Small animal surgeon?

We've still been having some slow days in the country, so yesterday I was thrown into Small Animal Land to play surgeon. I did two dog neuters, then was presented with a tumor removal case in a 12 year old dog. I'd seen the dog as an appointment last week when we diagnosed her with mammary adenocarcinoma. She had a very large mass associated with one of her mammary glands near her belly and a series of ugly nodules under her armpit. She was a lovely dog who was otherwise in top shape for her age, so her owners decided to go ahead with the surgery to remove the masses.

So I had just finished the second neuter when one of my bosses tells me that I'll be doing the mastectomy. Umm, I've never even seen a mastectomy, let alone done one. I figured that he'd be scrubbing in with me, but I found myself alone in the OR with the dog prepped and ready for surgery. I called to my boss to make sure he knew that I'd never seen or done this before, and I asked him if I could approach it like a bad calf hernia. He didn't seem concerned about my inexperience and said "just watch out for a big vessel that comes into the gland." Right.

Now, I certainly don't pretend to have a lot of small animal experience. Sure, I learned a lot in school, but I did very little small animal work during my clinical year (by choice). At the time school was over, I'd planned to do strictly dairy medicine, and maybe branch out to include a little horse work if absolutely needed. I never dreamed that I'd end up in a mixed practice. In fact, this is what happened to my small animal notes:

Let the sacrificial bon fire begin

Years' worth of papers makes for lots of smoke

At first my game was dumb, but wouldn't you know, by the end everyone was joining in the fun!

So here I am about to attempt a totally less-than-routine dog surgery. Take a deep breath, drape dog, pick up scalpel. One of my favorite pick-me-up songs comes on the radio (Black Eyed Peas "I've Got A Feeling") and I'm ready to go. I made a neat elliptical incision through the skin and WHAM! here come the bleeders. A fundamental principle of surgery is "all bleeding stops eventually"...well, preferably that's as a result of the surgeon's actions and not due to the death of the patient. So I grabbed every single hemostat (clamp) I have in the pack and then had to resort to tediously tying off vessels. I tied and tied and tied as I slowly dissected out the mass, and finally it all came out in one neat little package WITH NO BLEEDING AT ALL! HOORAY!

One of my cases from school, an example of a mass removal (fibrosarcoma in an 800lb pig); my main frame of reference

Calf hernia, looks a little like what I took out

OK, now comes a big challenge: closing the gaping hole where the mammary gland used to be. Instead of panicking or asking for help, I used my brain (for once) and cleverly put in some stay sutures to pull the skin together, thus letting up some of the tremendous tension on the incision. AND, I even whipped out a super-secret knot that I learned from a very famous French-Canadian bovine surgeon at a conference...it was the first time I'd ever tried it, and it worked like a charm! I was thrilled with how well the wound closed, and I hated to put skin sutures in because it obscured my artwork. Feeling all smug, I then realized I still had to tackle the nastiness under the armpit.

By this time another of the doctors had come in to work, so she decided to hang out with me and help. The area we were dealing with was huge...the more we kept digging, the more nodules we uncovered. We had to be very careful and try to keep the incision as small as possible for fear of being unable to close the skin. We took a lot out of this area, and the defect was sorta L-shaped with some zig-zaggy margins. I again used my slick stay-sutures and fancy knot, and I was pleasantly surprised with how well I got it together. Actually, I've never been so proud of my work! We laughed about the fact that it turned out to be a "cosmetic tumor removal." Again, I was sad that my masterpiece was covered up, this time with staples. Darn.

So that's the story of my first non-spay-or-neuter surgery. I have to remind myself that surgery is surgery; the same principles apply no matter what you're working on. I put in a lot of time in the OR at school assisting our food animal surgeon, so I must have passively absorbed some of her skills. That's a nice thought.