Dr. Phil Zeltzman’s Blog

Most owners are afraid of anesthesia, although it’s incredibly safe.

The risk of dying under anesthesia, taking into account the healthiest patients as well as the sickest, is a fraction of 1%.

Still, we all wish we would have zero deaths related to anesthesia.

One way to make sure your pet will be safe under anesthesia is to understand what happens, or should happen, during the 3 steps of any anesthesia.

1. How to keep your pet safe before anesthesia

We routinely (i.e. 100% of the time) take at least 4 steps to ensure a patient is a good candidate for anesthesia.

• Blood work. This allows us to make sure your pet can carry oxygen (enough red blood cells), can clot (enough platelets), can fight infection (enough white blood cells), has a healthy liver and healthy kidneys, has normal electrolytes, etc.
• We perform a physical exam.
• We assess the patient’s individual anesthesia risk (called the “ASA” risk).
• We discuss the anesthesia and pain management protocols as a team (surgeons and nurses) so they are adapted to the patient and their particular surgery. For example, we use a different protocol for pets with kidney, liver and heart disease. We use a special protocol for dogs (and cats) with a flat face (English Bulldogs, French Bulldogs, Boxers etc.). We use a different protocol for diabetics and pediatrics.

As we always say, “every patient is different.”

2. How to keep your pet safe during anesthesia

In the vast majority of patients, fortunately, everything goes perfectly well.

Occasionally, we run into problems: the heart rate drops or increases, the bloodqqq pressure drops or shoots up, the patient has difficulty breathing…

Fortunately, in the vast majority of patients, we can quickly get the situation under control.

But we never take anything for granted, so every single patient has a dedicated anesthesia nurse, whose only mission is to keep her patient safe.

Anesthesia monitoring means the patient is monitored by a fancy machine.

It allows us to monitor the heart (EKG), blood pressure, oxygen level (pulse oximetry), temperature, respiratory rate and CO2 levels (capnography).

And of course, every patient has an IV catheter to receive IV fluids, antibiotics, and pain medications.

3. How to keep your pet safe after anesthesia

A common misunderstanding is to believe that once a patient is out of the OR and awake, they’re safe.

The reality is that most deaths related to anesthesia occur AFTER surgery, not during.

Over half of patient deaths occur within 3 hours after the end of anesthesia.

That’s the reason why we continue to monitor our patients closely after they wake up from anesthesia.

We monitor their breathing, heart rate or pulse, comfort level, and more.

We’re also a tiny bit obsessed with keeping our patients warm.

The sicker the patient, or the higher the anesthesia risk, the more intensive postop supervision should be.

This is especially true in cats and dogs with a flat face (brachycephalic breeds).

So if your pet needs anesthesia, which question should you ask?

Here are some questions you should feel perfectly comfortable asking before your pet goes under anesthesia:

• What testing will be performed before anesthesia to make it safer?
• Will my pet be supervised by a nurse throughout anesthesia?
• What kind of monitoring do you provide during anesthesia?
• What kind of supervision will my pet have while recovering from anesthesia?
• Is there overnight care?

Bottom line: most pet owners ask questions about the surgery.

I think they should ask more questions about anesthesia.

Your pet’s well-being depends on it.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

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

As much as I enjoy a challenge, I would rather remove a small tumor than a big one.
There are at least 15 reasons for that:

1. A smaller mass means a less invasive surgery

2. A smaller mass means a shorter incision

3. A smaller mass means a shorter anesthesia

4. A smaller mass means a less expensive surgery

5. A smaller cancerous mass usually means fewer chances of spreading to other organs

6. A smaller mass means fewer chances of rupturing/bleeding/infection

7. A smaller mass means fewer complications related to surgery (fluid build-up, failure of the stitches, etc.)

8. A smaller mass means fewer complications related to the tumor (increased calcium levels, decreased sugar (glucose) levels, seizures etc.)

9. A smaller bone tumor means fewer chances of a fracture

10. A smaller tumor means fewer chances of losing a body part (leg, tail, eye)

11. A smaller tumor means less pain before AND after surgery

12. A smaller tumor means fewer chances of a life-threatening emergency (e.g. inability to pee or breathe)

13. A smaller mass may mean a shorter recovery

14. A smaller mass usually means a better outcome

15. A smaller mass removal means a safer surgery

Although some of the above reasons may seem obvious, we regularly remove large tumors.

We can still help these patients.

Sometimes the outcome is still good, and sometimes it’s much worse than it could have been…

Also please don’t fall into the trap of assuming:

• It’s just a fatty tumor
• It’s just a cyst
• It’s just a polyp

NOBODY can say for sure what a mass is by simply looking at it or feeling it. Only a biopsy can.

Anything else is an assumption, or an educated guess at best.

So for your pet’s sake, schedule a consult with your family vet or a board-certified surgeon as soon as you notice a mass, a lump, or a bump, anywhere in the body.

Better safe than sorry…

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

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Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
Pete Baia, DVM, MS, DACVS

NOTE: This is a free excerpt from my upcoming book about cancer in pets!

Fecchi, an 8-year-old Sheltie, had a firm, golf ball-sized mass in his left cheek. It was hard to be more specific since I couldn’t even open his jaw during the exam.

Note: I have pictures of the entire surgery, but I decided some were too graphic. So I will only show a few relatively “tame” pictures.

Upon further exam, it looked like the mass was coming from the upper jaw (maxilla) and/or the the lower jaw (mandible).

Clearly, a major reconstructive and possibly disfiguring surgery was necessary to remove the mass.

Fecchi’s owner had consulted with 3 surgery colleagues, who all had told her that this mass was some horrible cancer that couldn’t be removed.

Given the poor outcome and Fecchi’s lack of appetite, they all told her she should humanely put him to sleep. Yet that option wasn’t good enough for this client.

And that’s when we met. During the surgery consultation, she insisted on removing the mass.

I wasn’t so sure it was in the patient’s best interest. 

Fecchi had lost weight and wasn’t in very good health because of the tumor.

So we compromised and agreed on taking a biopsy first. A week later, the biopsy came back as osteo-chondroma – a benign tumor of both bone and cartilage.

Of course, I didn’t believe it. More convinced than ever about her decision, the owner insisted on removing the mass.

After a lot of soul-searching, I finally gave in. I accepted to “explore the area and see what I could do to help.”

Granted, removing jaw tumors is not an uncommon procedure. So why the hesitation? 

After all, with the numerous pain management modalities available, we can make these patients comfortable despite aggressive surgery.

Anyway, we ended up taking Fecchi to surgery. 

It turned out that the mass came from the upper jaw, but on both sides of the jaw.

As the tumor grew bigger and bigger, the teeth of the lower jaw dug sort of a “gutter” into it.

Surgery was long and challenging. It was followed by reconstruction of the surgery site to make it look as cosmetic as possible.

To make sure Fecchi would get enough nutrition after surgery, we placed a feeding tube to inject a special liquid diet directly into the stomach (see the red tube coming out of the skin).

The entire mass was submitted to the lab.

Fecchi recovered smoothly from anesthesia.

He stayed in ICU overnight, on IV fluids, pain medications, and antibiotics.

10 days later, the biopsy report came back. As you can imagine, it concluded… osteochondroma – still a benign tumor!

So what’s the moral of the story?

Fecchi’s owner kind of twisted my arm – in a nice way – and she was totally right.

Should we always do what clients require? 

Of course not. 

Otherwise, we would do ear crops, declaws, and tail docks all day long.

What’s the moral of the story? It is perfectly acceptable to perform a procedure, invasive or not, as long as client and practitioner are on the same page, and the procedure is acceptable and ethical.

Sometimes, it’s good to be pushed out of one’s comfort zone.

Almost one year later, Fecchi was reportedly doing great at home.

“The surgical site looks great,” the owner says. “You can’t even tell that he ever had surgery.”

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com 

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog 

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

Toast, a 4-year-old kitty, was sleeping on the couch when he was suddenly woken up by a porcelain vase that fell and broke into a million pieces. Spooked, he jumped from the couch and hid in another room.

Later that evening, the owner found his poor kitty crying out in pain and unable to use the left back leg.

The next day, he took Toast to his family vet. An exam revealed severe pain in the left knee. X-rays under sedation showed pretty drastic findings.

After reviewing the X-rays, I realized that the knee was completely dislocated (luxated). This is called a “deranged knee.”

I suspected that Toast’s leg got caught during the escape from the couch and the evil vase. While Toast was running for his life, he pulled on the leg, and that presumably caused the damage.

What’s a deranged knee?

Toast’s owner asked what this condition with a weird name was about. I explained that there are four ligaments in the knee: two inside the knee (anterior and posterior cruciate ligaments) and two outside the knee (collateral ligaments). When more than one ligament is torn, the knee is so severely affected, that the condition is called a deranged knee.

Most of the time, both cruciate ligaments and one collateral are torn. Occasionally, with very violent trauma, all four ligaments are torn.

How is a deranged knee treated?

A deranged knee is so unstable (wobbly) that the only hope for a good recovery is surgery. The goal is to make the knee more stable. Post-op care involves a combination of strict rest, pain medications and physical therapy.

During surgery, I confirmed that Toast had 3 torn ligaments (one collateral and both cruciate ligaments). They were repaired with heavy nylon sutures to mimic or imitate the original ligaments.

Toast recovered smoothly from anesthesia and went home the day after surgery.

Recovering from a deranged knee

After 2 weeks of strict confinement and physical therapy, Toast had his stitches removed. At that point he was “toe-touching,” which means that he was starting to put gentle pressure on the foot. After another 6 weeks of continued rest and physical therapy, he had another follow-up exam: he was using the leg very well.

It was time to progressively increase his activity level. We designed a program to help him rebuild muscle and regain flexibility in the surgery knee. By using toys and food, Toast’s owner managed to convince him to follow him around.

Long-term outcome of a deranged knee

Although patients can do well after surgery to repair a deranged knee, they will get arthritis.

We managed Toast’s arthritis by maintaining a healthy weight, and giving joint supplements (aka arthritis supplements) such as glucosamine and fish oil (omega 3 fatty acids) – for life.

In the end, Toast’s owner was happy with the outcome, and promised not to break fragile objects anymore!

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

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Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
Pete Baia, DVM, MS, DACVS

Trusting your vet or a surgeon with doing surgery on your beloved pet is not as easy as it sounds.

It requires a lot of trust.

To help you establish that trust, here are some questions I feel are reasonable to ask your vet or your surgeon.

• Are you a board-certified surgeon, i.e. a true specialist?
• What’s my pet’s exact diagnosis?
• What are ALL of the treatment options?
• What is the specific surgery you recommend?
• What is the purpose of the surgery?
• Why do you think this surgery is a better option than the other ones?
• Is my pet a good candidate for this surgery?
• Who is the best person to do the surgery?
• How many of these surgeries have you done in your career?
• How many of them have you done in the last year?
• What are the possible risks and complications?
• How common are they in general?
• How common are they in your patients, in your hands?
• What is your success rate?
• Are there additional tests required before surgery?
• How will my pet be monitored during and especially after surgery?
• How long will the surgery take, and how long will my pet need to stay at the clinic?
• If there is an overnight stay, who will supervise my pet?
• How will pain be assessed and addressed?
• What is the expected recovery like?
• How long will it take for my pet to fully recover?
• What are the postop care instructions and restrictions?

Even though this list looks long, and seems like it would take hours to answer, a good surgeon should answer many of these questions during the consultation anyway.

So check those questions off as they go, and ask the remaining questions after that.

It’s critical to have open and transparent communication with your surgeon to ensure you make an informed decision about your pet’s surgery.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

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