Tag: neutering

  • Stitches

    Stitches

    Legality within the veterinary profession can be a bit of a minefield, especially when it comes to things like drug licensing. This leaves many new graduates in fear of doing something against the law without even realising.

    However, while some veterinary legal principles are complicated but clear, others are genuinely vague, leaving us unsure on where we would stand in a court of law.

    A stab in the dark

    It was recently reported that stab victims, scared of the inevitable police involvement if they were to present at A&E, were turning to vets to have their wounds sutured, albeit at a handsome price of about £200. While the morality of doing a procedure such as suturing on people may be questionable, the legality certainly is.

    bloody knifeThe RCVS clearly states vets are not legally allowed to prescribe pharmaceutical products for people, but they have no specific guidelines on wound treatment.

    It could be argued that, ethically, suturing should involve the use of some form of local anaesthetic (either by a local block or a transcutaneous patch) and, therefore, cannot be allowed as this would involve drug administration.

    However, that’s not to say a person can’t consent to old fashioned gritting their teeth and bearing temporary pain for the sake of saving a four-hour wait in A&E.

    Friend or foe?

    For those who could be potentially incriminated if they sought medical help at a hospital, you can sort of understand why they’d ask someone else, like a vet, for stitches. But they aren’t alone…

    A number of vets who become injured either on the job, or elsewhere, will seek the help of their colleagues, rather than take the majority of a day off to wait for the NHS to achieve a vastly similar result. After all, vets are pretty damn good at suturing and would arguably do a better job than the junior doctor on an emergency ward.

    You could discuss the ethics of whether a vet should help someone who needs medical attention in varying situations and whether they are legally allowed to do so. However, charging for the service is an altogether different matter – stitching up a fellow vet, or even a family member, wouldn’t raise the question of fees, but a stranger who walks in off the street?

    Cash in hand

    A BBC article from 3 March (Stab victims ‘paying vets to stitch up their wounds’) reported the “going rate” to be around £200 – does this not infer the image of an underground medical procedure market, whereby vets can earn a bit of extra cash to extend their services to animals of the two-legged kind?

    You have to admit, when you consider the rough cost of a bitch spay at around £150 (weight and complication-dependent), that figure has quite an impressive profit margin. Once a vet charges for the privilege, it becomes a business venture, not just an act of goodwill.

    stitching
    Stab victims are reportedly turning to vets to have their wounds sutured, in an attempt to avoid police involvement. IMAGE: vzmaze / fotolia.

    And yet the NHS is screaming for help in A&E departments. With average waiting times at an extreme high, it’s begging prospective patients to consider whether their ailments are worthy of the emergency room or whether they could be seen elsewhere – the GP, minor injuries, pharmacy… and now the vet?

    By applying skills used on animals every day, would vets not be easing some of the burden on our struggling NHS?

    Risky business

    But what if something went wrong? An infection of a wound, of which the bearer couldn’t explain who sutured it, should surely raise some eyebrows – and, after all, with vets being legally unable to prescribe drugs to people, the injured party could not return to the surgeon responsible and ask for antibiotics.

    This is where the legal grey area becomes pertinent. Where would a vet stand if sued for wound breakdown? Members of the Veterinary Defence Society are supported for claims against their actions involving animals… but humans?

    There are a lot of unanswered questions that, for me, make conducting procedures such as suturing on members of the public too risky.

    Final decision?

    It may be different if it were a colleague or close family member who understands the trust he or she is putting in you to do a “simple” procedure works both ways. However, even then, it’s not without elements of risk.

    On a wider scale, should we, as a profession, be seen to advocate such practice? Or should our representing bodies be defining the limits of our medical interventions and reprimanding those who see the injured public as a business opportunity?

    But then, would we live in even more fear of being prosecuted just for helping a fellow vet who knows full well what he or she is agreeing to?

  • My various reasons for running

    My various reasons for running

    Maintaining a work-life balance can be difficult within the veterinary profession, unless you actively make an effort to do non-vet things.

    Jordan
    Although a “poor runner” Jordan is taking on a half marathon in aid of two charities close to her heart.

    Joining a sports team or other society requires a certain level of commitment (depending on the level), and this can be helpful to keep a frequent scheduled period of “escape time”.

    Another good way to motivate yourself to do “other” things is to set a personal target to aim for.

    Procrastination aid

    Several months ago, in the middle of fourth year exams, I think I was subconsciously craving any method of occupying time that didn’t involve staring at a textbook – so, in my revision-frenzied madness, I signed up for the Great Scottish Run Half Marathon.

    Just filling in the application and perusing training plans gave me a few sweet minutes of procrastination at the time. But after exams had been and gone, and final year rotations loomed, I started to question what an earth I’d gotten myself into.

    I’m a poor runner at the best of times, sporting an age-old ankle strain and intermittent shin splits – the furthest I think I’d run before beginning training was 5km (about seven years ago, when I was considerably fitter) – but I gritted my teeth, donned the ankle support and shin splint tape, got a decent pair of trainers and set out on a run.

    Staying motivated

    Despite my misgivings, by following a training programme almost impeccably, I’ve gradually been building stamina and have surprisingly avoided aggravating my shins.

    Now, having nearly finished the training, and with the half-marathon only two weeks away, I can appreciate how much having a target to aim for has helped me keep fit throughout my first few rotations – and with many of them being the sort of rotation notorious for having long hours, it would be so easy to miss out on exercise.

    In addition to keeping motivated to exercise, the main aim of my insane challenge (for me anyway) is to raise money for two deserving charities with which I have personal connections.

    Determined to finish

    Help In Suffering
    Help In Suffering has helped keep the people of Jaipur rabies-free for 14 years.

    The first charity is The Air Ambulance Service, which saved my life five years ago when I fell from a horse and sustained near fatal injuries.

    The other charity, Help In Suffering, runs a neutering clinic in India where my friend and I gained valuable skills last year, having been let down by another placement and stranded in an unknown country. This charity’s vital work has kept the people of Jaipur rabies-free for 14 years.

    I still hate running, but I’m glad I’ve tried to overcome the challenge to support these fabulous charities. While I know it’s going to be tough on the day, I’m determined to cross the finish line and not let down my supporters who have so generously donated.

    If you would like more information about the charities, or to donate, please visit my sponsor pages below:

  • Flank approach to the bitch spay

    Jordan surgery
    An experienced vet could complete the entire procedure easily within 10 minutes. We “tentatively ambled” through our surgeries in 20.

    Having finally settled in one place in Jaipur, India, my friend and I were able to relax a little, safe in the knowledge we had two weeks of neutering for population control ahead of us.

    Being in an unfamiliar environment, and with our patients mainly being strays, we were prepared for very different methods of anaesthesia, variations on drugs we’re used to at home, and potentially questionable sterility. Even so, when the vet, stood with his scalpel at the ready, said “oh yes, we use the right flank method” as if it were the norm, we were a little surprised.

    At home, we’re so used to seeing flank cat spays and midline bitch spays, my gut reaction was “is that even anatomically possible?”. As it turns out, it is.

    The method

    A small incision (<2cm) is made on the right flank, first through the skin and then each of the 3 underlying muscles (transverse abdominis, external abdominal oblique and internal abdominal oblique). A spay hook is then used to exteriorise the right uterine horn.

    Once identified, the surgeon follows the horn to the ovary and applies tension caudally to break the suspensory ligament. A ligature (note single) is placed around the blood vessel and the ovary cut from it using the three clamp method in the same way as spays in the UK. The surgeon then follows the uterus to the cervix and along the left horn to the left ovary, where the procedure is repeated. A ligature is placed just above the cervix (again using the triple clamp method) and the uterus removed.

    Closing the incision comprises placing a horizontal mattress suture in each of the muscle layers, a cruciate suture in the subcutaneous fascia, and intradermal sutures in the skin.

    The positives

    While the very idea of flank spays in the bitch just seemed alien, this method seems to be successful and works well in a charity environment in a country where certain resources are unavailable.

    The reasons for choosing this method include easier wound checking, a shorter wound healing time (meaning the dogs can be re-released sooner) and less tension at the incision site, decreasing the risk of wound breakdown – essential for animals that, once released, are unlikely to be seen again.

    Jordan surgery
    Despite her initial surprise at the method used, Jordan admits the flank approach is the best compromise, considering the resources available.

    The surgeons at the charity have found, over the years, the single horizontal mattress suture seems to be the least aggravating to the body wall muscles, and intradermals are the closure of choice in any stray or vicious animal that would be difficult to get near to remove sutures.

    Another key advantage to the flank approach is speed; important for two reasons:

    • The sheer number of stray dogs to neuter to reach an adequate level of population control means faster surgery is required to reach the target numbers.
    • The surgical time under IV anaesthesia should be kept to a minimum to avoid prolonged or rocky recoveries and minimise side effects.

    The experienced vet could complete the entire procedure easily within 10 minutes (in a normal young bitch, opposed to a pregnant or in season girl), and we, tentatively ambling through our surgeries, could complete within 20.

    The negatives

    Disadvantages to this method include more potential bleeding due to incising through the three muscle layers, a possibility of more postoperative pain and increased difficulty in extending the incision if there are complications. The most important, however, is that recovery of a dropped or bleeding ovarian stump is extremely difficult (or near impossible).

    The anaesthesia protocol used is premed: xylazine, induction/maintenence; IV ketamine and IM meloxicam as pain relief. Hence, the speed of the flank approach will also minimise the number of top ups needed and reduce the anaesthetic hangover comparing to a technique (such as midline) that is more time consuming.

    Compromise

    The method seems to be the best compromise, considering the resources available. I think the overruling disadvantage is that, if you were concerned about a slipped ligature, the ovarian and uterine stumps would be virtually impossible to find again via the original incision.

    However, that said, the only postoperative death we saw during our time on postmortem had all ligatures intact.

    It was eye-opening to see an entirely different approach to a bitch spay, and while it may not be the same as the routine at home, I still felt that we gained a lot of surgical experience and developed transferable skills.

  • Subcuticular sutures: a great idea in sensitive regions

    We routinely audit postoperative complications for our canine neutering surgery.

    Over time, it became clear we were seeing a few castration wounds come back in where the dog had licked both the wound and surrounding area, making it sore to the extent it was delaying healing. In some cases, additional treatment was required.

    We then wondered to what extent non-absorbable skin sutures were playing a role. Making the change to using absorbable skin sutures reduced our complication rate significantly – nuff said!

    How to bury knots at the start and finish of a subcutaneous suture. Video by John Inns via YouTube

  • What makes a good vet?

    Supervet
    Vets aren’t superheroes… or are they?
    Original image ©iStock.com/VasjaKoman

    As a student on placement, I’m often in awe of the vets I’m working with. The ability to take a history, examine an animal, run through differentials and come up with a diagnosis or action plan within 10 minutes – all while listening to an owner commenting on the weather or traffic – seems superhuman.

    This may seem an exaggeration (after all, vets aren’t superheroes), but when considered like that, it is pretty impressive.

    While seemingly intangible at the moment, I know the ability to do this with such ease comes with practice – and clearly some presentations are far more complex than that.

    However, while I find this impressive, others have a different opinion…

    A family friend recently commented on their own vets, claiming they would avoid seeing the partners if possible because – in their opinion – they see an animal for five minutes and see it as a money making exercise, whereas the younger vets spend a bit more time with the clients.

    Obviously I can’t comment on the vet/client rapport, which may have a huge influence on this opinion, but I can’t help but think that a younger, newly qualified vet would spend more time during consultations purely due to experience, or lack thereof.

    It has become evident recently that the profession has an image problem and we must try to change that for the better. But what do the public consider as a “good vet”? Apparently the opinion differs depending which side of the table you’re on.

    This is just one example, but in general, do clients want the vet to spend more time with their animal? They probably do – but, at the same time, they don’t want to be kept waiting and they want to be able to get an appointment. There has to be a balance between the three.

    As for cost, I’ve seen some vets charge meticulously, whereas others would try and keep prices as low as possible to please customers. In the clients’ eyes, the cheaper the better. But a vet practice has to function. It’s no good offering neutering for £10 because the practice would be bankrupt within a week.

    House
    “The most highly qualified and experienced surgeon in the practice might not be the best at client communication,” claims Jordan.

    Surgical skills and experience are perhaps something that the client will never fully appreciate. For a start, the vet seen in the consultation room may not be the same one who performed the operation, particularly if it’s something fairly routine. Also, the most highly qualified and experienced surgeon in the practice might not be the best at client communication.

    A vet can have such a diverse set of skills and knowledge that it is difficult to pinpoint which of these defines a “good vet”. Many vets have certain areas of expertise and will be better than others in certain situations, but not all.

    The key to time and money is striking the balance between what the client desires and what is realistic.

    Communication, however, doesn’t need to be compromised and can be the difference that alters the client’s opinion. For example, the manner in which an examination is conducted and the attitude of the vet during a 10-minute consult could leave the client feeling rushed, whereas a different vet with a different approach could leave the client with a far more positive impression.

    Client opinion is important, but at the end of the day, the welfare of the animal in front of you is your priority, whether or not the client values you highly.

    While the profession as a whole should take heed of what clients want, the customer is not necessarily always right, and at the end of the day, it is the welfare of the animal in front of you that should be paramount.

  • I’d recommend early neutering

    Pyometra in a dog, seen during surgery. The uterus is distended with pus.
    Pyometra in a dog, seen during surgery. The uterus is distended with pus. Image by Joel Mills [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons
    Last week I removed one of the largest, most pus-filled uteri from a large breed dog that I have ever seen.

    I’m a bit long in the tooth now, but I still found the whole procedure a bit scary given the size and vascularity of the uterus – and this made me reflect on the benefits of early neutering.

    We routinely spay bitches in our practice from five months of age with minimal long-term complications, and it’s so much easier.

    I am aware that recent research indicates early neutering may have some long-term implications in certain breeds, but the procedure is so much safer in young dogs, and anything that prevents them developing pyometra in later life has got to be an advantage.

  • Anaesthetising rabbits

    Vet holding rabbit
    Image ©iStock.com/4774344sean

    It is generally accepted rabbit anaesthesia can be challenging, but we do a lot of rabbit neutering as part of our work for an animal charity and use a protocol that has proved very safe and effective.

    We also use yellow gauge catheters placed into an ear vein for IV administration.

    Vetergesic (buprenorphine) 0.07ml/kg
    Hypnovel (midazolam) 0.2ml/kg

    • Combine these drugs in one syringe and inject subcutaneously 20 minutes before procedure.
    • Rabbit will become quiet and relaxed.
    • Ketamine 0.2ml/kg diluted with 1:10 saline (that is, 0.2ml ketamine in 2ml saline).
    • Give this slow IV to effect.
    • Most rabbits use half a syringe, but occasionally I have had to use the whole syringe. If it is not having an effect, flush the catheter, and mask with isoflurane if required.
    • Rabbit will react if it goes extravascular;
      • once induced, spray Intubeaze and intubate – listen to breath sounds; there is usually no cough.
    • Rabbit can usually be maintained on 2% isoflurane.
    • Slower to wake up, but eating.
    • Hypnovel must be discarded within 24 hours, so better to try to book in all rabbits on the same day.
    • Premed can be used for x-rays; incisor trimming.
  • Vets aren't limited to life in practice

    Image ©iStock.com/nsj-images

    When many people think of veterinary jobs, they think of those in the industry who work in veterinary practices, dealing with pets and farm animals who need examination or treatment. The truth, however, is that veterinary training can make it possible to work in a variety of different roles for different organisations – it’s the key to a career that can be incredibly varied.

    Those who work in a general practice will find their roles are quite diverse: day-to-day tasks could include the diagnosis and treatment of animals, operations, diagnostic tests, health checks, vaccinations, neutering and more. However, there are other career options that those with veterinary training may like to consider.

    Some vets choose to work in industry rather than choose to have daily contact with animals, with industry roles available for those interested in working with biological products, chemicals and drugs to develop, test and work on the production of such substances.

    Others may opt for a career that is more about regulation and standards, choosing to focus on a career that involves inspecting premises such as pet shops, zoos, farms, cattle markets, riding stables, catteries and kennels, in order to ensure the standards of care and hygiene present in these places comply with legal requirements.

    Alternatively, there are openings available for those who are veterinary trained and are looking to work in the public health sector.

    Bodies such as the Department for Environment, Health and Rural Affairs (DEFRA) work to help to both prevent and control outbreaks of disease that are spread by animals, with roles like these possibly including such tasks as working on the prevention of foot-and-mouth disease, or visiting slaughter houses and food processing plants to assess the ways in which the risk of the spread of disease can be reduced.

    It is clear that good veterinary training – and the right skill set – can open doors to a variety of different careers. The important thing for you is to decide just which one is the right one for you…