Sedation without examination?

Re: Sedation without examination?

Robin Grimmer — Sat, 22 Sep 2012 13:16:09 GMT

[quote user="CatherineThomas"]

[quote user="Evelyn Barbour-Hill"]

[quote user="CatherineThomas"]The owner says that the nails need clipping[/quote]

I read that as the owners clipping the nails at home. Is that right?

[

[/quote]

yes I think that is what they wanted. I have told them we will provide them with sedation if they can weigh the dog at home and they sign a disclaimer. Then they will need to put a muzzle on the dog and bring it to us so that we can examine her. The only problem is that we don't have ACP tablets and i don't think we can get them. We've got diazepam or xanaz.

[/quote]

Diazepam and alprazolam are absolutely useless for this type of situation. All they will do is make the dog forget that he's bitten you

Re: Sedation without examination?

Anthony Todd — Sat, 22 Sep 2012 09:44:32 GMT

[quote user="Gerry Henry"] if they cut the quick instead of the nail (and they will)[/quote]

I wonder how many dogs are turned from benign to lethal after their nails have been cut too [painfully] short. Owners and some vets have this compulsion to cut nails [in cage birds too] so they bleed. Obviously very painful and in my view unnecessary.

I never cut nails so that the animal feels it at all, it depends on the set of the nail, some go in an arc and are naturally long.

Have a look at bears next time they're on telly.

Re: Sedation without examination?

Mark Hedberg — Sat, 22 Sep 2012 08:05:41 GMT

Also, do you wear a consulting top? One of my patients hated the sight of green tops. Take it off, sometimes they're calmer if you appear in civvies.

Re: Sedation without examination?

Emily Nightingale — Fri, 21 Sep 2012 23:38:28 GMT

oops sorry dont know how I managed to suggest my own post as an answer- it wasnt really an answer just a suggestion =)

Re: Sedation without examination?

Emily Nightingale — Fri, 21 Sep 2012 23:36:49 GMT

Hi! This prob might not help your case, but there was a GSD I saw last year who couldn't even get in the door of the practice without turning into a monster, lunging, barking, snapping.. so had to be muzzled at home and then brought in, dosed up on ACP tablets (think I read on notes 25mg ACP tabs dispensed 4 at a time..).. A chronic skin case, which needed looking at, I suggested Zylkene and seriously cannot CANNOT believe the difference. The dog has completely gone from being bonkers nutcase, to examinable handlable dog. I would go as far as to say I can handle her on my own with the owner (before lots of nurses and vets required so Im told) and have had her in the consult room w/o a muzzle although for exam I did put one on which she tolerated fine (the dog had the muzzle on- not me!) So, Zylkene may help in addition to your ACP!! Cant do any harm =)

Good luck.

Re: Sedation without examination?

Stephen Courtney — Tue, 18 Sep 2012 22:30:36 GMT

I see a similar dog every now and then, but the owners can get a muzzle on her. She is about 5 years old, i have managed to listen to the heart between slavering growly noises, and use domitor and torbugesic, clip the nails as short as i cam and then dress the paws ( they bleed on reversal if i don't) what i'm going to do when she is too old for domitor i don't know. equally i am terrified she will come in needing more than a cursory examination....

In my experience of ghastly tempered dangerous dogs ACP is highly unreliable, and drugs like xanax and diazepam are probably even more so. Maybe i used the wrong doses - if anyone has a sure fire protocol I'd be grateful, though thankfully these don't come my way that often. i worry about disinhibition and increased aggression with diazepam. For euthanasias in the past i have used handfuls of phenobarbitone tablets plus ACP tablets and that has worked quite well.

But a dog that no one can put a muzzle on, you are very limited. I'd go with a max dose of ACP , with disclaimers, and have them bring the dog in muzzled once sedated. If they can't do that then the nails certainly won't be clippable, but the dog is likely to sleep for quite while, possibly a day or two.

Another option is to get them to muzzle train, and give the dog a sneaky dom/ torb outside the surgery/ in the car park before it gets wound up. just a thought. Good luck anyway!

Re: Sedation without examination?

CatherineThomas — Tue, 18 Sep 2012 22:11:06 GMT

I've told them that they can only have the sedation if they bring the dog in once it's had the sedation so that we can examine it and clip the nails.

I'll get the nurses to check if we can order ACP in again but last time I asked they said t wasn't available and possibly wouldn't be again.

I do plan on discussing euthanasia but didn't think it was the right time to discuss it over the phone when I haven't even seen the dog. Once I get the dog and owner into the practice with the dog sedated I plan to have a serious discussion about the aggression and the need for euthanasia.

Re: Sedation without examination?

Rajat — Tue, 18 Sep 2012 21:51:23 GMT

[quote user="An On MRCVS"]

Needs euthanasing. How would you feel if you didn't advise this and it killed a child?

That aside, don't see the problem with diazepam. ACP being chemical straightjacket and all that. I am concerned about welfare of dog, which before anyone questions, doesn't contradict with the me saying it needs euthanasing.

Suggestion that all GSDs need sedating - presume that supposed to be funny. Can't see how though.

[/quote]

Why are you anonymous?

Re: Sedation without examination?

Rajat — Tue, 18 Sep 2012 21:50:02 GMT

[quote user="CatherineThomas"]Apparently neither the owner nor us can put a muzzle on the dog and so it can not be examined. [/quote]

Never a good situation! These ones make me nervous..

[quote user="CatherineThomas"]Would anyone agree to giving out sedation in this situation?[/quote]

I would - I'd use low doses of multiple drugs rather than high doses of just one drug it may be safer - you could try acp1-2mg/kg with alprazolam and butorphanol/codeine tablets. This should be enough to get a tape muzzle on it. IF it is isn't you can use a dog catcher to help topup IM (I like using ketamine in this mix for aggressive dogs as it is very reliable!) You can also spray ketamine into the mouth for some effect, it works well in cats not sure about dogs..!

I have seen some dogs become more aggressive with acp only and I don't use it alone any longer..I think that bite/aggressiveness dis-inhibition theory is prob true!

Re: Sedation without examination?

Gerry Henry — Tue, 18 Sep 2012 21:32:40 GMT

Well I wouldn't, ACP can reduce bite inhibition, if they cut the quick instead of the nail (and they will) and it goes ape and savages the owner it could be interesting legally, also if the nails are that long they'll bleed, possibly copiously, how are they going to stop the haemorrhage? Get the dog catcher on it and stick it with Xylazine or simlar. Don't give owners sedatives to take home unless its for fireworks or travelling.

Re: Sedation without examination?

An On MRCVS — Tue, 18 Sep 2012 17:40:29 GMT

Needs euthanasing. How would you feel if you didn't advise this and it killed a child?

Suggestion that all GSDs need sedating - presume that supposed to be funny. Can't see how though.

Re: Sedation without examination?

David Mills — Tue, 18 Sep 2012 16:34:54 GMT

[quote user="Michael Woodhouse"]

We got some ACP tabs from Dunlops this month. 10mg

[/quote]

Also available on t'internet in singles from vet pharmacies if you don't want a full tub (and sounds like you wouldn't use it). ACP tablets into google.

Re: Sedation without examination?

patrick murphy — Tue, 18 Sep 2012 16:32:45 GMT

I had one in other day, aggressive Staffie, who asked how much, and then told me previous VS cahrged £16o.

Re: Sedation without examination?

Michael Woodhouse — Tue, 18 Sep 2012 15:02:47 GMT

We got some ACP tabs from Dunlops this month. 10mg

Re: Sedation without examination?

CatherineThomas — Tue, 18 Sep 2012 15:00:57 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="CatherineThomas"]The owner says that the nails need clipping[/quote]

I read that as the owners clipping the nails at home. Is that right?

[

[/quote]

Re: Sedation without examination?

Evelyn Barbour-Hill — Tue, 18 Sep 2012 14:26:53 GMT

[quote user="CatherineThomas"]The owner says that the nails need clipping[/quote]

I read that as the owners clipping the nails at home. Is that right?

[quote user="CatherineThomas"]Would anyone agree to giving out sedation in this situation?[/quote]

Sure, why not? The dog is registered, it was seen in 2009, you are acquainted with it, there's nothing stopping you questioning the owner closely, and one assumes you can warn the owner that you can't be totally responsible if there are unexpected adverse effect. Maximum dose of ACP tablets, and warn them that they will still have to be careful.

Re: Sedation without examination?

James Laidlaw — Tue, 18 Sep 2012 14:10:43 GMT

All GSD's? Is that a wind up?

Re: Sedation without examination?

David Mills — Tue, 18 Sep 2012 13:52:24 GMT

Its almost impossible to kill anything with ACP - they just sleep for longer at higher doses. Add in tramadol at 10mg/kg for added sedation.

I would happily give all GSDs sedation before examination.

Re: Sedation without examination?

Nixthevet — Tue, 18 Sep 2012 13:37:25 GMT

I agree with the majority that the safety of you and your personnel comes first in this situation- and I don't think that the RCVS/anybody would question that.

Bearing in mind that you will likely be able to nothing with the dog un-sedated I would therefore be happy to prescribe sedatives for the owner to give at home. I would do so alongside a consent fomr signed by the owner accepting the small risk involved and also a disclaimer that the owner must muzzle the dog/be able to keep the dog under control during the visit to the surgery or you will not be able to proceed to treat/examine the dog.

Re: Sedation without examination?

Iain McAllister — Tue, 18 Sep 2012 13:12:16 GMT

I would probably get the owner to bring the dog to the surgery for an initial visual check - of course this is not a clinical exam but if it can run up and down the car park and it's body condition ids good then chances are it will be fine with ACP

Also you can estimate it's weight even if you can't get it on the scales - that it may give you some peace of mind rather than sedating "blind" Then you can dispense the ACP still with a disclaimer that you haven't been able to make a full clinical examination

Re: Sedation without examination?

Clive Ansell — Tue, 18 Sep 2012 12:50:08 GMT

I agree with the others.

As long as the client is registered and previously seen so you have it on record the dog is aggressive, then prescribe maximum dose sedation on the basis that no pre sedation examination/assessment can be carried out so the risks are therefore higher, Ideally obtained signed consent or a disclaimer. Once sedated the owner must then present the dog ready muzzled.

maybe needs PTS?

Re: Sedation without examination?

Hannah Wynne Richards — Tue, 18 Sep 2012 12:30:54 GMT

This time I'm with Micheal

Extreme situations demand extreme remedies

Wynne

Re: Sedation without examination?

James Laidlaw — Tue, 18 Sep 2012 11:58:11 GMT

This is one of the few situations where I'd probably still use ACP other than in pre meds. Just be SUPER careful when they come in because they can snap out of sedation and be quite dangerous. Obviously there's a whole other issue here with an uncontrollable potentially (or already) dangerous dog, which is my opinion if the owners cannot muzzle it, but that's a totally different issue. Get them to sign a consent when they collect the tablets - side effects etc will be in formulary and you can just "copy and paste" them from there.

Re: Sedation without examination?

Michael Woodhouse — Tue, 18 Sep 2012 11:29:20 GMT

[quote user="CatherineThomas"]Would anyone agree to giving out sedation in this situation?[/quote]

Yes. Your safety and that of the staff come first. So long as they are sedating the dog to bring to you for the nail clip I have no problem.

Go top end of the dose range (I will give these kind of dogs 1 tablet/4kg (2.5mg/kg)) and give it an ACP sandwich on an empty stomach. Cheap white bread works well.

Never worth you getting bitten trying to listen to heart first. Never.

Just explain to owner there is a tiny risk as animal not examined.