Greyhound Protocol For Surgery

[Guest CyndiW]

I know that putting a greyhound under anesthesia is definitely different and many precautions must be taken. However, should vets take any extra precautions with greyhounds concerning antibiotics and pain meds vs other breeds?

 

We are now getting all of the medical records and info for what happened to Alex with the first abdominal exploratory surgery which happened 24 hours prior to him going into septic shock from an incisional infection and developing peritonitis among other complications. He was moved to a critical care animal hospital as soon as we were notified that he was not doing well and about $10,000 later he is home with us. He still has a way to go but we are optimistic at this point.

 

I was shocked to find out that that no antibiotics were used during or after the 1st surgery nor were any pain meds used except a small dose of torb after he started screaming in pain the next day. According to the board certified surgeon who saved his life with the 2nd surgery, pain meds and antibiotics after regular abdominal surgery are not protocol. She said she uses antibiotics in the IV during the surgery but it is not protocol either. We are still just trying to figure out what exactly caused this massive infection and what could have been done to prevent it. He did also have a dental on the day of the 1st surgery but we were not charged for it and it was not noted in the doctor's notes (hmmm..). We are usually sent home with Clavamox after dentals which is what he ultimately needed for this infection because it came back as e-coli. He had a surgery back in March and ended up with a severe bone infection which took 2 full months of Baytril to clear so it seems like extra precautions should have been taken but his vet and the owner of the clinic claim that the standard of care was met and protocol was followed. The vet is also now saying that when she went to sew him up that part of his skin and muscle ripped. She said she had never seen this before (and she was an emergency vet surgeon for over 20 years?). However, in her notes she put "normal closure." I realize that infections can happen anytime the body cavity is entered and often it happens regardless of precautions taken but it just seems this could have been prevented with some antibiotics during and after surgery. Any suggestions, ideas, similar experiences, or knowledge will be greatly appreciated.

[Guest budsmom]

I don't know if it's normal protocol, but every time any animal of mine has ever had surgery my vet has always sent them home with antibiotics. Last month when Bud had his stitches, he got a shot of penicillin at the vet and a week's worth of antib's sent home with us.

[dmswartzfager]

Wow, that's crazy. I was listening in on two of our vets talking in tones of shock about how a dobie was sent home from another clinic after abdominal surgery without more than a day or two of pain medication (and it was codeine) and absolutely no antibiotics. They're clients of ours, so Dr. Jim dispensed clavamox and deramaxx to them even though we hadn't done the surgery. I've also recently seen that the humane society does spays without sending home any pain meds or antibiotics (but then again, they're trying to keep down costs).

 

Anyway, where I was heading before I was distracted by DH and Blitz, is that being sent home without antibiotics and pain meds is kind of crazy. I've only been to four different clinics for varying degrees of surgery, but we have always been sent home with those medications.

Edited September 5, 2007 by dmswartzfager

[macoduck]

Wow, I don't know what to tell you other than THANK YOU for trying so hard on Alex's behalf.

Edited September 5, 2007 by macoduck

[Guest LynnM]

There's no "set" protocol for antibiotics or pain management. The two practices that I deal with are complete opposites of the spectrum, insofar as both pain meds and antibiotics are concerned. I can see where both mindsets come from and understand both points of view. I do my best to be an advocate for my dogs- my vet knows that I prefer to be involved in decisions regarding their care and we work together towards that end. Sometimes we don't agree, but do find some middle ground and do what's in the best interest of the dog.

 

Lynn

[Batmom]

No antibiotics? Ummmmmmmm ..... I'm flabbergasted. Especially given the type of surgery.

 

Anything deeper than a surface skin tear gets antibiotics here (and sometimes those tears get 'em too).

 

Over the years my vets have been more proactive with the pain meds. I can't imagine them doing a surgery like that and not giving any.

 

I hope your boy continues to improve. What a miserable experience for all of you.

[Guest CyndiW]

If only we had known about the tear before 3 weeks out from surgery. I feel like there was a lot that was hidden from us and they know that we are very involved, proactive clients!! We always like to be very involved in the medical decisions of our dogs and this vet really had the "God complex." She thought she knew what was best and only told us that everything went great until 24 hours later when he became septic. There are 3 other vets that we usually deal with and this vet normally doesn't see our dogs. She has some real control issues. The owner of the clinic did not find out that he had been moved to a critical care center until 10 days after surgery.

[RobinM]

DH is a lawyer and he said you may have a vet. malpractice case. If you want to pursue this PM me and he will try and find you someone.

[feemandvm]

What surgery was done? A spay is an abdominal surgery and if a vet is routinely sending home antibiotics with spays then I would question their sterile technique. Removal of the spleen is an abdominal surgery and again antibiotics are not inidicated unless sterile technique is broken. Now if the procedure involves entering an organ like the stomach, bladder, intestines, etc. then antibiotics would typically be indicated.

 

Pain medications should ALWAYS be indicated in an abdominal surgery. However, I don't know if I could say that the "standard of care" wasn't met.... but I would like to think that our profession has progressed enough that we would be more proactive with pain management. Having said that, I know someone that emailed me about their dog and they were furious their vet sent home pain medication for "Just a spay". I told them to go thank their vet for taking good care of their dog.

 

Feel free to email me if you have questions. Greyhounds have no specific requirements for additional antibiotics than other breeds but I do find that thorough pain management helps them in recovery a lot.

 

 

[Guest CyndiW]

It was an exploratory surgery because from the x-rays she was 99.9% sure there was a blockage (from eating corn cobs 2 days prior). There was not an obstruction when she got in there so she closed him up. It just seems that he should have been considered high risk considering he got a bone infection from his last surgery in March and he is 11 years old. Then, the whole tear thing when she was closing him up just makes me think she should have given him some antibiotics as a precaution not to mention he had a dental. We are always so involved in every little decision that is made about our dogs and we just feel that she did what she wanted to do without giving us any updates. She called at the end of surgery and said everything went perfect and there was no obstruction. That was it. Then when I kept calling the next morning they said he wasn't looking well and that he needed to stay awhile longer but wouldn't give any details until that afternoon when they suggested we take him somewhere else where he could be watched more closely.

[feemandvm]

If she didn't enter into the intestines or stomach then systemic antibiotics are not indicated. For an infection to develop there either:

 

1. The underlying cause which resulted in his vomiting originally resulted in infection and was unrelated to surgery

2. A break in sterile technique occurred.

 

If an incision was made into the stomach or intestines then systemic antibiotics are warranted as it can no longer be considered a "clean" surgery.

 

I don't know how to interpret the "tear thing" as without seeing it I can't comment about it.

 

Regarding antibiotics and dental cleanings. There are actually many board certified specialists that no longer recommend antibiotics following a routine dental cleaning. I still use them personally but the standard of care may be changing in that regard.

 

 

[feemandvm]

As for actually filing for malpractice... this is a decision that you need to take very seriously. You will be jepordizing the vet's license (although if they did nothing wrong they won't lose their license) and you will likely be ending your relationship with this clinic. If a client of mind came in on emergency and saw one of my associates and received what I believed to be a good quality of care and there was a complication and the owner sued them... I would not see them myself again. If I felt that the care the animal received was not appropriate than obviously that would be a different situation.

 

What about getting copies of your records from the vet that did the surgery and asking the vets at teh ER clinic to review them and find out from them if they think the "Standard of care" was used. They know how sick your dog was and with your records they'll know exactly what was done by the surgeon.

[Guest LynnM]

A bone infection doesn't mean any sort of predisposition towards any other infection. Bone infections (other than those that are post-surgical after orthopedic repair) are quirky little things.... they tend to happen from bacteria travelling from other sites of infection. Sometimes those original sites are so small that the owner never knows they're there.

 

As the good doctor said, if the stomach or bowel wasn't opened, the antibiotics aren't necessarily indicated.

 

A lawsuit is a VERY serious thing, indeed, and I'd be hesitant to even go there....

 

Lynn

[Guest trevdog]

When Dallas had to have her emer surgery for foreign object removal, they were able to push it though her intestines without opening them up. We were sent home with antibiotics and pain meds. She was also on IV for dehydration and we were told infection although not common could happen and she stayed 48hours at the vets where he personally monitored her the entire time. Luckily she was fine and has recovered well. I was very thankful for this and thanked them all profusely. When she had her spay she also had antibiotics only.

[feemandvm]

When she had her spay she also had antibiotics only.

I really hope you mean pain medications only. There is no good reason to use antibiotics for a spay unless you are not using sterile technique or unless the uterus was infected or a dental was done at the same time. Pain medications should without question be prescribed with a spay as it is a painful procedure 100% of the time.

 

 

[Guest gr84me]

Brody was sent home with both antibiotics and pain meds (I've forgotten what they were; I'd have to look it up). Also, while he was in recovery at the clinic after his intestinal obstruction surgery he was given both antibiotics and pain meds. But, as you know, he was obstructed and had to be opened up.

 

When he recently had his dental, he was sent home with antibiotics (there were no extractions and no problems). and he was in absolutely no pain at all (i.e., higher than a kite) from the valium he was given to calm him down upon "waking up". I'm so glad my vet cares about his comfort!

 

I was under the impression that the first surgeon did open the intestines ... is that correct?

[Batmom]

For the record, we haven't had antibiotics before/after simple dentals.

 

Joseph did have several days of pain meds (but not antibiotics) after his routine neuter, and strict instructions from the doc to give them all, no cheating. Dental and neuter were not done at the same time -- my vet doesn't like to, and since a neuter is a once-in-a-lifetime event, I can deal with that.

[Guest CyndiW]

She did not have to open his intestines up with the first surgery. She was "99.9% sure" that there was an obstruction and that she would have to but as it turned out the corn cobs had moved on to the large intestines on their own. Therefore, she just classified the surgery as exploratory to see if there was an obstruction. (Hindsight is always better than foresight I guess) It was stated in the surgeon's (the vet that cleaned out the massive infection and then aggressively treated him with antibiotics and plasma) summary that this was an incisional infection. She said she never had any reason to believe that the infection came from within. She said it started with the incision and then moved inward. However, when the first vet received the notes about it being an e-coli infection, she starts trying to explain to me that this infection must have been caused from e-coli that seeped through the intestine walls into the abdominal cavity and goes on about how his large intestines were in such bad shape from the corn cob trauma. However, the night she called me after finishing up with the "exploratory surgery" she said his intestines looked fine but that she needed to give pepsid and reglan to get things moving. It is all such a mess and I know that we will really never know exactly how and why this happened - just a surgery risk I suppose. When the other vets at our practice do a dental on one of our other greys, Clavamox is standard. Alex also had a dental that day but no Clavamox. That is the antibiotic that saved his life in the end but if she had given it then with our luck the bacteria would have been something else - probably something drug resistant. It seems like a no win situation trying to figure out exactly what happened but in the end we did win; we have our beautiful 11 year old boy home and filling our house once again with love and joy.

[feemandvm]

but in the end we did win; we have our beautiful 11 year old boy home and filling our house once again with love and joy.

 

I couldn't agree with you any more!