Any experience of teca procedure?

[gixer1]

Repost as I posted in general discussions initially -

Folks,


i have a ten year old black lab called buddy and unfortunately we have battled with a very nasty pseudomonas infection in both ears for the last two years, he has had every conceivable antibiotic known and it has never completely cleared up. Unfortunately at his last session of getting knocked out and his ears all cleaned out we discovered he has two perforated ear drums and the infection has gone into his inner ear the time has now come where he needs a procedure known as total Ear Canal Ablation with Lateral Bulla Osteotomy sometimes referred to as a TECA.


this procedure is not cheap and is fairly complex but he is our boy and I don't grudge him it at all, the initial quotes were around 5k and this would have meant him going to the veterinary college in Glasgow 140 miles away but with some searching around and help we have got it down to around 2k and a more local surgeon is going to do it (whom gets a very good report in the circles I have spoken with)


i have read read up as much as I can and the majority are very positive with lots of mention of dogs being like "new dogs" after the procedure, unfortunately he will be completely deaf after the procedure and the reason of typing this is I wondered if anyone has ever had this done to one of their dogs or known of it and what was the opinion.


Also has anyone ever trained a deaf dog as a gun dog? I realise he is ten but he is known for how young and healthy he is with most people believing he is half the age he is.


thanks in advance for any input.


regards,
Gixer

 

[Selous]

TECA is an effective way of dealing with end stage (past saving) diseased ears. It is not a procedure for the faint hearted and most commonly fails because of residual material being left in the middle ear. I would ask a direct question how many of these procedures the surgeon has done and what their complication rate has been. It can be a mistake to just look at the bottom line, I would also have a serious think about qualifications and experience before choosing a surgeon for such a major procedure

 

[Apache]

I'd echo the comments above. This is complex surgery with both risk of harm and risk of damage to important structures. Don't just pick on price, or reputation from other dog owners.

 

[gixer1]

Gents,

I appreciate the comments and advice - this is extremely frustrating as what other options do I have? from what I am told by my own vet (who has looked after my dogs for 5 years and whom seems to have a genuine care for my dogs) she was the one who recommended this vet (this vet works for another practice so this is of no gain to my current vets) she has said that the vet she has recommended did 3 years extra training on Soft Tissue procedures (I think this was the description) and that he has done this procedure before on 2 dogs she has observed (both west highland terriers) whom have been far happier in her opinion after the procedure.

As I said its a difficult call for me as we have been trying to treat this for 2 years and I really dont want the dog in pain but I certainly dont want to make this any worse by getting this procedure done.

As said any further advice is appreciated.

I hate to ask but if I was to PM the vet who we will be seeing for the consultation can you tell me anything from a vetrinarian community side?

Regards,

Gixer

 

[gixer1]

To add gents - when you say "most commonly fails because of residule material being left in the middle ear" what would your success rate statistics be?

I am obviously no vet and have based what i have said on reading up on the net and what the vets I know have said so if I am being unrealistic or over optomistic please do not hesitate to say, I value your input and appreciate it massively. I am obviously massively emotionally compromised as he is my dog and the last thing I want to see is him put down as other than this issue he is very healthy and full of life - that being said I will not see him suffer and would put him down if his quality of life was to be dramatically reduced.

I have read information here - http://www.veterinarypartner.com/Content.plx?A=1708 which states -
"In most cases, the results are nearly miraculous. Patients demonstrate more energy now that their headaches are gone. There is no more odor, ear cleaning, or pain."

"This surgery requires advanced skill and referral to a specialist is usually necessary."

and here http://www.petmd.com/blogs/dailyvet/2009/october/20-4840
Fundamentally, the TECA is a very rewarding surgery for the patient, owner, and veterinarian. Most owners report a dramatic improvement in the attitude of their pets postoperatively, claiming they see a return of social and play behaviors they have not seen in many years.
This, combined with releasing them from the drudgery of daily ear cleaning and medication administration, offers the owner a huge sense of relief. As we have gained more experience with the TECA procedure, there has been a movement to recommend it earlier during the course of the disease.
No longer is the TECA viewed as strictly a salvage procedure of last resort. Many dogs and cats with chronic otitis are candidates for the surgery once it becomes clear that they are in that all-too-familiar cycle of otitis that many of us find the bane of our daily lives.
Dr. Patty Khuly


and here - [url]http://www.vetsurg1.com/earcanalsurgery.html[/URL]

• [FONT=Arial,Helvetica]The likelihood of curing ear disease with TECA is as much as 92%.

• [FONT=Arial,Helvetica]TECA involves removing the entire ear canal from the skull, opening and cleansing the tympanic cavity.[/FONT]
• [FONT=Arial,Helvetica]The appearance of the surgical site when completely healed is quite cosmetic. The skin heals with a faint scar which cannot be seen if the ear flap hangs down.[/FONT]
• [FONT=Arial,Helvetica]General anesthesia is utilized for the procedure.[/FONT]
• [FONT=Arial,Helvetica]An overnight stay in the hospital is required so that post-operative discomfort can be controlled with injectable pain medication.[/FONT]
• [FONT=Arial,Helvetica]Hearing is typically no worse or better after surgery. [/FONT]
• [FONT=Arial,Helvetica]Chronic ear changes and presence of vital structures (e.g., nerves and blood vessels) near the surgical field make complications a real possibility (see below). [/FONT]

[FONT=Arial,Helvetica]Benefits:[/FONT]

• [FONT=Arial,Helvetica]Typically, after a recuperative period of 2-4 weeks, no further medication of the ear is required.[/FONT]
• [FONT=Arial,Helvetica]Pets are relieved of discomfort and often feel “like young pets again”.[/FONT]
• [FONT=Arial,Helvetica]Pets often lose their “head shyness” which had resulted from constant treatment and pain.[/FONT]
• [FONT=Arial,Helvetica]Hearing is generally unaffected.[/FONT]
• [FONT=Arial,Helvetica]In the case of tumors, cancer can be treated more effectively.[/FONT]

[FONT=Arial,Helvetica]Complications and Risks:[/FONT]
[FONT=Arial,Helvetica]Pets may experience the following problems after TECA:[/FONT]

• [FONT=Arial,Helvetica]infection and/or breakdown of the incision site[/FONT]
• [FONT=Arial,Helvetica]temporary facial nerve paralysis causing loss of blink and a drooping lip[/FONT]
• [FONT=Arial,Helvetica]persistent skin disease at the surgical site[/FONT]

[FONT=Arial,Helvetica]Rarely, pets experience:[/FONT]

• [FONT=Arial,Helvetica]reoccurrence of bulla infection, draining wounds or abscess formation [/FONT]
• [FONT=Arial,Helvetica]partial or complete loss of ear flap due to disrupted circulation[/FONT]
• [FONT=Arial,Helvetica]vertigo; which manifests as head tilt, incoordination and loss of appetite[/FONT]
• [FONT=Arial,Helvetica]permanent facial nerve paralysis causing loss of blink and a drooping lip[/FONT]
• [FONT=Arial,Helvetica]massive intra-operative bleeding resulting in death[/FONT]
• [FONT=Arial,Helvetica]complications (including death) arising from anesthesia[/FONT]

[/FONT]

 

[Selous]

Sorry if my comments have caused more confusion, I am certainly not saying that the vet that has been reccommended is not capable or competent. I dont know who they are or what their level of experience is. All I am trying to say is that for such a major procedure I would look beyond the cheapest price and make sure the surgeon who performs the surgery is both properly experienced and well qualified. To be honest with procedures like TECA looking at promises of success on the internet can be misleading. normally the complication rates are taken from published case reviews where very experienced surgeons who often perfom the procedure frequently will collate their results. Unfortunately this does not mean that every surgeon will have the same success, it could be better or worse! In my case I can only say that my success rate for TECA is 100% or 0% as I have never done one and have no intention of ever doing one! Please dont be afraid to ask the surgeon him or herself how many TECAs they have performed as primary surgeon, what their complication rate is and about where and how they have recieved their training. These are not cheeky or rude questions in any way.


I would suggest that you ask your vet about the differing levels of experience that are present at all of the centres that have given you estimates. There is a hierarchy of qualifications within the veterinary profession that it may be helpful for you to know about. Ideally look for someone who is recognised by the RCVS as a specialist or holds a diploma in surgery (will have a DSAS or similar after their name). A Certificate is not a specialist qualification and is recorded as Cert SAS after the name. You can find further details on this here http://www.kentdalevets.co.uk/2.html or here http://www.nwsurgeons.co.uk/blog/2011/08/

To paraphrase these links I have cut and pasted the following (PS this is not from my website!!) :

If you skipped to the last paragraph – this is it. If your general practice veterinary surgeon is suggesting referral for your pet to see a “Specialist” then you need to be savvy enough to ask a few questions about the specialist. What are the letters after their name? (Look for the “D” for Diploma (DSAS, DECVS, DACVS, DSAM, DECVIM, DACVIM et cetera) rather than the “Cert” (CertSAS, CertSAM et cetera) to be sure you are at the highest level of qualification. If the individual has “RCVS Recognised Specialist” written after their name then so much the better. Place no store whatsoever by any other accolade that the individual might claim such as “Specialist”, “Consultant” or “Expert” since none of these mean a thing. Finally, you should be aware that more and more veterinary practices have internal “specialists” often not at the highest level of qualification and corporate financial pressures can dictate that clients are directed towards these rather than to perhaps better qualified people elsewhere. Remember, this is your much loved pet and your money – it is your right to be referred to where you want to go (There is a separate blog on this) and if you want your pet looked after by someone with the best qualifications you should ask your vet to ensure that you are referred to a “Diplomate” or an “RCVS Recognised Specialist” and not just to any old specialist.


Hope these links help

 

[gixer1]

Srvet,

thank you so much for taking the time to respond, I have written down the questions and will be asking the vet/surgeon, I really have not gone on price but more on recommendation. the Glasgow vet college/uni was the first place that we recieved quotes from which were in the region of 5-6k but as said that is 140 miles away and really they didn't seem to want to discuss much and were more of the opinion we should take thier word for it which didn't sit well with me.

Regards,

Gixer

 

[Apache]

Depressingly there is only one RCVS recognised soft tissue surgeon in Scotland and they are at Glasgow Uni......

 

[Sharpie]

I have had the human equivalent. Radical mastoidectomy (one ear) and a decade later modified radical mastoidectomy (the other ear).

Then countless other operations including ossiculoplasty.

Performed by the best surgeons at the top London hospital in the UK, which only does throat, nose and ear work.

I experienced facial nerve paralysis (Bells palsy), extreme vertigo due to damaged semicircular canal, tinnitus and several other very unpleasant side effects.

I would not put my dog through this.

PM me if you would like to discuss.

Edit: I got the best available treatment at the time, having family contacts "in the trade". It is a very specialised procedure for humans. There is only one (London) hospital where the expertise is concentrated.

Perhaps there are some veterinary surgeons who are prepared to have a go (as long as you are insured). Question them hard as to their training, experience and success rates.

 

[gixer1]

Thanks for the input, all info will be considered and we have a consultation on saturday.