Why do we do what we do? (Part 2)

Have you ever wondered why vets and their nurses do what they do?

Ruby, a 2 year old Dogue de Bordeaux, wakes up from anesthesia after a TPLO to address a tear of her ACL

 

Last week, we described 5 things we do around surgery time, and why we do them

This week, we share 5 more features we provide routinely to your pet during anesthesia and surgery.

 

6. Why do we place a tube down the throat?

It’s not just down the throat, it’s into the windpipe, so that oxygen and anesthetic gas can be delivered to the lungs.

Interestingly, anesthetic gas is so powerful (yet safe) these days, that with the proper pain medications on board, we can often get by with only 1 or 2% anesthesia gas and 98 or 99% oxygen.

The tube allows us to have control of the patients breathing. So for example, we can breathe for the patient or “give a breath” if the patient doesn’t take enough oxygen in, or keeps too much CO2 in.

 

7. What do we monitor during anesthesia?

Monitoring a patient allows us to make anesthesia as safe as humanly possible. Depending on the sophistication of the hospital, we monitor multiple values, including:

. Temperature

. Heart rate

. EKG

. Blood pressure

. Oxygen level

. CO2 level

 

8. Why do we monitor anesthesia?

100% of the clinics I do surgery at have a dedicated anesthesia nurse, whose only job is to monitor the patient and make sure anesthesia is as safe as possible (if you read between the lines, this means that not all clinics take that precaution…).

Why does a nurse monitor a patient under anesthesia?

To make sure that the patient is sleeping soundly, and that the numbers on the anesthesia monitor are what they should be. Besides the monitor, nurses check on the patient. They check on the color of the gums, the depth of the anesthesia, the pulse, the breathing etc.

 

9. What’s the end result of monitoring?

Monitoring patients closely allows us to catch changes and correct them before they become a bigger problem.

* If you are not monitoring a patient’s blood pressure, how would you know that it is low and needs to be corrected?

* If the temperature is too low, we add even more devices that we had to begin with, in order to keep the patient warm.

* If you are not monitoring a patient’s EKG, how would you know that the heartbeat is abnormal and needs to be corrected?

In some cases, the nurse knows exactly what to do. In other cases, the doctor and the nurse come up with a plan to correct whatever needs to be corrected.

 

10. What happens once surgery is over?

Anesthesia stops after the patient is cleaned up and ideally has been on 100% oxygen for a while. Then the patient goes to the recovery area. There, the patient must still be monitored very closely.

Here is a little secret (too) few people know about: most pet owners are scared of anesthesia. In fact, most pets who die (thankfully extremely rarely), do so AFTER anesthesia is over. So this part is still critical and must be taken very seriously.

Similar to what is done during anesthesia, certain things are monitored during recovery: pulse, heart rate, gum color, temperature, as well as comfort level. Once the patient becomes conscious and won’t tolerate the breathing tube in their throat, the tube is removed.

Still, patients must be monitored until they are fully aware of their surroundings!

And then, nurses must still keep a close eye on their patients, on and off, until they feel confident that they are “out of the woods.”

 

In the end, these 5 steps are designed to make anesthesia and surgery safer for your pet. This is our ultimate goal.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Why do we do what we do?

Have you ever wondered why vets and their nurses do what they do?

A Bulldog under anesthesia

 

Here are 5 common things we do around surgery time, and why we do them.

1. Why do we do blood work?

We perform preop blood work to make sure that the patient’s organs are healthy and functioning properly. We mostly look at the immune system, the red blood cells, the clotting system, the liver and the kidneys.

If one of these organs doesn’t work properly, it can dramatically affect the safety of anesthesia or surgery. In some cases, we may need to treat or “stabilize” the patient before we even consider surgery.

Many drugs are processed by the liver and the kidneys, so if they are not working well, the drugs will stay in the patient’s system for much longer than normal and could lead to complications such as a delayed recovery.

 

2. Why do we place an IV catheter?

We place an IV catheter for several reasons:

* To “stabilize” a patient before surgery, for example to correct abnormal electrolytes.

* To give a tranquilizer, before or after surgery.

* To give IV pain medications.

* To give IV antibiotics.

* To give IV fluids.

* To give IV emergency drugs if needed.

 

3. Why do we give IV fluids?

We give IV fluids for several reasons:

* To correct abnormal electrolytes (to increase or decrease them).

* To dilute some IV drugs.

* To make sure the patient is well hydrated.

* To make sure the blood pressure is high enough.

* To make sure we have easy access to a vein in case we need to give emergency drugs.

 

4. Why do we give IV antibiotics?

Under anesthesia, the patient’s immune system is weakened. Since neither the skin nor the air nor the environment is completely sterile, bacteria always end up in the surgical site. To prevent an infection, we give antibiotics before, during and after surgery.

Some organs are riskier than others: there are more, and more dangerous, bacteria in the intestine (think about removing a rock or a tennis ball from the intestine), than on the skin (think about removing a skin tumor).

 

5. Why do we give IV pain medications?

We give pain meds before anesthesia because it sedates or relaxes the patient. Interactions and minor procedures (e.g. placing an IV catheter or taking X-rays) are therefore less stressful.

In addition, it is better to give pain meds before the surgery starts because a smaller amount is needed. If we waited until the patient has been “stimulated” during surgery, we would need a bigger dose.

 

Ultimately, these 5 steps are designed to make anesthesia and surgery safer for your pet. This is our primary goal.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Snoopy suffers from a slipped disc

Snoopy, a cute 7 year old Beagle, was taken to his family vet because he was in terrible pain.

He was unable to move his neck normally and was crying in pain. The limited range of motion in his neck and pain in one front leg (similar to a sciatica with a back problem) alerted his vet that he may have a serious condition, most likely a slipped disc. This remained to be proven.

Snoopy was sent for a CAT scan. The scan revealed that Snoopy did indeed have a huge slipped disc (or disc hernia) between C2 and C3 (the names of 2 vertebrae in the top part of the neck).

(Explanation: the white is the vertebrae. C2 and C3 are noted. The grey “ribbon” inside the vertebrae is the spinal cord. The disc is shown by the yellow arrow. You can also see that the “disc space,” directly below the disc, is collapsed)

Based on those findings, I recommended surgery to remove the slipped disc (“ventral slot” surgery). In addition, a preventive surgery (“fenestration”) was performed to remove the center of the discs below the slipped disc. Since we physically remove part of the disc, it lowers the risk of another slipped disc in the future (in case you’re wondering why the discs above were not taken care of, this is only specific to Snoopy, whose disc was at the very beginning of the neck).

Are there other treatment options?

Other treatments for a slipped disc can include medications (steroids – which are out of favor in 2018), acupuncture and physical therapy. For me, the best, definitive treatment is surgery. It’s like having a pebble in your shoe: you can try physical therapy, acupuncture or medications, but the only long-term solution is to remove the pebble.

Look at the picture of the CAT scan again. What else, besides surgery, is going to make this huge disc go away? What else is going to stop putting so much pressure on the nerves in the spinal cord?

Snoopy recovered at home uneventfully. He was confined to a small area for 8 weeks, then allowed to slowly return to his normal activity. Two months after surgery, his owner was happy to report that Snoopy was back to his normal Beagle self.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Troubling Mass for Tiny Reese

Reese, a 7 year old Chihuahua, was brought to his family vet because of raspy, difficult breathing.

He had a walnut-sized mass (in an 8 lb Chihuahua!) on his neck, near the thyroid glands.

Reese’s vet logically suspected that the mass was pushing on his windpipe. Surgery was recommended to remove and biopsy the mass.

Prior to surgery, chest X-rays were taken to make sure there was no spreading to the lungs. Blood work was normal, and it was decided that Reese was a good candidate for anesthesia and surgery.

I was called in to Barton Heights Veterinary Hospital (www.bartonheights.com ) to remove the mass

Surgery was successful. Reese recovered uneventfully and his breathing improved immediately following surgery, as soon as he woke up from anesthesia.

A week later, the biopsy confirmed that the mass was thyroid cancer (carcinoma), which had been removed it in its entirety. This is not a good disease, but we had bought time and improved Reese’s quality of life.

Reese’s owner was rewarded by a happy pup who can enjoy life again.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

What I’m thankful for…

I am always very thankful to my clients and for the trust they place in me.

They trust that I will be able to fix their pet, or relieve their pain, or improve their quality of life. This is my life’s mission, it’s my passion, and it’s a huge honor to be able to perform surgery on their family member.

Every year, a few amazing stories are top of mind. The kind of situations where I can’t even express how grateful I am. Such is the story of Scout.

Scout’s owner found me through my web site (www.DrPhilZeltzman.com). Amazingly, she drove all the way from Charlotte, North Carolina, for me to do surgery on her dog Scout, a sweet 8 year old Golden.

Scout’s owner wanted me to do a TTA Rapid on her buddy. This is a specialized surgery to address a torn ACL in the knee. I told her that there are plenty of board-certified surgeons in North Carolina, but she wanted me to do the surgery! So she drove all the way to Pennsylvania! This is quite humbling…

After two months of recovery and TLC at home, Scout is now doing very well. His owner says he is almost 100% close to normal.

My wonderful nurses and I wish you, your family and your pets a peaceful Thanksgiving.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified