Why Haven’t I Been Posting?

I promise to update some older blog posts on medical conditions, and also to post some new cases, and rehab/pain management techniques.

Part of the delay in posting was that over the last year I was focusing on attaining board certification from the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR).

The ACVSMR is the pinnacle of specialty training, as recognized by the American Veterinary Medicine Association (AVMA). This specialty college is a working group of diplomats in (separately) canine and equine sports medicine and rehab.

Starting in 2014, I began working on my requirements to be eligible to take this exam. This included rotations with mentors in other specialties, as well as a peer-reviewed research project.

With those steps completed, along with letters of recommendation, I had been accepted to sit for the specialty board exam in January of this year. In the fall of 2017 I started working at VOSM. I had been there about 4 months when I took a 10-week break from clinical work to prepare for my exam.

The board exam is given once a year, and consists of 400 questions over two days The first day is 200 questions on general topics, including exercise physiology, anatomy, and rehab concepts. The second day is species specific, so I had to review all the canine literature. There is a list of required reading, including multiple textbooks, and the last 5 years of medical journals on advances in research.

While this sounds like a daunting task, I approached my ten-week study period in short blocks, and worked seven days a week. A few of my colleagues were also taking the exam, so we had online review sessions, and worked together on difficult topics when possible.

Prior to starting the study period, I set up a system of how I wanted to approach the exam, and a daily routine. Having a set structure helped me to keep on track.

I decided that each day I would rise at 6am and walk the dogs. This helped to get my blood flowing a bit, and shake off the cobwebs. Then, I would study for the morning, and take a break around lunchtime. I would let the dogs out, and then take Penny (my pit bull) with me for a 3-mile run. The run helped me to organize my thoughts, and keep me physically active.

Penny and I ran 7 days a week, and it always helped me to clear the overwhelming amount of info that I was forcing into my brain. After the run, came lunch and a shower, and then back to studying until dinnertime.

After dinner, some nights I would return to studying for a few more hours, and other nights I relaxed, depending on how the day went.

Adelaide, my Newfoundland, would lie near my desk when I studied, and I affectionately called her my study prison guard. She kept tabs on my whereabouts in the house, and I appreciated it.

Did the studying go as planned? No, I got the flu and was out of commission for nearly a week in December. That whole time I slept and didn’t study. But I made headway when I felt better, and tried to stay on target.

About a month into studying, I started to go through review questions, and quiz myself. This helped me to understand my strengths, but also my weaknesses.

It was difficult to study during the holidays, but other than a short time off for sickness and a day or so for Thanksgiving and a half-day for Christmas, I kept to the routine. This was difficult, but I only wanted to take this exam once.

The board exam was given in late January, in Colorado. I honestly don’t remember much from that time, other than sitting and seeing question after question. My friends and I got through it, and then the next waiting began.

I flew back from Colorado and went back to work at VOSM in 24 hours.

We would be notified via email sometime 2-6 weeks after the exam of our results. The “ping” of a new email from my phone became Pavlovian, in that I began to sweat and become tachycardic. After two weeks, I muted my phone.

I share my birthday at the end of February, with my vet friend, Katie. I still hadn’t received my board results, and needed to stop pacing and making myself nervous. Before I left for Philly I got the email that I had passed! Being able to celebrate my birthday, Katie’s birthday, and passing boards all together was a great time.

A year later, while I don’t have to take the exam, I work on practice exams for the residents, helping to get them ready for their turn to take it. I am extremely thankful I never have to take it again!

Please check out VSMR.org for more information about the specialty, and leave your comments below.

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Update – I’m Back!

First off, my apologies for not updating this blog in almost two years. I have seen the traffic of people reading information, but time did not allow me to update the blog. My goal is to start posting regularly over the next several months.

In July 2017, I joined the team at Veterinary Orthopedic and Sports Medicine Group (VOSM) in Annapolis Junction, Maryland. I greatly appreciated my time at North Country Veterinary Referral Center (now Countryside Veterinary Medical Group) and am still in touch with the doctors there. Dr. Jill Zager has taken my position as rehab doctor, and the practice in New York is doing very well.

VOSM is a sub-specialty hospital, meaning that we deal only in dogs and cats that have mobility problems. With a fantastic team of nurses, technicians, and rehab therapists to compliment the doctors, we are constantly looking at new techniques and advanced procedures to help animals. We have three orthopedic surgeons, a neurologist/neurosurgeon and multiple rehab and sports medicine doctors.

We are also a teaching hospital, and have specialty interns and a sports medicine resident on staff, as well. We also host visiting residents, interns, rehab externships, and veterinary students who are interested in learning more about our work.

My role at VOSM is seeing consults for new patients, as well as internal referrals from other departments to help dogs and cats with their mobility issues. I diagnose through radiographs, PennHIP evaluations, and using diagnostic ultrasound of joints/tendons/ligaments, CT scans, and MRI. Based on those findings, I can initiate a treatment plan that could include joint injections (platelet rich plasma, stem cells, or other therapies) or oral medications, rehab therapy, or referral to our surgical department for arthroscopy, TPLO, CBLO, total hip replacements, or neurological surgery as indicated.

We work with patients from all walks of life, from military working dogs, agility dogs, cats and companion dogs. Our patients primarily come from Maryland, Washington DC, and Virginia, but we have seen patients from all across the United States, along with Canada and other countries.

I am proud and honored to be part of a tremendous team of caring people, and appreciate the learning that goes in all directions, and our ability to adapt to what each individual patient and family needs.

To learn more about VOSM, check out our website at:

http://vosm.com/

Irish Wolfhound Presentation

In May I spoke at the Irish Wolfhound Club of America’s 2017 meeting. It was held in Geneva, NY and during the day they had fantastic events of these gentle giants competing in athletic activities.

On Monday evening, I met with this great group, and discussed the vital role of proper spinal health in eventing, and a dog’s health in general.

We reviewed spinal anatomy, a number of spinal diseases (lumbosacral stenosis, spondylosis and degenerative myelopathy to name a few), and some key concepts in improving spinal mobility, as well as preventing certain aspects of disease as well.

I look forward to continuing the conversations with the member sof the group, adn future meetings.

Check out these great photos of the multiple day event.

https://maryo.smugmug.com/Irish-Wolfhounds/Events/IWCA/2017

Adelaide

This is a story about my own pup. I met Adelaide in January 2016 when she was 8 months old. I had known her breeder from my previous job and we have a good working relationship. Addie is a Landseer Newfoundland, and was from lines that are used for showing, working, and breeding. It is great to see these big dogs do their job, and they are wonderful pets to boot.

The concern was Adelaide wasn’t developing well, and seemed to walk funny.  I found some discomfort in her shoulder and hip joints, and suggested sedated radiographs. Those showed some mild hip dysplasia and osteochondrosis dessicans (OCD) lesions in both shoulders. OCD is a developmental orthopedic disease where the cartilage and bone don’t form correctly in a joint. This can lead to pain, arthritis, and the inability to work. It can happen in any dog, and there is some link genetically and environmentally. The key is to identify it early, remove that animal from breeding, and deal with the problem.

I sent Addie home that day with her breeder knowing that she could not be a show or breeding dog. However, she could make an excellent pet. About two weeks later, I called to check up on her and asked if she had been placed in a home yet. She hadn’t, and I took her in in February as a trial. If she would fit in with my pets, I would keep her as my own.

Addie fit right in with Penny and Milo, and soon I had a happy pup in the house. Great, now what do I do? Surgery was needed to minimize the arthritic damage in her shoulder joints. Then keeping her in good physical condition, protecting her joints and getting her moving would be my job. And since this is what I do for my patients, this is an easy fit for me.

Through some colleagues at the University of Pennsylvania, Addie had her shoulder joints cleaned out in April. The goal was doing them arthroscopically to minimize her healing time. The left shoulder went well, but the cartilage flap in her right shoulder was too large to remove. We successfully opened the joint and removed the flap. Then, we placed hyaluronic acid in both shoulders. This is essentially a synthetic joint fluid to help lubricate her joints and minimize further cartilage damage.

Addie recovered very well, and a month later, I spayed her and prophylactically did a gastropexy on her. This is tacking the stomach wall to the body cavity to prevent rotation or volvulus of the stomach during a bloat or GDV (Gastric Dilatation Volvulus) episode. Giant breed dogs are prone to bloat, and by doing this surgery I minimized her risk of gastric torsion. At the same time, I injected her shoulder and hip joints with hyaluronic acid and objectively measured her hips by taking radiographs in the PennHip method.

PennHip allows us to measure the distraction index between the hip joint of dogs, and correlates to how loose the joint is. Since hip dysplasia is based on laxity, the laxer a joint is, the higher the risk of arthritic change. Addie was dysplastic, but her score was mild. This allowed me to not consider a total hip replacement for her. If her scores had been worse, further surgery would be indicated.

After her recovery, I got Addie moving. She had continued to grow as well, and was now a lean 125 pounds. We began to work on walking and hiking. Last summer we hiked every weekend, and walked 2-4 miles each day during the week.

Penny, Addie, and I hiked to the top of Buck Mountain to overlook Lake George in July. By the fall, Addie could hike 10 miles a day nonstop.

Last fall, I had her groomed to a buzz cut. I weighed her the morning before, 125 pounds. Her weight right after the haircut was 113 pounds. 12 pounds of hair, and a reduction in 10% of her body weight. Not only is it easier to keep her clean in this cut, but reducing her body weight minimizes stress on her arthritic joints.

How do I keep her going? It is a multimodal approach. She eats Hill’s Science Diet J/D which is specifically formulated for dogs with arthritis. She also takes Dasuquin Advanced every day. This spring, I will inject her hips and shoulders with platelet rich plasma and bone marrow stem cells to further protect her cartilage.

I also keep her active, we walk 3-5 miles every day, and she plays regularly with Penny and her friend Dexter the Golden Retriever. We work on core strength through exercises on TotoFit equipment, and she gets out and swims when the weather cooperates.

At some point, she may need other medications, but currently she doesn’t have to take them. She is a wonderful girl and I am very thankful to have her as part of my family.

If you have questions about managing arthritis in your pet, please contact me.

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A Tribute to Milo

For those not familiar with my cat Milo, please check out my prior blog post about him here. https://drbrunke.wordpress.com/2013/07/28/matters-of-the-heart/

Milo turned 14 earlier this year, but had been slowly declining in health over the last few months. I had noticed he was drinking more and urinating more. He began to lose body weight, but was still happy, interactive, and eating. He also would have sneezing fits of 10-50 sneezes at a time.

In the last 4 weeks, he began to have trouble breathing, and would make a sound close to a snore when awake. I debated taking him to work for tests, but he would stress out about it. I also knew that he could not undergo anesthesia for a CT scan or biopsy due to his heart. Additionally, he could not be medicated, since any attempt to do so in the past was too much stress for his heart condition.

Given his signs, I was suspicious of a nasal tumor.

So, I waited. I kept his food bowl full and he would interact happily with Adelaide and Penny.

I was away last week for training, and he stayed at home with my pet sitter. We had previously discussed that if he went into acute crisis that he would be euthanized without me there. I did this for one reason, Milo’s best interest.

Shortly after arriving home Sunday, I found Milo having trouble breathing. I tried to relax him, but he was struggling. I dropped everything and took him to the hospital where I sedated him. Once he relaxed, I could appreciate a mass invading his skull.

I then humanely euthanized him, letting him be at peace.

While letting him go was difficult, it was absolutely the right decision for him and me. Diagnosing or treating his tumor would be near impossible given his heart condition, and it would not be fair to Milo to put him through that.

I am very thankful for all the lessons I learned from him. To take a chance, to give things time, and that not all the patients read the books nor follow rules. Milo lived thirteen years longer than he should have. Those years were full of fun, eating, playing, and hunting. In the end, his heart was still strong and that is the message I appreciate most of all.