The day started simply enough, with several surgeries scheduled: a few spays and some mass removals along with dental cleanings and tooth extractions. I was looking forward to a fairly light day where I had plenty of time to tend to my patients and could enjoy my tasks, as well as train a newly graduated veterinarian, Dr. Karen, who was visiting with us.
The morning proceeded without any disruptions, and we started our third procedure, an ovariohysterectomy (spay) on a darling Akita, “Destiny” Smith, who was new to the owners. Originally her owners planned to take her to a spay and neuter clinic, and I supported their decision as the owners do not have the funds for emergency care if pyometra should develop or if Destiny was impregnated and had trouble delivering. Destiny was their first pet and she came to them from a friend who did not believe in spaying dogs.
Mr. Smith wanted Destiny spayed prior to her next heat cycle; he had no desire to experience doggie diapers! Mrs. Smith was very concerned about Destiny’s surgery and called to ask several questions in the days prior to surgery. I answered her questions and assured her I would never put Destiny through a surgery that I did not believe benefited her or that she was not healthy enough to handle with minimal issues.
Destiny’s physical exam and blood work were ideal, I had no concerns about surgery. She was a sweetheart for her shot of premedications, the shaving of her belly, and induction of anesthesia was very smooth. As we scrubbed her belly to ensure a sterile entry for surgery, I checked one last time for a scar or small tattoo indicating she was previously spayed. She didn’t have any evidence of a previous surgery.
Many veterinarians shy away from spays on large dogs because their body has padded the ovaries and uterine horns in a thick bundle of fat, but I’m pretty comfortable with the procedure. The procedure is performed by entering the dog’s belly about an inch lower than the umbilical scar. Generally, I make an incision about an inch long through the skin, using a scalpel. Adult dogs have a decent amount of fat between the skin and the body wall, so I trimmed this fat away to make closing the belly easier. I then elevated the linea alba, a white center line in the body wall that is free of muscle tissue, and cut through it with the scalpel. The cut was clean and the structures beneath the incision looked healthy.
In a female dog, the reproductive tract starts at the vagina, which transitions into the uterine body past the cervix. These structures form the base of a “Y,” where the dog’s uterine horns form the arms of the Y by extending towards the dog’s ovaries (located just below each kidney). When we enter a dog’s belly, we have to access these organs, which are buried beneath all the intestines and the bladder.
I gently massaged her spleen out of the way, then introduced the spay hook to her belly. A spay hook is an 8 inch long device with a blunt curved tip used to catch or hook a uterine horn. I gently slid the spay hook down along the inner tissue of Destiny’s right body wall, angled towards her left knee, then brought it back up with a slight motion towards her intestines. With this technique, I can fish out the uterine horn (arm of the Y) and bring it out through the incision. I can trace the uterine horn to the ovary, then proceed to carefully remove those organs.
Now, hooking the uterine horn is a bit of a finesse move, and I don’t always manage it on the first try, which was true in Destiny’s case. Our new veterinarian has only performed a few spays and I was explaining to her that often I can ‘feel’ when I have the weight of the uterine horn on the hook rather than an intestinal loop. I repeated the motion with the hook, angling it slightly farther back but still didn’t feel any tissue catch on the hook, so next I adjusted it farther forward. When the hook came up empty, I sighed and said ‘good thing we have two sides!’ I reoriented the hook to direct it down the inner tissue of Destiny’s left body wall and repeated the same motions with the same results.
I frowned, but let Dr. Karen know that we had another option: we could increase the incision a bit in length and try to feel the uterine horn with our fingers. I used the scalpel to expand the incision down Destiny’s belly by about another inch, then slid several fingers into her abdomen, scooping them along her body wall. However, I couldn’t feel the uterine horn, which is nickel or quarter sized tube in a large healthy dog.
I slid my fingers along the other side of her body, but still came up empty. I muttered but repeated the action a few more times, coming to the dreaded realization that Destiny was possibly spayed already. With a sigh, I shared my concerns with Dr. Karen and she asked how we would know. Realistically, we don’t have a way to be certain. We would check for Destiny’s organs in the expected places, but it would require us to expand her incision large enough to perform an exploratory surgery so that we could visually and tactilely explore all of Destiny’s abdomen.
Dr. Karen scrubbed in to assist with the surgery, as additional hands help in moving the intestines, an organ that likes to expand to fill spaces. I expanded the incision so that I could see all of Destiny’s abdomen. A dog’s vagina is sandwiched between her colon and bladder, so that is where we started our search. By pushing the intestines forward, I could elevate the bladder away from the colon, which revealed only a small fibrous piece of flesh, possibly a ‘stump’ from a previous spay. We certainly couldn’t find any tubes between the colon and the bladder.
Next, we gently traced the entire intestinal system to ensure no uterine horns were somehow masquerading as intestines. We then moved the intestines out of the way to take a look for Destiny’s ovaries. A dog’s ovaries, typically the size of dried apricots nestled in nests of yellow fat, would rest just below her kidneys, but often are hard to distinguish from the fatty tissue that insulates the body. I ran my fingers across the fat, but did not feel any thicker nodules suggestive of ovaries.
Since we already had Destiny’s belly open, I checked her stomach, pancreas, spleen, and liver, all of which appeared healthy. We gently replaced her intestines and I sutured her abdomen closed. After we woke Destiny up from anesthesia, I left the operating room with a feeling close to despair
Today I performed an unnecessary surgery on a beautiful and charming Akita. I called Mr. and Mrs. Smith to explain that Destiny was already spayed. Mrs. Smith was very upset that Destiny would need to heal from a surgery she didn’t need.
I often hear reports of veterinarians performing unnecessary surgeries to have vacation homes and expensive cars, even though I don’t personally know of any veterinarians that have either (unless their spouse or family works in a well-compensated profession). The rumors exist likely because performing veterinary medicine is expensive: the cost for the staff, supplies, building, amenities, and equipment are 5-10 times what the veterinarian earns, but it is easy to blame the cost on the most prominent person.
Today I couldn’t claim that the costs were due to providing the best care for a pet. When a pet has an unnecessary surgery, like most veterinarians, I feel sorrow.
While we can perform surgery safely, and we have done all that we can to minimize risk, we cannot eliminate the risk. In Destiny’s case, a small simple tattoo on her abdomen would have prevented this unnecessary surgery.
Please ask your veterinarian to tattoo your pet when she (or he) has a de-sexing surgery. This simple technique involves creating a light scratch in the dog’s skin with a scalpel blade near the incision, then touching the tiniest amount of green tattoo ink to the scratch. Should anything ever happen to you or your pet, all future veterinarians will know your pet was already spayed or neutered.