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You Get What You Pay For Version 2

Spay-Neuter

Pictured above – a state government subsidized discount spay/neuter facility actually advertising on their website one of their veterinarians exhibiting appalling sterile surgical technique with no sterile gown, cap, mask, and a surgical drape that is far too small…taken from http://www.mcohio.org/services/arc/spay_neuter_information.html

I titled this post as I did, because I have posted about this topic in the past with regard to the millennial growth of discount vaccine and spay/neuter clinics.  I was confronted with the aftermath of two unbelievably troubling cases recently that from one of those types of clinics in my local area that I felt compelled to share with my national audience, as these types of places are now present just about everywhere.

The first case was a long-time client that who had traditionally always seeked out the best possible health care for her pets.  Recent health issues of her own and expenses that subsequently arose from them had decreased her disposable income, and in the midst of that, she and her husband had a homeless Pit Bull puppy literally show up on their door step.  Ever the compassionate couple, they took this dog in, but that last thing they needed was another household expense.  Thus, rather than come my clinic for puppy wellness and spay as she normally would, she thought instead that she would give a local discount spay/neuter clinic a try.

Within two months of having been spayed, the dog was showing signs of estrus (commonly known as heat).  When she returned to the clinic where she had the spay done suspicious that there still may be female parts inside her dog causing the heat cycle, the clinic charged her for an expensive hormonal test that could check for this.  They told her that if the test came back conclusive that the dog still had female anatomy left inside her, they would refund the cost of the test and absorb the cost of going back in to get it right.

The test came back inconclusive from their interpretation of the test, so the owner was stuck with the bill for the test in addition to the “spay”, while her dog continued to go further into a full blown heat cycle.  At this point, between the cost of the discount spay and the hormonal test, the owner had paid significantly more than she would have had she had the spay done at my hospital.  What’s more, the dog was not only at this point showing the vaginal bleed and vaginal engorgement typical of heat cycle, the dog had swollen mammary glands that were secreting milk in preparation for pregnancy!

Having no further recourse with the discount clinic, the owner came to my hospital for help.  Upon review of the history, examination of the dog, and interpretation of the hormonal test, both my associate doctor and I were nearly 100% convinced that the dog had female reproductive anatomy left in her abdomen, and advised exploratory surgery.  Subsequent exploratory surgery revealed a full ovary present on the left side, half of an ovary present on the right side, and most of the body of the uterus left behind!  It was one of the worst examples of incompetence and malpractice my associate and I had ever experienced in our careers.

In another similar case shortly thereafter, a local rescue group had used this same clinic to have a dog they were fostering spayed prior to adopting her out.  One of my clients had adopted the dog well after the spay, so she had no say in where and by whom the dog would be spayed.  Again, in comes the dog to see my associate showing clear signs of heat, despite showing a clear spay scar where a spay had supposedly been done.  One hormonal work-up and an abdominal exploratory surgery later, the result was even more astonishing than the previous case I wrote of earlier…there dog was COMPLETELY intact!  100% of the entire female reproductive tract was intact.  No one had even attempted to perform a spay on this dog.

Since clinics like this do not practice general medicine, their sole stream of revenue is cranking out as many spays and neuters as possible per day, while plugging every pet they see with every vaccine available, even if the dog or cat is not at either geographical or lifestyle risk for a given disease.  They ignore American Animal Hospital Association (AAHA) and American Veterinary Medical Association (AVMA) vaccine reforms that have mandated individual protocols unique to the needs of the patient, while moving the frequency of several core vaccines to once every three years.

From a surgical perspective, they are known to perform spays and neuters on the cheap by not using endotracheal tubes to protect the airway while under anesthesia, do not use IV catheters to deliver induction agents or fluids during the procedure (not to mention delivering life-saving drugs in the event of anesthetic complications), simply put on sterile gloves rather than properly scrub their hands and gown up with cap and mask for surgery, and almost never use even rudimentary intraoperative monitoring equipment.  In these aforementioned cases, they seemed to have clearly rushed through the first procedure to the extent that it was done incorrectly, the latter not having been performed at all aside from an abdominal incision.

As in most things in life, when it comes to pet surgery – including routine sterilization – and well care, you get what you pay for.  Events like this notwithstanding, the clinic responsible for the cases I wrote of today, is currently breaking ground on its third location in my county…so apparently the word has not gotten out enough.  With places like this spreading like a plague on veterinary medicine and the pets of the US, this lack of awareness seems to be a nationwide phenomenon.  I wonder how much malpractice it will take for pet owners to finally see these places for what they really are.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

3 thoughts on “You Get What You Pay For Version 2

  1. Linda Eastabrooks says:

    i did not know this, and I have friends that are thinking about having this done at one of these places the next time they come around. I thought that was a good thing that the “vets” we’re doing for people living on a tight budget. Now I am sharing this with everyone of them so they can see what can happen. Wow, I’m so glad I never used one of these places! Thank you for the timely post!

  2. Loni says:

    WOW. You just lost one of your longest time listeners and readers, and fans. I am SO disappointed in this article, as I do not feel you’ve done all your research on this subject Dr. Roger.
    I’m a veterinary technician at a nonprofit low-cost high-quality spay/neuter clinic and am proud of the work we do, and know it is just as high if not higher than the quality of some of the local veterinarians. We have spayed and castrated over 13,000 cats and dogs in just the last 2 years since we opened, including life-threatening pyometras that owners otherwise could not have afforded at their regular veterinarians. We have minimal complication rates and have lost only (although significant losses to their owners/shelters) 4 cats which is actually a much lower fatality rate than almost all veterinarians, when you consider we’ve done over 13,000 spay and neuter surgeries. As a tech I am constantly moitoring my patients while I am prepping them for the doctor, and there have been a few instances which I have saved lives by monitoring vitals closely and reversing an animal when the anesthesia is causing a complication.
    Every dog is examined prior to surgery, induced with IV anesthetic, intubated and maintained on gas anesthetic, and monitored with a pulse-oximeter during surgery. High-risk patients such as pyometras and older dogs always get IV catheters placed. Our veterinarians are so fast that placing an IV catheter into every dog would take much longer than the actual spay and neuter surgery. Any dogs that are dehydrated get either IV or SQ fluids during or after surgery free of charge.
    Our cat protocol is similar, though not all cats can be examined until they are under anesthesia since we do many barn and feral cats. Every cat is given an injection of pre-med and then induction about 10 minutes later. Then the cats are put on gas anesthesia for the prep and surgery. Our veterinarians do flank spays which take about 7 minutes per cat, so our prep time would take longer than the actual spay or neuter if we had to intubate every cat. Therefore we only intubate if their vitals are abnormal or if they’re immunocompromised or older cats. We do IV catheters when needed as well. We include SQ fluids and Vitamin B12 injections for no extra cost for any cat who is even remotely dehydrated, and almost every feral or barn cat.
    I am so offended by this post and am no longer going to be a fan of this page or your podcast. I can not stress enough how SO DISAPPOINTED I truly am.

    • Dr. Roger says:

      @ Loni Ellsworth I sorry to learn of your disappointment, Loni, but I do not regret reporting on this subject. I write and broadcast not for fame, money, or adoration, but to help educate and have pets and pet owners benefit from the knowledge of my experiences. I hope you read my article in its entirety…as you would clearly see that that what occurred to the cases I discussed were medical malpractice…sold to those pet owners as the same level of care and surgery that they would have gotten in my American Animal Hospital Association (AAHA) accredited hospital. Just because your discount spay/neuter hospital seems to be an exception with a better standard of care (with a majior caveat – see below), does not change the atrocities that occur in many of these places that not only belittle our profession, but hurt animals and the people that love them. It does not change the fact that the veterinarian pictured in this post is practicing appalling sterile technique. AAHA accreditation is a voluntary participation and includes a rigorous audit of best practices, standards of care, medical record keeping, and for all intents and purposes, conducting a general practice at the level of a veterinary university teaching hospital. Once accredited, an AAHA hospital undergoes an inspection every 2 years to ensure that they continue to operate under AAHA standards. Now let us discuss your hospital’s caveat in performing at a better standard of care…Lack of intubation for general surgery is not an AAHA standard, so while your clinic may operate at a higher standard of care than the ones I discuss in my article, that is a poor standard of anesthetic administration. Once a visceral pain stimulus is initiated, patients instantly run the risk of reflex vomiting, aspiration, and possible asphyxiation….hence the need for a protected and open airway. A procedure taking only 7 minutes is irrelevant, as it is still intra-abdominal surgery. What if a patient were to go apneic (stop breathing) during a procedure, an occurrence that is not uncommon? If not intubated, life sustaining positive pressure ventilation could not be initiated, as there would be no direct opening to do so. In the case of apnea, having to stop and take the time to intubate the patient in order to manually ventilate the patient loses precious moments as the patient becomes hypoxic (systemically deoxygenized), further destabilized, and less likely to recover. Thus, while you take a great deal of pride in the hospital that employs you, by your own admission, they operate in violation of a very basic AAHA and general practice standard of care. I would ask your doctors, why not intubate? They are taking the time to have IV catheters placed…from any reasonable medical perspective, a protected and open airway supersedes even the importance of IV catheter placement. While you probably think that your post served to disprove my assertions, but instead you proved them further.

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