Thursday, May 29, 2014

When Desexing your pet gets Complicated

(graphic photo alert at the end of the post)

Any surgical procedure on any living creature has the potential for complications.  Yet, when it comes to some pet owners, it is one where they feel they should shop around for a price for which fits in with what they feel it is worth.  What many pet owners don't know is that in the majority of veterinary hospitals, it is usually offered at a heavily subsidised price (which very few people are grateful for).




What has brought on this discussion?  


Well, it all started with a situation in the US where a dog was desexed at a veterinary hospital, who then developed complications that night.  The owners were forced  to visit their local Emergency Clinic.  Emergency Clinics are common in the US, with local veterinary hospitals not answering their phones after hours, but referring all sick or injured pets to a fully manned "emergency only" facility.   This after hours clinic then was  unable to treat the poor dog because the owners had no funds to authorise life saving surgery.  All of the pet's signs pointed to internal bleeding, which required emergency surgery. This costs money, which the owners just didn't have.

 Part of the problem in this situation was that the patient was part of  a "promotion" where there was a discount on the desexing (20% off type scenario), and there was a debate on whether corners were cut. Vets do not cut corners, even during promotions like this, as the animal's welfare is always paramount to them. Anyway, that has always been my experience with colleagues.  However, vets who do "production line" desexings, may feel rushed due to the sheer numbers they have to get done.

We don't do desexing promotions at Russell Vale Animal Clinic , nor do we operate as a "production line", simply because I could not perform the procedure any more cheaply than I am offering now  - I have no wiggle room with respect to prices or speed.

Back to this poor American dog -  The information I have heard is that no corners were cut  with her -  it was just a sad fact that a complication occurred from her surgical procedure.

An Emergency Vet!
The owners were justifiably upset because they could not contact their vet that night for advice and help. They vowed to never have a vet they could not contact after hours.  This is going to be hard as the situation is always going to be that as emergency clinics open, vets are not going to answer their own phones.

(At Russell Vale Animal Clinic, we do our best to answer our mobile at any hour of the day or night, but sometimes, technology does fail us. We are human and we are not perfect.)

It was a very very sad situation for everyone - it  echoed through the veterinary channels....and I heard about it even in our little neck of the woods in Russell Vale (Wollongong, Australia).

How? 


Well, beauty of the internet is that things goes viral - and bad news travels fast -  but in all fairness  - it is a scenario that could've played out in any veterinary hospital, anywhere, that performs surgery on any animal -  anaesthetic and surgical complications can and do occur, and owners need to be aware of that.

It took a tragic situation to highlight this very important fact.

It doesn't matter if the surgery is "routine" or "commonplace", if it is a "desexing procedure", it is still going to be the only major surgery that the pet is ever likely to  have in its entire life.

And with  any surgery, things can go wrong.

I have had some very unusual, technically difficult desexing procedures in the past, and so I know, that each pet is unique.  It is a fool who is complacent about anaesthetics and surgery. And I am no fool.

What about the funky female desexings?

I have had a female dog with only one uterus and one ovary (the other side were just a strip of tissue) - this is called uterine unicornus and is rare.  I have had another dog whose uterine body was so long, that I had to extend my incision to three times my usual length to be able to remove the entire tract.  Then there are the fat ones - they are always difficult, as there is usually a bulb of fat around the ovary too .

We don't desex dogs when they are in season, but some vets do.  I have had situations that externally looked ok, but internally were "in season" still.  The risk of complications increases in situations like this, so  my only advice here is - don't do it!

The testicle on the left is the normal one,
and the one on the right was the
"retained" one. 

Then there are the "fun" pets - where things aren't what they appear! 


Both testicles failed to descend in this adult
dog  - through careful palpation and
skill the surgery was a success.  X marks
the spot where the scrotum sits, and where
the testicles should be sitting.
there was this one dog that looked like a girl externally, but was a "boy" internally (this dog was a hermaphrodite).  That was a very interesting conversation with the owner that day!

 At the end of the day, though,  it was going to be an "it", irrespective,  so it didn't make a big difference. Cost wise, it was the same to the owner, as it was a "female" desexing procedure (with the "twist" for free).


 I shouldn't forget to mention the cryptorchid pets (they have either 1 or none  descended testicles, with the hope that we are going to be able to find the missing one, and they are just not missing in action.

 Missing (ie the pet never had them at all) testicles can happen.  The retained testicle is half the size of the normal testicle, so it can be a challenge to find, especially as it can be located anywhere from the base of the kidney to the inguinal canal, if it is in the abdomen. Or anywhere in amongst major vessels and nerves in the inguinal region if it is between that and the scrotum.

And let us not forget the older pets with problems 


This uterus weighed 2.8 kg  and an
estimated diameter of 10 cm,  (when it should actually be
measured in grams and be the width of a normal
2B pencil. 
And then you get the older female dogs with pyometrons (pus in the uterus), who are true emergencies (the last one I did was 7 pm on a Friday night, and the uterus ruptured just after I took it out of the abdomen - one very very lucky dog).

 In this case, the uterus weighed 2.8 kg!

Or the older male dogs with testicular cancers - one testicle can be the size of a mango whilst the other the size of a cherry tomato.


Complications of the actual surgery are very rare,

but I have had dogs with suture reactions, and some have had minor haemorrhage from the skin itself (not internally, thank God).  But as a pet owner, you need to be aware that these can occur, and you  need to be prepared and budget for this.

 Complications are usually at the expense of the owner, not the vet.  When I have had surgery myself, and complications arose, I had to pay for those bills, so there is no difference in my view,  when it comes to the animal side. Of course, there is always going to be flexibility in this, but owners usually need to pay the extras.

When I first graduated, I had seen several dogs (none of my own surgeries to my knowledge), where the abdominal wound had broken down, and the intestines had fallen out (with the dog chewing on them).  Those were the days of "cat gut", but this suture is rarely used (at least, I last used it in 20 years ago, so hopefully it is rare).

 Nowadays, I hear stories of desexings done elsewhere where the skin sutures have been pulled out. Or the stitches are too tight. As we use dissolving skin sutures at Russell Vale Animal Clinic, that complication cannot occur here.


Desexing your dog or cat (or rabbit or guinea pig) is a surgery like any other surgery - it requires skill, expertise, gentle handling of tissues and awesome technique. 

It is not a procedure that doesn't have consequences, and it is definitely one in which every vet should discuss with every pet owner on whether it is right thing to do for them.  In many dogs, it may be in their best interest to delay the procedure until their are skeletally mature, and in many cats, it should be done as soon as possible.

What we always aim for here, at Russell Vale Animal Clinic, is to make recommendations that are the best for your pet, in the short and long term. 


We don't like "complicated", and we know you don't either. 


I am Dr Liz, the mad vet from Russell Vale Animal Clinic.  If you have any questions about your pet's desexing procedure or any comments let me know.  We are always happy to answer any questions.