Recognising Clinical Competence

Re: Recognising Clinical Competence

Evelyn Barbour-Hill — Mon, 13 Dec 2010 20:12:48 GMT

[quote user="Martin Atkinson"]

[quote user="Evelyn Barbour-Hill"]

Elizabethan collars are another of my pet hates. I haven't put one on a dog for twenty-six years.

[/quote]

I don't use them after dentals either

[/quote]

Why not?

Re: Recognising Clinical Competence

Mark Hedberg — Mon, 13 Dec 2010 14:04:42 GMT

Well, that yorkie wasn't the brightest dog ever...

Re: Recognising Clinical Competence

Martin Atkinson — Mon, 13 Dec 2010 12:05:42 GMT

[quote user="Evelyn Barbour-Hill"]

Elizabethan collars are another of my pet hates. I haven't put one on a dog for twenty-six years.

[/quote]

I don't use them after dentals either

Re: Recognising Clinical Competence

Evelyn Barbour-Hill — Fri, 10 Dec 2010 19:58:05 GMT

Elizabethan collars are another of my pet hates. I haven't put one on a dog for twenty-six years. I might put one on a cat once a year after heavy ear surgery, if it proves necessary.

No, I don't use any useless bitter sprays or whatever, either.

Re: Recognising Clinical Competence

Vikki Halliday LLB — Fri, 10 Dec 2010 18:56:41 GMT

[quote user="Martin Atkinson"]I've recently tried those pepper 'Anti-lick Strips' but they're crap.[/quote]

Yep I tried those on a post op CCL, and the owner reported that the dog loved them and ate them!

Re: Recognising Clinical Competence

Martin Atkinson — Fri, 10 Dec 2010 18:39:36 GMT

I absolutely agree with Mark. It's true the vast majority don't interfere with the sutures and usually it doesn't matter too much if they do but one wound infection or one re-suture at my expense after evening surgery is one too many. And here is a sobering story about a Yorkie caesarian that chewed out her sutures. The owner clearly being a master of understatement phoned up out-of hours to say there was a little bit of something sticking out the wound and wasn't too worried but I suggested she come in and get it checked. When it came in the owner was holding its herniated guts in a towel. Not only had she chewed all the sutures out including those in the muscle, she'd started chewing her intestines. I had to do an enterectomy and removed about 4 inches of traumatised ileum then on recovery she vomited up another 6 inches she'd obviously eaten in a bout of self-cannibalism. She lived to tell the tale and never looked back which just goes to show how little ileum you need if a Yorkie can lose the best part of a foot and be fine! Now nothing leaves here without some sort of anti-lick device. I've recently tried those pepper 'Anti-lick Strips' but they're crap.

Re: Recognising Clinical Competence

Kate Richardson — Fri, 10 Dec 2010 13:03:03 GMT

Am probably tempting fate now, but practice policy here is to do midline speys in cats and intradermal sutures. Cannot remember when we last sent a cat home with a buster collar or had a problem with wound breakdown. Cats also seem much more comfortable post op with the midline approach so pay less attention to the wound.

Re: Recognising Clinical Competence

Mark Holmes — Fri, 10 Dec 2010 12:47:02 GMT

[quote user="Bob Russell"]

[quote user="Michael Woodhouse"]

[quote user="Martin Atkinson"] the owner takes the E collars off after the first day or so.[/quote]

You put collars on cat spays? A dab of superglue on the knot and they can't get them out.

[/quote]

Don't count on it!

[/quote]

The problem is having to protect yourself against client complaints, I would not put a collar on my own cat, but if a cat does lick out sutures or irritate the wound and you haven't sent them home with a collar then they generally complain " Its your fult you didn't give him a collar" The vast majority of cats don't need them, especially if they have id suturesa and glue but to be honest I really cannot be bothered with the complaints of the small number that do.

Re: Recognising Clinical Competence

Bob Russell — Fri, 10 Dec 2010 12:33:12 GMT

[quote user="Michael Woodhouse"]

[quote user="Martin Atkinson"] the owner takes the E collars off after the first day or so.[/quote]

You put collars on cat spays? A dab of superglue on the knot and they can't get them out.

[/quote]

Don't count on it!

Re: Recognising Clinical Competence

Michael Woodhouse — Fri, 10 Dec 2010 12:30:03 GMT

[quote user="Martin Atkinson"] the owner takes the E collars off after the first day or so.[/quote]

You put collars on cat spays? A dab of superglue on the knot and they can't get them out.

Re: Recognising Clinical Competence

Martin Atkinson — Fri, 10 Dec 2010 09:48:10 GMT

[quote user="Malcolm Ness"]

[Wound infections, like other complications, are something that happens to other people!!

[/quote]

Just to illustrate this statement is not just tongue in cheek: after my proud boast - that despite my apparent disregard of glove wearing protocol we have a neglible number of wound infections one came in yesterday in a cat that was spayed last week. But it was performed by a student who did a 5 minute scrub (by the clock) and wore gloves!! Perhaps more significant is that her surgical skills are as yet not well honed and it took her 40 minutes and even more so the cat comes from a multi-cat environment where hygiene is not a top priority to put it politely and the owner takes the E collars off after the first day or so.

Re: Recognising Clinical Competence

Vikki Halliday LLB — Wed, 08 Dec 2010 17:38:09 GMT

[quote user="alex gough"]I considered calling the RCVS first for their recommendations on treatment...[/quote]

I think they would probably not give you one, however they would remind you that if it all went wrong, you could be the recipient of a visit from the PIC?

Re: Recognising Clinical Competence

Alex Gough — Wed, 08 Dec 2010 16:40:36 GMT

We just had a case in of a dog that had swallowed glass. I considered calling the RCVS first for their recommendations on treatment...

Alex

Re: Recognising Clinical Competence

Martin Atkinson — Wed, 08 Dec 2010 15:21:56 GMT

[quote user="Jonathan Wray"]

Are you recommending that all vegetarian veterinary surgeons wear gloves, or at least scrub in a surgical fashion before going home?

JGW

[/quote]

Are we the only profession that washes our hands before we go to the toilet?

Re: Recognising Clinical Competence

Vikki Halliday LLB — Tue, 07 Dec 2010 14:42:34 GMT

[quote user="Simon Neuhoff"]I thought it would be more like repetitive shaking [/quote]

I think you would leave a better "imprint" of the"anaesthetic" with a sharp blow...............

Re: Recognising Clinical Competence

Simon Neuhoff — Tue, 07 Dec 2010 14:38:26 GMT

I thought it would be more like repetitive shaking - what's that word they use? Sussation?

Re: Recognising Clinical Competence

Vikki Halliday LLB — Tue, 07 Dec 2010 14:31:30 GMT

[quote user="Simon Neuhoff"]Perhaps a homeopathic general anaesthetic?[/quote]

Its called a blow to the head.......

Re: Recognising Clinical Competence

Simon Neuhoff — Tue, 07 Dec 2010 14:29:24 GMT

[quote user="Malcolm Ness"]

[quote user="Simon Neuhoff"]

[quote user="Mark Holmes"]

[quote user="Jonathan Wray"]

Are you recommending that all vegetarian veterinary surgeons wear gloves, or at least scrub in a surgical fashion before going home?

JGW

[/quote]

I guess that depends upon their objection to eating meat and animal products, as the animal did not have to die to enter their diet maybe its ok. In fact, maybe veggy vets are uniquely placed to be able to remove their sandwich fillings without the death of the animal in question and hence supplement their meagre diets without any eithical dilemmas.

[/quote]

Errrm - so GA an animal, chop off some choice cuts, appropriate use of analgesia etc and it's veggie appropriate meat! I like the idea. Might be a trifle expensive though. Mind you if we can make it "trendy" we could sell it in central london for a killing.

[/quote]

If you avoid the GA ("chemicals") it would be organic and therefore worthy of an even higher price.

[/quote]

Perhaps a homeopathic general anaesthetic? Or Reiki maybe? The possibilities are endless.

Re: Recognising Clinical Competence

Malcolm Ness — Tue, 07 Dec 2010 14:23:14 GMT

[quote user="Simon Neuhoff"]

[quote user="Mark Holmes"]

[quote user="Jonathan Wray"]

Are you recommending that all vegetarian veterinary surgeons wear gloves, or at least scrub in a surgical fashion before going home?

JGW

[/quote]

If you avoid the GA ("chemicals") it would be organic and therefore worthy of an even higher price.

Re: Recognising Clinical Competence

Simon Neuhoff — Tue, 07 Dec 2010 14:04:57 GMT

[quote user="Mark Holmes"]

[quote user="Jonathan Wray"]

Are you recommending that all vegetarian veterinary surgeons wear gloves, or at least scrub in a surgical fashion before going home?

JGW

[/quote]

Re: Recognising Clinical Competence

Mark Holmes — Tue, 07 Dec 2010 12:36:51 GMT

[quote user="Jonathan Wray"]

Are you recommending that all vegetarian veterinary surgeons wear gloves, or at least scrub in a surgical fashion before going home?

JGW

[/quote]

Re: Recognising Clinical Competence

Hannah Wynne Richards — Tue, 07 Dec 2010 12:18:47 GMT

Well said Malcolm I've come across some academics who are all for EBM -untilyou start reading some of their papers in a critical manner !!!!!!!!!!

Wynne

Re: Recognising Clinical Competence

J G Wray — Tue, 07 Dec 2010 11:21:01 GMT

Are you recommending that all vegetarian veterinary surgeons wear gloves, or at least scrub in a surgical fashion before going home?

JGW

Re: Recognising Clinical Competence

Mark Holmes — Tue, 07 Dec 2010 10:18:06 GMT

Re gloves, I have to say I have not noticed a distinct change in rates of infection since starting to use gloves routinely but I have noticed that my sandwiches taste somewhat less ferric than they used to!

For me the benefit is not having to spend hours getting the dried blood out from around my fingernails!

Re: Recognising Clinical Competence

Malcolm Ness — Tue, 07 Dec 2010 08:48:28 GMT

[quote user="Jonathan Wray"]Agreed, but then I think EBM has already become a cliche, hijacked to mean something else and I think it it is now deployed as a totem to prove or confound traditional and new treatment[/quote]

Unfortunately, this is absolutely true. I would encourage all in practice to read the Greenhalgh book - it is not very long and you don't even need to read all of it and I can guarantee that it will improve your day to day medicine and surgery. EBM is (or at least should be) an effective tool for clinicians/practitioners and emphatically not a system for allowing academics to assert their eminence.