A Day in the Life of a Spay at CHV

February 4, 2018 By admin Leave a Comment

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

Canine Influenza Update – Charleston, SC

June 21, 2017 By admin Leave a Comment

Back on June 9th, we posted a blog that stated that the H3N2 strain of Canine Influenza was reported in South Carolina, but we did not know the location. Recently, we have heard reports of a couple of confirmed cases in our lowcountry area.

Please, refer to the previously mentioned blog for information on the disease itself.

Dogs who are the most at risk for catching this virus are dogs that will travel to locations such as shows or competitions, where they will have exposure to high numbers of dogs from many different locations. For these dogs, we strongly recommend vaccination for influenza vaccinations H3N2 and H3N8 prior to travel to that event.

Dogs who are at moderate risk are locally social (visit dog parks or other pet friendly gathering spots) or attend boarding facilities. Vaccination for these pets may be of benefit and something that you may wish to discuss with your veterinary practice.

Remember, that it takes 1 vaccination and then a booster vaccination 3 weeks later to complete the vaccination series. Afterwards, it may take another week for your dog to have developed the immune response to be fully protected. Therefore, pet owners who feel that their dog has a strong need to be vaccinated for travel or boarding should prepare a month in advance to make sure adequate time is allowed for both vaccinations to be administered.

Even with vaccination, there is no guarantee that your pet will not develop clinical signs if exposed to the influenza virus. As with people receiving the human influenza vaccination, the goal is to lessen the severity of the symptoms should the disease develop.

We will continue to see all patients with respiratory infections outside in our parking lot for examinations, to decrease the chance of spreading this illness to any of our patients within the practice. Thank you, for your understanding in this matter.

As always, thank you, for your trust in Charleston Harbor Veterinarians. It is a joy to get to meet each one of your pets.

-Dr. Janette Blackwood

What Pet Owners Should Know About Canine Influenza

June 9, 2017 By admin 1 Comment

We know that many of our fellow Charleston dog owners have been wondering about the recent media posts about a “deadly” canine dog flu that has been documented in South Carolina. We thought we would take a moment to share with you some bullet points that we know about this recent report, so that you can learn a little more about this virus.

There are actually two strains of the canine influenza virus: H3N8 and H3N2. Influenza H3N2 is the one that has been currently reported in South Carolina. It has not been reported to spread to people, although nation-wide there has been the rare transmission to cats.
As of the writing of this blog, we still do not know where in South Carolina this virus was reported or how many dogs have been affected. It may simply be one dog in the upstate or several in the Lowcountry. What we do know is that The University of Florida College of Veterinary Medicine is one of the many schools tracking this disease, especially after a recent new exposure at a dog show in Perry, Georgia. The University of Florida issued a report this week simply listing the states that have had reported cases of H3N2. South Carolina was on this list.
H3N2 has actually been in South Carolina before this year. A veterinarian in Mount Pleasant diagnosed it in 2 dogs traveling to our lowcountry, after staying in an infected boarding facility in Atlanta, in the spring of 2015. The owner’s vigilant observation of her dogs’ newly developed respiratory signs and the quick thinking of the veterinarian to send off testing for the virus allowed these dogs to be isolated and likely prevented this virus from spreading to other local pets.
The canine influenza behaves similarly to human influenza. Dogs show signs of coughing, sneezing, lethargy, and fever. The virus is highly contagious, and dogs can spread the disease some time prior to their symptoms becoming readily apparent. Unfortunately, they can remain contagious for up to 4 weeks. The good news is that while the dogs likely feel miserable (much like us when we have the flu), the infection is rarely fatal. The University of Georgia’s College of Veterinary Medicine’s Infectious Disease Department speculates that there is a mortality rate of less than 1% for H3N2 (and less than 5% for H3N8). Similar to people who become sick from the flu, cases are more likely to result in death for individuals who are older, very young, or immunocompromised from another disease. While I appreciate the media for educating our community on the existence of this virus, the Charleston veterinary community sees a higher rates of pets passing away from other more common deadly diseases such as parvovirus, heartworm disease, and exposure to toxins such as antifreeze.
There are vaccines for H3N8 and H3N2. Similar to vaccinating people for human influenza, vaccination does not result in a guarantee from a complete lack of illness should exposure occur. The goal is to lessen the severity of symptoms should a dog become sick. This is considered one of several “life style” vaccinations that we offer at Charleston Harbor Veterinarians, limited to dogs who complete certain activities regularly that would increase their risk of exposure to this disease. This is similar to a conversation a person may have with their general practitioner about the benefits of receiving an annual “flu shot”.

What can you do to keep our community pets safe?

Be a good neighbor! If your dog is showing symptoms of coughing, sneezing, ocular drainage, and/or lethargy, this is a time for your dog to stay home and not socialize. This is true for any contagious disease, not just canine influenza. We have many contagious upper respiratory tract infections that are much more common in the Charleston area than canine influenza. If your dog is sick, don’t go to dog parks or to the groomer’s office. If you were making plans to board your dog, see if you can have a family member or a friend come to your home instead. Your boarding and grooming facilities’ owners and your community’s neighbors will thank you for this kindness.
If your dog is sick, contact your veterinarian. Our physical exam can screen for complications to respiratory infections such as fever, dehydration, and pneumonia. Testing to identify the offending pathogen is available, although it is completed at a reference laboratory and results can take about a week to return. Dogs must also be tested soon after clinical signs start for more accurate results. If indicated, we can prescribe medications to make your dog recover faster.
Talk with your veterinarian about your dog’s lifestyle to see if vaccination is recommended. Dogs that are exceptionally social or travel may benefit from the vaccination. This would include dogs traveling to dog shows, dogs traveling for agility competitions, regular attendees at doggie day cares, and regular attendees to local dog parks. Individual boarding facilities may start to require this vaccination, in an effort to minimize the chances of an outbreak within their businesses.

If you are making an appointment at Charleston Harbor Veterinarians to have a pet evaluated for a respiratory illness, please, do not be offended if we request to examine your pet in our parking lot, instead of bringing him/her into our building. Like all veterinary practices, we routinely treat the elderly, pediatrics, and patients undergoing immunosuppressant therapy for other illnesses. Due to the contagious nature of this disease, we do not want to place other individuals at risk and have a protocol in place to minimize the spread of respiratory diseases.

Charleston Harbor Veterinarians is here to answer questions that you may have concerning canine influenza and of course other medical concerns you may have. Feel free to contact us at 843-410-8290 or chvteam@charlestonvets.com.

You may also read more about it at both The University of Georgia and The University of Florida veterinary colleges’ websites:

http://vet.uga.edu/news/view/canine-influenza-helpful-information

http://hospitals.vetmed.ufl.edu/canine-influenza

Contributed by: Dr. Janette Blackwood

Tips to make an emergency clinic visit less stressful

November 2, 2016 By admin Leave a Comment

No one ever wants to be the one taking their pet to the emergency clinic. During a recent relief shift at a local veterinary emergency clinic, I decided to compile some tips that could help decrease some of the stress, should you find your pet needing after-hours care. We are fortunate in the Charleston area to have several great emergency facilities available for our pets after regular business hours. The level of care you’ll find from these enthusiastic doctors and technicians working in a state-of-the-art 24-hour facility when your pet has a serious sudden illness can greatly exceed the care that I was able to provide after graduation while providing “on-call” care for a small animal practice in rural Georgia. As excellent as that care is and the comfort you can take in knowing your pet is in the right place, seeing your pet sick and in the hospital can be stressful.

Here are some tips to make your emergency clinic visit less stressful and more successful:

If your pet has a chronic illness, grab his/her medications as you head out the door.

Unless your pet has been a direct transfer to the emergency clinic from your regular veterinary clinic or has been seen at the emergency/specialty center in the past, the emergency clinic is likely not going to have copies of your pet’s records from your regular veterinarian. This includes any medications, any previous laboratory work, and any history of preventative care (vaccinations, heartworm testing, etc.). I jump with joy when a client starts bringing out her pet’s pill vials from her purse during the exam, as I now know that I am not going to be prescribing any medication that could have a drug interaction with the pet’s usual medications. Bonus points if you can keep a folder handy with recent laboratory results too, as this could possibly save you some money in diagnostics to be completed. If laboratory work is determined to be needed to be repeated, those copies of past lab work can also serve as a vitally important baseline to help determine the severity of your pet’s current illness and aid in establishing a prognosis for further treatment.

Don’t give any medication before arrival without talking to the emergency clinic staff first, even if it is labeled “over the counter”.

The biggest culprit is usually aspirin; owners seeing their pet in discomfort try to make their pet comfortable by administering an aspirin first and then decide later to take their pet to the emergency clinic when the pain still persists. I have had a pet present for a mild lameness of minimal concern, only to have to hospitalize her for a potential ibuprofen toxicity secondary to the advil the owner gave the pet at home to to try to help with the limp. The most frustrating aspect about these human pain medications is that they can have potentially harmful side effects when combined with medications that we would routinely use in the emergency clinic for pain treatment. Therefore, my treatment options for making your pet comfortable become immediately limited, and I also have to worry about any adverse (especially gastrointestinal) side effects that an aspirin given at home may cause.

Please, please, please don’t lie!

I understand that people don’t lie to be mean. They know something happened at home (the pet ate something dangerous, someone accidentally stepped on the puppy, etc.) and they are embarrassed or afraid to let the veterinary staff know. Your veterinary staff understands that accidents happen in the home. Their main goal is to get your pet diagnosed and comfortable as quickly as possible, and the pets can’t talk to us to tell us what medication they got into and ate 30 minutes prior to when you found them sick at home. Withholding information can be dangerous (and expensive!), because it can take me down the wrong track of accidentally misdiagnosing your pet.

Keep your pet’s preventative care with your regular veterinarian up to date.

Over the past six months of emergency clinic shifts, I have treated dogs with deep bleeding wounds secondary to flea infestations, have had to euthanize dogs in congestive heart failure due to heartworm disease, and had to hospitalize lethargic and dehydrated puppies due to having a high burden of intestinal parasites. All three of these diseases are caused by parasites and are able to be prevented by a variety of parasite preventatives sold by your regular veterinarian at a much cheaper price when administered prior to clinical signs starting. Another disease commonly diagnosed in the emergency room is parvo virus. This highly contagious virus can be deadly to puppies. Treatment in the emergency clinic can be easily over $1,000.00, but the preventative vaccination can be started at your regular veterinarian for under $30. Spending a little bit of money on preventative care can easily save you hundreds of dollars in the future.

Come prepared to pay the bill.

This is always the most delicate subject when I speak with my clients in day practice about the benefits of sending their pet to the emergency clinic for overnight care. Usually, I am asked if the visit will be “expensive”. I suppose it all involves how you look at it. Many clients today are demanding human grade diagnostics and care for their sick pet members. Veterinary emergency clinics are able to provide something very comparable to human care at an absolute fraction of the cost. So, a life-saving surgery that might cost my husband $50,000-$100,000 in hospital bills may only cost $3,500-$5,000 for your dog. This is actually pretty amazing to me. Still, we all understand that $3,500 can be difficult/impossible for some to acquire in a weekend. Without the government assistance or health insurance agreements that human hospitals may receive, veterinary clinics must require funds up front at the time of service. There really is no other way they can operate, pay their hard working staff, pay their overhead, and stay in business. Acquiring pet insurance while your pet is healthy (before the emergency) is a great idea. I tell clients you should either do that or (if you are a good planner with excellent self discipline) store a set amount each month in a bank account of some form to save for such an emergency. If you are going out of town and having a pet sitter watch your pet, arrange an emergency plan with the sitter concerning who is permitted to make medical decisions and payments, should your pet become ill.

I have been asked by some why I continue to relinquish a valuable weekend to go in to work these emergency clinic shifts that can run into the late evening. The answer is that I love it! The doctors and technical staff that I have the pleasure to work with there are so skilled and passionate about their jobs that I believe experience alongside them make me a better practitioner while at my day job. I hope you never need to go to the emergency clinic with your pet, but should you, I hope the advice in this blog help make your visit a little a smoother.

Janette Blackwood, DVM at Charleston Harbor Veterinarians

Janette Blackwood, DVM

What does your dog like to do?

March 8, 2016 By admin Leave a Comment

By: Janette Blackwood, DVM Janette Blackwood, DVM with pup

My first couple of years out of veterinary school, I worked out in a military town in Georgia. One day, I had a client come in with a new adult shetland sheepdog rescued from the shelter. Even though it was about a decade ago, I still remember reading the paperwork filled out by the original owner at the time the dog was surrendered to the shelter. The paperwork had a list of the standard questions you would see on these forms, such as “Is this dog on heartworm and flea prevention?” or “Is he good with small children?” But, there was one question and answer that really stuck out to me, because it really made me think about the bonds (or lack of bonds) that we form with our pets:

Question: “What does he/she enjoy doing?”
Answer provided by owner surrendering pet: “I don’t know.”

The relationship (or lack thereof) between an animal and a pet can be so valuable, that it actually has a medical term taught in veterinary colleges and recognized by the American Veterinary Medical Association (AVMA): “the human-animal bond”. The AVMA’s website defines the human-animal bond as “a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors that are essential to the health and well being of both.” The definition further goes on to state that a veterinarian should work to maximize the potential of this bond between their clients and pets. As a new graduate, my mind was constantly in a whirl to make sure that I was keeping my animal patients’ bodies physically healthy. Were all my dog and cat patients on parasite prevention monthly and properly vaccinated to keep them safe from infectious diseases? Were my senior pets comfortable in managing their arthritis? And, were my senior sets treated appropriately for their periodontal disease, so that they would continue to eat without pain? But, reading that question from that shelter’s paperwork really got me thinking about wondering if I was doing enough to make sure that my pets were also happy in their daily lives, thereby building that human-animal bond.

At the time that I was meeting that newly adopted Sheltie, my own little white, fluffy mutt Radar was a young guy full of tremendous energy. And, even though we had only had him for a few months, I knew for sure how to answer the question: “What does he enjoy doing?” He has always loved the game of chase with anyone throwing a squeaky toy. He loves long walks in any new area; bonus points if there are random tuffs of grass for him to mark as his own. The end to a perfect day full of activity would consist of a quiet evening with a Greenie chew and maybe a little tomato for dessert after eating his dry kibble. And, if you were sitting on the floor, he can always find a way to position himself directly in front of you in the perfect location for a gaining a back rub.

As Radar and I both grow older and life finds me and my family somehow busier than ever, I do have to make myself stop and reassess: Am I still providing Radar what he needs to be happy? He is so quiet; he rarely complains. At these times, I usually stop what I am doing and grab his harness and leash. Then, we head outside for a walk through the neighborhood, making sure to walk a little more slowly in the areas with tall tufts of grass.

If you feel inclined, comment below on what you feels gives your pets meaning and happiness in life. It might give others ideas of activities to do with their pets, especially as the nice weather is starting to return.

Janette Blackwood, DVM

Website to the AVMA description of The Human-Animal Bond.
https://www.avma.org/kb/resources/reference/humananimalbond/pages/humananimalbonda vma.aspx

Here are some tips to make your emergency clinic visit less stressful and more successful:

If your pet has a chronic illness, grab his/her medications as you head out the door.

Don’t give any medication before arrival without talking to the emergency clinic staff first, even if it is labeled “over the counter”.

Please, please, please don’t lie!

Keep your pet’s preventative care with your regular veterinarian up to date.

Come prepared to pay the bill.