Rappie

I don't know of any registered veterinary surgical specialists in the Newcastle region, but there are several great ones in Sydney. David Lidbetter is in Parramatta and takes referrals from all over, and there are several at the Small Animal Specialist Hospital (North Ryde), Animal Referral Hospital (Homebush) and the University Veterinary Teaching Hospital (Campderdown).

Some of our nurses are doing their Cert IV through AIRC / Provet Learning, and I have been a workplace mentor for some of them. The standard of work expected and the quality of information is very good.

Glad you've found someone to help your pooch :laugh: I by no means doubt Dr Hilton's skills or experience, but for the purposes of discussion I think it is important to note that is he is not a registered specialist in dermatology, but a veterinarian who restricts his practice to dermatology. There are a great many excellent veterinarians who have a similar consultant / professional interest practitioner roles and do not have specialist registration, but they should not be referred to as "specialists" (this is not me being picky, it's a requirement of the Veterinary Practice Act and watched carefully by the various state boards.

Ness, there isn't necessarily a straight forward answer for you. By definition, in a grade 2 patella luxation the patella is usually in normal position, but can luxate when the limb is extended, then return to normal when the limb is flexed. If this happens only occasionally, then the limb is normal for most of the time and may not require surgery. If it is happening constantly, then it will cause a greater degree of wear on the medial trochlear ridge than higher grades and surgical correction is required to limit the damage done. Grade 3 and 4 are "worse" in terms of the degree of luxation, but in grade 3 the patella spends most of its time being dislocated, and in grade 4 it is always luxated and cannot be reduced. So, although the luxation is more significant, there is less wear and bone-bone contact occurring.

I will second that :) He was my dog's personal vet when I was at school, and I worked for him for several years (well, 5!) as a nurse while I was at uni :D

The technique chosen really depends on the individual dog - the trochlear groove will be shallow in the higher grades of luxation (grade 3 and 4) because the proper development of the groove depends on the presence of the patella sitting in it. The reason that the patella doesn't sit in the groove in the first place is varied - may be due to improper angle of the tibial crest, or a low medial trochlear ridge etc etc. The radiographs can go some way to identifying contributing factors but the final decision is often made in surgery. Tibial crest transposition is a more 'benign' correction since it doesn't involve altering the joint surface. There are a few techniques use to deepen the groove - either making a wedge in the cartilage, or lifting the cartilage, removing a wedge, and then replacing it. Either way, the joint is still 'interfered' with.

It's quite a common surgery to be done, and a triple technique is most often used but all the components may not be required in some dogs. The main purpose of radiographs is to determine whether there are a) degenerative changes in the joint and b)to determine whether there are anatomical abnormalities contributing (such as hip deformities or other conformation defects leading to patella luxation. The triple technique consists of a tibial crest transposition (to move the patella more laterally), deepening of the trochlear groove (in which the patella should sit) and lateral imbrication of the fascia (to tighten the tissues on the lateral side of the joint). The tibial crest transposition is the most important part of the surgery as it directly affects the alignment of the extensor mechanism. Altering the trochlear groove is not always done - depends on the dog.

When we lost our little girl, I bought myself some 'special' plants. On the recommendation of a DOLer, I found a rose called 'Best Friend' (at Bunnings but also online). I've got it in a pot on our front porch where Dusky used to sit with me while I had a cup of tea. It's got a lovely strong pink flower and it makes me smile. The other thing I bought was a native fuschia, called 'Dusky Bells' which is also bright pink and 'smiley'. While it has nothing to do with your friends pet, perhaps you could find another plant, or ornament or something with significance? I still haven't worked up the courage to print photos. I have a big frame ready to take an A4 print but I'm still not ready yet.

Sorry to hear about the little pup Tiny creatures are more at risk of complications than others, but anaesthesia and surgery can be performed safely if they are managed pro-actively. Unfortunately, it is often the case that they get treated like 'big dogs' and then they often end up in a sub-optimal position before they have even get anaesthetised . The problems that they experience are not that different from larger dogs, but they do happen faster and an attitude of "she'll be right" just wont fly. All anaesthesia and surgery has inherent risk, but if you are concerned it is always worth having a chat with your vet about what procedures etc they have in place.

Keep clean with saline or warm water. Also be absolutely sure that the wound is NOT being licked - the appearance in the photo is quite suggestive that this has been going on, so I would also suggest an elizabethan collar. The sutures looking tight is probably secondary to swelling of the skin, not necessarily that they have been too tight when placed. If we're now on antibiotics, you don't need to apply anything to the wound, just keep it clean.

Papillomas occurs in puppies and do tend to spontaneously regress. The lump on lip of the GSD above looks more like an inflammatory lump such as a histiocytoma (if it were a young dog, but other lumps like mast cell tumours can look similar). Older dogs get 'warty' lumps that are most commonly sebaceous adenomas - small round, pink, fleshy masses that often have a greasy covering on them. They're not actually warts, but they are very common and benign. If there's any concern over a lump it's always a good idea to see your vet and get a fine needle aspirate done to see what it is. We don't always get a specific diagnosis but should be able to get enough information to know whether we need to be concerned about it or not.

Vomiting is a known side effect of the medication, though it is usually soon after the medication is given and doesn't make them ill. Is there anything else common to the 3 dogs that could cause vomiting (gorging on food, scavenging, trip to the beach etc)? If you're unhappy with the product, I would suggest that you speak to the manufacturer so that they can record adverse reactions.

Depends on the purpose of testing. The 'routine' pre-anaesthetic blood test covers basic liver and kidney values, blood glucose, total protein, electrolytes and packed cell volume. It's a screen for any major problems that would affect an some aspect of an anaesthetic - liver disease affects drug choice, kidney disease affects the hydration status, choice of drugs and tolerance of anaesthetic effects , abnormal protein levels can indicate dehydration, inflammation or blood loss, and the packed cell volume if low indicates anaemia (and can be used to monitor blood loss). If run in house, this is usually $60-80. Even just a packed cell volume, total protein and electrolytes can tell you a lot. For some cases I will send off a full profile, for a couple of reasons: - they include full biochemistry and haematology - we might do a routine general screen for underlying problems (two major labs refer to these are a "Total Annual Health Profile" or a "Wellness Profile") - we might have a suspicion of a disease that will not show up on a preGA such as infection, or abnormalities with red or white blood cell levels - we have done an in house test and found some abnormalities and need to get more information These range from $150 - 300 depending on which specific test is run - some include interpretation by a pathologist, some include thyroid or pancreatitis tests etc. I rarely send off blood just to see what is there - usually have a good reason in mind, even if I suspect the result will be normal (such as running blood work on a patient that has had a seizure - metabolic disturbance are uncommon causes, but if they are present and significant enough to cause a seizure it's important to find them quickly).

This situation puts vets in between a rock and a hard place. If bloods and fluids are not done and not offered - a general opinion / expectation is that vets would do what is needed and they are better / more experienced because they do this. If bloods and fluids are offered but not compulsory - the vets are only offering to make more money. If bloods and fluids are compulsory - it increases the cost of surgery, vets are accused of hiking costs up and frequently, and frequently a decision is made on cost comparison alone regardless of the standard of care. In my hands, IV fluids are not negotiable, nor is pain relief. It's either just included in the cost (such as for desexing) or is a standard part of the estimate. If there is a good reason not to do IV fluids (very short IV only procedure etc) then they won't be run, but an IV catheter gets placed routinely. Pre-anaesthetic bloods are not negotiable for many unstable and/or elderly patients, strongly recommended for patients 7 years and older and optional but recommended as the best option for routine surgeries in other patients. It's all based on the relative risk of having a problem, sometimes I might say bloods are not essential but this is by no means indicating they would not be useful and you can bet that I will discuss why they are run and note that they have been declined. If the blood test is what stands between having a procedure done or not, then I'll work around it. Our patients don't talk and often owners are not acutely aware of their pet's health, I don't have xray fingers and sometimes I leave my crystal ball at home. Sometimes we need more information to make the best decision. I see my role as an advocate for the patient, I provide advice based on my knowledge and experience. I present available options, owners make decisions about which of those fit with their needs and budget.

They're not really anti-emetics as such, at least not with the same degree of efficacy as other drugs like maropitant and metoclopramide etc. More just anti-nausea, might not necessarily stop vomiting. I gather that the appetite stimulation is an undesirable side effect of using it in people. It is a tricyclic anti-depressant so it has limitations to the other drugs it can be used with due to risk of serotonin syndrome.

I have used a drug called mirtazapine with some short term success, it seems to help a little with nausea and acts as an appetite stimulant. It's not a long term solution but can sometimes help while other measures are put in place. It can't be used with some other drugs (mainly antihistamines and tramadol) but it might be something to keep in mind.

Exactly. Saves trying to guess

That's an old habit from the first degree I started (forensic science) - "Never speak in absolutes", but unfortunately there aren't always straight answers. Persistent hypercalaemia is a concern - the list of differentials if it is 'real' is fairly short. Neoplasia, primary hyperparathyroidism, renal failure, hypoadrenocorticism. Ionised calcium can be tested to help differentiate causes but it can be tricky to do as it needs to be run quickly. If it were Addison's chronic stress wouldn't help (as you've pointed out) but the clinical signs of weakness, polyuria and polydipsia, inappetance, vomiting etc can all be related to the increased calcium level. At the risk of stating the obvious, her response to pain relief suggests that pain is a signficant issue for her and with the other clinical signs and hypercalcaemia I would (without the benefit of seeing either the patient or the rads!) wonder whether a bone lesion (rather than simply spondylosis or chronic changes) is a possibility. Even if this is not the case, I would be inclined to give more pain relief but avoid NSAIDs in a dog that is PU/PD, vomiting and inappetant. These situations are always challenging, but as the saying goes - absence of evidence is not evidence of absence. Normal test results doesn't mean she is ok, just that the things covered in the tests are not abnormal. Feel free to PM me if you like.

Carpal pad injuries can take some time to heal. Do you mean that the laceration was separating the pad from the underlying tissue, rather than through the pad? The accessory carpal pad (back of the carpus / wrist joint?)? They often require suturing, although this in itself can sometimes be tricky. I've had some heal back together without it, I've had some heal slowly even with suturing (though these ones often had toothy help...). If the wound is clean and has started to granulate then antibiotics may not be required.

Muscular nerve entrapment can cause intermittent / acute shooting nerve pain, however so can some intervertebral disc disease and other problems. If it is significant enough to cause muscle wastage then it probably warrants some investigation.

The product is called 'Panoramis' - there is a recent thread on it. It does do fleas, heartworm and intestinal worms (except tapeworm). It is a tablet, so competes with Sentinel. It's point of difference here though is that it's 'flea ingredient' is an adulticide, rather than an insect growth regulator, while Sentinel does treat for tapeworm.

Hypoadrenocorticism can present with a range of signs - from 'classical' through to 'atypical'. Sometimes it's easy to diagnose and sometimes it isn't Typical changes on a blood panel include abnormal electrolyte levels (low sodium, high potassium, often causes a significant change in the Na:K ratio), mild non regenerative anaemia, sometimes a low blood glucose. There might also be an absence of a stress leucogram (a pattern of white blood cell changes), which in a sick dog might suggest Addison's. There can be a bradycardia (slow heart rate) noted due to abnormal potassium levels, and a small heart or hypovolaemia on chest rads. High calcium can be associated with Addison's but also with other disease, including malignant causes like anal gland tumours and lymphosarcoma.

The intestinal worming ingredient in Panoramis is milbemycin, also found in Milbemax and Interceptor / Sentinel. Although the product is new here, Comfortis (spinosad) has been out in Australia for a while with a good profile and we've found it to be very effective for flea control - particularly in those dogs that have skin conditions that might need frequent washing. There's no perfect product - Sentinel doesn't kill fleas, Advocate doesn't treat tapeworm (nor does Panoramis), Revolution is pretty useless for intestinal worms - but all the reps will have something to say about each others products.

My sister has requested a bean bag thingy for supporting her camera while doing macro work. I'm happy to try to fashion one from supplies at home, but hoping someone could give me an idea of the best size / shape to make it.

No problem You're on track with your assessment of Bella's levels - a continued increase in ALT over time is something to take note of, but the number isn't that exciting in an otherwise clinically normal dog. The liver enzymes are different to the bile acids, so a higher ALT is probably not breed related but different individuals can have different resting levels (the normal ranges are like a bell curve). The most common courses of action in my experience (and these are by no means the only options, so speak to your vet obviously) are: - continue to monitor over 3-6 months, sometimes they will go down again. Continuing upwards is an indication for investigation. - give a course of SAMe, it has a recognised antioxidant activity and can reduce liver enzymes. I would generally start with Denosyl (a veterinary formulation) and then retest after a few weeks. It may not be necessary to repeat or continue it after that. - go ahead with an ultrasound to rule out structural disease or shunts. Normal findings don't rule out microscopic disease (like microvascular dysplasia, toxicities) but they do rule out a lot of scary things. There's not one single 'best' way to approach this situation. It is quite common for us to do a general blood profile and find a small abnormality incidentally. Monitoring is a perfectly acceptable thing to do initially. The main thing is that you discuss your concerns with your vet so that you feel comfortable with the level of information (by this I mean diagnostic information - blood tests, ultrasounds etc) you have. Edit to add: It's important to remember that you have a clinically normal dog with a biochemical abnormalitiy. This doesn't mean that she definitely has liver disease so talk to your vet before putting her on a protein restricted diet as it might not be indicated at this stage.