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

Minnie has a tumor in the jaw bone

Minnie, a 9 year old beagle, had a cherry-sized mass behind her upper canine tooth.

The mass had been present for a while and kept growing. Is it generically called an epulis, an unfortunate name that doesn’t mean much. An epulis can be benign or malignant. It can be unimportant or extremely aggressive. So it’s a very misleading name.

She was referred for surgery at Mountain Shadow Veterinary Hospital ( www.mountainshadowveterinary.com ) .

After a physical exam, blood work and chest X-rays (to check for spreading to the lungs), it was decided that Minnie was a good candidate for anesthesia and surgery.

Part of her upper jaw (maxilla) would have to be removed in order to hopefully “get it all.” Surgery went well.

Even though pet owners are typically horrified when such an invasive surgery is recommended, pets don’t look as grotesquely disfigured as they imagine.

The most amazing thing is that most dogs eat soon after surgery, sometimes the evening of surgery! In Minnie’s case, she ate the day after surgery.

About a week later, the biopsy came back as ameloblastoma, which is a “locally aggressive” tumor. What it means is that the tumor eats the bone away. This is the other reason we need to remove so much tissue (bone) around the mass.

Even though a large portion of her jaw had to be removed, Minnie has recovered very well and can now enjoy life again.

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

Penny gets a new lease on life

Penny, a 7 year old Labrador, was in deep trouble.

She couldn’t go on walks or function normally. She was suffocating because of a condition called laryngeal paralysis (aka “lar par”). This meant that her larynx (or voice box) was paralyzed and didn’t allow her to have enough oxygen on board.
Her owner wrote: “Lately, Penny has had several episodes where she had great difficulty catching her breath, especially after exercise or excitement. The last one of these episodes was severe enough to make her tongue go bluish for a short time.”
She had surgery at Brodheadsville Vet Clinic (www.brodheadsvillevet.com) in Brodheadsville, PA, in order to open up her larynx with permanent sutures (tie-back surgery).
Three days after surgery, her owner writes: “Overall Penny is doing fantastic! Her breathing is immensely improved and our hardest problem right now is keeping her calm.”

She recovered smoothly and two months after surgery, she could go on walks in the woods again.

Here is her story in video: www.youtube.com/watch?v=TvSMSLNeZRs&t=5s

As I always say, laryngeal paralysis is not a death sentence. With the proper care, patients can have a normal, happy life.

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

You did cosmetic surgery on your dog’s WHAT???

Piper, a 6 year old Labrador, had battled bladder infections for her entire life. They cleared up with antibiotics, but kept coming back.

Her family vet at South Mountain Veterinary Hospital (www.southmountainvethospital.com) diagnosed what is called a redundant vulvar fold, which is an extra fold of skin covering her vulva. It is also called “recessed vulva” or “vulvar fold dermatitis”. This is a fairly common condition, especially in overweight dogs, and many go un-diagnosed for years.

How can a skin fold cause bladder infections?

The extra skin fold creates a deep pocket that traps urine. In turn, this pocket creates a warm, moist and dark environment, which is perfect for bacteria to multiply. This causes ongoing infections and sometimes a foul odor. Here is a picture of Piper’s back end before surgery: you can’t see her vulva at all.

Signs of bladder infections may include licking of the vulva, scooting of the back end, bloody urine and “accidents” in the house. Other conditions may cause similar signs, so your family vet should eliminate other problems, such as bladder stones and even bladder cancer.

How can we fix this annoying condition?

  1. The Band-Aid approach is the “medical” treatment. We only treat the symptoms by wiping the area and prescribing antibiotics. This does not treat the cause, so it often frustrating because the infection is likely to come back.
  2. The ideal treatment is surgery. It’s basically plastic surgery on a dog’s vulva! Surgery involves removing the extra skin to provide better ventilation of the vulva.

This reconstructive surgery is called a vulvoplasty or an episioplasty. The main difficulty of the surgery is to remove exactly the right amount of skin: not too much and not too little. Here is a picture of Piper’s back end after surgery.

Recovery generally takes 3 weeks. I don’t use external skin sutures, so there are no stitches to remove in this sensitive area… All stitches are internal and eventually dissolve. An E collar (plastic cone) is worn for the full 3 weeks to prevent licking and to protect the incision.

Overall, this is a common yet frustrating condition. Fortunately, surgery is typically very successful and pet owners are usually very happy with the end result… as well as their dogs!