Time for some honesty!!!

RE: Time for some honesty!!!

Sal the 1st — Wed, 07 Oct 2020 18:59:03 GMT

I remember doing this a fair bit in the past but didn't dare post it, pleased it isn't only me

RE: Time for some honesty!!!

Jan Harris — Wed, 07 Oct 2020 10:05:14 GMT

I think the talcum causing cancer was restricted to one particular (v well known) manufacturer with a higher than ideal silica content in their product that effectively causes 'stonemasons lung'. This particular company have settled several lawsuits and are easily Googlable. I have seen wound powder used instead of talc. I don't even know if you can still get wound powder? Does anyone remember P.E.P. powder? I don't know if you can still get that. It's years since I've worked in LA practice but it was used for cattle with listeria and general eye issues. That worked equally well but I think it's the drying effect and the fact it provides slight slippage that means that powder prevents the issues.

Getting the whole team to photograph wounds on their phones is a great idea.

RE: Time for some honesty!!!

shelly jefferies — Wed, 07 Oct 2020 09:41:52 GMT

I think this is a huge problem in a lot of practices, and it is something which we all need to be better at I think.

I often have the conversation with my team about continuity, recording what the wound looks like, what you have done, what you hope/plan to do next time, measurements of the wound and ideally a photo of the wound should be recorded on the patient notes each time.

I also spent a long time trying to educate my reception team about the importance of seeing the same person, and actually timings can be moved slightly and I would rather they come and ask me if they can't see an appropriate time. For instance, if a pet was due to come back on Tuesday to see Mr X and the owner could only do after 5pm and Mr X only works until 2pm on Tuesday, I would rather they came in at 9am on Wednesday and saw Mr X, than come in at 5pm on Tuesday and see someone else who is not familiar with the wound. If that makes sense!!

RE: Time for some honesty!!!

shelly jefferies — Wed, 07 Oct 2020 09:37:44 GMT

I LOVE the idea of a wound passport - could incorporate a photo as well at each dressing change, what a great idea Anneke.

Continuity is a huge issue and something we have to be really aware of in practice, we don't want to cause prolonged healing by multiple people having different plans and doing different things each time.

RE: Time for some honesty!!!

shelly jefferies — Wed, 07 Oct 2020 09:34:50 GMT

WOW Jan I've never heard of this either, can understand the thought behind it. But I second Georgies comment about being non-perfumed.

RE: Time for some honesty!!!

Anneke Kuipers — Wed, 07 Oct 2020 09:23:46 GMT

That sounds really good!

But I'm not sure owners will be keen on the idea with the recent news that talcum powder could be causing cancer (if i recall correctly )

RE: Time for some honesty!!!

Georgie Hollis — Wed, 07 Oct 2020 09:03:58 GMT

WOW! that's amazing - i've not heard of that one! I can see the logic.... I guess be sure that the talc is not perfumed to avoid any allergic reactions?

RE: Time for some honesty!!!

Jan Harris — Wed, 07 Oct 2020 08:44:21 GMT

Something real 'old school' that works a treat on hocks and elbows etc that are not injured but are at risk of injury from a dressing is making a sort of 'teabag' of talcum powder and placing it next to the skin. Use a non woven swab as they are naturally soft (unlike the woven cotton ones which are rough) open it up a bit and fill it with talc and refold. Placed over a prominence it is flat and doesn't impede the dressing but gives just enough 'slip' to prevent chafing. I learned this in LA practice on lambs with broken legs and since using this method in SA practice I have never seen even hair loss over a prominence.

RE: Time for some honesty!!!

Jan Harris — Wed, 07 Oct 2020 08:23:55 GMT

- Another big issue is the lack of continuity of the same people being involved I think. -

This. At my last practice the vets varied so widely in how they approached wounds that it was a nightmare as they would strip off something that had only been put on the day before and triumphantly replace it with what they considered more appropriate. We had one client that was on her uppers so we decided to try wet to dry dressings which work great if done well and are cheap as chips. Another vet decided this wasn't 'reflecting the ethos of the practice' and turned it into a riot of expensive dressings without discussing it with anyone. Chaos ensued.

RE: Time for some honesty!!!

Anneke Kuipers — Tue, 06 Oct 2020 22:03:48 GMT

Another big issue is the of lack of continuity of the same people being involved I think.

Because of this i made a 'wound passport' - a little booklet to very easily report what the dressing and the wound are like (as well as notes on the PMS of course). This is kept with any bandage material specifically for the patient in the bandage drawer.

RE: Time for some honesty!!!

shelly jefferies — Thu, 24 Sep 2020 18:45:13 GMT

Thanks for the answers guys, I totally agree compliance is a big issue. I think client education is key but there will always be the owners who don't follow the directions. I do love the comparison of if it was a person they would be in bed for weeks.

Sal I'm loving the term "cure" the vet of it ;-)

I too can remember when cohesive came out and it was put on sooooo tight it was like a tourniquet, bandaging equipment can be dangerous in the wrong hands.

RE: Time for some honesty!!!

shelly jefferies — Thu, 24 Sep 2020 18:39:44 GMT

Thanks for this Sal, poor dog sounds like a nightmare!!

I agree with the wound taking longer than the break and this was the case with the dog in the picture above. The original problem should have healed within a couple of weeks, but ended up with 2 months of bandages!! Bony prominences are such a problem and we really need to educate the whole team on preventing bandaging injuries.

RE: Time for some honesty!!!

Sal the 1st — Thu, 24 Sep 2020 18:38:08 GMT

[quote userid="35357" url="~/001/veterinary-nurse-clinical/small-animal/animal-wound-management/f/discussions/32054/time-for-some-honesty/176464#176464"]I'm old enough to remember when cohesive first came in and vets were winding it on like they were lashing two boats together in a rough sea! Terrible injuries and amputations as a direct result. Even now it frightens me half to death.[/quote]

I 'cured' a vet of this. Applied a dressing to his arm on his study afternoon the same way he would. He came to find me after about 1/2 hour to remove it

RE: Time for some honesty!!!

Jan Harris — Thu, 24 Sep 2020 10:49:52 GMT

I always say that if the critter was a human they would be in bed with the leg up and only allowed to potter to the loo and back. It mustn't get wet, The client has to sniff it four times a day. Reduce the animals carb intake so it isn;t so steamed it wants to exercise etc. It's one of the most challenging things in practice to get compliance. I think a leaflet that sets out the worst case scenario is no bad thing really. The one time I saw the leg come off with the bandage I was so glad it was the vet that put the bandage on. I'm old enough to remember when cohesive first came in and vets were winding it on like they were lashing two boats together in a rough sea! Terrible injuries and amputations as a direct result. Even now it frightens me half to death.

RE: Time for some honesty!!!

Georgie Hollis — Thu, 24 Sep 2020 09:20:07 GMT

This is really interesting, and we see so many cases where the issue is compliance above all. What sort of paperwork do you use to support your advice to clients? I've been looking at this for a long time, but its really difficult to produce a concise but 'binding' document that outlines the risks, client responsibility and potential implications. (without frightening people to death?)

PS. by binding i mean that the document gives the practice a legally valid document should there be a complication....

RE: Time for some honesty!!!

Louise Royle RVN CertCFVHNut — Thu, 24 Sep 2020 09:09:28 GMT

We had a small terrier with a robert jones bandage for treatment of 'simple' fracture, clients live opposite surgery and we regularly saw the dog running free in the garden! obviously as soon as she saw us, dog was picked up and placed back inside... Fast forward 2 days smelly bandage, gangrene infection leg amputation! Clients were even loaned cage to assist with rest. sometimes does not matter how hard you try they are determined to 'know' better.

RE: Time for some honesty!!!

Jan Harris — Thu, 24 Sep 2020 07:52:27 GMT

These injuries can be dramatically reduced if the animal is rested properly in a crate. Owners are so resisitent to this but I have always told them the rest is every bit as important as the bandage, the drugs, the redresses, the air the pet is breathing. I try whatever it takes to get that point across. If they move hardly at all the bandage will do the same.

RE: Time for some honesty!!!

Sal the 1st — Wed, 23 Sep 2020 21:20:05 GMT

forgot to say I love the allevyn shaped heel dressings for hocks and elbows where there is ulceration - with a little bit of trimming they make really good comfortable dressings for these areas. - had some freebies from a district nurse friend but would definitely spend the money should I need more, well worth it. Obviously better if you dont get to the stage of needing them in the first place tho

RE: Time for some honesty!!!

Sal the 1st — Mon, 21 Sep 2020 16:12:49 GMT

Had one earlier this year over an elbow (limited funds, non displaced fracture forelimb which had been split cast with fibreglass) eventually came right, but would say the ulcer took longer than the break. Ended up shortening the splint on one side to form a 'window' with regular redress (subsidised cost)

Same dog almost lost a toe - dressing got very wet after he went for a run on the beach (yes I know!!!) so owner pulled out all the wet stuff leaving the cast rubbing on top of foot about 3 days before contacting us. . Happy to report dog doing well now but have seen plenty of him since - huge skin wound on thorax from chasing rabbits - went straight through some barbed wire. Eye injury from not taking the hint that the cat did not want to play.

We don't see many problems but we take them very seriously when we do - a lot more seriously than the clients do