Hello, it's Anthony Chadwick from the webinarett welcoming you to another episode of Vet Chat. Today we're going to be speaking to Doctor Stefanos Klodais, who's a good friend of mine from Greece, works in the army but is also an expert, soft tissue surgeon. And we're gonna be talking about neutering of dogs and cats, mainly dogs.
So I'm gonna, welcome Stefanos in my best Greek. Carlos Sorie on Doctor Stefanos. I tried, I tried Stefanos.
You, you can be better though. I'm fine thank you thank you good, good, good. I'm, I'm showing off everyone because I've just come back from Rhodes for the ISFM conference and I was hoping to meet Stefanos, but unfortunately some of the, Team at his practise developed COVID, so you have to study the, study the ship, didn't you?
Yeah, it was pretty much uncomfortable for me to cancel the very last moment. We will have a chance to meet again. Yes, yes, definitely, definitely.
I'm I'm sure it was a great conference and a great place like Rhodes. Rhodes is a beautiful island, isn't it? Yes, of course it is.
Is it one of your finest Greek islands or are they all as good as each other? Well, my number one is the island that I was born, Crete. So everything is.
Of course, that's fair enough. It's a bit like Liverpool is the, the number one city in the UK. And not only for UK my preference.
We, we are also great footballers, but I promise everyone we're not going to be talking about, Liverpool, the football team. We are here to talk about, dogs and cats and, and the whole aspect of neutering and spaying and castrating. And I thought we'd start off with the handy acronym that I heard you talking about at the beginning, when you're thinking about spaying or neutering an animal.
You, you begin to think about the boat that I was talking about there before you were studying the ship, the boat. What, what does a boat mean to you when you're thinking about neutering Stefanos? Well, B is for breed, O is for owner, A is for age, and T is for timing.
I think that if we consider all those four things. But altogether as a whole. Then we might have the option to have a good decision and give a good recommendation to the owner of what should be done because as it seems at the moment, every case is different and we need to have a case by case counselling for the owners.
Exactly. I think there was a Tendency to have a very much, this is the way we do it, it doesn't matter what type of breed, it's just our strategy and some people were saying before seasons, some people after seasons, today, the 13th of July, step on us, I know you're not going to believe it, but it's the 32nd. Anniversary of me qualifying as a vet.
And I actually had a, a lovely lecture called Doctor Peter Holt, who was our external examiner, who was the expert on, incontinence in bitches. And it was all very much about, you know, when to spa and what makes, incontinence more likely in bitches. And that area is, was obviously an area that he championed, but it's developed.
Even over the last 3 decades to make us a lot clearer how we can. Reduce the incidences of those diseases and you're quite right, there are certain breeds that will be much more likely to develop incontinence than other breeds, isn't there? Of course, but as we start talking about the pros and cons of spa and uterine, you started very nicely from the incontinence thing.
You know that incontinence may develop 4 weeks to 10 years post Spain. Yeah, so. At the moment, we do know that it is more common in spayed pets, regardless of the surgical timing.
People, people, people believe that it is, some people believe that it is more common in pets that are spayed at an early age. Well, that is not true. We do know that the prevalence of incontinence in spay dogs is about 5 to 20% depending if you compare with exactly 0 to 1%.
And depends on the paper you read about the right percentage, but we do know that it's 5 to 20%, and we also know that there is no link between the age of space and the likelihood of developing urinary incontinence. So it's very, it's very clear for us at the moment, and it took us some years to understand that. I remember another paper more from the perspective of castration, where a Great Dane was castrated very early in life and then I think it got a fracture, I think it was a femoral fracture, but it may have been a growth plate fracture, they were again more prone.
But of course this was a case of one, which you know, isn't evidence based and isn't you know, double blinded and all these things because that's difficult to do. In a surgical Way, isn't it, to have that sort of non-biased test that you set up. This is one more problem that we have at the moment that we have a lack of evidence on appropriate timing.
There are no randomised controlled lifetime studies that we can read in order to have some things to say straightforward. That is why I told you from the very beginning that At the moment it's a case by case counselling, or at least that it should be. There, you can have a strategy if you want, for some breeds, for some owners.
I was gonna say, Stefanus, there seems to be something that sits in your stomach to say that this is right, that an older dog like a Great Dane that obviously reaches maturity much later than a Yorkshire terrier would do, that we should time those operations later. Than with the Yorkshire terrier, we do know that especially for large breeds or for giant breeds, space neuters should be done before beyond their musculoskeletal maturity. That means at least after one year, we have to go beyond 1 year.
There is no data saying that we can do some spa in the grey area when it's 4 months old. It's not, it's not something that we should do, and if we do that, we will face some problems. Yes, exactly, because, because we need to understand that space or neuters do not affect just the pet's reproductive status.
It's more than that. Yeah, it's profound, isn't it? Yes, we know that, we know that there are, there are papers to read that say that we have studies.
We want the animal to to mature and you know, in the end, one of the first things as a vet is to do no harm, isn't it? So if we're doing preventative type procedures, be they vaccinations, flea treatments. Operations like neutering, then we don't want to leave the animal worse off after.
As you said before, it's a very, before we joined, it's a very routine procedure, but it's also very difficult because this is a healthy animal. Yes. And at the end of the procedure you want to make sure the animal is still healthy, of course.
And as I see it as a surgeon, for me it's the most difficult operation I can do even now after more than 20 years. It's more I practise. And I think it also can, for young vets qualifying, it can be something that makes them lose their confidence because they're used to, being in control, passing all their exams first time and then suddenly, you know, fairly new into the profession, at a practise, they're asked to do a spay, maybe they're supported, maybe they're not.
A ligature slips, there's blood coming up to the surface. What's your advice as to how, You know, an inexperienced surgeon should cope with that sort of occurrence. Well, you do know that in surgery we have a small motto, and the motto is very simple.
It says, See one, do one, teach one. So there is a learning curve. You have to see first how it's done, then you have to try under the supervision, then you have to do it by yourself with someone supervising you.
And after that, when you feel confident. It's the right time for you to teach how it's done. This is the right way to work.
So, in, in, in small animal practises and clinics and hospitals, most of the times things should be working this way, not only for surgery, of course, but For surgery, because for surgery, we're talking that now it's very important. So if you do that, you will have less sweat in your face. And the other thing, of course, remembering, you know, my time operating, you can get too worried as well.
A bit of ooze coming from Fat, you know, blood coming up, that's normal, but sometimes people get so worried about that. You know when something is really bleeding cause the, the blood comes up very quick to you, doesn't it? Yes, yes, that, that is true.
I remember. Once, one of my, professors at the university, when we were talking about, castration in Spain, the advice that he gave me when it came to obese patients, I asked him, professor, OK, there are many patients, right, dogs, cats, overweight, obese. What do we do with them?
I mean, we have to spay them, and the answer was for him, no, you, you didn't have to spay them. Let, tell them to lose weight and come afterwards. And what he meant was that what you exactly said, I mean I mean before that, it, it has some potential risk if you go in surgery with an obese patient.
And yes, if you're not an experienced one, you should have been starting doing surgery with obese patients. For an experienced person, maybe it's OK. Yeah, but also the worry with an obese dog is when you spay it, you make the problem even worse because most dogs post spay or castration will put on further weight, won't they?
Well, regarding this thing, I must tell you this. I read a recent paper about obesity in pets in the United States, where approximately 50 to 60% of those are overweight or obese. Well, there are many diets, of course, we know that, that are available at the moment, so can be fed to our pets to complete their requirements, OK, of that, but if and after diagnosis and if they're, even after those pets were on a weight management programme, only 10% lose weight.
Maybe there is an owner, an owner compliance on that, probably yes. But only 10% lose weight, and from those 10% who lose weight, 40% of those will resume their overweight status in less than a year. The same with people, Stefanos.
Yes, the same with people. It's interesting. I mean, talking about not spaying a dog because maybe it's overweight or there's another issue.
Do you have much experience or any thoughts on some of the chemical agents that are available to chemically castrate or or delay season in the in the dogs? Yes, I, I know things about them, but I generally do not use them unless, unless, unless if it is for a therapeutic reason, of course. Yeah, what are your thoughts with, you know, the actual castration operation, and, and to some degree also the, the spa, using, those particularly maybe the ovarian stumps, what sort of stitch are you putting in there?
Is that a transfixing suture? Is that, how do you? Try and prevent that suture slipping off for those people listening again, perhaps who are a bit nervous about that part of the procedure and what do you do with the suspenary ligament?
Well, regarding suturing, I generally use the mill or knot. It looks, it looks very easy and safe to me to apply, no, no matter how big or small. The pedicle is regarding, regarding sutures, I generally work with monofilament absorbable sutures, but when it comes to ligatures, no problem to use multi filaments also.
I generally have no problems with that. I feel very confident and the reason I feel confident is that from all these years and practising surgery I stick to the things that I've learned when I was A young vet from my colleagues at that moment. So I got up the ladder, the ladder, the learning curve I told you before.
So I think that the Miller node is the best note that you can use. In order to sleep very nice at night and have of course less oozing, oozing from the from the pedicles. Yeah.
No, I must admit that was in the early stages, the, the sleeping at night stuff was, was always a tiny worry if you had something and you weren't quite happy with that, whatever the, the procedure was, whether it was spa or whatever, that the next day that the the pet was still alive. That's true. Do you want to join the largest online veterinary community in the world?
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To find out more, visit the webinar vet.com/m memberships. When you see complications sort of postoperatively, what are the complications that you see most perhaps from other people's surgery, for for sprays and castrates?
I, I, I think that the more often things that we see is anything that has to do about the incision. That means that we may have some dermatitis, maybe some leakage. Some of the pets are leaking the incision, probably because we have used sutures that are very tight.
So Elizabeth and colour is a mast after this kind of operations routinely used for both dogs and cats, seroma from the incision. Most of, of the complication has to do with the, with the incision about the wound, about the surgical wound that we create. I know that some people are, are talking about how long the incision is, how big the incision is.
I mean, some people are doing a big one incision, some others are making a small hole just to do this kind of surgery. The last years, we have many people, working with laparoscopes and doing this, keyhole, surgeries which are completely fine, of course. So at the moment there are many options that the No can have around, to have the best result for his double or c.
It's really interesting seeing the rise of la laparoscopy, and I remember when I was a student, I went to Zimbabwe and one of the vets in Harare there was just doing removing of ovaries and leaving the uterus in, obviously still as a surgical going in and and finding them rather than using a laparoscope, but it's it's again, it's amazing how things come around that was in in Harare and . Of course we'd all been taught 30 years ago that you removed, it was an ovario hysterectomy. Now, of course, we're seeing that removing the ovaries is perfectly acceptable.
So which do you prefer? Do you do quite a lot of laparoscopic spaces or do you mainly the the, the more surgical, you know, removing everything? In, in my routine more of these cases are open surgery cases.
When it comes to ovarectomy or ovar hysterectomy, of course, both are acceptable. I do both. What would be, what would be your reason to choose one or to the age of the patient.
If I have a patient that a dog or a cat, a very young one, I can definitely say that I may prefer ovarectomy. If my patient is a big one in age, I mean, 567 years old, I may consider a virusectomy. I suppose partly because if you leave the uterus in and it then becomes cancerous, that's something that you've potentially missed that you could have helped you.
Yes, but it's both acceptable no matter what you choose to do. It's one of my locums, a German locum once said to me, Stefanos, that if two vets are in the room and they both agree with each other, one of them is not a vet. So I, I thought that's quite a nice story.
That is true, same count with human physicians. Yes, yeah, 44 doctors, 5 opinions. Yeah.
My, my one of my vets early on in my career would do very small holes and, and, you know, could actually get everything out through that and, and obviously it wasn't a, it wasn't a laparoscopic spa, it was a, you know, a full surgical spa. But then at the same time, he would also remind me that big mistakes can come out of small holes as well, so it's, it's right to get it to the size that you feel comfortable that will help you to make a successful operation, but not so big. That the poor dog is split from one end to the other.
Your incision should be giving you confidence, so. Yeah, you need to have a confident incision to do your job properly. It is as simple as that.
If you want a big one, do a big one. If you do a small one, do a small one. Yeah, exactly.
Moving on, because you know I love cats, what is the current thought about flying space versus, Midline space, is that something you have an opinion on? Flank incision is not my option. Never was, even from the university, what we were taught was to do the midline one, and just in certain cases that we couldn't have access to to the midline would be choose to do a flank one, for example, for fibre epithelial hyperplasia, for example, those cases.
It's fascinating again, you know, different countries, we, we were all taught. In the UK to do flanks and that's what we did most of, of course, you know, I could do a a midline and often would do on the more fancy cats like Siamese and Persians because obviously you could actually have a different colour hair coming back on the flank if you did it. So both, both were comfortable, but yeah, it's interesting, it's a, it's, you see different things in different countries, don't you?
Yes, of course, and that's good about a profession. I mean, I, I, I do feel confident, I do feel confident pretty much to do both operations, no problem with me. So if someone tells me I want you to do a flank one, I will say, OK, no problem.
It's not, it's not unethical. I mean, it's, it's OK, but if you ask me what I prefer, I prefer what is less bloody. And going through the midline is less bloody.
Nice and avascular. Simple as that. Stefanos, we, you talked a little bit about timing before as well with your boat acronym.
What is your thoughts about, often with cats it's difficult if they're in season that you have to pick a time. To spay them obviously with dogs. If they're coming into season, when is the sort of optimal time that you like to operate on on dogs and then, you know, if you operate on a cat and you see that it's in season, when you open it up, what, what maybe further precautions do you take?
I generally try to avoid to do space during heat or season. I try to avoid that and I do, I do make it in approximately 99% of cases. The haemorrhage that you may encounter in dogs or cats under heat is unpredictable.
And also you do have some problems with anaesthesia, and that is why it's not my option to do. Space or others at an early age or when the females are in heat. It was obviously easy to predict with a female dog because you knew, depending on the dog that when it might come into season.
Certainly when I was in practise, there was still a controversy whether you could spay before or after season. Obviously if the animal has had a season, are you usually looking at about 3 months after that to book them in for the operation? Is that still your sort of strategy or what do you do?
At least, at least 1 month after, at least 1 month after, because at some points I have to consider also the owner needs. So if . We talk to each other and see what's the appropriate timing comparing when it comes to when he's available for that.
I mean, we all are living our life is too complicated at the moment, and especially the last two years. Because of COVID, walking around, going around is not so easy, so. At some point we have to see when it's good for all of us and, and of course for the pet.
And of course with cats it's more difficult. We used to work with a charity that trapped feral cats. You then have to take them as you find them and of course they could be early pregnant, they could be late pregnant, they could be, you know, totally in a nice stress or they can be in season and then it is just, as you say, it's a, It's a more difficult procedure, isn't it?
Yeah, yeah, yeah, yeah. When it comes to population control and you have to do the operation, then things are completely different. You will do it, of course, taking all the precaution measures, yeah, that you may think at that moment.
What are your thoughts on operating at what age do you think? You reach a certain stage and you say there's no point now in doing the spay, although we know there may be pyometer or whatever down the line. Do you at some point stop suggesting spaying perhaps to a client who has never quite got round to it?
Well, that depends, of course, on the owner first if he has no problem and and the animal is already. 10 or 12 years old, if we're talking about a dog, then OK, I will say it once. If he doesn't want to go more, then I will stop saying that.
We do have, we do have some owners who just do not want their animals to be spayed or neutered, no problem if they see that way, but our, our obligation as vets is to let them know about the relative risks. So we need an owner who is well informed. That's the number one for us.
So if he is well informed, then it's up to him or her or to decide. We cannot, we cannot push anything. Yeah, I know, of course.
A final one, female dog comes in with mammary tumours. It's about 5 or 6 years old. How do you, approach that now, because again, things change and habits change.
Is that just, Remove the mammary glands either as a strip or partial depending on, you know, where it is, or would you, would you look to spay those animals as well as, as an older dog, because obviously a younger dog, it's preventative, isn't it, but as they get older it isn't. I will always advise spay to, of course, to prevent other diseases like parameter, and we do know that the percentage of parameter, for example, in a in a female that is not spayed. It's at least 25 or 30% of our goal.
So it's, so it's a big one. I always say the owners these things and we take the decision together. I'm not forcing them to take this kind of a decision, but I want them to be well informed.
It's as you were saying before, you know, we've got that lovely acronym, the sort of boat, which is breed owner, age and timing, all of those factors have to be considered together, and then also from the other side you were talking about the patient, the owner, and then, You know, the community, particularly with cats, you don't want to be overrun with cats, so there's a, there's an obligation to the wider community as well, isn't there? Of course. Cats are, I, I don't know about the UK, but in our country we have a big population of cats.
So we do have the same problem. So we, we, we don't want this overpopulation to happen. So from time to time we are facing the same problem like you do.
I remember one of my favourite books was My Family and Other Animals and one of Jerry's tutors loved cats but would occasionally disappear with a shotgun as he was teaching Jerry and then . Come back crying because he'd obviously, this was in Corfu, he'd shot a cat we we now have a slightly better, well much better strategies for for limiting the cat population don't we? Yes, hopefully, yes we have.
Things have changed. Stefanos, thank you so much for that overview. It's so interesting cos obviously this was very much part of my life.
The last few years I've not been in practise, so it's always interesting to see where things are going, and it's always great to speak to you as well. Thank you very much for inviting me. Always a pleasure to talk with you.
And, and let's hope, next year we, we bring back the European Cup as well. Hopefully, yes, yes, we would love that. Thank you, take care.
Bye bye.
