Surgical Log. A Typical Wednesday

            The second floor of our clinic houses our kennels, kitty boarding alcove, staff lounge, doctors’ offices, radiology suite, dental tables, treatment area and our surgical ward.  I had the pleasure of helping design the space with Dr. Fritzler years ago and it is a joy to work in.  A client who toured the space referred to it as, “the inner sanctum” and I have called it that ever since.  While most of my week is spent examining patients during appointments, I dedicate one day to surgical and dental procedures.  Wednesday is my surgery day and I will see a combination of dentistry, teeth extractions, routine surgery, diagnostic procedures, growth removals and more extensive surgery.

            The surgical team on Wednesday includes two licensed technicians, Sarah S. and Kirsten H., an assistant, Hilari B., and often one other doctor, Nick Paulson.  This team may vary but this is a team I have had together for some time now.   We work together to accomplish the medical tasks in front of us.  The technicians are your pets’ nurses.  They administer and monitor the anesthesia,  clean the teeth during dentals and take all dental radiographs.  They also administer chemotherapy and prepare animals for surgery.  Assistants also prepare animals for surgery, perform radiographs and other diagnostic tests, hold and recover patients and perform other tasks as they are qualified.  My staff is exceptionally skilled and well trained and we could not provide the level of medical care we provide without them.

            When patients are dropped off the morning of a procedure, it is an emotional and stressful moment for owners when we walk out of the exam room with their pet and head upstairs.  Upstairs is unknown and procedures are unfamiliar and the thought of anesthesia is stressful.  We strive to keep owners aware of progress during and after procedures, though how long a given procedure may take is quite variable and we often find ourselves with unpredictable delays.  Complications or a more involved twist on one animal’s procedure will delay completion of procedures on the remaining patients. 

            Truthfully, there is no typical Wednesday.  I often say that I have quite literally never been bored.  A past Wednesday is a good example as it involved an array of cases.  Moose came in for a dental and tooth extraction.  He broke one of his big shearing teeth in the back of his mouth on his upper jaw.  He was showing no signs of pain; the broken tooth was found on his yearly physical.  On reflection, his mom did think he had been acting differently.  We cleaned his teeth, took radiographs of the affected tooth and surgically extracted it.  Zsuska also had a dental and a similar tooth removed.  She was showing her dad that her mouth hurt.  She is huge and can be aggressive.  Handling her was an additional challenge.  Another older kitty had multiple teeth that needed to be surgically extracted.  These teeth, especially in older animals, can be quite difficult to remove.  It is literally, “like pulling teeth.”  Both animals had a full set of radiographs taken of their mouths.

A pug was in for a minor growth removal.  All the Brachiocephalic breeds (smooshed face dogs such as Bulldogs, Pugs and French Bulldogs) add another layer of complexity to their anesthesia because of their breathing issues.  We have a very specific protocol, developed by Dr. Jeanine Barile, to handle brachiocephalics safely.   Dr. Barile has a strong interest in and extensive knowledge of brachiocephalic medical care. 

Also on that Wednesday, Dr. Nick Paulson performed an abdominal exploratory surgery to collect biopsies and diagnose why a dog was losing weight.  He found Lymphangectasia, a disease that is entrenched in the lymphatic system of the intestinal tract.  It is only diagnosable on biopsy, typically taken during a full exploratory.  There is medication to treat it and the dog should do well.

            We also took several sets of radiographs under sedation, performed an ultrasound on a kitty and removed fluid from around her lungs to help her breathe better.  Kirsten spent time with a golden retriever collecting samples for submission to the Golden Retriever Lifetime Study.  The enrolled animals come in periodically for urine, blood and toenail trimmings to be collected for evaluation. The data will be used to help develop protocols for treating cancer and other diseases in all dogs.

            I enjoy my surgery days, the challenges they bring and their randomness.  Know that everyone who interacts with your pets is skilled and knowledgeable and that we care about our patients and their recovery, comfort and safety.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Anesthesia Fears

      When we recommend a surgical or dental procedure that will require general anesthesia, fear of anesthesia is frequently paramount in the owner’s mind.  Fear of anesthesia is universal.  In people, patients often fear anesthesia more than the procedure itself.  This is true even though patients often are at a greater risk of dying from the procedure than from the anesthesia.   For example, women have about the same risk of dying from an uncomplicated pregnancy as they do from having anesthesia.  The fear of anesthesia is much greater than the real risk.  Though we can’t ever take the risk of anesthesia to zero, the risks are very minimal in animals and people.

     The first anesthesia was used by a doctor at Massachusetts General Hospital in 1846.  Ether was the first agent used; later chloroform was introduced.  In the 168 years since the beginnings of anesthesia, veterinary and human medicine have worked and struggled to improve safety.  We long ago stopped using drugs that were explosive. Current agents also do a much better job of protecting vital functions.  New drugs are constantly on the horizon and we are always fine tuning monitoring parameters and techniques.

       During anesthesia in our hospital, veterinary surgical staff monitors blood pressure, oxygen content of the blood, ECG and blood carbon dioxide levels, among other parameters.  In addition to mechanical monitors, we know, and have always believed, that the best monitor is well-trained staff. At the Lien Animal Clinic, every patient is assigned a licensed veterinary technician who is with that patient from the time they are prepped for surgery until they wake up. The technician administers drugs that relax the patient and provide pain relief, induces the patient and places an endotracheal tube, enabling the patient to breathe oxygen as well as the anesthetic gas. The same technician monitors anesthesia throughout the surgical procedure and is with the patient until it is fully awake following surgery. Our belief is that the technician should act as an advocate for the patient, including requesting additional pain control or other techniques to provide patient comfort and safety.

      Most patients have a blood test before anesthesia ensuring that they are normal metabolically.  All patients have intravenous catheters that supply vital fluids throughout surgery and give us constant access to their blood stream.   All patients are intubated so they can breathe oxygen along with anesthesia gas. This provides additional safety in cases where it becomes necessary to offer respiratory support. 

       We hear quite often that certain breeds are sensitive to anesthesia or specific medications.  This is rarely true. Each patient is unique and our drug and anesthesia protocols are based on what is best for that patient, not on their breed.  A multi-drug approach is the most effective and safest approach.  We add the benefits of certain medications while decreasing the negatives by using anesthesia cocktails with lower doses of individual medications.  Typically, animals receive pain medications with sedative medications prior to anesthesia.  This relaxes them, pre-treats for pain and removes the stress from their experience.  Then, an IV catheter is placed and the patient receives anesthesia-inducing medications.  The endotracheal tube is then placed enabling them to breathe anesthesia gas and oxygen.  Following the procedure, the patient is given oxygen until they eliminate the anesthetic gas from their body.  If appropriate, pain medication is repeated on recovery.

This scenario is exceptionally safe and is our standard protocol.  Know that the care-giving team providing your pet’s anesthesia is skilled and focused on your pet for the duration of its procedure and attentive to its needs through discharge from the hospital.

      Always feel free to discuss any concerns with us about any care your animal may need, including anesthesia or other procedures.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners