Charles Kuntz

Hi, Charles Kuntz here. If you need a specialist in Victoria I know one that can do it for more than 1200.00. Brachycephalic airway syndrome is a condition of short-faced dogs and some longer faced dogs (like maltese, cavies, etc) that consists of some primary abnormalities and some secondary changes as well. They consist of the following: 1. Stenotic nares- narrowed nasal passages (primary) 2. Elongated soft palate (primary) 3. Everted laryngeal saccules (sacs normally outside the airway that pop into the airway due to negative pressure caused by sucking air against the other obstructions)- (secondary) 4. Laryngeal collapse- collapse of the larynx secondary to the negative pressure (secondary) 5. Hypolastic (narrowed) trachea- (primary) You want to get the primary problems addressed early to prevent the secondary problems which can be more challenging to deal with. Recent studies have suggested a success rate of about 90% with surgery done by an experienced surgeon. Many dogs are better after surgery, but not necessarily normal. In addition, you definitely want 24 hour observation for a day or so after this surgery because some can be initially worse after repair. This is a congenital condition (not definitively hereditary) but probably should not breed affected animals. Let me know if more questions. Charles

Young dogs can have a defect in calcification of the intercondylar region (between the two sides of the elbow joint) that can predispose them to breaking with very little trauma. I have had dogs fracture them after jumping 30 cm off a curb. It is very common. I have repaired about 60 of these fractures, all identical. If that is the case, then you MUST do surgery because the break is within the joint surface. If you don't fix it, your dog will NOT regain functional use of the leg. The other type of fracture of the elbow of young dogs is a break of the olecranon (the funny bone). These WILL NOT heal on there own either because of the constant pull of the triceps muscle. Unfortunately what I am telling you is that: 1. There are very few fractures of the elbow of young dogs that can be managed without surgery. 2. It is common for puppies to fracture their elbows with very little trauma. Any chance you could photograph the x-ray and post it so that I can tell you what kind of fracture it is? Sorry to be so bleak, but these are common, they require surgery. WIth surgery, they usually do really well. Without surgery, they usually do really poorly. Please let me know if I can help. Charles

Prior to about 20 years ago, all cruciate repair techniques were directed at stabilising the knee using different types of natural and synthetic materials, all with reasonable success. About 20-25 years ago, a guy named Barclay Slocumb recognised that the tibial plateau sloped backward in dogs with cruciate ligament ruptures causing the femur to "slide" backwards on the tibial plateau (like a ball rolling down a ramp). This was putting stress on the cruciate ligament and over time ultimately it would fail. He developed a technique, which he patented, which involved correcting the abnormal slope (tibial plateau leveling osteotomy). It seems to work very very well in returning dogs to fairly normal function. In one study, it was associated with a 6 fold reduction in severe arthritis compared with a traditional nylon suture technique in larger dogs. When the patent ran out about 5 years ago, there was a flurry of other tibial plateau leveling procedures and plate designs, etc, all with similar results. We tend to use traditional nylon suture techniques in smaller dogs and tibial plateau leveling procedures in large dogs. I don't think that they have ever been compared in a small dog population. Charles

Arthritis cannot be definitively avoided by doing surgery. In big dogs, unrepaired cruciates result in arthritis. In little dogs, I don't think we can say that. I would wait the 6 weeks and see how he goes. Charles

Sorry, I stand corrected, although I am not sure a corrective surgery can be performed (has anyone had a corrective surgery to straighten a crooked tail??) Charles

Hi, Charles Kuntz here. I am a specialist here in Melbourne. I want to start by saying that there are several specialists in Melbourne, but in a 9.5 Kg dog, many general practitioners are happy to do cruciates on small dogs. The recommendation to wait an see is based on a study by Vasseur, et al which showed that in dogs weighing less than 15 Kg, many will do well with conservative management- permanently. The ligament usually doesn't heal itself. Scar tissue forms around the joint in response to the instability. Arthritis may develop, but the clinical outcome is still often successful In small dogs, often this scar tissue is adequate. In large dogs, it is often not enough and something else has to be done. What is usually recommended is to wait 6-8 weeks and if the outcome is less than optimal, surgery is then recommended. This is in contrast to large dogs where surgery is recommended immediately. Please let me know if you have other questions. Charles

Dear Rick, Bundoora has highly qualified vets and I would have confidence in their assessment. Charles

Kennel cough is typically caused by a BACTERIA- bordatella bronchiseptica. It can occasionally be caused by canine adenovirus 2 (CAV2) or parainfluenza virus. Regardless of the cause most dogs do not require antibiotic therapy and will spontaneously resolve after several days. In severe cases, supportive therapy may be required. Treatment is directed at rest and avoidance of exercise and excitement which may cause irritation of airways. Cough suppressants may be used if cough is severe. Some specialists believe that antibiotics are CONTRAINDICATED because the disease is self-limiting and antibiotics do not effectively clear the bacterial infection anyway. Steroids should not be used. Vaccines may be effective for reducing the severity of the disease in at-risk animals. Prophylactic antibiotics in unaffected animals would not be something that I would feel would be effective or indicated. Charles

I would definitely not worry about it. It is purely cosmetic and should not cause a problem. Charles

Hi, Charles Kuntz here. I have read your description and I have to say that I would be a bit perplexed as well. If x-rays are truly normal then the injury would probably be soft tissue in origin. Brachial plexus avulsion involves a tearing of the nerve fibres as they exit the spinal canal. They can be partial or complete. Generally they don't result in a leg-carrying lameness. Just a flaccid paralysis. Your vet has ruled that out because of the normal sensation. Other soft tissue injuries could be a torn ligament or tendon- obviously difficult for me to determine without an examination. If your dog were in my clinic, I would start with a complete palpation of the integrity of the ligaments, looking for laxity and pain. I would also closely check the toes, both radiographically and by palpation to make sure there is no fracture of a small bone, missed previously. Please let me know if I can be of more assistance. Charles

No worries. If you have questions, just post them, and give me a nudge by email. I am happy to discuss surgery, orthopaedics, neurology and a bit of cardiology. Please no skin questions... I take my own dogs to a dermatologist when they have problems. Charles

It is hard to say what is causing the murmur, especially since it has been present for so long. My tendency is to say that it probably will not ever cause a problem. If you were particularly keen, an echocardiogram would be a good idea. Other things that can be considered include chest radiographs- to look for cardiac enlargement, and an electrocardiogram, for the same reason. Again, a murmur that has not cause a problem so far is probably not a big deal. Charles

I have nothing against acupuncture or any other alternative modalities. I am not saying that acupuncture doesn't work- in fact, I believe that in certain instances, it works very well. I do, however, believe strongly in informed consent. That is giving pet owners the information they need to make an informed decision on treatment. Pet owners need to know the documented results that are available for the treatment that they are being offered and being charged for. If there is no documented benefit then owners need to know that the treatment is experimental and that there is no data to support it. I often offer "experimental" treatments for pets with cancer because in some cases, nothing conventional is effective. These include new radiation therapy protocols, chemotherapy protocols, etc. I am always VERY clear with clients that we have NO DATA to support what we are offering, and I also offer all alternatives that are available. I just think pet owners need to know what they are paying for, and if what they are paying for has been shown to work. Charles

I am not aware of any cardiologists in Sydney. An internal medicine specialist should be able to do a good cardiac ultrasound and electrocardiogram. I don't think you necessarily need a cardiologist if it is difficult to find one. Charles

That is a pleasure. Please feel free to direct questions to me and I will answer them as soon as I can. If I don't get to it quickly enough, send me a message directly. Charles

What does he expect to achieve with acupuncture and what evidence does he have that it will have the desired effect? As far as I know, acupuncture has been shown to provide pain relief, improve liver recovery after toxic injury and to improve neurological recovery after spinal cord injury. It has been shown to reduce requirements for anaesthesia and to provide sedation. To my knowledge, it has not been shown to improve recovery after tendinous or ligamentous injury. I am a big believer in "evidence-based medicine" which means that we, as medical practitioners, make treatment recommendations based on what has been shown to be effective in scientific studies. Otherwise, we must be clear that what we are doing has no basis in the scientific literature. Charles

This has been done 50 times in Australia??? I believe this is new technology here which has not yet been attempted. It is fairly commonplace in the US. Charles

Heart murmurs in puppies can be caused by several different things, some of which need treatment and some of which do not. Many are completely benign and some even resolve with time. Common causes of heart murmurs in puppies include: Patent ductus arteriosus- this is a connection between the pulmonary artery and the aorta which is supposed to close at birth. If it does not close, dogs will have a continuous or "washing machine" murmur. These need to be repaired surgically, and the success rate is very high- greater than 90% with a good surgeon. These are quite common. Atrial septal defect- this is a hole in the "low pressure" region of the heart. Quite large holes can be tolerated without surgery. Some of these can be repaired using a plug which is introduced through the femoral vein. These are uncommon. Ventricular septal defect- this is a hole in the "high pressure" region of the heart. These can be more serious because of the effect of the high pressure on the right ventricle. Many can be treated medically. Many don't need any treatment. Pulmonic stenosis- this is a narrowing of the valve between the right ventricle and the pulmonary artery. The determinant of whether or not they need surgery is the size of the pressure gradient between the two sides of the valve. Many of these can be treated with a balloon introduced through the jugular vein. These are uncommon. Aortic stenosis- this is a narrowing of the valve between the left ventricle and the aorta. They occur more commonly in Golden Retrievers. Again, the need for treatment is determined by the pressure gradient across the valve. Repair is not currently done in Australia. One group in the US repaired several and found that the success with surgery was no better than with medical management. These are uncommon. Tricuspid dysplasia. This is a defect in the valve between the right atrium and the right ventricle. These usually do not cause a problem. Mitral dysplasia. This is the typical Cavalier King Charles Spaniel congenital heart defect. Medical management is usually initiated when clinical signs start. Surgery is not currently an option in Australia. Tetralogy of Fallot. This is a combination of several defects and can be managed effectively with a "simple" cardiac surgical procedure. Having said all of this, most murmurs don't require any treatment. The irregular heart beat that you are hearing is likely to be a respiratory sinus arrhythmia which is completely normal in dogs (but not in cats). It arises from the heart speeding up to take advantage of a lung full of fresh new oxygen with each breath. I would recommend seeing a cardiac specialist who can use an echocardiogram and electrocardiogram to determine the cause of the murmur and make sure that there is not an arrhythmia that needs to be addressed. I would recommend addressing this soonish because some of these causes of murmurs can cause secondary damage if not addressed early. I don't mean to stress you. Most of these are benign and do not require care. Charles

Hi, We have to make sure that we are talking about the same directions here. Flexion of the carpus is the direction where the toes touch the arm, in the natural direction that dogs fold their carpi. This is the direction that you want the bandage to go, in 10 degrees. This will hopefully put the ruptured structures in closer contact with each other in hopes that they will heal. The other direction is "extension" or "dorsiflexion" (confusing, I know) and is the direction the carpus goes when a dog is standing squarely on both front feet. This is the direction that the carpus was stretched that caused the injury in the first place. You would not want to bandage the carpus ten degrees in that direction because that will make it harder for the tissues to heal (and is understandably painful). The best way to tell if there is instability is to take anaethetised radiographs and compare one side with the other with equal amounts of pressure. Regarding the cost of the surgery, $3,400 to $4,000 is about right given the extent of hardware needed to repair the injury and the surgical time required. Usually a soft bandage is placed at the time of surgery, then a cast is placed at 5-7 days out. This has to be reassessed and changed as necessary for 8 weeks and a radiograph is taken at that time. You want to find out if these rechecks are included in the initial cost or not. Hope this helps. Charles

Hi, sorry you are going through this. This tumour is probably a tonsillar squamous cell carcinoma. Unfortunately, they are fairly common and as your vet has suggested, they are pretty invasive. I have had some that can be removed at the base, but the other issue is that many have spread to lymph nodes by the time of diagnosis. If you are keen to pursue it further, chest x-rays should be performed to help rule out distant spread. The lymph nodes should be checked by fine-needle-aspirate to see if the tumour has spread there. If not, primary tumour treatment can be considered. This would involve surgical excision and possible radiation therapy to clean up residual tumour cells. Radiation therapy unfortunately is a bit limited in Australia and the only two deep-therapy machines are in Melbourne and in Brisbane. Given all of this, the prognosis is still pretty guarded. If there is any question about the diagnosis, I would consider getting a biopsy and consider seeing a specialist. Charles

Has she had seizures in the past? In dogs who develop seizures at 11 year of age, unfortunately you have to be concerned about the possibility of a tumour. If these seizures have just started, I would recommend some kind of brain imaging- CT scan or MRI. The comment about her brain being too big for her skull (hydrocephalus) doesn't apply to her because that is a congenital abnormality which usually shows up in much younger dogs. It also does not sound like vestibular disease to me., either. If it stopped at just the yawning and putting her head back, it would be consistent with anxiety (which, given her personality, certainly could apply). I am sorry you are going through this. Charles

Hi, Charles Kuntz here. I have to say that I have tried conservative management for several of these with little success. I have done about 35 pancarpal arthrodeses (complete fusions) with about 85% success rate. The big determining factor is if there is disruption of the flexor apparatus with increased mobility of the joint in extension or if there is just inflammation and pain. If it is the latter, then conservative management should be OK. If there is hyperextension of the joint, then you probably are going to have to do a fusion. I can see acupuncture helping with pain, but not much else. Good luck. Please let me know if I can be of any further assistance. Charles

Hi, Charles Kuntz here (specialist veterinary surgeon and subspecialist surgical oncologist). Regarding early desexing, I don't think there is an issue in male dogs, but if you spey females before their first heat you reduce the risk of mammary tumours by 99.5% and after the first heat by 95%. After the second heat, you lose any reduction in breast cancer. The link between late desexing and osteosarcoma is VERY VERY weak. The link between early speying and protection from breast cancer is ABSOLUTE. If not breeding, I would spey before the first heat.

Hi, Charles here. I am a specialist small animal surgeon and I would like to warn people about feeding bones that are too big. I have treated about 40 patients with oesophageal foreign bodies (almost all bones). Most of the bones were cooked, but some were raw. Greedy dogs tend to scarf down the bones which are too big to pass all the way down the oesophagus. Most of these cases incur large costs- up to $1,000 for endoscopic removal and 3,000-4,000 for thoracic surgery for removal of the bones. We have seen a few fatalities- what is quoted is 15% mortality rate for oesophageal bone foreign bodies. The ones that don't need surgery can stricture (scar down) in the months after surgery as well. I am really careful about feeding bones to my labs. I only feed raw bones, and only ones that are too small to get stuck (chicken necks) or to big (beef thighs). Charles

Regarding prevention of hip dysplasia, PennHip appears to have made some headway in prevention of hip dysplasia in at-risk breeds. The way this works is that it is an objective measurement of hip laxity (the primary cause of hip dysplasia) at a time when you can decide whether or not to breed the animal. It is accurate at about 6 months, compared with OFA extended-hip views which are only taken at 2 years, and which, incidentally, have not made ANY gains in reducing the incidence of hip dysplasia in the last 50 years. In an experimental study, hip dysplasia was eliminated in a line of labradors in just 2 generations, using PennHip to decide which dogs to breed. I am not PennHip certified, but there are vets in Australia who are. Charles Kuntz