It sounds like you've tried many things to handle his recovery without sedatives; so, no, I think you made a rational decision yesterday.  He's had serious surgery, and you're doing something in the short term to ensure his long term health.  It's not as if you immediately began a regimen of constant sedation just because he's an active dog.

Posey October 20th, 2009 10:06:57 AM

Poor Slummy.

And no, i don't balme you. If you're stressed out, it's just going to make his recovery that much harder.

Sarah October 20th, 2009 10:10:27 AM

Can't say I blame you for sedating him.  It is in Slumdog's best interest.  We had a cat, Smokey, that suffered from FUS.  We ended up opting for the costly surgical procedure that would create a bigger urinary opening (removing the penis and creating a larger opening).  After the surgery he wore the collar to keep him away from it for a couple of weeks.  It was removed when the vet determined he had healed.  Well Smokey was obssesive about his grooming and he licked the new opening so much that he ended up closing it.  So, back to the vet for more surgery to re-open the opening.  More weeks with the collar to keep him away, only have him close up the opening again.  The vet determined that Smokey would have to wear the collar all the time if he was going to survive or would have to live sedated.  We ended up having him put down.  It broke our hearts, but he would not leave it alone and we could not change his nature and behaviors.

Maria October 20th, 2009 10:13:15 AM

I think sometimes we have a tendency to over think things.  It's simple; one just has to do what is best for managing the patient, the client/pet-parent, and the situation.  I look back at one of my cats, Simon, who upon returning home from a rear leg amputation, proceded to ignore doctor's orders (and mine) by sliding open the pocket door to the bathroom where we were trying to isolate him. He did this three times in about 10 minutes and I finally gave up.  He did well, and settled down once he could be in the space he preferred. I lucked out.  (We lived in a very old house back then that did not have hnged doors) If the situation had involved something that could have been undone or damaged by his activities, I'd have taken whatever measures needed. It sounds like Slumdog is quite the little individual.  I'll bet he does well once you can figure out how to 'velcro' him down to something.  All my best to little SD!

Renee October 20th, 2009 10:31:41 AM

i don't blame you one bit. I'd take a Xanax too! ;-)

Whatever it takes for our pets to reciver quickly and completely, that's what I say.

tripawds.com October 20th, 2009 10:50:55 AM

I have a hard time understanding the logic behind the resistance to post-operative sedation. Of course sedatives should never be used in place of real pain control, for example, or for the casual convenience of the client. But I think much of the objection is irrational fear of "drugs" rather than a reasonable concern for the proper care of the pet. 10-14 days of being a bit sleepy in exchange for a properly healed and useful, pain free limb seems a reasonable price to pay. I had a friend who was hit by a car and had open compund fractures of both femurs and lots of other major injuries. She was kept sedated for almost two weeks because of th pain and the fact that she wouldn't have been able to do anything but lie still and suffer had she been conscious. It seemed a perfectly appropriate measure to ensure her comfort and proper healing, and the same is often true for post-surgical veterinary patients.

SketpVet October 20th, 2009 10:52:40 AM

Not only don't I blame you, I've been there.  My Lab suffered a corneal puncture earlier this summer.  Opthamologists were able to save the idea, but she was in a cone for well over a month and my girl - who, while show bred, normally is field training and romping with her canine siblings - was confined to leash walks.  Sedation was necessary to make sure she slowed enough to let the eye heal - just enough to take the edge off of her vivaciousness, but not enough to make her dopey. The cone precluded all the things I'd normally do to keep my confined dogs happy - stuffed Kongs (couldn't use her paws to hold and just frustrated her), buster cubes, hidden toys/treats, etc.  First time I've ever sedated a pet, but it ended up saving both her sanity and mine.   Oh, and the eye healed beautifully :)  However, it looks like there is damage to the lens and we'll be doing cataract surgery within the year - so back to the cone and possible sedation again!

Leslie K. October 20th, 2009 10:54:27 AM

Heck no!  That was an expensive, traumatic surgery.  If he injures himself by thrashing, he'll have to go through another one.  That's a lose-lose scenario.  So thumbs up to sedating Mr. Slumdog.  They can't all be good convalescents.

My pet peeve?  was when they'd pull out their IV.  So you could end up with a dog in a small crate (to limit movement) AND an e-collar on.

Julie in OH October 20th, 2009 11:36:40 AM

oh my!   another Beaner!!!!   You have my empathy!   

After Beaner's Tightrope, he was crated except to go potty on leash. I had my sister come and stay with him when I was at work.  He had 24/7 attention.

And he still chewed out 7 of his 15 staples.  Ate thru numerous bandages. 

If I had been offered sedation, I would have jumped at it.  I would have taken some for Beaner, too...   ;)

I am paranoid when it comes to heartworm pesticides, flea prevention topicals, and over-vaccination.  But sedation after surgery....not even a hesitation....bring it on!

agadoresmama October 20th, 2009 11:56:33 AM

Absolutely not. Sedation post-operatively is the only thing that has prevented some of my patients from re-injuring themselves or tearing out sutures. Great Danes are the worst. I had a GDV a few weeks ago, upon waking up from her surgery, she proceeded to try and walk, slipped, and crashed down on her freshly surgerized abdomen. I could just  HEAR my pexy ripping clean off the body wall. She really, really liked her acepromazine from then on.

Sometimes sedation post-op is a necessity. Animals can't heal well if they're stressed, painful, scared, or anxious. I absolutely believe in it, where appropriate.

ER Doc October 20th, 2009 11:58:39 AM

I was really lucky with my little pit bull post-op after both her knee surgeries. I expected her to be a nightmare. She was actually really really good for me. I was prepared to have to sedate her, and I would have if needed, but fortunately I didn't need to.

I don't blame you one bit for sedating Slumdog. Really, what other (sane, safe) option is there for him? He'll be happier, you'll certainly be happier. It seems pretty win-win from where I'm sitting. And I thought it was interesting that you chose Xanax over the Ace that seems to be the traditional go-to sedative.

Katie October 20th, 2009 12:09:10 PM

I think much of the objection is irrational fear of "drugs" rather than a reasonable concern for the proper care of the pet.

Or for the proper care of the human.  My mother heard "But you're going to get addicted!" well into her eighties when her docs prescribed some heavy duty drugs for her arthritis, broken hips, etc.  Her reply was something along the line of "How far do you think I'll get when I start robbing banks or mugging tourists?"

If it's needed for good and rapid healing,  sedate and then sedate more if that doesn't work.  (I'm all for it for me too considering what's available on the room TVs at Cedar-Sinai.)  The "War on Drugs" shouldn't be producing collateral damage to animals.

Will October 20th, 2009 12:13:20 PM

Gosh––makes me feel like an idiot for resisting it. Goes to show that I'm a little too tough on myself sometimes. Drugs I'd prescribe for a kooky post-op patient seem like something I should be able to do without. But clearly I have no special skills they don't. Slumdog proves it.

As to the use of Xanax over Ace: I'm not a big fan of acepromazine. Some dogs get dysphoric so I prefer to try other alternatives first. Moreover, it lowers blood pressure––so I never use it on my oldies.

Xanax, OTOH, is sort of like a martini in a pill. It should do the trick. I pick up the script in half an hour. Wish me luck. 

Dr. Patty Khuly October 20th, 2009 12:23:02 PM

Dogs are so varied.

I got upset when one ate her stitches, leading to another week of 24 hour observation.

The other, never seems to care or notice stitches.

Erich Riesenberg October 20th, 2009 12:39:47 PM

Wait, is the Xanax for you or the pup? ;)

Actually, I don't blame you one bit.  Sometimes you have to turn to the magic of chemistry to do what's best for the little guy.

Cindy October 20th, 2009 12:41:31 PM

Sedation sounds reasonable.

How about adding a diaper to help prevent or reduce soiling?

Mckillips powder and frequent bandage changes should aid in reducing bandage sores and mush foot.

Good luck

annie October 20th, 2009 01:04:06 PM

Could you explain more of the downside of sedatives for dogs?  I don't know anything about this issue, but I don't understand why it is a last resort.  Can't we just keep our dogs on a nice little high while they recover from things?  What's the harm?  It is not as though they are air traffic controllers or something.  I am cautious using sedatives or pain killers on myself, but that is because I AM human, and I have resposibilities that I need to be sharp for, and also a bit of a puritan ethos about my own pain.  But if my pup was hurt and had to be crated all the time, wouldn't it be kinder to have him floating along, not minding the boredom?  He is not, as an earlier poster commented, going to get hooked and go rob a liquor store.  I mean, the owner would just take him off the drugs when needed and that would be the end of it, right? 

caro October 20th, 2009 02:09:09 PM

No, no blame from this quarter. In fact, I think temporarliy sedating Slummy is a relief to him too.

oh holland October 20th, 2009 02:13:56 PM

Imagine if a human had a surgery then had nothing to occupy the mind.  No TV, no book, no one to talk to, no radio...nothing.  It would drive you nuts.  Same with a dog.  Now if one has the time to occupy a dogs time, petting etc, that might have worked, but outside of that, you had no options.

EAB October 20th, 2009 02:44:19 PM

caro: Some sedating/tranquilizing/dissociative drugs do make pets unhappy. If you didn't know any better, might you not find it odd to feel funny all of a sudden?

I think it's the risk of this side effect (common with many drugs but especially with the flagship veterinary tranquilizer, acepromazine) that keeps me from using them more often. If they're just feeling goofy and off but otherwise content, that would be OK. I'm just not sure that many of our veterinary drugs work this way in pets. That's why, in many ways, I think I'd prefer to keep them on loop-de-loop inducing opiates than on a sedative like Ace.

Remember, even humans commonly experience nasty side effects on these drugs. We have to assume pets would, too. And how would we know? Apart from the aggressive dog becoming even more so, it's kind of hard to tell. 

Dr. Patty Khuly October 20th, 2009 02:55:47 PM

Poor Slummy!  I think you did the right thing for his long-term outlook.  Let us all know how he does with the sedation!

SonyaW October 20th, 2009 03:53:01 PM

Don't blame you in the least.  Hope you'll keep this experience in mind when clients request similar.  Hey, maybe even another script for you if the one for Slumdog isn't enough :)

I'm with Will too.  As my mother lay dying in a hospital bed with AIDS related pneumonia, with a written directive on file and under which we'd reached the comfort care only stage, I got a lecture from a staff doctor on the long term hazards of the morphine she was getting, the potential for addiction, blah, blah...  My deadpan response was: "When you can tell me she has a long term, we can discuss that."  The knee jerk "no" reaction that most physicians tend to have to pain and stress treatment is silly in light of all the data and research showing that pain and stress delay healing, at best.

PJBoosinger October 20th, 2009 04:29:36 PM

I don't blame you at all.  I had a GSD Champion male who I had to sedate when I had bitches in season.  He destroyed everything in hhis path and no one could ever sleep at night. He was the one and only dog I ever had to go that route but it was necessary.

Holly October 20th, 2009 04:45:43 PM

Blame you? OMG, I thought I was the only one ready to jump off a bridge, post Pearl surgery!

Whining, crying, hissy fits, jumping, --all of it relentless (Sealys have a knack for wearing humans down till they get what they want)

What a relief when her vet suggested Benedryl and it actually WORKED!

Every pm, after her meal, it was one pill, maybe a second 5 hours later. I was so glad when that 5 weeks was up and it was declared that she could "ease" back into normal activity.

I feel your pain, hope for a speedy recovery !

Barb A./NH October 20th, 2009 05:53:24 PM

Our cocker spaniel has a pain tolerance that's out of this world.  He once had surgery to repair a torn muscle; both before and after the surgery he was acting quite normal, which is clearly NOT what he needed to be doing!  Similar experience with a slipped disk: much too active for his own good.  Put in a crate, he is still active enough to hurt himself when recovering from something major.  So we tried tranqing him, because he NEEDED to be less active in order to recover without adding more problems. 

...apparently his pain tolerance is only matched by his tolerance for tranqs and sedatives, oh boy.  The vet stopped trying new meds/doses when the edge was only slightly taken off...for about an hour...by a dose that they said would make larger dogs dopey enough to alarm their owners.

Later we found that a single size-appropriate dose of Benadryl knocks him right out.  Snoozey, dopey little guy for at least 12 hours.  Wish we'd known that when he was recovering from the muscle tear or the slipped disk!

Galadriel October 20th, 2009 06:15:11 PM

Dr. Khuly, YOU prefer other drugs over acepromazine in certain situations and that's fine but I think its wrong to give acepromazine such a bad rap. It can be the best choice in some situations and the worst in others. Like ALL drugs it has its benefits and its downsides. When used appropriately, at the correct dosages it can be an excellent tool in the sedation/anesthesia toolbox.

virginian October 20th, 2009 06:18:30 PM

I am absolutely bearish on the use of psych drugs for "behavior problems," most of which would be miraculously cured by reasonable exercise and a slap upside the owner's head.

And I am absolutely in favor of doping up animals post-op.  Send 'em off to happy-land for as long as it takes for the boo-boo to heal.  It's not like the dog is going to start mugging alley cats to get money for his next fix, right?

I'll never fathom how it is that the same vet who happily scripts out off-label human psych drugs for a normal animal who is annoying his lazy owners will, in the next breath, tell the owners of a ten-month-old Lab who has just had knee surgery to "keep her quiet for ten weeks" and offer no help.

I'm also a big fan of good ol' benadryl.  Nearly as good as my Irish grandma's baby pacifier -- sugared wiskey mixed in the formula.

H. Houlahan October 20th, 2009 09:46:25 PM

"I'll never fathom how it is that the same vet who happily scripts out off-label human psych drugs for a normal animal who is annoying his lazy owners will, in the next breath, tell the owners of a ten-month-old Lab who has just had knee surgery to "keep her quiet for ten weeks" and offer no help."  Nice to see it put so succinctly!  Nearly ditto for the human docs!

I have a tidy stock of OTC antihistamines, different ones work for different things and to different extents!  I've always wondered if the Irish pacifier would work on critters too but never gave it a try.  It's SOP in my family tree but had a friend who nearly OD'ed her baby son by putting WAY too much whiskey in the mix.

PJBoosinger October 20th, 2009 10:07:07 PM

virginian: Yes, of course, I was speaking for myself. (As is the case when I offer an opinion.)

But you're right. I should be clear lest others misinterpret...Ace has its uses and I'll pull it out when I need it. It's especially helpful in teensy pre-op doses. I will say, however, that I happen to believe it's overused as a sedative.

I know hospitals that will use it on each and every fractious animal when a myriad of other drugs would be far easier on the animal's nervous and circulatory systems. 

But again, let me disclaim, this is only an opinion. 

Dr. Patty Khuly October 21st, 2009 06:06:24 AM

Yes, Dr. Khuly, it was an opinion but an opinion stated on a blog meant for the general public about a very complex issue. The choice of acepromazine over other sedatives is as controversial in the vet world as  the choice of induction agent or gas. As you know, drug choice is made based on a multitude of parameters: age, reason for the sedation, demeanor, health, etc etc. If you bad mouth acepromazine, it makes it that much more difficult for the vet down the road who has chosen acepromzine for a very appropriate reason. Acepromazine can lower blood pressure but it also protects renal function even with lowered blood pressure. We do not, yet, know the effects on perfusion of that "other" drug commonly chosen for sedation instead of acepromazine. Anesthesia/sedation is constantly evolving and changing but your "opinion" will live on in the pages of this blog.

virginian October 21st, 2009 07:54:11 AM

virginian: Duly noted. You most definitely have a valid point.

However, if I truly believe it's in the best interest of my patients not to have to suffer the potential dysphoria associated with using a tranquilizer in place of a true sedative when sedation is the goal (as I believe occurs frequently) then should I not express my opinion so that owners have more information? 

It's like the declaw argument or any other issue I treat (e.g., hyperthyroidism and I-131 vs. methimazole, soft palate resections and bulldogs, TPLOs vs. extracapsular repairs, tacking large breed dogs during spays). All my opinions make it difficult for veterinarians to convince clients otherwise should these pet owners find their way to my blog. 

Because I recognize this, I do try to ensure that it's clear that others feel otherwise (as I've done here) but it's hard to write passionately about veterinary medicine (as I try to do) without injecting my personal beliefs along with the literature, specialist opinions, etc.

I agree that I have not done so here with respect to Ace (i.e., present literature or more authoritative opinions than my own). It's a clear lapse of my preferred approach and I should remedy that by addressing it in a complete post on the subject. 

But please (for your benefit and that of others who amy read this) do not interpret my words as an outright condemnation of this drug or of any other approach I may find less adequate than others. We all have to remember that medicine is an art and a science.

Thank you. Sincerely. 

Dr. Patty Khuly October 21st, 2009 09:01:57 AM

I had a bad experience with use of Torbutol prescribed for two different dogs, clearly causing some type of anxiety symptoms.

Couldn't wait for the effect to wear off and hope I never see that again.

Barb A./NH October 21st, 2009 05:15:51 PM

Not to keep the topic of Ace vs. Xanax going, but I am a thinking consumer of veterinary services and I enjoy this blog simply because Dr. K. writes with such passion and freely offers her professional opinions.

Ace is used a lot in the horse world and I've witnessed first hand the dysphoric reaction and it's not pretty. Most horses go to dopey-land. A neighbor's dog was prescribed it for fear of thunder and it didn't help at all. (He also had a dysphoric reaction — it made him more anxious.)

Which has got me thinking on an off-topic tangent.... I've been offered Ace for my dog for his last trip to the vet. Because of his cancer, I expect that my final decision will be to deliver him from his pain and that he will be quite aware of where I'm taking him and I want to put him chemically into the "I don't care" zone. I had forgotten about the dysphoric reaction. Now I'm wondering if I should ask for something other than Ace.

Thoughts?

Deanna October 22nd, 2009 12:21:52 PM

I don't blame you in the least.  Sadly extreme measures must sometimes be taken because we cannot explain to our pets what they must do to recover after surgury.  I'm with you on the whole "last resort" plan.  Don't forget that you do not need the extra stresses of worrying about him and constantly cleaning him to get in the way of your regular work load.

Truthfully I was waiting to see how he faired in post-op.  Every time I hear a puggle owner talking to the vet here (paper thin walls) they complain about not being able to control them after surguries.

I wish you and Slumdog the best of luck in his recovery.

Kathleen October 23rd, 2009 09:39:35 AM

Deanna: Ask your vet about a whopping dose of valium or alprazolam. It works wonders in this setting, IMO. But this is a discussion you should have with your provider. 

Dr. Patty Khuly October 23rd, 2009 03:52:49 PM

No..and I will remember this information when our little one has his surgery.

April November 10th, 2009 07:20:06 PM