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Many people have questions about various aspects of their pet's surgery, and we hope this information will help.  It also explains the decisions you will need to make before your pet's upcoming surgery.

Is the anesthetic safe?

1. Today's modern anesthetic monitors have made surgery much safer than in the past.  Here at South Coast Veterinary Hospital, we do a thorough physical exam on your pet before administering anesthetics, to ensure that a fever or other illness won't be a problem.  We also adjust the amount and type of anesthetic used depending on the health of your pet.  The handout on anesthesia explains this in greater detail.
2. Preanesthetic blood testing is important in reducing the risk of anesthesia.  Every pet needs blood testing before surgery to ensure that the liver and kidneys can handle the anesthetic.  Even apparently healthy animals can have serious organ system problems that cannot be detected without blood testing.  If there is a problem, it is much better to find it before it causes anesthetic or surgical complications.  Animals that have minor dysfunction will handle the anesthetic better if they receive IV fluids during surgery.  If serious problems are detected, surgery can be postponed until the problem is corrected.
3. We offer three levels of in-house blood testing before surgery, which we will go over with you when you bring your pet in.  Our doctors prefer the more comprehensive screen, because it gives them the most information to ensure the safety of your pet.  For geriatric or ill pets, additional blood tests, electrocardiograms, or x-rays may be required before surgery as well.
4. It is important that surgery be done on an empty stomach to reduce the risk of vomiting during and after anesthesia.  You will need to withhold food for at least 8 to 10 hours before surgery.  Water can be left down for the pet until the morning of surgery.
5. When should my dog have the first bowel movement after surgery? Many dogs may not have a bowel movement for the first 2 to 4 days after surgery.

Why Blood Test?

 A blood panel is required on every pet prior to surgery. The information gained in this blood panel helps us determine if there are any underlying medical conditions that might place your pet at an increased risk while under anesthesia. As the liver and kidneys are the primary organs responsible for excreting anesthetic drugs as gases, it is extremely important to know that these organs are functioning appropriately in your pet.

Reasons that a dog will not have regular bowel movements after surgery include:

1. The dog has been fasted prior to surgery
2. Dogs do not eat well during the hospital stay
3. They frequently do not eat well when they go home
4. They are fed highly digestible food that produces little stool
5. Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating.

My pet had surgery and will not eat.  What can be done?

Dogs

1. Most pets will not eat their regular dog food after surgery, especially if it is kibble.
2. Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source.  The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked).   The carbohydrate can be pasta, potato or white rice.
3. Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
4. Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal.
5. Try Hill's A/D diet available at most veterinary hospitals
6. Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
7. Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
8. Remember that most pets will not eat the first day or two after they get home from surgery

Cats

1. Offer smelly foods that contain fish such as tuna or smelly cat foods
2. Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
3. Hand feeding:  with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
4. Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
5. Some cats will only eat dry food, try kibble if your cat normally has been fed that food
6. Petting and stroking your cat frequently will help to stimulate appetite
7. Remember that most pets will not eat the first day or two after they get home from surgery
8. Appetite stimulants such as cyproheptadine may be helpful
9. If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop

My pet is vomiting.  What can be done?

1. The first thing for you to discern is whether your pet is vomiting or regurgitating.  Both will result in fluid or food being brought up.  Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus.  Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled.  Usually the regurgited material will be clear or brown colored fluid. 
2. Next is to identify the cause of the vomiting or regurgitation.

Causes and treatment of vomiting after surgery

1. When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
2. Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery.  In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart.  Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to.  The antibiotic in some cases may be changed to a different one, or may be discontinued.
3. Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days. 
4. An uncommon cause of vomiting after surgery is internal organ failure.  Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
5. If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present.  Do not ignore this sign.
6. Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. Cerenia and Metoclopramide are good anti-vomiting medications for dogs and cats.  You should always consult a veterinary healthcare professional before administering medication.

Causes and treatment of regurgitation after surgery

1. The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia.  Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis.  This results in poor motility of the esophagus, therefore water and food will accumulate in this structure.  In most cases, esophagitis is self-eliminating and will resolve within two or three days.
2. If the esophagitis is severe the esophagus may develop one or more strictures.  A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week.  This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope).  If an esophageal stricture is chronic surgery is needed.
3. Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other).  Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.

How do I know that my dog is in pain following surgery?

1. crying
2. biting if you get near the surgical site
3. grimacing (lips are pulled back and the dog looks anxious)
4. tragic facial expression
5. panting
6. restlessness and unable to sleep; pacing
7. if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired

What can I do to control my dog's pain?

The worst pain will be for the first 2 to 3 days after surgery.

1. Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
2. Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
3. If an orthopedic surgery has been done cold packing the surgical site may be helpful
4. A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack.  An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern.  Cooling the surgical site helps to numb the area.

How do I know that my cat is in pain following surgery?

1. Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
2. Signs of pain in a cat include the following:
3. biting if you get near the surgical site
4. growling or deep cry
5. not wanting to eat
6. hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)

What can be done for pain at home for my cat?

1. Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
2. Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
3. Anti-inflammatories can be used, but the dose is much less than dogs

Is it okay for my pet to lick the incision?

1. If a dog licks the incision, the healing process may be delayed.
2. Licking can remove stitches and cause the incision to open
3. Licking can become a severe habit that is difficult to break
4. Licking can cause infection as the mouth has many bacteria
5. Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.

To stop your pet from licking the following can be tried:

1. Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
2. Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
3. A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
4. A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
5. Bitter apple can be applied around the incision; many dogs will continue to lick  after application of this topical
6. Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
7. Antipsychotic medication in some cases is needed.

Will my pet have stitches?

For many surgeries, we use absorbable sutures underneath the skin.  These will dissolve on their own, and do not need to be removed later.  Some surgeries, especially tumor removals, do require skin stitches.  With either type of suture, you will need to keep an eye on the incision for swelling or discharge.  Most dogs and cats do not lick excessively or chew at the incision, but this is an occasional problem you will also need to watch for.  If there are skin sutures, these will usually be removed 10 to 14 days after surgery.  You will also need to limit your pet's activity level for a time and no baths are allowed for the first 10 days after surgery.

Will my pet be in pain?

Anything that causes pain in people can be expected to cause pain in animals.  Pets may not show the same symptoms of pain as people do; they usually don't whine or cry, but you can be sure they feel it.  Pain medications needed will depend on the surgery performed.  Major procedures require more pain relief than things like minor lacerations.

For dogs, we may recommend an oral anti-inflamatory the day after surgery and several days after to lessen the risk of discomfort and swelling.  We use newer medications, which are less likely to cause stomach upset and can be given even the morning of surgery.  The cost of the medication ranges from $10 to $15, depending on the size of your dog.

Because cats do not tolerate standard pain medications such as aspirin, ibuprofen, or Tylenol, we are limited in what we can give them.  Recent advances in pain medications have allowed for better pain control in cats than ever before.  We administer a pain injection 10 minutes prior to surgery.  After surgery, pain medication is given on a case by case basis.  Any animal that appears painful will receive additional pain medication.

We use narcotic patches for some surgeries in dogs as well.  The cost will depend on the size of the dog.  Injectable pain medications may also be used after surgery on both dogs and cats.  Providing whatever pain relief is appropriate is a humane and caring thing to do for your pet.

What other decisions do I need to make?

While your pet is under anesthesia, it is the ideal time to perform other minor procedures, such as dentistry, ear cleaning, or implanting an identification microchip.  If you would like an estimate for these extra services, please call ahead of time.  This is especially important if the person dropping the pet off for surgery is not the primary decision maker for the pet's care.

When you bring your pet in for surgery, we will need to 5 to 10 minutes of time to fill out paperwork and make decisions on the blood testing and other options available.  When you pick up your pet after surgery you can also plan to spend about 10 minutes to go over your pet's home care needs.

We will call you the night before your scheduled surgery appointment, to confirm the time you will be dropping your pet off and to answer any questions you might have.  In the meantime, please don't hesitate to call us with any questions about your pet's health or surgery.

If you have any questions or concerns regarding any procedures, please do not hesitate to call us.