Today I did surgery on a cat with a very large umbilical hernia.  I thought it was the perfect opportunity to take pictures and share with you exactly how a hernia is repaired.  The surgery would be exactly the same if this was a dog.

What is an umbilical hernia?

Some animals can be born with a small hole present on their body wall where the umbilicus (belly button) is.  This is always a genetic issue. (Many breeders will claim that the hole was made by the mom chewing too vigorously on the umbilical cord, but this is not true.) In most cases, the hole is very small.  Often it is so tiny that just a small amount of fat can poke out.  The fat is covered by skin and looks like an “outie” belly button.  But, sometimes, such as with this kitty, the hole is much larger.  This poor girl had a hole the size of a plum.  It was so large that her intestines were able to get into the hole.  This meant that the only thing between her hanging intestines and the outside world was a thin layer of skin.

Animals like this need to have their hernia repaired as soon as possible!  For animals with small hernias, it is still recommended to repair them, but we can often wait until it is time to perform their spay or neuter.

Here is a picture of the hernia on this cat with her belly shared as we started to prepare for surgery.  (Her head is to the right of the picture and she is lying on her back):

The surgery:

We prepared her for surgery and moved her into the surgical suite.  I gently made an incision over the hernia.  I had to be very careful, because there was no body wall underneath.  If I was too rough I would have cut right into her intestines!  Once I made the incision, here is what I saw:

You can easily see that her intestines were very vulnerable!

The edges of the hernia were covered in fat.  The fat was adhesed to the lining of the hole.  (Adhesed means that it was basically glued on to the body wall.)  I found some very interesting adhesions.  Check out the photo below!  I noticed that there was a large adhesion that was pulling the liver down into the hernia.  As an interesting note, this cat had an elevated ALT level before surgery.  ALT is a liver enzyme and I’m wondering if this adhesion was causing trauma to the liver as gravity would tug on it as it fell down into the hernia. (You can click on the photo to enlarge it.)

I carefully worked to break down the adhesions without doing any damage to the organs.  Next, what I had to do was cut a fresh edge along the edge of the hole.  If you suture the hole without having fresh tissue, it will eventually come apart again.  Here I am cutting the edges of the hernia:

Once the edges are fresh, then the next step is to place some strong stitches.  I used a suture material called 2-0 PDS.  PDS is a suture that takes a long time to dissolve and is very strong.

Once I had the hole closed, then the next step was to stitch the subcutaneous (under the skin) layer and then the skin.  However, because the skin had stretched I had to trim off a good amount of it before closing the incision completely:

Prognosis:

This cat should heal completely and not have any lasting problems because of the hernia.  Occasionally, when there is a large hole, part of the incision can come apart and sometimes multiple surgeries need to be done.

This week I had a cool surgery to do, a bilateral cryptorchid neuter. In non-medical-speak here’s what that means:

Bilateral = both sides
Cryptorchid = hidden testical
Neuter = remove testicals

So, this dog had two testicles that had not descended into the scrotum. If you want to read more about this condition you can read my article here:

Cryptorchidism in dogs

This dog was a big one!  A 150+ pound Newfoundland dog.  He is a beautiful boy and he was supposed to be used for breeding.  But, his testicles never descended into the scrotum.  While he could still physically be able to breed a female, he would be very likely to produce puppies that had cryptorchidism.

Cryptorchid testicles can be hard to find.  I had to search for several minutes before I found these boys in the abdomen.  They were trying to get out of the body and down into the scrotum, but never made it.

This big lad may have a bit more swelling than a normal dog after a neuter surgery but he should do just fine!

I’ve just written a new article with everything you need to know about anal glands.  Yes, I know it’s not a subject everybody likes to study!

The article includes my first video shot with my new camera, and a tutorial on how you can express your dog’s glands at home.  However, it’s not easy to do!  I have had many embarrassing and messy moments with anal glands including having them spray into my mouth!!!

You can read the article here:  How to express anal glands.

I saw a dog today that had run into a stick.  Or, at least we think that is what happened!  The dog was acting like nothing was wrong, but she had a nice gash on her side:

Fortunately the stick didn’t too penetrate too far so it was a relatively simple stitching job.  The dog went under a full anesthetic and we cleaned up the wound:

And a few minutes later, here’s what she looked like:

Do you have any experiences with a pet needing stitches?  I’d love to hear about it in a comment below!

I just spent the weekend in an intensive course on ultrasounds.  So, now I’m ready to roll!

All vets get some training in school on how to ultrasound but most will end up calling in a specialist to do their ultrasounds for them.  Now that I have this course under my belt I am excited to do some ultrasounds.

An ultrasound is better than an xray for many things.  It is generally better for finding tumors or cancer in the abdomen.

I had my first ultrasound case yesterday.  It was a large Golden Retriever.  Large dogs are usually more difficult to ultrasound so I had my employer help me.  It turns out that the poor boy has a tumor on his spleen.

Just thought I would let you know what I am doing.  I have been practicing for 11 years but I am always learning!

Dr. Marie

Today was another day full of spays!  I thought I would describe for you guys how a spay is done.

Anesthetic

The animal is given a sedative first.  We often use a mixture of drugs called hydromorphone, acepromazine and glycopyrrolate.  After about 10 minutes the animal is usually quite sedate.

We then place an IV catheter.  The IV fluids help to keep an animal’s blood pressure up which helps to support the kidneys while she is under anesthetic.  Also, if there was an emergency under anesthetic then we have quick access to administer emergency drugs intravenously.

We then do an injection of a medication which will cause the animal to be completely unconscious.  This is usually either a mixture of ketamine and valium or a drug called propofol.  When the animal is totally out then we place a tube in her trachea and she will breathe a mixture of oxygen and a gas anesthetic called isofluorane.  This will keep her asleep for as long as we need.

Preparation

The animal is then shaved on her belly and the skin is prepped.  We do a series of scrubs with chlorhexadine soap, alcohol and then an iodine type solution.  This is the best way to keep the area as clean as possible.  She is then moved into the surgery suite.

The surgery

The animal is laying on her back and we make a very small incision about an inch or so below the umbilicus.  Once we are in the abdomen we use an instrument called a spay hook to find the uterus.  Then, we pull the ligament that is attaching the ovaries and this allows the ovaries to be pulled up into the incision.

We then tie a stitch around the blood supply to the ovary.  The same thing is done for the second ovary.

Next, the uterus is pulled out so that we can see the area where the uterus attaches to the cervix.  Each uterine vessel is tied off with suture and then we put a big stitch around the body of the uterus.  It is then ready to be removed.

We usually close the body with three layers of stitches.  The first is the most important as it keeps the muscle layers closed.  We then close the subcutaneous tissues.  I usually put in buried stitches after this, but some vets will place stitches that have to be removed within 10-14 days.

Recovery

After this is done, we turn off the gas anesthetic and wake the animal up.  We will give an injection of some anti-inflammatory such as Metacam for dogs or Tolfedine for cats.

They are usually up an walking within the hour, but we don’t send them home until several hours later.

It is amazing how fast cats and dogs will recover from a spay!

Have a question for Dr. Marie?  You can ask an online vet question here.

I had a dog in today with a big lump on his toe.  We did something called a fine needle aspirate so I thought this would be a good topic to blog about today.

What is a fine needle aspirate?

This is a procedure where we use a very small needle (usually 22 gauge) and insert it into a lump.  The needle is usually attached to a large syringe.  Then, we pull back several times on the syringe to obtain some cells from the lump.  Sometimes instead of using the syringe we will simply stab the lump a few times with the needle instead.  Next, the needle is removed from the syringe, air is drawn into the syringe and the needle is put back on.  Then, we quickly depress the plunger on the syringe, causing whatever cells are in the hub of the needle to be expelled onto a glass slide.

We then smear the cells by using another glass slide.  Then, the slide is either stained in the clinic or sent to a pathologist to be examined under a microscope.

What is a biopsy?

A biopsy is a procedure where a piece of tissue is taken from a lump (or an area of abnormal skin).  This can sometimes be done with the help of a local anesthetic but some animals need to be under a general anesthetic to have this done.  The tissue is placed in a bottle of formalin and sent to a pathologist for examination.

Why do we do these tests?

There are a lot of things we can learn from a fine needle aspirate or a biopsy.  Here are some examples of what can be determined:

• Is this tissue likely to be cancerous?
• If it is cancer, what type is it?
• If it is cancer, do we need to make a very large around the lump to remove it?
• Is this lump likely to metastasize (spread) to other parts of the body?
• Does it look like there is infection in the area?

Which is better – FNA or biopsy?

There are pros and cons to each procedure.  While a fine needle aspirate can usually be done without any sedation, a biopsy almost always requires a local or general anesthetic.  A fine needle aspirate is also less expensive than a biopsy.  However, a biopsy is much more accurate as we are seeing a good chunk of tissue as opposed to a few cells.

I hope this information was helpful!  Is your dog or cat having a fine needle aspirate or biopsy done?  If you have questions about your pet’s condition you can ask an online vet question of Dr. Marie.

Do you have any experiences to share about fine needle aspirates or biopsies?  Feel free to leave a comment below!