Choose Your Surgeon with Care

D. E. Larsen, DVM

Marilyn carefully placed Dorie on the exam table. Dorie, a pretty, tabby and white female kitten, stood, unmoving, on the exam table. Her stance was rigid, not what I would expect to see in an 8-week old kitten. 

“She was fine yesterday when I brought her home,” Marilyn said. “I noticed she was a little reluctant to move last night, and she was a little painful when I handled her. But this morning, she will hardly move, and she cries out at the slightest touch.”

“Where did she come from?” I asked.

“I adopted her from a humane society over on the coast,” Marilyn said. “They insisted that they spay her before they would let her out the door. I pleaded with them to allow me to bring her to you, but they would not let her go.”

“She is pretty young for a spay,” I said. “But it is becoming a thing with the humane groups. They struggle with people not getting the surgery done.”

“I understand that,” Marilyn said. “But she is so tiny, waiting a few weeks would have been better. I tried to get them to call you as a reference, but they were adamant, they would not let her out the door without the surgery.”

I picked Dorie up as carefully as I could. She cried out with a soft cry. The incision looked fine. It was a very short incision, which means the surgery was done with a spay hook. Most veterinarians use a spay hook during a spay. It is a blunt hook instrument to retrieve the uterus during a spay. I virtually never used one, I always used a finger, something I learned from Dr. Ferguson, a surgical resident at CSU when I was there. It required a slightly longer incision, but that was of little consequence. Incisions heal from side to side, not end to end. I always felt more comfortable with a feeling finger retrieving the uterus, rather than a blind steel hook.

I tried to palpate her abdomen, very carefully. It was painful for her. Then I felt a swelling on the right side of the abdomen, near her back, about the size of a large grape. It was excruciating when I touched the swelling.

“She has something going on in the area where her right ovary was located,” I said. “I think I should open her up and see what is there.”

Marilyn agreed to an exploratory. I was unsure of what could be wrong. This was a pretty small kitten, I hoped I could solve the problem.

In surgery, I found a significant accumulation of fluid along the back. It was retroperitoneal, or behind the lining of the abdomen. I aspirated the fluid and explored the area carefully. The fluid had to be urine, but why was it there following a surgery. I investigated again, looking around the kidney carefully, and the ureter in the area. I could find nothing more.

We recovered Dorie, and she was like a kitten with the fluid gone. The area was not painful, but I would need to check her in the morning.

“I need to take her home for the night,” Marilyn said. “It has nothing to do with this clinic, it is just that she has been through so much in her young life, she needs some cuddling. I will have her back here the first thing in the morning.”

I did not have a restful night. I was going over Dorie’s surgery in my mind most of the night. If the fluid was urine, the surgeon who did the spay had to of ligated the ureter, that small tube that runs between the kidney and the bladder. If that was the case, the swelling would be there again in the morning.

I had never heard of a veterinary surgeon making that error. I am not even sure it is listed as a possible complication to that surgery. I did have a niece who suffered that very injury during a hysterectomy some years ago.

In the morning, Dorie was painful again. And the swelling had returned. 

“This swelling is back,” I said to Marilyn. “I have been up all night thinking about this problem. They had to of ligated her ureter, the tube between the kidney and the bladder. I can send you to Eugene for an ultrasound and some x-rays with a dye that will pass in the urine. We can confirm the problem.”

“Listen, Doc, I am a bleeding heart, and I love this little girl, but there are limits to what I can spend,” Marilyn said. “Is there anything else we can do?”

“We can remove her right kidney,” I said. “If I am correct, that will solve the problem.”

“If that is what it takes, let’s at least give her a chance to live,” Marilyn said.

So little Dorie went back to the surgery table. It was not a complicated surgery to remove the kidney. I also removed the ovarian pedicle where the ovary had been ligated. In doing so, I found the ureter in the mass. That confirmed my suspicion and allowed me to ligate the ureter so there would be no back leakage from the bladder.

Dorie recovered well, and despite having suffered through 3 surgeries in the last week, she was back to being a kitten. I saved the tissues in formalin, just in case I need to have a lab confirm my findings.

“I want to make sure that the veterinarian who did this to her, never does it to another kitten,” Marilyn said in a firm voice. “Can we do that?”

“We can get it investigated,” I said. “I am concerned that the humane society might have some charlatan doing their surgeries. I will send them a letter of inquiry and send a copy of that letter, and my surgery records, to the state examining board.”

“Thank you,” Marilyn said. “Do I need to do anything special for her?”

“I am sending you home with some antibiotics just to be safe, other than that, just make sure she is acting like a kitten,” I said. “She should be able to live a full life with one kidney. It might become an issue at the end of her life, but that should be a long time.”

I composed a letter to the humane society and forwarded a copy to the examining board. I had no idea what would happen from that letter.  In my letter, I explained Dorie’s problem. I expressed a need to determine if this was a surgical error or if there was a need for additional training for the surgeon.

It was a few days, and I got a call from the veterinarian who did the surgery. He was in his mid-seventies and working part-time doing surgery for the humane society. He had no problem saying it was his mistake. He was uncomfortable with doing surgery on these little kittens. 

“That will be the last surgery I do on these little kittens,” he said. “I don’t agree with the practice anyway, so this is going to be a good excuse for me not doing any more spays and neuters on the young kittens.”

At about the same time, the investigator from the examining board called to gather my opinion and to get information that went beyond my surgery records. He was most concerned about the age of the surgeon.

After the examining board completed their investigation, they determined there was no need for remedial action against the veterinarian. It was considered a surgical error. The veterinarian was not going to do any more early spay and neuters. The practice of early spays and neuters was not addressed and probably is still an unsettled topic.

“Marilyn, I talked with the veterinarian. He is not going to do any more early spays or neuters,” I said. “The examining board completed their investigation, and they are leaving it as a surgical error. They are not recommending any remedial action.”

“That is a little less than I was hoping for,” Marilyn said. “But at least they investigated it. Are you satisfied with their findings?”

“I think so, I think the veterinarian expressed enough remorse to me that he is not going to do any more young cats.”

Photo Credit: Photo by Pixabay from Pexels