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Last week I posted on the cost of spays and neuters in veterinary practice. In the comments below the post, it became clear that concern for the risks the procedures entail, particularly for the intra-abdominal spay, run high among you.
No matter what we veterinarians may say to calm your fears it’s true. Every surgical procedure has its risks. And while a spay is a surgery we may perform every single day of our careers, even common procedures have their dangers.
In fact, sometimes the most ordinary procedures can be the most dangerous. That’s why so many of you are wise to fear the lowly dental. You understand that anything can go wrong with anesthesia.
But that doesn’t mean you should avoid all veterinary care involving anesthetic risks. Minimizing their necessity, for example by brushing your pets’ teeth regularly, is the right approach. Giving in to your anesthephobic impulses and allowing your pet to suffer infected teeth as a consequence is the wrong one.
That’s why the best way of mitigating your pets’ risk is to choose your veterinarian and veterinary hospital wisely. My best advice? Get to know them well before electing an anesthetic procedure!
It’s also my preference, and this is personal of course, that your hospital of choice not downplay the risks. For my money, “Don’t worry we do this all the time,” doesn’t provide enough comfort. When I choose a doc for my son, for example, I want to know what exactly they do to decrease risks. How many staff, what kind of monitoring equipment, etcetera.
But most of all, I want to know that my surgeon shows, by taking my question seriously, that he or she has a healthy fear of surgical risks and anesthetic procedures. I don’t want a hyper-confident cowboy type in the OR working on my children. I want someone who gives a thoughtful, measured response to my questions and who admits the risks the procedure entails.
If I dropped my pet off for a spay and the staff said, “Don’t worry, shell be fine,” that’s one thing—it’s a courteous thing to say and it’s almost always the truth. But if my vet were to say: “Relax. This is really no big deal,” I think I might start shopping for a new one.
But that’s just me. I’m nervous about my pets just like you are. I want someone who thinks a spay is as big a deal as I do. No, it doesn’t mean I don’t ever let my guard down—‘cause I do sometimes. We all do. We're only human.
My point? Healthy fear is a good thing. It’s a philosophy of practice that makes life more stressful for the vet, but it’s ultimately what you want. Finding a veterinarian who takes that fear and uses it wisely isn’t so hard, either. Simply pick someone who you trust who admits to taking all possible precautions when it comes to your own pets’ care. That’s what I’d do.
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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.
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.
While combining some procedures under one anaesthetic is certainly in the best interest of the pet (spay, dewclaws, and entropion), adding others can be detrimental. For instance performing a dental at the same time as an abdominal (spay) or orthopedic surgery, can lead to serious infection.
As someone who performs anaesthesia on a regular basis I can also say that while multiple anaesthetics MAY have a detrimental effect, very long anaesthetics DO have a detrimental effect. For example a dental procedure that is approaching 4-5 hours- sometimes, the pet begins to get hypothermic (cold) and hypotensive (low blood pressure) despite all preventive measures. In these cases it is safest to abort the procedure, recover the patient, and do the rest later.
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!
If I haven't missed it, any chance of doing the pros and cons of spaying early or even at all? The peer reviewed articles I have seen published don't really support the theory that spaying before heat is a *major* risk factor in developing osteosarcoma but if I've missed something I would be interested as that is a nasty disease. Thanks.
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.
I also wanted to add- it is no surprise to me that the owners were shocked at how many teeth were removed. People often have no idea how bad their pets mouths are. On more than one occasion I have met with owners who were dropping their dog off for "just a cleaning". When I examine their pets mouths with them at admit and tell them that there will most definately be extractions they always refuse to believe me. Some of them walk back out with their pet because they are angry at me and think I'm just trying to get more money out of them. Most can be persuaded once the vet has a chance to talk to them.
I wonder if the people you refer to had signed something that gave the vet permission to do what was needed? We hate having to go back and forth with the owners when we find more disease than is expected, only because it is time consuming and leaves the patient waiting under anaesthetic. If clients are willing, I get them to let us go ahead and extract whatever is necessary (with an esimate of cost of course) to minimize time under anaesthetic for the patient.