This is a re-post of an article I wrote this summer on 8-9-2011,
it’s good information for every pet owner to know about.

8/9/2011

I’m writing this article to pass on some information from the view point of an educated pet owner about procedures that require anesthesia, be it a dental cleaning or surgery for another reason. I wrote this as a guest blogger for a blog called VetTech as additional information to go along with an article entitled; “Before a Routine Surgery”(Vet Tech: Before a “Routine” Surgery). That article covers a number of these issues, from the view point of a Registered Veterinary Technician. I recently had 2 of my dogs into the vets for several procedures; a dental cleaning, removing teeth, including a slab fracture, and a neuter procedure.

My two dogs that went in for procedures were age 4 and age 7. The 4 year old dog had known problems with his liver function due to a liver condition known as MVD. Fortunately his blood test results the morning of the procedure were almost perfect, quite amazing considering most of his previous tests were 5x that. My vet personally discussed the case (of my 4 year old dog with the liver issue) and any potential for modification that may be necessary with board certified Internal medicine doctor and with the anesthesia department at the state University. Both of my dogs did extremely well and didn’t have a single complication, I believe at least in part thanks to good planing and being a well informed pet owner.

A bit of what I have to say will be redundant with the above mentioned article, but I feel it important to be complete. I feel that every pet owner should learn at least some basic information about anesthesia, as it is very likely your pet will need anesthesia at some point in their lives. Having healthy teeth is vital to your pets health and longevity. Unless you religiously have always brushed your pets teeth daily, I’d don’t care what kind of food or treat or chews you give them, the will need a dental at some point in time. Even dogs who’s teeth are brushed very will may end up needing professional dental work at some point in time as well. Injuries any other medical emergencies can also require the use of anesthesia, though here I am talking more about the type of procedure you have the ability to plan for, like dental work.

I strongly believe, just like everywhere else in life, with veterinary care, you generally get what you pay for. If you want top quality dog food it’s going to cost you money, if you want top quality veterinary care, it’s going to cost you more that what the humane society charges on discount neuter and spay day. This isn’t to say that you must go to the most expensive vet in town by any means, from personal experience, the most expensive clinic is not necessarily the best.

I’m convinced a large number of anesthesia deaths of domestic pets are preventable. I have no hard studies to back this up, it’s my opinion after many discussions with different vets and reading many hundreds of pages of studies, reports, blog posts and discussions. Most often I feel it is the owners unwillingness to spend money on preventive measures. Sometimes they really can’t afford it, and at other times, they just don’t understand how important these items are.

Some items that are generally sold as optional, but should not be;
1. Blood tests prior to the procedure to check for the proper function of vital organs.
2. An IV catheter, with fluids running before and after the procedure.
3. An ECG before and during the procedure.

It is in your animals best interest to elect to have all 3 of the above items preformed and I would not consider a procedure without them.

It is also critical that your veterinary office has the proper equipment for anesthesia and monitoring. Isoflourane or Servoflourane should be used for the maintenance of anesthesia. Injectable medication should be used to start (Induction) the process of anesthesia. They should not just use gas to sedate your pet (masking down), it exposes your animal and the staff to unnecessary risk and should only be used in emergency cases where no other option is available. There is no excuse for using it with a planed, elective procedure. I would also inquire about how monitoring during the procedure is accomplished, such as pulse, blood pressure, and oxygen saturation.

You should discuss who will be monitoring your pet, before, during and after the procedure. You also should clearly understand who is doing the procedure and what their qualifications are. Do not assume the vet will be doing the procedure, it is often not the case. That isn’t necessarily a bad thing, there are many qualified technicians out there who do dental work all day long and in fact will do a much better job than the vet who rarely if ever does them. It would be best to have 2 people present during the procedure at all times, ideally the vet or a dedicated anesthesia technician and the person performing the procedure. In the cause of my pets recent care; the technician was going the dental work and extractions and my vet was supervising the anesthetic.

I like to have an idea of what is going on and exactly how busy they are when they are going to be working on my pet. Basically, I want to be reasonably sure that there is sufficient qualified staff present to deal with any emergency that might arise. In the case of my dogs, that was a very experienced veterinary technician and our veterinarian, with nearly 20 years of experience. I felt confident between the 2 of them that they would be able to deal with any situation that arose as well as anyone possibly could. In the case of the day that my 2 dogs went in, they were the only procedures of the day that were being done.

Some reports I’ve read have estimated anesthesia deaths in domestic pets to be as high as 1% or more, and that to me seems far high than it should be. With all the safeguards in place serious anesthesia complications, in my opinion should be rare. With good protocols for pre-testing, induction, as well as monitoring before and after, I don’t feel the risk should be anywhere near as high as I have read.

While I am sure it happens, I can’t recall reading a single report where all the proper precautions where taken and the animal still died from routine planed anesthesia. When I read of an animal that has died from anesthesia, there is almost always some critical element that was missed or a very horrible misjudgement; e.g. skipped blood tests, proceeded with standard anesthesia in the presence of abnormal labs, not enough staff, not well enough trained staff, no IV, improper monitoring.

The veterinarian or the staff may want to be able to contact you for a decision as to what to do if something goes wrong or in the case of dental work, to decide if teeth should be removed, repaired, etc. If you choose to have them call you during the procedure, it is very important to be reachable, as you do not want your pet under anesthesia any longer than necessary. I told my vet that he did not need to call me and that he should just take care of everything, I would only do this if you have a very clear understanding of your wishes with your vet. My vet very clearly understood that everything was to be done to properly care for and save my pets in an emergency. Also, the teeth that were cracked or bad needed to go, there was no point in having him call me to discuss, I just told him to extract any teeth that are bad now or likely to become problematic in the near future.

At the end of the day of my dogs procedure, I had the following done:
2 dogs in for dental cleanings, and polishings (they look amazingly good)
4 teeth extractions
1 dog was neutered
Both had all pre-op testing done including ECG.
Fully Monitored, during and after.
Nails quicked. (a good idea if their nails are too long)
Ears internally examined and cleaned. (strongly suggested on long haired dogs)
Injected pain meds; 3 days of metacam suspension.
A week of antibiotics. (due to the more extensive dental work and the nail quicking)

I also had a 3rd dog in for a ear exam and cleaning (no sedation) the same day, which did consume some of the time I was there. Between the drop off in the morning (I did help draw blood and put the cath in one of the dogs) and the pick up appointment, I spent over 2 hours at the vet clinic with the veterinarian or a tech that day. Our 2 dogs were the only surgical patients of the day. They were continuously monitored through recovery they both did great, not a single hint of a problem. So in addition to the above I consumed a large amount of the vets and the tech time, which you must take into consideration when looking at cost.

I was going to mentioned what this cost me to have these procedures done, but I decided against it. The reason being is that veterinary costs seem to vary greatly depending on where you live, so what is a fair price in my area may set an unrealistic expectation for you in your area. I don’t want your decision to be about price, I want it to be about quality and trust; knowing that your pet is coming back home with you. If you have read this far, chances are good your not just shopping for the best priced on the needed procedure.

I have some additional tips I would like to share; things that I feel strongly are important or things that I feel helped my dogs.

I strongly encourage you to get all of your questions answered prior to the procedure, not only by your vet, but with the vet tech that will be working on your dog(s) also. If your uncomfortable that they are too rushed or if they don’t give you answers your comfortable with, keep asking or look elsewhere, there are lots of vets, your pet only has one life.

A couple tips for the day of a procedure; Always inform them in writing of any medications or SUPPLEMENTS that your dog is on, even something as simple as fish oil and it can in some cases affect clotting time. If your dog was not fasted per there directions or your not sure if they were, TELL THEM, so the procedure can be delayed or they can prepare for any additional problems that may arise due to them eating.

Unless your willing to put a price limit on your dogs life; Please don’t decline any of the tests and don’t complain about prices; ever. Ask for costs, do what you can afford (which is hopefully all the suggested tests and precautions), discuss the costs, but don’t go into the vet and complain about how high the cost is for something. You do not want that vet to be thinking about a what a stingy customer you are while he is making decisions that will mean the life or death of your dog.

I strongly suggest you take the time in advance to have a good relationship with everyone in the vet office. Make friends with all of the vet staff, it’s quite helpful to be on a first name basis with all of them, even the office people. Stop by with some food / ice cream for everyone in the office on a hot summer afternoon once or twice a year (I do it a little more frequently, but I also need my vets services on a very regular basis), they will remember it.

You want these staff members to care about your dog and the results of any proceedure, not just do their job and run though the motions. I’m not saying they should be overly emotionally invested in your pet, just that I feel they are much more likely to go above and beyond if they know, respect and like you, than if your someone that just shows up every 4 years for a dental procedure.

The only problem with all of the things I mentioned and that I do is many people do not want or can’t pay for this level of care. I do not feel I could have gotten a higher level of care for my dogs anywhere, not at a university, specialty hospital or anywhere. My vet and the staff I know were far and away the best and safest option. As I mentioned, I consumed a huge amount of their time that day, and I do feel they were fairly compensated, I paid exactly what they ask, which I still feel was a good deal.

One more thing I will share with you; Though I felt a bit silly at first about them, I made special ID tags for each dog, in color, printed double side, laminated, with holes punched in the top, and I used hair ties to attach them to the dogs harness. The tag contained all the vital information about each dog, who they were, with a photo, and why they were there. It also had contact info and special directions for how to handle each dog. They all know me and my dogs at this clinic, so perhaps it was a bit excessive, but several techs at the clinic that day who saw them thought it was an excellent idea. They all stopped, even the vet and took the time to thoroughly read both sides of the tag and discuss. I’d highly recommend doing something similar if your doing is going in for an elective procedure, just to be sure there is no confusion.

I have some photos of the tags and my dog Vasco wearing the tag, when you see it, you will see how it made it virtually impossible to confuse the dog with another dog or do the wrong procedure on my dog.

Vasco (7 year old Male Shih Tzu) wearing tag:

 

Close up of the ID tags (front):

(click any image to view larger image)

 

I hope that some people will find this information helpful and that it will encourage you to take all the proper safety precautions prior to a surgical or dental procedure to ensure your dog makes a prompt, safe and healthy recovery.

Lastly; I want to state once again; if your not comfortable with your vet or vet tech for any reason, or if your not comfortable talking with your vet about these things; STOP and seek out a new vet.

We’re talking about your dogs life, if it doesn’t feel right, don’t do it. I don’t want to read about your dog dying, especially due to a error, lack of preparation or careless veterinarian. Pick up the phone book and start looking for a vet right now if your not comfortable with your current vet and their staff.

I know how scary it is to send your dog in for a procedure but when you prepare like this and take all the precautions, I feel like the chances of a good outcome are extremely high.

Best Regards;

Jamie Dolan

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