Rappie

The SASH team are just a wonderful to referring vets as well :)

My advice at this point in time would be not to over think things. Common reasons for ear infections in young pups are ear mites, structural factors (small or narrow ear canals, floppy ears) and environmental factors such as humidity, ear cleaning, swimming, bathing etc. While allergies (particularly food and atopic allergies) can contribute to ear infections I would normally recommend treating this first infection to resolution (based on cytology, adequate duration of treatment and repeat examinations) and then considering further work up if there are repeat episodes. Although not unheard of, true allergic disease is uncommon is pups this young.

If the invoice line item is actually all that was done the they have run an in house urinalysis (which may or may not have included a sediment examination), a PCV (which is a basic measure of red blood cell levels) and whatever the scan was (could be full abdominal or just bladder focussed). If there is an issue with recurrent haematuria (blood in the urine) then a urine culture and sensitivity (to confirm the problem is due to infection and if so, that the antibiotics are correct), blood testing and abdominal imaging (ultrasound or radiographs) are recommended. The imaging seems to have been done already so the other testing is indicated - also a thorough physical exam to see if there are any physical or anatomical factors contributing.

A comparison on price alone is not particularly helpful as there are so many variables - some things can be compared directly such as pre-anaesthetic blood testing and IV fluids and others that will depends on the individual hospital such as the cost of anaesthesia, hospital, dental treatment etc. Not every clinic will do things the same way or have the same fee structure, not every clinic will have the same overhead costs not every clinic will have the same level of experience amongst their staff so it is very difficult to use price alone as a judge of what will be done. Often the bulk of the cost will be hospital and anaesthesia but the cost of the dentistry may vary depending on how much dental disease or tartar there is (more takes longer to do) or whether, if there is dental radiography available, this cost is included or not (best practice often indicates that when there is a certain level of tartar or peridontal disease radiographs should be taken to assess for underlying pathology), or whether the estimate is accounting for some extractions. In general in the practices I have worked a "base" dental is around the $300-400 mark depending on the size of the pet and degree of dental disease and if there are multiple extractions this can easily become $1000+.

It was a closed, ruptured pyometra with subsequent peritonitis as I read it? Yep - already noted. Just distracted by distracting posts. See my edit on post above - I replied while distracted feeding a baby and didn't read the thread in its entirety

It was a closed, ruptured pyometra with subsequent peritonitis as I read it. Edit: Have just finished reading the thread, I replied too early and just realised there were more replies. Unfortunately with peritonitis and sepsis it will have widespread effects on multiple body systems and recovery can take some time. She has had a high level of care from the sounds of it and it is unfortunate that it comes at such a cost.

The bacteria that causes tetanus needs an anaerobic environment to grow so open wounds are generally not a problem, compared to deep and/or soil contamination and/or puncture wounds.

I would consider a second opinion with a surgical specialist if the defect is likely to require a mesh implant, particularly since there has already been one procedure performed already.

The minimum course of treatment for demodex is going to be 12 weeks regardless of the protocol used. I have primarily used oral ivermectin or dectomax injections and nearly all of the treatment failures that I have seen have been due to either underlying disease, or insufficient duration of treatment. Bravecto is registered in other countries for the treatment of demodectic mange but not in Australia. The information being published about it is promising - discuss with your vet if you want to change the treatment protocol.

The desexing reminder is likely to be automated. Reminders for a set time in the future, like a health check or vaccination (say for 4 week, or 12 months from 'now') are generally set manually, or at least in an automated way where the user has the choice to select or cancel the reminder. In the practices I have worked desexing reminders have either been manually set (as a phone call) or have been done monthly by selecting a particular data range (to determine age). I would just accept the reminder as nothing more than the practice letting you know that your dog has reached an age where many pets are desexed. There are most likely to be notes in your dogs file documenting your wishes. Mention it to your vet or the staff when you see them next, and if they follow up simply tell them that you do not wish to do it at this time.

I have treated several dogs with insulinomas medically. At the time I was treating them, we used a good quality puppy food but what works best for individual dogs may vary - some are better with low fibre / high protein, some are better on higher fibre / complex carbs. Although in the long term steroids are steroids and side effects will occur, the doses required for maintenance of blood glucose are not high. The blood glucose may not always be normal but the aim of the steroid treatment is neuroprotective so it will limit the clinical signs even if the blood glucose is loitering around low. Feel free to PM me if you wish.

Has there been any staging done (bloods, urine testing, chest X-rays, abdominal ultrasound) or just a biopsy? Not all grade 2 MCT behave in a malignant manner and pathologist will usually comment on this aspect in the histopathology report. In well differentiated grade 2 rumours with low mitotic index, clean surgical excision with margins can be curative. In poorly differentiate tumours they behave in a more malignant manner and chemotherapy is often required to follow up. If you are undecided then I would recommend that you pursue an oncology appointment - oncologists the best people to give you all the statistics and the most appropriate options available to you including surgical options. Going to see an oncologist does not mean that you have to pursue chemotherapy but it may help you to consolidate the information you have been given in order to make a decision. There are oncologists at the main referral hospital - SASH, ARH and the University of Sydney.

Georgina Child is a specialist neurologist based at SASH (Small Animal Specialist Hospital) in North Ryde. I will let others comment with their recommendations, but feel free to PM me if you need to - I used to live in the general area :)

In these situations (where we cannot rule out or confirm ingestion) I recommend one of two options - either do the blood test (PT) or treat with Vitamin K on suspicion. It's not a case where I really feel that waiting and seeing is an appropriate option because the results can be lethal. It is safe to give Vitamin K even if there has been no rat bait ingested but for larger dogs this can be quite expensive depending on which poison You're dealing with. If you go with the PT and it is normal then you should be in the clear, if it's abnormal you can start treatment before there is likely to be a clinical problem. Fingers crossed for normal ! Edit to add: don't feel bad about inducing vomiting or the blood tests. Sure vomiting makes them feel rotten for a few minutes but once it's over, it's over and let's not forget that some dogs think that things taste better the second time around anyway :laugh: Blood tests aren't a big deal either for most dogs, it's usually just 'enduring' a cuddle and a little needle prick. Miles better than internal bleeding!

I do understand the point being made, but at what point is one deemed to have 'enough' experience? I have worked with many vets with 20 or more years of experience and we have a mutually beneficial relationship due to different areas of interest and skills. They are progressive and update their knowledge just like all the 'young' ones. There's also many 'mature' vets who work alone, refer anything that is beyond their (sometimes limited) knowledge base, do the same thing they've always done and begrudgingly attend continuing education events because it's the only way to maintain their registration. There is a great deal of truth in the saying 'you miss more by not seeing, than not knowing' and a keen eye and curiosity go a long way to making up for a shortfall in grey hairs.

Given the often unfortunate tendency for trends to spread from the US to Oz, I don't think this stuff should be ignored. In the years I spent in Oz I went to a lot of vets. The older ones tended to stick to pretty basic meds and were ok with home remedy stuff like vinegar for yeasty ears . . . the younger ones seem to be more influenced by big pharma, and would recommend Epi-Otic rather than the home-made version. Some of the veterinary chain practices seem to have heeded advice from practice managers to sell as many products as possible, thus increasing profits. Display counters with everything from (overpriced) flea and tick meds, to sequined collars. Also important to keep in touch with what is being taught in vet schools, and how much influence big pharma has on the curriculum. I have started replying to this topic many times then just given up. However, I think your example of young vs old vets is making an assumption about the reasoning behind decision making when there are a number of factors involved other than whether the vet will get a massive kickback from big pharma (delivered on the back of a unicorn). What kind of infection is it? (Young vets are more likely to do cytology to find out). Will an acidic cleaner help? Is an aqueous cleaner appropriate? Is the tympanic membrane intact? Do I think the owner is capable of following instructions, can they do basic maths and determine a concentration of solution for their home remedy? What is the potential for harm? Is this treatment evidence based? Is there a registered veterinary product available to do this job? Can I defend my decision to use this treatment the Veterinary Practitioners Board, if this seemingly lovely client who has declined all my treatment recommendations decides to submit a formal complaint when things don't turn out the way they had hoped? To imply that the decision to use a certain ear cleaner is the result of either being young or in the pocket of a pharmaceutical company is really giving vets very little credit for being responsible for their own opinions, decisions and further education. The vast majority of vets are just trying to help you and your pets.

I doubt the pancreatic enzymes have made any difference to the course of the cancers. Any change in the level of gastric acid secretion is most likely due to the stomach cancer and nothing to do with the digestive enzymes. The bleeding could be from a mass in the stomach or possibly even the spleen. Antacid medication is a routine thing to do whenever there is a concern about gastric ulceration or bleeding. i know it is hard to do, but don't beat yourself up. There isn't much you could have done to prevent this from occurring, and from the sounds of it you were on top of it and at the vets quickly.

An elevated white count indicates inflammation, rather than infection specifically (though is often due to infection). If there were no wounds or evidence of gastrointestinal obstruction then I would be considering immune mediated causes in my list of differentials - including things like meningitis or polyathritis but also considering the possibility of serum sickness given the recent treatment for a tick. It can cause non specific signs like fever, lethargy, joint and muscle pain.

I have occasionally placed light supportive bandages on these guys when they aren't able to place their feet properly. Ordinarily I would only consider it for quite severe cases, and would choose supportive light bandages before splinting. It is an option but if they are able to walk and weight bear they probably aren't necessary.

That is fairly typical of slow wear from carrying balls, but occasionally I'll see it in dogs who have bones and no access to balls. Most commonly it is tennis balls but any means of abrasion can cause it.

If you're prepared to see a specialist surgeon and are in a position to consider specialist surgery then I would seek a second opinion soon so that you have the full range of options available to you. The window of opportunity for procedures like the TPO (triple pelvic osteotomy) varies in the individual dog but is not normally beyond 10-11 months due to the timing of growth plate closures. If the TPO is not an option, then you are left with waiting for a THR (total hip replacement), continuing medical management (perhaps expanding the supportive treatments to include assessment by a qualified physiotherapist or other rehabilitation consultant, consider pain relief and other modalities like acupuncture) or if he continues to deteriorate and specialist surgical options are not an option, considering femoral head ostectomy. The latter is a salvage procedure and cannot be undone, it can have variable results in larger breeds and it not a decision to make lightly - but in saying that can be an option that improves the comfort and quality of life significantly.

A colleague that I used to work with performed the tightrope procedure in large dogs. It is considered to be an extracapsular repair (so in the same category as the traditional DeAngelis repair) rather than a more invasive plateau leveling procedures like the TPLO / TTO / TTA / TWO etc. The recovery time is similar as for other extracapsular repairs as are the risk profiles. It is less involved than the leveling procedure (which involve cutting bones and using implants) but may not be the best option for all dogs.

It is worth asking your vet if it is possible to modify the fee for you if it is a medication that your pet will be on long term - however this means that you also need to accept that the answer may well be no Sometimes it is possible to reduce the dispensing fee, sometimes it is not. You can also check the prices on the (Australian based) online pet pharmacies - these will require a prescription for your vet. Prescribing the human version of meloxicam is my least favourite option and something I do rarely. The few cases I have seen of serious gastrointestinal issues (gastric ulceration and in one case, perforation) have been related to the use of mobic. This may well be anecdotal, or due to the limited dosing flexibility, but my first preferences are for veterinary formulations of meloxicam - generic or otherwise.

Yes the first 'adult' vaccination given 12 months after the final puppy vaccination is still strongly recommended even for a triennial protocol.

I suspect this reflects the vaccines the practices use. The two vaccine option with a C5 at 12-14 weeks is likely using an intranasal kennel cough vaccination and probably also a C3 registered for an early finish. The three vaccine option is likely using injectable kennel cough vaccination which requires two doses. Neither protocol is right or wrong - the early finish does mean more opportunities to get out and about, but the WSAVA guidelines still support a later finish regardless of the type of vaccine used.