Rappie

^^ What vetrq said.

I should modify that to say"reluctant to use in any undiagnosed gastrointestinal disease" and then except for "IBD, or neoplastic processes that are responsive to steroids" to cover possibilities like lymphoma and some other tumours. Steroids have a variety of other effects on the body including the gastrointestinal tract - including causing gastric and duodenal ulceration (which may already be present through other means. They can also delay wound healing and reduce immune response (including to a bacterial infection). They are used for IBD because in this condition the body mounts an inappropriate inflammatory response in the intestinal tract, which is full of lymphoid (immune) tissue. The swelling of the tissues result in reduced function - in this case the effects of the inflammation are reduced and gastrointestinal function improves. The effects are similar for cases like lymphoma where high doses of steroids can slow progression of the tumour and reduce the inflammatory effects caused by them.

I agree that if your dog has signs of allergies that now is a good time to get a longer term plan for trying to deal with them - whether this be a referral to a dermatologist, diet trials or symptomatic treatment. I use steroids in very short courses of oral tablets for skin flare ups, and don't give steroid injections unless a dog has had an allergic reaction. They are very good at what they do but I would try all the other symptomatic treatments (shampoos, conditioners, antihistamines, omega oil supplements, hydrotherapy, novel protein diet trials etc etc) before resorting to long term steroids. In a dog with pancreatitis, I would be cautious about supplementing omega oils due to the fat content. As a side note, steroids being a cause of pancreatitis has largely been debunked. There was a study a long time ago that showed that amylase and lipase levels were elevated after steroids were given and traditionally an elevation in these levels has been used to diagnose pancreatitis. We now know that there are various sources of lipase, not all of them are from the pancreas and that amylase and lipase can be elevated in any gastrointestinal disease. I would be very reluctant to use steroids in any dog with gastrointestinal disease (except inflammatory bowel disease where it is an indicated treatment), but they don't cause pancreatitis.

What clinical signs have lead to the diagnosis of acute prostatitis? Prostatitis is not hereditary, but it occurs only in entire male dogs. The prostate starts to enlarge generally after about 3-4 years of age through the process of benign prostatic hyperplasia. Some of the changes associated with this can predispose the dog to inflammation and infection of the prostate gland. Prostatitis can be treated, however while ever the prostate is under the influence hormones like testosterone the dog remains at risk of a repeat episode. Castration is recommended as part of the treatment in order to help decrease the size of the prostate and prevent recurrences, but these effects are not immediate and take a few week to occur. It is also possible to acute on chronic prostatitis and other variations like prostatic and paraprostatic cysts which do not respond well to medical treatment only. With 'just' prostatitis, it's important that the dog is treated for a sufficient period of time (usually 4-6 weeks) to fully treat the infection with an appropriate antibiotic - which might require getting a sample of prostatic fluid to send away for culture.

I think a vet check is probably a good idea. A nail bed infection (paronychia) can be quite painful and if it's allowed to progress can start to cause other problems like bone infection as has been mentioned. It can result from any kind of trauma to the base of the nail, or secondary to skin infections - a reasonably common cause is getting the nail caught and pulled enough to injure the toe / nail but not actually detach it from the skin. If there is pus, it may well require some antibiotics.

It would depend on what she was doing the FNA of. If the vet is confident that it is a soft tissue mass then an FNA can be done without GA. If there's still a chance it is a bony mass covered by soft tissue, then a GA and xrays would determine whether there is bone involvement. Although the best sample in this case is a bone biopsy with Jamshidi needle, it is possible to get a sample of abnormal bone with a needle aspirate in some cases.

A lot of our clients who have had problems with dogs getting fly bitten ears have reported good results from using Advantix. Might be something to try?

We learnt to place IV catheters in live patients when we were on our anaesthesia rotation. Every patient going under sedation or GA gets an IV cath, so over a month there were plenty of chances. Same with inducing GA and intubating, we did the real thing with a member of the anaesthesia staff standing right beside us.

Really, I think the cadavers were a decent compromise. Adapting to living tissue was not as much of an issue as I initially thought it might be, in some cases, I think having the opportunity to do things in a lower stress environment is much better because there was less multitasking. When you start doing surgery, there are so many little things that stress you out - maintaining sterility, whether things will start bleeding at you, trying not to drop instruments, getting accustomed to wearing a face mask, gown, cap (it can get quite claustrophobic and incredibly hot) etc. So in the regard, doing exactly those things with a non living patient means you can concentrate on what you're doing without causing harm. The tissues are still made of the same stuff, they are found in the same places and for the most part still behave in a similar way (intestines are slippery, liver is friable etc) so you can learn how to tackle them. I know I keep going on about surgical skills being more important than having done fabulous surgeries, but there is no use being able to do awesome stuff if you tie sutures too tight, or you crush tissue with your forceps or make all the nurses hold their breath and pray when you pick up scissors or a scalpel. Obviously the first time you do surgery on a 'real' patient is stressful and you have to learn to deal with a few new things, breathing for one and bleeding for two. I guess here though everyone was aware of our limitations and we started out on easy stuff, and then you start to up skill. Cat castrates lead to dog castrates, lead to cat speys, lead to dog speys. My biggest concern was not really whether I could do something, but whether I knew what to do. I like to be prepared, I like to write lists, I like procedural algorithms. We were forever being told about 'first principles' and wondering what the hell people were talking about - with surgery it become fairly simple. If it's bleeding, stop it.. If it's closed and you need to see inside it, open it.. If it's open, close it etc.

Well the models were only when there was nothing else to practice on. Mainly for trying out suture patterns and seeing how they work to spread out pressure etc. Model is probably a very generous term, it was 3 different thicknesses of foam glued together and then fashioned into a tube, supposed to represent tissue layers. Elaborate, maybe not but useful for what we needed to do. Tie too tight and the foam puckers, too loose and it will spring apart.

How do you learn to tie off a gushing artery if you're using a foam model? You learn to ligate vessels that are not gushing. Nice, intact ones like you find doing speys and castrates. By learning good technique, you reduce the risk of being the cause of the gushing artery. I mentioned the 'how' in the last part of my post - identify, clamp, ligate. Sure, a wash of blood gets your own blood pumping a bit faster but the approach it the same, you don't just stand there are gawk at it.

No, they stopped a few years before I started the the course. I don't think it was a significant disadvantage, although sometimes I do think it would have been useful to have done some procedures before graduating. In honesty though, having good basic surgical skills and knowledge of good surgical technique are more important than whether you can do a Billroth II procedure or relocate an ectopic ureter by the time you graduate. In a time of high pressure, I don't know that having done something once at uni is going to make that much of a difference. There is no shame in reading a surgery textbook before doing a new procedure and they all describe the same kind of 'generic' skills - identify, dissect, ligate, divide, appose, reflect etc. Once you can do those things, the specific location is not so important. I did extramural rotations in private practice during uni to get some additional experience, including at the RSPCA. I haven't found it a significant issue in any of the jobs I've had as a vet either, mostly I've had good mentors who are happy to watch / assist when doing something new. I don't do much orthopaedic surgery, but that is not anything to do with what I did or didn't do at university, but a reflection of what comes through the doors and the fact that we have an awesome surgical specialist nearby that does an excellent job on ortho cases. They are considered to be ethically sourced. The cadavers are not PTS at the pound for the use of the university, but with the approval of the ethics committee, the uni may source cadavers from the pound for the purposes of student training. If no dogs were PTS, we learnt surgical skills in other ways - foam models, plating plastic bones etc. All the students treated the animals, alive or dead with great respect. We were learning surgical techniques and we wouldn't have that opportunity without them, why wouldn't we treat them that way. Apart from the 'living' status our patients we were expected to, and did, treat them as we would any other patients. Nothing unnecessary was done, wounds were always closed fully after we had finished. Even in anatomy, where one group would have a preserved cadaver for the entire semester, they never got 'dumped' on the tables, we cringed and said sorry if we had to do something particularly invasive. The fact that you get used to being around dead animals doesn't mean you care any less. We all approached that part of our studies with a sense of purpose, it wasn't any less important because our 'patients' couldn't bleed. As for the other questions about how do you deal with things that bleed - you apply pressure or swabs, find what is bleeding, clamp and ligate. You have a reasonable idea of which vessels you will come across, which ones you are ligating routinely, and if you're using careful surgical technique then there is going to be less bleeding anyway.

Sydney doesn't do non-recovery surgery, but it does use cadavers from the pound for surgery training.

Surgeons in training programs also have the benefit of primarily seeing surgical cases and doing surgery. Veterinarians in general practice try to juggle everything - providing customer service, managing medical and surgical cases, dealing with hospital staff, clients etc, and THEN trying to improve surgical skills as an aside. I think it was stormie who has posted a list before about everything a vet is - general practitioner, pharmacist, surgeon, radiographer etc etc etc etc (and it was a lot of etcs!) There is a wall poster that lists them all, I think there's about 30 or so 'jobs' that we do.

Hernias can only be pushed back in if they are 'reducible' which means the hole in the abdominal wall is patent and will allow the contents of the hernia to be replaced inside the abdomen. Sometimes the ring of tissue is quite small and as the dog grows it traps some fat on the outside of the muscle. Larger hernias can have loops of intestinal pop in an out. Desexing is a good time to repair them as the dogs are already under anaesthesia. In terms of cost, all of the practices I have worked in charged between $50 and $100. It is generally a little less for female dogs as we do not have to make an additional incision, but repairing the hernia does take some extra time.

We aren't in a position to offer it for every medication and some vets prefer not to do it. For every client who does come back for regular rechecks, there are those that just want scripts for cheap meds, don't come back in for the check ups, and then get upset when we refuse to give another prescription, then blame us when their dog starts to deteriorate a few months later. . We have an obligation to maintain a genuine vet - client - patient relationship which means we should see the pet at least every 6 months. We do have clients who prefer to (knowingly) pay the bit extra for meds because we are always available in the clinic or on the phone for any questions they have, vets and staff spend a lot of time providing advice at no charge. Some find it more convenient, some would rather that we keep track of everything, explain the usage, check the dosage and generally just get to know them and their dog. However, consultations are services that take time, so they are not often done at no charge. This is one issue where the best thing I can recommend is to communicate with your vet. If you find the meds expensive, ask if there are alternatives ways of doing things. Not all vets will be comfortable doing it, and as I've mentioned (and as you've already said you will, so not having a dig) it is important that regardless of where the meds come from, any monitoring and testing is kept up to date.

Surgeons in training programs also have the benefit of primarily seeing surgical cases and doing surgery. Veterinarians in general practice try to juggle everything - providing customer service, managing medical and surgical cases, dealing with hospital staff, clients etc, and THEN trying to improve surgical skills as an aside.

Your vet might be willing to give you a prescription to purchase Florinef from a human pharmacy, it is up to their own policies and procedures. Just keep in mind that you will still need to have regular check ups and blood tests to make sure everything is in order.

They do get the experience when they graduate, but it takes time. There are formal internships available, but they are generally only in referral centres and universities which severely limits the number available. If a vet has been working for a few years, taking one of these internships often involves taking a pay cut back to new grad wages ($40k). Starting out in private practice has plenty of challenges, not all of them are medical or surgical. Routine surgeries like speys and castrates are easy to come by, but for most others you have to wait for the opportunities to present themselves (ie. coming across a patient with a lump that needs removing). I've been lucky, for the most part I've had good mentors, when something new came along I'd have another experienced vet scrubbed in to teach and assist, then the next time, they'd mill around the surgery to give advice, then later, they'd just be in the clinic to be called upon if I needed assistance. Sometimes though, clients just either a) don't want to see you, or b) will let you examine their pet, but don't want you to go anywhere near it in surgery. This is fair enough, but it doesn't help gaining experience. After a while though, it starts to make less difference whether you have a done most surgeries before. You develop a varied and adaptable skill set, have a good knowledge of surgical principles and become familiar with your capabilities. It always helps to have done something before, but it's not always possible.

If he's grossly obese then serious, strict reduction of caloric intake is going to be more important than exercise in the early stages. The key here would be moderate exercise, which for a grossly overweight dog means a bit more exercise than he already does - maybe a 5-10 minute walk. It is important to be aware of the weather and outdoor temperature and any other conditions that might be present like arthritis, with the hot weather lately it would be quite easy to induce heat stress in a fat, panting dog.

I'm not aware that the vaccine is available in Australia, the information on the US Pfizer website suggests that it only has a conditional licence. Most dogs I see have some degree of tartar build up and peridontal disease, which under ideal circumstances, would warrant dental treatment. I do see quite a few dogs with great teeth, not all of them eat bones and most of them are large dogs. I also frequently see bone eating dogs with fractured teeth, but then I see a lot of ball obsessed dogs with worn canines too.

If the ears are getting mucky quickly and not responding well to the Surolan then I try to re-evaluate the "microclimate" of the ear. If there is a lot of gunk in there, the topical meds wont work as well, they are best applied to a clean ear. I generally try to get ears cleaned initially once a day while we try to get the infection under control, then once the amount of gunk is reducing (usually after 4-5 days) then drop it down to 2-3 times a week, then weekly etc. It is possible to over clean the ears but it's also important to clean all the muck out before putting meds in. With general ear cleaners like Bayer Clean Ear and Epi-otic it's important to allow at least 30 minutes before putting the meds in. I do sometimes find that these two cleaners keep the ears quite wet, especially with floppy eared dogs - these can be the dogs that do need drying ear cleaners. With persistent yeast infections I have had more luck using Malacetic ear wash. In those dogs that seem to just be sensitive to yeast (red, itchy ears or ones that seem inflamed even with no discharge) we can add some steroid injection to the bottle of ear cleaner. This one is used only once a week or so. Some dogs need treatment with oral antifungals too, or a different ear med. In most cases unless there are complicating factors, if we can reduce the discharge, there should be a high enough concentration of the active ingredients in topical medications to treat the infection. Are you filling the ear canal with ear cleaner and giving it a really good "squelch" for 30-60 seconds? Then wipe out the excess and let them have a good shake.

What are you currently using to treat the infection? (ear cleaners, meds etc) Has she got any other signs of allergic skin disease?

Yes. Bordetalla bronchiseptica tends to cause secondary infections, most primary infections seem to be viral. I see loads of dogs with 'kennel cough' that have been vaccinated but the vast majority of them have what I consider to be mild clinical signs and the course of disease is quite short. They are frequently still very bright, happy, with the typical honking cough which is usually non-productive aside from the odd episode of gagging up white frothy saliva. Those dogs with secondary infections have high temperatures, mucus in their chest, mucus in their noses, mucus in their eyes, high temperatures, large lymph nodes and poor appetites - and these are the ones that I treat with antibiotics. The vaccinations don't prevent infection, but if dogs are infected with one of the pathogens they have received vaccination against it does tend to limit clinical signs. Limiting clinical signs then limits the spread of the virus / bacteria through aerosol droplets and contamination of food and water bowls etc. I've worked in several areas of Western Sydney - currently in one with a high uptake of vaccinations. Although I probably see just as many cases of canine cough now, I see far fewer cases with pneumonia type symptoms than I used to in an area where lots of dogs were either unvaccinated or only done with C3. The only cases I've seen like that recently have been in pound pups and geriatric dogs.

I would guess that your friend has Caninsulin (it's the most common choice for dogs with diabetes). If that is the case it is injected under the skin, commonly the back of the neck because the skin in loose. Some important things to know about Caninsulin: - don't shake it. It will settle, to resuspend it I gently roll the bottle over or back and forth then when it is evenly suspended you can draw up the injections. The insulin particles are quite fragile, so shaking it can inactivate it. - store in the fridge standing upright, don't lay the bottle on it's side as the rubber will affect the insulin. - discard the bottle after 6 weeks and get a new on, even if there is some left. - keep it refrigerated, draw it up at the time that the injection will be given and then put the bottle straight back in the fridge. - if you aren't sure whether the injection went under the skin, don't give another one. It's better to be temporarily uncontrolled then have a hypoglycaemic episode. - until the dog is eating reliably, I generally advise feeding first, then giving the insulin straight after.