Tibial Plateau Leveling Osteotomy (TPLO)

This procedure uses a fresh approach to the biomechanics of the knee joint and was developed with larger breed dogs in mind. Now we know this is the preferred surgery for both large and small breed dogs. This is the only procedure to significantly reduce the progression of arthritis in the majority of dogs when compared to extracapsular and TTA.

The procedure changes the angle at which the femur bears weight on the flat "plateau" of the tibia. The tibia is cut and rotated in such a way that the natural weight-bearing of the dog actually stabilizes the knee joint. As before the knee joint still must be opened and damaged meniscus removed. The cruciate ligament remnants may or may not be removed depending on the degree of damage.

This surgery is complex and involves special training in this specific technique. Many radiographs are necessary to calculate the angle of the osteotomy (the cut in the tibia). This procedure typically costs more than the extracapsular repair as it is more invasive to the joint but it is far superior.

• Typically, most dogs are touching their toes to the ground by 10 days after surgery although it can take up to 3 weeks.
• As with other techniques, 8-12 weeks of exercise restriction are needed.
• Full function is generally achieved 3 to 4 months after surgery and the dog may return to normal activity.
• Athletic dogs will have the greatest outcomes achieved with this surgery

Tibial Tuberosity Advancement (TTA)

The TTA similarly uses the biomechanics of the knee to create stability though this procedure changes the angle of the patellar ligament. This is done by cutting and repositioning the tibial crest where the patellar ligament attaches and implanting a titanium or steel "cage," "fork," and plate as well as bone grafts to stabilize the new angle. Like the TPLO, bone is cut, special equipment is needed including metal implant plates. Similar recoveries are seen relative to the TPLO but it does not slow down the progression of arthritis as well as the TPLOs.

Which Procedure is Better?

​The TTA and TPLO are much more invasive, more expensive, and require special equipment and specially trained personnel. They also have greater potential for complication. Are they worth it? For all the theory behind extracapsular, TPLO and TTA, results one year post-operative seem to be the same regardless of which of the three procedures the dog had performed. However, the progression of arthritis in the extracapsular technique and the TTA is rapid compared to the TPLO. The health of the joint with a TPLO  will be far better than the other techniques. There is some evidence that recovery to normal function may be faster with the TPLO.

How is the TPLO performed?
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Q: Does My Dog Really Need Surgery?  I Read That They’ll Do Just Fine Without Surgery.

A: Published data suggest that approximately 15% of dogs will recover reasonably good clinical function without surgery.  Most of those dogs will be small breeds, under 7 to 10kg of body weight.  Those that recover normal function tend to do so within 4-6 weeks after they first become lame.  For the majority of dogs, surgery is the only way to return them to good function, period…..not braces or medications or herbs or physical therapy or wishing or hoping!

Q: Which Patients Will Benefit From TPLO?

A: While the procedure can be performed on just about any patient, including small dogs and cats, TPLO seems to be most applicable to larger breed, active dogs.  Although some surgeons have differing opinions, most feel that smaller dogs will do equally well regardless of what procedure is performed.  In general, dogs weighing over 45 pounds (20 kg), especially if they are very active, will benefit the most from TPLO.

Q: Why Is TPLO So Costly, Especially When Compared To Other Cruciate Repair Surgeries?

A: TPLO requires specialized equipment including a motorized bone saw with a specially-designed curved blade, a surgical stainless steel bone plate and 6-9 bone screws, between 4-6 x-rays, a significant investment in training on the part of the surgeon, and up to 2-4 hours of preparation, surgical and recovery time for each patient.

Q: What Aftercare Is Required?

A: Individual surgeons approach this differently and there is no hard evidence to suggest what is best.  Some restrict post-operative patients from climbing stairs and encourage kenneling when the owners are not home to supervise their pet.  Others encourage leash walks and moderate exercise under the owner’s control.  Still others advocate active physical rehabilitation beginning immediately after surgery.  All will require follow-up x-rays at various stages to gauge healing of the cut in the bone.  Once bone healing is complete, then exercise can be gradually increased to normal.

Q: What About Possible Complications?

A: TPLO is a major surgery and complications are possible.  Published reports suggest the complication rates may be somewhat higher than with less invasive surgeries, but other factors may be involved including patient factors and surgeon experience with the procedure.  Most complications are minor in nature in that they can be resolved without additional surgery and have an ultimately successful outcome.  Included in this category would be things like infections and inflammation of the patellar tendon.  More major complications, including failure of plates or screws and fracture of the tibia or fibula, are uncommon.  The development of bone cancer many months or years later in the area of the surgery has been noted in a small number of TPLO dogs.  The possible connection of this cancer with the procedure is highly controversial as the top portion of the tibia is a common location for bone cancer in the dog even when no surgery or cruciate problem is a factor.  Whether the rate of such cancers in TPLO dogs is higher than normal is not clear.  One of the most common post-operative complications is not directly related to the TPLO procedure.  Tears of the meniscal cartilage in the stifle are a common consequence of an unstable joint.  Such tears may exist at the time of surgery and they can develop in up to 11% of patients after surgery.  That’s true in dogs and humans regardless of what kind of surgery they undergo.  Typically, these patients do well for weeks or months after surgery before suddenly becoming lame again.
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Q: Is TPLO Really Better Than Other Surgical Options?
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A: If your dog is larger, younger and active the answer is yes.  The data has not always been conclusive about this, however.  For a good part of the first 20-25 years after the development of TPLO, surgeons were faced with a paradox:  they were seeing significantly better results with TPLO than with other procedures they had used in large dogs….but the research data wasn’t backing up these observations.  Why?  Undoubtedly, Dr. Barclay Slocum’s decision to restrict availability of the procedure through patenting of the technique and equipment had a major effect on the amount of research that was done. 
In addition, one must realize that veterinary research is always more restricted in scope and numbers than is seen in human medicine.  The New England Journal of Medicine will commonly publish studies involving tens or hundreds of thousands of human test subjects.  In veterinary medicine a study of 50 animals is a big study!  Why?  Money.  The difference in available research funds between human and veterinary medicine is astronomical, which probably isn’t surprising.  In the last few years, the research data is starting to confirm what surgeons have known all along:  TPLO dogs return to function faster, they develop less joint arthritis, and they tend to return to better functional levels than is seen with other techniques.  Although we can’t say for certain, it appears that these positive results also apply to other similar techniques such as TTA, CWO, and TTO.         

The "Build-Up" is coming to the top end, and soon the tropical storms and cane toads will be upon us.
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Cane toads pose a serious threat to our pets with poisonings amongst dogs now very common. Over the past two decades in Katherine, we have seen the establishment of a strong cane toad population, and new pets to the Northern Territory may not be familiar with this pest.

Be careful, there are a few dodgy urban myths about toad poisonings. The most concerning one is that giving the dog activated charcoal can help. This is not true because the toxin is absorbed through the roof of the mouth. The charcoal will have no effect on the absorbed toxin. If the dog is shaking or having seizures and is fed charcoal, the dog may accidentally inhale the charcoal and this will cause dangerous breathing problems.

​It is recommended that once treated, your dog be checked over to ensure there are no after effects. If you are a long way from a vet, you should still call one as soon as possible to get any further advice.
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Last but not least..
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One last bit of advice… if you are unfortunate enough for your dog to go through a poisoning episode, after your dog recovers, please get rid of the toad. Preventing contact with toads is often difficult. Some animals will learn to avoid them as the poison doesn’t taste very nice, others will keep going back. One colleague in North Queensland had the same dog come in four times in the one night for toad poisoning.  So, if you see your pet playing with a toad you should remove the toad immediately, and observe your pet closely for at least the next hour. Drinking bowls should be placed up off the ground and checked and changed regularly or a safer alternative is small automatic waterers mounted off the ground.
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Lets just hope they find a way to get rid of these toads soon.

August 2018 - Recently at Northern Territory Veterinary Services in Alice Springs, we have seen a large outbreak of canine parvoviral diarrhoea including deaths of some animals. We have seen several cases in the past week, and there would be many more that do not make it into the clinic. Cases have also started to appear in Katherine. This is a tragedy, as this life threatening disease is easily prevented in most cases by simple vaccination.

Parvoviral infection must be considered as a possibility in any young dog with vomiting and/or diarrhoea, or any adult dog that is overdue for vaccination with similar symptoms. There have been reports of the new viral strain 2c infecting dogs that have previously been vaccinated but are overdue. We urge all dog owners to get their animals vaccinated for this disease. Prevention is far better and cheaper than treatment for this horrible disease. ​Regular vaccination ensures that your dog is protected.

Additionally, it is possible for cats to contract the new 2c strain, so we urge owners to ensure their cats are up to date with their vaccinations too. 

Please note: Parvovirus poses no viral risk to humans, horses and livestock

The virus multiplies in the dog into the millions and is shed into the environment through the vomit and diarrhoea of the dog. Wherever the vomit and diarrhoea lies, the ground becomes contaminated. The virus can survive in the environment for up to 7 months, even after the vomit or diarrhoea has been cleaned away. Only bleach or special disinfectants can destroy the virus in the environment.

​It is then, very easy for someone to walk through these areas and pick the virus on their shoes or clothing and spread it further. Dogs walking through these contaminated areas can pick it up on their feet and when they lick or clean their feet, they then can become infected with this virus.

It takes about 4 to 7 days from the time a dog is in contact with the virus to full signs of infection. Please note that during the first 4 days of incubation, dogs can still spread the virus.

Fortunately, parvovirus in dogs is a treatable disease and if caught early, can be cured, especially with the advent of a number of new treatments, but this can be expensive. In our clinic, we have a greater than 95% success rate with intensive treatment, but the dog usually has to be hospitalised for several days for intensive care and requires multiple medications.

Home treatment for parvo infection is a bad idea when compared to hospitalisation and intensive care. The death rate rises substantially, and the profuse diarrhoea and vomiting will lead to heavy viral contamination in the home. ​Without proper treatment, a dog can become weak, septic and eventually will die. ​

This is a new strain of parvovirus that has been seen in Australia and is particularly nasty. Reports have indicated that adult dogs that have previously been vaccinated but are overdue have been infected. The vaccine companies have advised that each of their parvovirus vaccines do cover for this new strain. Regular vaccination will ensure that your dog is protected.

Not many disinfectants will kill the virus, except for bleach and special disinfectants. If using bleach, mix 1 part bleach to 30 parts water and mop the floors. Allow 30 minutes contact time to ensure the virus has been destroyed.

Once better, your dog will no longer be infected with the virus, but they should be considered contagious for approximately a month as they may have virus particles still on their fur and skin. They will no longer shed the virus. It should be noted that they will be protected for life against future infections with parvovirus, but it is still important to vaccinate your dog for other life threatening diseases.

The virus can survive in the environment for up to 7 months. So if you are getting a new dog, and there has been no parvovirus in your yard for more than 7 months, it can be considered safe. However, you should still vaccinate your dog to ensure that they are protected, as virus can still be carried on your shoes and clothing if you were in contact with the virus elsewhere.

Dr Alex Burleigh BSc(Vet) BVSc

​Today is the day and your pet has come to us for their procedure, what now I hear you ask. Is it as simple as picking them up tonight? Not quite but luckily it isn’t too complicated. The answers to our frequently asked questions below should help you help your pet have the smoothest recovery. 

is fine to have ​​some dinner a few hours after they get home. It’s a good idea to just give a small bland meal such as boiled chicken breast and cooked white rice or a small amount of their normal food. We don’t want them eating too much too quickly as there’s a chance they can make themselves sick. They should have access to water as soon as they get home. 

​Yes. Your pet should be kept inside at least overnight and depending on the procedure longer may be needed.  

​Not necessarily. Your pet may have had a tube placed in their windpipe so we could give them a gaseous anaesthesia. Sometimes this causes a little bit of irritation, if this is the case the cough should only last a few days. If your pet’s cough lasts longer than this or they are otherwise unwell, such as they have lost their appetite, then you should contact your vet. 

you worry and call your vet are: continuous bleeding or bleeding in a large volume, bleeding after 24hours post surgery, any large swelling, if the skin becomes very red and hot or any discharge especially if this looks like pus. ​

Usually yes. Most of the time they are removed in 10-14 days, check with your vet when is the most appropriate time for your pet as this will depend on the particular surgery they’ve had. 

​So your pet is booked in for a general anaesthetic, I’m sure you now have a few questions about what that means and what you need to do. There’s no need to be too worried, hopefully you can find all your answers below but if not don’t hesitate to give the clinic a call to ask any questions that you need.

​An anaesthetic is when drugs are used to make your pet unconscious and unaware of what is happening. First we give your pet some drugs to make them relaxed and provide some pain relief in preparation for the procedure. The particular drugs 

​Your vet may or may not want you to give your pet its usual medication just before the procedure depending on what it’s on. Therefore if your pet is on long term medication make sure you check with your vet before if they want you to give it or not. 

​We admit patients for procedures between 8am and 9am so bring your pet down between these times. Make sure you dog has been for a toilet walk before hand and be prepared to stay for a little while when you drop your pet as the nurses will have a couple of questions for you. It’s really important that if your pet has been unwell at all in the days leading up to the procedure that you let us know. Sometimes we might feel it is safest to delay the procedure if your pet has been unwell. 

​There is a very small inherent risk associated with any anaesthesia, just as there is with people. The more details we have about your pet’s health on the day of the procedure the safer we can make it for your pet. Having said that the vast majority of procedures go really well and you shouldn’t be spending the whole day worrying. Monitoring your pet during the anaesthesia allows us to adjust what we’re doing to your pet’s individual needs.

​We usually ask that you give us a call between 2-4pm to check how everything has gone and organise a time to come back in and pick up your pet. 

At Northern Territory Veterinary Services, we are seeing many dogs in the NT getting sick from a relatively easily preventable illness. Pups are in particular danger of dying from this disease. What’s an even more concerning development is that we recently are seeing adult dogs succumbing to this horrible illness.  What is it? Hookworms. Yes! Hookworms. There are several worms that can cause health problems but recently hookworms have been rearing their ugly heads. We have seen an unusual number of worm infested dogs, especially puppies. Regular worming is easy to forget but it is so important to keep your pets healthy, both in the young and old.
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So what’s so unusual about this wet season? Well, we see a lot of these infections in the wet as the worms require water droplets to hatch out. So this wet season being particularly big and particularly long, we are seeing heavier burdens and greater number of animals affected.

​What is hookworm?
The hookworm is a particularly nasty parasite (about 3mm long) that hooks onto the inside of the intestinal wall and sucks out a large amount of blood to feed.  Puppies can become infected before birth, through the milk when feeding from their mum, or through the skin from the environment. This worm causes blood loss, weight loss, pain, failure to thrive and in severe cases, death.  Unfortunately, hookworm infestation is usually first noticed when the pup is already very sick with very pale gums, lethargy or bloody diarrhoea. Adult dogs are more resistant but we do diagnose infections in them too, particularly when the environmental conditions are right. They can cause a more slow lingering illness in adult dogs.

Can I catch it?
Hookworm is transmissible to humans. Personal hygiene is always important;- wash your hands after handling your dog and definitely before eating, Hookworm larvae can also hatch out in the yard and then burrow through the skin and cause itching. Children are particularly at risk. 

So how do we do we stop the cycle of infection?
Prevention is the best cure, and regular worming of all your dogs throughout their lives will help stop the vicious cycle of re-infection.
Puppies must be wormed from 2 weeks of age and every 2 weeks until they are 12 weeks old then every month until 6 months of age.  From then on, worming every 3 months is adequate, unless otherwise advised. Talk to one of our veterinarians for further advice. Over time, with regular worming, your dogs can act as vacuum cleaners for the yard and clean up the environment.
Cats don’t get hookworm but they are at risk of other intestinal worms, and so they should have a regular worming routine as well. Luckily for those slightly less sociable puddytats, there are effective top spot all wormers available now from vets. Phew!

​New dog? What to do…
When you pick up a new puppy make sure the breeder gives you information on when the puppy was wormed and what was used. If they cannot do this, it is best to assume the pup hasn’t been wormed. Any new dogs or pups should be wormed as soon as possible to avoid infecting your own yard with worms.
 
If in doubt, just ask
If you have a new puppy or are planning to breed, call into your local veterinary clinic and speak to the staff who can give you the correct advice on prevention and treatment of worms in your dog.

For further information, call us on 08 89723599 in Katherine or 08 89524353 in Alice Springs at Northern Territory Veterinary Services.

In Alice Springs, we are warning clients regarding the release of RHDV1 – K2, a new strain of rabbit calicivirus which is due to be released as a form of feral rabbit control throughout Australia in early March. There will be five sites around Alice Springs where it will be released. We are urging rabbit owners of Alice Springs to vaccinate their rabbits to reduce the risk of infection and death.

Currently for the first week of March, our clinic in Alice Springs is holding a vaccination amnesty where we are offering highly reduced rates for this vaccination.

How is RHD / Calicivirus transmitted?
 
RHDV is easily transmitted by direct contact with faeces, aerosols and secretions from infected rabbits. More importantly, whatever these secretions contaminate, it can easily aid in spread. So the virus can spread on clothing, cages and shoes. It can be found on grass cuttings, even flies can spread it.

What happens if my place becomes contaminated?
 
If an infected rabbit was housed in your place, it is important to remove the infected rabbit, disinfect the premises with 10% bleach or F10 disinfectant.

Dr Alex Burleigh

The Dry season is finally here, or at least attempting to be, so as the waters run off (in reality they have already run off), we start to see a range of hook related issues in our dogs. Can I just say out from the start, hooks and dogs don't mix. If you want to go fishing, it's probably best to leave your dog behind. They'll scare the fish away, or at worst, attract a loving six metre salt water handbag (or for those not in the know - a crocodile!!). But our biggest concern is hooks and dogs. Dogs can either get them hooked in a paw, in a lip, or even worse, swallow them.

allows the vet to gently manipulate the hook from the dogs stomach using specialised equipment. If you happen to pull the string, it could lodge the hook in the stomach wall or even worse, the oesophagus which could lead to complicated surgery. So please leave the hook alone.

So hopefully this gives you a good guide if this emergency should ever occur, but avoidance is always the best option. So leave your beloved fur friend at home if you decide to go fisihing. Your dog will appreciate not having to be driven to the vet in the middle of the night, and it will be a lot more helpful on the hip pocket.