The Pet Hospital of Granbury

1851 Acton Hwy
Granbury, TX 76049

(817)573-5003

pethospitalgranbury.com


Anesthesia Safety & Your Pet - 02/14/2017





As a practicing veterinarian, one of the biggest concerns I hear from clients is the risk of anesthesia when their beloved pet needs to undergo a procedure.  I know all too well the stories of pets who went to their veterinarian for a procedure and never came home.  As a pet owner myself, I can relate to those emotions.
As a doctor, I would love nothing more than to be able to tell my clients with 100% certainty that their pet will be perfectly fine when undergoing an anesthetic procedure.  I’d love to offer a complete, no questions asked guarantee.  Because of the nature of medicine and the variability between individual patients, doing so would be not only dishonest and unethical, it would be illegal.  Most state licensing boards restrict doctors from offering any guarantee of a cure.
What I can confidently tell clients is that, after 19 years of practice, the risks of anesthesia are very low- much lower than when I started in practice, and we do everything we can to minimize those risks.
As an accredited practice with the American Animal Hospital Association, we follow their guidelines (currently a 9 page guide found here)
Here is a summary of the steps we take:
1.       History of the patient- Have they had a problem in the past and are there any underlying health concerns that might affect anesthesia?

2.      A comprehensive physical exam- This is becoming a lost art in medicine, but nothing can replace a good nose to tail exam of a patient.

3.      Pre-operative bloodwork- Problems like anemia, abnormal blood sugar, and kidney or liver disorders can affect a patient’s ability to be safely anesthetized.

4.      IV catheter and IV fluids while anesthetized- Helps support blood pressure and maintain immediate access to the circulatory system if medications need to be given quickly.

5.      Pre-operative sedation and pain medication- This helps relax the patient, reducing stress and managing pain before it even starts, which allows for lower levels of anesthesia to be used.  Doses are calculated to the hundredth of a milliliter to assure appropriate dosing for the size of the patient.

6.      Endotracheal Intubation- a breathing tube in the airway allows us to control the amount of oxygen and anesthesia the patient receives.

7.      Surgical monitoring- heart rate, blood pressure, ECG, oxygen saturation, body temperature, hands and eyes.

8.      Body temperature support- body temperature begins to drop as soon as a patient is under anesthesia, so we use safe methods to keep their temperature up before and after surgery.

9.      Local anesthesia- local pain blocks allow patients to remain comfortable during and after the procedure.  This allows us to use a much lower level of anesthesia which increases safety.

10.   Gas anesthesia- administered through the anesthesia machine, with oxygen.  It can be quickly eliminated from the body if a patient experiences problems while anesthetized

11.   Post-surgical recovery and monitoring.  Patients are not just put in a cage once surgery is over.  Our patients recover in heated beds in our surgery prep room, where staff is present to monitor them until they are recovered.

Taking these steps helps minimize complications and allows us to be prepared should a problem arise.  Feel free to talk to us and express any concerns you may have about anesthesia and your pet- including problems that you may have experienced in the past.  We’re here to help and want you to be comfortable with our recommendations and plan.


Scott M. McCall, DVM


Chew Toys or Treats and Broken Teeth - 02/01/2017

In our first ever Facebook Live event, I discussed different chew toys and treats and problems that can occur from certain products.  Hopefully we can all agree that every dog and cat needs and deserves to have a comfortable and functional mouth.  Just like with us humans, this means preventative maintenance for good oral health.

Going to the local grocery store, pet store, or feed store can be overwhelming when you are trying to find a quality food or dental product.  As I mentioned in the video, some products are downright destructive.  These include butcher bones, antlers, and hooves.  While dogs love to chew on these different products, it is very common for them to fracture (break) their teeth on them.

I know many people who claim that wild dogs, coyotes, or wolves chew bones so it must be natural.  That may be true, but how many of them fracture teeth, which subsequently abscess, cause pain, affect that animal’s ability to hunt, eat, and defend itself, and therefore shorten its lifespan?  I don’t think there are many 15-17 year old wolves or coyotes in the wild and I suspect that dental disease has a major role to play in their demise (among many other things).

Think about it another way: If your dog fractured a carnassial tooth and you wanted the best possible treatment for them, so we referred them to a Board Certified Veterinary Dentist for root canal therapy and a crown, which cost around $2500 (ballpark guesstimate)- would you then let them chew on bones, hooves, and antlers with that beautiful $2500 tooth?  If not, then why allow them to do so before there is a problem?  Hopefully you’ll reconsider.
As far as products that are safe and recommended for good dental hygiene for your dogs and cats, I recommend using products tested and verified by the Veterinary Oral Health Council.  You can find those products (a separate list for dogs and cats with the manufacturer listed) at www.vohc.org

Please call or contact us if you have any questions about this or other pet related topics.

Scott M. McCall, DVM


Fireworks and Thunderstorm Phobias! - 06/30/2016

Fireworks and thunderstorms can cause significant anxiety and even physical harm to dogs.  Unlike people who can reason through frightening events, dogs tend to get worse over time instead of gradually improving.

There are several methods and treatments that can be used to help them through storms or fireworks season.

The best method is desensitization and counter-conditioning.  Dogs that are properly counter-conditioned learn to remain calm during these events so that they don't develop fear.  Unfortunately, this is often the most time consuming way to deal with these problems and oftentimes requires the expertise of a qualified dog trainer or animal behavior specialist.

Products such as Thundershirts and DAP pheromone diffusers are available, which work to help the dog feel secure and calm.  They work well for some dogs and have little effect in others.

Some people have tried over the counter Benadryl or Dramamine with mediocre results.  Now your dog is stressed from the loud noises and having to take ineffective medication!

There are also prescription medications which have been used extra-label in dogs for anxiety.  They include medications like alprazolam, fluoxetine, clomipramine, and most recently trazodone.  Like all medications, treatment success can vary depending on several factors.

Most recently, a new medication has received approval by the FDA for noise phobias.  This medication, called Sileo, is available as a gel which is given by an oral dosing syringe in the mouth to be absorbed through the gum tissue (mucous membranes).  Sileo is safe and effective for most dogs.

Call us if you have specific questions or would like more information about Noise phobias.

In the meantime, here are a couple of other articles for reference:
Fear of Fireworks
Thunderstorms


Want to Be a Veterinarian? - 06/21/2016


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Lots of young people talk about wanting to be a veterinarian when they grow up.  Dreams of helping sick dogs and cats, delivering calves, or caring for horses are common.  Because of the time required to pursue a veterinary medical degree, at some point, all of us had to think long and hard about whether to actually go ahead and follow our dream.
If you’re thinking about a career in veterinary medicine, here is a good web site that details a lot of the common questions and facts and figures to consider.
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Cats Need Regular Exams, Too! - 06/21/2016

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It might surprise you to find that in the United States, there are more pet cats (86.4 million) than there are dogs (78.2 million).  Yet, at the average small animal veterinary hospital, dogs make up about 75% of the pet visits and cats the other 25%.  Why is that?
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Do dogs live longer than cats?  No- in many cases cats- especially totally indoor cats- outlive dogs by 3-4 years.  (As a side note- some studies show outdoor cats live about 1/2 as long as totally indoor cats.  That is why the Indoor Pet Initiative at The Ohio State University is so important).
Do dogs have more diseases than cats?  Not particularly- especially when you consider the high incidence of upper respiratory viral infections in younger cats.  Also, older cats are very prone to diabetes, hyperthyroidism, and kidney disease.
Are parasites less of a problem in cats than dogs?  If they stay completely inside vs. dogs that go in and out- yes.  But, only in houses where there are no pets going outside.  If your dog or another cat goes in and out, your indoor cat has the same risks as if he went outside as well.  And mosquitoes don’t mind coming inside and biting your indoor only cat, risking the transmission of heartworm disease.
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Cats don’t have dental problems like dogs, right?  Unfortunately no- all pet dogs and cats are at risk for dental disease, including painful tooth resorption that cats can have.  And it is very unlikely your cat will stop eating or lose weight even if their mouth hurts- animals will still eat with substantial dental pain.  We have to look in their mouth to detect a problem.
Now, we all know that indoor cats don’t have some of the same big problems that we see in dogs- they’re not going to be hit by a car, attacked by the neighbor’s dog, or be subject to all sorts of other things we see every day in our indoor/ outdoor pets.  But that does not mean they are at no risk of illness or disease, including those mentioned above and more.
So, if their are more pet cats than dogs and there are many diseases that can cause illness in them, why don’t we see them as often?  Because most cats have a strong disdain for coming to see us.  I can’t really blame them.  They want to be left alone in their safe home environment.
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We want to help.  Here is some printed information and a couple of videos.  Please call us if you have any questions.  Scott McCall, DVM.  


Online Pharmacies and Your Pet - 06/21/2016

We’ve all seen the commercials for 1-800-OnlinePetPharmacyEtc- “I saved a ton of money, and didn’t even have to go to the vet!”  Although we know most of our clients love coming to see us, who doesn’t like saving money, right?  And when it comes to a commodity like medication that you can get from many different places, what difference does it make?
We recently addressed prescriptions for generic medications in the article "Keeping Medication Prices Affordable".
For us at The Pet Hospital, we are always willing to write a prescription for the pharmacy of your choice for appropriate medications for your pet.  We are bound by the regulations of the Texas State Board of Veterinary Medical examiners, however, which states that we must have a valid “Veterinary-Client-Patient Relationship.  That generally means that we have physically examined your pet at least within the last 12 months (or more frequently as determined by their current health status).
While we are willing to write prescriptions for your pet for purchase elsewhere, we would prefer you buy them from us.  Doing so allows us to more easily track how often your pet is getting their medication and gives us the opportunity to talk to you about how your pet is doing and answer questions you may have about him/her.
I know what you’re thinking, “Of course you’d like us to buy our pet medications from you.  Betty White told us you’d say that and you want to overcharge us for something we can get cheaper elsewhere.”  Who doesn’t love Betty White, but in spite of the millions 1-800-OnlinePetPharmacyEtc has spent in advertising, she’s got it all wrong.
We have done 2 things specifically to address the price issue:
1.  Our prices for common monthly preventatives (Revolution, Heartgard, Trifexis) and many pet specific chronic medications (Rimadyl, Metacam, Vetoryl, etc) are priced at or substantially below most legitimate online pharmacies.  We’re happy to provide a price comparison- just ask.  In addition, manufacturers occasionally give us rebates that you can use that aren’t available from online retailers, making the prices even more competitive.
2. We now have an online pharmacy, available through a link on our website.  There, you can order medications and even high quality diets directly through us and mailed to your house.  Shipping prices and delivery times are very comparable to online pharmacies.
If you do decide to still purchase online, please use discretion in which pharmacy you choose.  Not all pharmacies are legitimate and some have been caught selling counterfeit medications.  The FDA has an article that addresses those concerns here.  We’re here to help if you have any questions.
Scott M. McCall, DVM


New Study Confirms Importance of IV Fluids During Surgery - 06/21/2016

When it comes to surgery and pets, the number one concern we hear is about the safety of anesthesia.  That’s understandable- many clients have had or know someone who has had a pet with a serious complication- including death- from anesthesia.  Even with modern advancements in the types of sedatives and anesthetics available, anesthesia will always pose some risks to pets (and people for that matter).  As part of our American Animal Hospital Accreditation, we adopted the standard several years ago that all pets undergoing general anesthesia would have an IV catheter placed and IV fluids administered during anesthesia.
While that may seem like standard operating procedure (it is a standard for human healthcare), it frankly is not widely performed by many veterinary practices.  This is especially true for “common” and “routine” procedures which are thought to be quick and safe such as spays and neuters.  I quote “common” and “routine” because if you’re the one having the procedure done on you, I can assure you that you would think it was neither.
A new study conducted by a veterinarian at The University of Pennsylvania has shown the health benefits of intravenous fluids administered during anesthesia.  The basic findings of the study were that, by administering IV fluids during anesthesia, there was improved blood flow to the blood vessels which supply oxygen to all of our vital organs.  While a pet without IV fluid support may survive anesthesia and seem normal afterward, periods of low blood pressure that can occur during anesthesia can have a detrimental effect on important organs such as the kidneys and brain.  Those effects may not be noticed for years.  The idea that “my pet survived anesthesia, so everything’s OK” may not hold true.
You might be wondering,  “Why isn’t this a standard performed by all veterinarians?”  The only 2 reasons I can think of are that it takes more time and costs more.  We were all taught in veterinary school the value of IV fluid support to surgery patients and the risks of hypotension during anesthesia.  I believe that just like good pain management for pets should not be optional, this is an area where corners should not be cut.
It’s nice to see this type of study which helps reiterate the importance of what we have been doing for years now- even for spays and neuters in young, healthy dogs and cats.  Please let us know if you have any questions about this topic, or other concerns about anesthesia and your pet.
Scott M. McCall, DVM


What You Need to Know Before Surgery - 06/21/2016

Many people have questions about various aspects of their pet's surgery, and we hope this information will help.  It also explains the decisions you will need to make before your pet's upcoming surgery.


Is the anesthetic safe?
Today's modern anesthetic monitors have made surgery much safer than in the past.  Here at The Pet Hospital of Granbury, we do a thorough physical exam on your pet before administering anesthetics, to ensure that a fever or other illness won't be a problem.  We also adjust the amount and type of anesthetic used depending on the health of your pet.  The handout on anesthesia explains this in greater detail.
Pre-anesthetic blood testing is important in reducing the risk of anesthesia.  Every pet needs blood testing before surgery to ensure that the liver and kidneys can handle the anesthetic.  Even apparently healthy animals can have serious organ system problems that cannot be detected without blood testing.  If there is a problem, it is much better to find it before it causes anesthetic or surgical complications.  Animals that have minor dysfunction will handle the anesthetic better if they receive IV fluids during surgery.  If serious problems are detected, surgery can be postponed until the problem is corrected.
We offer three levels of in-house blood testing before surgery, which we will go over with you when you bring your pet in.  Our doctors prefer the more comprehensive screen, because it gives them the most information to ensure the safety of your pet.  For geriatric or ill pets, additional blood tests, electrocardiograms, or x-rays may be required before surgery as well.
It is important that surgery be done on an empty stomach to reduce the risk of vomiting during and after anesthesia.  You will need to withhold food for at least 8 to 10 hours before surgery.  Water can be left down for the pet until the morning of surgery.


Will my pet have stitches?
For many surgeries, we use absorbable sutures underneath the skin.  These will dissolve on their own, and do not need to be removed later.  Some surgeries, especially tumor removals, do require skin stitches.  With either type of suture, you will need to keep an eye on the incision for swelling or discharge.  Most dogs and cats do not lick excessively or chew at the incision, but this is an occasional problem you will also need to watch for.  If there are skin sutures, these will usually be removed 10 to 14 days after surgery.  You will also need to limit your pet's activity level for a time and no baths are allowed for the first 10 days after surgery.


margin-right: 10px; float: left;Will my pet be in pain?
Anything that causes pain in people can be expected to cause pain in animals.  Pets may not show the same symptoms of pain as people do; they usually don't whine or cry, but you can be sure they feel it.  Pain medications needed will depend on the surgery performed.  Major procedures require more pain relief than things like minor lacerations.
For dogs, we may recommend an oral anti-inflammatory the day after surgery and several days after to lessen the risk of discomfort and swelling.  We use newer medications, which are less likely to cause stomach upset and can be given even the morning of surgery.
Because cats do not tolerate standard pain medications such as aspirin, ibuprofen, or Tylenol, we are limited in what we can give them.  Recent advances in pain medications have allowed for better pain control in cats than ever before.  We administer a pain injection 10 minutes prior to surgery.  After surgery, pain medication is given on a case by case basis.  Any animal that appears painful will receive additional pain medication.
We use narcotic patches for some surgeries in dogs as well.  The cost will depend on the size of the dog.  Injectable pain medications may also be used after surgery on both dogs and cats.  Providing whatever pain relief is appropriate is a humane and caring thing to do for your pet.


What other decisions do I need to make?
While your pet is under anesthesia, it is the ideal time to perform other minor procedures, such as dentistry, ear cleaning, or implanting an identification microchip.  If you would like an estimate for these extra services, please call ahead of time.  This is especially important if the person dropping the pet off for surgery is not the primary decision maker for the pet's care.
When you bring your pet in for surgery, we will need to 5 to 10 minutes of time to fill out paperwork and make decisions on the blood testing and other options available.  When you pick up your pet after surgery you can also plan to spend about 10 minutes to go over your pet's home care needs.
We will call you the night before your scheduled surgery appointment, to confirm the time you will be dropping your pet off and to answer any questions you might have.  In the meantime, please don't hesitate to call us with any questions about your pet's health or surgery.


Keeping Medications Affordable - 06/21/2016

A news article on the American Veterinary Medical Association’s website discussed the wide swings in pricing seen for generic human medications that are commonly prescribed for animals by veterinarians.  As we strive to provide the best, up to date treatments for our patients, this is an issue that has definitely affected us here at The Pet Hospital.  For over 2 years, we have worked to lower the overall cost of medications prescribed for our patients.
You may not know that when it comes to medication for animals, there are quite a few medications that are specifically labeled for use in animals.  These have undergone rigorous testing by the FDA to prove safety and efficacy in the species they are labeled for.  Examples of these include medications like Cerenia used for vomiting and motion sickness, Metacam used for arthritis and postoperative pain, and Heartgard used to prevent heartworm infection.
Many of the medications we prescribe, however, are not FDA approved for animals.  That does not mean they are not safe or effective.  These extra-label medications have a proven track record of safety and effectiveness and most have been in use for a very long time.  Examples of these would include the steroid prednisone, the antibiotic cephalexin, and the heart medication benazepril.  We use drug formularies such as Plumb’s Veterinary Drug Handbook to determine dosages, potential side effects, and interactions.
Since many retail chains have started offering $4.00 monthly prescriptions for people, we have tried to write prescriptions for your pets, when applicable.  How do we do that?  We simply print a prescription from your pet’s medical record and fax it to the pharmacy of your choice.  The problem we are seeing is that, as mentioned in the AVMA article, prices can vary widely from one generic medication to another- even month to month or pharmacy to pharmacy.
An example of this is Humulin N insulin- a human insulin we recently prescribed for a diabetic dog.  At one pharmacy, the price was $150.00.  At another, it was $100.00, and at a 3rd, it was $40.00.
Another client needed a topical ointment for a skin condition for their dog.  Prices ranged from $100 to $400 for the same exact medication, strength, and size.
Cash paying customers sometimes pay much higher prices than those with insurance.  It is worth calling around to find the best current price.  You can also check prices on web sites like GoodRX.com- they list prices of different medications at local pharmacies and even offer coupons for special pricing for cash customers.
Medical advances in veterinary medicine have certainly improved our ability to diagnose and treat many diseases in pets.  We realize that with those advances, the costs to care for your pet have increased.  For the level of service provided and the advanced medical care available, veterinary medicine is still a very good value.  Because we are committed to helping your pet living a long, healthy life, we will continue to provide top quality care while working to keep costs affordable.


Why Do Our Pets Need Surveillance Screening? - 06/21/2016

Why do our pets need surveillance screening?
Firstly, our pets can't speak, they cannot tell us if they feel off color or unwell or have any other indicators of internal illness. We need to examine them every 6 months as well as run some routine screening tests to detect underlying disease BEFORE it is clinically apparent.
Secondly, pets will actively mask signs of illness until late in the course of disease. This stems from survival instincts in a pack or colony situation.
Use the age chart below to find your pets age in "people" years and the screening testing recommended for each stage of his or her life.
We believe the following tests give us the best chance of helping your pet's live longer, healthier lives.
These are approximations and may vary by gender, species and breed.
Blue/
Lilac 
Every 12 months - Baseline Blood Profile (a small blood test checking internal organ health)
Every 6 months - Urine Specific Gravity ( a urine test to check how well the kidneys concentrate urine - there is no charge for this test) 
Green
Every 12 months - Annual Health Profile (a blood test checking red and white blood cell counts and a more comprehensive internal organ screen)
Every 6 months - Urine Specific Gravity  
Yellow
Every 12 months - Senior Health Profile (comprehensive internal organ screen including Thyroid testing, electrolytes and red and white cell counts and urine specific gravity)
Every 6 months - Urine Specific Gravity +/- Urine Dipstick  
Red
Every 6 months - Golden Years Health Profile (comprehensive internal organ screen including Thyroid testing, electrolytes and red and white cell counts)