Post-Surgery Complications

Post-Surgery Complications


Question
Parker is a nine-month-old German shorthair that I recently had spayed. The surgery went great and she came home the same day. The doctor told me to have her "take it easy," which if you have either owned or been around a GSP -- especially a pup -- you know is a pretty big joke.


Nevertheless, I did my best to get her not to jump or run around. I forgot to mention he sent her home without antibiotics or a cone. She had full access to the incision. I asked when I was leaving if I should wrap it with an ACE bandage to keep her from licking it, but he said it would be fine. I was told to come back in 5 days to have the staples removed and for a recheck.

Obviously I should have gone with my better judgment. Over the next five days the area of the incision became swollen and hard. Also, around the staples it was pink and hot to the touch. I took her to her appointment and he said, "Yes, it's infected. Here are some antibiotics and I'll give her an injection."


Now, when I say swollen I am talking about tennis ball-sized, which I would think would be cause for alarm. I also had him give me a sedative (or tranquilizer) called Acepromazine, which he prescribed one 25mg pill every 12 hours. The sedative didn't do anything. No change in her demeanor at all. Two days later I took her back and he told me it was cellulitis. He drained 30 CCs and decided that it was time to bandage her. Took her back again two days later and he drained 20 more CCs. The area was still swollen and hard.

Finally they opened her back up and the vet said it was a seroma. He installed drains so the fluid could come out freely, but by then I had had it with this vet.

On Monday (five days after the drains were installed), I took her to a vet referred to me by my girlfriend's parents. At this point my shorthair was draining fluid out of the top of her incision. I gave them the rundown and the doctor examined her.

He thought she might be having a reaction to the suture the original vet put in and that was why it was not healing. He removed the drains and did a pretty good job bandaging her, plus sent her home with a cone.

Now the million dollar question. If she has a seroma, which by definition is a "pocket of clear serous fluid," then why is it still swollen with no more fluid is draining?

She was put on an anti-inflammatory and I was told to apply hot compresses to the area three to four times a day. It looks a little better, but it's still a big lump. She currently is still on Cephalexin, 500mg one every 12 hours.

And what about long term effects? Could these cause problems with her digestive system? Also, she has had staples in her stomach for three weeks now, and that can't be good, right?

I'm at about the end of my rope and I'm really worried she's not going to be the same or fully recover from this.
--S

Answer
Yours is an interesting series of issues. This is a good companion question to my column in the October issue dealing with veterinary/client relationships. I would not consider this a botched operation as you have titled it, but would be slightly kinder and call it a post-operative complication.

In my book a botched spaying is one in which a piece of ovary is left in the cavity or a foreign object is left in the abdomen or ligatures do not hold and hemorrhaging occurs or sterile technique is not maintained and peritonitis results. Incision sites are problematic just by their very location on the surface of the body.

This makes them vulnerable to contact with dirt, water, licking and chewing. Plus, the strain and movement of the animal creates tensions and causes excessive tissue inflammation that result in swelling and fluid accumulations in the tissues. All this is not to say that the veterinary surgeon does not have any responsibility for the post-op complication.

Some students are taught to undermine and cut out the subcutaneous fat in the incision line. This can create a pocket for fluid accumulation if not closed well. Also, animals react to the suture material that is used and especially if excessive suture is used it can lead to a more severe tissue reaction with a thickened firm incision line.

Staples are another source of irritation for the dog. They certainly irritate and invite the dog to lick and chew at the incision site. I used staples several years ago when they were just new to the veterinary market and got over them in a short time. I know some people like to carry staple guns with them on hunting trips and go blissfully along stapling every wire cut they come to with little thought as to what they might unknowingly be doing.

It is important to note also that staples should be removed in four or five days, which your veterinarian did recommend. Some leave them in the full 10 to 14 day healing period and they can be difficult to get out as they become imbedded in the tissue.

I'm not fond of sending dogs home on the same day that a major surgery was performed. I don't know that this had anything to do with the complications in your dog but as a general practice I think these patients need a chance to lie around and rest for 24 hours. It gives everything a chance to settle down.

Antibiotics and cones are not normally sent home following a spay surgery and I would not have expected your veterinarian to have done that. I also do not use Ace bandages on these dogs as they can be restrictive to the dog's respiration.

The swelling that has remained after the drainage procedure is from fluid in the surrounding tissues that has to be absorbed by the bloodstream or allowed to pocket up and be drawn off again. Hot packing increases circulation to the area and helps absorb this fluid.

I would anticipate that this has not affected the dog's digestive system. The seroma is on the outside of the body wall and thereby separated from the abdominal contents. Usually, if these are drained and given time (three to four weeks) they resolve nicely with only a mild amount of incision line thickening and a more obvious scar. Remember, surgery is an art and some veterinarians are better artists than others.

Question
We have two Labs, both 8½ years old, Buck (black) and Bailey (yellow). They are not from the same litter. We have always fed them regular dog food and changed to a senior diet at around age seven. They are indoor dogs. Both are active hunting dogs and hunt twice a week in Nebraska and Iowa November through January and 10 days in October in South Dakota. The problem is with Bailey, who is shedding non-stop and is overweight. She weighs 72 pounds and lacks energy.

Bailey was spayed in January, 2007. In July of that year Bailey began shaking and panting and she wouldn't jump up into the back of the tr

uck to go for exercise. She was very lethargic. The emergency vet noted she had dilated pupils, shaking and thickening palpable in cranial abdomen, and she had also suffered a seizure.

Over the next several months she was put on a variety of medications, and in February of 2008, she began bleeding from her rectum. More medications were tried but, since she was spayed, she sheds to the extreme. We can brush her endlessly and she still sheds.

Hair is lying all over the house. Wherever she lies down, she leaves a coating of hair. She is about 10 pounds overweight and can now only hunt about an hour before she is exhausted. We did decrease her food and added green beans mixed in her food. She didn't eat the green beans. Both dogs are exercised about a mile every day.

We did take her to our vet to see what can be done about the excess shedding and he has prescribed Thyro-tabs twice a day. This has not helped. She has been on these tablets for about four months. We would really like to decrease the shedding and get her energy level up.
--DH

Answer
I'd get more involved in diagnosing this dog's problem rather than just trying different medications. These clinical signs suggest early organ dysfunction. I would be suspicious of a thyroid problem, liver disease or adrenal problems. Have your vet do a complete physical exam with complete blood count, blood chemistries, thyroid profile, serum cortisone levels, and urinalysis.

This group of tests will rule in or out several diseases and guide your veterinarian to areas that might need further testing to arrive at a final diagnosis. I cannot emphasize enough the importance of these tests. Your dog is at the right age and shows the subtle onset of what could be a serious clinical disease.

I remain at htholcombdvm@qwestoffice.net.

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