What are “Elective Procedures”? This is a fairly loose term and can vary from practice to practice but in general means any procedure that can be deferred without causing any pain or suffering of the patient. Elective procedures include spays, neuters, dental cleaning, feline declaw, canine dewclaw removal, tail docking, sedated grooms etc. Just like any service rendered, there are different levels of quality and expectations. We take pride in the level of individualized care we provide for each pet from the moment the pet walks in the door, throughout the procedure, throughout recovery, then patient discharge with detailed instructions for home pain control and recovery monitoring. Let’s talk about some of them in more detail.
SPAYS AND NEUTERS
Often we get phone calls from people who are price shopping, they want the cheapest procedure. While our prices are very reasonable, we will not cut corners when it comes to patient care even if it’s “only a spay or neuter”. After all these are serious procedures in pets and can cause suffering or even life threatening consequences if mistreated. For that reason we take them seriously. Each patient presented is first thoroughly examined by the doctor performing the procedure. Sometimes we find conditions like ear mites or retained baby teeth causing trauma in the mouth, we make sure to plan on addressing these conditions all under one anesthetic event. Next we evaluate bloodwork (if owners are willing to check that). If the blood work and exam look good, then we calculate perioperative medications. This is always uniquely tailored to the patient taking into account their age, temperament, breed, and any ailments they may have. Most patients presented for routing spays and neuters are healthy in fact we never want to perform an elective procedure on a patient that is ill. After we calculate the perioperative medications, we begin anesthesia in a gentle step wise process. Each patient has an intravenous catheter placed for safety and in order that fluids can be administered during the procedure. Intraoperative fluids are essential for a safe anesthesia to maintain organ perfusion and normal blood pressure. Each patient is then moved to the surgery suit where inhalant gas anesthesia is used. A dedicated technician or technician assistant is there every moment to monitor the patient under anesthesia measuring blood pressure, cardiac function, tissue oxygenation, temperature, and anesthetic depth. The procedure is performed with aseptic technique, analgesic (pain control) medications are given to the patient, and the patient is then recovered in the treatment room in a fear free maner. To go home pain medications are prepared and when the patient is awake and alert we call for a pick up time. We realize that pets rest and recover best at home and owners are very good at providing the TLC and activity restriction they need.
Cats can be spayed or neutered any time after 4 months, and dogs after 6 months. Large breed dogs we recommend waiting to allow for the growth plates to mature (8-18 months depending on the breed). Deep chested dogs (such as Great Danes, Saint Bernards, German Shepherds, Weimaraners, Pointers and many more) we recommend combining the spay or neuter with a gastropexy procedure which is a life saving preventative procedure for the disease called Gastric Dilation and Volvulus.
We recommend that all pets that are not intended for responsible breeding be spayed or neutered in a timely manner to avoid unwanted shelter pets and avoid serious life threatening diseases that are sex hormone related, examples include mammary cancer, pyometra, testicular cancer, benign prostatic hypertrophy etc.
Dental procedures are another valuable elective procedure. Unless a patient is experiencing a dental infection or a traumatic event involving the mouth, most dental cleanings can be scheduled as an elective. Healthy teeth are vital to a pain free and optimal life. In fact, dogs and cats whose teeth are cared for can live two to four years longer than other dogs and cats! Dental disease causes inflammation and infection and is well known to lead to mitral valve heart disease, increase risk of cancer, cause systemic infection, and is linked to diabetes. Sometimes people think that because they’re not showing any signs of pain that dentals are not necessary. Dogs and cats have evolved to hide signs of dental pain but we know through science and experience that dental disease affects their life significantly. When a pet comes in that has multiple diseased teeth requiring extraction, invariably, the owners report a significant improvement in their activity level a week or two later (after healing from the surgery).
On the day of the procedure each patient has a fear free full physical evaluation by the doctor to look for other conditions that could affect the anesthesia and look to see if there’s other minor conditions that would be worthwhile to address at the time of the dental (such as a small tumor removal or ear flush). Bloodwork is always evaluated (not an option), and the patient’s individualized anesthetic plan is made. Anesthesia free dentals are unsafe and inhumane, for these reasons each dental patient is placed under general anesthesia where their airway is protected. Throughout the entire procedure a dedicated assistant is monitoring the anesthesia each moment (IV fluid therapy, blood pressure, temperature, tissue oxygenation, heart rate and pattern, breathing). A Certified Veterinary Technician (CVT) cleans, polishes, charts, and completes full mouth radiographs. A tooth by tooth assessment and treatment plan is made by the doctor that may include dental nerve blocks, surgical extractions, dental bonding of uncomplicated enamel fractures, or periodontal pocket treatments. We always use sterile equipment each time. Any surgical procedure is always completed by the doctor. It is unethical for uncertified assistants to perform the cleaning/scaling/polishing and for anyone other than a doctor to perform surgical procedures. It takes education to ensure that the proper techniques are carried out otherwise more harm than good can occur. We realize that these standards of care are not the same at every hospital and we hope that you appreciate this. When the patient is recovered in a warm and cozy environment, we call the owners and set up a to go home plan.
Some small dogs require a dental cleaning as often as every 6-12 months, and other dogs and cats require them less frequently based on periodontal disease or traumatic lesions. Often brachycephalic breeds (like bulldogs and pugs) benefit from laser assisted soft palate reduction and nares in order to help them breathe better and snore less.
Please note that we offer advanced endodontics such as root canals and vital pulp treatments. This is often a wonderful tooth saving alternative to extraction.
If you are wondering if it’s time for your pet to have a dental cleaning schedule a free preliminary dental exam where an estimate can be prepared for you.
Other electives include canine dewclaw removal, tail docking, feline declaw removal, and sedated grooms.
- For certain breed predilections, canine dewclaw removal and tail docking is best done between 2 and 4 days old. Younger for large breed dogs and closer to 3-4 days for small breed dogs. We will not perform anesthesia free tail/dewclaw removal beyond 5 days no exceptions. A local anesthetic is administered prior to the procedure and the doctor performs the task in a manner that the tail heals nicely and dewclaws won’t grow back.
- Regarding feline declaws, we strongly support the AVMA’s stand which is that we discourage declawing (onychectomy – surgical 3rd digit amputation). Cat’s are surrounded by predators, mainly dogs, and if you’ve ever seen a cat declawed fall fate to the prey instinct of a dog because it couldn’t escape up a tree or fight back, you would understand. In the event a person is immunologically compromised and is dedicated to keeping the kitty strictly indoor, then we can perform the procedure making sure to provide an aggressive multi-modal perioperative pain management plan.
- Sedated grooms for dogs and cats are sometimes a gentle fear free way of providing a service for pets that are anxious. Depending on the level of sedation required we recommend pre screening blood work.
NOTE: during this fluid time of COVID-19 some states and counties are limiting their practice to emergency procedures in a primary effort to limit the usage of personal protective equipment (PPE). For this reason we are limiting the usage of PPE but maintaining optimal sterile practices. We are not limiting procedures or appointments at this time. Also, as of now there is no established risk of COVID-19 causing disease in your pets.