Page 4 - Clinical Connections Autumn 2015

Transdisciplinary approach tackles complex emergency case
A highly unusual case drew on the expertise of emergency, critical care, neurology, internal medicine, diagnostic imaging and nutrition specialists.
The dog in question, an eight year old Labrador called Barney, was referred because of respiratory problems and being unable to stand. Unexpectedly, he was found to be in a diabetes crisis. The case was particularly confounding as Barney had normal
glucose levels when his blood was tested by his referring practice, a week before admission to the RVC.
Adding to the
complexity of
Barney’s condition, he was found by our team to have unusual neurological abnormalities, which were diagnosed by neurology specialists via an electromyogram.
Barney presented to the RVC’s Emergency Referral Service in July for stabilisation, as his condition had deteriorated following treatment at his primary veterinary practice for coughing
and a suspicion of laryngeal paralysis. His inability to stand was being attributed to an exacerbation of chronic osteoarthritis, for which he has been treated for some time.
As a result of the possibility of also having a contagious respiratory infection, Barney had to be treated in an isolation unit, whilst still requiring intensive care due to his diabetic crisis and neuropathy.
Once his respiratory issues and diabetic crisis were resolved, his care was then managed by the Internal Medicine Service. Within a week of hospitalisation and
effective insulin treatment, Barney was able to walk and made a great recovery. Dan Chan, head of the Emergency
Referral Service and the Critical Care Service, initially admitted him as an emergency case but then also helped the Internal Medicine Service devise a weight loss programme for Barney, as he also heads the Nutritional Support Service at the Queen Mother Hospital for Animals.
As Barney was severely obese, this was thought to have contributed to his crisis and the development of a polyneuropathy.
Within a month of being discharged Barney had lost more than 10% of his weight, which was 56 kg upon leaving the hospital.The owners report that he is continuing to do well on his weight loss programme.
Professor Chan said: “One of the best features of our multi-discipline hospital is the integrated team approach to every case. Despite the fact that we had to isolate Barney due to the concern of a contagious respiratory infection, we were able to perform a CT scan, a lung wash, get a neurological evaluation, including an EMG, and have his diabetes controlled and a long-term weight loss programme introduced all within days of his arrival. This collaborative approach is at the heart of what we do and we believe is best for our patients. It is particularly gratifying to see such amazing results with such complex cases.”
For RVC Small Animal Referrals contact details please see the back cover
Dental referral service supports trauma work
The RVC’s dental referral service, which was established last year, has been working closely with the trauma clinic to support patients.
The service, which covers dogs, cats and other small animals, was established last year after the appointment of specialist Simone Kirby.
Simone undertook a residency in veterinary dentistry at the University of Pennsylvania from 1999 to 2001 and
subsequently became a Diplomate of the European Veterinary Dental College. She worked in private referrals before joining the RVC.
The Queen Mother Hospital for Animals is a leading centre for trauma medicine, orthopaedics and neurology. The addition of a dental specialist enables referred trauma patients to receive all the treatment they need under one roof.
Cases treated at the RVC have included a rescue dog from Spain that had an inability to open the mouth fully as a result of trauma to the caudal mandible as a puppy.The maxillary fourth premolar tooth, which was extracted, had become painful as a result
of the badly-healed mandibular ramus. Two police dogs had root canal
treatment of fractured canine teeth. One of these also had two fractured incisors treated by root canal at the same time. A number of cats have received root canal treatment of fractured canine teeth and several with feline chronic stomatitis have benefited from multiple extractions. An Australian shepherd dog with head trauma was seen jointly between the QMHA Orthopaedic Service and the dental clinic.
For RVC Small Animal Referrals contact details please see the back cover
4 RVC Clinical Connections Autumn 2015