Pet Surgery Options
Surgery Options in Cary, NC
Our surgeons each have over 30 years of experience providing specialty orthopedic, neurosurgical, soft tissue, and oncologic surgery. Our surgical team consists of technicians, technician assistants, patient care coordinators, and receptionists. We all work together to improve your pet’s health and address your concerns during what is often an emotional time. Your pets are forever a part of our surgical family.
- Our four surgical suites offer both traditional ‘open’ and minimally invasive procedures (arthroscopy, laparoscopy). Your surgeon will consult you about the type of surgery or procedure best for your pet.
- Registered veterinary technicians guide every pet’s smooth anesthetic induction and recovery. Our multimodal approach to pain management keeps your pet comfortable before, during, and after surgery. We utilize a combination of oral and injectable medications, joint and nerve blocks, local anesthetics, constant rate infusions, epidural analgesics, and transdermal narcotics to achieve this.
- Our diagnostic services include joint taps, blood and urine testing, biopsies, gait analysis, digital radiographs, and CT scans. Ultrasonography is available on-site through our emergency clinicians or mobile specialists.
- Our surgical services include those listed below (click on them to learn more!), therapeutic bandaging, joint injections, platelet-rich plasma, negative pressure wound debridement, and closed suction drainage.
Body System Review
This body region includes the spleen, pancreas, adrenals, diaphragm, and abdominal wall. Masses in the spleen, pancreas (insulinoma), and adrenal glands (carcinoma, pheochromocytoma) are not uncommon, and surgical treatment is usually recommended. Surgical repair is also recommended for abdominal, diaphragmatic, umbilical, and inguinal hernias.
These surgeries encompass problems usually involving your pet eating foreign material which obstructs their GI system (stomach, intestines, rectum). Other surgical issues are GDV (gastric dilatation- volvulus or “bloat”), gastric and duodenal ulcers, cancers of the GI system, and idiopathic feline megacolon. Surgery near the rectum includes treatment of perineal hernias, perianal tumors or fistulae, and anal gland masses.
This system comprises the kidneys, ureters, bladder, urethra, ovaries, uterus, testicles, prostate, vulva, and penis/prepuce. Ectopic ureters and cryptorchidism are examples of congenital problems. More common issues are kidney and bladder calculi (stones), urinary obstruction in dogs and cats, pyometra in unspayed females, and testicular and prostate tumors.
Your pet may be limping or have weakness or pain in their limbs. Sometimes hereditary or congenital abnormalities can lead to lameness. Examples are: hip and elbow dysplasia, osteochondrosis (OCD of shoulder, elbow, knee, ankle), fragmented coronoid process (FCP), and ununited anconeal process (UAP). Injuries can also occur, such as fractures of any bone (for example, hit-by-car trauma), cranial cruciate ligament (ACL) tears, ‘rotator cuff’ tendinopathies (biceps, supraspinatus), traumatic joint dislocations, and Achilles’ tendon tears. Bone, muscle, and tendon cancers can also require surgical resection or limb amputation as part of their overall treatment planning.
Although we do not often think of surgery for skin problems, there are instances where a surgeon can be of benefit. Animals with ‘excessive’ skin folds or ‘screw tails’ can develop severe superficial infections for which some type of plastic reconstructive surgery is of major benefit. Our most common ‘dermatology related’ surgeries are for tumors (cancers), which, when removed, will require specific types of plastic reconstruction for a more cosmetic closure or allow a better function to a ‘moving part’ (limb, mouth, eye, ear).
This system includes the brain, spinal cord, and peripheral nerves, along with the substances and receptors which allow the transmission of electrical impulses. There are degenerative conditions, traumatic injuries, immune-mediated diseases, and cancers that affect this system; these can result in pain and paralysis. Surgical intervention is often included in the overall treatment of brain and spinal tumors; surgery is more imperative for the treatment of spinal fractures and ruptured intervertebral discs.
Many cardiac diseases are well-managed by cardiologists and interventional treatments. Surgical treatments of congenital heart abnormalities, such as vascular ring anomalies (PDA, PRAA), are still performed and are sometimes more appropriate than interventional treatments. Tumors that involve the heart and its surrounding tissues can sometimes be treated or managed surgically. Thymoma resection and pericardectomy are examples.
Breathing entails moving air from the nose to the alveoli. Air moves through the larynx and trachea into the bronchi and lungs. Diseases that prevent full lung capacity affect your oxygenation. Surgery is generally performed to improve airflow from the nose to the bronchi (i.e., for diseases such as laryngeal paralysis, stents for tracheal collapse, and removal of obstructions) or to remove lung tumors. Diseases that affect the expansion of the lungs (pleuritis) or movement of the diaphragm (rib fractures and tumors) can sometimes be helped with surgical intervention.
Surgery in this region involves the skull and jaw bones, salivary glands, oral cavity, larynx, thyroid, and parathyroid glands, ear canals, and lymph nodes. Dogs with chronic ear infections will sometimes require a total ear canal ablation to alleviate their chronic ear pain or headache. Unfortunately, tumors are quite common in the oral cavity and these structures.
Diseases of the liver are often treated medically, though in some cases definitive diagnosis requires a biopsy. Portosystemic liver shunts can be a congenital abnormality and are often amenable to surgical treatment. Liver tumors, gall bladder mucoceles, ruptured gall bladders, and bile duct diseases can also be surgically managed.
Veterinary Services in Cary, NC
Tracheal Stents in Cary, NC
Tracheal collapse is a common cause of cough in dogs. The condition results from decreased strength within the cartilage of the large airway, and it may affect the trachea in the neck region or within the chest. Treatment of tracheal collapse centers on the control of secondary problems such as obesity, infection, or chronic bronchitis. When medical treatment fails for tracheal collapse, stent placement may be discussed. Use of these stents in dogs with severe and intractable cough or respiratory distress can result in a reduction in cough and airway distress. Evaluation of a dog for tracheal stent placement starts with a work-up for airway disease, which may be performed by your regular veterinarian. We assess overall health status and perform blood tests and x-rays. At that time, we can perform specialized measurements to determine the appropriate length and diameter for the stent. Some patients require bronchoscopy to determine the presence of concurrent upper airway disease and to detect infectious or inflammatory lower airway disease that requires treatment prior to stent placement. Once the diagnostics visit has been performed, the appropriately sized stent can be ordered. Placement of the stent requires general anesthesia. Post-procedure radiographs are performed, and dogs are hospitalized for a variable time to ensure appropriate recovery. Post-operative care will include ICU monitoring and may include heavy sedation, cough suppressants, and antibiotics. Oxygen therapy may be needed in some cases. Stents can successfully control debilitating signs associated with tracheal collapse, but they are not without risk. Dr. James Clark is our airway specialist here at VSRP.
Thoracic Surgery in Cary, NC
Thoracic surgery involves treatment for abnormalities of the esophagus, heart, mediastinum, lung lobes, thoracic duct, and thoracic wall (rib cage). Congenital and developmental disorders such as patent ductus arteriosus (PDA) and vascular ring anomalies (persistent right aortic arch (PRAA) as an example) can be treated with interventional techniques or surgery. Pericardial effusion can be managed with a pericardectomy. Pleural cavity diseases such as pyothorax, pneumothorax, and chylothorax can be managed with the aid of surgical intervention. Lung lobectomy (for lung tumors) and diaphragmatic hernia repair (traumatic or congenital peritoneopericardial) are common reasons for your pet to have thoracic surgery.
Plastic and Skin Reconstruction Surgery in Cary, NC
Plastic and skin reconstruction surgery in pets is usually done for a medical benefit rather than as an elective ‘cosmetic’ procedure. Breeds with excessive skin folds can have chronic skin infections, which can become difficult to manage medically, especially on the face or surrounding a ‘corkscrew tail’. Although the surgical reduction in these folds can change the ‘look’ of your pet, it will help manage their pyoderma. The treatment of large wounds (induced by trauma, snakebites) can often include the use of skin flaps or grafts. The surgical resection of tumors may require these specialized techniques for a more successful outcome.
Oncologic Surgery in Cary, NC
Oncologic surgery encompasses many types of cancers in many locations throughout the body. Many types of cancer require some type of surgical procedure as a primary treatment. Cancers that are primarily treated with chemotherapy, such as lymphosarcoma, may only require surgery in the form of a needle biopsy or lymph node excisional biopsy. Other soft tissue tumors, such as sarcomas (of muscle, spleen, liver, intestinal, stomach) and carcinomas (of the anal gland, adrenal, lung, pancreas, thyroid), can be amenable to complete surgical resection. Successful surgical resection of tumors can require the use of specific muscle flaps and skin grafts. In other instances, amputation of a digit or limb (bone tumor) is recommended. Treatment recommendations may include surgical tumor removal along with additional chemotherapy or radiation therapy.
Laparoscopic Procedures in Cary, NC
At Quartet, our focus has always been to offer the most effective treatments for our animal patients and provide them in a manner that minimizes discomfort and maximizes recovery. Minimally invasive surgery seemed a natural progression, and we are, at present, in a position to offer a limited array of procedures with plans to expand the list as we acquire the instrumentation and expertise necessary. If you are interested in laparoscopic ovariectomy/hysterectomy, elective laparoscopic-assisted gastropexy, laparoscopic abdominal exploratory with liver biopsy, and in select cases, laparoscopic cholecystectomy (gall bladder removal) for your pet or veterinary patient, please contact the office to learn more about these new and exciting services.
Genitourinary in Cary, NC
Fortunately, many pets are spayed or neutered at an appropriately young age. However, intact female and male dogs and cats can develop infections (pyometra, prostatitis) or cancers (testicular, mammary ) of their reproductive organs. The urinary system tends to require surgery due to congenital abnormalities (ectopic ureters), cancer (kidney and bladder), and formation of ‘stones’ (kidney, ureteral, bladder, and urethral). Urinary obstruction in dogs and male cats is very common and can be life-threatening.
Ear Surgery in Cary, NC
Surgical procedures can be of benefit in the management of chronic ear infections and the removal of ear tumors or polyps. With mild intermittent otitis, sometimes ‘opening’ the ear canal with a Zepp procedure can reduce the frequency of infections. In more severe cases, say a Cocker Spaniel with longstanding otitis that no longer responds to oral or topical medications, complete removal of the ear canal is necessary (total ear canal ablation with bulla osteotomy). This surgery will resolve their ear pain and headaches. Cats can develop ear infections secondary to polyps in their middle ear, and these can be removed via another type of ear surgery (ventral bulla osteotomy).
Airway Surgery in Cary, NC
Airway surgery, simply stated, is used to improve breathing. Common surgery for brachycephalic breeds (for example, Bulldogs) is the surgical treatment of their stenotic nares and elongated soft palate; at times, tonsillectomy and laryngeal fold resection are necessary. Older Labradors that have difficulty breathing secondary to laryngeal paralysis can benefit from a ‘tie-back’ procedure (cricoarytenoid laryngoplasty). Small breed dogs with tracheal collapse can often be managed medically, but the placement of stents can become necessary.
Abdominal Surgery in Cary, NC
Abdominal surgery typically is focused on a particular organ or system which is found to be abnormal via radiographs or ultrasound. If your pet is vomiting, having diarrhea, or having abdominal pain, then their stomach and intestines may be the focus of surgery. Bloody urine or inability to urinate may be a sign of bladder or urethral stones or blockage. Anemia and blood in the abdomen can result from a bleeding tumor of the spleen or liver. Animals that have been traumatized can develop diaphragmatic or abdominal hernias. Small animal surgeons are trained in the treatment of a variety of abdominal diseases.
Vertebral Fractures in Cary, NC
Fractures of the spine are generally surgical emergencies, although not all types of spinal fractures will require surgical intervention. Some fractures will heal relatively well with conservative treatment, which includes strict cage rest and a body cast. Spinal radiographs, MRI, and/or CT, are useful tests, as well as knowledge of vertebral biomechanics.
Spinal Tumor Biopsy and Removal in Cary, NC
Tumors occur within the brain, spinal cord, and peripheral nerves; they also occur within the vertebrae. Clinical signs can include weakness, paralysis, headaches, pain, and lameness. Diagnosis and treatment options will depend upon the results of noninvasive (radiographs, MRI) and invasive (biopsy, spinal tap) results.
Lumbosacral Stenosis in Cary, NC
This is a narrowing of the spinal canal at the lumbosacral junction. The narrowing is secondary to malformation and malarticulation of the vertebrae, which can also lead to a disc prolapse. Essentially, the spinal nerve roots in the low back are pinched and compressed by the thickened ligaments and joint capsules of the vertebrae, along with bone spurs between the vertebrae (spondylosis). Fractures of the vertebrae, infections of the disc (discospondylitis), and spinal or pelvic bone tumors also can cause neurologic impairment localized to the lumbosacral spine.
Intervertebral Disc Disease in Cary, NC
Intervertebral discs are ‘cushions’ of tissue between the bones of the spine (vertebrae). They absorb the compressive forces which occur within the spine. Their extrusion or protrusion can damage the spinal cord and its nerve roots, resulting in back pain, partial paralysis, or complete paralysis. Disc herniations can occur in any breed, more commonly in the chondrodystrophic breeds (Pekingese, dachshund, bulldog, beagle, Welsh corgi, basset hound). These herniations also occur in cats.
Degenerative Myelopathy in Cary, NC
This is a nonsurgical condition. Degenerative myelopathy results in progressive deterioration of the spinal cord and, as such progressive paralysis. Large dog breeds are more commonly affected, such as the German shepherd, boxer, and Bernese mountain dog; the Pembroke Welsh corgi may have a similar condition.
Chiari-Like Malformation and Syringomyelia in Cary, NC
This condition is also known as caudal occipital malformation syndrome (COMS). It results in a plethora of signs and is seen predominantly in toy and small breeds, particularly the Cavalier King Charles spaniels and Brussels griffon. Common clinical signs include neck or back pain, persistent scratching, seizures, and loss of balance. It is a condition in which part of the brain (cerebellum) compresses the spinal cord, altering the flow of cerebral spinal fluid (CSF). Conservative (nonsurgical) and surgical treatments have been recommended.
Cervical Malformation and Vertebral Instability in Cary, NC
This diagnosis refers to a spinal disorder which is commonly referred to as “Wobbler Syndrome.” It is generally an acquired malformation, and malarticulation of the cervical vertebrae thought to be caused by a developmental bone disorder called osteochondrosis. Younger dogs tend to develop stenosis (narrowing) of their spinal canal, while older dogs develop degenerative joint disease in their spine. This results in compression of the spinal cord and, thus, a degree of paralysis. Hence, these pets can begin to ‘wobble’ in their pelvic limbs. Affected breeds include Great Danes, Rottweilers, and Doberman pinschers. Diagnosis and treatment options will depend upon the results of radiographs and a spinal MRI.
Atlantoaxial Subluxation in Cary, NC
This is a congenital condition in which there is instability between the first (atlas) and second (axis) cervical vertebrae. Miniature and toy breeds are most commonly affected. These dogs can exhibit neck pain, a reluctance to petting on their head, partial paralysis, wobbliness, or complete paralysis.
Total Elbow & Knee Replacements in Cary, NC
Patella Luxations in Cary, NC
Patella luxations occur in small and large breed dogs, as well as cats. The patella (kneecap) can dislocate (luxate) medially or laterally, and the limb conformation often dictates which type is present. Bowlegged breeds tend to have medial patella luxations (MPL), whereas post-legged breeds tend to have lateral patella luxations. Essentially, the genetic conformation of the pelvic limb dictates the alignment of the limb and can predispose to this problem.
Oral Maxillofacial Surgery in Cary, NC
Mandibular (jaw) and maxillary fractures occur in traumatized pets and often require surgical repair to allow normal occlusion and normal closure of the mouth. Tumors of the oral cavity are common, and surgical removal is often the initial treatment recommendation. TMJ luxation is also recognized and can require surgical intervention.
Limb Deformity & Realignment in Cary, NC
There are a variety of conformational malalignments that affect our pets, particularly dogs rather than cats. Some breeds are naturally ‘crooked’ in their limb structure, whether they be ‘toed out’, ‘bowlegged’, ‘pigeon toed’, or ‘cow-hocked.’ In these breeds, your pet’s appearance is symmetrical (i.e., the right forelimb looks the same as the left forelimb). As long as your pet’s ‘normally abnormal’ structure does not result in lameness, all is acceptable. However, there are occasions when an abnormal growth of a bone, secondary to an injury or disease, can severely alter the function of a limb. Your pet’s limb appearance will not be symmetrical in these instances, and often surgical intervention can improve the comfort and function of that particular limb. Some genetic conformations predispose to other acquired conditions, such as medial/lateral patella luxations and even cranial cruciate ligament injury.
Joint Luxations and Arthrodesis in Cary, NC
Dogs and cats have joints that flex and extend (ex. hips, shoulders, and elbows). They also have some joint surfaces which do not flex and extend (ex. some carpal and tarsal bones). Traumatic injuries and even immune-mediated diseases (for instance, Lupus) can damage joints such that they do not function as intended. Joints can dislocate, partially dislocate, break down, become deranged, lose their smooth cartilage surfaces, become fused, and become nonfunctional. The joints which tend to dislocate most often due to trauma are the hip, shoulder, elbow, carpus (wrist), and tarsus (ankle). Sometimes these luxations can be reduced without surgery. If the trauma is more severe, surgery may be necessary to realign the joint and restore stability.
Hip Surgery (Total Hip Replacement, FHO, TPO, JPS) in Cary, NC
Hip dysplasia is a genetic disease that can result in lameness and arthritis over time. Hip evaluation includes the radiographic evaluation of hip conformation, as well as palpation of the hip joints. Hip conformation can be assessed using the hip-extended (OFA type) radiographic view and also the PennHip technique. Both large and small breed dogs have hip dysplasia. Each individual animal, dog or cat, will have varying degrees of lameness attributable to their hip problem. Some dogs with severe hip arthritis do not limp or show signs of discomfort, while other animals with minimal arthritis are extremely painful and have difficulty walking. Thus, a clinical evaluation is important to determine the course of treatment. Conservative and medical management of hip discomfort is very common, though hip surgery retains an important role in managing hip discomfort and improving hip function. Our more common hip surgeries include the triple pelvic osteotomy (TPO; younger dogs), femoral head/neck ostectomy (FHO, FHNO; generally smaller, less active dogs), and total hip replacement (THR, cemented and cementless; generally any size active dog, large sedentary dog, or cat). We will also consider the JPS procedure (juvenile pubic symphysiodesis) in 16-20 week old puppies.
Fracture Repair in Cary, NC
Fractures occur when your pet has had some type of trauma, whether it be a fall from the bed at night or being hit by a car on the street. Fracture repair combines the art and science of orthopedics. Each bone has a different mode of bearing weight, and these fracture forces are what surgeons study to determine the best type of repair. Bone fractures are like puzzles in a way, as we need “to put the pieces back together” in a manner that allows the body to heal over time (2-5 months!). Surgeons utilize many types of surgical-grade implants to stabilize fractures. The best repair of a fracture may require pins (positive or negative threaded), plates and screws (stainless steel, titanium), external fixators, composite rods, ring fixators, synthetic bone graft products, and the list goes on. This requires a large implant and equipment inventory, especially when considering we repair broken bones on breeds ranging from teacup poodles to English Mastiffs!
Elbow Dysplasia (FCP, OCD, UAP) in Cary, NC
Elbow dysplasia is a general term for the genetic abnormalities which affect the canine elbow. It includes the more discrete problems we recognize, such as fragmented coronoid processes (FCP), osteochondrosis dissecans (OCD), and ununited anconeal processes (UAP). The term is also used to describe elbow incongruity, asynchronous growth of the bones which articulate in the elbow, and radial head subluxation. These problems result in lameness in the forelimb (front leg, analogous to the human arm).
Pet Cruciate Ligament Surgery (TPLO, TTA, FHT, TightRope, Extracapsular)
in Cary, NC
The human anterior cruciate ligament (ACL) is analogous to the canine and feline cranial cruciate ligament (CCL). Once torn, the CCL will generally degrade and become nonfunctional over time, resulting in knee instability and arthritis. This results in pelvic limb (back leg) lameness. Various surgeries can be done to passively or dynamically stabilize the knee with this injury. At Quartet, we believe that the tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) procedures generally achieve the best and most consistent results in dogs. However, we are trained in and do perform other procedures for this injury (fibular head transposition, extracapsular stabilization), though on a selective basis. We infrequently recommend the extracapsular “fishing line” stabilization technique, as its results tend to be inconsistent. We rarely recommend the Tightrope technique, as its mode of failure is similar to the ‘fishing line’ technique but at a higher cost. In fact, our most common ‘revision’ knee surgery is for those dogs that have had a prior TightRope procedure at other facilities.
Pet Arthroscopy in Cary, NC
Pet arthroscopy is a minimally invasive surgical procedure used to visualize, diagnose, and treat problems inside a joint. This procedure is performed using a small camera called an arthroscope, which is inserted into the joint through a small incision. Pet arthroscopy can be used to treat a wide variety of conditions, including joint inflammation, tissue damage, and arthritis. In addition, this procedure can also be used to remove foreign bodies, such as pieces of bone or cartilage. Pet arthroscopy is safe and effective, and most pets recover quickly from the procedure with minimal discomfort. If your pet is experiencing joint pain or other problems, talk to your veterinarian about whether pet arthroscopy may be right for them.