Neutering clinics

Re: Neutering clinics

patrick murphy — Mon, 20 May 2013 11:51:52 GMT

my first boss in UK who was of that generation that used to operate through cigarette haze, never tied ovaries, just used an ? angiotribe on them. but then one of the first practices that I locumed for ga for bitch spey was Immobilon with ip sagatal for relaxation, and sterile was a clean tissue forom the dispenser on the wall. freaked me out have just let North America where we gloved, maked and gowned for a cat OH.

Re: Neutering clinics

Thomas Johnson — Fri, 17 May 2013 10:28:46 GMT

My technique for tearing the ovarian ligament is to hold the ovary between my thumb and forefinger, and then place my middle finger under the ligament, pull up with my middle finger and rotate my hand clockwise, I can then be fairly certain that I'm breaking down the ligament but not pulling on the ovary, I use my left hand and stand on the dog's right side. I then tie off the ovary as described by Evelyn, but I usually use 2/0 Vicryl.

Re: Neutering clinics

Cat Henstridge — Thu, 16 May 2013 22:01:39 GMT

Back to the OP!

I worked in this rescue for a couple of months after I graduated and gained a massive amount of experience and had a great holiday at the same time, the island is beautiful!

http://www.pacthailand.org

It has been a while since I have been in contact with them but they used to have different vets all the time, mainly passing through while touring Thailand.

Cat

Re: Neutering clinics

Evelyn Barbour-Hill — Thu, 16 May 2013 21:55:34 GMT

[quote user="Tim Browning"]Don't overclamp. I often see vets struggling with double,treble clamps that can tear fragile tissues as they wrestle with them. Tying a ligature between two clamps in a fatter bitch means you are tying round a flattened structure that is trying to become a round structure when ligated and it resents it, clamping between the clamps does not make it any rounder, and it can tear as you struggle.[/quote]

Agree.

Not saying this is the best, but it works for me:

Apply first clamp a liitle way away from the ovary. Apply second clamp quite close to ovary. Release first clamp and re-apply it close under the second. Tie ligature (0 or even 1 catgut) on the bit that the first clamp crushed. If the ligature doesn't feel good it probably isn't, so do it again.Tear between the clamps by rolling the second one. Leave the first clamp on the stump for a bit while you do something else or until it gets in your way. Release it gently and watch the clamped bit as it slides out. If you want to grasp the stump to inspect it, Allis forceps as someone has already suggested.

Use your good and trustworthy big artery forceps, not the slightly dodgy ones or the pair the boss was using yesterday to bend wires.

I've no magic tips about tearing the ligament, but the main thing is that you need control. Rest the wrist of your tearing hand on the patient as you pull. Or use your other hand just resting on top of your tearing hand. Be patient.

Re: Neutering clinics

Bob Russell — Thu, 16 May 2013 18:03:41 GMT

I use angiotribes rather than artery forceps.

I was told many years ago that a healthy bitch will only come to harm from bleeding at the cervical end and this is where you need to watch for bleeding. I don't panic about tying off at the cervix any more, just where it is nice and convenient to tie off.

Having said this I was a nervous wreck when I spayed our puppy last week. We have had a really cr*p year with our dogs and cats and I dreaded having to explain to the family if there were problems. Of course it went like clockwork and next day she was almost back to normal!

We all worry at times!

Re: Neutering clinics

Tim Browning — Thu, 16 May 2013 17:16:59 GMT

I would offer two tips that work for me.

ligate the ovarian vessels seperately from the suspensory round ligament in fat bitches as they are heading in different directions after leaving the ovary and you end up with a massive conical tie off. The ligament can be tied seperately or included in the first suture. It is not as important as the main ovarian vessels buried in fat.

Don't overclamp. I often see vets struggling with double,treble clamps that can tear fragile tissues as they wrestle with them. Tying a ligature between two clamps in a fatter bitch means you are tying round a flattened structure that is trying to become a round structure when ligated and it resents it, clamping between the clamps does not make it any rounder, and it can tear as you struggle. I only clamp once above the ligature and it can be easier to place a ligature if the clamp is just above the ovary (which needs to be disected out to check removed).

Also a lower clamp can temporarily stop haemorrhage though with an inadequate tie and it spurts out sometime after release, with no lower clamp the tightness of the ligature is checked more accurately. Also I feel it is easier to get the ligature lower down this way with more distance above it to prevent it slipping off. Someone is training vets in multiple clamping and I suspect it is not someone who has done many bitch spays a week for many decades in a world of increasing canine obesity...

Re: Neutering clinics

Anthony Dennison — Thu, 16 May 2013 17:07:16 GMT

[quote user="Martin Atkinson"]So long as I've got the ovary out I just pack with swabs for a few minutes and wait and invariably it stops. I don't go looking for the torn end anymore If it has obviously stopped bleeding heavily IMO digging around looking unnecessarily prolongs the surgery and can cause more harm than good.[/quote]

The neutering clinic I went to in India never used to bother hunting for torn ends either, as time was important. They were injected with some special herbal preparation (licensed in India) that apparently helped with clotting!

Re: Neutering clinics

Martin Atkinson — Thu, 16 May 2013 16:40:11 GMT

[quote user="Mark Holmes"][quote user="K Burton"]

Breaking down the suspensory ligament, with the fear that I'll inadvertantly break down the artery too, or wrench the whole thing out through my incision!

[/quote] It rarely happens but if it does so what? The dog won't bleed to death that quick - just extend incision and isolate bleeder. Relax.

[/quote] My technique is to isolate the ovary grab the ligament cranial to it and apply gentle traction, it will gradually stretch and give you more to play with and eventually you'll feel it pop, Sometimes if its a bit tough I'll shave away at the ligament with my finger nails or if I can see it clearly snip it with the scissors. If it does tear off in your hand rather than you having cut it the bitch is very unlikely to bleed to death. So long as I've got the ovary out I just pack with swabs for a few minutes and wait and invariably it stops. I don't go looking for the torn end anymore If it has obviously stopped bleeding heavily IMO digging around looking unnecessarily prolongs the surgery and can cause more harm than good.. I always put 3 clamps cranial to the ovary, ligate above the third one, remove and put a second ligature on the crushed bit I removed the clamp from, twist and tear the pedicle between the last two clamps and leave the last one attached until I've ligate the other ovary and the cervical end. This approach hasn't failed me in 38 years. I would be far more worried if I lost the cervical stump and would go looking for that but it is a lot easier to find.

Re: Neutering clinics

Dagmar Steele — Thu, 16 May 2013 16:07:37 GMT

I clamp with forceps, ligate once under forceps, take the forceps off and ligate a second time where clamping marks are. I leave the ends of the ligatures long and grab these with forceps. The the stump goes in and I check for any signs of oozing, if so, out it comes again and another ligature is applied. Only if I'm happy I shorten the ligatures and let go.

Re: Neutering clinics

Anthony Dennison — Thu, 16 May 2013 15:52:24 GMT

What do people use to hold the ovarian stump to inspect for bleeding? I used to use rat-tooth forceps almost all the time, but I have had a run of morbidly obese bitch spays recently where this method causes a bit of tearing/slipping of the ligature, so have started using Allis tissue forceps.

Something I've found useful is to place my first ligature, cut the ovary away and move it out of my field of view. Hold the stump with Allis forceps and then tie a second ligature if it looks oozy even in the slightest.

Re: Neutering clinics

James Laidlaw — Thu, 16 May 2013 15:16:33 GMT

Second what everyone says. The one time I did have a tear in a fat labrador, the other vet told me to stop worrying, make the incision larger and pack the abdomen with lap sponges (sterile) while they scrubbed in to help. By the time they had scrubbed in the bleeding had significantly reduced and we were able to isolate the vessels and tie them off with relative ease. Put me at ease of problems happening, and having an approach to deal with them if they do.

There's no substitute for experience and doing as many operations as you can though, some are easier than others. Find someone who can support you in practice if possible to help give your confidence a boost and just have a plan if things do go wrong. IV fluids, larger incision, packing and then a second pair of hands tend to fix things!

Re: Neutering clinics

David Mills — Thu, 16 May 2013 14:27:03 GMT

[quote user="Mark Holmes"]Breaking down the suspensory ligament, with the fear that I'll inadvertantly break down the artery too, or wrench the whole thing out through my incision![/quote]

If this does happen, it's not necessarily a bad thing. It is only when you have something go bleed - and fix it - that you can then be sure that if it happens again you'll be able to fix it again, and that, to me, removes the worry.

There'll be plenty of more tips out there, but my favourite way is to isolate the tight band of the suspensory ligament - attached cranially to the ovary - and stroke it/nick it with a scalpel blade until you feel a pop and it becomes looser. Others I've seen tearing the ligament with great success manually deep in the dog where its less fibrous and easier to tear gradually.

If you've the spare readies, WVS do a yearly spaying camp in India - think it ends up costing around £1500 all in - where you'll spay into the 10s of bitches. I haven't been but some friends did and when they returned they were supremely confident. Apparently the prevalence of tick borne diseases is such that most dogs struggle to clot and so it gives quite a different perspective on how much blood loss is possible with no ill effect on the animal.

Re: Neutering clinics

Mark Holmes — Thu, 16 May 2013 13:23:42 GMT

[quote user="K Burton"]

Breaking down the suspensory ligament, with the fear that I'll inadvertantly break down the artery too, or wrench the whole thing out through my incision!

[/quote] It rarely happens but if it does so what? The dog won't bleed to death that quick - just extend incision and isolate bleeder. Relax.

Re: Neutering clinics

Kathryn Burton — Thu, 16 May 2013 13:04:59 GMT

Breaking down the suspensory ligament, with the fear that I'll inadvertantly break down the artery too, or wrench the whole thing out through my incision!

Re: Neutering clinics

Evelyn Barbour-Hill — Thu, 16 May 2013 13:00:25 GMT

[quote user="Bob Russell"]

Not much help perhaps but don't be afraid to make the hole large enough so you can see what you are doing! The longer incision makes life a lot easier until you become more confident.

[/quote]

I second that. And would also point out that when you get some decent lighting everything suddenly becomes much easier.

Which bit of the bitch spay is it that makes you nervous?

Re: Neutering clinics

Bob Russell — Thu, 16 May 2013 12:57:11 GMT

Not much help perhaps but don't be afraid to make the hole large enough so you can see what you are doing! The longer incision makes life a lot easier until you become more confident.

Re: Neutering clinics

Kathryn Burton — Thu, 16 May 2013 12:53:14 GMT

Thanks for your replies :-) I work sole charge but in a quiet practice - since I moved there last July I've done eight bitch spays so not really enough to get my confidence up! I have to ask a colleague from another branch to come along and give me a hand when I have a spay to do as I become a nervous wreck! My colleagues are great with giving me advice, but I think it's a numbers issue - just not doing nearly enough!

Re: Neutering clinics

Mark Hedberg — Wed, 15 May 2013 23:40:23 GMT

Where do you practice? Perhaps a more experienced vet could show you a few tips to make it easier for you?

Re: Neutering clinics

Bibs — Wed, 15 May 2013 22:46:47 GMT

The WVS is another option. I went on a neutering trip to Spain with them in 2007. There was a bunch of relative new grads doing the spaying and two experienced vets to support them when they got in trouble.

In any case I think it's a good idea to work with some people who are confident with spays because sometimes it's a few good tips that make all the difference.

Re: Neutering clinics

Busybee — Wed, 15 May 2013 22:04:47 GMT

I think there may be a similar thread somewhere on the forum but can't find it right now!

I travelled to a charity centre in South Africa immediately after graduation for 4 weeks in order to gain experience in neutering surgery. It was one of the best things I've ever done! Feel free to PM me for more information and I can give you contact details.They are crying out for volunteer vets to help out and they are the most amazing bunch of people :)

Re: Neutering clinics

CatherineThomas — Wed, 15 May 2013 21:41:03 GMT

When I had not long graduated I spent two weeks, basically doing extra ems, at Budget Vets in south Wales. It was great for my confidence with rouine neutering because they had so many booked in for each day and they let me do as much as I wanted to. That was several years ago so I don't know if it would still be the same but might be worth asking. If you want to go abroad I know several vets who have volunterred on the cook islands, but I don't know the details.