Ask the Expert
Veterinarian Surgeon, Dr. Eric Herman
Brief Bio: Dr. Eric Herman has been performing advanced veterinary surgeries in the Gainesville for the past 9 years since he finished his residency in veterinary surgery. He has noticed over the years how much an injured pet’s impaired movement strains the bond between their pet parents. This is the driving force that created Kinetic Pets. His goal is to strengthen the bond between his patients and their pet parents by improving their mobility through minimally invasive surgical and rehabilitation procedures to be free from pain as fast as possible
My dog had surgery on his leg last week, and HATES the cone of shame. How important is it that he wears it? Unfortunately, we cannot rationalize with our beloved pets to explain to them how important it is not to lick or chew at the incision. It is crucial that a patient does not lick or chew at an incision as this introduces bacteria into the incision, creates incisional infections, and can cause the incision to open. There are other options to either augment or replace an Elizabethan collar (e-collar, cone-of-shame) such as a Lick Sleeve www.licksleeve.com (if a rear limb procedure), surgical recovery suits and inflatable donut e-collars to name a few. Pet surgical recovery suits and inflatable donut e-collars can be found on Amazon and many other websites. If you are planning to use one of these alternatives for your pet after a procedure, discuss this with your veterinarian performing the procedure. They can help guide you as to which would be best for the location of your pet’s incision and your pet’s anxiety or activity level. I find the best outcomes are made with open communication between the veterinarian performing the surgery and the pet parent. Both parties want the best possible outcome for your beloved pet.
My dog is only 6 lbs and needs to have surgery, is it OK to put her under?
Many patients smaller than 6 pounds have undergone anesthesia safely without trouble. The important aspect of anesthesia is that the veterinary team performing the anesthesia needs to know any concurrent diseases such as heart murmurs, diabetes, seizures or endocrine diseases. They would also need to know if that particular patient has ever had a complication under anesthesia if performed at another hospital. Patients this small do pose challenges such as gaining IV access just due to their size. I’ve been very blessed to have rockstar veterinary technicians over the years working with me that have made gaining IV access in these patients look easy. These patients also are notorious for being difficult to maintain their body temperature under anesthesia. Frequently, we prewarm them with warm towels as a bed or warm air blowers into their kennels right before anesthesia, have heated mats for them to lay on while anesthetized, cover their body with something like Mylar that traps heat in or cover them with a blanket that has warm air gently blowing over their body. Dogs and cats lose a lot of heat through their paw pads. Therefore, we cover the feet of these small patients with the fingers from exam gloves to trap that heat they are expelling. In short, I recommend discussing your concerns with your veterinarian that would be performing the anesthesia to assure you of the different precautions they take with small patients in general as well as any pet specific needs your beloved pet may have.
I am afraid my cat’s incision from surgery is infected, but I am not sure. What would an infection look like and what should I do if it is?
If you are ever concerned about an incision, please reach out to the veterinary hospital that performed the procedure. Frequently, we will have pet parents email us a picture of their pet’s incision when they are concerned. This allows us to determine if it is acceptable or whether we need to have them bring in the patient for an examination. If we can save the pet the anxiety of a trip and the pet parent the time and money of an examination, then we always try. Surgeries do cause bruising and inflammation. Signs of infection can be excess redness, heat at and around the incision, pain around the incision, separation of the incision and drainage other than small amounts of blood from the incision. I find it helpful to take a picture of the incision the day you pick up your pet and then every few days thereafter unless there is a problem. This way if you are concerned, you can first look back at the last few pictures to see how the incision has progressed. This would also allow the veterinarian to see how it has healed over time. The more information we have available to us, the more we can help.
Our vet prescribed rehabilitation after my dog’s leg surgery, but he is refusing to get up and walk and just lays there. What do you suggest for motivation to help him recover faster?
This could be due to a pet’s personality, too much postoperative pain, or potentially too much postoperative pain medication causing sedation. I would first recommend you contact your veterinarian performing the surgery or the rehabilitation team if you elected formal rehabilitation. If this is merely due to the pet’s personality and lack of motivation, the best way is food motivation. Having things like a peanut butter stuffed Kong from the freezer, frozen Dixie cup of beef or chicken broth, or their favorite treats in moderation can work well. If none of this works, then try canned cat food. Frequently, dogs go bonkers for cheap cat food. Other dogs are not food motivated but respond to praise. These patients can do great by having their favorite person in front of the hyping them up to get going. We all enjoy positive reinforcement. So even if they are only making small improvements, make it seem like a huge deal to them. Over time those small improvements will build together, and you’ll end up having made a large amount of progress with their recovery. There are also many exercises that can be performed while they are lying down resting such as passive range of motion, massage, icing/warm compressing of the painful areas to name a few. If you would like more formal rehabilitation, we can have one of our rehabilitation certified veterinary technicians come to your home after the procedure to help speed along the recovery as well as give you personalized tips for your pet.
My cat seems to be in so much pain from her procedure, what are the best pain medications for her? Is there anything herbal I can give her?
It is so difficult to see your pet in pain. I find its first important to know if your pet is in pain. There are tests that pet owners can easily do at home to know whether their pet is in pain or not. For cats, I like to have pet owners use the Feline Grimace Scale www.felinegrimacescale.com and the Feline Musculoskeletal Pain Index www.painfreecats.com. These can help you determine if your cat is in pain. Once determined it is in pain, you should contact your veterinarian. The best way to address pain management is through multiple drugs and/or supplements. Each drug or supplement in that patient’s protocol should be targeting pain from a different method. This allows us to use lower doses of each medication to minimize the risk of adverse effects of that medication. Some supplements have been shown to improve various painful conditions. Herbal supplements can have serious drug interactions. Therefore, if you are giving any supplements, it is important to make your veterinarian aware of a complete list of anything other than food you may be giving. Depending upon the location of pain, there may be nonpharmacological options as well. Acupuncture, photobiomodulation (laser therapy), shockwave therapy (targeted sound waves), therapeutic ultrasound, warm and cold compresses, pulsed electromagnetic fields (PEMF), low grade electrical stimulation (TENS and NMES) are some options that rehabilitation practitioners can provide that have no systemic side effects to the patient. These are given locally to the tissue. Many of these modalities can be utilized to decrease medication doses or to get them off medications entirely. If you are interested in rehabilitation services, feel free to contact us at Kinetic Pets. We would be happy to discuss this further.
My 17 year old dog needs surgery on his foot, but, is there a potential that his age will put him at more risk for complications or even death? If it’s not life threatening, should we opt out?
I like to say that age is not a disease, but with increasing age we increase our risk of disease. Therefore, I look at each pet on an individual basis. I first ask can this injury be treated via something that doesn’t require any anesthesia. As someone who strives to leave as minimal of s surgical footprint as possible, it’s not possible to be more minimally invasive than no surgery at all. Having said that, sometimes surgery is the best option for the fastest or most complete recovery. If they are over 7 years of age in a giant breed or over 10 years of age in other breeds, then I advise a more systemic workup be performed to see if your pet has any concurrent diseases that may increase the risk of anesthesia or the procedure, or potentially negate the need for the procedure that was initially advised. If you have done these tests and determined there is no evidence of an increased risk from these tests, then it is safer to move forward with anesthesia. Special precautions would be made on a case-by-case basis to monitor parameters closely and intervene early if warranted to minimize any potential complications under anesthesia.
Our cat needs a very expensive surgical procedure, which we would like to do. Are there insurance programs that we can invest in to help?
Pet insurance is an extremely important investment for pet owners. Unfortunately, if you already know your pet needs a procedure and do not currently have insurance, that procedure likely would not be covered as it would be a preexisting condition. It would still be a good idea to get pet insurance for any future issues your cat may have. As a general rule, I advise any pet owner get insurance for their pets. Veterinary medical options are rapidly improving with the continued advancement of human medical options. With increased medical options and improved capabilities of diagnosis/treatment, comes rising cost of veterinary care. Different pet insurances pay out differently to pet owners. Some do a percentage of the total veterinary bills for a specific injury after a deductible has been met while others just have no deductible and pay a certain percentage of the veterinary bills. While there are many insurance companies to investigate for a pet owner, two that have been good to a lot of pet owners I’ve worked with are Nationwide and Trupanion. Many of the pet owners of my patients have given me good feedback on those companies. Certainly, there are and a great website to compare them is www.petinsurer.com
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As Americans, we have been conditioned to expect/accept overweight pets as normal. Frequently, when someone has a healthy body condition score pet, they get told by others in the public that their pet is too skinny. Studies show that keeping a pet at a lean body condition score as opposed to obese can increase their lifespan by 2 years! Wouldn’t we all like to have potentially 2 more years with our beloved pet? From a surgical and rehabilitation perspective, excess weight can overload bones, joints and muscles slowing their recovery. I’ve had numerous obese patients with both elbows or both hips severely arthritic get off medications or only be on supplements merely from getting them into a healthy body condition score. Many different breeds carry their weight differently. Even between Labradors, one of the top 5 most popular breeds, one could have short stocky body or tall and lean. It’s not as simple as saying all Labradors should weigh 75 pounds at a lean weight. This is why I love the Purina Body Condition Score system that I’ve attached a website with the information. It is a grading scale of 1-9 with 4 and 5 being ideal. It gives a short paragraph describing each score as well as a top and side view of a cartoon dog or cat for perspective. If a pet has undergone an orthopedic or neurologic surgery or if it is undergoing rehabilitation therapy for an injury, it is best to try to get them into the 4/9 score. This is on the lean end of normal, which would offload those injury sites to speed healing. If one is interested in exercise plans for your pet to get them to a lean Body Condition Score, please contact our Rehabilitation Team at Kinetic Pets and we would be happy to evaluate your pet and develop a great gameplan.