— By Dr. Henri Bianucci, Board-Certified Veterinary Surgeon
Jen and Denise are two of our dearest friends and favorite people on earth. And although they live on a farm in New Jersey, when their dog needed surgery, they called me (Henri Bianucci).
In her characteristic resolute and decisive manner, Jen told me that Bear, a cocker spaniel, needed surgery on his ears, and they only trusted me to do it.
Now this compliment, and I really do regard it as an honor, carries a mixed blessing. Not only is the anticipated procedure complex and invasive, and painful from the outset, it also carries the risks of long-term complications.
On top of that, when Jen and Denise come to town, they stay with us. So, I will spend the anxiety-filled eve of surgery, the night of his hospitalization, as well as Bear's first night home from the hospital, with his parents. I will be there with Bear as he returns home from surgery. I have little firsthand experience with this side of my job.
Bear's problem begins with his genetics. Cocker spaniels have an elevated risk for chronic, and often severe, ear problems, which makes them very hard to manage. I was informed that Bear's vet, as well as a surgeon, had determined that medical management had reached an end point, and now surgery was the only effective tool for eliminating these infections once and for all.
Although genetics certainly play a role, environmental factors such as allergies can contribute significantly to the problem. Getting a handle on these issues early in the course of ear disease can prevent the irreversible changes that occur with repeated flare-ups of inflammation. These changes eventually become so severe that they render medications virtually ineffective.
When they arrived with Bear, I performed my exam in the kitchen. My first impression was that these ears weren’t so bad, and could possibly still benefit from the right medical treatment. I hated to introduce doubt into an already stressful situation, but before performing surgery, I always have to be sure that all reasonable, nonsurgical alternatives have been exhausted.
My first call was to Dr. Randy Thomas at Southeast Veterinary Dermatology and Ear Clinic in Mount Pleasant. I know that if anyone can treat these, he can, because since he opened his practice, the number of ear surgeries that we do has dropped significantly.
He squeezed them in for a presurgical exam, with the hopes of a last-minute “stay of execution” for the ears.
His findings were that the ears could possibly be saved, but he agreed that the planned CT scan could tip the balance one way or the other. So, a CT scan was performed of Bear's ear canals and middle ears. The findings were that the changes in the ears were likely irreversible, meaning that surgery was the only option for permanently eliminating Bear's pain.
This surgery would mean removing, on both sides, the entire ear canal, ear drum and part of the middle ear. Hearing is, for the most part, sacrificed in favor of comfort and permanent resolution of infections.
As with any surgery, there is a risk of anesthetic complications, bleeding, infection, etc. Specific to this procedure is the risk of facial nerve damage, which leaves the patient unable to blink the eye. This is generally temporary but can be permanent.
After surgery, we place tubes in the surgical site that are used to deliver local anesthetic directly to the wound. Unfortunately, this also impairs an animal's ability to blink, so a couple of stressful days are often spent wondering if the nerve has been damaged or if it's just the pain medications. When Bear woke up from anesthesia, one eye was partially blinking, while the other was not at all.
We had dinner with Jen and Denise that evening, and sat up with them until fairly late. We talked about many things, but the conversation always drifted back to Bear. They put on brave faces, but the concern was there.
“What can we expect as he is recovering?” they asked. It dawned on me that in all the discussions about what should be done, and how we would do it, I had spent little, if any, time preparing them for what to expect in the early post-operative period.
The day after surgery, Bear looked great. Both eyes were regaining their blink, and he was eating, drinking and wagging his tail. He was ready to come home with me to his owners. I was feeling the anxiety normally reserved for my clients, anxiety over whether I had everything that I could possibly need tonight, how he would handle a car ride home and interactions with the other dogs at home. I could see the importance of absolute clarity in regard to medications and home care in general.
After three days of being “embedded” with my clients, I have a renewed appreciation for the surgical experience from the clients' side. I can say it's far more stressful than my usual perspective, and encourages me to do more to make this process as smooth as possible for them. I hope it’s a while until I have to do this again, but the insights from this experience are invaluable.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.
