Lower lid Entropion in puppies

Re: Lower lid Entropion in puppies

Vikki Halliday LLB — Sun, 06 Jun 2010 19:31:58 GMT

[quote user="Peter Ding"]

With the owners permission we inject them into a cadaver for cremation. You've just got to choose the right owner,.

[/quote][quote user="Peter Ding"]Although I get the impression that you might worry about off licence use![/quote]

Er um, not really since the animal is dead. Fairly easy one that as licences exist usually for living species...........

Re: Lower lid Entropion in puppies

Rob Loxley — Sat, 05 Jun 2010 19:46:29 GMT

[quote user="Peter Ding"]

i.e Sometimes one should look outside the conventional "wisdom" box in order to find better solutions to problems.

e.g. I have one which is our practice's answer to disposal of occasional small amounts of out of date liquid medication.

With the owners permission we inject them into a cadaver for cremation. You've just got to choose the right owner,.

I've asked every authority involved in COSHH etc if any rules are broken in doing this but no-one can see any objection. It's a very simple solution that is very practical and is cost free.[/quote]

Going OT: If you are disposing of out of date schedule 2 controlled drugs then the Misuse of Drugs Regulations 2001 apply, and are specific in requiring an authorised person to witness such destruction/disposal. For disposal of schedule 3 & 4 liquid CDs then the RPSGB provide useful advice on their website for simple disposal with suggested methods to render them irretrievable which don't require asking clients 'sensitive' questions, and commercial denaturing kits are also readily available which can then go in the DOOP bin. For non-CD liquid drugs is the DOOP bin not sufficient?

Re: Lower lid Entropion in puppies

Peter Ding — Sat, 05 Jun 2010 11:20:46 GMT

Alleviating the animals discomfort is obviously the aim. But if you have two options that work but one is looks better i see no problem with opting for that one. Cosmetic appearance is not a dirty phrase! It pleases owners.

You entirely miss the point that iatrogenic facial fold pyoderma can also be uncomfortable and if a percentage of pups end up rubbing their faces anyway with eversion sutures, one must consider other possible treatments. (Physician - do no harm!)

The suture method is good but it isn't perfect. I've actually just used it on the pup in question but have warned the owner of possible disadvantages, problems and side effects.

In my experience they just don't get any issues with an injection into the lower eyelid which can achieve the same result with a far simpler outpatient procedure, involving lower incidence of side effects and significantly less cost. With procedures, there are no "licences" nor any "cascade", it's down to what is being used by other vets and what is effective.

The only question in my mind is what type of injection works best.

I would agree that, despite it never causing problems in my experience, it's probably not a good idea in this litigious day and age to use a non-certified sterile product, but imho the cascade is pretty irrelevant when there is no licensed product to treat entropion. Cascade applies to the condition being treated, not the product. In any case if anything same species but another condition applies first! Certainly before staples designed for hairless human skin!

i.e Sometimes one should look outside the conventional "wisdom" box in order to find better solutions to problems.

e.g.

I have one which is our practice's answer to disposal of occasional small amounts of out of date liquid medication.

With the owners permission we inject them into a cadaver for cremation. You've just got to choose the right owner,.

I've asked every authority involved in COSHH etc if any rules are broken in doing this but no-one can see any objection. It's a very simple solution that is very practical and is cost free.

Although I get the impression that you might worry about off licence use!

Re: Lower lid Entropion in puppies

Vikki Halliday LLB — Sat, 05 Jun 2010 00:13:29 GMT

[quote user="Peter Ding"]

Why would having a product licence be a consideration for a minor surgical procedure?

[/quote]

#I would have thought that because you are using a licenced product for something other than that which it is intended/licenced for, then you are taking a bit of a wander into cascade territory!

[quote user="Peter Ding"]

Injecting liquid paraffin has been used quite successfully by some vets in the past. Not that it's sterile of course but it did seemed to do the job, lasting for several months, longer than depot preparations of antibiotics, for example.

[/quote]

Dread to think of the potential complications of injecting non-sterile material into delicate periocular tissues!

[quote user="Peter Ding"]

The eversion suture technique is ok but it looks worse and I've occasionally seen skin minor fold pyoderma triggered in the lids.

[/quote]

What is the issue here? The animal's comfort or cosmetic appearance?

Think you can guess the answer to that one. Not sure the defence of " it looked better" will help if you end up in a litigious situation.

Re: Lower lid Entropion in puppies

Rob Reid — Thu, 03 Jun 2010 16:28:52 GMT

I favour 'tacking' sutures in these cases - usually use wide metric polysorb or biosyn and find they work very well. Generally only need to use 1 suture in the centre of the lid but in larger pups may need 2. I do them all under sedation or GA now though in the past I have seen them done under local though I tend to favour having my patient a bit stiller!

This procedure works well I find but you sometimes have to go back and revise your tack again a few weeks later. If the tacks are correctly performed there are relatively few problems other than falling out - I have never seen one cause any skin irritation.

I have to say that I wouldn't be too happy injecting liquid paraffin into any area, never mind an eyelid...

Re: Lower lid Entropion in puppies

Peter Ding — Thu, 03 Jun 2010 13:32:23 GMT

Why would having a product licence be a consideration for a minor surgical procedure?

Are human staples licenced for dogs?

The eversion suture technique is ok but it looks worse and I've occasionally seen skin minor fold pyoderma triggered in the lids.

I just wondered if anyone has found something sterile that works for as long that is inexpensive..

Re: Lower lid Entropion in puppies

Vikki Halliday LLB — Thu, 03 Jun 2010 12:54:00 GMT

As anything you inject will not be licenced, I would tend to go for temporary sutures or staples, which can be applied conscious in some dogs.

Not sure what I would use for injection, but perhaps those with contact in the human field could get hold of some collagen off licence?