Charles Kuntz

Oleander is a highly toxic plant for all mammals. It contains a substance which is used to make the cardiac drug "digitalis" or "digoxin." It can cause rapid death and its consumption must be avoided. That being said, I have never seen a toxicity in dogs. Charles

No one really knows the cause of perianal fistulas. We used to treat them surgically with mixed results and a horrific postoperative period. Since the discovery that cyclosporin and ketokonizole, more than 90% of dogs can be treated successfully. Cyclosporin is an immunosuppressant (which is quite expensive). The ketokonizole is an antifungal medication that is used only because it reduces the metabolism of the cyclosporin, allowing you to use a much lower dose. Most dogs only need to be treated for a few months with a pretty high success rate. You are usually looking at a couple of thousand dollars for the whole course (which is about as much as the surgery would cost) with higher success rate and much easier recovery. Hope this helps. Charles

I have to put my two cents in...I take offense to the comment that vets don't care to keep up with the literature, etc. That statement is a gross generalisation and I see so many vets attending continuing education in order to keep up with currents trends in treatment. I am a specialist surgeon and I spend a HUGE amount of time teaching, reviewing the literature, reading journals, lecturing, etc, etc and I ONLY use surgical techniques that have been validated by PEER REVIEWED methods in highly regarded journals. I would venture a guess that this is in contrast to what is recommended by other "health practitioners" who have very little objective data to support their recommendations. I am all for alternative methods as long as they are used reasonably and that things that have known success rates are considered as well. Specifically, regarding patellar luxation, this is a condition that is easily corrected. There was a study in a peer reviewed highly reputable journal that showed that in dogs with bilateral luxations with only one repaired, that the one repaired had less arthritis than the one that was not repaired. We recommend surgery for most cases where that patella completely dislocates out of the groove (Grade II or above) with a 90+% success rate. I have personally operated on over 200 of these with success rates in the 90's. I recommend a transposition of the tibial crest (the attachment of the patellar tendon) as opposed to deepening the groove (which results in marked damage to the cartilage). I have seen this in dogs that were referred to me for a second attempt after a "groove deepening" procedure had been attempted and failed. I think gross generalisations are inflammatory and don't really serve to help anyone. Vets, like anyone else, can be viewed as being on a bell-shaped curve. You are going to have great ones and crappy ones, but most are pretty good (within a standard deviation of the mean, to put it in statistical terms). Charles

I have done about 25 of these using pancarpal arthrodesis. Obviously, the joint is fused. The success rate is about 80-85% with these, as in good function of leg. Charles

I am writing to remind you of a free lecture that I am giving on Tuesday 11th November 2008 at the RAS rooms at the Melbourne Showgrounds at 7:00 for a 7:30 pm start. I will be discussing cutting edge surgery and other treatment modalities for dogs with injuries and diseases. All are welcome to attend. Please RSVP to me on [email protected] ASAP. Remember that there will be graphic surgical photos and movies. Thanks, Charles

Sorry, when I mentioned the above mentioned studies, I was referring to the references behind the data you are reporting (that I had to read many moons ago when studying for my surgical boards : ). Thanks, Charles

There are definitely spots available. I have just finished putting the lecture together. It should be entertaining and informative for everyone. Charles

1. Doubles risk of osteosarcoma (Risk v high: cause of death of 1 in 3) 2. Increases risk of hemagiosarcoma x2.2 - x5 (Risk v high: most common cause of death) 3. Increases risk of orthopedic disorders (doubles risk of cranial cruciate ligament rupture; triples risk of patellar luxation) 4. Causes urinary incontinence in 4 - 20% of dogs 5. Triples the risk of hypthyroidism 6. Increases risk of adverse reactions to hypothyroidism 7. Increases risk of geriatric cognitive impairment 8. Doubles risk of urinary tract tumours / bladder cancer / TCC of the bladder x2-4 (Risk v low: <1%) 9. Increases risk of persistant or reccurent UTIs x3-4 10.Doubles risk of obesity Be very careful interpreting the above statistics from the previous posting. Note in that in all of the above mentioned studies, the INCIDENCE of the stated diseases was higher, but there was never a CAUSE AND EFFECT shown or even suggested. Remember that there are confounding factors- it has already been stated that neutered dogs dogs live longer. Dogs that live longer get more cancer. Dogs that are neutered have already not died from roaming related accidents, pyometras, pregnancy related deaths, etc. It would be impossible to prove a cause and effect. To say that it increases the risk of anything is JUST NOT TRUE. All that is ever suggested is that in a particular study, the incidence of a certain disease in neutered dogs was higher in their study population, not that neutering increased the incidence. Could it be that people in the general pet owning population (NOT AMONGST HIGHLY MOTIVATED AND CONCERNED BREEDERS) that neutered their pets were more likely to care enough to bring their sick pets for treatment??? I think that the most important statistic is that neutered dogs live longer. That is all I need to hear. Charles

Cushing's disease is caused by an excessive production of cortisone by the adrenal glands. It results in hair coat problems, liver disease, skin problems, decreased wound healing, decreased ability to fight infection, excessive coagulation of the blood, diabetes, and numerous other problems. Clinical signs include, in addition to the above, increased urination and drinking, excessive panting, muscle wasting and pendulous abdomen. THe causes of Cushing's disease include pituitary (85% of cases) where the the pituitary gland produces too much adrenocorticotropic hormone (ACTH- the hormone that tells the adrenal glands to produce cortisone) usually due to a microadenoma (microscopic tumour) or less commonly due to a macroadenoma (large and visible tumour- on an MRI or CT scan). The other type of Cushing's is called adrenal dependent which is due to an adrenal tumour. Adrenal tumours can be benign or malignant. The most important step after Cushing's is diagnosed is determining whether it is due to pituitary or adrenal problems. If it is pituitary, the treatment options include medical management (convincing the adrenal glands to produce less cortisone- fairly expensive and high-intensity) and radiation of the pituitary gland (fairly expensive). This is moderately effective and control of the cushing's is for a few years. If it is adrenal dependent, the best option is surgery, if it is not too invasive. I have done about 60 adrenalectomies with very good results and only about 3% perioperative mortality. That means that they do not require any more medical management in the future and they rarely spread to other organs (ie curative). If I had to choose, I would prefer adrenal dependent with adrenalectomy than pituitary dependent. Unfortunately, we can't choose, and pituitary dependent is most common. Hope this helps. Charles

Happy to reply to a PM!! Busy at this moment- about to do a spinal surgery, but send me a line. Alternatively, call me on 03 9532 5261. Thanks, Charles

You can always tell your vet that you are really concerned and would like a more complete workup. Referral to a specialist is also a possibility, but must be done at the request of your vet. If you are considering a specialist referral I would think about an internal medicine specialist (not a surgeon, like me, at least at this point). If a surgical problem is identified, then a surgeon may be indicated. Charles

Hi, Charles Kuntz here. I would be concerned about a benign polyp (adenoma- most likely), rectal carcinoma (malignant- less likely) or anal sac adenocarcinoma- really unlikely in that location. I would recommend a biopsy and a complete rectal examination to make sure that it is the only one and that the sublumbar lymph nodes are not enlarged. We usually endoscope these to make sure there are not other masses further up the colon. Charles

Yes, that would be fine. Priority goes to member of Dogs Victoria, but if we start getting too many respondents, I will move it to a bigger venue. THanks, Charles

Yes, I believe so. Charles

I am not aware of HOD causing a shortened life-span. In my experience, it is self-limiting and spontaneously resolves completely in most cases, with no residual effects. Good luck. Charles

I am just dropping everyone note to tell you that I am giving a free lecture on current trends in the treatment of injuries and diseases. The particulars are as follows: 11 November 2008 at 7:30 PM at the Royal Melbourne Showgrounds (RAS Rooms), Langs Rd. Ascot Vale. Please RSVP to [email protected] by 31 October 2008. Please call 03 9532 5261 if you have questions. The announcement published by Dogs Victoria is as follows: 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). Please let me know if you have questions or comments or would like a particular topic discussed (assuming you plan to attend).

Your pug probably has brachycephalic airway syndrome. The most common component is an elongated soft palate. The issue is that these dogs can get secondary changes like collapse of the larynx (not the trachea- tracheal collapse is uncommon in pugs- congenital narrowing of the trachea is more common) and everted laryngeal saccules. These saccules are an evolutionary remnant that serve no purpose but to cause brachycephalic dogs strife. The secondary changes can cause rapid progression of clinical signs. Excessive weight is certainly a contributing factor. I would suggest a laryngeal examination with the aim to correct any problems which may be present. Recognise that laryngeal collapse cannot be treated easily and is quite serious. We do find that when the other issues are resolved, the laryngeal collapse can improve. Let me know if I can be of further assistance. Charles

The other risk with waiting is that if you wait past the first heat, the risk of mammary cancer later in life is significantly greater than if you do it before the first heat. Charles

Desexing a small dog should be no more challenging than a large dog. In fact, the larger dogs (especially fat ones) can be quite challenging. Unless your vet has said otherwise, she/he should have no trouble. Charles

Dogs with brachycephalic airway syndrome are prone to respiratory infections, particularly ones with a narrowed trachea. These will often present for recurrent pneumonia. I don't have any reason to believe that your dog, in particular, has this component of the syndrome, but I would have it checked. The possibility that secondary changes have developed due to the negative pressure is certainly possible, as well as generalised swelling due to turbulent airflow and negative pressure. It would be worthwhile to have everything checked out, and to have everything corrected that needs correcting. Most of these dogs will do well long-term with appropriate management. Charles

Dogs with brachycephalic airway syndrome are prone to respiratory infections, particularly ones with a narrowed trachea. These will often present for recurrent pneumonia. I don't have any reason to believe that your dog, in particular, has this component of the syndrome, but I would have it checked. The possibility that secondary changes have developed due to the negative pressure is certainly possible, as well as generalised swelling due to turbulent airflow and negative pressure. It would be worthwhile to have everything checked out, and to have everything corrected that needs correcting. Most of these dogs will do well long-term with appropriate management. Charles

Good luck. I hope it goes well. Charles

That sounds great. I certainly know of several primary care vets that are very capable surgeons as well!! Keep me posted. Charles

I would also consider Staffies to be borderline brachycephalic as I have seen quite a few with 2 or more of the brachycephalic airway syndrome components. Charles

I did mean more. I was making a joke. As a specialist, I charge more that primary care vets for most procedures. While a specialist is not required, you do want someone with a lot of experience operating on soft palates, you want 24 hour care available and would want someone who can recognise everted laryngeal saccules and is comfortable with removing them if necessary. You cannot predict which dogs are going to have the everted laryngeal saccules. Charles