Small animals are complex animals and while it is not possible to cover in detail all of the potential complications and risks associated with veterinary treatment, the following sections provide an outline of the major recognised areas of risk.
- Risk with Tumour Removal
- Risk of Exploratory Laperotomy
- Risks after Orthopaedic Injury
- Risks of Caeserean
Risks with Tumour Removal
Tumour removal usually occurs under general anaesthesia. It’s safer than sedation and local desensitisation with a local anaesthetic as it allows us to do our best to remove all the tumour.
The most common issues are:
- Not removing all the tumour. Before surgery we like to diagnose how aggressive the tumour is. This will predict how likely it is to invade local tissues, or to spread to other organs. We may need to do a “fine needle aspirate”, “biopsy”, xrays, blood tests and lymph node assessments to get a full picture of how aggressive (or hopefully benign) the tumour is.
- After surgery we can send the tumour away for assessment by a specialist. They can tell us a more exact diagnosis of the tumour and/or tell us if we have ‘clean’ ie non tumour containing edges to the site. Some tumours are highly aggressive and still come back, even with clean margins.
- You can help us by monitoring the tumour and presenting your pet to us when the tumour is still small. Please note than 80% of dog skin tumours are benign, but only 30% of cat skin tumours are benign.
- The tumours can bleed – lots. It depends on what they are growing on eg the spleen and how many blood vessels they contain. If we suspect there may be significant blood loss, we can blood type your dog, and call on one of our team of blood donors to come in and donate blood to your pet.
- These surgery sites can be prone to breakdown. Anything very large or over a high motion area like a limb, is more likely to have issues. Our experienced surgeons have several techniques to try and prevent this, but some large tumours are extremely challenging. Your vet will discuss this when planning your pet’s surgery.
- Die back of the skin. This sounds dramatic, but usually just means some bandaging and management, but it can occur in certain locations (limbs, tails etc).
- Some tumours such as Mast cells tumours have unique risks. They can release substances during removal called Histamines sending your pet into anaphylactic shock. We always check suspicious tumours to try and pick these up before surgery so we vcan carefully manage removal and give your pet preventative medications.
- Other than the mast cell tumours, the anaesthetic risk is usually well managed. Older pets usually have a check of the liver and kidneys with a blood test, and we may give fluids during surgery to ensure a quick, gentle recovery.
Risk of Exploratory Laperotomy
There are several reasons why we may recommend to perform an Exploratory Laparotomy (opening your pet’s belly to look inside). Frequently it is because there are indications that your animal has an issues with one of the structures inside. These can include;
- Suspicion that something is stuck. If its bone and we can see it on Xray, then we are really confident what the issue is. If its invisible on an xray, say someone’s underwear or a corn cob, we may go in to try and diagnose (and treat) the issue.
- Suspicion of a tumour in the intestine, liver or spleen. This may be to biopsy or remove the tumour.
- Investigate vomiting of unknown cause.
- GDV – a life threatening condition where the stomach twists and swells enough to cut off the blood supply back to the heart.
- Infection or abcessation. Its often called peritonitis.
- Trauma; Being hit by a car, or in a serious dog fight.
- Bladder issues such as large stones.
The procedure can be done as a life-saving emergency with huge anaesthetic risks, or as an elective diagnostic tool to help us treat or diagnose your pet’s issue. When well planned this is considered a lower risk procedure.
In general the most common issues are;
- The risks of anaesthesia are increased during an exploratory laparotomy, especially if handling the stomach. Regurgitation (food spontaneously travelling up the oesophagus and then going into the lungs) is a possibility. We try to prevent this using advanced anaesthetic techniques, withholding food for 8 hours before surgery (if possible) and careful monitoring. If food goes into to lungs, there can be serious issues with pneumonia in the days following the surgery.
- Risks of getting very cold. This can be dangerous if not addressed. We put the pet in heated blanket, use warm fluids during surgery and can warm their IV fluids to try and prevent this.
- Wound breakdown. There are 2 sites this can occur. The most serious is internally if we have had to cut into the intestine or bladder. We take several precautions; careful technique, testing the site with sterile water before closure and wrapping the intestine. It can be a difficult thing, especially when the gut is already damaged by disease or trauma.
- The other area of possible wound breakdown is the large incision through the muscle wall that is necessary. Any licking or over exercise will exacerbate the chance of breakdown. It is catastrophic if the intestine herniate through a damaged body wall, so any signs that the dog is licking, or the wound doesn’t look pale, dry and is non-painful, it is best to talk or visit with us immediately.
- Another unique risk when entering the abdomen is bleeding. Every organ has an amazing blood supply and if damaged, or requiring surgery, there is a real risk of significant blood loss. We have a team of blood donors who can donate at short notice. Your vet may recommend a blood typing test before a surgery with high risk of bleeding so we know which blood type to get for your pet.
Risks of Orthopaedic Injury
The are 4 types of injury listed below. All will cause lameness and pain. All require a considerable period of time to resolve, even with surgery or medical treatment. We usually talk about 4-6 weeks minimum to see a return to normal life.
All 4 will need;
Total Rest, followed by a period of rehabilitation. Bored animals (especially young dogs) make poor choices when allowed free rein, even for a few minutes. All ‘exercise’ especially toilet breaks, must be under control on a lead. Rest means staying in an area or cage, usually only 2-3x the size of the animal. Cuddles etc are fine, but the patient must stay under control.
Most also need a bandage or cast as part of the treatment. These are often hard to place on a swollen limb, and we replace them regularly as swelling changes, and small movements in the bandage (like a slip down) can result in pressure sores. Excessive movement of the patient or a wet, dirty bandage also puts the bandage at higher risk of sores. These can be catastrophic and result in large, red raw patches which take weeks to heal. Prevention is the key with pressure sores.
Medications are always given as part of treatment. It is important to use these as recommended by your vet. Antibiotics are used to prevent catastrophic infections which can result in total injury breakdown and in the worst cases, limb amputation is the only option left. Pain relief such as Fentanyl patches, meloxicam, gabapentin etc. are used to encourage your pet to rest comfortably, and no lick or chew at wounds or bandages. Later on, sufficient pain relief will allow them to start using the leg correctly and build up muscle.
There are 3 ways we can try and treat a bone injury such as a fracture. With external support such as a splint or cast, internal support such as a plate or pin and total rest. The principle of all is to hold the pieces of bone still and near each other so they can begin to heal.
The major time of weakness is the first week after surgery, but any bone movement will delay healing and can even result in a non-union (it never heals and stays painful), or additional damage from bandage rubs.
Infection will also result in no healing. We are extremely careful in surgery to prevent infection, but it is always a risk. Licking, poorly maintained bandages or allowing bandages to get wet, are all more likely to result in disastrous infections. Antibiotics can be given, but they often work poorly in bone and especially if any internal hardwear has been used. Prevention of infection is the key!
Tendon or Ligament Injury
The most common joint affected is the stifle of the dog. This is called a Cruciate rupture or ACL tear (like the common injury in footballers).
In some ligament injuries, we can do surgery to stabilise the joint. This can involve changing bone angles, placing stabilising sutures round the joint or even pinning the joint together (arthrodesis). The treatment depends on the joint, and on the size of your animal. The larger and heavier the animal, and the more likely the implants are to fail unfortunately. This means they actually break and stop doing their job. We use more complicated techniques in dogs where this is more likely to happen.
Again infection is a major issue, and can be impossible to control, even with antibiotics. Rest, no licking and management of the surgical site are key to lower the risk of this.
With ligament injuries, the recovery depends a lot on the post surgery care, with physiotherapy being very important.
These can be small sprains which only take a few days to settle, to catastrophic ruptures which result in paralysis of the limb. The treatment is extremely varied, and the main point is to follow your vet’s advice and not allow over-exercise which makes the likelihood of reinjury more likely.
This can be included with ligament or bone injury. There are 3 main joint related issues;
Infection of the joint from a wound, or in puppies, a blood infection. The mainstay of this treatment is a large amount of antibiotics.
Dislocation of the joint; elbows and hips are the most frequently dislocated. The primary treatment is replacement of the joint in the correct location (if possible) and immobilization to allow the damaged joint capsule and tendons to heal. If this does not work – usually as the joint remains unstable from excessive tearing of the surrounding tissues – then a surgical fix may be required. Total rest after joint replacement is essential, to the extent of not letting the animal walk at all even outside to toilet.
Risk of Caeserean
Although a Caesarean can be life-saving for both Mum and babies, there are some risks involved.
The most common issues are;
- The risks of anaesthesia for both Mum and babies. We use a different anaesthetic protocol to a normal anaesthetic where we do not give pain relief to Mum until all babies are out. This decreases the amount of drugs which cross the placenta to the babies and they are easier to revive. Mum is subject to all the normal risks of having a full general anaesthetic.
- Risks of the anaesthetic are increased with an exhausted Mum who has be birthing for hours. The risks are much lower if we make the decision to go to caesarean early rather than waiting too long.
- Date to do a Caesarean. Sometimes it’s obvious; a puppy is stuck, poor Mum is trying hard and not making progress. Other times it’s really hard to tell. Mum is not right, there are no pups and you aren’t quite sure when her due date is. In these cases we can do a blood test to give us an indication of whether the correct hormonal changes are occurring with the impending birth. It is called a “Progesterone assay”. It is not infallible, but gives us an indication on whether the puppies are ready to be born.
- If you are doing a planned Caesarean, say Dad is much bigger than Mum, or she’s had issues before and needed a Caesar, we highly recommend doing a Progesterone Assay to confirm ovulation. For these animals we want to do the Caesarian a short time before labour would actually start to decrease stress on puppies (or kittens) and Mum.
- Reviving the pups. They have received some anaesthetic during the process of the caesarean (although its kept to a minimum with our protocol and speedy surgeons). Also if Mum has been struggling for awhile they may be oxygen starved which causes brain damage and they are dead/ dying at the time of the Caesar. This is why we ask you to call us early if you think Mum may be struggling.
- Post op; Mum is prone to hypocalcaemia as her milk comes in. We give an injection at the time of surgery to prevent this, but you need to ensure she eats within a few hours of getting home.
- Not mothering the puppies or inadequate production of milk.. Mums need to be watched especially post Caesar. They are at a slight increase of harming their pups especially if they are sore. You will need to ensure all pups get a supervised drink every few hours over the next 24 hours, Mum will be a little woozy and not do this on her own.
- Wound breakdown. Unfortunately the surgical site is between 2 large sets of moist mammary glands, with lots of milk and puppy slobber in the same area. You need to keep a careful eye on Mum’s surgery wound as they are more likely to breakdown that a normal inscision.