Surgery

Surgery 2017-09-25T15:36:05+00:00

Board Certified Veterinary Surgical Services

The goal of our surgeons, registered veterinary technicians and our highly skilled support staff is to provide comfort and personalized treatment with unparalleled care for each and every one of our patients. In addition, the surgery service is supported by our Anesthesiology, Emergency/Critical Care, Internal Medicine, Oncology, Radiology, and Rehabilitation departments, ensuring the most comprehensive care available anywhere for your pet.

A board certified veterinary surgeon is a licensed veterinarian who has obtained intensive, additional surgical training. A veterinary surgeon can offer special assistance in the following kinds of cases:

  • Traumatic injury and emergencies (such as fractures, skin wounds and lacerations, correction of gastric dilatation-volvulus, and exploratory (abdominal/thoracic) surgery.
  • Orthopedic surgeries (such as cruciate ligament surgeries (TPLOs), and arthroscopy for joint exploration).
  • Soft tissue surgeries (such as tumor/cancer removal and correction of congenital defects).
  • Neurological surgeries (such as intervertebral discs and spinal injuries).

While your general practitioner veterinarian can diagnose and treat many health problems, certain diseases and conditions require the care of a doctor who has had intensive, specialized surgical training in order to provide the very best outcome for your pet. Your veterinary surgeon will work closely with your general practitioner veterinarian, as well as other board certified specialists to ensure the best outcome possible for your pet.

Just as your own primary care physician may feel the need to refer you to the care of a specialist from time to time, your general practitioner veterinarian may feel your pet needs the additional expertise of a board certified surgeon for certain surgeries. In fact, many general practitioner veterinarians refer all but the most routine of surgeries to specialists, orthopedic and neurology cases, reconstructive surgeries, tumor removals, etc. Board certified veterinary surgeons are often affiliated with referral hospitals where they have access to specialized diagnostic and surgical equipment, the latest and safest anesthesia monitoring equipment, drugs and procedures, physical rehabilitation capabilities, and other critical care services to which a general practitioner may not have access. All of these specialized services may be necessary for the optimal care and recovery of your pet. You can be assured that a veterinarian who knows when to refer you and your pet to a veterinary surgeon is one that is caring and committed to ensuring that your pet receives the highest standard of care for his or her problem.

What Kinds of Problems Require the Expertise of a Veterinary Surgeon?

Board certified veterinary surgeons can repair complex fractures, use advanced techniques to stabilize knees with torn cruciate ligaments, and can correct or manage a large array of congenital or acquired orthopedic problems. They can also remove cancerous growths, manage extensive or non-healing wounds, and perform reconstructive surgery, such as transferring skin over large injuries. Veterinary surgeons can perform intricate surgeries in the chest or abdomen, such as correction of congenital or acquire vascular abnormalities, trauma surgery, gastrointestinal or biliary rerouting, and urogenital reconstruction and stenting. Spinal injuries and intervertebral discs are problems that are commonly referred to board certified surgeons. Our veterinary surgeons also perform minimally invasive surgery, such as arthroscopy, thorascopy, and laparoscopy.

In many surgical cases, depending on your pet’s particular disease and health problem, your primary care veterinarian will still supervise your pet’s veterinary care, especially if your pet is continuing to cope with a disease or chronic condition. Typically, though, your general practitioner veterinarian will oversee many aspects of your pet’s pre-operative and post-operative care, just as in human medicine. Recovery periods can be prolonged in many surgical cases, particularly in orthopedic surgery, and it is very important to follow your veterinary team’s recommendations concerning at-home recovery guidelines for your pet, follow up care and appointments, as well as any rehabilitation that has been prescribed.

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Our hospital offers gold standard anesthesia monitoring. Prior to anesthesia, your veterinarian will perform a thorough physical examination of your pet and may require them to have bloodwork in order to evaluate general organ health and suitability of anesthetic medications. While your pet is under anesthesia, he or she will have the undivided attention of a highly trained anesthesia nurse under the supervision of a boarded anesthesiologist. Your pet will be monitored in much the same way as a person undergoing anesthesia would be with continuous monitoring of blood pressure (direct and indirect), level of oxygen in the blood (SpO2), heart rate and  rhythm (ECG), levels of carbon dioxide (ETCO2), and body temperature. After the procedure is completed, your pet will continue to have vital parameters monitored until he or she is fully recovered. At Veterinary Referral Associates your pet will receive top level care, rest assured!

Some of the most common procedures done on pets involve repairing broken bones and injured joints. The surgeons at Veterinary Referral Associates, with the assistance of our highly trained surgical technicians and state of the art surgical equipment, can manage any orthopedic problem affecting your pet.

Our surgeons offer this procedure to aid in the diagnosis of bone tumors, infections, or cysts.

Our hospital offers gold standard anesthesia monitoring. Prior to anesthesia, your veterinarian will perform a thorough physical examination of your pet and may require them to have bloodwork in order to evaluate general organ health and suitability of anesthetic medications. While your pet is under anesthesia, he or she will have the undivided attention of a highly trained anesthesia nurse under the supervision of a boarded anesthesiologist. Your pet will be monitored in much the same way as a person undergoing anesthesia would be, with continuous monitoring of their blood pressure (direct and indirect), level of oxygen in the blood (SpO2), heart rate and rhythm (ECG), levels of carbon dioxide (ETCO2), and body temperature. After the procedure is completed, your pet will continue to have vital parameters monitored until he or she is fully recovered. At Veterinary Referral Associates your pet will receive top level care, rest assured!

There are many conditions which require surgery to treat, and can be life-threatening or dangerous to wait for prolonged periods of time. Common examples include being hit by a car, internal bleeding, a rupture or hole in the intestines, eating foreign objects that have become stuck or obstructed, gall bladder disease, difficulty giving birth, or a wide variety of other illnesses. In these scenarios, we have veterinarians trained in surgery available 24 hours a day. If your pet needs emergency surgery, we are always prepared and equipped to provide this life-saving procedure.

Hip dysplasia is a common developmental disorder of the hip joint that affects almost all breeds of dogs. Over time, dogs with hip dysplasia often develop secondary osteoarthritis. Symptoms associated with hip dysplasia range from none to severe pain and lameness of one or both hind legs and may occur during puppyhood or later in life.

Dogs suspected of having hip dysplasia are diagnosed as having the condition based on palpation of the hip joints during a physical examination and with radiographs. Treatment for the condition often depends on the severity of the clinical signs and may involve medical management (weight control, exercise moderation, anti-inflammatory/pain medications, joint supplementation and physical rehabilitation) or various surgical interventions.

Recent innovations in veterinary and minimally invasive surgical technology are changing the face of veterinary soft tissue and orthopedic surgery. New minimally invasive surgical approaches have been developed to compliment or replace traditional techniques. In many cases, quicker recovery time and superior visualization have also been demonstrated with minimally invasive techniques. Some of the minimally invasive soft tissue procedures offered are listed below:

Urogenital

  • Laparoscopic kidney biopsy
  • Laparoscopic assisted ovariohysterectomy (spay)
  • Laparoscopic ovariectomy
  • Laparoscopic cryptorchidectomy
  • Laparoscopic assisted cystoscopy (bladder stone removal)
  • Laparoscopic assisted cystopexy
  • Laparoscopic assisted cystostomy tube placement

Gastrointestinal/Abdominal

  • Exploratory laparoscopy with multiple biopsies
  • Laparoscopic assisted gastropexy
  • Laparoscopic assisted foreign body removal (intestinal)
  • Laparoscopic liver biopsy
  • Laparoscopic pancreatic biopsy
  • Laparoscopic abdominal mass explore and biopsy
  • Laparoscopic assisted colopexy
  • Laparoscopic adrenalectomy
  • Laparoscopic assisted feeding tube placement (low-profile gastrostomy, gastrostomy, jejunostomy
  • Laparoscopic assisted cholecystectomy – coming soon

Thoracoscopy

  • Exploratory thoracoscopy (Indications: spontaneous pneumothorax, acute pyothorax)
  • Partial lung lobectomy
  • Pericardiectomy
  • Complete lung lobectomy (with one lung ventilation) –coming soon
  • Pericardioscopy
  • Pleural biopsies

Orthopedic Procedures

Elbow Arthroscopy

  • OCD removal and debridement
  • Exploratory arthroscopy
  • Arthroscopic debridement
  • Subtotal medial coronoidectomy
  • Ununited anconeal process removal or repair
  • Arthroscopically-assisted fracture repair
  • Fragmented medial coronoid process removal and debridement
  • Biceps ulnar release procedure (BURP)
  • Septic joint assessment, debridement and lavage

Shoulder Arthroscopy

  • Exploratory arthroscopy (intraarticular tendon evaluation)
  • Biceps tenectomy
  • OCD lesion removal and debridement
  • Arthroscopically-assisted fracture repair
  • Septic joint assessment, debridement and lavage

Stifle Arthroscopy

  • Exploratory arthroscopy
  • Meniscectomy
  • OCD removal and debridement
  • Arthroscopically-assisted fracture repair
  • Septic joint assessment, debridement and lavage

Tarsal Arthroscopy

  • OCD lesion removal and debridement
  • Arthroscopically-assisted fracture repair
  • Septic joint assessment, debridement and lavage

Multimodal analgesia (pain relief) is simultaneous administration of 2 or more analgesic drugs (pain medications) affecting different parts of the pain pathway, simultaneously.

Multimodal analgesia is of great value as it allows us to treat pain more effectively as different drugs may have additive or synergistic analgesic effects when administered together. The additive/synergistic effect also allows us to use lower doses of each drug and, as a result, adverse side effects can be diminished.

Different routes of drug administration also play a role in multimodal analgesia. Routes often used in our hospital include systemic administration (intravenous, intramuscular, or oral), epidural administration (drug is directly administered around the spinal cord where the “pain” nerves originate from), and regional administration (giving medication at the site of the injury or to the nerves that go to that site).

Other modalities in veterinary medicine can also contribute to the multimodal analgesia. These can include physical rehabilitation, massage, laser therapy, and acupuncture.

When their pain is better controlled, patients tend to recover quicker and go back to their normal routine faster!

In veterinary medicine, reconstructive procedures are not beautifying procedures. Instead, reconstructive surgery is used to change the anatomy to alleviate discomfort and dysfunction whether from injury, illness, or congenital abnormalities.

At our hospital, we have a special interest in these quality of life procedures, and our experience and exacting standards mean your pet will be getting the best care possible. Some of the reconstructive surgeries performed include:

  • Oral and Facial Procedures
  • Airway/Respiratory Management
  • Wound Management and Skin Reconstruction
  • Nasal alar fold rhinoplasty (aka. Widening the opening the nostrils)
  • Cheiloplasty

The line between the working dog and the dog performing in competitive sports is blurred and ancient. Greyhounds were so treasured in ancient times that only the aristocracy was allowed to own them. Although Greyhounds were commonly used for hunting there is evidence at least as far back as 2500 BC that dogs looking very much like our present-day Greyhounds were used for competitive racing. Greyhound racing became a staple in Great Britain. The artificial lure, oval track in the 1920’s and legalized parimutuel betting in the 1930’s set the stage for widespread Greyhound racing in the United States.

Of course, for centuries Foxhounds, Deerhounds, Beagles, Pointers and many other breeds were hunting companions. These animals were responsible for many a meal eaten in homes around the world.

Although training methods were studied in great detail, it wasn’t until the same scientific approach to human diseases was applicable to our sporting companions that veterinary medicine became involved with sporting animals. This area of interest started to blossom in the 1950’s and 1960’s. Bateman in Veterinary Record noted in 1950 the accessory carpal bone fracture common to racing Greyhounds and described a surgical repair.

In the last two to three decades, an entire new area of canine human interaction has proliferated. Canine events are held by the thousands all over the world with very close knit-societies formalizing the rules and standardizing competitive achievements and goals. Likewise, the marriage of veterinary medicine to the improvement of dog health has given valuable hunting animals a second chance rather than the alternative of being replaced.

Veterinarians recognize their potential role as valued partners in recommending fitness protocols as well as their medical role in treating sporting injuries.

Popular and competitive sports such as agility, flyball, lure coursing, weight pulling, dock diving, Greyhound racing, disc dog, carting, mushing and fox hunting are activities that not only need specialized training but also each has their own set of potential physical injuries determined by the stresses that the dog may encounter. Also, specific conformations may expose the competitor to specific injuries not common to different individuals competing in the same event.

The demands placed upon the animal competing in events based predominately upon confirmation also have many areas that would make the veterinarian the natural expert. Areas such as nutrition, dental and skin health, as well as overall conditioning are critical in conformation competitions and yet veterinarians have taken a minor role in bringing these beautiful animals to perfect form.

The entire field of Human Physical Therapy, which has a very long history going back to Hippocrates, has naturally been called upon to aid veterinarians in treating the canine athlete. Using techniques such as Range of Motion, Muscle Mass Measurements, Massage, Hot and Cold treatments, and assessing soft tissue injuries and boney conformations in an entirely unique way has made the partnership between Physical Therapists and Veterinarians a very fruitful one.

As common Physical Therapy techniques have been applied to canines over the past few decades, it has become clear that a true merging of the sciences to form a new science is necessary. Variations in joints and movement as well as significant variations in gait and weight bearing in the canine require rethinking the application of human physical techniques in the same way. In addition, the actual physiology and recovery of function varies greatly between these two species. It is fair to say that veterinarians need to study what Physical Therapy has to offer and then consider how those techniques might be applied to our canine athletes. Unfortunately, actual scientific study has held very little attraction even though Canine Sports Medicine is gaining in popularity.

Any Physical Therapist as well as any person involved in Veterinary Rehabilitation will tell you that the most valuable tool they have are their hands. This is a given, but as this field grows the area of modalities has grown with it. The use of swimming pools as well as underwater treadmills, ultrasonography and its associated phonophoresis, therapeutic lasers, and cavalletti exercises, as well as exercise balls, and stairs, have all become the day-to-day world of anyone performing animal rehabilitation.

AtVeterinary Referral Associates we are proud to have been part of this movement almost from the beginning. We have a large rehabilitation area that has a dry rehabilitation room, a wet rehabilitation room with a pool and underwater treadmills, an outdoor area with different surfaces to challenge an animal’s gait. Dr. H. Steven Steinberg has lectured internationally on rehabilitation for many years and is on faculty at one of two schools in the country that certifies rehabilitation experts. He also authored two chapters in Canine Sports Medicine and Rehabilitation, Wiley-Blackwell, April 15, 2013. Under the guidance of Ms. Renee Mills, our certified rehabilitation director, we see more than a dozen patients each day. We actively treat recoveries from various severe illnesses in an unusual assortment of animals. Although by far we see mainly dogs, we have treated cats, rabbits, hedgehogs and others. We pride ourselves on helping the aged, beloved pet to reach the goals of the owner-companion. Not every animal can go through the rigors of surgery and not every owner can afford the surgeries being offered today.

Veterinary Referral Associates has been actively involved in conditioning animals for competition and in recognizing common injuries in those animals that compete. We are becoming more aware of the forces and conditions that lead to injury. We are proud to bring our expertise to this new area of veterinary medicine and have a great facility and staff to make these athletes get to their next level of competition.

Though not always indicated, tissue biopsies can be an essential feature in the diagnosing, staging, and management of your pet. The process involves the removal of a small amount of tissue from the area of interest. Depending on what is required, this procedure can be performed with either local anesthetics and sedation or may require general anesthesia.

To obtain a small sample in a readily accessible area, your pet will be sedated or placed under general anesthesia. If any overlying hair is present it will be removed to ensure the procedure remains sterile. Local anesthetics may then be injected followed by the removal of a small tissue core (needle biopsy) or larger circular core of tissue (punch biopsy). A skin stitch may be required that will be removed 10-14 days later. For these smaller procedures an overnight stay for observation is not generally required. However, animals may need to be discharged with an Elizabethan collar (E-collar) or other deterrent to ensure they do not traumatize the site being tested.

For internal lesions or to obtain larger amounts of tissue a more invasive surgical biopsy may be required. The specific procedure for your pet will be discussed with you prior to testing. Briefly, your pet will be placed under general anesthesia. A skin incision will be made overlying the affected area (incisional biopsy) or around the lesion (excisional biopsy). After removing the required tissue, several stitches will be placed. Although hospitalized care is not always required, depending on the type of biopsy and your pet’s recovery from general anesthesia, they may need to remain with us for up to 48 hours after the procedure.

Short term, mild discomfort may result with either type of biopsy. Therefore your pet may be placed on an anti-inflammatory or other anti-pain medication to ensure that any discomfort is minimized. Over the next several days it is important to monitor the area for any excessive redness, discharge, swelling or pain and equally important, do not let your pet lick or irritate the biopsy site. If you have any questions or concerns, please contact your veterinarian immediately for guidance.