View All Articles

Bilateral Vocal Fold Excision (Mucosoplasty) & Bilateral Arytenoidpexy (BVEAP) Approach to Laryngeal Paralysis in Dogs

Learn how your patient can benefit from the BVEAP technique over the “tie back”.


Ken Sadanaga, VMD, DACVS


Dr. Ken Sadanaga is recognized for pioneering a new surgical technique to treat laryngeal paralysis in dogs that addresses both the intraluminal and extraluminal contribution of laryngeal paralysis, which the traditional “tie back” method does not.

With the tie back method, one side of the lumen is opened permanently to allow for increased airflow. This technique works well to open the airway and improve breathing but increases the risk of aspiration pneumonia for the remainder of the dog’s life.

With the BVEAP technique, the compromised vocal cords are removed to open the lower intraluminal area of the larynx and the arytenoid cartilages are pexied to thyroid cartilage—thus, addressing the extraluminal contribution to laryngeal paralysis. This artytenoidpexy opens the larynx in a more conservative and symmetrical manner, maintaining a better interface between the glottis and epiglottis during the act of swallowing and therefore significantly reducing the potential for aspiration pneumonia.

Advantages of BVEAP Over “Tie Back”

  • Dogs can swim post-op, which is not recommended after tie back
  • Creates a more functional airway
  • Significantly less prone to aspiration pneumonia


To consult with Dr. Sadanaga regarding this innovative technique, contact him at 610-647-2950.

New Referral Relationship Manager, Joe Simpson

Meet Joe

Born in Philadelphia, PA, Joe earned a B.S. in biology from Southampton College in 2003 and has worked in the veterinary field since 2005.  During that time, he has worked in a variety of roles including as a veterinary technician, in vaccine production for Merck Animal Health, and a human resource/practice manager for a local AAHA accredited veterinary hospital.  Prior to joining VRC, he spent the last 3 years as a veterinary services representative for Petplan Pet Insurance.

During his freetime, Joe enjoys spending time with his wife Brittany and their two amazing daughters.  He also enjoys hiking with his two crazy dogs Harley and Oswald, running, and spending time at the beach.

What is a Referral Relationship Manager (RRM)? 

VRC has a Referral Relationship Manager to ensure that the needs of local general practice veterinarians are being met, to distribute up-to-date materials about new specialties and services, and to introduce our specialists to the referring community. Joe works with referring partners to schedule Lunch & Learn events and VRC doctor Meet & Greets that enable us to nurture relationships with one another. He also coordinates Continuing Education courses at VRC for rDVMs and technicians.

When you schedule a Lunch & Learn or Meet & Greet with doctors at VRC, we travel to your location (with complimentary breakfast or lunch) and provide education, training, and relationship building opportunities

Do you have a request for Joe?

Interested in inquiring further about the opportunities that we offer?

  • Schedule a visit from Joe
  • ​Request more materials (brochures, magnets, doctor directory, business cards, etc)
  • Schedule a Lunch & Learn at your facility (food provided)
  • Schedule a VRC doctor Meet & Greet at your facility (food provided)
  • Request Upcoming CE Information
  • Schedule a tour of VRC


Diagnostic & Treatment Advances for Urothelial Carcinoma


Presented by,
Colleen Martin, DVM, MS, Practice Limited to Oncology
Wednesday, September 26th, 2018

This lecture will review:

  • Overview of the biologic behavior of Urothelial Carcinoma
  • Advances in screening and diagnostics
  • New therapeutic options
  • Outcomes with treatment


Lecture provides 1 credit of complimentary CE to veterinarians and veterinary technicians through RACE.

Complimentary dinner and Meet & Greet starts at 6:00pm. Session begins at 7:00pm followed by Q&A.

340 Lancaster Ave
Malvern, PA 19355

RSVP by Friday, September 21st.


Case Study: Fecal transplantation– a novel approach to frustrating gastrointestinal disease

Overview: Fecal transplantation (or transfaunation) involves the deposition of a relatively large volume of “normal” gut flora from one individual to another.  This procedure is performed commonly in people associated with numerous conditions (especially Clostridium difficile infection following antimicrobial therapy) and in with relative frequency in ruminant veterinary patients.  More recently, this procedure has been investigated in canine and feline patients as an adjunct to other therapies for various GI conditions.

History and Diagnostics: A 9-year-old female spayed Yorkshire terrier was initially referred to VRC in November 2017 for an abdominal ultrasound to investigate chronic diarrhea and weight loss over the course of three months that was unresponsive to therapy up until that point.  She had been on multiple courses of standard symptomatic diarrhea therapies including metronidazole, tylosin, probiotics, diet trials, and ultimately prednisone without any significant improvement.  Her diarrhea was significant enough to be causing low blood protein levels (protein losing enteropathy).

Her ultrasound revealed diffuse gastrointestinal thickening, and a second immunomodulatory medication (azathioprine) was added to her medication regimen.  When no improvement in GI signs occurred following the addition of this medication, she was referred for an internal medicine consultation three weeks later.  An endoscopic examination and biopsy of her GI tract was recommended but ultimately declined in favor of continued empirical treatment for a presumptive form of inflammatory bowel disease with associated protein loss since this condition is common in this breed.

While we can only surmise at the actual diagnosis given that an endoscopy was not performed, had we proceeded with this test, the results may have looked like the below image. This endoscopic image is from a similar dog diagnosed with lymphangiectasia, a condition that I thought may have been the patient’s underlying issue.

Figure 1: In this endoscopic image from another patient’s duodenum, numerous raised white nodules are visible, consistent with lacteal dilation which is often pathognomonic for a process like lymphangiectasia.













Figure 2: In this ultrasonographic image of another patient, multiple loops of small intestine are seen in longitudinal view.  Present are numerous hyperechoic linear striations perpendicular to the lumen, consistent with lymphatic (lacteal) dilation.

The patient was switched from azathioprine to cyclosporine, but there was concern she was not even absorbing these medications.  Injectable dexamethasone was initiated, but she continued to decline, reaching a lowest body weight of 9.4 lb (down from her highest of 17 lb in early 2017).  At that point the decision was made to attempt a fecal transplant as a last resort before her owners were considering humane euthanasia due to the refractory nature of her disease.

Procedure: On March 20, 2018 the patient was very lightly sedated with an intravenous dose of butorphanol.  The previously screened fecal donor (another VRC employee pet) provided a fresh bowel movement the morning of the procedure.  A portion of this was mixed 1:4 with saline and blenderized prior to being strained in order to remove larger particles from suspension.  A total volume of 10 mL/kg fecal solution was instilled via a 12 Fr red rubber catheter as far into the patient’s colon as possible, and she was kept from having a bowel movement for as long as possible to provide more contact time.  An alternative option is to perform fecal transplantation under general anesthesia, occasionally at the time of endoscopic examination (which allows for deposition of fecal solution into both the duodenum and the colon).

Immediate Outcome:  Following discharge, the patient’s bowel movements began to improve almost immediately.  She was subsequently tapered off of injectable dexamethasone, without the need to resume oral prednisone therapy.  Her other treatments were discontinued one after another, with no deterioration in her condition at that time.

Discussion:  Fecal transplantation is a very appealing option for dogs and cats with refractory diarrhea given the relatively low cost and risk associated with it compared to various other options.  It is also being actively investigated as a potential therapy for numerous other non-gastrointestinal conditions including resistant urinary tract infections and other autoimmune disease processes.  While not all patients may respond, this procedure seems to have significant potential. Fecal transplantation can be considered at any point in a patient’s therapy.