Pre-surgical instructions:   Guidelines for practitioners and their staff. All surgical cases should be fasted from 10pm the night before. Blood work: a recent (within 30 days) blood panel is recommended on all cases, and is required on all cases seven years of age or greater. IV Catheter: An IV catheter is required on all cases, and fluid therapy is always recommended. Pain management: Transdermal pain patches are recommended, and application 8 to 12 hours prior to the surgery is optimal, but not necessary. I recommend premedicating the patient with an appropriate opiate 15 to 30 minutes prior to induction, and will provide dosage recommendations the day of surgery. Antibiotic treatment: Cefazolin or Na Ampicillin should be available for IV administration at the time of induction. Risks of complications should be discussed with the owner prior to scheduling the surgery. Phone consultation with the referring veterinarian is available to review these important details. Culture and sensitivity is recommended prior to lateral ear resections, in order to optimize peri-operative and post-operative antibiotic therapy.       Post-surgical instructions   Post Cranial Cruciate Ligament repair and Luxating Patella repair: 8 weeks of NSAID treatment. 2 weeks of strict rest with leash walking to go to the bathroom only. Ice the knee three times daily for 10 to 15 minutes. 4 weeks of moderate rest, allowing the patient to walk about the inside of the home, with toe touching on the surgical leg. No playing or jumping. On leash outdoors. Twice-daily passive range of motion exercises, accompanied by icing. 2 weeks of restricted activity when bearing weight, but promoting swimming or hydrotherapy, and continuing passive ROM exercises. Appropriate dietary management is prudent, as over-conditioned patients will greatly increase the chances of injuring the same ligament in the other leg during surgical recovery. There are several places in the county, which offer physical therapy, including hydrotherapy. Use of these services can greatly increase the percentage return to original function which may be achieved post-surgery, and the speed with which this may happen. See the useful links section. Monitor surgical site for excess swelling, redness or discharge. An E collar to avoid licking is often used. Rechecks every 2 weeks to monitor healing and progress.       Post Anal Gland ablation This surgical site is left open to heal by second intention, as the surgery site is non-sterile by nature. Antibiotic therapy is indicated for 7 days, and amoxicillin / clavulanic acid or enrofloxacin are the preferred choices. NSAID therapy is indicated for one week. Owners should be instructed to clean the sites and hot pack them twice daily with a warm washcloth for 7 days. A small amount of clear, red-tinged discharge is normal for 2 days after surgery. Any discharge that is not translucent should be rechecked immediately. An E collar is recommended for one week to avoid excess licking of the surgical sites. Expect the surgical sites to fill in with a bright red tissue in about one week, and then to heal completely within three to four weeks. Patients generally do not experience difficulty defecating after this procedure, but slight discomfort can exist for several days.       Prolapsed gland of the third eyelid repair: While the method used has the smallest reoccurrence rate, owners should be cautioned that this condition might reoccur and necessitate further surgical intervention. Antibiotic drops with steroid should be used three times daily for one week following the surgery.       Bark Reduction: Owners must be cautioned that this will not eliminate the bark, but merely change the pitch and loudness. This procedure occasionally needs to be repeated to optimize outcome. Appropriate opiate and NSAID pain management is indicated post-surgery.       Lateral Ear Resection: An Elizabethan collar is mandatory post surgery. Suture removal should be scheduled at a recheck a minimum of 14 days after surgery. Delayed healing must be checked for prior to suture removal. Patients should be maintained on both an appropriate oral antibiotic for days 1 to 14 post surgery, and an appropriate topical ear medication once daily for days 5 to 14.
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