An Interview with Dr. Phil Zeltzman
Dr. Phil Zeltzman is board-certified by the American College of Veterinary Surgeons (AVCS) and works at Valley Central Veterinary Referral Center, a specialty clinic in Whitehall, Pennsylvania, one hour North of Philadelphia. GoodNewsforPets publisher Lea-Ann Germinder recently interviewed Dr. Zeltzman as part of our series to promote experts in the field of veterinary medicine.
1. You wanted to be a veterinarian since the age of five. What made you want to be a veterinary surgeon?
I love the variety, and the fact that we fix sick and broken patients!
For example today, we did three abdominal surgeries (on two Akitas and one kitten), removed a slipped disc from a paralyzed mixed Retriever, took off a huge cancerous tumor from a Golden Retriever's forearm, fixed a nasty elbow fracture in a Cocker Spaniel and did a fancy surgery (in short, a TPLO) on a German Shepherd's knee.
That's what I call a great day: we did orthopedic, soft tissue, cancer and neuro-surgery. All in one day's work.
2. What does it mean to be a board-certified veterinary surgeon?
After eight years of veterinary school, you need to do a one year internship, followed by a three year surgery residency. After taking care of a few other requirements, such as publishing a research project, you can sit for "boards," a difficult, three-part exam. Once you pass, the veterinarian earns the title of Diplomate of the American College of Veterinary Surgeons (ACVS), a.k.a board-certified veterinary surgeon.
3. What differences do you find between cats and dogs regarding their reaction to pain?
Both cats and dogs are typically remarkably tolerant. I always say that they are much better patients than humans! A big difference is how they display (or hide) pain, which sometimes makes it difficult for veterinarians to determine if they are painful.
Pets are very good at hiding their pain, -an instinct from the Wild, where the sick and weak don't survive long. Crying does not always mean physical pain, as you can tell after leaving a puppy in a room alone: she may scream like she is being strangled, but she is not really in physical pain.
That said, dogs tend to be more vocal than cats. Dogs may vocalize (crying, screaming, whining), whereas cats may just sit still in a corner. Dogs may pant when they are in pain, even though it is not hot. Both cats and dogs can have an unusual posture: hunched back; sitting, resting or laying abnormally; head or tail hanging down. Some signs are obvious: shivering, inappropriate or difficult urination or defecation, limping, shaking, difficulty getting up (often mistakenly attributed to arthritis), facial expression (glazed eyes, fixed stare). Other signs are more subtle: difficulty grooming, lack of appetite, licking a wound or a surgical incision.
As a general rule, we can assume that a pet who is limping, or has a wound or a tumor, is in pain. Pain can also result from common conditions like dental disease or a bite wound, diseases like pancreatitis or arthritis, or any type of surgery. This pain should be recognized and treated.
Pain is very subjective and notoriously difficult to assess. It depends on the individual, the breed, the age... a common misconception is that a purring cat is a happy cat: we routinely see cats who purr despite a broken bone!
In addition, evaluating pain is subjective. Different people may rate a specific pet's pain differently... not a small issue in daily practice.
4. You also perform surgery on "exotic animals." What is the most unique case you have encountered?
I have been fortunate to work on wild and domesticated "exotic" animals. One of my biggest challenges was a fracture of the leg of a chinchilla. That bone was smaller than a match! I also remember amputating the damaged tail of a coyote, stitching up wounds on some fawns, and doing surgery on the colon of a pot bellied pig. Lately, we repaired the broken wing of a 20 year old macaw from our local zoo. The most unique case was probably helping with the removal of part of the lower jaw of a bear (a sun bear) because of a cancerous tumor.
5. One procedure that you work with, called the Tibial Plateau Leveling Osteotomy (TPLO), involves the anterior cruciate ligament (ACL). What is the ACL and what are the warning signs that there may be a problem? Is there a way to prevent stress on this ligament?
The ACL is an important ligament that connects the thigh bone (femur) and the shin bone (tibia). When it tears, dogs (and occasionally cats) limp or hold the leg up because they are in pain. There are many different surgeries to address the problem, including TPLO.
Most of the time, we do not know precisely what causes the tear, so it is difficult to prevent it. It is a partially genetic condition, so better breeding should help. Also, keeping dogs thin should definitely help, as being overweight or obese is a well-known cause of ACL problems.
6. You are interested in all aspects of soft tissue, orthopedic, cancer, reconstructive and neuro-surgery, as well as emergency cases. Have you recently had a challenging case that you could share?
Yes, many! We just treated Moby, an 11year old mixed Labrador Retriever who became suddenly paralyzed in the hind legs. He presented at the end of our day, on a Friday afternoon, dropped off by his care taker. His owner lives in China, after being expatriated by her employer.
Moby was losing a very important function called "deep pain," which makes the difference between success and failure. Once deep pain is gone, the chances of walking again decrease drastically. Time is of the essence.
After reaching the owner, despite a 12 hour time difference, we performed an emergency MRI at our local imaging center (AnimalScan in Easton, PA). Around midnight, I faced a cruel dilemma: do I get some rest and do surgery in the morning? Can I take a chance and let Moby lose deep pain?
I decided to do surgery that night. We finished surgery around 2 a.m. Against all odds, Moby started moving his back legs that morning, and was walking 24 hours later!
That made all of our efforts worthwhile.
7. What are the most common procedures that you perform?
Many of the procedures we've already discussed are common: ACL surgery, dislocated knee caps, fracture repair, slipped discs in the back or the neck, belly surgery, skin masses, and many more!
8. Are there any signs that pet owners can be aware of that indicate their pet is in pain or ill?
Pet owners know their pets well. Anything unusual should be a warning sign. For example, some dogs commonly skip a meal. For others, they'd have to be very sick to miss a single meal.
If a cat takes every opportunity to be on your lap while you are watching TV, and suddenly spends a lot of time hiding in a closet, that should be a warning sign.
When in doubt, take your pet to your veterinarian. If nothing is found, then it's wonderful news. However, if a problem is found, then we can deal with it and help the pet sooner rather than later. Sometimes, later is too late.
9. Do you find that there are specific illnesses often resulting in surgery that could be prevented with regular check-ups or preventive care?
Absolutely! Being overweight or obese leads to many conditions. We talked about ACL tears, but being or becoming thin helps patients with hip dysplasia and a number of other orthopedic and spinal diseases.
"Bloat" is a serious condition, typically in large dogs, that can combine bloating and twisting of the stomach. Well, there is a preventive surgery that can be performed to avoid the twisting part, therefore saving lives. The two Akitas I mentioned earlier, a male and a female, had exactly that procedure performed!
Many pet owners think it's important to go to the veterinarian to get yearly vaccines. Even though I don't give routine vaccines because I am a specialist, I think that it's only part of the reason to go. It's also critical to have a thorough physical exam and blood work once or twice a year.
A classic example is when a mass is found under the skin, in an anal gland or in the spleen on "routine" physical exam. It should make sense that it is better to discover and treat these problems early on.
10. Are there any upcoming advances in animal surgery that you are excited about?
Our patients constantly benefit from advances in surgery. Every time I go to a surgery meeting, every time I read a veterinary journal, I learn about a new procedure, or find information to improve an older technique. In the recent past, we have progressed greatly in the field of pain management, nutrition, antibiotic therapy and cancer treatment.
11. You have your own newsletter. How did you get started writing it?
Initially, I thought it would be a free, confidential, publicity-free newsletter, written as a thank-you to my clients for their trust. I have learned everything I know from my professors and mentors, so it was a way for me to give back, to "pay it forward." Through word-of-mouth, pet lovers started subscribing all over the country and abroad. People tell other pet lovers via email, veterinarians and veterinary technicians tell their clients during a consultation or in their own newsletter... People mention my web site and newsletter on their web site… It spread like a wildfire.
The result? My little newsletter is now read in all 50 States (and Washington DC) and 17 foreign countries! A recent trend is that breed group members become informed of the newsletter and start subscribing. Among other breeds, we have quite a few owners of Cavalier King Charles, Maltese, Cockers, Mastiffs etc. And there are many cat owners as well.
So now I have a huge responsibility!
12. What topics do you focus on in your newsletter?
So many topics, so little time... Veterinary surgery, dangers pets face, specific diseases like cancer, obesity and arthritis. Pets are a never-ending source of inspiration. We also have "special issues," for example dedicated to cats or large dogs, or how to afford quality pet care, or puppy mills. Every few weeks, I also interview a colleague, so that subscribers don't only read information from a surgeon. We recently welcomed a cancer specialist, an internist, a behaviorist and a Search and Rescue expert.
13. Can pet owners find the topics that you discussed in this interview in your newsletter?
Sure, and much more! Your readers can subscribe to the (free) newsletter by going to my web site, www.DrPhilZeltzman.com. It is very quick and easy to subscribe. Did I mention it's free?
14. What topics do you have in store in the next few weeks?
We have a few issues dedicated to cats, to dangers pets face in the Summer time and to "bloat," a deadly condition. We will also have an interview with an oncologist (a cancer veterinarian) who specializes in end-of-life care, a fascinating and emerging concept in veterinary medicine. It sounds sad, but it's a message of hope for owners of sick pets.