By T. J. Dunn, Jr., DVM
Just before noon one Saturday we were seeing the last of the morning’s appointments. No surgeries were scheduled on Saturdays because we all hoped to get outdoors and enjoy the weekend. Then the phone rang and everything changed.
An American Eskimo dog was on the way in for immediate assistance because it had just been hit by -- and this is the truth -- a logging truck!
We set up the usual emergency materials, radiographs and instruments and prepared for critical care patient management. Fortunately, our patient was conscious and after a thorough evaluation we determined that he had a broken pelvis, fractured femur and internal injuries.
The patient needed surgery immediately to repair the internal damages before we began the orthopedic repairs. Among other things a ruptured bladder was discovered and repaired and after a number of hours in surgery, the patient began an uneventful recovery.
This case is a good example of a situation where surgery is required to save the patient’s life. There is an entirely separate category of surgery, though, that does not qualify as "necessary." Those surgical procedures that are undertaken by choice are termed elective surgery. In other words … elective surgery is optional. It does not have to be done to save or stabilize the patient’s life.
We all are familiar with the common elective surgeries done on humans -- liposuction, face lifts and mole removal, just to name a few. And in dogs, ear cropping, spay/neuter surgery, tail docking, come readily to mind. Most people agree that ear cropping is a cosmetic procedure with little verifiable medical rewards for the dog. There’s a vast gray area though, where a dog owner needs to carefully consider the choice to proceed with a surgical procedure because there are many elective surgeries that, although may not be considered life-saving, still provide health-enhancing benefits.
The patient with fat deposits exemplifies the dilemma dog owners and veterinarians face regarding the decision to do or not do surgery. Many veterinarian recommend removing fat deposits, called lipomas, once they reach a certain size because if left to their own whims these fatty growths sometimes enlarge to huge proportions. But which fat deposits can be left alone and which should be removed? Even if probed and analyzed by needle biopsy and shown to be benign, some fat deposits simply do not stop growing!
Risks vs. Benefits
And what are the risks versus benefits of a procedure? Let’s take as an example dental procedures. If loose teeth, gingival growths and deep infections are present, a case could be made that the dental procedure really needs be done to improve and safeguard the patient’s quality of life. The down side is that, because these elective procedures require some form of anesthesia and surgical invasion of the patient, they are not entirely without risk. With modern veterinary medical presurgical protocols, though, the attendant risks can be minimized; and one important tool in identifying the "at risk" patient is the blood chemistry profile assessment.
Dr. Rhonda Schulman, a veterinarian at the University of Illinois Veterinary Teaching Hospital in Urbana, says pre-anesthetic blood screening before any surgery is important. "While most healthy animals are at minimal risk for complications during an elective surgery such as a neuter or spay, there is always the chance that an animal might have an underlying problem that might not manifest itself until the animal is put under anesthesia. Surgery is not a good time to discover that there is a problem."
Veterinarians always discuss the "risk versus benefit" topic with the dog’s owner, and relate the ways to reduce risk and maximize the benefit before any elective surgery is performed. In many situations the timing of the surgery is critical. Cancer surgery, if done early, may have rewarding benefits long term; but if indecision delays the procedure the benefit of surgery may be undermined. Orthopedic problems such as torn ligaments, fractures, cartilage damage and the ravages of progressive arthritis are time critical -- irreversible degeneration awaits whenever corrective or reconstructive surgery is delayed.
Timing of an elective orthopedic surgery should revolve around several factors according to Michael Bauer, DVM, a surgery specialist at Veterinary Specialists of Southern Colorado in Colorado Springs, CO.
"If the problem in question is likely to progress to the point that surgical repair will be unsuccessful, timely repair becomes important. An example of this is canine ACL (Anterior Cruciate Ligament) tears. Nearly all dogs with ACL tears develop debilitating, progressive arthritis. Because ACL repairs do not involve joint replacement but rely on the health of the existing joint, early surgical intervention is important."
"On the other hand, if the surgical repair will be effective regardless of duration of the problem, the decision to go to surgery depends on the severity of clinical signs and how badly the animal’s quality of life is affected," Bauer explains. "An example of this is total hip replacement for dogs with hip dysplasia. Regardless of the degree of arthritic change, within reason, an artificial hip is likely to be successful since the arthritic joint is actually being replaced. We never encourage clients to have a total hip replacement performed on their dog unless the clinical signs are significant. However, if we determine a hip replacement is warranted, we prefer to proceed with surgery sooner rather than later. Why make the dog live with an uncomfortable or painful hip for an extra year when a total hip replacement yields almost immediate and excellent results?"
Bauer encourages his clients to consider the expense, whether the problem is negatively affecting the animal’s quality of life and whether the problem is likely to worsen to the point that surgical repair will be significantly less effective. And regarding the anesthetic factors, Bauer says, "In unhealthy animals anesthesia may be a consideration, but with today’s anesthetics and monitoring equipment and with a presurgical blood chemistry evaluation, anesthesia risk is minimal."
Based upon information gathered regarding the pros and cons of the situation, the ultimate choice to proceed rests with the dog owner. Will the expected goal of the surgery weighed against the required anesthesia and chances for success of the procedure be worth the associated risks?
Should your dog be spayed (or neutered)? Should that bump be removed before it progresses into a life threatening cancer? Does that bad breath indicate a dental procedure is needed?
The right answer to these kinds of questions is achieved through understanding the risks and weighing them against the benefits -- and acquiring patient data. And even though the decision to proceed may not be as clear-cut as life-saving emergency surgery on a dog run over by a logging truck, you will nevertheless have the confidence that you did the right thing to improve or ensure the quality of life for your dog.
Image: John Donges / via Flickr