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Wound dehiscence following deciduous mandibular canine extraction

jd2008 — Tue, 16 Aug 2022 23:47:58 GMT

I would very much appreciate some advice as this is my own puppy and I’m struggling to think rationally!

21 week old ME English Springer. 16kg. Had fractured right maxillary deciduous canine extracted at 12 weeks old. Otherwise healthy.

8 days ago his retained left mandibular deciduous canine was extracted at our local general practice (I am not currently in clinical work). The flap made was longer than usual and, unfortunately, there was a lot of tension on the sutures. Regardless, it appeared to be healing OK, albeit slowly, until today. Today the distal section has dehisced leaving an approximately 1mm by 2mm section of alveolar bone exposed. There is no swelling or discharge and he appears comfortable.

He is due to be admitted again on Monday for extraction of the retained left maxillary canine. My question is whether anything should be done now and/or during GA on Monday.

Unfortunately I live in an area with no access to dental specialists or even GPs with a ‘special interest’ in dentistry. I’m not sure how/if a second flap could be created to cover the defect so I’m guessing the only option will be to let it granulate and hope he doesn’t develop an osteitis in the process, Am I correct?

Is there any benefit to antibiosis at this stage? ( I’m very wary of using antibiotics in puppies unless absolute necessary due to the risk of dysbiosis).

Thank you in advance for any advice you can offer.

Jane

Is this a bridge too far for our profession?

Mike Dale — Sat, 29 Jan 2022 11:36:49 GMT

It's in the Daily Mail so it must be true:-

Complaints about veterinary practices have soared by 64 per cent in just two years, a Daily Mail investigation reveals today.

But despite horror stories suggesting that our pets are being put at risk by corporate giants swallowing up the sector, a shocking 99 per cent of professional misconduct claims were not upheld in 2020.

A multi-billion pound takeover spree, starting when ownership rules were relaxed in 1999, means more than half of the 6,000 veterinary practices are owned by just six companies. And three of them are private equity firms."

The effects of pressure on veterinary employees from corporate ownership chasing profit is a cancer in our profession: Discuss.

What’s it like on the ‘other side’?

Jenny Tu — Thu, 03 Feb 2022 10:55:18 GMT

There’s much frustration as well as much love for this profession.

But really, what is it like on the other side? Has anyone left for another industry and later returned? If so, what was you experience, and what did you leave to do? What made you return?

Surgeon age restrictions.

An On MRCVS — Wed, 12 Jan 2022 07:19:52 GMT

Interested to hear opinions in the vetosphere re compulsory age restrictions on doing surgery.Not sure if true ,but read that human surgeons couldn't operate in NHS hospitals past 65yrs ,and 70 yrs in private hospitals.All to do with loss of motor skills and judgement apparently.Have recently had cause for concern with surgical outcomes from a couple of elderly locums(previously highly regarded in the profession).Poignant subject for me as I'm over 70 myself.

Behavioural or neurological?

Clive Ansell — Thu, 27 Jan 2022 13:55:25 GMT

I'm looking for any ideas please.

I have a case of a young, 2 1/2 year old speyed labrador x springer spaniel bitch, from a working dog background, showing unusual behaviour.

She has intermittant bouts of appearing very clingy, scarred and very anxious, to the point that she hypersalivates, pants excessively, trembles, will sometimes try to get through closed doors, and othertimes just takes herself off and sits outside. She will often become pyrexic during these bouts.

She is always responsive, has never collapsed or lost consciousness, has never involuntarily urinated or defaecated or shown any sign of any seizure activity.

It can sometimes be weeks or months between bouts, then it can be every day or night for a week or more. Usually in the evening or during the night.

There seems to be triggers, the latest being attacked by another dog. The first bout was following birth of a new baby. Was not disturbed by fireworks.

Her general health is good, and routine bloods are unremarkable. She is normally a very friendly boisterous dog, that interacts well with other dogs and with people she doesn't know. No sign whatsoever of aggression.

Zylkene and Calmex make no difference whatsoever, and both I and the owner are not keen on sedative drugs unless essential

I'm inclined to think it is behavioural, but cannot totally exclude some form of seizure(s)

I would welcome any thoughts or ideas.

Thanks

Certificate holders offering referral services

jd2008 — Tue, 11 Jan 2022 23:14:02 GMT

Tangent of: RE: Charging for work by a dental certificate holder

The original thread has been a fascinating read (thanks, all involved) and brought to mind a situation a pet-owning friend of mine faced a couple of months back. I'll keep the details here vague as I have no wish to inadvertently identify the practitioners or clinics involved and the issue isn't necessarily one of individual competence, rather one of lack of clarity regarding what level of expertise a CertAVP can legitimately claim to have.

In short, my friend's pet developed a condition that was beyond the capabilities of their GP vet. They were keen on referral and had the option of several referral centres within driveable distance. Their vet advised one on the basis that it would be easier/quicker getting an appointment there. No other pros/cons were apparently discussed. I'll add here that I am, of course, only party to my friend's account of events and conversations.

The pet was duly seen by the referral clinician, hospitalised for several days and then discharged. At this point my friend reached out to me as they were concerned that a diagnosis had not been reached and they described the treatment plan as "confusing". In short, they weren't confident that all avenues had been adequately explored and weren't comfortable with a 'try this and see approach'. My friend forwarded the clinical records to me with a request for my opinion.

Although I made it clear that it would not be reasonable to me to pass judgment on the case for the usual, various reasons I was interested enough to Google the referral practice and clinician involved with the view that I could perhaps reassure and encourage my friend to discuss their concerns with the referral clinician. I was a little taken aback, to say the least, to discover that this vet had a certificate to their name and no more. Even more surprising was that every single clinician in this referral centre was the same; certificate holders only. Further Googling revealed that there appears to have been a veritable explosion of referral services in the UK since I left and many of these count certificate holders as referral clinicians.

As tactfully as I could, I explained to my friend that they had been referred to a non-specialist and advised they seek a consult with a recognised specialist at one of the other, nearby centres, They did just this and the approach to work-up, treatment plan and communication from the specialist that they saw was, as I'd expect, exemplary, and stood in somewhat stark contrast to what appears to have been offered by the certificate holder. In short, a definitive diagnosis was reached through a carefully considered work-up based on contemporary evidence. I am not a specialist in the field in question but I worked alongside those who are for several years and, although I didn't mention this to my friend, the approach described in the clinical records from the certificate holder didn't jibe at all with what I had come to recognise from the specialist colleagues I'd worked with. One thing that wasn't different though, was the fees charged by both.

Anyway, perhaps of most concern here is the lack of information available to the public on what an old-style Certificate, PGCert or CertAVP actually mean in terms of competence. I had a look on the RCVS website and it took me quite some time to find any sort of description at all, buried in the 'Professionals" section. There is absolutely nothing at all in the 'Animal Owners' section.

I seem to remember, about 20 years or so ago, when I first pondered doing one of the old-style certificates, the RCVS taking something of a dim view of certificate holders setting out their stall as referral clinicians. As I remember it, it wasn't expressly forbidden but was cautioned against. Has that changed? Am I remembering incorrectly?

From a personal perspective, back then I though the RCVS were being unreasonable. Now though, having worked in a teaching hospital and having seen firsthand what goes into a residency and subsequent specialisation, I can appreciate that there is a world of difference in the training, skills, knowledge and expertise between a general practitioner who has undertaken additional learning in their free time and someone who has studied a field in-depth for several years under the continual supervision of recognised specialists. Most/many residencies now involve a masters by research as well.

My friend feels they've been conned and I'm finding it hard not to agree to some extent. Perhaps the introduction of a requirement for referral services to clearly identify staff as non-specialist referral clinicians would be a way forward?

How is competence defined?

Dinu Catilina — Tue, 11 Jan 2022 18:53:12 GMT

[quote user="Rachel Perry"]Hi Hazel, et al What an interesting topic and what a tangent this thread has taken! Hazel, you raise a really interesting point for discussion, especially as there are at least two GP certificate pathways in the UK now. The way I envisage these pathways enhancing our profession and veterinary dentistry as a whole, are not necessarily in the way that you suggest. The traditional model of veterinary dentistry in general practice is morning consults, sterile procedures, dental procedures, afternoon consults. This simply does not work in providing high quality, thorough dental care. There is simply not enough time to be meticulous with this model. Instead, the way I envisage you, and many other certificate holders could work would be to shift the way the practice works. Depending on the size of your practice, you could potentially perform dental procedures all day, every day of the week. Starting at 8am and performing 2-4 procedures through the day. Each patient would have a thorough job performed, full mouth dental radiographs, well performed extractions using nerve blocks, appropriate periodontal therapy, and time to discharge the patient showing the client dental charts, photos, X-rays. You can then charge appropriately for this procedure. We have traditionally under-charged for dental procedures in practice for decades (and the reasons for this could be another whole thread), but the knowledge and skills learnt within the GP certificate would enable this shift in the way we practice dentistry. Other vets in your practice would be more willing to make recommendations for dental work in the knowledge that someone interested and competent will perform it. You will have the communication skills and conviction to encourage clients to follow your recommendations to actually anaesthetise the patient for the necessary dental work. That's how your bosses will make more money- get more animals under anaesthesia for dental treatment, and you performing a thorough job and charging properly. Without committing to this shift, there is no point in your bosses paying for the certificate IMO. And to add a comment to the tangent thread, I feel that the days of 'having a go' should really be behind us unless the client has full and explicit informed consent. The RCVS guide to professional conduct makes it extremely clear, and the first Principe of Practice is Professional Competence. If vets are not competent in extracting a mandibular canine, then don''t do it. If you're not competent in distinguishing replacement from inflammatory tooth resorption in the cat, then don't offer feline dental procedures. If you don't know whether you're competent, then it's probably time to go on a hands-on, face-to-face practice dental CPD course. Imagine for a moment, going to your dentist because you need a wisdom tooth extracting. They say to you, "I've never done this before, and don't really know what I'm doing, but have no fear because there's a great YouTube video on it I'm about to watch!" I suspect not many of us would hang around in that dentist's chair. [/quote]

Tangent of: RE: Charging for work by a dental certificate holder

How do we define competence for a procedure that we do for the first time in general practice? This is a genuine question. Theoretical competence? Experience?

Can we really be truly competent in anything before doing it several times? I was told that true competence in arthroscopy in humans comes when you performed over 200 hundred, is this really possible with vet care?

Welfare issues in Modern Pentathlon

Jill Butterworth — Sun, 08 Aug 2021 11:36:22 GMT

I've fired off a letter to uipm@pentathlon.org (see below) in response to the reaction of the leading German rider and coach when the horse they were allotted refused to jump. The sport has long been criticised, as it is very difficult for the phase to be more than a lottery, and is very unfair on the horses (and their presumably horrified owners).

'I am writing to express my dismay at the equestrian phase of the 'modern' pentathlon. Using, or more appropriately 'misusing' someone else's animal in this event harks back to military days when animals were considered like machines, to be used and abused.

This is no longer appropriate in 21st Century competition and the ugly scenes from the German coach and rider underline how animals must not bear the brunt of human sporting frustration.

Please modernise this event and replace the phase with another, or find a way to evaluate riding ability with emphasis on skill in combination with partnership, which necessitates the rider on their own equine. This is not in contention with the sport's cavalry origins, as at that time soldiers often developed markedly close relationships with their horse.'

VetSurgeon.org

Thu, 11 Sep 2008 13:49:15 GMT