Dried-on Blood Is Biggest Enemy Of Surgical InstrumentsSeptember 30, 2013 In the bustle of a veterinary surgical ward, proper care of surgical instruments can easily be overlooked. But clinics that neglect proper cleaning and maintenance of equipment pay for such neglect in the long run in costly repairs and replacements. If properly cared for, surgical instruments can last the life of a practice, says Derek Lashua, director of marketing for Spectrum Surgical Instruments/STERIS Specialty Services in Stow, Ohio. The first step in proper care is to begin the cleaning process as soon as possible after surgery—within 20 minutes, he says. "Even if your instruments are not going to be sterilized until later, washing instruments shortly after surgery prevents blood from drying on them and is your best defense against staining, pitting and corrosion,” Lashua says. Cleaning, Sterilization Dried blood is the biggest enemy of surgical instruments, Lashua says. In fact, one of the most common problems his company sees is damage caused by dried-on blood and the use of improper cleaning solutions. If instruments can’t be washed immediately after surgery, clinic staff can use a pre-cleaning spray to prevent blood from drying on them, …
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Practical Tips To Improve Fluid Therapy ProtocolsSeptember 30, 2013 When you design a fluid therapy plan, three factors come into play: the patient history, the presenting complaint and the physical exam. What do you use as a maintenance fluid rate? How about your surgical rate? What if your patient is hypotensive? If you are unsure about what should be done, we have good news for you. A panel of experts from the American Animal Hospital Association and the American Association of Feline Practitioners recently published fluid therapy guidelines. Remember that these are suggestions, not a new definition of standard of care for fluid therapy. Yet these excellent guidelines are full of practical tips to improve fluid therapy protocols for sick, hypovolemic and anesthetized patients. They probably represent what most specialists would do and recommend in 2013. What follows is not an exhaustive summary of the article, but a review of some important points, especially as they relate to the surgery world. 1 Replacement vs. maintenance fluids When you design a fluid therapy plan, three factors come into play: the patient history, the presenting complaint and the physical exam. This information will help you determine whether there are changes in volume, content or distribution. …
Heaven And Hell In The Shelter WorldSeptember 23, 2013 Elliot’s owner thought she was wise by having her 1-year-old male pit bull neutered at a local low-cost spay and neuter clinic. A neuter for $25—what a bargain! Something went wrong with the surgery. Five days later, Elliot presented at the local emergency clinic for a grossly swollen prepuce and scrotum, along with ventral abdominal edema. Severe bruising covered most of the scrotum, and some of the skin was necrotic. He was lethargic, anorexic and extremely uncomfortable. The $25 castration included nothing more than the procedure itself. No medications, not even pain medications, were dispensed, and no written discharge instructions were provided. A scrotal ablation was discussed with the owner but she elected conservative treatment—hydrotherapy, cephalexin, tramadol and carprofen. Two days later, Elliot was back in the ER. This time, necrosis and infection were even more obvious. A scrotal ablation was the right thing to do. The perioperative protocol included antibiotics, pain medications and IV fluids, including a constant rate infusion. He was hospitalized overnight and recovered very well. The day after surgery, he was a different dog—immensely more comfortable. Big Money …
The 3 Surgical Options For C-SectionsSeptember 23, 2013 We continue describing our 10 steps for a happy C-section. [See Part 1, "The art and science of a safe C-section,” in the July issue.] This month, in the second of three parts, we focus on anesthesia and surgery. Our goals: safety and speed. 5. Anesthesia Melissa Goodman, DVM, board-qualified in the American College of Theriogenologists at Veterinary Reproductive Services in West Chester, Pa., skips premedication, and prefers masking patients down. She uses the smallest possible dose of propofol only if needed, e.g. in brachycephalic and fractious patients. When giving drugs to the dam, you are indirectly giving them to the babies. Many drugs are rapidly carried through the placental barrier and consequently affect the offspring. This may make resuscitation efforts more difficult. For example, acepromazine, ketamine and atropine can flow through the placenta, so they should be avoided. Glycopyrrolate, if needed, is a better choice than atropine. Choosing an anesthesia protocol that is safe for a caesarean patient is tricky at best. Because hypoxia is a concern for the patient and the neonates, pre-oxygenation for five to 10 minutes is an important precaution. Patients are then intubated and placed on isoflurane or …
Surgical Insights: Care Of Neonates After A C-sectionSeptember 23, 2013 While rubbing babies and clearing their airways, we also should strive to prevent the three "hypos" in neonates: hypothermia, hypotension and hypoxia. We conclude our three-part article on C-sections with resuscitation and care of the neonates. It is time to change a few old habits and to embrace more modern techniques. Part 1 is here; Part 2 is here. 7. Resuscitation While rubbing babies and clearing their airways, we also should strive to prevent the three "hypos” in neonates: hypothermia, hypotension and hypoxia. Hypoxia is a constant battle during a C-section. The amniotic sac should be removed as soon as possible, and the mouth and airway must be cleared with a bulb syringe. "Don’t use too much suction,” reminds Margret Casal, DrMedVet, PhD, Dipl. European College of Animal Reproduction, University of Pennsylvania School of Veterinary Medicine, "as it could damage the delicate tissue of the pharynx and larynx.” Alternatively, a mucus suction device for human babies can be used, e.g., the poetically called "snotsucker nasal aspirator.” Hypothermia can be prevented by using warm towels straight out of the dryer, or a …
The Joy Of Spaniel PuppiesSeptember 16, 2013 Hue and I have been doing rescue work with Cavalier King Charles spaniels for the past five years. We love being able to transport, foster and heal dogs in need. A few weeks ago we received a desperate phone call from one of the regional rescue coordinators, asking if we could head to north Jersey to pick up a pregnant dog that was just picked up from a backyard breeder. Of course, we dropped everything and headed north. We met another transport volunteer at a hotel near a turnpike exit. Shadow, the rescued mommy, was gingerly placed into my lap for the trip back to south Jersey. Normally we "rescue” older dogs with medical problems. It was very unusual to contemplate having puppies in the house. All our dogs are older. We had no area prepared for whelping and raising puppies. After a quick exam, it was apparent Shadow would be delivering within a week, but I figured we still had a few days to figure everything out. The first night we tried to make Shadow a bed on the floor in our bedroom. She took one …
The Dog-Spay Disconnect: It’s Time To Rethink This Formidably ‘Simple’ ProcedureSeptember 10, 2013 Not long ago a family member from out of town brought me her dog so I’d take a quick look at a lump. Because it would be at least a month before she’d be back to see her hometown vet, I agreed to remove the small mass ASAP. Once the surgery was underway, however, she called to ask if I could spay the dog, too—"as long as you’re already there." Strictly speaking, I wasn’t even in the neighborhood. The lump was in the skin over the right side of her belly. But, like most of you, I’m well-accustomed to the common client misconception that anything around the abdomen might as well be within the abdomen. As widespread as this muddling of anatomical locales might be, more common is the erroneous conviction this request implied: that a dog spay is a simple procedure, one that’s easily tacked on to most any other with a minimum of stress, discomfort, time, ability or expense. As you know, little could be further from the truth. The everyday canine ovariohysterectomy is a procedure that’s both hard to master and easy to underestimate. Is there any other routine procedure we …
Lap Cholecystectomy—Minimally Invasive OptionSeptember 10, 2013 Missy is an 11-year-old female spayed miniature schnauzer. She was happy, active and, to the owners, appeared normal. But she had a ticking time bomb inside. Her veterinarian had examined her regularly and had noted progressive increases in her liver enzymes. Missy was referred to radiologist Jessica Basseches, DVM, for an abdominal ultrasound. Her scan revealed that Missy had a fulminant gallbladder mucocele with no active evidence of inflammation. Gallbladder mucocele is a condition in dogs in which there is accumulation of mucus in the gallbladder. It has recently been reported as the most common cause of canine extrahepatic biliary duct obstruction. It is most commonly seen in older small- to medium-sized dogs. Cocker spaniels, Shetland sheepdogs and miniature schnauzers appear to be predisposed to the condition. There has been a weak association reported with hyperadrenocorticism (Cushing’s disease) and gallbladder mucocele. Findings Gallbladder mucocele may be an incidental finding but can be clinical in about 75 percent of patients diagnosed. Inflammation and necrosis of the gallbladder may result in gallbladder rupture and bile peritonitis. Clinical signs may be vague in milder cases, but in more severe cases, vomiting and abdominal discomfort are often noted. …
Facing Up To The Past After An Accidental SurgerySeptember 10, 2013 Declawing cats is my least-favorite elective surgery, but because my employer offers it, I long ago made up my mind to become very good at it and use the maximum possible pain medication that would be safe for the patient. Since our practice has an age and weight limit on declaw surgery, many patients present for simultaneous spay and declaw procedures. Two years ago, I accidentally declawed an 8-month-old, 5-pound kitten that was at the clinic for only a spay. When I began entering the surgeries into the computer, the surgery consent form stared back at me with the simple word SPAY. I gasped. No amount of squinting at the line or fiddling with the paper’s angle would change the fact: I made a mistake, the claws were in the wastebasket, and I had to cowgirl up and eat a slice of humble pie. Taking a deep breath, I called the client and put my cards on the table. I apologized, explained our pain management protocol and told her I would send home a bag of special cat litter used for declaw patients, all at my expense. Lucretia (not her real name) took the news …
Weekends With The Pack At The Jersey ShoreAugust 28, 2013 We have a place on the Jersey shore that is our favorite get-away spot on summer weekends. Unfortunately, we have a second floor condo and no yard, which is not very conducive to life with spaniels. Because we currently have 10 dogs living with us, we have to divide and conquer to make these trips. Our cute little English toy spaniel, George, is everyone’s favorite. He is also low dog on the totem pole and is easily scared by lots of traffic and congestion. So every weekend in the summer he packs his little doggie bag and heads to the grandparents’ house, where he is spoiled by four daily meals and all-day belly rubs. Our foster mommy dog has puppies that are too young to travel, so they win a stay at home with my son. His cocker spaniel is the best watchdog, and tends to bark a lot, so she also gets to stay home. The oldest, Lora Lu, is mostly blind and deaf, making it difficult for her to acclimate to new places; she also stays home. That leaves four who get to …
