Archive for December, 2011

Ovariectomy (OVE) Versus Ovariohysterectomy (OVH) Revisited

December 26, 2011
Licensed under a Creative Commons Attribution License.

Photo Credit: Roger H. Goun

If you’ve been reading my blogs for awhile now, you may remember two of my previous posts. While OVH surgery involves removal of the uterus and both ovaries, with OVE surgery just the ovaries are removed. Both are effective techniques for spaying (neutering) female dogs and cats. I am bringing this topic to your attention for a third time based on a recently published article within the Journal of the American Veterinary Medical Association.

The article is titled, “Ovariohysterectomy Versus Ovariectomy for Elective Sterilization of Female Dogs and Cats: Is Removal of the Uterus Necessary?” Let me get right to the article’s punch line by presenting the authors’ final paragraph:

We do not believe that there is any scientific evidence for the preferential teaching of ovariohysterectomy instead of ovariectomy by schools and colleges of veterinary medicine in the United States and Canada, and it is our view that ovariectomy provides an equally effective technique for elective sterilization of female dogs and cats with no recognized disadvantages. Potential advantages of ovariectomy include a smaller incision, better viewing of the ovarian pedicle, and possibly less risk of complications associated with surgical manipulation of the uterus.

The authors’ conclusion is based on a review of recent literature comparing these two surgical techniques. When I’ve previously recommended OVE as the spay surgery of choice, here are the two concerns that you, my readers have voiced:

  1. You are unable find a surgeon who will perform OVE surgery. Here is what I recommend. Call multiple veterinary hospitals in your community and ask if the vets on staff are willing to perform ovariectomies (if the receptionist is uncertain about what you are asking, you may wish to tactfully ask to speak with a veterinarian or technician). If nothing else, you will be raising awareness about this recommended alternative. Based on what you’ve told me, some of your vets have been willing to educate themselves and perform their very first OVE surgery in response to their client’s request, and the results have been fabulous. If one is adept at removing ovaries and uterus, removing just the ovaries is a “no brainer.” So, it is perfectly fine if your vet performs his or her very first OVE on your dog or cat (I would normally strongly advise against your pet being your vet’s “first” surgery or procedure of any kind). Board certified surgeons gladly perform OVE surgery and may do it the conventional way (incision made on the underside of the abdomen) or via laparoscopy (a method that employs scopes which are introduced into the abdominal cavity via small incisions). The only drawback to having a specialist do the work is that the price tag for the work will be considerably higher than the norm.
  2. You have voiced concern that if the uterus is not removed, your pet could develop pyometra, an accumulation of pus/infection within the uterus that necessitates its surgical removal. Please don’t buy into this ridiculous notion! Pyometra only occurs under the influence of progesterone, a hormone produced by the ovaries. Without the ovaries no progesterone is produced and there is no risk for development of pyometra. Period!

I want to emphasize that if you cannot find a surgeon who will perform OVE surgery on your dog or cat, no biggee! There is truly nothing wrong with removing the uterus. I only wish to create recognition for the fact that it is completely unnecessary to do so. Lastly, if you are contemplating spaying your older pet (her uterus has been around the block a few times), visual inspection of the uterus at the time of surgery is warranted. If the uterus appears abnormal, it should definitely be removed- the one situation where OVH rather than OVE makes perfect sense.

Has your pet recently been spayed? Which surgical procedure was performed?

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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The Cookie Thief!

December 18, 2011

I have the good fortune of lecturing professionally, and what I most enjoy presenting is the topic of communication between veterinarians and their clients. In every communication lecture I emphasize the importance of empathy. This involves veterinarians putting aside any preconceived notions and judgments about their clients so they can better recognize how their clients are feeling and what they are truly needing. In order to drive this point home during my presentation, I usually recite a poem I adore called, “The Cookie Thief.” While preparing a lecture earlier this week, it dawned on me that you might like this poem as well. Enjoy!

The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop.

She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be. . .grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene.

So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, “If I wasn’t so nice, I would blacken his eye.”

With each cookie she took, he took one too, when only one was left, she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half.

He offered her half, as he ate the other, she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude!

She had never known when she had been so galled, and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate.

She boarded the plane, and sank in her seat, then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes.

If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

Have your preconceived notions about someone ever been completely upended? Do you think your veterinarian has preconceived notions about you?

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

I Can’t Believe He Ate That!

December 11, 2011
Needle lodged within the intestinal tract © Cuyahoga Falls Veterinary Clinic
Dogs and cats eat some pretty darned crazy things! Sure, I can understand nabbing a loaf of bread from the kitchen counter or sneaking some “kitty roca” out of the litter box. But why on earth eat a sewing needle, panty hose, Lego pieces, or mama’s favorite diamond earrings? Just when I think I’ve seen it all, something new surprises me.

Dogs, more so than cats, tend to be “repeat offenders.” I recall one Labrador in particular who had six surgeries over the course of his lifetime to remove socks lodged within his intestinal tract (in spite of counseling his humans repeatedly on picking up their socks). As many surgeries as this dog had, we should have installed an abdominal zipper!

Not all cases of foreign body ingestion have such happy endings, particularly if the foreign object has perforated through the wall of the stomach or intestinal loop. This allows leakage of nonsterile gastrointestinal contents into the normally sterile abdominal cavity resulting in widespread inflammation known as peritonitis. With emergency surgery and post-operative intensive care, many of these patients survive, but it is certainly becomes a big deal, both for the patient and the pocketbook.

Esophageal foreign bodies are notoriously difficult to remove, particularly if they’ve been lodged for more than a day or two. (The esophagus is the muscular tube that transports food and liquids from the mouth down into the stomach.) Even if the foreign object is successfully removed, the resulting inflammation within the esophagus can result in the formation of a stricture (narrowing of the esophageal lumen) and chronic, severe swallowing difficulties.

Some dogs and cats are lucky. The foreign objects they eat pass freely without any ill effects. I see the not so lucky ones with objects that have become lodged within their gastrointestinal tracts. There are two means to retrieve a gastrointestinal foreign body, surgery and endoscopy. An endoscope is a long telescope device that can be passed through the oral cavity, down the esophagus and into the stomach and upper portion of the small intestine. The endoscope allows visualization of the inside lining of the bowel and its contents. A grabber type instrument can be deployed through a channel in the endoscope to grab the object and then pull it out through the mouth. Endoscopy requires general anesthesia, but it is often preferred over surgery because of its less invasive nature.

In order for endoscopy to be of benefit, the foreign body must be located within the esophagus, stomach, or the very upper part of the small intestine (this is as far as the endoscope can reach). Some objects (coins, needles, tennis ball fragments, cloth) are well suited to being removed endoscopically because they are more “grabbable.” Objects that have traveled further down the gastrointestinal tract (beyond reach of the endoscope) or are without “grabbable” surfaces (large rounded bones, balls) are better retrieved surgically.

What can you do to prevent your dog or cat from eating inappropriate things? First and foremost, “baby proof” your home and yard for your pet. Anything unsafe that your little snookums might want to “mouth” should be put away and out of reach. This is particularly important when caring for a puppy or kitten. Secondly, it pays to know your pet- some cats and dogs never grow out of the habit of putting strange things in their mouths. Some adult cats continue to graze on dental floss found in the bathroom garbage pail, and some adult dogs continue to scarf down panty hose and underwear. If you provide chew toys or bones to your dog, supervise carefully to be sure that he’s a nibbler rather than a “swallow it whole” kind of guy. The best defense against gastrointestinal foreign bodies is avoidance of the things your pet might be willing to swallow. In some extreme cases, I’ve encouraged folks to muzzle their dogs when outdoors unsupervised or on walks, so they can relax knowing that their dog cannot gobble something down in the blink of an eye.

Perhaps my most memorable foreign body retrieval was performed on an adult Saint Bernard. X-rays suggested something was lodged in her stomach, but I couldn’t be clear exactly what the foreign material was. I passed my endoscope down into the stomach and saw an intact hand. I thought, “Oh my goodness!” I looked around a bit more and spotted a foot, and then what looked like some human hair. My heart was racing until I finally removed what I could identify as the chewed up remains of a troll doll! Afterwards I chuckled remembering that the view I get through the endoscope is magnified significantly!

What crazy thing has your dog or cat eaten in the past? Did it pass on its own or was it necessary for your vet to come to the rescue?

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Introducing Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet

December 4, 2011

A few months ago, as I sat nestled with my laptop crafting a new blog post, my husband queried if I thought I might ever run out of words. Yes, he was joking, but this is the sort of thing authors worry about from time to time as they ponder if the day will come when they will have run out of worthwhile ideas and the right words to convey them.

I sense that I have the reserves to write with a purpose for many years to come. In large part, this is thanks to the inspiration I continually glean from you, my readers. Every time I hear that something I wrote guided someone through a difficult medical decision, provided moral support during the euthanasia process, or helped a person hold their ground with their veterinarian, I am inspired to write that next sentence. Thank you for this!

Speaking of writing new material, with no further adieu, I would like to introduce you to my new “baby” titled, Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet. It is sizzling hot off the press and is available via Amazon, other online retailers, and soon, your neighborhood bookstores. I invite you to give it a read, and if you happen to be looking for a unique holiday gift for your dog loving friends and relatives, search no further!

With Speaking for Spot my goal was to teach you why we need to be medical advocates for our pets and how to fulfill this important role. Now, with Your Dog’s Best Health my intent is to take you to the next level by spelling out what is reasonable to expect from your vet. Included are some expectations that may just surprise you. For example, did you know that it’s reasonable to expect email communication with your vet, discussion about your Internet research, and explanations of all options for your pet, regardless of cost? In the spirit of saving the best for last, I reserved the final chapter of Your Dog’s Best Health for clarifying what is reasonable for your veterinarian to expect from you! Needless to say, visits to the vet will never be the same!

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.