Bitch Spay bleed

Re: Bitch Spay bleed

Zita Okarina — Thu, 14 Apr 2011 03:44:12 GMT

[quote user="Martin Jones"]

[quote user="Michael Woodhouse"]

I appreciate what you say but my one and only bleed was an ovarian ligature and it's the same story with everyone I know who's had a bleed! A fat deep chested lab the ovary is much harder than the cervix IMHO.

[/quote]

Surely, if we can breed cattle without horns, we should be able to breed a bitch without a uterus

[/quote]

AGREED!!

Ovarian ligature is the most you need to concern about, because it's covered with fats. And if you slipped it, it's a bit hard to find it back. (this case is only for dog, big dog to be concerned).

Martin Jones's insanely right about bitch without uterus.

Re: Bitch Spay bleed

Martin Jones — Tue, 12 Apr 2011 21:01:11 GMT

[quote user="Michael Woodhouse"]

[/quote]

Couldn't agree more - had my own experience today with a 7yo, not morbidly obese by any means but plenty of fat round the stumps, retriever spay. Right at the end, sudden and large bleed on right side, which was traced back to a tear at the base: quick to describe, but nothing really compensates for the feeling of blood running cold when it wells up in front of you, not to mention the relief that it happened BEFORE closing up. And then having to describe it to the owner in terms that aren't too alarming.......

Surely, if we can breed cattle without horns, we should be able to breed a bitch without a uterus

Re: Bitch Spay bleed

Michael Woodhouse — Tue, 12 Apr 2011 19:32:28 GMT

[quote user="Andrew Wills"]ovariectomy is just as good as ovariohysterectomy and you avoid the risk of haemorrhage from the comparatively large cervical vessels.[/quote]

Re: Bitch Spay bleed

Mark Patteson — Tue, 12 Apr 2011 10:39:05 GMT

Always check a dog that bleeds for no apparent reason hasn't got Angiostrongylus

Do a faecal or treat it anyway.

A normal coag profile does not mean its clotting is normal and doesn't exclude Angiostrongylus

The surgical issues not my area but in some parts of Wales all elective surgery cases get checked / treated for this critter first

Mark Patteson

Re: Bitch Spay bleed

Andrew Wills — Tue, 12 Apr 2011 08:51:35 GMT

Another thought - ovariectomy is just as good as ovariohysterectomy (see long-term data from Utrecht on thousands of cases - no increased incidence of pyo etc afterwards) and you avoid the risk of haemaorrage from the comparatively large cervical vessels. Also we have recently started doing laparoscopic ovariectomies - when you can see the vessels up close and see they are sealed it adds an extra layer of reassurance. Takes a leap of faith at 1st when you have been using the 'traditional' methods for more years than I care to admit (I also qualified in the era of box rest, bute and a hosepipe with an intracranial lead injection if that failed!). MUCH nicer for the patient too - I can't believe how comfortable they are postop, and you don't get that rise in HR and RR when you tug on the ovaries either.

Just to cheer everyone up, I had a Staffie pyo nearly 10 years ago that went fine, then suddenly haemorraged 10 days later necessitating opening her up again. She survived, but it was hairy. This was in the days before Aelurostrongylus was talked about, though, so we never ran any diagnostics..

Re: Bitch Spay bleed

Mark Hedberg — Mon, 28 Mar 2011 21:26:22 GMT

They don't use angiotribes here where I work - I do extoll their virtues, though. The spays aren't really much different; I just learned with angiotribes and I love them well. :) I know which shelf they're on when I need them, though. :)

Re: Bitch Spay bleed

Catherine Coen — Mon, 28 Mar 2011 19:50:13 GMT

I'm glad everyone has mentioned angiotribes - when I started at this practice I had never seen them used before but have gotten so used to them I think I'll probably buy a pair to take with me to my next job.

Vikki - my boss hasn't done any operating for the past ten years or so, and only consults for 2 hours each day - the rest of the time I am mainly alone at one of our two surgeries. The job is always advertised as "suitable for a new grad" which it absolutely isn't. Suffice to say, bearing in mind there are only three vets at the practice (including myself and my boss), I have worked with 4 different vets (3 new grads) in the past 15 months! On the other hand, I think I will go into my next job with more surgical experience than most recent graduates, but am looking forward to working somewhere where I'm not constantly stressed about whether I'm making the right decisions.

Re my bitch spay - I took her stitches out yesterday, she is absolutely fine

Catherine

Re: Bitch Spay bleed

Bob Russell — Mon, 28 Mar 2011 17:59:35 GMT

I gather the hysterectomy clamps serve a similar purpose (ie they crush) but as the book says 'More reasonably priced than angiotribes'!!

I have to say I would hate to spay a bitch without angiotribes but some of this will be because it is what I am used to!

Re: Bitch Spay bleed

Rob Loxley — Mon, 28 Mar 2011 17:37:00 GMT

We have a couple of angiotribes but they get little use; the bitch spay kit has some long curved vet inst hyseterectomy clamps, which I prefer.

Re: Bitch Spay bleed

Alan Tevendale — Mon, 28 Mar 2011 17:11:12 GMT

[quote user="bob lehner"]

I dont think this would extend to inspecting individual instruments for efficacy.

[/quote]

We've never had an inspector look at surgical kits. Most of the inspection is just checking the appropriate paperwork is in place. I think it would be a good thing to actually check far more of the clinical side of a practice - although far more challenging to carry out for any inspector.

Re: Bitch Spay bleed

bob lehner — Mon, 28 Mar 2011 16:00:06 GMT

[quote user="Clive Ansell"]

What annoys me most are the 15 cm square drapes barely large enough to hold a cats uterus.

[/quote]

Absolutely - it drives me bonkers (well more bonkers than normal). Another pet hate are the needle holders/Gillies which don't close at the tips so you can't grasp the suture material - and the left-handed Gillies that are the only ones in the kit - and suture needles that are so blunt that you can't get them through the skin - and blunt scissors.

As far as the question about PSS - the Manual says:

'5.13. The practice must provide a range of suitable surgical instruments and suture materials for the work undertaken (BP)'.

I dont think this would extend to inspecting individual instruments for efficacy.

GP / ALL

VH / EQ

VH / SA

Re: Bitch Spay bleed

Bob Russell — Mon, 28 Mar 2011 14:57:20 GMT

Sorry, the locum wanted sharp, pointed scissors that seem potentially lethal to me! I am happy to use mayo's to open the wound after starting the incision with a blade but not scissors with a sharp 'stabbing' point. I would be worried that I might catch the point on something by accident.

Does the PSS inspect kits to ensure they are fit for purpose? We are not a PSS practice but I am reconsidering as we are not exactly rushed off our feet at the moment and hopefully it will be a constructive exercise once I come back from my holiday.

Whenever we are quiet the best way to ensure we are rushed off our feet is to threaten to paint the place. In 10 years we have never found time to paint it ourselves so hopefully applying for the PSS will have a similar effect on work load!

Re: Bitch Spay bleed

Clive Ansell — Mon, 28 Mar 2011 14:13:00 GMT

[quote user="Bob Russell"]

It is quite useful to get the opinion of locums as far as instruments are concerned. I have got used to our instruments and they become like old friends! They are hopefully in good nick but it is always good to get another opinion (this is a one vet practice).

[/quote]

It is nice to have scissors that cut tissue cleanly without causing too much trauma by compression or from several attempts at cutting. Equally needle holders that will hold a needle tightly, and sufficient pairs of hemostats.

What annoys me most are the 15 cm square drapes barely large enough to hold a cats uterus.

[quote user="Bob Russell"]

We did have a tantrum from one locum who wanted 'sharp' scissors to enter the abdomen. This was taken by the nurse as a comment about the cutting ability of the scissors. In fact the locum wanted pointed scissors which I would never use to enter the abdomen. They are very sharp and pointy!! I would be concerned that they might damage something that should not be damaged. They are now packed up individually (and have been for years) in case someone else wants to use them.

There are plenty of good quality instruments out there, many of which cost very little so there is not much excuse for knackered instruments. Is this covered by the PSS?

[/quote]

Me niether, I cut through the linea alba with a scalpel blade, place forceps beneath and run blade along them, don't use scissors.

Re: Bitch Spay bleed

Michael Woodhouse — Mon, 28 Mar 2011 13:42:26 GMT

[quote user="bob lehner"]A general point on bitch spay technique. I always used a pair of angiotribes to crush the ovarian and cervical vessels when in my own practice - seemed like a good idea for added security (plus used ligation of course).[/quote]

We have angiotribes packed separate and open them for bitch spays. Sometimes dog castrates too.

Re: Bitch Spay bleed

Bob Russell — Mon, 28 Mar 2011 12:50:48 GMT

There are plenty of good quality instruments out there, many of which cost very little so there is not much excuse for knackered instruments. Is this covered by the PSS?

Re: Bitch Spay bleed

Clive Ansell — Mon, 28 Mar 2011 11:52:12 GMT

I like using Angiotribes too and in my first job I managed to get my boss to order them. Now as a locum I can't remember seeing them in use anywhere.

Many practices seem to have too few and worn out instruments, clapped out needle holders ae the worst.

Re: Bitch Spay bleed

Bob Russell — Mon, 28 Mar 2011 11:33:00 GMT

[quote user="bob lehner"]

A general point on bitch spay technique. I always used a pair of angiotribes to crush the ovarian and cervical vessels when in my own practice - seemed like a good idea for added security (plus used ligation of course).

However in my subsequent travels elsewhere I have yet to see anyone else using angiotribes (or even having them available).

Anyone have any thoughts on this ?

[/quote]

Yes - we use angiotribes routinely. Page 178 of the latest Veterinary Instrumentation catalogue!

Re: Bitch Spay bleed

bob lehner — Mon, 28 Mar 2011 11:11:18 GMT

However in my subsequent travels elsewhere I have yet to see anyone else using angiotribes (or even having them available).

Anyone have any thoughts on this ?

Re: Bitch Spay bleed

Vikki Halliday LLB — Sun, 27 Mar 2011 22:02:27 GMT

[quote user="Catherine Coen"]My boss doesn't do any operating, and isn't overly helpful in these sorts of situations, and my other colleague is even more recently graduated than me [/quote]

Um, would it be impertinent of me to ask why your boss isn't helpful?

I have an assistant who even some 6 years qualified will still ask for advice/reassurance etc, and I am more than happy that she does. I will talk through cases with her, and even come and metaphorically hold her hand in theatre if she wants me to, as I would never ever ask an employed vet to perform any surgery that they were not 100% happy to do themselves, and in most cases, that I myself would not feel comfortable doing.

Are you a member of the New Grad network, because if you are not being supported by your boss for a routine op such as a bitch spey, I'm guessing they are generally not the most supportive employer?

But well done for asking here for advice, because those that don't are the ones that may end up in a pickle.

Re: Bitch Spay bleed

Toby Birch — Mon, 21 Mar 2011 09:35:32 GMT

I agree with all the above. Treat the patient and not the figures. By the sounds of it your dog will probably be fine and your actions to be applauded.

However since you did ask about the figures...

I tend to follow this rough guideline. A 'normal' dog will have a HCT of 33-55%. The PCV tends to be a couple of points higher but can be more variable due to user interpretation.

We do not know what your dog's initial PCV was but given the time frame it was probably unlikely to have been much more than 30%. When it bled it lost whole blood so the circulating PCV will not fall for a while. You may find it actually increases as splenic contraction increases the number of RBCs in the circulation.

It is important to also look at the total solids (can generally read as total protein as long as colloids have not been given) as this figure will also fall with a haemorrhage but will recover more quickly than the PCV. Regeneration tends to take 3-5 days to start to occur but is also dendendent on the PCV. I believe that a PCV of 18% causes maximum regeneration but wait to stand corrected.

If you have the ability then measuring lactate and/or PvO2 are very useful as transfusion triggers (I am talking here of Packed Red Blood Cells not of Fresh Frozen plasma which will be required if coagulation times are >25% prolonged (platelets really do not survive although a very fresh whole blood transfusion may be of some help - hopefully freeze dried platelets coming soon)).

Trying to judge when to give a PRBC transfusion can be difficult and depends on the disease process. You are aiming to give a transfusion to ensure adequate oxygen delivery to the tissues. Just because the animal is anaemic does not mean that the tissues are not getting sufficient oxygen. Roughly consider a transfusion for below 15% - however in severe blood loss blood products may be used during the rescuscitation process (even autotransfusion in some cases).

This is where the lactate and PvO2 come in. If a normovolaemic anaemic animal has an increased lactate then increased anaerobic respiration is occuring. Likewise a venous PO2 <30mmHg is indicative of poor oxygen return from the tissues and therefore that the supply to those tissues was likely low in the first place.

Therefore elevated lactate, reduced PvO2, severe anaemia and clinical signs can all be used as transfusion triggers.

Hope this make some sense.

Re: Bitch Spay bleed

Richard Carter — Mon, 21 Mar 2011 08:49:58 GMT

Ditto all the above - two things have happened - (1) you have now seen a bleed and (2) you did the right thing to sort it out so well on the way to becoming an experienced vet surgeon. The problem isn't the bleed - everyone will have similar at some point - the problem is the decision on whether you go back in!!

Re: Bitch Spay bleed

Catherine Coen — Sun, 20 Mar 2011 15:16:45 GMT

Lol Julie! I'll always be comforted by the fact that unless there is a jet of blood hitting my face and/or the ceiling then the situation could be worse! Hope everything is well and not so stressful now

Re: Bitch Spay bleed

Julie Innes — Sun, 20 Mar 2011 14:42:47 GMT

Hi Catherine

I'm sure your bitch will be fine! We've all had at least one that we had to go back into, and it's not a nice feeling, but the fact that she was clotting etc and that she is bright would suggest you have nothing to worry about. I agree with the others about looking at the patient, rather than the PCV.

I'm wondering if you ever saw practice with someone who might have made you a bit neurotic about haemorrhage in bitch speys ?? If so, I'm sure she feels partially responsible for your current stress!! Take care!

Re: Bitch Spay bleed

Catherine Coen — Sun, 20 Mar 2011 12:57:29 GMT

Thank you for all the advice,

My boss doesn't do any operating, and isn't overly helpful in these sorts of situations, and my other colleague is even more recently graduated than me so I am invariably left to deal with any difficult ops/complications myself! It's reassuring to be able to come here for advice, if only to put my mind at rest!

Re: Bitch Spay bleed

Hannah Wynne Richards — Sun, 20 Mar 2011 12:29:34 GMT

I bet even people who've gone on to soft tissue certs or diplomas have had at least one post-op haemorhage !

The fact that you're so worried means you will be a good veterinary surgeon

Re pre-op angiostrongylus treatment-regular patients are treated anyway-the problem lies with those done for the Dogs Trust under their voucher scheme-these inevitably are very rarely treated prophylactically beforehand, and there's a very tiny gross profit margin, so adding Advocate would erode this even further-I suppose I really ought to do it, and bear the loss

Wynne