Which problem would you treat?

RE: Which problem would you treat?

Anthony Todd — Wed, 26 Aug 2015 09:12:19 GMT

[quote user="Hannah Wynne Richards"] Anthony Don't tell me you've never seen dry eye.[/quote]

Lots, do you remember parotid duct transplants?

None that I could trace back to TM/S nor lame dobies.

That's why I posted previously to that effect.

Maybe 'cos I only used short max 5 day courses?

And I've even seen fluorosein running out of nostrils; some dinovets were very advanced.

RE: Which problem would you treat?

Hannah Wynne Richards — Wed, 26 Aug 2015 08:29:51 GMT

Anthony Don't tell me you've never seen dry eye. How many of those had had trimethoprim/sulphonamide in the past? The same applies to Dobermans with multiple joint arthritis. OK I know those conditions could have occurred spontaneously, but I'd rather not have it on my conscience that I could have possibly been the cause.

Micheal I don't know if the same side-effects occur in horses/cattle, but in the case of horses I'd see a good clinical argument for it's use - it's the only antibacterial prep supplied in an oral form - so if the horse needs antibacterial therapy, it's a case of weighing up the potential harm of repeated IV or IM injections. Cattle - I'm hopelessly out of date, but it was my 1st choice antibacterial for calf diarrhoea (some 30 years ago)

Wynne

RE: Which problem would you treat?

Evelyn Barbour-Hill — Tue, 25 Aug 2015 22:49:59 GMT

[quote user="robloxley"]Trimacare 20? Or I guess Septrin that new veterinary licensed TMS liquid[/quote]

Ah, good ideas.

RE: Which problem would you treat?

Rob Loxley — Tue, 25 Aug 2015 18:48:31 GMT

[quote user="Evelyn Barbour-Hill"]Norodine 20 tablets have been discontinued, what do people use when you want a trimethoprim/sulpha for the smaller patient?[/quote]

Trimacare 20? Or I guess Septrin that new veterinary licensed TMS liquid

RE: Which problem would you treat?

Anthony Todd — Tue, 25 Aug 2015 18:36:38 GMT

[quote user="Hannah Wynne Richards"]

I avoid trimethoprim/sulphonamide like the plague - unless a swab shows it's the only drug which will work - I'm too scared of side-effects.[/quote]

Wynne

I don't think I ever saw a side effect ever.

Must be a peer-reviewed paper to shoot me down though.....

RE: Which problem would you treat?

Evelyn Barbour-Hill — Tue, 25 Aug 2015 18:35:03 GMT

Now that Norodine 20 tablets have been discontinued, what do people use when you want a trimethoprim/sulpha for the smaller patient?

RE: Which problem would you treat?

Michael Woodhouse — Tue, 25 Aug 2015 18:18:15 GMT

[quote user="Hannah Wynne Richards"] I avoid trimethoprim/sulphonamide like the plague - unless a swab shows it's the only drug which will work - I'm too scared of side-effects.[/quote]

Don't be daft, Wynne. It's about as innocuous as it comes. I'd much rather use an old sulphur drug as first line, rather than a lot of other antibiotics.

Use as a first choice for respirtory, skin, prostate etc. NEVER seen a single side effect. Used lots in horses and cattle too.

RE: Which problem would you treat?

Hannah Wynne Richards — Tue, 25 Aug 2015 17:55:08 GMT

I avoid trimethoprim/sulphonamide like the plague - unless a swab shows it's the only drug which will work - I'm too scared of side-effects.

Wynne

RE: Which problem would you treat?

Clive Ansell — Tue, 25 Aug 2015 17:26:21 GMT

I think a swab for C&S is worth considering for recurrent or refractory infections. Not only is it good practice but in some cases will save money, particularly with large breed dogs on long courses of expensive antibiotics.

I had a case the end of last year, a large GSD, with an anal gland abscess that has previously had at least Synulox, Marbocyl, Antirobe, and Convenia - literally hundreds of pounds worth. A swab for C&S showed that basic TMS would do he job - 1 month course, job done.

RE: Which problem would you treat?

Michael Woodhouse — Tue, 25 Aug 2015 00:40:06 GMT

Is this because you 'pet vets' don't have any milking cow tubes? :D

I would give the dog steroids to open up the stenotic ear canals and it would undoubtedly help the backside with antibiotics.

I agree a smear would be nice.....

RE: Which problem would you treat?

Anthony Todd — Tue, 25 Aug 2015 00:14:57 GMT

[quote user="grumpyoldman"]3. show them how to use a spruells needle twice a day with hibitane[/quote]

Hard enough to teach vets to get anything into anal glands let alone a client with a dog with anal furunculosis.....!

A used 20 or 22 Venocath is easier to use by far, IMHO.

RE: Which problem would you treat?

Anthony Todd — Tue, 25 Aug 2015 00:08:27 GMT

I still can't fathom the rationale behind preds in this case, but, apart from that really minor dispute, I agree with James' post completely.

Surely the owner's attitude should be secondary or tertiary to helping the dog and perhaps an improvement in the dog may have a bigger effect on the client than criticism and threats.

RE: Which problem would you treat?

James Dunne — Mon, 24 Aug 2015 20:57:31 GMT

It doesn't cost a whole lot to make a smear, check for rods - if they're not present, then tx with [possibly] pred and [definitely] antibiotic [clindamycin or TMS] and revisit. You can give the client a 'talking to' in ways that are diplomatic and get the message across at the same time. It would not be in the interests of animal welfare if they were too annoyed/ frightened to go back to the vets and neglected their animal further. We never know what kind of stuff is going on in people's lives and sometimes they just don't see what's going on with their pets - that's why they come to us; we're the experts. They don't need to be patronised and we should all be professional enough to know how to impress the benefits of timely intervention on people without sounding off. I agree that best practice should always be offered, whether it is taken up or not. If it is not, 'going to plan B' is acceptable and the reason why entered in the clinical notes!!

RE: Which problem would you treat?

Anthony Todd — Mon, 24 Aug 2015 19:52:26 GMT

If money is a concern then your favourite A/B has got to be best value for a good period like 14 days.

Why anyone would want to use steroids in this scenario is beyond me [no wonder they get a bad name!!]

Local treatment to suit is cost-free and will do more good than any of the fashionable tests or cultures if combined with your favourite broad spec. A/B.

Irrigating and packing the ears and A/Gs would help too.

RE: Which problem would you treat?

Nhombokisheni — Fri, 24 Jul 2015 12:28:54 GMT

[quote user="Clive Ansell"]

I agree with Wynne on this one. Clients need to be told some home truths (in the nicest possible way) in regard to the patients welfare and their responsibilities, regardless of any client satisfaction surveys. Our primary duty is to the animal, not the client.

options:

3. PTS

[/quote] Regular clients mostly learn to respect and trsut their vet, and will accept "home truths" which are viewed as constructive and good or the animal. But if someone just walks in, there is always a thin line between "constructive and partonising" in the ears of that client. So, just telling them off may not be the best way, no matter how nice. If welfare is a primary objective, I suggest biting our tongue, offer the cheapest "shotgun" treatment, and aim to initiate a longer term relationship .......as Evelyn suggests, there are many reasons why things are the way they are. Its not always outright neglect/abuse........stereotyping clients can come back to haunt you. Sometimes I just say "this is my good deed for the day"......not all angels have wings and shiny clothes!!!!

RE: Which problem would you treat?

Luca Poddighe — Fri, 24 Jul 2015 09:21:27 GMT

[quote user="Silvia Maldonado"]As for animal welfare, feedbacks, etc, I recently had a penniless client whose akita was not the nicest of dogs. At that point, rather than the dog's welfare, I had in my mind my team's safety and keeping my fingers where they are [/quote]

Your personal safety comes always before anything else. And no one can argue on that!

RE: Which problem would you treat?

Hannah Wynne Richards — Fri, 24 Jul 2015 08:36:21 GMT

Evelyn There's local charities with whom I've built up a good relationship to whom I would have applied, and my approach afterwards would have been similar to grumpyoldmans - but with amoxycillin. I still think that people should be reminded that animals (like children) are a significant financial responsibility - and neither should be acquired by those who can't afford them.

Wynne

RE: Which problem would you treat?

Silvia Maldonado — Fri, 24 Jul 2015 00:22:09 GMT

I'd be concerned with using steroids and ABtherapy, taking for granted that there are no malassezia in the ears. I'd probably prescribe a 25ml canaural bottle, and the client should learn how to apply it both n ears and anal glands

As for animal welfare, feedbacks, etc, I recently had a penniless client whose akita was not the nicest of dogs. At that point, rather than the dog's welfare, I had in my mind my team's safety and keeping my fingers where they are

RE: Which problem would you treat?

Virginia Campbell — Thu, 23 Jul 2015 22:23:35 GMT

For the real scenario - icky bum but quiescent ears - I would use metronidazole rather than TMPS though.

RE: Which problem would you treat?

Virginia Campbell — Thu, 23 Jul 2015 22:21:27 GMT

Yep, TMPS, pred, and get it off whatever it's eating and onto Harringtons.

RE: Which problem would you treat?

ruths — Thu, 23 Jul 2015 21:02:06 GMT

I don't see the two problems as clinically distinct tbh

both are infections of the integument

RE: Which problem would you treat?

grumpyoldman — Thu, 23 Jul 2015 20:34:27 GMT

I said tribrissen because it usually works and its cheaper than anything else ,and a spot of dry eye is the least of its worries right now . Even really dim people can get to grips with a 10ml syringe a spreulls needle and dilute hibiscrub, and you can always order a new one for tomorrow, the dog feels better quickly.We get these situations on a daily basis. If you give these people expensive drugs and drops, they will just leave it to rot in future.

RE: Which problem would you treat?

Evelyn Barbour-Hill — Thu, 23 Jul 2015 19:24:36 GMT

[quote user="Hannah Wynne Richards"] Give the owner a real talking to - because they aren't suitable people to own animals in the 1st place.[/quote]

You have in the case as presented by the OP absolutely no idea why they are short of money.

Anyway, once you've given them the real talking to, what do you do about treating the animal (whose welfare is above all your first concern, or something like that....).... assuming they haven't walked out.

RE: Which problem would you treat?

Hannah Wynne Richards — Thu, 23 Jul 2015 17:40:43 GMT

Thanks We should never forget, our oath "My constant endevour will be to ensure the welfare of animals committed to my care" is vastly more important than client satisfaction.

Wynne

RE: Which problem would you treat?

Clive Ansell — Thu, 23 Jul 2015 17:39:19 GMT

[quote user="Hannah Wynne Richards"]

I'd use amoxycillin as opposed to tribrissen - less side-effects, and better for anaerobes.

Wynne

[/quote]

Ideally swab for C&S. Best practice and sometimes saves money in the long run, particularly with a big dog. I recently had a Rottweiler with a non healing anal gland abscess, that had been on several antibiotics including Synulox, Marbocyl, Baytril and Antirobe costing hundreds of pounds. In the end I treated it successfully with Trimacare based on C&S results. Would have saved a fortune doing it much earlier.