By T. J. Dunn, Jr., DVM
Just before noon one Saturday we were seeing the last of the morning’s appointments. No surgeries were scheduled on Saturdays because we all hoped to get outdoors and enjoy the weekend. Then the phone rang and everything changed.
An American Eskimo dog was on the way in for immediate assistance because it had just been hit by -- and this is the truth -- a logging truck!
We set up the usual emergency materials, radiographs and instruments and prepared for critical care patient management. Fortunately, our patient was conscious and after a thorough evaluation we determined that he had a broken pelvis, fractured femur and internal injuries.
The patient needed surgery immediately to repair the internal damages before we began the orthopedic repairs. Among other things a ruptured bladder was discovered and repaired and after a number of hours in surgery, the patient began an uneventful recovery.
This case is a good example of a situation where surgery is required to save the patient’s life. There is an entirely separate category of surgery, though, that does not qualify as "necessary." Those surgical procedures that are undertaken by choice are termed elective surgery. In other words … elective surgery is optional. It does not have to be done to save or stabilize the patient’s life.
We all are familiar with the common elective surgeries done on humans -- liposuction, face lifts and mole removal, just to name a few. And in dogs, ear cropping, spay/neuter surgery, tail docking, come readily to mind. Most people agree that ear cropping is a cosmetic procedure with little verifiable medical rewards for the dog. There’s a vast gray area though, where a dog owner needs to carefully consider the choice to proceed with a surgical procedure because there are many elective surgeries that, although may not be considered life-saving, still provide health-enhancing benefits.
The patient with fat deposits exemplifies the dilemma dog owners and veterinarians face regarding the decision to do or not do surgery. Many veterinarian recommend removing fat deposits, called lipomas, once they reach a certain size because if left to their own whims these fatty growths sometimes enlarge to huge proportions. But which fat deposits can be left alone and which should be removed? Even if probed and analyzed by needle biopsy and shown to be benign, some fat deposits simply do not stop growing!
Risks vs. Benefits
And what are the risks versus benefits of a procedure? Let’s take as an example dental procedures. If loose teeth, gingival growths and deep infections are present, a case could be made that the dental procedure really needs be done to improve and safeguard the patient’s quality of life. The down side is that, because these elective procedures require some form of anesthesia and surgical invasion of the patient, they are not entirely without risk. With modern veterinary medical presurgical protocols, though, the attendant risks can be minimized; and one important tool in identifying the "at risk" patient is the blood chemistry profile assessment.