of the sediment, this is done my removing the upper layer of urine, adding a drop of sedistain and then re-mixing the sediment. With a pipette we then suck up the remaining fluid and put a drop on a microscope slide and then cover with a very thin, glass cover slip. It is now ready to examine under the microscope.

Below are photos taken of a patients urine sediment.  When we request a urine sample from your pet this is one of the test that we do.  We centrifuge a sample of the urine, this sends all the "hard" particles to the bottom of the sample which we pipette out and examine under the microscope.

Struvite

Calcium Oxalate

As well a urine crystals we may also see red blood cells, casts and white blood cells.

If there are crystals present we now need to diagnose if they have yet formed stones which can be done by ultrasound examination of the bladder although this isn't 100% accurate so ideally x-rays and sometimes contrast x-rays should be used... See pictures below.

Large Bladder stone almost filling the bladder

Bladder stones in a Guinea Pig

If stones are present we need to be looking at removing them surgically and if they have not yet developed we need to do everything we can to keep it that way.

Prevention -

We need to change the pH of the urine, this is achieved through a diet change and we recommend Royal Canin Urinary prescription food which will dissolve the existing microscopic crystals and any tiny stones. We will need to keep a close eye on the patients urine, so regular dipstick and sediment rechecks will be done.

When feeding this prescription food it is important that no other food is fed - including treats, as it will instantly alter the pH of the urine and undo all the good work of the prescription food.

We don't charge to test your pets urine and we recommend you bring a morning sample to their booster appointment where a routine dipstick test can be performed if you wish.

Now go and share your new found knowledge and pictures with your friends :)