What would you do if presented with this?

RE: What would you do if presented with this?

David Mills — Fri, 14 Jul 2017 01:18:44 GMT

Surprised even discussion.

Pts. Purely based on current state.

RE: What would you do if presented with this?

Emma Middleton — Thu, 13 Jul 2017 21:46:39 GMT

Interesting thoughts re the locum perspective Neil and Robin.

I spoke to the vet that saw it yesterday and it sounds like she did think we could do something surgically but it was worded as "we'll try" and suture it etc, and luckily when I explained my concerns to the owner (as a fresh pair of eyes) he seemed accepting of the reality of the situation. I was worried that I was going to upset him In case his expectation was that we would "fix" it.

I agree that sometimes as a locum some clients seem to appreciate a different perspective but I think they can be cautious of locums too!

RE: What would you do if presented with this?

Neil Wheadon — Thu, 13 Jul 2017 21:24:57 GMT

[quote user="Robin Grimmer"]However, if you are the locum on ops that day, chances are you and the client haven't even met. If you say straight off that you advise PTS (even though this might be the correct/eventual course of action) when the cat has already had a long course of treatment and - importantly has been booked in for some sort of revision surgery then you might well have an unhappy client.[/quote]

I find the reverse on many cases. The advantage of a locum is that you can look at a case dispassionately. Vets are human, they become attached to their cases and sometimes an honest assessment from a 'second opinion within' is much appreciated by both client and the vet. As long as done sensitively it works.

Neil

RE: What would you do if presented with this?

Glenn Hodgson — Thu, 13 Jul 2017 20:16:04 GMT

If it's a cancerous hole I'd +1 for euthanasia.

check cytology of cavity pre surgery? Or ideally histo pre surgery. In the mean time Do something useful while in. Pack with a manuka swab, like a rabbit access?

RE: What would you do if presented with this?

Clive Ansell — Thu, 13 Jul 2017 17:56:15 GMT

+1 for PTS.

Given the cat is 17 years, very thin and losing weight, has the real possibility of metastatic disease, the lack of compliance with post op checks, in addition to this wound breakdown almost makes it a welfare issue.

Was the mass sent for histology?

RE: What would you do if presented with this?

Julie Innes — Thu, 13 Jul 2017 17:01:55 GMT

Ouch! Id be tempted to euthanase, I'm afraid, unless the owners were adamant they wanted something done. Trying to think what though! There doesn't look like there is much to debride or suture!!

RE: What would you do if presented with this?

Robin Grimmer — Thu, 13 Jul 2017 16:53:42 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Robin Grimmer"]You could try a debride and advancement flap,[/quote]

You could, but it's not going to be half so easy as one might be tempted to think.

As a general comment, if you're going to fill an eye socket with anything, Collastypt (Lyostypt) is the bee's knees.

[quote user="Robin Grimmer"]It's probably doomed to fail,[/quote]

So is it really kind to this unfortunate cat to try it?

[/quote]

I didn't say it would be easy - but therein lies the difference between being a locum in a multivet practice and being sole charge. If you or Martin had seen this cat and advised PTS the client would have accepted it as they know you and you would have been dealing with the case from start to finish.

However, if you are the locum on ops that day, chances are you and the client haven't even met. If you say straight off that you advise PTS (even though this might be the correct/eventual course of action) when the cat has already had a long course of treatment and - importantly has been booked in for some sort of revision surgery then you might well have an unhappy client. So I stand by my comments in this case.

RE: What would you do if presented with this?

Evelyn Barbour-Hill — Thu, 13 Jul 2017 16:23:16 GMT

[quote user="Robin Grimmer"]You could try a debride and advancement flap,[/quote]

You could, but it's not going to be half so easy as one might be tempted to think.

As a general comment, if you're going to fill an eye socket with anything, Collastypt (Lyostypt) is the bee's knees.

[quote user="Robin Grimmer"]It's probably doomed to fail,[/quote]

So is it really kind to this unfortunate cat to try it?

RE: What would you do if presented with this?

Emma Middleton — Thu, 13 Jul 2017 15:06:08 GMT

Thank you all so much for your thoughts, really helpful.

Had a frank discussion to manage owner's expectations, offering options of PTS, refer or I try my best to reduce the defect and close the skin. Owner quite realistic and is thinking about euthanasia.

Thanks again!

RE: What would you do if presented with this?

Robin Grimmer — Thu, 13 Jul 2017 13:26:19 GMT

As a locum too I have had to deal with similar cases/scenarios in the past. First thing is definitely speak to the vet who saw it last night and then the owner. Also - don't feel pressured in to doing anything immediately today with this cat - it won't hurt to leave it til tomorrow if necessary.

I think euthanasia would probably be the best option - but you may find having got this far, the owners may want to try one last time. You could try a debride and advancement flap, probably packing the dead space as Martin suggested. It's probably doomed to fail, but so long as you have a frank discussion with the owners (and record everything in the notes!) then you have done the best you can.

RE: What would you do if presented with this?

Neil Wheadon — Thu, 13 Jul 2017 13:13:39 GMT

[quote user="Evelyn Barbour-Hill"]Bit of a difficult situation, though, when you're the locum and some other v.s. has said you've to "debride and suture".[/quote]

Talk to the vet if you can.

If not, you must do what is in the cats best interest, you don't have to debride and suture and write good notes to justify your decision.

Martins advise to pack it isn't a bad one. In days gone by, vets used to pack enucleation sites with bandage that were pulled out after 3-4 days, once the skin had had a chance to heal.

Good Luck

Neil (a locum faced with these decisions in the past)

RE: What would you do if presented with this?

Evelyn Barbour-Hill — Thu, 13 Jul 2017 12:56:36 GMT

Euthanasia.

Bit of a difficult situation, though, when you're the locum and some other v.s. has said you've to "debride and suture".

RE: What would you do if presented with this?

Martin Atkinson — Thu, 13 Jul 2017 10:23:18 GMT

You're certainly straight in at the deep end and my first thought is I'm very glad its not me facing it. I can't see there is anything simple you could do other than try an advance a flap of skin from the lateral side use a lattice of releasing cuts to reduce tension. I wonder if you could pack the socket with alginate pads in the hope it may granulate enough to partly fill the deficit. I think euthanasia is a reasonable option especially as there is the risk of mets from the tumour.