Dr. Phil Zeltzman’s Blog

“You should be prepared for this puppy to die.”

This is the terrifying advice Novakai’s owner was given.
Novakai, a cute 7 month old Pitbull, did have a big problem in her mouth.
A cleft palate divided the entire roof of her mouth in two halves.
This gap allowed food to go from her mouth into her nose.

PICTURES BELOW ARE GRAPHIC AND ARE NOT FOR THE FAINT OF HEART.

All of the pictures below show the inside of the roof of the mouth, with Novakai on her back.

Puppies with a cleft palate cannot nurse properly, so they don’t grow as much as the rest of the litter. They are typically the “runt.”
Those who survive eventually can have discomfort, a reluctance to eat and drink, difficulty breathing, and ongoing infections. After all, the nose is not supposed to be full of milk or food…
His amazingly dedicated owner wrote: “Novakai was tube-fed until she was about 5 months old. At that time, small amounts of soft kibble were offered. Sadly, most of it would come back out of her nose. So she stayed on a pureed diet until she turned 7 months.”

The only good solution is surgery to reconstruct the hard and the soft palate.
The hard palate is the front portion of the roof of the mouth. It’s hard because there is bone behind it.
The soft palate is the back part of the roof of the mouth. It’s soft because there is no bone behind it.
Suturing one side of the defect to the other does not work. It is doomed to fail. The tissue is just too tight. So one solution is to rob (tissue) from Peter to give to Paul.

PICTURES BELOW ARE GRAPHIC AND ARE NOT FOR THE FAINT OF HEART.

After creating incisions in the hard palate, we created 2 “flaps” or bands of tissue. Then it became easier to stitch one to the other, in the middle of the roof of the mouth.
This left an area on each side where the bone is literally exposed.
Amazingly, those healthy areas progressively heal with new tissue.

Novakai recovered smoothly after anesthesia and surgery, and went home.
She had to stay quiet for one month, without any chew toys or hard food to protect the stitches and the surgery area.
Thankfully, the mouth has an amazing ability to heal. Think of when you bite your tongue or the inside of your cheek. It hurts at first, but then it heals within days.
Novakai needed a bit longer than that, but the end result was rather impressive as you can see below.
One month after surgery, we examined her mouth under sedation to assess the surgery site.

Thankfully, 100% of the surgery area had healed nicely.
Novakai’s owner concludes: “Today she is healthy, happy and very active. The surgery was a great success. She weighs in at a nice 60 lb. We are very pleased with the surgery. We knew the risk was 50-50. My family and I are all very happy that she turned out as well as she did.”

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

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

www.DrPhilZeltzman.com

Eve’s story is a bit unusual because her owner is the one who figured out her diagnosis!!!

Dr. Google led her to one of my blogs about laryngeal paralysis (or “lar par”).

Her recently adopted dog Eve, a 10 year old Lab, “definitely checked all the boxes.”

Eve’s owner remembers: “She has always had the “old lady bark.” As the warmer weather approached, she was panting a lot more. Her activity tolerance plummeted. She’d walk 2-5 miles when we first adopted her. But now she couldn’t even do 0.5 mile in the warmer temperatures.”

Her condition was really serious. “She was struggling when breathing, even just to go outside to potty. It was so hot and humid. Any little physical activity had her panting. Right before surgery, she came in stridorous and truly struggling. Her tongue was purplish. It really scared me.”

After doing her research, she “knew that it was a degenerative condition, and Eve would eventually suffocate to death.”

She continues: “I felt bad for her – a senior dog – going through surgery, but I was hopeful that she would feel better after recovery.”

Laryngeal paralysis (or “lar par”) is a serious and stressful condition where the larynx (or voice box) doesn’t allow enough oxygen to flow into the lungs.

It mostly occurs in older and senior dogs, most commonly Labs over 10 years of age. It can also happen in young dogs, and other breeds.

We scheduled Eve for an exam under light sedation, followed by surgery if the diagnosis were confirmed.

Sure enough, the exam confirmed lar par.

The goal of surgery (a “tie back” procedure) is to open up the larynx with two permanent nylon sutures.

Anesthesia and surgery were uneventful.

When Eve woke up from anesthesia, her breathing was slow and quiet.

She went home on the same day.

Here is a step-by-step summary of her progress, as told by her owner.

As you read those, please remember that every patient is different, and the improvement in breathing may vary from patient to patient.

• 2 weeks postop: “Eve had her staples removed today and did very well in the car. Appetite is great. She clears her throat upon getting up from sleeping, and after taking a drink of water. She’s tolerating being outside on the deck in the evenings, when it’s cooler (she used to want to go back inside).”
• 3 weeks postop: “Eve is doing very well. She clears her throat at the usual times. She is more alert and silly since stopping the pain medication. It’s going to be an interesting 5 weeks keeping her calm!!!”
• 4 weeks postop: “Eve is doing AMAZING!”
• 6 weeks postop: “Eve is acting like a puppy! So good to see.”
• 8 weeks postop: “WE MADE IT!! Eve is doing awesome! She’s like a puppy. Happy, alert and wanting to play.

After 2 months of rest and TLC, Eve could resume her Labrador life…

For once, I didn’t take a video before and after surgery.

You can watch this short video as it is very similar to Eve’s experience:

www.youtube.com/watch?v=fy7dWlAVqnM

What’s the moral of the story?

Lar par is a very stressful condition, both for the dog and the owner. Surgery is the best option to open up the airway and allow more oxygen to get to the lungs. Thankfully, in the vast majority of patients, results are good and patients can resume a pretty normal life.

Eve’s owner JP concludes: “Overall, our experience was phenomenal. Your instructions, genuine concern and willingness to be available with our worries was so great. Your nurse was also amazing. It was very comforting to know that you were only a call away.”

Here is a short video of the amazing Eve at the end of a 10 minute walk, 2 months after surgery.

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

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
www.DrPhilZeltzman.com

Wiggles, a 12 year old Terrier, recently had surgery at a colleague’s practice.

Her problem?

She had mammary (breast) tumors.

Before that, my colleague (wisely) recommended to take chest X-rays to make sure that if it were cancer, nothing had spread to the lungs.

This is considered standard of care, meaning this is the right thing to do in modern practice.

For whatever reason – financial, lack of trust, poor understanding, miscommunication – I am not here to judge – the owner declined the X-rays.

So Wiggles had surgery to remove the tumors.

Everything went well. She recovered smoothly and went home.

I came to that hospital a couple of days after that do perform surgery on a totally different patient.

As I walked through the kennel, I was rather surprised to hear a dog actively struggling to breathe, and clearly suffering.

Of course, having a really hard time seeing a pet struggle, I inquired about her, and this is how I learned the whole story I shared above.

While I was performing surgery, the nurses did the only reasonable thing to do: they took chest X-rays on Wiggles.

Here is one of them below.

Do you see anything abnormal?

Here is the X-ray again, this time with red lines around the areas of interest.

Well, I am sad to say that each mass or nodule or tumor inside a red circle is a sign of metastasis (or spreading) of breast cancer to the lungs.

No need to wait for the biopsy to come back.

Wiggles had cancer.

Terminal cancer.

The suspicion is that she was OK before surgery, and anesthesia and surgery pushed her body “over the edge.” We call this phenomenon “decompensation.”

After a probably unpleasant discussion about the new findings and the dire situation with her family vet, the owner elected humane euthanasia.

I tend to only write about happy stories and optimistic outcomes in this blog. I feel that there is enough misery in the world. I don’t need to add more sadness, drama and negativity.

So why did I choose to write about the sad story of Wiggles?

Because she and her family went through a lot, medically, financially and emotionally, and it all could have been avoided.

I don’t say this to make her owners feel bad – I feel terrible for them.

I decided to share this story with the hope that at least, it doesn’t happen to one of my clients or readers.

Now, of course, the other cautionary tale is that ALL of this could have all been prevented by spaying this poor pup before her 1st heat.

I realize this is controversial for some, so please hold the hate mail.

Don’t believe the ridiculous things you hear and read.

The ONLY way to prevent mammary tumors is to spay a female – dog or cat – before their 1st heat.

Unlike what you will read elsewhere, this is not based on dogma, or brainwashing, or made-up facts, but based on science – the only thing I believe in.

And keep in mind that this is coming from a vet who hardly ever spays a dog. I’m a surgeon, so I tend to do the fancier surgeries.

I truly don’t have a bone in this fight.

My hope is to help prevent other pets and their families from going through the horror of breast cancer.

Here are some undeniable scientific facts:
. Over 25% of non-spayed female dogs will develop breast or mammary tumors!
. The risk of a dog having mammary tumors is 0.05% if a female is spayed before the first heat.
. The risk goes up to 8% after their first cycle.
. Then it shoots up to 26% after their second heat.
. If a dog is spayed after 2 years of age, then there is no more protection against breast tumors.
. However, it will protect her against other conditions, including pyometra (an infected uterus – a deadly condition). This is the reason why most vets typically recommend spaying before the 1st heat cycle.
. In dogs, approximately 50% of mammary tumors are benign and 50% are cancerous
. In cats, 90% of mammary tumors are cancerous, so spaying is even more important!

I hope one pet lover learn from this sad story.

Even if only one pet is spared, then this blog will be more than worth it.

If you would like to learn more about how your pet can have safe surgery and anesthesia, contact us through www.DrPhilZeltzman.com

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
www.DrPhilZeltzman.com

Charlie, a roughly 12 year old Yorkie, just wasn’t himself. His appetite was poor. His breathing was faster than normal.

His owner recalls: “Charlie lives to eat so I knew something was wrong when I couldn’t even tempt him to eat tuna!”

Blood work was fairly normal except for high sugar levels – nothing new since Charlie was a known diabetic.

Chest X-rays showed an enlarged heart.

An ultrasound showed fluid around the heart. It also was suspicious for a tumor on the heart.

This is a pretty classic case of pericardial effusion.

What does that mean exactly?

The heart is covered by a sac called the peri-cardium (latin for “around the heart”). Its job is to protect and lubricate the heart, and to keep it in place within the chest.

Because this kind of tumor is fragile and very rich in blood vessels, it doesn’t take much for it to bleed.

Since the tumor is located inside the sac – the pericardium – blood builds up inside of it.

And because the sac can only expand so much, the fluid build-up eventually puts pressure on the heart.

Think of it as a bad headache or a migraine. The brain can only swell so much because of the skull around it.

This explained that Charlie didn’t feel well (poor appetite) and was out of breath.

Not only was the heart feeling squeezed, but the lungs had less room to expand.

The best solution is surgery, to relieve the pressure.

Anesthesia in a 12 year old diabetic dog with a sick heart is not exactly the safest thing to do.

I went over the pros and cons of surgery with Charlie’s owner.

Who on earth chooses surgery in such an old, sick little dog?

There was no doubt in his owner’s mind that it was the right thing to do.

She believes: “Once you take on the commitment of owning an animal, they become part of your family. (Despite) the bleak prognosis, we can’t willingly say goodbye to our beloved pet. (…) Even though he may only live a year (or less) or two years more, we feel we must do all we can to prolong his life.”

And she very kindly shared: “Honestly, I felt very reassured by your discussions with me prior to surgery. You clearly laid out postop care. I felt calm the day of surgery knowing Charlie was in good hands.”

Equipped with such positive vibes, and despite the risks, we took Charlie to surgery.

After an incision on the left side of his chest, between two ribs, a large section of the pericardium was removed.

ASSUMING YOU HAVE THE STOMACH FOR IT, you can watch the short video below.

As my wonderful nurses can attest, watching a beating heart is one of the coolest things we see, but I understand it is certainly not for everybody!

Before removal of the pericardium, the heartbeat is typically harder to see, because the heart is surrounded by the pericardium and lots of blood. In this video, that is not really the case, because a lot of the blood inside the sac had been removed with a needle to provide relief to Charlie.

After removal of the pericardium, a surgery called a peri-cardectomy, the heartbeat is easier to see, because there is nothing restricting it anymore.

We then needed a way to remove free air from the chest. This is done with a device called a chest tube. You can see a glimpse of it at the end of the video, on the left side of Charlie’s body. It only stays in place for a short time after surgery, and can be removed once there is no more air and not too much fluid left to remove.

After the chest tube was secured, the rest of the chest was stitched up.

Then it was time to transition from the OR to ICU.

Little Grandpa Charlie recovered from surgery and anesthesia very smoothly.

In fact, minutes after coming out of the OR, he looked surprisingly good and comfortable. I was so impressed, that I took a video of him (see link above). Of course, he’s in a daze because he went through a lot and he was high on doggy morphine, but he still looked amazing so soon after surgery!

This is a great testament to the wonderful anesthesia nurse who took care of Charlie. Anesthesia is always a bit more challenging when we do open chest surgery, especially in a patient with a compromised heart.

Even more encouraging, Charlie ate dinner the evening of surgery, for the first time in days!

Who eats a few hours after open chest surgery?!

The chest tube was removed the very next day.

After a few days on heavy duty pain medications and lots of TLC, he was able to safely go home.

His owner remembers: “I didn’t see Charlie for several days after surgery. When Charlie did come home, he had the cone on, but he seemed to almost be his old self. He didn’t seem like he was in pain (we gave pain meds anyway!). He ate and drank fine. When going potty, he was eager to do more, wanting to get back to his walks – though we said not yet!”

Charlie is very lucky his owner didn’t procrastinate and trusted her guts based on what were after all (seemingly) very minor signs.

Remember, all there was is a decreased appetite and faster breathing, that’s it!

She recalls: “I just had a bad feeling and knew things weren’t good. He just wasn’t acting like himself and I worried he was in pain.”

It’s only been 2 months since surgery, but so far Charlie is doing great.

His owner writes: “Charlie is doing marvelously well! He is eating, drinking and has a happy demeanor. He seems comfy and happy! Overall, the experience went very well and all of our fears have been alleviated. We have our energetic Yorkshire Terrier back!

And her final words of wisdom:

“The day will come when we won’t have a choice anymore and we will have to say goodbye. But for now, and thanks also to you, that day is not today. Some beings and their life/memories with us are more important than $!”

If you would like to learn more about how your pet can have safe surgery and anesthesia, contact us through www.DrPhilZeltzman.com

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

www.DrPhilZeltzman.com

Nobody likes to talk about it. Once we realize that our pets are, after all, not immortal, we may hope that they will just “go” in their sleep. Well, that almost never happens. Most of the time, we have to help them. Euthanasia is a very personal, heart-breaking, grueling decision. Let’s go over 16 common concerns and questions.

1. What is euthanasia?

According to the American Heritage Science Dictionary, euthanasia is “the act of painlessly ending the life of an animal who has a terminal illness or incurable condition, as by giving a lethal drug”.

I would say that euthanasia, or “putting a pet to sleep”, is the humane way to end a pet’s life with dignity when their quality of life is no longer acceptable. Euthanasia should not be a convenience when a pet becomes, well, an inconvenience.

2. When is euthanasia appropriate?

It’s all about quality-of-life. A quality-of-life scale helps you assess various criteria such as pain level, appetite, hygiene, happiness, mobility etc.

You can Google “quality of life scale HHHHHMM” to find a great example.

Basically, are there more good days or bad days? The challenge is that you need to try to look at the situation from your pet’s standpoint – not yours.

This is often difficult, because it is a very emotional situation that tends to make you lose your objectivity. In other words, if the same situation happened to your best friend’s pet, you probably would know exactly what to do. But because you are dealing with your own pet and your own emotions, you cannot see the situation as objectively. Sometimes, denial makes things even worse…

3. When will I know it’s time?

Some people say “You’ll know in your heart when it’s time.”

I’m not so sure it that’s easy. Sometimes, you just don’t know. Again, you are so emotionally close to the situation, that you often can’t reason with a clear mind. Therefore, some pet lovers just don’t know when it’s time.

It is a vet’s job and ethical responsibility to make the owner aware of the situation. It is however not a vet’s job to make the decision for a pet’s owner. So asking “What would you do if it were your pet” is usually not a fair question: it’s a very personal decision.

The vet’s job is to explain the facts, describe the medical situation, and present options. Only you can (and should) make the final decision.

4. How is euthanasia performed?

Each vet has his or her own protocol, so the description below is only one way to do things. Let’s try to forget emotions for a minute, and let’s try to focus on the scientific or medical aspect of euthanasia, so that you know what to expect.

An IV catheter is placed. Most veterinarians will give a sedative or tranquilizer IV first, to relax the patient, or even make them sleepy. Then, the euthanasia drug – an overdose of barbiturates – is given IV. This is a pain free, almost instant procedure. The heart and lungs stop. And it’s over. I think most pet owners are surprised how quickly euthanasia happens. It’s over in less than a second…

You may then want to spend some time alone with your pet to say goodbye.

Although not exactly glamorous, it is important to mention a few things that may or may not happen during euthanasia. For example, your pet may or may not have one last deep breath (called an agonal breath). Eyes typically don’t close. This is not Hollywood.

There may be noises or vocalizations, or muscle spasms, or urination, or defecation, as the body relaxes. These are just possible, physiological, medical things that can happen and may be traumatizing if you are not prepared or warned.

Regardless, euthanasia is a quick, smooth & painless process.

5. What do I do at the animal hospital?

An experienced team will guide you through the different steps. Here are two important suggestions:

. Ask if you can take care of all the paperwork and financial stuff BEFORE proceeding with the euthanasia. The last thing you want to do is stand at the front desk after the euthanasia, in tears, in the middle of a full waiting room. A good receptionist should spontaneously suggest this option.

. Have a friend or family member drive for you if you think you will have difficulty driving safely after it’s all over. Now is not the time to get teary-eyed and get into an accident!

6. Should I be present?

This is one of the most difficult questions to answer. There is no right or wrong answer. There are several options.

You can say goodbye, leave the room, and let the doctor proceed. You may or may not want to visit afterwards. Or you can be present, start to finish.

Here is a testimonial from a friend and former client in Cincinnati, OH:

“My daughter and son-in-law had to euthanize Banshee, their Bernese mountain dog. They had had his leg amputated, but the cancer progressed. In the end, they had to put him to sleep. It is always sad to lose a pet. He was one of the sweetest dogs I’ve ever known, and even in his illness, he kept his sweet disposition.

My son-in-law and daughter were both with him at the end. That is something I would encourage pet owners to do. It is a comfort to see how peacefully your pet can go, and for me their loyalty demands your presence. I recognize that some people may not be able to do it.”

7. A very special situation

In our surgical practice, there is another situation. We are occasionally faced with an incurable condition during a surgery. I will then call the owner on the phone during the surgery, discuss the situation, and if we both agree, humanely euthanize the patient “on the table.” In this situation, the patient goes from anesthesia to euthanasia with no awareness and no pain whatsoever.

Here is a testimonial from a client who had to make such a decision. Their cat Jackie needed surgery to remove a fibrosarcoma – a cancerous tumor – from the skin of her belly. It turned out that the tumor invaded multiple structures, including half of her diaphragm (the muscle that separates the chest and the belly). The cancer was inoperable.

The owner writes: “I was faced with a very difficult decision.

My kitty Jackie was on the operating table when I received a call from Dr. Zeltzman, telling me that the tumor she had was so extensive that he did not feel he could remove it all. Compassionately, he gave me my options:

#1 – He could wake her up from surgery and let her live out what would be the rest of her life. The tumor however would eventually cause her significant pain.

#2 – Put her to sleep now while she was still under anesthesia. He told me I could think about it for a bit and call him back with my decision.
I tried my husband at work, but was unable to reach him. I kept thinking about Jackie and that she was so young, only 7 years old. I thought about how she came to be my kitty. (…) She was my side-kick.
With Jackie still on the table, I called Dr. Zeltzman back. He talked me through my options, not making the decision for me, but helping me make the right decision. After my conversation with him, I decided to have Jackie put to sleep then, while still under anesthesia. My deciding thought: I did not want Jackie to suffer.
It has been two months since that day. I miss her so very much! The hardest part for me was that I did not get to say goodbye to her. But in my heart, I know I made the painful but right decision for Jackie. I take great comfort in that.”

8. What happens with the remains?

There are several options. Some people elect to bury their pet. This may be illegal where you live, so it is important to check. It you can’t, there are memorial gardens and cemeteries for pets throughout the country.

Most owners elect cremation. You then have 2 options: you may get ashes back, or not. Some people save the ashes.

Here is what a pet owner wrote after receiving her pet’s ashes. Cookie, a 1 year old female Boston terrier, had abdominal surgery that revealed a terrible condition called intestinal volvulus: 90% of her small intestine had twisted onto itself, which is deadly.

The owners were called during the surgery, and reluctantly elected the only reasonable choice: euthanasia. Later, they write:

“Cookie’s ashes now sit on our mantle in the beautiful box with her name on it. (…) Cookie has come home in style.”

Other pet owners sprinkle the ashes somewhere, such as the pet’s favorite place in the back yard. Again, this is a very personal decision.

9. What happens during the grieving process?

For most clients, losing a pet is like losing a family member, so the grieving process should not be taken lightly.

Typically, people who do not own pets don’t understand how sad a grieving pet owner may feel. This may be a good time to avoid such people, for example at work…

10. Where can you get support?

Support is crucial to get over a pet’s loss. It can require finding a friendly ear: a friend, a family member, a receptionist or a nurse you developed a good relationship with, or your family vet.

If you have other pets, they can also provide a support system, as you will need to redirect your attention to their needs. Actually, your other pet(s) will “feel” that their buddy is missing, and they will feel your sorrow. Now is the time to provide some extra TLC. They may become lethargic or have a poor appetite.

Your other pets may actually help you grieve, so you can actually help each other.

There are also some websites where you can share your feelings.

If you are completely overwhelmed, or you feel that you are grieving for an unusually long time, you may need counseling. This is now available through several vet schools and of course through a private counselor.

11. What can I do to get through this?

Here are a few things you can do to help you heal.

. Allow yourself to cry. It’s okay – really.

. Put your pet’s belongings (water bowl, food bowl, bed, leash and collar or harness, toys etc.) in a big box and store it away for the time being.

. Talk about it.

. Write in a journal. Nobody has to know.

. Depending on your artistic talents, you could draw a picture of your pet, write a poem, create a scrapbook with memorabilia and pictures…

. Create a memorial in your garden or on your balcony.

12. How else can I get closure?

Another vastly personal topic. Although it is difficult to believe it at the time of euthanasia, time heals all wounds. Eventually, you will get over your sorrow.

Getting closure requires going through the flow of the various stages of grieving.

You can write a letter, like the one above about Jackie the kitty. After writing it, she said: “I still miss her, but I think writing this text has helped.”

Getting your pet’s ashes and “taking care of them” may also help with closure, as this typically happens after a week or so.

13. When should I get a new pet?

Most people recommend waiting until you achieve complete closure before getting a new pet. Adopting a new pet too soon may lead to bad decisions that you might regret, which is not fair to the new pet (or you and your family).

14. What do I tell my kids?

This is another very complicated topic. I would rather direct you to web sites (mentioned below) that explain things very well depending on the age of the child. You just don’t explain things to a 3 year old the same way as you would a 13 year old. There a re many things to be aware of. For example, it may be inappropriate to say that your pet “went to sleep” or was “put to sleep” and will never come back, as this may traumatize a child at bed time for years. After all, their buddy is never going to wake up…

16. How can I help my grieving elderly parents?

Again, a touchy topic… Sometimes, a pet is the last link an elderly person has to the world. If a grandma or grandpa cannot walk Fluffy in the neighborhood, a whole part of their social interactions may vanish all of a sudden.

I hope this helps you understand the process of euthanasia. In a sense, euthanasia is an act of love. You will rarely see it that way the day you lose your pet. But after your grieving period, I hope you will understand that you made the right decision.

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

www.DrPhilZeltzman.com