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At Trinity Veterinary Hospital, we recognize advancements in the care for the surgical patient. No longer are surgeries considered “routine,” but a complex balance of physiologic and psychological needs of the individual animal. For the comfort and safety of your pet, the following components are evaluated to formulate a specialized protocol for each surgical procedure, whether elective or medically necessary.

  • The Individual
  • The Anxiety
  • The Pain
  • The Anesthesia
  • The Surgery
  • The Recovery

THE INDIVIDUAL

Veterinary medicine is unique in caring for a wide variety of animal characteristics. Species, breed, age, health status, behavioral characteristics and surgical procedure must be considered when formulating a specialized protocol for the individual pet.

THE ANXIETY

The doctors and staff at Trinity Veterinary Hospital strive to make every encounter for you and your pet as stress free as possible. We understand the impact anxiety can have on health and recovery, especially after a surgical procedure. For this, your pet may receive a calming medication on entry as well as receive additional medication to continue at home.

THE PAIN

Pain in animals has long been misunderstood, and often neglected, since pets don’t show pain as we do. Animals instinctively hide pain as to not appear weak or inferior. The physiologic processes are the same as in humans; we are just able, and willing, to voice when we are hurting.

The American College of Veterinary Anesthesiologists (ACVA) believes that animal pain and suffering are clinically important conditions that adversely affect an animal’s quality of life, either in the short or long term. The more invasive the procedure, the greater the tissue damage and the greater the degree of pain. There are two basic foundations that allow us to treat for pain more effectively:

  1. Preemptive treatment before the onset of pain will allow for better control of pain during the post-op period.
  2. Using different types of treatment (anti-inflammatory, narcotics, nerve pain, local anesthetics) will greatly enhance analgesic effects while allowing for reduced dosages and minimizing adverse effects.

THE ANESTHESIA

Historically, the risk of anesthesia and surgery may have outweighed the potential benefit for some pets; however, newer medications have made anesthesia much safer. This, along with the specialized diagnostics and monitoring listed below provides peace of mind that the long-term health benefits outweigh the risk.

Pre-anesthetic bloodwork

Pre-anesthetic bloodwork

Pre-anesthetic bloodwork provides a window into the internal workings of the body that cannot be detected on physical examination. Many issues can be hiding and not causing clinical signs, adding significant risk to the anesthetic patient.

Pre-anesthetic heart tracing

Pre-anesthetic heart tracing

Pre-anesthesia ECG can detect abnormal electric patterns to the heart that can be brought on by stress or disease and can add significant risk for heart complications. Most of these abnormalities are easily treated, thus making anesthesia safer.

Vital scan monitoring

Vital scan monitoring

Anesthesia is a balance of body and medicine, which continually change during a procedure. Heart rate, blood pressure, respiratory rate, temperature, ECG, and oxygenation level alert us to potential emergency situations and adjustments that need to be made.

IV catheter and fluids

IV catheter and fluids

An intravenous catheter provides a lifeline for fluid therapy, medications and emergency treatment if the need arises. Fluid therapy allows us to maintain blood pressure, ensure proper hydration, and flush the filters of the body (liver and kidney).

THE SURGERY

All surgical procedures are designed to improve health or prevent disease, but some level of tissue trauma is inevitable. The level of pain is often associated with the amount of tissue trauma that occurs. Advanced procedures will always require a more complex protocol as compared to minor procedures.

THE RECOVERY

The surgical protocol does not end when the patient goes home. Healing relies on more than just medication but involves good husbandry practices, nutritional support, rest and reduced stress – interaction with owners is great for this!

QUESTIONS

We understand that there may be questions not answered in this information. We encourage and offer a pre-surgical consultation with one of our veterinarians to review the specific protocol recommended for your pet.

ADVANCED SURGERIES

Advanced surgeries are those that are for a specific medical purpose such as fracture repair, organ surgery, mass removal, and others. These surgeries will always receive the OPTIMAL/PREFERRED group package below as these patients require additional support for their health and safety. 

SPAY and NEUTER

Spay and neuter surgeries are referred to as elective because they are preventing a problem instead of correcting a medical condition. To allow clients to choose the best recommendations without financial stress, we offer the following group options. 

1.  Spay or Neuter
​​2. IV Catheter and Fluids
3. Antibiotic Injection
4. Anti-Inflammatory Home Medication
5. E-Collar

Pre-Anesthetic Thoracic Radiographs– Optional and not included with any group.

​Please note: Any items available in the Standard or Optimal Packages can be added or removed to adjust for client and pet’s needs.  

1. Spay and Neuter

Spay is also known as an ovariohysterectomy. This is the surgical removal of the ovaries and the uterus. This is done through a small incision (typically 2-4 inches) on your pet’s belly. Spaying is mainly used to control the pet population by making the pet unable to reproduce.  There are additional health benefits such as distinct decrease in mammary cancer and eliminates the potential of a life-threatening infection called Pyometra. This is a routine procedure with minimal risk. However, it is worth noting that long-term spayed females are more prone to obesity and urinary sphincter incontinence.  Trinity Veterinary Hospital recommends performing this surgery in puppies and kittens about 5 months of age, but the procedure can be done at any age.

Neuter

The medical term for neuter is orchiectomy, or castration. No matter which term is used, the surgical procedure is the removal of the testicles and associated structures.  We perform this surgery in dogs by making a 1 to 2-inch incision just in front of the scrotum.  Cats are actually even easier with two very small incisions made over each testicle.  Neutering is believed to help reduce behavioral issues and also has the health benefit of fewer prostate problems as your pet matures.   Long term, the reduction in testosterone can increase the potential of obesity though this is really controlled more by diet and exercise.  Still the other benefits and importance in controlling the pet population makes this a necessary procedure.  We typically recommend this procedure about 5-6 months of age in both puppies and kittens though there are exceptions to this. Just like a spay, the surgery can be performed at any age.  

Further Information

Feel free to contact us or set up an appointment if you would like to discuss these procedures and what is best for YOUR PET (as each one is unique). Also, here are two sites to give you more information about these procedures:

1.  PetMD Video 

2. WebMD Q&A

2. IV Catheter and Fluids

Trinity Veterinary Hospital places intravenous (IV) catheters and runs IV fluids to all surgical patients. An intravenous catheter allows quick venous access if needed.  Anesthetic adverse events are pretty rare, but they do happen. In that moment when time is of the essence, an IV catheter can be a life saver by allowing medications to quickly and easily be placed in a patient’s vein for a fast response. The IV catheter also allows for the use of IV fluids, which can help maintain proper blood pressure throughout surgery. This decreases the potential for damage to the kidneys or other vital organs.

3. Antibiotic Injection

Antibiotics have been around for years to help treat bacterial infections. We use good sterile techniques for surgery and take many necessary precautions; however, in some cases, an addition antibiotic injection is necessary.  Therefore, this is included with the surgery cost in any cases deemed necessary.  

4. Anti-Inflammatory Home Medication

This is an injection of a NSAID (Non-Steroidal Anti-Inflammatory Drug) that is used to reduce pain caused by an inflammatory process. This is effective in surgical cases because surgery causes inflammation at the surgical site. By reducing this inflammation, pain is reduced.  

In some patients and for some surgical procedures, NSAIDs are not enough pain control or cannot be used. These patients require different therapeutic options like Tramadol or Gabapentin. These medications work as true pain medications by blocking pain signals being sent to the brain.

5. Elizabethan collar

Trinity Veterinary Clinic recommends all surgical patients go home with an Elizabethan collar, commonly referred to as an e-collar or the “cone of shame.”  We understand they are not the most fashionable item out there and that pets face challenges maneuvering through the house and eating with them on.  However, surgical incisions tend to cause pain and irritation post-surgery, which makes the pet itchy and want to lick their incision. The old wives’ tale that licking allows the wound to heal is far from the truth. The mouth is full of bacteria that can get introduced to the surgical site and cause an infection if this is allowed. In addition, pets can lick hard enough to tear open the surgical sutures.  

Basic Package Plus:

1. Pre-Anesthesia Bloodwork
2. ​Advanced Vital Signs Monitoring
3. Narcotic Pain Injection

1. Pre-Anesthesia Bloodwork

Our hospital strongly recommends blood work prior to anesthesia in every patient.  This is even more important the older a pet is because there is increased potential of underlying disease issues. Blood work can identify changes within the body that cannot always be identified on a physical exam alone. These changes can affect the way drugs are metabolized in the body during surgery, which can increase anesthetic risk. 

Identifying these problems prior to anesthesia allows us to change anesthetic protocols for better safety and pain control or postpone surgery until your pet is better suited for anesthesia. If the blood work is normal, this is great! It serves as a base line for detecting subtle changes in the future. 

The CBC is used to detect anemia, bleeding issues, and white blood cell changes that can affect the body’s ability to respond to infections.  The blood chemistry is used to determine internal organ function to make sure the organs are functioning normally to allow for proper function and metabolism of medications.

Examples of Patients Benefiting from Blood Work

Here are two examples of blood work preventing a potentially troublesome anesthetic event:

Susie was a 6-month-old Yorkshire Terrier that had been perfectly healthy and presented for a spay.  Her blood work revealed a mild elevation in her ALT.  Surgery was postponed and further work up revealed a Portosystemic shunt. This is where there are extra blood vessels that allow blood to bypass the liver. This could have severely affected Susie’s potential anesthetic outcome. 

Blake was a 9-month-old recently found pit bull puppy that was doing great at home and presented for a routine neuter.  His owner reported that he coughed once the previous night but was not concerned, and his heart and lungs sounded normal.  The CBC showed an elevation in his white blood cell count. Surgery was postponed and Blake developed further signs of kennel cough the next couple of days. He was treated and an uneventful neuter was performed a month later.

2. Advanced Vital Signs Monitoring

Anesthesia can be delicate, so every bit of information that can be given during anesthesia is beneficial.  Basic monitoring of heart rate and respiratory rate is nice but the addition of SPO2, blood pressure, temperature and ongoing ECG readings allow us to determine changes in anesthesia much sooner. SPO2 (peripheral capillary oxygen saturation) is used to estimate the amount of oxygen in the blood. Decreased oxygen in the blood can have life-threatening effects. Blood pressure can vary during anesthesia due to response to the medications used.  Monitoring blood pressure allows for better fluid and medication monitoring.  If blood pressure gets too low or too high, vital organs can be damaged. Temperature becomes important due to potential effects of hypothermia or hyperthermia.  Ongoing ECG monitoring allows for detection in changes of heart rate along with electrical impulses of the heart.  When caught early, these can be addressed with minimal issues. 

Trinity Veterinary Hospital has an assistant dedicated to monitoring these values and your beloved pet throughout the surgical procedure and recovery.

Patient Examples

The patient showed two different ECG reading strands.  One showed a 1st Degree AV block which is where there is a P wave that is not followed by a QRS and T waves.  This can become life threating.  However, it was quickly and easily identified at our clinic with our monitoring capabilities.  Medication was given to correct the problem and the lower ECG reading was taken shortly after the medication.  The remaining anesthesia was uneventful.  

3. Narcotic Pain Injection

Some patients, especially with more painful procedures, need additional pain control.  A narcotic can be used in these situations. Morphine is an example of a narcotic pain medication often used in people. This medication and others very similar to it are used in veterinary medicine for pain control.

Basic and Standard Plus:

1. Pre-Op Exam Appointment with
2. Pre-Anesthesia ECG
3. Calming Injection on Entry
4. Additional Pain Medication
5. At-Home Sedative/Anxiety Medication
6. Laser Treatment

1. Pre-Op Exam Appointment with Doctor

Have lots of questions?​

We have answers. This appointment allows you to address any concerns or questions you have for the doctor about the surgical procedure and anesthesia.  This is also a great time to do the pre-anesthetic blood work so we can go over it in person and address issues before the day of surgery. We will also be happy to go into more detail of post-operative instructions and potential restrictions. Following these directions closely can improve the overall outcome for your pet. 

5. At-Home Sedative/Anxiety Medication

After surgery, rest is very important part of recovery; however, some pets are so loving and full of energy, it is hard to keep them calm to allow proper healing. For these special patients, we can prescribe a medication to help them cope with anxiety post-surgery and thus also help keep them calmer to facilitate better healing.  There are a number of different medications that can be used for this like Trazadone, Acepromazine, Diazepam, etc.  Trinity Veterinary Hospital wants to work with you to choose the best medication for your pet’s at -home needs.  

2. Pre-Anesthesia ECG

ECG stands for electrocardiogram and shows the electrical impulse as it passes through the heart and causes contraction (beats) of the heart.  Subtle changes in heart size or abnormal electric waves can be detected and prevent potential anesthetic complications or even determine a patient is not ready for anesthesia.  Above is an example of a normal ECG reading. http://www.trinityveterinaryhospital.com/pre–ecg.html

Examples of Patients Benefiting from Pre-Anesthesia ECG

Sam, a 3-year-old male cat presented for straining to urinate with minimal to no urine production.  He was very out of it on exam and had a very large bladder on abdominal palpation.  The ECG showed hyperkalemia, which is very common in cats with urinary obstruction.  The waves are much wider and more bizarre than the normal ECG waves.  This is important to identify, because hyperkalemia with this kind of cardiac changes can be deadly, and hyperkalemia was addressed prior to anesthesia.  This allowed for a much better outcome.

Jack is an 8-year-old Boxer that presented for a routine dental cleaning.  On exam, he was alert, gum color was normal, lungs sounded clear, and heart seemed normal but was difficult to fully access because Jack was active and playful.  His ECG revealed ventricular pre-mature contractions consistent with Arrhythmogenic Right Ventricular Cardiomyopathy or commonly referred to as ‘boxer Cardiomyopathy”.  A dental cleaning was cancelled, and Jack was seen by a cardiologist and started on medications for his heart.

3. Calming Injection on Entry

Coming to the veterinary office can be very stressful for pets, especially after having food withheld in preparation for surgery. Some pets can benefit from a calming medication as soon as they arrive prior to getting fully worked up and stressed out while waiting for their pre-anesthetic medications.  This is similar to a person receiving Valium as soon as they arrive at the hospital while waiting for their own procedure. 

4. Additional Pain Medication (as needed)

Pain control is very important to us at Trinity Veterinary Hospital. Thus, our Optimal plan includes pain medication in addition to the Narcotic and NSAID injections if your baby needs it.  The narcotic injection typically last 6-8 hours, but some pets have break-through pain even during this time. For these instances, another narcotic injection may be necessary.  

5. At-Home Sedative/Anxiety Medication

After surgery, rest is very important part of recovery; however, some pets are so loving and full of energy, it is hard to keep them calm to allow proper healing. For these special patients, we can prescribe a medication to help them cope with anxiety post-surgery and thus also help keep them calmer to facilitate better healing.  There are a number of different medications that can be used for this like Trazadone, Acepromazine, Diazepam, etc.  Trinity Veterinary Hospital wants to work with you to choose the best medication for your pet’s at -home needs.  

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