Charles Kuntz

Hi, Charles Kuntz here. There are a few things that come to mind, most of which were already mentioned. I main thing that would be catastrophic if undiagnosed would be bloat, characterised by distention of the abdomen with unproductive wretching- life threatening emergency. Pancreatitis is possible- they usually present with vomiting, but not always. A disc rupture in the spine is possible, but less likely- they usually do not resolve spontaneously that quickly. In this breed of dog, disc rupture is usually a chronic pain issue rather than acute paralysis (like it can be in small dogs), so it is less critical that it be immediately diagnosed. German shepherds can also get a condition related to exocrine pancreatic insufficiency where they lack digestive enzymes and can twist their intestines- resulting in acute shock and rapid detioration (not likely in this case because of the spontaneous recovery). Exocrine pancreatic insufficiency is characeterised by chronic pasty light brown stools, voracious appetite and weight loss- I assume that you would have picked up on this by now. Please PM me if you have further questions. Thanks, Charles

Here in Melbourne, you have lots of choices when it comes to specialists. Wing Tip has a great reputation. Good luck with your puppy. Let me know if I can help. Charles

The reason for the encouraged activity is to encourage blood supply and also to encourage scar tissue to form that will be flexible and functional. WIth an FHO, the head of the femur is removed and the joint is replaced with a mass of scar tissue that is intended to keep the femur from rubbing on the pelvis. If the scar tissue becomes too tight from lack of mobility during healing, it will result in reduced range of motion. We often encourage owners to run the leg through a range of motion (like riding a bicycle) to allow "flexible scar tissue" to form. Please consult your vet as to whether or not this is appropriate and be careful that you don't get bitten (unlikely given the disposition of your dog). Charles

CHris is a good surgeon- fairly aggressive. When it comes to elbow diseases, you will have a hard time finding someone with more experience than Chris. Charles

FHO can be done on larger breed dogs with pain-free results and relatively good function. Total hip replacement may be a better option for larger dogs, but FHO shouldn't be ruled out even in large dogs. I encourage dogs having had an FHO to use their legs as soon as possible with controlled activity. The sooner they use the leg the better. You can do physiotherapy, directed by your vet right away as well. It is not unusual, however, for dogs not to want to use the operated leg for a few days to weeks (ask your vet about encouraging activity). Charles

Hi, Charles Kuntz here. I am a specialist surgeon and surgical oncologist. If you give me the tumour type, I can tell you a lot about how it is going to behave and what you need to do to treat it. Please email me on [email protected] with the biopsy diagnosis and we can go from there. Charles

Hi, Charles here. I am glad you contacted Valerie. She is really nice and really knowledgeable. Please keep me posted on progress. What did she say was the prognosis? Favourable I hope.

Remember, you have another option. Most people have a digital camera these days. Turn the flash off, go in a dark room with an xray viewer (in the practice), put the camera on a stable surface about 30-40 cm from the film and take a photo. I do this routinely and the quality of the image is quite good, as long as the flash is off and the camera is on a stable surface (or tripod). I cannot see a vet having a problem with your doing this. These images are often of diagnostic quality. We use them to get second opinions from other specialists via the internet. Charles

Hi, Charles Kuntz here. Just by way of review of what is known about haemangiosarcoma, here goes. It is a malignant cancer which occurs commonly in the spleen of large and giant breed dogs. Other sites include liver, heart (right auricle), skin, subcutaneous tissues, and muscle. The ones that occur in the spleen, liver, and muscle (also chest wall) are invariably pretty nasty, with a median survival time of only a few months. Chemotherapy has been shown to increase median survival time to about 6 months for tumours of the spleen. Chemotherapy usually involves a single agent call doxorubicin. The quality of life on chemotherapy is good in 80% of dogs. It is not as intense as chemotherapy for lymphoma. Stage does not seem to affect prognosis. It should be noted that haemangiosarcomas which occur in the skin are generally benign and respond to surgery alone with good survival, although local recurrence is common. It is solar -induced and commonly occurs on the stomach of non-haired dogs who like to sunbake on their backs. Hope this helps. Charles

Heart rate is quite variable, based on stress levels, etc. 90 does not really concern me. The 36 bpm that the other dog showed was because it had a third degree heart block and needed a pacemaker. If there are no clinical signs of collapse or weakness, I would not be particularly concerned. If you are concerned, then an ECG is appropriate. Charles

It sounds to me, as well, that there is still ovarian tissue remaining. I would definitely recommend having it removed. Otherwise, you could get into issues like vaginal and cervical tumours, pyometra (a serious infection of the remaining uterus) etc. If it were my dog, I would reoperate. In my practice, I would do a CT scan with contrast to help identify the residual tissue. Charles

I don't know of any one who has done pituitary tumour removal in Australia. I have thought about it, but have not attempted. Charles

As a surgeon, (when all you have is a hammer, everything looks like a nail)- I have to put my 2 cents in. If it is adrenal dependent Cushing's (Can be determined on blood work/ ct scan or ultrasound), surgery is often the way to go. Often the expense over the life of the dog for medical management will exceed the cost of surgery (typically with a very good prognosis). Charles

26 Feb 2009 7:00 pm KC Park at Skye (near Cranborne) in the pavillion No charge- Just happy to have you come. Thanks for the interest, Charles

Charles Kuntz, one Australia's most highly respected veterinary surgeons, will present a seminar for pet owners on current trends in the treatment of injuries and diseases in animals. In a light-hearted and entertaining format, Charles will discuss the latest in orthopaedics, cancer surgery, advanced imaging (computed tomography and MRI), radiation therapy and many more, available to animals today in Australia. Specifically, Charles will show that with appropriate diagnosis and treatment, diagnoses like cancer, cruciate rupture, elbow dysplasia, hip dysplasia, heart defects and many more are treatable and often curable diseases. Charles will also discuss a procedure that he developed for the treatment of epilepsy where the brain is split in half using the assistance of a small camera to reduce the incidence of seizures and need for medications. The discussion will be case-based and will include lots of video and surgical photos (not for the queasy or faint hearted). I have enclosed a brief biography. Dr. Charles A. Kuntz, DVM, MS, MACVSc, Diplomate of the American College of Veterinary Surgeons, Specialist of Small Animal Surgery, Fellow of Surgical Oncology Dr. Kuntz graduated from the University of Florida in 1990. He then did an internship at the Animal Medical Center in New York City. He completed a residency and Master's degree in surgery at Virginia Tech in 1994 and achieved specialty board certification in surgery in 1996. He did a one year fellowship in cardiovascular research and surgery. He completed a fellowship in surgical oncology at Colorado State University, is one of 20 people world wide to have received this training. He was then a professor of Orthopedic Surgery at Colorado State University before he left for Northern Virginia where he started a surgical referral practice which was among the busiest in the Washington DC area. Charles moved to Australia 4 years ago and is the director of Specialty Surgery for Animals in Melbourne. Dr. Kuntz has published many scientific articles, summary articles, abstracts, proceedings and book chapters on topics of surgical oncology. He was the chairperson of the oncology section of the National Meeting of the American College of Veterinary Surgeons. He is the section editor of the oncology section of the current edition of Slatter's Textbook of Small Animal Surgery. He was the surgical expert on panel discussions of feline vaccine associated soft tissue sarcomas at recent meetings of the American College of Veterinary Surgeons and the American College of Veterinary Internal Medicine. He was asked to write a chapter for a human surgical oncology textbook in bone cancer because of his reputation and expertise in cancer surgery. He started and currently runs Australia's first deep radiation therapy unit for animals. He has 5 United States patents for devices used in the treatment of diseases in animals. He has personally operated on over 5,000 patients with cancer with local cure rates of over 95%. Charles has been seen on "Talk to the Animals", "Animal ER", "A Current Affair", "National Nine News", "The Today Show" as well as numerous appearances on ABC radio. He receives referrals from all over Australia and consultations by phone and email world-wide.

Hi, Everyone. I am doing a free lecture similar in format to the last one discussing specialist veterinary care for dogs and cats with emphasis on what is available in Australia for animals. It is very informal but has very graphic photos and videos of surgery. I would invite everyone to come. Please RSVP to [email protected] for catering purposes. It is at 7:00 pm at KCC Park in Skye (near Cranbourne). 26th Feb 2009. I hope to see everyone there. Charles

Dogs' heart rates can drop down to 35-40 beats per minute at rest and at home. I would not be concerned about a slow heart rate at the clinic as long as the rhythm is normal. Dogs with a 3rd degree heart block will have a heart rate of around 35-40 even when excited and this can cause fainting. This would be fairly obvious on an ECG. I would not worry too much about your dog. Charles

Hi, Charles here. Regarding your staffie with a ligament tear, these are uncommon in dogs less than a couple of years of age. How was this diagnosed? If it is in-fact a ligament tear, they can respond to conservative management, but arthroscopic surgery may be required. I would also consider elbow issues, hypertrophic osteodystrophy (abnormal growth plates), and panosteitis (inflammation of the inside of the bone) in younger dogs. It is hard for me to give any advice without having seen your dog since there are so many different diseases of dog front legs, some of which are quite subtle, even with the dog on-hand. Let me know if I can of further assistance. Charles

I will give you my perspective. As a specialist surgeon, I do not sell dog food and I don't do dentistry. Vets obviously do make a profit from selling dog food (markup, obviously) and from doing dentistries, but most I know would not let that tarnish their recommendations. My concern with giving bones is that I have done surgery on dozens of dogs who have had bones stuck in the oesophagus, with universally high bills and variable success rates. The bones that get stuck, granted, are usually cooked bones and are of the perfect size to go part of the way down. I would only feed bones to my dogs that are either way too big to be swallowed (beef femurs) or too small to get stuck (chicken necks, etc). Comments??? Charles

TWO is similar to a TPLO but has theoretical disadvantages compared to TWO primarily related to the position of the patella as it courses through the groove. TPLO and TWO have never been compared in a study, but I would imagine results are similar. The other procedure you are referring to is probably the TTA which I address in my previous post. Bottom line is that all of the tibial plateau procedures (TWO, TPLO and TTA) probably have similar results. I would base my decision between those on cost and recovery in the hands of the surgeon. The comfort level you have with the surgeon is as important as anything, particularly how they deal with aftercare and complications (we all have them). Not all specialists are equal in this regard. Charles

Anytime. You can also PM me. Charles

With regards to dogs and cats, they are primarily concerned about things that are not already in Australia, most specifically, rabies. Rabies has to be transmitted by exchange of saliva with body fluids (ie- dog bite) and the system of fences they have prevents this. They are not concerned about things like Kennel Cough, which is already endemic (in Australia). Release of rabies in a completely naive population of mammals with no previous exposure or vaccination would be devastating with huge public risk potential (rabies is universally fatal) as well as economic catastophy. Australia is very lucky to be an island country. We are in a unique position to really protect ourselves from lots of things and I completely support their efforts. Charles

Cruciate ligament rupture is the most common orthopaedic disease seen in dogs. Traditionally, it was thought of as a specific injury resulting from acute stress on the knee causing an acute ligament tear. More recently, theories of an abnormal slope to the tibial plateau have been developed which probably more accurately address the inciting cause. When the tibial plateau is tilted backwards, the femur tends to slide “downhill” putting stress on the cruciate ligament. Repeated stress ultimately results in failure. Studies have shown that in dogs weighing less than 15 Kg, conservative (non-surgical) management is often appropriate. This involves weight-loss, pain relief, cartilage protectants and exercise modification (physiotherapy). In dogs weighing over 15 Kg, non-surgical management is only associated with a 40% success rate. Surgical management results in an 85-95% success rate depending on issues like body weight and proportions, rehabilitation and surgical technique used. We regularly perform three different techniques for cruciate ligament repair. There are advantages and disadvantages to each. The traditional technique for cruciate ligament repair is called extracapsular repair. It involves replacement of the ligament with a piece of nylon. Advantages of this technique include technical simplicity, infrequency of complications and cost. These are most commonly done at primary care veterinary clinics with good success. The primary disadvantage is a much higher incidence of severe arthritis when compared with other procedures. It is most appropriate for small to medium sized dogs with a moderate level of activity. The second commonly performed technique is called the TTA or tibial tuberosity advancement procedure. It is a fairly new procedure which has had very favourable results. In this procedure, the tibial crest is advanced forward so that the patellar tendon acts like the cruciate ligament. The advantages include very rapid recovery, when compared with any other repair technique, favourable outcome, and cost when compared with a tibial plateau leveling osteotomy. The disadvantages include relatively short track-record and potential for meniscal injury. The meniscus is a shock-absorber between the femur and the tibia. A meniscal release procedure can prevent this damage in the future. Results to date are very encouraging and we have been particularly impressed with the speed of recovery. The third procedure is the TPLO or tibial plateau leveling osteotomy. This procedure has been around for around 20 years and the results are as good or better than anything else published to date. This procedure is based on the fact that the tibial plateau in cruciate-deficient knees is tilted backward, causing excessive tension on the cruciate ligament. The top of the tibia is cut and rotated to make the cruciate ligament obsolete. The advantage of this procedure is the excellent outcome. The disadvantage is cost when compared with the other procedures.

I would guess a partial cruciate ligament rupture as well. Only 50% of dogs with a partial tear will have a positive drawer sign. The medial swelling (buttress) is a more consistent clinical sign. Conservative management is appropriate initially, recognising that many dogs will go on have a tear which requires surgical intervention. The typical history is a lameness which resolves with rest, but recurs after exercise. If it happens a few more times, you should probably consider surgery. The outcome with surgery is very good in most cases. Conventional extracapsular repair has been associated with 6 times the incidence of severe arthritis when compared with TPLO's. While complications with TPLO's do occur, they are uncommon. There are alternatives to TPLO's including TTA's which are relatively new but are associated with a very rapid recovery when compared with all other procedures that I have done. They are also a bit cheaper than TPLO's. Charles

I don't believe the vet should have removed the other dewclaw. It is unnecessary surgery in most cases and he could not have predicted that this would happen. On the anaesthesia side, we commonly anaesthetise geriatric pateints (12-15 years of age) 15 or 20 days in a row for radiation therapy with no problems. Thousands of dogs have been adminstered radiation therapy in this fashion for decades. Hope this allays your fears. Charles