When should my pet be going to the bathroom after surgery/discharge?
Many pets will not have a bowel movement for the first several days after surgery
Reasons that your pet will not have regular bowel movements after surgery include:
Fasting period prior to surgery
Decreased appetite after surgery and during the hospital stay
Decreased appetite frequently after returning home for the first few days
They are fed highly digestible food that produces little stool
Pain medication that contain narcotics which can be constipating
If a pet does not have a bowel movement by the 4th day post-operative there are several at-home remedies to help soften the stool and allow them to have a bowel movement
Metamucil 1 tsp per 25 Kg mixed in with each meal (canned dog food)
Canned pumpkin to increase fiber content
If there has not been a bowel movement after several days of conservative therapy then please contact either your veterinarian or the DVH staff for further advice. In many cases a series of enemas can be given which will help remove dry feces.
My pet had surgery and does not want to eat. What can I do?
Dogs
Most pets will not eat their regular dog food after surgery, especially if it is dry kibble.
Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low fat and should be cooked and any residual fat skimmed off. The carbohydrate can be pasta, potato or white rice.
Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth
There are several recovery diets including Hill's A/D diet and Nutramax recovery diet available at most veterinary hospitals
Hand feeding by placing a small portion of their food in the mouth so that they get the flavor
Warming food slightly in a microwave will make the food more aromatic; remember to stir the food before feeding and test the temperature to ensure that it is not too warm.
Remember that most pets will not eat well the first day or two after they get home from surgery
Cats
Offer aromatic foods that contain fish such as tuna or smelly cat foods
Hand feeding; place a small amount of food in the mouth so that they get the flavor
Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature with your finger; it should be only luke-warm.
Some cats will only eat dry food, try kibble if your cat normally has been fed that food
Petting and stroking your cat frequently will help to stimulate appetite
Remember that most pets will not eat the first day or two after they get home from surgery
If your cat refuses to eat anything for 2-3 days please contact either your veterinarian or the DVH staff so they can be evaluated and nutrition provided via alternative mean to prevent development of a serious liver problem (hepatic lipidosis).
My pet is vomiting now that they are at home. What should I do?
Causes and treatment of vomiting after surgery
When some pets return home after a stay in the hospital they may drink excessive amounts of water all at once and then vomit; if this appears to be happening the water should be limited to frequent smaller amounts.
Medications such as antibiotics or pain medications (non-steroidal anti-inflammatories are common causes of vomiting after surgery. In order to see which medication is causing the problem the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to.
Stomach upset from the anesthesia procedure is a potential cause of vomiting and will pass within a couple of days.
If your pet had surgery of the intestines or stomach, vomiting is always a serious concern, as it may indicate that leakage of intestinal contents has occurred and there is an infection of the abdominal cavity, called peritonitis, present.
Symptomatic treatment of mild vomiting involves with holding food and water for 12 to 24 hours, then introducing small amounts of water initially, and then a bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then. In order to decrease the acidity of the stomach Pepcid AC 0.5 mg/kg given by mouth twice daily for 5 days can sooth an upset stomach. You should always consult a veterinary healthcare professional if there is evidence of post-operative vomiting, especially before administering medication.
Causes and treatment of regurgitation after surgery
The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia or in the peri-operative time period. Acidic fluid from the stomach causes a chemical irritation of the esophagus, which is called esophagitis. This results in decreased motility of the esophagus so water and food will accumulate. In most cases with appropriate treatment the esophagitis is mild and resolves within several days.
If the esophagitis is severe the esophagus can develop strictures. A stricture is a narrowing of the esophagus due to scar tissue formation and does not allow passage of food down the esophagus, thus the pet has persistent regurgitation. This regurgitation can occur several weeks post-operative and is usually associated with post-operative vomiting or regurgitation but not always. Prompt medical attention to this condition can lead to a good outcome, but may require medical therapy in addition to an endoscopic procedure where the esophagus is dilated at the stricture site with a small balloon catheter.
Symptomatic treatment of regurgitation caused by esophagitis includes withholding food and water for short periods and then reintroduction of a bland diet (see above), use of acid reducing medication and administering a coating agent such as sucralfate. You should consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
Signs of pain include
crying
biting if you get near the surgical site
grimacing (lips are pulled back and the the dog looks anxious)
restlessness and not wanting to sleep; pacing
The pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
The most severe pain is usually for the first 2 to 3 days after surgery and then it is usually more of dull pain depending on the type of surgical procedure performed.
Pain medication such as sustained release morphine, tylenol with codeine, Tramadol (Ultram), butorphanol, Duragesic (fentanyl patch) and non-steroidal anti-inflammatories (NSAIDs) such as Deramaxx, Rimadyl, or Metacam are used to keep you pet comfortable after a surgical procedure. In rare cases a mild sedative such as valium or acepromazine can be used to augment the effect of pain medication and allow your pet to sleep
If your pet allows applying a cold compress to the surgical site may be helpful for the first 48-72 hours.
See physical therapy instructions for cold compress directions
Cooling the surgical site helps to numb the area and reduce inflammation which can extend the duration of the local pain sensation.
Some of the pain medications given. Pain medication such as butorphanol or a Duragesic (fentanyl) patch
Pain medications used commponly in humans and dogs, such as Tylenol can kill a cat with even a single large dose as they necessary enzymes in their liver to metabolize this drug.
Anti-inflammatories can be used, but the dose is much less than dogs and they should be given only for a few days. The only NSAID that is currently approved for cats in the US is Metacam.
If a pet licks their incision it will actually delay the healing process because they usually lick to much and traumatize the area. In addition licking the incision can lead to:
Licking can remove stitches and cause the incision to open
Licking can become a severe habit that is difficult to break
Licking can cause infection as the mouth has many bacteria
Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated or there are sutures/staples missing the most common cause is from licking.
To stop your pet from licking the incision site or catheter site the following can be tried:
Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
If the incision is over the chest a tee shirt can be put on your pet and the waist of the shirt fastened in place by tying the shirt tail.
If the incision is over the paw or lower limb a bandage or sock could be put on and kept up with tape.
Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
Antipsychotic medication in some cases is needed when the licking is causing significant skin damage.
What are the post-operative requirements for recheck evaluations at the DVH?
A: Each patient's requirements will be slightly different on their degree and speed of recovery, the type of procedure performed, concurrent illnesses or conditions you pet has and if there are any indications that a potential complications could be occurring. Most patients are re-evaluated initially at the time of suture removal. For many orthopedic cases we recommend a 4-week recheck evaluation with Mr. Charles Evans, our physical therapist, to allow individualized rehabilitation plans to be prepared for your pet and ensure that there are no concerns. For other patients there may be more frequent re-check evaluations such as patients with external fixators or bandages that require intermittent evaluations. In some cases your veterinarian may be able to help with recheck evaluations, blood draws etc… if it is more convienent and there is no evidence complications and the patient is progressing as expected. However, the DVH staff is potentially more likely to be able to reveal a more subtle problem occurring early as they are used to evaluating these patients on a daily basis.
What are at home physical therapy exercises that I can be doing for my dog/cat after orthopedic surgery?
For every case discharged from the DVH the client receives detailed instructions for regarding recommendations for at home physical therapy, exercise restriction and time lines for increasing the amount of acceptable activity. These recommendations are based on the type of surgery performed and are individualized for each patient. The following is a set of standard recommendations for patients that have had a tibial plateau leveling osteotomy and include the following topics:
Restricted Activity: It is important that your pet's activities be severely restricted during his/her recovery. He/she should be housed in a crate during the first 8 weeks after surgery to allow the bone time to heal properly. The crate should be large enough to allow your dog the room to stand up comfortably and turn around. The only times that your dog may be out of the crate would be to go out for bathroom duties and to have rehabilitation exercises performed. During these trips outdoors you dog should be on a leash and the sling be in position under his/her abdomen. The sling should not be used to carry your dog around. He/she should be allow to bare his/her own body weight and the sling be used to catch his/her weight should he/she trip or fall. Any other time that your dog is out of the crate is considered to be a risk for injury.
Rehabilitation Exercises: For the first 7 days post-operatively, there is a considerable amount of swelling due to the surgery. For these first 7 days, we recommend either cooling (for the first 3 days) or heating (day 4 on) the surgery site. To accomplish this we recommend that your dog be relaxed and comfortable at the start of each session. Select an area which is quite and free from distractions. Have your dog lay on his/her side with the injured knee up. Begin by wrapping the affected knee with either a cool or warm (based on what day post-op you are on) wrap on your dog's knee. Then gently begin a full body massage as demonstrated at discharge. Continuing the massage to include the muscles of the shoulders, lower back and surgery leg: continue this for approximately 5 to 10 minutes or until you perceive your dog to be relaxed.
Following your first recheck appointment, you are now ready to begin passive range of motion exercises with your dog. It is common for muscles to atrophy or weaken dramatically if they are not used in any way post operatively. Passive range of motion exercises allow you to take an active part in the recovery of your dog. You should follow the next 3 steps as outlined each time you begin your dog's exercises.
Hot packing: You should begin as outlined previously by laying your dog on his/her side with the affected knee up. Apply moist heat to the knee for 15 minutes. This will serve to reduce tissue tightness, increase blood flow and warm the joint. This can be done by immersing a hand towel in very warm water and gently wrapping it around the surgical area. Pre-test the towel on you first to ensure it is not too hot. Keep immersing the towel into the hot water as it cools off. Your goal is to heat the joint for 15 minutes. You may also purchase microwavable packs. These are available at most pharmacies and they are inexpensive. The microwavable packs should be wrapped in a moist warm towel before being applied to the surgical site. Never use an electric heating pad for warming a joint.
Passive range of motion: Once the joint has been warmed with the hot pack, you can begin gentle passive range of motion. This helps to maintain the joint's mobility and provides nutrition to the joint and cartilage. Start be gently flexing (bending) and extending (straightening) the hip as shown to you at your first recheck. Hold the joint flexed (bent) for 10-15 seconds, and then slowly move through the range of motion until the hip is in the extended position (straight). Hold this position for 10-15 seconds. Repeat these motions for 10-15 repetitions. Your dog may not enjoy this, so be careful to bend or straighten the limb to your dog's own resistance. If he/she whimpers or vocalizes more than usual or quickly turns his/her head toward you, you may be bending or straightening the hip too much. If that is the case don't flex or extend the hip joint as much during the next repetition.
Icing: Immediately following the passive range of motion exercises the joint needs to be cooled down. By cooling down the surgery site, you provide essential anti-inflammatory effects and as a result decrease pain associated with the surgery. If you are using a commercial ice pack, place a pillowcase over it to protect your dog's skin. You may also use direct ice in the form of ice massage. You can accomplish this by freezing small Dixie cups with Popsicle sticks in them to provide a handle. Gently rub the surgical area with the ice for approximately 10 minutes. Ice massage is the preferred method of icing because it is quicker and provides a better cooling effect. It may take two people to accomplish the icing as sometimes a dog can get squirmy. Be aware that your dog will experience the same sensations that we would with icing. At first they will feel cold, then a burning sensation, then an aching sensation, and then finally numbness. Once the icing has achieved the numbing stage they usually do not squirm any longer.
Depending upon what your schedule allows, these sessions should take place 2-3 times daily. A non-steroidal anti-inflammatory will also be dispensed for your dog to take for one-month post operatively. You may notice swelling along the incision site, this is not uncommon, however, should this occur please call. Increasing the time spent hot packing and additional passive range of motion exercises should help.
What are acceptable activities after a tibial plateau leveling osteotomy?
Restricted Activity: It is important that your pet's activities be severely restricted during his/her recovery. He/she should be housed in a crate during the first 8 weeks after surgery to allow the bone time to heal properly. The crate should be large enough to allow your dog the room to stand up comfortably and turn around. The only times that your dog may be out of the crate would be to go out for bathroom duties and to have rehabilitation exercises performed. During these trips outdoors you dog should be on a leash and the sling be in position under his/her abdomen. The sling should not be used to carry your dog around. He/she should be allow to bare his/her own body weight and the sling be used to catch his/her weight should he/she trip or fall. Any other time that your dog is out of the crate is considered to be a risk for injury.
Week 1: Full body massage and hot packing the surgical site 2-3 times daily. Controlled leash walks with the sling for bathroom duties, otherwise strict confinement in the crate.
Week 2 and 3: Begin passive range of motion exercises 2-3 times daily. Walk you dog outside on a leash with the sling for 5-15 minutes three times daily. This can be accomplished while your dog is outside on a bathroom break. Your dog should still be confined to his/her crate when you are not outside for these short walks or doing passive range of motion exercises.
Week 4: Should weather conditions and your dog's attitude about water permit, you may now allow your dog to swim, however, he/she should not be running in and out of the water. Start with your dog standing in the water with the water at about shoulder level. Allow your dog to either walk in the water at this depth or to swim from that position. Start with limiting the time spent in the water to 5 minutes and progress slowly by 2 minutes every other session. Dover Veterinary Hospital has a hydro-treadmill for those owners who may want to provide water rehabilitation year round. If you are interested in hydro-therapy please contact our hospital for an appointment with Charlie Evans, the physical therapy coordinator.
Week 5: Discontinue passive range of motion and add stretching after walks. Hold the stretch for 15-30 seconds for 4 repetitions. You may begin to increase the length of your controlled walks (using a short leash and the sling) up to 30 minutes a day as your dog tolerates it. To accomplish this safely, begin adding 3-5 minutes to your 15 minute walks every other day until you reach 30 minutes.
Week 6-7: Begin to increase your controlled walks (on short leash; you may leave your sling at home) to 45-60 minutes three times a week.
Week 8-9: You may now add a trot to your short-leash walks. Strive for a least one hour walks three times weekly. Begin to work on proprioception at this point. This means trying to remove weight from the non-surgical leg, which allows your dog to bear all of his/her weight on the surgically corrected limb. We have a number of suggestions for accomplishing this, please call Charlie Evans for more information.
Week 10-12: Gradually begin to move your dog to unrestricted activity. To accomplish this you may now use a flexi-lead that allows your dog to gently zigzag during your walks. You may also begin gentle incline walks. Slowly walk your dog up a small hill or incline. This will help strengthen the hindquarters. Your dog should still NOT be freely walking or bounding up stairs.
Week 12: Your dog may begin walking stairs without the aid of the sling. With your dog on a short leash, slowly walk him/her up 8-10 stairs three times daily. This will strengthen the leg muscles and help your dog begin to improve his/her balance and sense of position of proprioception of the hind limbs.
Continue with the previously recommended exercises for strengthening. Do not allow crazed activity such as leaping off of retaining walls, decks, etc., or jumping after Frisbees or ball chasing until 5 months post operatively.