Rappie

I haven't prescribed it personally, but I have looked into it previously for a cat with suspected diabetes insipidus (central diabetes). I can't remember the exact price, but it was "not cheap". The intranasal solution of Minirin is still about $150 even from a discount human pharmacy. There is an oral form available but if you have a larger dog I'm not sure that they end up being a great deal cheaper (and the response is not always the same as using it as eye drops).

We are currently using the Nobivac DHP and KC injectable, we're located in Wentworthville.

Thyroid tumours can occur in dogs but they are not generally functional (ie. they are not associated with changes in thyroid hormone levels). I think your current plan of vet check, bloods and assess the lumps with an FNA (if possible / indicated) is a good place to start).

Promeris is not available in Australia - but it is useful information for those DOLers in other countries.

The only contraindications I can think of off the top of my head are those related to the increased fat content - ie any dogs with a previous history of pancreatitis or hypertriglyceridaemia (normally Miniature Schnauzers).

Precisely.

Yes! I would love to have a white based doona cover with a tiny floral pattern on it, but white is a no go. I'm also reluctant to buy expensive bedlinen, because there will inevitably be some dirty foot prints or a stealth vomit that wont wash out and it would make me too sad, lol.

My own "big" brown dog (5.5kg)has just started on prednisolone too. I haven't seen him drinking more water, but he has been stirring earlier in the morning. The first thing he does in the morning is shoot outside for a pee, so I assume he is drinking more. I've just split their meals in two to try to avoid any fights over food from being 'hungry'. Our food situation is usually very well controlled, but since they once had a fight over a tiny lizard, I don't want to take any chances .

The medicated shampoos like Malaseb and Pyohex work very well, but should only be used when there is evidence of an infection that requires treatment. In dogs with dry, irritated or flaky (dry skin flakes rather than greasy yeasty crusts) then it would be better to use a soap free shampoo like Aloveen (although there are plenty of others). The recommendations for dogs with atopic type allergies might be slightly different as these dogs can sometimes react to shampoos with plant products in them like oatmeal. I also would try to keep things simple and avoid most products with essential oils in them unless they are a high quality product. I've seen quite a few nasty skin reactions from cheap / supermarket branded tea tree oil shampoo.

Just keep in mind that although it increases appetite, they do not need more food! Always have plenty of water available.

This condition is also known as hepatocutaneous syndrome or toxic epidermal necrolysis. The skin erosions and ulcerations are a result of underlying disease, which is usually hepatic but can also be from the pancreas. It is thought to be a result of incomplete metabolism of amino acids and nutrients, that then leads to degeneration of the superficial skin cells. Treating this condition as a skin problem only is not usually successful - the underlying disease needs to be identified and treated if possible. This might require further blood tests and an abdominal ultrasound. The only specific treatments are to a) treat underlying disease and b) IV amino acids but this is expensive (both the amino acids and the hospitalisation as it requires a jugular catheter), difficult to source. Supplementary treatments include antibiotics, anthistamines, omega oil supplements, zinc and other supplements but I would only start on these after discussion with your vet as they could affect underlying disease.

If there's a patented medication involved, it needs to be supplied to the compound pharmacy first - the compounding fee is only to reformulate it. For other medications, the fee covers the cost of drugs and compounding.

What's "ISO" ? Isoflurane = inhalant gas. It's predecessor was halothane (halo!). There is also sevoflurane (sevo) which is not used much in private practice.

Good luck with it all Flick Mac! Anaesthesia was one of my favourite subjects are uni, but we were lucky enough to have 3 fantastic tutors/ lecturers to challenge us. I know it seems overwhelming and some of the physiology gets boring, but it's really fascinating in practice Of course, there's the possibility that I'm just reminiscing all the fun times - I'm a mentor for one of our veterinary nurses doing her Cert IV and we've just had a final year vet student with us for a month.

Gas is generally the maintenance agent but it can be something else (IV infusion). Gas can also be the induction agent, but I generally treat this as a last resort option. It does all sorts of undesirable things to blood pressure, respiration and oxygen levels, is stressful to animal and personnel, and if nothing else means all the humans get a whiff of gas which is an OH&S issue. It can get confusing but the naming mainly refers to which stage of the anaesthetic process you're at - induction, maintenance, recovery etc. Edit to add: The important thing is that there is no ONE way to do things. As Stormie said in the other thread, the safest anaesthesia in a particular situation is one that you are comfortable with. There are lots of drugs that do lots of things and many can be used to achieve the same purpose. It is up to us (vets / anaesthetists) to choose drugs that are appropriate for our patient and the procedure, so that we can plan a safe anaesthetic. I know I bang on about 'planning' anaesthesia - it means taking into account 'expected' unexpected occurences and putting in place measures to prevent or counteract their effects. If we do an eye surgery, we know that meddling with the optic nerve can cause increased vagal tone which can slow (or stop, in extreme cases) the heart rhythm - so we might either include atropine in our premed, or have it drawn up ready. If I have an anaesthetic to do on a dog with heart disease, I will change my induction protocol, use local blocks where possible and have a written list for my nurse of emergency drugs and the doses specific for that patient. It also includes post operative pain relief etc. Although the great majority of cases are going to be 'same old', we must treat EVERY patient as an individual.

IV maintenance certainly has it's place but it's not generally used for long term maintenance for surgery. It's great for some situations where a light plane of anaesthesia is needed and it can be used as a constant rate infusion - good for situation with constant seizuring like snail baits or status epilepticus, or if for some reason you can't use an anaesthetic machine (like in an MRI). Sometime we might only use an IV agent if we want a very quick anaesthesia, like to pull a toe nail or remove a bone lodged in the mouth etc - but these cases would still get a premed. For interest, providing local anaesthesia is another way to reduce the amount of anaesthetic agent used. We use lignocaine blocks a lot for tooth extractions, it means we can have all the benefits of a lighter plane of anaesthesia like less hypotension but without having a dog react to stimulation from instruments in the mouth etc.

Acepromazine is a sedative drug used (in basic terms) to help the animal relax. It can help to reduce anxiety and awareness of surroundings, although technically it does not have an anxiolytic (anxiety reducing) effect. At higher doses it can cause quite a bit of 'grogginess' - although in Australia we tend to use lower doses than in the USA. Methadone is an opiod drug, used primarily to provide pre-emptive pain relief but it also has some sedative effects. By giving pain relief before the pain receptors are stimulated, we reduce the amount of reaction from stimulation during a procedure and can better control pain afterwards (much easier to prevent and treat, than try to 'rescue' it later). Together the two agents reduce the amount of anaesthetic agent required to induce and maintain anaesthesia. The induction agent is the one that is given to cause initial anaesthesia, they generally only have quite a short duration of action - the newer drugs only about 5-10 minutes, thiopentone a bit longer. This is long enough to place a tube into the trachea and start the animal on inhaled gas - or the maintenance agent, which is used to keep the patient asleep. The advantage of using gas over continued IV administration of a drug, or a longer acting injection is that we have much better, and more rapid control over the anaesthesia itself. If the patient is too light, we can deepen the plane of anaesthesia. Too deep and we can lighten it. Once the gas is turned off, the recovery is usually fairly rapid. In most routine surgeries, the premedication drugs last longer than the procedure, so the patients wake up nice and quietly from their 'snooze'. If no premed is given, a lot more induction is required to make the transition from awake, to asleep and it can be referred to as a 'crash' induction (although this often refers to a gas only induction). The recovery can be equally violent - much thrashing and incoordinated movement. There is a middle phase known as 'excitement' between conciousness and unconciousness - premedication allows us to basically skip this step. Why do we want to use more drugs? When we use them in combination, we can use lower doses of each drug and get greater effect. Each of the drug have their own side effects, so by combining them we get a better anaesthesia with less side effects, which then gives us a smoother result and better control over what is going on. That's a very quick run down, but I'd be happy to answer more questions. Let me know if it doesn't make sense and I will explain further. Edit for spelling/grammar. It's late, lol

Acepromazine is not used for induction. A 'typical' routine would be acepromazine and methadone (or butorphanol if the procedure is not painful, or buprenorphine) sedation, then induction with an injectable drug (such as alfaxan or propofol), then maintenance on isoflurane (gas). I'm not sure which induction agent they would be referring to that sounds like 'Ace' (which is how we refer to acepromazine).

Acepromazine is a sedative drug. It's a regular feature in most 'normal' premedications, in combination with an opiod drug like methadone. In this combination, it's a reliable drug to use. It's traditionally used for travel sickness / sedation but IMHO there are better drugs to use for both purposes now.

All anaesthesia causes hypotension to some degree, it's one of the very good reasons to have patients on IV fluids. Propofol can cause temporary but profound hypotension and respiratory depression. Many vets still believe a mask induction is the safest method of anaesthesia, but the potential for catecholamine release makes me cry on the inside. I use Alfaxan because it is the drug I have most experience with, I have very good results with it and it's predictable. If the situation calls for it, such as an epileptic patient, or one with heart disease then I modify my anaesthetic plan to suit. An excellent anaesthesia instructor once told me that the anaesthesia takes the patient one step closer to death. The skill is not in getting them there, it's bringing them back. Was she being blunt? Yes, probably. Was she right? Yes, absolutely. Getting them to sleep is the easy part - but planning and providing a balanced anaesthesia using principles of neuroleptoanalgesia is another thing entirely.

I don't use thiopentone currently, but I have previously. It's a useful drug to use in appropriate patients, but despite all the advances, there is no perfect drug for anaesthesia. Giving an induction agent according only to weight is an anaesthetist problem, not a drug problem - induction agents should always be given to effect. Alfaxan given to a sighthound without sufficient or appropriate premedication is pretty horrible too. In my hands, perivascular irritation should be a non issue because IMHO any patient undergoing a general anaesthesia should have an IV catheter in place, prior to induction. It's also prudent to dilute the thiopentone to 2.5% and in the event of leakage, take measures to dilute further.

The things you've been asked about are valid, but perhaps the way they are presented to you could use some work. If you truly feel uncomfortable about it, I would suggest you contact the clinic and let them know. I'm sure it's not their aim to guilt you into doing anything but there is no way for them to know the effect things like this have on a clinic unless there is feedback. A good clinic should take it on board as a constructive comment. We have several questions on our surgery consent forms now that are a direct result of client comments. Edit to add: I've outlined our anaesthesia protocols previously. Everything that is essential or necessary is included either as part of the surgery (such as in desexes) or in the estimate for a particular procedure (such as lump removals or dentals). Everything gets pain relief, almost everything is on fluids. If for some reason and animal was not on fluids and needed them, they'd get them. In risky anaesthesia cases, I also discuss what steps the owner would like us to take in the event of an emergency (DNR, closed CPR, all available measure ie open chest CPR). I believe that owners must be aware of what is being done to their pet, what treatments options are available and the various ways a particular situation can be approached - this is all informed consent. If option A, B and C are all acceptable, I will offer them all. If they are not, I let owners know that. I am not the one paying for the treatment, but I am the one that acts as the advocate for the animal and their welfare is my main interest. If you're offered a blood test, you don't have to take it, but we do have to tell you it is available, and what impact the results may have.

The uroliths that affect Dalmations are urate, which have a different composition and treatment to struvite. What testing was done?

Depending on whether the dog was more or less than 10kg (but less than 20kg) and the degree of tartar build up, our practice would be $250 - $350 for a dental exam under GA, scale and polish. Extractions, further treatment, dental xrays etc and pre-anaesthetic blood tests are additional. This is in Western Sydney. If everything was charged at it's full price in a general practice it could easily come to $500 by the time the final charge includes a general anaesthetic, hospital stay, blood tests, the dentistry, IV fluids and an antibiotic injection if it is given. Sometimes dentistry is charged at a different rate to other procedures, sometimes it isn't. It might also depend on whether a vet is performing the dentistry, or a qualified nurse.

It's not impossible but it's not something I've seen before. I would be a bit suspicious that there was an underlying immune issue that made the dog more susceptible to a having a food sensitivity, particularly since there also seems to be a seasonal component. When having a flare up with secondary infections then the additional stress can allow a jump in the numbers of demodex mites. Demodex in an adult dog nearly always has an underlying cause (usually resulting in immunosuppression), it's just sometimes hard to identify it.