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Monday, February 25, 2013

Pain Control as an Option? Really?

I'm going to share an "industry" secret with you. We price-shop our competition. All veterinary hospitals/clinics do this as a way to make sure our prices are in line. We have to do this by calling other veterinary clinics and pretending to be a price-shopping client. Anti-trust laws prevent us from having honest discussions with our competition about what they/we charge, so we all have to be clandestine.

Anyway, as we were calling around last week to get price quotes for dental and surgical procedures, we discovered something that disturbs me very much. A small number of veterinarians consider pain medication and/or IV fluids optional. The absence of pain-controlling medication for an invasive surgical or dental procedure is, in my opinion, barbaric. Would anybody out there be willing to experience a hysterectomy, castration, or tooth extraction and wake up with nothing to help the pain? Really? If you were the patient, would you want your surgeon to make that an optional thing?

When I was in veterinary school in the '80s, pain control was not a point of major emphasis. We were taught that animals don't experience pain in the same way as humans, and that some degree of pain was helpful in preventing our patients from "over-doing" it after surgery. We now know that animals in pain are adept at hiding it, but they are hurting/suffering just as much as we would be under similar circumstances. We also know that effective pain control actually speeds healing. So there is a comfort benefit and a medical benefit.

Without going into a boring physiological description, I would like to briefly describe the purpose of IV fluids in an anesthesized patient. First of all, it gives the surgeon/anesthesist quick venous access in case of an anesthetic emergency, or even if the patient needs additional pain control under anesthesia. Secondly, it allows much greater regulation of blood pressure in these patients. We now know that most anesthesized patients experience a significant drop in blood pressure, which could result in organ damage that may not show up for weeks or months. Even though these patients may "wake up" from their procedure just fine, damage HAS been done. Only IV fluids and blood pressure monitoring can minimize this risk for the patient under general anesthesia.

For a veterinarian to skip, or make optional, these services, in order to offer a cheaper spay (or whatever), is unforgiveably irresponsible.