#surgery discussion

[charlietheskonk]

personal update on health and such, surgery and all that.  i’ll explain under the read more in case certain verbs are not fun to read!

about 3 years ago i started feeling like i had a potato shoved up under my ribs on my right side?  that was the height of covid, so i didn’t go to the doctor right away for a number of reasons (covid, and also the stress of covid and keeping my preschool operating through the pandemic without getting myself sick).  the feeling didn’t go away though, and so a year later i went and got a ct scan.  the scan seemed to say i had a uterine fibroid, and i was so relieved by the idea that it wasn’t anything more serious or dangerous.  the doctors and nurses said that couldn’t be what i was feeling, though.

i was like well then what am i feeling?  and they kind of just gave me the shrug.

it kept feeling “there” and also hurting a lot, especially when i got my periods.  so i went last october to the women’s health place and got an INSIDE ultrasound, which is about as fun as it sounds like.  and the doctor there said “so you’ve got a pretty big fibroid” and apparently it is (and has been) about the size of a lime.  it’s no basketball (i guess they can be huge like that) but it’s not out of the question that i’d be able to feel it.  so there!!!  i can and have been feeling it!!!!

so i’m finally getting surgery next friday.  they’re taking everything but my ovaries, which i guess will just bounce around in there, untethered, neat.  i am nervous but not, mostly just relieved.  the preschool is closed for the month because i’m not sure how i’ll take the recovery, and it is a certainty that i will get headbutted in the eggs, you know?  so i’d like to be mostly healed before i return to that.

the fibroid is big enough that the word “morcellation” is in my paperwork.  chopping something into morsels!!  ewwww!!  it’s me!!!  anyway.  that’s what’s up.

[ask-a-vetblr]

Is there such thing as paw amputations? Like, humans can be missing hands... do animals ever have to to get paws surgically removed? Or does the whole limb usually just go?

vet-and-wild here.

We will take off toes, but if it comes down to a foot we usually just take the leg. Leaving a stump that they can’t evenly bear weight on can cause pressure sores, balance issues, and it can get caught on things. They do better just taking the whole thing off.

[fractiousrvt]

Awww, Gilmore is so beautiful! I’m so glad he’s doing well. I’m just curious, as far as the stitches go (I think they are stitches?) do they stay in forever? Or will his eyelids eventually heal shut and does he get them taken out? I’m sorry it’s a bit of a strange question, I’m just sort of curious about how the process works

Enucleation education time! This isn’t something that’s terribly common so I’m sure a lot of people don’t know. When an eye is removed, several associated structures are also removed. This includes the edges of the eyelids because a- you don’t need eyelashes growing weird places, b- because you don’t need tear gland secretions filling up the eye socket and putting pressure on everything and c- you need fresh tissue edge to fresh tissue edge in order for scar formation so that the socket actually remains covered rather than being an ugly open hole in the cat’s face. Gilmore has internal suturing/buried sutures that will slowly dissolve over time. By not placing external sutures, we’ve decreased the amount of irritating stimuli. If he had those, he would absolutely have to have an e-collar on at all times and those would be removed after a couple weeks of letting the tissues heal together.

[drferox]

Which bits for Bob?

Anonymous said to @ask-drferox: How would one tell the difference, on examination, between an undescended testicle and an ovary in a hermaphroditic cat? Is it obvious?

From the outside of the cat, you often have no clue what the gonads are unless you’re going to go ahead with an ultrasound scan, and the situations in which you’d do this are pretty rare. You might have an ultrasound performed in an infertility investigation, but honestly it’s pretty rare as if a tom doesn’t have both testicles present and correct where they should be on the outside, he shouldn’t be bred from. Cryptorchidism is genetic.

Most of the time an intersex animal (and i encourage you to use the term intersex, as it’s more current, more polite, and trying to classify individuals as hermaphrodites/pseudo-hermaphrodites/chimeras/masculinised-female etc is confusing, academic at best, and something of a waste of time in clinical practice) is discovered at the time of desexing.

If the gonad is in the scrotum, it’s a almost certainly a testicle. It might not be a completely normal testicle, but it still counts for the remainder of its brief existence. Likewise with gonads located in the groin or inguinal ring, as ovaries don’t tend to move that much.

A gonad which resided inside the abdomen is usually an ovary, but occasional intersex individuals will have internal testicles, or nothing, or one of each, or a pair of ovo-testes.

When you actually have the organ within your fingers, it’s not that hard to tell what you’ve got. Testes actually have a fairly defined structure with central fibrous tissue that radiates outwards, like the inside of a kiwi fruit. The ovaries are not as structured but are kind of grape-like when they get follicles.

So the normal organs do look very different to each other. The abnormal organs still are usually recognizable by how they are structured, just kind of small and empty.

If you really want to know you can send the gonad you’re removing away for histopathology, but that’s really just academic. You’re removing the gonads anyway, the animal can’t breed, so it gets a little footnote in its medical file and gets on with its life.

[transgender101]

Hi I'm an FTM I don't if I'm greedy or something but sometimes I can't help but feeling like no matter how much I try, I'll never truly be a guy like going to the doctor you might still be treated like a girl since there are biological differences they need to work with and inside stuff you can't change. Sometimes I wish I was just cis so I don't have to worry about transitioning I can just already be what I want.

pats gently,I feel ya, my dude. there’s nothing greedy about that. (mentioning specific surgeries and procedures)

Good news, though! A lot of GPs are good about pronouns and names!

Bad news: There’s inside stuff that you can’t change, as you said. But as long as you have the parts, you have to make sure they’re healthy, and if you need surgery, your surgeon will have to talk to you about that stuff. You’re still going to need to visit a gynecologist, check for breast cancer (Men get it too, don’t forget.), etc. That’s part of being a person in this society. Biologically, gonads aside, there are still differences between your body and a cis male’s body, but some of those things can be changed by T. You can change some of what’s going on inside through surgeries. You can get a hysterectomy to remove your uterus, and sometimes surgeons will also perform a bilateral salpingo-oophorectomy to remove your cervix, fallopian tubes and ovaries. I wish you luck, and I’m sorry you feel like you can’t truly be a guy. You are, my friend. Your identity is 100% valid.-Mod Fen

[drferox]

🐄 Sutures- dissolving or not

Anonymous said:🐄 my dog had surgery a while ago and had to have stitches and I was wondering what prompts the decision of regular vs dissolvable stitches in animals? Can you even use dissolvable stitches in an animal?

We absolutely can use dissolving sutures in animals - almost all of our internal sutures will dissolve over time. The suture material we use is not all that different to those used in human medicine, many of the manufacturers and suppliers are the same, but we still have some access to more old-school materials like chromic catgut (not made from cats) and some odd ones like pink-dyed nylon so that it’s easier to see in the skin against black fur regrowth.

We classify our sutures as either non-absorbable (eg nylon, which hangs around forever) or absorbable (lots of different ones that take different amounts of time to be broken down). Some sutures dissolve in water, and the body is mostly water, but some like catgut are broken down by phagocytosis of immune system cells. They all have advantages and disadvantages.

For a routine, planned, primary intention healing surgery like a routine castration, I prefer to use absorbable sutures. This is because the wound is clean, not infected and it’s frequently awkward to have to remove skin sutures from this relatively delicate area. They cause less irritation than non-absorbable skin sutures, I don’t have to fiddle around later to remove them, and I don’t need to worry about the owner forgetting to show up for suture removal.

For a compromised wound, I may still use some absorbable sutures, but I will likely use non-absorbable sutures for the skin if it’s infected (infections causes faster suture breakdown), damaged skin which may die back in the next few days, very thin skin that I can’t trust to hold an intradermal suture, or under a lot of tension. For example, dog fight wounds.

There are some exceptions to this rule. Sometimes we will use non-absorbable suture in a hernia repair or to anchor a prolapsing 3rd eyelid gland, for example, but those are general rules.

Individual vets may also have different surgical preferences, and in many scenarios it’s significantly cheaper to use non-absorbable skin sutures off a reel, so many budget clinics will use these. Cost is definitely a factor in veterinary medicine.

[drferox]

Doc, I just have to get this off my chest. Why do some human doctors stitch people up so BADLY? My mom cut her hand doing something really dumb. A doctor stitched her up and the stitches were absolutely horrible! Just surface stitches, nothing else. Nothing to tack her skin down to stable tissue. Not to mention the 3,000 USD it cost. Now, today, even after waiting 14 days, her hand still has an open cut. It's horrible, and I'm extremely angry about it!

Well, you can’t paint all doctors everywhere by one experience. That’s not really fair, is it? And no comment about money because while that’s certainly a large amount of cash, not sure you can say the price tag is directly the doctor’s fault.

I don’t really ‘do human’, but I do remember from the uni days that human skin has a very different microvascular structure to small carnivore skin. I mean, grab the scruff on the nearest dog or cat. See how much movement they’ve got? Is there anywhere on a human that moves like that?

I really can’t give you an answer, but I’m sure there are multiple factors at play. You can’t go as deep surgically with local anaesthetic rather than a GA, and I have no way of knowing what her skin tension was like. I don’t know what direction the cut was in relative to the skin blood supply, or whether anything was devitalised or what your mother’s health status is. That’s even before speculating on the wound aftercare.

Wounds sometimes go bad, despite our best efforts and intentions. It’s always a risk we take and I can’t speculate on the what’s or why of your situation, but trying to demean doctors as a group helps nobody. You could always discuss your concerns with the clinic you attended.

[drferox]

Do you have a favorite surgical tool? In my principles of clinical medicine lab, we have to identify different surgical tools, and I am very fond of the retractors and alligator forceps.

It’s kind of funny, but while I definitely pick ‘favorite’ diseases, there aren’t particular surgical instruments that stand out for me. I’m fairly fond of our gold handled needledrivers, but will also always have a soft spot for our sterilized cardboard (we use it in skin grafting).