Tag: surgery (page 1 of 3)

Spay & Neuter – A Revised Point of View

The times they are a changing.  Every now and then in the course of medicine, we get new research that guides us to change our ways of thinking and how we practice.  And we live in exciting times because now is one of those moments.  New research has been presented regarding potentially more appropriate age of spay or neuter surgery for your dog, most notably larger dogs.  Don’t worry, I’ll also discuss cats.

age of spay or neuter can affect many heath factors

No, I haven’t changed my stance that the procedure should still be done.  But I agree and am glad to see some changes in the timing of when we as veterinarians recommend the surgery happen.  Let’s explore this and try make sense of the differences.

The first thing you have to look at is what breed, or at least size, of dog you have.  The next thing you have to consider is what are your goals you’re trying to achieve with your pet’s health – joint development & health, cancer risks, behavior, etc.  Lastly, we need to consider their lifestyle.  Much of the research focused on some common breeds (Golden Retrievers, Labrador Retrievers , Rottweilers, Viszlas) but we can try to extrapolate from this data.  So let’s discuss…. Continue reading

Cats, Strings, & Intestinal Things

cats and string

from kittenwhiskers.com

The country song goes “Mamas don’t let your babies grow up to be cowboys…” and the same thing applies to cats playing with string.  Media is chock full of images of kittens playing with balls or yarn whether it be cartoons, advertisements, or the endless supply of cute videos on YouTube.  But behind all this cuteness lies a deadly risk if a cat eats string, thread, yarn, or dental floss.  These kitties can be fixed but it’s not easy.  This is Mira’s story…

Mira cats and string

Mira

Sometimes you see your cat eat the string and sometimes you don’t.  Often times the first thing you may notice is vomiting.  This was the case with Mira.  At just 2 years old, she’s still an intensely curious cat.  All cats may vomit from time to time – hairballs, catching a mouse, chewing on plants, but never just vomiting out of spite.  When Mira started vomiting multiple times over several hours, her family knew something wasn’t right and brought her in to see us.  The diagnosis was easily found as a string was seen wrapped over and under her tongue.

When a string gets trapped at this spot, the other end of it starts moving through the stomach and intestines.  Essentially what happens is the string begins to act like a saw cutting through the intestines as it pleats them like an accordion.  Palpating a cat’s abdomen like Mira’s you can feel the intestines bunched up and thickened.  At this point, we weren’t sure how long the string had been present.  What we were all sure of was that Mira needed help in the form of surgery.

Yet, surgery isn’t just a simple snap of the fingers.  Many factors need to be considered.  Due to her vomiting, Mira was dehydrated.  With the risk of the string cutting into the intestines, blood and protein gets lost through these injuries which can complicate healing as well as leaking intestinal contents contributing to infection.  And the biggest mystery, what will you do once you’re there actually seeing the abdominal contents.  Mira’s family elected to go ahead and get her fixed up.

cats and string

Mira’s plicated intestines

Once we had her on some IV fluids and got her a bit better stabilized, I took her into surgery and investigated the damage.  In total, 7 perforations were noted and I discovered the other end of the string was in the colon.  Effectively, it was acting like a drawstring on pair of sweatpants pulling on her intestines at both ends.  Due to the number of perforations and their locations, the best option was to remove a large section of intestine and reattach the good ends.  After releasing the ends of the string through separate incisions in the stomach and end of the small intestine, I removed 32cm of the small intestine and reattached the ends before rinsing her abdomen and closing her up to recover her.

Over the next couple of days, we monitored Mira in the hospital.  Things weren’t going as we had hoped.  She wasn’t eating, kept spiking fevers, and seemed generally quieter than expected.  She only would eat tiny amounts when her family visited.  On the third day post-op, we checked some blood as she still wasn’t doing as we expected and noted several changes in the blood cell count and protein levels that concerned us and raised the suspicion that something had broken down inside.  The results were worse than before the initial surgery.  Despite all the precautions and steps we had taken to help Mira, something was leaking.

After some discussion, her family elected to have us attempt a second surgery as a means of fully discovering the extent of the problems and to fix what we could.  As soon as I got back into her abdomen, I had all the explanation we needed.  Her anastomosis site (the reattached portion) had broken down and a small leak was seen near it.  Given the amount of damage that was found and the previously removed section of intestine, I felt it best to call her family immediately and give them an update.  Assessing the extent of everything internally, I let them know her prognosis was very guarded to poor even with attempting a second repair and advised them that euthanasia was not an unreasonable option.  Her family conferred for a moment and told me to do my best to save her.  Back in surgery, I removed as little intestine as possible that was no longer viable and reattached the new ends.  After a very thorough rinsing of the abdomen and closing her back up, we all hoped for the best.

blood donor cat

Pioneer, the blood donor

Great news the next morning!  Her temperature was normal and she greeted us with alertness and purring unlike any other morning before.  A recheck of her blood now showed dangerously low levels of red blood cells and protein.  Mira needed a transfusion to give her the best chances for survival.  Luckily, one of our staff members volunteered to have her cat donate.  Mira received the much needed blood and was on the complete road to recovery.  By the next day, she was feeling spunky, her blood values had improved, and she was eating everything we gave her.  Mira was going home.

cats and string

Mira getting her transfusion

I like to think of Mira as a little “Mira-cle in May.”  Not all cats get this outcome.  It took the right combination of family commitment, veterinary team care, and a bit of luck.  The important message here is that when your pet seems sick, it’s best to not wait to see if it will pass — at a minimum, please talk with your veterinarian.  Waiting too long could make things worse.

Disclaimer: Blog posts may contain some opinions which are my own and may not reflect those of any current or former employers. Mira’s story is published with permission from her owners and some non-essential details have been omitted for brevity.

Don’t forget to follow along on Instagram @drryanllera , Facebook , or  Twitter for more pet info and interesting daily happenings!

Spaying Saves Lives & Families

The following are true stories.  *Names have been changed to protect the furry and innocent.

hugging dogThe past few months have brought up a few emotional challenges as a veterinarian.  But none more difficult than those cases and patients whose problems could have been avoided.  On more than one occasion, technicians that I work with and myself have surrounded a patient as we said goodbye and more than a few tears were shed.  It’s not only the situation that was disheartening, but also the circumstances of how we got there.

Maggie* was middle to older aged shepherd cross who was brought in to the clinic for vaginal discharge.  The next question is always the crucial one…is she spayed?  In her case, the answer was “no” and the diagnosis became much more suspicious for a pyometra (uterine infection).  She was an otherwise healthy dog.  The blood tests further heightened my suspicion and this is where we ran into problems.  Financial costs were a concern for Maggie’s family.  Further diagnostics were not an option, but more importantly, neither was treatment.  Treatment which would have involved surgery including hospitalization, IV fluids, antibiotics, and pain medications can be quite expensive.  Every attempt was made to find a financial solution that would work.  Even a payment plan was offered of which the terms of could not be met by her family.  Re-homing her was not desired by her family and sadly, euthanasia was elected.

Gertie* was another patient who presented with vaginal discharge that looked like pus.  She was a middle aged English Bulldog who had previously had a C-section.  She was not feeling well for a few days prior to her examination and her family had to decide what to do for her as well as figure out finances.  They agreed to go to surgery where I came across a most unusual finding….a gigantic ovary.  The ovary was closely attached to the kidney on that side of the body and had extremely enlarged blood vessels.  I was able to remove it, explore the rest of her abdomen, and finish the surgery.

Gertie took an incredibly long time to wake up, much longer than it normally takes.  We began to worry and started looking into causes to explain what was happening.  Ultimately, we went back into surgery only to discover an abdomen full of blood & blood clots.  Calmly checking everything, my colleague & I noted that all 6 ligatures were intact and in place and we could not find the cause of the bleeding.  Given the appearance of the ovary earlier, we were suspicious of a malignant tumor which may have weakened tissues or spread to other organs.  With the constant flow of blood and no way to stop it, in addition to her poor recovery thus far, her family made the decision to let her go.  I felt a sickness and surge of emotion as her heart stopped and the monitors went silent.

Two dogs and two different situations.  In both cases, pets’ lives ended and the bond with their family broken prematurely.  And patients like Maggie and Gertie are not the only ones; this happens almost daily within the veterinary profession and with cats as well.  Myself and the rest of the veterinary team hate this part of our jobs.  The knowledge that we can save lives and help animals, but in some circumstances fail to achieve that goal, is gut wrenching.  A simple  ovariohysterectomy (spay) surgery years earlier could have avoided both of these incidents.  Month after month, we end up euthanizing patients for potentially preventable issues.  I understand that costs can be an issue but many areas have programs or clinics that can help.  Alternatively, I strongly recommend either looking into pet insurance or make a savings account for your pet.  Every time you get paid, just put away a little bit for Fluffy or Rover in case of those larger expenses or unexpected emergencies.  Talk with your veterinarian if you have concerns and maybe get a plan in place.  So if you are reading this, please listen to your veterinarian when it comes to preventative care.  It can save your pet and allow the bond you have to remain strong for as many years as it should rather than be ending too soon.

Disclaimer: All blog posts may contain opinions which are my own and may not reflect those of any current or former employers.

An alternate version of this post was published on Dr. Andy Roark’s site to more directly address the veterinary teams working with your pets.  You can check it out here.   Thanks for reading and don’t forget you can subscribe on the right side to get new posts directly to your email!  And I’m now on Instagram @drryanllera and as always on Facebook, Twitter, and Pinterest!

Older posts