The Dog-Spay Disconnect: It’s Time To Rethink This Formidably ‘Simple’ ProcedureDr. Patty Khuly discusses the seemingly “simple” (to clients) spay procedure. September 10, 2013 By Patty Khuly, VMD, MBA 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 perform that compares to the canine spay for its high degree of difficulty and annoying unpredictability—not to mention its impressive complication rate? Stressing the Stress These practical challenges are probably why most of us tend to count the humble dog spay among the most stressful surgical procedures we routinely perform. And though it’s the first one many of us undertake, I’m sure I’m not alone in observing that the steep part of its learning curve seems to go on for years. Not only does the OVH (or OVE) require a mastery of anatomy and high proficiency in tissue handling, it’s complicated by factors arising from the tremendous variability among dogs. Which is why what seems like a "simple" spay worthy of a 20-minute stint might just end up in an hour-long slog in a sea of friable fat and leaky vessels. Or worse, in a "peek and shriek" that ends on the surgeon’s table, or a blood transfusion and an overnight stay at the ER—if we’re lucky. After all, 2 to 200 pounds is an extreme range. And when you factor in the vagaries of any given canine patient’s life stage, body condition score and reproductive cycle, it’s a wonder more recent grads don’t dissolve in a scrubs-green puddle of tears at the mere sight of a fat 6-year-old Rottweiler in heat. I do. Though our hospital’s policy requires that we reschedule any bitch who is obviously in heat, there’s no rescheduling fat. Not when you’ve already talked yourself blue, offered tools and still observed the tipping scales. And while I’ve seen few inducements to weight loss as helpful as an estimate—I charge more for the fatties—it’s never turned a fat-dog spay into a slim-dog spay. In any case, even if my fee schedule were wholly based on body condition score, I don’t believe I could ever get away with charging what an obese bulldog’s OVH is truly worth. Not what it’s worth to me, anyway. (I dislike it so.) Yet for all its potential trickiness and its perilously steep learning curve, the dog spay remains the one procedure pet owners feel free to toss off lightly in conversation, as if it involves little more than a "tying of tubes." It’s also the one most likely to earn us complaints whenever we attempt to increase its price tag. Boys and Girls In fact, the average fee for canine castration clocks in at just about half of what a spay costs, and yet a dog spay is way more than twice as hard. Indeed, so underrated is the canine OVH that on the menu of veterinary items, even castration seems to garner more respect (from my male clients, anyway). What’s up with that? I’ve concluded that this "dog spay disconnect," as I term it, has less to do with the fact that our clients don’t know their anatomy than with the widespread notion that a spay is an undemanding procedure every dog should undergo and, as such, that it must be easy to do. As significant and challenging as we all know an OVH to be, you’d think we’d be the last to advance the idea of the simple spay-for-all. Yet it should be obvious that we—historically, the procedure’s biggest champions—have been largely responsible for any lack of respect afforded it. After all, it’s obvious that veterinary medicine has worked hard to popularize the procedure and solidify its acceptance in popular culture in part by playing down its many significant risks and challenges. Why else would we continue to call it a "spay" instead of an ovariohysterectomy (or ovariectomy) if we didn’t want people to think it was something straightforward every female dog should have? While it’s true that the widespread campaign to see all our pets sterilized might’ve had a "dumbing down" effect on the concept of the dog spay in our culture, I’ll argue we’re now all grown up enough to market the procedure for what it is: a highly effective tool for treating and preventing female reproductive diseases and a means of achieving population control—yet a procedure that is, nonetheless, not without its considerable risks. As such, I’ll argue that the spay should be considered more respectfully in our culture. It should be treated neither like a surgical tack-on nor a financial loss leader. Procedures this substantial, valuable and risk-fraught don’t deserve to be emasculated for the purposes of mass consumption –– even if what’s at stake is something as significant as pet overpopulation. What’s more, given the continual evolution of veterinary medicine toward individualized medicine, along with emerging questions surrounding the ideal timing of sterilization, I believe it’s high time we reconsidered the larger role of the dog spay in general practice. The procedure’s inherent difficulty, coupled with the impact of shelters and dedicated spay/neuter facilities on traditional private practice spay rates, offers further inducements to change. Whatever your opinion on any of these issues, a revision of the "simple” dog spay’s oxymoronic status quo is undoubtedly in order. Dr. Khuly is a small animal practitioner in Miami and a passionate blogger at drpattykhuly.com.