Yosemite Pet Hospital, Inc Exceptional Care for Exceptional Pets Consumer Guide to Elective Surgery and Procedures Thank you for recognizing your pet may need to undergo an elective procedure such as spay or neutering. Many people "shop around" for the best price for surgery without realizing that there are many differences in the quality of care that their pet may receive. This guide was put together to help you find the best fit between the veterinary practice and your expectations for the care of your pet. I recommend you ask for the details and a hospital tour before scheduling an elective surgery or procedures for your pet. There are many ways corners can be cut during anesthetic procedures. Although your pet may survive the procedure, greater risks may be taken to keep costs down. The chance of infection, pain, suffering and death increases when quality care is denied. Since there are no laws that regulate these issues in California, some veterinary hospitals cut corners to be able to offer the lowest price possible. We firmly believe that clinics who cut corners are not adequately informing clients of the risks involved with surgery. We believe pet owners should have choices and options explained to them. We understand that pricing can be an issue and we respect the owner s decisions regarding the level of care they desire. However, we feel pet owners should be informed that the lowest price usually means the lowest service. We have developed our surgical protocol and procedures following the guidelines set forth by AAHA (American Animal Hospital Association). We believe our patients deserve uncompromising care. We created this list for you to use when shopping around so that you can compare apples to apples. ------------------------------------------------------------------------------------------------------------------- --- Spay and neuter comparison check list Yes/no Cost Hospital 1. Will a veterinarian perform a full physical exam on my pet prior to surgery? If abnormalities are found will they be discussed with me prior to surgery? 2. If my pet has retained baby teeth, a hernia or rear dewclaws can these be treated at the same time as the spay or neuter? 3. Will there be any preanesthetic blood +/- urine testing, if yes what does this include? 4. If my pet is a senior will there be any preanesthesia chest x-rays performed? 5. Will an iv catheter be placed preoperatively? 6. Will iv fluids be used? 7. Will my pet be intubated to protect its airway? 8. Will pain meds be given preoperatively, post operatively and sent home? 9. Will a nurse be present at all times during the surgery monitoring my pet?
10. What type of monitoring equipment will be used blood pressure, pulse oximeter, ekg, temperature, pulse and respiration, ventilation and how often area these readings recorded? 11. What type of warming measures do you take- bair hugger, heating pad, blanket and is this continued post operatively? 12. Are emergency drug doses calculated prior to my pet s anesthesia in case of emergency? 13. Will my pet be monitored post op, will they check vital signs and degree of pain, how often? 14. Does my pet recover in a private cage or is it recovering next to multiple pets? 15. To help ensure a smoother recovery do you use feliway for cats or dap for dogs in the recovery cage? 16. Is the surgical pack autoclaved(sterilized) and only used on my pet (not used on multiple pets)? 17. Is my pet surgically prepped in a separate area from the surgery suite? 18. Is the surgery suite used for any other procedures or dedicated to surgery only? 19. Does the surgeon wear a cap, mask, booties, sterile gloves and gown during the procedure? 20. Does the attending nurse wear a cap, mask, and booties? 21. Do they use suture off of a reel or individual sterile packs? 22. When I come in to pick up my pet will a nurse or doctor discuss post operative care with me and include written instructions? 23. Will my pet receive an e collar so that it will not lick at its incision, possibly causing infection or removal of its stitches? 1. Why is a pre-anesthesia evaluation important for my pet to have prior to surgery? A physical examination helps us to assess if a patient has any congenital issues such as a heart murmur, cleft palate or hernia. We can assess if there are any retained baby teeth which should be extracted while they are under anesthesia. Combining procedures helps limit anesthetic cost and risk. The physical exam also helps ensure that the pet is not debilitated from parasites or any other infectious diseases. 2. A preanesthesia blood test can detect hidden problems such as: 1. Congenital issues with the liver or kidneys- these organs help metabolize the anesthetic. If they are not functioning properly this could lead to prolonged or poor recovery and in some cases death. 2. Anemia (low red blood cell count)-red blood cells are important for delivering oxygen to the organs and tissues. Some bleeding may occur during surgery therefore it is important to make sure the pet is not anemic prior to surgery. 3. Low body protein- low body protein can interfere with the pet s ability to heal 4. Low white blood cell counts-one of the important functions of white blood cells is to help fight infection. If the white blood cell count is low the pet may be at higher risk for developing infections postoperatively.
5. Hypoglycemia (low blood sugar) - some puppies are not able to maintain normal blood sugar levels and if the blood sugar drops too low, the pet can have seizures. 6. Low platelet count- platelets are important for helping the blood clot-you can see why this would be important to know about prior to surgery. 2. What safety precautions should be taken with my pet during surgery? While most surgery is uneventful, emergencies sometimes arise. Early detection of impending problems greatly aids our ability to intervene and correct the problem. An IV catheter will be placed prior to anesthesia induction. The IV catheter allows for immediate administration of emergency medications intravenously if an emergency arises. Trying to place an IV catheter while the pet is crashing can be difficult and is not optimal. Having a catheter placed ahead of time is one of the most important procedures for the safety of your pet. IV fluids will be administered to help maintain blood pressure, provide internal organ support and to help keep your pet from becoming dehydrated. A breathing tube should be placed (intubation) on all anesthetized animals. This keeps the airway open and allows for supplemental oxygen or gas anesthesia as needed. Intubation is also very important to prevent aspiration of substances into the lungs if a pet vomits or has excess fluids/materials in its mouth. If there is an aspiration, this can cause a serious pneumonia. We dedicate an anesthetic nurse solely to monitor and record your pet s vital signs. Vital signs include blood pressure, temperature, pulse rate and quality, respiratory rate and depth, heart rhythm (EKG) and oxygen saturation. Recording vital sign readings every 5 minutes allows us to see trends which may indicate an ensuing problem. The sooner issues are noticed and treated the better the prognosis. It is not a safe practice for the surgeon to monitor vital signs while performing surgery. The practice should have emergency drug doses calculated prior to anesthesia and emergency drugs and supplies immediately at hand. The above mentioned items are important factors that are easy to overlook when checking prices. If anesthesia is performed without a nurse carefully monitoring the patient, the patient has an increased risk, and potential harm can occur. 3. What safety precautions and comfort measures should be taken during my pet s procedure? Patients can lose considerable body heat when they are under anesthesia. Warmth should be provided during and after anesthesia. If patients get too cold heart function can be affected. Maintaining body temperature during procedures helps reduce the pet s recovery time. We utilize BAIR huggers which are used in human as well as some veterinary practices. Bair huggers provide warm air through a vented blanket that envelopes the pet. Patient temperature should be monitored at regular intervals during and after surgery and supplemental heating provided as needed. Your pet's gum color, pulse, and respiration should also be monitored. IV fluids can be warmed to body temperature to reduce heat loss. 4. Should pain be controlled for my pet? Pain management is very important - surgery hurts! The anesthetic does not provide pain control once the pet wakes up. Pain should be controlled before, during and after surgery. 5. Should written post-surgical care instructions be provided for my pet?
Aftercare of surgical patients is very important for proper healing. The hospital should provide verbal as well as written discharge instructions for your pet. 6. In what ways can services be compromised when considering lower priced options? There are many ways corners can be cut during anesthetic procedures. Although your pet may survive the procedure, greater risks may be taken to keep costs down. The chance of infection, pain, suffering and death increases when quality care is denied. Since there are no laws that regulate these issues in California, some veterinary hospitals cut corners to be able to offer the lowest price possible. We firmly believe that clinics who cut corners are not adequately informing clients of the risks involved with surgery. We believe pet owners should have choices and options explained to them. We understand that pricing can be an issue and we respect the owner s decisions regarding the level of care they desire. However, we feel pet owners should be informed that the lowest price usually means the lowest service. We have developed our surgical protocol and procedures following the guidelines set forth by AAHA (American Animal Hospital Association). We believe our patients deserve uncompromising care. 7. What factors can affect the price of Veterinary Care? The facility: Take a tour of the hospital and look at the areas where your pet will be treated. Surgical prep area: The patient should be prepared for surgery in a preparation area, not in the surgery room. This prevents hair and debris from possibly contaminating the surgery area. The patient should be clipped, vacuumed free of debris and special disinfectants should be used to prepare the surgical area prior to being moved into the surgical suite. Surgery Suite designated only for surgery: It is expensive to have an area where only sterile surgeries are performed. If the surgery area is not a single use area infection rates are increased by increased traffic & contamination within the room. Having a sink for cleaning instruments in the same room as the surgery is performed increases infection rates. Carpeting or poorly maintained flooring, ceilings or walls in the surgery room increases the infection rate as these can harbor debris, bacteria and viruses. What should be done when preparing the patient for surgery? The patient should be examined and have a preanesthesia screening. In most young healthy pets, preanesthetic screening is a simple blood test. In senior pets or pets that have other medical problems a more comprehensive blood test and a urinalysis is recommended. Chest x- rays are also recommended to help screen the heart and lungs for preexisting problems prior to anesthesia. To reduce the cost of procedures, some clinics either limit or completely omit screening tests. Abnormalities may not be detected until it is too late. At Yosemite Pet Hospital, the pet is admitted on the morning of the procedure and medications are used to decrease anxiety and start the pain management program. Anxiety increases the release of epinephrine in the body which can lead to abnormal heart contractions. Not providing pain medication before, during and after surgery, not placing an IV catheter, not starting IV fluids, not intubating, not monitoring for temperature, pulse, respiration, heart
rhythm, blood pressure, and oxygen all reduce the cost of anesthetic procedures, and significantly raises the level of risk during the surgery. Surgical preparation and attire of surgeon and assistants Surgeons and assistants should prepare themselves to prevent contamination by wearing a surgical cap and mask for any surgical procedure, including Dental cleanings. Hands should be scrubbed three times before donning a sterile surgical gown and gloves. It is somewhat ironic that food workers are required to wear a cap or somehow control their hair, but veterinary surgeons are not. Special surgical booties are also worn to reduce the chances of contamination in the surgical suite. Surgical instruments and supplies Instruments used should be of high quality and be well cared for. Using low quality instruments can lead to increased tissue trauma and increased pain and a longer healing time. The surgical pack of instruments should be used on only one pet, then cleaned, lubricated, repackaged and sterilized. Using instruments on more than one animal between cleanings and autoclaving can lead to increased chance of infection and infectious disease. Surgical gloves are made to be disposed of after each surgery. In some hospitals, gloves are reused. The chance of microscopic holes drastically increases and leads to increased rates of infections and complications. Some places do not use gloves at all, or use non-sterile exam gloves for surgery. The choice of suture material varies greatly. The difference may not be readily apparent to pet owners, but published research has shown that the type of suture material has a significant effect on tissue reaction and healing. Some clinics reuse suture materials not used up from a prior surgery. These materials have been passed through the tissues of the prior animal and may be placed in a cold sterile' solution until used again. Infection rates can be increased as well as tissue trauma can occur when material is used more than once. Suture materials may even weaken or break from such practices. Another cost cutting method is to use suture off a reel. This is an inexpensive way to purchase suture materials. Sutures are rolled off a reel and threaded through a needle (which may have been used on multiple pets in the past and be dull). The longer the reel has been in use, the greater the chance of contamination, leading to higher infection rates. Additionally, the suture that is threaded through the needle leaves a much larger hole in the tissue it penetrates. This increases tissue trauma, pain and healing time.
A better alternative is to use suture materials that are prepackaged for single use and have a swaged on needle. The suture material is one piece with the needle and is inserted into the rear end of the needle. This allows for very tiny, non-traumatic punctures that produce less pain and tissue trauma. Since the needles are only used once they remain sharp, leading to decreased pain and tissue trauma. Suture selection also involves determining what material to use. Some materials are not strong, and cause increased inflammation and tissue reaction. If the material is not strong enough it can break or the knots can come untied. Better products have less reaction, cause less pain and tissue trauma/inflammation, and allow faster healing and greater security. The surgery performed Most surgeries are performed swiftly and with skill. We have mentioned many things that can affect the outcome of the surgery. These factors all affect the price of the procedure, and the level of risk that a patient incurs. The above-mentioned cost cutting choices should be evaluated when you are comparing the price of a procedure for your pet. Antibiotics and absorbable vs. non absorbable suture material Yosemite Pet Hospital does not use absorbable sutures in place of skin sutures in most cases (unless we have a very grumpy patient). The use of nonabsorbable suture allows our nurses to check the incision prior to removing the sutures to make sure that the incision has healed properly without any signs of infection, irritation or incomplete healing. This inspection and suture removal is performed at no additional charge. We have found that on occasion some pet owners will miss a problem that needs attention. We also do not give antibiotics for spays and neuters. If the surgery is performed with sterile technique, no antibiotics are needed and some pet s can have allergic reactions to the antibiotics. So why take a risk, or pay for unnecessary medications? Monitoring the pet during post operative recovery One of the highest risks of complications associated with anesthesia happens during the post operative recovery period. Complications such as hypothermia or hyperthermia, vomiting with resultant aspiration pneumonia, increased pain & stress and heart arrhythmias can develop postoperatively. To help minimize these risks at Yosemite Pet Hospital, your pet is placed in the ICU where vital signs and degree of pain are continuously monitored, assessed and treated accordingly. The recovery cage is sprayed with dap or feliway- (these are pheromones that have an antianxiety effect). Soothing pheromones provide a smoother recovery. Unfortunately at some hospitals recovering patients can be piled on top of each other with no one assessing them for hours. Home care Unfortunately surgery hurts. Pets experience the same degree of pain that we do, but are unable to tell us. They instinctually hide their pain because in the wild if they show weakness they are at risk for predation. We have to be advocates for our pets and assume if they had surgery they will hurt. At Yosemite Pet Hospital we send home pain medication for you to give your pet for the next several days to help them during their recuperation. We also highly
recommend sending home clear e collars to prevent them from licking or chewing at their stitches. It is important to prevent post operative infection and premature removal of stitches. In a matter of seconds, pets can remove sutures and open the incision site.