Thursday, June 18, 2015

Why I hate pre-anaesthetic blood tests in our pets!

 Be prepared - opinion ahead with a wee bit of tongue in cheek too!

There is a huge problem that can arise when we start doing pre-anaesthetic blood tests in our pets.

Just for those who don't know, doing a blood test on a pet prior to them having an anaesthetic is now a common place procedure.  In the olden days, however, the majority of pets would be lucky to get a haematocrit (to look for anemia), and a BUN (blood urea nitrogen) as a kidney screen.  

These days, our pre-anaesthetic panels include the haematocrit, but also a urine sample (checking concentration, sugar, protein, bilirubin, and blood), and an assessment of six parameters (glucose, urea, creatinine, total protein, ALT and Alkphos). In some of the older dogs/cats, I even upgrade at no extra charge to measuring 12 parameters. 

In the olden days, the majority of pets undergoing surgeries would not get any blood work done, or rarely. Rarely would they go onto intravenous fluids for extra support. The majority of animals did OK during the anaesthetic, with many  being a bit off for a few days after wards - but it was always blamed on the surgery anyway. In fact, it was almost expected that the dog desexing would not move for 5 days!  These days, that would be unheard off! 

In those days, if the dog died a few days afterwards, well, everyone just blamed the vet and the surgery.  When they drive past the vet hospital, they would shout out to their friends - "That's the vet that killed my dog!"  I have never had that happen to me, but I know it has happened to colleagues. But again, in those days, they were "just a dog" or " just a cat", anyway.  It was easy enough to go down to the pet shop to pick up another pet for $50, or a free one from the pound or from your neighbour's dog who just had a litter. 
"Am I so easily replaced?  Methinks not!"

In those days, in the practice I used to work at, we would be doing 10-15 anaesthetics per day. There was no fancy pre-anaesthetic testing which took up time, or putting animals onto the drip.  The monitoring was minimal - watching the chest move up and down was about the sum total of it, and the pets usually recovered on the floor, whilst you started on your next surgical procedure.  So long as the chest was moving, you knew they were still alive. (no secret that I hated those days, and it makes me feel sick that I was forced to practice veterinary medicine that way!)

Are there veterinary hospitals still like this out there?  Yup - some of them even have their own TV show in the US! Sad, but true! 

Vet fees were also cheaper in those days too, and for a good reason. There was no fancy equipment, licensing or or facilities needed to have a vet hospital, not like now.   The only fancy equipment that the vet hospital needed was an Xray machine, which wasn't used most of the time anyway, as it was too clunky and cumbersome to use, and the radiation exposure to us, well, radiation tags was not standard either!   It wasn't even a requirement for there to be a gaseous anaesthetic machine. You just needed to pay a licence fee, and that was it... you could call yourself a vet hospital.

These days, you need to pass alot of very expensive council requirements on noise, location, facilities, and the Vet Board also is pretty strict too - from things as minor as sinks in consult rooms, to  fully equipped isolation rooms (although they are rarely used or needed these days).  Give me the good old days! (not... standards are there for a reason!).

So why would I hate pre-anaesthetic blood testing in our pets?  And why does doing them cause so many problems?

Because ignorance was bliss! 

In the assumption of all being OK, in the good old days, we we were able to knuckle down and tackle any and all procedures that needed doing.  No mucking around, we were able to knock over 10 or 15 or even more surgeries in a couple of hours. 

These days, with this new fangled blood testing,  from taking of the blood sample, to running it through the expensive biochemistry analyser, takes precious time,  skill, and money (to purchase the equipment).  And then, if we identify a problem, then it puts a halt onto everything that was planned for the day.  We have to get onto the phone to talk to the owner, and give them the news that no pet owner wants to hear "We found something wrong in Muffy's blood test today, and this is what we need to do now".

Frankly, owners do not want to know of problems, they just want solutions! (- I know most of you want your pet to be happy, and you are as devastated as I when you know there is a problem). 

Do you realise how many dental procedures I had to delay to sort out why the liver enzymes were elevated or to manage a kidney infection?

Do you know how many desexings in otherwise "healthy" six month old dogs couldn't be done  all because the blood tests indicated a problem. In some cases, they  turned out to have  congenital liver disease (such as a portosystemic shunt, and in others, the dog had a toxic treat two days previously  that caused liver damage.

 All of these problems unrelated to the surgery that was planned, but without identifying them, the pet could've died, and it would all have been the vets fault. 

Talk about frustration for me!

 I am psyched up to remove ovaries and testicles, get those teeth cleaned up, and remove the infected ones! And now, I can't!  
All dressed up for surgery - well, Miss Piggy is.

On a serious note - I do not hate pre-anaesthetic blood tests at all - I actually adore and love them.  

Thanks to these all important blood tests in a "healthy" dog or cat, that we have been able to show that they have not been as healthy as all appeared.  We have been able to treat those diseases successfully, and plan for their future anaesthetics, guaranteeing a survival for many many more years!  

Instead of the compensatory renal disease dog collapsing due to renal failure two days after the anaesthetic, we are able to prepare the patient with fluids, monitor their blood pressure throughout, ensuring a problem free  anaesthetic, recovery and prolonged survival. 

Phew... helping pets live happy and healthy lives is what drives me, and, I have no doubt, all of my fellow veterinarians. 

We just want to be there for you and your loved family pet, so thank you for allowing all of us to continue doing what we love doing.

Identifying and treating disease is what I do best!
I am Dr Liz, the mad vet from  Bellambi. We are here for happy, healthy pets, always!