Stress Free Vet Visits | Charleston Harbor Veterinarians

By: Dr. Janette Blackwood, Charleston Harbor Veterinarians

At Charleston Harbor Veterinarians, we receive multiple questions from our clients about the spay and neuter process. These questions range from asking how do we keep our patients comfortable to why is there a price difference between us and the local SPCA practices. To help answer those questions and more, we were fortunate to have our patient Kona volunteer to have her experience documented for this blog and to show a “behind the scenes look” at how CHV handles our spay process from start to end.

My first experience having a pet spayed was unfortunately not the best. This was back in the 1990s and I was a child. We dropped our cat off at the veterinary clinic in our small town in Georgia and picked her up the next day. I remember my entire family being squeamish and not wanting to look at her incision, but short of paying the bill, that was the extent our our involvement in her spay procedure. I don’t ever remember meeting her doctor or surgical nurse. Several years later, I was a teenager and looking to pursue a career in veterinary medicine. I excitedly received my first job at that same veterinary practice. I was dismayed to watch the process. At this time, I found out that this particular veterinary practice had a habit of reusing surgical instruments as there were often more procedures scheduled in a morning than the surgical packs or technical staff available.

What I saw a couple of decades ago shaped how I decided I would practice veterinary surgery in the future. Finding a veterinary partner in Dr. Kahuda was very exciting for me, as we quickly realized that we shared almost identical goals in how we wanted our surgical protocol and team to operate.

Surgery is such an important event in a pet’s life that at CHV we purposely choose to keep our daily surgical numbers low. While a veterinarian at a high volume practice may be scheduled to spay or neuter 6+ patients in a morning, CHV typically schedules a maximum of 3 surgeries in a day. This number can be much higher even at high quality shelters, whose veterinarians may be scheduled for 20-30 surgeries in a morning. Charleston Harbor Veterinarian’s lower volume allows for more personal attention to each patient and a process that is tailored to their comfort level and specific anesthetic needs.

A Day in the Life of a Spay at CHV

Drop off | Kona is dropped off at our practice between 7:30 and 8:00 am. The night before, her owner received an email that contained her surgical paperwork and instructions to not feed her after midnight. At drop-off, Kona’s owner received the option to speak directly with the surgical team to have any last minute updates, questions, and concerns addressed.

Physical Exam | After drop-off, Molly and I completed Kona’s examination. She was nervous to be at the veterinary hospital, so we tried to ease her anxiety by performing the exam on the floor instead of the treatment table. She also had time to rest and acclimate to the hospital.

Bloodwork | Once it was determined that her physical examination was normal, blood was drawn for preoperative screening. Bloodwork checks are to make sure that Kona is not anemic (does not have a low red blood cell count), has normal electrolytes, is hydrated, and has normal kidney and liver values.

Anesthetic calculations | Kona’s bloodwork was normal! Jesse and I calculated the anesthetic doses that Kona will need during her surgery. Kona’s anesthetic calculations and pharmaceutical choices were based on her age, the results of blood work and physical examination and her history of any previous or concurrent illnesses. Fortunately, Kona is currently a healthy girl so no adjustments to our standard protocol was needed the morning of her surgery.

Pre-medication | Next, Kona received a pre-medication injection. Pre-medication helps provide sedation and a high level of pain control during the upcoming surgery. The injection is placed in the muscle. Kona was given 30 minutes for a final bathroom break and to allow the pre-medication to take effect.

IV catheter placed | All patients receiving general anesthesia at Charleston Harbor Veterinarians have an IV catheter placed. The IV catheter allows for additional anesthetic medication to be delivered intravenously. During surgery, IV fluids will also be administered through this catheter. IV fluids keep our patient hydrated and maintains the patient’s blood pressure at a normal level during anesthesia, both of which helps prevent anesthetic complications. Here, Molly and Tara placed Kona’s IV catheter.

IV induction | Kona’s entire abdomen was clipped in preparation for surgery, and she is transported into the surgical room. On the surgery table she received IV medication from Molly and me to induce her into going into general anesthesia.

Intubation | It is protocol for patients receiving general anesthesia at Charleston Harbor Veterinarians to have an endotracheal tube placed. This plastic tube is placed into the trachea to keep the airway open and to allow a steady stream of both oxygen and anesthetic gas to go into the airway, allowing us to easily adjust the level of anesthesia as needed. This tube also prevents dangerous stomach contents from going down the airway, should the patient start to regurgitate under anesthesia. Molly and I placed the endotracheal tube.

Positioning | Kona was then placed in dorsal recumbency (on her back). She was provided a warming water blanket to help her body maintain a warm, comfortable temperature.

Sterile prep and gowning | Molly performed a sterile abdominal prep on Kona’s skin, as I scrubbed and prepared myself to perform surgery. Afterwards, Molly helped me put on my sterile gown and gloves.

IV fluids start and sterile drapes | Kona’s IV fluids were started. Sterile drapes were placed over Kona’s already sterile, prepped abdomen.

Spay procedure | I performed her spay.

Blood pressure monitoring | Meanwhile, Molly was very busy monitoring Kona under general anesthesia. She monitored and recorded her blood pressure.

Fluids monitoring | Molly monitored that Kona’s fluids were running properly.

More monitoring | Molly monitored and recorded Kona’s pulse ox, heart rate and respiration.

Adjustments | The information that our anesthetic team records helps determine how the patient is doing under general anesthesia. This monitoring allows us to detect small changes under anesthesia early, as that can alert us that a problem could be slowly developing. The goal is to catch small issues early before they could possibly develop into an emergency. Molly adjusted Kona’s anesthesia as necessary during the procedure to ensure at all times that the patient was at proper anesthetic depth.

Pain medication | Towards, the end of the procedure, Kona received a second injection for preventing pain. At the time of discharge from the clinic, she also went home with oral medication to prevent discomfort. Her type of pain medication was chosen again based on her physical examination, blood work and history of any type of other medical issues.

Recovery | After the procedure, Kona is transferred into our surgical recovery area. Kona was provided with a warm air blanket in recovery. Molly sat with her until she was completely awake.

Those who have toured our practice know that we have a relatively open floor plan. This recovery area can be viewed from the surgical suite, the treatment area, the laboratory computers, and even one of our examination rooms. One of the most critical times that an anesthetic mishap can occur is during the recovery period. For this reason, our patients are not left alone until they are fully awake and recovered from general anesthesia, and our floor plan allows for easy monitoring, even during more busy days. Molly in particular is known at CHV for snuggling her patients in recovery, making sure they recover in comfort and given her full attention.

Communication and discharge | Kona’s owner received a phone call from me after the procedure letting her know that Kona had recovered well. Kona was kept in the clinic for a few more hours in order to continue to monitor her recovery. Both Molly and I updated her medical record to include her anesthetic and surgical notes.

At discharge, Kona’s owner met with both Molly and me. Molly sat with Kona’s owner and reviewed Kona’s discharge instructions and pain medications to be administered at home. She told Kona’s owner how to care for her surgical site and how to prevent infections. She also showed Kona’s owner the “cone of shame” that would be needed to be worn until her recheck in 2 weeks.

Follow-up and recheck | Molly called Kona’s owner the next day to check and make sure that Kona had been comfortable overnight at home and was pleased to hear that she did very well.

In 2 weeks, Kona returned for her surgical recheck examination. She had healed very well and her sutures were removed with a little coaxing to lay down.

Clean bill of health | Kona had recovered well and was full of her old energy. She was given permission to stop exercise restriction and return to her regular level of activity.

Janette Blackwood, DVM

By: Dr. Christa Kahuda

Years ago I set out to become a veterinarian because I love animals (obviously – otherwise I made a very bad decision) AND, just as importantly, I enjoy people – especially teaching people! Yet more often than not I find animals cower in fear, pace, and pant when they come to see me and their families dread the visit just as much. There is so much good that is done during a veterinary visit – there must be a way to make it better for everyone. We need to change the accepted standard. When Dr. Blackwood and I set out to create our own practice we took a step back and noted the many triggers and frustrations for our patients and their owners. We made it our goal to find solutions…To make it easier and more comfortable to be the best pet owner you can be. To tailor our practice to you.

Here are some of the things we noticed about the typical vet clinic and how we’ve set out to change them:

It feels like a cold hospital: The typical medical grade floors, seating, and décor are largely removed. You will find you feel you are walking into a friend’s living room when you enter CHV. Get comfortable and relax in our home-like atmosphere with a cup of coffee and a snack for you and your pet.
The waiting room is stressful: How often do you hope that you are the sole visitor in the waiting room because otherwise your dog will completely embarrass you with his unruly behavior? Do you hope you can find a quiet corner to hide your cat’s carrier? Believe it or not, the veterinary team struggles with the waiting room just as much! The receptionists dislike clients staring at them, the doctor winces whenever a dog fight almost breaks out, and the nurses hate trying to be heard over the phones, conversations, and barking. The solution: ELIMINATE the waiting room! You may walk into the clinic, be greeted by a team member – and escorted immediately into a private room.
The exam room is uncomfortable: In many cases once you escape the waiting room you end up in a tiny, hot room with uncomfortable seating, harsh lighting and unsettling pictures of heartworms and fleas. Check out the changes we’ve made:
- larger than average exam rooms
- outdoor windows in every room
- dutch doors: you will no longer be captive inside a closed room wondering if you were forgotten! Our doors allow you to let your pet off leash or out of the carrier separated from other pets while still allowing you connection with the hospital staff
- free WiFi
- comfortable seating and décor for you and your pet
The unseen treatment areas are distressing: It is sometimes worrisome to allow your pet to be taken to the back treatment area for diagnostics. We will make it our goal to do most procedures in the exam room. If your pet is taken to the special procedures area – you will find you can watch each step of the process through large windows. You will even be able to catch glimpses of the OR and dental surgeries.
The laboratory testing is concealed and results are confusing: Diagnostics on the microscope will be able to be viewed in the exam room and either Dr. Blackwood or myself will explain our findings directly and clearly. Your pet’s blood work will largely be run in-house with results that day – and often during the visit. You will be able to ask questions and make informed decisions while meeting with your doctor without waiting days for results.
The pet is in new and scary situations: Encouragement and positive support with healthy treats and a calm quiet environment will help to relax your pet. Team members trained in low-stress techniques, limited use of metal exam tables, a designated feline room, comfortable resting areas, and other small alterations in standard procedures will go a long way to a better experience for all.
Lack of communication: We can email, text, phone, facetime, Skype, facebook, or even meet in person – with the many ways to communicate we promise to connect with you on your level. Part of the connection form lets you tell us how to reach you – and provides you with various methods of contact for us. We want you to have all the information you need so that as a team we can keep your pet healthy and comfortable.
Healthcare is expensive: The advances in medicine for both humans and our pets have made costs increase. While we cannot magically make the costs go away, we will work hard to be open-minded and flexible with our medical recommendations to keep your pet healthy.

So, those are a few of the ways we want to change what a visit to the vet looks like and hopefully if even a little bit of that resonates with you we’re on the right track. I imagine we’ll have all sorts of new ideas to implement over the years and we can’t wait to get started by meeting you and your pets very soon!

Dr. CK