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Feature, General

Choosing an insurance policy

By admin On February 7, 2012 - 0 Comments

Of the cases we see at Northwest Surgeons, 95% of these are insured for veterinary fees. Like everything in life, you get what you pay for. Even the insurance companies say this! So how do you know which insurance policy to choose for your dog or cat?

NEWSFLASH

Lloyds TSB and Halifax have pulled out of the pet insurance market. This has left many consumers stranded. If your pet has an on going condition covered which has already been subject to an insurance claim you probably will not be able to get cover for this on a new policy. 

The best insurance policies will of course be more expensive, but choosing a cheaper policy could leave you with inadequate cover or no cover at all. So where do you start?

The question how much can you afford can be viewed many ways! Firstly, work out how much can you afford per month for an insurance policy. Then check the policy limit. Consider what happens if you reach the limit on your insurance policy. Many people don’t realise that there may be a gap between what the insurance will pay out and the vet bill, and because there is no NHS for pets it will be you left to pick up this amount.

How much cover do you need?

Insurance policy limits vary from £500 to £12000. The days of limitless policies are gone.

Bills for specialist veterinary treatment can be somewhere between £2000-5000 so this gives you an idea of where to start, but bear in mind that certain conditions can be more than this.

In recent years there has been an increase in cheaper insurance policies and of course, at the same time veterinary fees are increasing. In many cases this is leaving a bigger gap between what the insurance covers and what the client has to pay. If your cover limit is £2000 and your vet bill is £4500 you need to find £2500 out of your own pocket.

What is an excess?

Most policies will have an excess. This is an amount, usually around £70-£100 which you have to pay yourself when you make a claim – so really it is not worth claiming on your insurance unless the bill is over this amount. The older the pet, the higher the excess will be. Some policies also require that you pay a percentage of the claim, usually 10-20%, although this is more common with older animals. Beware on a £3000 bill this will be £300.

How long will the insurance pay out for a condition?

Dogs and cats diagnosed with diabetes will need lifelong insulin treatment, to pick an example. The cheaper policies will only pay out for a year, so if you need the reassurance of lifelong cover make sure you get the right policy. Don’t make the mistake of picking the cheapest online policy. Phone the company and discuss your needs to make sure you fully understand what you are buying. And read the small print.

What is pre-authorisation?

Many private medical insurers insist on pre-authorising claims. This is a slick process whereby you are assured that your insurance will pay for your private healthcare. Some pet insurers request pre-authorisation for certain claims but the process is rarely a well-oiled one and can delay your pet’s treatment. It is not uncommon for our clients to have to wait several hours for this. Check when you buy a policy whether the company ask for pre-authorisations.

What not to do!

Cancel your policy – all of us have seen clients who, having never claimed on their policy decided to cancel it, only for the worse to happen and the pet become ill. Only do this if you can afford to pick up any subsequent bills!

How we can help you

If you are referred to Northwest Surgeons for specialist treatment, for certain insurance companies we will process the claim for you and the insurance company will pay us direct (known as a direct claim). This saves you having to pay us first and then claim back the money yourself. We do not do this for all companies because some have poor reputations for paying claims. (Although we would like to tell you which companies to avoid this is not particularly professional!) We have a dedicated Claims Manager to process claims and communicate with the insurers which is why we levy a small fee for doing so. You must provide us with your certificate of insurance and sign a direct claim agreement which allows us to act on your behalf to make the claim.

So think carefully when buying pet insurance and check exactly what you are paying for and what is not covered. If in doubt, ask your vet.

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Feature

Dogs give blood too!

By admin On January 31, 2012 - 0 Comments

Did you know that just like the NHS we perform blood transfusions in veterinary medicine?  Blood transfusions for dogs and cats are common practice here at NWS for our sick patients requiring blood.

We are able to source the blood we need from two places – calling upon staff pets or from the Pet Blood Bank (PBB). Dogs have two main blood types – negative and positive. We keep a stock of both types of canine blood in at NWS ready for emergencies, but just like the NHS our supplies can run out, meaning we do not have blood readily available for our critical cases. Click here for our blog on cat blood donation. We made the decision to help out by hosting our own blood collecting session with the Pet Blood Bank, to ensure there is always blood available should your dog require it.

Firstly we had to find some volunteer donors – the dogs must be between 1 & 8 years old, have never been abroad, on no medication and in good health, be fully vaccinated and be over 25kg body weight. The first session was held on Sunday January 8th 2012 and we had 18 dogs come along to donate. So how did the session run? Click here to see our photos!

On arrival at NWS each dog was weighed to ensure they were over the required 25kg. Each dog first had a full clinical examination by one of the Pet Blood Bank’s vets; this also included a blood test to ensure they were able to donate. The PBB also send away a blood sample once a year for a full analysis to ensure donors are healthy, and to potentially pick up any changes. Two small patches were clipped from each dog’s neck – one for the blood test and one for the donation. They also checked the donor’s microchip – all donations are linked to the dog’s microchip number. Any dog wanting to donate needs to be microchipped and the PBB with do this free of charge at the time of donation.

Once the donors had passed through the pre-donation check, they were then taken through to the donation room. They were then lifted up on to a table with a padded mattress and laid on their left side.   Here a fully qualified phlebotomist collected about 450ml of blood. The actual donation took between 5-10 minutes.  The needle was then removed from the vein and a dressing was applied to the site of venipuncture to help reduce the risk of bruising.

After donation every dog was encouraged to stay at NWS for a short while to have a drink, lots of treats and fuss and to be observed by the PBB staff. Each dog received a Goodie Bag which included an “I’m a Lifesaver” Bandana and Tag to thank them. Owners received a call from one of the PBB staff within a few days of their dog donating and paperwork relating to the donation was sent to them and their veterinary practice.

All of the 18 dogs that attended were first time donors and of the 18, 7 dogs successfully went through to donation. Each donation will go to help save the life of up to 4 dogs!

Dogs that didn’t donate this time were a little anxious about the clippers needed to clip away the fur.  For these dogs we used this session as training for them, the PBB are happy to do lots of training with donors to ensure they are happy to donate – the PBB will not muzzle or sedate dogs

Our next donation day will be Sunday 26th February – for more information please contact NWS on 01928 711400 and ask for Caroline or Michaela.

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Feature

Laryngeal Paralysis in dogs

By admin On January 9, 2012 - 0 Comments

What is Laryngeal Paralysis?

For most older dogs, Laryngeal Paralysis (LP) occurs due to an aging process of the nerves that supply the laryngeal muscles and cartilages. The larynx (voice box) is the first part of the upper airway and is made up of 5 cartilages. The epiglottis cartilage flips upwards and protects the entrance of the airway (the glottis) during swallowing and the paired arytenoid cartilages function to open and close like a pair of curtains as the patient breathes in and out. If the arytenoid cartilages are paralysed or partially paralysed, they will hang in the entrance of the airway (the glottis) and obstruct airflow. The patients develop a raspy breathing noise and over time, usually months they become less able to cope with exercise. Any slight exertion or excitement can potentially leave these dogs in a very compromised state, they struggle to breathe, it can be a life threatening situation.

Who is affected?

Laryngeal Paralysis of the older dog can occur in any breed but at Northwest Surgeons, we tend to see this condition mostly in large breed dogs. The most common breeds to present are Labradors and Golden Retrievers but we have seen the Greyhound, Rhodhesian Ridgeback, Hungarian Visla, Leonberger and a Bouvier de Flanders breeds during the past year.

What should we look for?

A gradual onset of noisy breathing, not coping with exercise , having to excessively pant, tongue and gums turning a purple colour (cyanosis)  during periods of stress, throat clearing and the pitch of the bark may also alter with time.

How do we confirm the diagnosis?

Laryngeal function cannot be assessed in the conscious patient, so we have to try and view the larynx moving at a point which most represents its function in real life. We do this by viewing the larynx moving as the patient is given a small amount of intravenous anaesthetic, just enough to slacken the jaw tone but to minimally affect the patients attempts to move their arytenoid cartilages. At Northwest Surgeons we usually record these images to demonstrate to the patient’s owners the degree of LP.

How do we treat Laryngeal Paralysis?

A non surgical / conservative approach can be taken for those patients who may have a number of medical conditions, are too debilitated to undergo anaesthesia or where finance precludes a surgical treatment. We would normally advise that these dogs use a harness for exercise restraint and are only walked in cooler weather. It is worth considering the purchase of a mobile air conditioning unit, so that one area of the house can be made very cool on humid and hot days – we find this is a very useful aid to cool and reduce the stress that hot weather can cause to patients with LP. Medications such as anti-inflammatories can be useful to reduce the inflammation that surrounds the larynx.

The aims of surgery

  • Increase the size of the aperture leading into the airway (the glottis) allowing easier breathing
  • Preserve airway protection

 The larynx is approached surgically from the left side of the neck. Careful dissection between the muscles of the neck and larynx gives access to the paralysed left arytenoid cartilage. This cartilage is then carefully mobilised from the surrounding chassis of the larynx and re positioned so that it sits to one side – it has been ‘tied-back’ (lateralised). This cartilage is secured into its new position by two small but very strong sutures that do not dissolve.

Following surgery, owners are advised to make sure their dog eats slowly by hand feeding or incrementally feeding small amounts at any one time. This limits the patients bolting their food, coughing during eating and hence reduces the risk of sucking back food particles into the airway. Aspiration pneumonia is an uncommon complication for LP surgery providing the feeding protocol is adhered too for at least 4 weeks post surgery.

Future advances in the treatment of laryngeal paralysis include the use of lasers to partially ablate one side of the paralysed cartilage and the use of stents to fortify the weakened cartilage of the larynx.

Laryngeal paralysis in the older dog is a common condition that we see at Northwest Surgeons. For most patients, surgical intervention results in a significant improvement in their ability to breathe. These older patients can then resume the activities they enjoy without the constant concern of an ensuing respiratory crisis.

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My puppy has a heart murmur – should I worry?

By admin On December 21, 2011 - 0 Comments

All of us would be worried if we are told at the first vaccinations that our puppy has a murmur. A murmur could represent a serious congenital heart defect – (congenital means a defect the puppy is born with).  The chances depend on the breed of the pup and the loudness of the murmur.  To put things into perspective, the incidence of congenital heart disease is about 7 cases per 1000 puppies, so the chances that your puppy is affected are slim.

 A murmur represents turbulent blood flow through the heart.  This is usually the result of high velocity flow caused by either blood flowing through a narrowing under pressure or the leakage of one of the main valves within the heart.  Murmurs are scored out of 6 with 1 being the quietest, audible after listening carefully for a few minutes in a quiet room.  Grade 6 murmurs are audible with the stethoscope lifted off the chest!

 Almost all puppies with congenital heart disease have a murmur and the louder the murmur, the more serious the problem.  If we can feel a vibration or “thrill”, on the side of the chest wall representing grade 5 or 6, then there is likely to be significant disease and further investigation is needed. 

 Some murmurs have a characteristic sound and the majority occur when the heart is contracting, during systole. If the murmur is continuous, then the likely diagnosis is a congenital heart defect called patent ductus arteriosus (PDA). This is one of the three most common congenital heart defects in dogs.  The other two involve narrowing or “stenosis” at the base of the main aorta (from the left ventricle) or pulmonary artery (from the right ventricle).

 Indecision often exists about the significance of a murmur at a young age because we also see innocent flow murmurs in puppies.  These are murmurs that have no underlying disease and get quieter as the puppy grows.  They have often disappeared by maturity.

 Unfortunately, some breeds that are prone to congenital heart diseases such as the Boxer also commonly have innocent flow murmurs as puppies.  Innocent flow murmurs are usually quieter and have soft blowing character.  Indeed about 50% of all boxer puppies have detectable murmurs.  This does not mean that they will need treatment for heart disease as many are innocent flow murmurs or mild sub-aortic stenosis.  The significance may also depend on the future of the dog.  Mild sub-aortic stenosis that would not affect a pet would be catastrophic for the breeding potential of a dog.  Unfortunately it is usually impossible to differentiate between an innocent flow murmur and mild to moderate sub-aortic stenosis without further investigations, such as echocardiography (heart scan).

 If the murmur persists and further evaluation is required, a non-invasive technique using ultrasound can confirm the diagnosis and give guidelines regarding severity.  This can usually be performed with the puppy lying on its side being gently restrained.  Sedation is rarely required although we usually have to shave a small patch of fur behind the elbow on the chest wall.

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Feature

So how do you become a veterinary specialist?

By admin On December 7, 2011 - 0 Comments

In past blogs we’ve discussed the subject of veterinary specialisation, including referral to a specialist and the future of veterinary specialisation. But how does a vet actually become a specialist?

We all know that training to become a vet takes 5-6 years, depending on which vet school you are fortunate enough to study at. Many students will decide whilst at vet school that they want to follow a specific career path, whilst some of us take a little longer to experience what life as a vet is like, before deciding where our interest lies. For determined, driven individuals the next step on the specialist pathway is either an internship, or a period in general practice, although with competition for specialist training positions becoming fiercer, an internship is seen by many as essential.

Interns are junior vets working in referral practices, where they rotate through different areas within the practice to gain a broad experience base. At this stage many interns will already have an idea of where their interest lies, be it surgery, medicine, anaesthesia or one of the other specialities that this varied profession can offer. The key to furthering an interest is experience and experience can only be gained over time and with a sufficient case load. This is the basis of specialist training programs, known as residencies.

A residency is a structured program over a set period of time, under the supervision of an existing specialist in a specific area of veterinary work, such as surgery or medicine. Most residencies are undertaken within a university, but more private specialist practices now offer this opportunity. Northwest Surgeons is the only private referral centre in the north of England to offer an RCVS approved residency in orthopaedics.

The intensive workload undertaken during a residency, which is typically over a 3 year period, is the foundation for achieving specialist status. Combined with this, a resident must conduct research and publish scientific papers to fulfil the requirements of their chosen diploma. Once these criteria are achieved then the resident is eligible to sit their diploma exam. The achievement of specialist status, whether European specialist or RCVS specialist, assures that the vet you are seeing is of the highest calibre. But it doesn’t stop there. For continued assurance specialists must continue to work hard to maintain their status and ensure they keep up to date. Every 5 years we undergo a revalidation where we must prove that we actively contribute to the veterinary profession.

At Northwest Surgeons we offer specialist services in surgery (soft tissue, orthopaedics & spinal surgery), medicine, cardiology, anaesthesia & pain management and diagnostic imaging. Each service is led by either an RCVS or European Specialist which allows us to offer you the very best for your pet.

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Feature, General

Spinal surgery: it’s all about the aftercare

By admin On November 22, 2011 - 0 Comments

Dogs with spinal problems form a large part of our specialist orthopaedic case load, with intervertebral disc disease high on the list. Spinal surgery is complex and requires a high level of surgical experience to perform. But that’s only half the story. Following surgery aftercare is of paramount importance and these dogs really benefit from physiotherapy. Here we give you an idea of the rehabilitation techniques used by the nursing team at North West Surgeons.

The spinal cases we see at NWS are predominantly dogs so the focus of this blog is canine physiotherapy and the rehabilitation of dogs following spinal disorder. The spinal cord (in humans and dogs) transmits information from the brain to the rest of the body. The cord is soft and easily damaged. Spinal injuries, disorders and disease can often cause compression of the cord which results in a failure of this transmission of information between the brain and the rest of the body. (There are other reasons a cord can become damaged). Most commonly, the patients we see have lost movement, strength and coordination of one or more limbs as well as the loss of bladder and/or bowel control. Some are unable to walk or stand on their own, some have weak, flaccid muscles while others have tense muscles and rigid limbs. Often the animal can be in a lot of pain, they may be stressed and are sometimes frightened. Pain control is paramount and these cases will be under the care of our specialist anaesthetist as part of the rehabilitation team.

Once a diagnosis and treatment plan has been made by one of our specialist veterinary surgeons the patient is passed on to the nursing team to implement their care. One of the elements of spinal patient care is physiotherapy and rehabilitation which we aim to perform 2- 3 times a day, more often if necessary. Hospitalised spinal patients: During the initial stages (this can be anything from 1- 2 days and up to 2 weeks depending on the level of damage to the cord) we aim to;

  provide muscle relaxation and stimulation

  prevent muscle atrophy (wastage) and further injury

  maintain joint flexibility and muscle mass with a long term goal of improving muscle tone 

  improve sensory awareness and use of the limbs so the patient can stand and walk with minimal assistance. Once this is achieved we can think about discharging the dog home.

Rehabilitation and Physiotherapy -What we do:

Each session aims to provide the patient with mental and physical stimulation so they have to be fun and rewarding for the dog. We use plenty of verbal praise, treats and toys to encourage them. Regardless of the stage the patient is at in terms of progress each session starts with massage techniques, then we focus on maintaining the range of motion in each joint of the affected limb (or limbs) followed by stimulating and re-educating affected muscles then stretches of each major muscle group.

For our massage we use stroking and kneading techniques as both are easy to perform and easily tolerated by animals. Ideally each session should finish with massage. As the patients begin to progress to standing or walking by themselves we can then add in more advanced exercises to improve muscle strength and balance. The activities used to improve their coordination, strength and balance can be physically tiring so are carried out little and often throughout the day with plenty of rest periods in between.

 Why do we use massage?

 To promote mental and physical relaxation of the patient.

 To increase blood flow to the muscles being massaged. This will help improve oxygen supply to those muscles and remove any metabolic waste products which if left to build up can cause muscles to ache (like the day after a strenuous work out!)

 To warm up the muscles before we can stretch them

 To help stimulate endogenous endorphin release (natural pain relief) When do we use massage?

  At the beginning and end of each session and always before and after further movements and stretches as it prepares the patient for further tissue manipulation

  Massage can be relaxing or stimulating depending on the techniques used so is useful when a patient has too much or too little muscle tone; ie tense rigid limbs or floppy weak limbs. The muscle tension or spasms can be secondary to their spinal condition or can be if they are frightened/ uncomfortable. Deep massage can help relax these patients.

To prevent muscle atrophy (wastage) and maintain joint flexibility and muscle we perform passive range of motion exercises (PROM) followed by stretches. During PROM the handler gently flexes and extends individual joints over several seconds as far as it will comfortably go through its natural range. PROM exercises can be performed with the dog either lying down or standing up, if the limbs are weak and floppy we assist the patient to stand to perform PROM and if the limbs are tense and rigid then we perform PROM with the patient lying down.

Why do we use PROM and stretches?

 to help maintain or improve joint mobility

 to help prevent muscles becoming stiff and being at risk of contracture

 to help improve neuromuscular awareness and function

 to mimic the sensation of walking by encouraging the foot pads to come into with the ground (or your hand if done lying down)

It is important to get the spinal cases up and about on their feet as early as possible, If they are unable to walk they area assisted by the handler using a sling (or hoist in larger dogs) to take the dogs’ weight. This can require up to 3 people depending on the size and mobility status of the patient. The purpose of assisted standing is to encourage nerve and muscle function, re-educate muscles, develop strength and enhance proprioception (knowing where their feet are), not forgetting mental well being – often being stood up and taken outside and encouraged to interact with our nursing staff can lift a dog’s spirits. Often spinal cases can be hospitalised for a couple of weeks so access to outside, daily routine and interaction with staff is really important to stop them becoming bored or depressed. Each day we try to get the patient standing for a little bit longer, maybe starting with 5 minutes 2-3 times daily building up to 5 minutes 3-4 times daily and increasing to 6 minutes 3-4 times daily etc.

 How: The feet are correctly positioned on the ground and their bodyweight supported (but not taking all bodyweight) with a sling. The amount of bodyweight we are taking is gently reduced to allow the dog to take as much of their weight as they can. We start by letting them take their weight for a few seconds then support them again. Gradually the amount of time they are taking their own weight is increased. Some dogs are able to hold enough of their own bodyweight to allow the handler to perform PROM with a second handler providing sling support.

Progression from assisted standing to the dog beginning to walk for themselves can be a slow but steady process. Once the dog shows signs of voluntary movement in their limbs (ie the messages are getting from their brain to leg muscles to tell them to walk) we can begin to encourage assisted walking, this is similar to assisted standing in that a handler uses a sling or hoist to take some of the dogs body weight but the dog is encouraged to slowly take “baby steps”. The dogs need plenty of encouragement and praise as this can be a very tiring process and they need to know they are doing a good job! It is not unusual for our kennels staff to stand at one end of the corridor with squeaky toys and treats encouraging a spinal case to walk towards them and then getting very excited by the efforts made by that spinal dog in re-learning to walk. What about at home? It is usually at the point that a dog can walk with minimal assistance and has some (or full) bladder and bowel control that we can think about getting them back home to their owners. Often the dogs will still need some assistance when walking and a continuation of rehabilitation exercises at home but this is something that can easily be taught to owners.

 How long will recovery take? Full recovery can take 4 to 6 months, but most dogs are walking again (albeit in a wobbly fashion) within 4 weeks. Dogs that are more severely affected to begin with, or those that have been affected for longer before treatment, are often slower to recover.

You can see that care of the spinal patient really is a team approach and the reward of seeing a paralysed dog walk again is immense.

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General

Dressings – The dos and don’ts

By admin On October 28, 2011 - 0 Comments

If your dog or cat is lame, and you get referred to Northwest Surgeons, you are likely to see one of the orthopaedic team. Some lame patients have fractures or ligament damage and have a dressing placed by the referring vet for support. Some cases may have damage to the skin and tendons in the leg, and a dressing is applied to cover and protect these. In the management of wounds at Northwest Surgeons your pet can benefit from the expertise of our soft tissue surgery specialist Catherine Sturgeon. Equally some of the cases seen at Northwest Surgeons require management by the placement of a dressing and may be sent home from the hospital with a dressing in place to protect the skin, soft tissues or healing bones.

Having seen some complications recently, we felt that some general advice on dressings may be of use. Many of the complications seen are avoidable.

• It is always worthwhile considering that a complication with a dressing, however trivial it may seem, is worth reporting as some complications can develop into limb-threatening problems.

• If a dressing is properly applied then the patient should be comfortable. We feel that a dressing should be well tolerated if it is comfortable. If your dog or cat is chewing or licking the dressing, this should raise doubts about the comfort. If the dressing is uncomfortable it may be putting pressure in areas it shouldn’t and complications can arise.

DOS

• Contact a vet you have any concerns.

• Keep the dressing dry. This can be achieved by applying a plastic bag or specially designed boot (which can be ordered from a vets or on-line) over the dressing to stop it get wet when walking on damp ground.

• Monitor the dressing for signs of the dressing slipping. The dressing will slip down the leg so watch the toes (if they are visible) and if you can no longer see them then the dressing is likely to have slipped. Also look at the top of the dressing, is it possible to see part of the leg which you couldn’t originally?

• Monitor for swelling. This is often seen in the toes, if they are visible, but can also be seen at the top of the leg.

• Monitor the dressing for abnormal smells. This could indicate a problem and the dressing probably will require changing.

DON’TS

• Ignore your pet if they start to chew at the dressing. If the dog or cat seems to be paying more attention to the dressing than normal then it probably is uncomfortable and needs to be changed.

• Allow the dressing to get wet and not seek veterinary attention. The foot can become damp and start to fester if left unattended.

• Leave the plastic cover in place after the animal has been outside as the foot can become sweaty and damp.

• Ignore any abnormal smells.

• Ignore a dressing if it has slipped.

Once a dressing has been applied and an animal is sent home with the dressing in place, we, as vets, can no longer control what happens to the dressing. It is therefore requires excellent ownership to carefully monitor and protect a dressing. But between the team at Northwest Surgeons and your own vet, we are here to help. Northwest Surgeons is staffed 24-7 by a Veterinary Surgeon so there is always advice at hand.

As vets we would much rather be contacted about a problem and find out it is a minor concern and nothing to worry about, rather than seeing a dog or cat where a dressing problem had arisen, nothing was done initially, and the problem becomes major and we find nothing more can be done to save the limb. Luckily, these cases are rare but they do happen and we all need to be aware of the potential risks.

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The future of veterinary specialisation – have your say now!

By admin On October 13, 2011 - 0 Comments

We have previously written detailed blogs on the complicated and unclear nature of specialisation and referral procedures in veterinary practice

11th August 2011:  Is my veterinary specialist a proper specialist?   

26th August 2011:  Referral to a Specialist: Your freedom to choose (Provided you ask the right questions). 

We strongly believe that the system of veterinary specialisation is currently unfair to the animal owning public and that it does not ensure that animal owners are always given the best options for care of their much loved pet.  Pet owners need a system that is transparent and robust to ensure that they are always given the best possible advice when referral to a specialist is indicated.  The public must also have absolute confidence in the qualification and re-accreditation of any veterinary surgeon they are seeing, especially those claiming “Specialist” status.  At present this is not the case:  The problem is a complex can of worms and if you have the time you might want to read the previous blogs to understand why.
There is, however, a glimmer of light on the horizon.  The Royal College of Veterinary Surgeons (RCVS) is the body that governs the veterinary profession in the UK and which is charged with acting in the interests of the animals and the public, not the interests of the profession.  A Working Party of the RCVS has reported on the issue of specialisation in the profession and has produced a public consultation paper (which you can read HERE).  This report is independent of any vested commercial interest in veterinary practice and it very much endorses our view of the current problems.  The report goes on to propose very significant changes to the organisation of specialisation in the profession which, if adopted by the RCVS, should go some considerable way to improving matters for animal owners and animals in the UK.  

Northwest Surgeons completely supports the findings of this Working Party and we are keen to see the findings of the report enshrined in our Professional Code of Conduct.  There is no guarantee that the findings of the report will be adopted in full or in part by the RCVS.  The report must go before the Council of the RCVS and it is the Council that will decide which (if any) parts of the report are adopted. By its very remit, the council must take both veterinary and public opinion into consideration when making its decisions, but should put the public needs first.  However, The Council is a large body with over 40 representatives on it with very diverse opinions, not all of which will be in favour of clarifying matters for the public in the way that the Working Party has proposed.  It is therefore very important that you have your say if you care about the quality of the specialist that may be looking after your animal in the future.  It is unlikely that another Working Party would be convened on this subject for many years.
You might also want to visit www.rcvs.org.uk to read the RCVS view.
On page 25 of the consultation document there is a list of 10 questions for consultation.  Please take the time to read the document and to report back to the working party by answering the questions on page 25, explaining in your reply that you are a member of the animal owning public. 

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Feature

Think before you throw that stick!

By admin On October 7, 2011 - 0 Comments

For many dog owners, the longer summer evenings mean a chance to enjoy some of the beautiful countryside of the North West with their pet. Inevitably for many people, the temptation to throw that stick your dog lovingly drops at your feet during the walk is just too much to resist. What could the harm be? Unfortunately, that innocent game of fetch could turn in to a painful injury for your pet and an expensive trip to see the vet.

Every summer we see a number of dogs who have a penetrating injury of the delicate tissues at the back of the mouth after jumping to catch a stick. Sticks can travel long distances in the tissues of the neck and pieces of stick will sometimes end up as far down as the chest cavity. It is impossible to know when the stick is removed by the owner whether any pieces have been left behind. In addition these dogs can also have painful injuries to the back of the throat, oesophagus or windpipe. We also see dogs that have developed an abscess in the tissues of their neck due to the pieces of stick which can be left behind after a penetrating injury. This can happen up to several months after the initial injury.

Treatment of stick injuries often requires camera examination of the oesophagus and windpipe and advanced imaging such as a 3D x-ray scan (computed tomography) or an MRI scan to try and identify where the soft tissue damage is and also the location of any pieces of stick which have broken off as the stick is pulled out. Attempting to find pieces of stick without the help of such scans can be very difficult and involves large scale dissection of the soft tissues of the neck. It is a little bit like attempting a road trip in the middle of the countryside with no map and no satellite navigation. This therefore increases the risk that pieces of stick will get left behind leading to the development of further abscesses.

Surgery also means navigating some very important and delicate structures such as nerves, blood vessels and the windpipe. In some cases, opening and exploration of the chest cavity can be required to ensure all the pieces of stick are removed. Luckily here at NorthWest Surgeons we have access to the specialist scanners and cameras we need to help these dogs and our soft tissue surgeon Catherine Sturgeon is experienced in dealing with these tricky cases. However, it is important to remember that even with the expertise of a specialist surgeon and specialist scans, it is difficult to give an owner a cast iron guarantee that all foreign material has been removed. It is therefore much better to avoid the risk in the first place so why not treat your dog to a new toy!

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Feature, General

Do dogs and cats get DVT?

By admin On September 22, 2011 - 0 Comments

A deep vein thrombosis (DVT) is a blood clot that develops in the veins deep within the body, partially or totally blocking blood flow. In human patients this is most likely to occur in the veins within the muscles of the calf and thigh although it will occasionally form in other veins. We presume that the situation is similar in our pet patients.

Deep vein thrombosis forms part of a complex called venous thromboembolism. Venous relates to those vessels that return blood to the heart. A thrombus is a blood clot and an embolus is a part of a clot that breaks off and lodges in another vessel. When a clot lodges in a large vein supplying the lungs this is called a pulmonary thromboembolus (PTE).

Thrombi form in veins for many reasons; however these fall broadly into three categories: changes in blood flow, changes in blood composition, or changes in the vessel wall. Therefore situations which alter any of these three things will predispose to the formation of blood clots and the potential for PTE. Blood usually flows rapidly through veins aided by movement of the legs. A patient that is immobile for a long period of time eg: during a surgical operation or due to illness is at risk of clot formation. Long distance air travel in people is a well known risk factor. High blood pressure will also alter blood flow increasing the risk of clots forming. Changes to the vessel wall happen when the lining becomes inflamed. This can happen during surgery or in serious illness such as sepsis when a vasculitis may develop. Other damaging events include the need for repeated catheterisation, eg: if a patient requires intravenous fluid therapy or from certain drugs.

Changes to the blood itself that result in clotting are usually due to alterations in blood proteins that prevent inappropriate clots developing. With all body systems there is a delicate balance between providing a protective defence but avoiding an inappropriate reaction that may itself cause damage. Diseases that cause excessive loss of protein such as some kidney diseases and some gastrointestinal disease are termed prothrombotic. Some hormonal conditions such as hyperadrenocorticism (Cushing’s disease) can also alter components of the clotting system and combined with their hypertensive effects can result in increased probability of blood clot formation. Any patient with hypertension as part of their illness such as kidney patients, heart patients and diabetics may need observation for clot formation when hospitilised and checking of blood pressure.

 DVT can go undetected if the thrombus does not result in complete blockage of the vessel. However, if a piece of thrombus breaks off and forms an embolus which passes through the veins and heart to the lungs symptoms may be serious. These range from mild to severe breathing problems and in a few cases sudden death. It is estimated that 1 in 10 people with an undiagnosed DVT will develop a clot large enough to be at risk of serious PTE. Fortunately our understanding of the reasons for clot formation allows us to take certain measures to help prevent it in our veterinary patients. These include making sure animals get up and about as soon as possible after surgery. This is done by providing appropriate pain relief, but in those animals whose operations make walking difficult our nurses ensure the patient is turned frequently, receives appropriate cage side physiotherapy and when ready receives assistance in exercising such as supported walking and use of an exercise ball.

 In sick medical patients with known predisposing factors for clotting are identified we can provide anticoagulant medication such as heparin and low molecular weight heparin to ‘thin the blood’ and stop a clot developing. Patients with hypertension can have this treated with various medications. If a pulmonary embolus does develop patients are given oxygen therapy. Unfortunately we do not yet have veterinary emergency anti-clot drugs like those used in human medicine eg streptolysin because of both expense and poor patient outcomes where they have been used historically. We therefore put lots of effort into identifying pet patients at risk of clotting and thinking of the best patient plan to minimise the risk of this.

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