Surgery on young things

RE: Surgery on young things

Martin Atkinson — Fri, 16 Dec 2016 10:41:27 GMT

[quote user="Bob Russell"] A kitten or puppy can be humanely euthanased and 'replaced' with a healthy one. Harsh perhaps but the reality. A child cannot be replaced [/quote]I appreciate that this is now very tricky moral ground and it may be touching on eugenics but ultimately no-one has the right to have children and it is not the end of the world if you can't. Sometimes nature lets you and sometimes it doesn't. There seems to be a blind intransigence to have children at whatever cost, be it even more advanced methods of infertility treatment or extreme measures to save lives whatever the handicap or quality of life consequences there may be for the carer or the individual themselves. It is the innate instinct to reproduce that drives us to ensure the survival of our species but in an over-populated and sociological society is it really necessary?

RE: Surgery on young things

Bob Russell — Fri, 16 Dec 2016 10:22:42 GMT

I am not moralising as I bet I would do everything these parents are!

I am in that 'luxury' position of being able to make judgements from a distance. You cope with the cards you are dealt as best you can.

I am not claiming to know what is best but the loss of an unborn baby with spina bifida is the closest I have been. It was a choice to continue or not!

Medical improvements sometimes allow the previously un-survivable to be survived but at times the cost is too high!

RE: Surgery on young things

Dagmar Steele — Fri, 16 Dec 2016 10:14:52 GMT

You know Bob I tended to think the same, but as I'm not in their shoes really I tend to take a very carful approach. One of my colleagues has three kids, two of whom are very disabled due to a rare genetic condition. Her son, who was already blind, turned deaf a year ago. It must ave been a horrible time, especially as they had, despite his mental disability, been able to set up a basic sign communication before that. The poor boy reacted horribly to his vision loss and spend his days whacking his head against the wall. He now has adapted to the situation and she reports him to be very happy again, they enrich his life as much as they can (things to taste, things to feel, human body contact). I don't think we who have never experienced something similar are able to know what's best for them. And yes, I am lucky that my kids are healthy at the moment though some incidents in the past have shown to us how quickly things can change.

RE: Surgery on young things

Bob Russell — Fri, 16 Dec 2016 09:28:49 GMT

[quote user="Clive Ansell"]

[quote user="Bob Russell"]I would not advise puppies or kittens be put through massive procedures unless there is a fair chance of good quality of life later. Feel a bit the same when I see children living short lives mostly in hospital, having procedure after procedure when the outcome is hopeless.[/quote]

My step niece in law had a premature baby about 5 years ago, smaller than a bag of sugar, it was touch and go whether or not he would survive. Before the point he should have been born he had undergone open heart surgery, bowel resection and partial amputation of some toes.

He is now a happy, healthy and normal little boy with no ongoing issues, so it was right to proceed against what were overwhelming odds that he would not survive and a guarded prognosis being given.

The technical expertise in terms of surgery, anaesthesia and intensive care are clearly there, maybe it should be what we aspire too? maybe not? who knows?

[/quote]

I am hesitant to get that far into human situations because they are not the same. A kitten or puppy can be humanely euthanased and 'replaced' with a healthy one. Harsh perhaps but the reality.

A child cannot be replaced so I have great sympathy with parents and their medical advisors. If an abnormality can be fixed then it should be fixed. We don't need all toes and not all of the bowel. I would have done exactly what the parents did and battled on!

Some conditions just cannot be beaten and death only delayed by constant interventions and I worry about the fairness of putting children and parents through a few years of hell.

Obviously I am lucky that my children are healthy!

RE: Surgery on young things

Martin Atkinson — Fri, 16 Dec 2016 09:08:59 GMT

[quote user="Anthony Todd"]Humans cope with disability better than animals in that they have a wider spectrum of understanding acceptance and interest.[/quote]Not sure I agree entirely. Animals don't have the social aspect of their disability to deal with, their level of self-awareness is much lower, they don't feel guilt if they are a burden on others, their survival instincts are much more basic and most of all they don't wallow in self pity so they cope better in most circumstances.

The argument is not about coping with disability but the necessity of repeated and distressing interventions which they don't understand such as repeated surgery, continual chest draining, anaesthetics to unblock kittens but this is still different to spend large amounts of resources on an animal which quite honestly is easily replaceable. Yes we have a responsibility to ensure their welfare but lets be realistic, in the end they are just animals.

RE: Surgery on young things

Glenn Hodgson — Thu, 15 Dec 2016 19:55:07 GMT

Each case is different.

Often use such phrases when concideratiom, and consent, may not appear to be informed enough for my liking:

A ?60% sucvess rate means that fluffy will have a 60% chance of the procedure going well, be in mild-severe discomfort for x days, then live a happy life after. This means there is a 40% he could go through this procedure and die afterwards or during. We must be comfortable with this before we proceed. ( relevant for this young colon kitten)

He must have enough time after the procedure to enjoy the benefits and make the streas and discomfort worthwhile. (This imspires us to fix such colon kittens!)

Have gone in stronger before now... When clients are misguided.... Fluffy has fluid on his chest from his heart failure which no one can fix. This is like drowning. If you take him home to die he will drown to death. We cant happening for his sakes. (phrases like this avoid having to call the Sspca ) cross refferency to human euthanasia thread here somewhere!

Its sometimes hard to decide how much influence to have. Combine this with the essential requirement to sleep deep every night and there we have part of the 'art'

RE: Surgery on young things

Anthony Todd — Thu, 15 Dec 2016 18:03:52 GMT

[quote user="Martin Atkinson"]However, despite what some of the more passionate animal's rights supporters on this forum may think he is human and the considerations bear no comparison with what we were discussing. [/quote]

Humans cope with disability better than animals in that they have a wider spectrum of understanding acceptance and interest.

I have a very good friend with advanced Crohn's; many bowel resections etc etc, now has a permanent discharging fistula which is dealt with daily etc. etc.

Physically not good; mentally fine 'cos he accepts it, copes with it, understands it, nutures himself.

Animals can't do that, nor should they.

RE: Surgery on young things

Martin Atkinson — Thu, 15 Dec 2016 17:13:03 GMT

[quote user="Clive Ansell"]He is now a happy, healthy and normal little boy with no ongoing issues,[/quote]I am very happy for your step-niece and her baby boy Clive and I sincerely wish him a long and happy future but would it be inappropriate to insert the words 'currently apparent' between 'no' and 'ongoing' within that sentence?

However, despite what some of the more passionate animal's rights supporters on this forum may think he is human and the considerations bear no comparison with what we were discussing. And that is even before we consider whether all the resources spent on this little boy would have helped a much larger number with far less serious issues. Not a criticism just an observation as the father of 2 girls who are the love of his life and for whom he would move heaven and earth to keep healthy.

RE: Surgery on young things

Clive Ansell — Thu, 15 Dec 2016 16:12:47 GMT

He is now a happy, healthy and normal little boy with no ongoing issues, so it was right to proceed against what were overwhelming odds that he would not survive and a guarded prognosis being given.

The technical expertise in terms of surgery, anaesthesia and intensive care are clearly there, maybe it should be what we aspire too? maybe not? who knows?

RE: Surgery on young things

George Cooper — Thu, 15 Dec 2016 15:49:46 GMT

[quote user="Anthony Todd"]

So, just because you can, should you?

[/quote]

This I fear is the disease of the profession, and was neatly addressed by Prof May in one of his two articles in The Record. I think it is the sole reason that there is an undercurrent of dissatisfaction regarding vet practice.

RE: Surgery on young things

Bob Russell — Thu, 15 Dec 2016 11:22:02 GMT

Clearly I am old school!

I would hesitate to criticise a particular case (and absolutely not with this kitten) but I have a reputation (it seems) of being straight talking!

Our old kidney cats don't always get the work ups they perhaps could. I treat the best I can within the limits of quality of life and affordability. I don't believe things should be done just because they can. I have seen stuff on TV that horrifies me! Might be clever but is it really in the interests of patient or owner?

I would not advise puppies or kittens be put through massive procedures unless there is a fair chance of good quality of life later. Feel a bit the same when I see children living short lives mostly in hospital, having procedure after procedure when the outcome is hopeless.

A few minutes discussing things honestly and sympathetically with a client can save a lot of heartache and I feel it is one of my duty's as a first opinion practitioner.

Can be tough and it does not mean I give up on anything without a fight. I try to chose the battles carefully.

RE: Surgery on young things

Anthony Todd — Thu, 15 Dec 2016 09:54:19 GMT

[quote user="Robin Grimmer"]Sub total colectomy for congenital megacolon - no.[/quote]

Judging by my citation from Davies I'd be pretty reluctant to recommend it for a cat of any age......

This raises, for me anyway, a general ethical question; does just because you can, does it mean you should?

I watched "supervet" applying a complex external fixating structure to the foot and carpus of a pup after some sort of crushing injury; brilliant on X-ray, but as far as i could see there was no blood supply to the area at all and, sure enough, it failed and they got to discussing prostheses....

So, just because you can, should you?

RE: Surgery on young things

Martin Atkinson — Thu, 15 Dec 2016 08:49:04 GMT

[quote user="Virginia Campbell"]I'm pretty sure we've enucleated eyes from CP feral kittens in the past,[/quote]Sorry, but perhaps I didn't make this clear.

1) the CP had no intention of releasing this kitten back to a colony, it's future would have been living under the wardrobe, scared shitless in some nutty cat women's spare bedroom as it was effectively un-rehomeable.

2) The CP has barely enough funds to spend on caring for healthy, re-homeable cats so why waste precious resources on something with a more than likely miserable future?

I'm not doubting the surgery would have been 100% successful but it is a quality of life issue and proportionate application of limited resources we're dealing with here. I guess that this has become a tangent of a tangent though as it is not principally dealing with the OP as this could just as easily been an older cat albeit that would have probably already have been in a stable environment.

RE: Surgery on young things

Robin Grimmer — Wed, 14 Dec 2016 20:34:08 GMT

Examples where I would operate quite happily on a young kitten - intussusception, FB.

Sub total colectomy for congenital megacolon - no.

RE: Surgery on young things

Anthony Todd — Wed, 14 Dec 2016 20:13:24 GMT

[quote user="Martin Atkinson"]We had a feral kitten a few weeks ago with a ruptured eyeball.[/quote]

Chances of a successful outcome? >= 95-100%

Megacolon in a kitten: give me a figure; adult outcomes with out complications you tell me, but nowhere near that....

Eye Enucleation: Suffering, pain, discomfit after surgery; Not much

Megacolon: a lot more than a lot.....

RE: Surgery on young things

Virginia Campbell — Wed, 14 Dec 2016 19:37:06 GMT

I'm pretty sure we've enucleated eyes from CP feral kittens in the past, as long as the remaining eye is good and doesn't look as if it's going to fall victim to a herpesvirus ulcer, and as long as it has safe colony to go back to after a day or two with the rest of the TNR ferals.

RE: Surgery on young things

Martin Atkinson — Wed, 14 Dec 2016 19:12:25 GMT

[quote user="Virginia Campbell"]I understand your opposition to surgery in the case of a procedure with a poor prognosis, but why does the size/age of the patient matter....unless this is wholly in relation to prognosis.[/quote]I answer your question with a case/question.

We had a feral kitten a few weeks ago with a ruptured eyeball. The CP lady wanted the eye enucleated for a kitten that would probably never be re-homeable and live in terror in some nutty cat person's spare room even though the surgery would no doubt have made the kitten comfortable and it could live with one eye. I suggested that resources may be better directed at treating cats that could have a normal life and effectively refused to enucleate the eye even though it would have been profitable for me.

That is an obvious decision for me but how many of those on here who think the decision to operate on the megacolon kitten was correct would make a different call on my case?

RE: Surgery on young things

Virginia Campbell — Wed, 14 Dec 2016 18:33:51 GMT

Quote fail sorry.

Where do you stand on, for example liver shunt surgery in baby things?

Fairly drastic surgery with a not insignificant mortality rate.

I suppose the difference is with the chance of a complete cure which was unlikely in a kitten with congenital megacolon.

I understand your opposition to surgery in the case of a procedure with a poor prognosis, but why does the size/age of the patient matter....unless this is wholly in relation to prognosis.