Page 7 - Manual of Equine Field Surgery
P. 7
Introduction 3
CLIENT COMMUNICATION DECISION FOR SURGERY
Client communication is probably the most The decision to perform surgery on a specific case
important factor in preventing misunderstand- can be difficult. Is the surgery necessary? What are
ings and addressing problems when things do the best- and worst-case scenarios for a present-
not go well. The owner ( or trainer) should be ing problem or specific procedure? The decision
informed of the options for therapy, costs, prog- is complicated by adding the field scenario into
nosis, potential complications and consequences, the equation. The temperament of the horse, the
anticipated outcome, and recommendations prior potential surgical environment (i.e., facilities,
to surgery. Ideally, this conversation should be terrain, weather, etc.), the availability of needed
with the person who will actually pay the bill and eqt1ipment, the availability of trained assistants,
with the person responsible for the horse's care. the expectations of the client, the skill of the
However, in many instances in equine practice, surgeon, and the ability to handle unforeseen
the person paying the bill may not be available. developments all enter into the decision. Certainly
Keeping good written notes of conversations many clients have excellent facilities; however,
and estimates and providing written discharge there are other clients with facilities where field
instructions concerning aftercare is essential. All surgery may be a greater adventure than anyone
communications should be as realistic and honest needs. After considering the factors for a given cir-
as possible. Clients must be warned of the poten- cumstance, the surgeon must decide whether to
tial complications and expected outcome. General perform a particular procedure.
complications such as the development of rhab-
domyolysis or colitis seen in horses stressed by
transportation, anesthesia, and surgery should be PATIENT EVALUATION
communicated to the owner when appropriate.
The specific complications associated with the A thorough history should be gathered on all
procedure to be performed should also be dis- horses presented for elective surgery. Previous
cussed. However, overstating the difficulty of the treatments, responses to treatment, potential ad-
recommended surgery or the gravity of the poten- verse reactions to previously administered med-
tial consequences to minimize client expectations ications, and the genetic background (e.g., the
is inappropriate. potential for developing hyperkalemic periodic
paralysis) should all be reviewed.
A thorough physical examination should be
INSURANCE performed, concentrating on the rest of the
animal prior to focusing on the potential reason
When contemplating surgery on an insured horse, for surgery. Blood should be submitted for evalu-
the veterinarian should be aware that it is the ation including a complete blood cell count or at
client's responsibility to inform the insurance least a packed cell volume and total protein deter-
company of a pending surgical procedure, partic- mination prior to the time of the surgery. Serum
ularly for an elective procedure, which is the case chemistry evaluations are desirable but are not
for most procedures covered in this book. The always necessary for elective procedures. If the
veterinarian may choose to contact the insurance horse's physical condition or laboratory values
company, but it is the client's responsibility. The are abnormal, elective procedures should be
insurance company will then make a decision postponed.
about whether to cover the animal for the proce-
dure. These deliberations are between the owner
and the company, but the veterinarian may be PATIENT PREPARATION PRIOR TO SURGERY
drawn into the process when decisions regarding
treatment options, prognosis, and euthanasia are For most elective procedures, feed should be with-
considered. Because of potential conflicts of inter- held about 6 hours prior to surgery. Water should
est, guidelines for those situations are available be allowed ad libitum. Withholding feed for up
from the American Association of Equine Practi- to 72 hours can be tolerated for elective proce-
tioners Equine Insurance Committee.1 dures. However, it should be recognized and
