Admissions Form

When your pet is discharged, your pet may not be fully alert! Dr. DeForge never discharges any patient unless it is safe to do so! Recovery time cannot be assumed. It can be up to 24 hours in some patients. Monitor well! In dogs leash walk; do not leave outside unattended; and avoid stairs without direct supervision. Do not allow to hide under beds or furniture. Cats should be kept in a large carrier or in a small room until fully recovered. Ask a nurse what can be fed upon returning home.

Normal Findings at home DURING awakening can be: Shaking, shivering, whining, trembling, vocalizing in dogs, meowing in cats, hyper-excitement, or lethargy. This has been described in humans as, emergence delirium! In babies, the reaction rate is between 2% to 80% after the introduction of medicines for anesthesia or sedation! The findings listed above may or may not happen.

Do not leave your pet alone and especially during the summer months AVOID hot rooms without adequate ventilation or air conditioning. Do not allow strong play, jumping on and off of furniture, or running around on slippery floors. If you are concerned with your pet’s recovery and Dr. DeForge is not available, please contact your nearest 24/7 ER Center. Patient comfort and a quality of life without pain is our mission! *A copy of these instructions is available upon request.

Sedation-Tranquilization-Anesthesia Release

Dr. DeForge is a member of the International Veterinary Academy of Pain Management. He feels it is paramount that no patient be in pain during any procedure, diagnostic test, treatment, or surgical intervention. He has committed over three decades to the concern of all patients for a quality of life and a pain-free existence. Expediency should not replace sedation and pain control to prevent any discomfort.

By signing below, you give permission for Dr. DeForge to perform sedation-tranquilization-analgesia-and/or anesthesia for the necessary care of your special friend. Also, by signing below, you give permission for this care with the understanding that the reaction to any sedative, tranquilizer, analgesic, and or anesthetic is patient-specific. You assume with informed consent responsibility for the injectables and/or gas inhalants below and cannot hold Dr. DeForge and/or the other doctor[s] at Silver Sands Veterinary responsible for any adverse reaction if it occurs.

You also realize that the patient when discharged may not be one hundred percent awake from the sedation. You must monitor at home to be sure that the patient does not fall or hurt itself on stairs, slippery floors, jumping, or practicing any play pattern or activity that is not recommended, by the doctor, during recovery. Recovery time cannot be assumed. It is different in each patient. Full reversal is not seen for 24 hours in many patients. Reversal agents are not given unless the doctor feels it is necessary. Some agents do not have reversal agents. In most instances, reversal agents are not recommended because the pain control of the agent used will be modified. Common sense must prevail leash walk, no food can be given after midnight the night before surgery, water can be given up to admission. Do not leave home unattended or allow playing with other pets while reflexes are poor. [up to 24 hours] If you have questions, always feel free to call Dr. DeForge. If Dr. DeForge is not available call the nearest ER Center. Patient comfort, quality of life, and a pain-free life are the three most important concerns at Silver Sands Veterinary. Procedure:

Injectables Utilized: Ketamine/Midazolam

Anesthesia Used: Isoflurane

IMPORTANT FASTING INSTRUCTIONS

PRIOR TO THE USAGE OF ANESTHESIA FOR DIAGNOSTICS, TESTING, AND OR PROCEDURES

If you are on any prescription medicines, you must notify Dr. DeForge prior to scheduling anesthesia. If your pet is having surgery, NO Aspirin of any strength* or NSAID’s for one week prior to surgery.* Aspirin should never be used in canines or felines without directive and prescription by a licensed veterinarian or specialist. Severe life threatening conditions can occur with indiscriminate usage of Aspirin in Companion Animals. You have been informed of this by telephone or in person, please sign before if the checklist is completed.

The Day before surgery/anesthesia a Liquid Diet Only:

• Baby food
• Yogurt
• Clear Broth
• Fruit Juices
• Jello
• Ensure Pediatric
• Liquid Food Supplement

Give 3-4 small meals of any of the above the day before anesthesia! Very Important 12 hours before surgery! No food may be given after midnight the night before surgery. Water may be given up to admission.

• No food 12 hours or water 6 hours prior to anesthesia!

If you pet has any medical condition that requires frequent water intake discuss this with Dr. DeForge prior to scheduling anesthesia.

Patient and Client Bill of Rights

In recognition of our responsibility in rendering patient care, these rights are affirmed in the policies and procedures of Donald H. DeForge, VMD, LLC and all professional and para-professional staff at Silver Sands Veterinary; The Centers for Oral Care; and New England and New York Referral and Mobile Dentistry.

• To be treated with respect and dignity and consideration in all phases of examination, diagnostics, treatment, and care.
• To be provided complete and appropriate assessment and management of pain
• To be certain that each patient is cleared for anesthesia with the appropriate pre-anesthetic testing and Letters of Clearance for Anesthesia from the referring veterinarian or specialist performing such pre-anesthetic scrutiny.
• To provide access for all patients to after hours 24/7 care. SSVC is an Urgent Care Center but is not a 24/7 Care Center. We can direct you to options for 24/7 care if needed after treatment and or surgery at SSVC.
• To provided written estimates for all services realizing that an estimate is not a completed fee structure. It is impossible to give exact fees until after the patient’s procedure is completed and/or discharged from our Center if hospitalization is needed.
• To receive from the doctor information necessary to give Informed Consent prior to the start of any procedure and/or treatment or after a phone consultation during the procedure. Such information for Informed Consent will include the specific treatment and or procedure, significant medical risks involved, and the probable duration of incapacitation [i.e. recovery]. Where significant options or alternatives for medical care or treatment exist, or when the client requests information concerning medical alternatives, the client has the right to such information and the consequences of not complying with recommended therapy. The patient shall be given a Curriculum Vitae of Dr. DeForge prior to initiating the treatment or procedure[s] to have a better understanding of background, knowledge, and commitment to animal care.
• To have the right to change primary doctor to seek another opinion at any time requires exchange of medical information. This could take 3-7 business days to complete depending on the content for records for review and transmission.

Elizabethan Collar-E-Collar-Release

The Elizabethan Collar is essential to your pet’s recovery from surgery. It will be difficult for the first few days after the collar is applied. You must realize that the anxiety you are experiencing in watching your pet adjust to its E-Collar is far worse than the discomfort the E-Collar causes the patient.

Many times you have to use a giant breed dog crate and confine your pet until the E-Collar becomes comfortable. Be careful around stairs because of depth perception difficulty when the collar is worn. Carefully carry or help your pet go up and down stairs on a short leash when wearing an E-Collar.

Reward your pet after the pet begins to accept the collar. Talk to your pet and let your pet know that the collar is not a punishment but a system of health care to assure complete and proper healing. Keep the E-Collar clean and be sure to wash the face after eating. Elevate the food and water bowl about 12 inches from the floor so that your pet can easily maneuver to eat and drink.

Be sure the head collar reaches to at least 2” past the bridge of the nose when the patient is standing. If it resets low on the neck, it will become functionless. Removing the head collar before instructed to do so will only lead to terrible consequences in healing. There can be delayed healing or complete disruption of the surgery site leading to further surgery. Also, an infection can occur at the surgical site; the head; the neck; and the face if the collar is removed and the patient paws at the face. The infection that is caused by the patient many times is very difficult to treat.

If you remove the head collar prior to the time recommended by Dr. DeForge, you will be fully responsible for added care including re-checks, re-exams, additional medicines, injectables, and even further anesthesia and surgery. By signing this release, I fully understand the purpose of the E-Collar and I also understand that I am fully liable for all complications that can occur by removing it without Dr. DeForge’s consent. If your pet does not adapt to the E-Collar after one week, consult with Dr. DeForge if you wish anti-anxiety medicine. Most patients do not need this medicine but it is an option if needed.

American College of Veterinary Anesthesia [ACVA] Monitoring Guidelines

Dr. DeForge follows the ACVA Guidelinesfor Monitoring anesthetized veterinary patients

Position Statement

The ACVA recognizes that it is possible to adequately monitor and manage anesthetized patients without specialized equipment and that some of these modalities may be impractical in certain clinical settings. Furthermore, the ACVA does not suggest that using any or all the modalities will ensure any specific patient outcome, or that failure to use them will result in poor outcome.However, as the standard of veterinary care advances and client expectations expand, revised guidelines are necessary to reflect the importance of vigilant monitoring. The goal of the ACVA guidelines is to improve the level of anesthesia care for veterinary patients. Frequent and continuous monitoring and recording of vital signs in the peri-anesthetic period by trained personnel and the intelligent use of various monitors are requirements for advancing the quality of anesthesia care of veterinary patients.

Circulation

Objective: to ensure adequate circulatory function.

Methods:1)Palpation of peripheral pulse to determine rate, rhythm and quality, and evaluation of mucous membrane (MM) color and capillary refill time (CRT).

2)Auscultation of heart beat (stethoscope; esophageal stethoscope or other audible heart monitor). Continuous (audible heart or pulse monitor) or intermittent monitoring of the heart rate and rhythm.

3)Pulse oximetry to determine the % hemoglobin saturation.

4)Electrocardiogram (ECG) continuous display for detection of arrhythmias.

5)Blood pressure:a.Non-invasive (indirect): oscillometric method: Doppler ultrasonic flow detectorb.Invasive (direct): arterial catheter connected to an aneroid manometer or to a transducer and oscilloscope.

Recommendations: Continuous awareness of heart rate and rhythm during anesthesia, along with gross assessment of peripheral perfusion (pulse quality, mm color and CRT) are mandatory. Arterial blood pressure and ECG should also be monitored. There may be some situations where these may be temporarily impractical, e.g. movement of an anesthetized patient to a different area of the hospital.

Oxygenation

Temperature

Objective: to ensure that patients do not encounter serious deviations from normal body temperature.

Methods:(1) Rectal thermometer for intermittent measurement.

(2) Rectal or esophageal temperature probe for continuous measurement.

Recommendations: Temperature should be measured periodically during anesthesia and recovery and if possible checked withina few hours after return to the wards.

Record Keeping

Objectives:(1) To maintain a legal record of significant events related to the anesthetic period.

(2) To enhance recognition of significant trends or unusual values for physiologic parameters and allow assessment of the response to intervention.

Recovery Period

Objective: to ensure a safe and comfortable recovery from anesthesia.

Methods:(1) Observation of respiratory pattern.

(2) Observation of mucous membrane color and CRT.

(3) Palpation of pulse rate and quality.

(4) Measurement of body temperature, with appropriate warming or cooling methods applied if indicated.

(5) Observation of any behavior that indicates pain, with appropriate pharmaceutical intervention as necessary.

(6) Other measurements as indicated by patient’s medical status, e.g. blood glucose, pulse oximetry, PCV, TP, blood gases, etc.

Recommendations: Monitoring in recovery should include at the minimumevaluation of pulse rate and quality, mucous membrane color, respiratory pattern, signs of pain, and temperature.

Personnel

Objective: to ensure that a responsible individual is aware of the patient's status at all times during anesthesia and recovery, and is prepared either to intervene when indicated, or to alert the veterinarian in charge about changes in the patient's condition.

Recommendations:(1) Ideally, a veterinarian, technician, or other responsible person should remain with the patient continuously and be dedicated to that patient only

(2) If this is not possible, a reliable and knowledgeable person should check the patient's status on a regular basis (at least every 5 minutes) during anesthesia and recovery

(3) A responsible person may be present in the same room, although not necessarily solely occupied with the anesthetized patient (for instance, the surgeon may also be responsible for overseeing anesthesia)

(4) In either of (2) or (3) above, audible heart and respiratory monitors must be available.

(5) A responsible person, solely dedicated to managing and caring for the anesthetized patient during anesthesia, remains with the patient continuously until the end of the anesthetic period.

Comments from the Desk of Dr. DeForge

Whether human or animal, it must be understood that risk is present with all formsof anesthesia. Dr. DeForge only utilizes General Inhalation Anesthesia which is the safest of all anesthesia systems. Dr. DeForge will not proceed with General Inhalation Anesthesia without Clearance for Anesthesia with a detailed Physical Examination and Pre-Anesthesia Testing by himself; by the referring veterinarian [i.e. your personal veterinarian]; or by Internal Medicine and Cardiology in patients with advanced cardiopulmonary problems.You are encouraged to seek the counsel of Internal Medicine and Cardiology in patients with heart murmurs; abnormal Electrocardiograms; abnormal chest X-rays; or those pets exhibiting coughing or exercise intolerance at home.

By signing below, I realize that all exams; and pre-anesthesia diagnostics; and procedures have been performed by either Dr. DeForge; your referring general practice doctor; and/or a veterinary specialist at your request.I have been advised of the natures of these tests and procedures and the potential risks and benefits for the usage of anesthesia. I, also, fully understand that veterinary medicine and dentistry is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. All precautions will be taken for a safe anesthesia journey.

Dr. DeForge wants you to, completely, understand that anesthesia complications can occur which he may not be able to reverse leading to loss of life. Scheduling general or orthopedic surgery for your pet can be a scary proposition. Every procedure carries some measure of risk, so it’s tough to think about your loved ones under anesthesia. But before you panic, let Dr. DeForge know your concerns. Don’t let horror stories prevent your pet from receiving necessary veterinarycare.Without this care, a pet can live in pain with a poor quality of life. Complications do occur, but deaths are rare. Studies suggest that for normal, healthy dogs and cats, the risk of death is very low. A well-trained veterinary team will take every reasonable precaution —including having a knowledgeable staff, appropriate patient monitoring procedures, and proper patient evaluation and preparation —to minimize these risks.

Before signing this Anesthesia Consent Form, Dr. DeForge wants to make sure that you are fully informed; well educated about anesthesia; and fully knowledgeable about all efforts that he undertakes to have a safe anesthesia journey. If you are not comfortable, do not proceed. If you understand Dr. DeForge’s commitment to safety in anesthesia and the risks involved-please sign below...A Consent for the Usage of General Inhalation Anesthesia in my pet.