Flow Cytometry vs PARR


Flow cytometry and PARR are newer diagnostics used in cases of lymphoma and leukemia. We use these tests more so in dogs, as they are not as reliable in cats.

Flow cytometry is a type of immunophenotyping that detects the expression of cell surface and intracellular antigens, along with their level of expression. Cells are exposed to antibodies against different proteins. These antibodies are bound to a different set of fluorescent antibodies. Once bound, these latter antibodies emit a degree of light that is proportional to the amount of antibody bound. This diagnostic cannot be performed on serum or slides. The sample has to be fresh and ideally taken within 48 hours of testing. This test can be done on blood, cavity effusions, and lymph node tissue.

PARR stands for PCR for Antigen Receptor Rearrangement and is a clonality assay. Every naive B and T cell has its own unique receptor. PARR can detect a monoclonal expansion of neoplastic lymphocytes. This distinguishes it from an inflammatory population which is polyclonal. This test can be performed on blood, bone marrow, lymph node tissue, and cavity effusions. It differs from flow cytometry in that it can be performed on cytology slides.

Which test you submit depends on clinical signs and what specific diagnostic information you are seeking. If you need to confirm neoplasia, then PARR is preferred because it can not only determine if a neoplastic population is present but also provide phenotype. The other instance PARR is preferred is when you have dead tissue (ie. lymph node cytology slides). Flow cytometry is especially helpful in distinguishing among the various types of leukemia in patients with a lymphocytosis.

These two diagnostics have allowed us to learn more details about lymphoma and leukemia cases. This data can guide our treatment recommendations and provide prognostic information.

Learn more about the Oncology service at NorthStar VETS

Dorothy Jackson, DVM, DACVIM (Oncology)Dorothy Jackson, DVM, DACVIM (Oncology)
Originally from the South, Dr. Jackson attended Mississippi State University for her undergraduate studies and veterinary school. Following veterinary school in 2009, she completed a rotating internship at the University of Missouri followed by a specialty internship at Georgia Veterinary Specialists in Atlanta. Dr. Jackson was lucky enough to obtain both academic and private practice experience during her residency, training at the University of Pennsylvania and Veterinary Cancer Center in Connecticut. Following her residency, Dr. Jackson obtained board certification in Oncology and worked at Red Bank Veterinary Hospital for 2.5 years before joining the Northstar VETS team.

Being an Italian from the South, Dr. Jackson loves food. She loves cooking new recipes and trying new restaurants with her girlfriend…another Italian. When not traveling to new places, they enjoy their time at home with their 3 cats who keep them quite entertained.

Posted in Veterinary Medicine | Tagged , , , , , , | Leave a comment

Meet the NorthStar VETS team: Heather Knapp-Hoch, DVM, MS, DACVS


Dr. Heather Knapp-Hoch is a member of the Veterinary Surgery team at NorthStar VETS. In this blog post and video below, she talks about her education, the types of surgeries in which she specializes, and why NorthStar VETS is at the same level as the nation’s top academic veterinary specialty hospitals.

Dr. Knapp-Hoch’s education
We caught up with Dr. Knapp-Hoch, who was checking up on a patient. Dr. Knapp-Hoch is a veterinary surgeon, and she has always had a passion for helping animals. “I originally went to school to become a marine biologist and got into some research. I fell in love with research and I went to grad school for genetics and molecular biology. While I was there, I fell in love with clinical medicine, and working with animals during that process. That’s when I decided to take a different approach and go into veterinary medicine to embark upon a clinical journey to help animals.”

“I did my veterinary education at Washington State, then I did my internship and residency at Cornell University. I stayed on as a clinical instructor at Cornell for three years after I finished my residency. I mainly specialized in soft tissue surgery, however I also did orthopedics.”

“What led me to NorthStar VETS was that I had family in the area and I wanted to get back into northern New Jersey, which is where I grew up. I was looking for a progressive private practice that had an academic feel to it and I found a really great home here at NorthStar VETS.”

Dr. Knapp-Hoch’s specialties
Dr. Knapp-Hoch has several different specialties, and she treats a wide variety of cases at NorthStar VETS. “I do surgery on pets either on an emergency basis or on a planned surgical basis as a referral. I do both orthopedics and soft tissue, however, my passion is definitely surgical oncology. I do a lot of tumor surgeries and excisions of large masses and I also really love minimally-invasive surgery. I specialize in both surgical oncology and minimally-invasive surgery as well as Interventional Radiology.”

Why NorthStar VETS is on par with the top academic veterinary hospitals
Dr. Knapp-Hoch works alongside 40 different doctors at NorthStar VETS. “The patient care and the expertise of the doctors here is on par with any academic university I’ve ever been at and I think that that’s wonderful because I know when an animal comes here, they can get the well-rounded, specialized care of every specialty needed and that’s really an amazing thing to find at a private practice.” Dr. Knapp-Hoch and the team at NorthStar VETS are looking forward to helping you and your pets. She continued, “Seeing my patients come back for a recheck and seeing them with an improved quality of life, and being happy and healthy and returning to what they were before they had their problem that led them to have to visit me is what I love. That’s a really cool thing about my job, and it’s pretty impressive that we can practice medicine and surgery at a veterinary level with the same expectations that humans get. One thing that makes me happy is when pet parents come in and say that they would rather be treated here than at a human hospital. That really makes me feel good about the kind of care and quality of care we provide.

Learn more about the Surgery service at NorthStar VETS

Heather Knapp-Hoch, DVM, MS, DACVSHeather Knapp-Hoch, DVM, MS, DACVS
Originally from New Jersey, Dr. Knapp-Hoch is excited to return home and join the NorthStar VETS surgical team. Dr. Knapp-Hoch earned her Bachelor of Science in biology from Long Island University in 2001. She then traveled across the US to obtain a Masters degree in genetics and cell and molecular biology from Washington State University where she also obtained her Doctorate of Veterinary Medicine in 2007. Dr. Knapp-Hoch then completed a small animal rotating internship at Cornell University in 2008. Following her internship she completed a three-year surgical residency at Cornell University in 2011. She obtained board certification in 2012 and practiced as a small animal clinical instructor at Cornell University from 2011-2014.

Dr. Knapp-Hoch’s special areas of interest include surgical oncology and minimally invasive surgery including laser ablation of ectopic ureters. She is proficient in advanced wound management and has a special interest in the use of negative pressure wound therapy (NPWT) to treat difficult surgical and traumatic wounds. She is trained in both the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity advancement (TTA) surgical procedures for cranial cruciate ligament disease.

Posted in Pets, Veterinary Medicine | Tagged , , | Leave a comment

NorthStar VETS Cool Case Bear


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This is a new series of posts to be shared highlighting cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Watch the doctor tell you the story in their own words via the video below. This is the story of K-9 Officer Bear, a German Shepherd that came to NorthStar VETS for an innovative new surgery technique to prevent bloat. Dr. Jason Coggeshall of the Surgery team was able to quickly get this working dog back on the job.

Learn more about the Surgery service at NorthStar VETS.



Jason Coggeshall, DVMJason Coggeshall, DVM
Dr. Coggeshall is a Maryland native with a passion for veterinary surgery, research and teaching. He earned his undergraduate degree at the University of Maryland and his doctorate in veterinary medicine at Tuskegee University’s School of Veterinary Medicine. Dr. Coggeshall completed internships at the Dallas Veterinary Surgical Center and Iowa State University. He also completed a Comparative Orthopedic Research fellowship at the University of Florida. Dr. Coggeshall completed the first year of his surgical residency at the Louisiana State University in Baton Rouge and the subsequent two years at the Veterinary Referral Center in Malvern, PA. Dr. Coggeshall has a strong interest in clinical research, orthopedic surgery, minimally invasive surgery, and trauma surgery.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Uncategorized | Leave a comment

What you Need to Know about Dog Flu


You can get the flu, but did you know your dog can as well? It’s called canine influenza (CIV) – or dog flu – and cases of it have been popping up all over the country. In fact, canine influenza has impacted dogs in more than half the country – just since March 2015 – and new cases are being diagnosed every week. It’s made dogs sick (some very ill) and six dogs have died as a result of CIV.

As a pet parent, here’s what you need to know. There are two strains of canine influenza – H3N8 and H3N2. H3N8 has been around for several years but H3N2, an Asian strain of CIV, is brand new in the United States, which means dogs have not been exposed to it before and have no immunity.

A dog may have the CIV H3N2 for up to 24 days, which means the dog is contagious and spreading the disease throughout that time period. As a result, the infection can spread quickly among social dogs in inner cities, doggie daycares, boarding facilities, dog parks, sporting and show events and any location where dogs commingle. H3N2 is also incredibly contagious. It can be spread easily by direct contact with infected dogs (sniffing, licking, nuzzling), through the air (coughing, barking or sneezing), and by contact with contaminated objects such as dog bowls and clothing.

Protect Your Dog

  • To prevent the spread of disease, wash your hands with soap and water or disinfect them with an alcohol-based hand sanitizer after contact with dogs.
  • Dog owners whose dogs are coughing or showing other signs of respiratory disease should not participate in activities or bring their dogs to facilities where other dogs can be exposed to the virus.
  • Consider vaccination against CIV based on your dog’s lifestyle and risk factors. If you answer yes to one or more of the questions below, your dog is greater risk for contracting canine influenza. Does your dog:
    • Visit doggie day care?
    • Board at a boarding facility or pet hotel?
    • Attend training classes?
    • Play at dog parks?
    • Participate in dog-friendly events?
    • Attend dog shows or sporting events?
    • Often greet other dogs during walks?

Signs of CIV
Call your veterinarian immediately if your dog has the following symptoms:

  • Coughing
  • Discharge from the nose or eyes
  • Loss of appetite
  • Lethargy/lack of energy

If you’d like more information about canine influenza, you also will find valuable pet parent information at doginfluenza.com.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Pets, Veterinary Medicine | Tagged , , | Leave a comment

Meet the NorthStar VETS team: Jennifer Kim, DVM, DACVIM (Oncology)


Dr. Jennifer Kim is a member of the Veterinary Oncology team at NorthStar VETS. In this blog post and video below, she talks about how she got into veterinary medicine, what veterinary oncology is about, and the words from a client that keep her going.

How Dr. Kim got into veterinary medicine
We caught up with Dr. Kim, who was checking up on a patient. Dr. Kim was originally pre-med with a desire to practice medicine on humans, but she fell in love with veterinary medicine and now specializes in oncology. “Human medicine, for some reason, didn’t work for me. That’s when my best friend in college said, ‘Hey, why don’t you become a veterinarian?’ and I thought that was perfect. So I started working in a veterinary clinic and got my first cat, and it just went from there.”


“I went to college at the University of Pennsylvania and then I took a couple years off from school to work at NIH (National Institute of Health) and the National Cancer Institute doing cancer research. That’s where my interest in cancer came in. After that, I applied to PhD programs and veterinary schools and I ended up going to Tufts. And then I did a rotating internship at AMC in Manhattan followed by an Oncology internship at Cornell. I didn’t match for residency, so I came to NorthStar VETS eleven years ago as an emergency doctor, then got offered an oncology residency at Michigan State.”

What veterinary oncology is all about
Dr. Kim works with oncology patients, treating various cancers to extend and improve a pet’s quality of life with their families. “I’m a veterinary oncologist, which means I treat only patients with cancer. A lot of people think that’s sad, and yes, there are sad aspects to my job, but what they don’t realize is that I get to have these incredible bonds with my patients and clients. A lot of my patients live a lot longer than people would ever expect with a good quality of life.”

What one client said to Dr. Kim that keeps her going
Dr. Kim is one of more than forty veterinarians at NorthStar VETS who work to provide world class care to you and your pets. “The thing that makes our hospital special is the team we have here. There is not a single person you will meet who doesn’t honestly love what they do, and you feel it. You can walk into other hospitals, and it feels cold, but you will never feel cold here, you will always feel like everyone cares.”

Working in Oncology has its tough days, but Dr. Kim enjoys the chance to help give pets and their families a longer and better quality of life. “I received this beautiful email from a client that essentially read, ‘Thank you so much!’ Even though her pet died, it was this beautiful way of saying, ‘Hey, I know that you’re sad, too, but you gave my dog another two years of life that we wouldn’t have otherwise had.’ It’s really the clients and their support, and of course my coworkers, I couldn’t live without my coworkers.”

Learn more about the Oncology service at NorthStar VETS

Jennifer Kim, DVM, DACVIM (Oncology)Jennifer Kim, DVM, DACVIM (Oncology)
Dr. Kim grew up in New York and received her BA from the University of Pennsylvania. After two years at the National Cancer Institute performing cancer genetic research, she attended veterinary school at Tufts University. Dr. Kim completed a rotating internship at the Animal Medical Center in Manhattan, New York, and an oncology internship at Cornell University. She began at NorthStar VETS as an emergency clinician in 2005 and returned in 2010 to treat oncology patients after completing her residency in medical oncology at Michigan State University School of Veterinary Medicine. In her free time, Dr. Kim is an avid foodie and knitter.

Posted in Pets, Veterinary Medicine | Tagged , , | Leave a comment

NorthStar VETS Cool Case Fiona


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Read the story below in the doctor’s own words about the case. This is the story of Fiona, a patient of Dr. Laura Culbert of our Surgery team, and how she repaired this dog’s leg deformation.

About Fiona
IMG_2741Fiona presented to the Surgery team in Robbinsville in January as a 5-month-old female intact Boxer with a right forelimb angular limb deformity. She had an abnormal curvature of the right radius and ulna which was causing her limb to curve to the inside (carpal varus). She also had a shortened right forelimb due to the premature closure of her distal medial radial growth plate.

About angular limb deformities

Before and after radiographs showing Fiona's limb straightening

Before and after radiographs showing Fiona’s limb straightening

The radius and ulna bones develop and lengthen in a growing animal as a two bone system. If the growth plate of one of the bones is compromised by injury or disease, and closes prematurely, then the bone will have asymmetrical growth. Depending on the exact situation, this will cause the limb to angle in or out, or have cranial bowing. This will depend on which growth plate, or portion of the growth plate, is injured and not growing. The ulna is particularly vulnerable to injury because it has a conical distal growth plate. Any impact to the cone could cause premature closure and therefore arrested growth. This is what secondarily causes the angulation.

Angular limb deformities are challenging cases to correct because straightening the bone is of concern, but lengthening the bone is also of concern. Depending on the age of the patient and the severity of the deformity, we sometimes need to perform more than one surgery to accomplish our goals. The list of procedures to correct angular limb deformity include an ulnar osteotomy, a dome osteotomy, a closing wedge osteotomy, an opening wedge osteotomy, and distraction osteogenesis as the most common. These procedures involve cutting the bones to straighten the limb, and then procedures to lengthen the bone.

How things went for Fiona
IMG_2742
With Fiona, we performed an ulnar osteotomy, an opening wedge radial osteotomy, and distraction osteogenesis. Both radius and ulna were cut, the limb was straightened and then a circular external fixator was applied to hold the bones in place. The rings were connected with threaded rods and motors which allowed us to distract the bones across the cut each day and therefore lengthen her now straight bones.

Fiona’s parents had to follow specific instructions on how to do the distractions. What we know is that if we distract the bone at 1/4mm every 6 hours, we can achieve new bone growth that will keep up with our distractions. Therefore, a trail of bone will form in the space that we create and this bone will eventually form and harden to whatever length we need. We maintain the fixator for as long as that takes. Often the length of time in a fixator will be 8-12 weeks at minimum.

There is a tremendous amount of time put into one of these cases and a fair amount of expense. We have had a number of cases done at NorthStar VETS that have resulted in great success.

IMG_2740Fiona has done very well and she now has a straight limb and a limb that is approximately the same length as her other forelimb. This allows her to be functional and pain-free. She is now 10-months old and enjoying life as an active puppy!

Learn more about the Surgery service at NorthStar VETS

Laura Culbert, DVM, MS, DACVSLaura Culbert, DVM, MS, DACVS
Dr. Culbert has been part of the surgical team at NorthStar VETS since 2006. She received her veterinary degree from Cornell University in 1992, and completed an internship and surgical residency at the Animal Medical Center in New York City. She has conducted research in the areas of developmental biophysiology and muscular biochemistry, and her residency project focused on neurologic diseases in dogs and complications associated with steroid therapy. Dr. Culbert’s areas of interest in veterinary surgery include cardiothoracic surgery, oncologic surgery, plastic surgery and fracture repair, and she offers the tibial tuberosity advancement (TTA) procedure for large dogs and cranial cruciate ligament repair. Dr. Culbert has worked with various rescue groups over the years including Greyhound, Australian Shepherd, Jack Russell Terrier, Golden Retriever and Boxer rescue.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Pets, Veterinary Medicine | Tagged , , , | Leave a comment

NorthStar VETS Cool Case Buster


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Read the story below in the doctor’s own words about the case. This is the story of Buster, a patient of Dr. Kelly Kraus of our Surgery team, and how she repaired this dog’s fractured leg.

About Buster
buster-hankinsBuster is a 1-year-old boxer puppy who jumped over a fence and unfortunately landed incorrectly on his hind leg. He sustained a fracture to his tibia and fibula. He came to see us for a consultation regarding fracture repair.

How things went for Buster
Fractures of the tibia are not uncommon in dogs and cats, and most likely result from some sort of trauma (falls, road accidents.) Some of these fractures are amenable to treatment with a splint, which allows the bones to heal on their own. However, in a larger and active dog with a fracture such as Buster’s, surgical repair with open reduction and internal fixation with stainless steel surgical implants is a more stable option.
buster-rads
The implants allow the bones to remain in position for optimal healing. In most dogs, implants are not removed unless there are problems (like infection, implant migration, or implant failure.) Complications with fracture repair are more likely to occur if a dog does too much activity too soon after repair. In dogs and cats, bone healing typically takes at least 8 weeks – sometimes sooner in a very young dog.

Buster had surgery with a bone plate, screws, and cerclage wires to stabilize his fracture. He did very well under anesthesia and was able to go home to his parents the next day. Buster will be due back for follow-up xrays in 4 weeks to check on his bone healing and progression.

Learn more about the Surgery service at NorthStar VETS

Kelly Kraus, VMD, DACVSKelly Kraus, VMD, DACVS
Dr. Kraus is originally from Connecticut. She obtained a Bachelor of Science degree from Loyola University in Baltimore, Maryland in 2003 before moving to Philadelphia, where she did molecular genetics research for two years at the University of Pennsylvania. Dr. Kraus then completed veterinary school at the University of Pennsylvania in 2009. After graduating, she completed a rotating internship at Oradell Animal Hospital in Paramus, NJ. She then moved to Texas to complete a one-year internship in surgery at Gulf Coast Veterinary Specialists. She was fortunate to then move back to New Jersey for a three-year residency in surgery at Red Bank Veterinary Hospital, which she completed in 2014.

She is excited to be part of the surgery team at Northstar Vets. Her special surgical interests include, but are not limited to, wound management and reconstructive surgery, surgical oncology, cardiothoracic surgery, and hepatobiliary surgery. Dr. Kraus also enjoys management of orthopedic conditions. She is trained in the tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament disease. Outside of work, Dr. Kraus enjoys spending time with her family, cooking, traveling, and helping her local SPCA.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Pets, Veterinary Medicine | Tagged , , | Leave a comment

NorthStar VETS Cool Case Patches


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Read the story below in the doctor’s own words about the case. This is the story of Patches, a patient of Dr. Laura Culbert of our Surgery team, and how she repaired this dog’s fractured elbow.

About Patches
Patches presented to the NorthStar VETS Emergency service with unknown trauma presumed to be a hit by car case. The one-year-old spayed female cat sustained chest trauma and a fracture of the left olecranon.

How things went for Patches
pre-post-patches-lat
The chest trauma caused a mild pneumothorax (air in the chest cavity), a pneumomediastinum (air in the space between the lungs) and subcutaneous emphysema (air under the skin). She was also very anemic. Patches spent 2 days in ICU recovering from her chest trauma and building up her red blood cells. As soon as she was stable for anesthesia, she had her fracture repaired.

An olecranon fracture is a fracture of the proximal (upper) portion of the ulna. This type of fracture is categorized as an avulsion fracture. An avulsion fracture is a fracture of a bone that has a muscular tendon attached to the bone. In this case it was the triceps muscle tendon of insertion. The muscular attachment acts to pull the fractured bone away from the point of reduction. Therefore these fractures require surgical fixation for the bone to heal. The hardware that we utilize for the repair will counteract the force of the muscular pull on the bone. Dr. Culbert used a simple pin and wire to achieve this.

This repair is called a tension band fixation. The pin and the wire are placed in such a way that they counteract or neutralize the force of the muscular contraction of the triceps muscle. This causes the triceps muscle to stretch back to its normal length and allows the fracture to be reduced so that the bone can heal.

Patches will have to be very calm and quiet while she heals. She will have an X-ray at 6 weeks post-op and if the fracture is healed, she will be allowed normal activity.

Learn more about the Surgery service at NorthStar VETS

Laura Culbert, DVM, MS, DACVSLaura Culbert, DVM, MS, DACVS
Dr. Culbert has been part of the surgical team at NorthStar VETS since 2006. She received her veterinary degree from Cornell University in 1992, and completed an internship and surgical residency at the Animal Medical Center in New York City. She has conducted research in the areas of developmental biophysiology and muscular biochemistry, and her residency project focused on neurologic diseases in dogs and complications associated with steroid therapy. Dr. Culbert’s areas of interest in veterinary surgery include cardiothoracic surgery, oncologic surgery, plastic surgery and fracture repair, and she offers the tibial tuberosity advancement (TTA) procedure for large dogs and cranial cruciate ligament repair. Dr. Culbert has worked with various rescue groups over the years including Greyhound, Australian Shepherd, Jack Russell Terrier, Golden Retriever and Boxer rescue.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Pets, Veterinary Medicine | Tagged , , | Leave a comment

NorthStar VETS Cool Case Casey


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Read the story below and watch the doctor tell you the story in their own words via the video at the end. This is the story of Casey, a patient of Dr. Steven Berkowitz of our Emergency and Critical Care team, and how a relatively new technique helped save this dog’s life in an innovative way.

About Casey
Casey was an 8-year-old Labrador Retriever that presented to NorthStar VETS late one morning after her owner found her laying on her side and minimally responsive. After a little investigation, they realized that she had eaten an entire bottle of her phenobarbital that she was on for seizures secondary to a brain tumor. Unfortunately, she had ingested just under 100mg/kg of body weight (her actual dose was 2mg/kg)!

About Phenobarbital
According to multiple sources, the elimination half-life of phenobarbital in dogs is anywhere from 12 hours to 2 days. In other words, it could remain active in her body for up to 5 times the half-life, or up to 10 days in her system, and thus have harmful effects.

For years, the treatments for phenobarbital and other barbiturate intoxications was to merely treat the symptoms with supportive care and IV fluids, and there was some literature that recommended using activated charcoal to speed the gastrointestinal clearance of the medications, with limited success.

How things went for Casey
On presentation, Casey was found to be minimally responsive, had a heart rate of 60 beats per minute with poor pulses, and a respiratory rate of 20, and had lost her gag and swallowing reflex. At the dose of phenobarbital she got into, she was at risk of severe central nervous system (CNS) depression, including cessation of breathing and heart contractions secondary to medullary depression.

About the new procedure
Due to recent studies and case reports, Dr. Berkowitz of the Emergency and Critical Care team opted to try a novel therapy of giving her intravenous lipid emulsion. This is a product made of 100% soybean oil that has been purified and approved for parenteral nutrition and some intoxications. The exact mechanism of action of this therapy is not well established, but in cases of highly lipophilic (fat soluble) medications, it has been surmised that there is a “lipid sink” effect as well as an “extended lipid phase.” In these two theories, we suspect that by giving a substance with a high fat content, that we prevent the toxins from leaving the vasculature, and therefore preventing it from reaching the neurological tissue, thus preventing the effects of the drug. The extended phase theory also intimates that it can actually cause the bound medication/toxin from the tissue, and back into the highly lipid filled vasculature, thus removing the toxin from the affected tissues.

Within 1 hour of initiating the intravenous lipid emulsion, Casey was not only more alert, but she was wagging her tail and trying to stand up and walk to the nursing staff. Now that she was able to swallow, she was then also given an oral dose of activated charcoal. Approximately 4 hours later, she started to become very dull again. She was given a second round of intravenous lipid emulsion, and within hours, she was walking around, barking at other dogs and eating well. By the next morning, which was less than 18 hours after presentation, Casey was doing so well that she was discharged and walked herself out of the front door! Beyond the obvious success, what is so wonderful with this result is that in cases where lipid therapy was not given, many of these dogs passed away as a result of intoxication and the inability, even with CPR, to maintain a respiratory drive. In addition, those patients that did make it, often needed to be hospitalized for several days and Casey left in less than 1!

NorthStar VETS had recent success with the lipid emulsion technique when a dog got into insecticide.

Be prepared for pet emergencies at home. Download your free copy of the NorthStar VETS Pet Emergency Care Handbook.

Learn more about the Emergency and Critical Care service at NorthStar VETS



Steven Berkowitz, DVMSteven Berkowitz, DVM
Dr. Steven Berkowitz attended St. Georges University and did his clinical year at the University of Illinois. Berkowitz joined NorthStar VETS after serving as the Chief of Emergency and Critical Care at another specialty hospital. Prior to that, he completed a three-year residency in Emergency and Critical Care medicine at the Oradell Animal Hospital in Paramus, NJ. His residency was completed at one of only a few recognized veterinary trauma centers in the United States. Prior to his residency, he was a staff Emergency Veterinarian at Animal Specialty Center in Yonkers, NY as well as serving as an emergency doctor at Animal Emergency and Referral Associates in Fairfield, NJ for 3 years. Dr. Berkowitz can be seen on seasons 5 and 6 of “Animal Precinct” on Animal Planet, which was filmed during his internship at The Bergh Memorial Animal Hospital of the ASPCA in New York City.

Dr. Berkowitz has special interest in the management of metabolic and endocrine derangements, trauma, as well as management of the septic patient.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Pets, Veterinary Medicine | Tagged , , , | Leave a comment

NorthStar VETS Cool Case Romeo


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. This is the story of Romeo, a patient of Dr. Heather Knapp-Hoch and Dr. Kelly Kraus of our Surgery team, and how advanced wound management and a skin graft helped save this dog’s leg.

About Romeo

Dr. Kraus with a healed Romeo

Dr. Kraus with a healed Romeo

Romeo is a 7-year-old male neutered Cock-a-poo who came to NorthStar VETS in January after being hit by a car. After initial stabilization, he was transferred to the Surgery department for management of degloving wounds sustained to the right forelimb.

About this type of wound

Figure 1

Figure 1

A “degloving” wound is one in which a large portion of skin is stripped off the body, and they are a common injury when a high-velocity object (car) shears across a limb. These wounds are notoriously difficult to manage, because as well as skin damage, there may also be damage to the joints, ligaments, vessels, and nerves. Because these wounds are often contaminated with asphalt, dirt, and hair, combined with the damage to the delicate blood vessels supplying the skin, just stitching the skin back together often fails.

Romeo’s initial wound removed approximately eighty percent of the skin from the wrist down (Fig. 1), and also damaged part of the pad tissue. The carpal (wrist) joint was open and several important ligaments were missing. The options at that point were either amputation of the leg, which the surgeons did not recommend, or allowing his body to try and heal the wounds, followed by likely reconstructive surgery, which is what was elected.

How things went for Romeo

Figure 2

Figure 2

Surgeons use a variety of techniques to help severe wounds heal. Some possible methods include surgery for removal of unhealthy tissues (debridement), vacuum-assisted wound therapy (“VAC” therapy), and management with sequential bandaging to allow the body to start to heal. Drs. Kraus and Knapp-Hoch managed Romeo’s initial wounds with a combination of surgical debridement and open wound management with bandaging. In the beginning, part of Romeo’s pad, one of his digits, and a large portion of skin required removal (Fig. 2). Once all the unhealthy tissue had “declared” itself and had been removed, the doctors used various types of bandages, in combination with a splint, for Romeo’s tissue to heal enough to accept a graft. This time also allowed the wrist to scar in place after the ligament loss. The process from initial injury to obtaining a tissue bed healthy enough to accept a graft took approximately 1 month.

About the skin graft

Figure 3

Figure 3

A free skin graft involves removing a healthy piece of skin from another area of the body and transplanting it to a new location. When a skin graft is transferred, it relies upon nourishment from the bed onto which it was placed. That is why it is so important that the tissue bed is healthy, like Romeo’s granulation bed (Fig 3). Drs. Kraus and Knapp-Hoch performed Romeo’s skin graft (Fig 4) using a piece of skin from his side. He was kept in a splint and bandage for 2 weeks while his body finished healing, and the majority of the graft (around ninety-five percent) survived, which was excellent news for Romeo (Fig. 5). After hair regrowth (Fig. 6), Romeo is looking fantastic and living a normal life.

Figure 4

Figure 4

Figure 5

Figure 5

Figure 6

Figure 6

Learn more about the Surgery service at NorthStar VETS

Heather Knapp-Hoch, DVM, MS, DACVSHeather Knapp-Hoch, DVM, MS, DACVS
Originally from New Jersey, Dr. Knapp-Hoch is excited to return home and join the NorthStar VETS surgical team. Dr. Knapp-Hoch earned her Bachelor of Science in biology from Long Island University in 2001. She then traveled across the US to obtain a Masters degree in genetics and cell and molecular biology from Washington State University where she also obtained her Doctorate of Veterinary Medicine in 2007. Dr. Knapp-Hoch then completed a small animal rotating internship at Cornell University in 2008. Following her internship she completed a three-year surgical residency at Cornell University in 2011. She obtained board certification in 2012 and practiced as a small animal clinical instructor at Cornell University from 2011-2014.

Dr. Knapp-Hoch’s special areas of interest include surgical oncology and minimally invasive surgery including laser ablation of ectopic ureters. She is proficient in advanced wound management and has a special interest in the use of negative pressure wound therapy (NPWT) to treat difficult surgical and traumatic wounds. She is trained in both the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity advancement (TTA) surgical procedures for cranial cruciate ligament disease.

Kelly Kraus, VMD, DACVSKelly Kraus, VMD, DACVS
Dr. Kraus is originally from Connecticut. She obtained a Bachelor of Science degree from Loyola University in Baltimore, Maryland in 2003 before moving to Philadelphia, where she did molecular genetics research for two years at the University of Pennsylvania. Dr. Kraus then completed veterinary school at the University of Pennsylvania in 2009. After graduating, she completed a rotating internship at Oradell Animal Hospital in Paramus, NJ. She then moved to Texas to complete a one-year internship in surgery at Gulf Coast Veterinary Specialists. She was fortunate to then move back to New Jersey for a three-year residency in surgery at Red Bank Veterinary Hospital, which she completed in 2014.

She is excited to be part of the surgery team at Northstar Vets. Her special surgical interests include, but are not limited to, wound management and reconstructive surgery, surgical oncology, cardiothoracic surgery, and hepatobiliary surgery. Dr. Kraus also enjoys management of orthopedic conditions. She is trained in the tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament disease. Outside of work, Dr. Kraus enjoys spending time with her family, cooking, traveling, and helping her local SPCA.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

Posted in Pets, Veterinary Medicine | Tagged , , , , , | 1 Comment