Of course I agree with you.

As you use your son as an example, I would add that both for ourselves AND for our pets we need to ask all those questions, and take the time to try to discern the quality of care that will be provided. Unfortunately, sometimes experience is the best teacher of what questions need to be asked.

I would also urge everyone, for themselves, their human loved ones, AND their pets, to do another thing in addition to asking questions: Check for disciplinary records with your state's medical board/veterinary board (for humans/pets respectively).

The mere presence of a disciplinary file may or may not mean you should stay away (there are some disciplinary records I don't worry too much about, such as a BRIEFLY expired licensed, which may merely be the result of a little procrastination; although if they were practising on an expired license repeatedly or for years, it would raise some concerns).

BUT if you see ANYTHING in the record related to patient safety or quality of care, I urge you to really think about whether you would feel comfortable if that SAME behavior were applied to your pet/self/child, etc. If the answer is no, go elsewhere. Also, you really need to read between the lines and assume the worst with these records, because they often are devoid of information about patient outcome, IMHO deliberately to avoid implying cause and effect. You will read, for example, "a dose in excess of what was indicated for the dog's weight was given." You may not get to read: The dog subsequently died of a drug overdose. It depends on the case and the state.

If anyone wants info on requesting vet disciplinary records, let me know.

My friend the nurse-anesthetist used to scoff at my abundance of caution re: procedures requiring anesthesia (for humans or animals). He just didn't see what I worried about. He's very, very good at his job. He will put you to sleep, and he will *wake you up.*

Then his wife (also a nurse) went into his *own hospital* for a procedure, someone screwed up a pre-op dosage by a factor of ten, and he found himself performing manual CPR on his beloved while shouting out the hallway for help. Had he not been by her bedside ...?

Oh.

There's also some more recent research that indicates that there are measurable physiological effects on the human body for *months* after a general anesthesia. No reason to think other animals are any different.

I try to advise my clients to make the most of every necessary anesthesia. If the dog is being neutered, or any other non-emergency procedure, get the hip radiographs required by the breeder, the dental, the rear dewks removed -- whatever you might need -- right then.

Yet some vets around here seem to push a parade of serial anesthesias -- we'll do the dangly dewks at four months, the entropion at five months, the spay at six months, and knock her down for a dental at one year. Maybe they have their medical reasons -- but it sure looks like they are milking the client. In any event, it doesn't seem very respectful of the major risks or chronic effects of general anesthesia.

Wow, Meghan, that is really useful info. Here is a question:

My mom's dog is going to be spayed soon, she is about 9 mos. She also has an extra tooth, which looks like it may be getting in the way of her bite.

Her vet said that she plans to extract the tooth at the same time as the spay is done. I gather that is a bad idea?

Also, I think most people don't know about the 4-5 hour thing. I was contacted by a heartbroken older couple whose 11 year-old dog went for a dental -- he was referred to a high-end veterinary dental clinic here in the area where that is all they do, so you would think these guys are the experts, right?

Well, according to the couple, they sat in the waiting room for HOURS. At some point, someone came out to tell them he was doing ok, but then somewhere around 3-4 hours they were still at it -- the vet came out and told them their dog "didn't make it." Obviously, they were floored. When they recovered his body, they found that they had removed EVERY SINGLE TOOTH on one side of the dogs mouth, but they had NOT told the owners that is what they were doing, and the owners expected a few extractions only.

They were told by a lawyer they didn't have a case, and dissuaded from filing with the vet board.

But it seems to me that in a geriatric patient, they should not have attempted all these extractions at one go, keeping the dog under 3+ hours -- and you would think THEY would know that, of ALL people.

If the poor owners had only known, they could have specified limits. It would have been different if this dog was suffering imminent consequences of dental infection and was going to die from it if they weren't all taken that day, but apparently, that was not the case, and they just took him there to a dental speciality clinic on the advise of their regular vet because they all thought that was EXTRA conscientious in a patient his age -- yet they keep him under 3+ hours and pull all the teeth on one side w/o notifying owners. Till he dies. Some experts!

Stefani-

Pulling a deciduous tooth at the time of spay is commonly done, and as far as I know, quite safe. What I was refering to was performing a dentistry on a mouth with significant dental disease at the same time as abdominal or orthopedic surgery. The idea is that when you start cleaning and extracting, you stir up all the bacteria and cause the gums to bleed, possibly allowing bacteria into the bloodstream and opening the patient up to a serious infection.

Sometimes- when the dental disease is severe, and the surgery cannot be postponed- it may be worth the risk to get the teeth cleaned. Otherwise you will wake the dog up with a constant source of pain and infection.

The time factor is not set in stone. If a patient is stable while under anaesthetic and staying warm we will often leave them under to get the job done. Dentals with lots of extractions can often take 3-5 hours. However, if the patient is becoming unstable the procedure should absolutely be aborted.

In the case of the 11 year old dog you refer to- it is possible he was stable- until he wasn't... Confusing I know, but occasionally it happens that a patient arrests without warning. Possibly he threw a clot- it's hard to know without a necropsy. The key is monitoring- was he being monitored? Were there any signs that he wasn't doing well? Was he cold? Was his blood pressure, heart rate, or respiratory rate dropping? In any case it is sad that he didn't survive- I'm sure the veterinary staff were just as shocked and saddened.

What a sad and unfortunate outcome but do you really know the source of this story? It isn't jiving with me because how many people are left waiting in the lobby while their pet has a dental no matter what number of teeth are being pulled? Between the intake, procedure and recovery its an all day affair. The speciality clinic where I took my geriatric dog to did a lengthy consult, xrays and then discussed what they were planning. We did 6 extractions in one day rather than put him to sleep twice.