Surgical Paranoia
October 20, 2012
Students from the class of AVC 2013, travelled to Nain as participants on the Chinook Project. As part of the experience, the students craft various pieces of writing. No photos were submitted with this anonymous essay; photos are supplied from other trips to Nain and Postville.
The part of the Chinook project that I found the most challenging was confidence with surgical manipulation. Was the challenge knowing that something I could do—some misstep—could have drastic consequences? Even though paranoia included double ligations and careful cutting, I had seen how unpredictable surgery can be. The number one challenging surgery for me was the type that would be performed the most frequently during the Chinook project – the mature dog spay.
People in small communities are more likely to spay their female dogs than to neuter their male dogs. Part of this can be a status symbol – having the big male intact dog is seen as more masculine. Part of this can be the squeamish owner not wanting to put their dog through that perceived traumatic surgery. The main reason females are altered rather than males is that the owners of the dogs do not want to have to deal with having puppies and finding homes for them. They are not thinking about the fact that the male dog is also a crucial component in this issue.
After a simple explanation that their dog was also part of the problem of overpopulation and letting them know that they were helping all of Nain by neutering their dog, many owners finally agreed to have the surgery. Another example of resistance to surgery was an owner who was worried about aftercare and the need to wear an Elizabethan collar. We assured this owner that e-collars are often not needed and that her dog Blackey was likely to have an uneventful recovery from surgery. We were pleased she agreed to sign up for a surgical appointment.
Mature dog spays are the most common surgery performed in an isolated location. The reason is that people do not want to have a dog who goes into heat and attracts the neighbourhood males. Also, they do not want to have a litter of puppies to take care of and rehome. It was not often that an immature dog came in for a spay, most dogs were full grown when they visited with us. Many dogs had had multiple litters, some had early pregnancies and some were in heat. All these factors make for an intimidating and challenging surgery.
Since surgery does not follow any kind of rule book, even with the best planning things may not go the way you anticipated. On Day two of surgery, while still working closely with the instructors, we had some increased bleeding in a mature husky mix. The knotted sutures came loose from the end of the pedicle (blood vessels going to the ovary), the kind of complication that really gets your heart racing. Thoughts run through your head regarding dealing with this challenge, what could you have done differently and the knowledge that sometimes these things can happen despite your best efforts. The key as we are taught in school is to not panic. If you panic you will have a hard time finding a bleeding blood vessel in a body cavity that is trying to keep you out. At a time like this, you realize how vital it is to have other colleagues around. Although they may not be helping you directly, they are there to instill calm if you need it.
In seeing surgical complications, you realize that the more that you experience, the better you will be able to cope when you are on your own. Perhaps you will not have someone around to seek advice from. You can be grateful for your experiences whether good or bad, and then are able to help others by teaching what you learned. Watching different clinicians’ techniques they have gathered over the years from doing solo surgery can be very confusing, but at the same time you can gain from the challenges they have faced and hopefully avoid those same problems yourself.
A good thing about an experience like the Chinook Project for someone seeking to gain confidence is that after a complication, you have the chance to practice again on the next patient and learn from these challenges. The jam-packed surgery days allowed for a lot of practice with difficult maneuvers such as finding the linea in a fatty mature dog or stretching the suspensory ligament which I still find challenging to this day. I even got the chance to see the use of a great instrument called the Dowling spay retractor. This retractor acts as your third hand and can take some of the uncertainty away from stretching pedicles and clamping them to the point of being worried they are going to break. It effortlessly pushes the body wall away and gives you great exposure to tie ligatures on the pedicle.
The Chinook Project was a wonderful experience to improve my surgical skills. Confidence and finesse can come naturally to some, but I did not find that it did for me. The more experience I had the better I felt going into the next surgery. One clinician we worked with had only done one dog spay in fourth year before going into private practice. This would have been terrifying for me, so I appreciate all the time I spent learning from all the clinicians.. It was a great lead into my next rotation at a shelter where I will perform many spays and neuters. I learned to expect the unexpected and to always be prepared. It is an experience I will treasure forever.
Comments