further investigation in a CKCS

Re: further investigation in a CKCS

Stephen Courtney — Mon, 04 Jun 2012 15:34:09 GMT

I wonder if Mr Mills seriously believes that an animal waking up from a soft palate resection feels perfectly fine. Post op pain can be managed successfully, certainly, but there are issues such as feeding and short term breathing issues, plain old sore throat etc, and all the analgesia in the world isn't going to make anything feel normal straight away - it takes time to heal, even if an op has been done by the truly gifted. Fine if you need to have done it, quite another if you didn't.

There is no evidence in the original post that this dog has any restrictions at this point - it is 9 weeks old and it is a cavalier - it is hardly likely to be rounding up sheep is it

The relevance of my own experience of surgery is certainly relevant to how i consider treating animals, and perhaps if all of us had had interventions we might be a little less dismissive of post operative issues,

Re: further investigation in a CKCS

Mark Holmes — Mon, 04 Jun 2012 10:33:48 GMT

[quote user="David Mills"]The point, surely, is that this pups enjoyment of life - if on restricted exercise etc - is going to be massively reduced due to some applied precautionary principle that appears to have no basis in evidence, other than 'he may grow into it' (?!) and dyspnoea being the key interventional sign. The animal is showing signs of a clinical problem, if not debilitating at this point. What is better - to wait til he collapses or shows ex intolerance - or operate now? If it was my animal I'd have it operated on now so it could enjoy a full and happy puppy and adulthood - rather than sitting and waiting until it magically 'went away' - because, in fact, they never do, whether it be remnant snoring[/quote]

The dog presented with nothing more that nasal stertor, I have seen loads of pups in a similar situation, not one has had its abilty to exercise compromised or have any died of heat stroke. I have not seen fit to suggest surgery to any in 12 years. The last one a Beagle is now perfectly fine and whilst she may snore a bit when sleeping has no problems. Her exercise compromise is due to her breed related lead exercise rather than respiratory problems. Had any of these dogs received surgery, the surgery, any post operative complications and potential deaths would have been completely unnecessary.

I know how you object to stories but I think the onus is on you to provide evidence. In particular number of puppies with asymptomatic respiratory stertor that develop respiratory compromise and to what extent. Assuming these asymptomatic dogs are operated on, the expected complication rates associated with their surgery and then demonstrate that the number of dogs with complications are significantly lower than the numbers of dogs which develop respiratory compromise. It would also be useful to see how many of the dogs having been subjected to surgery showed any significant change in life quality once they had recovered.

ie show evidence that it has a benefit.

Re: further investigation in a CKCS

David Mills — Sun, 03 Jun 2012 23:33:37 GMT

[quote user="Stephen Courtney"]

As for surgery being unpleasant - of course it is! for the patient there is post op discomfort at the very least, during a period of healing, and for the surgeon the problem of limited access, at the very least, as well as needing skill and confidence to do this properly - first do no harm etc.

[/quote]

Conflation of ideas. Of course surgery per se is unpleasant. That's why we use anaesthetics. Every operation requires skill; no one was suggesting that the OP did surgery herself, but there were some who (me included) pointed out it is a technically demanding surgery that takes some training to do properly. Can't really see your point otherwise.

[quote user="Stephen Courtney"]

i had my adenoids removed as a kid - and it was awful.[/quote]

This is irrelevant to the discussion.

[quote user="Stephen Courtney"]

There is no way i would contemplate anything radical in a growing animal unless it was dyspnoeic.

[/quote]

The point, surely, is that this pups enjoyment of life - if on restricted exercise etc - is going to be massively reduced due to some applied precautionary principle that appears to have no basis in evidence, other than 'he may grow into it' (?!) and dyspnoea being the key interventional sign. The animal is showing signs of a clinical problem, if not debilitating at this point. What is better - to wait til he collapses or shows ex intolerance - or operate now? If it was my animal I'd have it operated on now so it could enjoy a full and happy puppy and adulthood - rather than sitting and waiting until it magically 'went away' - because, in fact, they never do, whether it be remnant snoring or coughing, that SP is always going to be overlong regardless of dogma, and the owner is always going to treat the dog more cautiously than otherwise.

Re: further investigation in a CKCS

Stephen Courtney — Sun, 03 Jun 2012 09:56:05 GMT

I totally missed the fact that this dog was 9 weeks old, I misread the age, sorry.

There is no way i would contemplate anything radical in a growing animal unless it was dyspnoeic. there is every chance that he will grow into his soft palate. If things get worse then you can reconsider. i agree that it is better to operate before serious consequences of URT obstructive disease develop.

the point of surgery is to leave the individual better off in the long run in spite of any short term discomfort or pain. So decisions are a balance, always. i had my adenoids removed as a kid - and it was awful. Never forgotten that.

Re: further investigation in a CKCS

Mark Holmes — Sat, 02 Jun 2012 16:36:55 GMT

Maybe I should have said fully grown, which a Cavalier is pretty close to at 8 months. I buy into the argument that if performing surgery, particularly that with potential life threatening complications it needs to be of benefit. Given that in 12 years I have never needed to or even considered the need to refer for or perform this susurgery I would conclude that the benefit in a puppy is minimal and in the majority of cases they will out grow the problem. In this case there was no history of any problem beyond noise. If you are suggesting surgery on a prophylactic basis I think you need some very convincing evidence yourself. It is for you to prove it is necessary methinks!

Re: further investigation in a CKCS

David Mills — Sat, 02 Jun 2012 15:54:51 GMT

[quote user="Mark Holmes"] until 8 months at least.

[/quote]

Why 8 months? Is this based on any evidence?

I don't really buy into the 'until causing a problem' argument - surely the problems when manifest - collapsing, apnoea, 2y infections etc - are far more dangerous in the immediate timeframe than a skilled resection of the offending tissue on a healthy animal leading to permanent resolution early on in the course of a disease; possibly more so in the case of a puppy: not allowing a growing puppy to run around too much because of fears about problems is a bizarre logic - whatever happened to quality of life?

I also disagree with the surgery being 'unpleasant' - for whom, animal or surgeon? Certainly no more unpleasant for an animal than spaying.

Re: further investigation in a CKCS

HMC — Sat, 02 Jun 2012 12:21:02 GMT

Thanks guys. That's really helped.

Re: further investigation in a CKCS

Rob Loxley — Sat, 02 Jun 2012 10:15:14 GMT

[quote user="Mark Holmes"]I wonder how many you need to perform to make a difference[/quote]

If you read the RCVS DC report, lots!

Re: further investigation in a CKCS

Mark Holmes — Sat, 02 Jun 2012 07:55:20 GMT

I agree but would see how things go as it grows before panicking. Soft palate resection is unpleasant and I wonder how many you need to perform to make a difference. It's only 9 weeks and I would wait until 8 months at least. Unless its causing immediate problems beyond noise.

Re: further investigation in a CKCS

Stephen Courtney — Fri, 01 Jun 2012 22:45:30 GMT

^^^ What they said!

This dog should be OK to vaccinate. He is at real risk of heat stroke. there is little point in you starting to investigate this unless you are OK about doing a soft palate resection or other nasty ENT wizardry.

Refer if at all possible, if the client isn't up for it then you need to chat with them about the care they need to take to make sure he doesn't overheat, and what to look out for as his upper airway disease progresses

Re: further investigation in a CKCS

Evelyn Barbour-Hill — Fri, 01 Jun 2012 21:31:39 GMT

[quote user="David Mills"]Needs light GA to assess soft palate and laryngeal cartilages - instant answer.[/quote]

Seconded. Well, instant answer quite likely anyway.

Before that, a quick test that can be helpful: does the noise go away when you open his mouth wide and pull his tongue forward?

Re: further investigation in a CKCS

David Mills — Fri, 01 Jun 2012 18:15:21 GMT

Needs light GA to assess soft palate and laryngeal cartilages - instant answer. Likely need resection as well if elongated SP - not for the feint hearted.

Re: further investigation in a CKCS

Martin Atkinson — Fri, 01 Jun 2012 17:11:08 GMT

Its a CKCS, elongated soft palate must be top of the list.

Re: further investigation in a CKCS

tess — Fri, 01 Jun 2012 16:15:30 GMT

Could it be a soft palate problem or some other upper airway obstruction? Might be worth a look down there.

Re: further investigation in a CKCS

Bob Russell — Fri, 01 Jun 2012 15:17:28 GMT

Our X-ray system allows the plates to be removed from their cassettes and can then be used for i/o views (within the limits of their size!). We place them in zip-loc bags to stop contamination. They are then returned to the cassette for processing as normal. We have managed to get useful views.

The plates are treated with respect to stop damage.

Another way would be to use 'self-processing' dental film but I don't know how well this would work. Seems OK with our dental X-ray machine but we only have the very small size films so have never tried this sort of view.