What does a board-certified surgeon do all day?

A look back at 2014…

The beginning of a new year is a great time to reflect on past accomplishments. For me, as a surgeon, it includes thinking of all the patients we helped and which surgeries we performed.

Dr. Phil Zeltzman cleans up a patient after surgery

“Dr. Phil Zeltzman cleans up a patient after surgery”

Why should you care? Because this little exercise can make you aware of the most common surgical conditions in cats and dogs.

As one of my professors used to say in vet school, “Common diseases are common.” What this means is that most of the time, statistically speaking, your pet’s diagnosis is going to be straight forward.

This list can empower you to figure out what your pet’s problem may be. I’ve had clients correctly diagnose their pet with an ACL tear or laryngeal paralysis!

So here are my top 10 surgeries in 2014.

  1. TPLO & TTA
  2. Belly surgery
  3. Fractures
  4. Tumor removal
  5. Joint dislocations
  6. ACL – nylon repair
  7. Perineal urethrostomy
  8. Laryngeal paralysis
  9. Hernias
  10. TECA

Let’s go over these surgeries in more detail

  1. ACL SURGERY
    It never fails, ACL surgery remains the most common surgery I perform, mostly in dogs, and occasionally in cats.  There are reportedly 100 ways to fix an ACL.  We’ve talked many times about ACL surgery, so let’s keep it short.
    I have tried several techniques over the years, and now use mostly three: the “traditional” technique with heavy nylon sutures can be used in dogs and cats. In some dogs, the TPLO (Tibial Plateau Leveling Osteotomy) and the TTA (Tibial Tuberosity Advancement) are additional options that typically gives great results.
    These days, TPLO is THE most common surgery I perform.
  2. Belly surgery
    Belly surgery or “exploratory laparotomy” can be necessary for a number of reasons. The most common reason in 2014 was to remove all kinds of foreign objects: toys, string, hair ties, pieces of a yoga matt, a foam ear plug, a trichobezoar (Harry Potter fans may know this is a hair ball), a sock, pieces of a basketball, an acorn etc.
    Other common reasons included removing body parts (gallbladders, benign or cancerous masses), taking biopsies, removing bladder stones, etc.
    Some cats had their colon removed because of a condition called megacolon. This is the only reasonable option then cats are so severely constipated, that the colon has become a useless bag of rock-hard poop. At that stage, medications are a waste of time and money. Procrastinating to move on with surgery invariably leads to a much worse anesthesia candidate. These cats may go from otherwise healthy to skinny and unhealthy. Not to mention the fact that they suffer from untreatable constipation.
    A few wise clients who knew their dog is at risk for “bloat” (stomach twisting) wanted a preventive procedure performed, called a prophylactic gastropexy.  By tacking the stomach to the inside of the belly, we can prevent the twisting of the stomach.  It is a life-saving procedure that should be considered in Great Danes (the #1 breed for this disease), German shepherds, Labs and several other large dog breeds.
  3. Fractures
    Many pets surprised their owners and escaped through an open door or an open gate. Most got hit by a car. Others were hit by their owner’s car – always a horrible situation. Some were on a leash but ran after something (a dog, a truck etc) and either the (loose) collar slipped off the dog’s neck, or an “extendable” leash offered no control.
    A large number of pets are victims of falls.  They fell from their owner’s arms, from the couch, from the bed, in the stair etc.  We have also seen a number of pets who had a fracture after someone fell on them.
    Prevention is possible in most cases: use a (tight) leash, make sure the collar is tight enough, close the door to the outside, lock the gate, and know where your pet is when you drive out of the garage. Oh, and neuter you male pets: many pets with broken bones are not neutered, so they are much more likely to roam and get in trouble.
  4. Tumor removal
    This list is sadly endless: in and under the skin, in the chest or on the heart, in the bone (legs, pelvis, jaw…), in the liver, on the stomach, in the intestine, on the bladder…
    Thankfully, not all tumors are cancerous, and we’ve removed many benign masses.
  5. Joint dislocations
    We’ve dealt with virtually every joint dislocation: the shoulder, the elbow, the wrist, the hip, the knee and the ankle!  Some are traumatic, some are congenital (i.e. the pet was born that way).
    The most common one is the kneecap dislocation.  The kneecap slides out of the groove where it is supposed to live, at the bottom of the thigh bone (or femur). It is common in dogs, and we’ve seen quite a few kitties with that condition last year.
    In some cases of hip dislocation, or because of hip dysplasia, we may need to perform a Femoral Head Ostectomy (FHO). The “ball” of the hip (femoral head) is removed during surgery.  FHO is also done in pets with a hip fracture or deterioration of the bone (e.g. Legg Perthes disease in tiny dog breeds).
  6. Standard ACL repair:
    see # 1 above.
  7. Perineal urethrostomy
    Perineal urethrostomy (or in short a P/U) is performed in cats who have had a urinary blockage several times. The idea is to remove the end of the urethra (aka the penis) and stitch up the lining of the urethra to the skin in order to end up with a much wider opening. It may sound weird, but it typically works very well.
  8. Laryngeal paralysis
    Dogs, mostly Labs, can have a condition that paralyzes their larynx, a.k.a. voice box, and causes them to suffocate. It’s an incredibly stressful condition. Fortunately, surgery (a “tie back”) allows them to have a wider airway, which typically works very well.  These patients quickly go from suffocating to being able to breathe comfortably.
    Traditionally, we see most “lar par” patients in the summertime, when the heat and humidity make their condition worse. What I’ve noticed in the past 2 years, is that we have performed this surgery several times in the winter (November, December).
  9. Hernias
    A hernia is a condition where an organ ends up where it shouldn’t be. There are several types of hernias.
    A perineal hernia is a condition where organs (mostly fat, occasionally intestine or even the bladder) slip through weakened muscles in the pelvis, and slide along the rectum.  The end result is a bulge on the side (or sometimes both sides) of the anus.
    Why are the muscles weakened? Most of the time, the condition happens in unneutered dogs (rarely in females and neutered dogs).  Therefore, we think that in most patients, testosterone from the testicles causes some muscles in the pelvis to shrink.
    The best prevention is to neuter male dogs early in life.
    Diaphragmatic hernia is a condition that most commonly happens after a pet is hit by a car. Organs from the belly slip through a rent in the diaphragm and end up in the chest. Surgery involves putting organs back in the belly and carefully stitching up the diaphragm.
  10. TECA
    Total Ear Canal Ablation (TECA) is the best solution for dogs (most often Cockers) who have repeated ear infections. Those can be very painful and some of these dogs become head shy or even aggressive.
    Sadly, many of these dogs are treated, sometimes for years, with medications, which can’t even go down into the ear canal because it has become so swollen.
    TECA is an invasive procedure, with possible complications, which fortunately works very well in the majority of patients.

Remembering some of the surgeries we’ve performed in 2014 is also a way to give credit to the wonderful vets, nurses, and pet owners who have been caring for them.

Until next time,

Phil Zeltzman, DVM, DACVS, CVJ

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a mobile veterinary surgeon and award-winning author who’d like to share his adventures in practice along with information about veterinary medicine that can really help your pets. Sign up to get an email when he updates his blog, and follow him on Facebook, too!