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Elective Surgery Info for Consumers

The Informed Consumer's Guide to Elective Surgery  

Thank you for recognizing that your cat may need to undergo an elective procedure such as spay, neutering, declawing, or dental care. Many people "shop around" for the best price on this surgery, without the knowledge of why the cost varies among veterinary practices. After all, Americans are great bargain hunters and, surely, the best price is the best bargain, right? And a spay is just a spay, right? Well, no. In medicine, price typically reflects expertise and attention to anesthesia safety standards. Some hospitals elect to perform anesthesia as cheaply as possible in order to make it available to more people, recognizing that the short-cuts and cheaper drugs mean increased risk to the patient.

This guide was put together to help you, the consumer, find the best fit between the veterinary practice and your expectations for the care of your cat. We will also de-mystify anesthesia and surgery, so that you make informed decisions. In it, you will find outlined the most current recommendations for anesthesia care and how to evaluate what a hospital can offer you, as well as what we do specifically at the Cat Hospital of Chicago. We always recommend you ask for precise details and a hospital tour before booking elective surgery and procedures for your cat.

These are the questions we recommend that you ask when evaluating the level of care offered by a hospital:

  1. Do you have a dedicated nurse with the patient at all times whose sole responsibility is to monitor anesthesia?
  2. Will my cat be given a breathing tube?
  3. Will my cat be given an IV catheter?
  4. Will my cat's anesthetic medications be individually tailored?
  5. Do patients receive intra-operative fluid support to maintain blood pressure health?
  6. Do you support organ health by monitoring blood pressure? Are you able to take corrective action with blood pressure medication(s) if there is a problem?
  7. Are patients monitored for heart health under anesthesia (EGC, oxygen monitors)?
  8. Are patients monitored for respiratory health (lung function) under anesthesia with oxygenation monitors and a carbon dioxide monitor?
  9. Are patients actively kept warm to prevent anesthetic problems and improve recovery from anesthesia and how do is it done?
  10. In the event of an emergency, are emergency medications readily available?
  11. What training do the doctors and staff have in anesthesia and safety?
  12. What does "everything is included in the price of surgery" actually include?
  13. Can you describe your pain management protocol?
  14. What specific measures do you take to reduce my cat's anxiety (and pre-existing pain, if applicable) while hospitalized for the procedure?

Surgery and Anesthesia FAQ's

  1. What pre-anesthesia evaluation will my cat have prior to surgery?  
  2. This is important for a number of reasons. A physical examination by a veterinarian is our first defense against performing surgery on a patient that may have an infectious disease, a heart murmur/condition, or debilitation from parasites. A pre-anesthesia blood test can detect for hidden organ system problems that could cause serious complications when the cat is under anesthesia or in surgery. In some settings and hospitals, these steps are omitted. Be sure to ask.

  3. What safety precautions will be taken?
  4. We believe that each patient is an individual and not a number. As individuals our anesthesia responses and tolerances vary, too. While most surgery is uneventful, emergencies sometimes arise. Early detection of impending problems greatly aids our ability to intervene and correct the problem.

    At Cat Hospital of Chicago, an IV catheter will be placed prior to the start of anesthesia. The IV catheter is our port for providing emergency drugs if problems arise. Having a catheter pre-placed to anesthesia is one of the most important procedures for safety. (The only exception to this is if the patient is too stressed or it is too hazardous to personnel to place the catheter first. Additionally, if the procedure is extremely abbreviated, we may elect to forego the catheter.)

    IV fluids need to be administered to help maintain blood pressure, provide internal organ support, and to prevent your cat from becoming dehydrated following fasting and a surgery.

    A breathing tube should always be placed (intubation) in all anesthetized patients. This keeps the airway open and allows for supplemental oxygen delivery in a patient who is not conscious enough to breathe well on their own. It also allows us to control the level of anesthesia through the administration of anesthetic gas. This tube is also important to prevent aspiration into the lungs of saliva (or water during a dental procedure) from being unable to swallow. If this happens, pneumonia could develop following surgery.

    Respiratory monitors for blood oxygen and carbon dioxide levels, a heart rate monitor, and an ECG, allow the anesthetist to keep track of heart function, as well as how well the patient is breathing and intervene before serious problems arise.

    A good practice should also have an emergency drug supply box or cart available in case of problems.

    Here at Cat Hospital of Chicago, blood pressure is monitored in all patients under anesthesia because anesthesia is notorious for lowering blood pressure to unhealthy levels, which can result in organ and brain damage due to lack of oxygen delivery from the bloodstream. Small patients, such as cats-particularly the young and the elderly, are especially vulnerable to this. Fasting (and subsequent diminished water intake) also predisposes to blood pressure problems. If the blood pressure drops to unhealthy levels, corrective measures need to be taken which include increased delivery of IV fluids, as well as the use of continual IV medicated blood pressure drips (vasopressor CRIs).

    Since anesthesia causes an inability to maintain body temperature effectively, which can result in prolonged anesthesia recoveries and increased heart stress, it is important to address this. Small patients are especially prone to this with their decreased muscle mass. At Cat Hospital of Chicago, all of our patients are cocooned for their entire surgery in a warm air blanket. Since body heat tends to be lost through the paws, they also wear baby booties. They receive continuously warmed, body temperature IV fluids. All patients are awakened in a cage with heated flooring and under warm toweling/blankets with supervision by their anesthesia team member.

    And, the most important single monitor is a trained team member. Each patient is monitored continuously throughout the entire procedure by a veterinary anesthesia team member whose sole responsibility is to fine-tune anesthesia and watch the patient. This person also records vital signs in the chart for future reference and to allow detection of small changes in anesthesia tolerance before large problems become apparent. In most instances, there are two staff members with the patient throughout the entire surgery (a doctor and a veterinary team member). Unlike in some hospitals, our anesthesia team member is not expected to also clean teeth or restrain/work with other patients at the same time, which would obviously cause a splitting of focus and can result in subtle anesthetic changes being missed. Nor is it expected that the doctor would be expected to keep track of anesthesia while focusing on surgery at the same time. We believe that your cat deserves to have dedicated attention from a trained anesthesia team member at such a delicate time.

    At Cat Hospital of Chicago, all of our anesthesia team members are fully trained in anesthesia safety and support. We pay for educational courses for our staff so they may be capable of the responsibility that anesthesia requires. Our doctors participate in online anesthesia message boards and consult with board certified anesthesiologists to ensure that our anesthesia standards and patient care are top-notch. As part of that top-notch care, we routinely adjust anesthesia medications based on patient health status and anesthetic risk. There is no "one-size-fits-all" approach with anesthetic medications but this is a common cost-cutting measure. At Cat Hospital of Chicago, we have several medication options and probably about a dozen potential combinations of medications to tailor the anesthesia specifically to the patient's level of anxiety, pain, age, and health.

  5. What comfort measures will be taken?
  6. Here at Cat Hospital of Chicago our patients receive individualized care. There are no barking dogs in the hospital (or in the next cage). Our staff is trained in handling nervous patients and utilizes low-stress patient handling techniques so they are more comfortable with us. Extremely anxious patients are given cage "condo" with fleece bedding to hide in. We use calming pheromones liberally in the hospital. Particularly nervous cats may be given their own quiet room away from all activity in the hospital ward. In pre-arranged instances, it may be possible to wait with your cat while the pre-medications take effect before the anesthesia. We treat many anxious patients prior to surgery to reduce their stress levels because we know that pre-operative stress can exacerbate post-operative pain.

    All patients are checked for infectious diseases, ringworm, and parasites prior to being assigned a bed in our hospital. If any parasites are found, or any patient is infectious to others, they are housed in an isolation ward to prevent your cat from picking up any contagious problems.

    Once patients are awake from anesthesia, we feed them a small snack and we send them home as soon as they are ready. There is no need to wait until the end of the day, if both you and your cat would be more comfortable together.

  7. How will pain be controlled for my cat?
  8. This is very important-surgery hurts!

    The anesthetic will not control pain responses in the body, nor provide pain relief after the patient is awake. All patients at Cat Hospital of Chicago receive a combination of pain relievers including local nerve blocks, pre-operative and intra-operative pain medications, and at least one, if not more, pain relievers for home use in the days following surgery. These are selected based on the nature of the surgery and the degree of discomfort the patient is anticipated to experience. This is called multi-modal pain control and follows a modern philosophy in patient comfort. We know that the commonly offered single, pain medication injection at time of surgery is usually completely inadequate to control post-operative pain. Our spays receive a minimum of 5 days of pain relief, with more available if needed. All of our declaw procedures (which is an amputation procedure! see our declaw handout), are automatically sent home with a minimum of 2 weeks of pain medication.

    Ask if this progressive, multi-modal approach will be used for your cat. Frequent combinations of pain relief that are sent home with our patients include the use of buprenorphine with gabapentin, or pain patches with gabapentin. These combinations are potent and attack pain through more than one chemical pathway. There are other less effective pain relievers that may be offered at lower cost such as torbugesic or meloxicam.

    When IV catheters are placed, we numb the vein with a numbing cream so that patients are more comfortable.

    We also offer laser surgery which helps reduce pain and inflammation. And, we use a therapeutic laser ("cold laser") post-operatively on all routine surgical incisions to reduce inflammation and speed healing.

  9. Will I receive written post-surgical care instruction for my cat?
  10. Aftercare of surgical patients is very important for proper healing. The hospital should provide written discharge instructions for your cat and be available for follow-up questions. We offer free technician appointments to check on post-operative concerns.

  11. In what ways can the services be compromised to lower competitor's prices?
  12. There are so many ways that corners can be cut. Although your cat may survive the procedure, greater risks may be taken. These risks are known to increase the chance of infection, pain, suffering, long-term organ damage, and, rarely, death. Since there are no laws that regulate these issues, some veterinary hospitals cut corners in order to offer the lowest price possible.

    We believe that owners should have choices and should not be disrespected if they cannot afford uncompromising care, but feel all cat owners should be informed that the lowest price likely reflects the lowest service and minimal medical care. At Cat Hospital of Chicago, we believe that our cats deserve the best care possible to minimize pain/stress and hold ourselves to the highest standards of patient care and comfort.

We welcome your questions! Please feel free to call us and discuss any concerns you may have.

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