08 September, 2012
animals - dogs, cats, hamsters, guinea pig & rabbits.
Key Performance Indicators
for a fat dog spay
Dr Sing Kong Yuen, BVMS
08 September, 2012
Be Kind To Pets
Sunday Sep 2, 2012.
Sunny day, blue skies
Three dog owners told me today:
1. Dog at 5 years old, if neutered, will develop prostate
2. Dog at 11 years old. Too old to neuter to prevent urine
marking. I checked the health. Has heart disease now. So,
anaesthesia not advised.
3. Dog, 4 years old. If spayed, will still get heat
bleeding. "This is not possible," I said."Unless the vet
leaves behind some ovarian tissue after spay."
I took over the spaying of this overweight Maltese X, at
9.15 kg, as Sunday is a busy day and I can spay faster,
due to more years of experience. Still, I pray not to get
A. 10am Sedation with D + K at 50%. Dom = 0.18ml
Ketamine = 0.23ml IV.
B. 10.28 am Isoflurane gas first given
C. 11 am Isoflurane gas stopped
D. 10.34 am First skin incision
E. 11.02 am Completion of stitching
Lots of oily fat. Hooked 2nd attempt.
10.42 am Left ovary hooked out
10.48 am Right ovary hooked out.
10.51 am Uterine body pulled out
10.55 am Uterine body ligated twice at 2 locations
10.56 am Linea alba stitched
11.02 am End of stitching.
12 noon Dog alert and goes home.
E-D = 28 minutes
E-A = 62 minutes (includes dental scaling before spaying).
Therefore, excluding dental scaling, just for spay, E-A
should be lesser.
SPAY TIPS FOR YOUNG VETS
1. The incision started 1.5 cm from the umbilical scar.
2. Ensure ovaries are exposed thoroughly including at
least 5 mm of the ovarian suspensory ligament. Incise
anteriorly 5mm more if you find difficulty in pulling out
the ovary or can't access the suspensory ligament. In this
dog, I was able to pull out the whole ovary and my finger
could feel at least 5 mm of the suspensory ligament.
3. NICK INSTEAD OF RUPTURING THE SUSPENSORY LIGAMENT AS
ADVISED BY THE PROFESSORS.
What to do with this suspensory ligament. I know the
professors in the University may say "snap" it off with
the finger by pulling hard to break it. The danger in fat
dogs and small breed is that the force may break the whole
ovarian ligament including the ovarian blood vessels,
leading to profuse bleeding.
3.1 I use the scalpel blade and nick off the taut
suspensory ligament on the dorsal side at around 2 mm
depoth. A young vet asked me whether I would also nick off
the ovarian blood vessels with the scalpel. My answer is
no if you just nick at the taut ligament. You can feel it
very tight when you pull out the ovary and at the tight
area, use the scalpel to nick it. For big breeds, you can
feel this tight ligament. I also nick it in big breeds.
4. TRANSFIXING SUTURE. The professors advise transfixing
the uterine body. Now, the theory is great but in
practice, the uterine body of a small breed like the
Maltese or even this fat Maltese X Silkie is less than 8
mm in width. Transfixing ligature may rupture this uterine
body as there is not much space. In this dog, I ligate the
uterine body 2 times at 2 locations.
5. PROFUSE BLEEDING SEEN. If you incise the linea alba
correctly and not the muscles, you seldom get profuse
bleeding. I don't separate the omental fat surrounding the
length of the uterine horn in this fat dog. Some vets will
pull off the omental fat before ligating the uterine body
and in big breeds, this may need to be done. In small
breeds, I don't do it and ligate it together with the
uterine body. Hence two ligatures at 2 locations. Profuse
bleeding may come from omental blood vessels and it can be
very alarming, as the body fills with flowing blood.
In cases where bleeding is non-stop, even when swabs are
used, it is necessary to extend the incision to look for
the bleeder and to save the dog from bleeding to death.
There is no choice. Sometimes, the dog is on heat and the
omental vessels are fragile and bleed easily. If the vet
does NOT clamp the omental fat from the uterine horn area
but just bursting it away with fingers before ligating the
uterine body, there may be alarming profuse bleeding.
5. NO. OF SUTURE PACKETS
I used one packet of PDS 2/0. The last bit was to suture
one horizontal mattress suture on the skin.
In conclusion, for the young vet, keep spaying simple by:
1. Making a large skin incision of over 4 mm. It is
unlikely you can do a 2 cm incision and so don't try till
you know the best location.
2. Try not to use fanciful stitching. Simple interrupted
stitches x 3 (in this dog where the linea alba is around
2.5 cm long) and one horizontal mattress suture for the
skin. No subcuticular or hidden sutures to impress the
owner. Efficiency (short surgery, accuracy, speed
and completion) rather than take your sweet time to do a
Sunday Sep 2, 2012 was a busy
day. So I did a spay of a fat SilkieXMaltese, 5 years old. This
case was written earlier. Today, Tuesday, I phoned the owner to
find out what happened after spay and to let them know the blood
test results were OK.
"Why did your sister want the dog spayed?" I asked.
"My sister moved to a new apartment and did not want the
furniture soiled by blood from the dog's heat," he said. "Also,
mum is getting old and having to clean up the blood stains of
heat would be too tiring for her."
Good reasons to spay a dog. I was intrigued to know why the
sister asked me a few times and now the brother as to whether
the dog would still have bleeding of heat after spay.
Here are the reported findings on this dog after spaying.
Day 1. Sep 2, 2012. Spayed in the morning. Went home at around 1
Evening, the dog could not
sleep properly as she needed to rest her head on her two front
paws but the e-collar was obstructing. She paced. After the
owner took out the e-collar, she was OK. Not eating except when
given cheese (ate a bit). Slept sideways.
Day 2. Sep 3, 2012. Morning. Walking and barking. Able to eat.
Jumped on chairs.
Day 3. Sep 4, 2012 (today). Morning. Normal. Not wearing
e-collar. Monitored. Plaster with blood - not able to replace
with new one. Dog ran away.
No tolfedine painkillers (oral) were prescribed. A tolfedine and
baytril injection were given post-op.
Fast recovery. Could possibly be due to small skin incision of
around 2 cm in length and no surgical complications like
peritonitis? In most of my spay cases, the female dog is normal
on Day 3, as in this case.
All rights reserved. Revised: September 08, 2012
Toa Payoh Vets