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Lance: A Southern Gent in SoCal…

Lance

Lance is one of our many sweet, insightful, and talented ER team members. We work with him every day and wanted to know more about who is he and what brought him from Houston, Texas to Southern California.

Why Veterinary Medicine?
“It found me” says Lance. After high school, Lance attended the University of Texas and soon returned to his roots in Houston. He has always loved animals and attended a job fair where he found a career as a veterinary assistant. He was able to do some on the job training and eventually earned his Certified Veterinary Assistant certification, or CVA. It’s been all animals, all the time ever since!

What does Lance like about emergency medicine?
Lance actually prefers the ICU, where our most delicate and critical patients are. He finds that he is able to remain calm under pressure and fits in with a fast paced environment. Lance is “comfortable in the hustle and bustle and likes having the ability to save a life.”

Where is his favorite place to visit?
Lance loved visiting Germany and Europe! Ever the traveler, he also enjoys Mexico, the Caribbean, and seeing places with rich history and culture.

What is Lance’s favorite animal?
Big cats! Lance has loved cheetahs ever since he was little—their speed caught his attention, as they’re the fastest land animal! Lance also loves domestic cats since he “finds their personalities intriguing. They’re sensitive, so you have to treat them gently. One cat may not like having his back feet touched, another might love to be petted. Veterinary medicine is all about figuring out the pieces of the puzzle to make it work.”

What would he be doing if he weren’t at ACCESS?
Lance could see himself working at a pharmaceutical company, following his passion for science and problem solving.

What is Lance’s favorite dish?
Pizza and barbecue, of course!

Does Lance collect anything?
He used to collect baseball cards and had over 5,000! Now, Lance is working on his collections of gold and silver pieces, family heirlooms, and old books. His favorites? Shakespearean books from the 1800s.

What are his tips for pet owners?
Please understand that the animal emergency process is similar to that of the human side—the most critical patients come first.“We get emotional too.” Lance adds. From the front desk staff to the technicians and assistants, to the doctors, we all want the best for the little guys and are just as emotional as the pet owners.

What is the most challenging case Lance has ever had?
Lance will never forget a sweet little cat from his very first year in the veterinary world. The cat had been severely burned in a house fire and he still vividly remembers that night as the most emotionally trying night of his career.

Lance does enjoy a good challenge though, which is why he enjoys emergencies. He helped in a save a Weimaraner with a twisted lung. Lance sat with the pup all night long to make sure he was comfortable and receiving all of the treatments he needed to survive the night before his emergency surgery. The pup lived, and Lance continues on in the field that stole his heart.

What does he consider his greatest achievement?
“Helping take care of my niece and nephew in Texas.” Lance is close with his family and found fulfillment in guiding his young relatives and watching them grow up and become good people.

When he’s not working, you can find Lance hanging out with friends, enjoying a good barbecue meal, or keeping up on the latest advancements in veterinary medicine. Lance brings a positive attitude, humble know-how, and a heaping helping of manners to each and every day he works. Lance is one of Lead Technicians for the emergency room, which means he is the go-to guy on his shifts and he recently took over scheduling for all of our technicians! We are lucky to have Lance on our team and hope that you say hi to him the next time you visit us!

Lance-and-team

Life as an RVT: Puppy Anesthesia Challenges..

By Rhianna Depew, RVT…

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Dr. Steven Cole, our board-certified cardiologist, approached me and asked a very delicate question. “How do you feel about doing anesthesia on a two-week-old, tiny puppy?”

“Puppy” as she was aptly called, since she hadn’t acquired a name yet, was a cute and cuddly, and very fragile Burmese Mountain Dog neonate that was already having cardiac issues at her young age. She had patent ductus arteriosus, or PDA, which is a congenital vascular communication between the aorta and pulmonary artery. This is normal for humans and animals in the womb, however in some cases, this vessel fails to close normally at the time of birth.

If left untreated, a PDA can cause severe cardiac enlargement, and eventual congestive heart failure (fluid in the lungs), or pulmonary hypertension (high blood pressure in the lungs).
In fact, most dogs with an untreated PDA do not survive the first few years of life. Because of how tiny she was, she wasn’t a good candidate for the typical, minimally invasive technique with catheters. Instead, Puppy needed open chest surgery in order to accomplish the PDA ligation; but that also meant a lot of risk, and a whole host of potential complications.

Dr. Cole knew I loved challenges, and was always up for our most difficult cases, but this one was different—a suckling neonate under general anesthesia is extremely high risk. But we were determined to do everything we could to help this puppy, so I started planning ahead. I thought about this small, delicate puppy every day leading up to the procedure, as well as the night before. She kept me awake, going over every detail and making mental checklists of everything I needed to get her safely through her risky life-saving surgery.

That morning I woke up early and wanted to make sure I arrived at the hospital ahead of schedule to start planning and preparing. This was the smallest heart surgery I had ever assisted with. She would need the tiniest versions of all the equipment we normally used. Tiny catheters, tiny endotracheal tube, tiny, tiny doses of medication and anesthetic drugs. I calculated all the “what if” emergency medications ahead of time and went over and over again everything we needed. I went over to Puppy’s cage and scooped her up. She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.

She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.
I gave her a kiss and held her up to my cheek and told her that she was going to do great, and that there would be plenty of days of running through grassy parks, toys, and treats in her future. Then I placed her back in her bed of cozy blankets so she could get some rest before her big procedure, and so that I could go triple check that everything was in place.

When it came time for surgery, we prepped the puppy before we put her under anesthesia and had every warming device at our disposal to keep her temperature up. I gave her micro doses of anesthetic to get her sleepy, placed ET tube in her trachea to control her breathing, hooked her up to the anesthesia machine and patient monitor, listened to her little heart beating on the monitor, and gave her some tiny breaths.

Then, I remembered to breathe, as I was holding my breath with each step taken to prepare Puppy for her big procedure. We were on our way.

Our board-certified surgeon Dr. Jana Norris, along with Dr. Cole, arrived into the OR, and we wasted no time getting right to it. The room was silent. We were all hyper focused in our tasks at hand: to accomplish this procedure and get this puppy out quickly and safely. Dr. Norris’ skilled hands were each the size of the entire patient, and they worked precisely and efficiently around the puppy’s tiny heart and lungs. I continuously watched between my monitor, the patient and the doctors, monitor, patient, doctors, monitor, patient, doctors—trying to stay a step ahead at all times. You could cut the tension with a knife, and I don’t think any of us had taken a full breath, then….

Dr. Norris assured everyone in the room with a confident “I got it.”

Puppy was doing great under anesthesia, and knowing the mission was accomplished, I could feel some nervous tears welling up. We finished the surgery and gave each other well deserved verbal high fives. I brought our tiny patient into recovery and stayed by her side until she fully woke up. Within a couple of hours she was back to being her cute and wiggly self, and wanting to be bottle fed.

Puppy was able to go home a few days later and recently came in for a recheck with her beloved cardiologist. She’s doing very well and is expected to grow fully to her Burmese Mountain Dog size and live a long, happy life. Puppy will be a constant reminder that preparation, precision, dedication, and team work, are all crucial to saving an animal’s life. For now, Puppy will continue to steal our hearts and bring joy to the hospital with each and every visit.

Dr-Norris-Dr-Cole-Rhianna-Depew

From Left to right: Dr. Jana Norris, Dr. Steve Cole, and Registered Veterinary Technician, Rhianna Depew.

Thank you…

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Kiki’s Nephrolithotomy: Big Word, Little Dog.

Surgically Assisted Nephrolithotomy

What to do with complicated kidney stones in dogs? Laser them out!

Kiki is a beautiful four-year-old female spayed Japanese Chin who was kindly rescued with pre-existing kidney issues and an abnormal eye. Kiki repeatedly saw Dr. Erinne Branter, head of our interventional radiology department, for kidney stones and kidney disease. The kidney stones were not able to be medically dissolved and as a result, Kiki kept having painful urinary tract infections.

Nephrolithotomy1

Often, kidney stones can be left alone if they are not causing any issues, but Kiki had developed stones causing obstructions to her kidneys by blocking the ureter, the tube that brings urine to the bladder from the kidney.

Dr. Branter discussed options to remove the kidney stone with Kiki’s owners—shockwave lithotripsy from outside the body, lasering the stone in the kidney in a minimally invasive way, or a surgery where the kidney is cut open to remove the stone.

Nephrolithotomy2

Kiki’s owners opted to remove the stone with a nephrolithotomy, a minimally-invasive procedure to remove stones from the kidney by using a small catheter through a small incision, and then place a ureteral stent. This made sure the kidney had very little damage and that all the stones were able to be removed. We used a combination of minimally invasive approaches to the kidney to reduce damage to kidney tissue. We then used an endoscope and a laser to break up the stone and make stone fragments that were small enough to be removed without damaging the kidneys.

Nephrolithotomy3

This entire process is called a nephrolithotomy (kidney stone removal) and is the standard of care for humans with complicated kidney stones. Although few have been done in veterinary medicine, Kiki was able to go through the procedure without any issues and is recovering very well with no negative changes in her kidney values or function. We are thrilled to report that little Kiki is now stone free! Many pet owners do not know that their pets can suffer from many of the same illnesses that humans do. Unfortunately, pets suffering from illness can also experience the same pain and discomfort as we do, though they may be better at hiding it.

If you suspect your pet is experiencing urinary issues, contact your primary veterinarian right away.

Key words for pet owners:

  • Kidney stones- A hard mass formed in the kidneys
  • Lithotripsy- A treatment, typically using ultrasound shock waves, by which a kidney stone or other calculus is broken into small particles that can be passed out by the body
  • Nephrolithotomy- A minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin
  • Stone retrieval- A process in which a doctor retrieves and removes stones from within the body
  • Ureteral stent- A thin, flexible tube threaded into the ureter
  • Ureteral stones- Stones that form within the ureter
  • Urinary obstruction- An obstruction that occurs within the urinary tract. Obstructions in the urinary tract cause distension of the walls of the bladder, ureter, or renal pelvis, depending on the location of the obstruction
  • Urinary stones- Stones that form within the urinary tract
  • Urinary tract infection- An infection in any part of the urinary system, the kidneys, bladder, or urethra
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Big or (Very) Small, We Love Them All…

What could one of our criticalists, Dr. Joyce Lee, be doing?

Caring for her smallest patient of the day– a hummingbird!

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This is why we’re here!

Giovanni was hospitalized at ACCESS LA (#ACCESSLA)and became best friends with Leo. We pride ourselves on patient care–not only making sure that they are treated medically, but also cared for emotionally.

Leo did a great job of making Giovanni happy and comfortable!

Giovanni

From Sudden Paralysis to Up and Running…

SimbaSimba, a male Chihuahua, came in to ACCESS LA for suddenly not being able to walk. This can be very unnerving for many owners, as there are several reasons for how this may have happened. Luckily, Simba was in the care of Dr. Clarisa Robles in our Neurology Department. After some diagnostics, Dr. Robles concluded that Simba had a condition called atlanto-axial subluxation, or AA Lux for short.

This means the first two bones in Simba’s neck were unstable in relation to each other. This can be very dangerous, as an AA Lux causes compression of the spinal cord, resulting in signs as mild as neck pain to complete paralysis of all limbs.

After speaking with Simba’s owner and discussing all of the options and possible outcomes, it was decided that Simba would go through surgery to correct this scary issue. Along with technicians and assistants to monitor anesthesia and assist with the procedure, Dr. Robles was able to stabilize these two bones with screws and bone cement. After some time for careful recovery, we are pleased to say that Simba is walking well these days and back to creating mischief!

If you suspect your pet has a back, neck, spinal, or brain injury, please contact your veterinarian right away.

No Stone Left Unturned…

Ozzie-IR

Ozzie is a beautiful 12 year old Himalayan cat who was referred to Dr. Erinne Branter at ACCESS Specialty Animal Hospital, Los Angeles, after being hospitalized for several days at his primary veterinarian’s office with a right ureteral obstruction. Ureteral obstructions are blockages that prohibit urine to drain from the bladder and can be caused by blood clots, mucus, crystals, strictures, tumors, or in Ozzie’s case, stones. Blockages are no walk in the park for any patient—animal or human— but can be deadly to dogs and cats. Untreated, a blockage can cause death due to complete kidney shut down.

Typically, a stent (tube that links the kidney to the bladder) can be placed to help a patient’s body pass the urine and stones. Ozzie had a stent implanted previously, which worked well for him for some time. Unfortunately, some patients are simply prone to re-obstruction, and in Ozzie’s case this called for a different approach.

Ozzie-fluoro-image
Dr. Branter, the head of our Interventional Radiology Department, consulted with Ozzie’s owners, and it was decided that a subcutaneous ureteral bypass, or SUB, would be placed to help Ozzie pass urine.

(Click on image for larger view.)

The SUB works as a secondary ureter, having one end of a small catheter implanted into the kidney and leading to the port, which rests under the skin, and connects to the end of the catheter which leads to the bladder. The port makes it possible for a veterinarian to flush the catheters to obtain urine samples for testing; while the catheter acts as a filter for the urine, making it possible for the fluid to pass through successfully.

Dr-Branter-Dr-Carey

Dr. Branter performed the SUB placement alongside Dr. Kim Carey, an ACCESS surgeon. With two veterinary technicians to assist and another to monitor the anesthesia, Ozzie was in good hands. The sub was placed successfully and they also were able to extract fat cells to culture stem cells. Ozzie’s stem cells will be used to help his kidney function in the future. It is not uncommon for cats to stop eating while they are under stress from being out of their normal environment, so Ozzie also had an esophageal feeding tube, or e-tube, temporarily placed to help him during his recovery process. After recovering well from anesthesia, Ozzie stayed in our hospital for a few days to be monitored after his surgery. It’s safe to say that Ozzie stole all of our hearts here during his stay, and we are so happy to have been able to help him.

Ozzie’s case is not uncommon, though it may be hard for some owners to recognize the signs of an emergency with their cat. Symptoms of ureteral blockages may include change in appetite and general signs of lethargy, vomiting, or reduced appetite. These are not typical “urinary” signs as seen with bladder or urethral issues, but they should be evaluated by a doctor.

If you think your cat may be blocked, call your primary veterinarian immediately. Additionally, if your cat has elevated kidney values, please have him or her checked with an ultrasound of the kidneys. This is very important as you can significantly improve kidney function by addressing ureteral obstructions.

Ozzie-post-op-from-owner

Shannon Brown
Marketing Coordinator | ACCESS Specialty Animal Hospitals

The Hot Facts About Heat Stroke and Your Dog

ACCESS-Heat-Danger-For-Animals

It’s summertime— the sun is bright and the days are long. You’d like to go for a jog with your best friend and there’s a nice breeze, so you suspect that it is not too hot… Fido should be fine!  What you don’t know is that serious injury could be lurking right outside your door, for you and your pet.

Did you know that when dogs pant it helps cool their bodies much like sweating cools us down? Panting is their main cooling mechanism; without the ability to pant, they overheat.

If you put a muzzle on your dog, or any other device that prevents the mouth from opening wide enough to pant, you could cause your dog to overheat.
Sometimes, even if a dog is able to pant, the body can get so hot that the heat buildup overwhelms the panting mechanism and heat stroke can ensue. Imagine that your dog is a car—if your car isn’t able to run properly, it can overheat and breakdown. Unfortunately, if your dog overheats, he or she could die.

It is important to note that the temperature outside doesn’t matter. It could be 70 degrees with a breeze and your dog could still get heat exhaustion or worse. Dogs particularly susceptible to overheating on walks are brachycephalic breeds (dogs with a short snout) like Bulldogs, Pugs, Brussels, and Griffons; overweight dogs; and thick coated dogs such as Huskies, German Shepherds, and Bernese Mountain Dogs.

Please, never leave your pet in a car. On a 78 degree day, the temperature in a car, even with windows cracked, can elevate to 120 degrees within minutes.

Signs indicating that your pet is overheating and has potential for heat stroke include: lethargy, vomiting, shallow breaths, seizures, and confusion. If you note any of these signs, you must immediately remove your pet from the heat source, give your pet water to drink, fan your pet,and allow him or her to rest. In severe cases of heat stroke, you may wet the dog’s body with room temperature to slightly cool water. However, please be careful because if the water is too cold, it could shock the system. It is important to see a veterinarian right away if mild or severe signs of heat injury appear.

Summer should be full of time outside and fun with family, friends, and your pooch. Please be safe and play outside on cooler days, as well as earlier or later in the day for short amounts of time on warmer days. Always be sure there is plenty of water for Fido, and if there are any signs of overheating, rest your dog and seek veterinary advice immediately. Also, be sure to report any animals inside of a car to the proper authorities. You could save a voiceless creature’s life.

#LoveWins

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Tel: (310) 320-8300 - Fax: (424) 293-7254

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Tel: (310) 558-6100 - Fax: (310) 558-6199

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Tel: (818) 887-2262 - Fax: (818) 704-0323

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