Posts Tagged ‘surgery’

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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Even More to Say About a Better Way to Spay

March 17, 2011
In January I wrote a piece called, “A Different Way to Spay” (http://speakingforspot.com/blog/?p=1931) describing two techniques for performing spay surgeries.  The method widely embraced in the United States is ovariohysterectomy (OVH) in which both ovaries as well as the uterus are removed.  The second way to spay- popular in many other countries- is ovariectomy (OVE) in which only the ovaries are removed and the uterus is left behind.  

Charlotte, OVE spay at 7 months © Kathie Meier

Since publishing the piece, many of you wrote to me expressing your frustration at not being able to find a veterinarian willing to perform OVE surgery.  I’ve written about those comments and provided an overall update on this topic for PetConnection.com- I sure hope you will read it (http://www.petconnection.com/blog/2011/03/15/a-better-way-to-spay-your-dog-that-you-probably-never-heard-about/).  Additionally, Dr. Tim McCarthy, a wonderful PetConnection colleague provided a response blog discussing the benefits of performing spays via laparoscopy- a form of minimally invasive surgery (http://www.petconnection.com/blog/2011/03/17/another-better-way-to-spay-that-you-probably-never-heard-of/).     

I look forward to your feedback about both articles.  If you are new to PetConnection, I hope you will follow my blog posts there as well as the ones you find here at Spot Speaks.     

Best wishes for good health,      

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
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.   

    

 

A Different Way to Spay

January 2, 2011

This blog presents an idea that will be new for many of you and may be new for your veterinarians as well.  I thought presenting a novel idea would be a great way to kick of the new year! 

Taking a fresh look at the things we take for granted can be wonderfully enlightening.  Sometimes, the little light bulb overhead begins to sizzle and sparkle, illuminating a new and better way of doing things.  Consider this example- when some savvy veterinarians took a fresh look at performing spays, a surgery we’ve been doing the exact same way for decades, guess what happened!  They came up with a revised technique that accomplishes all of the objectives of the spay surgery with fewer complications!  How cool is that!

Spay is the term used for neutering a female dog.  As I was taught in veterinary school, the medical jargon for spaying is ovariohysterectomy (OVH). “Ovario” refers to ovaries, “hyster” refers to uterus, and “ectomy” means removal of.  In other words, spaying the traditional way involves surgical removal of the uterus and both ovaries.  The objectives of the spay surgery are to render the dog infertile, eliminate the mess and behavioral issues associated with a female dog in heat, and prevent diseases that may afflict the uterus and ovaries later in life.  Thanks to some innovative veterinarians, what we now know is that ovariectomy (OVE)- removal of just the ovaries sans uterus accomplishes these objectives just as effectively as does the OVH.  And, here’s the icing on the cake- removal of the ovaries alone results in fewer complications when compared to removal of the ovaries and uterus combined.

Here’s a simple short course in canine female reproductive anatomy and physiology that will help explain why leaving the uterus behind makes sense. The shape of the uterus resembles the capital letter “Y”.  The body of the uterus is the stem and the two uterine horns represent the top bars of the “Y”.  An ovary is connected to the free end of each uterine horn by a delicate structure called a fallopian tube (transports the egg from the ovary into the uterus).  While the uterus has only one purpose (housing developing fetuses), the ovaries are multitaskers.  They are the source of eggs of course and, in conjunction with hormones released by the pituitary gland, ovarian hormones dictate when the female comes into heat and becomes receptive to the male, when she goes out of heat, when she ovulates, and when her uterus is amenable to relaxing and stretching to house developing fetuses.  After the ovaries and the hormones they produce have been removed from the body the uterus remains inert. The dog no longer shows symptoms of heat, nor can she conceive. Additionally, any chance of developing ovarian cystic disease or cancer is eliminated.

What happens when we leave the uterus behind- is it not subject to becoming diseased later in life?  Here’s the good news- the incidence of uterine disease in dogs whose ovaries have been removed is exceptionally low.  Pyometra (pus within the uterus), is the most common uterine disorder in unspayed dogs, and typically necessitates emergency surgery to remove the uterus.  Without the influence of progesterone, a hormone produced by the ovaries, pyometra does not naturally occur. The incidence of uterine cancer is extremely low in dogs (0.4% of all canine tumors)- hardly a worry, and studies have shown that the frequency of adult onset urinary incontinence (urine leakage) is the same whether or not the uterus is removed during the spay procedure. 

If you are not already convinced that the “new spay is the better way”, consider the following complications that can be mitigated or avoided all together when the uterus remains unscathed:

– Compared to an OVH, an OVE requires less time in the operating room.  This translates into decreased likelihood of anesthetic complications.
– Removal of the uterus requires that the surgeon perform more difficult ligations (tying off of large blood vessels and surrounding tissues with suture material before making cuts to release the organs from the body).  A uterine body ligation that isn’t tied quite tightly enough can result in excessive bleeding into the abdominal cavity and may necessitate blood transfusions and/or a second surgery to stop the bleeding.
– The ureters (thin delicate tubes that transport urine from each kidney to the bladder) run adjacent to the body of the uterus.  If a surgeon is not being extremely careful, it is possible to ligate and obstruct a ureter in the course of removing the uterus.  This devastating complication requires a second corrective surgery, however damage to the affected ureter and adjoining kidney may be irreversible. 
– Removal of the uterus occasionally results in the development of a “stump granuloma”- a localized inflammatory process that develops within the small portion of uterus that is left behind.  When this occurs a second “clean up surgery” is typically required. 
– We know that the degree of post-operative patient discomfort correlates with the degree of surgical trauma.  No question, of the two surgical options the OVH creates more trauma.

European veterinarians have been performing OVE’s rather than OVH’s for years.  In fact, the bulk of the research supporting the benefits of leaving the uterus behind has been conducted in Europe.  Slowly, veterinarians in the United States are catching on, and some veterinary schools are now preferentially teaching OVE rather than OVH techniques to their students.  What should you do if you are planning to have your dog spayed?  Talk with your veterinarian about this article and provide a copy for him or her to read.  Perhaps OVE surgery is already their first choice.  If not, perhaps your vet will be willing to take a fresh look at performing this old fashioned surgery.

Wishing you many blessings for the new year,

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
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health 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.

How to trust an ER vet you just met

November 20, 2010

While I’m busy recovering from some back surgery, you have the good fortune of reading posts from some of my favorite doggie bloggers!  Today’s post comes from Dr. Tony Johnson who blogs regularly at www.PetConnection.com.   Please make him feel welcome by posting your wonderful comments.  Be back soon! 

Best wishes,

Dr. Nancy Kay

“I’m sorry, ma’am, your pet is going to need surgery”. 

These are words any pet owner dreads hearing, especially on an emergency basis. For a pet owner, a trip to the veterinary ER can be a terrifying and frustrating experience; almost always unplanned… certainly unwelcome…usually expensive. 

Part of the stress of an ER visit comes from having to entrust your pets care, and very possibly their life, to someone you have just met. This is a little bit like embarking on a perilous sea voyage with a captain you know nothing about. It can be a very scary and unsettling prospect.

How can you come through this stressful experience intact? How can you maximize the chance of your pet having a successful outcome and minimize your stress level? 

Hopefully I can give you some pointers so this journey across the stormy seas of veterinary emergency care doesn’t end up on the rocks.

 

The first thing to know is this: Vets are not the enemy. They are in that ER in the dark of night because they want to help your pet get better.  Sure, there are dishonest veterinarians just like there are dishonest hairdressers and dishonest orchestra conductors, but the vast majority of animal docs are there because of a sincere desire to help.

I think the easiest way to find a path to trust in these circumstances is to plan ahead, so you are armed and empowered with some information before the crisis hits.  Emergencies don’t often give you the benefit of warning, but if you can pre-screen your veterinary ER options you will be ahead of the game.

I recommend contacting your trusted family veterinarian to find out where they send patients after hours.  Consider calling or visiting the ER before an emergency happens to get a feel for how they run their ship. Do they make you feel welcome? Secure? Is the hospital clean and well equipped? If so, then you will likely feel more trusting when a true emergency takes place.

During the emergency visit itself, try and get a feel for your doctor. Do they seem rushed and unfocused, or do they take the time to answer your questions? Do they seem confident, overconfident or insecure? In order to earn your trust, they should be willing and able to answer your questions to your satisfaction. Part of the responsibility falls on you, however, to limit your questions to the important ones and avoid repetition. (We want you to be informed, but time is a precious commodity in the ER). Bring a notebook and write down the questions as you think of them along with the answers.  It can be very difficult to remember all of the pertinent details when you are stressed and emotional.  And remember not to take your stress out on the doctor or staff.  Keep in mind that they are there to help you through this difficult situation. 

When it comes to making treatment decisions, the important words here are ‘options’ and ‘advice’. A good doctor will give you realistic options for care (from the basic to the cutting edge) and advise you as to the risks and benefits of each as you plot a course. Their job is to help you come to a decision you are comfortable with that also meets the medical needs of your pet. 

If the diagnostic and treatment options do not feel right to you, ask if there are any other options to explore.  In many cases (but not all) there are plans A, B and C (and even sometimes D). 

It is a tall order to be asked to trust your beloved pet’s life and health to someone you just met, but with just a little luck and a little knowledge, you can chart a course for a good outcome.

Dr. Tony Johnson

www.PetConnection.com

Dr. Tony Johnson received his veterinary degree from Washington State University in 1996 and obtained board certification in the specialty of emergency medicine and critical care in 2003. He completed a residency program in Portland, Oregon prior to becoming an emergency specialist. He is currently a clinical assistant professor at Purdue University School of Veterinary Medicine and a consultant and editor for the Veterinary Information Network. He has lectured for several international veterinary conferences and is an active blogger for http://www.PetConnection.com. He is also the recipient of the 2010 Small Animal Speaker of the Year award from the Western Veterinary Conference.   

He used to live in a converted one-room schoolhouse in the middle of a cornfield, but has since taken up occupancy in a normal house in a normal neighborhood with very little corn.  He has a young son named Connor (which is Gaelic for ‘dog lover’) and a beautiful wife named Gretchen, who is also a veterinary emergency and critical care specialist.  

Their animal family consists of: The Cats:Cupid – formerly shot with an arrow, now a feline meatloaf and Crispy – formerly set on fire, now rules the basement with a furry iron fist.       

The Dogs: Rocco – missing a leg from a Buick-induced nerve injury and    NYSE – former hoodlum-owned Pit Bull, now a creampuff.           

The Lower Vertebrates:Fontina –  a cockatiel found in a parking lot  and he has lost count of how many fish they have, although it really isn’t that many, he  just isn’t all that good at counting. 

In his spare time Tony enjoys sleeping, eating and breathing with occasional forays into woodworking, cooking and reading and writing (but not arithmetic).

_____________________________________________________

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
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health 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. 

Free Christmas or Chanukah gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

The Evil That Lurks in California

October 2, 2009

You’ve heard it in the news.  There’s the gazillion dollar budget deficit, declining academic test scores, state park closures, and never-ending heated discussion about gay marriage and illegal immigrants.  What you may not know is that there is something even more sinister lurking in California.  It is of the ilk that science fiction writers fantasize about- alien creatures that penetrate body cavities, migrate through tissues, and wreak havoc!

Take the recent case of Emma Louise, a darling four-year-old residing in northern California.  One minute she was a healthy, happy, go-lucky little girl.  The next minute she was writhing in pain.  Doctors could not figure out what was wrong.  Little did they know that an alien had invaded her being and poor little Emma Louise was incapable of describing the evil that lurked within…….

Hmm, as I write this I’m wondering if I’ve been denying in inner desire to write science fiction!  I met Emma Louise just a few days ago.  She came to me for a second opinion to try to figure out the cause of her abdominal discomfort. Emma Louise is undeniably adorable- part hound dog and part Brittany Spaniel- and there’s nothing she enjoys more than running through fields with her nose to the ground.  The problem is, the fields are loaded with foxtails- awful little bristly weeds that grow rampantly throughout California in the late spring and summer months.  They seem hell bent on finding their way into dogs’ noses, ears, eyes, mouths, and just about every other orifice.  Not only is the dog’s body incapable of degrading or decomposing them, the foxtails are barbed in such a way that they can only move in a “forward” direction.  Unless caught early, they can migrate through the body causing infection and tissue damage.  Once foxtails have moved internally, they are notoriously difficult to find- they become the proverbial needle in a haystack.

Apparently Emma Louise was a “foxtail magnet” having accumulated several in her ears and nose over the years.  Her current symptoms were different than any she’d experienced before- she appeared to have abdominal pain and was straining to urinate and have bowel movements.  Other than a mild fever and some abdominal splinting, her physical examination findings were unremarkable. I performed abdominal ultrasound and discovered a gigantic abscess tucked up under Emma Louise’s spine and extending back (towards her tail) into the pelvic canal.  Given this girl’s history, I just knew there had to be a foxtail somewhere in that huge abscess pocket.  The question was, would we be able to find it.

I prayed to the “god of foxtails” and turned Emma Louise over to one of my esteemed colleagues (a surgical specialist) for abdominal exploratory surgery. After approximately two hours of me biting my nails and some expletives heard in the operating room, there was a shout of “Hurray!” My colleague had located and removed the foxtail!  Now with some post-op exercise restriction and a course of antibiotics, Emma Louise will be good as new.  Not finding the foxtail would have meant lifelong antibiotics, unless the foxtail migratory course happened to exit the body.

Perhaps you’ve always wanted to experience the unique flavors and marvelous beauty of California.  After reading this, you might just have a change of heart- now that you know of the evil that lurks there!

Now, here’s wishing you and your four-legged family members much good health!

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine

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