It’s an odd phrase, ‘foreign body.’ It’s like something that a caricature of a 1960s Home Office worker might have found. But of course, when we use it medically, we mean something very specific: an object that has sneaked, or been put, into an inappropriate place in the body. It’s often a vet’s job to get it out.
A number of vet practices have been reporting problems in the last few days in getting hold of the anaesthetic gas isoflurane, due to supply problems from the manufacturers. However, instead of lasting a few days and then coming back on stream, the shortage sounds like it might last a while, with the Veterinary Medicines Directorate (VMD) reporting that 2 of the main suppliers have restock dates as late as February or even March next year. In this blog, we’re going to look at how this might affect vets and pets across the UK in the next few months.
Question from Pam Gilmour
Hi my chi(huahua) is 6 months , he only has one testicle. I will be having him done, what would be the best age to wait to see if it will come down?
Answer from Shanika (online vet)
Hi Pam and thank you for your Question regarding the best age to have a dog castrated which has a retained testicle.
I will start by explaining a little about the testicles, what they are, where they develop and what can go wrong along the way.
The testicles are two oval shaped structures normally found in the scrotum (loose sac of skin near your dog’s bottom). Testicles are male sexual glands and produce the hormone testosterone along with sperm and various other secretions which assist in reproduction.
The testicles start developing while the puppy is inside the mother’s uterus (womb); they are at first located inside the abdomen (tummy) and just behind the kidneys. A few days after your puppy has been born the testicles should be in the scrotum, they travel from their starting point down through the abdomen and through an opening called the inguinal ring in order to get to the scrotum.
When you take your puppy to the vets to have his first examination they will check for the presence of two testicles in the scrotum, if these cannot be felt then this will be checked again on future visits. If both testicles are not present this condition is referred to as cryptorchidism (retained testicles), either one (unilateral cryptorchid) or both (bilateral cryptorchid) of the testicles may be missing from the scrotum. In very rare cases on or both of the testicles has not actually developed at all.
What should you do if your dog has cryptorchidism?
Your vet is likely to suggest that you wait to see if the missing testicle comes down into the scrotum at a later date, this would usually be by 6 months of age but in some cases can occur up to 1 year of age.
What to do if the testicle does not appear?
Your vet will discuss a castration procedure with you in which both testicles are removed, it is a simple procedure to remove under general anaesthesia the testicle present in the scrotum, the retained one has to be located in your dog’s abdomen, and this can take some time. The surgical procedure to find and remove the testicle from the abdomen can be tricky as the testicle which has not found its way to the scrotum is often smaller and therefore not so easy to locate in amongst the contents of your dog’s abdomen.
Why should I have my dog castrated if he has cryptorchidism?
If the testicles are not in their correct location in the scrotum there is an increased chance of them becoming diseased, such as developing into cancerous tissue. Also a dog with cryptorchidism is likely to have reduced fertility and would not be an ideal candidate for breeding.
I hope that I have managed to answer your question regarding the timing of castration in a cryptorchid dog and have managed to explain some of the reasoning behind why it happens and what the best plan of treatment is.
Shanika Winters MRCVS(online vet)If you are worried about your dog please book an appointment with your vet or use our online symptom checker.
Question from Jo Padfield
Why is my staffy rubbing his bum on carpet after his glands were done. Pls
Answer from Shanika Winters (online vet)
Hi Jo and thank you for your question about your dog’s anal glands. I will explain a little about what anal glands are, where they are and why dogs have them followed by a discussion of what can go wrong with them and how these conditions are treated.
What are anal glands?
The anal sacs (commonly called the anal glands) are a pair of sacs found either side of the anus (bottom); they are around 1cm across and open via a duct (tube) in the anus. As with your dog the anal sacs often become blocked and or infected and this is called anal sacculitis. The substance inside the anal sacs is produced by glands that line the inside of the sacs, this smelly substance should be passed each time your dog does a poo, and leaves a scent marker to other dogs.
What goes wrong with the anal sacs?
Diseases of the anal sacs include anal sacculitis as mentioned and less often tumours. Other conditions around the bottom include anal adenoma (small non-cancerous lumps around the anus), anal furunculosis (cracked infected skin around the anus usually found in German Shepherd Dogs) and perianal hernia (where muscles weaken and separate either side of the anus allowing pelvic and abdominal contents to push through, seen in older uncastrated male dogs).
It is really important to have your dog thoroughly examined by your vet to make sure that the condition has been diagnosed correctly so that the correct treatment can be given.
How are blocked anal sacs treated?
We usually treat blocked anal sacs by manually emptying them out, this can be done by inserting a gloved finger into the anus and gently squeezing on the sac to empty the contents into a piece of tissue paper. The anal sacs can be emptied from the outside but this does not allow the anatomy of the sacs to be examined as thoroughly. Some owners feel confident that they can learn to empty their dog’s anal sacs, this is something to discuss with your vet who can show you how to do this.
If there is infection in the anal sacs then your vet might give your dog antibiotics, this can be given orally or put directly into the anal sacs after they have been flushed out. If the anal sacs are going to be flushed out, most dogs will need sedation or general anaesthesia to allow this to be performed, a small cannula (plastic tube) is passed into the anal sac via the opening of the duct on the anus and saline is then flushed in and the glands then emptied, the process is repeated until the glands appear clean. Antibiotic and anti-inflammatory preparations can then be put into the anal sac. Sometimes steroids may also be given to ease the irritation caused by anal sacculitis.
Anal sacs sometimes are not properly emptied if your dog has soft poo or diarrhoea; this usually improves once your dog’s poo is firm again and can be helped by a change in diet.
When is surgical removal of the anal sacs an option?
If there are severe repeated anal gland infections and the dog does not tolerate medical treatment and manual emptying of the anal sacs then surgical removal is considered. The procedure is performed under general anaesthesia and does carry a small risk of disturbance to the dog’s ability to control passing poo. In most cases the lack of control when pooing is temporary but due the closeness of the nerves controlling continence to the anal sacs themselves there is this risk of them being damaged. Remember that your vet will discuss the pros and cons of a procedure with you so that a joint and informed decision can be made by you with the help of your vet.
I hope that this answer has been helpful for you and that your dog starts to feel more comfortable soon.
Shanika Winter MRCVS (Online Vet)If your dog has a problem with its anal glands please book an appointment to see your vet, or use our online symptom checker
As we saw in the previous part of this series, Medical colics are those which can be managed medically, usually on the yard. However, about 1 in 10 cases of colic require emergency referral to an equine hospital for surgery.
This is what most horse owners are terrified of. The general indicators that a horse has a surgical colic are:
1) Heart rate over 60 that isn't relieved by injectable painkillers.
2) Dilated loops of small intestine on rectal exam.
3) Positive stomach reflux from the stomach tube.
4) A definite rectal diagnosis of a surgical problem.
5) "Toxic rings" - dark red or purple gums, that indicate that the horse is going into toxic shock.
Of course, it varies between horses, and the vet has to make a judgment call based on all the evidence available.
We also have to talk to the (by now usually frantic) owners about costs. Colic surgery usually costs between £4000 and £5000, but can easily be a lot more. Even if the horse is insured, it is important to check how much the insurance company will cover - there are a couple of companies out there who will only cover part of the costs of emergency surgery. If in doubt, always call your insurer's helpline.
However, colic surgery is one of the most genuine emergency operations there is - and it can be truly life-saving.
So, what causes a surgical colic? Probably the most common are:
1) Twisted bowel. If a length of bowel twists around itself, it can cut off the circulation. At this point, the gut begins to die, and unless it can be removed by surgery, and quickly, the horse will go into toxic shock and die. This commonly happens in the small intestine or occasionally the colon, but there's also a condition where the caecum gets turned partially inside out (an intussusception).
2) Small intestinal blockages. Horses rarely eat things that get stuck in the small intestine (although it can happen). More commonly, a really heavy worm burden can simply block up the bowel; with the bowel overfull, the blood supply starts to fail, and the gut, again, can die. I once had a patient who was a little foal with a severe colic; we removed two gallons of worms from her small intestine!
3) Strangulating Lipomas. These are really common in older horses and ponies. A small, benign, fatty tumour forms somewhere in the abdomen, causing no harm at all. However, it grows on a stalk, and eventually, the stalk gets wrapped around a length of gut, cutting off the blood supply... This results in the bowel dying, as if it had twisted. Fortunately, these are usually really simple surgical procedures; unfortunately, older horses and ponies are less likely to be insured for surgery.
There are also a number of medical conditions that can mimic those requiring surgery - particularly peritonitis and anterior (or proximal) enteritis. Horses with these conditions are often referred for possible surgery because it's very hard for the vet in the field or on the yard to be 100% certain they're not surgical. I think that most of us would say it makes a lot more sense to have the horse at the hospital, with a surgeon on call, to make the definitive diagnosis, rather than waste time in the stable, and risk having to then decide it needs surgery when it's still an hour or more away in travelling time from the hospital!
So, what happens when the vet decides that a colic case isn't suitable for medical management?
Firstly, they'll talk to you about the options. If a horse isn't insured, or there's no money for treatment, it is a perfectly respectable and responsible decision to decide, sadly, to put the horse to sleep rather than prolong its suffering.
Hopefully, of course, that won't be the case. Once you and the vet have decided that referral is the way forward, your vet will get in contact with a referral hospital. If you're very lucky, it will be one run by your vet's practice, but in most cases, it will be a specialist referral hospital. I must say here that not every centre with surgical facilities is able to cope with emergency colic surgery - they need not only to have the facilities (knock-down box, operating theatre, recovery box etc), but also the staff (not only a surgeon, but also enough vets and nurses to take care of your horse in the vital recovery period). Your vet will have a list of suitable referral hospitals - generally, its best to send the horse to the closest one with the shortest transport time, but your vet will be able to advise you.
Making an emergency referral is simple - but only your vet can do it. A referral hospital will not accept referrals from the horse's owner! Once you've made the decision to refer, your vet will call them and speak to the veterinary team on call, who will be available 24/7/365 (when I was part of one such team, we ALWAYS seemed to get our referrals at about 10pm!). They'll let him or her know what they want done during transport - generally, they'll describe what painkillers they want given, and what samples they want taken (don't be surprised if your vet gives you a couple of blood tubes to take up and give to the referral team). In addition, they'll sometimes ask the vet to put in a stomach tube and tie it in for the journey - this is to prevent the stomach from getting over-full and bursting if there's an obstruction in the small intestine. Don't forget your horse's passport - legally, they do need it even when being rushed to emergency surgery.
Your vet will generally give you directions and a contact number for the hospital, and send you on your way. Remember, they can't normally go with you, because your horse's colic, while devastating, is probably only one of several cases they'll have to deal with.
If there's a problem (e.g. your horse getting distressed) in transit, call your vet or the referral number you were given - but if at all possible don't stop unless they tell you to! Remember, you're on your way to the best equipped help available.
On arrival at the hospital, you can expect to be met by the veterinary and nursing team. Your horse will be rushed to an assessment area, and you'll probably be given a lot of scary-looking paperwork to sign. Generally, this comes into 2 parts - firstly, you're signing to give consent for whatever they need to do (and remember, a lot of drugs aren't technically licensed for use in horses, because the manufacturers haven't paid for an official license for that drug in horses. It doesn't mean a drug is dangerous or experimental, it's probably used on a daily basis by the hospital. You'll have to sign consent to use unlicensed medication - it's absolutely routine, and nothing to worry about). Most hospitals will also ask to see your passport - if you haven't got it, or it isn't signed to mark the horse as "not intended for human consumption", legally the hospital can refuse treatment (although they rarely do).
The second set of paperwork you'll sign is a bit more pedestrian - you'll be signing to say that you will pay for any treatment!
While you're contemplating the paperwork, your horse will be undergoing another examination by the veterinary team. This is to establish what's going on, and what's changed since your vet examined him back on the yard. They may well repeat some tests - most colic conditions are dynamic (i.e. constantly changing), and sometimes the change is more useful in working out what's going on than a one-off test. Other tests they may wheel out include ultrasound - the powerful ultrasound systems available in a hospital environment can give the vets a lot more information about what's going on. The vets will then make a decision about what to do - don't be disappointed or worried if they don't rush immediately to surgery! They may decide to try a course of medical treatment first (remember, they don't have to rush as much as your vet does - if your horse's situation deteriorates, they can operate at a moment's notice).
In many cases, however, they will decide to take the horse straight to theatre. If so, you normally won't be able to follow, so I'm going to describe what happens once you've been gently steered in the direction of a waiting room.
To begin with, the horse will have an intravenous catheter fitted, to allow easy access for fluids and drugs. A horse with colic is systemically weakened, so will almost invariably be given intravenous fluids during surgery. He'll then be given a premed - this is a sedative, designed to make induction into anaesthesia gentler. It will usually contain the drug acepromazine, because the use of this before surgery has been demonstrated to reduce the risks of anaesthetics.
He'll then be led into a knock-down box: this is a special padded room, designed to make induction of anaesthesia safer. Then he'll be anaesthetised with an injection containing (usually) a mixture of 2 anaesthetic agents, ketamine (no, it's not a tranquilizer, it's an anaesthetic) and diazepam or a similar drug. Shortly after the injection, he'll go wobbly, and then quickly lie down.
Once he's asleep, the team will swing into action: a tube will be passed down his throat to help him breathe and he'll be moved into the operating theatre. While this was going on, the surgeon(s) will have been scrubbing up, ready to start.
Once he's in theatre and safely ensconced on a well cushioned table (to prevent pressure sores etc), he'll be put onto anaesthetic gas to keep him asleep.
The surgery involves a long incision down the midline of the belly. The surgeons can then have a good look through all the intestines, to find the problem. This is the exciting, sexy bit, but it's actually pretty simple in principle: "if in doubt, cut it out". In other words, removing devitalized (dead) bowel, emptying out anything in the bowel that shouldn't be there (e.g. a caecal impaction), replacing anything that's got stuck in the wrong place (e.g. an entrapment) and untwisting anything that's tied up. There are usually at least 2 surgeons, because one person is needed to hold loops of intestines (and they don't stay still - sometimes they wriggle around in your arms)! Meanwhile, the anaesthetist will be carefully monitoring all sorts of parameters (heart rate, blood pressure, ECG, reflexes, breathing and blood gasses can all be monitored at many hospitals) and adjusting the anaesthetic and any other drugs to give the safest and most effective anaesthetic.
Once whatever the problem was has been found and (hopefully) sorted out, your horse will be returned to the recovery room. In many ways, this is the most dangerous part of the procedure. Horses are very prone to breaking things when they wake up, so everything is done to keep it as calm and quiet as possible. Sometimes, the veterinary team will help the horse to rise, using hoists and lifts; other times, it works out better to let him get up in his own time. In either case, he will be moved into a padded room, and left in dim light, as quietly as possible, so he wakes up slowly.
Once awake, and steady on his feet, he'll be moved to an intensive care box; he'll almost certainly be on a drip to keep him hydrated. At regular intervals through the next 24 hours (or longer) he'll be checked by vets and nurses. In some cases, the guts don't start working properly on their own, and medication may be needed to encourage motility (e.g. a lidocaine drip). Although everyone gets excited about the surgery, it is this recovery period that is in many ways the most important in getting a good long-term prognosis.
As time goes on, the vets and nurses will try and tempt the horse to eat - normally, we'll try and get him eating fresh grass as soon as possible. As soon as he is stable enough and eating on his own, he'll be sent home - most horses do better in their own home environment, so as soon as they no longer require advanced medical intervention, they can go home. Once home, it's important that the discharge instructions from the hospital are followed - it can be tempting to try and speed things up, but don't rush it! Major abdominal surgery takes time to recover from.
Colic is a worrying condition to have to deal with as an owner, especially as it often seems to come out of the blue. However, if you ever have to go through it, I hope that having read these blogs, you'll have some idea of what's being done, and why. Remember, our aim as vets is to help your horse and, if at all possible, send him home to you fit and well.
If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.
At one time or another we all have to face our beloved pets having an anaesthetic which can be a scary process if it’s not properly explained. Fortunately most veterinary practices have a fantastic team of nurses that can help you understand the procedure. (NB. I have used “he” in the article for continuity but this goes for all dogs a
and cats regardless of gender).
To give you a head start, here are some top tips:
1. The number one golden rule for preparing for an anaesthetic is no food after midnight (this does not apply to rabbits or guinea pigs). Also, some practices may give you an earlier time say nine or ten o’clock but the principle is still the same, basically no midnight feasts and no breakfast. The reason for this is two fold. The main reason is to stop your pet vomiting and potentially inhaling it. This can also prevent nausea on recovery. Another reason is to try and prevent any ‘accidents’ on the operating table which increases the risk of contaminating the surgical environment although to safe guard against this, some practices routinely give enemas and express bladders before surgery. So, while it breaks your heart to tuck in to steak and chips with Fido giving you the big brown eyes treatment console yourself with the knowledge that you are actually acting in his best interests to help minimise the risk of anaesthetic.
2. Give your pet the opportunity to relieve himself before coming into the surgery. Obviously this is easier with dogs but while we advise taking dogs for a walk before coming in we don’t mean a five mile hike on the beach with a swim in the sea, we mean a nice gentle walk around the block to encourage toileting. If you bring your dog in covered in dirt and sea water, you’re increasing the anaesthetic risk as we have to keep him asleep longer while we prep him. (See my previous article about how we prepare your pet for a surgical procedure).
3. Tell the nurse when she is admitting him whether you have noticed any unusual behaviour. Vomiting, diarrhoea, coughing or sneezing can all be indicators of problems and may need to be investigated prior to anaesthesia. Also tell the nurse if your pet is on any medication, when he last had it and bring it with you if you can. This way, if your pet needs to stay in after his operation, they will have everything he needs without adding extra to your bill.
1. Some pets get a little worried when in a new place so it may be helpful to bring in a jumper of yours or a blanket that smells like home. Be prepared for this to come home dirty! Some animals have accidents on recovery and with some of the larger practices getting through over fifteen loads of washing a day (with different people doing the laundry) it may not be possible to locate your blanket once it has disappeared into the washing room abyss. It does help tremendously if the blanket is labelled with your name. That way, if it does enter the washing room, it can be found again. Eventually. Obviously with smaller practices it’s much easier to keep track of individual items.
1. Give the practice a phone number that you can be contacted on. This is something that has surgeons and nurses tearing their hair out on a regular basis. All too often we’re given a phone number only to call it and hear a message saying that the mobile phone has been switched off or to hang on the end of a ringing phone. The reason behind this is sometimes we need to contact you during surgery because we have found something unusual or that we weren’t expecting and need to gain your consent to a change of procedure. It’s your pet and your decision and we want you to be involved every step of the way but we need to be able to speak to you to do that. I’m not saying you need to be sat by your phone from the minute you drop your pet off but please give a phone number that you or someone who can get hold of you will answer. Or at the very least, a answering machine that you check regularly.
1. Have faith in your veterinary team! If they suggest extra procedures such as intravenous fluids or blood sampling it’s because they think it would benefit your pet. I had one incident where a long haired cat was coming in to be sedated and lion clipped (shaved basically as his hair was matted). As he was over eight years old and hadn’t had a blood test I suggested a basic profile just to check what the liver and kidneys were doing. The blood tests revealed elevated kidney values which meant that there was some degree of kidney disease present. Finding this early meant that we were able to recommend a special diet to help slow the degeneration down (it’s never reversible) and the cat is now more likely to be monitored before he gets too ill. 70% of the kidney needs to be affected before clinical signs appear, wouldn’t you want to know before it gets to that point? Also, if we can see there’s an irregularity before we do the surgery, we can provide additional care to further minimise the risk.
1. Ask questions. We would much rather sit with you and explain away your concerns than have you sit at home or at work worrying. Also, if you are going to search the internet for information about the procedure your pet is having, please use reputable sources such as this one or ones written by the veterinary profession. The last thing you need to be reading is a blog by Joe Smith (fictional) about his one off experience about x, y or z and scaring yourself silly. The whole process is stressful enough, don’t torture yourself!
1. Bring your pet in suitably restrained. A cat needs to be in a cat carrier and a dog needs to be on a lead. A cat wrapped in a towel can easily become dinner for nervous, hungry German Shepherd. Don’t laugh, I’ve seen it happen! Yes this is a minority case but why put your pet at risk? We can’t predict how our pets will react in stressful situations (and coming to the vets certainly counts) so keep everybody safe by having control over your animal. Putting a cat in a carrier usually minimises their stress anyway as they feel safer and more secure and having your dog on a lead means that you can prevent him from bolting out of the door and on to the road.
9. That’s it! You are now fully prepared! Give your pet to the nurse to settle in and walk out the door. That’s actually easier said than done but in order to make this a smooth transition for your pet you need to be calm about it. Animals are very good at picking up stress and will become more worried about the situation the more worried you are. Obviously if your pet is aggressive the nurses may ask you to pop him in his kennel for them but the majority of veterinary professionals are more than capable of handling any type of animal and if you hand them the lead and walk out the door, nine times out of ten the dog will stare out of the door after you for a second or two then follow the nice sounding nurse who is being very enthusiastic and telling him what a good doggie he is through the door to the surgery. Don’t forget that we nurses are masters of cajoling and soothing. We have to work with vets as well after all!
If you are worried about a problem with your pet, please talk to your vet or try our Interactive Symptom Guide to check how urgent the problem may be.