Low residue diet for dog with perineal hernia

RE: Low residue diet for dog with perineal hernia

Julian Earl — Mon, 06 May 2019 10:37:12 GMT

What is the state of the prostate? Okay I know it is castrated but that does not rule out a prostatic tumour. These are very difficult cases and I always found surgical repair difficult but prostate therapy as appropriate can help a lot. Plus a standard low-residue diet.

RE: Low residue diet for dog with perineal hernia

Rob Loxley — Sun, 05 May 2019 19:37:46 GMT

[quote user="Alistair Graham-Evans"]That estimate sounds high to me. Maybe my fees are too low![/quote]

Quick google of referral places that publish prices comes up more £2-2.5k

RE: Low residue diet for dog with perineal hernia

grumpyoldman — Sun, 05 May 2019 19:08:16 GMT

[quote user="Michael Woodhouse"]

I'f I'd done the surgery the first time and it had failed, I'd go back in with mesh a 2nd time and really charge to cover my costs.

I can't see where thousands of pounds of surgical time or equipment comes in?

[/quote]

We always try to do remedial 2nd surgeries at (cost) as long as the clients have followed instructions, sometimes when something has gone out of the door post op care is terrible meds are not given and follow up is poor or wound tampering has happened. The practice does not take the hit on that. My first boss always said if you restore a wound for nothing you will do it a half a dozen times but if you charge them for it they will look after it the next time ,and he did have a point. Just for interest I looked at 50 insured surgeries and compared them to 50 uninsured surgeries and found that post op wound consults were 3 times higher in the insured group, clients were more vigilant with post op care when they had paid the bill themselves.

RE: Low residue diet for dog with perineal hernia

Alistair Graham-Evans — Wed, 01 May 2019 07:24:46 GMT

I think I can give a competitive quote for doing the surgery at your clinic which includes my travel expenses .....

from Brisbane

RE: Low residue diet for dog with perineal hernia

Michael Woodhouse — Wed, 01 May 2019 01:40:22 GMT

[quote user="David Mills"]The dog needs surgery or PTS really. As above, it's not technically challenging. Imo it's not even a referral level surgery.[/quote]

I'f I'd done the surgery the first time and it had failed, I'd go back in with mesh a 2nd time and really charge to cover my costs.

I can't see where thousands of pounds of surgical time or equipment comes in?

RE: Low residue diet for dog with perineal hernia

David Mills — Wed, 01 May 2019 00:15:52 GMT

[quote user="Bob Russell"]Don't you find that most referral surgeries are of the order of £3-4K almost whatever they are?[/quote]

Ha, yep, we've been researching this recently and it's true. Some of it for simple procedures like anal gland removal or pyometra.

There is mission creep here with increasing corporatisation. Once clients are in the system they can't always get out. Most things are referred upwards. New grads are told.to refer things that 2, 5 years ago would be considered routine in GP. It's a vicious, deskilling cycle to maximise profits and minimise individual thought, innovation or clinical judgement in pursuit of the insurance dollar. There are even CPD lectures these days on maximising the insured client for your practice. Heading for the wall one fears.

RE: Low residue diet for dog with perineal hernia

David Mills — Tue, 30 Apr 2019 23:53:51 GMT

[quote user="Delia Richter"]

Thanks everyone! I will nudge the o back in the direction of surgery. The original surgery was done at the practice I am at, before I was here, by a vet that has left. I understand the surgery has a high failure rate anyway, and I am not a surgeon so wouldn't like to comment on anyone else's surgery. No-one here now really wants to touch this surgically with a barge pole.... We'd much rather refer!

[/quote]

The dog needs surgery or PTS really. As above, it's not technically challenging. Imo it's not even a referral level surgery.

RE: Low residue diet for dog with perineal hernia

Delia Richter — Tue, 30 Apr 2019 20:59:54 GMT

RE: Low residue diet for dog with perineal hernia

grumpyoldman — Tue, 30 Apr 2019 11:25:11 GMT

[quote user="Bob Russell"]

Don't you find that most referral surgeries are of the order of £3-4K almost whatever they are?

Probably tangent territory!

[/quote]

Yes at least, usually though the guru is required by their employer to turn over 10K a day, and they are not doing many consults or any minor ordinary stuff as well to put bread and butter on the table. Its also aimed at a 90% insured clientele. You may also find that the client is prevented from going locally by a tied in healthcare scheme that only allows referral up the corporate food chain. So the client has to get themselves sacked to go elsewhere locally.

RE: Low residue diet for dog with perineal hernia

Bob Russell — Tue, 30 Apr 2019 09:18:36 GMT

Don't you find that most referral surgeries are of the order of £3-4K almost whatever they are?

Probably tangent territory!

RE: Low residue diet for dog with perineal hernia

Thomas Johnson — Tue, 30 Apr 2019 08:31:09 GMT

[quote user="Delia Richter"]His owners are not keen on a repeat surgery - insurnace has run out and referral is about £3000 - £4000.[/quote]

Have you thought about speaking to other local first opinion practices to see if there is anyone with experience of doing the surgery? Costs may be significantly lower than at a big referral centre. Or you may be able to find a specialist who will come in to your practice to do the surgery, again costs likely to be a lot less than an external referral.

RE: Low residue diet for dog with perineal hernia

Alistair Graham-Evans — Mon, 29 Apr 2019 21:49:07 GMT

I’m afraid only appropriate surgery will resolve this. The overall cost may well be less than the inevitable repeat GA’s and removal of impacted faeces and the dog will be happier too. I assume it is castrated and you have ruled out any other predisposing causes of tenesmus. That estimate sounds high to me. Maybe my fees are too low! Good luck.

RE: Low residue diet for dog with perineal hernia

grumpyoldman — Mon, 29 Apr 2019 21:21:27 GMT

Its a relatively easy surgery the first time ,the internal obturator lift generally works extremely well , there was a fall back repair involving lifting and plugging the defect with the Semi tendinosus harvested from the thigh area. Surgical problems require surgical solutions . I see these cases as a 3rd or 4th opinion with chronic medically induced diahorrea and tenesmus because someone has tried repeatedly and failed to refer them up the corporate food chain. Just get some balls really and fix it or send it back to where the original repair failed and mess up their clinical audit numbers a bit with some reality.

RE: Low residue diet for dog with perineal hernia

Dinu Catilina — Mon, 29 Apr 2019 19:53:30 GMT

Hi Delia

I personally found these cases not to respond to any type of diet and they end up ethanasied without surgery. Have you considered repeating the surgery and closing the defect with a polypropilene mesh? The results are excellent and the surgery ispretty straight forward. Not costly either, we charge about 1000-1200 depending on the dog's size.

RE: Low residue diet for dog with perineal hernia

Thomas Johnson — Mon, 29 Apr 2019 15:38:21 GMT

[quote user="Delia Richter"] Is Royal Canin GI low residue enough? Does anyone know of something better we can put him onto long term?[/quote]

Purina Proplan EN Gastrointestinal is advertised as low residue, but not sure if it is any better or worse than Royal Canin GI.