Neutering/vaccinating/dental work

Re: Neutering/vaccinating/dental work

Anthony Todd — Sat, 03 Jul 2010 00:21:38 GMT

"ate a load of rat poison between vaccination and blood sampling. Obviously this is not the same as surgery, "

This is a start but I think we need a bit better evidence than this......

Re: Neutering/vaccinating/dental work

Rob Davis — Fri, 02 Jul 2010 14:56:32 GMT

[quote user="Anthony Todd"]No anecdotes or evidence about concurrent vaccination yet though?[/quote]

The only dog I can remember having failed to mount an adequate rabies tire for PETS ate a load of rat poison between vaccination and blood sampling. Obviously this is not the same as surgery, and it may have been coincidence, but I have always thought that any "stress" including surgery may effect the immune response to vaccination, hence the advice not to vaccinate unwell animals.

Re: Neutering/vaccinating/dental work

Anthony Todd — Fri, 02 Jul 2010 11:08:07 GMT

[quote user="Camilla Edwards"]We could always publish evidence from our own practices[/quote]

Just keep a record of problems, the number of uneventfuls will be there anyway. Then after say a year, we'll have at least some evidence upon which to base our advice.

Re: Neutering/vaccinating/dental work

Anthony Todd — Fri, 02 Jul 2010 11:02:47 GMT

This is peer reviewed evidence and as such must stand until knocked over.

Got to be better than"feelings" or what "we were taught", when ever that may have been.

So can we now say that vaccinating at the time of spaying is OK?

[bit worried about the poor serological responses though, knocks early vaccination into query surely?]

Anyone got any more references?

Re: Neutering/vaccinating/dental work

Camilla Edwards — Fri, 02 Jul 2010 08:14:16 GMT

A quick search on pubmed reveals about simultaneously vaccinating and neutering - http://www.ncbi.nlm.nih.gov/pubmed/17199493 and http://www.ncbi.nlm.nih.gov/pubmed/18593319 quite small studies, but, seeing as we're talking in anecdotes here anyway....

Couldn't find anything on dentals and soft tissue surgery, so I guess the best bet is to go with the advice of our dental surgeon Evelyn and avoid doing it!

We could always publish evidence from our own practices, seeing as quite a few of us are doing it for charities, if only we had the time!

Re: Neutering/vaccinating/dental work

Anthony Todd — Fri, 02 Jul 2010 06:33:49 GMT

Sorry "sullen" struck a nerve, will say "exhausted silence" next time.

Goody, we've got some anecdotal evidence of problems following "dual" procedures although stump granulomas following spays are well recognised and may be commoner than imagined, as not everybody palpates every abdomen when taking the stitches out.

I've certainly known of golf ball sized masses following single-procedure spays which are asymptomatic and seem to resolve with antibiotics and/or time. No incidence figures though, and the cause could be factors other than infection.

A separate thread perhaps?

The aerosolisation created by ultrasonic cleaning is a recognised health hazard for dentists, not their patients, but then we would expect wound infection not a stump reaction in the bitch??

No anecdotes or evidence about concurrent vaccination yet though?

Of course cost shouldn't enter into a medical discussion about perioperational problems but if the animal won't get a dental, even a dashed off one, probably until the smell is really bad and the owner has forgotten how much vets cost, I have a feeling our duty should be to dash of a dental after we've spayed the bitch and give it the first vacc. because they may not come back for the second anyway.;-)

We'll be quids in and the animal will feel a bit better and might even be somewhat immune.

Awaiting any evidence on the concurrent vaccination feeling.

Re: Neutering/vaccinating/dental work

sophia guymer — Thu, 01 Jul 2010 19:08:23 GMT

[quote user="Anthony Todd"]

Does sullen silence indicate agreement, disagreement, contempt or ridicule or just the usual "we were told that" [by someone who'd probably never done a dental in their life]?

[/quote]

Didn't join in because I find it hard really, as I totally agree with everybody that it is better to do them seperately, but I totally agree with you that we have done it together for years without (m)any (?) problems that we are aware off. We live in an area where people happily throw the 'its all about the money ' thing in our face and they don't have that much, so yes we do mention that we would prefer to do them seperate, and some people do opt for that, but most will actually still want it done together, as yes, it is much more expensive as the extra price for the seperate anaesth comes on top. No need to tell me that we should waver or lower that price, am only an part time vet working for a very large company (I think they are planning world domination, own vets, labs, etc etc scary!) and I just have to do what I am told! And I suppose that is why I felt there is hardly any point in replying.

I really don't think it is as much of a problem as some of you seem to think.

Re: Neutering/vaccinating/dental work

Mary Thomson — Thu, 01 Jul 2010 15:31:20 GMT

Thanks for your contributions Anthony- I've taken them into account with everyone elses. No sullen silence here- just a busy practice, late evening branch surgeries, 2 preschool children etc etc!!! I just don't log on to vet surgeon that often. I don't have scientific evidence to hand I'm afraid. I stick to the methods I have used and base these methods on my university teaching, 12 years of experience of mixed and small animal general practice, advice from more experienced colleagues and several dedicated dental cpd courses.

I have worked in practices as a locum in the past and they all stuck to the principles we use at the practice I currently work at. That's why I logged onto vet surgeon and posted this discussion- to find out other opinions on the subject!

Once again thanks everyone, I think I have a spectrum of opinions on the subject now and can report back to the others at work!

Regards

Mary

Re: Neutering/vaccinating/dental work

Hannah Wynne Richards — Thu, 01 Jul 2010 15:05:07 GMT

I'm in a Dogs Trust neutering area, so owners (on benefits )can get dogs spayed/casrated for £30, and Dogs Trust makes up the rest of the (subsidised ) fee. Some years ago, they had a "blitz ". For a limited time, owners could get worming, neutering, and vaccinating all done FOC The original Dogs Trust idea was for 1st vaccine to be done at neutering, and 2nd at s/o, because they thought that we would not agree for the proce offered if a further consult was needed. I phoned them up , as I thought it was bad medicine, and since I was prepared to do it at a seperate time, for the same price, then they agreed

As far as dentals and neutering are concerned -NO, NO, NO

I speak from experience. A local charity which takes in ex puppy farm bitches for re-homing asked me to neuter them, and as many had dreadful teeth, do dentals at the same time. I had misgivings, but agreed as they wanted a fast throughput, or had no space to rescue more. Several (4 or 5 ) out of over a hundred, developed granulomatous lesions at the cervical stump. I haven't had this problem in any other of my spays, before or since, so can only conclude that aerosol infection from dentals was responsible-sometimes, there was more than 1 bitch requiring both spaying and dental on one day-despite pressure, and knowing the reason for the pressure, I would not do so again

Wynne

Re: Neutering/vaccinating/dental work

Anthony Todd — Thu, 01 Jul 2010 02:48:14 GMT

OK, I give in. I'm sure those reading this thread will make their own minds up, even those who've been dashing off these undefined dentals and doing them the wrong way for years which seemed to please the animal and the owner.

If we're down to defining an "abscess" and a "dental" there's not much point anyway.

Re: Neutering/vaccinating/dental work

Evelyn Barbour-Hill — Thu, 01 Jul 2010 02:26:45 GMT

[quote user="Anthony Todd"]Still waiting for some, any, sort of scientific evidence, even anecdotal [which, when added together becomes scientific] but absolutely none tendered.[/quote]

Can't quote you papers off the top of my head, but the bacteraemia and the aerosol are well established and it's a pretty good principle not to mix dirty and sterile procedures. Can't give you anecdotal evidence, because I have never done it the wrong way. Most - all? - dental experts you may talk to will advise the same principle.

If you've done hundreds of dental procedures in the same session with sterile procedures, with no problems, that's fine. I've done hundreds of second GAs with no problems, and I just can't see it about "the risks and inconvenience of a second GA".

[quote user="Anthony Todd"]Surely it is better for the animal to have the teeth sorted soonest? My experience is usually that animals post-dental "eat better and are happier" the next day. Grotty teeth must be uncomfortable if not outright painful[/quote]

Yes, dental disease should be treated as soon as possible, of course. Before the neutering if necessary. Grotty teeth? Well, it depends what you mean by "grotty". Sure, if there's periodontal disease there's discomfort - not necessarily "outright pain" - it depends on the degree.

[quote user="Anthony Todd"] it's a bit like draining an abscess surely? [/quote]

Well no, not really, unless there actually is an abscess.

People keep talking about "a dental". What do you mean by "a dental"? If it's so trivial it can be "dashed off" it probably is serving no purpose whatever (except maybe cosmetic).

A dental procedure to treat periodontal disease is just the beginning of the lifelong care and attention that the patient's teeth will need.

If you do a dental procedure to treat periodontal disease when the animal is not in the hands of a permanent owner, with whom do you hold your discharge consultation where you explain what's been done, what the state of the remaining teeth and their supporting structures is, what's going to be necessary lifelong, and introduce the idea of brushing and other cleaning? Who do you see for the re-examination a week later when you check that all is healing, show the owner how to brush and supply them with correct brush and paste, or else devise another means of oral hygiene, and generally customise an oral hygiene plan for that particular animal-owner combination? How do you arrange the next checks, say one month and three months later, where you see how they are getting on and advise, praise, cajole or reprimand as seems appropriate?

Silence might not be sullen, Anthony. It might indicate that people are busy, or tired, or gone away for a holiday (hooray!), or that they feel the debate has gone on long enough and it's time to leave it.

Re: Neutering/vaccinating/dental work

Evelyn Barbour-Hill — Thu, 01 Jul 2010 01:47:29 GMT

[quote user="Rob Wilson"]

We do a lot of local RSPCA cat work and we will "sort the cat out" (neuter/dental if needed/1st vaccination and ID chip) at the same time. Cats can then be rehomed as soon as possible. Been doing this for years and never had any unexpected issues with it.

[/quote]

I've been doing second GAs (and thirds, and fourths) for many years and never had any problems or unexpected issues.

Nobody has yet explained why it's better for the patient to have its dental procedure, if it needs one, before it goes to the new owner. It seems so obvious to me that if possible it should be when it is with the new owner.

Many of you are talking about "a dental" . What exactly do you mean by "a dental" ?

Re: Neutering/vaccinating/dental work

Robert Wilson — Thu, 01 Jul 2010 00:17:09 GMT

Re: Neutering/vaccinating/dental work

Anthony Todd — Thu, 01 Jul 2010 00:06:00 GMT

[quote user="Mary Thomson"]My feeling is[/quote]

Gee, I find this common attitude so so disappointing.Where do these "feelings" come from? They must come from somewhere!

Still waiting for some, any, sort of scientific evidence, even anecdotal [which, when added together becomes scientific] but absolutely none tendered.

This is the same as the responses on the steroids for allergy thread: ohhhh, all bad but no evidence at all except the evidence of years of untoward successful use. [if used correctly, I add]

[quote user="Mary Thomson"]with cases of severe dental disease I'd rather know I've sorted the mouth out first[/quote]

Here again, but this time a poster has been doing it for years with no problems and my cry for contraevidence has produced just feelings and protocols, apart from an unsubstantiated "no,no,no" and frankly, I'm afraid, because of the concept that a dental is such a major procedure, totally glossing over the risks and inconvenience of a further GA.

Surely it is better for the animal to have the teeth sorted soonest? My experience is usually that animals post-dental "eat better and are happier" the next day. Grotty teeth must be uncomfortable if not outright painful and I would be surprised if bacteraemia was increased after teeth and tartar removal, it's a bit like draining an abscess surely?

Again happy to be corrected and even embarrassed but my aim on these forums is to end up doing things better.

Does sullen silence indicate agreement, disagreement, contempt or ridicule or just the usual "we were told that" [by someone who'd probably never done a dental in their life]?

Re: Neutering/vaccinating/dental work

Mary Thomson — Wed, 30 Jun 2010 20:41:04 GMT

Thanks for all your comments everyone. We have a vets meeting next week to discuss this further and it is really helpful to know your thoughts.

My feeling is that we will continue to vaccinate at post op checks as we do at the moment-it's not incurring any extra cost to the client because post op checks are FOC anyway. I can't say I've ever had a client complain about the inconvenience of having to return for poc.

These are not all young animals- we see many entire older greyhounds with significant dental disease.

I'll let the decision makers at the practice have the final say on the dentals! I know we don't live in an ideal world, but I feel that with cases of severe dental disease I'd rather know I've sorted the mouth out first, then carry out neutering under a separate GA at a later date.

Thanks again for the comments

Mary

Re: Neutering/vaccinating/dental work

Anthony Todd — Wed, 30 Jun 2010 13:07:56 GMT

[quote user="Holly Lee"]As for vaccinations my understanding (and I'm happy to be corrected...) is that it is the physiological stress of GA/surgery that provides the contraindication for vaccinating at the same time and as has been pointed out these animals should be having post-op checks so why not vaccinate at this stage instead?[/quote]

Sorry me again.

Can someone direct me to the evidence of this apparently understood contraindication, not theoretical or experimental.

I'm sure there's evidence of a better or worse serological response to an antigen under various physiological states but did this mean that some animals did not actually become immunised?

Surely the sooner animals are vaccinated the sooner they are immune and there are even some bosses around who actually would prefer vaccinated animals and some clients who find "going to the vet" again for a shot which could have been given last week a real pain.

Re: Neutering/vaccinating/dental work

Evelyn Barbour-Hill — Wed, 30 Jun 2010 12:58:29 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]"It's just a dental, dash that off while you've got her under the anaesthetic" [/quote]

Remember this is an animal being spayed so we assume it's young and not requiring a specialist procedure, and yes, I'm afraid, it can and should be dashed off while still under GA but after the spay for sure.

[/quote]

I don't think anybody is suggesting we are considering specialist procedures here. If it's something that can be dashed off, are you sure it's actually necessary or beneficial at all?

Re: Neutering/vaccinating/dental work

Evelyn Barbour-Hill — Wed, 30 Jun 2010 12:51:46 GMT

[quote user="Anthony Todd"]

And no one is going to suggest are they that a mouth requiring a dental is less a potential source of wound infection and bacteraemia than one where the teeth have been scaled, the rotten teeth removed [allowing drainage].

I'm not to sure about "aerosolisation after a dental as opposed to the careful and gentle pasting of an oral culture by a sympathetic canine tongue [not that they often lick the wound]

[/quote]

There's something in that; which again suggests that the dentistry should be done first and the sterile surgery delayed. But there's also a bit of slight misconception; there are oodles and zillions of bacteria in the mouth anyway, whether it is in need of dentistry or not.

No, I'm afraid I can't quote references off the top of my head, and I believe you when you say you've done hundreds of "dentals" at the same time as neutering with no trouble at all. I still say it's wrong to do dentistry at the same time as an elective sterile operation. The arguments about a second anaesthetic induction I understand but in the end I disagree. The arguments about cost I just don't understand.

Re: Neutering/vaccinating/dental work

Anthony Todd — Wed, 30 Jun 2010 12:49:20 GMT

[quote user="nikki"] we've been doing this for yrs and never had a problem.[/quote]

So older greyhounds with horrible teeth [ got to be the worst breed for grotty teeth??] have no problems with concurrent procedures after years of cases, yet you don't agree with "normal" clients.

As I asked at the beginning; why not?

Re: Neutering/vaccinating/dental work

Anthony Todd — Wed, 30 Jun 2010 12:43:09 GMT

[quote user="Evelyn Barbour-Hill"]And of course the considerable prolongation of anaesthesia, for those who worry about such things.[/quote]

And, I venture, that anaesthetic deaths are a more a function of anaesthetic inductions not length of anaesthesia. ie 200 GAs of 10 minutes each have a higher "problem" rate than 20 of 100 minutes

[quote user="Evelyn Barbour-Hill"]"It's just a dental, dash that off while you've got her under the anaesthetic" [/quote]

Re: Neutering/vaccinating/dental work

Martin Atkinson — Wed, 30 Jun 2010 12:37:11 GMT

[quote user="Holly Lee"]I thought the risk of dental at the same time as sterile surgery was the bacteraemia it creates more than the airbourne pathogens [/quote]

That's why I wouldn't perform a sterile procedure that involed entry into a body cavity or orthopaedic work at the same time as a dental on a patient with severe pyorrhea, but as suggested before the likelyhood of needing a routine neutering on an animal with that condition other than an odd rescue greyhound is low. IMO the aerosol risk is so low if managed correctly as to be insignificant.

Re: Neutering/vaccinating/dental work

Anthony Todd — Wed, 30 Jun 2010 12:33:47 GMT

[quote user="Rob Reid"]I would do neutering first as doing dental first aerosolises lots of bugs which could then contaminate surgical field? I would have thought more important than contaminating a sutured wound?[/quote]

Oh dear, now I see. No one would do a dirty dental procedure, wipe their brow and then do a sterile spay, surely.

Truly a No! No! No!

But if you do it the other way round let's have all the evidence of horrible infections etc.

I'm not to sure about "aerosolisation after a dental as opposed to the careful and gentle pasting of an oral culture by a sympathetic canine tongue [not that they often lick the wound]

Re: Neutering/vaccinating/dental work

Evelyn Barbour-Hill — Wed, 30 Jun 2010 12:30:46 GMT

[quote user="Martin Atkinson"] I think the risk is outweighed by cost considerations and that of the animal not coming back.[/quote]

I don't really understand about the cost considerations. As for not coming back, yes, but then with any patient booked in for dentistry (or any other operation for that matter) there's always a chance they won't turn up.

Re: Neutering/vaccinating/dental work

Evelyn Barbour-Hill — Wed, 30 Jun 2010 12:25:28 GMT

[quote user="Holly Lee"]I thought the risk of dental at the same time as sterile surgery was the bacteraemia it creates more than the airbourne pathogens [/quote]

It's both.

And of course the considerable prolongation of anaesthesia, for those who worry about such things.

And, to my mind....... please don't be horrid to me now............ the cheapening or belittling of dentistry that is implied: "It's just a dental, dash that off while you've got her under the anaesthetic"

Re: Neutering/vaccinating/dental work

Anthony Todd — Wed, 30 Jun 2010 12:24:35 GMT

[quote user="james hunt"]Agree completely and often have had to explain to clients the reasoning for this.[/quote]

Sorry to be thick but can you explain it to me, just not the theoretical possible disadvantages, but actual evidence of problems following combining the two procedures. Then the possible problems of two GAs as opposed to one. Then compare the two rates of problems.

[that's assuming the client turns up for the next procedure]