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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

Don't Opt Out of Pre-Anesthetic Lab Work

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July 31, 2012 / (22) comments


Most veterinary hospitals now recommend pre-operative lab work for pets undergoing general anesthesia. It’s the standard of care these days, but veterinarians still get a fair amount of push-back from owners who don’t understand the importance of these tests.

 

The complaints I’ve heard the most frequently tend to fall into two categories:

 

1. "But Rascal is only 6 months old and has been healthy her whole life. Why should I have to pay an extra (insert dollar amount here) for testing that will surely be normal?"

or

2. "But Siegfried just had blood work, why do we have to run it again?"

 

I get it. I’m frugal and hate the thought of paying for something that isn’t really necessary, but pre-anesthetic lab work is really no place to scrimp.

Let’s look at a typical example that elicits the first argument — a young animal undergoing an elective procedure (e.g., a spay or neuter). Yes, the chance of a problem being detected on pre-operative screening is small, but not negligible. Here’s just one example I know of: a five month old dog scheduled for a neuter that was found to be in the early stages of renal failure and died a month later. What a tragedy for all involved had that dog undergone surgery.

In the case of a young pet, pre-anesthetic testing does not have to be involved or expensive. One of the most progressive clinics I’ve worked for was "okay" running only a packed cell volume (checking primarily for anemia and evaluating the color of the serum for diseases that affect the liver or red blood cells), total solids (looking mostly for infection or protein-losing diseases), and an AZO stick (a quick check of kidney function) in these individuals and proceeding if all was normal. I believe the fee for a PCV/TS/AZO was only $15, and this was in a part of the country with an exceptionally high cost of living. These simple tests require just a few drops of blood and would have picked up the kidney failure in the aforementioned dog.

For owners who chose more in depth testing, this clinic would run a complete blood count (CBC) and either six or twelve blood chemistry parameters with electrolyte levels to give us a better look into whether or not a pet could be suffering from anemia, dehydration, infection, parasitism, bone marrow dysfunction, liver disease, kidney disease, etc. Additional tests might also be recommended based on a pet’s breed and history.

The question of when "old" lab work is too outdated to be useful has to be answered on a case by case basis. My general rule of thumb is one month — as long as no relevant abnormalities were found on the previous tests, we’re dealing with a pet without a history of health problems, and the patient’s physical exam and history immediately prior to anesthesia are normal. Otherwise, I want the most up-to-date results possible. Many illnesses that veterinarians see on a day-to-day basis can go from undetectable to potentially deadly (particularly when combined with surgery and/or anesthesia) over the course of just a few weeks.

Pre-anesthetic screening is a life-saver. Don’t put your pet’s health at risk by opting-out.

 

 

Dr. Jennifer Coates

 

 

Image: Ivonne Wierink / via Shutterstock

 

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COMMENTS (22)
1
Pre-anesthetic lab work
by ChezChiens on 07/31/2012 12:40am

I've always opted for pre-anesthetic lab work - my vets present it as a normal part of procedures, not an optional add-on. I hadn't ever had it turn up anything until recently when it led to my then 6 month-old Weimaraner puppy being diagnosed with kidney failure. We had noticed the polyuria and polydipsia, and even treated for a UTI, but hadn't gone so far as to run bloodwork. We were going to get a baseline set of hip x-rays at six months and sadly now orthopedic issues are the last of our worries.

Hopefully this relatively early detection will help us give her better kidney support and earn a little more time with her. This experience has definitely made me an even stronger proponent of pre-procedure lab work.

2
Pre Anesthetic Lab Work
by 3mutts on 07/31/2012 07:02am

I've always spent the $50 or $75 for the lab work. It sure beats worrying the whole time they're in surgery about whether they've got a pre existing condition that might be a problem while the vet is working on them.

3
Bloodwork
by TheOldBroad on 07/31/2012 07:17am

I'm a big fan of bloodwork regardless of the situation.

I once asked for a full blood panel for a kitty that had a full blood panel just the week before. There was really no reason, but something just told me it was necessary.

It turned out to be very helpful because we caught the beginning of liver problem that didn't show up the previous week.

4
Bloodwork
by annet on 07/31/2012 09:16am

I have a similar story - we thought rescue kitty was young and healthy but did pre-dental blood work because he had never had a full panel done (that we had seen). Based on the state of his teeth and his newly discovered renal failure he's probably more than a few years older than we thought. We also got a heart murmur checked out before he went under for his teeth. He still got 5 teeth out but the vet knew exactly what she was in for and now we can give him kidney support. (The heart murmur was nothing, but it was cool to see the EKG)

5
Pre-op blood work
by loveon4legs on 07/31/2012 09:34am

Hello doctor:
We had a story that ended sadly also. I had purchased a baby kitten for my mom, she already had a puppy and I thought that giving her a kitten would help with the puppy and he would have someone to play with. The Vet told my mom that it was fine to neuter him before 6 month's of age. So at four month's my mom took him in..he was a doll his name was Amos. My mom dropped him off and told him she would see him later in the day.

Later in the day never came. She recieved a phone call around noon from the Vet saying he was so sorry Amos didn't even make it past opening up the surgery site when his heart stopped. The Vet closed him up ASAP while restarting his heart. He was put in a cage with constant care. His heart was too weak and Amos died a few hours later.
If he would have done pre-op bld work he would have found out that his heart was weak. We never got over Amos leaving us so soon.. I just pray I will see him at Rainbow Bridge.

by alice in lala land on 07/31/2012 11:36am

I am so sorry your cat died but I do not see how bloodwork would have caught a bad heart..I never opt for "pre operative bloodwork" as I see no advantage to it.. regular annual blood work is satisfactory to me ( I am not a vet but my vet agrees with me) I do not spay or neuter.. especially young animals as I see no benefit to early castration and many disadvantages. Surgery should never be "routine", especially to remove healthy organs for the convenience of the owner.
While "pre op" bloodwork" may catch some disease early the chances are few.. if a young animal has renal failure there is no chance for them to live a long and healthy life. Pulydipsia is always a reason to do blood work.. or run other tests.
As for vets who add this service in as part of the surgery instead of asking, shame on them. That is "padding the bill"

by Caitie Mastafiak on 07/31/2012 12:38pm

I agree bloodwork most likely wouldn't have caught this. But I have to disagree with not spaying or neutering.. the advantages far outweigh any risk or disadvantage.. control the pet population, prevent testicular cancer/mammary cancer, prevent pyometras. It definetely does harm your pet to leave them intact.

For the original poster, so sorry for your loss. Unexpected deaths are the most difficult.

by alice in lala land on 07/31/2012 05:42pm

if animal were meant to be castrated they would be born that way.. sort of impossible isn't it.. actually early castration of either sex is a definite disadvantage to both sexes.
It is easy to find all sorts of studies that show the benefits of leaving animals in their natural state.. it just takes a bit more care than normal owners want to take..which is sad in a way.. they would rather have an early surgery that could damage their pet than actually make sure they are not bred or castrated until they are fully mature.. face it it is not about the dogs/cats.. it is about the owners.. and convenience for them.. and money for vets.. most dogs in Europe are not castrated.. in fact in some places it is against the law unless there is a good medical reason. If you cannot control your pet maybe you should not have one rather than subject them to a surgery that is invasive and can be risky.. why do you think you have to sign a permission slip when your dog undergoes castration? Because there is risk involved. There is no risk in leaving your dog in a natural state as long as you are vigilant and watch them.

6
Great advice!
by Tomcat on 07/31/2012 09:39am

Thanks, Dr. Coates, for sharing this important information. Far too often, people do try to go the "frugal" route and we all understand why, but pre-anesthetic lab work can be so helpful in establishing a baseline AND finding those abnormalities. Plus, maybe your veterinarian will adjust the anesthetic protocol based on the findings...

At the Veterinary News Network, we just released (July 15th) a new video story resource on this type of topic...some veterinarians can even run this pre-operative blood work right there in their hospital. http://www.youtube.com/watch?v=7jILhguMhxY

7
Pre Anesthetic Lab Work
by eLew on 07/31/2012 09:40am

When a dog gets his teeth cleaned do they undergo general anesthesia? Reason being, my 6 year old will be getting his teeth cleaned in 2 weeks and your article convinced me to get the optional lab work done.
So I am wondering if you advice is the same for teeth cleaning?

Thank you,

by alice in lala land on 07/31/2012 11:37am

My dog died on the table having his teeth "cleaned"with pre op blood work.. I would never given my dog a drug to knock them out just to clean their teeth

by Dr. Jennifer Coates on 07/31/2012 09:46pm

Yes, a thorough dental prophy requires general anesthesia - there's no other way to clean under the gum line and the inner surface of teeth safely, unfortunately. I do routinely recommend preanesthetic blood work prior to dental cleanings.

by dogpeople on 08/08/2012 09:39pm

We had a recent vet visit for cyst on our dog's nose. Vet suggested a dental was needed, then she found a heart murmur...2/6.
Today we left our specialty clinic (yay Medvet Cardiology!) with a diagnosis of degenerative valve disease on our apparently healthy and perfect rescued male hound mix.
Now...if he undergoes anesthesia, those doing the surgery will know what drugs will support the valve disease, and those to avoid.

If you trust your vet, then trust him/her to guide you to the right next steps.
Many thanks Dr. C for another great essay!

8
One Week Too Late
by BichonLover on 07/31/2012 09:46am

I just had my 17 month old Bichon neutered last Friday. I was a bit skeptical about have the pre-lab work done because he just had blood work 2 months prior. The Vet assured me that it was a good thing to have done, so I proceeded. This article reassured me that I made the right decision.

9
by Caitie Mastafiak on 07/31/2012 12:47pm

I work at a vet hospital and our policy is to do bloodwork prior to anesthesia if the pet is over 8 years old or has had health issues. A thorough exam is usually sufficient otherwise. (which we require an appt for one before any anesthetic procedure).

I'm curious as to why it took until the pre-op BW to find the 5 mo old was in renal failure? If it was that severe that he died just a month later shouldn't an exam have figured out something was wrong? Maybe I'm wrong to assume, but in my experience any pet that has come in with renal failure it has been easy to spot. Of course BW was done to confirm it, but on exam it was easy to see something was wrong.

by Dr. Jennifer Coates on 07/31/2012 09:51pm

His physical was normal. The renal failure was caught early but progressed extremely rapidly. Upon further questioning the owners did say he was drinking/urinating more than normal but they had thought that was normal for him.

10
spay/ neuter info
by alice in lala land on 07/31/2012 05:44pm

http://saveourdogs.net/2009/03/28/summary-of-health-affects-of-spayneuter/

11
Empirical probabilities?
by David Hughes on 08/09/2012 03:55pm

Generally speaking, our dearly-beloved malamute Mischa gets whatever treatment his vet indicates for him, so this isn't really a question of cost. But even so, I would be interested to have some idea of the actual numbers here.

For example, a vet has told me that, under normal circumstances, the probability of a dog dying under anaesthesia is somewhere around one in a thousand. Do you know if there are any clinical studies on whether bloodwork is effective at predicting OP mortality? Or, more anecdotally, can you say how many apparently-healthy candidates for anaesthesia will turn out to have significant risk factors that preclude the operation?

by Dr. Jennifer Coates on 08/09/2012 04:05pm

I looked for stats like these while I was writing this post but unfortunately couldn't find any hard data. Anecdotally, I've postponed or cancelled many a procedure to get to the bottom of an abnormality found on a preanesthetic work-up.

12
Pre-anaesthesia blood wor
by Eliza11 on 09/17/2012 01:26pm

We had our 13 year old Yorkie's teeth cleaned a few months back and the doctor
never did any blood work. When we picked him up, he was in distress, panting heaviiy
and just was not himself. I brought that to his attention and he did a quick xray and stated that he had Cardiomegaly and immediately put him on Lasix and a blood pressure med. I called him that evening as Cody was the same and he said to remain on the meds.
We left for New Hampshire (summer home) for a planned trip and waited for the meds to work. Unfortunately he remained listless and would not eat. To make this short, we took him to our local vet in NH who immediately took blood and called us a few hours later saying that his kidneys were failing and to take him off the Lasix ASAP.
We them had to bring him to a wonderful dog hospital who hydrated and saved his life!!
He never had cardiomegaly, he had kidney issues which would have been picked up on the blood test if done prior to his dental.
Question,Is it "Standard of Care" for blood work pre-anaesthesia especially in this age group?

Thanks for any input

by Dr. Jennifer Coates on 09/18/2012 03:31pm

Funny you should mention "standard of care". A post about just this subject will appear sometime this week. I believe it would be a breach of the standard of care for a veterinarian not to at least offer preanesthetic bloodwork and explain its benefits. If an owner declines, it would be up to the vet as to whether or not proceeding would be in the pet's best interests.

by Eliza11 on 09/18/2012 05:34pm

Thank you, I will keep a watch for the article!

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About fully vetted

Jennifer Coates, DVM

Photo of Dr Coates

Image credit: Jim Piraino

...graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999. In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado. She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-Speak Deciphered for the Non-Veterinarian. Dr. Coates also writes short stories that focus on the strength and importance of the human-animal bond, and freelance articles relating to a variety of animal care and veterinary topics. Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and various species of pets.

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