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Pre-Surgical Information

Spaying or neutering your pet is a big step! There is a lot to consider when we are planning your pet’s surgery. Here is some information to help you make wise decisions. Click here . . .

Special Library

Our Special Library is a collection of informative articles on a variety of health topics. Click here . . .

Discharge Instructions

Click here for information on how to care for your pet at home. Click here . . .

Consumer Guide
to Elective
Surgery: Surgical Options

On another page we have discussed
Best Practices, but sometimes Best Practices
aren't an option. Our goal is to get the best care
possible for our patients with the budget we have.

Sometimes, economics forces us to make some choices and compromises in health care. What follows is intended to help you make some good decisions about the level of care you choose for your pet. It is not an exercise in high-pressure sales, nor is it a big guilt-trip. But it is an honest discussion. Let's face it, anesthesia and surgery are complicated things. Just as there are consequences to doing things, there are consequences to not doing things. The following will help explain some of these consequences, what the risks are, how they can be managed, and hopefully help you to make some good decisions about how to get the most care for the budget you have. Let's start with the basics.

The Basic Surgical Package

What you get for the Basic Surgical Package is just that: the basics. It is the mimimum level of care that we feel we can ethically offer. The patients get some pre-medication, but not the good stuff, and this means that we have lost a major opportunity to do some substantial pain control. We induce anesthesia and maintain it with gas, and we monitor carefully as usual, but there is no IV line. Because of this, blood pressure is more likely to drop, and if it does drop we are limited in our ability to respond to it. A

nd then there are the life-and-death safety issues with not having IV access in case of an emergency. We do the surgery the good old fashioned way, with a steel scalpel blade, just as surgery has been done all along. Our patients wake up, and then they are started on the pain pills that they go home on. Simple and basic, 1970's style veterinary medicine.

But let's face it, if the 1970's were so great, we'd all still be wearing leisure suits and playing Pong. We have come a long ways since then, and we have a lot more to offer our patients now. What kinds of things? There are four upgrades, Best Practices, if you will, that can be added to the Basic Surgical Package to greatly increase patient comfort and safety.

Pre-emptive Pain Medication

All surgery patients experience pain, 100% of them. Although some people don't believe pets feel pain, or that they don't feel it for very long, at Sunnyside Veterinary Clinic we believe that surgery hurts, that pain needs to be aggressively controlled, and the pain needs to be thoroughly treated for several days post-op. We recommend that your first upgrade be Pre-emptive Pain Management. The concept of Pre-emptive Pain Management is powerful. Modern science has shown us that if potent opioid pain medication is given before the painful stimulus ever happens, the patient's whole pain response is dampend down. The nervous system does not register pain as strongly as it would have.
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The medications we give at the dosages we use make the direct effects of the Pre-emptive Pain medications last from 8 to 12 hours, which makes for a much more pleasant post-operative experience. But is doesn't stop there. Because of the dampening effect, even after the medications have worn off the effect remains throughout the recovery period. Click here for an in-depth discussion of pain management.

Pre-emptive Pain Management does not replace take-home pain medications. Rather, it supplements them. They operate in different ways to control pain, and their effects add up. In fact, as part of our Pre-emptive Pain Management, we often use yet another class of medications to provide pain relief. Local anesthetics, just like the novocaine your dentist uses, can be infused in the areas to be operated on. This further dampens the pain before it even starts, and even after the locals wear off their dampening effect linger throughout the recovery period. Using several different kinds of medications whose effects add up is called multi-modal pain management, and can greatly increase the comfort of our surgical patients.

These medications are much better than the pills often used for post-op pain relief. They are comparable to morphine or demerol, which are the highly potent pain drugs you would get if you had major surgery. This costs only about $18, and we recommend it because of the increased pain control and stress relief it provides. Click here to go to a page on the science behind pre-emptive pain management. Or, click here for a somewhat more "user-friendly" video presentation on pain management by the pain management team at the Colorado State University College of Veterinary Medicine entitled Is Your Pet in Pain?".

IV Fluid Support

In the old days before veterinarians measured blood pressure during surgery, they didn't know that many of their patients were getting into blood pressure problems during procedures. The research literature shows that about 30% to 40% of our surgical patients experience low blood pressure at some point during their anesthesia. (Practices that do not monitor blood pressure do not even know that their patients are experiencing low blood p

ressure.) Now, this is not because we are doing something wrong. It is just part of the anesthesia game. It happens to humans under anesthesia too, even in the best operating rooms around. This is why whenever a human is anesthetized, there is always am IV line in and there are always fluids running.

The consequences of low blood pressure, or hypotension, can be severe. Patients that develop hypotension are at a greatly increased risk of anesthetic-related problems. It has been recently reported at the 2005 annual meeting of the American Society of Anesthesiologists (a human anesthesiology group) that "Low intraoperative blood pressure is associated with a significantly greater number of negative outcomes after surgery, according to preliminary results of an ongoing investigation. Researchers at the University of Michigan Medical School, Ann Arbor, said the study showed that patients whose systolic blood pressure drops below 90 mm Hg are more likely to die than are their counterparts whose systolic blood pressure remains above this level." They found that patients with hypotension had from two to six times the risk of death. You can read the full text here. Our animal patients face the same risks, with some added species-specific problems. For instance, in cats, hypotension has been associated with kidney damage that may not show up until later in life. Low blood pressure during surgery also predisposes the feline patient to have adverse reactions to pain medications given post-op. At the very least, hypotension causes the patient to feel bad for the next few days post-op, presumably due to decreased blood flow to the brain. It's kind of like being hung over without the benefit of having been drunk the night before.

And then there is the huge safety issue. In the event that something goes wrong during anesthesia, how in the world are you going to give emergency drugs to a crashing patient with low blood pressure if there is no IV line in place? The answer is "not very quickly if at all." Without an IV line, you may not be able to get venous access at the time you need it the most.

To help prevent dangerous episodes of low blood pressure, and to provide an important safety net, we recommend that your second upgrade be IV fluid support. Giving IV fluids helps maintain healthy blood pressure, replaces fluids lost during surgery, helps prevent kidney damage, makes the post-op pain medication safer, and provides emergency venous access for resuscitation in case of problems during anesthesia. This upgrade costs about $35.00, and we recommend it because of the increased safety and comfort it provides.

Laser Surgery

For as long as surgery has been done, the instrument of choice has been the steel scalpel blade. The blade has served us well, but modern technology has brought us another option. The CO2 laser gives us another way to cut tissue that is better than the steel blade in many respects.

Steel just cuts. The laser not only cuts, but it simultaneously cauterizes the blood vessels, resulting in much less bleeding. With the laser, because nothing

ever really touches the tissue, there is none of the crushing and tearing that happens on a microscopic level even with the sharpest steel, resulting in less swelling. Also, the laser seals lymphatics as it cuts, which also reduces the amount of post-operative swelling. Because the laser vaporizes bacteria, laser incisions are less likely to become infected. And probably most importantly, lasers not only cauterize blood vessels, they seal the nerves as they are cut as well, resulting in less pain. To the left is an image of an actual surgical incision made with the laser. Notice that it is not bleeding, not even a little.

Laser technology allows us to do some surgical procedures in a new way. In particular, the laser declaw surgery and the laser dog neuter surgery are done in quite different ways than the traditional scalpel methods. In both cases the new techniques result in fewer complications and more rapid return to function.

Laser surgery results in less pain, less swelling, less scarring, less bleeding, and a quicker return to function. Not bad for a new-comer. Now, laser surgery doesn't eliminate the need for excellent pain medication. Laser incisions still hurt, and there is still great benefit to be had from pre-emptive main management. Laser surgery in another important modality in our multi-modal approach to pain control. Laser surgery adds about $28 to the cost, and we recommend it because of the increased comfort it offers.

Pre-Anesthetic Blood Testing

This is often done before humans are given anesthesia. The reason is that not eve No Description

rybody is as healthy as they look. A blood sample is drawn, and it is analyzed to determine whether or not there are any problems with the liver, the kidneys, blood sugar, dehydration, etc. We find that not all of our veterinary patients are as healthy as they look either. Somewhere on the order of 1% of the healthy-looking patients end up having some significant problems when they are tested. While this is not a huge percentage, we do more than 100 procedures a year, so we do find significant problems from time to time. I can honestly tell you that pre-anesthetic blood testing has saved more than one life in this practice. Testing costs about $45 and is well worth the added safety it affords.

How to Decide

When we meet for your pet's Pre-surgical Exam, we can discuss any concerns or questions you may have. You will be asked to decide whether to accept or decline our recommendations for pre-emptive pain medication, IV fluid support, and pre-anesthetic blood testing. We recommend all the safety and comfort options, but realize that this may not be an economic option all the time. In real life, we often have real life budgets, and we understand that. The Pre-Surgical Exam is not meant to be an exercise in high-pressure sales or a big guilt-trip. Our goal is to get the highest level of care for our patient with the budget we have. To help you make the best choices for your pet, we recommend that you choose the options in this order:

First: Pre-emptive pain medication. 100% of surgical patients experience pain, and for $18.00 you get a lot of benefit per dollar.

Second: IV Fluid support. 40% or so of anesthetized patients experience blood pressure problems, and the effects can be quite severe. Also, there is the safety net an IV line provides in case there is an anesthetic emergency.

Third and Fourth: laser surgery and pre-anesthetic testing, in no particular order. It's hard to tell which is more important out of these two. Laser surgery increases patient comfort for every patient, while pre-anesthetic testing can be a real life-saver for a few patients.

I hope you've enjoyed your trip through The Consumer Guide to Elective Surgery. I'm sure you found it to be somewhat of an information overload. During your pre-surgery consultation, there will be plenty of time to discuss any questions you may have. Surgical FAQ's is another helpful page about spay and neuter surgeries. Declawing Cats is a helpful page on declawing. Click Here to return to Consumer Guide: Best Practices.
Click here to Return to Pre-Surgical Information.