Dr Paws

🔶 Transpalpebral Enucleation 🔶 Enucleation is probably the most common orbital surgical procedure performed in small animal practice. 🔸Rocky a 5 y old Shih tzu represented to our facility after fight with another dog with bite wounds and eye proptosis. 🔸Physical examination: With inspection eye proptosis was clear and there were deep 8 bite wounds in the face and neck bilaterally, they bled aggressively. 🔸Lab works: -CBC showed hypovolemia due to excessive blood lost -Serum chemistry: showed elevated ALT& AST due to the traumatic injuries After stabilization our patient with painkillers and resuscitation hypertonic fluids to correct the hypovolemia encountered, ophthalmic examination preformed. 🔸 Ophthalmic examination: There wasn’t response during testing the PLR, no menace response, vision was lost and the affected eye was completely blind. So surgeon decided to do transpalpebral enucleation. 🔸 Diagnostic imaging: Radiography, AFAST and TFAST preformed to exclude any other injuries. 🔸 Surgical approach: Under general anesthesia, In ventral recumbency, •Eyelids closed with simple continuous suture pattern using 3/0 nonabsorbable suture material, leaving the both ends of the suture long enough for eye traction. •Then applying circumferential incision around the traced eye 5mm from the eyelid. •Stepping forward for blunt and sharp dissection of s/c tissues after which canthotomy of medial and lateral canthus' tendons applied, clamping of ocular muscles near to it’s insertion before cutting them to reduce bleeding. •Till reaching free rotation of the globe. •Clamp the tissues at the posterior pole of the globe, remove the hemostat, and incise the stalk 5 to 10 mm posterior to the globe. •Remove the globe, lid margins, orbital lacrimal gland, conjunctiva, and nictitans, Flush the orbit and close the lids with 3/0 nonabsorbable suture material in simple continuous manner. 🔸Treatment plan: -Alpha chymotrypsin (for the traumatizing facial edema) -Amoxicillin-Clavulanic acid (for 2ndry bacterial infection) -Liver tonics (for the elevated ALT and AST) -Wounds cleaned and dressed with 0.9%saline, chlorhexidine and antibiotic spray. Procedure took 30 mins after which Rocky had smooth recovery Elhumdullah, continuing his fluids, receiving painkillers, antiedematous and antibiotic. Dr. Paws just wanted to take a moment to express heartfelt thanks to the entire team for the steadfast commitment to achieving our goals, your hard work and dedication truly keep the momentum going, thanks for rescuing these speechless creatures with your consistent effort and positive attitude.🙏 Surgeon: Dr. Ahmed Bahr #Surgery #Ophthalmology #Veterinary #Canine #Enculeation

Ultrasonography with color doppler of intestinal mass which was lymphoma metastasized to kidney pole in geriatric feline patient. Case: Dr. Ahmed Bahr Ultrasound: Dr. Dr. Mohamed Elsaid, PhD.

☁️Carpal hyperextension injury☁️ Caused by injury or tearing in the palmar fibrocartilage which support the carpal joint and prevent it from overextension Have you dealt with such case before? ☄️Rafeea, a 7y old neutered male Golden retriever, presented to our facility with a 48hr history of lameness in her left front limb. Her owner noted that she had been more reluctant to move around the house and was limping when walking. ☄️The owner also mentioned that Rafeea had recently been playing with other dogs at the park, which involved running and jumping, and had possibly sustained an injury during these activities. ☄️Physical exam: • Firstly the gait was altered show limbing and non- weight bearing intermittent lameness which worsen upon effort, paw sinking. • Palpation of the right front limb revealed localized swelling and moderate pain. The rest of the physical examination, including a neurological assessment, was unremarkable. ☄️Diagnostic Imaging: -Radiography: Lateral and craniocaudal views of the left front limb were taken. Revealed transverse, displaced fracture of the 1st, 2nd, 3rd and 4th metacarpal bones was noted, In addition to broken carpal joints. There was soft tissue swelling around the fracture site. ☄️Treatment Plan: Initial Stabilization and Pain Management: -Administer opioids for acute pain relief. -NSAIDs: meloxicam injections on day of presentation and continuing in home on carprofen tabs til the day of surgery. ☄️Surgical procedure: -Carpus Panarthrodesis- Fusing the bines together, relieving pain, limit the joint movement. 1- Open joint capsule 2- Remove the cartilage 3-Pack joint with a bone graft 4-Hold bones in position by driving K-wire dorsally 4-Using INTRAUMA S.P.A. dorsal carpus panarthrodesis plate 3.5mm. 5-Attach the plate using screws. Now Rafeea is doing so well Elhamdullah, returning after rehabilitation to walk with his fellow behind the sea, jog and jump normally and comfortably.💙🙏 By our humble surgeons: Dr. ahmad tarek Barakat Dr. Nadia Essam #Orthopedics #Surgery #Arthrodesis #Canine #Lameness #Veterinary #open_reduction

✨FCP Diagnostic Imaging - CT Scan✨ ✨FCP is component of the elbow dysplasia complex mostly encountered in Golden, German shepherd and Labrador breeds. The owner reported that our patient had been showing signs of discomfort for several months, especially after moderate to intense exercise. Initially, the lameness was intermittent and it was weight bearing lameness. ✨Elbow appeared to be swelled, marshmello texture due to effusive acute arthritis with pain upon palpation and crepitus sound and restricted motion when trying the range of motion. 🌟Diagnostic imaging: ✨Radiography of the elbow joint showed only tiny narrowing of the joint space. ✨ Initially we tried to prescribe NSAIDs and supplements hoping to improve this acute arthritis but the lameness worsened last 2 wks so CT scan was performed to further evaluate the left elbow joint. The scan was done under general anesthesia. ✨CT Findings: • A small, fragmented bone was identified within the medial coronoid process of the left ulna, consistent with the diagnosis of fragmented medial coronoid process. • The fragment appeared displaced into the joint, causing articular incongruity. • Mild subchondral bone sclerosis and joint effusion were noted, which are typical secondary findings in elbow dysplasia. • There was no evidence of significant osteochondritis dissecans (OCD). ✨The CT scan confirmed that our patient had a fragmented medial coronoid process (FCP) in his left elbow, a common cause of elbow dysplasia in dogs, particularly large-breed dogs. FCP is a developmental disorder where a small fragment of the coronoid process of the ulna becomes detached, causing pain, inflammation, and progressive joint instability. He is doing so well now Elhamdullah, walk normally, lameness disappeared, continuing his chases and joyful exercise every single day with his owner.🥰 By: Dr ahmad tarek Barakat Dr Afnan Elznati

☁️Eye Proptosis Reduction☁️ 🌟Traumatic ocular proptosis is defined as forward displacement of the eye with entrapment of the eyelids behind the eye. 🌟Main causes encountered in blunt head trauma, bite wound, retrobulbar hemorrhage, orbital fracture, or excessive restraint of animals with large palpebral fissures and shallow orbits, force required to displace the globe in brachycephalic breeds is minimal due to their shallow orbit. 🌟Loki a 5 y old Chihuahua intact dog represented with eye proptosis due to blunt trauma during fight with another dog. ✨Physical ex.: Full physical ex. and diagnostic imaging is crucial to evaluate if there’re life threating injuries that should be treated first, such as internal bleeding or any fractures.. during this time globe should be kept moist. -Forward globe displacement and entrapment of eyelids evident with inspection, Auscultation revealed tachycardia, rapid shallow respiration, compensated shock with 12% dehyd. -Neurological ex. Of the globe gave normal direct pupillary light reflex and intact vision which were favourable prognostic indicators and intact optic nerve. -Ophthalmic ex. Revealed congested globe ,hyphema, bruises over the upper eyelid. ✨Surgical procedure: The eye showed normal vision, vascularity and movability so after correction of the dehydration and stabilizing the patient surgeon decided to do globe replacement by tarsorrhaphy suture technique with the sequence of: 1. Lateral Canthotomy 2. Globe reduction 3. Temporary Tarsorhaphy ✨Treatment plan: • Systemic broad spectrum antibiotic 7-10 days. • Mydriatic eye drops as 1% atropine Q12hrs. • Topical triple antibiotic ointment q6-8hrs. • Systemic corticosteroid 5-7days. • Soft palatable food Re-evaluate the patient after 5-7 days for assessment suture placement, swelling, comfort, Generally suture removed after 14-21 days. After removal full ophthalmic ex. assess vision, blink response, globe position, Schirmer tear test preformed to assess moisture of the eye. By: Dr.ahmad tarek Barakat

❄️Laryngeal mass❄️ ✳️Space occupying lesion causing upper airway obstruction which required laryngoscopic and resp. endoscopic ex. for evaluating the cause of progressive dyspnea and distress during exercise. ✳️A 11y old Rotweiller dog represented to our small animall veterinary hospital with signs of acute respiratory distress, stridor, voice changes, cyanosis during exercise and high temperature, other signs of dysphagia, and weightloss notieced by the owner. ✳️Physical ex.: Revealed inspiratory dyspnea, rapid shallow respiration with wheezes on auscaltation larynx and lung fields. Cough test was positive giving paroxysmal coughs. ✳️Diagnostic imaging: -Radiography: Cervical radiographs showed soft tissue opacity occupying the thoracic inlet. Laryngeal tumor and granulomatous non neoplastic laryngitis were on the top of the differintial diagnosis list, so that, cytology or punch biopsy from the lesion was crucial for differentiating. ✳️Resp. endoscopy preformed and findings noted in the attached endoscope sheet. • Findings: Upper airway obstruction evident, large immovable, cylindrical mass attached to the cricoarytenoid area and first 2 tracheal rings collapsing the lumen, cytology brushes used to collect samples, biopsy with electrocautery preformed and the histopathology result is pending. • Recommendations: Surgical excision with partial or total laryngectomy, Tracheostomy, Antiinflammatory medications and bronchodilators. Looking forward to hear Your thoughts about this case?💙 ahmad tarek Barakat #Endoscope #Laryngoscope #Surgery #Vet #Respiratory #Dyspnea #Canine

🌟KCS🌟 Keratoconjunctivitis sicca, the fancy way to say the eye is dry. 🌟Owned 3y old cat with unclear vaccination profile represented with asymmetry between both eyes, swelled eyelids inflamed eyelids, ocular yellow to gray discharges, cloudy dull eye, blepharospasms and photosensitivity. 🌟Physical ex.: -Ocular examination showed hyperemic conjunctiva with tortuous scleral blood vessels, mucopurulent discharges, yellow crusts sticking on eye corners, opaque corneal. -With schrimer tear test special paper inserted in the lower eyelid in the outer corner of the eye, the moisten paper height reached 10mm which was indication for eye dryness. -Fluorescein stain was negative for corneal ulceration. -Eye cytology, culture and sensitivity was recommended, characterizing bacterial infection and appropriate antibiotic ttt. 🌟Treatment: • Artificial tears QID • Dexpanthenol eyedrop QID • Platelets rich plasma QID • Ocular broad spectrum antibiotic ointment • Topical antiinflammatory eye drops after excluding corneal ulcerations contain 0.1% Dexamethasone. Improvement seen after 3wks after initiating treatment plan Elhamdullah.💚

We're beyond proud and overjoyed to announce and warmly congratulate Dr. Paws veterinary hospital owner Dr. ahmad tarek Barakat for receiving a best vet for pets in Egypt prize in top vets for pets ceremony.✨ Dr. Ahmed Barakat was recognized yesterday in the first ever All 4 Pets Expo as one of the top 10 vets influencing small animal medicine in Egypt, He was recognized for his overall accomplishments in orthopaedic, neuro and laparoscopic surgeries pioneering in them, giving helping hand for all his colleagues, exchanging experience with veterinarians around the world. Which made our hearts filled with joy at the sound of these good news.💚 May Allah reward all your hardworking and huge efforts for improving and providing modest technologies in small animal medicine, May success be with you, always. Warmest congratulations on your achievement.💚✨

🌠Double-Layer Mucoperiosteal Flap Technique🌠 ☄️The most useful technique for clefts involves less than 1/3 of the width of the hard palate. 🚨Traumatic clefted palates considered as emergency due to the risk of aspiration fluids and food particles which threaten the animal life. ☄️The nasal cavity should be flushed with saline to remove purulent exudate and foreign bodies then swabbing the oral cavity with diluted chlorhexidine solution. ☄️In a dorsal recumbency, head is placed on a soft pad, with ET-tube secured and fixed to the mandible, taping with the lower jaw and tongue. ☄️Surgical technique: -Create bilateral flaps based on the edges of the cleft with preservation of the palatine artery which supply the flaps. -The mucoperiosteum is elevated from the hard palate by a periosteal elevator with the major palatine artery. -The nasal mucosa and mucoperiosteum are apposed in two layers over the hard palate defect. -Appose the nasal mucosal edges at the margin of the defect with buried interrupted sutures. -Roll the flaps over the cleft to create epithelium-lined closure. -Suturing the two flaps together at midline with tension free interrupted pattern using 910 polyglactin suture material. ☄️Post-operative care: -Feeding soft blended food for 1 week using feeding tube, continue on soft palatable diet for a month. -Spray the oral cavity with mouth wash QID. -Broad spectrum antibiotic for the purulent discharge for 5-7 days. -Chew toys, hard objects or dry food should be withheld for a minimum of month to avoid the suture dehiscence which's the main complication encountered in cleft palate repair. Our patient is doing so well now Elhamdullah, We ought to send flying thanks to our cooperative team-working, there're unlimited hidden huge efforts behind the senses unfortunately it couldn't be captured.. Thanks for all these huge efforts which shapen this final result, I always have to say this and I always will.♥️ By: Dr. ahmad tarek Barakat

😍