dog requiring pyometra surgery but microchip registered as missing

RE: dog requiring pyometra surgery but microchip registered as missing

Glenn Hodgson — Sat, 01 Aug 2015 10:04:12 GMT

Op!

I happily donate to charity.

I will help out an animal but don't support those who think everything should come to them on a plate. I refused credit to a client for a £800 odd op, new client that day and support those who do the same. A well known charity then got on my case for doing so and attempter to haggle with me on the clients behalf..... had the charity came to me with the dog signed over to them I would have helped.

RE: dog requiring pyometra surgery but microchip registered as missing

Martin Atkinson — Sat, 01 Aug 2015 09:14:54 GMT

[quote user="Glenn Hodgson"]

If the dog is ill treat it appropriately.. I would log a second opinion that the treatment course was suitable. Putting the dog's welfare 1ST places you in a strong position if anyone gets tetchy.

[/quote]Not sure if this is the OP's case or mine you're referring to Glenn, but after the n'th incidence of getting my fingers burnt and not being paid, especially by the 'traveller' community, my philanthropy has worn a little thin. IMO and that of a second vet and my nursing staff, euthanasia was the appropriate treatment choice in the case I have illustrated.

RE: dog requiring pyometra surgery but microchip registered as missing

Glenn Hodgson — Fri, 31 Jul 2015 20:57:42 GMT

If the dog is ill treat it appropriately.. I would log a second opinion that the treatment course was suitable. Putting the dog's welfare 1ST places you in a strong position if anyone gets tetchy.

RE: dog requiring pyometra surgery but microchip registered as missing

Dagmar Steele — Fri, 31 Jul 2015 18:03:17 GMT

[quote user="Martin Atkinson"]

What would other's have done in these circumstances?

[/quote]

I am notoriously silly. I would have tried and rehomed whatever survived. My wrinkles are bad enough, I don't need anything else upsetting me when I brush my teeth in the morning and have the first look in the mirror.

RE: dog requiring pyometra surgery but microchip registered as missing

Richard Carter — Fri, 31 Jul 2015 18:00:22 GMT

Good for you.

Note to Chris - despite your comments there are a few things that are definitely in favour for immediate action if you as a professional are standing in front of a case that has a serious debilitating condition. Nobody will condemn you for making a clinical decision based on your judgement whether you have permission or not. If you have an expressed owners decision then you cannot go against it and if it is against your judgement, then you record that x action was taken due to y decision on part of the owner and send them on their way. Whether you get paid later is another story.

In the case of the above where the person who brought in the dog was not in a position to give you a decision and that there may have been a third party but was not immediately contactable, then the clinical decision rests with the vet to either carry on with surgery or pts or treat. Data protection, writing letters to confirm ownership etc is not in the picture as the case needs resolution immediately and welfare and suffering trumps all the others.

We deal with this with rtas all the time where a stranger brings in the accident victim but the owner isn't available until later.

I do think that if there was a favourable prognosis but the vet chose pts rather than do the surgery and save the dog but risk some financial loss to the practice and then the legitimate owner turned up later to a dead dog, there may be a case to answer.

RE: dog requiring pyometra surgery but microchip registered as missing

Martin Atkinson — Fri, 31 Jul 2015 17:09:42 GMT

Not sure if this should be a tangent or not but let me tell you about a not dissimilar situation I faced a couple of weeks ago. Some 'travellers' (i will try to remain polite!) brought in a moribund still heavily pregnant whelping bitch just as I was coming back from lunch, claiming they'd found it under their van on the pikey traveller's camp and that they'd go back and try to find the owner. I didn't believe this for one moment and am sure it was their's but it was admitted by the assistant and a nurse and put on oxygen. I took over and there was an obvious dilemma. This bitch probably wasn't going to survive surgery or produce live pups and if she did who was going to care for them? I suspect the original 'travellers' had taken her to another vet,been told it was going to cost them and decided to come to me and try a different ruse. I called them on the mobile number they gave and I got the same story. I told them that if they weren't going to pay for surgery the bitch would die or I would have to euthanase her. They kept to the original story.

I didn't phone the RCVS because I knew I'd get the same crap advise as the OP in this thread, but I did call the VDS and they said that provided in my opinion it wasn't going to survive without immediate surgery and no-one was prepared to pay then I was justified in euthanasing her and they would defend me. This is the course I followed. I kept the body for 2 weeks before disposing of it and surprise, surprise no 'owner' has ever called enquiring after her.

What would other's have done in these circumstances?

RE: dog requiring pyometra surgery but microchip registered as missing

Luca Poddighe — Thu, 30 Jul 2015 09:19:28 GMT

The two messages...

[quote user="intelligenteaser"]they said we had to wait until after such a letter had been sent and recieved..... [/quote]

...and...

[quote user="chris barker"]Perhaps if they turned the enquiry round - if they had asked you "Do you think the animal's future health will be adversely affected by waiting for permission?' 'Is the animal's condition critical and the animal to be experiencing unnecessary pain/'suffering?' 'Do you fear long-term kidney impairment from any further delay?' And if in reply you had answered 'Yes' then the decision is made, the problem sorted and your defence to any future allegations of misconduct, legal or professional, firmly established.

The advice line is staffed by solicitors - they are not clinicians. The clinical judgement bit is up to you! But be assured that they do contact people like me for veterinary input if the query strays into areas in which they have limited previous experience.[/quote]

...mean two completely different things. I agree with the fact that staff are solicitors and not clinicians, but clearly they have been misunderstood as the OP reported that "he had to wait until the letter was sent and received" and I would add answered positively, therefore there's a problem of communication that has to be addressed. The reason why I say so, with no acrimony believe me, is that if someone is ringing for advice is clearly not sure of what to do and needs some guidance. If they guide loses, or doesn't have the knowledge to evaluate, the main picture (i.e. an animal that has a very serious condition and could get worse) and give a very straight forward advice to wait, I would wait and believe that I have all the rights to do so. Bear in mind that the person who's phoning is likely to be somebody that hasn't a lot of surgical and clinical experience, and is expecting experts to lead him.

RE: dog requiring pyometra surgery but microchip registered as missing

Chris Barker — Thu, 30 Jul 2015 08:33:05 GMT

OK - without your permission (your name, not an alias, the date of enquiry, and details of the case) I cannot go back to the advice dept at the RCVS and find out what their records of the advice offered to you actually say. But remember, if you operate on an animal without an owners consent then you are performing a trespass. Whether that opens you up for legal action/redress will depend on the circumstances. So the RCVS is simple reminding you that you must be satisfied that the clinical situation warrants your immediate intervention.

Perhaps if they turned the enquiry round - if they had asked you "Do you think the animal's future health will be adversely affected by waiting for permission?' 'Is the animal's condition critical and the animal to be experiencing unnecessary pain/'suffering?' 'Do you fear long-term kidney impairment from any further delay?' And if in reply you had answered 'Yes' then the decision is made, the problem sorted and your defence to any future allegations of misconduct, legal or professional, firmly established.

RE: dog requiring pyometra surgery but microchip registered as missing

Luca Poddighe — Tue, 28 Jul 2015 09:15:13 GMT

[quote user="intelligenteaser"]not the advice the person at the RCVS told me....i think i called them (again maybe) after the phone call .they said we had to wait until after such a letter had been sent and recieved..... and not to proceed with the surgery until then unless it became imminently/immediately life threatening cant remeber their exact words but yeah.. obviously i queried it but they didnt budge on their recommendations..was quite shocked really...and made me more nervous for future cases....(hence posting on here)[/quote]

And this is a good system to (set of nasty words indicating some sexual activity) you (in general not you in the specific). Because, beside your judgement of immediate risk for the life of the patient, what is required to decide? And if I decide to wait and the situation slowly deteriorate, for example causing some kidney impairment due to immuno-complexes secondary to the pyo, who's responsible to have waited for the letter to be sent?

RE: dog requiring pyometra surgery but microchip registered as missing

intelligenteaser — Mon, 27 Jul 2015 23:03:50 GMT

[quote user="Luca Poddighe"]

[quote user="Martin Atkinson"]I don't think where a situation exists that an animal is in discomfort or it's condition may deteriorate if not treated urgently, whether that be life-threatening of not, that 'making every attempt to contact the owner' includes waiting for a recorded delivery letter[/quote]

I agree completely with Martin on this. If the patient is presently suffering and immediate approach can resolve the problem, contacting the owner is not a priority on humane grounds.

[/quote]

not the advice the person at the RCVS told me....i think i called them (again maybe) after the phone call .they said we had to wait until after such a letter had been sent and recieved..... and not to proceed with the surgery until then unless it became imminently/immediately life threatening cant remeber their exact words but yeah.. obviously i queried it but they didnt budge on their recommendations..was quite shocked really...and made me more nervous for future cases....(hence posting on here)

RE: dog requiring pyometra surgery but microchip registered as missing

Luca Poddighe — Mon, 27 Jul 2015 11:13:14 GMT

I agree completely with Martin on this. If the patient is presently suffering and immediate approach can resolve the problem, contacting the owner is not a priority on humane grounds.

RE: dog requiring pyometra surgery but microchip registered as missing

Martin Atkinson — Mon, 27 Jul 2015 09:32:12 GMT

[quote user="intelligenteaser"] Have previously contacted RCVS for similar issue (dumped -definitely abandoned rabbit with one testicle hanging out with a microchip (think it was chipped by the shop it was sold at). They then advised unless imminenly lifethreot ing with surgery until every attempt to contact owner had been made, [/quote]So when you get reported for allowing the animal to suffer 'for a few days' what would be their response then? I don't think where a situation exists that an animal is in discomfort or it's condition may deteriorate if not treated urgently, whether that be life-threatening of not, that 'making every attempt to contact the owner' includes waiting for a recorded delivery letter. The denial on the telephone number recorded is more than enough. Personally I would have taken that as enough to justify euthanasing the poor rabbit if I wasn't going to be philanthropic enough to treat it for free.

RE: dog requiring pyometra surgery but microchip registered as missing

Silvia Maldonado — Sun, 26 Jul 2015 23:05:55 GMT

[quote user="Kate Richardson"]

My one and only pyometra treated with Alizin was a messy affair. And not really that cheap in a reasonable size dog

[/quote] Agree I've done it a couple of times (cost, age) and within 3 months the problem was back. However, the protocol I used was the one for abortion (2 injections in 48h, I think...)

RE: dog requiring pyometra surgery but microchip registered as missing

Catriona MacIntyre — Sun, 26 Jul 2015 22:06:43 GMT

I had similar experiences Kate.

I definitely wouldn't use it in a closed pyometra. Even in open pyometras, as long as they are reasonably stable, or you can make them so fairly quickly, I can't help thinking the best way to improve things for the bitch is to remove the ovaries, uterus, and the pint of pus contained therein!

If presented at night or at the weekend, I will often operate there and then if they are stable. I'm in a small mixed practice and find it better to deal with these immediately rather than plan to do it another day, then have a load more stuff like blocked cats etc crash on in to the operating list :)

RE: dog requiring pyometra surgery but microchip registered as missing

Kate Richardson — Sun, 26 Jul 2015 21:20:14 GMT

My one and only pyometra treated with Alizin was a messy affair. And not really that cheap in a reasonable size dog

RE: dog requiring pyometra surgery but microchip registered as missing

Hannah Wynne Richards — Sun, 26 Jul 2015 16:47:33 GMT

Evelyn This time I agree with you.

Wynne

RE: dog requiring pyometra surgery but microchip registered as missing

Rob Loxley — Sun, 26 Jul 2015 16:18:42 GMT

[quote user="John Flynn"]I'd use the regimen of 10mg/kg on days 0, 2, 5, 8[/quote]

Interesting, I'd missed this and when I spoke to Virbac a month ago they didn't mention it either. Currently have a border with CEH/pyo trying to treat with Alizin as is had a very bizarre congenital cardiac dysrhythmia. Have given a couple of further doses beyond the 'classic' protocol and while the scan looks very much better, still some vulval swelling and mucoid discharge.

RE: dog requiring pyometra surgery but microchip registered as missing

Utlendigur — Sun, 26 Jul 2015 10:33:41 GMT

[quote user="John Flynn"]Generally you need to do what your boss requires of you unless it's totally unreasonable. Every vet will have their own opinions, and the luxury of being the boss is that your opinion trumps everyone elses.[/quote]

I don't completely agree with that. Yes you are required to stick to practice policies which shouldn't stray too far into interfering in clinical management, but as far as individual clinical decisions, as a vet I consider that I am a professional responsible for my own decisions that are made, together with the owner, in the best interests of the patient.

RE: dog requiring pyometra surgery but microchip registered as missing

Utlendigur — Sun, 26 Jul 2015 10:28:43 GMT

[quote user="Silvia Maldonado"]I suggested alizin as another option and was criticized for we (they) would get in trouble if it didn't work. [/quote]

If you had advised the owners of the fact that there was a chance it wouldn't work, the dog could deteriorate before it had a chance to work, pyo could recur and the cascade (particularly if you had got signed off-licence permission) I would say that is informed consent and there would not be a problem. If the owners couldn't afford what you considered best treatment, they have to accept there are risks with alternatives. I would wonder whether it was more a case of the OOH provider seeing a nice juicy pyo fee vanishing in favour of medical treatment that would be continued by the member practice.

RE: dog requiring pyometra surgery but microchip registered as missing

John Flynn — Sun, 26 Jul 2015 08:54:37 GMT

[quote user="Silvia Maldonado"]Opinios? Experiences?[/quote]

Generally you need to do what your boss requires of you unless it's totally unreasonable. Every vet will have their own opinions, and the luxury of being the boss is that your opinion trumps everyone elses.

Alizin is reasonably expensive here (Ireland), however, and will require multilpe revisits ( I wouldn't dispense it due to product risks in humans), so surgery is quicker and cheaper for me and by far my prefered option. Ignoring money and from a clinical perspective, I can see no advantage to rushing into surgery wihtout medically stabilising the patient at loeast to the extent of restoring circulating fluid volume first though (unless perhaps an otherwise closed pyo ruptures internally), and in many bitches I cannot see a clear clinical advantage of surgery over medical treatment - indeed in some cases I would have a clear preference medical treament.

Regarding evidence for efficacy, read in detail the paper where I posted the abstract above. Pay attention to details (or lack of them) on case presentation and selection to see what cases these findings may be extrapolated towards.

RE: dog requiring pyometra surgery but microchip registered as missing

Silvia Maldonado — Sun, 26 Jul 2015 00:36:41 GMT

Nice to hear there was a happy ending ;)

Team, I have a question in regards with off license, the cascade, etc. When I was working for an OOH corporation company, and had to discuss a pyo case whose owners couldn't afford surgery, I suggested alizin as another option and was criticized for we (they) would get in trouble if it didn't work. Opinios? Experiences?

RE: dog requiring pyometra surgery but microchip registered as missing

intelligenteaser — Sat, 25 Jul 2015 20:07:45 GMT

Apologies for typos on a small mobilephone atm. Just an update on the case contacted the person the microchip registered to, not contesting ownership, thought microchip details had been changed by new owners (not the current ones) so went ahead and spayed to remove a huge uterus (def pyo) so luckily all worked out ok in this case but interesting to hear everyones replies. Have previously contacted RCVS for similar issue (dumped -definitely abandoned rabbit with one testicle hanging out with a microchip (think it was chipped by the shop it was sold at). They then advised unless imminenly lifethreot ing with surgery until every attempt to contact owner had been made, the mobile number the person who answered denied all knowledge of any rabbits so had to delay surgery for a few. days until a recorded delivery letter had been confirmed as recieved and still no attempt to contact us

RE: dog requiring pyometra surgery but microchip registered as missing

John Flynn — Sat, 25 Jul 2015 19:41:52 GMT

[quote user="Evelyn Barbour-Hill"]The dog needs surgery.[/quote]

I would do surgery personally in this case (and indeed on most pyometras due to cost and probable reduced antibiotic use and risk of recurrence otherwise), but I think medical treatment is reasonable and use it in select cases (e.g. patients with severe mitral regurg at risk of going into CHF after anaesthetic)

I can see little disadvnatage to starting medical treatment in this case (although personally I'd just spay it, particularly in charity setting) if the vet wishes to speak to registered owner who has reported dog missing and involve them in decision making on the basis that iv fluids, drip and a single injection of algepristone in a reasonably well patient is not a particularly risky intervention and unlikely to lead to a more negative prognosis for the patient than opting for "urgent" ovariohysterectomy.

Vet Res Commun. 2015 Mar;39(1):1-5. doi: 10.1007/s11259-014-9619-9. Epub 2014 Oct 18.

Effectiveness of a modified administration protocol for the medical treatment of canine pyometra.

Contri A¹, Gloria A, Carluccio A, Pantaleo S, Robbe D.

Author information

Abstract

Pyometra is one of the most common diseases in intact bitches. The aim of this study was to evaluate the effectiveness of a modified aglepristone protocol for the medical treatment of pyometra in the bitch. Of these, 73 bitches affected by pyometra of different breeds and age (2-14 years old) were enrolled. They were randomly assigned to a control group (CTG - 26 bitches) treated with classical protocol (aglepristone at 0, 1 and 6 days - day 0 = day of the diagnosis) and a modified treated group (MTG - 47 bitches) treated with a different administration protocol (aglepristone at 0, 2, 5 and 8 days). The classical protocol with the anti-progestagen aglepristone was effective in 88.5 % (23/26) of CTG bitches while the modified protocol was effective in all (47/47) of MTG bitches. One of the 23 CTG bitches received a further administration on day 14, which resolved the pyometra, while in the three cases of CTG bitches, in which the treatment was ineffective, an ovariohysterectomy was carried out. The modified protocol showed a success rate of 100 %, compared with the classical protocol proposed in the literature, and no recurrence of the disease was recorded in the 24 months follow up. After treatment, the oestrus onset was earlier than expected (interoestrus of 128 ± 32 days). In this study, the modified treatment protocol showed high efficacy and lack of recurrence within 24 months, suggesting a complete recovery of reproductive function in the bitch, with a normal fertility.

RE: dog requiring pyometra surgery but microchip registered as missing

Evelyn Barbour-Hill — Sat, 25 Jul 2015 15:24:57 GMT

Sorry if I've missed something, but:

The dog needs surgery. The person who is quite clearly at present the "carer" and the "person having charge" has given consent. So get on and do it.

The ownership matter is a different question that you can sort out at leisure.

Are you worried about the person currently in possession of the dog refusing to pay if they can't keep the dog? Well, that's a risk you have to take I guess.

RE: dog requiring pyometra surgery but microchip registered as missing

Clive Ansell — Sat, 25 Jul 2015 11:12:37 GMT

[quote user="Chris Barker"]Under data protection rules you are not allowed to report this finding either to the database holder or to the registered owner unless the person in front of you, the current 'carer', gives their permission. Even if they have stolen the animal they can forbid you to release this detail.[/quote]

I had a case about 4 years ago; a 9 month Bull Mastiff presented for first vaccination after being bought in a pub. It was microchipped, and turned out to have been reported stolen about 2 weeks before. Following VDS advice, we were able to contact the original owners to report that their dog had been presented and was fit and well, but could not pass any details of the new "owners" to them. The new "owners" were asked, but refused to allow their details to be forwarded, at which point the police became involved. When I mentioned data protection to the police, they told me it was now a police matter and a criminal investigation and I had to comply with their request for the information relating to the new owners. Happy ending and dog was reunited with his rightful owners. I think the important thing is to get VDS/RCVS before doing anything.