PART 1 - What happened to my dog Pax and why I decided to neuter him
Pax loves water and this time the river is wild. He doesn’t seem to notice how strong the current is, running and jumping over the rocks with the ease and finesse of a Cirque du Soleil acrobat. I turned away for just a second, and when I turned back, I scanned the rocks on the river until my eyes locked on Pax’s struggling body being swept away by the current, disappearing over the edge of the waterfall just 30 feet away!
He is okay, he is okay!!!! I am trying to convince myself out loud, running as fast as I can, gasping for breath, stumbling and falling on the slippery rocks to get to the edge of the waterfall. Paaaaaax! I leaned over the edge, and I saw his lifeless body on the rocks below.
It was just a dream, and I opened my eyes with a sense of relief. The room is still dark on a rainy November morning. My heart is still pounding. I look to the right at Pax’s usual spot. He is snoozing on his comfy natural rubber foam bed. I’m relieved but I also know that my nightmare is the result of last week’s events…
2 months ago, September 2020
“Here it is!” my colleague veterinarian, Doug, proclaims victoriously, pointing at a small plum-sized shape on the ultrasound screen. Pax’s undescended testicle was stuck inside his abdomen, never arriving at its final destination. Cryptorchidism is relatively rare but not unheard of in dogs, and Pax drew the unlucky card. I recalled one of my patients many years back where the undescended testicle turned into an orange-sized Sertoli cell tumour, which is one of the potential outcomes of cryptorchidism. I knew I would have to eventually decide whether to leave it be, or put Pax through abdominal surgery, and I dreaded the thought of both options.
However, I also knew that in the end, I would take the path of least possible regret. Not going ahead with the surgery could mean problems down the road, so despite the trauma and stress of the surgery, it still looked like the better option.
It has been a few years since I decided to hang up my surgery hat and there were a few reasons why. My workload at peterdobias.com has increased, and there was also my loss of fine focus vision, the result of a concussion after I was rear-ended by a truck. Leaving surgery wasn’t difficult, because there is no shortage of veterinary surgeons out there. I have also never lost a dog under anesthesia, and it seemed like the right time to stop right there, at my best.
The night before Pax’s surgery, I slept okay, but not great. It didn’t matter that I knew anesthesia and surgery were very safe. Taking my own dog in for surgery felt as strange as it did for my first dog Skai, 19 years ago. Back then, I neutered Skai on my own; this time, I asked my longtime friend to do the job while I decided to be in charge of anesthesia.
Generally, I like doing sedation before the patient comes into the facility, letting them relax within the comfort of their car. One small “jab” and they are on their way to doggy dreamland! I gave him his sedative and settled beside him in the back seat of the car, watching him drift off.
NOTE: If possible, ask your vet to sedate your dog in a similar way to reduce stress, or at least request to be present during the sedation period. Dogs are much more relaxed going into surgery and there is no real reason why they should be thrown into a cage before being sedated. If the clinic has several patients booked on that day, ask them to call you when they are ready for your dog’s procedure. It is stressful to be in a strange environment full of weird smells and noises.
When Pax was sedated, I carried him to the anesthesia room. It felt like I stepped back into the past; I remembered all the procedure steps and drug dosages as if I used them just yesterday. I drew up Pax’s meds, put an IV catheter in, connected the drip, and shut off my emotions in order to focus.
This was my old survival mode that allowed me to focus and not get derailed by the fact that I had my own dog’s life in my hands. I imagine this is how airline pilots feel. They have the lives of others in their hands, yet they don’t think about it while flying.
The sound of clippers was familiar too. I carefully stretched the skin on Pax’s belly to avoid clipper burns. When done, the assistant tried to be helpful and started shaving a little patch of skin for the pulse oximeter. “Be careful,” I asked her but it was too late. Pax’s skin was bleeding in a split second. “Damn it, I should have never let her touch the clippers,” I thought. I have seen “clipper burns” happen way too often! “It’s okay, it will heal,” I pretended to be all good about it, it made no sense to get all worked up about it. What was done, was done and I know it wasn’t done on purpose.
Searching for the lost testicle
“The lost testicle is in the groin, I am sure!”, the clinic owner put his two cents in. “Yes, it looks like it,” my surgeon friend agreed. First I thought they were wrong, but then I got excited. What if I was wrong? In that case, we would not need to open the abdomen. There was a slight possibility that the testicle truly descended.
I felt the groin and wasn’t convinced, but it was two against one, and I would feel awful if we opened Pax’s abdomen and found nothing there. I agreed to explore the groin.
I carried Pax carefully into the surgery, he was breathing regularly, his heart rate and blood pressure were good, his pink belly scrubbed clean. There are still some clinics that don’t use IV fluids in surgery, but most vets now use standard intravenous fluids to protect the kidneys from damage by maintaining adequate hydration and blood circulation.
I placed Pax on the surgical table, and gently stretched and supported his legs so that his hips and lumbar-sacral spine weren’t overextended.
Note: Dogs that are stretched too much on the surgery table during procedures may suffer an injury or subluxation (misalignment of the sacral-lumbar region). Such injury may lead to urinary incontinence, which can be easily misdiagnosed as low estrogen level incontinence. Correcting such misalignments often resolves this problem.
The scalpel slid through Pax’s skin. I took a deep breath and closed my eyes, thinking that perhaps I made a mistake by taking part in the surgery. But then I quickly dismissed that thought, because I could now oversee the process and make decisions on the spot, if needed.
Removing the descended testicle was easy. I remember asking, what gave us the right to “alter” our animal friends without their consent. (I will touch on this topic in more detail in PART 2 before I am finished today.)
After a 30 minute exploration of Pax’s groin, it was clear that my colleagues were wrong and the testicle was in the abdomen. However, the unnecessary groin trauma was done and I could do nothing about it. “Let’s open up the abdomen,” I asked my friend.
In general, it is much easier to perform abdominal surgery on a female because, in males, their “bits” are right in the midline, making surgical access more difficult. Sometimes the incision has to be made parallel to the penis, which is more painful. Based on the position of Pax’s testicle on the ultrasound, I asked for the incision to be made a little more forward.
“Make sure you are right in the midline!,” I jokingly suggested to my friend because making the incision outside of the “white line” or linea alba is more painful, it bleeds more and heals slower.
Locating the “wandering” testicle can be difficult, as it is often hidden in between the loops of the small intestine. I watched Paxi’s healthy, glistening intestinal loops coming to the surface, but somehow I could handle it. I thought how strange it was that I could see a dog’s skin being cut, and their abdomen opened, but any human wound or surgery makes me queasy.
“Be gentle,” I prompted my friend, as a typical second cook in the kitchen. Ten minutes passed, then twenty, and thirty, and then I stopped counting. We couldn’t find the stray testicle, and I was worried because I knew this is not how it was supposed to go. I also knew we had to find it, as I didn’t want to put Pax through a second surgery.
“Can I get a gown and gloves?” I asked the assistant. I scrubbed and gloved up, shutting off any remaining bit of emotions so that I could hold it together. My fingers entered the warmth of Pax’s belly.
After 10 or 15 minutes with no luck, we decided to enlarge the incision and my friend and I swapped positions. “I found it, here it is, grab it with the forceps!”, he yelled. “Let’s make sure it is truly it,” I replied. I didn’t want to mistakenly pinch an intestinal loop, which has a very similar colour. I ran my finger across the firm tissue surface and grabbed it with the forceps before it slithered away again.
The clamp clicked closed, and I was relieved! The whole surgery took close to two hours of exploring, much longer than any other previous neuter. It wasn’t anyone’s fault. We had to make sure the testicle wasn’t stuck in the groin, and we had to look for it as long as it took.
Note: Closing the incision was routine. I usually like to do intra-cuticular (in the skin) sutures, because dogs don’t lick at those as much. I learned to neatly hide the last knot under the skin and it rarely caused any problems.
Recovery and pain-control
The worst part of surgery is that we can’t explain to our pets what happened, and why they woke up all cut up, hungover, and hurting.
When I used to do anesthesia years back, I was lucky enough to work alongside another colleague, Kathy, who was a real post-anesthetic recovery geek. She always studied the latest methods of pain control and we used to use a really cool method of using ketamine/morphine drip. With this method, our patients recovered gradually without any panic and crying which was otherwise relatively common.
Unfortunately, the clinic where Pax’s surgery took place used a different protocol and didn’t carry morphine. I had to settle for an injection of hydromorphone.
The moment Pax started to recover he was crying, probably from being disoriented. We had to give him another sedative to settle him down and my stress and regrets were mounting. What have I done to my Paxi!?
“Do you have buprenorphine?” I asked the clinic owner, “I would like to take some home for the next couple of days.” Buprenorphine is a relatively new method of pain control that wasn’t used in the old days, but research confirmed it was superior to Tramadol, and with fewer side effects. Unfortunately, they had a few doses of buprenorphine so I used only one injection and then Tramadol. You should also give him meloxicam (Metacam), and also antibiotics, just to be sure,” my colleague recommended but I decided against worrying I would use them unnecessarily and risk potential side-effects.
I have seen several incidences of severe side-effects caused by NSAIDs following surgery, from gastrointestinal bleeding, to sudden onset of kidney failure, and I was determined not to use NSAIDs on Pax because of their potential side-effects.
The trip from the hospital was short and uneventful. We put a blanket on Pax’s favourite couch. He looked groggy from the sedative, but was fairly comfortable. The next day was not great, but still okay and I decided to put Pax on antibiotics because the incision looked a little swollen. It was the path of least regret.
Two days later, I woke up to check on the incision and things were not good. Pax’s groin was hugely swollen, and the scarlet coloured skin was tight and angry. He also started to show some signs of anxiety and agitation from the pain meds, side-effects that can appear in more sensitive animals.
The next night was tough.
Pax was anxious, whimpering, and could not settle. His incision looked even worse than it had a few hours before, and I started to worry that this could really turn ugly, perhaps sepsis and ICU in the worst-case scenario. I knew too much, and by 2 am, my fear and guilt about inflicting so much suffering on Pax took over. I was sitting on the floor, Pax’s head in my lap, tears rolling down my cheeks, wondering if I made the wrong decision. I have been helping thousands of other dogs, solving difficult challenging problems, and here I was having a real human moment with my own dog.
“You should put him on Metronidazole and NSAIDs” my friend urged me the next day, “You shouldn’t risk it. There can be an infection.”
I took a few minutes to think.
Pax was already on a broad-spectrum oral antibiotic, and while infection was possible, it was not high on the list. Adding more antibiotics, such as Metronidazole, will further suppress his immunity, and adding Baytril (another antibiotic) and Metacam, seemed too much.
This was the moment I did what I always do for my patients. Weighing the options, and choosing the path of the least possible regret. I could be wrong, but at least I would not go against what I felt was right.
The turning point
Instead of more drugs, I started Pax on a tablespoon of FeelGood Omega three times daily in a small amount of coconut yogurt. Omega 3’s are scientifically proven to have the same anti-inflammatory effect as NSAIDs, without the side-effects. I added turmeric and I gave Pax the homeopathic remedy Calendula 1M three times daily. My partner was great in icing Pax’s wound every half an hour for 10 minutes which also helped reduce inflammation and discomfort.
The improvement was shockingly fast, and within less than half a day Pax was happier, and the wound was much less inflamed and swollen. I have used this same approach many times before, I just had to forget about being the “dog parent” and put on my professional hat! This all was a good reminder to me about how difficult it is for many pet lovers who have to make decisions for their four-legged family members.
For the next two days, Pax was getting better. He bravely put up with his inflatable collar “MiDog” that I would highly recommend as a great alternative to the hard and uncomfortable plastic Elizabethan style collars that prevent dogs from licking.
Note: If you want to administer any pills and your dog is picky, you can freeze them rolled up in a piece of salmon, goat cheese, or something tasty that can be formed and frozen well.
On day 6 post-surgery, I woke up to find two very unhappy and angry bumps near the abdominal incision. The groin looked great, but the bumps stoked my worry again. An infection? A super bug? A suture reaction, or a reaction to the tissue glue? It was hard to tell.
This time, I just applied the same protocol I used before, and in a few days Pax was pretty much back to normal as if nothing had ever happened!
Seeing him happy, as if nothing much had happened was a true lesson about living in the moment. Wow.
Who was Mr. Hering and what does he have to do with healing?
There is one more note I would like to make. Over the course of Pax’s recovery, his response to the trauma was intense. In retrospect, it doesn’t appear he had an infection but rather a reaction to the trauma, sutures, and possibly tissue glue. Seeing him go down and then back up again so fast, is a good reminder that physical vigour and overall health can produce a stronger, more dramatic, healing response. Inflammation is part of healing, redness and swelling brings more blood, oxygen, and white blood cells, to deal with healing. Most people are conditioned to see the process as negative, and they reach for drugs to dull the defences of the body.
Note: In holistic healing and homeopathy, we often talk about Hering’s law of cure. The body’s natural tendency is to expel impurities and imbalances through the skin, ears, discharges, urine, and feces. Sometimes these “cleansing” reactions may be mild, at other times more dramatic, but suppressing them with “anti” medication often drives the disease and imbalance deeper within, which results in organ disease and more serious chronic degenerative issues.
The main premise of Hering’s law of cure is to SUPPORT but NOT SUPPRESS, which is what I did with Pax.
PART 2 - Is it better to neuter a male dog? - Yes? No? Maybe?
I gather that some of you are wondering what my “verdict” is about neutering and spaying dogs. I have been receiving countless questions and inquiries on this topic, and until now I hesitated about writing an article on this topic. I wasn’t 100% clear.
However, after going through this ordeal with Pax, I am able to give you concise, and more solid advice below.
Shall we neuter, or not neuter, male dogs?
There are several aspects of this quandary and they are health, emotional well-being, and safety. The true naturalists, and especially many men, are adamantly against neutering, but I am not opposed to neutering and spaying in general.
What I am opposed to is early juvenile neuters and spays of dogs less than 6 months old that have become commonplace. These juvenile surgeries lead to poor muscular-skeletal and joint development, as well as other health problems such as cancer, as seen in studies such as, “Long-Term Health Effects of Neutering Dogs: Comparison of Labrador Retrievers with Golden Retrievers.”
I have seen many intact males frustrated by not being able to follow nature’s call if they weren’t intended for breeding, or their mating process was heavily restricted. This frustration sometimes leads to male dogs ‘humping’ anything and everything in sight. People get embarrassed and scold and reprimand their dogs which leads to more frustration, and sometimes aggression. Searching for females to mate with is what nature tells them to focus on, and forbidding them from doing so is like telling someone not to breathe (or breed).
Dog population control also deserves to be addressed and leaving a male dog intact can lead to unwanted pregnancies, dog homelessness, and more suffering.
Prostate diseases, such as inflammation, infections, or cancer, are also almost non-existent in neutered dogs which is a big plus.
Overall, I find neutered male dogs to be much happier and less frustrated in the artificial environment humans have created for them.
Is a vasectomy better than neutering for dogs?
Some people ask me if a vasectomy would be a viable method. The answer is yes, from the population control point of view, and no from the perspective of emotional and behavioural well-being.
If your dog is absolutely lovely, non-aggressive, and you want to keep him intact, you should feel free and un-judged to leave him intact. I am not here to tell people to breed or not breed dogs. Purebred heritage of dogs is seen as important by some, and so is reducing the homeless dog population.
PART 3: To spay, or not to spay?
Female dogs come with a whole other set of considerations. When it comes to making the final decision, having done thousands of spay surgeries, here are a few points for you to consider before you make your decision.
Unless you plan to responsibly breed your female dog, dealing with heats, blood spotting, the complexity of preventing unwanted breeding, and false pregnancies, is challenging and I lean towards spaying.
The traditional method involves removing both the uterus and the ovaries, but I do not generally recommend such surgery.
Should you spare the ovaries, or the uterus?
Not that long ago, I spoke to a canine reproduction vet who agreed that ovary-sparing spays are not as good as they seem to be.
When the ovaries are spared, heats and hormonal cycles still kick in while the uterus is missing. This results in what I call a ‘hormonal roller coaster’ with frustrating periods of heat, alternating with unfulfilled urges for motherhood. The uterine stump, the remnant after spaying, can be also susceptible to inflammation and swelling during the heat, which can be problematic.
Spayed females with spared ovaries are also predisposed to mammary tumours, similar to intact bitches.
If you decide to spay, I recommend removing the ovaries and sparing the uterus, which I did in practice during the last ten years of my surgical work. Such surgery is much less traumatic, and female dogs do very well with it.
Should female dogs be spayed before, or after, their first heat?
This question comes up often and the answer is a little complicated. I generally suggest that dogs should be altered after they are fully grown. This is practically easy in male dogs, but a little bit more of a gamble with female dogs. Some of them will go through the first heat before spaying, others will not.
Technically, mature spay is more traumatic and demanding when it comes to the surgeon’s skills, but either is sensible. The benefit of spaying before the first heat is that the risk of mammary tumours is drastically lower.
In either case, I generally do not recommend spaying before 12 months of age.
At what age should you spay or neuter your dog?
If you decide to spay or neuter, I would recommend waiting at least until your dog’s growth is completed, which varies depending on the breed. I waited with Pax until he was 18 months.
Over the course of my practice, I have not seen dogs who are neutered after they matured having any problems or having a shorter life span. In fact, they are less at risk of running away or getting into an accident by having blinders on while tracking a female in heat. I lost Pax once in a park for about 10 minutes in the dark, and it was scary.
Isn’t spaying and neutering unnatural?
Yes, it is, but here is why I am still inclined to spay and neuter animals outside of a responsible breeding program.
In the past few thousand years, we have created artificial conditions that are far from natural. Dogs no longer roam the wild, and homelessness and overpopulation are serious problems in many parts of the world.
No matter how we look at this, the suffering of one homeless dog is one too many. It’s true that the odd intact male is fine not to breed, but most dogs get frustrated from not being able to follow nature’s call.
In principle, I agree with those people who say that under the ideal natural circumstances, we should not be altering our dogs at all. HOWEVER, we all know that our world is far from what it used to be, and the emotional well-being of our dogs should be our priority.
I neutered Pax because I knew that not neutering him would cause him long term frustration, and emotional suffering, due to the world we live in. Hormones are powerful substances, and restricting our dogs from being sexually active is like driving a car with the parking brake on.
Now, less than two weeks after surgery, he is happy and energetic, despite my worries.
To say this, no one should make you feel guilty about a well informed decision that you’ll make. If everyone spayed and neutered their dogs there would be no puppies, and soon the world would be a very sad place.
The choice is yours and I can’t give you a definite answer
The only purpose of this article is to help you make the best decision for yourself and your dog. I decided to neuter Pax, not only because he was a cryptorchid, but also because he became increasingly frustrated, humpy, and breeding wasn’t an option. I waited until he was fully grown and then made the best decision considering his circumstances and quality of life.
Despite the unexpected and rare challenges we went through, it is very likely that I would make the same decision for him again.
Give your dog a hug for me!
Dr. Peter Dobias