Rappie

I haven't actually looked at the website, however: IBD often requires steroid treatment. All NSAIDs are contraindicated with the use of steroids. Not to mention that Rimadyl chewables are beef flavoured, so that discounts it's use beef allergic patients, along with the already present potential for their to be gastrointestinal ulceration in IBD patients. Addison's requires steroid administration (admittedly, this is supposed to be at physiological levels to correct a deficiency). See above. Addision's can also lead to gastrointestinal problems. Cushing's results from an increase in the body's own steroid levels. Dog with iatrogenic Cushings may have been administered very high doses of steroids. See above. NSAIDs are very useful drugs, but they, like most other drugs are not without side effects and often used inappropriately.

Preanaesthetic blood screens assess kidney function (BUN, creatinine), liver function (ALP, ALT), blood glucose, total protein levels in the blood and the PCV (red blood cell levels). Most clinics that offer this have the capacity to do it within their own clinic on demand (with in house lab machines). It only requires a small blood sample (1ml) to be collected from a vein, but gives very valuable information to the vet and allows any modifications to the anaesthesia plan to be made before it goes ahead.

Age alone isn't a barrier to giving a general anaesthetic, but the changes that come with age are often what complicates the process and increase the risk associated with the procedure. Making the decision to go ahead with a GA can be very difficult for a lot of owners, for a variety of reasons. I can't tell you that everything will be fine, because there are real risks that something untoward may happen. However, your vet should be taking all these risks into consideration when they plan for the procedure, doing everything they can to minimise negative effects. If you're uncomfortable, then discuss it with your vet and find out what they will be doing and why. It's not an easy decision to make, and sometimes there aren't right answers. If you have any questions then you can feel free to PM me

From the other side of the fence: In terms of standards of care, the ideal would be that all patients undergoing a general anaesthetic receive intravenous fluids. Any general anaesthetic will lead to a reduction in blood pressure by the nature of the drugs administered - intravenous fluid support will help to prevent significant fluctuations in pressure, not to mention ensuring patent venous access in the event of an emergency so that a bolus of fluid, or emergency drugs may be administered IV immediately. The problem is that most young healthy patients are able to tolerate the changes that occur during anaesthesia and recover uneventfully afterwards so that IV fluid support is considered "unneccessary" - however that doesn't mean that the changes don't occur. In the event of an emergency, it can sometimes be difficult to then establish IV access in a decompensating patient. Routine surgeries are something that are commonly "price shopped" and for some reason, cheapest is generally accepted as being the best. If clinic incorporated IV fluids into the already discounted cost of speys and castrates, a situation may arise where ess people would get those elective surgeries done. If I do not feel comfortable doing surgery on a dog (or cat) without IV fluids, then I don't give the option to the owners. If an animal did crash under anaesthesia, then they would get whatever emergency treatment was required to stabilise them, it's not a matter of "Nope, the owner didn't tick the box, we'll just stand back now" (with the exception of critical cases that were declared DNR etc.). As for pre-anaesthetic blood testing - a lot of clinics will offer this as a matter of course. It is an option available to any surgical patient, just because you are offered something does not mean that you must accept the offer. It is something that I especially recommend for any patient that I suspect of having a problem, or as a "routine" check for any older patient. It is not something that I would push for a young dog but you may choose as you wish. Some people resent paying for a test that tells them that their dogs liver and kidney function is normal, while others find it a great relief.

It's a technicality Erny Russell Mitten is a Diplomate in radiology but is very well known for his expertise in cardiology and respiratory medicine. Fiona Campbell is a Diplomate in Cardiology - so is technically a cardiologist.

"Grade III" is a description only of what the murmur sounds like - it does have a direct relationship to the cause or the prognosis. The "loudness" (Grade) does not neccessarily reflect the severity - small defects may cause a lot of noise due to increased turbulence of the blood, and conversely large defects may only cause a soft murmur etc. The only way to tell for sure what is causing the murmur is to have echocardiography done, and if you are concerned, I would second the suggestion of having the pup examined by a cardiologist.

They don't need canines to function normally Whether or not they need to be removed depends on what state they are in. Teeth that have been worn down through chewing (usually tennis balls / rocks / concrete) are a different story to broken teeth with rough surfaces (that can cause ulceration etc). If the tooth is worn, but otherwise healthy then it may well be fine to leave so long as you monitor it closely and get it checked if you ever notice pain or discolouration in the tooth.

Aust Vet J 2000;78:92-95. Chiari 1 / syringomyelia complex in a King Charles Spaniel. Aust Vet Practitioner 2007;37(2):42-47. Chiari Type1- like malformations and syringomyelia in three Cavalier King Charles Spaniels.

Just a quick note regarding antihistmaine use in dogs: In general, the human antihistamines do not always have same effect that they do in humans. We rarely see the sedation side effects, but equally sometimes they aren't always effective at relieving itching. The dermatologists often do an antihistamine trial, which involves cycling through a number (10-12) of different antihistamines, using each for about 10 days in order to find one that works. They work best in combination with other therapies like soothing shampoo, "barrier conditioners", omega oils etc etc - but I wouldn't discount their usefulness based on one type, I would suggest trying another one. Although for intense cases I will use a course of steroids (as short as practically possible) I really try to manage allergies without them and have had a number of dogs respond well to antihistamines but they are all on different drugs .

If her main problem is just increasing age, then I would suggest fish oil at the rate that Poodle Wrangler suggested - 1000mg / dog / day. I strongly second the recommendation to keep her lean - being even mildly overweight can make a really significant impact to a dog's level of comfort, unfortunately many people don't recognise that until their dog begins to have a problem (when it is much harder to shift it). If your dog has evidence of joint problems, then I would use a higher dose of fish oil and add a glucosamine / chondroitin supplement to that.

I used to have a little CKCS that had problems with an elongated soft palate and everted laryngeal saccules. It was done by by Geraldine Hunt at the uni (while I was still a student) at that time I'm sure it was around the $800-$900 (including a biopsy of something else). She did seem a lot more comfortable and active after the surgery. The prices between specialists will vary considerably through Sydney

No worries Dru Re: elimination diets, if a very strict diet made no difference then a true food allergy is unlikely. If that is the case, then a BARF diet may well help - assuming that the dog is not sensitive to any of the ingredients making it up. However the absence of preservatives and the control over the content means that it is a known quantity. Sometimes having a low allergen diet for an extended period of time can lead to some reduction in symptoms even if is not a food allergy, just because the body has one less thing to react to - there is a concept of "thresholds" with allergies, and once that threshold is crossed the effects can snowball (unfortunately sometimes it hard to control the original problem). Put blunty, "rod ears" suck. The point of doing all the extra things is to make sure that anything that is easy / able to be treated or eliminated ...is. It narrows down the list of possibilities and lets us take care of the secondary problems. Sometimes at the end of it all, as much as we try, there just isn't the structure of a "normal" (or even sort of normal) ear to aim for because the ear canal has calcified etc etc. I am feeling a bit stuffed ATM, but PM me whenever and I will get back to you when I can (I read my PM's almost daily, even if I don't get around to replyinh).

Remember that I haven't seen the dog etc etc etc. Dru - from what you are saying, I don't think that a lateral ear resection is the answer for this dog right now. If the vet has described the infection (and I assume that by this stage there has been a culture and sensitivity done) as an aggressive bacteria then I assume that it involves Pseudomonas aeruginosa. If I ever see this in a swab I warn owners from the outset that we could be in for a long, frustrating, expensive and potentially life long ride. It is not an impossible situation to solve, but the bacteria is an obligate pathogen and typically resistant to most things that you throw at it. IMHO one of the most important factors in treating chronic ear infections is owner commitment, and that is often hard to come by. I am going to quote from a standard surgery text now, for the sake of some objective information: "Lateral ear canal resection increases drainage and improves ventilation of the ear canal. It also facilitates placement of topical agents into the horizontal canal. Lateral ear canal resection is indicated in patients with minimal hyperplasia (thickening of skin)....It should not be performed in animals with obstruction or stenosis (narrowing) of the horizontal canal or concurrent otitis media, or in patients with sever epithelial hyperplasia. ...Owner counselling is extremely important before performing a lateral ear canal resection. Most studies have shown that owners satisfaction is low when lateral ear canal resection is performed for chronic otitis externa in dogs. Note: Make sure the owner understands that lateral ear canal resection is not a cure and that medical management probably will be neccessary for the remainder of the animals life. " (Small Animal SurgeryFossum et al. 2nd ed, 2002) In any chronic, nasty ear infection there is usually some otitis media (middle ear infection) even if mild enough not to cause additional clinical signs. Most "chronic ears" that I examine don't have an intact tympanic membrane (ear drum) and probably haven't for a while. A lateral ear resection wont cure anything, it will just make it easier to physically treat the ear and help with drainage - it doesn't eliminate the need for owner involvement and IMHO from what you have said the owners effort hasn't been tried to it's full extent. If there is middle ear involvement then the recommended is a total ear canal ablation with a bulla ostectomy - that is seriously major specialist surgery. very painful and not without significant risk. It sounds as though this dog has more problems than just it's ear and I would treat the whole dog aggressively before I suggested surgery. It is going to take dedication. Things I would do: - religious flea control - very strict elimination diet and I wouldn't suggest BARF at this point (due to potential for allergies to beef, lamb and chicken being most common) --> it needs to be entirely novel protein and carbohydrates, not just fresh and organic but something the dog has never eaten before. It would need to last at LEAST 6-8 weeks. It could be commercial but in this situations it often works better to have home cooked. - thorough dermatology work up --> skin scrapes, ear swab and then culture and sensitivity, sticky tape preps for yeast, Woods Lamp and fungal culture if needed. - if the dog has (diagnosed) yeasty skin, then it needs to be treated - if that means Malaseb, then it needs to be washed every week, if oral antifungals then until the skin is improved. - if the ear is that bad then it probably needs oral antibiotics as well, because a topical preparation wont do much damage to a bone infection. - topical meds chosen based on C & S. - this is one of those situations that steroids are often needed, if to do nothing else but open the ear canal so cleaning actually gets where it is needed. - do everything possible to support the skin --> omega oils, zinc, antihistamines to reduce itching and histamine release. - sedate the dog, flush, clean, clip and pluck the ears if neccessary --> they NEED to be clear. - make sure the owner knows that sometimes the best outcome is that we can MANAGE a chronic ear without detriment to the dog. - I insist on the seeing the dog back at least every 2 weeks to repeat swabs and keep an eye on bacterial numbers (and I can tell if owners haven't been keeping up their end of the bargain. - If this gets no where --> consider a referral to dermatologist It's not easy, it's not cheap, but I hope it's clear that an ear resection is going to make it easier to do all the other management things that need to be done, but I suspect that there is at least one if not more underlying causes in this dog. The surgery basically relocates the opening of the ear to "sideways" not "upways" - all the other factors remain the same. Please feel free to PM me if you like.

*rubs hands together in glee* Thems my words y'all using

Have you been back for regular checks with your vet - ie. do they know you're not happy and are concerned with the progress? It can often take a while to get back to adequate function - non weight bearing on leg that has had a cruciate repair is not absolutely indicative of pain. All of the techniques that are commonly used involve "changing" the joint somehow. None of the repairs create a joint that is "good as new" but aim to stabilise the joint to allow a return to function. Particularly with an extracapsular repair (DeAngelis suture) although the relative movement between the femur and the tibia is resolved, and the angle of the suture approximates the cruciate ligament, it does apply external pressure to the whole joint where there would not normally be tension. Thus - sometimes the stiffness will be an physical limitation to movement because the joint doesn't flex quite as well as it used to, sometimes depending on the length of time between injury and repair there can be a significant loss of muscle mass that means that the injured leg gets tired more quickly and sometimes the dogs just learn that it is easier to hitch the leg up if you want to run faster. That does not discount the possibility that the leg and joint may BE painful, but it is not the only possibility. I think if you are concerned that you should get your vet to recheck the leg - I suspect they will be able to give you an idea of what is going on without taking xrays. Since the operation was expensive, you owe it to yourself to try to get the best possible outcome - that will start with a recheck, and possibly some physiotherapy or proactive joint support.

C4: Parvovirus, Hepatitis (CAV2), Distemper and Parainfluenza C5: As for C4 with addition of Bordatella bronchiseptica (the bacterial component of canine cough).

I'm not going to try to guess the cause of lameness, just wanted to comment on xrays. If not a general anaesthetic, most hip xrays will need sedation because a ventrodorsal view requires extension and forced rotation of the legs and this isn't practical in a concious dog (not to mention that if there is a clinical condition, it is painful). Unless there is some dire circumstance (emergency x-rays and I have absolutely no other assistance) , I will not allow owners to be present while radiographs are actually being taken. I try to minimise my own exposure to xrays, and since I am licenced to use the equipment and responsible for other people in the room owners are a no-go.

Well, compared to the 52kg Border Collie I saw recently, it was probably was doing (comparatively) OK. :D

That is what I would do Puggles :D I would do bile acids if I felt that there were a functional problem with the liver and that we were dealing with more than Pb induced changes. I'm sure you are well aware that epileptic dogs + medications = one big balancing act!

I think that Protexin only contains "safe" bacteria without fillers, the data sheet says very little about fillers. I did get a bunch of information from Protexin (the overseas company) at the conference so I will check that out for you...*cough* when I find the kitchen bench :D They had a full range of products there, I'm not sure if they are coming to Australia soon but I think they would be useful for what you're after - especially the daily probiotic.

Yes Puggles - when we do a routine screening we are checking the levels of ALT and ALP which reflect what is happening in the liver. How about a 2 minute clinical pathology lesson? :D Normal biochemistry panels and preanesthetic panels will test (at least) two enzymes that give us information about the liver. ALT (alanine transaminase) and ALP (alkaline phosphatase). ALT reflects damage to cells particularly those in the liver, but does not indicate cell death (it reflects an ACTIVE process). ALP reflects cholestasis (literally "bile without motion") which may be secondary to damage, or may suggest a physical obstruction to bile ducts. Both these enzymes are sensitive indicators of changes occuring in the body and are dynamic - their levels can change in a few hours in some circumstances, or in a few days. Neither ALP or ALT is 100% specific to the liver, they can both be influenced by outside factors - especially drugs or toxins. The magnitude of change in an enzyme level does not (neccessarily) reflect the magnitude of the problem (a small active tumour? or a mild insult that affected the entire liver?), nor the reversibility --> All we know is that there is a change. Bile acids test for reduced functional liver mass. The abridged verision of the physiology --> Bile acids are made by the liver cells from cholesterol then stored in the gall bladder. Eating stimulates the release of bile into the small intestine where they help break down fat, then get reabsorbed. Any process that affects this cycle means that bile acid levels will be increased. We test before eating, then feed a small fatty meal and retest 2 hrs later. Generally, if a dog started with normal levels then we would just monitor liver enzymes. If a dog had a pre-existing liver problem, then we started seeing increases in liver enzymes with Pb then we might do bile acids to check what was happening.

We were taught throughout our nutrition course - although primarily concerning production animals, it certainly covered companion animals. Some vets may not feel moderate obesity impacts on an animal, sometimes owners do get terribly offended and sometimes after the 5th or 6th time you've had an earnest talk with the owner they still say "Well I think Fluffy is fine" and it becomes an uphill battle. I try to keep pups on the lean side, and any breed at risk of hip / elbow dysplasia gets an additional talk. I've seen a number of cases of hip dysplasia in 9mth -12 month old dogs where the owners tried to do everything right with respect to weight, exercise etc, but still ended up with a clinical problem - and I feel it would have been a lot worse if the pups had been fat. I have a body score chart in the consult room, and maybe I'm just blunt, but I have no hesitation saying "The ideal body condition is a 3 (out of 5), and if I'm being really generous I'd say Fluffy is a 4.5 (5 is enormous)". I also have clients who bring their absolutely stunning Boxer, or Weimeraner in because it's "skinny" and want me to find the problem with it. The only problem I can see is that not enough dogs look like that....

Oh dear, you're alert....the world needs more lerts

I would second the suggestion for Protexin - I frequently incorporate into my treatment of GIT issues. I think it's beneficial if there's some suggestion of a problem but I'm not sure about the need for ongoing maintenance if there appears to be a balance. I've recently started taking Inner Health Plus capsule myself and I have noticed a difference in my general well being (couldn't face the thought of Yakult - all the drinking yoghurt I had as a teenager when I got braces has scarred me for life). Edit to add: It shouldn't interfere with the meds.

Routine blood work will pick up abnormalities in liver enzymes. Pre and post prandial bile acids are used to further investigate liver function if there are changes evident.