# We've joined the Staph club :~(



## LisaT

I had Max in to the vet today to recheck some kidney values and have the vet look at his nose. It gets crusty and pitted, but more importantly, it looks very swollen when you look up it. 

The vet wasn't sure it would work, but she did a swab up the nose a bit, but couldn't get in very far. I was expecting yeast. I was wrong -- tons of staph, along with white blood cells. The vet said that the nose typically has staph, but the amount, with the white blood cells, tells us long term aggressive antibiotics.

I expect to talk to the vet tomorrow (Wed) and develop a plan. 

Sigh. Has anyone beat this thing?


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## LisaT

Oh, forgot to ask....any idea of whether or not this is an issue if I'm around my dad, going through chemotherapy and thus immune-compromised?

Do I have to worry about Indy, since they lick each others' food bowls? Or does it stay localized to the nose? He does always have a runny nose.....


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## Northern GSDs

Aww geez, it sounds like you have enough on your plate already...

I think it depends on the type of staph that it is. Normally however, it should not be contagious I don't think from dogs to humans (as I think the staph that are usually dog related are not the same as those that are human related so to speak) and/or dogs to dogs unless the other dogs are immunocompromised. As for your dad, since he is on chemo plus likely (I am assuming) he may have a central type line for chemo access, you would need to practice good hand hygiene etc when visiting him anyways ut if it isn't the same kind of staph, I don't think it poses a risk to humans. I'm no microbiologist though and I would definately want to know what kind of staph it is specifically, for if it is a "human" type one, then that may be a different story. 

I'm most interested in what you find out on this!


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## LJsMom

Lisa, I know this sounds odd - but could you post a picture of the swollen nose?


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## Sweet Mammy

OMG!!! My lab has a crusty ugly cracked sometime bleeding nose.... it comes and goes. right now its UGLY.... my husband said, its just chapped. I did take him to vet but the day we went (at least a year ago) it looked fine. YIKES.... yes please post a picture ... or I will try to get one of Lou'e nose............
Now Angel (8mo GSD) has had yuk coming out of her eyes the past few days, wonder if they are related! Guess I will call vet!


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## JakesDogs

Whoa - Staph is an all-comer, all-exposed kind of bug, depending on which strain. One of the reasons Staph is causing so many hospital complications and non-medical-setting complications is because it has mutated so fast. I've always jokingly said that my 'cause of death' would be some exotic zoonotic disease that is found to come from dog kisses. BUT I personally would observe a pretty intense hygiene for everyone at least until you see the culture and sensitivity results (they did do that, right?), and then until the abs were on-board a while. But that's just me.


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## Sweet Mammy

This is my lab's nose today....
sometimes bleeds...
does it look like your dog's infected nose?


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## WiscTiger

OH, Lisa I am sorry that you joined the club.

Lakota was I think the first dog on this board to have a Staph Infection in his nose. But his was mostly internal with just a little bit of sore at the bottom outside edge. I am a believer that dogs shouldn't get nose bleeds. So when I saw blood running out of his nose while he was laying down I called the Vet. We got in that morning and she did a quick peek up his nose with the lighted scope and then we talked. From what she could see the lining was all inflamed. So he stayed at the Vet and the game plan was to sedate him, x-ray to look for tumors or masses, if she didn't see them on the X-ray then she would do a Rhineoscope and possibly a sinus flush. Well she ended up doing the flush and said there was all kinds of gunk so she sent ot off to be cultured.

This was the long term Cephlexin treatment for my guy. First it was a pretty high dosage 750 mg 2 times a day for either 56 - 60 days. I know so many people are against using Pred. but sometimes 3 or 4 days of Pred helps take the swelling/inflamation down and makes the dog more comfortable.

No more problems with his nose, but he has had other Staph Infections just not that bad. I am also more heads up on when I think he has a Staph infection and we go get our second opinion (the vet) and get the ABX.

Val


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## codygsd

I don't think that Prednisone, being an immune surppresant would be wise in using while fighting an infection. You want the immune system as strong as possible.

My dog was being treated for a bulging disc with Prednisone until yesterday when an MRI revealed diskospondylitis. I'm now on Ceph. to fight the infection and trying to get off the steroid ASAP but have to ween him off and just using Tramadol to fight the pain.


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## JeanKBBMMMAAN

They are sure it's staph and not two of my fear diseases blasto or aspergillosis? (sp)

Sorry to add to the issue, just always think of those two things though it does sound like it's staph. 

I'd definitely take the lab to the vet too. 

I did used to take Kramer to visit my sister who had cancer/compromised immune system when he had staph infections and was on meds, but had her ask her doctor, and I asked Kramer's vet.


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## WiscTiger

The two times when Lakota's Staph infections were really bad, I did give him the Pred. for two or three days. He went from being totally miserable non stop scratching to little scratching. 

I understand the Immune suppresant stuff, but I also know that the Pred. short term helped my dog feel better. It knocks the inflamation down faster than any other drug. There are cases where I will give Pred and cases where I won't. I guess that everyone needs to do what they feel is in the best interest of their dog.

I will say that you need to give a Probioitic when you dog is on any ABX, and Ceph seems to be one that is really hard on the digestive system. If you are giving your ABX at say 7 am - 7 pm then you need to give the Probioitics at say noon or 1 pm. You don't want to give them at the same time as the Ceph. will be so busy fighting the Probioitics there won't be anything left to fight the Staph. When Lakota goes long term Ceph. I know that about after 20 days or so I can start home cooking to keep him eating.

Val


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## LisaT

Max was on Ceph for 10 days for his dew claw, and it made him bite at himself, and trashed his digestive system









Val, I knew that you would have good input. I understand why the pred was used -- the swelling can be very bad, and now I know why he mouth breaths so bad sometimes. Makes me wonder if some dogs that bloat don't mouth breath for the same reason....

Jean, his ears always show yeast -- I'm wondering if we shoujldn't have the flush done and see what all is in the mix before we start anything. Opinions on that????

In the next thread, I'll post some pics. I really need to get ready for work Aack!


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## WiscTiger

Crap Lisa I forgot that Max doesn't do well on Ceph. 

Can they do a culture to see what is going to work. I know that for humans they are using some really different drugs on the MRSA. I can go through DH's paperwork and look what they were. One was not good he broke out in a rash all over his body.

Val


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## LisaT

*Indy's normal nose* -- (she does have pigment problems though) notice how the sides match, etc....









*Max's nose* -- notice how the ends flare (I didn't see that before we really started looking -- it happened so slowly that it seemed normal, can't believe I didn't catch it sooner). There are cracks in the top edge of the nose that you might see also.




















And this was when the nose first flared -- an anti-fungal, antibiotic cream with a bit of steroid would keep it away -- he's a dirt digger, so we think that may have compounded or even started some of these issues. Plus that stellar GSD immune system...

I don't think there was as much swelling in the nostril as now back then. Heck, it's not clear that the top of the nose is the same issue as the inside, but sure seems like it would be.

This is not his nose at it's worst, and now there is just a bit crusting at the sides of the nostrils, probably from his constant dripping nose (which, by the way, is ALWAYS clear, no nosebleeds either -- I agree with you Val -- nosebleeds are a big warning sign!)


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## LisaT

> Originally Posted By: Wisc.TigerCrap Lisa I forgot that Max doesn't do well on Ceph.
> 
> Can they do a culture to see what is going to work. I know that for humans they are using some really different drugs on the MRSA. I can go through DH's paperwork and look what they were. One was not good he broke out in a rash all over his body.
> 
> Val


I think I'm going to ask for the flush and the culture -- this may even be what the vet is thinking about -- I haven't spoken with her yet. With Dad and his chemo, I think any and all precautions are warranted.

Now I"m wondering about this constant stuffy nose I've had for months.....can I say hypochondriac? (I know I can't spell it, but thank goodness for the spell check in Firefox so I could fix my first attempt at spelling it!!







)


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## Alto

Flush & Culture? - Absolutely!
Will they also test antibiotic sensitivity on the cultures?


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## LisaT

Sweet Mammy, I would definitely take your boy in....

Alto, I don't know about the sensitivity test. I'm looking forward to talking with the vet.


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## LisaT

Vet mentioned an x-ray in a quick email. What would that be for?


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## WiscTiger

With Lakota the Vet wanted to check for Masses or Tumors. X-ray works best for that, might miss some thing with the scope if there is too much inflammation.

The she scoped and then flushed, sent samples for culture and sensitivity to ABX.

Val


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## DancingCavy

Oh no. Poor Max! *HUGS* to both you and sweet Max and the best of luck figuring out what's going on and getting it treated.


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## LisaT

Thanks Jaime, we could use some luck around here!!

Val my read of the quick email that the vet sent is that she was thinking of treating without all the diagnostics. I'm worried about having something stuck in the nose, and worried that now would be the right time to get a good culture, in addition to wasting time and money on the wrong drugs. 

Sucks that this vet only works a couple days a week. I expect to get another email or phone call soon though.


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## WiscTiger

Lisa I could see forgoing the Xray if she is certain that it is Staph. But I would want the Culture and the Sensitivity done to get the right ABX since Max can't handle Ceph. IMHO without the sensitivity test you are playing Russian Roulette with ABX, keep shooting until you find the right one. 

Since Lakota has had more than a couple of Staph Infections we know that for now he responds and handles Ceph. But until the Sensitivity test came back she had him on Baytril. 

Val


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## LisaT

That makes sense. The vet was actually thinking of doxy and clavamox. Got me thinking, when he was on clavimox for his paw, his eyes seemed to clear within a day, and after the 10 days, it took a day for the redness to come back. Maybe we will get lucky and he won't have to have any super nasty abx. 

Did you ever try pau D' arco?


I hope that I get to talk with her soon - we both have terrible schedules.


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## Alto

Dog's noses are sooo important - I'd want to diagnose & be sure there are no underlying problems rather than just treating symptoms with antibiotics, especially as he's reactive.


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## LisaT

Man, it's never anything simple, is it.

Sigh.


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## WiscTiger

I know, Lakota in the first two years cost me more than all my dogs put together including purchase price. If it wasn't one thing it was another. Plus I swear every year he comes up or down with some things so he can go visit the girls at the Vet's office, he is such a ham and the all love him and cuddle on him. 

Lisa if you feel comfortable with giving the Doxy and Clavamox a try then go for it. No I havn't tried D' arco, herbal dumby here I don't even know what it is?

Val


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## LisaT

Looks like we might do the trial, as my vet doesn't have all the equipment for full diagnostics (the scope that goes up the nose), and if I go anywhere else, he will probably have to be vaccinated.I guess life is full of trade offs. 


Thinking about staph being an opportunistic infection. I am concerned that maybe there is something up his nose. He paws at it occasionally, but that could just be discomfort. The flip side of that is that his eye meds are immune suppressants - wondering if they have suppressed any immune function he might have had to fight this. When I used a nasal inhaler with steroids in it for my allergies years ago, I developed a fungal infection in my esophagus. 

Pau D'Arco is a powerful herbal anti-fungal, with some anti-bacterial action. Thinking of using it as an adjunct. 


I guess Lakota just wanted make sure you knew how, uh, special he is from the very beginning? I thought indy was my Lakota, but Max has sure caught up to her.


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## Alto

I like the sound of the Pau D'Arco as an adjunct - accidentally read a couple of threads on fungal infections in dog noses :-(

Confused though, why would he need to be vaccinated to go somewhere else?


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## WiscTiger

Alto, Some Vets require that your dogs be Vaccinated. Some of us believe or have dogs that it is better for them not to receive yearly vaccinations.

Val


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## Alto

Thanks, I thought as she mentioned a compromised immune system, perhaps it was an exposure concern; most specialists (locally) would not require vaccines - tho they might require you to sign a release form.
Many of the 'general' vets would require vaccines - easily solved by vaccinating the dog as he walks in the door! <sigh> guess they neglected to read the vaccine manufacturers statement that their products only be given to healthy animals ...


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## LisaT

Yeah, last time I took Max to the big clinic in the area, the vaccine question was one that they not only asked on their form, but followed up with one-on-one questioning.


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## LisaT

Well, we have a tentative plan, which starts with a two week trial of two meds. An antibiotic, and an anti-fungal which also has anti-inflammatory properties. 

For two weeks, through Walmart, the meds would be $75 and $300. Ouch. If it works, recommended treatment would be for 3-6 months. That's about $750 a month...and a cure is not guaranteed, even if we have the right meds. 

I'm currently looking for options where to fill the prescription. Haven't ever looked before, but I hear some folks go through Canada...


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## LisaT

Looks like the compounding pharmacy where I get Max's tacrolimus (thanks to someone on this board!!) can fill the prescriptions for $63 and $70. Now THAT makes me happier. Who woulda thought I'd be happy with meds for two weeks at those prices? It also looks like we don't have to stay at the initial frequency and doses, so that will also bring the cost down.

I'm so glad that I have a vet that is willing to work with me on getting some reasonable prices for these meds.


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## LJsMom

That's great Lisa! LJ's favorite antibiotic is $10 a day x 30 days. If only we could claim our fur kids as dependents.


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## LisaT

Ouch for you too!!

Yep, I think we should lobby the IRS


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## LisaT

forgot to mention, just for general info in case anyone else has input or has to go through this....

Part of the plan is that hopefully this treatment will start working, and once we get some of it under control, and a lot of the inflammation down, then do the flush under anesthesia. Looking at case histories, it is notoriously difficult to effect a complete cure, even with months of treatment.

The vet has put a lot of time into this -- she has talked to the lab and found out which tests/cultures really are and are not worthwhile. I guess a large number of them have false positives and false negatives, and for what we are dealing with, nothing stood out as a "must do", in light of the uncertainty of many of the tests. We are holding off on more diagnostics because, so far, they don't seem necessary (MRIs, etc.), and we are managing costs so that we can spend the $$$ on the expensive drugs....

She was going to go with the antibiotic doxycycline, but since Max has been on that quite a bit, she is going with azithromycin. We are adding the itraconazole, an anti-fungal, not only for fungal involvement (which may also be induced by long term antibiotics), but because it can act as an anti-inflammatory and also help if there is an allergic component to this. Considering how sensitive Max is to yeasts and sugars, and how susceptible GSDs are to fungal infections from the literature, the anti-fungal is worth the added expense. The vet did offer the option of going without it, but i"m not comfortable with that.

Anyway, it will take a bit for the meds to get order and to get here. I have started him on extra bioflavanoids (for the allergic component), cetyl myristoleate (for the inflammation), and Pau D'Arco. DH didn't know I did that last week, and just yesterday he said he thought the nostril's looked better, so maybe we will be able to manage this thing.


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## LisaT

I started his new antibiotic today. For 14 pills, $65. It's a once a day antibiotic.

I gave it a bit before his breakfast. About fifteen minutes after his breakfast, he threw everything up. And then panted for about 20 minutes. I guess I'll try again tomorrow just in case they weren't related.


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## WiscTiger

Lisa, let us know how the second trail goes? Do you know the side effects of the ABX? 

Val


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## LisaT

Will do. I will give it in the evening so I can be home if anything happens. 

Side effects include nausea, vomiting, etc. It does say to take with food to decrease stomach upset. Maybe I should feed a small amount with the pill as a test.


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## WiscTiger

I was wondering if this was one of theose that you need to do food with. 

Val


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## LisaT

I started giving Max the antibiotic immediately before his dinner, and that seemed to do the trick. He still has discomfort, pants a lot after dinner, I try to distract him with a walk to the mailbox or something similar, but no more vomiting, phew!









After about 5 days on the antibiotic alone, I started the antifungal. I think the antifungal may help more, but it's too soon too tell. Both drugs required monitoring of liver values....great.

His nose is better -- I can see more space where air can go through. I think it may have been worse on the antibiotic alone, bt I'm really not sure yet.


Today Max has been *really* active in his sleep. He's not that much of a dreamer or mover when he sleeps, but he has been paddling his feet a lot, and he even stood up and started digging at the wood floor until he somehow snapped out of it. He's been on the couch now for awhile, and his back legs were really going a little while ago. Just kinda odd for him....


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## WiscTiger

Lisa, just wondering if the "doggie dreaming" is a side effect of the drugs. I know there are some human drugs that bad dreams/nightmares can be a side effect.


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## LisaT

I hadn't thought of that.

I will have to keep an eye on that. 

It sure was odd watching him paw at the floor and then slowly realize what was going on. Poor Maxwell.


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## LisaT

Well, just thought I'd update.

We were moving right along with the meds, and got a refill on each of them. The antibiotic refill, a generic, had a different manufacturer, and Max did worse on that one -- panted a lot. Came home one day, he had vomited in his crate (poor boy), so I took him off of that med, kept with the antifungal. 10 days later we ran some bloodwork to check liver and kidney values.

The good news is that the liver and kidney values are very good, BUT, his platelets have dropped to well below the low range. So any procedure or biopsying could run the risk of uncontrolled bleeding. Turns out both meds he was on run the risk of lowered platelets, so he has also been off the second for a week.

So, instead of getting his nosed flushed out and a possible biopsy if they find anything that gets flushed out, we can only recheck the blood on Tuesday.

After he threw up, I noticed that his gums, his 3rd eyelids, his lower lip, were all incredibly pale,and his gums were all swollen. I almost rushed him to ER -- I bet his platelets were *really* low at that time. The color seems to fluctuate now, getting better.

I was really "looking forward" to getting his nosed flushed out, even though it's a procedure they have to do under anesthesia -- I think it will help him a lot.

I'm supposed to watch for potential bleeding through the skin, bruising, pin-prick red dots, etc.

We recheck bloodwork on Tuesday. Sure hope the boy is getting better.


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## LJsMom

Poor handsome Max. I will keep him in my thoughts Tuesday.


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## LisaT

Thank you Joanne, we appreciate the support.


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## BowWowMeow

Oh, dear. Poor Max! So sorry the drugs didn't work out. I wish I could wave a magic wand and heal your dogs, Lisa. They both have so much going on.


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## WiscTiger

Lisa,

That sucks. I think we need a Pharmacist to review the Meds out Vets perscribe. They look for reactions and things like both Meds causing low platlets.

I hope Max rebounds from this quickly with no problems.

Val


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## natalie559

> Originally Posted By: Wisc.TigerI hope Max rebounds from this quickly with no problems.


Me too!


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## LisaT

Thank you BowWowMeow, a magic wand for all our dogs would be very nice!!

Val, that's the perfect word -- this really sucks. We waited a month for a good time slot to get this procedure done, and then this crops up. I'm SO glad that we ran that blood last week.

Thanks for the well-wishes Natalie.

I got an email from the vet, in response to a question I ask her. She's home sick fighting the flu, but expects to be able to make it tomorrow. I hope she can make it. But then I'll spend the next couple of days evaluating whether or not I should go see my dad while he's taking his oral chemo pills. I'm supposed to do their taxes on Thursday.

I think I just want to go back to bed and sleep for a week.....


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## LisaT

*Re: We've joined the Staph club/ Spleen Ultrasound*

We should have the new bloodwork tomorrow, but knowing how many dogs have suddenly shown problems with the spleen, and after a discussion on the tick list, I asked the doc to feel Max's spleen today. He said it felt a bit enlarged.

I told him I had been thinking of having an ultrasound done, for my piece of mind, and he was able to arrange it right there. The verdict is that his spleen looks normal, it just is large.

Or maybe it is enlarged, they couldnn't distinguish between large (being his normal) and being enlarged. I asked him what could cause an enlarged spleen. She said some immune system inflammatory process, much like the saga of the dew claw: http://www.germanshepherds.com/forum/ubbthreads.php?ubb=showflat&Number=907240

She also said a large, normal looking spleen presents itself in lymphomoa.

And then she said that Max gets a clean bill of health.

Of course, I'm left wondering.....he didn't have an enlarged spleen last time I asked the doc to check it (I request that about once a year), so what the heck does this mean?

Anyway, will know more when we get the blood results back tomorrow on the platelets. Good news -- liver, gallbladder, bladder and prostate look good. She didn't get a great look at the kidney because it was blocked by gas.

Took Max a couple of hours to stop panting after the ultrasound. I'm wondering if it caused him pain?


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## LJsMom

*Re: We've joined the Staph club/ Spleen Ultrasound*

Did they drug Max?


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## LisaT

*Re: We've joined the Staph club/ Spleen Ultrasound*

No, it was very quick, they shaved his belly but not his sides, and it was $160. I don't know if that's high or low though -- when they were recently bought out, they raised their prices on everything.


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## LJsMom

*Re: We've joined the Staph club/ Spleen Ultrasound*

I think I paid a little more than that for Niko's. I think they medicated him first, but he was awake.

When Lady Jane had her echo done, they gave her butorphanol and diazepam. She panted like crazy. Never again.


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## LisaT

*Re: We've joined the Staph club/ Spleen Ultrasound*

Hmmmmmm, makes me wonder if they slipped him something. They weren't going to, but my regular vet wasn't there, so they wouldn't let me back in there, and Max is typically so compliant, I didn't worry. 

I would hope they wrote that down. I will check the file next time. They said they wouldn't have to, but I didn't confirm, he does pant a lot at times, I think it's pain though.


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