Welcome to my Surgery Page. Here you'll find a brief description and pertinent comments to help you know what to expect when your pet needs surgery. As with all my pages, I'll try to improve, edit, and add to this page as time permits. Thanks
Recommendations for Before, During, and After Surgery
Before Surgery
First of all, if you're nervous about your pet's safety in surgery, please relax.
Anesthetics, especially for shorter procedures on healthy pets for routine things like spaying, castrating, and minor wound repair, have become much safer in the last 5 years. But, to maximize the safety and comfort of your pet prior to surgery, here's a list, most of which we talk about in person when we schedule surgery.
1. Empty stomach to avoid vomiting/aspiration. Don't feed anything except water for at least 6 hours prior to surgery.
2. Consider presurgical antibiotics. Your vet will recommend them when appropriate.
3. Consider presurgical pain medications. Not a bad idea for some surgeries...your vet will recommend them when appropriate.
4. Preanesthetic Sedation. Usually done at the hospital but sometimes dispensed to the owner to be given an hour or two prior to coming in. The advantage of preanesthetic sedation is that it reduces the fear and anxiety of the patient and greatly reduces the amount of anesthesia needed.
5. If your pet hasn't been seen for awhile, or if your pet is seeing the veterinarian for the first time, perhaps for a routine Spay, for example, that pet must first become a patient. This is both legally and medically important. That pet will need a Presurgical Exam.
You would think this is obvious, but I list it here for all those people who call vet to vet pricing different surgeries looking for the cheapest price.
Don't expect a good veterinarian to do surgery on an animal. even so called routine surgery, without first making sure that the animal is fairly healthy. Completing a good exam takes time and costs money...the price of which may or may not be included in a quoted sugery fee.
He or she will be checking for signs of anemia, bleeding disorders, fever, infection, parasitism, malnutrition, jaundice, dehydration, and lack of vigor before risking anesthesia and surgery.
We will want to know whether intact females are in heat or pregnant. It will make a difference to the safety and outcome of the surgery.
We will want to know any important historical information; has the pet had any trouble in the past with drug sensitivities? anesthetic sensitivities? any history of metabolic diseases such as diabetes? ETC
The survival rate and success rate for the vast majority of routine veterinary surgery is excellent in this country. Guess what? One of the reasons is that most of us are extremely careful and meticulous...and we don't skip things like a presurgical exam.
6. Consider preanesthetic and presurgical blood work. Blood work prior to surgery is routine in human medicine and nearly routine in many veterinary practices. It identifies kidney, liver, anemic, electrolyte imbalances, and other internal problems before we start anesthesia allowing us to modify which type anesthetic we'll use and how much etc.
It helps us make sure that your pet doesn't have heartworm disease if you've been negligent about giving preventive heartworm medication (or if the pet is new to you and you don't know.)
The only reason this step is often skipped is because of cost...usually in the range of $20-75 depending on how many tests are recommended.
In truth, most young pets that are well cared for and seem healthy on presurgical examination, usually do fine without the benefit of presurgical blood work...but not always. You and your vet need to decide together how important money is to you versus maximizing the safety of your pet while it undergoes the potential dangers of anesthesia and surgery.
In older pets, obese pets, and in pets with health problems...the importance of presurgical blood testing becomes greater. If you love your pet enough to do the surgery in the first place...it is probably wise to do the blood work too.
During Surgery
To keep prices down in this very competitive business we vets often skip things that would be routine in human surgery and we almost always "get away" with it. We vets are highly skilled at successfully making do with what we have.
This is not our choice. We'd rather be like human surgeons with several operating assistants, a seperate doctor passing gas, monitoring EKGs, blood gases and electrolytes, nurses giving IV fluids etc.
But such a team would cost several thousand dollars an hour, so in veterinary medicine we keep it pretty basic. Otherwise, if we didn't keep prices down, pets would instead be "put to sleep" or wouldn't be neutered etc.
At any rate, there are some things that would be worth the extra cost in some patients, and we'll recommend them whenever I think they're especially needed.
At our clinic, my most common recommendation is for IV fluids. Especially for patients who are getting weak, dehydrated, or are fighting a chronic infection, getting a C section etc, hydration of the tissues makes a big difference in recovery rates, and I will add these treatments automatically if it's obvious they're needed.
Just let your vet know if you want to do things like IV fluids , EKG and Blood Gas monitoring , or Oxygen Therapy during recovery. Ask your vet about the cost and benefits.
Another extra some vets may recommend during surgery that's not critical but nice:
If your pet is young and it's teeth are clean and shiny, let us seal your pet's teeth with floride dental sealant. It hardens and strenghtens the enamel which slows the rate of future dental and gum disease. It's inexpensive. But...
If your pet is older and already has a fair amount of tarter and gum disease present, then dental cleaning would need to be done prior to sealing the teeth, and ideally we don't do dentistry and surgery at the same time. Why? Doing a good job of gum cleaning and tarter removal invariably leads to short term bleeding of the gums and absorption of bacteria into the bloodstream...something we don't want during surgery.
Pets under anesthesia can lose body heat quickly. This can greatly complicate the safety of your pet, leading to depressed respiratory and heart rates, so your veterinarian and techs will be watching your pet carefully and keeping it warm and pampered during and after surgery. If IV fluids are needed, they will probably be warmed to body temperature first.
Trust your vet and his or her surgical team. It's true that every once in a while, things go badly...but rarely because of a lack of caring or trying.
After Surgery
It's amazing how most of our patients recover to normalcy after just one or two days after surgery. Often after just a couple of hours. Sometimes in under an hour. It depends on the type of anesthesia and surgery.
But it's still important to take some sensible precautions:
Don't feed for at least 4 hours after surgery and feed small amounts at a time for the first day. Don't feed "special treats" that are hard to digest (like PIZZA and TABLE SCRAPS) as part of your post surgery pampering.
Do consider post op electrolyte replacement...either superior veterinary products made specifically for pets that your vet has to dispense...or helpful things like chicken broth, pediactric solutions, or things like Gatorade.
Sometimes a special diet will be recommended during recovery.
Encourage, or force if needed, rest. Don't play rough or active games. Walk on a leash. etc. Consider with you vet whether or not tranquillizers might be appropriate for your dog if an over active type.
Expect a little inflammation or swelling, but call your vet or come in for a recheck if you think something is obviously wrong with the incision site or anything else about the patient for that matter. For you to know if there's a problem...take a close look at the incision on a twice daily basis for at least the first few days.
Keep the incision clean. Squirt with a gentle antiseptic 2-3 times daily for the first few days. Hydrogen peroxide is fine for most incisions. I perfer chlorhexidine for sites with high risk of infections such as abscess wounds, draining incisions etc. Your vet will automatically give you a wound cleaning topical prep if it's needed. Keep your post op patient in a clean area. Keep flies away.
Consider extra pain relief.
At our clinic, we routinely use a pretty potent pain medication combination (carprofen, acepromazine, xylazine and Telazol) prior to surgery that has fairly good lasting effect. but for surgeries where I must cut through muscle or bone or handle intestines or bladder, I'll recommend Rimydal or Ectogesic to give for a few days after surgery. Other vets use different combinations to achieve excellent pain control and may recommend one of the different post op pain medications available.
We usually don't recommend aspirin or Tylenol though, as they cause side effects we want to avoid after surgery such as reduced clotting. (Also; go to our page on poisons if you don't already know that Tylenol (acetominophen) is potentially deadly to cats.)
You might want to spend the small amount these meds cost for a few days just to make sure your pet is more comfortable even after less traumatic surgeries such as spaying and castrations etc. They are very safe, new, non -steroidal medications normally used for arthritic discomfort but turn out to be great post surgery pain drugs.
Consider buying a restrictive or elizabethian collar if needed to stop your pet from excessive wound licking.
Consider a little extra love and time and affection spent with your recovering patient...maybe a new stuffed toy ...after all, your pet may be a little anxious about what's going on.
That's it, except that you need to bring the pet back to remove sutures 10-14 days after the surgery unless dissovable sutures or surigal glue was used.
Referral to Veterinary Specialists:
Veterinary specialists have come to play a more visible role in the care of animal patients.
Today, though, the climate is clearly changing. More specialists have entered into private practice, where they complement the services of the general practitioner.
A veterinary specialist is generally recognized to be a graduate veterinarian who has completed a special and lengthy course of advanced training in a given discipline. Most commonly, the veterinarian will have studied in a residency program offered by a veterinary teaching hospital, institution, or laboratory, with supervision by recognized specialists in the field. In the United States, where veterinary medicine is perhaps most specialized, specialists are organized into Colleges or Boards, where members have earned Diplomate status through training and testing.
Each discipline establishes its own training guidelines and criteria for certification as a member of that specialty. A minimum number of supervised training hours, performance and publication of original research, and successful completion of rigorous examinations is required by the majority of the 20 specialty groups recognized by the American Veterinary Medical Association. A minimum of two to three years of training beyond veterinary school is typical; some academic programs offer advanced degrees, such as the Master's of Science or Public Health or Ph.D., concurrent with residency.
Currently, the American College of Veterinary Internal Medicine, ACVIM; the American College of Veterinary Surgeons, ACVS; and the American College of Veterinary Pathologists, ACVP, list the largest number of active veterinary specialist members. ACVIM oversees training and certifications of diplomates in the subspecialties of internal medicine, cardiology, neurology, and oncology. During examination, members of each college must demonstrate an understanding of the general principles of internal medicine and physiology that are shared by all species, large and small, then focus on their specific discipline in a lengthy certifying examination.
Candidates certified by the ACVS are required to undergo a didactic course of training, conduct and report original research, and maintain a detailed log of their surgical training prior to examination. Veterinary surgeons are trained in orthopedics, neurosurgery, and soft tissue procedures. Additional training in oncologic surgery, cardiothoracic surgery, or neurosurgery through surgical fellowships may be offered as well.
Pathologists train a minimum of three years after graduation from veterinary school. They focus on clinical pathology, which includes the study of blood elements, analysis of blood chemistries and microscopic pathology, as well as general principles of pathology.
Residency programs continue to emphasize understanding the basis of animal disease, therapeutics, and comparative aspects, but are reckoning with the changing professional goals of candidates in training-since many of them are seeking positions as specialists within private practice. In this arena, the specialist will be more likely to participate directly with patients, as well as general practitioners.
Most specialists in teaching hospitals and private practice see patients exclusively on a referral basis. The local veterinarian who supervises the regular care and health maintenance of the patient is usually best prepared to determine when a patient should be referred for consultation with a specialist and where that patient should be seen.
Veterinary clients may consult specialists in the fields of dermatology, behavior, ophthalmology, radiology or radiation oncology, dentistry, exotic animal medicine, nutrition, critical care, or reproduction if their animal(s) need such specialized attention.
The referral process operates most smoothly when the specialist, general practitioner, and client work as an integrated team. This teamwork is critical to providing optimal patient care and maximizing the chances of a good outcome.
To learn more about the various specialties, check out the following web sites:
Links, Resources, and Misc Comments
ThePetCenter - excellent site with pictures of different surgeries and well written, sound advice from Dr Dunn.
- portrays many of the personalities, failures and breakthroughs that have shaped modern surgery. Allows you to step back in time to the 1800s to become either a survivor or a fatality as a result of early American medical care.
Vesalius - an online graphical resource for the medical and surgical communities including anatomical and surgical images, and short educational narratives designed for online reference and study.
Stitch Craft - An index containing pictures and descriptions of various suture patterns
MEDLINE is the National Library of Medicine's premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.
On This Page:
Introduction to Veterinary Surgery
Before Surgery
During Surgery
After Surgery
Surgical Specialists
Links of Interest
On Other Pages
Diseases of the:
The Pharmacy Page; about the medicines we use as well as information about alternative medicines
A perspective about Veterinarians vs Human Physicians that I liked from a recent article by Christopher J Allen DVM:
How can clients expect so much from us, we ponder, when they demand less from their own physicians.
Medical Doctors routinely make patients wait more than an hour from a scheduled appointment time.
They expect us to have instant answers to complex medical problems when their own doctors are puzzled for weeks or months before establishing a diagnosis.
On top of that, the MD only has one species or even one organ system to worry about.
But one of the biggest difference is in patient referrals.
Consider the scenario which routinely unfolds when a human patient has sudden severe pain in his right hip. The patient calls an orthopedist and is told that the doctor only takes patients by referral.
Then the family doctor is contacted and an appointment is scheduled for three weeks later. Finally, after much agony, the family doctor sees the patient and orders an MRI of the hip and lower back.
The MRI is scheduled for 10 days later. Two weeks after that, there is a follow up with the family physician.
The family physician reads the radiologist's MRI report and advises the patient to schedule an appointment with an orthopedic Surgeon.
Next available appointment? One month later. After about four months of excruciating pain, disc surgery is scheduled.
Bills later arrive from a family physician, a radiologist, an anesthesiologist, and orthopedic surgeon. Also from an MRI facility, a hospital and a physical therapist.
And each medical practitioner sleeps soundly knowing that they did not commit malpractice by treading in an area in which they were not fully knowledgeable and skilled.
When the owner of a grossly overweight German Sheperd, on the other hand, calls your office complaining that the dog has a sudden leg pain, you are expected to see the patient at once, diagnose the problem with two plain x rays, schedule hip surgery within a week and return the dog to its owner with the expectation that it will be walking limp free in a month.
Physical therapy is not available, of course, and it goes without saying that you have managed to avoid any anesthetic complications with this over weight dog.
It's amazing how often we, as vets, can do all this...but what happens when things don't go perfectly?
What if the limp doesn't go away?
Or there are anesthetic complications?
What happens when the client tells the judge that if she had known better diagnostics were available, she never would have hesitated to pay to have them performed?
Let me add a little to this article...
What if things don't go great and she finds out you only perform a few hip surgeries a year and are therefore not considered an expert in this field? Even if you did recommend referral but she didn't want the extra expense. Hoo boy.
We vets avoid most legal problems by being realistic, communicative, and honest with our clients...but you the pet owner must also be honest. Please let your vet know about your expectations.
If you want to skip tests and radiographs and so forth due to expense, that's understandable; but you shouldn't complain in hindsight if that turns out to be a bad decision.
