A better way to spay your dog (that you probably never heard about)

March 15, 2011

Did you know there’s a new and different way to spay your dog that may be safer, quicker, easier and less expensive? Probably not — and that’s a shame.

In January I wrote a piece called “A Different Way to Spay,” describing two techniques for performing spay surgeries. The method widely embraced in the United States is the ovariohysterectomy (OVH), in which both ovaries as well as the uterus are removed. The second way to spay — popular in many other countries — is the ovariectomy (OVE), in which only the ovaries are removed and the uterus is left behind.

My contention was (and remains) this: Why remove the uterus if doing so serves no useful purpose? The most common canine uterine disorder is pyometra (pus in the uterus), a disease that occurs only under the influence of ovarian hormones. Removal of the ovaries prevents pyometra from occurring.

The incidence of uterine cancer is exceedingly low (representing only 0.4% of all canine cancers). Additionally, a 2006 literature review comparing the two surgical techniques revealed no significant differences in long-term post operative complications such as uterine disease and urinary incontinence. The authors concluded that OVE was the preferred methodology.

So why do we continue to treat the uterus like the human appendix, and remove it whenever we get the chance? As my favorite song from “Fiddler on the Roof” tune goes, “Tradition!”. It’s simply the way our veterinary forefathers were taught, and the tradition has been passed down through the generations.

After my January blog post, many readers emailed to let me know that their family veterinarians were unwilling to perform OVE surgery. In some cases, their vets had not heard of OVE surgery nor were they inclined to learn about it. Many vets adamantly said, “No way!” and some even declared that the notion of OVE was heresy. They attempted to scare their clients into believing that leaving the uterus behind would result in the dreaded outcome of pyometra.

I have to wonder, why spend so much money and time to go to vet school and then espouse such quackery? I just don’t get it.

I encouraged these folks to consult with board-certified surgeons in their area to either have the surgery performed by them, particularly if cost was not an issue, or to attempt to find out from the specialist which general practitioners in the community were open to performing OVE surgery.

In all honesty, I felt discouraged by these emails — discouraged by the notion that some of my colleagues are so set on doing things the same old way, in spite of new information. In some cases, the familiar saying “You can’t teach an old dog new tricks” may be most applicable to the dog’s doctor.

All the news isn’t bad, however. I am delighted to see that a talk called “Review of Ovariohysterectomy Versus Ovariectomy” will be presented at the upcoming annual meeting of the American Veterinary Medical Association. The more veterinarians thinking about this issue the better.

Additionally, educators are catching on and some veterinary colleges in the United States are currently teaching their students how to perform OVE surgery.

In my January post, I discussed European research that found the OVE resulted in shorter surgery times and fewer complications, and since then, one new study was published that found the two procedures differed only in the length of the incision.

The study, performed by researchers at Utrecht University and published in the January 15, 2011, issue of the Journal of the American Veterinary Medical Association compared surgical variables (blood loss, length of incision, duration of surgery) and short-term post-operative complications in 40 healthy dogs undergoing ovariohysterectomy versus ovariectomy:

Significant differences in total surgical time, pain scores, and wound scores were not observed between dogs that underwent OVH and dogs that underwent OVE via standardized protocols.

Apparently the only significant difference was the length of the incision (longer when the uterus was removed), yet the length of the incision did not significantly influence the duration of surgery. I love this point because it is a fabulous demonstration of how evidence-based medicine can contradict intuition.

That being said, it’s tough to know that this outcome truly applies in the real world — all of the surgeries in this study were performed by one board-certified surgical specialist. The results of this study suggest that OVE and OVH procedures have equivalent outcomes in terms of length of procedure and short-term complications. Even if this is true across the board, my question remains: Why remove the uterus if doing so serves no useful purpose?

I realize I’ve not addressed the topics of laparoscopic (minimally invasive) spay surgery or at what age (some might question if at any age) dogs should be spayed — all good fodder for future blog posts. So many topics, so little space! Now, let’s hear your comments.

Filed under: pets, connected,veterinary medicine — Dr. Nancy Kay @ 10:13 am

76 Comments »

  1. You mentioned post-surgical complications several times, but I didn’t see you mention post-surgical recovery times. One would think post-surgical recovery would be both shorter and less painful for the OVE. Was any work done to confirm this supposition?

    Comment by The OTHER Pat — March 15, 2011 @ 10:52 am

  2. Thanks! I read your blog on my Kindle. I have a 15 week old Doberman female, so this was timely. I will look around for vets that perform the OVE in Pensacola FL area.

    Comment by D Mosier — March 15, 2011 @ 11:40 am

  3. Does this apply to cats, too? And I’d love to see future posts from you about laparascopic spays and at what age you recommend spay/neuter!

    Comment by Ingrid King — March 15, 2011 @ 11:47 am

  4. Is there anything similar for neutering? Why in dogs are the testicles removed versus the vasa deferentia being severed? (or cauterized, or tied in a bow, or whatever method)

    Is it because of side effects, of either having or removing the testicles? Getting rid of hormones might have behavioral benefits, but how about health concerns?

    Admittedly, I’m not that familiar with the procedure (for any species).

    Comment by Melissa Duffy — March 15, 2011 @ 12:09 pm

  5. Hi Ingrid,

    My oh my- we are never paying a fair share of attention to those kitties! To my knowledge there is no evidence based data pertaining to OVE versus OVH in cats. What is your sense about this?

    Comment by Dr. Nancy Kay — March 15, 2011 @ 1:19 pm

  6. So how about post-recovery time and pain?

    Comment by The OTHER Pat — March 15, 2011 @ 1:21 pm

  7. Hi Melissa,

    The main reason testicles are removed to neuter male dogs (rather than a vasectomy-”tying the tubes”) is to eliminate undesirable testosterone driven behaviors. Keep in mind, many male dogs are quite civilized, even “under the influence”. Removing the testicles prevents testicular cancer (90% of which are benign) and removing testosterone production prevents most types of prostate gland disease. Unfortunately, prostate gland cancer can develop in dogs whether neutered or not. Does this answer your questions?

    Comment by Dr. Nancy Kay — March 15, 2011 @ 1:24 pm

  8. Hi to the other Pat,
    There has been no data specifically addressing the point you make which is, does the type of surgery affect recovery time. First of all, how does one define “recovery time?” Exercise/activity restriction is routinely recommended until the time the sutures are removed- whether OVE or OVH is performed, the vast majority of young healthy dogs will be wanting to resume normal activity well before then. Pain was assessed in the recent JAVMA study I referenced and there were no differences detected. That being said, keep in mind- an experienced board certified surgeon performed all the procedures. Certainly, there is more internal tissue manipulation with an OVH, therefore more pain would be anticipated, but this was not reported.

    Comment by Dr. Nancy Kay — March 15, 2011 @ 1:28 pm

  9. Attention D. Mosier- please let us know how difficult it is to find a vet in the Pensacola Florida area who is willing to perform OVE surgery.

    Comment by Dr. Nancy Kay — March 15, 2011 @ 1:29 pm

  10. My biggest mistake in dog ownership so far has been getting a female spayed. No, not because I regret not breeding her, but because she developed spay incontinence. It’s a major PITA that has kept me up nights, ruined a mattress, slashed her confidence, and worst of all requires lifetime hormone treatments with a drug that is no longer approved for human use for causing cancer.

    It’s nice to see that there is a new option, one that might be shown to be healthier, less invasive, and with fewer side effects. More options are always superior to fewer. Just as more information is better than less.

    I know you’re not supposed to judge a decision based on the outcome, but this experience with SI proved that I didn’t know the magnitude of the risks.

    Perhaps they’ve been downplayed by the speuter lobby. Perhaps they’ve been downplayed by Vets. And perhaps I was just uninformed because of my own failings. Anyway, thanks for putting out and advertising options for us. It will only be through finding new solutions and vetting them, then advertising them, that the overall health and wellbeing of pets will increase.

    Comment by Christopher@BorderWars — March 15, 2011 @ 2:03 pm

  11. I’m aware of spay incontinence, but I guess I’ve never known just which aspect of the surgery it’s caused by. Would the less-invasive OVE also be less likely to cause spay incontinence, or is the mechanism of SI related to something else altogether?

    And Dr. Kay, perhaps you could get Dr. Downing to weigh in with her thoughts on the question of post-surgical pain relative to these two procedures. Particularly considering what we know about how good animals are at masking it and remaining active even in its presence. In other words, just because they aren’t SHOWING a lot of pain doesn’t necessarily mean they’re not uncomfortable. And it seems to me that more current thought on the subject reflects that reality.

    I know that Gina took this entire subject VERY seriously when she had McKenzie spayed:

    http://www.petconnection.com/blog/2009/07/17/reflections-on-the-aftermath-of-a-spay/

    And having had “both versions” myself, I can tell you from personal experience that it hurt a LOT more when they went in to yank ALL the plumbing!

    Comment by The OTHER Pat — March 15, 2011 @ 2:26 pm

  12. I’d like to second the request for a discussion of whether and when to spay–with regard, in particular, to a pet bitch one has no intention of breeding. I’m fairly conversant with the current literature on the subject, but I find this an uncommonly difficult decision to make.

    Lisa in Cape May County, NJ

    Comment by Lisa — March 15, 2011 @ 4:40 pm

  13. I guess my question is… what is the benefit of leaving the uterus?

    It wouldn’t make a difference for spay incontinence, would it? The ovaries are the big hormone-producers and they’d still be gone. Same with the cancer-sparing benefits (thinking osteo, hemangio, tcc)?

    Comment by Katie — March 15, 2011 @ 5:23 pm

  14. Just stepping out on a limb here…but what would the benefits be of removing the uterus and leaving the ovaries?

    Can’t get pyo when there ain’t nothing in which to get it, but you still get the hormones and what-have-you.

    I obviously haven’t put much thought into the idea, but I’m just intrigued. I’m aware that women can get hysterectomies that leave the ovaries alone, even if it’s not as common as taking out the whole shebang.

    Comment by Viatecio — March 15, 2011 @ 5:30 pm

  15. Hi Christopher,

    Thus far the research shows no difference between OVE and OVH surgery and the likelihood of developing adult onset urinary incontinence.

    Comment by Dr. Nancy Kay — March 15, 2011 @ 6:32 pm

  16. I will give a shout-out to Dr. Downing and will see if she can provide her impressions of pain associated with OVE versus OVH. My understanding is that measurement of blood pressure correlates most consistently with pain (the more pain the higher the blood pressure). In the study sited, this was not evaluated. Let’s see what Dr. Downing has to say.

    Comment by Dr. Nancy Kay — March 15, 2011 @ 6:39 pm

  17. Hi Viatecio,

    You pose an interesting question. Believe it or not, when we remove the uterus, we are always leaving a small amount of it behind (the part that attaches to the cervix). While this partial “uterectomy” would prevent pregnancy, it would not eliminate all of the behaviors associated with the heat cycle (bleeding, receptivity to the male, etc.) nor would it prevent the disease we refer to as a “stumpy pyometra” or pus within the little nub of uterus left behind. In fact, when a dog has been spayed via an OVH and she later develops a stump pyometra, the surgeon must not only clean out the remainder of the uterus, she or he must also go look for a bit of ovarian tissue that managed to get left behind the first time!

    Comment by Dr. Nancy Kay — March 15, 2011 @ 6:44 pm

  18. Hi Katie,

    Be sure to read the original blog post cited at the top of this blog. It provides a laundry list of potential intraoperative complications that can potentially be avoided by leaving the uterus behind. Honest to goodness, the canine uterus simply doesn’t seemed preordained to developing cancer. Now, if we want to proactively remove the thing that is most likely going to become a cancer factory later on in life, let’s remove the spleens at the time of spay surgery- particularly in large breed dogs. Now, that’s a study I’d love to see!

    Comment by Dr. Nancy Kay — March 15, 2011 @ 6:47 pm

  19. you know there are striking similarities in this discussion to that regarding women who have uterine fibroids… It used to be standard practice to do complete hysterectomies; now there are recognized techniques that are less radical (though of course many doctors adhere to the old way of thinking.)

    Comment by EmilyS — March 15, 2011 @ 7:10 pm

  20. Greetings, Dr. Kay – -
    What a GREAT post!!! You and I are contemporaries, so we have witnessed this societal transformation in our relationships with animals, and likewise MANY transformations in our profession… Readers have posted some terrific comments and good questions… thought I might weigh in on a couple of things.

    One comment – - the link to the study actually takes you to a paper on gastropexy, not OVE versus OHE (FWIW)…

    Dr. Kay writes:
    “… Why remove the uterus if doing so serves no useful purpose?…”
    Humans loathe change… it is often easiest simply to confuse the edge of the rut for the vastness of the horizon… :-)

    The OTHER Pat writes:
    “…perhaps you could get Dr. Downing to weigh in with her thoughts on the question of post-surgical pain relative to these two procedures. Particularly considering what we know about how good animals are at masking it and remaining active even in its presence. In other words, just because they aren’t SHOWING a lot of pain doesn’t necessarily mean they’re not uncomfortable…”
    And Dr. Kay adds:
    “…I will give a shout-out to Dr. Downing and will see if she can provide her impressions of pain associated with OVE versus OVH. My understanding is that measurement of blood pressure correlates most consistently with pain (the more pain the higher the blood pressure). In the study sited, this was not evaluated. Let’s see what Dr. Downing has to say…”

    So… here we have a sticky wicket…

    Let me address a couple of things. First of all, it is appropriate for me to educate/remind readers that general anaesthesia does NOT prevent pain, it ONLY prevents conscious perception of that pain. Without appropriate pre-emptive multi-modal pain management (analgesia), the nervous system is subjected to an incredible barrage of painful input that wreaks havok on the nervous system as well as the post-operative pain experience of the animal.

    Interestingly enough, with appropriate analgesic plan in place before and during a procedure, the surgical patient will NOT experience a rise in heart rate or blood pressure no matter which abdominal procedure we choose. This makes blood pressure measurement as a measure of pain a very unreliable matrix… unless there is NOT appropriate pain relief on board at the time of surgery.

    IF (and unfortunately, this is still a HUGE “if”) a good multi-modal pre-emptive analgesic regimen is provided to the patient at the time of surgery, the real difference between the OVE patient and the OHE patient will come AFTER the procedure is over… This translates to the less invasive the procedure, the less tissue trauma, and we do know (science bears this out) that the less tissue trauma, the less tissue damage, the less activation of nociceptors (sensors that initiate the pain experience), and the less pain medications needed post-operatively.

    Any time we can minimize tissue trauma – - in this case by only removing the ovaries and by doing so with a laparoscope versus opening the entire abdomen – - we have the opportunity to minimize the patient’s pain experience.

    That said, PLEASE do NOT confuse “minimally invasive surgery” as a “free pass” to neglect a multi-modal pre-emptive pain management protocol for these surgery patients! They need and deserve full attention to pain prevention – - which we now know how to provide – - and they reap the benefit of a faster recovery with discomfort that is EASIER to manage because their tissues have not been as traumatized. (It’s not that they don’t need pain management…)

    Precisely BECAUSE animals are great at masking their pain, we have a moral and ethical obligation to give them the benefit of the doubt when it comes to pain. A great mentor of mine maintained “when it comes to pain, when in doubt, treat”. But tissue is tissue, and nerves are nerves, and the less trauma we do, the easier it will be to intervene with an appropriate level of pain management.

    For those interested enough to look, here is the link to the American Animal Hospital Association/American Association of Feline Practitioners Pain Management Guidelines for Dogs and Cats. I had the pleasure of co-chairing the task force that authored these guidelines, and in the document you will find some interesting food for thought as we try to advocate on behalf of beings who cannot advocate for themselves…

    http://www.aahanet.org/PublicDocuments/PainManagementGuidelines.pdf

    It is the VERY FIRST (and still the ONLY) document of its kind in veterinary medicine…

    Hope this information helps with thinking through some of the complexities off this issue…

    Comment by Dr. Robin Downing — March 15, 2011 @ 8:56 pm

  21. Hi, Dr. Kay:

    As a “seasoned” small animal veterinarian who has performed literally thousands of canine spays over the years, I’m very open-minded to adopting any modifications to my surgical technique that will reduce procedural time, patient discomfort, and post-op complication risks. I haven’t yet reviewed in depth the studies you mentioned– how is the ovary excised from the uterine horn in an OVE? If a ligation must be performed either at the cranial aspect of each uterine horn, or between each horn and ovary where the oviduct connects them (a very narrow isthmus)– prior to transection between each horn and ovary– then it would seem an OVE would offer no time advantage over an OVH, in which a single uterine body/”stump” is ligated and transected. (I imagine both procedures would involve similar ovarian blood vessel ligations and transections.) Is this one of the reasons that the JAVMA study found no significant difference in surgical time between the two procedures? I’m also troubled by the canine uterine cancer statistic you cited (0.4% of all canine cancers)– that 0.4% figure is meaningful and reassuring IF it pertains specifically to the population of intact female dogs, but is less compelling if it was determined from a general canine sample that included spayed females and males. Since the vast majority of my female canine patients are spayed, I really don’t have a clue what the true incidence of uterine cancer might be in dogs that maintain a uterus into their geriatric years. Of course, if it is shown (or has been shown) that ovarian hormones/estrogens promote the development of uterine cancer as they do mammary cancer, then an OVE procedure should theoretically greatly reduce any uterine cancer risk (even a small one). Thanks for the thought-provoking discussion!

    Comment by Dr. S.G. — March 15, 2011 @ 9:12 pm

  22. Dr. Downing,

    Thank you for your thoughtful response. In particular, I was pleased to see you write “Precisely BECAUSE animals are great at masking their pain, we have a moral and ethical obligation to give them the benefit of the doubt when it comes to pain.” That’s why I was hoping some attention had been paid to this particular aspect of OVH v.s OVE – particularly post-surgically.

    Intuitively, I tend to like the idea of the OVE from that aspect. But it would be nice to see some work done to support (or not – depending on what the evidence turns out to show) that idea.

    The whole subject is certainly worth further discussion.

    Comment by The OTHER Pat — March 16, 2011 @ 5:09 am

  23. As noted, I did do a lot of research before getting McKenzie spayed, and I wish I’d considered OVE as well. What McKenzie had was a traditional spay combined with a gastropexy, the latter intended (I hope) to prevent any incidence of gastric torsion a/k/a “bloat,” or at least the stomach-flipping elements of “bloat.”

    Even with the work done by a boarded surgeon and very advanced pre- and and post-procedure pain protocols, she was really unhappy for a few days. And the long-term result for her day-to-day life is not good: She is constantly hungry, and has a difficult time maintaining good weight, even with a vigorous amount of daily exercise and twice-weekly training runs with a friend who’s an ultramarathoner.

    The next time I consider spaying a dog of mine, I will be going back to the boarded surgeon and choosing lapascopic (having had a lap intestinal surgery myself, I can speak to how much easier it is) and will additionally be considering all options to keep my dog as whole as possible while removing reproductive capacity.

    As for the lap procedure, I’m going to ask fellow Pet Connection team member and boarded surgeon Dr. Tim McCarthy to come in and comment on that, or (if he has time) to follow up with a post on lap spays.

    I will say, however, that the pushback from the Speuter Militia when you question ANYTHING about spaying/neutering is really vicious. It’s like questioning someone’s religious beliefs. And it makes about as much sense: When you suggest that leaving an animal intact is a viable choice for that animal’s well-being, the Speuter Militia wants you drawn and quartered. The same people will suggest the same penalty for you if you allow that declawing may be acceptable as a last-ditch effort to keep a cat in a home.

    And yet, as I’ve noted before: Why is invasive intestinal surgery not “mutilation” if declawing is? Why is natural, normal clawing/marking behavior something all cats MUST enjoy if the health and behavior benefits of being sexually mature and intact are not equally desirable?

    While the answer is going to be: We’re killing shelter pets!! OMG, STOP THE KILLING! … that’s really not the issue at all. We’re not killing ANY “shelter pets” because my male retriever has his testicles, and we wouldn’t be killing any shelter pets had McKenzie kept her reproductive system, for the simple fact that I don’t have a problem controlling/training my animals. Period.

    (Side issue, related: The same Speuter Militia have a bloody cow at the suggestion that a spay is a major medical procedure and should be treated as such and priced accordingly. I’m always astonished at the people who practically break into tears at the mere mention of a “choke collar” on a dog — oh the cruelty! — but who accuse veterinarians of “padding the bill” for insisting on good anesthesia and pain protocols for spays. And can you imagine the howling at the cost of a lap spay? It seems for many people that concern for an animal’s comfort is directly related to concern for the owner’s comfort at a price point for a given procedure.)

    While spay-neuter has undeniable population-control benefits for animals owned by careless/clueless people, and some behavioral advantages as well for the dogs of people who are unable/unwilling to train their animals, I think the real reason it has become so popular is that these procedures are really convenient for PET OWNERS.

    That’s even more true in cats, of course, and the behavioral issues of unaltered male OR female cats is honestly not anything I’d want to deal with myself. But dogs? It’s really not that difficult to live with intact dogs, and if you choose to do so, it’s not that difficult to keep them from reproducing.

    But I resist any “tradition!” dogma that insists that one surgery (OVH)is ALWAYS right and another (declaw) is ALWAYS wrong. Our animals are individuals, and their medical decisions should be made individually as well. Do the household/human needs factor into these decisions, not just the animals? Of course they should, but again, these are decisions, not laws. (And for those who read this as an “endorsement” of declawing … it’s not. It’s an endorsement of THINKING, of questioning everything.)

    Dr. Kay, thanks for the thought-provoking post, and thanks, everyone, for the discussion.

    Comment by Gina Spadafori — March 16, 2011 @ 5:54 am

  24. Thanks so much Dr. Downing. Lots of wisdom here. For my own clarification, please give me your thoughts on using blood pressure as a means for monitoring pain in awake animals- this is what I was truly referring to. Thanks much.

    Comment by Dr. Nancy Kay — March 16, 2011 @ 7:07 am

  25. Hi Dr. S.G.

    You raise some great points. Yes, ligations between the ovaries and their attachment to the uterus are required, which may explain why, in the one study cited, a significant time between performance of OVE’s and OVH’s was not cited. You are correct, given the number of neutered females the frequency of uterine cancer may be an underestimate. Truth be told, I’ve been practicing for almost 30 years and have never diagnosed a uterine malignancy in a dog, have you? Thanks so much for commenting.

    Comment by Dr. Nancy Kay — March 16, 2011 @ 7:13 am

  26. If we’re doing a lap spay, why not just do a lap tubal ligation? Far less invasive because they’re not removing any tissue. The dog gets to keep her ovaries and have a fairly normal metabolism because of it. I suppose it would put you right back to unspayed where there would be the risk of pyometria, but how frequently does that occur, really? I think it’s kind of like saying we should get rid of ovaries in all healthy women not bearing children so they don’t run the risk of ovarian cancer.

    Comment by C.L.H. — March 16, 2011 @ 7:14 am

  27. Hi Gina,

    Thanks for chiming in- love the points you made. What I will say in response is that, if performed properly, with all of the appropriate bells and whistles for maximum patient comfort and a really good surgical and anesthetic outcome, most veterinarians are losing money on their spay and neuter procedures. When you think about facility costs, drugs used, maintenance of the operating room, sterilization of surgical instruments, suture material, gloves, mask, gown, someone monitoring anesthesia 100% of the time, hospitalization for the appropriate amount of time for supervision and pain management, etc. the cost of spay surgery should likely be around $1,000. Of course vets don’t charge this much because they need to be competitive. As you alluded to, neutering is the norm for most folks and, unfortunately, they shop around for this service. In fact the cost of neutering may enter into who they choose to be their pet’s vet for the rest of that animal’s life.

    Comment by Dr. Nancy Kay — March 16, 2011 @ 7:21 am

  28. Interestingly enough, I paid around $1,200 for the spay/gastro by a boarded surgeon. Frankly, it was good value for the money.

    I know what you mean when you write “bells and whistles,” but I don’t think you should feel the need to describe proper care that way at ALL. I consider those “bells and whistles” to be proper surgical protocol, and if people need/want to bargain-hunt for “cheap” spays, I think they need to be fully aware of exactly what they are — and aren’t — getting for the money, and the risks/benefits that entails.

    Comment by Gina Spadafori — March 16, 2011 @ 8:03 am

  29. I think the veterinary profession has surrendered spay surgery to the bargain hunters without a fight, frankly. The whole thing is really very complicated, because even suggesting a spay is an expensive invasive surgery with big recovery issues, including pain management, and possible negative consequences such as incontinence, obesity, increased aggressiveness, or increased risk of ACL tear (etc.) has political consequences.

    All I know is that I never asked my veterinarians to cost-cut on my dogs’ spays or neuters. I go to board-certified surgeons every time, and I’d consider a grand for a spay to be getting off lightly.

    If vets want to defend this turf, they should do a better job education (I mean on the trade level, not aiming this at individual vets). And if they want to use it as a loss leader to attract new clients, they should do that openly. Hell, give the spay away FREE if you want to. But frame it to yourself as a loss leader, and market it as a value added, so you don’t just attract the deadbeat clients.

    Serious messaging problem on this in the profession, IMO.

    Comment by Christie Keith — March 16, 2011 @ 8:42 am

  30. we have spayed around 200 females…I don’t like the word “bitch” even though most female gwp’s are..LOL

    We have had only 3 that have developed incontinence problems in the long term, and I have asked adopters. There are many groups that utilize “cheap” spay procedures to save money, and state law of course requires this.

    We have opted to stay with our long time vet and friend that does cost the group as much as 6 times the amount of low cost spay neuter facilities, but have never had an issue with his spays. The three that did were done by shelters that required the dog/puppy be spayed before we could pull.

    Does the problems seem to stem from the one actually doing the spay surgery? Regarding incontinence issues?

    Comment by Mary — March 16, 2011 @ 8:49 am

  31. Just heard from Dr. Tim McCarthy, a boarded surgeon and one of our advisory team members. He says he’ll come in and comment, especially on the lap spays, when he gets a break in his schedule today.

    Comment by Gina Spadafori — March 16, 2011 @ 9:45 am

  32. Thank you so much for this thought-provoking article. I’ve frequently wondered why we simply didn’t remove the ovaries and leave the rest of the reproductive system intact, as it would seem to accomplish my ultimate goal of ending reproduction without creating any more pain or health issues than absolutely necessary. And if this procedure could be done faster and with less risk than a traditional spay, we could spay much greater numbers of pets at low-cost events than we typically do now, which would be a plus for everyone.

    Comment by Vicky — March 16, 2011 @ 10:59 am

  33. What I’m looking for (at night, while I sleep) is the perfect solution.

    One that would allow my girls to retain ALL the parts they were born with, until death do them part.

    One that wouldn’t involve mammary cancer or pyo (my only real concerns, when it comes down to it).

    This discussion, about the TRUE benefits and risks (short term AND long term) of both spay and neuter procedures, is a rare one – and one we should be having and addressing on a regular basis.

    Personally I’m in a particularly tight spot as far as my beliefs stand on this matter – I’ve never altered a dog that belonged to me until well after it was fully mature – currently we have three intact females, age 2, 3 and 6. I’ve kept the 6 year old intact so long because her breed suffers from serious rates of osteosarcoma, however we’re getting to the point where a decision is going to have to be made in regards to all of them.

    At the same time, I run a rescue organization and we have spayed and neutered hundreds of dogs over the past several years. To allow an animal to leave my care without performing this procedure (without a medical exemption) would get me in hot water with the local AC, the SPCA and the rescue community in general (who seem to hunt reproductive organs as if they are gremlins…).

    I have a very difficult time morally – subjecting these animals to a procedure I refuse to submit my own animals to, but every time I consider allowing adopters to make their own choice I’m overwhelmed by the number of unknowns involved.

    If only there was more study, more information, more details – and most importantly, more discussion (like this one!) about speutering pros and cons.

    I’ll be following this very closely, and watching even closer for the follow up article and discussion. When/whether to spay my girls is a huge decision, and one that in my experience most vets either aren’t capable of discussing rationally or simply unwilling to do so.

    Comment by Kim — March 16, 2011 @ 3:23 pm

  34. Thank you for this education. Why take out more if it’s not necessary.I”m going to share this with my family members who have female dogs as well.

    Comment by Lorraine Robles — March 16, 2011 @ 4:22 pm

  35. Greetings, Dr. Kay – -

    Sorry I’m late to the party today – - lots of cases to see! :-)

    “…thoughts on using blood pressure as a means for monitoring pain in awake animals- this is what I was truly referring to…”

    Sorry that I mis-heard your underlying question…

    Here’s the bad news… while physiologic parameter such as heart rate, pupil diameter, and blood pressure MAY be influenced by the presence of pain, they are EXTREMELY unreliable indices, and don’t make for good pain monitoring… Consequently, we actually do NOT use BP at all when assessing painful awake patients.

    Bummer. Still looking for the elusive “holy grail” of a reliable pain-o-meter!

    Comment by Dr. Robin Downing — March 16, 2011 @ 5:39 pm

  36. Such a great post and I love all the discussion! When I read Dr. Kay’s original post on this topic in January, I wanted to go hide behind a tree, because I still do OVH. No convincing reason why, but as Dr. Downing said, humans loathe change. (I like to think I’m pretty open to change, but I’m missing the mark here.) I’m glad to see this topic will be addressed at AVMA, as you mentioned, as I think a change in such a traditional procedure requires that “regular” vets like myself have a sense of comfort that it’s the right way to go, and that comes from lots and lots of discussion like this.

    Comment by J.C. Burcham, DVM — March 16, 2011 @ 8:32 pm

  37. Hi, JC! :-)

    Comment by Dr. Robin Downing — March 16, 2011 @ 9:20 pm

  38. My hope is that there will be much more research forthcoming on this topic particularly pertaining to how removing ovaries does or does not influence longevity and development of cancer later in life. I am participating in a newly formed task force for the American Hospital Association. Our mission will be to establish Canine Life Stage Guidelines based on evidence based medicine. Will be interesting to see what we come up with re: spay recommendations!

    Comment by Dr. Nancy Kay — March 16, 2011 @ 9:20 pm

  39. Good for you, Dr. Kay!! Will you be at the AAHA conference in Toronto? If so, I would love to meet up with you there! Our hospital is being recognized as a finalist in the AAHA Practice of the Year Awards!
    http://olatheanimalhospital.com/2249/olathe-animal-hospital-a-finalist-for-aaha-practice-of-the-year-awards/
    (We’re very excited, in case you can’t tell!!)

    Comment by J.C. Burcham, DVM — March 17, 2011 @ 7:07 am

  40. Dr. Kay, I am having my two girls spayed next month. I suspect that spay clinics resort to “one size fits all” types of surgeries, in the interest of “get em in, get em out”. But, what can a person reasonably ask for at a spay clinic? I dont imagine that most have the equipment needed for a lap surgery. Can an OVE be performed as quickly and easily as an OVH, even though more invasive without the special equipment?

    Comment by Brenda Hubsher — March 17, 2011 @ 7:53 am

  41. Hi Brenda,

    Sorry to tell you this, but I recommend against using a spay/neuter clinic unless an absolute financial necessity. Most (perhaps not all) really cut corners in terms of preventing intraoperative and postoperative complications. At the risk of tooting my own horn, please try to get your hands on a copy of Speaking for Spot- supplies important questions to ask your vet before anesthesia and an elective surgical procedure.

    Comment by Dr. Nancy Kay — March 17, 2011 @ 10:59 am

  42. Congrats to everyone at Olathe Animal Hospital. No, unfortunately I will not be at the AAHA conference this year.

    Comment by Dr. Nancy Kay — March 17, 2011 @ 11:00 am

  43. Dr. Kay…..Yes, sorry to say, but financial considerations are at work here. But, that doesnt mean that I cant work to make sure that everything goes well. Being unemployed shouldnt mean that I cant get surgery done with a minimum of post and preoperative issues. Having 6 dogs, (5 of whom are rescued strays), 4 altered, and 2 on the list to be done, cost cutting has to be done. Perhaps presenting myself as an educated consumer will pay off. I can hope, anyway.

    Comment by Brenda Hubsher — March 17, 2011 @ 12:50 pm

  44. Brenda, do you have more than one spay clinic available to you?

    I’m thinking that maybe you could approach them and ask about post-surgical pain meds – perhaps not standard at these places, but perhaps available at extra cost? You’d still be saving on the surgical costs overall, but could “fill in” a bit to help your animals’ recovery go a little better.

    If one spay clinic isn’t open to working with you on this, perhaps another would be (assuming you have the choice of more than one).

    Chances are they wouldn’t be open to changing their standard operating procedures DURING a surgery (changing for an individual would kind of defeat the whole purpose of the “assembly line” “get-’em-in-Get-’em-out” model) but they may be willing to let you pay a bit more for some extras before and/or after.

    Thoughts from the vet types on this approach?

    Comment by The OTHER Pat — March 17, 2011 @ 1:01 pm

  45. Hi Brenda,

    I truly understand your predicament- know that you are not alone, particularly in this day and age. As the Other Pat alluded to, not all spay and neuter clinics are created equal. I don’t think it would be realistic to convince a spay neuter facility to change up how they are doing their work, but I encourage you to get answers to the following questions:

    - How are patients monitored during anesthesia such as will there be full time assistant monitoring anesthesia, blood pressure, pulse oximetry (measures blood oxygenation)
    - Pain medications prior to surgery and during the post-operative period
    - What form of monitoring is performed immediately post-operatively (ideally under watch at all times rather than “recovering in a ward” without supervision)
    - How experienced is the surgeon (how many spays does the surgeon perform each week)
    - What percentage of patients experience complications
    - Who will be monitoring your dogs overnight (please don’t leave them unattended in a hospital setting- far better they be at home with you than alone in a kennel)

    Take the answers to these questions and see how the facilities in your area compare. Hope this helps

    Comment by Dr. Nancy Kay — March 17, 2011 @ 1:55 pm

  46. Thank you Dr. Kay. This answers my questions perfectly.

    Comment by Brenda Hubsher — March 17, 2011 @ 1:58 pm

  47. Having read your first article, I tried very hard to find a vet who would perform the procedure. My local vet was dead against it and I would have had to travel 3 hours each way to someone I didn’t know in order to get it done.

    Reluctantly, we did a conventional spay.

    Comment by Linda — March 18, 2011 @ 6:40 am

  48. My cat vet said, “NO WAY” to OVE surgery. She said in Vet schoool, (Many years ago) she witnessed a stump left in a dog after a spay.

    Comment by Tom Demma — March 18, 2011 @ 7:30 am

  49. Dr. Kay,
    I am reading all this with interest. Personally I prefer to live with intact dogs, I have now and had in the past some that have been traditionally neutered and spayed and there has only been one instance, an already 10 year old dog, where there were actually some positive behavior changes, with the rest I have always regretted my decision of messing with their hormones due to the behavioral and physical changes I have seen. I currently have one male that had a vasectomy, he’s had an accident as a young pup and his movement is somewhat odd, though all his joints have been x-rayed and are good, but I was so glad he had not been neutered as I feel it is a benefit for him to have his testosterone to support his muscle mass, he only has one testicle btw. So I am looking at alternative procedures for my female dogs as well, and I am guessing if I want to preserve the hormones, I would have to opt for a hyesterectomy and leave one or both of the ovaries in place to accomplish that and to prevent future problems with pyometra as well as preventing heat cycles which admittedly are no fun do deal with especially in a multi dog household and intact males around.I understand that breast cancer rates are reduced with hormone reduction, but at the same time leaving the hormones intact will prevent spay incontinence.

    Comment by Marlene — March 18, 2011 @ 8:05 am

  50. I thought the same thing, Marlene. Unfortunately, as long as you have ovaries you have a heat and all that comes along with it. Simply removing the uterus bears NO benefit. There is always a “stump” left over, and as previously mentioned in a traditional OVH the only time the stump causes a problem is when the surgeon ALSO forgets a piece of ovarian tissue.

    Also, if your only concern is spay incontinence, the chances of getting mammary cancer greatly outweigh the possibility of SI.

    Here is an EXCELLENT article detailing what we know (or think we know… so far) about the pros and cons of both spay and neuter surgeries.

    http://www.naiaonline.org/pdfs/longtermhealtheffectsofspayneuterindogs.pdf

    Print it out so that you can go through it an highlight what is pertinent to your situation and then address any questions you have to your vet (or if they’ll oblige, one of the vets here!).

    In regards to your dog with a single testicle – was one lost, or was one retained?

    Comment by Kim — March 18, 2011 @ 9:42 am

  51. The woman that works for me has a female she would like to get spayed using the OVE surgery but she too is having a problem finding a vet. I meet very few vets that continue their education after vet school. They say they are too busy with their practices to take time off.

    Comment by Terry Shackleton — March 18, 2011 @ 10:26 am

  52. Hi Marlene,

    I think there remains a good deal we don’t quite yet know about some of the potential ill effects of neutering, particularly at under a year of age (it is possible that we’ve not yet discovered the ideal time window). As Kim talked about, removing the uterus does not prevent a stump pyometra and we know that spaying before a year of age protects against breast cancer. Spaying also eliminates the hassle of going through heat cycles. And let’s not forget prevention of unwanted litters. These are all good things and I think we are just beginning to figure out some of the “not so good things” in terms of possible associations of spaying with development of certain types of cancers and reduction in overall longevity, particularly in large breed dogs. There is a great deal more work to be done, and I don’t think it will boil down to something as simple as “spay or not spay”. Rather we might recognize a more ideal time (age) to spay.

    Comment by Dr. Nancy Kay — March 18, 2011 @ 2:22 pm

  53. Could cats have the same type of spay?

    If so, all the cat people would be very interested in this info.

    Thank you very much for educating us.

    Lisa

    Comment by Lisa — March 18, 2011 @ 4:35 pm

  54. “Rather we might recognize a more ideal time (age) to spay.” – Dr. Nancy Kay

    Please keep us updated on this work, Dr. Kay. This question has been driving me nuts for years!

    Comment by Kim — March 18, 2011 @ 5:23 pm

  55. I don’t suppose one of the DVMs on here could explain exactly WHY a stump always remains.

    Is the surgery not possible any other way? Riskier? What’s the rest of the story?

    Just out of sheer curiosity – and so I can put it out of my head once and forever.

    Comment by Kim — March 18, 2011 @ 5:56 pm

  56. Great discussion. I have just one comment on the following post (below) regarding monitoring BP to assess pain. Have there actually been any reliable studies done on this subject? I know that people are completely different that our four legged friends in some respects, but since BP can rise dramatically when a person is in pain (I have witnessed it with my own father in the ER), I wonder on what basis the following statement was made regarding monitoring BP as NOT being a valid indictator pain level.

    POST IN QUESTION REGARDING BP/pain indices:
    I’m late to the party today – - lots of cases to see! :-)

    “…thoughts on using blood pressure as a means for monitoring pain in awake animals- this is what I was truly referring to…”

    Sorry that I mis-heard your underlying question…

    Here’s the bad news… while physiologic parameter such as heart rate, pupil diameter, and blood pressure MAY be influenced by the presence of pain, they are EXTREMELY unreliable indices, and don’t make for good pain monitoring… Consequently, we actually do NOT use BP at all when assessing painful awake patients.

    Bummer. Still looking for the elusive “holy grail” of a reliable pain-o-meter!

    Comment by Peggy — March 18, 2011 @ 6:34 pm

  57. I realize this is not going to agree with what a lot of you “know” about spaying dogs and mammary cancer. Maybe you’ve read what’s “out there” on the InterWebs. Maybe you’ve read websites and blogs by veterinarians. Maybe you’ve read veterinary textbooks, or even summary articles published in respected veterinary research journals.

    But here’s the scoop… almost everything you “know” about the risk of mammary cancer in dogs and spaying is a misquote of published research, a misquote that has been repeated so many times it has become accepted as “fact”. Almost everything that’s written about this subject is a misquote of this 1969 research article that was published in the Journal of the National Cancer Institute.

    It would really help a lot if the experts who are advising dog owners on this subject would READ THE ORIGINAL RESEARCH ARTICLE, instead of repeating the same false claims about this study that everybody else is repeating. The mammary cancer risk reduction is, after all, the single biggest health benefit claimed for spay/neuter in dogs.

    You don’t have to spay dogs before 1 year of age or before the first or the second estrus to reduce the lifetime risk of mammary cancer. No published research supports this oft-repeated claim.

    The 1969 study by Schneider et.al. found that the risk of mammary cancer for female dogs spayed after two or more estrus cycles is only 26% of risk that intact female dogs have. That’s still a nearly 75% risk reduction. This finding is nearly always misquoted with the false claim that waiting to spay until after the 2nd estrus yields the same risk as not spaying at all. NOT TRUE.

    Sonnenschein et.al conducted a similar study, published in 1991, and found similar results that Schneider et.al. Sonnenschein found that the mammary cancer risk reduction with spaying does not end once a dog has had two heats. It continues up to around 5 years of age.

    You do not have to spay puppies to prevent them from having a 26% chance of developing mammary cancer. You can wait until your dog is several years old before spaying, and your dog will still have a significantly lower risk of mammary cancer.

    Quoting from Sonnenschein:

    “Spaying between 1.1 and 2.5 years of age was significantly protective (odds ratio (OR) = 0.11 (95 percent CI 0.03-0.4) and OR = 0.13 (95
    percent CI 0.03-0.4) for the cases vs. the cancer controls and the noncancer controls, respectively). Spaying from 2.6 to 5.0 years
    of age was significantly protective for the cases versus the cancer controls (OR = 0.3 (95 percent CI 0.1-0.7)).”

    So even spaying between 2.6 and 5.0 years of age has a 70% risk reduction of mammary cancer compared to intact female dogs.

    Sonnenschein EG, Glickman LT, Goldschmidt MH, McKee LJ. “Body conformation, diet, and risk of breast cancer in pet dogs: a case-control study.” Am J Epidemiol. 1991 Apr 1;133(7):694-703.

    AFAIK, there are no other published research findings on this topic. There’s a mountain of misquotes though.

    Comment by LauraS — March 18, 2011 @ 7:40 pm

  58. The link to Schneider et.al. got deleted from my comment. Click on my name below to access it.

    Comment by LauraS — March 18, 2011 @ 7:42 pm

  59. The talk of the thousand dollar spay is giving me the vapors.

    Our breed rescue is decentralized; we have animals neutered by the foster people’s veterinarians. Most of the time we don’t get a discount.

    If the thousand dollar spay were to become an industry standard, I can assure you that rescues will be placing a lot fewer animals.

    Pittsburgh has a for-profit low cost neuter clinic. I’ve used it for a couple rescue animals and for my barn kitties. I’ve been very impressed with the beautiful tiny incisions and nearly seamless closing, the fast recoveries, and the proactive attention to pain control. While the waiting room has simple folding chairs (no latte machine!), everything is clean and I haven’t felt that the animals’ care was compromised.

    The surgeon does virtually nothing but spays and castrations, all day every day. I imagine it would take a special effort not to get good at them.

    Comment by H. Houlahan — March 18, 2011 @ 8:57 pm

  60. Where I find most high volume clinics fall down on the job is in monitoring. We have a society that has put all its pet population control eggs into one single basket — mass spay/neuter — and thus created a situation where the sex organs our dogs were born with are treated like tumors that need to be removed or horrible things will ensue, and where we have this mass imperative to speuter, and no mechanism to offer that service at the price it needs to be offered at to ensure everyone can and does have it done AND best medical practices are followed.

    I’ve been in dozens of high volume clinics, from the best (such as you describe) to the worst, and there is not one I’d let anesthetize my dog, no matter how well they did their incisions. They just don’t have the monitoring needed to make it as safe as I need it to be.

    Which is why I write the four-figure check. But I’m fortunate that I CAN write that check. I don’t know what I’d do if I couldn’t, knowing what I know.

    Comment by Christie Keith — March 18, 2011 @ 9:08 pm

  61. Lots of great points raised above that I would like to address:

    -As mentioned above, OVE can certainly be performed in cats, but there is no data as of yet comparing outcomes between OVE’s and OVH’s in this species (the poor neglected kitties).
    -In the abdominal cavity, there is really no clear distinctive mark/change in feel/clear line that delineates where the uterus ends and the cervix begins. Surgically one removes all that one can within reason, but invariably a small amount of uterine tissue is retained. This is where a stump pyometra can develop.
    -Regarding the questions raised re: the incidence of breast cancer, for some a 26% risk would not be reasonable. They would prefer to eliminate any risk by spaying before the first heat. No question that spaying before two years of age also reduces the likelihood of mammary cancer, but not to the same degree. I really do think we are saying the same thing here. Once more research is done, however, we may find that there are more problems resulting from spaying before the first heat than we’d ever realized in which case more people might be willing to compromise on the mammary cancer risk issue. In other words, if spaying at 2 years of age rather than 6 months of age reduces the risk of developing primary bone cancer by 70%, spaying at 2 years of age seems like a reasonable compromise in spite of the increased risk of mammary cancer. Hope this makes sense.
    -Lastly, we’ll see if Dr. Downing will comment more extensively on blood pressure monitoring. One paper quite awhile back (can’t readily put my finger on it at the moment) identified blood pressure as the tangibly measurable parameter most closely correlated with pain. That information may now be outdated.

    Comment by Dr. Nancy Kay — March 18, 2011 @ 10:41 pm

  62. Any comments from DVMs on ultrasonic surgery (Harmonic scalpel) for a spay?

    http://www.portolaplazaveterinaryhospital.com/

    Comment by CathyA — March 19, 2011 @ 5:20 am

  63. Thank you for that explanation, Dr. Kay.

    Now in regards to your comment about mammary cancer, I’ve heard these numbers Laura is quoting before, but I’ve never been able to get a straight answer from a vet in regards to what the ACTUAL number is.

    For example, you state that after the age of 2 there is a 26% chance of mammary cancer (1 in 4).

    However, Laura’s interpretation of the study is as follows:

    “The 1969 study by Schneider et.al. found that the risk of mammary cancer for female dogs spayed after two or more estrus cycles is only 26% of risk that intact female dogs have.”

    Not a 26% risk, but 26% of the total risk. Meaning 74% LESS risk than the overall risk to an intact dog (of what age, I wonder?).

    These are very different numbers – the second of course, hinges on the actual risk percentage of an intact female, which unless it is 100% (which strikes me as ridiculous) means that the risk is actually much lower than the 26% that gets quoted (if I’m not mistaken, this is the point Laura was trying to make.

    Any clarification?

    Comment by Kim — March 19, 2011 @ 8:35 am

  64. Dr Kay, I don’t believe we’re saying the same thing.

    The often cited 26% risk of mammary cancer in dogs spayed after 2 years of age or 2 estrus cycles are misreadings of Schneider [1]. That is not what this study found. Please refer to Table 4 of Schneider (click on my name below to access a copy of the article). Here one will find the source of the numbers that have been misrepresented in many thousands of blogs, websites, veterinary “fact sheets” about spay-neuter, and other veterinary sources. The right most column of “Relative Risks” have been misrepresented as absolute risks. These are totally different things.

    Sonnenschein [2] found that the odds ratios (relative risks) for mammary cancer as a function of age at spay and juvenile body weight to be:

    Age at spay……..Juvenile Body Weight
    (years)………. not thin ……..thin
    Intact…………. 1.0……….. 0.30
    >5.0…………… 0.94………. 0.28
    2.6-5.0………… 0.30………. 0.09
    <=2.5………….. 0.03………. 0.008

    To apply these relative risks to a specific breed, one needs to know the absolute risk among intact dogs of that breed. In Boxers this was found to be 40% [3]. Priester [4] determined relative risks of mammary cancer for a number of breeds.

    Let's use German Shepherd Dogs as an example. Combining the findings from the aforementioned studies, the absolute risk of mammary cancer in intact female GSDs appears to be about 16%.

    Now let's estimate absolute risks for spayed GSDs. Combining the 16% risk with the findings from Sonnenschein [2] indicates that "not thin" GSDs spayed between 2.6 and 5.0 years of age have about a 0.30 * 16% = 5% risk of mammary cancer while "thin" GSDs spayed between 2.6 and 5.0 years of age have about a 0.09 * 16% = 1 – 2 % risk of mammary cancer.

    For GSDs spayed before 2.5 years, estimated mammary cancer absolute risks are 0.5 % and 0.1 – 0.2% for "not thin" and "thin" GSDs, respectively.

    The point here is that the often repeated warning that dogs need to be spayed before their 2nd estrus or they will have a 26% risk of mammary cancer is not only a misreading of Schneider [1], it is quite exaggerated.

    An owner can wait until their dog is a few years old to spay her. She will end up with a low risk of mammary cancer and will experience health and behavioral benefits due to delaying the surgery.

    One of the key findings of Sonnenschein [2] is that juvenile weight is a major risk factor for canine mammary cancer (a disease mostly of old age). The risk is about 3 times higher for "not thin" dogs than for "thin" dogs. The "not thin" category includes both "average" and "overweight" dogs. Judging from what I see in my veterinarian's office and at parks that have lots of dogs, few dogs are "thin". Indeed, Sonnenschein [2] found that only about 20% of dogs were "thin". Most dogs carry too much weight.

    There are no health benefits for having a dog overweight and many health benefits for keeping her lean. Spaying, on the other hand, has both adverse and beneficial impacts to health. Yet one will find orders of magnitude more discussion about the health benefits of spaying — much of it erroneous or misleading — than about the health benefits of keeping dogs lean.

    [1]Schneider, R, Dorn, CR, Taylor, DON. Factors Influencing Canine Mammary Cancer Development and Postsurgical Survival. J Natl Cancer Institute, Vol 43, No 6, Dec. 1969

    [2] Sonnenschein EG, Glickman LT, Goldschmidt MH, McKee LJ, "Body Conformation, Diet, and Risk of Breast Cancer in Pet Dogs: A Case-Control Study", American Journal of Epidemiology, 1991, Vol 133, No 7, 694-703

    [3] Moe L. Population-based incidence of mammary tumours in some dog breeds. J of Reproduction and
    Fertility Supplment 57, 439-443.

    [4] Priester WA. J Small Anim Pract. 1979 Jan;20(1):1-11.
    Occurrence of mammary neoplasms in bitches in relation to breed, age, tumour type, and geographical region from which reported.

    Comment by LauraS — March 19, 2011 @ 1:59 pm

  65. in regards to my male with one testicle, yes he had a retained testicle, it was removed at the same time he had the vasectomy and had all his joints x-rayed to rule out any problems there that would cause how he moves.
    I am glad that more people are starting to find out about the not so good things in regards to neutering, especially at a very young age. I have known about it for over a decade, had a hard time finding info in the US at the time, so I looked for info in my home country of Germany, where neutering isn’t routinely done and elective surgery like that falls under the cruelty laws which we have in the US too, but nobody seems to care that animals are subjected to unneccessary pain and the dangers that come with any surgery mainly because it’s more convenient to have them desexed. If people object to the behaviors that come with male dogs, why do they get a male dog then, if they hope for the dog to be calmer after being neutered, why didn’t they get a calmer dog/breed? It is quite possible to select a dog/puppy to match one’s lifestyle and expectations, I find that a lot more responsible than getting a dog that is not a good match and then try to fix that with elective surgery.
    Unwanted litters can happen even to the most responsible breeders, but in general they deal with such a litter in a responsible way. Sterilization certainly provides convenience as it takes away the need to be vigilant about preventing unwanted pregnancies. For myself, I feel guilty when I put my dogs through elective surgery for no other reason than my convenience and I have not done this to my current dogs. I would never forgive myself if I would lose one of them to unneeded surgery. So the only time they will be sterilized is if something else requires anesthesia.
    I do understand the risk of stump pyometra, but according to my vet whom I talked to yesterday, it seems to be different from a closed pyometra with an intact uterus. My guess would be that there may be more obvious symptoms than with a closed pyometra. I am hoping to find more info on this subject.

    Comment by Marlene — March 19, 2011 @ 11:42 pm

  66. If we leave the ovaries in a human (unless there is a rpessing need to remove), would we not be better served with leaving the ovaries in the dog (or cat)? Would the hormones be helpful? Tubal ligation would prevent pregnancy, yet retention of the ovaries would seem still less invasive than even OVE.

    Comment by JenniferP — March 20, 2011 @ 1:42 pm

  67. Jennifer, you just made me wonder…

    What is the effect of an OVH on a woman’s breast cancer risk? Does it affect it at all? If so, how? How does this compare to the real canine risk (if we can ever agree on an overall number – I’d guess that VPI or another pet insurance company would have statistics on the risk for intact bitches at various ages?).

    I just had to wonder, that if I knew I could remove or greatly reduce my chances of breast cancer in myself by having my ovaries removed, would doctors consider that a reasonable decision? What percentage of reduction would make it reasonable? How does this compare with how we assess the risks involved with OVH in dogs and mammary cancer?

    Comment by Kim — March 20, 2011 @ 2:19 pm

  68. Dr. Kay, thanks for your explanation regarding BP and pain. As a layperson, I realize that I am only basing this on anecdotal observation of my loved ones (human) when they were in great physical pain. I just can’t imagine BP not being a reliable indicator of pain, when stress, fear, pain, etc, can all drastically impact BP in humans. Since there are so many similarities between two legged and four legged animals, I’m just surprised at the comments/lack of research,lack of monitoring regarding BP /pain indices in our four legged companions.

    Comment by Peggy — March 21, 2011 @ 7:58 am

  69. Just a heads up that Dr. Kay is dealing with a family emergency right now and will be away from the blog for a few days.

    Comment by Christie Keith — March 21, 2011 @ 8:31 am

  70. Oh dear! I hope all will be well with her and her family!

    Comment by The OTHER Pat — March 21, 2011 @ 9:59 am

  71. Got nuthin. Just noticed that in Gina’s post on McKenzie, linked above, Jennifer Fearing commented: “I’m really hopeful that a safe chemical sterilant is not too far off in the future. It seems archaic to have to surgically remove organs to prevent reproduction.”

    Archaic indeed [among other things], considering all you really have to do to prevent reproduction is practice responsible management of your dogs.

    Also: good to see Marlene’s comments like #65 above, including reference to a country [Germany] where neutering isn’t routine.

    Comment by Luisa — March 21, 2011 @ 3:40 pm

  72. We need a few european vets to chime in and estimate average pyo or mammary cancer cases in their experience while practicing. With altered being the exception over there, surely a better data model is achievable than the one we have.

    Comment by Kim — March 22, 2011 @ 7:20 am

  73. I have wondered for a very long time why vets don’t just do ovariectomies. It seems to me it is old school to take out so many body parts “just in case,” especially when the incidence of pyometro is so low. It would also seem to cut down on recovery time and maybe infections if done laproscopically.

    Spaying is a necessity in our culture to keep unwanted animal populations down, however, I have had many GSD’s and they are different after the surgery. I have resorted to not sterilizing my dogs until they are at least 18 – 24 months old and I have seen good results from this both physically and in their personalities. I know this is not an option for everyone and it brings with it an entirely new set of responsibility when you have an intact animal. I firmly believe then when you deprive a young animal of their natural hormones at a very young age it has a negative effect on their health and well-being. My dogs are hearty, eat lots of meat, eggs, vegetables and grains along with high grade commercial food and I have had excellent luck with them living very healthy and extremely long lives. (Currently my oldest female is 14 years old and still wobbles outside for a slow walk).

    Comment by patti — April 8, 2011 @ 6:41 am

  74. Spaying is a necessity in our culture to keep unwanted animal populations down, however, I have had many GSD’s and they are different after the surgery.

    Comment by patti — April 8, 2011 @ 6:41 am

    Patti, how are they different?

    Comment by Mary Mary — April 8, 2011 @ 7:42 am

  75. They seem more placid and not as instinctually base as the dogs I have kept intact. This works for a lot of dog owners, but I just love the breed and I love their natural instinctiveness (although it requires a lot of training to keep them in check!). The females I have had seem to be naturally more attentive then the males regardless of being spayed or not. So the females I have spayed don’t seem to have as pronounced behavioural changes as the males I have neutered. However, this being said I have not spayed a female before her 2nd heat cycle so I don’t know if this makes a difference or not. The males definately lose a little panache. Not quite as sharp. Don’t get me wrong I am all for spaying and neutering to keep population down but I have noticed a difference in my dogs.

    Comment by patti — April 12, 2011 @ 6:17 am

  76. I have looked at the available research, including the referenced article above and decided for my puppy we are going to have a laparoscopic ovariectomy. We are waiting until she is at least a year old to reduce the risk of osteosarcoma, and decided on the just removing the ovaries as we understand without the hormones they produce we won’t run the risk of pyometra so we are leaving the uterus intact. The reduced risk of mammary cancer as well as not having her go through estrus a couple times a year are positive aspects of ovarian spaying we can live with despite knowing we are interfering with her hormone production and increased odds of other medical problems.

    We have had 2 female dogs and both have gone through one estrus cycle. Our 8 month old puppy is currently going through estrus, and has been dripping fluids throughout our house for three weeks. We have plastic sheeting on the floors, as well as old bedsheets and blankets on the floors and furniture. There is no way we will do this a couple times a year for years on end. The mess, and the odor is something we certainly won’t miss… She is also very high-strung and would not do well in a confined area so that option is out.

    If there was an alternative sterilization method where we could leave the ovaries and uterus intact without going through estrus we would choose that. Until then, we have chosen what we feel is the best alternative available.

    Comment by DDN — April 13, 2011 @ 10:43 am

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