Episode 8 - Two week takedown. Leaving the uterus behind, Charlotte raving about Ketamine and spaying from outside the abdomen!

1.The GP hook

A practical, UK‑GP conversation about everyday neuters and everyday consults: the real decisions we’re making, the protocols we actually use, where the evidence helps – and where we’re honest that it doesn’t.

A practical, UK‑GP conversation about everyday neuters and everyday consults: the real decisions we’re making, the protocols we actually use, where the evidence helps — and where we’re honest that it doesn’t.

If you’ve wrestled a springer’s suspensory on a busy Tuesday, tried to find a cat uterus through a perfect flank window that suddenly isn’t there, or watched a healthy bitch’s BP slide as you nudge the ISO dial — this one’s for you. We also get real about making vaccine consults matter, not just “do the jab”.

2.OVH vs OVE, lap spay vs open — what’s happening in UK GP

What was discussed on the pod

Open OVE in GP? Yes, sometimes

Monday‑Morning Move

If you hit a thick, crunchy, oedematous uterus through a small incision, consider an open OVE rather than extending caudally. Make sure your practice policy covers it and your ligatures are rock solid on both pedicles.

• The day‑to‑day in UK primary care is still dominated by open midline OVH in dogs and flank OVH in cats. Laparoscopic OVE (keyhole) exists and is growing, but in most GP settings it’s still uncommon — factors include training, kit cost and realistic neuter caseload.
• Owners who pay for lap spay usually do it for recovery experience. Clinically, keyhole patients often “look more normal” by day 3–4, which many owners love — but that depends on operator skill and setup.
• The hosts discussed a UK dataset of roughly 519 bitches comparing lap OVE with traditional open OVH. Speaker‑reported findings included similar anaesthetic durations once lap setup was counted; broadly similar intra‑op complication rates; and fewer owner‑reported post‑op problems (inappetence, discomfort, licking/chewing) after lap OVE in that dataset. The podcast also flagged a key caveat: data collection differed between groups, so reporting bias is possible.
• Several hosts said they’re increasingly comfortable doing an open OVE when the uterus is oedematous/spongy or when a smaller incision is a priority. It can feel odd the first time you “leave the uterus behind”, but it’s a useful technique to have in your locker.
• Confidence and training matter. Many vets remain more comfortable with OVH, especially in cats.

3.Cat spays: flank vs midline — choosing your battles

Clinical pearl

Quick check

• Both flank and midline work. In the UK, flank spays are common and many vets feel recoveries are brisk with fewer seromas; others prefer midline for predictability. Owner choice after a clear explanation is reasonable.
• Flank “hunting” tips that regularly help:
• Look for the yellow “shiny fat” and work caudally behind it.
• If you’re lost, put the spay hook down, rest your hands on the drape, let the abdomen settle, and try again. Resist the urge to “stir” the abdomen.
• Seromas with midline cats: the hosts suspected over‑undermining of subcut fat to visualise the sheath as a likely contributor. Gentle handling and avoiding dead space helps.
• Seromas love dead space. In small cats it’s easy to over‑undermine — be kind to tissues and be sparing with dissection.
• Struggling to find the horn on a flank? Stop, hands off for a few seconds, re‑probe. Fingers and “shiny fat” cues are often kinder than heavy hooks.

4.Real‑world anaesthesia & analgesia for neuters

Premed and induction (speaker‑reported practice)

Nausea and side effects

NSAIDs and paracetamol

Local anaesthesia: small moves, big wins

Practice move

Ketamine: the intra‑op “smoother”

Medetomidine tweaks for recovery

Blood pressure reality check

Common trap

• Common approach: medetomidine at a “lowish” dose, adjusted to the dog. Methadone is the opioid most hosts prefer for OVH‑level pain; some report occasional post‑op nausea and manage it as needed. Induction with propofol, maintenance with isoflurane/oxygen.
• Hosts noted they see more nausea with methadone compared with older regimes but still prefer its analgesic profile.
• NSAIDs: used routinely for elective neuters in many practices, but usually given once the hypotension risk has passed.
• IV paracetamol in dogs: used frequently intra‑op by some hosts; avoid in cats.
• Lidocaine “splash” blocks on ovarian pedicles and intratesticular lidocaine for castrates were discussed as useful and time‑saving. Bupivacaine infiltration for longer closure analgesia is attractive, but the hosts didn’t settle on specific combined dosing. If you combine local agents, keep within safe total doses and follow local guidance.
• Intratesticular technique: inject until the testicle feels turgid; many find the cord clamps no longer evoke the flinch — smoother planes and less HR/BP reactivity follow.
• Pre‑draw sterile local before you scrub and park it on the instrument table. If your nurse splashes pedicles for you, keep the technique as sterile as your setup allows and audit wound outcomes.
• One host described being a “massive ketamine convert.” Her on‑air practice was to give a small IV ketamine bolus for panty/reactive/ISO‑hungry cases; this was reported to be ISO‑sparing and friendlier to BP than topping up medetomidine. Small boluses were favoured to avoid unwanted recovery character.
• “Micro top‑ups” of diluted IV medetomidine to smooth rough recoveries were described; many hosts avoid routine atipamezole and will only reverse if necessary.
• Turning ISO up even modestly can sink BP. The hosts advised fixing the cause (analgesia: locals, ketamine bolus) rather than chasing depth with vapour.
• Chasing depth with ISO to “hold” a twitchy spay — and then firefighting hypotension. Address analgesia first; use the ISO dial last.

5.Chronic pain: subcut ketamine — anecdote, with eyes open

Honesty with owners

Owner conversation example

• Growing use in GP: several vets are using subcutaneous ketamine for chronic osteoarthritis and reporting striking owner impressions.
• Speaker‑reported regimen (anecdotal): small SC ketamine injections given weekly to monthly; frequency and dose vary by clinic and case. Evidence is currently limited and largely anecdotal.
• Amantadine was mentioned as an oral NMDA antagonist alternative operating in a similar mechanism space.
• Be explicit: this is low‑evidence, off‑label in many situations, and should be framed as a trial for quality‑of‑life‑driven, hard‑to‑control pain. Agree outcome measures with owners before starting.
• “This is a low‑evidence, off‑licence option we reserve for hard‑to‑control pain. If we try it, we’ll judge success together on your dog’s day‑to‑day comfort and function.”

6.Make the vaccine consult count

We’ll return to vaccine schedules

• Vaccination is not “just a jab.” It’s where we align values, build trust and make future difficult conversations easier.
• Tailor the consult to the client and patient:
• Five‑minute “in‑and‑out” when that’s what the client wants.
• Longer, hands‑off discussion for nervous patients.
• Floor time and a relaxed exam for excitable dogs.
• Keep things positive: praise one specific behaviour every vaccine consult (e.g., “You’ve nailed nail care — that’s why these feet look great”). Clients leave motivated and more open to your next ask.
• Be careful not to sound merely “salesy” about parasite control, dentals or screening: frame recommendations around patient benefit and practical next steps.
• Weight and lifestyle conversations need empathy: be direct about risk, normalise how it happens, and offer a small, doable next step.
• The hosts planned a follow‑up on WSAVA guidance versus UK data‑sheet norms for dogs and cats. For now, focus on delivering a consult that owners feel good about.

7.Take‑home points

Final practical note

Resources will be added shortly.

Source note

Takeaway

• OVE vs OVH: in day‑to‑day GP, both are valid. Open OVE can be handy when the uterus is oedematous or incision size matters.
• Lap spay: owners often love the recovery; complication rates look similar in the discussed dataset, with fewer owner‑reported post‑op issues after lap OVE. Cost, training and caseload remain barriers.
• Cats: flank and midline both work. Flank needs a calm, methodical “horn hunt”; midline may show more seromas if you over‑undermine.
• Neuter analgesia: methadone + medetomidine remain common backbones; IV paracetamol for dogs, NSAIDs once BP stable, and local blocks are practical staples.
• Ketamine micro‑boluses intra‑op can smooth planes and spare ISO; start low and watch recovery character.
• SC ketamine for chronic OA is an off‑licence, anecdotal tool — reserve for QOL‑driven cases and set expectations clearly.
• Vaccine consults are relationship‑building clinics, not injections. Tailor to client and patient, keep the tone positive, and avoid a sales pitch.
• Many of the drug/dose examples discussed on the podcast reflect individual speaker practice. They were shared on air as clinician‑reported workflows — not universal guidance. Always check local protocols, product data sheets and your practice policy before applying a technique or dose.
• This article reflects the clinical discussion from Episode 8. Figures and approaches are reported as discussed by the hosts on the podcast; dosing and outcome figures were presented as speaker‑reported practice or from a UK dataset mentioned on air. Verify all clinical details with up‑to‑date guidance and your local protocols before applying them in practice.
• Small tweaks (a sterile splash block, a tiny ketamine bolus, a calmer approach to finding a cat horn, or one positive phrase in a vaccine consult) often give the biggest wins in GP.