For Pet Owners

What is a board-certified surgeon?

Dr. Kwan, like all veterinary surgeons, has undergone additional training after veterinary school in order to become a specialist. This training requires a minimum of a 1-year internship followed by a 3-year residency program that meets guidelines established by the American College of Veterinary Surgeons (ACVS).

During the residency there are specific training and caseload requirements that must be met. In addition to these requirements, applicants must perform research that is published in a scientific journal and then pass a rigorous examination.

Specialists are called a “Diplomate of the American College of Veterinary Surgeons” or a “board-certified surgeon.”  This is abbreviated DACVS, and may be specified as SA (small animal) or LA (large animal).  Dr. Kwan works primarily with cats and dogs, although she has occasionally helped small hoofstock and other exotic species.

All veterinarians may perform surgery as part of their veterinary practice. However, difficult cases may be best managed by a specialist. Board-certified surgeons work closely with the owner and the primary veterinarian before and after surgery in a team approach to ensure continuity of care for your animal.

Following surgery and any postoperative follow-up care, the primary veterinarian resumes ongoing care of the animal.

Veterinary surgeons are dedicated to providing the very best in surgical care. They also act as a resource for your primary veterinarian by providing consultations on difficult or unusual cases. With their advanced training, these specialists offer expertise that ensures the best possible outcome for the animal and animal owner.

When might a surgeon be helpful to my pet over my regular veterinarian?

Surgeries that are in more difficult locations, such as the head and neck or near the feet, or more complicated surgeries that require specialized equipment and experience are often referred to board certified surgeons over regular veterinarians.  By obtaining additional training and focusing their practice solely on surgeon, board certified surgeons have the expertise and the equipment to give your pet the best possible outcome.

What is an emergency or specialty referral center, and how does that differ?

An emergency or specialty center can provide 24 hour care for more crticial patients, and often have more advanced diagnostics available (such as an MRI or CT scanner).  If your pet has a medical condition that would be best served by multiple specialties (like a cardiologist, anesthesiologist, surgeon, and criticalist) then your veterinarian may recommend you go to a referral center.  Appointments often have to be made far in advance, and fees are generally more due to the increased overhead costs of running such a facility.

How does mobile surgery work?

Dr. Kwan will work with your veterinarian to provide necessary care for your pet - diagnostics, surgery, and after-care.  Please speak with your veterinarian first about what your pet needs, and whether they are able to work with Dr. Kwan.

Am I able to consult with Dr. Kwan directly?

Yes! You can speak with your veterinarian about setting up an in-person consult in the clinic, a phone consult after Dr. Kwan has examined your pet at the clinic, or a tele-consult via video or phone after your veterinarian has examined your pet and performed diagnostics (such as radiographs or bloodwork).  Dr. Kwan is happy to discuss your options or why additional diagnostics may be necessary.  Empowering pet owners to make the best decision on behalf of their pet is one of her passions, and she recognizes every family has different goals when it come to their pet's well being.

What happens the day of surgery?

Do not feed your pet breakfast the morning of the procedure, but a small amount of water is fine.  You should also not give medications unless otherwise directed by your veterinarian.  If necessary to give medications, give it in a very small treat or without any food at all.  Communicate what medications you have been giving your pet - take photos of the bottles if you can't remember!

You will be called prior to surgery and any additional questions you have for Dr. Kwan can be answered at that time.  You will also be called after surgery to be updated on how your pet did, and to discuss any postoperative care and medications.

Why is there swelling below the surgery site or incision?

Gravity will cause swelling to move lower and pool away from the surgery site.  This will go away with time.  You can gently massage the fluid towards the body/heart to encourage it to dissipate.  The more active your pet is, the more fluid will form so keeping them quiet and their blood pressure down will help prevent additional fluid build up.

My pet has not defecated since before surgery.  Is this a problem?

Due to fasting before surgery, pain medications slowing down the intestinal tract, and anesthesia causing decreased intestinal transit, your pet may not defecate for 3-5 days after surgery.  As long as they are eating normally and seem comfortable, do not worry.  Pets are not like humans in this way and we do not worry if we have not seen a bowel movement for several days!  If you wish to add some additional fiber to their diet, such as canned pumpkin (1-2 tablespoons per meal) then this can help encourage a bowel movement.

When should I cold/warm compress the surgery site?

Any compress should be tested to ensure it is not too cold or hot to the skin.  You may use a bag of frozen peas or microwave a sock full of uncooked rice, but wrap in a thin towel and ensure it is not too extreme in temperature.  Cold compresses are best used for the first 48-72 hours after surgery, or after activity if your pet is undergoing physical therapy.  Cold compresses constrict blood supply and limit swelling in an injured area.  Warm compresses are best used if it has been more than 72 hours since surgery AND your pet is resting (not active or just returned from activity).  Warm compresses help bring blood supply to an area to encourage healing or dissipate fluid build up.

There is discharge coming from the incision.  Is this is a problem?

A small amount of bloody discharge can be seen for 24-48 hours after surgery.  As long as the amount is decreasing over time, it is OK.  If there is a lot of swelling in the first week, clear, pink, or yellow tinged discharge can be seen.  Keep the incision covered with a bandaid, clean sock/pant/shirt, or other bandage.  Clean the incision with a mild soap and water and dry with a clean washcloth or paper towel.  If your pet is painful around the incision, or the amount of discharge is increasing over time, call your veterinarian as this can be indicative of infection.

How do I know if my pet is painful?

A majority of pets do not vocalize when in pain.  Sometimes they will hide, avoid people, not eat, limp, pant excessively, or be aggressive/defensive.  It is recommended to give the pain medications provided at regular intervals for the first 72 hours, even if your pet does not seem painful to you.  Often times a local anesthestic was given during surgery that is keeping the surgery site numb for up to 3 days, and your pet may become more painful once it wears off.  It is much harder to suppress pain than it is to prevent it.  After 72 hours, if your pet seems very comfortable and lets you touch the surgery site lightly, you may try spacing the pain medications out more than usual (for example, instead of giving it at 12pm, try waiting until 2-3pm).  If in doubt, it is recommended to err on the side of giving the medication.  Please contact your veterinarian for more instructions.

My pet is vomiting or has diarrhea. What should I do?

If you are giving a non-steroidal anti-inflammatory drug (NSAID) such as carprofen/Rimadyl, deracoxib/Deramaxx, meloxicam/Metacam, firocoxib/Previcox, or other, discontinue it.  Call your veterinarian if your pet cannot keep water or food down.  If they are still eating or drinking small amounts, you can try a bland diet (rice and a small amount of boiled chicken) or a prescription diet (like Hill's i/d or Purina EN).  Some inappetance can be expected following surgery, but if it continues more than 2 days or is something specifically cautioned in your discharge instructions, seek help from a veterinarian.

What kind of activity restriction will be required?

For dogs, activity restriction means no off-leash activity outside, no running, jumping, or playing with other animals in the house, and staying in a small pen, room, or kennel if not on a leash.  Generally walks should not be taken and dogs should only be outside for bathroom purposes.  If stairs cannot be avoided, dogs should be kept on a leash and/or carried.  For cats, activity restriction means no running, jumping, or playing with other animals.  They should be kept in a small space such as a dog kennel, glass shower, or small room without furniture to climb on.  Most soft tissue surgeries (mass removals, bladder stones, etc.) will require 2-3 weeks of activity restriction.  Most orthopedic surgeries (TPLO, fracture repair) will require 6-8 weeks of activity restriction, although this may be more or less depending on your individual pet and surgery type.

What is a cranial cruciate ligament (CCL)?

TPLO stabilizes the knee after a cranial cruciate ligament (CCL) tear.  The CCL is the same ligament as an anterior cruciate ligament (ACL) in human knees, so the terms CCL and ACL may be used interchangeably.  The CCL prevents the knee from over rotating or hyperextending.  The ACL is mostly used when we pivot on the basketball court or kick a ball, but it is not used when we are standing or walking/jogging because human legs are straight.  Dogs stand and walk with their hindlimb bent and the knee is at an angel.  In dogs that tear their CCL, they will have instability when standing, walking, and running on the leg, as their tibia (shin bone) slips forward when they put weight on the leg.  This can also cause a meniscal (cartilage) tear, which is very painful and often results in dogs sometimes preferring to hop on 3 legs.  Often dogs with CCL tears do not want to sit square and fully flex the knee, so they keep it relaxed and to the side.  This is known as a “positive sit test.”

Surgery for human ACL tears replaces the ACL with a ligament or graft.  This type of surgery is not successful in dogs since the dog CCL is an active stabilizer that keeps the tibia from sliding forward at all times.  Instead of replacing the CCL, TPLO surgery changes the mechanics of the dog knee so they do not need a CCL for normal activity.  This is very beneficial for partial CCL tears, as the constant stress is removed from the CCL.  Small partial tears of the CCL can heal after TPLO surgery.

What happens during TPLO surgery?

During TPLO surgery, the knee is assessed and torn parts of the CCL and/or meniscus are cleaned up and removed.  The bone is cut in a semi-circular fashion and turned to make the top of the tibia “level” or parallel with the ground.  The cut tibia is held in this new position with a bone plate and screws.  It takes about 6-8 weeks for the bone to heal, and activity must be limited to leashed walks during this time.  Most dogs will start putting weight on the surgery limb 24-48 hours after surgery.  Pain medication is given for 7-14 days after surgery.  Once they feel their knee is more stable, limb use steadily improves.

What are complications of TPLO surgery?

The most common complications of TPLO surgery include infection, meniscal tears, and implant breakage.  Given advanced technology such as locking plates, it is unusual for dogs to require additional surgery, even if a couple screws break during the healing process.  Occasionally implants have to be removed due to implant or bone infections (<3% of cases), or the joint has to be cleaned up due to meniscal tears occurring after surgery (<5% of cases).  These are more minor surgeries that have faster recovery times.

How long is the recovery from TPLO surgery?

Most dogs start putting weight a little weight on the surgery leg 1-2 days after surgery.  The bone is usually healed about 8 weeks after surgery, although it can take longer for muscle mass to rebuild with physical therapy.  >95% of dogs are back to normal activity within 3-5 months after surgery.