We decide what labs may be needed for certain patients based on age, physical exam, and if they're having any symptoms. For instance, if I have an overweight middle-aged lab that we're having trouble getting some weight off, I'm probably going to have a blood test that includes a thyroid test. Our thyroid has a lot to do with our metabolism, and unfortunately, labs commonly get hypothyroidism or low thyroid, and that can have an effect on their metabolism. It's really going to be based on what I find in my exam. On the other hand, cats go the absolute opposite direction as they get hyperthyroid so their metabolism ramps up, and then all of a sudden, these cats are eating everything in sight and dropping weight like crazy. So if I have an older cat that's doing that, we're also going to check their thyroid and I'll be surprised if we don't see an elevated thyroid. It's based on the physical exam and on talking with the owners about what the symptoms or the clinical signs are, but we tailor each individual lab profile according to what is appropriate for that patient.

Even if we don't have a definitive answer after all these tests, we would have ruled out a long list of diseases. We have to be able to sit here and clinically look at the diagnostics you have done, what the patient is doing, and build a list of things that maybe aren't so common. We may have to do additional testing to get there. If we reach a point where we've exhausted all testing resources here, we may consider a referral to internal medicine or surgery. We may also consider more sensitive testing that we can't do here. It can be frustrating not to have all the answers right away, but please know that we are persistent and will work as a team to figure out what's going on with your pet.

Diagnostic imaging helps us narrow down the causes of symptoms. There are instances where it provides a clear answer, like if a dog has eaten a toy or if a cat is urinating blood due to bladder stones. In some of our more sad cases, if an older large breed dog comes in limping, it could just be arthritis, but maybe it's not. We have to look for bone cancer, and x-rays are very sensitive for bone cancer. It's very diagnostic, especially if it's farther along in the course of disease. If I don't catch it, then the radiologist will. The same goes with ultrasound. If your dog or cat is vomiting, has abdominal pain, lethargy, and is hiding and not wanting to eat, we do an ultrasound. If the pancreas is mad, you're going to see it. A pancreas that's normal, you're not usually going to see on an ultrasound. When the pancreas is mad, we see it. When the liver is upset, we can see it. If there's a tumor in the spleen, we see that on an ultrasound. We get very definitive answers.

The process will depend on the type of imaging we're doing and the dog's condition. Most sessions are done without sedation or anesthesia and usually take less than an hour, especially for X-rays. If we're not statting the X-rays, we usually have results back in a day or two. The actual procedure itself is typically done in less than an hour, often within half an hour.

It really depends on the situation. Most of the time, we have our blood work done before our diagnostic imaging. For instance, if your dog has elevated liver values, we would want to look into this via an ultrasound. In our practice, we focus on preventative medicine and annual blood work, allowing us to catch a lot of problems before they become symptomatic. There are cases, however, where a patient comes in feeling sick, in which instance we might have diagnostic imaging going at the same time that our blood work is going. This helps us get a better clinical picture of what's happening and to narrow down the possible causes, leading to a more targeted treatment plan. With dogs and cats coming in for vomiting or diarrhea, the list of possibilities is pages. Because you can think about it, every abdominal organ that could be having problems can cause these symptoms. So we have to very quickly narrow the field down so we can have a targeted treatment plan to figure out how we can address this.

Is it the liver that's having problems? Then we're going to do liver medication and possible hospitalization. There's a lot that goes into it, but these diagnostics are there to help us narrow the field. If I'm looking at a dog that comes in for vomiting and diarrhea and I don't have any imaging or lab work, I have to just treat it symptomatically, and that's not always the best because what if the liver is failing, and we're just addressing tummy upset but we don't address the liver disease. If an older patient vomits and doesn't feel well, the owner doesn't want to or maybe can't afford diagnostic imaging, and we treat it symptomatically, what if that patient has a big cancer tumor in its abdomen. We would have made a completely different decision on what to do and what steps to take if we'd had that imaging.

The duration of anesthesia varies depending on the procedure. Neuters might not take as long while spays are more lengthy and invasive procedures. Dentals depend on the grade and the amount of dental work that has to be done. The specifics can be asked prior to having your cat set up for anesthesia.

Pain control in cats is taken seriously as cats are good at hiding their pain. The premeds include ketamine for pain-blocking effects. Before placing the breathing tube, they get an injection of Cerenia for anti-nausea and anti-inflammatory effects. They might also get an injection of Onsior, an anti-inflammatory that lasts for 24 hours. Local blocks are used to control pain from the skin and muscle layer. Once in recovery, they get an injection of buprenorphine for pain control given either under the skin, lasting 24 hours, or by IV, lasting about six to eight hours, depending on which type of buprenorphine you give.

The same monitoring used during human anesthesia is used for cats. This includes checking blood pressure, EKG, oxygen levels with the pulse ox, CO2 levels in the blood, temperatures, jaw tone, respiratory rate, and heart rate. A veterinary technician is assigned to monitor the pet while it's under anesthesia.

Yes, they will. You do need to be a current client with Four Paws at Fulshear because you need a doctor-patient relationship prior to getting a treatment plan for surgery. That is required by Texas state law. By having an exam, I can catch any possible health issues that your cat may have prior to anesthesia. That way we can tailor anesthetic procedures for them.