Behind the scenes-St Mary's Veterinary Clinic-Ferndown

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This section provides information on a number of subjects. It should be realised that it is not a substitute for professional veterinary advice.

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Leaving your pet with us

Most pets will at some time need to stay with us for the day for procedures such as dentals, neutering, lumpectomies or investigations which involve anaesthetics. This can be a worrying time for you. Knowing a little of what is ging on may help to put your mind at rest.

Feeding

If your cat or dog is going to have an anaesthetic you will be asked to withhold food from 7 o’clock the previous evening and to take up the water when you get up in the morning. This is so the stomach is empty and will reduce the chance of vomiting under the anaesthetic. As rabbits and rodents do not vomit this is not necessary for them. For their comfort we ask you to give dogs a short toilet walk and to make sure cats have had access to a litter tray prior to coming in. No very muddy dogs please!

Checking in your pet

Unless otherwise instructed please bring your pet in between 8.30 and 9.00 o’clock. You will be seen by one of the nurses or vets who will check all our information is correct. You will then be asked to sign a consent form. On the form is the phone number for us to contact you. Please make sure this is correct and that you are going to be available. If we cannot contact you we may have to make decisions without you or cancel procedures.

Premed

Your pet will then be taken into the hospital area. Each animal is assessed cattery

and given a premed. The premed consists of drugs to reduce any agitation or worry, reduce the amount of anaesthetic needed and to provide pain relief over the next 24 hours. This is generally given as an injection into the muscle of the back leg. Your pet will then wait in our air-conditioned kennels or cattery.

Your pet's anaesthetic

After the premed has taken effect they are brought into the prep room where one of the nurses will hold them while the vet injects a potent anaesthetic into the vein in one of the front legs. You may notice a clipped area where this has been done. Once your pet is asleep a tube is placed into the airway to ensure it remains patent and to allow us to deliver oxygen and isofluorane, an anaesthetic gas to keep them asleep during the procedure. Throughout the anaesthesia they are monitored by one of our trained nurses.

Coming round

After the procedure is completed the anaesthetic gas is turned off and soon they are awake enough for the airway tube to be removed. Your pet then rests in its kennel or cage until we feel it is around enough to go home. As a result of the tube some animals may cough for a day or so.

Phone call

We try to phone owners by 1.00 o'clock to let them know when their pet will be ready to pick up. We may phone earlier if we need to discuss unexpected findings before we can proceed further. Please ensure we have an emergency phone number to contact you.

Coming home

Most animals are discharged on the afternoon of the same day. Either a nurse or a vet will talk to you about the procedure and any aftercare required. The effect of the drugs given may take 24 hours to clear from the animal’s body during which time they may become sleepy if left. With cats it is advisable to keep them in during this period as they may misjudge jumping or traffic and injure themselves Back

Dental treatment

Premed

Each animal is assessed and given a premed. The premed consists of drugs to reduce any agitation or worry, reduce the amount of anaesthetic needed and to provide pain relief over the next 24 hours. This is generally given as an injection into the muscle of the back leg.

Your pet's anaesthetic

Dental assessment

Your pets mouth is carefully assessed as to the type and extent of any dental disease. Most pets have accummulations of scale on their teeth which looks like the scale in your kettle. This scale and associated bacteria results in gingivitis (gum inflammation) and periodontal disease (infection around the tooth roots). Other disease that may be seen include root abscesses, fractured teeth, epuli (benign lumps) and growths.

Descaling your pet's teeth

Removal of the scale is the first job. This allows us to see the teeth and gums better and will reduce the number of harmful mouth bacteria in the future. This is done using an ultrasonic scaler and/or hand instruments. It is important for future oral health to remove all visible scale above the gum line and hidden scale below it.

Polishing your pet's teeth

After the scale is removed the teeth are polished using a small high speed rotating rubber cup filled with paste. This removes any minor irregularities which would give purchase to bacteria and scale.

Dental extractions

If any of the teeth have extensive root exposure due to peridontal disease or root abscessation they will need to be removed. Some teeth such as the incisors at the front have a single root. Removal of these involves pushing an elevator (chisel) down between the root and its socket until it wobbles free. The molar teeth at the back may have 2 or 3 roots. The crown is first cut into the same number of pieces as roots and each piece removed as described for an incisor. Removal of teeth can be challenging as they are much more firmly embedded than peoples teeth.

Coming round

After care

Over the first few days after a dental you may need to give medication to control discomfort or to treat infections. These will be given to you when you collect your pet. Following dental treatment it is important to slow down further deterioration in the teeth of your pet as it gets older. Special dental diets, dental chews and brushing are useful. Ask us for further advice.
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Neutering

Premed

Your pet's anaesthetic

Preperation of operation site

The area to be operated on is clipped of hair and the animal moved into theatre. It is then cleaned using a surgical scrub to remove any dirt and to kill surface bacteria. The surrounding area is then covered with sterile drapes to prevent contamination of the vets hands or instruments

Bitch and cat spays

In the bitch a skin incision is made midline at the umbilicus and extending backwards approximately 6cm. This is extended through the fat and underlying muscle. In the cat a 2cm skin incision is made in the left flank and again extended through the fat and muscle layers. The uterus is then hooked out with a finger or forceps. The uterus is used to pull out the ovaries. The attachment of the ovaries to the body is tied and then cut through. This frees the ovaries and the front part of the uterus. The back part attached to the cervix is then tied and cut through allowing removal of both ovaries and uterus.

The muscle and fat layers are sutured (stitched) together using an reabsorbable thread. The skin is then sutured with nylon sutures which are removed after 10 days

Dog and cat castrates

In the dog the incision is made midline just in front of the scrotum. Each testicle is pushed up to the incision and the overlying tissue incised. This frees the testicle to be brought out through the skin incision. A single absorbable suture is used to tie off the blood vessels prior to cutting and removal of the testicle. Absorbable sutures are used to close off the deeper tissue. Nylon sutures are used to close the skin and are removed after 10 days.

In the cat the skin incisions are made through the scrotum, one for each testicle. The testicle is pulled out on its blood vessels which are knotted on themselves before cutting the testicle free. No sutures are needed.

Coming round

After care

Your pet will need to be kept in at home overnight and given a light low fat meal such as chicken , fish or recovery diet as supplied by us. Male cats and dogs are pretty much normal the following day. Female cats are best kept in a few days. Bitches should be restricted to short lead exercise to go to the toilet until the stiches are removed.

You should prevent your pet from constantly licking at the wound. You should also monitor for any swelling, oozing or pain associated with the wound. If you have any concerns please contact us.

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Investigating your pets disease

Diagnosing your pets problem is not always straight forward. It certainly isn't anything like it is on medical TV dramas! A number of stages may need to be gone through. Sometimes taking a history and a clinical examination is as far as we need to go before we can start treatment and sometimes we need to do more.

Your pet's history

This is a very important part of the picture. It consists of the signs/symptoms your pet is displaying and how long each particular sign/symptom has been present. Without a history it can sometimes be very difficult to decide on the best course of action. Diarhoea of 2 days requires a completely different approach to one that has been present for 2 months! The history can help direct the next part of the examination

Clinical examination of your pet

This is the physical bit where we look, listen, feel and sometimes smell your pet. The examination will vary a little depending on what the problem is but often involves

examintaion of the mouth especially the colour of the gums for anaemia, jaundice, circulatory problems etc
palpation of superficial lymph nodes which may be enlarged in some infections or some cancers
listening to the heart and lungs for evidence of heart failure, pneumonia, bronchitis etc
palpation of the abdomen for evidence of pain, organ enlargement, foreign bodys in the gut, tumours etc
examination of the skin which can help with identifying internal disease as will as skin disease itself
examination of the eyes which may help with identifying internal disease such as diabetes, high blood pressure, jaundice, anaemia etc as well as eye disease itself
taking the body temperature which may be increased in infection or pain or decreased in poor circulation

A mental list

At this point we formula a mental list of possible disease problems. This may be short with only one or two possibilities or quite extensive. We then need to decide if the list is such that we can consider treatment. If the list has only two options and both will respond to the same treatment then there is little point in doing tests to differentiate them. Often the outlook and treatment will vary hugely depending on which of our possible options it is. This is where further investigations will be offered.

Testing your pet's blood

Generally a range of tests known as a profile are run in-house or at an external laboratory. Some tests are fairly specific and may tell us how, say, the kidneys are doing but many tests are just like a pieces of a jigsaw puzzle. Several test results may need to be put together to say how a particular part of the body is working. Some of the same tests may be looked at with other tests to tell how another bit is working. Unfortunately, sometimes, the tests by themselves do not give us an answer and need to be used together with the history and clinical examination to further refine our list of possible problems. We then decide if we have enough information to start treatment (see A mental list) or if further examinations are needed.

Imaging your pet

The use of radiography (Xrays) and ultrasonography can provide important clues as to the nature of the disease. For instance, our clinical and laboratory tests may suggest kidney disease but only imaging could identify a kidney stone requiring surgery. For more on these see imaging

Specific tests

These are tests which have a rather narrow use. We may for instance perform a blood test to identify the presence of a specific disease but it will tell us only the likelyhood of that particular disease. It will tell us nothing about other diseases. As there are hundreds of these specific tests (and not all diseases have one) it would not be practical or economic to randomly use these tests. Before selection we must narrow our list of possible diseases through the examinations in previous sections.

Biopsies

This is the removal of all or part of a lump or diseased organ for microscopic examination of its cells and structure. Lumps or growths may only have a piece removed initially to help plan the surgical procedure. If it is reported as benign then only the lump and a small area of surrounding tissue may need to be removed. If it is reported as cancerous then we would need to look for evidence of spread prior to making a more radical removal or consider if chemotherapy is appropriate. Clinical examinations, bloods and imaging may tell us the organ (eg liver) and the type of change (eg enlargement) but we may need to biopsy to distinguish between several diseases which may require very different treatment (eg lymphoma or lipidosis).

Yes, no, maybe

We run some tests and they inidicate a particular disease possibility. Good. What if they are all normal? Well thats good also. Knowing the kidneys aren't affected is just as important as knowing they are. We can take that off our mental list of possibilities and look elsewhere. Often the problem is identified by finding out what, on our list of possibilities, it isn't.

Nothing in life is certain. Many tests do not give a yes/no answer but merely increase or decrease the likelyhood of a condition being present. Even the humble thermometer test can be misleading. High temperature equals an infection and the need for antibiotics and a low one, no infection. Incorrect. A high temperature increases our suspicion of an inflammatory process which could be an infection, associated with cancer, physical injury or an immune disease. It could also be the result of non inflammatory conditions such as enviromental temperature, humidity, exercise, pain, excitement, hormonal disease or brain disease. All those listed under a high temperature can also be present with a normal temperature. Not easy, is it? Many tests give results in a similar way and it is only when the result is intergrated with all other findings and historical information that it can become useful.

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Xrays and ultrasound

Radiography (xrays) and ultrasound scans allow us to examine the internal organs of your pet. They are complementary examination techniques and are often used together.

Radiography (Xrays)

The Xrays used in radiography act in a similar way to a bright light casting shadows. A short burst of invisible xrays are shone through your pet to cast a shadow on a photographic film. This film is then developed to produce a visible picture called the radiograph. The radiograph is blackened in those areas the xrays penetrate and left clear where they do not. In between there are shades of grey where a part of the body has allowed some to pass through. This 'shadow' picture is the reverse of normal with the shadows appearing white and the surrounding area black.

Hold up a coin and cast a shadow on the wall. If it is edge on it appears as a rectangle and if it is side on, a disc. With only one view you could think the shadow was cast by a rectangular box or a ball respectively. It is only with both views the true shape is understood. This is why generally at least 2 xrays of your pet are taken.

The images created in radiography are much more complex than the example given above. If the 2 views are not at right angles to each other creating a composite mental image is all the more difficult. In addition we are used to looking at standard views. If the coin casts an oval shadow then it could be either abnormal or slightly twisted when the shadow was cast. If we can be sure that the coin wasn't twisted then we can be confident that the coin is abnormal. This is the reason we often have to use sedation or a light anaesthetic to keep your pet accurately positioned. (Holding animals to radiograph them is no longer an option due to health and safety regulations.)

Ultrasound

As its name suggests this is the use of high frequency sound waves to examine the body. A probe, which emits a pulsed stream of sound waves, is held against the body . These waves are reflected back by the tissues of the body. Certain tissues reflect more strongly than others. The same probe receives the reflected sound and relays to the processor. The delay between the initial pulse and the echo tells the processer how far away the tissue that reflected it was. The processor then puts a white dot on the scanners screen to represent this. Using thousands of such dots an image of the body is produced.

The image produced is a cross section like a thin slice of bread taken out of a loaf. By moving the probe around we can get multiple slices in different directions (unlike your sliced loaf!). Then using the processor between our ears we create a 3 dimensional image in our minds. Ultrasonography is a dynamic examination compared with radiography. Radiography is like being shown an object while ultrasonography is more like handling it.

Which is best?

Ultrasound cannot penetrate mineral or air/gas so is of no use for looking at bones or lungs. Radiography is the only option for these sites. The situation in other areas is not so clear. When looking at heart disease you can see inside the beating heart with ultrasound but need radiography to evaluate the effect on the lungs. With abdominal disease radiography will give an overview of organ shapes and relationships but ultrasonography will allow you to examine internal structures. Both aspects may be important.

In general we can say that both techniques have their place, giving different information on the same problem.

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