Rappie

Absolutely. I always discuss treatment options without judgement, regardless of the financial situation of the owner. I discuss all the valid options and then we work out what we're going to do. Sometimes we do 'the works', sometimes we have try to find the best solution we can with very limited funds. I have clients who think nothing of spending $10k on spinal surgery and other clients who are trying to save up for a surgery that their dog might need from their pension, just in case. My role is an advocate for the pets, it's not my place to judge people.

There are a few oncologists in Sydney - depends on what area you are in. Peter Bennett has recently joined the University of Sydney Teaching Hospital, Tony Moore and Angela Frimberger are at the Animal Referral Hospital at Homebush and Veronika Langova is at the Small Animal Specialist Hospital in North Ryde. Hopefully some DOL members will be able to let you know their experiences. I have referred several cases to Veronika and find her great to deal with and my clients have all been happy. I haven't had any personal dealings with the other oncologists but they are all held in very high regard.

Whether to splint, not splint or do surgery depends on the dog, the injury and the owners - its not always clear cut and the decision is often based on the results of xrays. A side comment about taking xrays - as a general rule I will GA most patients that require xrays. There are some exceptions obviously such as critical patients, heart patients, pregnant animals and so on but unless I trust that the animal will sit quietly on a slippery xray table, that is about 70cm from the ground, while restrained with only sandbags or towels then they will be asleep or otherwise chemically assisted. Other vets may make different choices, but I have better things to do than expose myself to radiation each and every time I need to take an xray, it means we get better views with less re-takes and a brief GA is in many cases much safer than deep sedation. It's also keeping with the ALARA principle of working with radiation. I will not allow owners to be in the xray room and if someone does need to hold an animal then we rotate through our willing staff and use appropriate PPE.

Keep looking for a tick, ideally have more than one person do a thorough tick search and do it a few times per day. In addition to general signs of tick paralysis, watch out for any signs of a reducing gag reflex such as difficulty swallowing, or coughing after drinking. If there's any doubt, then get a vet check. More benign causes of a hoarse bark can include very mild upper respiratory infections, laryngitis (often from 'overuse' :laugh:) or other irritation of the vocal cords.

It's been a while Clyde, but not more than a few years. The new classification suggests that low grade mast cell tumours can be considered to have more benign characteristics. This means they can be removed with smaller margins etc. Accurate grading still requires histopathology after removal but the pathologists can often get an impression of the characteristics from cytology.

It may be a combination of both a reduction in activity and also in distraction :laugh: Probably hurts a bit more if you don't have a girlchild to pay attention to you :laugh:

I agree that it is a thorough and sensible article and certainly this is the type of approach I take with pain management. A note about the use of NSAIDs in cats however - I by no means disagree that cats are more sensitive to the effects of these drugs and they should be used with caution, however the rate of adverse effects in Australia appears to be lower than in the USA. I don't know of a significant reason why. There are freely accessible publications on the guidelines for the use of NSAIDs in cats so they can be safely use with due care and attention to the individual patients health status.

I think the opinion of a medical specialist is probably worthwhile. Pseudomonas is known for being multi-resistant and it is an opportunistic infection so the long term aspergillosis (and subsequent damage to the nasal passages) and the diagnosis of hyperadrenocorticism are certainly contributing factors. It's a difficult location to treat but a specialist may have some ideas about how to help with some of the physical factors. Anything that can reduce the bacterial load before adding another antibiotic will increase the chances of it making a difference.

For a recurrent UTI I would generally always do a culture from a sterile sample. As I said before, the crystals reflect other aspects of urinary tract function and diet and I don't get that excited if I see them on an otherwise normal sample from a normal dog.

They probably form in pooled urine in the external urinary tract and get swept out with fresh urine.

Has she had a urine culture done - that requires a sterile sample of urine collected by cystocentesis (collecting directly from the bladder with a fine gauge needle). That would be indicated while she is having an episode to confirm that it is in fact due to bacterial infection. The high pH is often a reflection of bacterial activity in the urine (which should be sterile) and the pH causes the crystal to precipitate out of the urine. High pH urine will irritate inflamed mucosal tissue in the urinary tract, but unless they are stones they are too tiny to cause abrasions. The blood in urine is from inflammation of the lining of the bladder - from infection, stone, stress etc.

I just wanted to make a passing comment about struvite crystals... Struvite crystals are not, in themselves, a symptom of disease. They can certainly be associated with urinary tract disease, but their presence alone is not always a problem. They are a normal feature of well concentrated 'normal' urine and can form in urine that is stored before analysis. In dogs with signs of a urinary tract infection, in association with an increased pH (which is a result of bacterial infection) then you can see struvite crystals and in chronic cases like Anne describes, urinary stones can also form. They can also form in association with other diseases. An investigation for underlying causes is certainly warranted with recurrent urinary tract problems, but they are not directly caused by struvite crystals.

The charges you've listed are quite reasonable. The LDDST is the initial test of choice of many specialists and if positive it can sometimes be used to discriminate between pituitary and adrenal tumours. If the results are equivocal an additional test called an ACTH stimulation test may be required for diagnosis. If the testing indicates Cushing's and you do start trilostane, the ACTH stim is used to monitor the treatment.

An MRI would be the next step to obtain a diagnosis, certainly. A neurological exam is thorough but specific physical examination. The vets may have done a cursory one as part of their assessments - it involves testing the function of different nerves in the body and can take some time. It's usually a series of things like checking the gag, checking pupil responses, palpating the skull, tapping in the corners of the eyes, a menace check and then testing postural reactions and refexes - using a patella hammer, checking placing reflexes and wheelbarrowing etc. Although it can't give a specific diagnosis it can be useful to localise a neurologic lesion even if it's just as far as a central (brain) lesion or a peripheral one.

Vertical nystagmus is more often associated with central disease. The shorter episodes could be transient ischaemic episodes. Has she had a neurological exam to look for other signs? If there are any postural deficits this may provide more clues.

It's unlikely to cause any problems. There is a range of doses used for Baycox and the safety margin is quite wide

That sounds like a fine idea Jules. A specialist consult can sometimes be one of the most cost effective 'diagnostic tests' :)

I haven't read everything thoroughly so apologies in advance - I just saw your question about doing spinal xrays first. As someone has mentioned - xrays will show bone and MRI shows the soft tissue. The issue with IVDD is that the disc itself does not show up on xrays. A myelogram (which is an xray with contrast medium) will show the effect on a ruptured disc as an indent in the spinal cord / column of contrast media but not the disc itself. An MRI will demonstrate the lot. As for decision making: - an MRI is the least invasive and most informative way to get a diagnosis of IVDD (and other conditions), particularly before surgery. - plain spinal rads can infer a lot of information but in most cases cannot diagnose a protruding disc. It can rule in / out some causes of spinal pain such as bony neoplasia, discosponylosis and discospondylitis. A severely narrowed intervertebral space that corresponds to the suspect location (based on neurological exam) of a spinal lesion lends weight to a ruptured disc as a diagnosis. I have had the odd occasion case where a dog has had calcified discs (which does not mean IVDD!) and it has been located in the vertebral canal (which is highly suggestive of IVDD). If you are not going to proceed with surgery at all then an MRI will give you a diagnosis but perhaps not change the treatment. Spinal rads may not give you a diagnosis, but if interpreted with caution they can provide a lot of other information. Spinal rads can certainly be done in practice but there does need to be a degree of care and attention paid to the positioning of the patient to ensure that the chance of artifacts is reduced. It also requires a lot of xrays to be taken - for a CKCS I'd probably take 3 views in 2 planes - a single shot of the "spine" is not a set of spinal rads. They are better than no information, you just need to be aware of the limitations.

We have two different bodies and a bunch of lenses. We've never really had any exposure to Nikon / Canon but have no issues with the quality of the images from the Pentax cameras. We have an *istD (an early 'pro' model from 2003-4) and a K200D. Worth a look anyway :)

Most of the Pentax lenses will fit the Pentax DSLRs - we have two bodies and a range of lenses. The prime lenses are lovely - the 50mm is pretty good, but the 77mm is an excellent portrait lens.

I've treated quite a few parvo pups with a similar protocol. It's not ideal but it's worth a try but it does depend on having the right combination of patient and owner because it's not the 'easy' option.

The award rate for a Level 3 vet is around $55k - that's for your average senior associate veterinarian. In my area and among my uni cohort the average actual wage is probably $70-80k after 7 years of hard slog and being general dogs bodies. As a general rule, while there are additional payments and allowances for being on call but paid overtime or time in lieu is not common (I get one or the other if I work shifts that are additional to my rostered ones - but not if my shift runs overtime UNLESS if was for an after hours procedure in which case it is charged as such). If you have any questions go ahead and ask :)

You will find a range of costs and inclusions and there has been plenty of debate over it previous threads. While the mention of veterinary overheads etc certainly influence veterinary charges I think it's important to keep in mind that the veterinary profession discounts the cost of desexing to try to keep it affordable for the general population. In many practices it would cost around $300 to anaesthetise, hospitalise, administer fluids and pain relief BEFORE there was any surgical procedure performed.

Generally speaking a plateau leveling procedure would be recommended for a dog that size (TPLO, TTA, TWO, TTO etc). I can think of two things that could explain the advice that you've been given about the suture. One is that they are referring to a tightrope procedure which is not commonly done but is an alternate option for large breed dogs. It used a very strong braided suture and bone tunnels for isometric stabilisation of cruciate deficient stifles (the aim for TPLO etc). It is still classed as an extra capsular repair but is not a De Angelis suture. The other reason is perhaps that they are now using a product called Ligafiba which is a reasonably new suture material that is much stronger than the nylon that is traditionally used. It is stronger and will hold up better, and a DeAngelis repair is better than none but it would really depend on the measurements of the rads as to whether it's a good alternative or not.

Westiemum - I didn't think you were being critical at all. I can only think of two or three non specialist surgeons that I know in some personal capacity that would even contemplate doing a TECA. They are all older vets that have done further formal training and returned to take on general practice roles that are more that of 'consulting surgeons'.