Dr. Phil Zeltzman’s Blog

Kali, a 15 year old Australian cattle dog, was drinking and peeing more than usual. These are very vague signs, and thankfully her owner acted on them. Then Kali had vomiting and diarrhea.

Since these signs can be seen in multiple conditions, Kali had a physical exam. Blood work showed high liver numbers, so she had X-rays, which showed a liver mass.

An ultrasound revealed that the mass was the size of a pear.

Statistics tell us that most liver masses are cancerous. Kali’s owner didn’t know what to do. “Friends and family” told her that it was not reasonable to do surgery on an ancient dog with cancer.

Yet amazingly, this loving pet owner decided to give her 15 year old dog a chance. She chose to have the liver mass removed at Harmony Animal Hospital in NJ.

Kali was given IV fluids. Pain medications and anesthesia drugs were chosen to minimize the impact on her liver.

BEWARE, the next picture is graphic. You have been warned!!!

In surgery, the mass turned out to be much larger than anticipated. Instead of being the size of a pear, it was the size of a cantaloupe!

Because the risk was much higher than anticipated, I decided to call Kali’s owner in the middle of surgery to brainstorm and to make a decision together. Removing a mass this large greatly increased the risk of bleeding.

Of course, leaving a mass this large had its own risks. Left alone, the mass would continue to grow and would likely rupture, which would lead to internal bleeding. After careful consideration, the owner decided to continue with surgery.

So we finished the surgery, which was not exactly an easy task… We did have some significant bleeding. But overall surgery went well.

Here is the mass postop. The coin next to it is an American quarter… (a bit under 1 inch or 2.5 cm in diameter).

Kali stayed overnight on IV fluids, pain medications and antibiotics. Her red blood count stayed surprisingly high.

I stopped by the clinic the next day. Kali looked pretty good.

Two days later, Kali was bright and alert. She was ready to go home to heal and rest.

A week later, the biopsy results came back as… benign! Unbelievably, this enormous mass, that everybody was convinced was cancer, turned out to be a benign tumor (hepatocellular adenoma).

Twelve days after surgery, the update was very positive: “She is doing wonderful! Feeling a lot better, more like herself. She has a good appetite and good energy.”

One month later, her owner said that she “couldn’t be happier. Kali is doing phenomenal. She’s happy and back to her old self.”

And the best part: “Choosing to do surgery in spite of the odds and in spite of her age was totally worth it.”

Then something unusual happened at home:

“We recently found her on the couch sleeping upside down… and it dawned on us that it has been almost a year or so since she stopped jumping on furniture. We thought it was because of her arthritis in her elbows… but now we believe the tumor was making her uncomfortable to jump and lay on her back.”

So what’s the morale of this story?

. Just because your pet is old, doesn’t mean that you should give up.

. Don’t (always) listen to friends and family. They have good intentions, but ultimately you should make a decision you are comfortable with. You have to live with your decision. They don’t.

. Never assume. Just because everybody “knows” a mass is cancer, doesn’t mean that anybody is right. The only test I trust is a biopsy read by a board-certified pathologist.

. As I have said many times before, “Age is not a disease.”

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

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

“I am absolutely terrified of surgery”

I probably hear this statement from loving pet owners once or twice a week. Since I am a surgeon, this statement obviously hurts my feelings.

Surgeons have feelings too, you know!

I typically ask questions to try to understand where my client is coming from. The story usually involves fear of the unknown, or the loss of an older or sick pet under anesthesia years and years ago.

Then I help the client realize that their fear is not really about surgery, but about the anesthesia. Even though surgeons hate that quote, in our profession we say that “there are routine surgeries, but there is no routine anesthesia.”

So we take anesthesia extremely seriously. And you should make sure that the veterinary team about to treat your pet takes it seriously as well.

What does that mean? It means doing blood work to ensure your pet is a good candidate for anesthesia. If there are abnormalities, it gives us a chance to correct them. If the bloodwork is normal, then this is wonderful news.

I feel strongly that every pet should have a trained, dedicated nurse monitoring them throughout anesthesia. This allows the doctor to focus on your pet and the surgery, while the nurse focuses on the anesthesia. This is similar to what happen in human medicine.

Years ago, a huge scientific study (almost 100,000 dogs and 80,000 cats) found out that the death rate around anesthesia time is 0.17% in dogs and 0.24% in cats. I said “around anesthesia time” and not “under anesthesia” because the researchers looked into pets who died up to 48 hours after the end of anesthesia.

Even better: these numbers are actually the average death rate. It’s the average between perfectly healthy patients, extremely sick patients and everything in between. And the study included puppies and kittens, adults as well as seniors.

So if you have a healthy pet, you’d think that going under anesthesia for a planned (ie non-emergency) surgery, the risk of death under anesthesia is even lower.

Sure enough: in healthy dogs, the death rate around anesthesia time is 0.05%. In healthy cats, it’s 0.1%.

Numbers are a bit worse for sick patients. In sick dogs, the death rate around anesthesia time is 1.3%. In sick cats, it’s 1.4%

These numbers are incredibly small, which means that anesthesia is incredibly safe in our cats and dogs.

That said, the risk is sadly never zero. And that is why we take it so seriously – and you should too.

Now… there is something else you should know.

Anesthesia is not the riskiest thing for your pet. The biggest risk, believe it or not, is the period right after anesthesia, when they wake up.

This is not the time to be complacent and walk away from a patient. This is the time to continue to monitor and make sure the pet is comfortable and warm and breathing well.

Monitoring after anesthesia should be taken very seriously.

So how do you ensure that your veterinary team takes your pet’s anesthesia seriously? As your pet’s best advocate, you have the right to ask questions.

Here are 10 suggestions to discuss openly with your vet:

. Will someone monitor my pet during anesthesia?

. How qualified is this person?

. Will you monitor my pet after surgery?

. Will you monitor my pet’s blood pressure?

. Will you monitor my pet’s CO2 level?

. How will you ensure my pet remains warm during and after surgery?

. What kind of pain medications will my pet receive?

. Will my pet have an IV catheter and receive IV fluids?

. Does my pet have specific risks under anesthesia?

. What will you do if my pet gets in trouble?

If you’re not happy with the explanations you receive, then you have the right to investigate another option you’re more comfortable with.

If you’re happy with the answers you hear, then rest assured that your veterinary team will do the absolute best to ensure your pet’s safety.

This is not about ego or offending someone.

We’re talking about your pet’s safety after all.

And you have a right to take it very seriously.

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

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

As promised last time  (How to Find a Veterinary Surgeon Part 1), we share 5 more ways to find a surgeon for your cat or your dog.

6. Visit the clinic’s web site

The web site of the clinic where your prospective surgeon works will also give you some valuable information. You can get a feel for the clinic in general and the surgery service in particular.

7. Visit the surgeon’s page

Within the clinic website, there should be a page or a section dedicated to your surgeon. You can look at their biography and learn more. You can verify the surgeon’s credentials (do they have the letter DACVS after their name?). You can tell where your surgeon studied, where he or she specialized and how long they have been in practice. You can read about professional and personal accomplishments.

8. Does the surgeon understand your needs?

When you talk to the surgeon, feel free to explain your particular situation. Do you have any special requirements? Does your surgeon understand your goals with your pet? Do you and your surgeon have the same expectations? Expectations may or may not be realistic, but can always be discussed.

9. Does the surgeon answer the tough questions?

Ask about your surgeon’s success, failure and complication rates. Nobody likes to talk about failure or complications, but it should be discussed honestly. Do you truly understand exactly what your pet will go through? Do you understand what you will need to do after surgery? How generous is your surgeon with pain medications? Who will monitor your pet during and after anesthesia?

10. Trust your intuition

During the consultation, ask questions, and decide if you feel comfortable with the surgeon. Did the surgeon explain things well? Did the surgeon use simple words? Has the surgeon performed the surgery your pet needs multiple times before?

Keep in mind that some conditions are rare, and therefore that particular surgery may be performed rarely.

11. Bonus: a traveling surgeon

There is one more solution you may find convenient. Your family vet may work with a traveling surgeon. In this case, the surgeon comes to your vet’s hospital to perform specialty surgery. You don’t need to travel anywhere. This instantly fulfills several of the criteria above. Clearly, your vet would trust the surgeon they work with!

Called me biased since I am a traveling surgeon, but there are many benefits to staying local.

Ultimately, your choice of surgeon has a lot to do with trust. You need to find a surgeon you trust to operate on your beloved pet. Once that happens, you can in turn help other pet owners and their pets by referring them to someone you trust.

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

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

I am happy to say that I have a lot to be thankful for…

In fact, most pet lovers can hopefully be grateful as well. We all should be thankful for our pets. A happy furry face after a long day, a wagging tail every time we come home, or a purring, warm body next to us on the couch… pets make us smile and help us close the door on life’s problems for a while. These are little gems pet lovers simply cannot live without. Unconditional love is getting hard to find these days!

There may have been times over the years when you may have lacked the companionship of an animal friend. And it usually feels like there is a small hole in our lives. Hopefully, you currently have at least one pet who, no matter how your day went, is happy to see you and ready to play or cuddle.

Although I’m sure pets (and non-pet lovers) think playing is mostly for their benefit, it is cathartic for us. They help us take our minds off the stresses of life and focus instead on the simplicity of watching a furry ball of energy chase a toy across the room, chomping and squeaking happily on their way back to us, before tirelessly repeating the cycle over and over again. Like it’s the first time ever.

As a surgeon, I’m thankful for being able to fix the various problems my patients have. I’m thankful for the many pet lovers who trust me with the lives of their beloved pets after only talking to me during a consultation. When I perform surgery on a patient, I am thankful that I can improve that life and, indirectly, the lives of their owner and their family.

On a broader scale, I’m thankful for all of the colleagues who refer patients to me and trust me with their care. They trust that I will be able to help them live happy and healthy lives.

In addition, I am thankful for all of the support staff for helping me on a daily basis. Technicians, assistants, receptionists and my wonderful traveling nurses all make my job immensely easier.

I’d be willing to bet that if you polled most people in the animal healthcare field, anyone from veterinarians to technicians, from kennel personnel and rescue groups, would all say that the main reason they do their “job” is for the love of animals. We love what we do.

It’s unfortunately becoming less and less common that someone can truly say they love what they do.

So as the holiday season gets closer, and the pressure of gift-giving, party-planning, and family gatherings rises, remember to take the time to step back and be thankful for that wagging tail or purring whiskery face. And while you’re at it, don’t forget to thank those who help keep them healthy and happy by your side – yet rarely get the recognition they deserve.

Sure, there are good and bad days in the field of veterinary medicine, but the occasional bad day is far outweighed by the good days. The thank-yous received after a successful surgery, the gift baskets, the thank you cards, a happy dog or cat leaving the clinic after being given a clean bill of health, or the smile on an owner’s face when the life of their beloved pet was saved, all serve as reminders that we have the greatest jobs in the world.

Enjoy your family and your pets, have a safe and happy Thanksgiving.

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

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

If you are starving for Thai food or tapas, how do you choose a restaurant?

If you are looking for a car with great gas mileage, where do you turn?

If your cat or your dog needs surgery, who should you trust?

You can probably think of a few ways to answer the first two questions. The third question is probably more difficult to answer. Fortunately, this blog can help.

When your pet needs surgery, you have a choice: you can use your family vet, or you can enroll the help of a surgery specialist. If your vet recommends a surgery specialist, how should you decide? You probably shouldn’t pick a surgeon the way you choose a restaurant or a car dealer. After all, we are talking about your beloved pet.

What is a surgeon?

In the US, a surgeon is someone who only performs surgery. Technically, and I realize this is slightly controversial and extremely confusing, the only person who can claim to be a surgeon is somebody who is board-certified in surgery. In the US, a veterinary surgeon has undergone additional training after college (4 years) and vet school (4 years) in order to become a specialist. This training consists of a minimum of a 1-year internship followed by a 3-year residency.

So that’s at least 12 years of training! Then they need to pass the difficult exam of the American College of Veterinary Surgeons (ACVS).

Here are some suggestions to help you find the right person to perform surgery on your pet.

1. Ask your vet

Can your veterinarian perform the surgery? Or should a surgeon do it? Assuming a surgeon should do it, which surgeons has your vet had a good experience with? What kind of results has your vet heard about? What was their complication rate? Were previous clients happy with their decision? Feel free to ask questions.

2. Ask other pet owners

Your vet should be able to put you in touch with other pet owners who have experience with the prospective surgeon– with their permission of course. They would be an ideal source of information since they have already lived what you will go through.

3. Ask friends and family

Similarly, if you know of friends and family members who have used a surgeon for their pet, ask for feedback.

4. Beware of social media

Don’t trust Yelp and other social media ratings blindly. The Internet can be a great resource for useful information, but it can also be a cesspool of complaints. Remember, far more people will post about negative experiences than positive ones. Also beware of people who have more opinions than experience.

5. Visit www.acvs.org

The American College of Veterinary Surgeons (ACVS) offers an online directory that lists all board-certified surgeons. And by the way, this is a great way to make sure that your surgeon truly has the credentials claimed. You can search by location (worldwide) or by name. There is some basic information about each surgeon, and usually a link to the clinic’s web site.

We will go over 5 more ways to find a surgeon next time – plus a bonus 11^th way!

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

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!