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Spay/Neuter:Targeting, Techniques, & Special ConsiderationsApril 4, 2013
Kathleen Makolinski, DVM([email protected])
University of WisconsinShelter Medicine Course
(Spring 2013)
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Where Will We Go?
Spay/Neuter• Benefits/detriments
• Medical guidelines
• Complications
• Program models
• Training opportunities
• Non-surgical sterilization
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Reasons to Spay/Neuter
Individual animal health benefits include:• Decreased risk of:
- Mammary gland tumors- Prostatic enlargement
• Eliminate risk of:- Ovarian/uterine cancer- Pyometra- Testicular cancer
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Reasons to Spay/Neuter
Neutered male cats have decreased:
• Roaming to find a mate• Fighting• Spraying/urine marking
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Benefits/Detriments ofSpay/Neuter
•Determining the optimal age
of gonadectomy of dogs and cats
Margaret Root Kustritz, DVM, PhD, DACT
www.avma.org/avmacollections/spay_neuter/www.avma.org/avmacollections/spay_neuter/
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Possible Detriments toSpay/Neuter
• Castrated dogs have ↑ risk prostatic neoplasms
• Spayed/neutered cats have ↑ risk diabetes mellitus
•. Spayed/neutered dogs have ↑ risk(…influenced by breed):- Cardiac and splenic hemangiosarcoma- Osteosarcoma
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Important to Note
When evaluating studies that compare risksfor certain conditions between
spayed/neutered animals and intact animals,it is important to look at the incidence ofsuch diseases in each animal population.
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Important to Note
Example:• In female dogs, the incidence of pyometra is:
- 15.2% by 4 years of age- 23% - 24% by 10 years of age
• Hemangiosarcoma is the most common cardiactumor in dogs, with reported incidence of 0.2%- Breed predilection exists- Spayed females reportedly have 5 times the risk
of cardiac hemangiosarcoma compared with therisk for sexually intact females
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Association of Shelter Veterinarians’Veterinary Task Force to
Advance Spay/Neuter
In December of 2006, 22 veterinarians met toaddress the need for increased capacity
and a consistent level of care withinspay/neuter programs.
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ASV’s Veterinary Task Forceto Advance Spay/Neuter
High-quality, high-volume spay/neuterprograms are efficient surgical initiativesthat meet or exceed veterinary medical
standards of care in providing accessible,targeted sterilization of large numbers of
dogs and cats in order to reduce theiroverpopulation and subsequent
euthanasia.
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Medical Guidelines forSpay/Neuter Programs
Goals
Instill confidence inpublic regarding
use of spay/neuterprograms
Promoteacceptance of thispractice area by
veterinaryprofession
Provide guidancefor veterinarians
involved inspay/neuterprograms
Allow fundingagencies todetermine ifspay/neuter
programs provideacceptable level of
animal care
Provide referencefor use by state
boards ofveterinarymedicine
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Medical Guidelines forSpay/Neuter Programs
JAVMA articleMaintain high standards of patient care
regardless of where spay/neuter is performed orwhich program model is utilized
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Medical Guidelines forSpay/Neuter programs
The Association of Shelter Veterinarianswww.sheltervet.orgTask Forces and CommitteesVeterinary Task Force to Advance Spay/NeuterMedical Care Guidelines
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HIGHvolume mustmean LOW
quality
HIGHvolume mustmean LOW
quality
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HIGH VOLUME HIGH QUALITY
HIGHvolume mustmean LOW
quality
HIGHvolume mustmean LOW
quality
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High Volume Leadsto High Quality
• Very efficient systems
• Protocols to maintain standards
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Medical Guidelines forSpay/Neuter Programs
Four sections ofguidelines document
• Preoperative care• Anesthesia• Surgery• Postoperative care
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Preoperative Care
• Withholding food prior to surgery- Pediatrics to be fed 2-4 hours prior to surgery- Other animals: Fast minimum of 4 hours
• Water not withheld prior to spay/neuter• Is animal receiving any medication?• Does animal have any health problems?• Client consent
– Acknowledging risk, authorizing surgery
• Establish medical record for each patient- To abide by DEA and state veterinary regulations
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Preoperative Care
Physical exam by veterinarian• Good medicine• Liability issuesFocus of exam• Mucous membrane color• Hydration status• Heart/lungs• Hernias• External parasites• Body condition score• Infectious disease?
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Preoperative Care
Physical examination
• Verify gender/reproductive status- Intact female- Spayed female- Intact male- Neutered male- Cryptorchid male
• Body weight- Verified close to surgery- May be estimated in feral/fractious patients- Used to guide drug dosing
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Preoperative Care
Example:Example:Presented with a2 year male cat withno palpable testicles.
Is he already neuteredor is he cryptorchid?
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Medical Guidelines forSpay/Neuter Programs
Preoperative careExample: You are a veterinarian in a mobilespay/neuter clinic that visits a rural animal shelteronce monthly. Today, a feline patient(DSH, 9 month old, ‘Love Bug’) presents to bespayed. She has the following clinical signs:- Sneezing small amount yellow mucus for 3 days- Mild clear ocular discharge- Appetite good- No fever- Very active 24
Medical Guidelines forSpay/Neuter Programs
Preoperative careExample: The shelter indicates that they willprovide care for the cat if spay/neuter is notpossible today. They do not have a formalized‘Foster Care Program.’ Once spayed, if she isadopted, she could leave the shelter withantibiotics to be administered at home if necessary.
WHAT TO DO ?
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What About Pre-Anesthetic Testing?
Is routine pre-anesthetic haematological andbiochemical screening justified in dogs?
Alef, M. et al., Veterinary Anaesthesia and Analgesia,Volume 35, Issue 2, pages 132–140, March 2008
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Anesthesia
Needs to achieve
• Pain control- Opioid- Non-steroidal antiinflammatory- Alpha2 agonist- Local anesthetic
• Stress reduction
• Muscle relaxation
• Unconsciousness
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Anesthesia
Pain control
• Multimodal analgesia
• Preemptive administration of analgesics
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Drug Dosing ChartFeline Drug Protocol
WeightWeight Drug #1Drug #1 Drug #2Drug #2 Drug #3Drug #3
Lbs. ml (IM) ml (IM) ml (IM)
2.0 0.01 0.05 0.03
2.5 0.02 0.06 0.04
3.0 0.02 0.07 0.04
3.5 0.02 0.08 0.05
4.0 0.03 0.09 0.06
4.5 0.03 0.10 0.07
5.0 0.03 0.11 0.07
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Anesthesia
Thermoregulation
• Reduce contact with cold surfaces
• Provide carefully protected contact with circulatingwarm water, heated containers, or use of forced hotair warming devices
• Avoid close contact with electric heating pads, blowdryers, heat lamps, drying cages
• Avoid excessive use of alcohol
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Preventing Hypothermia
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Preventing Hypothermia
Rice Sock
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Anesthesia
• Monitor for depth of anesthesia- Pulse quality, rate, rhythm- Respiratory rate and pattern- Jaw tone- Eye position and pupil size- Palpebral reflex
• Mask/chamber induction to be avoided- Highly stressful for patient- Bronchial irritation- Increased risk of aspiration of GI contents
• Be prepared for emergencies
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Surgery
• Separate, sterile instruments for each patient
• Surgeon: Properly performed handand arm scrub with appropriate agent
• Surgeon should wear cap,mask, and separate pairof sterile gloves for each surgery(sterile gown is optional)
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Surgery
• Ovariohysterectomy and ovariectomy are acceptable
• Both testes and ovaries need to be removed
• Prescrotal and scrotal approaches for neuterare acceptable
• Ventral midline, flank, and laparoscopic approachesfor ovariohysterectomy are acceptable
• Gentle tissue handling, meticulous hemostasis,aseptic technique
• Either interrupted or continuous suture pattern isacceptable for abdominal closure
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Surgery
What to do with fetusesWhat to do with fetuseswhen spaying a pregnant animal?when spaying a pregnant animal?
•• Open uterus and euthanize individual fetuses
• Intraperitoneal injection of euthanasia solutionthrough closed uterus
• Do not euthanize fetuses
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Surgery
Prevention of fetal suffering duringovariohysterectomy of pregnant animals
Sara White, DVMJAVMA, Vol 240, No. 10, May 15, 2012 (Commentary)
Prevention of fetal suffering duringovariohysterectomy of pregnant animals
Sara White, DVMJAVMA, Vol 240, No. 10, May 15, 2012 (Commentary)
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Surgery
Various surgical techniquesallow for safe and efficient
spay/neuter surgeries
Veterinary SeminarsIn Spay-Neuter Surgery: Pediatrics
www.humanealliance.org
Veterinary SeminarsIn Spay-Neuter Surgery: Pediatrics
www.humanealliance.org
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Surgery
Permanent identification of animalsas spayed/neutered
Choose a consistent means of identifyinganimals that have been neutered
TATTOOSTATTOOSEAR TIPS FOR FERAL CATSEAR TIPS FOR FERAL CATS
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Scoring Process for Tattoo
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Tattooed Animal
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Ear Tipped Cat
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Postoperative Care
Minimize risk of complication through vigilantobservation of animal in recovery period and
quick/appropriate response to abnormal findings
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Postoperative Care
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Postoperative Care
• Offer small amount water to all patientsas soon as ambulatory
• Offer small amount of food to pediatric,geriatric, frail patients as soon as possible
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Postoperative Care
Before release of patient• Patient should be ambulatory with no signs of distress• If possible, check surgical site
Review with animal’s caregiver• Oral and written
discharge instructions
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PostoperativeQuestions/Concerns
Spay/neuter programs must establish policies for handlingpostoperative questions, complications, and emergencieswithin at least 48 hour period following surgery
• Staff member carries cell phone that receives calls• Voice mail that is checked frequently• Establish relationship with local veterinarian or
emergency hospital who will see patients for recheck
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Morbidity/Mortality Data
In the event of patient death, necropsy should beperformed to establish cause
Program to identify
• Trends in deaths that occur during stay at spay/neuterprogram or following surgery
• Trends in post operative complications(Ex: Incision site infections, dehiscence, suture reaction)
Compare data collected from one year to the nextand to other similarly structured programs
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Prevention of Complications• Good surgical principles, aseptic technique
• Short anesthetic/surgical time
• Meticulous tissue handling
• Attention to hemostasis
• Careful placement of ligatures
• Adequate exposure
• Good post-op instructions/care
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Potential Complications
• Scrotal swelling/bruising• Incision site seroma/infection• Suture reaction• Hemorrhage• Urinary incontinence in female dogs• Ovarian remnant• Uterine stump pyometra• Inadvertent ligation of a ureter• Incision site dehiscence• Post operative vaginal bleeding
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ASV websitewww.sheltervet.org
contains supplemental informationto the Medical Guidelines
that were published in JAVMA
ASV websitewww.sheltervet.org
contains supplemental informationto the Medical Guidelines
that were published in JAVMA
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Mash Style Spay/Neuter Clinics
ADVANTAGESADVANTAGES
• Go to areas in need• Large geographic radius• Lower start-up cost• Quicker start-up time• Utilize core of volunteers•Work with & assist multiple
organizations
CHALLENGESCHALLENGES
•Wear & tear on equipment•Wear & tear on staff• Need for multiple volunteers• Need for home base
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Shelter Outreach Services(SOS)
• Provides MASH style spay/neuter program
• Established in June 2003
• Spay/neuter approximately 10,000 cats anddogs per year
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SOS Transport Vehicle
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SOS Program
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In-Shelter Spay/Neuter Clinic
ADVANTAGESADVANTAGES
• Spay/neuter prior toadoption• Transport not needed
for shelter animals• May be less expensive
than other options• May be able to use
facility for spay/neuterof public animals
CHALLENGESCHALLENGES
• May have limited accessfor public animals• Veterinary Education
Law in some states• Disease control and
housing for publicanimals
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Smoky’s Spay-Neuter Clinic
• Located within Richmond SPCA in Virginia• Opened in 2002• Clinic serves:
- Shelter animals- Public animals- Free roaming cats
• Animal control officers distributeeducational material in areastargeted for spay/neuter• Goal is 65 surgeries/day
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Mobile Spay/Neuter Clinic
ADVANTAGESADVANTAGES
• Travel to populationsin need
• Self contained• Could be multi-use vehicle• Presence in community
CHALLENGESCHALLENGES• Expensive to buy & maintain• +/- dedicated driver• Small space to work in• Find location to park• May need separate
recovery area• Cost of insurance, fuel• Difficult to manage remotely
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ASPCA’sMobile Spay/Neuter Clinics
• Five Mobile Spay/Neuter Clinics that providefree or very low cost spay/neuter to:- Shelters- Rescue groups- Feral cat caregivers- Animals whose owners are on public assistance
or in targeted geographic locations
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ASPCA’sMobile Spay/Neuter Clinic
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APSCA’sMobile Spay/Neuter Clinic
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ASPCA’sMobile Spay/Neuter Clinic
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ASPCA National Spay/Neuter Project
• Personalized training for small cities andrural areas to provide high quality,high volume spay/neuter services
• Helps community implement or enhance mostsuitable spay/neuter program model:- Mobile Clinic- MASH Program- In-Clinic Program
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Mobile Spay/Neuter Clinic withOff-Board Recovery
An off-board recovery spay/neuterprogram has been operating in
Oklahoma since 2004SPAY FIRST!
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StationarySpay/Neuter Clinic
ADVANTAGESADVANTAGES
• Can focus on performinglarge number spays/neuters• Self contained• Can cover large geographic
area with transport system• Visible presence in the
community
CHALLENGESCHALLENGES
• Start-up costs higher• Start-up time longer• Comply with building and
maintenance requirementsand zoning laws
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Humane Alliance(Asheville, North Carolina)
• Stationary spay/neuter clinic
• Established in 1994
• Serves Western North Carolina
• Sterilizes over 21,000 cats and dogs/year
• Uses extensive transport system
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Humane Alliance
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Humane Alliance
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Humane Alliance’sNational Spay/Neuter Response Team
Nationwide strategic placement of targeted,high-quality, high-volume, affordable
spay/neuter clinics
Assist with:• Floor plan• Budgeting• Surgical training• Selection of computer software• Anesthetic/analgesic protocols
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National Spay/Neuter Response Team
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Spay/NeuterTraining Opportunities
From Humane Alliance…• Externship for vet students, receive training in:
- Disease control- Patient assessment/selection- Patient preparation- Surgical technique- Record keeping- Anesthesia/pain management- Patient monitoring
Housing for students is provided at no cost72
Spay/NeuterExternship Opportunitiesfor Veterinary Students
• Association of Shelter Veterinarianswww.sheltervet.org
• The Humane Society Veterinary MedicalAssociation Field Services Programwww.ruralareavet.org
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Other Types Spay/Neuter Programs
• In veterinary practices- Voucher programs- Non-voucher programs
• In schools of veterinary medicine orveterinary technology
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Non-Surgical Sterilization
Alliance for Contraceptionin Cats and Dogswww.acc-d.org
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