What Is Critical Care?
What does a Critical Care Hospital do?
How can a Critical Care Hospital be of assistance to other Veterinarians?
My pet had surgery and will not eat. What can be done?
My pet is vomiting now that he/she is at home. What can be done?
How do I know that my cat is in pain following surgery?
How do I know that my dog is in pain following surgery?
What can be done for pain at home for my cat?
What can be done for pain at home for my dog?
Is it okay for my pet to lick the incision?
When should my dog have the first bowel movement after surgery?
What is Integrative Medicine at VCS?
What Types of Alternative or Unconventional Therapeutic Options Do We Offer?
What is Reiki?

What Is Critical Care?

Critical care is a recent specialty within veterinary medicine, recognized in 1989 as the American College of Veterinary Emergency & Critical Care. Critical care evolved as an adjunct specialty to aid the needs of very ill or potentially ill surgical, medical, or emergent veterinary patients. The critical care specialist is trained to monitor for, recognize, prevent, and treat disease, disease complications, or potential complications in patients with potentially life-threatening problems. Education of the critical care specialist involves training in the specialty areas of critical care, internal medicine and its various subspecialties, surgery, anesthesia, ophthalmology, nutrition, clinical pathology, toxicology, and diagnostic imaging.

What does a Critical Care Hospital do?

Critical care involves the frequent monitoring of patient’s whose clinical condition can change from minute to minute. The use of serial physical examination, diagnostic testing, and physiologic monitoring devices allow the critical care specialist to tailor a therapeutic plan that provides optimum support and treatment for the patient’s clinical condition.

The goal of critical care is to diagnose any primary or secondary disease conditions, anticipate complications and prevent or treat them, initiate and continue treatment of these problems, and support and monitor these patients until the patient is well enough for follow-up by a general practitioner, internist, or surgeon.

Technology is important for the critical care specialist to perform optimally. Many patient abnormalities are not readily detectable on physical examination or changes in the status of vital parameters may not be perceptible by examination alone. Monitoring of electrolyte and blood glucose status, acid-base status, coagulation ability, cardiac function, ventilation and pulmonary function, vascular volume, hydration, renal function, immune status, as well as other vital parameters are improved through the use of monitoring devices.

A critical care specialist has training in the use of blood gas analysis, capnography, pulse oximetry, electrocardiography, abdominal ultrasound, echocardiography, use and interpretation of laboratory analysis among their many skills. Technology can also play a vital role in the therapy of the critical patient. For example, the use of external ventilatory support may provide a patient with compromised ventilatory or pulmonary capacity sufficient time until normal ability is regained.

Specialists in other areas of veterinary medicine are vital for a critical care specialist to perform optimally. Using a team-oriented approach, critical care specialists consult with other specialists to plan and implement diagnostic and treatment plans. These other specialists may or may not be involved in the continuing care of the critical care patient once the patient’s condition improves.

How can a Critical Care Hospital be of assistance to other Veterinarians?

Many patients present to the general practicing veterinarian or emergency veterinarian with disease processes or traumatic injuries that may benefit from continuous monitoring, ongoing diagnostic procedures, and ongoing therapy.

These patients may require 24-hour care and monitoring, blood and blood component transfusions, enteral and/or parenteral nutritional support, surgical intervention, post-surgical care, specialized anesthetic protocols for high-risk patients, or advanced diagnostic testing and therapies that may not be available in the general practice setting.

Not all critical care patients are ill at the time of presentation to the general or emergency veterinarian. Exposure to certain toxic substances may not produce clinical signs for several hours to days after the exposure; the critical care specialist can treat the patient to prevent clinical consequences and/or monitor the patient for the earliest signs of toxicity and initiate therapy prior to the development of catastrophic consequences.

Anesthesia for high-risk surgical patients can be tailored to minimize detrimental effects of anesthesia and can be extensively monitored during and after the anesthetic event for potential complications of the anesthesia and surgical procedure.

The doctors and staff at Veterinary Care Specialists have the experience and training to provide for these critically ill patients. Please contact us if you have any questions about critical care or if you may require assistance for one of your valued patients.

My pet had surgery and will not eat. What can be done?

  • Most pets will not eat their regular dog food after surgery, especially if it is kibble.
  • Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low fat and should be cooked and any residual fat skimmed off. The carbohydrate can be pasta, potato or white rice.
  • Try canned dog food; to enhance the flavor mix it with chicken or beef broth (no onion in broth).
  • Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal.
  • Try Hill's A/D diet available at most veterinary hospitals.
  • Hand feeding; place a small amount of food in the mouth so that they get the flavor.
  • Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
  • Remember that most pets will not eat the first day or two after they get home from surgery.

  • Offer smelly foods that contain fish such as tuna or smelly cat foods.
  • Try Gerber strained meats for babies such as the chicken, beef, turkey or veal.
  • Hand feeding; place a small amount of food in the mouth so that they get the flavor.
  • Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature with your finger; it should be only luke-warm.
  • Some cats will only eat dry food, try kibble if your cat normally has been fed that food.
  • Petting and stroking your cat frequently will help to stimulate appetite.
  • Remember that most pets will not eat the first day or two after they get home from surgery.
  • Appetite stimulants such as cyproheptadine may be helpful.
  • If your cat refuses to eat anything for 5 days she/he should be seen immediately. An esophagostomy tube may need to be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop.

My pet is vomiting now that he/she is at home. What can be done?

  • The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the dog usually just opens the mouth and fluid or food will be expelled. Usually the regurgitant will be clear or brown colored fluid.
  • Next is to identify the cause of the vomiting or regurgitation.
  • Causes and treatment of vomiting after surgery:
    • When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be happening the water should be limited to frequent smaller amounts.
    • Medications such as antibiotics or anti inflammatory drugs are are common cause of vomiting after surgery. In order to see which medication is causing the problem the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued. The tylenol/codeine should be discontinued and another type of pain medication tried to help minimize vomiting.
    • Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
    • Unusual cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
    • If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
    • Symptomatic treatment of vomiting involves with holding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then. In order to decrease the acidity of the stomach Pepcid AC 0.5 mg/kg given by mouth twice daily for 5 days can sooth an upset stomach. Metoclopramide is a good anti-vomiting medication for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
  • Causes and treatment of regurgitation after surgery:
    • The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, which is called esophagitis. This results in poor motility of the esophagus so water and food will accumulate in this structure. In most cases esphagitis is self-eliminating and will resolve within two or three days.
    • Regurgitation also can be caused by a neuromuscular degeneration of the esophagus and this problem will persist. It is not associated with surgery, rather other underlying diseases.
    • If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus, does not allow passage of food down the esophagus, thus the pet has persistent regurgitation. This problem should be brought to the attention of your doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
    • Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent such as sucralfate. You should consult a veterinary health care professional if the regurgitation continues for more than a couple of days.

How do I know that my cat is in pain following surgery?

Pain is more difficult to assess in cats versus dogs as signs can be more subtle and they usually do not vocalize.
Signs of pain in a cat include the following:
  • biting if you get near the surgical site
  • growling or deep cry
  • not wanting to eat
  • hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)

How do I know that my dog is in pain following surgery?

Signs of pain include:
  • crying
  • biting if you get near the surgical site
  • grimacing (lips are pulled back and the the dog looks anxious)
  • tragic look of the face
  • restlessness and not wanting to sleep; pacing
  • if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
  • the worst pain will be for the first 2 to 3 days after surgery

What can be done for pain at home for my cat?

Pain medication such as buprenorphine or a Duragesic (fentanyl) patch.

Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver.

Anti-inflammatories can be used, but the dose is much less than dogs and they should be given only for a few days. Discuss the use of any Anti-inflammatory drugs with your doctor prior to use.

What can be done for pain at home for my dog?

Pain medication such as tramadol, butorphanol, Duragesic (fentanyl patch) anti-inflammatories such as Deramaxx, Rimadyl, Metacam, or Precicox ; in some cases a sedative such as acepromazine will augment the effect of pain medication and allow your pet to sleep.

If an orthopedic surgery has been done cold packing the surgical site may be helpful.

A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out and in circular motions (directly on skin) cool the surgical site around the incision. Cooling the surgical site helps to numb the area.

Is it okay for my pet to lick the incision?

If a dog licks his incision it will actually delay the healing process because they usually lick too much and traumatize the area.

Licking can remove stitches and cause the incision to open.

Licking can become a severe habit that is difficult to break.

Licking can cause infection as the mouth has many bacteria.

Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.

To stop your pet from licking the following can be tried:
  • Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region.
  • Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site.
  • If the incision is over the chest a tee shirt can be put on your pet and the waist of the shirt fastened in place with an ace bandage or duct tape.
  • If the incision is over the paw or lower limb a bandage or sock could be put on and kept up with tape.
  • Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical.
  • Bitter Apple can be applied next to the incision.

When should my dog have the first bowel movement after surgery?

Many dogs will not have a bowel movement for the first 4 to 5 days after surgery.

Reasons that a dog will not have regular bowel movements after surgery include:
  • The dog has been fasted prior to surgery.
  • Dogs do not eat well during the hospital stay.
  • They frequently do not eat well when the go home.
  • They are fed highly digestible food that produces little stool.
  • Pain medication that contain narcotics (such as tylenol with codeine, tylenol 3, tylenol 4, morphine) can be constipating.

If a pet does not have a bowel movement on the 5th day of being home a stool softener such as metamucil can be fed.

Dose of metamucil 1 tsp per 25 Kg (50 pounds) mixed in with each meal (canned dog food).

What is Integrative Medicine at VCS?

The goal of the integrative medicine service is to provide ‘unconventional’ or alternative treatment options to pets and their owners that are integrative with conventional or western-type medicine. On this service there is a team approach with multiple individuals meeting and assessing the patient’s health care needs in a thoughtful organized manner and then applying unconventional therapeutic options that compliment the standard veterinary care being provided at VCS or by the referring veterinarian.

We strongly encourage referring veterinarians to consider working with our team. Patients can be evaluated and have treatment plans constructed that will compliment the continued care of the patient at the referring veterinarians office.

What Types of Alternative or Unconventional Therapeutic Options Do We Offer?

Since integrative medicine and unconventional medical therapies are new services to veterinary medicine it is helpful to offer some definitions:
  • Alternative Medicine – Treatments used instead of traditional medicine.
  • Complementary or Integrative Medicine - Non-traditional Therapies used with conventional treatment.
  • Holistic care – Medical care that focuses on treating the whole person, addressing social, physical, emotional and spiritual needs.
  • Naturopathy - Form on medicine based on the belief that the body has a natural ability to heal in a healthy environment. It relies on natural remedies such as sunlight, air, water and supplements, as well as massage and acupuncture.
  • Homeopathy – Form of complementary or alternative medicine that believes the body can heal itself and tries to stimulate self-healing with small, sometimes highly diluted plant, animal and mineral substances.

What is Reiki?

Reiki is an ancient healing technique. It was discovered by Sensei Dr. Makao Usui in 1914 Tokyo, Japan, where he opened a clinic. Thru the years it has become a more widely accepted complimentary practice to western medicine. Reiki is practiced throughout the world including over 300 major hospitals and medical centers in the U.S. Until recently Reiki was made available only to people but an increasing number of practitioners are establishing practices exclusively for animals.

Reiki comes from the Japanese words “Rei” which means Gods wisdom of Higher Power and “Ki” which means life force energy. Roughly translated the term reiki means spiritual guided life energy. In principle, this energy, “universal life energy” is in everything, surrounding us and within us. When the energy flow becomes blocked, the disease process begins. Reiki does remove the variety of blockages in a gentle and effective way, allowing the life force energy to flow freely enabling our bodies to heal, maintain balance and well being. As a healing system, Reiki is simple, non-invasive, stress free and highly effective. Though Reiki is spiritual in nature, it is not a religion. There is no dogma or nothing you must believe in to benefit or use reiki.

Reiki heals on all levels; mental, physical as well s the emotional and spiritual. Though reiki has been primarily used on people to facilitate healing in conjunction with western medicine, animals can benefit from reiki as well.

Reiki can expedite the healing process due to traumatic injury and surgical procedures. A session can offer relief from debilitating diseases. It can also have a calming effect of the highstrung and hyperactive Animal. Most importantly, reiki can relieve stress that any animal may have , at home or in the hospital environment. Lastly, these sessions can help relieve pain and anxiety associated with the ‘transition process’ that the animal and their owner go through during the time of passing.

The Original Reiki Ideals
The secret art of inviting happiness
The miraculous medicine of all diseases
Just for today, do not be angry
Do not worry and be filled with gratitude
Devote yourself to your work and be kind to people
Every morning and evening join hands in prayer,
Pray these words to your heart, and chant these words with your mouth
USUI Reiki Tretment for the improvement of body and mind.
Dr. Usui Mika

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Veterinary Care Specialists

24 H / 7 Days
205 Rowe Rd Milford, MI 48380
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Fax: 248.685.8122
Customer Care 248.684.0468
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