Why do I need to cut? (Day –281)

Vet Student Operating

I enjoy surgery so much that it is almost a love, I find it so rewarding to be able to anesthetise an animal, and whilst it is sleeping fix it or stop the pain. For me it has been obvious for a while that my path will follow that of surgery, I’ve seen as much practice as I could with a focus on surgery. And I have spent every spare hour I have within the surgery department here.

Surgery is a massive thrill, the adrenaline rush of scrubbing in and picking up a scalpel is something that I am told will never vanish. And I love this. It makes me happy doing surgery, and it makes me feel fulfilled when the dog or cat or rabbit wakes up after surgery fixed. Well sometimes it is not so simple and there is a period of rehabilitation however every single day from the surgery the poor animal is getting better.

As I get better at surgery, my understanding and experience is deepening. Where before I looked for every opportunity to cut as a chance to do what I love and take the animal to surgery I am now not so fast to want this.

I was speaking about this with one of doctors the other day who told me that many years ago he was told that the art of surgery was not doing surgery, but knowing when to do surgery.

Something that has always bothered me is that sometimes surgery is simply to fix problems caused by humans. This came to a head for me on the Ophthalmology conference weekend when Professor Ron Ofri spoke about a surgeon walking out of surgery holding up a piece of skin he removed from a dogs forehead that stretched to the floor.

I asked the question – should we as vets be performing such surgery without requiring the castration or spaying of the animal at the same time? When a breeder has a litter of puppies that all require a visit to the ophthalmologist and surgery before they are a month old? Is this ok?

It’s not just the eyes though, another common surgery is for BOAS – Brachycephalic Obstructed Airway Syndrome – where part of the soft palate is cut away because it is too long and is stopping the dog from breathing properly. Often this is combined with plastic surgery to widen the nostrils which are too narrow.

Then there are dogs that have been bred so badly that they cannot give birth naturally. They can only be born by caesarean section.

Many years ago I read a book by a surgeon from America asked to present at a UK conference on castration implants in dogs – the press thought it was about plastic surgery and filled the entire room. And the surgeon lectured about the use of “implants” to replace the testicles removed during castration – he passed around some samples and one of the attendees mentioned how lifelike they felt to be told that the ones they had were the human version…

The outcry was because vets are not allowed to carry out cosmetic procedures on animals – this is why tail docking, ear clipping etc are all outlawed as cruel because they are cosmetic. Yet now the two cases above that I mentioned are commonly happening the press is silent.

Emma Milne recently did an amazing job of raising the issue of brachycephalic dogs such as pugs that cannot breathe properly as a welfare concern which got some media attention. Pedigree dogs exposed covered some of the crazy welfare issues. And yet at crufts a unhealthy German Shepherd was allowed to win.

I can cut, however the question will be whether ethically and morally I should cut. I believe if the deformity is so great as to require surgery than that animal should not be bred from. If by surgery I can relieve pain or suffering from the animal then it may be justified – however I believe that in this case the animal should be castrated or spayed before or at the same time.

My first ever castration on a cat…

Vet student in surgery

Yesterday morning I picked up the scalpel blade, tensed the skin and made my first cut into the scrotum of a cat… or at least that was my intention. Not enough pressure on the brand new scalpel blade and the skin remained pretty intact. It was my first time performing any surgery on a cat; sure I’ve assisted a lot, but actually taking the role of the surgeon and performing a procedure alone… This was my first time making the skin incision. I knew what I was doing, yet the skin was a lot tougher than I expected.

Yet it is not just about me here, it is about the patient on the table who I am operating on. This cat never asked for the surgery, that was the decision of the owners looking out for the cats best interest. With male cats castration reduces roaming, fighting and urine spraying (marking) in over 90% of cats neutered. With the number of cats that I’ve seen over the past few months with infected abscesses from fighting being able to reduce the likelihood of this to me is a good thing. Plus urine marking is not something us humans appreciate, so removing this behaviour means happier humans and less stress in the home.

Now the actual surgical procedure is one of the simplest in veterinary medicine, a small incision into the skin of the scrotum, opening the sack containing the testicles. Ligation (tying) of the blood vessels and spermatic cord and then cutting these to remove the testicle. The second testicle is then taken through the middle inside wall of the scrotum so there is only one incision through the skin. The skin incision is so small it does not need to be sutured close as it will heal itself rapidly in the few days after the surgery.

So passing the scalpel blade across the skin again it parted, and I saw the sack containing the testicles which I opened with just the tip of the blade as it is really thin. I don’t want to damage the testicle as one of the most important rules in surgery is good haemostasis (aka controlling and minimizing bleeding). I am holding the testicle, and separate it from the attachment to the containing sack. I expose the cord to ligate it, placing two ligatures with several “throws” on my knot, and then pass the scalpel blade across it detaching it from the body. I am checking for bleeding to make sure my ligatures are good, there is none so that is the first testicle removed. I repeat the process for the second testicle, with a little more speed now I have finished the first, I check for bleeding and finding none let the cord retract back into the scrotum.

Surgery complete I pass into the role of anaesthetist and monitor the patients recovery until they are ready to go home…

Why price shopping for a vet is so dangerous!

Vet Price Shopping

Todays diary entry is sponsored by Pet Hair Remover

Recently I have seen a lot of posts on social media comparing the prices for things like spays and castrations for different animals. Sometimes it is really easy to fall into the trap of looking just at the procedure, for example lets talk about castration of a rabbit (I had an interesting conversation on surgical techniques here the other day)…

So prices ranged from around £40 right up to £120, whilst there is some influence on the area that the person lives and the size of practice lets look at possible reasons why there is such a big difference.

Getting new clients through the door
Some vets will use castration and spay surgeries as what is known as a loss-leader, basically they lose money as a way to attract new clients. Afterall if you have a great first experience you will likely use them regularly in future.

A package deal
It depends what else is included in the castration “package”. Some vets will include the followup appointments and any aftercare medications. Others may also include microchipping, free insurance and more to get your pet of to a great start!

Surgical Protocols
Now there is considerable variation in the type of surgery protocol between vet practices. There are different ways to anaesthetise an animal so the cost of the drugs used may vary. Sometimes a inhalation anaesthetic may be used as well which may require intubation, here in cats and rabbits there are options as to how this is done either using a endotracheal tube or a special device called a V-Gel. Then there is whether a cannula (a injection port into a blood vessel for drug and fluid administration) is placed, and if IV fluids are given. Also the way the animal is monitored may vary, it may be done manually, or the vet practice may have invested in special monitors which give more advanced notice when something is going wrong!

The Surgical Technique
There is then the surgical technique employed which is dictated by the vet performing the surgery. As I said the other day it was a interesting discussion as there are many different approaches. Sometimes there may be one or two incisions, the sac containing the testicles may or may not be opened, the incisions may be sutured, glued or even left open. Suture material is rather surprisingly expensive (especially if it is absorbable) so the surgical technique can in turn affect the pricing.

Follow up careResearch has shown that many animals can feel pain, so its important to consider surgery to be painful to animals as well. Especially with small mammals this can lead to stress and then onto major complications like gut stasis and so forth. I personally believe that any animal should be given adequate pain relief after surgery. It is also important that patients are monitored properly after the surgery as well!

There are loads of different ways to do things and no one way is the best, however it is important to dig deeper than the title next to a price in a list. Vets will be happy to explain things to you, and if you have questions you should never be scared to ask. Question how things are cheaper, and more importantly question how your pet will be looked after during the procedure!