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Clinical

It is not often that a veterinary surgeon is performing spay and neuters on patients. It happens, but probably not as much as general practitioners, leaving a majority of the responsibility to them. However, when issues that could be life-threatening, such as pyometra, occur in patients, general practitioners may be looking for tips and tricks to help avoid pyometra. 

On this episode of The Vet Blast Podcast, Shadi Ireifej, DVM, DACVS, shares 5 tips that general practitioners can implement at their practice to help clinics possibly see fewer pyometra cases with our host Adam Christman, DVM, MBA. 

 One of the pearls I like to stress when I give pyometra talks is surgical exposure. It's all too often that very experienced, well-intentioned general practitioners will try to create as small an incision as possible for their spay. And it looks impressive, it's quicker surgery because less closing time, the pet owner loves the tiny incision which means [their pet] is not going to be in that much pain postoperatively, [and] less chance of complications. However, if you are trying to operate on a large breed dog or a deep-chested dog, and you're working in those caverns, you need to not be shy about making a larger incision in order to get access to the ovarian tissue and that uterus. You don't need to overdo it, you should be adequate. You can always make your incision longer if you need to start small and go longer, but that's point No. 1. 

Point No. 2 is retraction. So I'm fortunate as a boarded surgeon, that usually I have all the bells and whistles. I got all the toys, I can have 3 assistants in there if I want to right to retract stuff and hold things. That's  me. Most spays are done by general practitioners. They're not going to have the staffing for that, nor the toys. So you need to have not only a big incision, as seems realistic for that dog that size a dog but also need to retract either have somebody, or something, push those organs aside, you can actually visualize the ovaries in that gutter or self-retracting Balfour retractors. Great solution. 

Learn how to have precision without the fuss and pus from Shadi Ireifej, DVM, DACVS, on this episode of The Vet Blast Podcast 

5 hacks to the Pyometra

, or wherever you get your podcasts. This episode is sponsored by Nationwide.

On this episode of The Vet Blast Podcast, Adam Christman, DVM, MBA, welcomes back June Long, DVM, to answer some common spay neuter complication questions.

Below is a partial transcript. Listen to the full podcast for more.

: For me personally, and I am sure it differs depending on the surgeon, the most difficult [spay] would be a fatty spay no matter how big the dog is. I have had like Chihuahuas and Yorkies and they are so difficult because of their condition so everything is slippery, everything wants to rip, and I really have to take my time with those and I also watch them very closely post-op as well. As far as the type of spay I have seen that is a little more tricky when it comes to post-op complications, particularly hemoabdomen, are pregnant spays because all the vessels are bigger, you have to really tighten your ligatures, really tie to make sure you are getting that hemostasis. In post-op, the uterus is gone so everything shrinks so then your ligatures aren't always as tight as they were when you left them.

Dr. June Long answers your questions on spay/neuter complications 

Your spay/neuter complication questions answered

June Long, DVM has been a high-quality, high-volume spay/neuter (HQHVSN) surgeon for more than 6 years. She joins The Vet Blast Podcast to share her experience with helping clinicians become more confident with spay and neuter procedures. 

: I wanted to share this knowledge with anyone who is interested, since it's not routinely taught in veterinary curriculum. And I saw a lot of colleagues that have anxiety when it comes to spays or overweight spays or in-heat spays. [They] were having anxiety like the night before and couldn't sleep and were nervous the rest of the day after the procedure, and I just kept thinking to myself, "Well, I can help them with that. I can show them that it's doesn't have to be scary." And so I just had the idea of creating [The Six Minute Spay] course than anyone could access it and get some CE credit, too, and hopefully help not only just gaining their confidence in their surgery procedures, but also help with their efficiency as well.

A high-quality, high-volume spay/neuter surgeon shares her tips for a quick, efficient surgery under a variety of conditions

The 6-minute spay with June Long

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Lacey Rosenberg, DVM, DACT, shares her tips for a successful neonatal resuscitation

Best practices for neonatal resuscitation

In an interview with Lacey Rosenberg, DVM, DACT, an associate veterinarian for Veterinary Specialties at the Lake in Sherrills Ford, North Carolina, she explained her start in veterinary theriogenology and interest in animal reproduction. She also described the technique for a neonatal resuscitation and some of the tools she uses during the Fetch dvm360 conference in Charlotte, North Carolina.

 So growing up, I had like pretty much every pet and my mom had this hyper fixation on breeding animals. So, we had purebred collies and we had a litter of collies. And then we like had a cat that got out and got pregnant, we have a litter of kittens...So kind of just growing up, [I was] always exposed to animals, always exposed to breeding, and really just found the science of reproduction fascinating.

Neonatal resuscitation, when we kind of think about it, from our perspective, it's after a C-section. So usually you've got a whole litter of puppies or kittens that were trying to wake up from some level of anesthesia at once. So the most important thing is really having your resuscitation area ready and having all of your tools.

Conference

Lacey Rosenberg, DVM, DACT, gives an overview of metritis, mastitis, hypocalcemia, and more

Potential postpartum diseases in the female dog

In an interview with Lacey Rosenberg, DVM, DACT, an associate veterinarian for Veterinary Specialties at the Lake in Sherrills Ford, North Carolina, she explained what postpartum diseases can occur in the female dog and how each of these diseases present in a patient during the Fetch dvm360 conference in Charlotte, North Carolina.

 The most common things that we're gonna see in the postpartum bitch or the postpartum female dog are mastitis, metritis, hypocalcemia, [S

, and then subinvolution of placental sites or SIPS. 

So mastitis is inflammation of 1 or more mammary glands, we're going to see like a permanent memory discharge, or the milk may have some blood in it, if it doesn't have pus, [and] usually the glands are going to be warm [and] painful to the touch. We treat these obviously with pain management appropriate antibiotics.

Metritis is going to be inflammation of the uterus in the 2 weeks after whelping. So in that postpartum period, it can be from a retained puppy. Severe retained placentas [with] really long whelping or bacteria just has a chance to invade. Depending on the severity of the case, sometimes these are spayed [and] sometimes we will medically manage them.

Lacey Rosenberg, DVM, DACT, explains the many causes and best management practices of dystocia

An overview of dystocia from a theriogenologist

In an interview with Lacey Rosenberg, DVM, DACT, an associate veterinarian for Veterinary Specialties at the Lake in Sherrills Ford, North Carolina, she explained what can cause dystocia, a birthing complication, and her expertise in managing this condition during the Fetch dvm360 conference in Charlotte, North Carolina.

 Dystocia basically is difficult labor or difficulty giving labor in small animals. There's thousands of different causes, but most of the time, what we're gonna see is stuck puppies, uterine inertia—which is where the uterus just isn't contracting appropriately from the get go. Or what we call secondary uterine inertia, which is where a female has had a certain number of puppies and just gets exhausted. We can see metabolic problems that can cause dystocia, like hypocalcemia or hyperglycemia, pregnancy toxemia, lots of different things that can cause it.

Managing dystocia [would start with] getting a really thorough history, confirming that the patient actually has a dystocia, and then usually, we have to be very cautious with medical management. So really making sure that it's an appropriate candidate for medical management [and] that we have a decent chance of success with medical management.

Lacey Rosenberg, DVM, DACT, explains the best treatment approach for pyometra

Treating pyometra

In an interview with Lacey Rosenberg, DVM, DACT, an associate veterinarian for Veterinary Specialties at the Lake in Sherrills Ford, North Carolina, she explained how to combat pyometra—a severe infection of the uterus that can cause an overflow of bacteria and pus, during the Fetch dvm360 conference in Charlotte, North Carolina.

 Our treatment of choice for pyometra is spay. We've got a pus filled uterus, [so] we want to get rid of the uterus [and then] we get rid of the infection. We will medically manage these patients at times if they're stable. So if the cervix is open, if they're bright, alert, and responsive, if they're feeling good, still eating, still acting okay. And then the other important thing to that is that if I feel that there's still a good prognosis for future fertility, because in cases of pyometra, there is underlying uterine pathology. We're going to worsen the prognosis for them having subsequent litters.

Theriogenology

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