Your pet has been scheduled for dental procedure and /or surgery in the near future with us. In our attempt to assist clients, and provide you clear communication on what is involved, we ask you review this important information to ensure your surgical check in, the day of surgery, and the post-op period is as easy and stress-free as possible for you and your pet.

Please read carefully all of the information, as it answers most of the common questions we get from owners.  We like you to be fully informed of your pet's big surgery day. If you have any questions, please feel free to call us.

You should have already received a Treatment Plan that includes expected cost for your pet at the time of your pet's exam.  On that treatment plan is an expiration date at the top. If surgery is performed after that date we may request an updated exam (exam fees may apply) to be sure your pet's condition has not significantly changed. We will review the Treatment Plan and cost again at your pet's Check-In.

Prior to your pet's surgery day we will need you to complete the following consent forms with all required information. If you have not completed this Pre-Surgical Check-In within 24 hours of your pet's surgery it may be cancelled and need to be rescheduled.  

We require a good phone number(s) where you can be reached on the day of surgery. Failure to be reached on the day and time of the procedure may result in postponement of treatments we find your pet needs at the time of surgery. 

The Night Before {petsName}’s Surgery

Please withhold food and treats after 9:00pm. Do not withhold water, it should be kept available for {petsName}. If your pet has been given medications for anxiety or temperament, give the first dose in the evening if prescribed.

The Day of Surgery

If {petsName} has been prescribed medications for anxiety or temperament, be sure to give the morning dose 2 hours before your expected arrival time if at all possible.

If {petsName} is currently taking any medications for other conditions, give those medications as you normally do unless you have otherwise been instructed by the doctor. You may give a small treat if needed to give any needed medications, but remeber don't feed {petsName} a full meal. If by chance your pet has accidently had a morning meal, please let us know at check-in. 

Plan for {petsName} to be dropped off on the morning of scheduled surgery day between 7:30 and 9:00 am.  It is important you Check-in prior to 9:00 am.  After 9:00 am staff are focused on helping with the surgical procedures and may not be avialable to complete check-in. If you are late you may have to re-schedule your pet's procedure.  If we have several patients arrive at the same time, we will need some time to get you checked in, so your patience is appreciated. You will check in at our Surgical Center on the side of the building. ( Signs should be posted. )

The person checking in the pet MUST be able to make medical and payment decisions.  They must be an authorized user on the client account.  We cannot be responsible for miscommunications between clients not with their pet at the time of check-in.  We expect clients to communicate clearly with their family, spouses, and partners that are not present at Check-In.  If you want to know information about your pet's surgery, we ask you be present at the time of check-in and discharge. 

Our veterinary nurse will escort you and your pet to an exam room to complete the Check-In and to go over {petsName}'s Treatment Plan for the day.

After checking in, our team will collect samples for any elected blood tests and get them running in our In-House lab. If any concerns arise, a team member or doctor may contact you at the contact number you provide. They will also give oral pain medications and get things ready for your pet's surgery.  

You are welcome to check up on {petsName}’s status at any time, however, keep in mind our doctors plan the order of surgeries based on how to get all the work done in the timeliest manner. The order that pets are checked in IS NOT the order that surgeries are performed. In general, the less complicated, shorter procedures are done first, followed by the more complicated longer procedures. Surgeries that require an overnight stay with us are the last to be performed.

As surgeries are done our team will send several text messages to you. Texts are sent to the Primary Cell number we have on file. It is important you not opt out of text from our office so you can receive these text messages and reminders. The first text message will be sent when the procedure has been completed, and a second will have a link to {petsName}'s discharge instructions. Please look over the discharge link prior to pick up so our team can answer any questions you have at discharge.

When you arrive to pick your pet up, the receptionist will bill you out and the assistant team will go over all discharge orders verbally. There will also likely be a web address on your paperwork for the discharges if you need it to review again. If you do not understand any instructions, please do not hesitate to ask our staff to go over them one more time. If you have any questions, please let us know, we want you to have all the information you need for your pet.

We hope surgery day will be a pleasant experience. Our team knows surgery can be an anxious time for you and {petsName} and we are available to answer any and all questions concerning the upcoming procedure.

We look forward to serving you and your pet on the upcoming surgery day and for years to come.

Our utmost priority is the well-being of {petsName}. Before proceeding with anesthesia, we routinely conduct a brief surgical physical examination to ensure that your pet remains a suitable candidate for the procedure.

We strongly recommend, and in some cases require, Blood Profiles for pets undergoing anesthesia. These profiles serve to alert our doctors to potential issues such as dehydration, anemia, infection, diabetes, or kidney and liver diseases that could complicate {petsName} anethetic recovery. These conditions might not be apparent without blood test. While our protocols are generally safe for most conditions, adjustments may be necessary based on blood testing to guarantee the safest anesthetic regimen.

Furthermore, these tests can prove valuable if your pet's health status changes or deteriorates later on. Establishing baseline blood values through these results provides a reference point for future comparisons.

Our in-house lab enables us to perform blood profiles on the morning of {pet's name}'s surgery, ensuring the most up-to-date information on your pet's health is available on the same day.

Chemistry Profiles:
These profiles examine blood chemicals and assist us in assessing the functioning of major organs, particularly the liver and kidneys. Given their role in metabolizing the injectable drugs we administer, any decrease in liver and kidney function requires additional care during and after surgery.

CBC:
This test allows us to evaluate red blood cells, white blood cells, and platelets, helping identify anemia, infections, or clotting issues in your pet. The Packed Cell Volume (PCV) is a fundamental measurement of red blood cells to check for anemia.

Clotting Profiles:
These profiles determine your pet's ability to stop bleeding by measuring key clotting factors. They are essential for assessing the safety of surgery and are mandatory for certain breeds, specific health conditions, a history of clotting concerns, or advanced surgical procedures. If clotting profiles are part of your pet's surgical plan, they are not optional.

Testing May Be Performed After Sedation/Pre-Anesthetic:
While we prefer to collect and run blood work before anesthesia induction, some pets may not allow it. To minimize stress for {pet's name}, we may need to collect blood samples after sedation or pre-anesthetic medications. Despite the tests being conducted post-sedation, the information gathered still guides informed decisions regarding your pet's medical and surgical needs.

Types of Anesthesia

We use a combination of pre-anesthetic medications with injectable and/or inhalant anesthetics to achieve optimum Balanced Anesthesia for your pet. As part of a balanced anesthetic approach we have a focus on providing the best pain management we can provide, before, during, and after the procedure. With these combinations of drugs we can use lower doses of each drug.  This helps reduce the risk of anesthetic complications. 

For most procedures {petsName} will receive oral or injectable NSAID pain medication shortly after they check-in.  This helps ensure the medication is on board and working when it's time for surgery.  If your pet is taking a daily NSAID, or other pain medications, and you gave the morning dose, please let us know.   

For short or common procedures or for budget cases, a combination of medications are used to provide Total Injectable Anesthetic.  This type of anesthesia produces a good plane of surgical anesthesia with a quick recovery. Oxygen will be supplemented if needed by an anesthetic mask. 

For longer procedures, your pet is provided a combination of pre-medicatons and then intubated (insertion of a tube into the trachea or windpipe). This will ensure that your pet is able to receive oxygen at all times and reduce the risk of aspiration of any fluids into the lungs. Inhalent anesthesia is then used to maintian your pet's anesthesia until the procedure is completed.

For some pets that are intubated they may experence a cough after the procedure.  Often this cough starts with a few days after the procedure.  Intubation can cause damage to small hairs in the trachea (cilia), and some inflammation of the tracheal lining. This impedes the function of the Mucociliary Escalator mechanism of the trachea.  These hairs move mucus and debris, normal to the lungs, up and out.  The cough typically improves within a few days and is of no major concern.  This is often mistaken as "Kennel Cough" and blamed for the fact they were in a hospital. This is seldom the true cause of the cough for pets that where recently intubated for surgery.  If the cough does not improve or resolve within 48-72 hours, becomes productive, or your pet seems bothered by it, please inform us so that we can arrange a recheck exam. 

Patient Monitoring

Monitoring of patients during anesthesia is done in several ways.

First, physical observation by our tained surgical team of {petsName}'s heart rate, respiratory rates, level of anesthesia, and temperature.  Our doctors and assistants are with your pet continuously from beginning of anesthesia to recovery. 

Second, we have numerous types of electronic monitors that track heart rate, pulse rate, oxygen levels, respiration, ECG, and temperature. Electronic monitoring is a great tool, but it does not replace physical observation of your pet. 

Post Surgical Pain Management

Our clinic strongly believes in compassionate, quality, medical care, for our patients. To live up to that mission, all surgery patients will receive pain management before, during, and after surgery. Additionally, pain medication will be prescribed to be given at home. With good pain management your pet will recover and heal faster from surgery. Be sure to give all NSAID drugs provided until they are gone, even if your pet does not seem painful.  The anti-inflammatory will reduce swelling at the surgical sites and improve healing. 

Intravenous Catheterization & Fluids

We highly recommend the placement of an IV catheter and use of IV fluids during longer anesthetic procedures. This allows us to have quick, available access to the circulatory system (blood) in case of an unforeseen emergency. The fluids help provide support to the circulatory system and prevent dehydration, as well as aid in a quicker recovery from anesthesia. Our doctors will include catheters and/or fluid for appropriate surgical plans.  For some short procedures an intravenous catheter may not be required. You will have the option to include them if you wish.  

Anesthetic Risk

It is important for you to understand that there is always a risk of anesthetic and surgical complications anytime these procedures are performed. We strive to provide the highest quality care of your pet and take all precautions, you allow, to avoid potential problems. In general, the risks are far outweighed by the benefits of the procedures we agree to perform. 

The single most common reason severe dental disease effects 70-80% of pets is often the perceived cost prohibitive nature of preventive dental procedures.  Owners then postpone dental cleanings until the disease has progressed into significantly worse heath issues such as abscessed teeth, loss of teeth, or the pet is refusing to eat due to the pain. 

Avoiding preventive care leads to more costly dental treatments, and the need for extractions of teeth.  It does not stop in the mouth though, the infections in the mouth can then get into the blood, and that bacteria can now move into major organs like the Heart, Liver, or Kidneys causing significant other effects on the pet's health.

Here at Premier VetCare, we have made a commitment to reduce the cost of dental care as significantly as possible.  We do this to help owners provide more timely dental prophylaxis in order to reduce the severity of dental disease in the pets we care for.  The design of our treatment area centered around this idea, which has three fully equipped dental tables to accommodate our clients needs.  All of our doctors and our staff are trained and experienced in a multitude of dental procedures and dental prophylaxis. 

Prophylactic dental cleaning is possible for stage 1 and 2 periodontal disease.  Stage 1 is considered the only truly reversible stage, as there is no significant damage yet to the periodontal ligament and the underlying bone.  So once cleaned the gum health will return, but its important to Improve or maintain home care as it will come back if the teeth are not kept clean.  The plaque and gingivits can return in as little as a few months if daily dental care is not maintained.  

Stage 1 Dental Diseae

At Stage 2 we can work to slow further progression of periodontal disease, but damage to the underlying periodontal ligament and the bone has occurred.  We can not reverse the damage to the bone or periodontal ligament.  So after they are cleaned it vital you brush your pets teeth daily to help prevent the accumulation of plague and tartar that will eventually return. After the cleaning, diligent home care can delay the eventually need to extract the effected teeth. With out homecare the disease will come back as soon as just a 3-4 weeks, and with in a few months it may appear that no dental care was even performed. 

Stage 2 Dental Disease

Yearly Prophylactic dental cleaning is an invaluable tool in maintaining your pet's dental health. That is why we are committed to delivering the best care we can at the most affordable rates possible.

WHAT IS INCLUDED IN THE STAGE 1 & 2 DETNAL CLEANINGS

• Oral Exam

• Standard Total Injectable Anesthesia

• Dental Cleaning and Charting

• Surgical Monitoring and Recovery Fees

• Written Script for Antibiotics (As indicated)

• Starter Dental Home Care Kit

 

Stage 3 & 4 Dental Treatments

These cases have more significant health concerns that are individual to each pet. If not already done, an exam will be need one our veterinarians to develope a treatment plan prior to making an appointment for your pet's dental treatment.

Stage 3 Dental Disease

Stage 4 Dental Disease

At this level of disease there will be a significant number of teeth that will need to be extracted. The damaged soft tissue and bone structures of the tooth will not come back, and saving the teeth will take diligent daily home care and extensive, as well as expensive, oral surgery. Failure to extract these teeth will lead to the quick return of the dental disease. Home care and early professional intervention is needed to keep the mouth healthy, as this point the damage is often to far to practically save any effected teeth. Treatment will help restore the remaining good teeth to health and remove any infection and pain the pet is having. Your treatment plan will include a large number of extractions, these are based on our best quess and we may need to contact you if you find more extrations are needed than we expected.  

Dental Extraction Policy 

Your treatment plan for Stage 3 and 4 Dental treatments have built in fees for Surgical and non surgical extractions.  We have done our best, based our experense and expertes to quess how many teeth may need extracted.  We typicaly have overestimated those numbers.  On occasion though we may discover other pathology and more sever dental problems and more teeth than expected may need to be extracted.  

It is our policy to not extract undamaged teeth that have healthy peridontal ligament and gums. So if we are making the recomendation for a tooth to be removed it is in the best long term benifit for the pet oral health. 

We encourage all out clients to trust our judgement and allow us to extract all diseased teeth we find at the time we are providing dental cleanings and treatment. 

If you do not wish to allow us to perform any extractions we will believe to be necessary we will be glad to refer you to a Veterinary Dentist that consult with you on the best options for your pet.

Non Surgical Extractions

Non-Surgical Extractions are typicaly single rooted teeth, the exception beign the large canine teeth. When there is signigicant disease of these teeth they are extracted with out use of dental drills, and gum surgery. 

Surgical Extractions

Surgical extraction are typical of multi rooted teeth.  These are typical of the large premolars and molars. This may also include the large canine teeth.  Surgical extractions require surgery of the gums and use of dental drills to remove the teeth.   

Fractures Canines and Carnasal Teeth

The large canine and carnasal teeth are often prone to fractures.  These can happen due to agressive chewing or truama.  When there is not alot of dental disease involved these teeth are the most difficult to remove.  As such the time and level of surgery to remove them does require additional fees. We may have already planed for this in your pets treatment plan, but if not we may need to contact you to get additional premisions to extract these teeth.  

Oral Nasal Fistula 

With some pets with severe or even mild dental disease the bone in the nose is damaged and a hole opens up into the nasal cavaty.  The repair of these defects is extensive, and sometimes may need additional surgery depending on the severity. As such the time and level of surgery to repair this problem does require additional fees. We may have already planed for this in your pets treatment plan, but if not, we may need to contact you to get additional premisions to extract these teeth and repair the oral nasal fistula.  

Posible Complications of Dental Treatments

Dental treatments in pets, including procedures such as cleanings, extractions, and other oral surgeries, are important for maintaining {petsName}'s overall health. However, like any medical procedure, dental treatments in pets can be associated with certain complications. Here are some common complications that may occur:

Anesthesia-related issues: Dental procedures often require general anesthesia, and there is always a small risk associated with anesthesia. Complications may include adverse reactions, respiratory issues, or cardiovascular problems. However, modern anesthesia protocols and careful monitoring by trained professionals help minimize these risks.

Infection: Infections can occur at the site of dental surgery. This risk is mitigated by the use of sterile instruments, proper surgical techniques, and post-operative antibiotics when necessary.

Pain: Pets may experience pain after dental procedures, especially if extractions are involved. Pain management is an important aspect of post-operative care, and or veterinarians will prescribe pain medications as needed.

Oral hemorrhage: Bleeding can occur during or after dental surgeries, particularly extractions. Veterinarians take measures to control bleeding during and sometimes after the procedure. Usually this will stop on it own, but occastional additional surgery may be needed to stop the bleeding. 

Swelling and bruising: Swelling and bruising around the mouth, gums, or toungue may occur, but these are usually temporary and resolve on their own.

Damage to surrounding structures: In rare cases, there may be inadvertent damage to nearby structures such as nerves, blood vessels, or neighboring teeth during dental procedures.

Delayed healing: Some pets may take longer to heal than others. Factors such as age, overall health, and the extent of dental disease can influence the healing process.

Incomplete removal of dental disease: In cases of severe dental disease, it may be challenging to remove all affected teeth or fractured roots or address all oral issues in a single procedure. Additional treatments may be necessary.

Fractured or broken teeth during extraction: While efforts are made to minimize the risk, the extraction process itself can lead to the inadvertent fracture of a tooth. In such cases, the veterinarian will manage the situation accordingly.

Pre-existing health issues: Pets with pre-existing health conditions may be at a higher risk of complications. The veterinarian will assess the pet's overall health before the procedure and take necessary precautions.

It's crucial to follow post-operative care instructions carefully. Regular dental care, including professional cleanings and at-home dental care, is essential for preventing oral health issues and minimizing the need for more invasive procedures.

Fees for Post Operative Complications: Despite our best efforts, occasionally a pet will open or infect the incisions. This is nearly always due to excessive licking, chewing, or jumping. Surgical complications are ALWAYS POSSIBLE with any procedure. Please return your pet anytime you are concerned about complications. Post-op rechecks are performed at no charge, but the client is responsible for any and all drugs and materials needed to treat the pet as a result of any complications occurring after surgery.

CPR Consent

CPR in pets, or Cardiopulmonary Resuscitation, is an emergency lifesaving technique designed with the goal to attempt to revive a pet in the event of cardiac or respiratory arrest, which is when the heart,lungs, or both have stopped working and responding properly.  This procedure involves a series of chest compressions rescue breathing, and emergency medication administration mimicking the principles of human CPR.

CPR is only performed in emergency situations where your pet has stopped breathing or their heartbeat has ceased. 

Possible Complicaitons & Outcomes of CPR in Pets

While pet CPR (Cardiopulmonary Resuscitation) can be a life-saving measure in emergency situations, there are potential complications and risks associated with the procedure. It's important to note that pet CPR should only be administered by individuals who have received proper training.

No Guarantee of Outcome: While pet CPR can be effective in certain situations, there is no guarantee of success. The outcome may vary based on the underlying cause of the emergency and the timeliness of intervention. Generally, the chances of successful CPR are higher when it is administered promptly. However, even with timely and appropriate intervention, the success rate may not be as high as one might hope, and the overall prognosis may depend on the specific circumstances.

Internal Injuries: The forceful chest compressions involved in CPR may lead to internal injuries, such as broken ribs or damage to internal organs, such as the lungs or heart. This risk is particularly higher in smaller or fragile animals.

Aspiration: If rescue breaths are administered too forcefully or incorrectly, there is a risk of air entering the stomach instead of the lungs, which can lead to aspiration pneumonia.

Ineffectiveness: The effectiveness of CPR can vary based on the underlying cause of the emergency, the time elapsed since cardiac or respiratory arrest, and the individual characteristics of the pet. CPR may not always be successful in restoring normal function.  Even if heart rates and breathing is resotored, there may be no or long lasting effects of brain damage casued by lack of blood flow and oxygen to the brain. 

Aggravation of Pre-existing Conditions: For pets with certain pre-existing health conditions, CPR might exacerbate their condition or complicate their recovery.

Lack of Response: In most cases, pets may not respond positively to CPR, and the intervention may not result in the restoration of vital signs.

Stress and Anxiety: The process of administering CPR can be stressful for both the person performing it and the pet. Stress and anxiety may further complicate the resuscitation process.

Understanding the potential complications and limitations of pet CPR is essential for making informed decisions in emergency scenarios.

Deposit & Financial Responsibility Policy

I agree to pay any required deposit of the estimated fees prior to treatments beginning and assume financial responsibility for the balance of all services rendered either by cash, accepted electronic payment card, Care Credit, or Scratch Pay at the time {petsName} is discharged from the hospital.  I understand hospital financial policy does not allow billing, and I will be able to clear the balance at the time of my pet’s dismissal.

Communication 

In the event {petsName} is hospitalized for more than 48 hours, and your attending doctor is unable to reach you, you understand it is your responsibility to call the hospital at least every 24 hours, during business hours, to inquire as to the medical status of your pet and the fees incurred for medical services up to that day. 

Overnight Supervision

Though most our surgeries will go home the same day, some of the more complicated or emergency surgeries, or those performed in the afternoon will be asked to recover one evening maybe more with us.  Typically, these pets are stable, and this so pet is allowed to rest without being excessive disturbed as they recover with the benefit of pain medications.  Occasionaly we may ask you transfer your pet to overnight care if they are critical or unstable. 

You understand no staff is on premise to observe {petsName} continuously after hours, and you have the option to transfer your pet to the care of a overnight or a 24 hour facility at any time.  If you elect to not transfer to a overnight or 24 hour care facility, you understand and accept all additional risk that may involve in not having continuous observation of my pet. 

Pet Abandonment Policy.

You further agree that you, or an authorized agent of yours, will pick up {petsName} and pay for all accrued charges once you receive text, email, written, or oral notification that your pet is ready to be released from our hospital.  If not picked up as informed, all appropriate boarding and hospitalization fees will apply.  Such notice will be given via text, and email maintained on the hospital's patient/client record. If {petsName} has not been picked up with in 48 hours past the defined discharge time {petsName} will be considered abandoned by you.

You agree that if you fail to comply with this policy PREMIER VETCARE may handle this abandonment in the best interest of the animal and the hospital. You are a aware and understand pet abandoment is also against Tennesses Code, and the abandoment may be reported to Rutherford County PAWS.

For the Unexpected Findings

You understand that the Treatment Plan for {petsName} that has been provided, or will be provided at check-in, was made with the current information available to the staff and veterinarians of Premier VetCare based on {petsName}’s history, past physical exams, and testing at the time that plan was created or revised.  After treatments have begun, new information and findings might identify other concerns that may require medical or surgical attention.  Although no one likes surprises, you understand it’s sometimes impossible to give a complete accounting of cost before treatments begin. 

From a financial standpoint, it is much more economical to complete all needed treatments/procedures during the initial procedure and sedation/ anesthesia rather than having to schedule another appointment with additional sedation /anesthesia and the assocaited cost.  You understand that those additional treatments will change the cost of the current treatment plan.  In the event that additional services may be needed, you may indicate below how you would like the doctors and staff of Premier VetCare to proceed with treatments.

Fees for Post Operative Complications

Despite our best efforts, occasionally a pet will open or infect the incisions. This is nearly always due to excessive licking, chewing, or activity. Surgical complications are ALWAYS POSSIBLE with any procedure. Please contact us or return your pet anytime you are concerned about complications. Post-op recheck exams are performed at no charge for anything determined to be related to surgery, but the client is responsible for any and all additional surgery, medications, and materials needed to treat the pet as a result of any complications occurring after surgery.

E-collar Is Recommened

For most pets we recommend you purchase an E-Collar. These helps restrict your pet's ability to lick and chew at the stiches. We are not responsible for surgical sites that come open or infected after the pet leaves our hospital. Fees apply to re-suture any open wounds or needed antibiotics. When used properly an E-Collar can reduce the risk of your pet causing damage to the sutures and reopen the wound.

Phone and Contact Info

Being able to communicate with you or your agent during your pets procedure or treatment may be neccessary, please provide us the best phone numbers to reach you in the event we need to.  

We will send you updates on {petsName} when they are in recovery, as well as discharge times, and home care instructions via text messages. Text messages are the best way to have all the information you need. Please inform us at check in if you do not want updates and discharge information by text messages.  

Treatment or Surgery Consent 

I, {yourName} , or owner's agent, of the pet identified above, {petsName}, certify that I am over eighteen years of age, and thereby consent to the examination of my pet by staff veterinarian(s) at PREMIER VETCARE, and after consultation with me, to prescribe medication for, treat, hospitalize, anesthetize and/or perform surgery on my animal.  I understand that some risks always exist with all medications, vaccines, anesthesia and/or surgery, including unknown physical abnormalities, medication allergies, surgical complications, internal bleeding, shock, incision dehiscence, and post-surgical infections, and that I have been encouraged to discuss any concerns I have about those risks with the staff or if needed the attending veterinarian before the procedure is initiated.

I also certify that I have been provided an treatment plan that includes the expected costs for veterinary services that includes, but not limited to, diagonstic test, blood sample collection, surgery, administration of medicaiton, and/ other treatments that will be preformed for {petsName}. I have discussed all fees attendant to such care before services are rendered and during my pet's ongoing medical or surgical treatment. 

I also certify I have had the opportunity to ask any and all questions I may have regarding any diagnosits test, medical treatments, or surgical treatments that have been or are to be performed for {petsName}.