HD x rays

Re: HD x rays

Eamon McAllister — Mon, 14 Feb 2011 11:50:48 GMT

I've never really understood the enthusiasm for doing surgery under deep sedation when you can do it more conveniently (and therefore probably do it better), more cheaply and arguably more safely under a lightish anaesthesia.

Totally agree!

Re: HD x rays

bob lehner — Mon, 14 Feb 2011 09:43:52 GMT

[quote user="Vikki Halliday"]

[quote user="bob lehner"]With respect that sounds rather OTT ![/quote]

. Can you really honestly say it is safe to tie a sedated animal to a table and leave the room to take the exposure?

[/quote] Well actually, yes - provided the protocol I described is followed - they won't be going anywhere, as they are fast asleep. Also they can quite readily be intubated for peace of mind re hypoxia. (Although I don't tie the animal to the table for HD X-rays - use positioning aids and sandbags).

I know of some practices where the dom/torb combo is used as a routine premed followed by a minute amount of induction agent (or straight onto gas) for surgery.

As is so often evident on these discussions there are different ways of doing the same thing and if it works for you and is safe and effective then that's fine.

Re: HD x rays

Evelyn Barbour-Hill — Sun, 13 Feb 2011 18:13:05 GMT

[quote user="Wren"]

I'm confused too! The Dom/Torb combination was marketed as being suitable for castrates/stitch-ups etc. (remember the ad campaign featuring the post-castrate dog being awake and well enough to pick the kids up from school?). If it's not humane to take radiographs under Dom/Torb then surely surgery should be totally out of the question?

[/quote]

Being marketed as suitable doesn't mean it actually is suitable.

Re: HD x rays

Vikki Halliday LLB — Sun, 13 Feb 2011 14:11:00 GMT

[quote user="Wren"]The Dom/Torb combination was marketed as being suitable for castrates/stitch-ups etc[/quote]

I wouldn't do either under purely Dom/Torb either. I don't think it provides enough analgesia during surgery, so stitch ups get local blocks, and castrates I knock out and intubate.

It has it's place, and can be a very useful combination, however I personally feel the risks to the animal of using it solely as an agent to carry out hip score xrays outweight the benefits to the client.

Re: HD x rays

Wren — Sun, 13 Feb 2011 13:55:33 GMT

Re: HD x rays

Vikki Halliday LLB — Sun, 13 Feb 2011 11:33:22 GMT

[quote user="bob lehner"]With respect that sounds rather OTT ![/quote]

Well I will explain.

Yes I agreed there are different levels of sedation, however sedation does still allow the animal to respond to noxious stimuli, pain, noise, light etc. General anaesthesia the animal should not respond unless a very light plane of anaesthesia and the stimulus extremely painful. Note, an anaesthatised animal should not respond to light or noise, if it does, it is not anaesthatised, merely entering the light plane of anaesthesia.

Therefore a sedated animal is at risk of still responding to all three types of stimuli, and that response can include movement.

That is why I would never ever tape or tie a sedated animal to the xray table as if the animal does respond, injury can occur.

The reason I insist on GA is also that for hip xrays, you are placing an animal in dorsal recumbency, potentially compromising lung and cardiovascular function. If the CV system is already compromised by use of a CVS depressant sedative such as medetomidine, and the animal is not intubated, you are potentially at risk of a hypoxic episode.

Therefore I prefer to have full control of both airway and level of anaesthesia. I think it's safer that way for the animal, as well as for our staff. We can prolong the anaesthasia much easier than with sedation. What do you do if a number of films are incorrectly positioned or exposed, and by the time you are taking your subsequent exposures the animal is coming round from sedation?

There is no reason that having a digital system makes it any different, I agee, however it does mean that multiple exposures can take place within a much shorter time frame compared to film processing systems, and therefore the length of time the animal needs to be under anaesthesia for is reduced. If I were using a film system and sedation, the length of time the animal requires to be immobilised for is undoubtedly longer.

Harsh, maybe, but I'd rather do it properly than risk any complications, injury or VDS claims. Can you really honestly say it is safe to tie a sedated animal to a table and leave the room to take the exposure?

Re: HD x rays

bob lehner — Sun, 13 Feb 2011 10:12:14 GMT

[quote user="Vikki Halliday"]

I'm afraid havi g a digital system, insist on GA.

If clients want a cheap job under sedation, they can co elsewhere, but I would not put my name to something I had not been able to tape at the knees and tie to the table.

And if you are doing that under sedation alone, IMHO, you want struck off

[/quote]

With respect that sounds rather OTT !

Given an appropriate dose of Dom/torb i.v. and given time to reach a proper state of relaxation there is absolutely no problem positioning or taping legs. Clearly there are different depths of sedation, just as there are different planes of anaesthesia - and at some point the two states will be indistinguishable. (You might just as well say that someone doing a bitch spay where the patient reacts to traction on the ovary should be struck off).

Not quite clear why having a digi system should have any bearing on patient restraint ?

Re: HD x rays

Michael Woodhouse — Sun, 13 Feb 2011 00:32:05 GMT

[quote user="Vikki Halliday"]And if you are doing that under sedation alone, IMHO, you want struck off.[/quote]

Have you tried doing them under IV sedation? They can be taped and tied to the table. They don't move. In our set up it is difficult to have them on the anaesthetic machine as we radiograph in a small room. It can be done but not ideal. With reversal they are standing in 10 minutes. I do almost all my radiography under sedation [with suitable analgesia when needed].

Rather a harsh suggestion Vikki! What clinical grounds have you for that statement?

Re: HD x rays

Vikki Halliday LLB — Sat, 12 Feb 2011 21:26:52 GMT

I'm afraid havi g a digital system, insist on GA.

If clients want a cheap job under sedation, they can co elsewhere, but I would not put my name to something I had not been able to tape at the knees and tie to the table.

And if you are doing that under sedation alone, IMHO, you want struck off.

Re: HD x rays

Busybee — Sat, 12 Feb 2011 19:18:40 GMT

My boss always recommends a combination of 0.2ml Torb and 0.3ml Dom IV for all Labrador hip/elbow scoring. Seems to work beautifully! Never done it under GA so I can't compare.

Re: HD x rays

Michael Woodhouse — Fri, 11 Feb 2011 14:35:04 GMT

For the sake of fair comparison what does of Dom/Torb do you use, was it given IV and was the dog in for hip scoring?

Not really fair if was suspected problem to start with.

We use 0.1ml/10kg Torb and 0.2-0.25ml/10kg Dom - depending how bouncy, always IV.

Re: HD x rays

Bob Russell — Fri, 11 Feb 2011 14:11:07 GMT

Slight change of opinion - we have just done hip X-rays on a choc lab with terrible hips. The pain relief was not good enough!

Re: HD x rays

nikki — Thu, 10 Feb 2011 22:55:46 GMT

always done them under GA but we've just started doing a few more of them for people who used to go down to someone on the south coast who used to only give a touch of sedative and let the owners hold them - apparently people used to go from absolutely miles away for this service. Anyway, we're not doing that but they are getting done under dom/torb and not seen any probs with it so far and they're up and awake to go home v quickly.

Re: HD x rays

Wren — Thu, 10 Feb 2011 22:00:34 GMT

[quote user="Clive Ansell"]

yikes! - are there really practices out there that allow clients to be exposed to x-ray radiation by holding animals for radiography ?

[/quote]

Most equine ones!

I used to work in a practice where the boss was an opthalmologist and did eye scores. He then sent all the 'passes' out back to me for hip scoring and I IV Dom/Torb'd them, took the pics, woke them up and sent them home. Usually the clients had travelled a fairish way as there wasn't anyone else close who did eyes. It suited the clients to have everything done in one trip. I never questioned the anaesthesia regime as I was a new grad following orders, but it seemed to work OK.

Re: HD x rays

Evelyn Barbour-Hill — Thu, 10 Feb 2011 19:21:49 GMT

There's a practice I interact with now and then......... they do their HD scheme Xrays with Dom/Torb. Many breeders go there because they reckon they get lower scores.

You work it out.

Re: HD x rays

Bob Russell — Thu, 10 Feb 2011 14:22:57 GMT

[quote user="CatherineBoden"]

We also had a breeder client who apparently travelled to another practice for hip scores and she would hold the dog down while the vet took the xrays. We were in East Anglia, I have a feeling it was somewhere on the south coast but I can't quite remember. Anyway it was somewhere a long way away from where she lived and she went there specifically for the hip scores.

I always use full GA. I've never tried with sedation.

[/quote]

Definitely not us! Dom/tob i/v works well for us but we live in fear of our next one because we are now digital!!

Re: HD x rays

CatherineThomas — Thu, 10 Feb 2011 13:54:38 GMT

I always use full GA. I've never tried with sedation.

Re: HD x rays

Clive Ansell — Thu, 10 Feb 2011 10:26:28 GMT

I always prefer full and intubated general anaesthesia. I have in the past found sedation alone insufficient and have often had to use mask o2/halo or iso. Being a locum and sometimes not familiar with a practices x-ray equipment it can take me longer than it would a regular staff member, thus if patients are properly anaesthetised I haven't got to race the clock before they wake up.

I came across a breeder client recently that has all of her hip scores done at practice X, because "they just give a shot of ACP and I hold them for the x-ray to be taken" yikes! - are there really practices out there that allow clients to be exposed to x-ray radiation by holding animals for radiography ?

Re: HD x rays

bob lehner — Thu, 10 Feb 2011 10:11:18 GMT

[quote user="Julian Earl"]

Also, on the same subject, how many people give out the plates to owners if they request them (any x rays II suppose, not just hips)? Is there not some legal reason for keeping hold of clinical records for a certain length of time anyway?

[/quote]

From GtPC:

Case Records

5. Case records including radiograph films and similar documents are the property of, and should be retained by, veterinary surgeons in the interests of animal welfare and for their own protection. Copies with a summary of the history should be passed on request to a colleague taking over the case.

(N.B. Where a client has been specifically charged and has paid for radiographs or other reports, they are legally entitled to them. The practice may however choose to make it clear that they are charging not for the radiographs, but for diagnosis or advice only. In appropriate circumstances they may be prepared also to provide copies of the radiographs)

6. The Data Protection Act 1998 gives anyone the right to be informed about any personal data relating to themselves on payment of an administration charge.

7. At the request of a client, veterinary surgeons must provide copies of any relevant clinical records; this includes relevant records which have come from other practices, if they relate to the same animal and the same client. It does not include records which relate to the same animal but a different client. Where any significant expense is involved in providing such copies, as there might be, for example, with the provision of radiographs, a charge can be made. Expense should not be a reason for declining to provide copies.

8. It follows that the utmost care is essential in writing case notes or recording a client's personal details to ensure that the latter are accurate (particularly in relation to financial details) and that the notes are comprehensible and legible.

9. Disclosure of records may be ordered in disciplinary or court hearings, and the RCVS may request copies of case records routinely in the course of investigating a complaint.

Re: HD x rays

bob lehner — Thu, 10 Feb 2011 09:59:20 GMT

[quote user="Julian Earl"]

I don't know if it has been discussed before but how many people do hip x rays under Domitor/Torb (or equivalents) rather than under GA? Am I right in thinking that the accuracy, such as it is, of hip scoring is better when done under GA because of the higher degree of relaxation?

[/quote]

I often do HD X rays under Dom/Torb - always give i.v. rather than i.m @ 0.1 ml of each/10kg. Must then wait until they are fully relaxed - don't rush into postioning the legs. Wouldn't try it on a very excitable/nervous dog as the results tend to be much less predictable. Generally works fine.

Re: HD x rays

James Laidlaw — Wed, 09 Feb 2011 23:23:36 GMT

My understanding has always been that X-rays are the property of the clinic that took them, not the client that paid to have the procedure done.

Re: HD x rays

Michael Woodhouse — Wed, 09 Feb 2011 22:50:50 GMT

IV Dom and Torb here. Perfectly relaxed. Our T&C state that the radiographs are our property and they are paying for the procedure of us taking them and our interpretation. Then goes on to say we will release them for a fee. Give them to other practices or referral FOC. Never had an owner ask for them.

Re: HD x rays

Robert Wilson — Wed, 09 Feb 2011 22:37:45 GMT

[quote user="Julian Earl"]

[/quote]

Would always do it under GA; best chance for getting it right first time!

Re: HD x rays

Gillian Mostyn — Wed, 09 Feb 2011 22:35:26 GMT

[quote user="Julian Earl"]how many people do hip x rays under Domitor/Torb (or equivalents) rather than under GA?[/quote]

Never have, never would.

[quote user="Julian Earl"]how many people give out the plates to owners if they request them[/quote]

only if they are taking them with them to another veterinary practice / referral vet. Otherwise they stay with me.