VetInfo Digest November 1998
This issue
What is a "spay" or a "neuter", anyway?
Treating and Transporting Injured Pets
When it's not just the dogs fighting...
What is a "spay" or a "neuter", anyway?
Most pet owners understand that a spay or neuter procedure makes it impossible for their pets to have puppies or kittens but don't know much else about the procedure. The variety and type of questions that people ask as they drop off their pets and read our surgical release forms is pretty amazing.
Spaying is generally used to describe the surgery for female cats and dogs. Neutering is generally used to describe the surgery for male dogs and cats. Ovariohysterectomy is the surgical term used by veterinarians to describe the spay surgery. Castration is a term that both veterinarians and their clients understand as a description of the neuter surgery but it is a term that makes men walk carefully as they leave the office so we use the more euphemistic "neuter". The surgical term for neutering is orchidectomy.
"Ovario" refers to the ovaries. "hyster" refers to the uterus. "ectomy" is surgical removal. So an ovariohysterectomy is removal of the ovary and uterus. Why do we remove these organs instead of doing a tubal ligation or other less invasive procedure? The simplest answer is that most people do not want to deal with a cat (queen) in heat or a bitch in heat. Cats really appear to be in pain sometimes when they are in estrus and dogs have blood tinged discharges and attract lots of suitors, both of which are irritating to pet owners. If a tubal ligation was done instead of removal of the ovaries the signs of estrus would occur on a regular schedule even though reproduction could not occur.
A similar situation exists with male pets. Tom cats prowl for females, leading to absences from home, increased risk of injury, cat fights, abscesses and an increased risk of feline immunodeficiency virus and feline leukemia virus infection. Intact (not neutered) tom cats are more likely to spray urine in the house to mark their territory. Intact male dogs may disappear for days at a time when a neighboring bitch is in heat. They get hit by cars, shot by angry female dog owners, bitten by dogs they are fighting with for access to the female in heat and they are also more likely to mark their territory than neutered males. There is a slight decrease in aggressive behaviors when male dogs are neutered.
The surgical procedure for spaying is similar in dogs and cats. Spaying is considered to be a major surgical procedure because an incision is made into the abdomen and because there are major blood vessels that must be ligated prior to removal of the ovaries and uterus. Anesthetic time is fairly long and many cats and dogs will be still be woozy several hours after surgery. An incision is made along the mid line of the abdomen. This is a good site for a surgical incision as the muscle layers meet here in a strong tissue known as fascia. It is possible to incise the fascia without much bleeding and the tissue holds sutures well and is very strong when it heals. I think that it is an advantage in veterinary medicine to be able to make incisions into this layer of tissue and aids in the healing time. We are fortunate that our patients are not concerned about their appearance in a swimming suit - probably the major reason that mid line incisions aren't made very often in humans. After entering the abdomen the surgeon finds the uterus, which is a "Y" shaped organ in dogs and cats. There is an ovary at the tip of each end of the "Y". The ovaries are anchored by a ligament and the arteries and veins that supply blood run alongside the ligament. A clamp is placed below the ovary and two or sometimes three ligatures, or loops of suture that are pulled tight and knotted, are placed around the ligament and the blood supply to stop blood flow. The ovary is then removed by cutting above the ligature. This process is repeated for the other ovary. The uterine body makes up the base of the "Y". It is attached to the cervix and has blood vessels running parallel to it in the tissue surrounding the uterus. A clamp is placed across the uterine body and the blood vessels and then ligatures are placed around it as well. The uterus is then removed and the cervix allowed to retract to its normal position. The surgeon checks to be sure there is no bleeding from the blood vessels that have been cut and ligated. If everything checks out OK, the abdomen is closed by suturing the inner fascial/muscle layer, putting a second set of sutures in the subcutaneous tissues and then closing the skin. The suture patterns for closing the skin vary among surgeons and there may or may not be visible skin sutures depending on how the surgeon elects to close the skin.
Is a spay always the same procedure and is price the only difference between one surgeon and another? I don't think so. The type of anesthetic chosen can impact the safety and the cost of the surgery. I think that isoflurane is the best available gas anesthetic, but only slightly safer than halothane. Choice of suture material is important. It is hard for me to justify the use of catgut suture at this time. There are much better suture materials which are stronger, less irritating to tissue and less likely to cause reactions. My favorite suture is PDS (also called Maxitrol) but there are other synthetics that are good, too. Equipment to warm the patient during surgery, to monitor the patient during surgery and the choice of whether or not to have a certified technician in the room to monitor the patient all impact on the cost and quality of the surgical procedure. Some practices include some pre-anesthetic lab work in the quoted price of a spay procedure and some do not. If your veterinarian charges more for a spay or neuter than surrounding veterinary hospitals there may be a very good reason for the difference.
Spaying a female dog has very strong health benefits if it is done before the first heat cycle. Female dogs have approximately a 25% chance of developing mammary cancer if they are not spayed until after their second heat period. Spaying prior to the first heat reduces the risk of mammary cancer to less than 1%. Spaying between the first and second heat periods reduces the risk to about 8%. In addition to this, one of the most serious health risks to female dogs is a condition known as pyometra, which is literally "pus in the uterus" or a serious uterine infection. Due to the way in which the bitch's reproductive cycle works she is more prone to serious uterine infection than any other domestic species. Even worse, there is no easy way to tell a uterine infection is developing in many cases, since the cervix is normally closed between heat cycles and little to no discharge may occur. Approximately 8% of female dogs will develop pyometra during their lifetime unless they are spayed. Often the dogs with this problem are very sick before symptoms become obvious and treatment may involve high risk surgery or intensive hospital care. For female dogs, the benefits of spaying far outweigh the risks of the surgical procedure. Female cats are less prone to developing problems if they are not spayed but the benefits of population control and other previously mentioned benefits still apply.
Neutering is a very simple surgical procedure. Most of the men who drop off their dogs and cats for surgery at our practice have a hard time believing this, but neutering really does fall into the "minor" surgery category except for the slight risk of general anesthesia. When neutering cats, most surgeons make two incisions into the scrotum, one directly over each testicle. The tough sheath (tunic) around the testicle is incised and the testicle removed. The blood supply is ligated and allowed to retract into the subcutaneous tissues. In most cases the scrotal incisions are not closed with suture but the collapse of the scrotum brings the tissue edges together and they heal well. In male dogs one incision is usually made just in front of the scrotum. Each testicle is then pushed forward under the skin until it is under the opening in the skin. The tunic is incised and the testicle freed from it. The blood supply to the testicle is ligated and allowed to retract into the deeper tissues. In dogs the incision is normally sutured. We favor subcutaneous sutures because they seem to bother dogs less than skin sutures but either way is acceptable. If there are skin sutures they should be removed when your veterinarian advises doing so. If he or she forgets to tell you to come back for suture removal it is usually safe to do so after seven to fourteen days.
Dogs and cats seem to recover from spay and neuter procedures very rapidly. A few dogs will be uncomfortable for two or three days but most seem to be fairly normal by the next day. It is still a good idea to be careful for a few days and resist encouraging exercise. Pain relief may be a good idea. At the present time most pets do not receive pain relieving medications after spay or neuter procedures. In our practice we do not routinely prescribe pain relievers but we do mention that they are available to almost all owners on discharge. I think that it would probably be better to prescribe pain relievers but we are limited in our options for pain relief for cats and are often limited by the owner's finances in dogs. If your pet is spayed it would be a good idea to ask your vet about pain relief. It is probably less important for neuter surgeries but it is reasonable to use pain relief medications after almost any surgery. We do not keep pets overnight after spaying or neutering for a very simple reason. We do not have 24 hour a day staffing. If we kept pets overnight they would be alone for several hours at night. It seems better to send them home where someone can watch them. If you are thinking of leaving your pet overnight at your vets it is a good idea to know if someone is at the hospital at night. There are legitimate reasons to keep a pet even when 24 hour care is not available at a clinic, but sometimes other alternatives are available, such as a local emergency or critical care center.
Why do American veterinarians believe so strongly in spaying and neutering? Partly it is due to the obvious overpopulation of dogs and cats in the U.S. Partly it is due to a recognition of the potential health benefits. But lots of times it boils down to personal experience. We treat the pets that have problems because they aren't spayed or neutered. The following is a true story. One of many that occur in veterinary practices with surprising regularity. We had a dog who was brought in one afternoon by a person who hit him with her car. The dog had difficulty breathing, weakness and pain in the rear legs. The woman said "he came out of nowhere and ran straight across the road in front of my car". We took chest x-rays expecting to find collapsed or bruised lungs or perhaps a diaphragmatic hernia due to the car accident. Instead we saw a large caliber bullet in his chest. X-rays of his pelvis revealed that it was broken in three or four places. Our best guess is that he was hanging around a female dog in heat long enough to make the dog's owner mad. He was probably shot with a pistol. This was frightening enough to send him straight home, which unfortunately involved crossing the road, leading to his encounter with the car. All in all a very bad day --- and one that didn't have to happen. It is possible to have an un-neutered male dog and to care for him in such a way that he isn't exposed to these risks but many people are not willing to fence their dogs or to take them outside only when supervised. We wouldn't be so sure about what happened to this dog except for two subsequent patients that day, male dogs who had also been shot, from the same neighborhood. Our practice record is five male dogs with bullet wounds on the same day. This probably isn't as big a problem in less rural practices but I'm sure it happens everywhere.
There are some problems associated with spaying and neutering pets. There are many pets who make it to the age range in which these surgeries are performed but have underlying health problems that make anesthesia risky. Often these health problems will not show up in routine lab work or on a clinical exam. One example of this is cardiomyopathy in cats. It can be extremely difficult to detect prior to surgery but is probably one of the leading causes of anesthetic death in cats. Performing major surgery on a large percentage of the population inevitably leads to some deaths. I have never found a good estimate of the actual risk involved but my personal estimate is that about 1 in 200 to 400 dogs or cats dies during the anesthetic induction or surgical procedure. This is a much smaller number than would die from giving birth or complications associated with not spaying or neutering pets but it is still a risk. Spaying and neutering scare me more than any other surgical procedures simply because they are routine and yet they are major procedures. No one expects their pet to die during a spay or neuter surgery and it is very difficult to call a pet owner and tell them their pet died unexpectedly in our clinic. Most of the time pets will have no problems with the actual surgery, though. Longer term effects can occur and have to be considered among the risks, though. It has been noted that aggressive female dogs may actually become more aggressive after being spayed. Spaying female dogs seems to cause urinary incontinence to occur in a small percentage of cases, probably about 1 to 2%. This is usually responsive to medications but it is still an inconvenience. Weight gain after spaying or neutering is worrisome to many pet owners. In all honesty, I think that this effect is less common than people think. Most pets gain weight after they become mature adults, just like most people gain weight in the same age range. When spayed and neutered pets are compared to "intact" pets in studies, there is only a 5 to 10% chance that a pet will gain more weight than they would have otherwise. It may be necessary to cut down on the amount of food given to a pet after spaying or neutering and this is equally necessary in many instance when pets are not spayed or neutered. In the case of spays and neuters the benefit almost always outweighs the risks.
Treating and Transporting Injured Pets
It is not uncommon for clients to tell my receptionist that their pet has been injured and that they need a vet to come to their home because they are afraid to move the pet. I think that some of this feeling comes from first aid training in which people are advised to keep trauma victims still and not to move them in order to minimize the risk of further injury. This is good advice in humans since there are usually trained emergency medical personnel with specialized equipment to move injured people. It isn't as valid a fear in veterinary medicine because there are few places with animal ambulances and most vets are not able to leave their offices or hospitals to travel to a patient to provide on-site care. In veterinary medicine it is important for a pet owner to know how to transport an injured pet.
The first thing that must be considered is the safety of the pet and the safety of the humans attempting to attend to the pet. Injured dogs and cats are more likely to bite than pets that are not injured. Even a pet that has never shown any inclination at all to bite may do so after a painful injury or when in shock. Pets will even bite themselves at times in these circumstances and sometimes even inflict pretty severe wounds on themselves. It is a good idea to practice making a temporary muzzle for dogs while your pet is un-injured and more likely to be cooperative. I like to use Conform (TM) gauze for temporary muzzles. It is stretchy but strong and comes in a nice width of 2 inches. Many drug stores sell Conform or similar guaze. I keep a roll of this in my glove compartment and it has come in handy on several occasions. Anything that can be tied around the muzzle will work as long as it is 2 feet or more in length, though. We make a large loop with one overhand knot (the same knot as the first part of tying your shoe) in our guaze to start the procedure of making a muzzle. Make the loop large enough that you can get it over your dog's muzzle while your hands are still several inches or more away from the muzzle and teeth. Tighten the first loop so that the knot is on the top of the muzzle. Immediately make a second loop, drop your hands down below your dog's chin and tighten this one so that the knot is on the bottom of the muzzle. Now you should have two loops around the dog's muzzle, one with an overhand knot on top of the muzzle and one with the loop on the bottom and you should still have two long ends. Tie the ends behind the dog's head below the level of his ears and you have a good temporary muzzle. Some dogs are very difficult to muzzle due their temperament or due to the shape of their face. If this is the case you may just have to be very cautious and stay well away from the dog's mouth and teeth and watch carefully for sudden attempts to bite.
Cats are a lot harder to deal with when they are frightened and injured. Sometimes it is possible to coax an injured cat into a box or cat carrier because they want to hide and the box or carrier looks like a safe place to go. Often, this won't work. If it is possible to wrap a cat in a towel or blanket so that their head is covered but still controllable it is possible to reduce the risk that the cat will bite.
For both dogs and cats a flat board or any reasonably stiff flat object can help a lot in making transportation of an injured pet easier and make transportation safer, too. If the pet can be gently slid onto a board it can then be taped down with a strip of duct tape across the neck, shoulders and hips or covered with a blanket that is secured to the board.
A blanket can also be used to transport a pet that is too large for one person to carry. The blanket may be folded over double and then placed parallel to the injured pet's back. The pet can then be rolled over onto the blanket. One person on each end or one person on each corner can then share the load. We have used this method to transport an African lion into our clinic on several occasions and so far ordinary blankets have held up under the 250 pound weight of an adult lioness. So far, I haven't met a dog this large.
People are often concerned about stabilizing broken legs before bringing a pet into the office. It is a good idea to try to stabilize a fracture that is below the level of the elbow on the front legs or below the level of the knee on the rear legs. A simple splint for this stabilization is a folded newspaper made into a "U" and then taped to the leg. Magazines will work, too. If you suspect your pet has a fracture above these joints it is usually not much help to try to splint the leg. Just transport your pet to your vet as quickly as you reasonably can and in most cases there won't be much more damage than there was when the leg was first injured.
If a pet has an injury that is bleeding excessively an effort should be made to stop the bleeding. Direct pressure on the wound, preferably with an absorbent pad, is usually the best course of action. If the blood coming from the wound is dark bluish-red colored and pooling or dripping then it is probably from a vein and less of a threat than blood that is bright red and pumping several inches out from a wound and coming from an artery. It is imperative to gain control of arterial bleeding if at all possible. Don't remove the cloth or pads that become blood soaked. Just apply more. If the wound is on a leg it can help to fasten the pads or cloth bandages to the leg with duct tape or masking tape to allow you to transport your pet without applying pressure manually at the same time. It is almost never a good idea to apply a tourniquet. Even major bleeding can usually be stopped with persistent direct pressure. Elevating the wound can help a lot, if the pet is cooperative.
If you have to, you can even do mouth-to-nose resuscitation on pets. It is necessary to try hard to hold the dog or cat's mouth shut and sealed and then to blow directly into the nostrils. If you are successful you should see movement of the chest up when you blow air into the nostrils and then down when you stop. Dr. Rebecca Kirby, one of the leading emergency veterinarians in the U.S., recommends keeping the neck as level as possible when attempting to breath for a pet -- so laying down on the floor and extending the pet's neck is better than turning it up to make it possible for you to attempt mouth-to-nose resuscitation while kneeling.
Don't argue with your veterinarian's receptionist about the need for the vet to come out. If this service is possible the receptionist will know. If it is not possible then arguing is wasting time that might be important to your pet's survival. In most cases, if the vet does come to the house he or she won't be equipped to deal with the problems on the spot, unless you use a well equipped housecall service already. By the time the vet gets to the house and then back to the clinic the time before definitive treatment can be initiated is doubled. I learned this lesson the hard way trying to help when clients seemed really distraught. It is almost always better to just to work quickly to be sure that no one will be injured, stabilize your pet on a board or other similar object if one is available, call your vet to let them know you are coming and make sure they are not in the middle of surgery on another pet or some other situation that makes it necessary to seek help at another veterinary hospital and then head to the appropriate veterinary facility. Remember that hard turns, sudden braking and other symptoms of driving too fast can be pretty painful to an injured pet. Drive safely and carefully.
You can help your pet through a crisis. Think about what you have available right now to aid in transporting your pet. If you need to get some guaze for a muzzle or to locate a suitable board for moving your pet so you know where it is, do this before you need these items in a crisis. Like the Boy Scout motto says "Be Prepared!"
When it's not just the dogs fighting...
Treating dog fight injuries and wounds from dog attacks on cats and smaller less aggressive dogs are a routine part of a country veterinarian's job. Leash laws and fenced yards are not very common in rural areas and dogs are often allowed to wander freely around the neighborhood. Rural vets tend to cover their own emergencies. Consequently, I find myself alone at my office with anxious owners and injured dogs pretty frequently.
People who own large aggressive dogs often fail to see any reason why their dogs shouldn't be allowed to wander just like everyone else's dogs. People with small wandering dogs can't understand why their dog would be attacked by the neighbor's big aggressive dog when it wanders into the neighbor's yard. Many times people have expressed the sentiment that dogs have been living together for thousands of years, it seems logical that they would have learned to get along. I usually try to point out that the same could be
said for humans and that our track record isn't any better than dogs and we're supposed to be more intelligent.
When people come into the office with a dog badly injured by another dog they are often pretty mad. While I am working on the dog they either tell me how they are going to find the neighbor who is irresponsibly letting a killer dog run loose and "settle things with him" or "give them a piece of my mind," or even "kill them" or else they tell me how the dog is going to disappear the next time it steps foot on their yard or attacks their dog.
I used to wonder what would happen if the other dog was injured as well and both owners showed up at my doorstep at the same time. Surprisingly, it took several years of practice before I had to deal with that problem.
The phone call that brought me to the clinic that night was pretty typical. "My dog is bleeding all over the carpet and I can only find a couple of little holes in him. I think someone shot him. If I find out who it was, they're gonna pay for this!" I always worry that clients think I am going to work on their dog and then wait for the mysterious shooter to pay me when a statement like this is made, so I usually make it clear that isn't the case.
" I'll be glad to meet you at my clinic and work on Harry, Mr. Eaton, but you need to understand that you'll have to pay me yourself since Harry is your dog." It is best to get right to the point when dealing with people in emergencies.
"Is that all you vets care about, getting paid?" is often the reply, as it was tonight.
"Well, Mr. Eaton, I just agreed to leave my house at night and to meet you at the clinic but I'd be glad to send you twenty dollars not to come." That's what I want to say. Usually I say something like this, instead, " I will meet you at the clinic and see what we can do about fixing Harry. I just wanted you to know who would be responsible for the bill."
The Eatons didn't appear to think about braking their old pickup until the last minute. A great cloud of dust drifted across the spot in front of the door illuminated by the floodlights. Two or three small pieces of gravel bounced off the front door of the clinic. Mr. Eaton came running in to announce their arrival and the fact that he was afraid to pick Harry up as it might hurt him to move him. Since Harry was standing up and barking out the window at this time, I didn't think that was too likely but took a leash out, put it on him and walked him into the clinic.
Harry had a large triangular flap of skin hanging off his left side where the other dog had apparently gotten a grip and not let go. He had blood oozing from puncture wounds on his elbow and from both lips. His eyelid was torn a little over his left eye. He really did look bad. I didn't think it was too likely he had been shot. I was wondering how the Eatons had missed the big wound on the left side when they noticed it.
"Look at that big hole in his side, Doc! Do you reckon that's where the
bullet came out?"
"Well, I really think that these are bite wounds, Mr. Eaton."
"Do you think another dog could do all that? Harry has always been able to hold his own in a fight."
"Well, I think these are bite wounds. I don't know if it was one dog or two dogs or some other animal but I think these are bite wounds," I said, knowing that I probably didn't sound convincing enough. Mr. Eaton wanted to know how I could be sure. I explained that I could take X-rays and look for bullets but that it would cost considerably more than just taking care of the wounds and assuming I was right. "Besides," I said, " you don't know who lost a fight until you see the other dog."
"Well, Doc, do what you have to do. Someone else is paying for this one, by God."
Once again I was compelled to explain that no matter what had happened to Harry, the Eatons were going to have to pay the bill if no one else would.
"Don't worry, Doc, I'll find whoever's dog did this and they'll pay the bill or one of us will end up in jail." From some people that might sound like an empty threat but I was aware of the fact that Mr. Eaton had on occasion been in jail for things like disturbing the peace and minor assaults.
I gave Harry a mild sedative and then an anesthetic. He was soon asleep on our surgery table and I was busy sewing up the bigger wounds and cleaning out the littler ones. The Eatons had settled down in the exam room after Mr. Eaton got a little woozy at the sight of surgery. They were just sitting there quietly when the door burst open and someone came running in shouting. "Doctor Richards are you here? My dog is nearly dead. Some S.O.B. lets his mean old retriever run loose in our neighborhood and it tore my dog to pieces".
I came out of the surgery room just in time to see Mr. Phillips notice Mr. Eaton and begin to yell at him. "Your dog is a killer and I'm going to shoot him the next time he steps foot on my property." I knew that the situation was going to get a lot worse, very fast.
Mr. Eaton wasn't much for verbal sparring. He just said something that might have been "Your damned dog is the problem" and hit Mr. Phillips in the middle of his chest with his head as he dived at him. Both men hit the floor hard.
I wasn't really prepared for what happened next. As Mr. Eaton and Mr. Phillips slid across the floor a gun appeared between them, then slid across the floor. With reflexes that only sheer terror can produce, I leaped across the room and landed on the gun before anyone else did. I immediately ran to the back room with it and threw it in our controlled drug safe and slammed the door shut. Mr. Eaton was hot on my heels.
"Give me my gun back. You got no right to take it away like that, " Mr.
Eaton shrieked. Mr. Phillips was right behind him, thumping him on the head, apparently with no idea that Mr. Eaton had been armed just moments before. The word "gun"
finally sunk in and he got a little pale.
"Mr. Eaton, get out of my office and don't come back until tomorrow morning. I will be done with Harry's surgery and he will be recovered by then, " I said, straining to stay calm.
"Not without my gun". He had forgotten all about the fighting with Mr. Phillips now and his attention was focused on me. His face had obtained a shade of purple that I usually associated with people who had been in car accidents and bounced off the windshield. He was swinging wildly with one arm, trying to hit me. Mrs. Eaton was hanging on the other arm. Fortunately, he was also a lot smaller than me and Mrs. Eaton had a firm grip on his other arm by now, so I was able to hold him at arm's length with
one hand and dial 911 with the other one.
"The deputy will be here in a couple of minutes and you can see if he'll make me give your gun back," I said.
Mr. Eaton elected to make a quick exit instead. This was before the time of gun permits and such in Virginia but I think he wanted to avoid legal entanglements for a while, anyway. Mrs. Eaton told me that the V.A. had diagnosed post-traumatic stress syndrome in Mr. Eaton and that she would make sure that he settled down and then left to find him and take him home.
The deputy told me to give him his pistol back in the morning if he showed up for it and assured me it was OK to take the bullets out and keep them, just in case there was some question over the bill or residual anger over calling the Sheriff's department about him.
Mr. Phillips spent a half hour telling me how irresponsible it was for the Eatons to let their dog run loose since it fought with other dogs while I finished up working on Harry and cleansed several punctures in Sailor, his dog. I didn't try to discuss the fact that both dogs appeared to be pretty damaged and both were obviously running free in the neighborhood. The night had been exciting enough already. Fortunately, he suddenly decided that the surgery room was pretty hot and that he better go sit down awhile, too. Sailor wasn't hurt as badly as Mr. Phillips thought and he was able to take him home that night.
Mr. Eaton did come back for his gun. In the light of the day it was possible to see that it was held together in several places with electrical tape and that it questionable just who might have been killed if the trigger had been pulled. No one ever asked about the missing bullets. Both dogs healed well and both came in later as the result of fights with other dogs, or perhaps even with each other again. But they never came in together on the same night again.
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