What can I expect from a "Complete Physical Examination" for my pet at Topaz Veterinary Clinic?
The doctors at Topaz Veterinary Clinic believe that annual complete physical examinations are an essential part of a preventive health plan for all pets. Pets age up to 7 times faster than we do, so a once yearly exam for pets can be the equivalent of a person only seeing a doctor once every 4-7 years. Many things can change during that period of time and a complete physical exam can often help detect health problems long before the symptoms become visible to pet owners. Since our pets can't talk to us, veterinarians are trained to look for sometimes subtle changes that may indicate more serious underlying problems. During a physical examination, our doctors check out each patient's visible body systems for any signs of illness. We call this a "nose to toes" exam because we look at all of the following:
- Dental examination: A thorough check of your pet's teeth, gums, and palate for tartar accumulation, gum disease (gingivitis), bad breath and/or pain caused by diseased teeth, retained baby teeth that can interfere with the development and health of the adult teeth, and palate defects like cleft palates in puppies and elongated soft palates in certain breeds of dogs.
- Eye examination: An assessment of the outer parts of the eye including the eyelids and membranes around the eyes (conjunctiva)looking for any signs of inflammation, unusual growths, hair loss, abnormal or infected tear production along with an examination of the eye itself from the outer covering (the cornea) to the lens in the center, and all the way to the retina.
- Ear examination: An assessment of the outer part of the ear for signs of infection or allergy along with using an otoscope to look into the ear canals for any discharge, infection, foreign bodies, or parasites.
- Throat/Neck examination: An assessment of the neck structures including the lymph nodes, thyroid glands, and trachea for any enlargements or sensitivity that could indicate infection, inflammation, or cancer.
- Heart: Assessment of the heart by listening with a stethoscope with two different sides that allows us to listen to the hearts of both 150 pound Saint Bernard dogs and tiny newborn kittens. We listen for any changes in the rhythm of the heart (called arrhythmias that indicate a problem with the electrical conduction system of the heart) and for any heart murmurs that can indicate problems with the size of the heart or the function of the valves that separate the chambers of the heart. We also check each patient's pulses to make sure they are strong indicating good blood pressure and normal blood flow from the heart to the rest of the body.
- Lungs/Respiratory system: Assessment of the lungs by listening with a stethoscope for any changes in the lung sounds that could indicate fluid in or around the lungs, asthma, and also assessing the breathing rate and effort for signs of difficult or labored breathing. We also look at the nose for any discharge, asymmetry, pigmentation changes, and congestion.
- Abdominal palpation: For this, we use our hands to feel the various organs inside the abdomen including the liver, spleen, stomach, intestines, kidneys, and bladder for any physical changes including tumors, foreign bodies, pain, distention, possible bladder stones etc.
- Examination of external genitalia: An assessment of the vulva in females and penis, prepuce, and testicles in males for any signs of infection or cancer and also looking for any hereditary defects like undescended testicles or hypoplastic vulvas.
- Muscles, bones, and joints: An assessment of the whole body looking for any muscle weakness or muscle loss, joint stiffness, loss of joint flexibility, "crepitus" in the joint that can be felt with degenerative joint disease (arthritis), pain associated with palpation of the spine and/ movement of the neck, difficulty getting up and down, and general conformation.
- Brain and spinal cord: An assessment of mentation , seizure activity, circling behavior, differences in pupil size and facial muscles indicating brain and nerve problems along with assessment of the legs and reflexes for symptoms of spinal cord problems
- Skin: A thorough examination of the skin and fur for problems including allergies, skin infections, parasites (fleas/ticks/mange mites), fungal disease (ringworm), trauma, hernias, toenail infections, dry skin, hair loss . Some of these changes can be seen with dietary problems or underlying thyroid or adrenal gland disease.
- Lymph nodes: An assessment of the lymph nodes located under the neck, in front of the shoulders, and behind the knees for any enlargement that could indicate infection, inflammation, or cancer.
- Weight: We assess the overall body condition for weight changes that can indicate certain diseases like thyroid disease or diabetes and initiate discussions with owners about possible lifestyle and diet changes that can be contributing to unwanted weight gain or loss
- Temperature: We take the temperature of every patient to look for fever that may not be apparent to the owner. Both dogs and cats have higher normal body temperatures than people so they can feel warm to us even when they don't have a true fever.
What is a spay? What is a neuter? How are these surgeries done at Topaz Veterinary Clinic?
We are asked these questions frequently and hope this information will help you understand what goes into a spay surgery at Topaz Veterinary Clinic. Then you can make an informed decision about where to have this important surgical procedure done.
For most of our patients, a spay or neuter surgery is the first and sometimes only surgical procedure they go through. A "spay" is a complete ovariohysterectomy surgery in which both ovaries and the uterus are removed in a female dog or cat to prevent them from having puppies or kittens. A "neuter" is an "orchidectomy" or castration surgery in which both testicles are removed from a male dog or cat to prevent them from mating with female dogs or cats to create puppies or kittens. The decision about whether to have these surgeries done and where to have them done can be a difficult one for owners especially because of concerns about the risks of anesthesia and surgery and because of the cost differences found when comparing full service veterinary hospitals with spay/neuter clinics. At Topaz Veterinary Clinic, we recognize these concerns and have made decisions regarding surgical preparation, drug choices, patient monitoring, surgical technique, and patient recovery with the goal of maximizing patient safety and comfort and not necessarily minimizing cost. In the veterinary profession, there are many choices available for drugs, monitoring equipment, personnel, surgical equipment and suture materials, and the choices we make influence the cost of our surgeries. The following is a step-by-step description of a spay and neuter surgery performed at Topaz Veterinary Clinic describing everything that happens and the choices we have made that we believe are the best for our patients.
Getting ready for the big day:
All of our patients receive a comprehensive physical examination on the morning of their scheduled surgery. (What is a comprehensive physical examination?- see above question #1) If the doctors find certain types of abnormalities, they may recommend delaying the surgery until they are sure the patient is healthy enough for surgery. In some cases, they find abnormalities like retained baby teeth or skin growths that can be treated while the patient is under anesthesia and save the patients and their owners from having another anesthetic procedure done at a later date.
Pre-anesthetic blood tests
We recommend running blood tests on all patients prior to any anesthetic procedure to check liver and kidney function and also to make sure they have adequate numbers of red blood cells, white blood cells, and platelets. These parameters cannot be measured with just a physical examination and can affect the way each patient responds to anesthesia. Many patients with underlying diseases may have no visible symptoms so these problems can only be found with blood tests. We have detected liver disease and cancer in patients just by running pre-anesthetic blood tests and were able to avoid likely tragic anesthetic deaths in these patients because of this knowledge.
Cost: $85 for complete blood cell count (CBC), liver and kidney function tests, blood sugar, and blood protein measurements.
The day of surgery:
- Before surgery:
- Owners arrive at our hospital at 8 a.m. with their pets. The pets must have had no food since 10 p.m. the night before and minimal water in the morning.
- * It is very important that patients have an empty stomach on the day of surgery to help prevent nausea and vomiting during and on recovery from anesthesia.
- * We meet with owners in the morning to discuss the surgery, answer any questions they may have, go over our anesthetic consent form and estimate, and make sure we have contact information for owners throughout the day to give them updates on their pet's progress.
- Pre-anesthetic blood testing:
- If the patient has not had blood tests done already, a blood sample is drawn and the tests are done in our in-house laboratory that morning.
- If there are any problems noticed with the blood tests, owners are called and the doctor discusses these results and whether to continue with the surgery or delay until we have more information.
- Pre-anesthetic sedative and pain medication injection:
- An injectable sedative and pain medication is given to each patient to help alleviate any anxiety and to start blocking pain receptors and keep them comfortable during surgery and on recovery.
- Placement of an intravenous catheter:
- A small patch of fur is shaved from one of the front legs, the skin is cleaned with surgical scrub, and an intravenous catheter is placed into the vein and secured in place to allow administration of anesthetic medications and intravenous fluids during the surgery.
- This catheter also allows quick administration of life-saving medications if needed for any complications that may occur during surgery.
- The surgery:
- An injectable anesthetic is administered through the intravenous catheter to provide fast anesthesia and allow the doctors to place a tube into the patient's trachea to start administering oxygen along with an inhalant anesthetic that the patient will breathe in during the rest of the surgery. We use an injectable anesthetic drug called Propofol that is also used commonly in human medicine and can be used safely in pets of all ages and breeds. The inhalant anesthetic that we use is isoflurane.
- As soon as our patients are anesthetized, they are connected to the following different monitors:
- An EKG monitor that records heart rate and rhythm.
- A monitor that records their blood oxygenation.
- A blood pressure monitor.
- A body temperature monitor.
- In addition to these monitors, a veterinary technician is at the patient's side throughout the surgery monitoring each patient, recording the readings, and making adjustments in the level of anesthesia, intravenous fluid rate, and administering medications under the direction of the doctor.
- For surgeries, any fur that is located at the surgery site is clipped and the skin is cleaned with a surgical scrub. Patients are then placed on a heated surgery table along with a circulating warm water blanket to keep them warm since it is common for body temperature to drop in patients that are under anesthesia, especially small dogs and cats. The warm water blanket safely helps prevent this loss in body temperature and the constant body temperature monitoring allows the doctors to raise or lower the heat based on the patient's needs.
- Each patient is started on intravenous fluids to help maintain normal blood pressure and normal blood flow to the kidneys. The constant monitoring of patient blood pressure allows the doctors to determine if the rate of the fluid administration needs to change during surgery.
- The doctor prepares for surgery by wearing a surgical cap and mask, scrubbing their hands and arms with a surgical scrub, and then putting on a sterile surgical gown and gloves.
- Separate sterile surgical equipment is used for each surgery.
- For a spay, an incision is made into the abdomen going through 3 layers of tissues including the skin, the subcutaneous fat, and the "linea alba" (the tissue that connects the two sides of the abdominal muscles).
- The abdomen is explored and both ovaries are located, examined for any abnormalities, and removed using high-grade absorbable suture.
- The uterus is then located, examined for any abnormalities, and then removed also by using high-grade absorbable suture.
- The abdomen is examined again to make sure there are no areas of bleeding.
- Each tissue layer of the abdomen is closed separately starting with the muscle, then the subcutaneous fat, and then the skin. In most patients, the skin is closed with a high-grade absorbable suture using a buried suturing pattern that leaves no stitches on the outside that may bother the patient. In some patients, external sutures are a better choice and these patients will have stitches that need to be removed 10-14 days after surgery.
- For a neuter, an incision is made through the skin just in front of the scrotal sac. The incision extends through the subcutaneous fat and both testicles are exteriorized through this one incision. High-grade absorbable suture is used to tie off the blood vessels and spermatic cord going to the testicles before removing the testicles. The subcutaneous tissue is then closed with a high-grade absorbable suture and the skin is closed with the same type of suture using a buried suturing pattern that leaves no sutures on the outside that may bother the patient.
- Once the spay or neuter surgery is complete, the doctor will perform any other procedures that owners have requested including removing retained baby teeth, placing a microchip, removing dewclaws, etc.
- All toenails are trimmed at no charge.
- After surgery:
- Once the anesthesia has been turned off, the patient remains on oxygen until they are awake enough to have their tracheal tube removed and breathe and swallow normally on their own.
- A technician stays with each patient during recovery to make sure that they wake up safely.
- The patient's heart rate, respiratory rate, temperature, mental status, and pain score is monitored over the next 3-6 hours with additional pain medication given when needed.
- The doctor calls each owner to discuss the surgery and set up a discharge time for later that day.
- Each patient goes home with pain medication, discharge instructions, and emergency contact information for the doctor in case they have any questions or concerns after-hours.
ANESTHESIA: $120 This includes the pre-anesthetic sedation and pain injections, injectible anesthetic (propofol), placement of a tracheal tube, 30-45 minutes of inhaled anesthetic (isoflurane) and oxygen, and post-surgical pain injections.
PATIENT MONITORING: $28 This includes the EKG, blood oxygenation, blood pressure, and body temperature monitoring. This also includes the cost of having a dedicated veterinary technician monitoring each patient throughout the surgery.
INTRAVENOUS FLUIDS: $62 This includes the intravenous catheter, intravenous catheter placement, electrolyte balanced fluids, and a fluid pump to accurately dose the fluids.
SPAY (OVARIOHYSTERECTOMY) SURGERY:
- $45 for cats
- $125-$165 for dogs depending on weight
NEUTER (CASTRATION) SURGERY:
- $25 for cats
- $40- $80 for dogs depending on weight
These fees include the doctor's time, skill, and training to perform this operation, along with the surgical equipment, sterilization equipment, heated surgery table, warm water blanket, and high-grade suture material.
Does Topaz Veterinary Clinic provide reduced fee spays?
Topaz Veterinary Clinic is committed to helping with the pet overpopulation problem and to assisting animal rescue organizations in their work to place abandoned pets in loving homes. Because of this, we have partnered with 2 dog rescue groups and 3 cat rescue groups for whom we provide the same high quality spay and neuter surgery services at very reduced fees. We are not willing to compromise the quality of our medical care, but we are very happy to offer our services to these wonderful rescue groups.