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Rebecca
Rebecca, Dog Veterinarian
Category: Dog
Satisfied Customers: 8708
Experience:  29 years of companion animal practice.
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Hi, Have an adopted male (neutered) Bernese Mountain Dog.

Customer Question

Hi,
Have an adopted male (neutered) Bernese Mountain Dog. Whta started as a droopy eye tuned into a pretty large periorbital inflammation that close the eye almost completely shut. He had to be sedated three time (alpha 2) and servo for his vet (day 1), eye specialist (day 2) and CT scan (day 3). We stared on Clavamox after the eye specialist visit and today (2 days later) his eye is almost completely open, the swelling has subsided and there is very little serosanguinous discharge now. My question is should we still do a US FNA or do we extend the Clavamox for up to 6 weeks. If so, what precautions do we need to take with prolonged antibiotic use (vis-a-vis his intestinal flora for example)?

Thanks
Submitted: 1 year ago.
Category: Dog
Expert:  Rebecca replied 1 year ago.

Rebecca :

Hello,

Rebecca :

I am sorry to hear about Bobbie. It is good that this is looking better.

Rebecca :

My name is Rebecca. I am a veterinarinan, and I will do my best to help.

Rebecca :

What was seen on the CT scan? Why do they want to do a US FNA?

Customer:

The saw what they believe to be a retrobulbar abscess

Rebecca :

Most dogs do tolerate a long term course of antibiotics. I would put him on a probiotic if you are going to continue the Clavamox. I like the ones made for dogs, like Proviable, Fortiflora and Benebac. The one made for humans called Culturelle is also supposed to be good.

Rebecca :

I see!

Customer:

chest CT was free on neoplasia as was the head CT

Rebecca :

A retrobulbar abscess usually requires draining.

Rebecca :

Often, no matter how long the dog is on antibiotics, when you stop, the infection comes back.

Rebecca :

Good that the chest was clear.

Rebecca :

But seeing how he does on antibioitics is not the wrong way to do. Once in awhile a dog gets better on antibiotics alone.

Customer:

I see, so even if the inflamation has dramatically subsided it is too deep in the tissue? I thought the FNA was just for cytology and to relive pressure?

Customer:

releive

Customer:

relieve

Rebecca :

Abscesses, by definition, are walled off. Almost always there is a "nidus" of infection that hides and lurks and almost always comes back. The antibiotics do not penetrate the wall that the body makes to surround the infection.

Rebecca :

I usually lance these so they can drain. That, along with a course of antibioitics, usually takes care of the problem.

Customer:

The CT says there is no true cavitation though, it says abscess is moderately suspected

Rebecca :

Otherwise, the infection could move into the ears, sinuses, or even the brain.

Customer:

I understand

Customer:

Do you think this needs to be done ASAP?

Rebecca :

I have suspected these, poked a hole in the mouth behind where the eye is, and that gives the infection a place to drain down with gravity

Rebecca :

If this were my dog, I would do it in the next few days or so.

Rebecca :

Not an emergency, but not something I would let go too long.

Customer:

I understand, will he stay on the clavamox post FNA? I just would not like to do it to soon. He has now been sedated 3 days in a row (he needed deep because of the pain from the pressure)

Customer:

I thought for the retro-orbital FNA with US they go from the dorsal aspect with the fine needle, rather than ventral?

Rebecca :

Yes, I would keep him on the Clavamox for a week or so after.

Rebecca :

If they are still trying to get a definitive diagnosis, that might be the approach. But if you want to drain one of these, you have to let it drain ventrally; it won't drain "uphill".

Rebecca :

If the antibiotics are working, the abscess might be much smaller now. The US would show it best.

Customer:

But we would still have to take him in again for the ventral approach?

Customer:

after the initial FNA, or can they do everything right there?

Rebecca :

That would be a question for them. If they see an abscess, why not drain it right then, using the US to guide the needle?

Rebecca :

I would think they could.

Customer:

Ok, so you think 3 or 5 days would be too long?

Customer:

of waiting before we do the procedure

Rebecca :

Too long to wait? No, that should be fine.

Rebecca :

Yes, that should be fine.

Customer:

ok, but even if he is back to full form, you would still recommend it?

Customer:

It is just not clear form the diagnosis whther it is cellulitis/inflamation or a true abscess

Rebecca :

It would not be wrong to see how he does on antibiotics. If after stopping, his eye starts to look red or get swollen again, you know what you have to do..

Rebecca :

If it is not clear that it is an abscess, then waiting sounds reasonable to me, especially since it sounds like he is looking a lot better.

Customer:

OK, many thanks for your help

Rebecca :

You are welcome!

Rebecca :

Is there anything else I can help with or answer?

Customer:

That is all for now, you were most helpful

Rebecca :

You are welcome.

Rebecca :

KIndly rate my answer, but only if all your questions have been answered.

Rebecca :

I hope he continues to improve.

Customer:

will do, thanks again

Rebecca :

You are welcome.

Rebecca :

Sorry!

Rebecca :

Try again; I had hit the wrong button!

Rebecca, Dog Veterinarian
Category: Dog
Satisfied Customers: 8708
Experience: 29 years of companion animal practice.
Rebecca and 4 other Dog Specialists are ready to help you
Expert:  Rebecca replied 1 year ago.
Thank you for the great rating!

Rebecca

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