In the last post on shelter medicine, I delved into what it’s like to work for a low cost clinic, and what that means in terms of client relations. Customer service may or may not rank high on a pet owner’s list of qualifications when choosing where to have an animal spayed or neutered, but I think we can all agree that the level of medical care at a facility is top priority, no matter what financial restrictions exist.
So what does choosing a low cost clinic for your pet mean in terms of the care the animal will receive? As with pretty much everything else in the veterinary world, the answer depends on the clinic. It is a good idea to do a lot of research when selecting a low cost alternative, because some clinics provide better care than others, and all facilities make sacrifices in different ways. Generally speaking, many low cost clinics have a lot of information on their websites and/or on their intake paperwork. A good place to start researching is online. This will help prevent an owner from asking questions that are readily available, thereby wearing out their welcome before even setting foot in the door.
And what about shelter animals? We’ve already established that homeless pets don’t have a concerned owner looking out for them. Does this mean they go any old place, regardless of what risks that means for the animal? The short answer is no. Shelters, and especially rescues, do a lot of research when it comes to selecting what low cost clinic to use. In our area, for example, there are five low cost alternatives within twenty minutes of each other. While the price point in these clinics only varies by a few dollars, many other variables come into play. Our clinic, for example, takes on a lot of the high risk shelter animals because we have anesthesia monitoring, and have a vet who is extremely experienced in shelter care.
Let’s explore the factors that may affect how a low cost clinic functions in terms of the quality of medical care.
Regardless of what clinic you choose, surgery can only be performed by a licensed veterinarian. It’s the law. I often get concerned pet owners who look at me in wide eyed horror as I sign them in and ask, “Are you the one performing surgery?” The answer is a resounding no. Similarly, many people assume that low cost means ‘teaching hospital’ and that their pet’s surgery will be performed by students.
A veterinarian at a low cost clinic must have the same credentials as any other practicing veterinarian. He must be currently licensed in the state he is practicing in, must participate in a set number of continuing education hours, and must not have any kind of suspension on his license. In general, the average level of qualification is the same in low cost clinics as it is in general practice.
Of course, there is quite a variety of veterinarians working in shelter-affiliated clinics. Some have retired from full service practice and focus on helping homeless animals as a way to give back. Some run low cost alternatives out of their full service practices, and make up the difference on non-rescue clients. Some are new veterinarians trying to get a foot in the door. As with general practice, their skill levels and specialties vary greatly.
The vet I work for has an advantage over some of the other local low cost alternatives in that she has years of experience dealing specifically with shelter medicine. The rescue groups and shelters like her because she can think outside the box to find effective solutions to medical dilemmas that are specific to the homeless animal population. She often applies the simplest (cheapest) solution with the best results.
When looking into a low cost alternative, it is important to learn about the veterinarian’s credentials. How long has the vet been licensed? How much of that time has been spent in the full service field? Does he have any specialties? What are his reasons for choosing to offer low cost services to the public? In many cases, this information is readily available through a low cost clinic’s website, and I advise looking for the information there rather than calling to ask in person. As I discussed previously, being able to do surgery at low cost means doing more surgery per day, which leaves less time for answering questions, even if they’re good questions to ask.
Frequently, large scale low cost clinics, such as the Humane Alliance, employ many veterinarians at an hourly rate. The veterinarians on staff vary from day to day and bring different skills to the operating table. The benefit of a large scale operation such as HA is that they are able to reduce costs drastically, make a big difference in the animal population, and have more state of the art facilities than their smaller scale equivalents. The down side is that you might not know what surgeons are working on any given day, and you may not have a say in which veterinarian performs your pet’s procedure.
For animals in a shelter setting, however, none of this matters. So long as the animal is healthy and the surgeon is qualified, rescues and shelters typically pick whichever low cost alternative is closest and/or open on any given day.
One of the things that drives costs up in full service practice is the price of pre-surgical screening. This screening often includes running blood work and urinalysis, and giving the animal a preoperative physical exam. While these sorts of tests are required for a pet to be scheduled for surgery at a full service veterinarian, this is not always the case in the low cost world. Some low cost clinics still do preoperative screening, and it’s included in the price. Others require the screening, and it comes in the form of a hidden fee. Some low cost clinics don’t require any kind of preoperative screening, but offer it as an option for an additional cost. Still others don’t even offer screening as a possibility.
So what is the importance of preoperative screening? As most people know, anesthesia comes with risks. While spaying and neutering is fairly common, it still involves your pet going under general anesthesia, and spaying is a major abdominal surgery. Preoperative screening typically consists of a Chem/CBC. The CBC is a Complete Blood Count, which primarily gives the veterinarian information about your pet’s red and white blood cells. Since white blood cells fight infection, and red blood cells help with clotting, this information is very important when it comes to surgical incisions! The Chemistry Profile reads the levels of various chemicals associated with the body’s organs. The chem panel can alert veterinarians to conditions affecting the liver, kidneys, and pancreas, for example. Conditions such as renal compromise or diabetes can increase an animal’s anesthesia risk.
All of that can sound pretty scary. It’s important to know whether your animal falls in the at-risk category. In general, dogs over five years old or those with preexisting medical conditions are the most at-risk, and benefit greatly from preoperative screening. While nobody can determine how much risk you are willing to take with your own pet, young dogs in good health generally do well under anesthesia for routine procedures such as spay/neuter.
According to a study done by Sheilah A Robertson of the University of Florida, the mortality risk in healthy dogs undergoing anesthesia was only .05%. Being a senior, underweight, or otherwise ill significantly increased these risks. Knowing your pet’s specific risks should play a role in deciding whether to pay extra for preoperative testing, or to pass on a clinic that doesn’t offer it. (Is your dog a Brachycephalic breed? Is he overweight? Does he have a preexisting heart condition?)
When selecting a low cost alternative for your dog’s medical care, it is important to ask whether the clinic offers preoperative screening options. If so, are they included in the price? Do you have the option of paying extra for screening that is not routinely done?
Along those same lines, full service practices often require certain vaccine histories before a pet can be scheduled for surgery. Often times, this entails a series of boosters and wellness visits, which can make your bill sky rocket before your pet is even on the table. These policies also make it impossible for ferals to be done at these practices.
Low cost clinics often have no prerequisites for surgery and will take animals with no vaccine history or offer vaccines at the time of surgery. Some clinics will even include the cost of certain vaccines in their surgery price for stray, feral, or shelter animals.
Be aware that a clinic’s vaccine practices do not always align with local laws. In NJ, for example, all cats and dogs must be vaccinated against rabies by the time they are six months old. While a low cost clinic may accept a six month old puppy without a rabies vaccine for neutering, under the assumption that the owner is planning to attend a free rabies clinic or schedule a visit with their regular vet, these policies do not exempt an owner from obeying the law.
Once your dog is past the pre-op process, what kind of care will he receive at a low cost clinic, as opposed to a full service practice? Once again, the answer varies greatly from clinic to clinic and vet to vet. It is important to make an informed decision. Here are some ways in which anesthesia practices at a low cost clinic may vary from those at your regular vet.
For starters, there are a wide variety of drugs that can be used for sedation. This article by Dr. Lyon Lee of Oklahoma State University’s Center for Veterinary Health Sciences explains the pros and cons of many commonly used anesthetics.
There are many factors that determine which sedatives are used, and what protocols are employed. The surgery protocol can vary drastically from practice to practice.
For example, the clinic I work at has a maximum of one animal in surgery and one animal in pre-op at a time. We aim for a low stress environment for both the staff and the animals. Our goal is to have animals fall asleep with minimal drama, be safely monitored during surgery, and wake up quickly afterwards, due to our limited staff and our same-day discharge. This means we give pre-op sedation (acepromazine and xylazine, intramuscularly) to take the edge off of dogs. By the time dogs are ready to go into prep, they are relaxed and slightly sleepy. Then we administer Telazol intravenously. The dog is completely unconscious within seconds. For the actual surgery, we intubate and use isoflourane to maintain. Cats are sedated with a low dose of Telazol and then are masked for isoflourane administration, due to the delicate nature of their tracheas. We only intubate cats if there are risk factors. All animals in surgery, regardless of species, are monitored with a pusle oximeter, a machine that reads oxygen level and heart activity. We keep careful charts of each animal’s progress in case of post-op complications.
When selecting a low cost alternative for your dog, keep these concepts in mind: Will your dog be given a pre-op sedative such as acepromazine? Pre op drugs are generally given IM to take the edge off an animal. Animals that are not give a pre-op sedative tend to struggle more and experience more stress. Will anesthesia be induced via intramuscular or intravenous injection? IV drugs work faster and are more accurate, but they also require a more skilled technician. Will your dog have a catheter placed during surgery to allow for fluids and pain medications to be administered?
While many low cost clinics, including the one I work at, use inhalant anesthesia to maintain sedation, I have heard of clinics that don’t even have a gas machine on site! In those practices, injectable sedatives are used alone. Obviously, this means a higher dose of injectable drugs. In general, inhalant anesthesia wears off faster than IM or IV sedation, and leaves less lingering effects, and a lower dose can be used to maintain an unconscious state.
As I’ve discussed, low cost can often mean high volume. Larger clinics with more staff often have as many as ten animals prepped at once. Some even have multiple surgeries with multiple veterinarians at once. This sometimes means that animals are asleep much longer than they are in the setting I described above.
A good question to ask before scheduling an appointment is whether gas anesthesia is used during surgery. If so, ask whether your pet will be intubated during surgery. Intubation in dogs can reduce the risk of respiratory complications during surgery, and allows for a faster response time in the event that something should go wrong.
Don’t be afraid to ask what is done in terms of anesthesia monitoring during your pet’s surgery. Because of the equipment expenses, staff limitations, and relatively routine nature of spay/neuter, some clinics do not have monitoring technology. While there is generally a staff member assigned to assisting the veterinarian with surgery, pulse oximeters greatly reduce the risks of anesthesia related complications. It is a good idea to seek out a clinic that employs this technology as part of their anesthesia protocol.
Once your dog is out of surgery, how will he be treated at a low cost clinic? Studies have shown that most anesthesia-related deaths occur post-op.
One of the most important aspects of recovery is keeping body temperatures at normal levels. At most clinics, this is done through the use of electric heating pads. Some clinics, however, skip this crucial step. It is a good idea to ask about recovery practices before scheduling your dog for surgery.
Another crucial part of recovery is having staff monitor the semi-conscious animals. While one tech can easily monitor many animals at the same time, there are some clinics that don’t have staff specifically assigned to this task. At the clinic I work at, the recovery occurs in the surgery room. Animals are watched by both the doctor and myself, and are within a few feet of the oxygen tank and intubation station, in case things go poorly.
What sorts of things can go wrong during recovery? Animals can go into respiratory or cardiac arrest. They may also regurgitate food or stomach fluid. This is especially dangerous if they’re not fully awake, because they can choke on or inhale the vomit and end up asphyxiating or developing aspiration pneumonia. Additionally, many animals coming out of anesthesia undergo behavioral changes, which may include aggression. It is vital to have staff members who are qualified to handle these potential risks.
Follow Up Visits
Due to the high volume nature of low cost clinics, many people running such operations do everything possible to avoid unnecessary follow up visits. Low cost clinics routinely use dissolving suture to avoid having to remove stitches at a later date. They often use stronger, one-time antibiotics or pain killers to avoid dispensing medication. These actions are fairly routine and may not be cause to avoid using a low cost clinic.
However, it’s good to know what happens in the event that your dog experiences complications following a spay/neuter procedure.
Some low cost clinics do not do follow up visits under any circumstances. Those clinics usually feature a disclaimer either on their website or on their admission forms. This disclaimer basically states, “If you have problems following surgery, you must see your regular veterinarian for follow up care.” This route can quickly turn scary and expensive. I have seen major vet hospitals charge $4000+ for visits resulting from minor complications following a spay/ neuter. An example of such complications is a cat removing one or two skin sutures. Needless to say, that sort of bill defeats the purpose of scheduling a low cost spay/neuter to begin with!
On the other end of the spectrum are clinics, including the one I work at, that provide free follow up care for anything related to surgery performed at that practice. Most clinics fall somewhere in between, allowing follow up visits for a relatively small fee.
These are all topics that should be explored before choosing a low cost alternative.
In conclusion, there are a few ways in which low cost clinics may vary from full service practices when it comes to medical care. In general, it’s a good idea to ask a lot of questions about what goes on before, during, and after your pet’s operation. The reality is that some low cost clinics do the absolute minimum and are best reserved for homeless animals who don’t have many other options, while other clinics provide care that is on par with a regular veterinary hospital.
One thing to remember is that all veterinary practices, regardless of price point and target clientele, are governed, specifically by OSHA and state laws. While the AVMA, another organization concerned with animal welfare, is a professional organization and doesn’t regulate individual clinics, it does provide guidelines that many clinics use as a basis for their practices. Familiarizing yourself with these standards can help you make an educated decision on where to take your pet. Essentially, there are strict rules that prevent even the cheapest practice from cutting certain corners, which helps ensure a standard of care for even the least-wanted of animals.
Of course, inspections are not done on a daily basis and there are practices that fall through the cracks. However, even full service hospitals aren’t immune to these scenarios. It is always important to be a vigilant pet owner, do your research before choosing a clinic, and file complaints if you find a practice that you believe is unnecessarily endangering animals.