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Systemic Complications

     Beyond your pet's wound/surgery site, you should be aware of how your pet is doing overall.

Monitor for evidence of systemic complications, including lethargy, depression, vomiting, difficulty breathing, not eating or not urinating, etc. Notify your veterinarian if you recognize any of these. Risk of life-threatening problems is greatest in the first week post-op.

     Generally, if your pet is eating, drinking, urinating, defecating, walking, and seeming comfortable, your pet is doing well.

      Some further guidance is provided below:

Lethargy

  • Your pet is likely to be tired upon returning to your home
  • If you have ever been in a hospital, you probably appreciate how the presence of other patients and the need for regular monitoring can interfere with proper rest.; your pet may just be tired
  • If your pet is taking smooth, even breaths, and the pink part of your pet's gums is a healthy pink color -- especially if you push on the gums to blanch the site, and the healthy pink color returns in 2 seconds or less -- your pet is probably just tired.
  • Your pet may be sent home with sedatives, particularly if an orthopedic procedure was performed. The goal is to prevent your pet from injuring him or herself. Use the pain medications (non-steroidal anti-inflammatories -- such Previcox, Metacam, Carprofen, Deramax, etc. -- and narcotic-type medications -- Recuvyra (topical fentanyl), fentanyl patch, tramadol, oral/sublingual buprenorphine), and only sedative medications like Acepromazine if your pet cannot get comfortable.
  • If your pet is too sedate/lethargic, you may be giving your pet too much sedative or narcotic-type pain medication. 
  • Sleeping a lot is OK, but your pet should be awake/alert when not sleeping.
  • If your pet is overly sedate, or lethargic despite not receiving sedatives, contact your veterinarian.

Depression 

Rather than emotional depression, this refers to a depressed/decreased level of consciousness/activity. It largely crosses over lethargy, but more specifically refers to a general malaise. Sedation may be playing a factor, but if your pet just seems sick, contact your veterinarian.

Vomiting

Lots of things can cause your pet to vomit

  • Antibiotics can wipe out the normal gastrointestinal (GI) flora, causing nausea, vomiting, or diarrhea.
  • Anti-inflammatories can irritate the stomach lining. They can also potentially cause liver or kidney problems, which can also cause vomiting. If your pet is vomiting, stop using this medication and contact your veterinarian.
  • Narcotic pain medications can slow down intestinal motility, which can delay emptying of the stomach, resulting in lack of appetite and/or nausea/vomiting. Narcotics can also directly stimulate the brain's nausea centers. If your pet seems nauseous, inappetant, or is vomiting, back down on the use of narcotics. If you are not sure if your pet is painful or otherwise uncertain on how to manage things, contact your veterinarian.
  • Severe pain, particularly visceral (associated with the body's organs) can cause nausea and vomiting.
  • Acid indigestion can occur due to stress (both the physical stress of surgery and pain, as well as the emotional stress of hospitalization, being away from home, etc.).
  • Abdominal surgery -- especially but not limited to gastrointestinal (GI) surgery -- can result in ileus, or lack of intestinal motility, which can delay emptying of the stomach, resulting in lack of appetite and/or nausea/vomiting. Even just opening the abdomen and exposing the intestines to air will cause ileus. 
  • Peritonitis (inflammation of the abdominal cavity), especially due to leakage of intestinal contents, but possibly also due to pancreatis (inflammation of the pancreas) or even just abdominal surgery, is a serious cause of vomiting. If your pet has had intestinal surgery, vomiting is a major red flag. Your pet should be examined for the presence of abdominal pain, fluid accumulation, etc. Contact your veterinarian immediately if your pet is vomiting following intestinal surgery, especially if your pet is lethargic and/or otherwise seeming sick.
  • Esophageal reflux and secondary esophagitis (similar to GERD) typically cause regurgitation (a more passive release of food or fluid) rather than vomiting (a forceful ejection of stomach contents), but the two can be sometimes hard to distinguish.
  • Drinking or eating too much in a short time period can cause a pet to vomit. Pets are often thirsty from panting, and they will frequently try to drink a whole bowl of water in a short time period, after which they may vomit. While your pet needs to have access to fresh water, try to limit the rate of intact by placing small amounts of water every 5 to 10 minutes until your pet is satisfied. You can also give your pet ice cubes or place down a block of ice your pet can lick.

Treatments that can help with nausea/vomiting

  • Probiotics - Activia and other types of yogurt, or probiotic medications, such as Fortiflora, can help replace the normal/helpful intestinal bacteria that can be wiped out by antibiotics.
  • Anti-acid medications
  • Pro-motility medications
  • Direct anti-nausea medications
  • Bland diet
  • Appropriate pain management

Difficulty breathing

  • Your pet should be taking smooth, even breaths, particularly when resting. 
  • Panting is very common and may be a result of excitement, heat, discomfort, or medications.
  • Labored breathing is when your pet is struggling to get a breath: deep, rapid expansion of the chest cavity
  • Stridor is noise caused by air moving through a partially obstructed larynx.
    • In an old Labrador Retriever, for example, you may hear "roaring" when panting due to decreased ability to open the larynx.
    • In an English Bulldog or Pug, you hear a lot of noise due to overlong soft palate.
  • Stertor is noise caused by air moving through partially obstructed nasal passages.

Not eating

  • Inappetance is a decreased appetite
  • Anorexia is not eating at all
  • Many of the causes and treatments are similar as for vomiting

Not urinating

  • Difficulty emptying the bladder
  • Urethral obstruction
  • Dehydration
  • Kidney failure

Notify your veterinarian and/or recheck ASAP if your pet is not urinating at least once daily.

Not defecating

It is common for pets not to have a bowel movement for a few days after surgery

  • Causes:
    • General anesthesia
    • Fasting pre-operatively
    • Narcotic pain medication.
    • Poor appetite post-operatively
  • Do not be concerned as long as your pet is eating, not vomiting, and not physically straining to have a bowel movement.
    • You may add some Metamucil or pumpkin to your pet’s diet if there has not been a bowel movement for 2 days. Add small amounts (start with a child's dose, or less in a small dog) and increase progressively to the desired effect.
  • Contact your veterinarian if:
    • Your pet has a history of constipation
    • Your pet is vomiting
    • Your pet is not eating and/or drinking
    • Your pet is not urinating
    • Your pet is physically straining to pass stool
    • If you are concerned, you may bring your pet in for an examination.
      • Your veterinarian will want to assess your pet's general condition and hydration.
      • Your veterinarian can palpate (manually feel) your pet's abdomen and may wish to do a digital rectal examination.
      • If appropriate, your veterinarian may recommend bloodwork, to rule out dehydration or other systemic complications; and/or radiographs (x-rays) of the abdomen to assess the volume of the feces.

Notify your veterinarian (e-mail Dr. Christiansen or call your regular veterinarian; for after hours emergencies) if you recognize any of these.