Dr. Phil Zeltzman’s Blog

A Board-Certified Surgeon’s Plea to Pet Owners

We’ve had this conversation hundreds of times, and it breaks our heart every single time.

A pet owner, tears streaming down their face, looking at their beloved dog or cat. There’s a tumor  – now the size of a grapefruit – that’s invaded surrounding tissue, wrapped around blood vessels, or spread to the lungs.

And almost always, they tell us the same thing:

“It was so small 6 months ago. We were just watching it.”

We understand the impulse. We really do.

No one wants to put their pet through surgery for “just a little bump.”

No one wants to spend money on something that might be nothing.

And frankly, subconsciously, no one wants to face the possibility that something could be seriously wrong.

But here’s the reality: in veterinary medicine, “wait and see” is almost never the right answer.

The Tumor That Started as a Pea

Let us tell you about Max.

Max was a 9-year-old Labrador who was presented with a softball-sized mass on his back leg.

It was ulcerated, bleeding, and painful.

His family was devastated.

“When did you first notice this?” we asked.

“About a year ago,” his owner said quietly.

“But it was tiny. Like a pea. Our regular vet said we could just monitor it.”

Here’s the thing: a year ago, we could have removed that pea-sized tumor quickly and easily.

Max would have gone home the same day.

Instead, we were now looking at a massive surgical procedure – removing a significant portion of his leg muscle, and possibly amputating the limb entirely, followed by chemotherapy, with no guarantee we could get it all.

The cost would now be much higher.

The recovery would now be longer.

And Max’s outcome had gone from excellent to guarded.

All because they “just watched it.”

Now, who in their right mind would pay to remove a mass the size of a pea, or a grape?

Well, lots of our clients.

Even some pea-size masses had biopsies that came back cancerous.

Size doesn’t matter.

The size of a tumor doesn’t predict whether it’s benign or cancerous.

But a small mass means a quicker and easier surgery, a shorter anesthesia, less money spent, a quicker recovery, and a better outcome.

Why “Just Watching” Rarely Works

When clients tell us they want to “watch” a lump, we just don’t dare asking: “What are you watching for?”

The answer would likely be: “Well, to see if it gets bigger.”

And that’s the problem.

By the time a tumor is visibly growing, it could be late in the game.

Here’s what happens when you wait:

1. Small tumors become big tumors
That pea becomes a grape.

The grape becomes a golf ball.

The golf ball becomes a grapefruit.

And with every millimeter of growth, the surgery becomes more complicated, more expensive, and riskier.

2. Even benign tumors can become more complicated
Let’s take the example of a tumor on the gum.

It starts out as small and benign, and then can become “locally aggressive”.

This means that, although they are benign, they can invade into the jaw bone.

Catching them early means catching them before the invasion.

3. Tumors invade surrounding tissue.
Say a small tumor sits nicely in one spot – easy to remove.

A large tumor sends “fingers” into muscle, wraps around nerves and blood vessels, and sticks to vital structures.

Now we’re not just removing a lump.

We’re performing reconstructive surgery.

4. Tumors spread.
Some cancers metastasize, i.e. they spread to the lungs, the liver, or lymph nodes.

Early removal can prevent that spread.

Delayed removal gives cancer a head start.

5. You lose options.
A small tumor gives us options: simple removal, shorter anesthesia time, quicker and simpler recovery.

A large tumor may mean leg amputation, radiation, chemotherapy, or in some cases, humane euthanasia because surgery is no longer feasible.

“But My Vet Said We Could Monitor It”

We hear this a lot, and we want to be clear: we’re not blaming your family vet.

Some vets try to be conservative, to avoid putting you through unnecessary procedures and expenses.

But here’s the reality: monitoring is only appropriate in very specific circumstances, e.g. usually in an elderly pet with other serious health issues where anesthesia is supposedly “too risky,” or in cases where it’s already tested and confirmed it’s benign.

In most other cases? Monitoring is a gamble.

And sadly, the house always wins.

If your family vet suggests monitoring, ask these questions:

• “What exactly are we monitoring for?”
• “At what point would you recommend removal?”
• “What are the benefits of waiting versus removing it now?”
• “What are the risks of waiting versus removing it now?”
• “Should we at least test it to see what we’re dealing with?”

And if the answer is vague or unsatisfying, get a second opinion from a board-certified surgeon who deals with these masses every single day.

It’s Not Just Tumors

The “wait and see” trap doesn’t just apply to lumps and bumps.

Limping: “She’s a little off on her back leg, but it doesn’t seem to bother her.”
Dogs and cats hide pain.

That mild limp could be a torn ACL that’s getting worse with every walk, leading to arthritis and pain.

Early intervention preserves joint function.

Waiting destroys it.

Ear infections: “He shakes his head a lot, but we’ve been treating it at home.”
Ongoing ear infections lead to ruptured eardrums, middle ear infections, and a thickened ear canal that require extensive surgery.

The surgery (a TECA or Total Ear Canal Ablation) is a common one in our hands, but it’s much trickier as time goes by.

The Money Factor

Waiting doesn’t save money.

It multiplies the cost.

And that’s just the financial cost.

The emotional cost – watching your pet suffer through a major surgery, a prolonged recovery, or a poor outcome – is immeasurable.

What We Prefer You Do

If you take nothing else from this blog, please remember this:

1. Don’t ignore lumps and bumps
If you find a new mass on your pet – ANY mass – get it checked.

Not in 6 months.

Not when you have time.

Now.

2. Ask for testing
There is a quick, inexpensive test, where a needle is stuck into the lump to look at the cells under a microscope.

It won’t give us a definitive diagnosis in every case, and sometimes an incorrect negative result, it can usually tell us whether we’re dealing with something benign or cancerous.

3. Don’t wait for symptoms.
By the time your pet is limping badly, refusing food, or showing obvious pain, the problem is advanced.

Pets are masters at hiding discomfort.

Subtle changes – a little stiffness, a slight decrease in energy, a small lump – are your early warning system.

4. Trust your gut
If something feels off, it probably is.

You know your pet better than anyone.

If you notice a change – even a small one – don’t let anyone talk you into ignoring it.

5. Understand that “benign” doesn’t mean “ignore it.”
This is probably the most important thing to remember!

Even benign tumors can grow, bleed, ulcerate, get infected, or interfere with movement and quality of life.

Some benign tumors can become problematic simply due to their size.

“Benign” means it won’t spread to other organs – it doesn’t mean it won’t cause problems.

The Conversation We Wish We Never Had to Have

We never want to talk to another heartbroken pet owner and say, “We wish we’d seen your pet 6 months ago.”

We never want to tell someone that their dog’s leg needs to be amputated because a small tumor was allowed to grow so much bigger.

We never want to explain that their cat’s cancer has spread to the lungs and there’s nothing more we can do.

Yet we have those conversations all the time.

And almost always, it didn’t have to be this way…

Early is Easy. Late is Hard.

Here’s the truth: surgery is easier, cheaper, safer, and more successful when problems are small.

A small tumor removed early has clean edges (clean margins), minimal tissue disruption, and an excellent outcome.

A large tumor removed late requires extensive surgery, has a higher risk of complications, costs more, and often has a worse outcome.

Small problems stay small – until they don’t.

And once they’re big, we just can’t turn the clock back.

Your Pet is Counting on You

Your dog or cat can’t advocate for themselves.

They rely entirely on you to notice changes, to ask questions, to push for answers, and to act when something isn’t right.

So please, don’t wait and watch.

Act and protect.

That little lump? Get it checked.
That slight limp? Get it evaluated.
That missed meal? Don’t procrastinate.

Because the best time to fix a problem is before it becomes a crisis.

And the best surgery? The one that happens early.

The longer you wait, the smaller the window of opportunity…

If you would like to learn how we can help your pet with safe surgery and anesthesia, please

contact us through www.DrPhilZeltzman.com.

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Pete Baia DVM, MS, DACVS

When your veterinarian or your surgeon says the words “cancer in your pet,” time seems to stop.
Your mind races.
You’ve heard horror stories.
You think of a family member.
You wonder if treatment is truly worth it.
You worry about your pet’s quality of life.
As veterinary surgeons who have treated thousands of dogs and cats with cancer, we’ve seen firsthand how misconceptions and myths can prevent pets from getting life-saving or life-extending treatment.
Let’s clear up some of the most common myths so you can make informed decisions for your pet.
A week doesn’t go by without a conversation with a pet lover who fell into one of those traps…
Please don’t be one of them!

PET CANCER MYTH #1: A cancer diagnosis means my pet will die soon
The Reality: Not all cancers are the same, and many are highly treatable – even curable.
Just like in human medicine, “cancer” is an umbrella term for hundreds of different diseases.
Yes, some cancers are aggressive and fast-spreading.
Others are slow-growing and localized.
Some can be completely cured with surgery alone.
The key is getting an accurate and early pet cancer diagnosis.
A lump that’s been there for months or years isn’t necessarily “just a fatty tumor.”

Any new lump or growth on your dog or cat, or any growth that’s changing, should be evaluated by your family vet or a surgeon.

PET CANCER MYTH #2: Surgery will just spread the cancer
The Reality: This is one of the most harmful myths, and it’s simply not true.
We hear this constantly: “My neighbor’s dog had surgery and the cancer spread everywhere.”
Let’s be clear: cancer surgery in dogs and cats does not cause cancer to spread (when done properly of course).
What actually happens is this: sometimes when we remove a tumor surgically, it is impossible to prove spreading (aka metastasis) before surgery, because it was too small to detect at that time.
The surgery didn’t cause the spreading.

It was already there, but we could not prove it.
For many cancers, surgery is the only chance for a cure.
Removing a tumor completely before it has a chance to spread can save your pet’s life.
The goal of cancer surgery is to achieve “clean margins” – i.e. removing the tumor along with a rim of healthy tissue around it to ensure we got all the cancer cells.
Sometimes this means removing more tissue than you might expect, but that’s because we want to give your pet the best possible outcome.

PET CANCER MYTH #3: My pet is too old for cancer surgery
The Reality: Age is not a disease.
What matters is overall health, not the numbers on the calendar.
We’ve performed cancer surgeries on 14, 15 and 16-year-old pets who recovered beautifully, and we’ve recommended against surgery for 6-year-old dogs with cancer that was ignored for too long.

It’s not about age—it’s about:

• Overall health status
• Heart and lung function
• Kidney and liver function
• Ability to handle anesthesia
• Expected quality of life after surgery

Modern veterinary anesthesia is incredibly safe for dogs and cats.

We tailor anesthetic protocols to each individual patient, and we monitor pets constantly during surgery (heart rate, blood pressure, oxygen levels, temperature, CO2, and more).
Don’t let age alone prevent you from exploring treatment options.
A healthy 12-year-old dog who has a curable tumor removed could have 2-4 more wonderful years with you.

PET CANCER MYTH #4: Chemotherapy will make my pet miserable
The Reality: do dogs and cats tolerate chemotherapy?Pets tolerate chemotherapy better than humans do.
When most people think of chemotherapy, they picture hair loss, severe nausea, and debilitating side effects.
But here’s what’s different in veterinary medicine:

• We use lower doses. Our goal isn’t to cure cancer at all costs (i.e. quantity of life) – it’s to extend quality of life.
• We use gentler protocols that cause fewer side effects.
• Pets typically don’t lose their hair (except in rare cases with certain breeds).
• Pets don’t have psychological issues. They don’t know they’re sick. They don’t anticipate feeling bad. They don’t experience the psychological distress that humans often do.

Side effects are usually mild. The most common side effects are:

• Mild digestive upset (usually managed with medication)
• Temporary decrease in appetite
• Mild fatigue for a day or two after treatment.
• Nothing dramatic in most patients.

Most pets receiving chemotherapy continue to eat, play, and enjoy life.
In fact, many owners tell their oncologist, “I can’t even tell (s)he’s getting chemo!”
Your oncologist will or should go over the most common side-effects so you are fully informed.
One last very important point: nobody will force you to choose chemo (or radiation for that matter, another option to treat some cancers)!
Your surgeon or oncologist will only recommend it if it’s been shown to make a difference.
It all depends on the type of tumor.

PET CANCER MYTH #5: If the lump isn’t bothering my pet, I should just leave it alone
The Reality: By the time a tumor “bothers” your pet, it will be much harder (and invasive) (and costly) to treat.
Cancer doesn’t hurt in the early stages.
A small, removable tumor doesn’t cause pain.

That’s why a diagnosis of cancer is sometimes delayed.
But if you wait until it’s ulcerated, infected, bleeding, stretching the skin, or interfering with movement, the surgery becomes much more complicated and invasive – and the cancer may have already spread.
Early detection and early treatment offer the best outcomes.
If you notice a lump on your dog or cat, don’t panic, but don’t ignore it.
Have your family vet or ask for a referral to a surgeon to examine the mass.
Remember: Not every lump is cancer, but every lump should be checked.

PET CANCER MYTH #6: Cancer treatment is always expensive and not worth it
The Reality: Treatment costs vary widely, from a simple pill to injections. Many options are more affordable than you think.
Yes, some cancer treatments – especially with a board-certified surgeon – can be more expensive than with your family vet.
But there is a reason your family vet might recommend a surgeon, depending on the complexity of the surgery.
You don’t have to do everything.
You can choose surgery without chemotherapy, or palliative care without aggressive treatment.
What matters is making the choice that’s right for you, your family and your pet.
My favorite tool against difficult financial decisions: pet insurance for cancer treatment.
Some include cancer treatment, some have it as an option.
Pet insurance can save your pet’s life.

PET CANCER MYTH #7: Amputating a leg is cruel
The Reality: most dogs and cats adapt to having 3 legs remarkably well – and it can save their life.
This is a conversation we have with 99% of pet owners whose pet needs an amputation.
You just cannot help but think of yourself hoping on 1 leg for the rest of your life.
But that’s just it.
Pets don’t hop on 1 leg, they can walk, run, jump, and play on 3 legs!
Bone cancer in dogs (osteosarcoma) is one of the most common reasons for limb amputation.
And we understand why the idea seems devastating.
Pets don’t have the same emotional attachment to having 4 legs that we do.
They don’t even know how many legs they have!
They live in the moment.
They don’t mourn the loss of a leg – they’re just relieved the pain is gone.
Most pets are walking within hours of surgery – we see it all the time, as hard as it is to believe.
Within weeks, they’re running, playing, and acting like nothing happened.
We’ve seen 3 legged dogs hike, swim, and even do agility courses.
Living with bone cancer pain, and the risk of breaking the weakened bone, is far more cruel than living with 3 legs.
If amputation can give your dog or your cat more comfortable, happy years (especially with chemotherapy), that’s a gift.

PET CANCER MYTH #8: Natural or holistic treatments can cure cancer without surgery or chemo
The Reality: there is no scientific evidence that holistic or natural treatments alone can cure cancer in dogs or cats.
If they did, we would know.
We’re all for integrative approaches, such as:

• A diet change to an “anti-cancer” food
• Supplements that support immune function
• Acupuncture for pain management
• CBD for comfort (where legal and vet-recommended).

These can be wonderful complementary options that improve quality of life.
But they are not replacements for proven treatments like surgery, chemotherapy, or radiation.
Delaying effective treatment to try unproven therapies can allow cancer to progress to a point where it’s no longer treatable.
If you’re interested in holistic approaches, work with a vet who can integrate them safely alongside scientifically proven treatments.

PET CANCER MYTH #9: I would know if my pet were suffering
The Reality: Pets are masters at hiding pain and sickness.
Remember, if an animal acts sick in the Wild, they get eaten.
Dogs and cats are hardwired to mask weakness – it’s a survival instinct.
Your pet might still wag their tail, eat, and greet you at the door even while dealing with significant discomfort.
This is why regular veterinary exams are crucial for early cancer detection in dogs and cats, especially as they age.
Your vet can detect subtle signs of cancer such as:

• Weight loss
• Changes in muscle mass
• Enlarged lymph nodes
• Pale gums
• Lumps and bumps.

Annual exams for younger pets, and twice-yearly exams for senior pets (7+ years for large dogs, 10+ for small dogs and cats), give us the best chance of catching cancer early.

PET CANCER MYTH #10: My friend told me I should not treat my pet
The reality: always seek professional veterinary advice for pet cancer decisions.
Of course there are multiple variations: “my neighbor said”, “my colleague thinks”, “a family member told me”…
People have all kinds of ideas about all kinds of topics.
The last people you should get advice from is people who don’t have pets (or don’t like them!!!).
They simply cannot understand the bond and the love you have for your pet.
And the worst place to get advice is most online forums, where anybody with a keyboard will be happy to share their opinion, seemingly for free, but sometimes at a great cost to your pet.

BONUS PET CANCER MYTH #11: A good vet can tell if this is cancer or not
The reality: vets are not magicians.
We can have an impression.
We can even have a conviction.
But there is simply no way to confirm cancer in a dog or cat without diagnostics such as cytology or biopsy reviewed by a veterinary pathologist looking through a microscope.
We remove “benign” masses that turn out to be cancer, and “cancerous” masses that end up being benign all the time.
With all due respect to our colleagues, to this day, we have never ever met anybody with microscopic vision.
The only way to come up with the correct diagnosis is to look at actual cells under a microscope.

THE BOTTOM LINE: WHAT EVERY PET OWNER SHOULD KNOW ABOUT CANCER IN DOGS AND CATS
Cancer in pets is not an automatic death sentence.
Many cancers are treatable.
Some are curable.
And even when a cure isn’t possible, we have more tools than ever to extend quality of life and keep pets comfortable.

SIGNS OF CANCER IN PETS EVERY OWNER SHOULD WATCH FOR
Tips to remember:

• A loss of appetite is not normal
• Difficulty eating, chewing, or swallowing is not normal
• Bleeding is not normal
• Suffocating is not normal
• Limping is not normal
• Difficulty urinating or defecating is not normal
• Check your pet regularly for lumps, bumps, or changes
• Unintentional weight loss should be a cause for concern
• Notify your vet of any wound that just won’t heal
• Don’t wait. Have new lumps evaluated promptly
• Ask questions. Your vet wants to help you understand your options
• Age is not a barrier to treatment if your pet is otherwise healthy
• Surgery does not spread cancer – it often cures it
• Chemotherapy in pets is gentler than you think
• You have options at every budget level
• Quality of life matters more than quantity, and we can help you navigate that balance

10 IMPORTANT QUESTIONS TO ASK YOUR VETERINARIAN IF YOUR DOG OR CAT MAY HAVE CANCER

1. What type of cancer is it, and how aggressive is it? 
2. Has it spread, or is it localized? 
3. What are my treatment options (surgery, chemo, radiation, palliative care)? 
4. What’s the goal of treatment – a cure or extending quality time? 
5. What’s the expected outcome with and without treatment? 
6. What will my pet’s quality of life be like during and after treatment? 
7. Do you know a surgeon and/or an oncologist you trust? 
8. How much time do I have to make a decision? 
9. What signs should I watch for that mean something has changed – and when should I get help?
10. How do I know if my dog or cat is in pain from cancer?

Searching for answers about cancer in your dog or cat can feel overwhelming, but early detection, accurate diagnosis, and the right treatment plan can make a life-changing difference for your pet.

Cancer is scary.
Armed with accurate information, you can make decisions with confidence, give your pet the best possible care, and cherish whatever time you have together.
As we always say, “we would rather have 6 months of happiness, than 6 years of misery.”
Your pet is lucky to have an owner who cares enough to learn the facts.
And whatever you decide, know that you’re doing your best for the friend who has given you so much.
Ultimately, only you can make the decision.
We firmly believe that the best decision you can make is by working as a unified healthcare team, with your family vet and your surgeon.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com 

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog 

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Most pet owners are not really concerned about surgery.

They’re mostly afraid of anesthesia.

Here are their top 5 concerns, based on multiple conversations with pet lovers.

Note: we will not discuss one classic question here, which was answered in a previous blog:

https://www.drphilzeltzman.com/blog/is-my-pet-too-old-for-anesthesia/

1. Is Anesthesia Safe for My Pet?

Having a pet die under anesthesia is probably the #1 fear of most pet owners.

And we’d be the first ones to tell you that no anesthesia is 100% safe.

Few things in life are.

Driving a car, flying on a plane or eating peanuts in not 100% safe.

The fear of anesthesia is very emotional and somewhat irrational.

It has to do with fear of the unknown.

It probably has to do with the magic of anesthesia.

Think about it.

We put a patient under anesthesia.

We do surgery, – and sometimes very invasive surgery (cutting tissues, removing body parts, putting broken bones together) – while the pet is sound asleep and completely pain free.

And then they magically wake up – all thanks to our amazing nurses.

Maybe not super happy, but overall comfortable.

And after a few hours or a few days, they look like they never had anesthesia.

What we can to help pet these days is truly remarkable!

Yet most clients are terrified of anesthesia.

Science confirms how incredibly safe anesthesia is.

The risk of a pet dying under anesthesia is, on average, under 0.25%.

While every death is an absolute tragedy, this number is incredibly low.

The risk is even lower in healthy patients, and a bit higher in very sick patients.

Still, this number is very low, which means that anesthesia is overall very safe.

2. What Are the Real Health Risks of Pet Anesthesia?

Many pet owners are concerned about how their pet’s preexisting health conditions could affect their ability to handle anesthesia.

Now, that’s a fair concern.

As you can imagine, a pet with severe heart disease, kidney disease, or liver disease, can be affected by anesthesia.

It’s very clear that pre-existing health issues increase the risk of anesthesia, making this a significant concern.

So what do we do to minimize the risks?

. We do a physical exam before any anesthesia and surgery.

. If we detect a mild heart murmur, we can change one of the drugs we use to put a patient under.

We can be more conservative with the amount of IV fluids we give to the patient, so we don’t overload the heart.

Some pets with severe heart disease should have an ultrasound of the heart and may need heart medication.

That would make anesthesia safer.

We require full blood work before any anesthesia and surgery.

If we find out that the patient has kidney or liver disease, we put them on IV fluid first thing in the morning to give their body time to get rid of the toxins before anesthesia and surgery.

Then we rely on the family vet to decide what medications, food, or supplements could support the liver or the kidneys.

3. What to Expect After Anesthesia?

Some pet owners worry about how their pet will recover from anesthesia.

They want to know how long it will take for their pet to wake up, how they will feel afterward, and what to expect during the recovery process.

A. How long will it take for my pet to wake up?

It takes a few minutes to a few hours.

It’s hard to predict, every patient is different.

As you can imagine, a young, healthy pet will usually wake up faster than a senior pet with a serious health condition.

B. How will my pet feel after anesthesia?

We wish we knew!

We don’t know how pets feel after anesthesia.

They refuse to tell us!

It’s probably safe to assume that they feel the same as a human waking up from anesthesia: groggy, spacey, and discombobulated.

The main difference is that pets, unlike humans, have no clue what just happened.

That’s when it’s important to have amazing, loving, caring nurses who can reassure their patients and make the waking part less stressful.

4. Will My Pet Be in Pain After Anesthesia?

Some pet owners are concerned that their pet is in pain during and after anesthesia.

We are extremely aware of this, which is the reason why we are so incredibly generous with pain medications.

Before, during and after our most common surgery, the TPLO (to address a torn ACL), we use about a dozen different types of pain medications!

That’s a lot!

In other surgeries, we use every possible way to fight pain.

For example, we routinely inject a pain-blocking medication near a nerve (similar to what you get at the dentist), under the guidance of an ultrasound.

As we always say, “pain is not acceptable.”

We have made a tremendous amount of progress in the last few years to understand, prevent and treat pain.

We now have access to safe and powerful drugs, and we use them every time we can.

5. What to Expect After Surgery?

Pet owners who haven’t worked with us before probably worry about not fully understanding the surgery, the risks and the postop instructions.

We provide a ton of information so that our pet owners are fully educated before anesthesia and surgery ever happens.

We explain food and water restrictions, which medications to give or not give, and all specific preop and postop instructions.

We communicate via phone, email, video and face-to-face.

We provide written instructions, which we go over line by line, right before a pet goes home.

We always ask “do you have any questions?” several times, until all questions are answered.

So our clients should feel very well prepared before their pet’s surgery.

And if that were not enough, we’re just a phone call away if there’s any additional questions.

We may have done a procedure 1,000 times.

Yet for most pet owners, it’s their first time.

So we educate them step by step, so they are fully prepared.

Hopefully the answers to the top 5 concerns you may have before your pet’s anesthesia and surgery reassured you.

We will do everything we can to ensure a safe and happy outcome.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Is my pet too old for surgery?

We often hear this question from pet lovers, and even occasionally from family vets.

What they really mean is: is this pet too old for anesthesia?

Our usual answer is “Age is not a disease,” which is true.

Age is just a number.

We’ve seen extremely sick 5 year old patients, and very healthy 15 year old patients.

Which one do you think is at higher risk for anesthesia?

In addition, all dogs are not treated equal. A 10 year old poodle cannot be treated like a 10 year old Mastiff (we are alluding to the fact that it is said that small dogs live longer than large breeds).

Rather than a blanket, somewhat tongue-in-cheek answer (“Age is not a disease”), the solution to the dilemma is a bit more nuanced.

It’s not so much the age, or the number of years, that matter.

Instead, it’s the consequences of aging that we should focus on, because it makes the patient more “frail”.

What is a frail patient?

In humans, “frailty” is defined as having less “fuel in the tank” and being “easier to be stressed out” (in the medical sense).

Frailty better predicts getting in trouble (or dying) under anesthesia, compared to age alone.

A frail patient will have a tougher time maintaining their heart rate and blood pressure, or staying warm, or breathing well, while under anesthesia.

Their liver and kidneys may be less capable of eliminating toxins (e.g. anesthesia drugs).

Who is considered a senior patient?

• Senior age is tough to tell in a dog, so it is considered to be the last 20% to 25% of the pet’s lifespan.
• Cats are more uniform in size compared to dogs, so they’re considered senior once they turn 10.

So how do we keep senior patients safe?

We take multiple precautions, depending on the particular patient, including:

• smaller drug amount.
• more padding, from the kennel to the OR and back.
• more heat support.
• more oxygen at the beginning and the end of anesthesia.
• conservative amounts of IV fluids to avoid overloading the heart.
• appropriate amounts of pain medications: not too little, not too much.
• overall more TLC, which might include hugs, kisses and handfeeding.

How about anesthesia drugs in older patients?

The general idea is to give as little as needed.

More specifically, we can lower the amount of drugs to put them, and keep them, under anesthesia.

In addition, we sometimes will avoid using a certain type of drugs altogether, depending on the organs affected, such as heart, liver, and kidneys, based on preop exam & blood work results.

And of course, like any of our patients, a senior pet will be closely supervised by one of our amazing nurses, from the very beginning to the very end of anesthesia.

How many senior patients die under anesthesia?

Thankfully, dying under anesthesia is exceedingly rare when all of the above precautions are taken.

In 2008, a gigantic British study (on almost 100,000 dogs and almost 80,000 cats) showed that 0.17% of dogs and 0.24% of cats die under anesthesia.

And you would think those numbers could be even lower today with safer drugs, better protocols and fancier anesthesia monitoring.

A death is always a tragedy, but these numbers are incredibly low when you remember that they combine the absolute healthiest and the absolute sickest of patients.

So remember, it’s not the age of the patient that matters, as much as how sick they are.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com 

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Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Pete Baia, DVM, MS, DACVS

I was very fortunate to attend the 12^th Symposium for the International Association of Veterinary Rehabilitation and Physical Therapy (IAVRPT) in Cape Town, in South Africa.

Below are some notes that can be of interest to pet lovers.

I will also intersperse a few nice pictures, with a caption. 

It was an amazing conference, with over 200 people, from all over the world, who dedicate their lives to physical therapy and rehab in pets.

What is a force plate?

I attended a day of “lab” work centered around the use of a force plate.

A force plate is a sensitive platform embedded in a walkway, that objectively measures the weight a patient places on each leg, in order to diagnose subtle lameness and track their progress during rehab.

Vets (mostly surgeons) have said for years that the weight distribution is not 50-50 between the front and back legs. We’ve said it’s 60% in the front, because the front legs “carry” the head, the neck and the chest. And the back legs mostly “carry” the belly, so that’s only 40% of the weight.

Force plate analysis shows that this is a generalization. We just can’t compare the body shape of a mini Doxie, a Bassett hound and a mastiff.

This is important when we talk about the impact of weight loss and leg amputation.

Weight loss benefits the entire body, and now you understand why it helps the front legs even more, since they “carry” more weight.

The speaker, a physical therapist, also explained that seemingly minor things can change the results of force plate analysis: the position of the pet’s head, a wagging tail, turning the head to get a treat, pulling on the leash, wearing a neck collar rather than a harness, etc.

Bottom line: a force plate is very helpful to diagnose a difficult lameness, and we have a lot more to learn!

How to best treat arthritis pain?

I loved a lecture presented by a surgeon, who reminded us that the source of pain in a patient with arthritis is the LINING of the joint.

Therefore, treatments should target the lining of the joint.

We’ve started to inject various products and medications in our patients’ joints, with excellent results.

We started years ago with:

• stem cells 
• PRP (Platelet Rich Plasma), both of which you may have heard of in people.

Now, we also inject:

• collagen (Spryng®)
• steroids (cortisone)
• hyaluronic acid etc.

The results have been very impressive, including in “desperate” cases where nothing else had helped the patient.

When should we use modern arthritis drugs?

Another physical therapist reminded the audience of something surgeons know all-too-well. The newer anti-arthritis medications like Librela® and Solencia® should not be used when a joint is instable. To avoid potentially devastating side-effects, surgery should be recommended first in these patients, specifically to stabilize the joint.

In addition, these drugs should NOT be combined with Non-Steroidal Anti-Inflammatory drugs (NSAIDs), again for fear of potentially disastrous side-effects.

So remember, our current understanding is that there are at least 2 situations when Librela® and Solencia® should not be used:

• with an unstable joint
• with an NSAID

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com 

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog 

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified