Tiffany Hills Animal Hospital


Surgical Suite at our Animal Hospital

Tiffany Hills Animal Hospital has an up-to-date surgical suite, and the equipment to handle most routine procedures. For complicated surgeries, Dr. Fortney believes your pet should be in the hands of a specialist like a Board Certified Surgeon. We are lucky in Kansas City because we have two specialty practices that have the experience to handle these difficult cases. Blue Pearl Veterinary Specialty and Emergency and VCA Mission Med Vet both have outstanding board certified specialist.

Let’s look at the elements of our surgical suite:

Preparation wet table where the pet is anesthetized and prepared for surgery. To give you an idea of the expense involved, this table cost about $2000.

The Anesthetic machine utilizes an oxygen delivery system, CO2 scrubbing system, and an anesthetic gas vaporizer, usually Isoflurane and/or Sevoflurane. We have both types of vaporizers because each has specific advantages over the other. The expense for an anesthetic machine is $4000.

The surgical table needs to be flexible for positioning as well as heated to prevent hypothermia during surgery. This type of surgical table cost $3000.

Surgical lights illuminate the surgical area so the surgeon can discern the surgical site better. Surgical lights usually come in a pair, costing about $2500. There is also one surgical light over the preparation wet table.

Surgical instruments are needed to perform the surgery and depending on the surgery there are different instruments needed. There is always a general surgery pack for opening and closing the site, then there may be special instruments needed for the actual surgery; orthopedic, ophthalmic, or soft tissue. The total cost of instruments can be about $2000.

Before we can begin our surgery, we have to make sure the instruments are sterile. Most sterilization is done with an autoclave. Steam and pressure insures that no contamination will occur during surgery. Autoclaves are expensive, with a cost of $3000.

During surgery the patient’s vital signs need to be monitored. We have a monitor that incorporates a pulse oximeter, electrocardiogram, and blood pressure. This instrument cost about $2500.

Many patients need supportive care during surgery and recovery. We may put an intravenous catheter and run fluids to insure blood pressure and vital organs have good perfusion. The least costly piece of equipment, about $200.

Then there is all the disposable items used during surgery, gauze sponges, bandages, sterile gloves, gowns, drapes, suture material, iv fluids, and surgery masks.

Once the surgery is completed and appropriate pain medications have been administered, there are the recovery kennels. An array of kennels can cost $12,000.

So we have safely prepared the patient, preformed surgery, and had an uneventful recovery, now we can discharge the patient. All in all, the investment for the above equipment is about $31,000. That does not include the cost of the building, technicians, or doctor’s time. There can be no compromise on using the above equipment; to do so would increase the risks and outcomes.

When you look at the virtual tour on the web site, see if you can spot all the equipment mentioned above.


Pet Food, Part 3: Special Cases

This will discuss the special cases that take the above information and tweak it. There are circumstances like age and diseases that warrant changes in the pet’s diet. There are tombs of books on the different diseases of the pet; my intent is to make suggestions once the diagnosis is obtained.

The first circumstance I mentioned is age. I have already covered juvenile, adult, and senior pets, but I want to mention one subcategory of juvenile pets, the little tiny puppies and kittens that lost their mother. These orphans need to be fed, but the obstacle is finding something they will eat. Kittens and puppies less than 4 weeks will probably need to be bottled fed. There are several good milk replacers on the market and baby bottles. The trick is having the hole of the nipple be big enough for suckling, with a little encouragement from the bottle holder. The second trick is feeding numerous times (5-6) in a 24-hour period. The third trick is to get the orphan on canned puppy/kitten food as soon as possible. This is usually accomplished starting at 4 weeks of age.

There is one more young pet consideration. I have seen numerous small breed puppies come into my exam room, just obtained and are skinny. Almost always the problem is, they are being fed dry puppy food and do not have any idea how to eat. Usually it is a multi-fold problem: improper weaning and wrong form of food. The solution is usually simple, canned puppy food. Warning, do not put your finger with a dollop of food in front of the puppy, they will bite it trying to get to the food. The canned puppy food is temporary. After several weeks to one month, dry puppy food can be introduced slowly reducing the canned puppy food.

Some of the common diseases that I want to mention are: kidney, liver, pancreatitis, diabetes, bladder stones, feline lower urinary tract disease, and food allergies. This is not a dissertation on veterinary medicine, but some dietary suggestions. Always consult your veterinarian first.

Kidney disease usually requires diets that are low in sodium and low in protein. Kidney disease is usually monitored with blood pressure readings and blood parameters. Sodium retains water; too much sodium causes too much water retention. Look at your feet the next day after eating a bunch of salty snacks. Too much water retention causes high blood pressure. So this compounds the hypertension already caused by the kidney disease. One of the blood parameters is blood urea nitrogen (BUN) and kidney disease usually has high BUN. Urea comes from protein metabolism. So if the patient is fed a high-protein meal, this increases the urea level. A high BUN level makes the patient feel worse, decreasing appetite and water consumption, ultimately making the kidney disease worse.

There are two general liver disease states that are treated differently with diet. Chronic liver failure requires a very high-quality diet, but again, restricted protein. High protein metabolism can cause elevated ammonia levels that affect the brain. Acute liver problems (normal liver but the organ has been insulted and enzymes are elevated) require a very high-quality, easily-digestible diet.

Pancreatitis is usually complicated by high fat content. Once the disease has been treated and the crisis is over, this condition responds very well with a low-fat diet. I personally prefer the low-fat, high-fiber diet. This disease is very controllable if the owner is very strict with the specific diet. Or conversely, relapses are very common if the owner is not strict. Chronic pancreatitis patients may end up with diabetes requiring insulin and/or digestive enzymes every meal so the pet can digest their food.

Diabetes mellitus is a disease in which the patient requires insulin supplementation. Consistency is the cornerstone for successful treatment. For dogs, the best diet seems to be a high-fiber diet. The fiber slowly releases the carbohydrates into the blood, therefore causing less glucose spikes. Cats on the other hand require more of a high-fat diet. Be very consistent with everything, because at some point your veterinarian is going to have to figure out why the blood sugars aren’t being controlled. The fewer variables you give your veterinarian, the easier it is to figure out.

Bladder infections in cats are a unique disease. Many variables like genetics, stress, diet, and sometimes bacterial infection all play a part. Again, I have found that a strict diet used for feline urinary disease not only treats the disease, but usually prevents re-occurrence. In dogs, there are other non-dietary predispositions that cause their bladder infections. Diets can help dogs a little, but not as well as diets can help cats. Bladder stones are another issue in dogs. Bladder stones can be dissolved with a very strict specific diet and can also be prevented with a very strict specific diet.

The last disease is food allergies. Food allergies are not that common; 4-10% of all allergies are food related. Food allergies are caused by the protein source in the food. It is very difficult to test for food allergies. There is no skin test or blood test that tests for food allergies. The only test is a food trial. Food trials must be conducted for 8–12 weeks and must be very strict. With a little guidance, is does not have to a hit or miss type of proposition. Hydrolyzed protein diets are very good at proving if a pet has food allergies, again, over a strict trial period of 8-12 weeks. The hard part is finding a diet the food allergic pet can eat. Again, with a little guidance from your veterinarian, there are numerous choices.

Nutrition directly impacts the health of your pet – whether normal feeding or using special diets for special cases, whether treating for, or preventing, disease. Please consult with your veterinarian about what is best to feed your pet.

What is All the Confusion with Vaccines? Part Three

Puppies and kittens have unique set of circumstances that needs to be addressed so ultimately they will be protected. Puppies and kittens are born with a pure untainted immune system, no antibodies or memory cells. If they are exposed to disease, they get sick. So in order to protect newborns, an amazing phenomenon happens. The mother’s milk contains all of her antibodies. This first milk is called colostrum. The first 24hrs of nursing, the infant’s gut will absorb these large protein molecules directly into their blood stream. After 24hrs, the milk is digested. So, it is very important for newborn puppies and kittens to nurse the first 24hrs. It is also important the mother be current on her vaccines before breeding.

So what does this maternal immunity do? It protects the puppies and kitten from all the diseases the mother is protected against. But there are two catches, it is temporary and it cannot tell the difference between vaccine pathogen and the disease pathogen. These two “catches” dictates the puppy’s and kitten’s vaccine schedules.

Statistically, 95-99% of the 6 week old puppies and kittens that nursed are protected by the maternal antibodies. At 8 weeks of age about 80-90% of the puppies and kittens are still protected by the maternal antibodies. At 12 weeks of age 10% of the puppies and kittens are protected. And by 16 weeks of age the maternal antibodies are gone. Any attempt to vaccinate puppies less than 12 weeks of age has a chance the vaccine will be neutralized by the maternal antibodies and the puppy and kitten will get no benefit.

An immune system needs stimulation from at least two injections. The first vaccine starts the process and then 3-4 weeks later the second stimulates the memory response. Then each booster rekindles the memory cells.

So how do we vaccinate puppies and kittens? The vaccine schedule is made by using the statistics of the maternal antibodies. So any vaccine given 6 weeks or earlier did not hurt the puppy or kitten but did not help the puppy or kitten either. Most veterinarians start the vaccines at 8 weeks of age, give boosters at 12 weeks of age, and finish the series at 16 weeks of age. This is the least amount of shots that ultimately stimulates the puppy’s and kitten’s immune system for a full year. Whether the puppy gets a 100 vaccines or 3 leading up to 16 weeks of age, the outcome is still the same.

Boosters are given 1 year later. Evaluating the pet’s environment and exposure dictates what vaccines to give. This is also another good time to use 3 yrs vaccines.

Rabies vaccines are handled a little different. Each municipality dictates the vaccine schedule for puppies and kittens. Rabies vaccine can be given as young as 12 weeks of age. Dogs and cats are then revaccinated 1 year later. Again, the municipality will dictate whether 1 or 3 year vaccines will be recognized. Only licensed veterinarians can give rabies vaccine to be valid.