Rappie

One of my little dogs does what we refer to as 'ninja pees'. She barely stops - she does a super quick squat with her right leg off the ground, pees, then continues on like nothing happened.

I think the 0-4 system IS the Putnam system. I'll see if I can track down one of the original articles to make sure. Xraying would confirm whether medial patella luxation is present but also would allow assessment of any arthritic changes or conformational defects that may be responsible for the luxation.

As far as I am aware this is the standard Grade 0-4 system. Very simply: Grade 0 = normal Grade 1 = luxates when leg extended and pressure applied to patella, Grade 2 = patella mostly lies in normal position but will luxate when leg is flexed Grade 3 = mostly luxated but can be returned to normal position Grade 4 = patellas remain in luxated position.

Beagle pain syndrome is more commonly seen in young dogs. Intervertebral disc disease is quite common in Beagles and often more so in middle aged adult dogs. What are the symptoms? Which medications were used and what investigation has been done so far?

double post

I think the profession needs to step up and focus on some generic business things like professional service and communication. It's not enough to just say 'we'll do everything', clients need to know what the options are, the difference between them and they need to make the decisions based on correct information. They need to know what the forms say. We need to dot the I's and cross T's and document everything. If people want a little of column A and little of column B, they can have it. If something is 'necessary' it no longer becomes optional (in an ideal world). Necessary means I will not proceed without it. Some things are highly desirable (such as blood work) in many situations but we are regularly put in situations where we have to get the best outcome we can within in a set $$ limit. Do we spend the money on our best guess treatment that might not work? Do we spend the money on diagnostic tests? Do we get some basic information to do some rule outs and then go with treatment? Vets makes the decisions about whether there is an option A, B and C and we are advocates for the welfare of the patients but we are not the one paying the bills. Clients need to know what the options are, what the benefit or risk of each is, the cost of each etc etc. It's not enough to just say 'most young dogs don't need a preanaesthetic test so we wont discuss them' because there will one day be the case where something DOES go wrong and it will probably happen to someone who said 'I didn't know I could have a test done'.....

I suggest that you do tell the new vet that your dog has been undergoing treatment and outline what that has been and the outcomes of it. There is nothing wrong with wanting a fresh set of eyes, or different opinion if you are not happy with the results so far. You don't need to get into anything personal but it does help the second vet gauge the situation better if they know what has been done (or not done) already.

We are to introduce some packages soon, but apart from bloods the options are not choices related to the surgery itself. The decision to do this was influenced by requests from owners. Our minimum standard includes a PCV/TPP, IV fluids, the surgery and surgical monitoring of blood pressure / O2 saturation / heart rate etc by a nurse, post op pain relief injection for 24 hours and 2 (or however many required) post op checks and overnight boarding if required / desired. The main option is whether or not a preanaesthetic blood test is run for liver and kidney function, but all patients get a very basic test run to check for dehydration / anaemia. The other options include pre/post op baths, full day of boarding any point in the post op period etc.

Pre-anaesthetic blood work let us assess kidney function, liver function and hydration levels before an anaesthetic. Is it essential in a young dog? - no. Is it useful? - Yes. The vast majority of young dogs we test have normal results but the occasional one will show up an abnormality which may indicate further investigation or treatment should be undertaken prior to GA. Choosing between doing it or not doing it might depend on cost, or how much information you need to feel comfortable going ahead with a surgery, or whether you want to do 'everything' or choose the routine options. You shouldn't feel guilty for not choosing them, you have only been offered bloods. Most practices that do this have in house equipment and offer bloods to every patient (key word offer - it is available for any and every patient). If they feel it is essential, it would likely not be negotiable in that particular situation. As for intravenous fluids, yes, yes, yes and yes. Fluids and pain relief are two things that my clients don't get offered a choice in. Intravenous fluids maintain blood pressure which in turn supports the blood perfusion of vital organs like the liver and kidneys (and brain). Any level of GA reduces blood pressure and we need to do something to counter that. The fact that most animals are "OK" without fluids just means that their compensatory mechanisms can kick in for 'long enough' to prevent damage. It does not mean there is no drop in blood pressure or drop in organ and tissue perfusion.

I have seen young puppies with anal gland infections before. Rubbing the bottom on the ground is uncommonly a sign of worms, more often related to direct irritation of the anus and perianal area such as anal glands or irritation from fleas. I have also met one pup (an 8 week old SBT) that screamed so loudly and dramatically when I tried to lift it's lip to check gum colour that I was more than little concerned that it was truly that painful. It wasn't, just had no idea about being handled by humans, it's grown up in to quite a nice pup.

If the leg is painful and affecting quality of life, and there's no concurrent problem that would prevent mobility on 3 legs (such as severe arthritis, other injuries etc) then amputation is a good option. Dogs and cats have few hang-ups about having 3 legs and I think it is preferable to having a very painful or non-useful limb. It's not a decision made easily in some situations, such as deciding whether to do an expensive surgery to maintain a limb with moderate chances of success vs amputation, but if it's a decision made between amputation and euthanasia I'd certainly consider it a good alternative. In a large breed of dog, I would opt for a specialist assessment, as even if repair is not an option they can give advice on how well they might cope with the added strain on the opposing leg (such as an untreatable injury in one hind leg and hip dysplasia in the other).

Dorothy is absolutely lovely - she runs two canine kindy classes per week on our hospital grounds. We've had great feedback from both our clients and our staff who have joined in the classes. Her website is actually http://www.cheekypup.net.au/

That's interesting. How would it be used (penal size reduction aside ..... I get that. LOL). And how come it works? Does it cause a reduction in blood vessels or something? A strong sugar solution is hyperosmolar, it will draw water out of swollen tissues. It's quite useful for applying to a prolapsed uterus that has been dangling on the ground for several hours and is several times larger than the hole it has to be pushed back into

I'm interested to hear more too as I'm not sure of the procedure. Edit: I've done some reading and I'm not convinced that 'laser dentistry' is a stand alone field. As far as I can gather a (non surgical) laser is used AFTER a ultrasonic clean and polish to seal the sulcus and stimulate reattachment of the gingiva. 'Laser' does not make it magical. I have the same concerns regarding subgingival procedures, not to mention access to the lingual surfaces of teeth - it's sometimes difficult enough in a dog under GA. I would also have some reservations about doing dental procedures under any type of sedation - reduced gag reflex / airway protection, access to the mouth, loss of inhibition (getting personnel or equipment bitten accidentally or otherwise) etc would all make me very cautious. I would assume that an ultrasonic scaler and oscillating polisher would need to still be involved somewhere.

Proheart SR12 is the only form available here. It's registered to administer at 12 weeks of age, and if done then, it will last for 3 months (so until 6 months of age). I don't think I've ever given an injection at this age. If given at 6 months of age, it will last for 9 mths (or until 15 mths of age - when first 'adult' vaccination should be given). If over 9 months but less than 12mths, lasts approximately 12 months. For adult dogs - 12 mths protection. Heartworm testing is recommended if there has been no prevention medication given in the preceding 6 mths.

Rappie, Could you give me an idea of what area this would be? Cases that we've seen have been from Blacktown, Mt Druitt, St Mary's, Granville off the top of my head.

Western Sydney is having an 'outbreak'. Prior to April, we saw 2 cases in 18 months. We've seen 5 since Monday this week, and several a week over the rest of the month. If the message got to the people who SHOULD be vaccinating (those people who have puppies that have never been vaccinated) then it would be a good thing. Unfortunately, the more common scenario for us is a completely unvaccinated pup with no funds for treatment - by that time it's too late to explain that even one well timed vaccination would have been cheaper than a consult and parvo test.

Human patients talk (which is why I'm not a human doctor ). Human patients go through all their life stages in 70+ years. A dog or cat is "senior" by 7 and "geriatric" at 15 years. I'm sure there is a statistical and financial reason that blood work is not routine. I would imagine that with all the thousands of people who have a GA that statistically the % of people who have a complication is very very small. However, we tend to work with a limited history of generally poor accuracy and patients who eat their own poo so I'm willing to accept a few differences .

This is very true. And I think, especially as a nurse, that you tend sway toward what is done around you. Having said that, I worked at a clinic prior to this one where i was to offer and encourage bloods prior to desexings.. but when i had my own pug done there the vets laughed and said "he's a perfectly healthy young dog, you don't really need to get it done, but it's up to you.." I got them done. He was a perfectly healthy young dog. Unfortunately even at cost price to have these bloods done on the special card it cost me a heap. I felt guilty encouraging this to clients when i knew even the vets working around me thought it was a waste of time. I do a wellness profile on my own dogs annually, to make sure everything IS normal. If you read any medical textbook, the minimum database listed for an unwell animal is a complete blood count, biochemistry and urinalysis. It's easy to scoff at that and say it's overkill, but it's obtaining baseline information. The fact that the results might all be normal does not mean the test were not useful. We might not "need" the whole panel for a healthy anaesthesia, but my minimum database is a PCV / TPP and electrolytes. I always discuss pre-anaesthetic testing for any surgical patient (and also for any patient on long term medication including NSAIDs), I strongly recommend for those over 7 and I don't negotiate at all for any patient that I think is not quite right. I've seen enough zebras and found enough strange things to believe that decision making based on information is a good thing.

I think that there are minimum standards of care, and different clinics have different minimum standards. If I ever heard one of my nurses tell a client that even fluids were a waste of money, they would get a swift kick in the behind. Add to that if they could not explain to me why they were a good idea, they would be finding out in a hurry before I kicked them (figuratively speaking) again. All of our surgical patients have a basic PCV / TPP and electrolytes done prior to surgery, regardless of the owners choice (and it is a choice, and an informed one for desexing) of whether to do pre-anaesthetic blood tests (which are available to every patient). All surgical patients go on IV fluids. All patients receive post operative pain relief appropriate to their needs.

It is very unlikely, yes. I think hypothyroidism is diagnosed more often than it truly occurs, but low TT4 levels are seen frequently (which is not the same as "hypothyroidism", TT4 is not a stand alone test in dogs).

If skin disease is severe enough to cause chronic stress and cortisol release, that could also push the T4 down. I gather (and this is from general reading, not direct from source) that Dr Dodds obtains at FT4 level by a process that is not equilibrium dialysis. It is also my understanding that a treatment trial with thyroxine is frequently recommended by Dr Dodds when some of the thyroid levels are towards the low end of normal, even when all of the values are within the normal ranges specified by her own laboratory. These recommendations to treat are also (as I understand) made without ever having laid eyes, if not hands on a patient, which are the very basic requirements for having a valid veterinarian - client - patient relationship. The other issue that you may find is that the testing and treatment recommendations are not consistent with the current guidelines from other endocrinologists and this can certainly make vets uncomfortable with the process.

Total T4 is used as a screening test. Free T4 by equilibrium dialysis is considered the 'gold standard' for measuring the T4 level as it is not affected by thyroglobulin antibodies. If a low T4 if detected, then a TSH level is also run to see whether the low level is due to reduced output or whether the T4 is affected by non-thyroidal illness. Testing the T3 level is rarely of clinical significance. I'm not sure of the value of testing for antibodies, except for in a breeding programs or in cases where a patient appears to have hypothyroidism but the other tests do not support it. If they are elevated, then a dog may be prone to progress to hypothyroidism - however hypothyroidism is a clinical syndrome so treatment is not indicated unless you have clinical signs of the disease AND supporting laboratory evidence. The antibody test may have predictive value but they do not dictate whether treatment is appropriate.

I've seen an 11 week old puppy suffer a complete urinary obstruction from a bladder stone, so I would always consider imaging (abdominal radiographs or ultrasound) in a dog with recurrent urinary tract infections. I usually do my own urinalysis and sediment, and send a sterile sample off for culture in anything that is 'suspicious' (low concentration, repeat episodes of cystitis etc).

There was a heap of road work being done when we there, including on a bridge. Got sent on a detour off to one side, down a slope and across a ford, looked like the rocky track had been cleared just by driving a big truck through it to push everything out of the way, lol. Glad the Yaris was nimble. The narrow bridges are pretty special too. No railings, just a slightly more than one car wide bridge about 50cm off the creek, lol. When we went over the ferry - the guy was wearing council issue fluro orange board shorts