- How can I lift my big dog if it is struggling to walk?
A harness is a very useful “handle” for lifitng the front end
The towel belt from a dressing own or a broad leather belt can make useful loose loops to function as slings for under the tummy to help lift the hind quarters. These are better than using towels, as they are easier to hold and less likely to slip out of your hand.
See our information sheet
- How can I get my dog to feed from a height?
Some dogs with long term oesophageal and swallowing problems – eg patients with megaoesophagus, which remains present after vascular ring anomaly surgery – need to be fed from a height long term
Feeding pups from height can be done as shown:
For adult dogs, you can buy food/water bowls that are elveated on a stand, and train the dog to eat in a seated position so that the oesophagus slopes down from the mouth to the stomach. If your pet is resistant to eating seated, you can achieve the same effect in the standing dog by having the bowl even higher and putting a step – an aerobic exercise step works well for big dogs – in front of the bowl so that the dog has to put its front feet up on the step to reach the bowl.
- How do I put an Elizabethan collar together?
- How to make an inflatable collar from bubble wrap
Bubble wrap can make an excellent inflatable collar – -cheaper and better than the ones you can buy because it can’t deflate. Inflatable collars are useful used behind classic Elizabethan collars as the inflatable one helps hold the plastic collar forwards, making it harder for the pet to “get round it”.
- Bruising after surgery – is this normal?
Some surgeries bruise and swell post-op. Some cruciate ligament surgeries do this. The key things to look for are:
Is your pet still well in themselves and eating well?
Is there any discharge from the surgical wound?
If the surgical wound is an orthopaedic one, is the leg capable of weight bearing?
If in doubt, take a picture and email/text it to us.
The picture below was taken 2 days post-op after a cruciate ligament surgery, done with a bone cutting technique (closing wedge TPLO). This one has bruised and swollen more than most, but there is no discharge and we expect this to settle down over the next few days. So a simple picture emailed through, and a phone conversation was all that was needed.
- When should I get hydrotherapy? Where should I get hydrotherapy?
First question: “Does my pet need hydrotherapy?”
Some cases really benefit markedly from hydrotherapy – eg femoral head and neck excision.
Many cases can benefit from hydrotherapy – eg cruciate surgery
In some cases, hydrotherapy is specifically NOT recommended eg total hip replacement.
The aftercare sheet we will have given you very often specifies whether hydrotherapy is recommended after the surgery your pet has had. It will often have been discussed during the consultation. The wounds must be well healed before hydrotherapy, and this means no hydrotherapy at least until we’ve seen you at 2-3 weeks post-op. We see almost every case back at this time. If in doubt, ask us!
Where should I get hydrotherapy?
The hydrotherapy industry is unregulated – meaning just about anyone can set themselves up as a hydrotherapist. Skills, experience and facilities vary widely.
Ask your own vet as they will know about the hydrotherapy centres close to you!
Rehabilitation, physiotherapy and hydrotherapy have moved on in recent years and many vets are now getting personally involved with rehabilitation. The use of underwater treadmills is becoming very popular as a more readily available method of using water for rehabilitation than a large expensive swimming pool with all of the plant that that requires. In addition, there are often wider physiotherapy services available alongside hydrotherapy.
There are two organisations that hydrotherapy centres can voluntarily submit themselves to for assessment, which includes assessing their cleanliness and standards of hygiene. These are the Canine Hydrotherapy Association (CHA), www.canine-hydrotherapy.org and the National Association of Registered Canine Hydrotherapists (NARCH), http://www.narch.org.uk.
There are two good options for getting quality hydrotherapy and physiotherapy local to Lichfield with veterinary supervision. While many centres continue to do a good job without veterinary staff on the premises, centres that have veterinary staff involved with the rehabilitation are able to offer a more refined and involved rehabilitation service.
Pool House Veterinary Hospital are located in a rural on the southwest side of Lichfield. They are a large well established general practice with an excellent reputation giving a very good service at sensible prices. Their lead hydrotherapist is a Registered Veterinary Nurse who is involved in the advanced training of other hydrotherapists.
Emma Poore is a veterinary surgeon with special interest and expertise in physiotherapy and rehabilitation. Emma runs her own general practice, the Star Veterinary Clinic at Appleby Magna. Her clinic is also in a rural setting on a small industrial park but it is very modern and she has invested heavily in quality equipment right from the off, including a water treadmill and gait analysis mat. Emma sees a heap of agility and working dogs, and rehabilitation is her passion! She is involved in the training of other rehabilitation practitioners.
- How can I restrict my pet’s activity?
Stair gates are a good means of preventing access to stairs or to particular rooms. If your pet is normally allowed into the lounge to climb onto chairs etc, or if it has a favourite window sill to climb onto, consider keeping the door to that room firmly closed, and hang something on both sides of the door handle to remind you to shut it! Use a lead, this can even be considered for cats, and cats often do better with a lead and harness rather than a lead and collar. For neck injuries you need to use a harness rather than a collar anyway. Assist your pet into and out of cars. Use ramps, or else use a helping hand under the pelvis on the way up, and a helping hand on the breast bone on the way down.
Consider using a cage. Ones that are about 36″ long (approx 90-100cm) work well for cats and small dogs. We sell these for £60, but we suggest you buy in advance on-line, or else beg/borrow one from friends/neighbours to save yourself some money. Try putting a request to borrow one on your Facebook network – you’ll be amazed how many of your friends have one folded away idle in their garage.
Really big ones can be conveniently and economically bought from large stores or on-line. Keep your pet’s playmates calm and under control. Avoid winding them up to exercise with toys. Make sure children know the rules!! If you aren’t sure they’ll comply, consider using cable ties as a cheap way of securing the cage door from inquisitive fingers! But in our experience, children often love the responsibility of feeling that they are in charge of supervising the pet’s restricted activity!
- Should I clean the wound?
As a rule, no. Gentle blotting of any discharge with a dry, clean, non-linting cloth like a clean tea towel or kitchen roll is a good idea. Avoid cotton wool. Avoid rubbing. If you wet the wound you may make it look cleaner to the naked eye, but you are actually turning bacteria on the skin and any discharge into a soup that is then washed back into the wound. If there is discharge, seek advice. Consider sending us a digital photo to firstname.lastname@example.org. Two particular wounds that can often look a little crusty in the early stages are ear wounds, and perineal urethrostomy wounds in male cats that have had surgery for an inability to pass urine. These wounds should be left alone other than blotting. They will look much better after suture removal!
- Why does my pet lick at the sutures and what should I do about it?
Licking at the wound can result from clipper rash, which is skin irritation caused to the skin during wound preparation. Licking might also reflect suture irritation, sutures may become a little tight if the wound swells at all. Discharge, sometimes indicating infection, can encourage licking as normal cleaning behaviour. But licking can be destructive and it is best avoided. Seek prompt advice if licking persists. We may use dressings or collars to prevent licking causing damage to the wound.
- How would I know if a wound was becoming infected?
Discharge, especially smelly discharge, from a wound is cause for concern. Infection often causes increased interest in the wound with licking noted. Your pet may be off-colour and declining food.
- How likely is infection in the wound?
Not likely at all. We are scrupulous in our standards of disinfection and hygiene, and in preparing wounds for surgery. We strive for zero-infection rate, but the sad reality of surgery is that this elusive goal is never quite reached. Infection risk in otherwise routine surgery is often quoted at around 1%.
- Hair around a wound is accumulating exudate and smelling. What can I do?
Willow had a tracheostomy procedure to allow her to breathe through a stoma (hole) in her neck, by-passing the larynx. (Some saggy flaps of skin were also resected from either side of the neck to stop them flopping over when she slept and inadvertently blocking the stoma). Hair round the stoma can accumulate exudate and smell a little. The moist skin under the wet hair can get sore. It is an easy matter to keep hair clipped from around the hole. This is best done with two people, one to gently hold the head up, and the other to use a quiet pair of clippers (eg male grooming kits from Boots or Argos) and a vacuum cleaner on a very low setting to draw the clippings away from the stoma.
This technique also works well on simple skin wounds – eg on the legs and body.
Then just blot the stoma or wound dry with kitchen towel (not cotton wool which will “lint”). Once it is dry, a sparing smear of vaseline/petroleum jelly will help protect the clipped dry skin from further moisture.
- My pet hates the Elizabethan collar. Is this normal?
Let’s be honest, your pet isn’t likely to want the collar on! But consider the consequences of the collar coming off. It is usually best to put it on and leave it on. They can often be cleaned in situ with a damp cloth without the need for removal. Let them get used to the collar, have their moment of annoyance, and then come to terms with wearing the collar. If you keep taking the collar on and off, the pet gets frustrated because it thinks the collar is a punishment and they don’t understand what they’ve done wrong. If you take the collar off, they are back to square one, having to get used to it all over again. Most animals can eat and drink just fine with these collars on, even though at first it might look impossible. An alternative to an Elizabethan collar is an inflatable one which may be adequate to protect wounds from licking in some cases.
- What alternatives to Elizabethan collars are there?
- A dressing has been put on. How do I look after it?
Don’t let the dressing get wet. Walk your pet on pavements, on paths or on well mown, dry grass, not muddy fields! For limb dressings, use a thick polythene bag over the end of the limb during toilet breaks. We often give out out drip bags (bags that have previously had saline in them). If these are cut in half and the inside is dried out, they make for strong “wellies”. Parcel tape is handy for keeping the bag up for the few minutes that they need to be on. But don’t leave bags on for more than a few minutes at a time, as they keep moisture in as well as out. That means that if they are left on for long periods, the foot will become sodden anyway.
Some animals urinate on dressings by mistake; to guard against this, you can place a bag over the foot as above, and then wrap the dressing that is still exposed above the bag with cling film. This can then be removed a few minutes later after the toilet break.
If the dressing slips, get it seen to. A slipped dressing is an irritation to your pet, is no longer protecting or immobilising what it should be protecting, and may even be increasing the leverage on injured bones/joints. The great majority of our dressings are put on so that you can just see or feel the claws at the end of the leg. If you could see them, but now can’t, the dressing has probably slipped.
Make sure the dressing is changed at the appropriate interval. If you can’t remember when, please ring and ask!! Usually dressings are removed and/or changed every 3-7 days. Sometimes we’ll leave them on a bit longer but it would be very unusual for the interval to be more than 10 days.
Most dressing changes can be done conscious while you wait. For some more fiesty pets, sedation may be needed so it would be wise not to feed your pet for a few hours before a dressing change, just to be on the safe side.
For some surgeries, a dressing incorporating a splint or a cast is used, often for several weeks.
Animals will often try to pull the padding layer out of a dressing if they are given half a chance, so please be pro-active in using an Elizabethan collar to prevent interference with the dressing.
Dressing sores will unfortunately occur from time to time. These are more common if the dressing is allowed to get wet; if the dressing incorporates a splint or cast; if the dress is maintained for several weeks; if the dressing slips; or if the dressing is interfered with. These sores usually resolve uneventfully once the dressing is removed.
Many surgeries will simply have a thin Primapore dressing over the site. This is a thin white dressing. If the wound is exudating, it will be obvious through the dressing which will be wet. If this occurs, let us know promptly. Many wounds will leak the odd spot of blood or tissue fluid immediately post-operatively, but in this case the the evidence of exudate will be minimal, dry, and the Primipore will look the same every time you look at. Be wary of trying to replace the Primpaore yourself unless advised to do so. We glue ours on, and it is unlikely that you’ll be able to get a replacement to stay on long at all.
We advise that you just leave the Primapore alone and let it fall off in its own good time. This often occurs in 2-3 days, which is fine. The record is currently held by a post-op spine patient who kept his original Primapore on for 4 weeks before even we got impatient and took it off!
See dressing information sheet.
- How can I stop my dog scratching at wounds?
Socks held up with loose laces
Sports socks (they are harder wearing!) can be adapted to cover the claws. Laces can be threaded through them. Be careful not to over tighten these as this could interfere with blood supply and also adversely affect tendons (eg the Achilles tendon).
“Hobbling” the bag legs together with elastoplast can be used if all else fails to prevent the legs from being lifted forwards by the pet independently. Be careful not to use tape applied too tightly; we would advise that this is only ever done under vet/nurse supervision, at least for the first time you do it so you are shown what is required.
- What is the likely outcome after osteotomy (TTA, TPLO, closing wedge osteotomy) procedures for cranial cruciate ligament ruptures?
Owners often ask what the future holds after an osteotomy (“bone cutting”) procedure for cranial cruciate ligament rupture. These dogs either have at the time of surgery, or else will go on to get in the future, some degenerative joint disease (DJD). This is to be expected because a joint with a ruptured ligament and/or torn cartilage is no longer “pristine”. It is also important to remember that many dogs develop problems with the cruciate ligaments in BOTH of their stifles (knees).
But after osteotomy surgery for cruciate ligament rupture(s), most dogs return to a quality and level of activity that is, for all practical purposes, normal. They can run round the park, enjoy games with the kids and go on long family walks. Often owners report no significant lameness at all in the months/years following surgery, or else report a dog that just gets a bit of stiffness for a few moments on first rising from rest but is not apparently stiff or lame after that. Later in life, treatment for the DJD that follows cruciate ligament injuries might be required – see our information sheet on this topic under “fact sheets”.
Consider, the footballer Michael Owen had the best cruciate ligament surgery that money can buy … but it won’t save him from arthritis in that joint when he is older!
We recently heard a very pleasing report from the owner of Otto, a large breed dog (Doberman), sent to us a by a delighted owner one year after surgery. This dog returned to full-on athletic function. In March 2015 Otto was 2 years old and 40 kg in weight when he had a TTA osteotomy procedure. He also had a cartilage tear which was tidied up at the same time. In March 2016 we received an email update:
“I wish to thank you for the remarkable recovery my working Doberman Otto has made in the 12 months since his cruciate repair. He has gone from being totally lame to competing in the dog sport Schutzhund and claiming his first title of IPO 1. Not only that, but he had the highest overall score of all dogs competing and the highest Tracking score of all the dogs entered! I cant thank you enough as he is so fit and agile. From the state he started from, never thought this would be possible. Once again thanks for the care you gave him and top class surgery that put him on the road to recovery from a serious injury. I have attached a couple of pics from the day he arrived home and from last Sunday to show him before and after. I cant say how much I appreciate what you and the team did for Otto. Many thanks from Mark & Otto”
[From Wikipaedia: Schutzhund (German for “protection dog”) is a dog sport that was developed in Germany in the early 1900s as a breed suitability test for the German Shepherd Dog. The test would determine if the dog displayed the appropriate traits and characteristics of a proper working German Shepherd Dog. Today, it is used as a sport where many breeds other than German Shepherd Dogs can compete, but it is a demanding test for any dog that few can pass].
We were similarly delighted to get this email . It is always nice to hear long term follow up on how cases are doing.
“Good Morning All, One year ago today our 3 year old Cocker Spaniel Cav was admitted to your fantastic hospital for a cruciate ligament operation. I must admit I was extremely nervous and Cav was to! From start to finish all the team at west midlands referrals were fantastic and the operation has been a huge success. I would just like to say one year on he is back to his old self with long walks and always looking for the next adventure. You looked after my best friend like he was your own and I am extremely great full for all your help and hard work so please accept and enjoy a small token of some flowers which will be with you today and please enjoy them in your reception. We’ve sent a picture of Cav, back to his best! Thank you again kind regards. The Scott family, Derbyshire”
- Could there be a problem with the metalwork in my pets leg, long after surgery?
Pins and wires, and screws and plates, can sometimes be the cause or irritation months or years after surgery. If this happens there will often be swelling and/or licking at the site.
Removal of the metalwork usually leads to rapid resolution of the problem.
- What are these drugs that we have been given? What are their side effects?
Claviseptin and Baytril are two antibiotics that we commonly use. Side effects of these are few and far between.
Metacam and carprofen are our usual choices. Only one NSAID is used at a time. They can sometimes cause gastrointestinal upsets – vomiting or diorrhoea. If these signs are seen, stop the medication and seek prompt advice. We may avoid these or use reduced doses in the event of liver or kidney problems.
Tramadol. This is an opiate painkiller. Side effects are occasionally seen and can include drowsiness and vomiting.
- Why can’t I get further medication from West Midlands Referrals?
Our fixed price scheme includes an initial supply of drugs from us.
We typically supply antibiotics (usually clavaseptin), non-steroidal anti-inflammatories (NSAIDs, usually carprofen or meloxicam), and sometimes extra analgesia (usually tramadol for dogs and buprenorphine for cats).
We typically supply enough medication for 5 days, a common time for an early post-op check-up.
We don’t make any charges for follow up checks but we do make charges for any follow up drugs. As policy, we ask that further medications are sourced from the referring veterinary practice. As a surgical practice our drug stock is far more restricted in range and quantity than is the case for a typical general practice. So we can’t supply some medications, and even if we could, they are almost certain to be substantially cheaper when sourced from your own practice.
- My pet hasn’t passed motions since surgery. Is this normal?
Eating and drinking should be occurring pretty much as soon as you get your pet home. Your pet will normally have been observed to eat and drink in the hospital before discharge, although some animals, especially cats, simply refuse to eat in a strange environment. Urination should have occurred in the first 12-24 hours after discharge. If it hasn’t we need to know promptly! The bowels often grind to something of a halt with a general anaesthetic and with the opiate drugs that we give for pain relief around the time of surgery. Add to this the starvation before anaesthetic / surgery and reduced appetite post-operatively (or enforced with-holding of food in some cases), and it can take a few days for defaecation to normalise.
- How do I do the extension exercises after femoral head and neck excision surgery?
Passive extension exercises are required in the two months following this surgery. We recommend 3 sessions of 5 minutes each per day, for two months. Giving your pet pain killers over this time will make life a lot easier for them and for you.
Femoral head and neck excision (FHNE) involves removing the ball of the hip ball-and socket joint, usually with an oscillating saw. As healing progresses, a fibrous tissue articulation develops to replace the joint. Diligent physiotherapy and/or hydrotherapy is needed in the following two months to keep this pseudoarthrosis (“false joint”) articulation flexible to achieve a decent range of long-term extension. One major benefit of FHNE over almost every other orthopaedic procedure is that there is no need to restrict activity in the post-op period. Activity, including stair climbing etc, is very much encouraged. See our post-op aftercare sheet for FHNE for more detail.
This surgery is vastly cheaper, less technically demanding and less complication-prone than total hip replacement. Indeed, when THRs do get serious complications, they often get revised to FHNEs. The function that is achieved with FHNE is usually more than adequate in cats and small dogs. FHNE is generally less adequately functional the larger the patient gets. That having been said, good outcomes can still be achieved in larger dogs.
Common indications for FHNE include:
* Luxation of the hip joint(s) secondary to hip dysplasia where hip replacement is not an option.
* Chronic degenerative joint disease failing to respond to medical management where other surgical options have been ruled out.
* Fractures involving the joint where fracture fixation is not possible /desirable or is ruled out by economic considerations.
* Legg Perthe’s disease, typically seen in young terriers. One or both femoral heads lose their blood supply and disintegrate. Legg Perthe’s disease is painful.
These images show how to do the extension exercises:
- How can I help my pet walk after spinal surgery?
Slings can be bought, or they can improvised from a leather belt, a scarf or an old bath towel. Helping your pet to balance, while letting them take much of their weight, can be very useful. Keep your own back straight when you are lifting them!
Regular short periods of lifting, every 2-3 hours, are better than less frequent periods of lifting. If intervals are longer muscles stiffen up and cramp.
Partly inflated Pilates balls can be useful for big dogs. Straddle the dog over the bag and gently rock left and right, forwards and back to encourage them to make decisions about weight bearing and adjusting posture.
Your pet should be regularly alternating how it lies, and on which side. Hydrotherapy is really useful, as is advice from one of our recommended physiotherapist / hydrotherapists, click here for links. Short, dry grass, rubber matting or rough carpet is an ideal surface for early walking attempts. The texture is good for stimulating sensation, while providing some grip and cushioning.
Take great care that your pet doesn’t traumatise the top surface of their feet on hard surfaces. Steps made out of paving slabs are a nightmare for this as they have very sharp and unforgiving edges. To screen off these edges, get some foam pipe lagging material from a DIY shop, slit it long ways and stick it with duct tape over the edge of the step.
Tickling the toes with an electric tooth brush is a good way of stimulating sensation.
For large dogs, a frame supporting a sling can be very useful to take the dog’s weight while the individual legs are worked on.
- What does hydrotherapy achieve?
Swimming under the control of an experienced hydrotherapist or physiotherapist helps maintain muscle mass and joint range of movement after orthopaedic surgery, and using the support of water can greatly assist mobilising limbs after spinal surgery before recovery has progressed far enough to allow unaided walking. Wounds must be healed before immersion, so we would rarely advise swimming earlier than 3-4 weeks post-operatively. We only recommend Canine Hydrotherapy Association (CHA) approved hydrotherapy pools, click here for links.
Some hydrotherapy services have veterinary and physiotherapy advice available on site. Pool House Veterinary Hospital in Lichfield and STAR Rehabilitation Clinic at Appleby Magna near Swadlincote (see links).
- My pet has an external fixator; what do I need to do?
Some orthopaedic procedures involve the use of an external fixator see photo which involves pins protruding from the skin connected to a scaffolding that links them (see information sheet). Some minor discharge from the pins is normal. Blot any discharge gently with non-linting material once or twice a day and don’t bathe the wounds. It is very important that the frame doesn’t get hooked on to carpets, tassles on furniture, curtains, the bars of cages, under radiators etc etc. If your pet escapes from the house, there is a pretty good chance the frame will get hooked on a fence so keep them in!! Consider the use of a cage. Consider screening off the bars of the cage with cardboard or hardboard inside the cage. The sharp ends of the pins often concern owners because they fear that the sharp pin ends will prang the other leg. Animals very quickly learn to avoid doing anything that hurts! However the sharp pin ends pose quite a risk to your hard-earned furniture. Please take precautions before bits of wood get gouged out of favourite chair legs etc!
The clamps, (the bits with nuts and bolts which connect the pins coming out of the leg to the connecting bars), should be well clear of the skin. if you can’t see “daylight” between the clamp and the skin, get advice. You can bring the patient for a recheck, or you might consider taking a photo and emailing or texting it to us, and then giving us a call.
- If my pet can’t urinate on its own, what are the options
Simplest is to “express” the bladder. Gentle pressure is applied across the abdominal wall to compress the bladder so that urine is expressed down the usual channels. This requires a compliant patient that will tolerate the manipulation. We do this a lot for hospitalised patients. Some owners and some patients might be suitable for this technique being taught for the owner to do at home on a short or long term basis.
Bladder expression is done 3-4 times per day. Sometimes drugs can be used to reduce the the outflow resistance, to make it easier to express the urine.
In male dogs (that have willies!) it is easy to pass a catheter and we regularly teach owners how to do this, so that they can empty their pet’s bladder at home. This most commonly done for convalescing spinal surgery patients where the ability to urinate has not yet returned, and where cost issues mean that prolonged hospitalisation is not desirable. There is some risk of introducing infection into the bladder at the time of catheterisation, which could cause ascending urinary tract infection (UTI) with cystitis, and even pyelonephritis (kidney infection). So hygiene is imperative for catheterisation and we often have these animals on prophylactic (precautionary) antibiotics and bladder wall protectants (Cystaid, Cystease etc).
We can place indwelling catheters (most commonly in females), but this has increased risk of UTI and there is the need for an Elizabethan collar to prevent the patient from interfereing with the catheter.
- RSA Insurance
For years, we’ve been saying to each other within the veterinary industry that the steady inflation of veterinary prices and especially the steady inflation of referral practice prices is just not sustainable. It has been obvious that it would lead to more and more clients not being able to afford their escalating insurance premiums, or to the insurers having to place caps on their liabilities and cover, to the detriment of pets and their owners. We’ve seen both of these occurring year on year.
The RSA insurance group which underwrites More Than, Marks and Spencer, John Lewis and Argos insurance policies has led the way with a strategy to address this looming problem. They have put together a group of referral practices, their “preferred providers” that includes specialists and advanced practitioners covering a range of veterinary disciplines across the country. These allow pet owners to get a quality referral service, while keeping a limit on ongoing costs for the insurer. The aim of the RSA network is to provide a quality service that will be sustainable and so will be there for the generations to come.
We are proud to be one of the RSA preferred providers.
- Does West Midland Referrals extend credit?
Unfortunately we are not usually able to extend credit. Our fees are exceptionally competitive, and we can only keep them that way by requesting payment at the time of treatment. If you will have difficulty settling your account at the time of surgery, please raise this with reception and with the admitting vet before the procedure. We will try our best to find a way of accommodating your needs, but any negotiation on payment or price MUST be in advance of the procedure, not afterwards.
- Does West Midland Referrals take cheques?
Unfortunately we can’t accept cheques, but we do accept debit cards, credit cards or cash.
- Can you claim directly from my insurer?
We may be able to claim direct from your insurance company. If you think that you may want to take advantage of this, please make sure that you raise this with us in good time. Insurance companies will often need a few days to agree to fund a procedure. For elective (non-emergency) procedures we need any direct claim to be authorised by your insurer in advance. For emergency procedures there may not be time for such formalities, but please make sure that you discuss your desire for a direct insurance claim with the surgeon at the time of consultation/admission.
We can’t offer direct insurance claims for sums under £300 (eg for consultation or for a course of laser therapy) so please have be sure to have means of payment with you for these relatively small sums. We can still process an insurance claim form for you though, so you will be reimbursed by them according to your policy details.
If you want us to make a direct insurance claim, please still have the means of settling your insurance excess with you when you come to see us. Even if you have already paid this excess at your own vets, it is our experience that insurers usually subtract the excess from the claims that we submit because our claim often gets to your insurer before the one from your own vets. We then end up wasting time chasing up owners for the payment of the excess fee. If you settle your excess with us and it then isn’t deducted from our claim, we promise to reimburse you promptly once we have received payment from your insurer.
- I’m insured. Will you help me with my insurance claim?
Yes. If you will be making an insurance claim, please bring a claim form and your policy details with you at the time of consultation/admission. We guarantee to process insurance claim forms on the day that you give them to us so that you are remunerated as soon as possible by your insurer, and we make no charge for processing insurance paperwork.
- I’ve heard that West Midlands Referrals offer fixed prices. What does this mean?
When we opened in 2011, fixed price surgery was a “new” idea in the veterinary referral world. Those practices offering fixed prices were very few and far between. A few are now following the trend with fixed prices for some procedures like cruciate ligament surgeries, but we are proud to say that our fixed prices for cruciate surgeries are extremely competitive – well under 50% – of what is being charged elsewhere. We are able to offer this value for money because our complication rates are low and our overheads are relatively low. Our fixed prices for surgical cases includes all follow up checks in normal working hours, and all post-operative radiography with us.
For some ophthalmology and most medicine cases, follow up consults are often chargeable, as some of these cases can’t be “fixed” by surgery, and need ongoing checks well into the future. Please ask whether your case is likely to need ongoing checks and what ongoing charges are expected. Some ophthalmic surgeries like cataract surgery include a number of follow up checks in the fee, getting you through a defined period post-op.
We offer fixed prices for almost all of our other surgery cases, not just the common elective procedures like cruciate ligament injury. These fixed prices assume that payment is made before discharge and the fixed price includes:
- Referral consultation
- Hospitalisation, up to three days as required
- Digital radiography, as many exposures as required, including follow up radiography for the same problem. We put no limit on the number of radiographic exposures that we will take to follow up the same problem, and these can be on an unlimited number of occasions.
- Anaesthesia, with intravenous fluid therapy as standard.
- Patient monitoring with advanced multi-parameter equipment throughout as standard.
- Surgery, surgical consumables, catheters & implants
- Analgesia, anti-inflammatory & antibiotic therapy to cover the patient’s needs to the first recheck
- Elizabethan collars to prevent wound interference and initial post-operative dressings
- All subsequent post-operative check-ups with us in normal working hours for the same problem. We put no limit on the number of these check ups.
We don’t make annoying additions to your bill for an extra dressing here or for an extra dressing there. We don’t make extra charges for drips, or extra charges for processing insurance claim forms. We can usually manage to obtain follow up radiographs with your pet unsedated, but if we need to sedate them to get images, we usually wouldn’t make any further charge for the sedation if we would normally expect to need to give sedation to get diagnostic views in most patients (eg for hip xrays).
For most cases such as cruciate ligament ruptures, joint replacements, most fractures, ear canal surgery, laryngeal surgery etc etc we agree a fixed price in advance. If we are sent the case history, photos and radiographs, we can often do this before we even see the pet!
So what isn’t covered by the fixed price scheme?!
- Our fixed prices don’t include medication beyond the first routine re-check which is usually 3-5 days post-operatively and this first re-check will often be at your normal veterinary practice. So any on-going drugs required (eg antibiotic and anti-inflammatory) would usually be supplied by the referring general practice.
- Fixed prices don’t typically include the costs of pathology investigations like blood tests or histopathology carried out by external laboratories unless these tests were something expected as part of the procedure, when the inclusion of these costs within the fixed price will need to have been specifically agreed in advance.
- Fixed prices don’t include prolonged inpatient care. Beyond three days hospitalisation, we make a daily charge that is likely to be very comparable to that which is charged at you own veterinary practice.
- There may be a need to make additional charges in the event that the patient requires unexpected intensive care or very close/continuous supervision in the post-operative period.
- Our fixed prices don’t typically include revision surgery, or surgery to remove implants when this is required unless we have agreed this in advance. It is the nature of surgery that complications will occur from time to time. However we pride ourselves on being accessible, reasonable and generous to assist with any further surgery that is required.
We reserve the right to make charges for any sedation that is required for interventions like dressings or x-rays where we would not normally expect to need to sedate patients (ie where we would usually expect a patient to tolerate redresses and/or xrays). So we reserve the right to charge for sedation where, because of nerves or aggression, we have to give sedation for the safety of staff and/or for the protection of the patient (eg to avoid over-stressing fracture repairs during the early healing process).
Fixed prices may need to be surcharged if an individual patient has special medical needs, for example if they are diabetic.
Fixed prices may need to be surcharged if an individual patient has special medical needs, for example if they are diabetic.
Fixed prices may need to be surcharged if there is a need for unexpected extra care like blood transfusions for example. Please rest assured that the need for an unexpected blood transfusion is very, very rare!
If you are working on a strict budget, please ask us about our “In House Insurance” which add extra inclusions into our fixed price scheme. So, for a surcharge on the initial procedure we will undertake to cover any further revision surgery at no further charge.
If you think you are going to struggle to pay the bill, please be sure to ask in advance of the procedure being performed, and we’ll see what we can do to help.
- What should a cruciate ligament look like and how can you tell if it has ruptured?
Most general practitioners are pretty sharp at picking up these common injuries and the instability that results can usually be appreciated by manipulating the joint in a certain way. This can often be done completely conscious, though it sometimes requires sedation or even GA in tense animals.
Cruciate ligaments are “soft tissue” and can’t be seen as distinct entities on xrays, but sometimes the instability that results leads to the femur (thigh bone) being postioned more caudally (backwards) with respect to the tibia (shin bone) than is normal. There is usually a marked effusion (accumulation of joint fluid) which can be felt by the vet and/or seen on X-ray. X-rays often reveal bone changes indicating degenerative joint disease (DJD, often referred to as osteo-arthritis), and this is a sign that the problem has been going on a while.
In some cases there is a prominent firm swelling on the medial side (the inside) of the stifle (the knee) joint. We call this a “medial buttress” and it almost invariably indicates a chronic cruciate ligament injury. The injury will be “chronic”, because it takes time for this buttress to form.
DJD in the stifle joint invariably follows cruciate ligament injury, and often leads to a reduced range of flexion. This loss of flexion usually has no significance on the functions of walking or running, but the inability to fully flex the stifle as normal often leads to these patients choosing to sit with the leg out to the side.
- Myelogram or MRI?
For spinal surgery, the classic way to image spines to look for compressive lesions as a prelude to surgery was myelography. This involves injecting a contrast agent into the cerebrospinal fluid – CSF – that surrounds the brain and the spinal cord. Myelography still works just as well as it ever did, but MRI is now more widely available. MRI is a modern advanced imaging modality that uses very strong magnetic fields in the course of generating images of internal body structures.
So how do myelography and MRI stack up against each other?
Myelography is a lot cheaper than MRI (typically about £700 versus £1500-2000) and this is the main reason it is still used, when cost is an issue. MRI machines are very expensive to buy and to run. We don’t have an MRI at WMRs, but we can easily arrange for one to be done locally where this is required.
Myelography is generally quicker and more immediately available than MRI, as all that myelography requires is the means of injecting the contrast agent and an x-ray machine. MRI usually requires a bit of travel and the MRI procedure itself can take the best part of an hour.
MRI gives information about structures that myelography doesn’t; for example myelography might show where the spinal cord is being squeezed, but in addition to this, MRI gives information about what is happening inside the spinal cord itself.
Both MRI and myelography require general anaesthetic (GA). Beyond the risk of the GA, MRI has no risks. Myelography is generally safe but does carry some additional risks. While the risk of myelogrpahy is not that great (say 1 in 200), the potential hazard is high, because in the rare cases where the myelogram does have adverse effects, these can be potential short or long term deterioration of the neurological status, and in extreme cases, death can result from the myelogram. This is because the needle and the contrast agent used for myelography can potentially damage the delicate neural tissues.
Generally speaking, where cost is not an issue we recommend MRI over myelography.
- I dropped my pet at 8.30am – why wasn’t it operated on until the afternoon?!
For efficiency, we admit cases between 08.00 and 09.00 or thereabouts. We obviously can’t do all the operations between 10am and 11am! So we prioritise the order in which we do surgery cases according to clinical need. We completely understand that your pet is of paramount importance to you – of course it is – but please try to remember that every other owner feels the same way about their pet too!
Breathing issues, spinal compression and eye trauma cases are generally top of the list of priorities
Fractures are often high up the list because they are often painful, but most can wait a short while. Joint fractures are more pressing than mid-shaft fractures, and fractures high up the legs are more pressing because these can’t be temporarily supported by splints etc.
Cruciate ligament injuries and luxating patella (knee cap) surgeries are “elective”, meaning that these surgeries are for problems that the pets have usually had for weeks or longer, and they won’t be in much discomfort while they wait. So these cases are a lower clinical priority.
Some procedures are classed as “dirty” ops, like ear surgeries and anal furunculosis cases for example. We typically do these last because the theatres can then be blitz-cleaned after them.
If we know that clients have come from afar and have very long journeys home, we will do our very best to get these cases done in timely fashion.
Our aim is to achieve client satisfaction and we will our very best to accomodate the needs of you and your pet.
- Will my pet definitely be going home the same day?
If you’ve been told that discharge of your pet is likely later the same day, then it is very probable that we’ll be able to discharge your pet late afternoon or early evening the same day. But we can’t say definitely.
There is always the possibility that we will need to change the plan. If another very pressing case has to be done first, then that can lead to delays which mean that it may prove to be impossible to stick to the original plan.
If your pet requires extra aftercare – extra fluid therapy or analgesia, or if it has a slower than usual recovery from the anaesthetic / procedure, then that too might lead to a change of plan.
We will do our very best to avoid un-necessary hanging around for you.
Many clients go home, go to work or find something to do to occupy themselves for the day before ringing us in the afternoon to confirm that they can come back to collect. This can avoid a lot of potential frustration for you!
- Will my pet be supervised overnight?
Animals waiting for procedures the next day, or animals that that aren’t on drips and aren’t needing analgesia injections at short intervals may be left unsupervised overnight.
No animal needing supervision will be left unattended. Overnight care may be by a nurse or by a vet as appropriate. We can provide “eyes on” veterinary supervision throughout the night for cases that need close monitoring. For this, we use the services of a large local animal hospital. We provide the transport of animals between that hospital and our own facility. For the great majority of cases, the cost of this “eyes on” hospitalisation is included in our fee and we cover their charges, at least for the 3 days that would usually be covered by our fixed prices (see separate section on fixed prices). Exceptions to this might include cases that had initially been referred to us by that very practice (in which case we’d have already reduced our charges in respect of this).
On occasion our vets may take patients home with them. For example we often take hospitalised spinal cases home with us for the weekend so that we can empty their bladders at regular intervals and do rehabilitation exercises.
- Why is metalwork required? Why not just a cast or a splint?
Dressings / casts / splints often seem like a really good, economic, minimally invasive and simple way to immobilise fractures and orthopaedic injuries but there are some issues relating to dressings / casts / splints that make them less than ideal:
No dressing / splint / cast is ever going to fix an injury as rigidly as a rigid metallic fixation construct, whether that be a plate, fixator etc. The small movements that are still allowed within a dressing / splint / cast will have consequences:
There will be more discomfort because of movement at the injury site.
Inadequate immobilisation may lead to less satisfactory healing or healing failure. Movement at a fracture site may well stop bone union from occurring and may result in much larger bone callus forming.
For a dressing to work to immobilise a fracture, the joint above and below the injury must be immobilised. This means that injuries near or above the elbow or the stifle simply can’t be effectively immobilised with a dressing.
Even for injuries below the elbow and stifle, the immobilisation of adjacent joints by a dressing / splint / cast can lead to adverse consequences – joints don’t “like” to be immobilised and loss of range of motion and muscle loss often accompanies dressings / splints/casts that are maintained for significant lengths of time.
Fractures are usually painful, and to get effective dressing / splint / cast changes done, repeated sedation or even anaesthetics may be required. This can significantly increase costs and also the impact on the patient.
In growing dogs, the limb can outgrow the dressing in a matter of days, and frequent dressing changes are required.
Sores can develop under dressings, especially over pressure points like the ankle. Sometimes the way the dressing is put on can make these sores more likely, but all vets and nurses who put on dressings on regularly will get the odd dressing related sore in their patients. These sores usually clear up really well once the dressing is removed, but if the dressing has failed to solve the problem and a “Plan B” of internal fixation is subsequently required, it is far from ideal to be creating surgical wounds through inflamed skin. The risk of infection developing after the revision surgery would then be significantly increased.
If dressings get wet or slip they will actually make things worse, not better:
Wet dressings lead to skin sores (imagine what a baby’s bottom would look like if it was left in the same wet nappy for a day …)
Slipped dressings are now no longer protecting the injury, and in fact are effectively lengthening the limb, increasing the forces acting on the injury.
So although we do occasionally use splints and casts, for the most part we prefer metalwork for rigid fixation and immobilisation of injuries.
- What is the difference between a General Practitioner, an Advanced Veterinary Practitioner and a Specialist?
All vets practicing in the UK must be registered with the Royal College of Veterinary Surgeons (RCVS). The designation Member of the RCVS (MRCVS) legally allows them to do any act of veterinary surgery. Nowadays most vets, after qualifying, developing an interest and expertise in particular sub-fields of veterinary medicine and/or surgery. Some choose to go on to get post graduate qualifications. These are Certificates or the more advanced Diplomas.
A “specialist” is an expert in a given field, recognised by the Royal College of Veterinary Surgeons. They have usually passed the relevant Diplomas. The criteria required to be called a “specialist” is difficult and somewhat onerous to achieve and many experienced surgeons have not sort to be recognised with this qualification. We are not “specialists”. Our veterinary surgeons have passed one or more post-graduate surgery examinations called Certificates. The pass rate for these was something like 1 in 5.
Some referral procedures do need the attention of a specialist – intrahepatic liver shunts would be a good example. Surgery within the central nervous system itself would be another. If we think that you and your pet will be better served by redirection to a specific specialist, we will tell you so and we have good and close relations with specialists in neurology, oncology and cardiology to name but a few.
However many advanced procedures can be carried out by experienced Certificate level surgeons such as ourselves, and often at a fraction of the cost, with very comparable outcomes. Take fracture repair for example; there will be many specialists who have not repaired anything like the number of fractures that we have. Surgeries for cruciate ligament ruptures are another good example. We have done thousands of cases and we have complication rates and outcomes that we are rightly proud of. We have friends who’ve become Diploma holders having done no more than 50 cruciate ligament surgeries.
In 2015 the RCVS introduced the Advanced Practitioner status as a middle tier between general practice and specialists. Jon and Andy are recognised by the RVCS as Advanced Veterinary Practitioners in Small Animal Surgery; Lorna is recognised by the RVCS as Advanced Veterinary Practitioners in Veterinary Ophthalmology and Roger is recognised by the RVCS as Advanced Veterinary Practitioners in Small Animal Medicine.
- Are cats and dogs kept in the same kennel room?
We have separate kennel room for cats and dogs. Many dogs, however well meaning they are, make a lot of noise! Unfortunately most cats don’t appreciate this! So we keep these species apart in separate rooms. We have a range of kennels and cages in various sizes to accommodate all sizes of pets. Cats that are hospitalised for any period of time have cages that are large enough for them to pace around stretch their legs and.
- Do blood tests make anaesthetics safer?
Probably not, in the immediate sense of “anaesthetic safety”. Pre-operative blood tests can identify pre-existing liver and kidney disease and so these tests do reduce the likelihood that a patient with pre-existing liver or kidney problems will undergo an anaesthetic without the owner having been counselled as to the risks. If the liver is diseased, then your pet may have more trouble clearing anaesthetic drugs from its body. If the function of the kidneys is already reduced, then the kidney problems might be further exacerbated by anaesthetic drugs that reduce blood pressure and reduce blood flow to the kidneys. Pre-anaesthetic blood tests are often best done in advance at your own vets to avoid un-necessary travelling or delay.
- How risky is the anaesthetic?
Everybody worries about anaesthetics, but the truth is that unexpected anaesthetic deaths are rare. Age is not the huge factor that many think it is: an otherwise “well” elderly pet is often a less risky anaesthetic than a “poorly” younger one. We use modern anaesthetic methods, we only employ experienced Registered Veterinary Nurses, and we stay with your animal from the moment of induction of anaesthesia to the time at which they are recovered and sitting up. We have comprehensive multi-parameter monitoring equipment in the prep-room and both theatres. With monitoring of expired CO2 levels, blood O2 levels, blood pressure, body temperature, ECG (heart electrical activity), heart/pulse rate etc etc, you can rest assured that we will watch your pet like hawks!
- How likely is infection in the wound?
Not likely at all. We are scrupulous in our standards of disinfection and hygiene, and in preparing wounds for surgery. We strive for zero-infection rate, but the sad reality of surgery is that this elusive goal is never quite reached. Infection risk in otherwise routine surgery is often quoted at around 1‰.
- Why does the clip need to be so big?
We need to prepare wounds thoroughly for surgery to minimise the risk of infection. This requires that the hair is clipped back to the skin. We need to ensure that there is a wide margin of prepared skin around the planned wound. It will grow back!!
- How does a Tibial Tuberosity Advancement (TTA) work?
TTA was devised in Switzerland a few years ago. The idea is that the tendon that links the knee cap (patella) to the shin bone (tibia) is made perpendicular to the top of the tibia (the tibial plateau) when the patient is weight bearing. This helps stop the tibia from shearing forwards with respect to the thigh bone (femur) when muscles tense during weight bearing. The change in the angle to a perpendicular one is achieved with a bone cut in the tibia, the insertion of a spacer (titanium cage) into the gap, and stabilisation during bone healing using a variety of metalwork.
Healing typically takes around 6 weeks.
- What is a liver shunt?
A liver shunt is an abnormal blood vessel or vessels that allow the “dirty” blood from the intestines to bypass the liver which is equipped to process it, and gain access straight into the “clean” circulation beyond the liver. The “dirty” blood can get to the brain where it can cause lethargy, or neurological signs like seizures.