Dog limb dressings

RE: Dog limb dressings

Bob Russell — Thu, 05 May 2016 13:29:54 GMT

Worth remembering that the body can do impressive things when it comes to healing. Tendons manage to heal when you don't think they will and most will return to pretty acceptable function in time. Probably not adequate for a high performance dog.

They don't require the dexterity that humans do!

Even if things look depressing at this stage, all is not lost!

RE: Dog limb dressings

Anthony Dennison — Thu, 05 May 2016 09:31:39 GMT

When it comes to these sorts of things, the thing to look at is would other vets have done what you did.

1) Most of us agree leaving the foot out isn't a bad thing and many of us do it.

2) Most of us agree leaving a foot bandage on for 10 days without rechecking/redressing is not good practice.

Who looks bad now?

RE: Dog limb dressings

Malcolm Ness — Thu, 05 May 2016 08:02:11 GMT

Several aspects to this both clinical and otherwise:

In my experience, wounds on the palmar/plantar aspect of the distal limb are often complicated by involvement of the underlying vasculature and flexor tendons. These complications are not infrequently overlooked by the attending veterinary surgeon. However, it is also my experience that such wounds are more likely to break down than a simple skin wound in the same location whether dressings are used or not.

I prefer to leave the foot out of dressings or casts when appropriate for the reason that Evelyn mentions in addition to the desire to maintain near normal weight bearing on the limb.

In this case, the implicit flexor tendon injury was an indication for including the foot, but only if the injury had been recognised and treated and in that case a much more substantial dressing that prevents weight bearing and protects the repaired tendons against loading over several weeks.

Ideally, the full extent of this injury should have been appreciated on day one. But we don't live in an ideal world and this is an oversight that I have seen made by numerous vets on many occasions and I have done it myself.

At this stage, the tendons should still be repairable with a good prognosis for an excellent cosmetic and functional outcome. However, the surgery is always more extensive, complex and fiddly than most imagine and there is a requirement for careful dressing/cast management after surgery so there is considerable cost and hassle associated with these cases.

I would get in touch with VDS - I expect that they will make you feel a lot better and defend robustly your actions as described in the OP.

RE: Dog limb dressings

Clare Tapsfield-Wright — Thu, 05 May 2016 07:15:46 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Clare Tapsfield-Wright"] We all ? get lines where the tops of our socks are tight and just wearing elastic socks prevents my feet swelling on a plane without them cutting off the circulation to my feet.[/quote]

Yeah, but that's just lymph distribution. No inflammation is involved.

[/quote]Yes of course , still uncomfortable though for dog or human . interesting discussion which endorses the fact that different vets have different opinions . Main point is not to bandage too tightly in the first place.

RE: Dog limb dressings

Evelyn Barbour-Hill — Thu, 05 May 2016 02:15:54 GMT

Yeah, but that's just lymph distribution. No inflammation is involved.

RE: Dog limb dressings

Anthony Todd — Thu, 05 May 2016 00:16:36 GMT

[quote user="Evelyn Barbour-Hill"]When I was a very new graduate I received some sound advice from an expert. Enclosing the foot does not somehow magically preserve a normal circulation distal to a bandage that is too tight. It just conceals the foot. It might well "prevent the foot from swelling" – with detrimental results as the foot tries to swell within its coffin......[/quote]

As usual, more cast iron advice. Enclose a foot with anything constricting above it, plaster, bandage or whatever, and you'll never know the circulation is compromised until the foot falls off......

RE: Dog limb dressings

Clare Tapsfield-Wright — Wed, 04 May 2016 23:40:29 GMT

Re including foot , I'm not convinced of that although I know I'm not an expert . We all ? get lines where the tops of our socks are tight and just wearing elastic socks prevents my feet swelling on a plane without them cutting off the circulation to my feet. Bandaging without constriction is a real skill

RE: Dog limb dressings

John Flynn — Wed, 04 May 2016 23:36:25 GMT

I'd avoid a war of words:

"Thank you for your feedback that the dressing may have been too tight causing the foot to swell and that the wound broke down. Best wishes, John"

Whether the foot was swollen 2 days later due to vascular damage or a dressing that was too tight is going to be impossible for you to tell now in your position.

Whether the wound broke down due to infection, excessive tension or inadequate post-op management is also probably impossible for you to tell.

I'd forget about this case (assuming you have no responsibility for it anymore or any authority to respond to a request for a refund) as I don't think you'll get any more value from reflecting on it further - I think enough respondents here have confirmed that the inclusion of the foot in a bandage is not something that is universally considered a good idea.

RE: Dog limb dressings

Bibs — Wed, 04 May 2016 23:26:45 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Elizabeth Billimore"]very bad of me to have not enclosed the foot and that was the root of all the problems[/quote]

That is, if you will pardon me, absolute c**p.

You have grounds for a complaint against the "other vet" (if you can be bothered).

I rarely enclose the foot in a dressing unless what I'm dressing is very close o the foot.

When I was a very new graduate I received some sound advice from an expert. Enclosing the foot does not somehow magically preserve a normal circulation distal to a bandage that is too tight. It just conceals the foot. It might well "prevent the foot from swelling" – with detrimental results as the foot tries to swell within its coffin......

[/quote]

Thats what I thought too.

RE: Dog limb dressings

Evelyn Barbour-Hill — Wed, 04 May 2016 23:10:03 GMT

[quote user="Elizabeth Billimore"]very bad of me to have not enclosed the foot and that was the root of all the problems[/quote]

That is, if you will pardon me, absolute c**p.

You have grounds for a complaint against the "other vet" (if you can be bothered).

I rarely enclose the foot in a dressing unless what I'm dressing is very close o the foot.

RE: Dog limb dressings

Robin Grimmer — Wed, 04 May 2016 22:32:53 GMT

[quote user="Elizabeth Billimore"]

The vet sent a letter complaining with photos of the dehisced wound from 10d later. Basically the wound had just broken down and that was it. They were unhappy the client had paid whatever cost

[/quote]

Actually staggered by this. I would write back and say that you did nothing wrong and that wound breakdown is a common sequel to a wound repair and perhaps they were ill advised in leaving the dressing on for 10 days without changing. Then suggest they might like to cover their own ooh work. Then call VDS.

RE: Dog limb dressings

grumpyoldman — Wed, 04 May 2016 22:18:08 GMT

I have heard of these situations before , the vet uses an OOH service provider but a proportion of their clients are not happy about it , and bump their gums about fees when made to go there , however there is something of a personality cult going on so the clients put up with it because they like their hero. The usual vet then sides with their "matey" client against the evil money grabbing OOH corporate monster and grovels, looking as if he is trying to get them a refund. He would do it himself the on call etc "but" ,family life children etc, so he is a victim too. After the string quartet has finished playing the client agrees to stay with their hero.

Dirty wounds dehisce, animals meddle, with dressings ,arseholes criticise other peoples work without having a heads up. I hate all dressings ,most of its for the clients benefit.

RE: Dog limb dressings

Bibs — Wed, 04 May 2016 22:10:23 GMT

[quote user="Gillian Mostyn"]

[quote user="Elizabeth Billimore"]the day vet had admitted it and not got around to doing it [/quote]

Is this the same vet who has now complained to you?

[/quote]

No, the OOH vet who worked the Saturday day time. I started at 7pm and this was waiting for me in a kennel. He offered to stay back and finish it....I wish I'd made him

RE: Dog limb dressings

Michael Woodhouse — Wed, 04 May 2016 22:10:21 GMT

[quote user="Elizabeth Billimore"]I might approach the vet at some point but not sure what I'd say. [/quote]

If they behaved as you say, then I think this would be wasted breath!

Sounds like you did a fine job - I would likely have dressed as you did.

RE: Dog limb dressings

Clare Tapsfield-Wright — Wed, 04 May 2016 22:08:57 GMT

Don't beat yourself up Elizabeth , these things happen , youve immediately taken steps to rectify and been honest about the whole thing. Onwards and upwards and don't lose sleep, you're only human

RE: Dog limb dressings

Gillian Mostyn — Wed, 04 May 2016 22:04:00 GMT

[quote user="Elizabeth Billimore"]the day vet had admitted it and not got around to doing it [/quote]

Is this the same vet who has now complained to you?

RE: Dog limb dressings

Bibs — Wed, 04 May 2016 21:59:43 GMT

[quote user="Gillian Mostyn"]

[quote user="Elizabeth Billimore"]I think money back. [/quote]

I really hope that doesn't happen. [quote user="Elizabeth Billimore"]The client has been offered a discounted attempt at repairing the tendons because I ideally should have picked it up at the time of injury by extending the wound and exploring.[/quote]

Sounds like a generous goodwill gesture, and a good attempt at a compromise. I'm not sure that it should be worded that it is due to any 'fault' on your part though. You did your best with the information/wound you had in front of you in a very busy clinic. Hindsight is always perfect....!!!!

[/quote]

Thanks. This has made me feel a bit better. I got the impression that the vets thought it was very bad of me to have not enclosed the foot and that was the root of all the problems. I just wanted to suss out if this was such a crime. Anyway as always airing the problem has helped.

RE: Dog limb dressings

Clare Tapsfield-Wright — Wed, 04 May 2016 21:55:29 GMT

Sounds like passing the buck to me , if they saw it two days later why did they not see the dog had knocked up toes at that stage? Why did they or the owner leave the dressing on for a further week! it must have been oozing if it had broken down . Wound dehiscence nothing to do with including the foot or not, the only reason would be to stop the foot swelling. I would robustly defend myself on the bandage front if I were you.

RE: Dog limb dressings

Gillian Mostyn — Wed, 04 May 2016 21:51:34 GMT

[quote user="Elizabeth Billimore"]I think money back. [/quote]

[quote user="Elizabeth Billimore"]I might approach the vet at some point but not sure what I'd say. [/quote]

I don't think I'd struggle with what to say. I might have a problem trying to reduce the number of 4 letter words I used in the conversation.....

This vet's behaviour is reprehensible. If they genuinely had a problem with how you handled the case, they should have contacted you directly, either written or phone call, and discussed it with you. They should certainly not have discussed your 'poor standard of treatment' with the client (beyond saying they would speak to you about their concerns) and money should certainly not be a part of the conversation.

Rest assured, what goes around comes around. Eventually.

RE: Dog limb dressings

Bibs — Wed, 04 May 2016 21:46:27 GMT

[quote user="Gillian Mostyn"]

[quote user="Elizabeth Billimore"]The vet sent a letter complaining with photos of the dehisced wound from 10d later. Basically the wound had just broken down and that was it. [/quote]

That sounds very unprofessional. I presume there must be a very good justification for a vet to do this. As I said, I'd want to speak to them directly.

[quote user="Elizabeth Billimore"]They were unhappy the client had paid whatever cost and it had failed. [/quote]

Wow. Never heard of a vet complaining on behalf of what a client has paid. I'm lost for words....

[quote user="Elizabeth Billimore"]They also sent their history from the post op checks which didn't say anything specific about the dressing, wound or foot. Only that they changed the dressing. In the letter they say the foot was swollen at the post op check.[/quote]

What is this vet actually wanting from you/your practice at this stage?

[/quote]

I think money back. They ended up getting a free consult with a surgery diplomat re the knocked up toes (I currently work in a OOH service out of a referral practice). The client has been offered a discounted attempt at repairing the tendons because I ideally should have picked it up at the time of injury by extending the wound and exploring. The dehiscence has been put down to an accepted risk with any wound repair and probably not helped by having a dressing left on for so long. I've been told not to worry about it too much but you know, I don't feel good about it.

I might approach the vet at some point but not sure what I'd say.

RE: Dog limb dressings

Joyce Whitehead — Wed, 04 May 2016 21:44:23 GMT

[quote user="Elizabeth Billimore"]

I've seen a lot of things that were not great sent from other vets but I would not tell the client they were not great. I guess its my turn this time.

[/quote]

This is an awful situation. And I would agree that if I see something not as I would have done, or a slightly less than great situation, I would do my best not to trash another vet to the client. Or write to complain. At the least they could have had a friendly word by phone. Not at all professional.

RE: Dog limb dressings

Gillian Mostyn — Wed, 04 May 2016 21:38:16 GMT

[quote user="Elizabeth Billimore"] The client said the dog was walking normally after the cut so I put ideas of significant tendon injury out of my mind really. [/quote]

As you would! Even more reason to think you did nothing wrong!

RE: Dog limb dressings

Gillian Mostyn — Wed, 04 May 2016 21:36:58 GMT

[quote user="Elizabeth Billimore"]The vet sent a letter complaining with photos of the dehisced wound from 10d later. Basically the wound had just broken down and that was it. [/quote]

That sounds very unprofessional. I presume there must be a very good justification for a vet to do this. As I said, I'd want to speak to them directly.

[quote user="Elizabeth Billimore"]They were unhappy the client had paid whatever cost and it had failed. [/quote]

Wow. Never heard of a vet complaining on behalf of what a client has paid. I'm lost for words....

What is this vet actually wanting from you/your practice at this stage?

RE: Dog limb dressings

Bibs — Wed, 04 May 2016 21:33:52 GMT

[quote user="Gillian Mostyn"]

[quote user="Elizabeth Billimore"]It doesn't help that the dog had "knocked up" toes after the second dressing removal and I had missed or under appreciated the presence of flexor tendon injury. I accept that I probably made a mistake there.[/quote]

So you, as the OOH vet, was expected to assess the full extent of tendon damage in what was presumably a 10/10 lame leg?

I wouldn't get too worried about it, if possible. It will be about money.

[/quote]

The dog had a big dressing on when I first saw it because the day vet had admitted it and not got around to doing it but it was bleeding. The client said the dog was walking normally after the cut so I put ideas of significant tendon injury out of my mind really.

RE: Dog limb dressings

Bibs — Wed, 04 May 2016 21:31:23 GMT

The vet sent a letter complaining with photos of the dehisced wound from 10d later. Basically the wound had just broken down and that was it. They were unhappy the client had paid whatever cost and it had failed.

They also sent their history from the post op checks which didn't say anything specific about the dressing, wound or foot. Only that they changed the dressing. In the letter they say the foot was swollen at the post op check. I did tell the owner very specifically to remove the dressing if there were any problems like that.

Anyway I'm not saying that I dealt with the situation perfectly but I don't like to think of myself as sub standard so I want learn from this.

I've seen a lot of things that were not great sent from other vets but I would not tell the client they were not great. I guess its my turn this time.