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I'm sorry, x 3! I know we've talked about this ad nauseam, but it's time for the yearly vet visit and I just can't remember. This is the notification we got. 

OCCULT HEARTWORM TEST (12/09/2018)
LEPTO VACCINE (12/09/2018)
DHPP VACCINATION (12/09/2018)

Maggie is almost 2 1/2. I know she was vaccinated appropriately at this time last year. My current vet is very pro Lepto. And the girls do sometimes swim in the lake. Heartworm test, obviously. Lepto... if it's the safe one. Which one is that? And do I DHPP or do I pass?

As a human I am pro vaccine. I get my flu shot every year, and I believe that it's important to be vaccinated. I don't believe vaccines cause autism. But at the same time I don't think we need to over vaccinate. That's not good either. Should I ask for titers? Should I just opt to do it every 3 years like rabies? Add the possibility of having a foster dog here at some point. Does that influence the recommendation? 

Thanks! Sorry for being repetitive. I really need someone to just hold my hand all the time!

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Okay, so if they swim in the lake, they should have the lepto vaccine. The newer,"safer" one is given in two doses about a month apart. It's a good sign that it was listed separately and not as part of the cocktail, i.e. DHLPP. Obviously, if it's part of a cocktail, it can't be the newer two-dose version. 
Personally, if Maggie had a one year DHPP vaccine last year, I would titer. I can almost guarantee you she will show strong immunity. Then you can revisist it at whatever interval is suggested, maybe in two years. Or if you choose to do the vaccine (it's a lot cheaper than titering), insist on the three year version. Then you don't have to think about it again for three years. 

Thank you! That's what I needed to know. This is the vet who I feel is the most cutting edge, up to the minute educated vet I've had, so I feel like he will be with me on the most progressive vaccine protocol. (He's also the most expensive by far, so I guess he should get credit for that too.) I think I will ask to just have a titer done. It's not so much about the cost, it's about keeping her healthy. I just can't bear the thought of what happened with Ava happening again. I should take Katie to see him for her ears and see if he passes the ear culture test. I suspect he would. 

In other news, I offered to foster a 3 year old white lab mix today, from a very small rescue group who is always begging for help, and no response. There don't ever seem to be any homeless doodles around here for me to love. I'm starting to get a complex! I'm a good dog mom. In Feb. I'm going to be starting weekend option so I only have to work 2 days a week. I feel like my girls have it pretty good. I can't afford to stay home all the time, but two days a week is almost as good as it gets. I admit it. I don't need three dogs, but I need one more dog in the bed. I feel like having a foster could be the way to go. Where is my foster dog?

One will show up. They always do. 

I hope so. 

For the sake of reference, we had our yearly vet visit and Maggie got Lepto (the vet says it's endemic in this area.) Interestingly he said there are a few working dogs who are starting to vaccinate for Lepto biannually. Though he felt like that was overkill. Flu, and Bordatella. We did titers for Distemper and Parvo. This vet's background is in immunology and he feels that if she has a high titer this year that there's no reason to repeat it next year. That we just revaccinate her in 2020 or 2021. Flu... I had mixed feelings about. There haven't been any reported cases in this area, which isn't to say that there haven't been any cases, but reporting is not always perfect. And in the cities where they have seen big pockets of flu it's been really nasty. Ultimately, I felt like I got my flu shot so Maggie should get hers too. 

Price difference, the titer testing was $120 compared to the $35 or so for the vaccine. But I decided that she shouldn't get it if she didn't really need it. Hopefully the titer testing will come back fine and we'll be done with that. 

Next up on the list of vet bills, Maggie needs her teeth cleaned. Not emergently, but it does need to be done. I haven't been great about brushing and she's not a fabulous bone chewer. The estimate for that was actually significantly less than I expected. Good dental hygiene is important! So that's the next thing on our list. 

We also talked laparoscopic gastropexy. I know I need to do it, though the vet is more 50/50 in his opinion. I'm just procrastinating because I'm afraid. I know the risks with the surgery are small, and they are much smaller than the risk when it is emergent. But I'm still struggling with being a chicken. 

This sounds very positive, and it sounds like you have found a good vet. As far as the price of the titers, you hopefully won't need to do it again, nor vaccinate until at least 2021. So that $120 spread over three years is not such a bad deal. :)
Regarding the gastropexy, my question to the vet would be, "If she were a purebred Standard Poodle, would you still have the same opinion?" One in every four Standards will bloat in their lifetimes, and if there is a family history (which of course we don;t know), the odds are increased. I have heard of a few vets who advise gastropexy surgery for every single one of their Standard Poodle clients, but not for their Standard Poodle mixes. Why? In one case, the answer was "The doodle owners always refuse it. They often have never heard of bloat. Whereas most Standard Poodle owners are well aware of the risk and the seriousness of the condition." 
If I could change one single thing that I ever did in my 66 years of life, it would be to have had gastropexy surgery done on Jack when he was young. And trust me, I have a whole lot of things that really need do-overs, lol. 
There is nothing scarier or worse than bloat. Nothing. And the younger the dog at the time of any surgery, the lower the risks and the easier the recovery. I hope that helps you make up your mind.

I really do like the vet. And it's an AAHA accredited animal hospital, so that should count for something. What we talked about with the gastropexy is that it's an insurance policy, and how much better would I sleep at night knowing that it was done. I think if she hadn't already been spayed he would be 100% for it. We also talked about how gastropexy doesn't prevent bloat and there is still the possibility that they can torse around the pexy. It's unlikely, but possible. And of course no surgery is completely without risk. It was very much a pro and con conversation.

I'm disappointed that they can't do it laparoscopically there. I asked him about the vet who I found who could do it, and he had good things to say about him. I also need to find out if the specialty vet can do it. It would probably be more expensive, but it's the vet who did Ava's surgery and I trust him implicitly. He's my guy.

I look at Maggie and how deep chested and poodle like she's built, and I know I could never live with myself knowing what I know and seeing what you went through if I didn't do it and something happened. I would feel like I failed her. I still feel like I failed Ava. I know we did everything, but if only there had been something else we could have done.

So the decision is really made, I've been talking about it for months. I just need to get it done. There's a little post traumatic stress from Ava's spay-gone-wrong. I'm having a hard time pulling the trigger. Clinically, I know that the chances of anything like that ever happening again are one in a million, but that little voice in my head keeps saying, what if something goes wrong? I was so glad that Maggie was spayed before she came home. I thought, at least we won't have to do that. I just wish I could go back in time and have this done at the same time. Of course I don't expect rescue to do that. But my anxiety would sure appreciate it!

Yes, they can still bloat after gastropexy, but I was told the stomach can't twist, and that's what causes fatality, the loss of blood flow to the heart and other organs. I am very, very surprised to hear that you can still have torsion after the surgery. I'm guessing that's very rare. Certainly, it wouldn't happen as fast. 
I'm also thinking about the fact that she will be under anesthesia anyway when her teeth are cleaned, so....(insert smiley face here). 

Yes, you're right. That's not supposed to be able to happen. Sometimes I think they forget to tell the dog that though. I guess it's like any surgery that somehow fails. And certainly I don't think it's a reason not to get it done. There are different methods of gastropexy too. I need to look it up. My vet said he uses the "belt" method. I have no idea what that is. He was telling me a story about some poor dog who bloated, had torsion and surgery to correct it and a gastropexy. Then bloated a second time, torsed *around* the gastropexy, had surgery again and survived and was doing very well. That dog either has some bad luck or some serious angels. 

I was thinking that as well about doing both at the same time. I wonder if they'll do that. It would be the obvious choice. 

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