The stress we see in our patients only contributes to the disease process. The stress response is good for you if you are being chased by a mountain lion or, perhaps, a rogue clown; your heart races to get more blood to your muscles, your airways become larger to get more oxygen into your system, your pupils dilate so you can take in more visual information. The end result is you can run faster and see better and, with a little luck thrown in the mix, outrun the venomous and razor-sharp talons of the rogue clown and pass on your DNA to the next generation.
However, if you are sitting in cage recovering from being hit by a car, the stress response can work against you, or even kill you if the meridians all align in the wrong way. That same adrenaline that courses through your system to raise your heart rate also raises the amount of oxygen that your cells consume, leaving little left over for healing. The same cortisone that your glands produce to get you through a crisis can impair healing and cause blood clots to form in some very bad places (see last week’s post on blood clots for more information).
Stress also makes animals harder to handle and more unpredictable. I have seen many patients behave in new and interesting ways when they are ill or faced with a yahoo in white labcoat coming after them with a thermometer. Pet owners are almost always shocked when their lovable lapdog becomes a snapping, snarling beast when illness or injury set in.
I am not talking here about situations where we are looking for general anesthesia, like surgery or a dental cleaning. I am talking about the routine handling of patients for relatively minor things. A bandage or cast change, small wounds that need care, or diagnostic procedures like x-rays or ultrasounds can be done quickly and safely with some sedation, but often end up being messy and dangerous power struggles with uncooperative patients.
I can’t blame them. Patients want to protect themselves, and are naturally (and understandably) resistant to having strangers like the aforementioned yahoo do things to them, especially when they don’t feel well.
In order to take some of the anxiety out of the equation and hopefully make things go a little smoother and safer for everyone involved, we often turn to sedatives to help calm them. Technically, we use the term ‘chemical restraint’, and we have several choices to select from when we are looking for a little something to calm our patients.
The sedatives of today tend to be far safer than ones used in years past, but there are still risks, as there are with with any medication. Some of them can cause low blood pressure, some of them can actually increase anxiety (just like for some people a glass of red wine makes them sleepy, while for others it causes them to strip to their Hello Kitty boxers and start belting out Ethel Merman tunes) and some can have no effect. I have rarely encountered a problem with my sedated patients, however, and some of the newer sedatives are actually reversible, meaning that an antidote can be given in case of a problem or when the procedure is over. I think in the vast majority of cases I have helped make whatever it is we are trying to accomplish go easier with less stress to the patients, my staff and myself, but I do understand that some owners are nervous.
It seems like I encounter a little resistance when I suggest that we use sedation for someone’s pet. Properly managed and monitored, doing a procedure is safer with sedation than having to try and stress out a patient, or use excessive physical restraint.
What has been your experience with sedation for your pets? Do you feel it is overused? Unsafe? Or do you think it helps take the edge off of what has the potential to be an unpleasant experience?
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