To keep prices down in this very competitive business we vets often skip things that would be routine in human surgery. This is not ideal, but luckily it usually works out. We do this for practical reasons. 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.
On the other hand, I caution you from choosing the cheapest veterinarian.
There are some things that are worth the extra cost in some patients, and we'll recommend them whenever we think they're needed.
On this page, I outline what to expect when your pet needs surgery. Many of the things I'll discuss are probably not necessary in young and healhty patients needing routine or minor surgery ... but will be critically important in other patients. Hopefully this page will help you understand what's involved and what your choices will be. But my main advice will be to trust your veterinarian to recommend what's needed.
I discuss different surgeries more specifically on other pages .... see the links to your left
God Bless, Roger Ross DVM
What To Expect When You Go To The Vet When Your Pet Needs Surgery
A few basics; A presurgical exam to make sure your pet doesn't have a fever, isn't dehydrated, in heat, has a heart murmer, isn't fighting an infection and so forth.
We will ask you to sign a consent form and use it as a device for making sure you understand that anesthesia and surgery is a serious business and that you need to make some serious choices about options designed to maximize the safety and comfort of your pet.
Such choices will include:
- Various lab tests to make sure there aren't hidden problems that would make anesthesia extra dangerous
- Pre-surgical pain management
- Pre-surgical sedation which makes anesthetic induction smoother and reduces the amount of anesthetic needed
The Basics of any Surgery
Your vet will perform at least a basic pre-surgical exam to assess hydration, temperature, pulse, and other vital signs.
It's important to make sure your pet has an empty stomach prior to anesthesia
You or your vet will need to choose whether or not to insert an IV line and run IV fluids. Some vets will require this in all cases. Others will leave this as an option for minor surgeries on young healthy animals. The only reason to omit this step is to reduce cost.
One advantage is an instant access to a vein if emergency medications are needed.
A bigger advantage is that any anesthetic and surgery combination is very stressful to your body and very dehydrating ... equivalent to running a marathon. Keeping a patient well hydrated and electrolytes well balanced prevents metabolic disasters, flushes out unwanted toxins and anesthetic metbolites that result in any surgery, and greatly smoothes out and speeds up recovery.
You or your vet will need to consider doing some lab work prior to anesthesia and surgery. How much lab work will depend on the type of surgery and the standards of your vet. More expensive and sophisticated vets are likely to insist on extensive lab work to cover all the safety bases. Less expensive operations are likely to stick to the basics.
Basic lab tests typically include:
BUN/Blood Urea Nitrogen and/or Creatinine: screening tests for kidney disease and hydration
Liver Enzymes: a screening test for liver disease
Glucose Level: a screening test for diabetes and stress
Pack Cell Volume: a screening test for anemia
Total Protein: a screening test for the immune system, liver function
Additional tests that will be considered depending on the age and condition of the patient and the type of surgery being done:
Complete Blood Count: information about platelet numbers, presence of infection, severe inflammation, anemia
Electrolyte panels, Alk Phos levels, pancreatic enzymes, protein panel, cholesterol levels, and thyroid tests all to give us a much more extensive picture of the patient's total health. And from a practical stand point, commercial labs often offer all this information for only a few dollars extra when combined with a Complete Blood Count, Pack Cell Volume, Glucose and kidney tests.
Clotting time tests to make sure there aren't any clotting problems
Radiographs may be appropriate for abdominal exploratory cases, cancer cases, and certainly for bone surgery, gall bladder surgery, and bladder surgery.
Pre-surgical antibiotics in cases where infection is present or likely to be a post op danger such as in bowel surgery
Pre-surgical pain management
Pre-anesthesia sedation to smooth induction of anesthesia and to reduce the total amount of anesthetics needed
Anesthetic Monitoring: this might be anything from the surgeon simply paying close attention to respirations and mucus membranes during a minor surgery to attaching probes and clips to digitally record and display EKG readings, Oxygen saturation, Pulse, Blood pressure, Temperature, and respiration rates.
Surgical Prep: depending on the body part in question, we need to shave off the hair and make the surgical site as close to sterile as possible
Anesthesia: this can range from local anesthesia for removing a cyst, to a combination of injectable anesthetic agents for short to medium procedures, to gas anesthesia via an intubation tube closely supervised by a trained anesthesiologist.
Oxygen Therapy: This is automatic when on gas anesthesia but an option if injectable anesthesia is being used. You might not know this, but both anesthesia and surgery are extremely stressful to the cells in your body. Cell dehydration and cell hypoxia or lack of oxygen are the major problems associated with surgery. We can counter this problem by supplementing with IV fluids and Oxygen. Lack of oxygen to the cells is also painful. Lack of oxygen to the cells increases the risk to heart attack. And lack of oxygen greatly increases recovery time.
The Actual Surgery: Often an anti-climax. Sometimes the actual surgery only lasts minutes after all that time and effort in preparation. And of course, the surgery may be long, intricate, and complicated. Your veterinarian may work with traditional scapel and suture or use the latest in electro-cautery, lasers, and maybe even remote, micro-surgery techniques. Your veterinarian may be a general practioner or a board certified surgeon with 3-7 years of post doctoral training. The cost may range from under $100 to thousands of dollars.
I discuss specific surgeries on other pages. See the links on your left and below:
Spays (Ovariohysterectomies) in Dogs, Cats, and Other Pets
Castration in Dogs, Cats, and Other Pets
Extras: Having a sedated patient is a great time to trim nails, remove a mole, apply dental fluoride or sealants, cut out matts and so forth. Your vet may offer some extras while your pet is anesthesized.
Biopsy: For cancer patients, your veterinarian may recommend biopsies following up surgery to identify the type of cancer present and also to see if cancer cells remain near the surgery site or near by lymph nodes
Recovery: Patients after surgery need time to recover and have to be closely monitored. A lot of patients have trouble regulating their body temperature after anesthesia. We have to watch for aspiration. We have to manage pain. Sometimes we have to manage post anesthetic shakes and mini convulsions. We have to manage panic. We have to enforce rest. Moving around too quickly after a major surgery is dangerous.
Medications: For some diseases, surgery is only a part of the treatment. Often medications will be indicated, special diets may be needed, and in diseases like cancer, chemotherapy and radiation therapy are complements to surgery
Follow Up and multiple surgeries: Some surgical problems, injuries and cancer cases will require follow up treatments and repeat surgeries
God Bless, Roger Ross, DVM
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.
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. 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
Links of Interest
On Other Pages
Spays (Ovariohysterectomies) in Dogs, Cats, and Other Pets
Includes an interesting short history about a women doctor pretending to be a man performing the first modern C Section
Castration in Dogs, Cats, and Other Pets. Includes recipes for Rocky Mountain Oysters, Montana Tendergroins, and Swinging Beef. What Viagra is made from.
On Other Pages:
malaria, yellow fever, encephalitis, plague, heartworms, Rift Valley Fever, Lymes Disease, Rocky Mountain Spotted Fever, Tick Paralysis, Monkey Pox, etc
Heartworms; a parasite spread by mosquitos that causes severe heart, vascular, and respiratory disease in dogs, cats, and maybe humans. Denistry: why oral hygiene and health is so important and what you can do about it Orthopedics: How I treat arthritis, pannus, hip dysplasia, and other problems of the bones and joints Metabolic Diseases like Diabetes, Cushings Disease, Addison's Disease, and Thyroid Disease History of Veterinary Medicine in the United States
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.