Kylie is going to have Ovariohysterectomy Surgery today.
This is Kylie checking in for surgery with her owner Savanna signing paperwork for her Ovariohysterectomy and pre-surgical bloodwork.
We have an Open Hospital Policy; this gives all owners the ability to remain with their pet throughout any procedure.
Kylie, weighing in for surgery
Next step includes prepping and placing the IV catheter, so we can administer IV medications and fluids. Just like people.
Spraying Bitter Apple to prevent her from chewing at her catheter before surgery.
Before surgery we do pre-surgical blood work to test for any abnormalities that can interfere or complicate anesthesia.
Just like people this is essential before surgery for safe anesthesia.
Depending on age we have 3 different levels of pre-surgical bloodwork that we run. Mini, Routine, and Complete.
Pre-Surgery
Dr. Koulianos performing a physical exam. Each patient gets this exam done before surgery.
Start Anesthesia
Now starting with anesthesia. Kylie is being an amazing patient for us through this whole surgery.
In the following pictures you see our intubation process. All animals are intubated for surgery so that their airway is protected and so that we can give positive pressure ventilation for the safest anesthesia.
After intubated we then hook up Kylie to our ADS machine for positive pressure ventilation (which will breathe for her while sedated and control the amount of isoflurane gas anesthesia she gets), SPO2, and EKG to monitor her vitals. Also while sedated Kylie is unable to blink to produce tears so we apply artifial tears to both eyes while sedated to keep lubricated.
Cleaning the Area
Before moving Kylie into the surgery room we shave around the surgery site to clear the way for a sterile field.
Here we have our companion Therapy Cold Laser System which increases your pets ability to heal faster after surgery or any traumatic injury.
This system helps to ease pain, improve mobility, and speed healing. This system is also used in human hospitals for the same purposes.
Here is the ADS positive pressure ventilation in our dental suite. This allows us to regulate the amount of gas anesthesia (Isoflurane) given to each patient while sedated.
This machine is set to each patient’s weight in order to be sure they each receive the proper amount of oxygen.
This is our Surgical Suite monitoring equipment. This includes our State of the Art Wireless Patient Monitoring System.
This allows us to record and monitor Pulse Ox, SPO2, Blood Pressure, EKG, and Temperature.
All surgical packs are autoclaved and 100% sterile. We use only one pack per patient.
Dr. Koulianos scrubbing before gowning up and going into surgery.
The surgery site is then cleaned again and sterilized with surgical scrub and alcohol.
The doctor is now gowned and gloved in a sterile manner for surgery.
Now surgery has started by placing a sterile field over the area where the doctor will make the incision.
Then the abdomen is opened.
The uterus and ovaries are identified and removed.
The suture used in the abdomen is absorbable.
The doctor is then careful to check for any areas of bleeding or abnormalities.
Then the abdomen is clothes with three layers (the abdominal wall, the subcutaneous area, and skin).
During this time the anesthesia/Surgical tech is carefully monitoring the patient’s vitals.
Recovery
After surgery the patient is moved to recovery.
By using high-tech anesthetics we can quickly bring patients out of anesthesia. The pre-surgical anesthetics and pain medications make for a very smooth and calm recovery.
As our veterinary hospital is open, pet owner Savanna is able to sit with her little girl while she is waking up from surgery.
Pets really appreciate a calm soothing voice and touch therapy during recovery.
Waking Up
Now fully awake, but a little drowsy from the post op pain medications, the patient is just about ready to go home.
The catheter is now being removed and pressure bandage placed to cover the catheter site.
Dismissal with the Technician and Doctor.
Going over all details and answering any questions the owner may have.
Discussing discharge instructions and post operative pain medications to go home with.
Information on Ovariohysterectomy (Spay) For Dogs and Cats
First, some basic reproductive terminology:
Spayed = a female cat or dog who has had both ovaries and uterus surgically removed, and is not capable of producing offspring.
Neutered = a male cat or dog who has had both testicles surgically removed, and is not capable of producing offspring. Also known as castration. Some refer to “neutered” as a male or female dog that has been surgically altered to render them sterile (testicles removed or ovaries removed, making them not capable of producing offspring).
Related terms: desexed, fixed, altered
Intact = not spayed or neutered, the animal has reproductive organs capable of producing offspring.
Queen = intact female cat
Tom = intact male cat
Bitch = intact female dog
Dog = intact male dog
Is spaying a major surgery?
Yes, because it involves surgically entering the abdomen, it is considered “major surgery”. This should not frighten pet owners however, since this surgery is routinely performed, and very safe. There are inherent risks with any anesthesia or surgical procedure, and talking over your fears and concerns with your veterinarian should help you understand any special risks that your pet may have. (For more on the actual surgery, see below.)
Myth #1 – I’ve heard that my pet should have a heat cycle first — she will be a better pet.
Myth #2 – I’ve heard that my pet should have a litter first — she will be a better pet.
These are two common misconceptions about spaying. You will do so much more for the health of your pet by spaying before the first heat. It has been reported that by doing so, you will reduce the chance of mammary (breast) cancer in your pet by as much as 97% over their lifetime. The chance of other reproductive cancers (uterine, ovarian, mammary) and uterine infection is eliminated in spayed animals. Even after the first heat, spaying will reduce the risks of certain cancers and eliminate reproductive organ disease.
Providing a loving environment for your pet, proper health care, and proper training will be the most influential benefit to maintaining a happy pet that fits into your family.
Non-spayed females have an increased risk cancer (uterine, ovarian, mammary) and an increased risk of a life-threatening uterine infection as they get older.
Why does my vet want to do pre-surgery blood work on my pet?
Many veterinarians offer pre-anesthesia screening to their patients, and may have you sign a waiver if you decline these blood tests. Why is this so important? It provides a way to assess kidney and liver function prior to undergoing anesthesia among other things. The liver and kidneys are the primary routes that the anesthetics are broken down and removed from the body. If they aren’t working well, then anesthesia may be more of a risk. There are many anesthetic agents available, and your veterinarian may also use the blood screening information to determine the best anesthetic protocol for your pet.
What happens during the surgery?
Your pet will be sedated and anesthetized so she won’t feel any pain or be aware of what is happening. Her breathing and heart rate will be closely monitored by the veterinary staff. The surgeon makes a small incision on her abdomen (belly area) and removes the two ovaries and uterus, usually just above the cervix. All vessels and tissues are ligated (tied off) to prevent bleeding and lessen chances of post-operative bleeding or infection. Once the ovaries and uterus are removed, the surgeon begins the closure of the body wall and skin — muscle, subcutaneous, and skin are sutured (stitched) back together. Your pet may have absorbable sutures, skin staples, or sutures visible in the skin that will need to be removed by your vet 10-14 days after surgery.
How soon will she be “back to normal”?
Most people are surprised at how quickly their pets recover from surgery (certainly much sooner than their human counterparts!) Most pets are up and alert shortly after surgery and after resting quietly for a day or two, most are back to their “normal” self. It is very important to restrict activity in those pets that are very active — too much activity can actually delay healing or cause post surgical complications, such as dehiscence (opening of sutures) or bleeding.
Altered rabbits are healthier and live longer than unaltered rabbits. The risk of reproductive cancers (ovarian, uterine, mammarian) for an un-spayed female rabbit stands at <>is virtually eliminated by spaying your female rabbit. Your neutered male rabbit will live longer as well, given that he won’t be tempted to fight with other animals (rabbits, cats, etc.) due to his sexual aggression.
Altered rabbits make better companions. They are calmer, more loving, and dependable once the undeniable urge to mate has been removed. In addition, rabbits are less prone to destructive (chewing, digging) and aggressive (biting, lunging, circling, growling) behavior after surgery.
Avoidance of obnoxious behavior. Un-neutered male rabbits spray, and both males and females are much easier to litter train, and much more reliably trained, after they have been altered.
Altered rabbits won’t contribute to the problem of overpopulation of rabbits. Over 7 million adorable dogs, cats, and rabbits are killed in animal shelters in this country every year. In addition, unwanted rabbits are often abandoned in fields, parks, or on city streets to fend for themselves, where they suffer from starvation, sickness, and are easy prey to other animals or traffic accidents. Those rabbits who are sold to pet stores don’t necessarily fare any better, as pet stores sell pets to anyone with the money to buy, and don’t check on what kind of home they will go to. Many of these rabbits will be sold as snake food, or as a pet for a small child who will soon “outgrow” the rabbit.
Altered rabbits can safely have a friend to play with. Rabbits are social animals and enjoy the company of other rabbits. But unless your rabbit is altered, he or she cannot have a friend, either of the opposite sex, or the same sex, due to sexual and aggressive behaviors triggered by hormones.
Spaying and neutering for rabbits has become a safe procedure when performed by experienced rabbit veterinarians. The House Rabbit Society has had over 1000 rabbits spayed or neutered with approximately .1% mortality due to anesthesia. A knowledgeable rabbit veterinarian can spay or neuter your rabbit with very little risk to a healthy rabbit. Don’t allow a veterinarian with little or no experience with rabbits to spay or neuter your rabbit.
Quick FAQ
Is surgery safe on rabbits?
Surgery can be as safe on rabbits as on any animal. Unfortunately, the vast majority of veterinarians aren’t experienced with safe rabbit surgery techniques. Don’t allow a veterinarian with little or no experience with rabbits spay or neuter your rabbit. Using isofluorene as the anesthetic and appropriate surgical and after-surgery techniques, spaying and neutering of rabbits is as safe as for any other animal.
At what age should rabbits be spayed or neutered?
Females can be spayed as soon as they sexually mature, usually around 4 months of age, but many veterinarians prefer to wait until they are 6 months old, as surgery is riskier on a younger rabbit.
Males can be neutered as soon as the testicles descend, usually around 3-1/2 months of age, but many veterinarians prefer to wait until they are 5 months old.
When is a rabbit too old to be spayed or neutered?
Veterinarians will have their own opinions on this, but in general, after a rabbit is 6 years old, anesthetics and surgery become more risky.
It is always a good idea, in a rabbit over 2 years of age, to have a very thorough health check done, including full blood work. This may be more expensive than the surgery, but it will help detect any condition that could make the surgery more risky. This is especially important if anesthetics other than isofluorene are used.
Can you tell if female rabbit has already been spayed?
The probability is very high that she hasn’t.
One can shave the tummy and look for a spay scar. However, when veterinarians use certain stitching techniques, there is no scar whatsoever. Hopefully, these veterinarians will tattoo the tummy to indicate the spay has been done, but otherwise, the only way of knowing is to proceed with the surgery
There are two cruciate ligaments which cross inside the knee joint: the anterior (or, more correctly in animals, “cranial”) cruciate and the posterior (or, more correctly in animals, the “caudal”) cruciate. They are named for the side of the knee (front or back) where their lower attachment is found. The anterior cruciate ligament prevents the tibia from slipping forward out from under the femur.
Finding the Rupture
The ruptured cruciate ligament is the most common knee injury of the dog; in fact, chances are that any dog with a sudden rear leg lameness has a ruptured anterior cruciate ligament rather than something else. The history usually involves a rear leg suddenly so sore that the dog can hardly bear weight on it. If left alone, it will appear to improve over the course of a week or two but the knee will be notably swollen and arthritis will set in quickly. Dogs can be presented in either the acute stage (shortly after the injury) or in the chronic stage (weeks or months later).
The key to the diagnosis of the ruptured cruciate ligament is the demonstration of an abnormal knee motion called a “drawer sign.” It is not possible for a normal knee to show this sign.
The Drawer Sign
The veterinarian stabilizes the position of the femur with one hand and manipulates the tibia with the other hand. If the tibia moves forward (like a drawer being opened), the cruciate ligament is ruptured.
Another test that can be used is the “Tibial Compression test” where the veterinarian stabilizes the femur with one hand and flexes the ankle with the other hand. If the ligament is ruptured, again the tibia moves abnormally forward.
If the rupture occurred some time ago, there will be swelling on side of the knee joint that faces the other leg. This is called a “medial buttress” and is a sign that arthritis is well along.
It is not unusual for animals to be tense or frightened at the vet’s office. Tense muscles can temporarily stabilize the knee preventing demonstration of the drawer sign during examination. Often sedation is needed to get a good evaluation of the knee. This is especially true with larger dogs. Eliciting a drawer sign can be difficult if the ligament is only partially ruptured so a second opinion with an orthopedic specialist is a good idea if the initial examination is inconclusive.
Since arthritis can set in relatively quickly after a cruciate ligament rupture, radiographs to assess arthritis are helpful. Another reason for radiographs is that occasionally when the cruciate ligament tears, a piece of bone where the ligament attaches to the tibia breaks off as well. This will require repair and the surgeon will need to know about it before beginning surgery. Arthritis present prior to surgery limits the extent of the recovery after surgery though surgery is still needed to slow or even curtail further arthritis development.
How the Rupture Happens
There are several clinical pictures seen with ruptured cruciate ligaments. One is a young athletic dog playing roughly who takes a bad step and injures the knee while playing. This is usually a very sudden lameness in a young large breed dog.
A recent study identified the following breeds as being particularly at risk for this phenomenon: Neapolitan mastiff, Newfoundland, Akita, St. Bernard, Rottweiler, Chesapeake Bay retriever, and American Staffordshire terrier.
On the other hand, an older large dog, especially if overweight, can have weakened ligaments and slowly stretch or partially tear them. The partial rupture may be detected or the problem may not become apparent until the ligament breaks completely. In this type of patient, stepping down off the bed or a small jump can be all it takes to break the ligament. The lameness may be acute but have features of more chronic joint disease or the lameness may simply be a more gradual/chronic problem.
Larger overweight dogs that rupture one cruciate ligament frequently rupture the other one within a year’s time. An owner should be prepared for another surgery in this time frame.
What happens if the Cruciate Rupture is not surgically repaired
Without an intact cruciate ligament, the knee is unstable. Wear between the bones and meniscal cartilage becomes abnormal and the joint begins to develop degenerative changes. Bone spurs called “osteophytes” develop and chronic pain and loss of joint motion result. This process can be arrested by surgery but cannot be reversed.
Osteophytes are evident as soon as 1-3 weeks after the rupture in some patients.
This kind of joint disease is substantially more difficult for a large breed dog to bear though all dogs will ultimately show degenerative changes. Typically, after several weeks from the time of the acute injury, the dog may appear to get better but is not likely to become permanently normal.
In one study a group of dogs was studied for 6 months after cruciate rupture. At the end of 6 months, 85% of dogs under 30 lbs of body weight had regained near normal or improved function while only 19% of dogs over 30lbs had regained near normal function. Both groups of dogs required at least 4 months to show maximum improvement.
What happens in surgical repair?
Lateral orthopedic wire is shown taking the place of the anterior cruciate ligament. Usually thick suture is used rather than wire but for illustrative purposes the wire shows where the suture would be placed around the knee.
There are 3 different surgical repair techniques commonly used, and a fourth method which has fallen out of favor in recent years:
Extracapsular Repair:
This procedure is currently favored as it can be performed in a relatively shorter surgery time than the other procedures and does not require specialized equipment. The knee joint is opened and inspected. The torn or partly torn cruciate ligament is removed. Any bone spurs of significant size are bitten away with an instrument called a “rongeur.” If the meniscus is torn, the damaged portion is removed. A large, strong suture is passed around the fabella behind the knee and through a hole drilled in the front of the tibia. This tightens the joint to prevent the drawer motion, effectively taking over the job of the cruciate ligament.
Typically, the dog may carry the leg up for a good 2 weeks after surgery but will increase knee use over the next 2 months eventually returning to normal
Typically, the dog will require 8 weeks of exercise restriction after surgery (no running, outside on a leash only including the backyard)
The suture placed will break 2-12 months after surgery and the dog’s own healed tissue will “hold” the knee.
Tibial Plateau Leveling Osteotomy (TPLO):
The TPLO rotates (as indicated by the arrow) the sloped tibial plateau until it is perpendicular to the line between the stifle and the hock joint centers.
This procedure uses a fresh approach to the biomechanics of the knee joint and is meant to address the lack of success seen with the above technique long term in larger dogs. With this surgery the tibia is cut and rotated in such a way that the natural weight-bearing of the dog actually stabilizes the knee joint. As before the knee joint still must be opened and damaged meniscus removed. The cruciate ligament remnants may or may not be removed depending on the degree of damage.
This surgery is complex and involves special training in this specific technique. Many radiographs are necessary to calculate the angle of the osteotomy (the cut in the tibia). At this time the TPLO is felt by many experts to be the best way to repair a cruciate ligament rupture regardless of the size of the dog and is especially appropriate for dogs over 50lbs. This surgery typically costs twice as much as the extracapsular method and requires a specialist.
Typically, most dogs are touching their toes to the ground by 10 days after surgery although it can take up to 3 weeks.
As with other techniques, 8 weeks of exercise restriction are needed.
Full function is generally achieved 3 to 4 months after surgery and the dog may return to normal activity.
Tibial Tuberosity Advancement (TTA):
The TTA represents another take on how to use the biomechanics of the knee to create stabilization. The idea is that when the cruciate ligament is torn, the tibial plateau (the top of the tibia) and the patellar ligament should be repositioned at 90 degrees to one another to combat the shear force generated as the dog walks. To make this happen, the tibial tuberosity (front of the tibia where the patellar ligament attaches) is separated and anchored in its new position by a titanium or steel “cage,” “fork,” and plate. Bone grafts are used to assist healing. This procedure was developed in 2002 at the University of Zurich and since then over 20,000 patients worldwide have have had this surgery. Some experts prefer it to the TPLO while others prefer the TPLO. Both procedures require specialized equipment and expertise.
Typically the leg is bandaged for a week after surgery.
The patients activity must be restricted and confinement is a must post-operatively with gradually increasing activity over 3-4 months. Most dogs can return to normal activity by 4 months after surgery.
Intracapsular Repair: (sometimes called the “over the top” method)
We mention this procedure for its historical significance though it is not one of the “big three.” This procedure has fallen out of favor lately as it has been unable to demonstrate results superior to those of the extracapsular technique described above though apparently it is still a popular repair method in the U.K.
Intracapsular repair intuitively seems like it should do better as it uses living tissue (rather than an artificial material) to essentially make a new ligament. This takes more time surgically. As with the extracapsular repair, the knee joint is opened, fragments of the ligament are removed, as is damaged meniscus. After this a strip of connective tissue is dissected locally and passed through the middle of the joint exactly where the cruciate ligament used to be. The “new ligament” is attached at the opposite end to an implant or simply sewn into place.
Bandaging for a couple of weeks after surgery is commonly recommended.
Again, the dog may not bear weight for a good two weeks after surgery and will likely require 2 months to return to normal function.
Again, 8 weeks of exercise restriction will be necessary for healing.
General Rehabilitation after Surgery
Rehabilitation following the extracapsular repair method can begin as soon as the pet goes home. The area can be chilled with a padded ice pack for 10 minutes a couple times daily. (Do not try to make up for a skipped treatment by icing the area longer; prolonged cold exposure can cause injury.) Passive range of motion exercise where the knee is gently flexed and extended can also help. It is important not to induce pain when moving the limb. Let the patient guide you. Avoid twisting the leg. After the stitches or staples are out (or after the skin has healed in about 10-14 days), water treadmill exercise can be used if a facility is available. This requires strict observation and, if possible, the patient should wear a life jacket. Walking uphill or on stairs is helpful for strengthening the back legs but no running, jumping or other “explosive” type exercise should be performed for a full three months after surgery. Rehabilitation for patients with intracapsular repair is similar but slower in progression.
Rehabilitation after TPLO or TTA is gentler. Icing as above and rest are the main modes of therapy. After 3 to 4 weeks, an increase in light activity can be introduced. A water treadmill is helpful. No jumping, running or stair-climbing is allowed at first. Expect the osteotomy site to require a good 6 weeks to heal.
What if the rupture isn’t discovered for years and joint disease is already advanced?
A dog with arthritis pain from an old cruciate rupture may still benefit from a TPLO surgery and possibly from the TTA. It may be worth having a surgery specialist take a look at the knee. Most cases must make do with medical management. Visit our section on arthritis treatment.
Meniscal Injury
Looking head-on at this model of the flexed knee, one can see the menisci (cartilage pads separating the femur and tibia) as well as the cruciate ligaments crossing inside the joint.
When the crucial ligament ruptures, the medial (on the inner side of the knee) meniscus frequently tears and must either be removed, partly removed, or ideally repaired. This is generally done at the time of cruciate ligament surgery and we would be remiss not to mention it.
Pets with meniscal damage may have an audible clicking sound when they walk or when the knee is examined, but for a definitive diagnosis the menisci must actually be inspected during surgery. It is difficult to access the menisci and thus repairing a tear in the meniscus is problematic; furthermore, poor blood supply to the menisci also makes good healing less likely. For these reasons, removal of the damaged portion of the meniscus is the most common surgical choice. This leaves some meniscus behind to distribute the compression load on the knee but removes the painful, ineffective portion.
Areas of current research include techniques to improve blood supply to the healing meniscus so that repair can be more feasible. If meniscal damage has occurred in a cruciate rupture, arthritis is inevitable and surgery should be considered a palliative procedure.
The patella slides in a groove on the lower end of the femur (the bone that runs between the hip and the knee). There is a ligament called the “patella ligament” which runs from the bottom of the patella to the tibia, (the bone just below the knee joint). This ligament keeps the patella in place. The thigh muscles are attached to the top of the patella. When the thigh muscles contract, the force is passed through the patella and through the patella ligament, which results in straightening of the knee joint. The patella can luxate because the point where the patella ligament attaches to the tibia can sometimes be attached too far inward. As the thigh muscles contract, the force pulls the patella against the inner groove that it is sitting in.
After several months, the inner side of the groove wears down and the patella is free to move out of the groove or luxate. This can be quite painful when this happens and the dog may have difficulty putting weight on the leg. After a while, some dogs learn to kick the leg and push the patella back in place. However, because the groove is gone, the patella can easily move out of place again. Some dogs can tolerate this problem for a while, but the joint may become arthritic and painful.
Can a luxating patella be fixed?
A surgery called, “Medial Luxating Patella Repair”, can be performed.
There are three steps to the surgery:
The point where the patella ligament is attached is moved and surgically fixed to its proper location.
The groove where the patella sits is deepened so the patella will stay in place.
The capsule around the knee joint is tightened.
It is important to have this surgery performed before arthritis occurs in the joint. If there is no arthritis, the dog should regain full use of its leg. If there is arthritis in the joint already, the joint can still be painful, especially in the cold weather.
View an automated slideshow of a luxating patella surgery below (coming soon).
Are there breeds that are predisposed to this condition?
The University of Sydney’s “Listing of Inherited Disorders in Animals” (LIDA) names the following breeds as being predisposed to this condition:-
Affenpinscher
American cocker spaniel
Australian silky terrier
Basset hound
Bichon frise
Border terrier
Boston terrier
Cavalier King Charles spaniel
Chihuahua
Dandie Dinmont terrier
English springer spaniel
Griffon Bruxellois
King Charles spaniel
Lhasa Apso
Maltese
Papillon
Pomeranian
Poodle (Miniature)
Poodle (Toy)
Pug
Shar Pei
Yorkshire terrier
How do you know if your pet has a luxating patella?
This condition is usually noticed in dogs less than two years of age. Signs range from mild to severe, and include temporary or occasional lameness possibly accompanied by a ‘hopping’ motion. Eventually the dog may hold the leg permanently off the ground. If both legs are affected, the dog may adopt a crouched gait and posture, appear bow legged and may even walk on the forelegs with the hind legs completely off the ground.
There are many organizations that provide excellent continuing education in avian medicine. If a bird needs to have surgery performed on the beak, or in the mouth area, instead of placing the breathing tube into the windpipe (correctly called the trachea), a tube can be placed into an air sac through a hole made in the bird elsewhere on the body.
The oxygen and anesthetic gas can then be administered through the air sac, keeping the beak and mouth free of tubes in order to safely perform surgery there! How cool is that?
An air sac tube can also be placed when a bird is having difficulty breathing due to an obstruction in the trachea or related areas. For example, if a seed is inhaled into the windpipe, it may prevent the air from passing in and out of the bird. If the owner can get the bird to an avian vet immediately, the vet can place an air sac tube, which will usually relieve the breathing difficulty like magic! Air sac tubes can also save a bird that has a fungal lesion in the upper portion of the respiratory tract that is partially preventing normal breathing, for example. Air sac tubes cannot be left in place permanently, but they are useful to aid breathing until the problem can be resolved.
The heart rate and rhythm may be monitored with an ECG capable of registering high heart rates, and the monitor should have a freeze function for interpretation. An esophageal stethoscope may be slid into the esophagus of a bird, which is attached to a monitor and amplifier that allows the surgical team to listen to breathing sounds and the heart sounds. An ultrasonic Doppler flow apparatus may be attached to an area over the wing artery of a bird, allowing the surgeon to listen to an audible signal of arterial blood flow.
A physical exam would be performed on each bird prior to the procedure. Once a bird was anesthetized, an area on the left side near the hip and thighbone (femur) would be prepped for sterile surgery.
The feathers are plucked, the area scrubbed with surgical soap, a sterile drape is placed over the site and a small incision was then made through the skin. A sterile tube would then be slipped into the hole. This hollow sleeve then provided access into the body cavity of a bird.
A bright, cool light source is connected to a rigid fiber-optics endoscope (usually designed for human joint surgery), and this sterile telescope would then fit into the hollow sleeve already in place.
Once the ovary or testicle was identified, the surgeon applies a tattoo using sterile ink injected into the wing web of the appropriate wing to permanently identify the sex of the bird.
While the avian surgeon examines the gonad (ovary or testicle), it was possible to evaluate the bird for potential problems, such as an enlarged liver or spleen, cloudy air sacs, abscesses or scar tissue. It was possible to swab a lesion for bacterial or fungal culture, and for the very brave surgeon, an organ (liver, kidney or spleen) might be biopsied for microscopic evaluation and testing.
This same procedure is used for diagnosing disease in the abdomen. While using our special rigid fiber optic cameras we can examine and do biopsies of internal organs like the kidneys, liver, pancreas, air sacs, and lungs.
Once the ovary or testicle was identified, the surgeon applies a tattoo using sterile ink injected into the wing web of the appropriate wing to permanently identify the sex of the bird. Since females (of parrot species) usually only possess an ovary on the left side, the left wing web was tattooed to identify hens. Since males have testicles, left and right, they were tattooed under the right wing. (As an aid to help us remember, we were told that “males are always right” so tattoo the male under right wing!).
Entropion is a rolling-in of the eyelid. This causes the hair on the surface of the eyelid to rub on the eyeball, which is both painful and often causes corneal ulcers or erosions. The corneal damage can also result in corneal scarring, which can interfere with vision. Usually the dog will squint and tear excessively. However, many flat-faced dogs with medial entropion (involving the inside corner of the eyes) show no obvious signs of discomfort.
Entropion is treated by surgical correction (“blepharoplasty“), which is essentially plastic surgery. Excessive folds and sections of facial skin are removed, and the eyelids tightened. It is uncommon for entropion to recur after surgery unless the entropion is quite involved, particularly in the Shar Pei breed. Very young puppies with entropion will often have “lid tacking” performed (rather than plastic surgery), in which temporary lid sutures are placed to roll out the lids. Often, these puppies do not require permanent plastic surgery once they have matured and “grown into” their facial skin. Permanent plastic surgery is usually not performed in puppies less than 5 or 6 months of age, giving the dog some time to develop its mature head conformation.
Dogs with inherited entropion should not be bred, as they can pass the trait on to their offspring. The Canine Eye Registration Foundation (see CERF information) publishes a list of breed-specific breeding recommendations for purebred dogs with entropion.
If you suspect that entropion is present in your pet, please consult with your family veterinarian. Your doctor may elect to have your pet referred to a veterinary ophthalmologist for further evaluation and possible surgical treatment.
2. EYELID TUMORS
Older dogs commonly develop eyelid tumors (cancer). As in humans, cancer can be either benign or malignant. Fortunately, eyelid tumors in dogs are usually benign and do not spread to distant tissues. However, eyelid tumors do slowly or quickly grow, and can destroy the structure of the eyelid, in addition to rubbing on the eye. It is usually best to remove them when they are still small.
Eyelid tumors are treated by surgical removal. While there are many different surgical procedures possible, most eyelid tumors in old dogs can be removed at Animal Eye Care without requiring general anesthesia. The patient is given a sedative, and then a local eyelid anesthetic is given to numb the eyelid. The tumor is removed and the site frozen with liquid nitrogen (cryosurgery) to kill any remaining tumor cells. Tumor cells are usually very sensitive to freezing, and normal eyelid tissue is more resistant. After surgery, the eyelid margin turns pink (depigments), but usually repigments within 4 months.
It is rare for the eyelid tumor to recur following surgery. 85-90% of tumors do not recur following surgery.
3. DISTICHIASIS AND ECTOPIC CILIA
Eyelids of dogs can grow abnormal hairs. These hairs grow from the oil glands (Meibomian glands) of the lids and are called distichia if the hair protrudes from the oil gland opening onto the edge of the eyelid. Distichia are often irritating, especially if the hairs are long and stiff. Ectopic cilia are also hairs growing from oil glands on the eyelid, but the hair protrudes from the inner surface of the eyelid and is very painful, often causing corneal ulcers.
Dogs with distichiasis may or may not show signs of discomfort, ranging from slight intermittent squinting and/or rubbing of the eyes, to severe squinting and discomfort. Dogs with ectopic cilia are always uncomfortable. Most dogs with ectopic cilia are young adult dogs or older puppies. Both conditions are common in Shih Tzus. Many other breeds have problems with distichia. At Animal Eye Care, both conditions are treated surgically under general anesthesia, with a procedure called cryoepilation. With this procedure, the abnormal hair follicles are frozen using a liquid nitrogen probe, and the hairs then removed.
After surgery, the eyelids are swollen for 4-5 days, and the eyelid margins will depigment and turn pink. Usually, the lid margins will repigment within 4 months. It is important to understand that new abnormal hairs can grow from new sites after surgery, but this is uncommon in dogs older than 3 years old (unless the dog is a Shih Tzu). With cryoepilation, 85-90% of the treated hair follicles will not regrow. Repeat surgical treatment is rarely required, unless the animal is a puppy (and grows new hairs in new sites) or a Shih Tzu.
4. PROLAPSED THIRD EYELID GLAND (PTEG)
This condition is also called Prolapse of the Nictitans Gland. A slang term (which is to be discouraged) is “cherry eye”. Dogs have a third eyelid that slides up over the surface of the eye for protection. The third eyelid also has a tear gland located deep within its tissues, called the third eyelid gland TEG). Each eye of a dog actually has 2 tear glands (also called lacrimal glands), unlike people (who have one). The orbital lacrimal gland produces 60% of the tears for the eye, and the third eyelid gland produces 40% of the tears. The TEG has a T-shaped piece of cartilage in it, and is hidden out of sight and anchored to the tissues of the eye socket by ligaments. Some dogs are born with weak ligaments, which allow the TEG to pop out of its normal position and look like a pink roundish object in the inside corner of the eye.
PTEG is suspected to be inherited in some breeds, as it occurs with increased frequency in some breeds, notably the American Cocker Spaniel, Lhasa Apso, and English Bulldog. The condition can be in one eye or both eyes, and if in both eyes, it can occur weeks to months apart. Treatment is surgical, and involves repositioning the PTEG and suturing it into place. The prolapsed TEG should not be removed! If the condition is left untreated, the eye is at great risk for developing dry eye months to years later. Additionally the PTEG can swell and be uncomfortable, and interfere with vision. However, while surgery decreases the chances that the eye will develop a dry eye problem, it does not eliminate this risk.
The success rate of surgery is approximately 95% for non-recurrence of the PTEG, except in the English Bulldog and Mastiff breeds, in which the success rate is lower.
If you suspect that your pet has PTEG, please consult with your family veterinarian. Your doctor may recommend referral to a veterinary ophthalmologist for evaluation and surgical treatment.
Studies done at multiple veterinary schools show that when veterinarians use the same techniques and protocols as used in humans – the risks for surgery are reduced to same level or even below human hospitals. As a pet owner you need to know about the most significant surgical risks to your pet. When comparing one hospital with another you need the facts to make an informed decision.
1. Type and Method of Anesthesia used
by the Veterinarian makes all the difference
in your pet’s safety during surgery.
Havanese getting prepped for minor surgery.
There are many very different drugs and methods of anesthesia used by veterinarians. The safety and the cost of these drugs vary greatly. You may wonder why a veterinarian would choose anything other than the safest technique.
Anesthesia for an ovariohysterectomy (spay) can cost a veterinarian from $5.00 for cheap injectable anesthetics with no monitoring to over $220.00 for inhalant anesthesia monitored with EKG, blood pressure, pulse oximeter, computers that breath for your pet during the anesthesia, and highly trained anesthesia technicians. That is why low cost spay and neuter facilities are so profitable.
In today’s current economy, a veterinarian who does low quality, high risk anesthesia can actually charge ½ the fee that a veterinarian doing high quality, safe, low risk anesthesia surgery can charge. On top of that, the veterinarian offering the less expensive high risk anesthesia can earn twice as much money from a surgery such as an ovariohysterectomy (spay) or neuter. Low cost surgery is much more profitable for veterinarians.
Mistakenly, most discount spay neuter facilities do not explain the shortcuts that they take – using inexpensive but high risk injectable anesthetics, little to no monitoring, poorly trained low wage staff, using the same instrument pack for multiple patients, not autoclaving instrument packs, using discount suture.
Discount low cost spay and neuter facilities provide a great service in providing a low cost alternative for families that have financial difficulties. At the same time low cost surgical centers reward veterinarians with a much higher profit. But, rarely do these facilities explain to clients the shortcuts that they are taking, the lower standards of care and the higher risk for anesthetic death and infection for the dogs and cats. Like many things in life you get what you pay for.
A Safer Way
The only way to reduce a pet’s anesthesia risk to the same or lower than people is to use the same techniques and equipment used by human anesthesiologists. That is why veterinarians whose primary concern is about their patient’s safety purchase such expensive anesthetic equipment and use more expensive anesthetic drugs.
The first step is preanesthetic blood screening and exam to determine if your pet is healthy enough for anesthesia and if they have any conditions or problems that could affect anesthesia.
Then an intravenous catheter is placed in the vein with sterile technique. Then the pet receives pre-anesthetic drugs that reduce anxiety along with pain medications. Pain medications before surgery are much more effective than pain medications after surgery.
Then a short acting anesthetic is given so that a tracheal tube can be placed. This tube prevents aspiration pneumonia and provides a safe and effective path for oxygen and gas anesthesia.
High tech veterinary anesthesia utilizes very safe gas anesthetics balanced with intravenous medications such as morphine, lidocaine and ketamine. Veterinarians providing state of the art safe anesthesia always give intravenous fluids during surgery.
The pet is monitored with a pulse oximeter, EKG, blood pressure monitor, body temperature, breathing rate, and attached to a computer that gives a specific amount of oxygen and anesthetic by body weight algorithms. In this way the pet’s lungs are safely fully inflated during surgery reducing anesthetic hypoxia.
Not only is the type of anesthesia critical for the safety of your pet, but also the skill and level of training of the veterinarian and anesthesia technician determines the safety of your pet’s procedure.
The type of anesthetic drugs, the surgical equipment, and level of training of the technicians and veterinarian determines the safety of your pet’s surgery more than any other factor.
2. Cellular Hypoxia during Anesthesia
is what usually what causes death during anesthesia.
The number one cause of complications leading to death for a pet is cellular hypoxia. This happens when cells are starved of oxygen. When the cells of the heart are starved cardiac complications occur.
Oxygen is transferred to the blood stream through the lungs. Then the heart is responsible for pumping the oxygenated blood to the cells. During anesthesia, pets do not expand their lungs and breathe in as much air as when awake. This combined with lower cardiac output can lead to dangerous cellular hypoxia.
Cellular hypoxia varies greatly with different anesthetic drugs and anesthetic protocols. Less expensive drugs and techniques greatly increase the risk of fatal cellular hypoxia. To prevent cellular hypoxia anesthetized patients need positive ventilation that expands the lungs to get more oxygen into the body. Close monitoring of both the heart and body oxygen levels. This requires special anesthesia equipment and highly trained anesthesia technicians.
The Animal & Bird Medical Center uses expensive ADS 1000 computers that breathe for your pet while under anesthesia, Nelllcor pulse oximeters to monitor oxygen, blood pressure and ekg’s to closely monitor cardiac function. Our technicians are required to go through extremely comprehensive training.
3. The importance of Sterility
and Quality of Surgical Equipment and Sutures.
Another complication in surgery can come from improperly sterilized surgical instruments. There is only one acceptable method of sterilizing – extreme heat and pressure created by an autoclave that kills all bacteria, fungi, and viruses. Quality veterinary hospitals use a single pack of autoclaved instruments for each surgery, just like in human hospitals. A common practice in discount veterinary hospitals is to use one surgical pack for many patients to reduce costs resulting in cross patient contamination of bacteria and viruses.
A lower and less sanitary option of cleaning is immersion in a cleaning solution and using the same surgical pack on multiple patients. Since the late 1800’s, we have known poor sterilization results in sepsis and the spread of disease.
Also surgical instruments vary greatly in quality. Poor quality surgical instruments have poor tissue handling resulting in more trauma and higher complications. Quality veterinary practices purchase expensive German instruments. Other hospitals purchase low quality cheap instruments made in Pakistan.
The most common cause of fatal hemorrhage is poor surgical technique, often from using inexpensive and inferior instruments and cheap suture that has poor tissue handling capabilities. Discount spay and neuter clinics often purchase second rate products in rolls, just like fishing line. Rolls do not remain sterile as they become used and frequent handling can weaken substandard sutures. Quality suture is sold in individual, sterile packs with an individual needle.
At the Animal & Bird Medical Center all routine surgeries are done with an individual autoclaved surgical pack. The surgeon wears a sterile surgical gown, cap and gloves exactly like in human hospitals. We use the most expensive German instruments because our patients deserve the best. We use the same sutures used by plastic surgeons because this high quality suture causes less reaction and discomfort for our patients.
4. Your pet’s safety depends on the
Surgical Training of Veterinarians and Staff
and this varies greatly from one hospital to another.
In human medicine doctors are required to do advance training after medical surgery before doing surgery in hospitals. In veterinary medicine, no such training is required. That is why there is such a wide range of surgical abilities and training in veterinarians as compared with human surgeons.
It is up to each veterinarian to get advanced surgical training and develop their surgical skill after veterinary school. The skills of veterinarians vary widely from extremely unskilled to high levels of mastery. Surgical fees reflect the additional costs of advanced training and continuing education of veterinarian’s that are highly skilled. Veterinarians are very aware of their personal level of proficiency and charge according to their surgical expertise.
The skills of the veterinary technician and anesthetist in assisting the doctor before, during, and after the surgery are critical in your pet’s surgery and recovery. Dr. Murphy personally trains all veterinary technicians in his hospital to meet his level of expertise. Because they are highly motivated people, Dr. Murphy hand picks each technician for training. He pays for his staff to attend continuing education classes. The veterinary technicians at ABMC are very capable in phlebotomy (taking blood samples) , running laboratory panels, intubation and monitoring all devices like the pulse oximeter, EKG, blood pressure, etc. during surgery, among other procedures.
Before one is allowed to assist in surgery, a vet tech needs to show the ability to follow doctor instruction and also the aptitude to think ahead and anticipate circumstances, as well as adapt to fast changing conditions. They become the connection between the doctor, pet, and machines as the surgery progresses. After surgery, nurses lovingly care for your pet and vigilantly watch for changes in your pet’s condition, alerting the doctor if anything seems unusual.
Now that you know the risks how do you know your pet is receiving the care you expect? Ask to watch the procedure. Hospitals that take pride in providing care are happy to have you watch your pet’s surgical procedures.
There are two cruciate ligaments which cross inside the knee joint: the anterior (or, more correctly in animals, “cranial”) cruciate and the posterior (or, more correctly in animals, the “caudal”) cruciate. They are named for the side of the knee (front or back) where their lower attachment is found. The anterior cruciate ligament prevents the tibia from slipping forward out from under the femur.
The patella slides in a groove on the lower end of the femur (the bone that runs between the hip and the knee). There is a ligament called the “patella ligament” which runs from the bottom of the patella to the tibia, (the bone just below the knee joint). This ligament keeps the patella in place. The thigh muscles are attached to the top of the patella. When the thigh muscles contract, the force is passed through the patella and through the patella ligament, which results in straightening of the knee joint. The patella can luxate because the point where the patella ligament attaches to the tibia can sometimes be attached too far inward. As the thigh muscles contract, the force pulls the patella against the inner groove that it is sitting in.
The oxygen and anesthetic gas can then be administered through the air sac, keeping the beak and mouth free of tubes in order to safely perform surgery there! How cool is that?
