Af­ter knee re­place­ment, dog’s wound lick is too ick

Cape Breton Post - - Obituaries/Advice/Games - Keith Roach Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2017 North Amer­ica Syn­di­cate Inc. All Rights Re­served

DEAR DR. ROACH: I had bi­lat­eral knee re­place­ment two months ago, and I’m con­cerned about in­fec­tions. My doc­tor wants me to take an an­tibi­otic be­fore any den­tal pro­ce­dure, in­clud­ing clean­ing, which I will do. I also have a dog that loves to lick any cuts, es­pe­cially if there is some blood to lick. What are the chances of a pros­the­sis be­com­ing in­fected? Can one’s im­mune sys­tem fight off any bac­te­ria that gets into the blood­stream? -- S.S.

AN­SWER: I of­ten have heard that dogs’ mouths are clean, but that is not the case. Bac­te­ria from a dog’s mouth can in­deed cause an in­fec­tion in any kind of open wound, even a small cut or scratch. Our im­mune sys­tem is nor­mally very good at fight­ing them off, and I rarely see sig­nif­i­cant in­fec­tions caused by the germs in a dog’s mouth (cats, mon­keys and hu­mans tend to be much worse).

How­ever, in an ar­ti­fi­cial joint, such as af­ter a knee or hip re­place­ment, the im­mune sys­tem can’t ef­fec­tively fight off in­fec­tion, which is why your doc­tor rec­om­mended the an­tibi­otic be­fore a den­tal clean­ing. They of­ten cause some bac­te­ria to tran­siently en­ter the blood­stream. Bac­te­ria can en­ter the blood through an in­fected wound as well.

The chances of a joint in­fec­tion af­ter a den­tal clean­ing or a cut, with or with­out a dog, are small, but the event is dev­as­tat­ing. Keep the dog away: Cleanse any wound thor­oughly with mild soap and wa­ter -- but no harsh dis­in­fec­tants like per­ox­ide, which do more harm than good. Ap­ply some an­tibi­otic oint­ment (such as triple an­tibi­otic) and cover with a clean ban­dage.

DEAR DR. ROACH: Would you give me in­for­ma­tion on blocked bowel move­ments? I had a colonoscopy two years ago, and they said they couldn’t com­plete the pro­ce­dure be­cause of bowel block­age. I am 86 years old and don’t want a colostomy. -- H.I.

AN­SWER: A bowel block­age or ob­struc­tion can be par­tial or com­plete. There are nu­mer­ous causes of bowel ob­struc­tions. Can­cer is the first one I think of, as it’s the worst case, but others in­clude a volvu­lus (twist­ing of the bowel on its axis) and in­tus­sus­cep­tion (fold­ing in on it­self like a sock).

Symp­toms of a bowel ob­struc­tion in­clude pain and ab­dom­i­nal full­ness, and, para­dox­i­cally, can in­clude di­ar­rhea. This is be­cause the part of the bowel be­yond the level of ob­struc­tion can se­crete fluid and mu­cus, con­fus­ing the fact that there is an ob­struc­tion. A com­plete bowel ob­struc­tion is a sur­gi­cal emer­gency, and there is a sur­gi­cal maxim that “the sun never sets on a bowel ob­struc­tion” -- i.e., im­me­di­ate surgery is life-sav­ing. Clearly, you did not have a com­plete bowel ob­struc­tion, and I am con­vinced that there was a mis­com­mu­ni­ca­tion at the time of your colonoscopy two years ago. If they were con­cerned about a se­ri­ous or wors­en­ing ob­struc­tion, they would have rec­om­mended ad­di­tional tests or pro­ce­dures, such as a CT scan or eval­u­a­tion by a sur­geon.

It’s hard for me to guess what it is they meant. I won­der if the prepa­ra­tion they gave you for the colonoscopy wasn’t ad­e­quate to clean the bowel com­pletely, and they had a hard time get­ting to the whole colon. I spoke with a gas­troen­terol­o­gist, Dr. Doug Weine, and he thought that you might have a stric­ture (nar­row­ing in the colon) due to di­ver­tic­u­lar dis­ease or tor­tu­ous, re­dun­dant colon (ex­cess bends and a longer-than-av­er­age length).

In any event, two years is too long to wait and worry about your colon health. Get back to the doc­tor who did the colonoscopy, and get a com­plete exam done.

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