I spayed a dog today (sort of)

I say "sort of" because I wasn't really the one spaying the dog, although I watched very closely and helped a little bit!

My rotation this week is Community Practice-Surgery. On the first and last day of the week, we see medicine appointments (mostly healthy pets for vaccines, but some minor things like ear infections, lumps & bumps, etc.). On the middle days, we juniors scrub in for elective surgeries (mostly spays and neuters, rarely declaws) with the seniors.

My surgery today was supposed to be a 9 month old yellow lab mix, about 50 pounds. She came in yesterday afternoon and I got a chance to say hi to her while she was hanging out in a kennel. However, turns out she had an ear infection, urinary tract infection, AND was currently in heat, so no spay for her today!

My actual surgery today was a 2 year old Beagle who was used for one of the many research studies going on in the VTH but has now found a home. I didn't meet her while she was awake (not before anesthesia, at least) but she was a cute little thing.

I have never really scrubbed in for surgery before, so I was fairly nervous. Once while working in Arizona, I "scrubbed in" to help with the removal of a massive 6 lb lipoma (coincidentally, also on a Beagle), but that was pretty much "wash your hands really good and put on these sterile gloves" - no proper scrubbing, no gowning.

We did learn all about the proper ways to scrub, gown, and glove for sterile surgery during my first week this year (surgical principles lab), and thank goodness, or I would've had no idea what I was doing.

The scary part, though, is how much they talked to us during that first week about the stresses and strains of being scrubbed in for surgery - how you have to drink lots of water to stay hydrated yet make sure you won't have to go to the bathroom, eat something right before surgery so your blood sugar stays up, try to wear appropriate clothing so that you don't get overheated, don't lock your knees, ask for help if you feel like you're getting hot or dizzy, etc. I think I was not alone among my classmates in feeling fairly intimidated by all of these warnings.

However, I think my years of choir must have paid off, having seen enough people keel over on hot Sunday mornings in a crowded loft! I tried to stay very aware of my body position, shifting weight, etc. so that I wouldn't be "that junior" who passes out on their first day in surgery.

The scrubbing, gowning, and gloving all went smoothly, as I'd hoped. It helped that the senior student with whom I was working was very willing to give me little tips along the way and encourage me.

I helped towel and drape the Beagle, then watched as my senior made the skin incision (good thing, since what I thought was the umbilicus wasn't -- oops!). She found the linea alba and made a stab incision then extended it cranially and caudally, and lo and behold, intestines appeared!

(It's sort of funny, but I had nearly forgotten that all of that viscera is just sort of hanging out together in the abdomen; it's not like we were cutting into a special pouch that just held the uterus and ovaries.)

Apparently one of the most difficult parts of doing a spay is actually finding the uterus among all of those other organs, many of which look very similar. In fact, when my senior did fish out the first uterine horn (very efficiently), we both thought it was a loop of intestines -- they looked that similar.

My senior showed me how to palpate along the uterine horn until you get to the ovary (very firm, much different feeling than anything else I felt) (and by the way, it is really HOT inside that abdomen when you stick your fingers in!). She broke down the suspensory ligament that anchors the opposite side of the ovary inside the body, then I watched as she clamped below the ovary and tied off the vessels and tissue that would be cut and stay inside the dog.

I got to fish out the second uterine horn and ovary, although I failed to break down the suspensory ligament on my own. (In my defense, you are pulling on something that you're supposed to break just by sort of yanking on it, but without hurting anything else by pulling too hard... so I guess it's an acquired sensation.) I clamped below the second ovary and ligated it myself, and was very excited when we released the clamps and I had done a good enough job that it wasn't bleeding.

My senior ligated the uterine body above the cervix, then we sliced it off (goodbye, reproductive capabilities!) and set it aside. There was some bleeding going on, apparently a little more than usual, but my senior deemed it okay to close the dog's abdomen anyway. She sutured up the body wall (which is a really important part, so I was glad to let her do it).

I sutured the subcutaneous tissue (my first time ever suturing live tissue, and although a banana is good practice, it is WAY not the same), then she did an intradermal suture pattern to close the skin. We "shared" placing the line block (injections of local anesthetic along either side of the incision, in the muscle layer).

(It's funny, but what a lot of clients base their opinion of your surgical skill on is how nice the incision looks afterward. That, and how neatly the skin was shaved [which the techs usually do, not even the vet]. Not too many owners are really worried about how pretty or effective your actual surgery inside the animal was.)

A couple drops of tissue glue to help bury the knots in the skin, a pretty line of green tattoo ink along the incision, and we were done!

All in all it took most of the morning (from 9:50 or so, when we went to help the anesthesia team get the dog under anesthesia, till 11:50 when we actually finished the surgery) to get that dog spayed, but only about 50 minutes of that was actual surgery time, which I guess is pretty good considering that I was definitely slowing down my poor senior with my laborious efforts to not jab the dog in the wrong places.

Little miss Beagle had a rough awakening -- she came to very dysphoric (disoriented and panicky) which is usually more of a bad reaction to the anesthesia than an indication of pain, especially since she was loaded up with all sorts of pain drugs. She calmed down pretty quickly with a little extra sedation, but I felt a little more responsibility for her disorientation and upset having been one of the two people that potentially caused it.

Overall it was a really neat experience, and I'm definitely looking forward to getting in on another surgery tomorrow (I don't know what -- a cat maybe?). I now know that at least I won't pass out every time I scrub in (although it could still happen, who knows). And I managed to do some things surgically, and not mess them up too much. But it's definitely going to be a lot more stressful when I'm the senior in charge of the surgery, and my little junior assistant has no idea what they're doing!