Doberman spay

Re: Doberman spay

emma_j — Sun, 07 Apr 2013 12:02:01 GMT

ooh, i seem to have suggested that as an answer!! well it is, I agree, this is my reasoning for using the standard equipment rather than just making a random nick with a scalpel blade - I did that once when the practice didn't have the surgicut, the dog bled beyond the time limit so we delayed sx. Rechecked a week later with the surgicut - it was fine - no problems at surgery. Maybe I was just an overenthusiastic new grad and a bit heavy handed, but have always gone with the surgicut since. Not that it's in any way a regular occurrence!!! Really haven't seen that many Dobermans, and some of the ones I have seen have come from breeders who screen their breeding stock so the pups they sell are clear.

Re: Doberman spay

Neil Wheadon — Sun, 07 Apr 2013 01:46:56 GMT

PS Using a surgicut also gives a standardised cut which can be referenced to the clotting times found. For £7 I'd do this

Neil

Re: Doberman spay

Neil Wheadon — Sun, 07 Apr 2013 01:42:18 GMT

Pet Blood Bank UK have also reported many cases of bleeding in Staffordshire Bull Terriers and some of these were Von Willebrands

Neil

Re: Doberman spay

John Flynn — Sun, 07 Apr 2013 00:21:22 GMT

Am interested in the different appraoches to BMBT for those in favour of doing this pre-spay in Dobbies.

I had been led to believe that a standardized device was really needed for anything but the crudest assessment of primary haemostasis as the length, but particularly the depth, of incision needed to be standardized; it was suggested that using a scalpel was a bit like assessing secondary haemostasis by an 'activated clotting test' if done well and 'whole blood clotting' if done badly (as opposed to APTT/PT) - i.e. you can do it, but is pretty crude.

The approach that I've previously used was to do after premedication (assuming NOT medetomidine), but before induction and:

tie-back the upper lip with gauze to lightly occlude vessels and expose area
swab saliva etc away
Use a surgicutt/simplate device to make standardized incision in area adjacent to mucocutaneous junction + start the clock
wick blood away every 5-10secs with filter paper adjacent to wound without touching wound
stop the clock with no more bleeding

With this technique, I was advised to interpret <4mins in a dog as acceptable, though I think this figure was based on conscious dogs rather than those sedated with acepromazine/opioid (I doubted the latter would make a huge difference, but am always amazed how dramatically sedatives can affect clinical pathology testing...)

Now, as the people that advised me of the above were quite possibly involved in the selling of the devices through a well-known commercial lab, I would be interested in hearing the theory or evidence or experience of those performing the scalpel-based approach. Have you ever had any that bled too long? How long did you take to be too long? Were these followed up with vWF and if so what was result?

I've stopped testing Dobbies currently as in the area I work have never had one with extended BMBT (or positive vWF for those being sent for ventral slotting), nor any post-op bleeders, so assume the incidence locally to be negligible - still, this thread has got me thinking if I should start again...?

Also interested in David's comment about clinical signs generally being present if APTT/PT being prolonged, so if no (detectable) bleeding then can assume are normal; if only testing dogs that are actively bleeding, then I would struggle to decide whether prolongation was due to consumptive coagulopathy or genuine primary defect with secondary haemostasis - does that mean that the only truly useful result is normal APTT/PT in a bleeding patient?

Re: Doberman spay

Clive Ansell — Sat, 06 Apr 2013 09:50:40 GMT

[quote user="Anthony Dennison"]

[quote user="Michael Woodhouse"]should the plural of Doberman be Dobermen?[/quote]

Is that not a little sexist?

[/quote]

Guess it should be Doberperson these days

Re: Doberman spay

Gillian Mostyn — Sat, 06 Apr 2013 09:38:14 GMT

[quote user="Anthony Dennison"]even if you had rock steady hands and aim, is it possible to say hand on heart that one can get exactly the same depth of incision each time? Brings a bit of standardisation so things can be comparable[/quote]

If you was doing follow-ups on a diagnosed case, then perhaps. But if you are just seeing if it is safe to spay .... all you need to know is will it clot or not!

Re: Doberman spay

Glenn Hodgson — Sat, 06 Apr 2013 01:23:42 GMT

I find the scalpel blade technique works well too. I'm sure someone at a cpd many moons ago confirmed to me that it was sensible.

[quote user="Martin Atkinson"]

I've never done a VWD test pre-spay and have spayed few Dobermanns in my time but would now at least offer the test. Can't see why anyone needs any fancy kit for BMBT test though - whats wrong with a No 15 scalpel blade, a bit of care and a bit of tissue?

[/quote]

Re: Doberman spay

Anthony Dennison — Fri, 05 Apr 2013 14:48:19 GMT

[quote user="Michael Woodhouse"]should the plural of Doberman be Dobermen?[/quote]

Is that not a little sexist?

I would rather use a specific bit of kit rather than just a scalpel blade and care - even if you had rock steady hands and aim, is it possible to say hand on heart that one can get exactly the same depth of incision each time? Brings a bit of standardisation so things can be comparable

Re: Doberman spay

Evelyn Barbour-Hill — Fri, 05 Apr 2013 13:36:27 GMT

[quote user="Martin Atkinson"]whats wrong with a No 15 scalpel blade, a bit of care and a bit of tissue?[/quote]

You can't charge for it?

Seriously, though, as with pre-anaesthetic blood screens, I don't understand the "offer the client the option". If it's something that you consider to be wise to do, just do it.

Re: Doberman spay

Clive Ansell — Fri, 05 Apr 2013 12:13:02 GMT

[quote user="David Mills"]

How useful do people think a clotting profile is especially in dogs without signs?

[/quote]

In truth, very little probably. Considering the possibilities and the disastrous consequences if things go wrong, and giving the client the options covers ones backside if a bitch spey goes belly up - full of blood OOH.

I once declined to carry out a Doberman bitch spey that had a prolonged time with BMBT test, but I gather it was carried out elsewhere with no problems at all.

Re: Doberman spay

David Mills — Fri, 05 Apr 2013 11:48:41 GMT

How useful do people think a clotting profile is especially in dogs without signs?

I've always considered them to be very insensitive - in fact at college we were told that if an animal has clotting factor defects severe enough to prolonged APTT/PT etc then it'll be showing signs. I think a little like heart murmurs as a sign of cardiomyopathy coagulation tests have a poor sensitivity but if targeted to the right patients their PPV increases. A bit like 'screening bloods' for seizuring dogs. In the new spirit of the forums, this is a musing rather than a criticism.

I'm not sure BMBT would be that useful as an A.v. screen - the coagulopathies with A.v. are very poorly understood and current thinking is it's unlikely to be just a thrombocytopathia and likely to have significant immune component. Which begs the question whether advocate as a one-off would prevent the problem (as opposed to monthly applications) - perhaps advocate plus dex a week pre-op would be a better option?

Re: Doberman spay

Clive Ansell — Fri, 05 Apr 2013 11:31:54 GMT

I usually offer a BMBT or haematology with coagulation screen, both inexpensive and easy to do compared with the consequences of a bitch spey with a clotting problem. I never run an assay for Vwf.

Re: Doberman spay

Martin Atkinson — Fri, 05 Apr 2013 11:17:01 GMT

Re: Doberman spay

emma_j — Fri, 05 Apr 2013 10:38:45 GMT

The kennel club website lists the known clear/carrier/affected dogs that have undergone DNA testing and recorded. I have had a dobermann breeder request samples for DNA testing to select breeding stock. For pet dobermanns, if they do not have any info from the breeder about their possible status, then I personally strongly recommend a BMBT before neutering, it's not an expensive test. Only had a few but have found them ok to do conscious generally!

After a very bleedy neuter was found to have lungworm I also try to make sure they're up to date with their advocate before neutering too. Maybe we should be recommending BMBTs on all dogs not up to date with lungworm prophylaxis prior to elective surgery!

Re: Doberman spay

Colin Thomson — Fri, 05 Apr 2013 07:45:15 GMT

I've been told there is genetic differences between Dobermans in Europe and the USA, making VWD far more common there. Anybody any idea of the incidence of it in the UK population of Dobermans?

The last bleeder we had (for no apparent reason) was a Labrador (after castration). Can't recall another over the last 2-3 years. We have spayed some Dobermans in that time.

Colin

Re: Doberman spay

Michael Woodhouse — Fri, 05 Apr 2013 01:54:45 GMT

[quote user="ruths"]How much would you charge for a BMBT? It seems the most sensible option as a screen.

[/quote]

Think we charge £20 +vat. The little kit is (was) about £7.50 from Idexx. Takes less than 5 minutes to do (if not DON'T SPAY )

I have done them on conscious dogs but they move. Better on anaesthetised dogs. I had a couple of practices with a swab and some lancets that came with the glucometer on some anaesthetised patients.

The BMBT is used in 2 settings:

As an in vivo presurgical screening test for vWD, especially in Dobermans, which have a high prevalence of the disease and a high incidence of bleeding. A prolonged BMBT in a young Doberman with unknown vWf:Ag concentrations is virtually diagnostic of vWD (in the absence of thrombocytopenia or platelet inhibiting drugs, such as aspirin) and indicates the necessity for vWf supplementation with fresh or fresh frozen plasma or cryoprecipitate. However, this test is insensitive to deficiencies of vWf, and will only be prolonged if vWf:Ag concentrations are < 20%, therefore it should never be used as the sole diagnostic test for vWD.

From here

Re: Doberman spay

Rob Loxley — Fri, 05 Apr 2013 00:00:02 GMT

BMBT: the cost of the device (have got surgicutt devices from IDEXX) plus something for the time to do the test

BMBT is the most sensible in-house test, but like the OP not sure of the benefits of BMBT vs. Vwf assay vs. genetic testing?

Re: Doberman spay

ruths — Thu, 04 Apr 2013 23:41:55 GMT

How much would you charge for a BMBT? It seems the most sensible option as a screen.

Re: Doberman spay

Michael Woodhouse — Thu, 04 Apr 2013 23:01:23 GMT

I have twice offered to do buccal mucosal bleeding time measurements on two Dobermans pre- surgery. Both owners decided not required. Both still alive.

A BMBT is a nice way of asking the question "can this dog clot ok". You can measure VWB factor but have never done so.

[should the plural of Doberman be Dobermen?)