# Dangers of prophylactic Gastropexy



## CharismaticMillie (Jun 16, 2010)

Yikes! I'm sorry you had such a bad experience and I hope your boy is well on his way to recovery. I still strongly recommend a prophylactic gastropexy because it can save a poodle's life. It can be done laparoscopically or, in a bitch, as part of her spay surgery (stomach is already opened up - incision is just a little longer for the tack.) I think it's really important to find a vet who has a lot of experience doing the procedure and also to really do a lot of research on the different types of gastropexy procedures.


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## fel (Jan 8, 2014)

I thought I had done that. Didn't work out so well. I couldn't find a single journal article that document the mortality of elective gastropexy. Do you know of one?


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## Rachel76 (Feb 3, 2014)

I'm so sorry to hear about Kepler. I wish him a speedy recovery.


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## Tiny Poodles (Jun 20, 2013)

I am so sorry that this happened, and I wish him a speedy recovery.
Once he is well, you may want to have a strong talk with the hospital about the additional costs that resulted from their pour infection control. If he was a human being, what happened would be a great basis for a malpractice claim.


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## patk (Jun 13, 2013)

i think your original surgeon should be reported to the professional organization to which she belongs and to any licensing organization in your state. paws crossed and candles burning for kepler.


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## PoodlePaws (May 28, 2013)

Oh no!! Hope he heals quickly! Poor guy ?


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## Feelingdoc (Feb 18, 2014)

I hate to hear stories like yours. It sounded like you switched doctors from the first surgery - to do the second? It baffles me how quality of care can be so varied from vet to vet. I would think reporting him would be an appropriate measure to make him increase his standards. I do trust your Kelper will be back on his paws soon.


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## lily cd re (Jul 23, 2012)

I hope Kepler recovers fully, but I don't think this is about the gastropexy at all, but instead an indictment of the first surgeon. I agree with patk, report her to her state board.


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## Carolinek (Apr 2, 2014)

Glad he's on the mend. How scary that must have been.

I would have had the same question- what is the morbidity/mortality rate with elective gastropexies? And then weigh that against the risk of bloat in standard poodles (is that known?). Need to know both of these to make an informed decision. 

Routine surgeries can have very poor outcomes even in the best of circumstances. As pet owners we need to know if the risk of the disease is significant enough to warrant subjecting the animal to a major surgery simply for prophlylaxis. I don't know much about bloat, other than it is a problem with bigger dogs, but it seems there are a lot of unanswered questions. 

This is one thing I find very frustrating in providing veterinary care for my pets- it's very hard to find good data. It seems so many things are done based on anecdotal evidence, or a reluctance to look at new ways of doing things. Thanks to Dodds and Schultz, we finally have something to follow for vaccines.


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## fel (Jan 8, 2014)

The second surgery was done at the vet ER. The first one was done at a small office that doesn't have weekend hours. When we saw the first vet for follow up owing to complications on Friday, she said if there were issues over the weekend we would have to go to the ER. I think she knew there were issues at that point. But proving negligence to a veterinary board would take more than just a suspicion.


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## N2Mischief (Dec 3, 2012)

I too am so very sorry you are going through this! 

I agree with other people though, you can't blame the kind of surgery. This could happen with ANY surgery. 

It is always a tough decision to do elective surgery. But in your case he would have had surgery anyway and it might still have resulted in infection. No way to know. 

Hang in there, I sure hope he recovers quickly and that you can get some satisfaction from the surgeon!


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## Tiny Poodles (Jun 20, 2013)

That small office should be refunding every dime of the original procedure. Infection like that in a healthy young dog is due to their incompetence!


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## patk (Jun 13, 2013)

proving negligence would be difficult. but complaining and reporting what happened can help create a record that may lead to improvements or may help someone else to make a strong case for negligence down the road. i am sure there are protocols re treatment and surgery that vets are expected to follow. whether that actually happened is open to question in view of what happened and you have every right to raise questions.


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## Poodlebeguiled (May 27, 2013)

I am so sorry you've had this terrible worry about your sweet baby. I hope there will be a quick and complete recovery and soon. It sounds like that vet sent you on your way without taking enough precautions. If it has been shown that tissue that should have been removed but wasn't is the culprit, you might have a cause for compensation. But still...might be hard to prove. I would think that vet would settle to avoid further disintegration of her reputation. I agree that it is not the _type _of surgery per say but somehow the way it was handled. 
And she should be reported so this type of thing doesn't continue.

I am glad things are starting to look better for your dog. It has to have been really traumatic for you both. Best wishes.


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## fel (Jan 8, 2014)

Just by way of update, Kepler is resting in the hospital tonight and may be sent home tomorrow for 2 weeks of sedated rest. We all miss him. He still has to fight off any remaining infection to survive, so we are not out of the woods yet.


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## Theo'sMom (Mar 23, 2011)

I'm so sorry he and you are going through all of this.


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## Carley's Mom (Oct 30, 2011)

Wow, that is scary stuff. I am so sorry. I don't know enough about this to voice an opinion, but most of the time I go with the less done the better.


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## Tiny Poodles (Jun 20, 2013)

In human medicine, a rapid post-op infection in a young healthy person would be considered a failing on the hospital/doctor's part.


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## lily cd re (Jul 23, 2012)

Tiny Poodles you are absolutely spot on with that assessment. I agree there was a failure here too. Not just at the time of the surgery to have lack of proper aseptic technique but if as OP suspects she saw a problem on Friday and just said go to ER if there is a problem over the weekend is negligence.

fel, it is in your dog's favor that he is young and otherwise healthy. I hope Kepler comes home ASAP.


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## Manxcat (May 6, 2013)

Hope Kepler gets better quickly.

Sounds to me like dodgy infection control or maybe lack of experience with pexy's... And I agree that you should report it, even if nothing comes of it, so that a record is built up about this vet. In human healthcare it is important that a "trail" is established showing a high incidence of post operative infection for the licencing body to see the whole picture. I'd imagine it is the same for vets. It's one of the reasons I would ALWAYS report concerns, even if I had no expectation of compensation or anything like that.


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## frecklesdmk (Mar 27, 2013)

My girl had a spay/Pexi and had a reaction to the dissolvable stitches that were under the incision. The external stitches were not dissolvable. 

She did require surgery to remove tissue, had a drain, and be resutured. 
My vet split the cost of that with me since her reaction to the sutures wasn't his fault 

I am curious if this could be the case with your boy. 

Her infection was at the incision site. If she needs any other surgeries in the future with a different vet, I'm going to make sure they know about her reaction to dissolvable sutures


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## frecklesdmk (Mar 27, 2013)

Forgot to add - I am sorry he is going thru this and send wishes for a speedy recovery!


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## fel (Jan 8, 2014)

Thanks everyone for your support. I really need it right now. 

Kepler is still alive and so far the infection has not come back. The surgeon had to remove tissue around the wound, so I don't know what that will mean with regard to healing and scarring. If he makes it a week without a new infection, that will probably mean he will survive. Nevertheless, his doctor/surgeon reports Kepler is already eager to move around and they must sedate him. For similar reasons (his "boisterousness", the surgeon advised us not to visit him in the hospital.)

We elected to keep him in the hospital 2 extra days so that we can have the cultures come back before taking him home. This will assure he is on the correct antibiotic. 

The original veternarian is blaming us for the infection, and admits no responsibility. I am considering options. If there are any poodle loving lawyers on this forum who would like to help me, let's connect off list. 

I am having trouble sleeping -- hence the 2:00 am reply.


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## marialydia (Nov 23, 2013)

Just to let you know that I am so sorry you and Kepler are going through this, and very best wishes for a full recovery, and soon. It sounds like he is getting excellent care now and you are doing everything possible to help him recover.


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## Poodlerunner (Jul 4, 2014)

I am so sorry for what you and Kepler are going through. Your first vet sounds dreadful... not only did he get a post-op infection, but then did'nt even deal with it. She left it for the ER vet to clean up. Awful.


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## MiniPoo (Mar 6, 2014)

Talking about post surgery infections, my brother had heart bypass surgery several years ago. The operation was a success but he got an infection of the tissue around the suture site and had to go back into surgery to remove the infected tissue, then be on antibiotics in the hospital for a week, then was sent home. Great care had to be used to change his bandages to avoid further infection. He healed but had to return to the hospital six months later for a final time of IV antibiotics to really kick the infection. He is now fully healed and feels fine but he has more scars than he would have had if there had been no post surgery infection.

I personally blame the hospital for the infection but the most important thing after it happens and the infected area is cleaned up is that great care is taken to avoid further infections.

I hope Kepler gets better quickly and that you find a vet that you can trust more than this one.


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## lily cd re (Jul 23, 2012)

MiniPoo said:


> Talking about *post surgery infections, my brother had heart bypass surgery several years ago. The operation was a success but he got an infection of the tissue around the suture site and had to go back into surgery to remove the infected tissue,* then be on antibiotics in the hospital for a week, then was sent home. Great care had to be used to change his bandages to avoid further infection. He healed but had to return to the hospital six months later for a final time of IV antibiotics to really kick the infection. He is now fully healed and feels fine but he has more scars than he would have had if there had been no post surgery infection.
> 
> I personally blame the hospital for the infection but the most important thing after it happens and the infected area is cleaned up is that great care is taken to avoid further infections.
> 
> I hope Kepler gets better quickly and that you find a vet that you can trust more than this one.


These are called nosocomial infections and they are incredibly common and can be very dangerous. In addition to being costly of lives they are costly to the healthcare system in terms of extra days in hospital and expensive drugs over extended times. MiniPoo I am very glad your brother recovered from his infection. This was always my greatest worry when my niece (the one going to Mt. Holyoke in a couple of weeks) had her heart surgeries (yes more than one, actually three majors in four years). We watched like hawks for everything that was done when she was in hospital and all knew what to watch for once home too.

This problem is certainly not limited to people. I just recently read a paper about multiply drug resistant enterococcus in dogs that had been in intensive care.

These kinds of infections are associated with surgical wounds, urinary catheter use in hospitals, dialysis and other medical procedures that are invasive. Here is a link to the CDC's website for the reports of the National Healthcare Safety Network. Data & Reports | NHSN | CDC There is a lot of information linked to there regarding these infections.

fel, I know your main concern right now is for Kepler's well being, but this situation seems really to fall back on the original surgeon. If nothing else she should have been very specific about dressing changes and signs of infection.


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## fel (Jan 8, 2014)

There were no dressing on Kepler. He was left wide open, and the vet just said to take him to the ER if the wound completely opened up, which is what happened some 15 hours later. I think it was a foregone conclusion the wound would open up at that point. 

I pick up Kepler tomorrow. I hear he is wagging his tail when approached by the doctor, even tranquilized.


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## frecklesdmk (Mar 27, 2013)

Glad to hear he's perking up. Keep us posted.


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## Mfmst (Jun 18, 2014)

Demand Trevor's file and the name of the practice's liability carrier. Tell her you will also file a grievance with the state veterinary disciplinary board for failure to practice clinical infection control and failure to meet standards of care. Go scorched earth, when he's home and you're calm. This is so outrageous, no wonder you can't sleep. Very glad that he's doing better.


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## fel (Jan 8, 2014)

Kepler is home and doing OK so far. He is being tranquilized to prevent him from starching the stitches out, and also he has a compression sweater which really helps protect the wound. i wish we had the compression vest from the beginning.


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## BorderKelpie (Dec 3, 2011)

Best wishes to you both. 

What a frightening experience for you all.


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## Theo'sMom (Mar 23, 2011)

I really hope Kepler feels better soon.


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## frecklesdmk (Mar 27, 2013)

Glad he is home and sending good thoughts for a quick recovery


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## fel (Jan 8, 2014)

Thanks everyone. I just realized I had said "starching his stitches out-- ugg spell check messes me up sometimes. Anyway, so far so good, the new stitches are holding. 

On the other hand he is barely eating and he seems kind of sad. I am not sure what to do to keep him happy. His new cone e-collar is so long he really can't comfortably sniff, or chew on a toy, or lick from a kong. He can't look down to play with a toy, and he isn't supposed to spend too much time standing anyway. He is only allowed 3-4 walks a day, about 5 minutes each. This is a tough regimen on a typically bright and energetic poodle.


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## BorderKelpie (Dec 3, 2011)

Oh, poor baby - bed rest is so hard. 
What about really gentle massage. It may be soothing and help circulation which should hopefully aid in healing. I have no idea what to suggest for the poor lad. 
It so hurts watching your loved ones in misery and not being able to help, doesn't it? 

I'm sorry. 
Trting to see a silver lining, I'd rather he be temporairily miserable and live a long happy life in the end. You're doing right by him.


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## frecklesdmk (Mar 27, 2013)

I used the e-collar when I couldn't watch her or when I slept. I spent a lot of time laying on the floor with her in the living room watching tv. That way I could keep an eye on her and she had time with that collar.


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## fel (Jan 8, 2014)

Another update for all you kind and supportive folks on the forum. 

Kepler is doing very well. His suture looks so much better than it did after the first surgery, and it is no longer leaking fluids. We have to keep him sedated most of the time, however, as otherwise he would like be back to his old schedule -- long walks, running around the yard, etc. Even with tranquilizers, wearing the cone and a protective sweater, he is still pulling at the leash rearing to go explore. The doctor said if he made it a week from surgery without recurrence of the infection, he would have a good chance of making it. Today is the week mark. 

On the other hand, I now believe more than ever that he was not treated appropriately by his initial vet who did the first surgery.


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## patk (Jun 13, 2013)

thank you, fel, for keeping us in the loop. i don't want to add to your sorrow, but i believe, as you do, that his first surgeon was not competent. i am glad your second vet apparently seems to be far more capable. i bet he has a few thoughts of his own about the original surgery which, of course, he would not share for fear of being sued for slander. 

paws crossed for kepler's continued recovery.


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## frecklesdmk (Mar 27, 2013)

Thanks for the update. Happy to hear good news!


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## lily cd re (Jul 23, 2012)

I am very happy to see that update. I hope you are starting to be able to sleep better and to enjoy being with Kepler now that you see his old self coming back. Even though it is hard to keep him quiet I am sure you are glad to see that he is ready to get back to his regular life and activities.

I do hope that once you are more certain that he is really recovered and have a chance to pay attention to the idea of it that you will make a complaint about the first vet to the state board. That was malpractice in my estimation. The most important thing of course is that Kepler is doing better!


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## marialydia (Nov 23, 2013)

So glad to hear that Kepler is well on the road to recovery! You both have been through the mill and it sounds as if the very worst is over. I wish Kepler all the best for a swift full recovery.

I would agree with lily cd re about making a complaint; it might help others avoid a similar circumstance.


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## fel (Jan 8, 2014)

So I just want to say Kepler is doing really well, except that he is more than ready to be out of his cone of shame and his compression sweater to cover the incision, and he still has a week left of them. Poor boy, we have to keep him sedated or he doesn't know what to do with himself. Today he started alarm barking at our neighbors. While this is one of those bad habits we have been trying to train him out of, it was wonderful to hear that he finally has the strength to do a deep "ruff". 

I miss snuggling with him -- it is hard to hug a poodle wearing a giant plastic cone.


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## fjm (Jun 4, 2010)

I am so happy to hear good news after everything you have both been through. I don't know the US system, but if this had happened here in the UK I would start with a written complaint to the head of the practice, and escalate if necessary. The key issue for me is that no action was taken when things were clearly going wrong after the operation - your concerns were fobbed off, and your dog put in a life threatening situation as a result. It may be hard to prove whether the infection came from poor management during the procedure - which seems very likely - or was contracted after, but the failure to treat it appropriately is unarguable.

Give Kepler a hug from all of us, just as soon as he is ready for hugs!


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## Carolinek (Apr 2, 2014)

So happy to hear Kepler is out of the woods. How horrible that must have been, I can't even imagine what you've gone through in the past week and a half :-(

I agree with going to the practice first and asking very specific questions like- should he have been treated more aggressively when he first showed signs of an infection? How could this have been prevented? How often do you see this type of complication? Then let them know you are following up with a report to the state board. If they are a conscientious practice, they are probably also looking at the case trying to figure it out. 

I do think it will be impossible to trace the origin of the infection. It might have been poor surgical technique, but it also could have been a lot of other things like- the cage they recovered him in was not cleaned right, or someone was not careful with hand washing when they were checking the incision. The bacteria could have been introduced in many ways, but by bringing this forward you will force the issue, which will hopefully lead them to examine their practice to see if something was amiss. If they are as good as the initial recommendations you received, that will occur. If they are not and were negligent, you also are doing the right thing by reporting it. 

Good luck with all of this.


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## Mfmst (Jun 18, 2014)

So relieved that valiant Kepler is doing better. It must be SO frustrating for a bright, active dog to have so many restrictions/medical appliances. For you too! Can you take the cone off briefly for some puzzle games? Did the surgeon's office have any suggestions for aftercare activities? They must field this question a lot.


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## lily cd re (Jul 23, 2012)

Actually carolinek they probably can figure out where the infection came from if it was cultured from Kepler. They can go back and take samples from the vet and her staff and environmental cultures in the surgery area and the recovery area. If any of those other samples match Kepler's organism by species then they can do DNA fingerprinting to get an exact answer. This is what they would do for human hospital infection control. The idea of doing that in veterinary practice makes sense since we live in such close physical proximity to our dogs that sharing of microbiome organisms is not a far fetched concept.


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## frecklesdmk (Mar 27, 2013)

How is he doing?


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## fel (Jan 8, 2014)

Hi, Thanks for asking. Kepler is doing really well, except that he is distraught about the limitations on his walks and other activities. Especially, he is upset that he is not allowed to approach or play with other dogs. He has to wear the cone until his stitches come out next Tues., and then he will be allowed to gradually resume a more active lifestyle. I don't see any sign of pain in Kepler anymore -- just boredom.The new veternarian said Kepler is healing great, and she commended us on our care of him. 

Meanwhile,since he had one leg that was shaved on the upper half for the two surgeries, I tried to even him out by giving him some semblance of bracelets. So when his cone is off he will be clipped as a very stylish poodle.


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## Carolinek (Apr 2, 2014)

So glad to hear Kepler is doing well ...nice to have to think about how his bracelets will now match instead of whether he will be around to worry about it!

Lily cd- I would hope they did culture Kepler's wound- failing to do so in such a sick dog would be really negligent. Fortunately he responded to the antibiotics, so the choice of antibiotic might have been a good guess, but hopefully they used a culture to guide the therapy. 

And I agree that if the reservoir still exists, they can isolate the source of the bacteria...and if it's as simple as something like the walls of the OR are colonized with some super virulent organism, or the workers are colonized, then it is easy to trace. But all too often in the human setting (I'm sure it's similar in vet care) the cause of these infections is really hard to identify. They're often a result of poor hand washing(and and you're probably aware that poor hand washing is the number one reason for infection in hospitals). But then to identify who exactly carried what bug where? And from whom, or what, did they carry it? On an instrument that has since been sterilized? From a patient that went home yesterday? Or on scrubs that have now been washed? Forty -eight hours later when the clinical signs of infection surface, tracing the source is next to impossible unless it is a persistent reservoir. 

You're a scientist, and I appreciate your perspective... and I'll freely admit that I'm a tad jaded from dealing with the frustrations of infection control in the clinical setting. It seems like it should be so simple....but sadly it is not:sad: What should be pure science gets lost in the chaos of the practice setting. Thankfully this was a good outcome in the end for Kepler, and we can only hope that the vet practice used this as an opportunity to examine their procedures at the point of care.


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## lily cd re (Jul 23, 2012)

fel, I am so glad that Kepler's worst problem right now is being bored and having an uneven haircut! That's great news.

Carolinek, given how poor the infection control seems to have been at the first vet I would imagine that they haven't been clever enough to clean up after themselves so the organism is likely to still be in the environment. Also if the organism was transferred from hospital personnel who carry it as part of their microbiome they can't have taken a shower and rid themselves of the organism. The indigenous microbiome is too persistent to change that rapidly. Unfortunately all too often nosocomial infections can be traced to personnel. I do agree with you though that all too often the chaos of the healthcare environment does let things slip through the cracks. Infection control is not only complicated by human behaviors, but also by the pace of emerging resistance.


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## Carolinek (Apr 2, 2014)

Lily cd- I think we're hijacking the post:act-up:
But I'll just say I don't know if we really know how big of a risk colonized health care workers are. Despite the fact that so many health care workers are colonized with MRSA, if they're asymptomatic, it doesn't pose a risk to to the patient. Substandard infection control practices I think pose the biggest risk to the patient. But- with the accelerated rate of mutations now, the game may be changing, and we have to look more closely at individual flora. And then what do you do- treat all the carriers even if we don't know the risk, and produce more resistance? Scary times we are in. 

Sorry Kepler to hijack! Good discussion Lily cd- thanks


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## fel (Jan 8, 2014)

I am fine with the hijack. I hope what happened to Kepler never happens to another poodle. We would have lost him if we didn't have the funds to pay for emergency surgery, as well as the resource of a world class veterinary hospital within a half hour of our house.


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## lily cd re (Jul 23, 2012)

We could start a discussion about this in off topic if you want. It is an important issue with implications in human and veterinary medicine. I am going back to the trial soon and it will be a long day since I will bring Lily home and then go back to steward. Carolinek start if you want and I will look later.

Thanks for your gracious take on our sidebar fel.


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## Carolinek (Apr 2, 2014)

Kepler- thank you for your understanding.

Lily cd, I agree it is an interesting discussion and perhaps I will start another thread. But with school starting this week, it's been a bit crazy here! The good news is my chair is going to reduce my load by a third so I can actually finish my dissertation this year, so I may have some time to poke around on PF. This forum is a good stress reliever for me- it's what I do when I need to decompress a bit!


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## Feelingdoc (Feb 18, 2014)

I know this is a already long and hijacked thread...but it all of a sudden puts a question in my head. My girl has a compromised immune system and requires frequent vet visits...The vet tech yesterday was giving her treats from a jar in the waiting room...where all sorts of sick animals pass through...and then we go into an exam room and Noel licks on the floor. I'm sure they don't totally disinfect after every pet exam...all of a sudden I'm worried that a vet visit may be hazardous to your pets health!


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## lily cd re (Jul 23, 2012)

Feelingdoc I just started a new thread about nosocomial infections under off topic chat. Check over there and you can ask questions and I am sure someone will answer. There are vet techs, nurses and others here with knowledge in these areas that are PF members.


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## fel (Jan 8, 2014)

Just letting you all know that Kepler is completely fine now. He no longer has to wear the cone, and has no more exercise restrictions. Today he had his first play date since surgery with one of his "husky" (that is siberian husky) girlfriends, and he was ecstatic. 

On the other hand, the day after he got the cone off he chewed a good pair of shoes and my asthma inhaler. I guess we have some retraining to do. 

Cheers,

Fel


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## frecklesdmk (Mar 27, 2013)

Thanks for the update. Glad to hear he's recovered and making up for lost time with his mischief!


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## fjm (Jun 4, 2010)

It is not often that chewing up good stuff seems like cause for celebration and congratulations, but after the weeks of fear and anxiety you have been through it must be wonderful to see him being a normal pup! Thanks for the update - I hope for many more new threads about your happy adventures together.


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## lily cd re (Jul 23, 2012)

That's great news! I'd even be willing to right off the shoes for seeing how happy and healthy Kepler is after such a long period of worry.


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