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.

Pyometra, a very good reason to spay your bitch…

Pyometra uterus removed from boxer dog in emergency surgery

Today’s Diary Entry is sponsored by Eickemeyer

Normally I avoid graphic images here, however sometimes a picture is worth a thousand words, which is why I do not feel too bad about the photo on the right here. This is pyometra, a uterus full of pus that was removed from a dog, on the left you can see where it has ruptured and the pus is leaking out – this luckily happened after it was removed simply when we tried to move it to take the photo… If this had ruptured inside the abdomen it would have been very bad indeed.

So how did we get here? Well the 30 minutes before closing stampede happened again today, 5 patients arrived this time however unlike Christmas day which was completely crazy with just me and 1 vet there were 2 vets today.

One of the patients presented with discharge from the vagina, and abnormal findings on the palpation of the abdomen. Now this generally suggests pyometra, however we took her to ultrasound to confirm, and seeing the ultrasound image which showed the massive loops of uterus we knew the only hope for saving this dog was going be surgical.

Being an old dog, of a certain breed, and with heart problems the anaesthesia was going be very high risk. This dog had also had previous abdominal surgery for a caesarean section so it was also expected that there would be serious adhesions (where organs stick together) around the uterus. Now at this point in time we were struggling to get another doctor in, so with the 3 of us here, I was elected to assist in the surgery, I wasn’t entirely happy with this with so little experience for such a delicate operation but needs must and it was best chance for dog.

So starting prep, we get a call back from one of the other doctors that was able to come in for the surgery so I move to doing the anaesthesia. This scared me as I am just getting comfortable with running anaesthesia on healthy low-risk patients and this patient was nowhere near low-risk. At this point I was not sure what was worse doing the anaesthesia or assisting in the surgery.

Because of the high risk here I actually brought the emergency drugs with me into the operating room instead of leaving them in the prep room where they are normally kept. This was a little comfort as if I needed to I could do something, but still it didn’t make me entirely happy. Then trying to get the monitor working failed so I ended up with just pulse-ox and temperature to work with. However being abdominal surgery I could get access to the chest to listen to the heart, and actually monitor the heart rate manually.

I was just waiting for the surgery to be over so I could start waking the patient up, all my attention was on the anaesthesia however when the first uterine horn was lifted out and was the size of an salami we knew we had been right to do the surgery. The second uterine horn however had major adhesions, and when this was lifted out I was glad that I wasn’t assisting in the surgery. It was connected to the intestines and the bladder so was some very delicate work that took the attention of both doctors to remove.

Once the uterus was out the abdomen was closed, this was done with intradermal sutures so that there were no visible stitches for the dog to remove. It actually looked almost as if there had been no surgery, and then the extra doctor left and I was into recovery mode moving the patient from theatre to recovery and then starting the process of waking them up. I am not entirely sure why but recovery was very fast – I’m thinking this could be to do with the length of anaesthesia as usually procedures here are orthopaedic and very long so long recovery?

An hour later the dog walked out alive, and without the pyometra… Now when vets say pyometra is a very high risk in older bitches it really is, however vets are not always great at communicating just what a pyometra means. Hopefully as nasty as it is, this photo has giving you a very good reason to spay. This entire event (including my extra gray hairs) could all have been avoided by simply spaying the bitch when she was younger, and healthier.

EDIT: Saw patient for check up today and is doing very well, alert, urinating/defecating and walking with no signs of pain.