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  • Questions and answers about veterinary hospital pet care

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I dropped my pet at 8.30am – why wasn’t it operated on until the afternoon?!

For efficiency, we admit most cases between 08.00 and 09.00 or thereabouts. Some cases can be admitted the night before in preparation for surgery. 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 trauma cases are generally at the top of our list of priorities.  

Fractures are often high up the list because they are often painful, but most can wait a short while. Open fractures with bone exposed are high priority and joint fractures are more pressing than mid-shaft fractures. Fractures high up the legs are more pressing because these can’t be temporarily supported by splints etc. In contrast fractures well below the elbow or knee can often be temporaily stabilised with splints and so can often wait, several days if needs be.

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 then need to 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 are beyond our control and this may mean that it is simply 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. Alternatively why not plan to leave your pet with our nurses overnight and collect the next day? This can avoid a lot of potential waiting around and frustration for you! 

Will my pet be supervised overnight?

From 2021 we had grown big enough to justify having our own nursing cover on site over night on weekdays. So unless we have staffing gaps, in patients can now have round the clock nursing care with us. Our overnight hospitalised patients include animals waiting for procedures the next day, or animals recovering from surgery.

While patients that aren’t on drips and aren’t needing analgesia injections at short intervals might not need overnight care, no animal needing such supervision will be left unattended.

Overnight care with a vet on site may be more appropriate for some cases. We still provide such “eyes on” veterinary supervision throughout the night for cases that need close monitoring by using the services of a large local animal hospital. We provide the transport of animals between that hospital and our own facility. 

We do make extra charges for overnight hospital care.

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.

The cheapest solution to a problem is invariably the one that works first time!!

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. Our vetshave been recognised by the RVCS as Advanced Veterinary Practitioners in Small Animal Surgery or Small Animal Medicine.

Are cats and dogs kept in the same kennel room?

We have separate cattery and kennel rooms for 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 also generally don't much like how dogs smell! We have one of our six consulting rooms kept solely for the use by cats, so it never gets the lingering scent of dogs. 

Cats that are hospitalised for any period of time have cages that are large enough for them to pace around stretch their legs. The cat cages don't face each other so they can't wind each other up!

Big dogs have "walk in" kennels and we have secure cages where our longer term canine in-mates can safely get a breath of breath of fresh air!

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!

What should a cruciate ligament look like on X-rays and clinically, 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 a good number of cruciate liagment case - around 35-40%, and especially in the bigger patients that have had a complete ligament rupture for a prolonged period of time - the mensicus ("cartilage") may have torn. This is not visible on X-rays as it has the same density to X-rays as the joint fluid that surrounds it. 

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.

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Myelogram, MRI or CT for imaging spines?

For spinal surgery, the classic way to image spines to accurately locate compressive lesions as a prelude to surgery was historically myelography. This involved injecting a radiogrpahic (X-ray) contrast agent into the cerebrospinal fluid – CSF – that surrounds the brain and the spinal cord. That allowed anything putting pressure on the spinal cord to be visualised by taking X-rays. The effects of the injection itself and the pressure of the injection of this agent do constitute a risk to the central nervous system tissue, which can (at least temporarily) make clinical signs worse. This is because the needle and the contrast agent used for myelography can potentially damage the delicate neural tissues. While the risk of myelography is not that great (say 1 in 100?), the potential hazard is high, because in the rare cases where the myelogram does have adverse effects, there can be long term deterioration of the neurological status, and in extreme cases, death can result from the myelogram. 

CT - Computed Tomography - uses a computer to put together hundreds of X-rays to generate compostite images. Huge advances in the compilation of these images has been made in recent years. CT is good for showing bony anatomy but not so good for soft tissue. In many of the spinal surgery cases we see, disc material has extruded up into the vertebral canal which is occupied by the delicate central nervous system. The limited space available means that the CNS is "squeezed". If the extruded disc material is mineralised, (as is often the case in eg Dachshunds), CT is a very quick and effcient way to visulaise and locate it as a prelude to surgery. We can often acquire CT images under just sedation. 

MRI is a modern advanced imaging modality that uses very strong magnetic fields in the course of generating images of internal body structures. We don't have an MRI machine at present - we have a room ready for it but that will have to wait until we can afford one - they are about £750k to buy and also cost a fortune to maintain. MRI images take longer to acquire than CT images and general anaesthesia is required. But the MRI images can give exquisite detail of the soft tissues that make up the central nervous system, and this is soemthing that CT can't rival. 

Myelography still works just as well as it ever did, but CT and MRI are now much more widely available and although more expensive, are undoubtedly much better in the information they give, and they are undoubtedly safer. We would not offer myelography now as a stand-alone diagnostic method. We might combine it with CT if clients couldn't afford referral onwards for MRI, and if CT alone had failed to give answers.  

What is a liver shunt?

A liver shunt is an abnormal blood vessel or vessels that allows the “dirty” blood from the intestines to by-pass the liver which is equipped to process it, and the "dirty blood" can gain access straight into the “clean” circulation beyond the liver. The “dirty” blood can then get to the brain where it can cause lethargy, or neurological signs like seizures.

How do Tibial Plateau Levelling Osteotmy (TPLO) and Tibial Tuberosity Advancement (TTA) work?

TPLO was developed inthe 80's by Barney Slocum. Whether it is done by means of making a curved radial cut in the tibia or by removing a wedge of tibia, the goal is to reduce the natural slope of the top of the tibial (the tibial plateau that forms the lower side of the knee joint) to something close to perpendicular to the long axis of the tibia. In normal dogs the slope of the plateau is around 250. So the femur, the thigh bone that sits above the knee joint, "wants" to "ski" backwards down the sloping tibial plateau. The cruciate ligament, when intact, stops the femur from doing this. But if the ligament is broken ....   So by making the palteau "flat" we engineer a situation where the femur doesn't want  to try and ski off the tibia any more!

TTA was devised in Switzerland aroudn 2004. 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 or TPLO and TTA typically takes around 8 weeks to have any significant strength. 

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!!

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. We do pre-anaesthetic blood tests as routine and the information gained is often used to tailor the pre-med and anaesthetic regime and fluids to the particular patient. 

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 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 does the medicine referral service work at West Midlands Referrals?

Surgery (orthoapedics, soft tissue and spinal surgery) is by far the main discipline that we offer, but we are able to offer a more limited medicine referral service. This is provided by Mayra, a skilled and experienced ultrasonographer. Mayra isn't available every day and there may be a short waiting time, probably of the order of a couple of weeks. Our medical referral service is best suited to more chronic cases where an ITU is not required. Acute/urgent referral cases are likely to be better managed at a referral centre that has staff medics on site every day.