Pet surgery makes any owner anxious and nervous, especially since they cannot see what happens to their fur babies once they enter the operating room. Veterinary surgeon Dr. Sheldon Padgett is here to set the score on what really happens when your cats or dogs go under the knife, and why there is nothing you should be afraid of. Together with Janet King and Dr. Alice Jeromin, he breaks down the different surgical methods they use to ensure the safety of pets during surgery and keep them away from peril at all costs. Dr. Sheldon also discusses how today’s cutting-edge technology is continuously transforming pet surgery to make it more accurate and less dangerous.
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Watch the Episode here
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What Actually Happens In Pet Surgery With Dr. Sheldon Padgett
Welcome to the show. When you drop your pet off for surgery. Don’t you worry? I worry. That’s why. It’s a big mystery because surgery, as surgeons say, a chance to cut is a chance to cure. We are going to ask our favorite veterinary surgeon, Dr. Sheldon Padgett from Metropolitan Veterinary Hospital. To help us not be so nervous about when we drop our dog off until we get that phone call that everything’s okay. Welcome, Dr. Padgett. You’re a repeater, which means you’re a co-host now.
Sounds good. I’ll wait for the royalty check. Good to be here guys. Thanks for the invitation again. Appreciate it.
What Happens In A Pet’s Surgery Room
Go over, when I drop my pet off at the door for a prepared surgery, tell us what goes on.
First off, as a pet owner, it is a little scary. It’s not like when you take someone for a colonoscopy, you sit with them and then they take them in. They put them in the back room. You don’t know what’s happening.
It’s very true. What’s going on in the back room? Thanks for the question because it is scary. I get that all the time. I understand that when I give a call after surgery, I can hear people finally exhale. They’ve been holding their breath the whole time. When we look at that, I’ll talk about our experience here at Metropolitan Veterinary Hospital, some of it is efficiencies.
When you drop off your pet to me, I’m in rounds. I’m going over the patients that were in hospital. My staff who does this on every single patient brings them in, asks all the questions that they need to know. What medication did you give? Making sure they are faceted and all those things. They’re coming back. They’re getting their vitals taken just like you and I would, blood pressure and temperature, and making sure everything’s going well.
When we drop off the pet, usually it’s early for our hospital. Those animals are undergoing things like getting their intravenous catheter in and getting started on fluids. People say, “I dropped them off at 7:30 AM. Why haven’t we had surgery yet?” There’s a lot of prep on that. As you said, Janet, in the human situation, you can be with those people the whole time. They understand what’s happening, all that.
We commonly use something called the chill-out protocol, which is giving them some medications beforehand. They’d rather be at home, but at least they’re not nervous. There’s certain medications that we give commonly, like Carprofen, that we use to help the patient experience and also makes anesthesia better. If they’re not so jumped up and nervous, then we can give fewer anesthetic agents and help them out.
To answer your question, they’re going through all things. It’s the same things that you would go through if you were having a procedure. In my world, especially as a soft tissue surgeon, emergencies come up all the time. There’s animals with airway issues. Sometimes, even if we have a planned surgery at 9:00 AM. That’s getting pushed until 10:30 AM because Fluffy over there can’t breathe very well. Everybody understands that from a logistical standpoint and everything, but you don’t want your dog to wait. I understand that.
Owners don’t understand that.
I get it. I wish we didn’t have emergencies. I wish we didn’t have animals that weren’t breathing well. I totally understand it. There’s nothing bad happening, especially if they get their anti-anxiety medications beforehand. It’s just like when you get a blood draw, there’s a little pinprick. After that, there’s not much. We’re using very similar anesthetic protocols as they do on the human side. We have lots of different drugs that we use in combination that is the safest for them.
I work on patients that are one pound and 100 pounds. We are used to mitigating those risks as much as possible. You have to trust your surgeon and the anesthesia team that’s working with them to do that. If you have specific questions, of course, you should bring them up. I love it when clients come with a list of questions about anesthesia. It’s important.
Cats. Managing dogs is a little different than managing cats.
The cat doesn’t want to be there.
The cats didn’t sign up for this.
I have a feeling 94% of our dogs wouldn’t either. Maybe the golden doesn’t want to be there. Cats are a different situation. Those animals commonly need maybe a medication that’s going to start the anesthetic process. They’re more amenable to it. We have some great drugs that are safe that we can give a small amount of volume for an injection.
They’re pretty sleepy, in the twilight type of thing. It’s easy too. Again, in my world, I’m just talking about that because I know it the most. We’re doing soft tissue surgery, doing cancer surgery, or oncologic surgery. These patients are not young, healthy goldens that have torn a cruciate ligament in their knee. These animals have multiple issues.
Our job is to mitigate risk as much as possible. We’re so lucky in veterinary medicine. We have the same resources that we do on the human side that we can start that anesthetic process. Take its hands here, and then put the intravenous catheter in so they’re not stressed out when they’re getting in and all that stuff.
A veterinary surgeon’s job is to mitigate risks as much as possible. Share on XThe other thing that I think people get shocked at. As a vet, I understand it. Janet, I know you would be. Say, you have like a golf ball-sized skin mass on your golden. You take it to Dr. Padgett to take it off. They come out and their whole side is shaved. Explain, Sheldon, why that is.
I try on every patient to say, “The shave job is going to be bigger than you think. The incision is going to be bigger than you think.” It’s very true. Sanitary reasons, a lot of it. We can’t have hair coming in there and especially on our golden and our long-haired ones and whatnot. There’s the area during surgery, the area that you have under the drapes.
Not only about the shave job, truly that’s to make it lowest complication as possible. The incision, if you have a golf ball-sized mass, we take some tissue around it to make sure we get all the microscopic disease. You have a circle that’s big. You can turn that circle into a line, it’s that long. My mass was only this big, but my incision’s that long. I get that. I totally understand. That’s for sure.
That’s also because you’re getting, what do they call it, the margins.
If it’s a type of mass, we should know that beforehand. That has microscopic disease that will send out little tentacles or roots or whatever you want to say. We want to make sure we get those so it doesn’t grow back.
Examples Of Soft Tissue Surgeries
What are examples of soft tissue surgeries?
My compatriots, you mentioned Dr. Daye, they do all the bone things. Any joints, any bones, any of the locomotion things. Soft tissue surgery, I’m basically a general surgeon in veterinary medicine, which means I’m usually in a cavity in the chest or in the abdomen. We can be taking out a tumor. It’s what majority of what I do. We can also be taking out a gallbladder, taking out that tennis ball that they ate.
Making sure that there are some preventive ones that we talked about on last episode that try and prevent problems from happening in the future. Taking things off the outside as well, the oncologic. To share what we do, a lot of congenital abnormalities are soft tissue. We have liver issues. We have heart issues. Those things that we’re doing are congenital ones. In my world, I’m working on puppies that have congenital issues that may be three or four months old. A teenager that has some tumor that needs to be taken care of as well.
We had Karen Tobias on. She told us a funny story. Remember Heckel and Jekyll? I remember Heckel and Jekyll and the squeak toys. She opened the dog up, and Heckel pops up. She said to her assistant, “Here’s Heckel. Jekyll’s got to be in there somewhere.” What’s the funniest thing you’ve ever removed? You’ve seen it with some underwear.
You’ve seen on Instagram where people will play their music and it’s coming out of the dog. They swallowed the little earbud thing.
The ear buds, that’s never a good one. The list is long and varied of things that I’ve taken out of a dog. The ones that are most fun are like you just said, Alice, the ones that look like something. You open it up and test. There’s something smiling at you. We just had a Santa Claus. We know where Santa spends his summers when he’s not up in the North Pole. It’s funny you mentioned Dr. Tobias was my resident mentor. She and I have a lot of stories together as well. I’m very lucky to have trained with her, a great person. I’m glad you had her on.
Lucky to know her. Sheldon, I have to tell you, and I digress for a minute. When I was in vet school, I saw this little gal just fluttering all around in Dave Allen, these big football-sized surgeons. There was Karen Tobias weaving in and out. I always remember that she was such a busy little bee.
I’ll be honest with you, I’m not trying to call you out, Alice. You might’ve gone to vet school a little bit earlier than I did. Let’s put it that way. I remember being an undergrad and working in the vet school, just wishing I could become a veterinarian, painting the hallways. I saw her in surgery. You can tell you that same frenetic energy and everything. That’s funny.
How To Properly Treat Bladder Stones
Let’s talk about bladder stones. I was helping out Silver Snout Senior Dog Rescue in Venice, Florida. It’s all little old dogs that they were going to put to sleep at various places. They’d call Shelly, she’d run and pick them up. We’ve had them flown. Southwest Airlines will fly these dogs for free. Janet, we need to promote that.
Good for calling them out.
We had a little Yorkie. She showed me the jar of stones. I can’t believe this poor dog, so sad.
How big were the stones?
It’s like green grapes.
They can go from a few millimeters to one stone filling the entire bladder, this big. As you said, it’s usually a handful. You can have five and that can cause a problem. You can have 150. You just didn’t know about it. That’s crazy.
How do you know you got them all, though? That’s what I can’t understand.
Don’t you see them in there?
You can see them in there, but what Alice might be bringing up is you can’t see everything. The tube that comes out of the bladder that gets everything out of the bladder, is the urethra. You can’t see in the urethra. We’re doing a lot of flushing when we do that. We pass a urinary catheter up. Honestly, I teach my residents the same thing that Dr. Tobias taught me in the way you do it.
Making sure you get them all. We even use cameras to go down and look in there. The cameras that we use for joint scoping and those things are high resolution. You can see a fragment of a millimeter of a stone. We can see all that. We always take an X-ray afterward to confirm that we got them all out. That’s for sure.
How To Deal With Pain Management
What about pain management?
Pain management is a huge deal. The reason for me is because I’m a wimp. I don’t want to be in pain myself. I know the things that I’m doing with these animals can cause pain. If we do our job, they do exceedingly well. People are always so surprised at how well they’re doing at home. Our release instructions will say something like they can’t jump. They’re not allowed to jump on the bed. They’re not allowed to do stairs.
People automatically assume why they just had surgery. They just had a big chest surgery. They just had a lung tumor taken out. They’re never going to want to. They want to play ball in four days. That Golden’s asking to play ball. Some of the reasons for that, the ways we go about that, we know we are causing discomfort. While there are some physical signs associated with it, we can’t ask our patients.
We almost potentially over-treat these patients, not in a bad way. My patients are always on a fentanyl drip during and after surgery because you can change those concentrations easily and quickly. We taper them off onto the medications they’re going to be on at home. There’s a relatively new product out there that is wonderful.
That’s a three-day-long-lasting local anesthetic. We inject that into the incision. You can go up to a patient the day after surgery and push on their incision that they just had. They don’t even care or know. Between that and some of the at-home oral narcotics that we have a potential for, they usually do well.
At home, as a pet owner, you have to be watching for certain things. You have to be making sure they’re not shying away. They’re not paying extra attention to the incision. That they’re doing all the things they would normally do. We want them to have a great quality of life after surgery. Up here in Ohio, it’s a very nice spring day here.
Owners must watch for certain things after their pets undergo surgery. Make sure they are not shying away or paying extra attention to their incision. Share on XEverybody wants to be outside and play ball. You have to be mean to them. Only take them on a ten-minute walk on a leash. They usually do well. We just taper their pain medications over two weeks after surgery and they do nicely. Sometimes, we’ll get a patient that needs more or needs less. We can just tune that plan for that patient.
My best friend from vet school, Heidi Ward, is internal medicine in Sarasota. I get pictures all the time, which I do by book. She sent me this picture of probably a four-year-old mixed-breed dog.
You’re still open for consults, Alice? I didn’t know that.
Yeah, right now. It had a pouch here. She said, “Hey, Al.” I was like, “It’s probably a Cialis seal.” We’ll talk about that, Janet. When they pressed it, stuffed pus came out of the ear.
Out of the ear? Isn’t that crazy? When the ear canal separates?
Not good. She was sending it to the surgeon. I have to say, in all the years I did derm and had horrible otitis cases, I’ve never seen that. Have you?
I have. Sometimes, it’s traumatic. That’s been reported that something happened. Unfortunately, the ear gets pulled. There’s two cartilages that separate so they can have an abscess associated with that. Some bad abscesses around there that you’ve probably seen, Alice. That ends up being pretty ugly that we have to treat surgically. Once they’re on the right antibiotic, usually they feel a lot better.
What Continuous Post-Op Care For Pets Looks Like
After your pet surgery and they’re at the vet’s office, sometimes they stay overnight. Sometimes, they don’t. Is there someone there overnight checking on them in general?
There is some variability in veterinary medicine. You don’t have to have somebody there. One of the benefits of going to a specialty hospital that’s relatively large is that there’s always lots of doctors and nurses there. Alice knows we have a couple of different hospitals in our system. One has been open every single minute since 1967-ish.
We just opened another one in 2022. They just never closed. It doesn’t matter what’s going on. There’s always lots of people there. There might be one or two fewer people when there’s a blizzard in Northeast Ohio, but there’s always people there. It’s important. These are animals that need continuous monitoring and care. It’s got to happen.
Speaking of that, the continuous post-op care, is infection a big problem?
It depends on what we’re talking about in the first place. It’s like on the human side, any incision theoretically can’t be infected. In veterinary medicine, surprisingly, it’s not higher. The numbers aren’t higher than in human medicine. It’s around, depending on the study you look at, 6%. There’s some variability within the different procedures.
Interestingly, some of the worst infections come from households that have medical people in them because we are bad about bringing bugs home. Bugs meaning bacteria. We get the bad infections. Where did this come from? Mom’s a nurse or dad, there’s PT, something like that. Infection is a thing. Preventing self-trauma is important afterward.
I found that with that long-lasting local anesthetic, animals have a lot less tendency to lick the area. They just don’t even know what was there to tell you the truth, which is nice. There’s becoming more and more popular. I have surgery suits, which is basically a onesie that people get for their dogs. There’s all kinds of different cute colors and patterns and all that stuff.
Keeping the area covered, but not liking to lick at it. Preventing self-trauma are all important, following whatever veterinarian’s advice that you have. It’s around 6%. No one wants to. People get upset when their animal has an infection. I don’t want their animal to have an infection either. We do everything we can. We ask you to do everything you can. Sometimes, it’s just the characteristic of the wound.
With this antibiotic stewardship, which to be honest, I’m sick of hearing. Sometimes, we’re going in the wrong direction. Are all your post-ops on post-op antibiotics or no?
Again, that varies a little bit by procedure. However, if we didn’t start with an infection, then they get intravenous antibiotics at the time of the surgery to cover any potential contamination. Typically, not afterward, because everybody assumes that if you’re on antibiotics, you don’t get an infection. Many of these things have underlying reasons and they’re going to get an infection.
You have an infection that’s resistant to the antibiotic they were on. Certainly, if an animal comes in infected, they have a ruptured bowel. They’re going to have it. I understand what you’re saying, Alice, about being a little bit tired about hearing that. It’s a little bit of a buzzword and has been for a while. Having said that, we definitely see some scary infections out there that are highly resistant. No oral antibiotic would even touch it.
Animals are getting injections for two weeks either by their owner or come and see us. We do see it. It does strike a chord that we need to be careful with antibiotics and not just send an antibiotic home with everything. I understand it when a client has an animal that gets an infection, “Why didn’t you send them home on it?” I get that. It’s not usually the antibiotic prevention that’s the problem. It’s something wrong with the indecision itself.
My human friend had a hip replacement. She had another complication and has to have another surgery. They won’t do it until six months post. As they said, they put this foreign part into your body. A lot can go wrong with infection. She has to wait six months to get the other.
Implants are scary about that. The orthopods have it a lot worse than I do, to tell you the truth. When they’re putting screws and holes in bones, it is worrisome. That’s the reason they do it.
It always amazed me in vet school when we were in equine. A stall isn’t clean. There’s poop in there, no matter how you muck it. You’ve had these big incisions that you’d use the hose on. You saw very few infections there. That’s amazing to me.
It is. Mother Nature takes care of a lot of it. It truly is an effect. Usually, an infection is when there’s some other physiologic component that happens. A lack of appropriate blood flow and a lot of things that can’t do. I agree with you. Honestly, my patients, like us humans, look like wimps. Humans have a lot more problems than the animals do. They take care of themselves sometimes, which is nice.
I remember we had a goat that came in. It had been attacked by a Rottweiler. You could see the cervical vertebrae. You could see the back. Every day, we water-picked that wound. When that goat went home, we all cried because that goat made it. She was so nice to work with. The power of just healing is something else.
Animals want to heal. Give them the right circumstances and they’ll do it. The whole thing with the hose. There’s a lot of wounds that we say, take them outside and spray it with the hose.
Animals want to heal. Give them the right circumstances, and they will do it. Share on XUnderstanding Lipomas And Hemangiosarcoma
I want to ask you about lipomas. You hear that some lipomas, which are fatty growths, Janet. First of all, you don’t know it’s a lipoma unless your vet takes some cells out of it. Just because it’s soft and moving does not mean it’s a fatty tumor. How do you know when you go in, Dr. Padgett, that it’s not one of those infiltrating lipomas with the fingers?
A real number of 3% of lipomas cause a problem, 97% don’t. I get a lot of clients that say, “We’re taking the gallbladder out. Can we take those lipomas out, too?” That’s just, in my opinion, playing a game of whack-a-mole. They’re going to make more. Once they start doing lipomas, they think it’s going to be a good idea. They do other ones and whatnot.
Alice, what you’re referring to is the infiltrated lipomas. Most lipomas are like a water balloon with fat in it. It’s got a thin membrane around it. You can literally take it out, set it on the table, and it’s globby like that. Two to three percent of them don’t have that membrane around. They’re just following the path of least resistance.
They’re not truly invading like tumors do. They just go where it’s easiest to go. It’s true. There are some areas that are involved that are pretty delicate. You’ve got nerves and veins and those things. You don’t want to harm anything. In those 3% that I know that I’m going in, and most of the time it’s a location thing that you know and the feel.
For some reason, those like to hang out in the armpit and in the area of the thigh. When I’m going in, I warn owners that there’s a potential that we might leave a little bit in if it doesn’t have that membrane around it. We don’t know. They’ve tried to find that on CT scans, etc., that we can predict if they are going to be these infiltrative ones. Sometimes, you can’t. In those situations, I say at least we’ve gotten it down from this big, the average that I’m dealing with to microscopic disease. If it grows back, then we can address it at that point. Not very common, though.
We’ll talk about hemangiosarcoma. In sarcomas, again, when I was working at the shelter, helping out at the shelter, we had a little Maltese. When you take some cells out of a mass, you don’t know what it is, Janet. There’s a saying about sarcomas. They don’t like to give up their cells very well. Like lipoma, I can suck that out. There’s a bunch of what we call liposides. Anyway, the first time I aspirated, we didn’t get anything. Second time, I got sarcoma. It was the right front leg. It’s amazing to me. The vet took the leg off. That dog that evening was up and running around chasing the ball.
Nobody believes me when I say it. I deal with sarcomas every single day, Alice. I know you know that, but they’re tough.
You saved my dogs.
From a location standpoint and a size standpoint, that can be challenging. What you’re getting at is how well our patients do with amputations. My patients make humans look like wimps. There’s the old saying. They’re born with three legs and a spare. That’s not to be glib about it, but they do well. There are two studies.
One’s older and one was relatively recently repeated that 97% of people who had to have an amputation done on their pet would do it again. That’s a high acceptance rate. It’s just incredible, especially if an animal was having some problems with that leg. They were holding it up. They’re used to it. They already know what a tripod is. I don’t know if I’m allowed to say other websites on your show.
There’s a great online community called TriPawds.com that I always send my clients to when I give them the initial paperwork. It shows not only how well animals can do. A lot of people are getting on there because their animal has been suggested to have an amputation. Nobody wants their pet to have an amputation. I understand that. The fact that they can do so incredibly well, people are always amazed.
My patients are ordered to walk outside four hours post-amputation. We’re going to put some runners out so it’s not slippery or anything like that. They’re ready to go. Especially that harkens back to what you said, Janet, the pain medications. They’re comfortable. They’re like, “I could have sworn I had four legs when I went to sleep. Now, I have three and I’m feeling good.” That kind of stuff they do well.
Don’t you think, Dr. Patchett, that part of our pain perception is mental? If I get out of bed, that’s going to hurt. They don’t feel that. They have no concept.
They don’t go through the, “I’ve had four legs all my life and now I only have three. I just had my gallbladder out.” Those awful things. Again, that’s one of the reasons we love animals. They’re just so adaptable. As long as we can ask them to do that and they’re not in pain while they’re doing that. They do a great job. I commonly have people asking me about physical therapy afterward, going to see rehab. I love rehab. Believe me, we’ve got some fantastic ones in our area. I say, “Give me two weeks. We’ll see if we need it.” They don’t need it.
They know a treat tastes good.
Anything new with hemangiosarcoma? I hate to even bring it up.
I wish there was some new stuff, but we’re trying. There are some clinical trials out there. We’ve been in one for a couple years called the PUSH Study. Basically, what it is it’s looking at the genetics of hemangiosarcoma and specific treatment for it. I’m not a medical oncologist by far, but I deal with hemangiosarcoma a lot. We deal with this study a lot.
We’ve got some great studies out there. It helps the clients out and gives them some money for diagnostics and surgery. Our beloved goldens get that way too often. All the animals get it way too often to be honest with you. We don’t have anything great yet. I tell you, we’ve had so many changes. I’ve got a lot of gray hair. I’ve seen a lot of changes in the last 10 to 15 years. It used to be when you go to a cancer surgery meeting, we talked about cancer surgery.
We’re talking about the genetics of cancer. We’re talking about how we can get these profiles. As science gets quicker and quicker, we’ll be able to do a genome mapping of a tumor within a day pretty soon, which is amazing. The more studies we do, the more we find, 98% of hemangiosarcoma have this. We have drugs that target that and nothing else in the body. Isn’t that great? We’re just killing hemangiosarcoma cells. That’s happening. It’s not news anymore.
Another type of tumor, melanoma, which is a terrible disease in dogs and people. We have a vaccine for it that only goes after melanoma. We had that for osteosarcoma, now bone tumors and it could be improved. It’s not an end-all, be-all, but it’s going in the right direction. It might not help a patient now, but patient might help somebody tomorrow. That’s for sure.
Dr. Sheldon’s Schedule On A Regular Day
What’s a typical day like for you? A work day, not a weekend.
Not on the boat. What’s the name of the boat?
Wanderlust. We have a boat in a warm area and a little further south than Alice. Her name is Wanderlust because that’s what I have, that’s for sure. To answer your question, in our hospital, we’re a teaching hospital. Not only are we busy clinically, but I have many residents, surgical interns, and a lot of our departments have residents.
Some people in the public think that’s a bad thing. It’s a good thing. You are always doing the absolute best job because you’re teaching people how to do the absolute best job, all the current literature and whatnot. On my day, probably two or three days a week, we have a 7:00 AM class. That class can be going over new journal articles or something like that.
I’m teaching the surgical oncology class where we go through every single specific type of tumor and talk about all the things associated with them. That class lasts a year. We do that, then typically we’ll do rounds, just like the one you see on TV with doctor rounds. All the doctors gather. We talk about the patients and make sure that everybody knows everything that’s going on.
Two brains are better than one if there’s a tough case. In one of our hospitals, everybody rounds together. I’ve got the cardiologist there. I’ve got critical care there. I’ve got everybody. We can pick at each other’s brains. I’m either going into appointments, seeing Fluffy, and talking to clients about what we can do to help them out.
Most of what I do is cancer. I enjoy helping those people find a path through what isn’t always good news. Everybody hears the word cancer or thinks about chemotherapy. They think it’s the end. That’s not necessarily, or even typically true, in veterinary medicine. I’m doing surgery all day. In our hospital, I’ll do anywhere from four to six or seven surgeries a day, depending on emergencies.
It’s just like any job, but especially medical, there’s a lot of paperwork. We’re always doing paperwork and all those things. We’re starting to use AI a lot. A lot of the medical are and that’s helping out. It gives us more complete histories and gives us a better opportunity to give more complete information to clients. It’s good.
It helps with the paperwork, too.
It does. It takes a while to get used to changes. Change is scary sometimes, but it does.
Doing Plastic Surgery On Dog Tails
Do you do any plastic surgery like tails on bulldogs or entropion?
I know Alice knows this, but plastic surgery is anything that you’re just changing something to be honest with you. We always think of cosmetic plastics, but that’s not necessarily true. If somebody comes and says, “I want my dog’s ears to look different.” Not at all. We’re not in the business of doing that. I don’t think any veterinarian would do that.
You brought up tails. I love my Frenchies, but we see so many Frenchies for so many problems. One of their problems is something called screw tail, where their tail, which was supposed to be straight goes like this, gets corkscrewed, and corkscrews in on itself. I just had one that I took out. They were doing a great job at home, trying to get into little crevices and everything with baby wipes. It’s painful. It gets infected and all that.
We go in there and take that portion out. This was a good-sized Frenchie. It was probably 28 pounds. The portion of tail that I took out was literally as big as my fist. It was just buried in there. I just saw him for a recheck for his suture removal. The owner said, “I can’t believe the difference between prior to surgery and after surgery, because he was just so uncomfortable. He was getting mean with his housemate. He didn’t want us around there. Now, he’s loving and playing with a housemate. He was not playing too much.” There was an exercise restriction. In general, they can do well.
You mentioned entropion, Alice. Entropion is where we take extra skin from around the eyes. Again, a common bulldog thing. Our ophthalmologist does those surgeries. We do that. I’m trying to think of other “plastics” that we would do. A lot of the reconstructive surgery that I do after taking a tumor, I would just consider plastic surgery because we’re moving skin around. That would probably be most of it. Some of the breathing things that we do for, again, our Frenchies and our English, making their noses not so pinched. That would be plastic surgery. It’s all about quality of life.
Doing Laryngeal In Dr. Sheldon’s Old Lab
I remember when you were telling me about your older lab, about doing the laryngeal. Can you talk about that?
What Alice is referring to is a genetic abnormality in Labrador retrievers. We certainly see it in almost all breeds, but 85% of them are Labrador retrievers. It’s very similar to some of the human neuropathies. We know Michigan State University did a ton of great research on this disease. The disease is called laryngeal paralysis. Our Adam’s apples are supposed to open up every time we take a breath in like that. There’s a nerve that says, “Open that up.” There are some nerves that don’t work well when you have certain changes. That’s one of them.
These animals are fit otherwise and they’re not sick, but they can’t open up their airway all the way. This is the season up here in Northeast Ohio that we get these. We’ve been quiet in the winter all day, all winter long. Let’s go play. All of a sudden, I go out to play. I can’t breathe very well because I can’t open up my airway as much. That is a disease that will affect other nerves. Those animals will eventually get weak.
We can affect a huge quality of life change by doing surgery on them. We can’t fix the nerves. I wish we could in the humans too. We go into the side of the neck. We opened up that airway on one side. They do great. It’s one of my favorite surgeries to do. It’s intricate and one of the reasons I like it. These animals come in struggling to breathe. As soon as they wake up from anesthesia, they’re like, “I can breathe.”
They do it. A great change in quality of life. There are some special things you have to look at because of the whole nerve complex thing. They can get pneumonia afterward and whatnot. In the big picture, I do it seven ways from Sunday to help those animals out and they feel better. Honestly, once they have the disease in their clinic, you do it sooner because they have longer to live. These are always older animals. The average age is eleven years old at the time of diagnosis.
Is it all a large breed?
Almost always, but we do see smaller ones too. I’ll probably do two or three surgeries a year on a small breed dog, including chihuahuas. Other things can affect your nerves. If you have severe diabetes, you could have severe thyroid problems. There’s some things to work out and that makes sure they don’t have those things.
If it’s a lab and he comes in, their voice changes. They have a change in bark, maybe a little bit wobbly in the back end. They probably have that disease. While it’s not a great disease, you mentioned my boy. I had him for four years after surgery. I did him in eleven and a half. He lived a nice, long time. Again, he ran around all the time, a disease they can live with well once they’ve been treated.
At the end of my surgery time at OSU, they were doing tracheal collapse. Did anything ever come of that surgery in small dogs that have tracheal collapse?
If you have a Yorkie, anywhere from 4 to 12-years-old, that starts coughing, Alice knows this, the classic goose halt. If they go, that kind of stuff. The cartilages in their trachea, literally, instead of staying circular, start collapsing. To your point, Alice, we used to do surgery. We haven’t done a true surgery for that disease for a very long time because we already have stents.
A lot like they would put in my arteries to open them up. We know non-surgically with a patient under anesthesia can put that stent down into the trachea and deploy it. You have this thing pushing on me inside of the trachea opening things up. That was a game-changer. That was a huge deal. That was developed mostly by a very well-known veterinary surgeon named Chick Weisse.
At the time, he was at the University of Pennsylvania. Now, he’s at AMC. He pioneered that. It’s a night-and-all stent. It’s the same kind that they put in your micro-audited arteries. Those dogs wake up breathing and it’s lovely. There’s literally not even an incision on their body. Unfortunately, the rest of the respiratory tract can start collapsing, like the bronchi, the smaller ones down in their lungs. We get those patients living a high quality of life for a lot longer.
Unfortunately, it’s expensive that the specific piece of equipment is many thousands of dollars. In general, they can do well. There’s some talk about doing surgery in that. The vast majority of patients have just the stent. They’re truly treatable. There’s some lifespan to the stent, just like people that get a total hip replacement or something. We try and do all we can medically to help those patients out because they can respond to medication well for a number of years. Once that medication is starting to be as effective as we want it to be, that’s when we put a stent in.
Performing Ear Surgery On Pets
What about ear surgery? It always amazed me that you can do a total ear ablation and they can still hear. I never know what to ask. The client will say, “He’ll be deaf after that.” I’m like, “They’re not.”
What you’re referring to all this is some patients that have bad ear disease. Their ear canal goes in, obviously, it hits them. It hits a membrane, your drum. There’s a cavity on the other side where the inner ears can hear. I can always liken bad ear disease to having a clogged pipe. When we do a total ear canal ablation, that surgery you’re talking about.
If you were to take out a clogged pipe, you open the ground, take out the pipe, and close the ground again. When we do a total ear canal ablation, we open the skin, take out the ear canal, and close the skin again. When you lift up your dog’s ear, you see a scar, not a hole. The thing is that they’ve been hearing through that clogged pipe for how long?
It’s like you stick your fingers in your ear. You can still hear things. You can’t hear things well. When we do that surgery, we don’t take out the wiring that you can hear. You’re hearing through your skin. Basically, you’re not hearing through that clogged pipe, but the wiring is still there. Most of the studies say, both clients and animals. When you test the animals, their hearing is about the same, which makes sense. I’ve had a few clients that say, “I swear they hear better.” Great. I’ll take the credit.
That to me would be a tough area because that is such a high area of innovation. You’ve got to sidestep all those nerves in there.
We call that expensive real estate. There’s a lot of important things in there. That’s why you go to a Board-certified surgeon and have it done. We’re supposed to know all those things.
Speaking of isolating nerves, I had a client. I had never met her before, an older lady. I was looking at her dog. We’re talking and said, “How’s your day going?” “My husband just had surgery.” I said, “In one of the hospitals in Cleveland? “Yes, a very well-known one.” I said, “He had heart surgery? How’s he doing?”
“He did okay for the surgery. Two days later, he couldn’t breathe.” They cut the vagus nerve. Here’s the thing. I treasure you because you do surgery. I’m terrified of surgery. I do know the vagus nerve, just like the aorta. The things with the shortest names are the most important. My focus, if I would cut someone, would be where’s that vagus nerve?
We talk about that all the time. What’s in this area that we don’t want to see? Make sure let’s not see that happen.
This one side of his lung was filling up every day. Long story short, I said, “What are you going to do?” She said about suing. I didn’t mean it that way. She said, “Here’s the thing. My lawyer says my husband lived. He’s old and this hospital has wonderful lawyers where they’ll just carry out this suit for years and years. I’ll just end up saying, forget about it.”
That’s terrible.
It is terrible. The reason I’m saying that is people think that in surgery, you just open them up and there’s the tumor. You’ve got to retract things. There’s important blood vessels. You might nick one. It’s very complicated.
That’s one of the reasons I like cancer surgery, Alice. It’s never the same. It’s never the same interaction. Again, no offense to the orthopods, but every knee is a knee. That’s what they like. I like the challenge of being able to say, “This is what’s involved on this one.” It’s challenging. That is the advent of high-end, pre-operative diagnostic tools has changed our game.
I’m going to ask you about that. You’re not surprised when you go in there.
That’s exactly how I frame it to the clients. Is it necessary? No. I’ve been a veterinarian for a long time. We weren’t always fancy. I hope your pet has surgery and it helps. If we shouldn’t do surgery, I’d rather a CT scan tell me that, than be in surgery and find it out. Either opening and closing or having a complication that we didn’t expect because we have something we could have known from advanced imaging. Thanks for bringing that up. It’s an important point.
Modern technology, such as a CT scan, can help determine a pet’s internal problems without having to open and close their body. Share on XDiscussion Wrap-up And Closing Words
This has been fascinating. Alice, we’ve got to wrap it up. We could keep going. Here’s our question for our surgeon who’s a two-peter. If your life had a theme song, what would it be?
We sit in surgery, the geeky thing to say is if you could be a surgical instrument, what would you be? I’m not going to get into that.
Hemostat, stop the bleeding. I don’t like bleeding. Blood needs to stay in that vein.
All bleeding stops eventually. There’s a forceps called a DeBakey. It’s fancy. Why use regular forceps when you can use this? It’s like driving a Ferrari. It’s great. Probably, Janet, the first thing that came to mind is a Kings of Leon song. I’m a music guy, so this is a big deal called Revelry. It’s basically about just enjoying your life as much as possible, no matter what you’re doing. I am so lucky that I get to do things like this, work with great people, and teach great residents. It’s all Revelry. It’s all good.
And the boat.
I almost named her Revelry.
Thank you for being a two-peter. We’re just happy to provide more information.
We can always put all this information out to the public.
It’s behind that curtain. Do you know what’s fun? When they take your pet back there.
It’s a mystery to people when people think of that back room. We’re working in that back room. There’s not always donuts there. We need to keep up our energy.
Almost always donuts. Thanks guys. I appreciate it.
Thanks for reading. Thanks for sharing. Thanks for liking us. We’re high up there in the pets and animals category on Apple. We appreciate you. Take care everybody.
Bye, everyone.
Important Links
- Dr. Sheldon Padgett on LinkedIn
- Metropolitan Veterinary Hospital
- TriPawds
- American College of Veterinary Surgeons
About Dr. Sheldon Padgett
Dr. Padgett grew up in northwest Ohio, and attended The Ohio State University for both his undergraduate studies and his veterinary degree (making him a true Buckeye). After graduation from veterinary school, he spent a year of intensive training at the Animal Medical Center in New York City. Following this, he pursued a surgical residency at the Washington State University College of Veterinary Medicine. During the 3-year surgical residency, he also obtained his Master’s degree. After practicing in Massachusetts for 3 years, he then came back to Ohio in 2000 and established the surgical practice at Metropolitan Veterinary Hospital.
Since then, he has been able to focus his professional energy on specializing in soft tissue surgery, with an emphasis on cancer treatment, minimally invasive techniques, and respiratory disease. He is proud of the educational program at MVH, where many doctors, in multiple specialties have received advanced training and gone on to achieve board certification. When not working on patients, or teaching, he is happy to spend time with family, or on a sailboat!