Patient Care

For procedures requiring sedation (e.g., testing day)

In the morning, follow your normal routine. Feed your pet and give insulin as you would normally.

On Surgery day (for general anesthesia)

• No food after midnight the night before surgery.
• No water after 7 am on surgery day.
• Do not give insulin that morning. Bring your pet's insulin (kept cool), a small amount of your pet's regular food, and a couple of your insulin syringes with you on surgery day. Be sure to also give your current dosage at check-in.

Later that night after surgery

It is one of our goals to minimize the impact of general anesthesia on your pet's diabetes. If your pet does not eat, it is not necessarily safe to give insulin. If your pet will not eat the normal amount at dinner, a full insulin dose might create a low blood sugar problem. If you have trouble that night, please contact either our veterinarians or your regular vet. If your pet is awake and alert enough to eat a full meal, let them have it so that you can give insulin as you normally would.

Each surgery is different but the procedure remains the same to ensure your pet has a safe and successful surgery at Northwest Animal Eye Specialists.

The Night Before Surgery

Unless you have been told otherwise by a member of our staff, remove all access to food by midnight, as your pet will be getting a sedative or general anesthetic for which an empty stomach is required. Water can and should be allowed during the night. In some situations, this recommendation is modified. But our general "rule of thumb" is no food after midnight.

The Morning of Surgery

Remove all water sources at 7 am. If your dog is coming in for surgery, we recommend taking them for a long walk before you come to the hospital and making sure that they both urinate and defecate. The sedatives and anesthetics relax control of these bodily functions, and we do not want your pet to become soiled or to contaminate the surgery site.

Admission to the Hospital

You will receive a confirmation call the day before surgery (typically in the early afternoon), at which time you will be given an admission time for surgery day. You will have an actual check-in appointment with one of our technicians to go over any last-minute points or questions.

The doctor generally has multiple procedures and surgeries on the same day, but we have your pet come early for several reasons. Your pet will usually receive a sedative, an analgesic, and an IV catheter before surgery. Also, our patients oftentimes receive a variety of eye drops before the actual surgery is performed. Please bring any and all medications that your pet is currently on, including those not prescribed at this hospital.

Communication During the Day

One of our staff members or the doctor will call you when your pet has come out of surgery. It is critical that you can be reached in the event of an emergency. Voice mail is not sufficient. You can be assured that you will be contacted if there is any problem with your pet. If you have not heard from us, it means that we have not finished your pet's surgery. We understand your concern while your pet is hospitalized.

Please understand that we have many patients and that sometimes we become delayed in our schedule due to either emergencies or unanticipated delays in the operating room. We do our best to plan the day, but not all circumstances are within our control. If you are concerned about your pet, feel free to give us a call for a progress report.

Risks (of Sedation/Anesthesia)

In the majority of cases, the risk for major complications from sedation or general anesthesia is quite low. Every possible measure is taken at this hospital to minimize risks including (but not limited to) use of the safest anesthetic drugs, tailoring of the anesthetic protocol to the patient, extensive continuing education on anesthesia for all team members, use of every monitor available, and optimal staffing of the operating room for close monitoring. Nonetheless, there is always a small risk for a major, life-threatening issue associated with anesthesia. In the event of a life-threatening crisis, it is important for us to know your intentions. We will make every effort to contact you by phone, but it might take a few minutes for our doctor to be able to leave the patient plus it is not uncommon that folks are not phone available when we need them. The option is to perform CPR to try to reverse the situation, but some people choose DNR or do not resuscitate.

Discharge From Our Hospital

Please allow some flexibility in your schedule on surgery day. In general, you can plan that your pet will be ready for discharge from the hospital by late afternoon. When possible, your pet will be discharged earlier in the day. Pets are not hospitalized overnight. (In the rare instance that overnight veterinary care is needed, your pet will need to be transferred to an overnight/emergency hospital.) When we call you after surgery, you will be given an exact time for discharge from the hospital. At this time, you will meet with one of our technicians to go over post-operative instructions. If you have not heard from us, please call before coming to the hospital.

Note: Be aware that your pet will probably have the hair on a front leg clipped for an IV catheter, and the area around the eyes may be clipped for a sterile prep.

After your pet's surgery is complete, they will wake up from general anesthesia and could be a bit disoriented. Here is everything you need to know about post-anesthetic care for your pet.

General

Your pet was given a general anesthetic today. Although animals often seem to recover quite quickly from anesthesia, it is important to allow your pet plenty of rest this evening. Most animals will be back to normal by the next day after anesthesia. Occasionally it may take an extra day, particularly in geriatric animals.

If your pet is still pretty "groggy" at the time of discharge from our hospital, you may notice occasional whining, whimpering, or restlessness. These signs can be associated with confusion during the period of complete anesthetic recovery. These signs do not necessarily mean that your pet is in pain.

Eating And Drinking

You may offer your pet small amounts of food and water this evening if they seem alert and interested. We generally recommend that you only give your pet half of the normal amount of food the evening after surgery. Do not be alarmed if your pet is not thirsty. All of our patients receive intravenous fluids during anesthesia thus your pet may not be thirsty at the time of discharge from our hospital. Due to the IV fluids, you may notice that your pet needs to urinate more often than normal.

Collar

Most of our patients are sent home with a protective "Elizabethan collar" on their heads. Animals will usually quickly adapt to the presence of the collar and will eat, drink, and sleep while wearing the collar. You may need to make some adaptations for feeding such as changing the size or position of the food and water bowls so that your pet can access them readily. We know that most owners hate the collars and we hate it ourselves when our own pets must wear them. But it is incredibly important during the healing period that your pet is not allowed to rub their eyes. Eye surgery is very delicate. When sutures are required, they are very small and critical to the integrity of the eye structures. It is not worth the risk to remove the collar prematurely. We are sympathetic and are happy to give you suggestions if you are having problems with the collar.

Bandage

You may notice a colorful wrap on one of your pet's legs. This is a bandage covering the site where an IV catheter was placed. This should be removed later this evening.

Questions Or Concerns

Please call us if you have any questions or concerns!

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Cataract surgery is one of the surgeries commonly performed at our veterinary clinics. Here is everything you need to know regarding caring for your pet after this operation.

1. Activity should be restricted, particularly during the first month after surgery. This means no running, jumping, swimming, or rough play.
2. Leash walking is allowed, but the leash must be placed so that direct pressure on the neck is minimized. A harness is ideal, but you may be able to improvise by looping the leash around a front leg.
3. No baths should be given during the first 1-2 weeks after surgery. Otherwise, please check with the doctor for advice.
4. It is preferable to give pills in a small amount of canned food. This is the easiest method and the safest way to prevent accidental trauma to the eye.
5. Please follow the medication schedule carefully. Call if there are any questions or problems. Do not discontinue any medications unless instructed to do so by the doctor.
6. Keep the protective Elizabethan collar on your pet for the first 2-3 weeks after surgery. Your pet may take 1-2 days for your pet to adjust to the collar. As distressing as it may seem, it will prevent the need for additional surgery to save a traumatized eye.
7. Please follow our recommendations for postoperative rechecks. Postoperative care is vital to the success of cataract surgery.
8. Please call immediately if you detect any of the following signs:

• Overall cloudiness of the eye(s)
• Squinting of the eye(s)
• Bloody drainage from the eye(s)
• Loss of vision AFTER surgery

The purpose of the E-collar is to aid in healing by protecting the eyes.  During the healing process, some eyes become very itchy and irritated.  Even the best-behaved pet may want to rub at the eyes.  Unfortunately, this type of rubbing can traumatize the eyes.  In the case of surgery patients, it can destroy delicate surgical sites.  For recovering intraocular surgery patients, it is important to note your pet's eye is very fragile for the first 2-3 weeks.  Extreme caution must be exercised to help your pet through this healing period.  Do not remove the E-collar until the doctor has determined that your pet has healed.  When in doubt, call first.

The goal we all share is to help your pet heal.  One moment of rubbing can set back the healing period from days to weeks.  In some cases, vision can be threatened by self-trauma.

This time period can sometimes be emotionally difficult and challenging for pets and their owners.  It is essential to remember that this is a necessary, but not permanent, step for your pet.  With this in mind, we have put together some helpful suggestions from veterinary staff and pet owners.  We hope you find these ideas helpful and reassuring.  If, after review, you encounter additional problems or concerns, always feel free to call our office.  We are here to help you!

My Pet Can't Eat Or Drink

It may be helpful to elevate your pet's food and water dish.  A phone book or the bottom of a large mug or bowl work well.  For pets that aren't on restricted diets, offering canned food can encourage eating.  As a last resort, please remove the E-collar with strict supervision.  Allow your pet access to food and water then immediately replace the collar.  We recommend two people for this:  one to hold the pet and one to place the collar.

My Pet Won't Eliminate (Bowel Movement Or Urination)

Please be aware that your pet may not have a bowel movement for 24 hours after general anesthesia.  For cats: do not use a covered litter box.  Cats need to be able to get in/out and turn around easily.

The Collar Is Too Big

Your pet's E-collar has been custom fit for your pet.  Do not cut the collar!

Unfortunately, not all eye diseases are treatable thus blindness may affect your pet.  Causes of blindness include irreversible retinal disease, advanced glaucoma, inoperable cataracts, serious eye injuries, and a variety of other diseases.

Pets utilize their senses of hearing and smell very efficiently. Because of this, loss of vision in cats and dogs is less traumatic compared to loss of vision in people, and they usually adapt very well. They will bump into things, and it can be a difficult time for you and your pet. In just 1-2 months, over 95% of blind pets readily memorize the layout of their home and yard and can function normally or near normally.

Here are a few guidelines to provide better care for your blind pet:

1. Pets will navigate using memory, so avoid changing the environment, such as moving furniture or food and water bowls. Give them time to adjust to new surroundings. Be careful of stairways, open doors, or other objects that could injure your pet. If you have children, teach them to pick up after themselves. Things that are left out will cause your pet to bump and lead to disorientation.
2. If your pet gets disoriented, take it to its bed or food bowl. This will be a landmark that will reorient your pet.
3. Teach your pet to walk on a harness or lead so it can be exercised safely. Choke collars are discouraged.  Encourage exercise, whether in a front yard or on a leash, to prevent excessive weight gain. Never let your pet out without supervision, unless it's in a fenced yard. Be careful of in-ground pools and hot tubs.
4. Encourage your pet to use its' other senses to compensate for vision loss. Buy noisy toys or toys that have a distinct recognizable odor. Some people also get a companion animal that the blind pet can follow around using its' hearing and smell. It can help to put a bell on the other pet's collar.
5. Some behavioral changes (aggression, depression, and fear) can sometimes be observed with sudden blindness. Instruct family members (especially children) to vocalize the pet's name and approach it slowly. This fear usually passes with time as the pet learns to adjust to the blindness.
6. Most causes of blindness are not painful, so the quality of life for a blind pet is usually good. If pain is involved it will cause the pet to be depressed. Other signs to watch for are changes in the appearance of the eye such as reddening of the white of the eye, increase in the size of the eye, a large amount of discharge, and scratching or rubbing of the eye. If these signs develop, your pet should be examined, since a blind eye can still become painful in some cases.

Blind cats and dogs can have a good quality of life and make very happy pets as long as you follow these steps. Your companion can still have a fulfilling life with you.

There is a lot of very useful information on the Internet and a few of them are listed below. If you have any questions, please don't hesitate to contact our office.

Your pet has been prescribed medication that needs to be made at a special compounding pharmacy. There are several different compounding pharmacies in the state, but not all of them can make ophthalmic medications. To do that takes a sterile room called a "clean room" that has special equipment.

The compounding pharmacy we use is Stokes. We will call in your pet's medication as prescribed by the doctor, and you can either pick the prescription up at their facility or they can mail it to you for no additional charge. For mailed medication, you will need to call them with a credit card number. They will not mail your medication to you without payment information.

If you have a compounding pharmacy other than Stokes Pharmacy that you have previously worked with, we will be more than happy to call your prescription in to them. Please don't hesitate to ask if you have other questions about your medication.

Your pet has received a contact lens over his or her cornea. This is a therapeutic lens and will not affect your pet's vision. It is used in most cases for corneal ulcer.

A common question is how long will the contact lens remain on the eye. Our vets will determine the length of treatment based on each case and will remove the lens themselves.

In order for the contact lens to serve its purpose, it needs to remain on the eye for the prescribed time frame. This means that your pet cannot rub at the eye. An Elizabethan collar will ensure they cannot rub their eye. Even without self-trauma, pets can occasionally get the lens out due to their third eyelid.

In most cases where a lens has been placed on the eye, the cornea was first debrided. Although this is beneficial as it can stimulate ulcer healing, it can also temporarily make your pet uncomfortable. We commonly receive phone calls about the lens causing pain. In the vast majority of cases, the discomfort is actually due to the condition of the eye.

We find the displacement of the lens on the eye to be a rare complication of lens use. If you are ever concerned about the lens position, please let us know and we are happy to check it out to make sure that there is not a problem.

Last but not least, if you feel that your pet is uncomfortable, please let us know so that the medical plan can be adjusted. We share a common goal of wanting your pet as comfortable as possible as quickly as possible.

Our vets sometimes feel that we can supplement their pet's care by performing pressure checks (tonometry) in between full examinations. We would like to point out a few things regarding pressure checks:

1. Pressure checks are intended to provide information in addition to that gained from a full examination by the doctor. Remember that glaucoma is more than just elevated pressure and a full assessment cannot be made based on tonometry readings alone.
2. If your pet's problem has been controlled and all of a sudden vision or the appearance of the eye has changed, your pet will be better served with a complete eye examination (including tonometry) versus just having the pressure checked.
3. The pressure check will be performed by one of our experienced assistants. You generally do not see a doctor for this sort of visit.
4. A doctor reviews the results on all pressure checks. The doctor looks at not just the absolute number but at trends over time.
5. If the pressure is in the normal range, you will receive a follow-up phone call only if the doctor feels that an adjustment to the treatment plan is indicated.
6. If the intraocular pressure is elevated, there is a good chance that you will be asked to leave your pet with us for an emergency evaluation and medications may be prescribed.
7. There is a charge associated with the pressure check of $28.00. This is to cover the time of the technician who performs the test, the doctor who reviews the test results, as well as the expensive instrumentation. These "pressure checks" help us to closely monitor intraocular pressure while minimizing fees associated with full examinations.
8. Although we can usually perform the test upon your arrival, we ask that you call before stopping by. Once in a while, we will all be unavailable for one of several reasons (emergency, patient care, continuing education, staff meeting, training). We would never want you to make a trip then be unavailable to you or to make you wait for us.

If there are any questions about the role of tonometry in your pet's care or about the logistics of how we perform these visits, please check with us in advance of your first pressure check visit.

Your pet might need to be sent home with an IV catheter in place. If you do not feel comfortable with this for any reason, please let us know and it will be removed.

If we are suggesting it be left in place overnight, it is because we know that it will likely be needed tomorrow. In some pets, especially if they are diabetic or have had other health problems, their veins are in poor condition, and placement of the catheter can be challenging. Due to the anatomy of some breeds, access to veins can also be more difficult. If we know the catheter will soon be needed again, it seems nicer to your pet to leave it in place.

These are almost always in a front leg and it will be covered with a colored bandage. You do not need to specifically care for the catheter in any way. All that we ask is that you keep it wrapped and that the bandaging material be kept clean and dry.

Your pet should only go outdoors briefly and with supervision (i.e., on a leash) to urinate or defecate. There should be no running, jumping, etc. with the catheter in place. If it is raining outdoors, it is best to cover the bandage with a waterproof material such as Saran Wrap.

Make sure that the bandage does not get too tight and that the toes are not swollen at all.

If there are any questions or concerns at all, please contact us. If it is after hours, you can call the clinic for directions on how to reach Dr. Jones. Alternatively, you could contact your regular veterinarian or an emergency hospital.

Your pet recently had an intravenous mannitol injection for emergency treatment of glaucoma. There are several things that you should be aware of.

This drug will make your pet urinate excessively. Although we give your dog the opportunity to urinate after the injection, you should walk him or her again before leaving the hospital and frequently once you get home until the effects have dissipated.

Dogs are usually very thirsty after receiving this injection. But you do not want your dog to go home and gulp down a big bowl full of water. First of all, this can partially negate the effects of the injection. Second of all, that behavior could contribute to bloating, which is a dangerous condition.

Therefore, do not let your pet have any food or water for 3-4 hours after the injection. At that point, allow only small amounts of water at a time. So long as your dog has tolerated the re-introduction of water without any vomiting, you can give him or her some food.