Dr. Phil Zeltzman’s Blog

Hip dysplasia is a fancy way to say that the hip joint did not form correctly.

The hip is a “ball and socket” joint. It is made of the ball of the femur or thigh bone (aka femoral head), and a socket or cup in the pelvis (aka acetabulum).

We typically think of hip dysplasia as a canine condition. In fact, cats can be affected as well.

Hip dysplasia can cause pain.

Young patients are typically painful because of stretching of the ligaments of the hip as the ball slips in & out of the socket.

A very important point is that there is not always a good relationship between how bad X-rays look and how bad a patient feels.

In other words, patient A may have “horrible” hips on X-rays (meaning full of arthritis), yet may be functional and happy and able to run.

Whereas patient B may have “OK” hips on X-rays (meaning without much arthritis), but may act very painful.

As I always say, “I don’t treat X-rays, I treat pets.”Depending on the severity and the stage, there are many ways to help hip dysplasia patients.

The conservative way is to use all or some of the options we have discussed before to help arthritis: weight control or weight loss, arthritis supplements, arthritis diets, physical therapy, controlled exercise, pain medications etc.

The surgical way involves 4 mainstream options:

• Two “puppy” surgeries: Juvenile Pubic Symphysiodesis (JPS) and Triple Pelvic Osteotomy (TPO). They can only be performed in young patients who are very carefully selected. If a young patient is not a good candidate, then the following options will be more successful.
• and two “salvage procedures”: Femoral Head Ostectomy (FHO) and Total Hip Replacement (THR). Those can be performed at any age.

In cats, the most common option is the FHO, although a few surgeons have performed total hip replacements in cats.

Overall, hip dysplasia is a treatable condition.

It’s not a death sentence.

Make sure you get the right advice!

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

To answer this excellent question, let’s go over 3 classic, real-life scenarios.

Amber and the torn ACL

Amber, a 9 month old Lab, was presented for a torn ACL. An ACL can literally tear at any age, so we see it in puppies, young dogs, mature dogs and seniors. Even cats can occasionally have a torn ACL.
And we certainly can address them at any age.

Because of a bit of denial and back-and-forth between rest and pain medications, Amber’s surgery was delayed for a couple of months.

During that time, the body tried to patch things up by adding scar tissue and bone spurs around the knee. After surgery, I described her arthritis as severe. Yet she was only 11 months at the time of surgery!

Why? Simply because the knee had been wobbly for a long time, which gave the body plenty of time to try to patch things up – which it did poorly.

By the way, please note that when I say “arthritis”, it’s a bit of a simplification.

It may be a bit oversimplistic, but basically:

Arthritis = osteo-arthritis = Degenerative Joint Disease = DJD = bone spurs.

Sweetie and the dislocated kneecaps

Sweetie, a 6 month old kitten, was really struggling to run and jump like her sibling Simba.

She limped and was painful in both back legs.

Her issue? Both her kneecaps (or patellas) were dislocating (or dislocated, or luxated).

Because of a common misconception that cats don’t need their kneecaps fixed, surgery was delayed by 3 months.

After surgery, I described her arthritis as severe.

She didn’t have that many bone spurs, but her cartilage was discolored. Instead of being white, shiny and smooth, it was pinkish, dull and irregular.

Worse, it was partially gone under her kneecap and in the groove where the kneecap is supposed to stay.

The reason for the “bone on bone” (instead of cartilage on cartilage) is that every time the kneecap popped in & out of the groove, it mechanically damaged the cartilage.

It’s simple wear and tear.

Tank and hip dysplasia

Tank, a 9 month old Cocker spaniel, was in severe pain in both back legs. He was very painful in both hips. His problem? Severe hip dysplasia, which means that his hips were not formed properly.

Similar to Sweetie’s case, the ball popped in and out of the socket. Not only did it mechanically damage the cartilage (wear and tear), but as in Amber’s case, that abnormal motion also led to bone spurs.

The hip is a ball and socket joint.

Tank got pain relief thanks to a surgery that removed the ball part (Femoral Head Ostectomy or FHO).

As you now understand, the severity of the arthritis in Amber, Sweetie and Tank has nothing to do with their ages.

It has to do with their conditions, and the duration of the issue before surgery took place.

By doing surgery early on, we can’t fix the arthritis.

Surgery can however correct the actual problem, and slow down the progression of arthritis.

If you would like to learn more about how your pet can have safe surgery and anesthesia, contact us through www.DrPhilZeltzman.com

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
www.DrPhilZeltzman.com

Vets have been able to dramatically decrease the death rate under anesthesia thanks to better anesthesia drugs and better monitoring.

What does monitoring mean?

Let’s review some techniques we use at our hospital to reduce the risks.

Please understand that not all practices have this equipment, for financial reasons mostly. As a general rule, we perform higher-risk and longer anesthesia and surgery, so we have an obligation to provide the best equipment available.

Vital signs

One of the many roles of the anesthesia nurse is to record the pet’s vital signs and numbers indicated by the devices described below: body temperature, blood pressure, heart rate, respiration rate, temperature etc.

This is critical to determine if there is a trend.

For example, is the blood pressure slowly dropping?

The surgeon is then alerted, and decisions can be made in a timely manner.

ECG

Most people have had an ECG (aka EKG), so most are familiar with the concept. An ECG measures the electric currents generated by the heart. It helps monitor the heart rate and rhythm. It allows early recognition of heart issues, such as arrhythmias (extra heart beats), which can then be treated appropriately.

Blood pressure

Blood pressure measurement is probably the earliest indicator of problems with anesthesia in pets.

Pulse oximetry

This is a way to estimate how much oxygen is being carried by red blood cells.

You may have been connected to such a device at the hospital.

This is the clip that is usually placed on your finger.

In pets, the probe is usually placed on the tongue.

Temperature

Anesthesia commonly reduces the body’s temperature.

We are obsessed with maintaining pets’ temperature, especially small ones.

Opening a body cavity (chest or belly) leads to losing even more body heat.

So we use several modalities to keep the temp up.

For example, every single patient gets a “Bair Hugger,” which is a warming blanket, in addition to a heating pad under their body.

It is important to warm patients up after surgery as well.

Capnography

This is a fancier machine, not routinely available in general practices.

It monitors the amount of CO2 (carbon dioxide) in the patient.

If it becomes too high, it means that the patient is not breathing enough to “blow off” the toxic CO2.

The anesthesia nurse would then help the patient breathe.

Such equipment undoubtedly helps us greatly improve the safety of anesthesia.

By far, my favorite way to monitor my patients is my skilled nurses.

The risk obviously depends on the patient and the type of surgery.

For example, spaying a healthy 6 month old Lab puppy is less risky that removing a 1 pound cancerous tumor from the liver of a 14 year old diabetic, seizure-prone poodle with heart and kidney disease!

That said, the OVERALL death rate under anesthesia is:

. 0.06 to 0.43% in cats;

. 0.11 to 0.43% in dogs

according to several studies conducted in the late 1990s.

As you can see, careful monitoring makes the anesthesia as safe as possible, so that we can reach our ultimate goals: a healthy pet and a happy pet owner.

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

Surgeons love little sayings. One of them is “There are routine surgeries, but there is no routine anesthesia.”

It is a good reminder that while pets rarely die because of the surgery itself, they can die because of anesthesia.

This is why it is so important to do a thorough physical exam and blood work before surgery.

While not 100% foolproof, blood work helps us know whether internal organs are normal or not, especially the liver and the kidneys.

Those organs are especially important as they may filter some of the anesthesia drugs.

So we may change which drugs we use based on blood work alone.

This is much more important than only considering the pet’s age.

A (sick) 2 year old cat could have a higher anesthetic risk than a (healthy) 12 year old.

Another way to assess preop patients’ anesthesia risk is to determine where they fit in the American Society of Anesthesiologists’ (ASA) classification. This is a human scale, but perfectly adaptable to pets.

In fact, our wonderful nurses apply it to every single patient they anesthetize.

There are 5 classes.
Fitting a patient in one particular category is somewhat subjective, but here is the gist of the classification:

• Class 1 is “a normal patient with no organ disease”. This would be your happy, healthy, crazy 6 month puppy or kitten undergoing a spay or a neuter.
• Class 2 is “a patient with mild organ disease”. This is for example a puppy with a foreign body in the intestine or a cat with a fracture, or a patient with well-regulated diabetes or Cushing’s disease.
• Class 3 is “a patient with severe organ disease that limits activity but is not incapacitating”. This would be a patient with poorly controlled diabetes or hypertension.
• Class 4 is “a patient with incapacitating organ disease that is a constant threat to life”. This is a patient with severe heart disease or end-stage kidney failure.
• And let’s face it, class 5 is “a moribund patient not expected to live 24 hours with or without surgery.” In my opinion, the only reason to do surgery on such a patient would be to try to save his or her life. So it would be a risky life-saving procedure. Luckily, we are rarely faced with patients in that class…

Now let’s look at statistics from various scientific studies that answer this question: how often do pets die under anesthesia?

• The death rate for anesthetized dogs at the Colorado State vet school dropped from 1.2% in the 1950s to 0.43% during the late 1970s and has remained stable at 0.43%.
  The initial 64% decrease in mortality most likely reflects technological advancements in surgery, anesthesia monitoring, and availability of safer anesthetic drugs.
• The current feline mortality rate at the Colorado State vet school is also 0.43%
• Vermont family vets reported a 0.11% mortality rate in dogs and 0.06% in cats.
• In one of the largest studies ever, British vets reported a canine mortality rate of 0.21% and a feline mortality rate of 0.27%.

As you can see, even though there is no routine anesthesia, the overall death rate is very low in most cases: all studies show a death rate that is a fraction of 1%.

Accidents do happen, and our job is to minimize their occurrence.

Thankfully, in the very vast majority of cases, we can return a surgery patient to their family to heal after safe and happy anesthesia.

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

Before we start, I would like to point out a few important thoughts:

1. A specialist is not a competitor of your family vet. Rather, the specialist should be considered as an extension of your primary care veterinarian, similarly to what happens in human medicine.
2. The ideal situation is that your family vet and the specialist have a prior relationship. They may not have dinner once a week or be BFFs, but they should work well as a team and communicate well – for your benefit and your pet’s.
3. It is important to remember that there are many family vets with considerable expertise in various areas despite not being “specialists.” Yet it is not possible that any one vet can be an expert in all areas.
4. The only vets who can call themselves specialists, or “board-certified,” or “boarded” in short, are those who have gone through additional training beyond vet school (8 years): an internship (usually 1 year) and a residency (typically 3 years). Then, they must pass a very difficult exam. The only proof of all of that is extra letters after their name. For a surgeon, you should see DACVS or Dip. ACVS or Diplomate ACVS after their name.

That said, let’s go over my top 10 reasons to see a board-certified surgeon:

1. A surgeon has extensive training. You tend to do well what you do often.
2. A surgeon may have treated several patients like your pet. Surgeons naturally see more challenging cases because so many family vets refer to them.
3. A surgeon has the specialized equipment needed. There are surgeries you simply cannot possibly do without special equipment.
4. A surgeon can provide a second (or third) opinion.
5. A surgeon tends to know the latest research and advances, because all they read is surgery journals and all they attend is surgery conferences.
6. Some patients may need a high-risk or difficult surgery.
7. Some patients may require specialized anesthesia because they are “high-risk”.
8. A surgeon’s clinic might provide 24-hour care, which is extremely rare in family practice.
9. A surgeon and their nurses offer comprehensive pain management through multiple modalities. For example, in my practice, we use 10 different ways to prevent and treat pain before, during and after a TPLO (a surgery to address a torn ACL).
10. Performing a surgery is a technical act. Knowing how to prevent complications, or how to deal with them if they occur, is a whole different story.

Basically, you should see a specialist for your pet for the same reasons you would see a specialist for yourself for open heart surgery or joint surgery.
So if your pet needs surgery, have an open discussion with your family vet and decide if they can handle it, or if you should consider a surgeon specialist.

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