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

Five secrets for a happy cat

Having a happy, un-stressed cat is easy to do.

Below are 5 secrets to help you achieve kitty Zen*.

Cat in a box

1. Provide a safe place

Every cat needs a safe and secure place where (s)he can retreat to and feel protected. It can also be used as a resting area. Kitty should have the ability to exit and enter the space from at least 2 sides if it feels threatened. Most cats prefer a space large enough to fit only themselves, that has sides around it, and that is raised off the ground.
Good examples of safe places are a cardboard box, a cat carrier, and a raised cat perch. There should be at least as many safe places, sized to hold a single cat, as there are cats in a household. Safe places should be located  away from each other, so that cats can choose to be on their own if they feel like it.

2. Provide multiple and separated key environmental resources

What on earth are key environmental resources?
They include include food, water, litter box, scratching posts, play areas, and resting /sleeping areas. These resources should be separated from each other, so that cats have free access without being challenged by other cats or other potential threats (like a dog!).

Separation of these resources reduces the risk of competition, stress and stress-associated diseases (e.g. bladder disease).

3. Provide opportunity for play and predatory behaviors

Play and predatory behaviors allow cats to fulfill their natural instinct to hunt. Play can be stimulated with the use of interactive toys that mimic preys, such as a toy mouse that is pulled across a floor or feathers on a wand that is waved through the air. Allow your cat to capture the “prey” every once in a while to prevent frustration.

Early in a cat’s life, introduce interactive play, so they learn to avoid going after your hands and feet for play. Using food puzzles or food balls can mimic the action of hunting for prey, and provides more natural eating behavior. You can encourage your cat’s interactive play by rotating your cat’s toys, so they don’t get bored.

Use treats to reward and provide positive reinforcement for appropriate play. If you have more than one cat, remember to play with them individually.

And because I am a surgeon, I have to remind you to never leave cat toys unattended, especially anything that looks remotely like a string or a ribbon. They can be swallowed by your cat – or your dog.

4. Provide positive, consistent, and predictable human–cat social interaction

A cat’s individual preferences determine how much they like human interactions such as petting, grooming, being played with, being talked to, being picked up, and sitting or lying on a person’s lap.

To a large extent, this depends on whether, as kittens, they were introduced to and socialized with humans during their period of socialization from 2 weeks to 2 months of age. Remember that every cat interacts differently and respect your cat’s individual preferences.

Remind guests and all household members not to force interaction and instead let the cat initiate, choose, and control the type of human contact.

5. Provide an environment that respects the importance of the cat’s sense of smell

Smell and chemical information is a primary means by which cats assess their surroundings and affirm their sense of security and comfort within their living quarters. It is important for pet owners or other humans to avoid introduction introducing odors or substances (e.g. detergents, medications, foods, laundry or unfamiliar clothing) that compete with or disrupt the cat’s sensory perception of its environment. When a cat encounters an unpleasant or threatening smell, the stress can cause problem behaviors.

Marking is an important form of olfactory communication. A fundamental principle of maintaining a secure in familiar sensory environment is not to punish cats for house soiling.

These are 5 great tips to remember to keep your cat happy and healthy.

Until next time,

Phil Zeltzman, DVM, DACVS, CVJ

* The following 5 tips are inspired from a document published by the American Association of Feline Practitioners.

5 New Year resolutions for dogs

Dear Human,

This is your dog writing*.

With the start of the New Year, I thought I would send you a few suggestions to make sure I maintain my place as leader of the pack. I was made to be catered to, and this is how we should keep it this year.

Dog walking

1. Play with me every day

Please don’t just open the door to “let me out.” It’s so boring out there without you. Join me and play with me. Throw me a ball. Run with me. Play hide and seek. There are so many fun things we can do together!

Do this every day, and I promise I will entertain you, make you smile, and lower your blood pressure. Besides, I hear it’s great exercise, and we could all afford to lose an ounce or two after the holidays.

2. Help me love the car

I overheard that not vomiting in the car is my ticket to getting out of the house more frequently. I would love to get out of the house, and be transported by a chauffeur as I deserve. But I hate the car. Help me change that. Help me love car rides, and I promise I won’t hide and fight you every time. Talk to my vet to give me an anti-vomiting medication. I’d rather swallow a pill that than feel nauseous and vomit. And let’s take it slow. Let’s start with short rides, just for fun. Then we can make the car ride longer.

3. Take me on a walk

Let’s walk in the park from now on. The yard is getting so boring… And let’s go to a different park every once in a while. Or a forest. Or the fields or something!

People will fawn all over me because seeing someone like me on a leash will be a treat for humans. Think of all the petting and attention!

4. Teach me a trick

Keep my brain active by teaching me new tricks. I can show your friends how smart I really am and make you proud of being owned by me. You’ve always suspected that I understand every word you are saying, so allow me to prove it by letting me learn new tricks.

5. Take better care of Me

Measure what I eat. Schedule an appointment with my vet if I haven’t been there in the past 6 months. I wouldn’t want to be accused of being chubby or having fleas. Also help me keep my pearly whites in good condition! Preventive health care is the secret to a long and happy life, and only you can help me achieve that.

Help me make 2015 the year I remain the leader of the pack. Help me reclaim my well-deserved place in the world. Help me make this dream a reality. So please do your part and follow these 5 simple steps* to keep me happy, healthy, and deservedly pampered!

Until next time,

Phil Zeltzman, DVM, DACVS, CVJ

* These 5 New Year resolution are loosely inspired from similar information provided on cats by the CATalyst Council, an organization dedicated to cat health and welfare. Find more information at catalystcouncil.org.

5 New Year resolutions for cats

Dear Human,

This is your cat writing*.

With the start of the New Year, I thought I would send you a few suggestions to get me closer to the status we felines once held in ancient Egypt. We were worshiped as gods, and this is the status I would like to return to this year.

Cool cat

1. Play with me every day
Some people who are owned by a cat think that we don’t need that much attention. I beg to differ. We need lots of attention. We felines crave attention. And we deserve attention. So play with me – every day. In the process, I will entertain you, make you smile, and lower your blood pressure. Besides, I hear it’s great exercise, and we could all afford to lose an ounce or two after the holidays.

2. Help me love my carrier
I overheard that my carrier is my safe ticket to getting out of the house more frequently. I would love to get out of the house, and be transported by a chauffeur as I deserve. But I hate my crate. Help me change that. Help me love my crate, and I promise I won’t hide and fight you every time. Here is a video you can learn from: http://www.catalystcouncil.org/resources/health_welfare/cat_carrier_video/index.aspx

3. Take me on a walk
Dogs should not be the only ones allowed to be walked outside. As long as you don’t interrupt my nap, teach me to walk on a leash, with a kitty harness. First let’s do that inside so I get used to the idea. Then maybe you can walk me in the yard, and possibly even on a sidewalk if you feel it’s clean and safe enough for someone of my status.
Your friends and neighbors will fawn all over me because seeing a cat on a leash is such a rare treat for humans. Think of all the petting and attention!

4. Teach me a trick
In an effort to elevate my status, I am willing to prove that I am smarter than dogs. Teach me tricks and I will show you how smart I really am. You’ve always suspected that I understand every word you are saying, so allow me to prove it by letting me learn a trick.

5. Take better care of Me
Measure what I eat. Schedule an appointment with my vet if I haven’t been there in the past 6 months. I wouldn’t want to be accused of feline obesity or diabetes. Also help me keep my pearly whites in good condition! Preventive health care is the secret to a long and happy life, and only you can help me achieve that.

Help me make 2015 the year I begin elevating my status in your house. Help me reclaim my well-deserved place in the world. Help me make this dream a reality. So please do your part and follow these 5 simple steps* to keep me happy, healthy, and deservedly revered!

Until next time,

Phil Zeltzman, DVM, DACVS, CVJ

* These 5 New Year resolution are loosely inspired from information provided by the CATalyst Council, an organization dedicated to cat health and welfare. Find more information at www.catalystcouncil.org.

What should you do if your pet gets lost?

One of the most traumatic events a pet owner can go through is having a pet on the run.

Lucky sign

Think it could never happen to your pet? Many smart and loving pet owners did before…

Yet many un-sterilized pets run away, (mis)guided by hormones. And as many as 20% of pets, end up MIA after being scared by loud noises such as thunderstorms or fireworks.

Here are 10 tips to help you find your pet ASAP:

  1. File a “lost pet” report with every rescue organization, every shelter and every animal control office within a 60-mile radius of your home. Also make a point of visiting all nearby shelters every day.
  2. Alert all veterinary clinics, both day practices and emergency clinics, in your area. Prepare a flier to be posted at the front desk. It’s not uncommon that people bring a stray dog or cat to their family vet, no matter how far from where the animal was found.
  3. Several times per day, walk around and/or drive around your neighborhood. Ask friends and family members to help out.
  4. Alert everybody you meet. Pet owners especially will be sensitive to your situation.
  5. Give anybody who is willing to help a recent picture of your pet and your contact information.
  6. Post flyers everywhere: all over the neighborhood (telephone poles etc), as well as in private and public locations (businesses, stores, post office…).
  7. Slick trick: to avoid scams, leave out one characteristic when you describe your pet. If someone calls and claims to have seen your pet, ask them to describe the missing item.
  8. Use the Internet. There are several pet recovery websites such as FidoFinder.com, TheCenterForLostPets.com and Craigslist.org.
  9. If you don’t have the time to do all of the above, or can’t take off work easily, consider using a lost pet recovery service. They will contact neighbors, vets, shelters and other organizations – for a fee.
  10. Just in case your pet comes back home when (s)he is hungry or thirsty, you could place food and water around your home. You could even place the bowls in a (humane) pet trap to catch them.
  11. Bonus tip: use social media. Facebook, Twitter and texting can be good ways to spread the word quickly.

Bottom line: The first few hours are critical. You need to put in place all of these strategies. But you just can’t do it all by yourself, so enroll help. Get the word out quickly. Never give up. It’s a cruel world out there… and your mission is to save your pet.

The information above is loosely borrowed (with permission) from our colleagues at DVM360, a professional magazine.

I would like to add a few important points: what should you do to prevent your pet from getting lost?

• Take pet identification seriously. A name tag on a collar is a minimum. It should have your pet’s info, your vet’s info, and yours. Of course this doesn’t do any good if the collar is not around your pet’s neck.

A tattoo can be done by your vet (under anesthesia). The best solution is a microchip. This is a tiny electronic device, about the size of a grain of rice, that is implanted under the skin. It can be done awake – anytime.

When a lost pet is found at a shelter or a vet clinic, the first thing people do is “scan” the pet to see if there is a microchip. As long as the microchip is linked to a CURRENT address and phone number (hint, hint), you should get a call with the good news. PLEASE microchip your pets.

• If you allow your pet to be unsupervised in the yard, make sure the fence is 100% secure.

• Don’t trust electric fences 100%. An excited dog can run right through them. However, once on the other side, they may not want to be “shocked” again, so they may remain outside the perimeter. Oh, which reminds me: several of my clients dearly regretted not having the special collar around their dog’s neck the day they were hit by a car. If you go through the expense of installing an electric fence, then please always put the collar on your dog’s neck every time (s)he goes outside. One exception is all it takes…

• ALWAYS walk your dog on a leash. If you are a long-time reader, you surely have read countless stories of pets who have been hit (or worse) by a car. This is a DAILY occurrence in my practice.

• In my opinion as a surgeon who has seen countless horrifying injuries, I would never, ever let a cat outside. My cats are banned from the outside world, and they are perfectly happy indoors.

• Freedom is a wonderful concept… until somebody gets hurt, or until the teary owner realizes that they just can’t afford a 2-3-4-5 thousand dollar bill at the vet.

• Be especially careful and secure the house (doors, gates, windows) when there are fireworks (July 4th, New Year’s Eve etc), around Halloween (especially if you have a black cat) and when you hear thunder.

As in many endeavors, prevention is easier than the “treatment.” You now have a script to prevent your pet from running away. And if you are if this unfortunate situation, or know somebody who is, you have some tips to get your pet back home.

Good luck.

Until next time,

Phil Zeltzman, DVM, DACVS, CVJ