Jumping the rails

Re: Jumping the rails

Vikki Halliday LLB — Tue, 14 Dec 2010 00:31:33 GMT

[quote user="Anthony Todd"]

I read it as the head nurse??

[/quote] Anthony, I do hope you are not suggesting what you appear to be? Lets just say that I would not want to discuss why a member of staff left a practice on an internet forum, therefore I will refrain from further comment.

Re: Jumping the rails

Clive Ansell — Mon, 13 Dec 2010 14:38:53 GMT

[quote user="Julian Earl"]

[quote user="Clive Ansell"]

It may have been even quicker with a simple continuous suture for the linea alba?.

[/quote]

Maybe, but the standard method then was simple interrupteds. Also, with the wound only being three to four sutures-worth, it might not have made a lot of difference.

[/quote]

True enough.

Re: Jumping the rails

Clive Ansell — Mon, 13 Dec 2010 14:37:55 GMT

I normally use just one simple continuous, except in one of the practices I occasionally locum where they insist on interrupted ones. Prefer pds for the linea alba, but will use vicryl. Some of the low cost clinics it is catgut or catgut, unless the client decides to accept the optional upgrade to vicryl for a fiver ! (Which pushes a bitch spey up to the pricely sum of £81)

Re: Jumping the rails

Julian Earl — Mon, 13 Dec 2010 14:36:23 GMT

[quote user="Clive Ansell"]

It may have been even quicker with a simple continuous suture for the linea alba?.

[/quote]

Maybe, but the standard method then was simple interrupteds. Also, with the wound only being three to four sutures-worth, it might not have made a lot of difference.

Re: Jumping the rails

Julian Earl — Mon, 13 Dec 2010 14:35:19 GMT

[quote user="Jonathan Wray"]

[quote user="Julian Earl"]I think it is more than acceptable to "boast" of doing rapid surgery as the risks are minimised[/quote]

Back in the mists of time a vet called Eddie Straiton wrote to the Veterinary Record about how he and his colleague had their version of the "Spey Race", which was a pun, a play on words for the "Space Race" - Google it if you don't know what it means. The RCVS took a view which caused Mr Straiton, a colourful character and media darling, profound public embarassment. It was almost certainly the last time the Record published anything quite so crass, but since this is a private forum, go ahead, along with "An-On" - boast.

JGW[/quote]

I remember that. But I am not (a) talking about a race, nor (b) actually boasting. The "boast" was in inverted commas as a possibly relevant word to An-On's post, and Anthony Todd's; no doubt equal or better words could also have been used, and the fact remains that my comments are relevant to the discussion. If the RCVS wish to talk to me about this, I'm at work all day.

Re: Jumping the rails

Mark Hedberg — Mon, 13 Dec 2010 14:30:10 GMT

[quote user="Clive Ansell"]

It may have been even quicker with a simple continuous suture for the linea alba?.

[/quote]

I prefer a double line of those; independently knotted off both ends. That said my boss hates simple continuous suture in the midline so in this practice I don't use them much. (I can see his point; but that's why you use two lines of simple continuous.)

Re: Jumping the rails

Clive Ansell — Mon, 13 Dec 2010 14:26:13 GMT

It may have been even quicker with a simple continuous suture for the linea alba?.

Re: Jumping the rails

Julian Earl — Mon, 13 Dec 2010 14:22:17 GMT

[quote user="Mark Hedberg"]

[quote user="Julian Earl"]

My previous boss speyed a lean, young JRT in eight minutes - it was the cleanest, quickest and most elegant bitch spey that I have seen. I think it is more than acceptable to "boast" of doing rapid surgery as the risks are minimised (as long as ligatures are tight etc., etc.). Charging the same or even higher is justified by the quality of the surgery.

[/quote]

What suture pattern did he use for abdominal muscle?

[/quote]

Simple interrupted with Vicryl. Probably about three or four sutures as it was a young, lean JRT.

Re: Jumping the rails

Rob Reid — Mon, 13 Dec 2010 10:35:11 GMT

[quote user="Jonathan Wray"]Back in the mists of time a vet called Eddie Straiton wrote to the Veterinary Record about how he and his colleague had their version of the "Spey Race", [/quote]

http://www.independent.co.uk/news/obituaries/eddie-straiton-532634.html

His obituary recounts the story a little bit.

Re: Jumping the rails

bob lehner — Mon, 13 Dec 2010 09:56:25 GMT

[quote user="Jonathan Wray"]Back in the mists of time a vet called Eddie Straiton wrote to the Veterinary Record about how he and his colleague had their version of the "Spey Race", [/quote]

Yes - I remember that - in fact he recounted the 'spey race ' story on the Jimmy Young programme on Radio 2, where he had a weekly spot as the 'Radio Vet' answering listeners' questions. It caused a right old rumpus and he was gven a real drubbing by the profession.

Re: Jumping the rails

bob lehner — Mon, 13 Dec 2010 09:44:14 GMT

[quote user="Rob Reid"]he would also do them 'back to front' ie ligate the cervix etc. first, the theory being it gave you better access to the ovaries. I don't do this routinely but have occasionally employed this technique for very fat dogs and find it can help.[/quote]

I have always ligated left ovary, then cervix then right ovary - someone must have taught me that method years ago - but I think it can make getting a very deep right ovary out rather easier.

Re: Jumping the rails

Malcolm Ness — Mon, 13 Dec 2010 08:36:15 GMT

[quote user="Anthony Todd"]she might have told me to tie the legs and tilt the table[/quote]

Be very careful about this technique. Gastric reflux leading to distal oesophageal stricture is a very rare but extremely serious complication of anaesthesia. Of the cases I have managed over the years, most have been in bitch speys and several in bitches known to have been positioned like this for their op. Not a statistically robust analysis but enough of an association to make me very wary, especially when a gravity assisted pathogenesis seems to present itself.

PS. Though all good surgeons are quick, not all quick surgeons are good!

Re: Jumping the rails

J G Wray — Mon, 13 Dec 2010 07:34:52 GMT

[quote user="Julian Earl"]I think it is more than acceptable to "boast" of doing rapid surgery as the risks are minimised[/quote]

JGW

Re: Jumping the rails

Anthony Todd — Sun, 12 Dec 2010 23:18:15 GMT

"My guess is she got pissed off with the pervading stubborn arrogance of ignorance and left."

I read it as the head nurse??

Re: Jumping the rails

Vikki Halliday LLB — Sun, 12 Dec 2010 23:13:22 GMT

[quote user="Anthony Todd"]

My guess is she got pissed off with the pervading stubborn arrogance of ignorance and left.

[/quote]

Who left?

Re: Jumping the rails

Anthony Todd — Sun, 12 Dec 2010 23:10:50 GMT

[quote user="Vikki Halliday"]Anyone else have any tips of genius?[/quote]

I'd ask the head nurse; she might have told me to tie the legs and tilt the table..... The good ones know much more than us, have seen it all done well and quickly and know why.

My guess is she got pissed off with the pervading stubborn arrogance of ignorance and left.

My impression of "slow" surgeons is the time spent actually not doing it. X factor discussion, blotting tiny bleeders, trying to find the uterus [probably the greatest time waster] and having " my hand in" is not good on all sorts of counts, nor is general dithering.

I'd like to see a time and motion study showing where the time goes. Bet the actual surgery time in a "slow" and an "8 minute" bitch spay would be about the same, the difference being the above wasted time.

Probably the ligating and suturing time would be a bit slower as that's practice and dexterity which I never had much of, the dexterity I mean.

Re: Jumping the rails

Rob Reid — Sun, 12 Dec 2010 18:48:34 GMT

Jumping the rails - damn I thought that I was logging into a snowboarding thread (seeing as we've had a cycling one already!) Oh well seeing as I'm here...

[quote user="Vikki Halliday"]

Anyone else have any tips of genius?

[/quote]

An old boss of mine was very quick and rarely had any complications - he could spey a bitch in the time it took me to spey a cat (and I am no mug at cat speys - used to do conveyer belts of them for the CPL, 8-10 minutes was the expected time.)

He too used to tie the legs back and tilt the table, but he would also do them 'back to front' ie ligate the cervix etc. first, the theory being it gave you better access to the ovaries. I don't do this routinely but have occasionally employed this technique for very fat dogs and find it can help.

I could never claim to be a sub 10 minute speyer, but I think 20 minutes is a fairly realistic target for most cases.

Re: Jumping the rails

Mark Hedberg — Sun, 12 Dec 2010 15:46:50 GMT

[quote user="Julian Earl"]

[/quote]

What suture pattern did he use for abdominal muscle?

Re: Jumping the rails

Mark Hedberg — Sun, 12 Dec 2010 15:44:26 GMT

[quote user="Vikki Halliday"]

What did speed me up and revolutionise my speys was the realisation after watching my boss that if you tie the hind legs, tilt the table head down slightly, (obviously not in a fat old labrador!), and make a small 4-5cm incision just caudal to the umbilicus, you get much better access to the ovaries and cervix.

Prior to that I had been taught to open them from 5cm below umbilicus to just above pubic brim, which in some dogs meant ovaries were poorly accessible and the suturing took forever!

Anyone else have any tips of genius?

[/quote]

Aside from tipping the table (table here doesn't do that well) do you have a picture of that? Sounds brilliant! (that said, my incision will have to be larger; I simply can't fit my hand in an incision that darn small! :D

Re: Jumping the rails

Malcolm Ness — Sun, 12 Dec 2010 11:57:02 GMT

Good surgeons tend to be quick surgeons, not because they are hurrying but because they know what they are doing. There isn't any real virtue in being quick as long as the technique is good. The converse is slow surgery and that should be cause for concern - if an ordinary bitch spey is taking more than 30 minutes (skin to skin time) then you need to review your technique because there simply isn't 30 minutes of surgery to do.

Unfortunately, most veterinary surgery is effectively self-taught and rarely subject to the kind of review that might lead to improvement.

Re: Jumping the rails

Vikki Halliday LLB — Sun, 12 Dec 2010 10:48:01 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Vikki Halliday"]The head nurse used to sigh and tut[/quote]

That should be a sacking offence.

[/quote]

Hmm. I totally agree, and funny you should mention it, she "resigned" not long after this....................

Re: Jumping the rails

Alan Tevendale — Sun, 12 Dec 2010 10:05:05 GMT

I know that nobody is suggesting that any vet should have a routine of clock watching but I'm sure we all know that in some practices this does exist. I absolutely agree with your point that good fast surgery is better than good slow surgery. This is true for both the practice but mostly for the animal that will have to spend less time under anaesthetic, with an open wound etc. I've always agreed with this point and have seen this most clearly in cattle caesers where surgical sterility seems to matter less than surgical speed and good technique. Maybe I should have made my position clearer on this point previously.

I don't think anyone would suggest that there isn't a world of difference between the two surgeries (OVH vs gastrotomy + glass).

Re: Jumping the rails

Julian Earl — Sun, 12 Dec 2010 09:35:01 GMT

[quote user="Alan Tevendale"]

Well put Katja. I don't like clock watching either as I find it starts to put pressure on staff (vets as well as nurses). Don't get me wrong if someone can do a bitch spay in 8 minutes and not reduce the quality of the surgery in any way then I don't see anything wrong with it. From a buisness point of view it certainly increases potential turnover. My point is that especially for new grads clock watching will probably slow things down as stress levels increase. As long as a vet has good surgical technique and isn't seeing post operative complications time is not so much of an issue - within reason.

Maybe the vets who are doing these super fast spays have found some new technique - I'd be happy to hear about it.

[/quote]

No, there was no practice routine of watching the clock. He was just so smooth that it was noted how quickly the surgery had been done, that is first incsion to last suture. Standard technique of ovariohysterectomy as well. Nobody is suggesting that new graduates (or experienced ones) should have a routine of clock-watching, but I stand by my point that good fast surgery is better than good slow surgery.

Also, there is a world of difference between a spey being a specific procedure with a fixed protocol and known objective, and the removal of glass via a gastrotomy where there are multiple unknowns at the start. So the latter cannot be compared on time with another gastrotomy where different factors come into play.

Re: Jumping the rails

Evelyn Barbour-Hill — Sun, 12 Dec 2010 00:19:30 GMT

[quote user="Vikki Halliday"]The head nurse used to sigh and tut[/quote]

That should be a sacking offence.

Re: Jumping the rails

Vikki Halliday LLB — Sat, 11 Dec 2010 12:17:15 GMT

I agree about not clock watching, there are many new grads in practice (and some older ones) who have been put under pressure by bosses and nurses with regards to spey times. I recall one of my previous bosses being able to do a bitch spey in 15 min, however I was 20-25min for uncomplicated lean dogs, 30-40 mins sometimes for fat, hyperaemic, deep chested dogs.

The head nurse used to sigh and tut as I was "so slow", yet under the circumstances I considered myself to be average speed and careful enought that there were few if any post op complications.

Prior to that I had been taught to open them from 5cm below umbilicus to just above pubic brim, which in some dogs meant ovaries were poorly accessible and the suturing took forever!

Anyone else have any tips of genius?