The secret to super surgery – instruments!

There is a secret to performing great surgeryhaving decent instruments! There it is, the secret is out!

 

One of our pet hates at MSM Vets is blunt, old, or poor-quality needle holders, which are just plain dangerous when it comes to performing instrument ties. It really isn’t clear why our profession sees this instrument as a heritable item because your children will certainly not need them! When they are worn out and beyond repair just get rid of them.

 

A good investment

 

This is an area well worth investing more in and tungsten carbide Olsen-Hegar with replaceable faces are a joy to use. Get yourself a large and smaller pair – the larger for 3-4 metric and smaller for 1-2 metric – and you will notice a massive difference in your suturing accuracy.

 

Cheap instruments have less finishing to them and can have sharp burrs that damage suture material which can easily cause catastrophe. This is doubly important when training surgeons as this can destroy confidence.

 

We also understand from human surgery reports that Gillies are thought to promote hand strain as well, so be mindful when making your choice.

 

Inexpensive option

 

DeBakey forceps are an excellent instrument and these inexpensive beauties can transform your fine surgery by giving you atraumatic grip. The parallel lines of fine points do not crush the tissue – they were designed for vascular surgery in humans – and make manipulation of fragile tissues effortless.

 

In contrast, the skin and thicker tissues need a more coarse pattern and while we like Adson-Brown or rat tooth forceps are perfectly acceptable. Try to avoid forceps that are made of really thin metal that bends too much, it makes you squeeze really hard which causes more trauma. 

 

A lot of people are fearful of using rat tooth forceps and address skin and muscle issues with dressing forceps but they crush rather than pierce, which is a lot more damaging to vascularity. Rat tooth forceps on viscera are a bit coarse though, which is where the likes of DeBakey can be an advantage.

 

Shedding light on the situation

 

You can’t dissect if you can’t see! So, once you have decent lighting, something you should never skimp on, you need retraction. Mini Gelpis are lovely. Best used in pairs, they allow a grid pattern to dissect down to deep structures – a process essential for glandular work.

When it comes to the tools of your trade, come and join us on the dark side and become an instrument dork – it’s the future!

 

Benefits of lapspay mean it is fast becoming the surgery of choice

Lapspay is fast becoming the surgery of choice 

 

Most people have either had or know someone who has undergone keyhole, or laparoscopic, surgery and the vast majority would suggest this is a far superior method in comparison to open surgery

Interestingly, the first medical doctor who introduced keyhole surgery to human medicine, specifically for gallbladder removal, was ridiculed by his colleagues. Then, when he refused to stop pursuing the method, they tried to have him sectioned on mental health grounds! 

The complete converse is true today and a routine gallbladder removal procedure would not be considered in any way other than through keyhole surgery. 

CHANGING TIMES

Within veterinary medicine, the bitch spay is undergoing a transition. Keyhole surgery offers huge post-operative advantages for dogs, and owners are now seeking out this technique with increasing frequency

Post-operative pain is vastly reduced through this procedure, a fact which is backed up by post-operative comparative studies that show blood glucose and cortisol at significantly lower levels from 30 minutes to two days post-operatively. 

Pedometers attached to dogs also show a far quicker return to normal movement levels and it is not uncommon now to suggest that only 48 hours rest is necessary before returning to full exercise post spay. The open method is 10 days! 

BREAKING WITH TRADITION

The traditional method of opening the abdomen to remove the ovaries and uterus, an ovariohysterectomy, has long been practiced but in the last 15 to 20 years many researchers and practitioners have argued against the need to remove the uterus

Without the influence of oestrogen the uterus is dormant and doesn’t need removing. Indeed, a lifetime study of dogs spayed via keyhole techniques has been published in the US and reveals 0% of participants having any uterine complications over their lifetime

Commonly cited hurdles to introducing the keyhole spay, known as lapspay, into a given practice are equipment expense and a reluctance to change – rather like the original medics we spoke about earlier. 

AN INVESTMENT THAT WILL PAY OFF

The technology is quite pricey with some setups costing tens of thousands of pounds, but in our experience if the laparoscopic kit is being used appropriately it will pay for itself within 12 months

The surgical learning curve is also a little steep and the technology can be off-putting to some, but this is fairly quickly overcome with the correct training and once the lapspay procedure is mastered it opens the door to a plethora of other techniques. 

We will still find many practitioners who prefer not to move into this area of surgery, suggesting that they can ‘see more’ and ‘make a keyhole-sized incision anyway’, meaning a lapspay is merely a gimmick. 

A MUCH BETTER OPTION

It’s a short-sighted view and one which fails to realise the overall benefits of lapspay. You only need to see one procedure or watch one video online to see that the images available through a lapspay are spectacular in comparison to what is visible through open surgery.

The vessel-sealing technology used to dissect and seal the blood vessels means no internal sutures are needed and there is complete confidence that nothing left behind is bleeding, making the keyhole procedure arguably safer. 

The size of hole created in an open spay is often a badge of honour to practicing vets – the smaller it is the more impressive it is viewed. However, the size of hole is often inversely proportional to the amount of pulling needed – and therefore pain inflicted – in the extraction of the required anatomy. 

Our hope is that all first opinion practices transition to lapspaying over the next few years. The interest in the method is on an exponential increase and we hear of anecdotal evidence of long waiting lists for available courses. 

We predict a point in the near future where practices will either be doing lapspays or not doing spays at all, as their clients will be seeking the procedure elsewhere – the open spay having gone the way of the open gallbladder removal in human surgery!

 

Why you shouldn’t worry about anal gland surgery

Anal gland infection must be a miserable condition for dogs. A piece of leftover evolution, serving no purpose for our modern companions, they abscessate and irritate. Yet as a profession, we tend to just keep squeezing them – a procedure that must be unpleasant in itself!

 

In rare instances it has been known that these annoying little glands can rupture internally and lead to peritonitis, but we are all more familiar with those horrible fistulae on the thighs of dogs that are so painful and unpleasant.

 

Making a difference

 

As strange as it is to champion anal glands as a crusade, we at MSM Vets feel strongly that we should be removing more of these pesky glands. In our experience it makes a huge difference to the quality of life of dogs – not to mention the benefits to their owners who don’t have to make regular trips to the vets or make awkward explanations to guests at dinner parties as to why their dog is doing the ‘bum surf’!

 

We know what comes next! What about incontinence, that’s a major issue, right? Well, according to a Journal of Small Animal Practice paper by T.M Charlesworth in 2014, not so much. A retrospective 10-year study showed that no dogs had permanent incontinence after the surgery. None!

 

While this is only a small study, others do support this assertion and we have to be careful about propagated myth. Articles have been written citing papers which date back to the 1960s but our husbandry and surgery are in a very different place today.

 

Fifteen percent of cases did have some faecal issues post-op and we are sure the surgery does move things around, but don’t forget we put a purse string suture in all these patients – something we appreciate must be a little ouchy for a few days as well!

 

A better option

 

That JSAP paper also noted that adenectomies performed using gel had higher complication rates and, on initial introduction to this technique, it certainly didn’t seem elegant at all – quite the contrary, in fact.  

 

There will be those out there who love this method, and familiarity is wonderful. If you are assessing your outcomes and getting consistently good results, don’t change! However, if you are starting out then the balloon catheter technique is wonderful.

 

It’s inexpensive, only requiring a cheap foley catheter and £50-£100 of instruments, if you don’t already have them, and comes with a shallow learning curve for your average surgeon.

 

Anal adenectomy should be understood, recommended and made available in all general practices. Balloon catheter anal gland adenectomy – viva la revolution!

For more information on surgical mentoring for this technique, email us at info@msmvets.co.uk

 

A Q&A with MSM Vets founders 

MSM Vets has worked with veterinary practices across the country, and we’re happiest doing what we do best and sharing our skills with other veterinary surgeons.

 

Our founders Rob Hamilton and Ryan Davis have more than 40 years’ combined experience in the veterinary field and we thought you would like to hear their thoughts on the industry and what makes MSM Vets so special. Here’s what they had to say:

 

Q: How do you keep vets in practice?

A: The question has multiple answers but we can answer one of them – provide vets with the job satisfaction and skills to thrive.

Veterinary surgery is an amazing profession and we want to see practices loving it again. Our goal at MSM Vets is to close the continually widening gap between first opinion and referral surgery – something which can ultimately only benefit everyone involved, vets, pets and their owners. 

It’s important to understand that you don’t need fancy instruments or diplomas to make a massive difference to your patients. You just need the right mindset, a great team and great communication. 

Q: So what is MSM (Mobile Surgical Mentoring) Vets?  

A: Whether you are returning to practice, starting out or just wanting to widen your repertoire, we offer bespoke mentorship programmes to cost-effectively increase the operating potential of your practice and save you time. 

We come to you, operating in your theatre, and mentor you and your team through the procedures you wish to retain in-house. With time being at such a premium at present, working with less experienced team members takes a back seat. We aim to resolve that situation for you.  

Q: Have you got an operating nurse performing procedures to help the vets?  

A: Part of the service we provide is to train nurses to be active members of the surgical team, optimising efficiency and providing real career enrichment. Within a few visits, you will be performing these procedures solo, retaining turnover, clients and most importantly empowering your team along the way.

It’s all about getting the best from the resources you have and helping your team members make the most of their talents, which in return brings greater job satisfaction and fulfilment.

Q: What procedures do you perform, teach and mentor on?

A: Our offering includes laparoscopy, including the lap spay technique, endoscopy, endosurgery, ortho soft tissue surgery, nurse surgery, mentoring and surgical efficiency. 

 

Our unique service of visiting a veterinary practice and operating within the premises while mentoring vets through the procedures are carefully designed to dovetail with the working day and commitments of the practice.

 

We are able to bring along any surgical equipment the practice may not have and being on-site means we are ideally placed to talk through the process before helping you through the procedure itself. It will mean fewer referrals, a greater self-reliance and will provide the opportunity to cut down or eliminate the need to call in mobile surgeons 

 

We can help practices meet their orthopaedic and endosurgical needs and provide a level of training which is second to none – helping a practice attain a greater level of surgical efficiency along the way.

 

Starting up your veterinary practice with support

Launching an independent veterinary practice creates a high workload and an extremely busy time for all involved.

From business planning and administrative set-up to tools of the trade, recruitment and marketing – and that all has to be put on the backburner when it comes to the clients to be treated.

Here at MSM, we are really pleased to be able to be part of the support team for vets in a new veterinary practice – helping them to create a practice that supports their patients in every way possible.

Positive impact

We have been working with Alveley Village Vets, which opened its doors earlier this year, and spoke to Lauren about the impact it has had on the business.

Lauren Wheeler said: “As we’re a new start-up we’re currently working with MSM on a case-by-case basis. 

“It’s so reassuring to know the team at MSM are there when we need them. I feel the clients also really like the fact that specialist work can be done at their local and familiar practice without being charged a premium. And we’re able to keep all the follow-up and rehab work in-house also, benefitting us as a new, small business.”

Mentoring services

Vets Lauren and Charlie Greenwood are utilising the MSM Vets surgical services but hope to work with us on mentoring services as they head into the future.

“It’s a fantastic service MSM Vets offer, it really is,” adds Lauren. “As our client base and caseload grow, I hope we can take advantage of the mentoring service also. Big thank you to the team at MSM.”

If you are a new or existing practice looking for a way to incorporate specialist work into your practice without asking your patients and their owners to travel elsewhere, then please do let us know. We would be happy to chat through the options we can offer and how we can work alongside you.

Get in touch with vets Rob on 07496 322059 or Ryan on 07496 359164 or via our contact form.

 

The importance of education and mentoring in veterinary practice

Veterinary surgeons have a commitment to lifelong learning – but we know hectic schedules can prove a challenge to accessing CPD or improving through mentoring.

This is why, as a mobile surgical mentoring team, we visit practices to operate alongside, and mentor, veterinary surgeons and registered veterinary nurses (RVNs) through the procedures they wish to retain in-house.

 

Instil confidence and skills

One-to-one teaching and mentoring is not only a really effective way to learn but also enhances a veterinary practice’s surgical offerings by instilling confidence and developing skills. 

RVNs especially can often feel their careers are becoming stagnant and want more responsibility and more confidence, and many RVNs and vet practitioners return after maternity leave looking for a refresh.

 

Customised teaching 

Our experienced surgeons are dedicated to providing customised teaching that meets the specific needs of those we are mentoring. From surgical techniques to diagnostic procedures, we aim to help them enhance and develop their confidence and skills in order to provide the best possible surgical outcomes for patients.

Every veterinary professional has unique needs based on their practice, patients and the resources available to them – and we are also able to advise on these resources as part of our offering.

 

Fits the schedule of the veterinary practice

Our approach ensures that instruction is personalised, tailored to needs and fits the schedule of each practice. We can also identify areas for development and work with teams to create a learning plan.

We are committed to creating the right mindset and communication within a team and sharing our knowledge and expertise to ensure that surgery is kept in first-opinion practice.

If this is something that you feel your practice would benefit from, please do get in touch with us to discuss options.

 

 

Back at BVA Live

We had a great couple of days at BVA Live!

It was a pleasure to be on site as the veterinary community gathered to develop their knowledge and skills at a conference and exhibition that is designed to provide hours of CPD in a practical and inspiring way.

Developing skills, knowledge and confidence

As trainers and mentors, developing the knowledge, skills and confidence of the veterinary community is what we aim to do every day, from cherry eye surgery to complex fracture repairs.

The conference saw MSM Vets founder Ryan Davis talking on theatre efficiency covering topics such as using great equipment, investing in staff training, balancing workflow and many other hints and tips to have your surgical day running smoothly.

MSM Vets co-founder Ryan Davies.

Theatre efficiency

Theatre efficiency can be an issue for many practices, and we have touched before on investing in new equipment – as well as in-surgery mentoring and teaching we also aim to support practices when it comes to decisions about equipment and options.

In-practice mentoring and teaching

Our stand on the show floor was busy throughout the event, and it was great to chat to veterinary professionals from across the country about their hopes for development and the options of our in-practice mentoring and teaching.

Partner Rob Hamilton said: “Our lap spay trainer and laparoscopic challenge was very popular and attracted several vets with new startup practices, I was interested to hear about their vision for these practices and how MSM can help them realise their potential”.

Bridget Atkinson, winner of the prize draw

Bridget Atkinson, winner of our prize draw.

Contact us

We are always happy to chat through options for veterinary professionals that will help to close the widening gap between first opinion and referral surgery so do get in touch with us at info@msmvets.co.uk if we can help.

 

How to ask your employer for veterinary mentoring

Are you eager to improve your surgical skills but not sure how to ask your employer to invest in you?

Sharing the huge list of benefits for your employer, your practice and your patients is a necessary step – but you will need to be prepared.

Here, we share our top tips on asking your employer for veterinary mentoring.

Have a plan of action

When approaching an employer to ask for mentoring or training from an external provider, it’s important to have a plan of action beforehand, so you’re well prepared to answer any questions they may have.

List all of the benefits of the training or mentoring

This likely won’t just relate to you; think about the positive impact your training or mentoring will have on your practice and the wider team, as well as your individual performance.

Knowing what the benefits will be in advance and how they will affect others in the practice is a great selling point.

What does the long-term picture look like?

Having a list of the benefits will enable you to have an idea of what the long-term picture looks like for you and the practice.

This is always a good picture to paint for an employer; a member of their team is getting trained in-house to become a surgical superstar and will have the skills, confidence and passion to perform surgical cases they previously weren’t able to. That makes the future look very bright!

Carry out a cost analysis

Keeping the long-term picture in mind, it’s worth doing a cost analysis beforehand, too. 

A lot of practices we’ve been to were previously referring their cases elsewhere because they couldn’t offer the services… think about how much money your practice will generate by no longer having to do that. 

Typically, our clients make up the cost of their training after performing one or two surgeries. After that, it’s extra income for their practice!

Some employer benefits

If you’re struggling to think of the benefits your training or mentoring would have on the wider practice, here are just a few…

  • Keeping surgery in general practice, rather than having to refer elsewhere.
  • The ability to bring MSM in when the surgical caseload is busy – that practical assistance is very beneficial.
  • More satisfied vets doing the job they love, meaning lower staff turnover.
  • Improving the scope of services being offered by the practice.
  • Our mentoring can be classed as CPD, so vets can meet their professional learning targets.
  • Inspiring and reigniting passion for veterinary surgery with all members of the team – not just clinical staff.

Returning to veterinary work after maternity or paternity leave

Returning to work after parental leave or an extended time off can seem daunting, and often parents can feel they’d like a helping hand in the process. 

When organising your return to work, it’s worth letting your employer or practice manager know you’d like some extra support to help you get back on your feet. This will have a real benefit to your practice as you’ll be much happier at work and will be able to ‘get back to it’ much quicker and with more confidence.

Support for newly graduated vets or those needing a boost

We can all have a wobble from time-to-time. As vets, we hold ourselves to extremely high standards and can often be hard on ourselves if a case hasn’t gone as well as we’d hoped.

If you feel like you need some moral support, would like to try a new technique, or just need a confidence boost, our training or mentoring sounds right for you. 

Let your employer know how you’d benefit from training or mentoring from MSM Vets and how it will impact your quality of work and your happiness. 

Get in touch

You’ve read this blog, followed our steps, and now your employer’s on board with veterinary training or mentoring. What do you do now?

You contact us! 

Email us at info@msmvets.co.uk outlining what you’d like support with, and our amazing Operations Manager Jo Wright will get back to you with our availability.

 

Liver cases in dogs and cats – where to go next

Liver cases in dogs and cats often end in a dead end. 

After presentation, bloods and diagnosis of a liver-based issue, where do you go next? 

Our blog takes a look at where you can go…and what can be achieved…

 

Blood results

The bloods will show raised ALT, ALKP, GGT, and perhaps bilirubin. The next step is usually an ultrasound. Imaging to identify lesions and irregularities in both the hepatic parenchyma and bilious system is very useful and can reveal masses and other pathology. However, many of these scans do not show much change from normal livers – so why are the biochemical markers all raised? 

 

Where to go next

Further advanced imaging, such as CT, can be extremely useful but can be cost-prohibitive. Ultrasound-guided needle aspirate or tru-cut is another option, but it can be fraught with disappointing histology reports. A complete open laparotomy to examine the organ macroscopically and take a wedge biopsy will give the full answer- or you can go laparoscopic. 

 

Laparoscopic Liver Biopsy 

The images achieved with a laparoscopic exploration are exceptional. Space, light and magnification on a monitor outstrip even an open laparotomy, where accessing all of the hepatic surfaces can be challenging. 

Using just two 5mm port holes on the midline, liver biopsies comparable to an open wedge biopsy can be obtained. The procedure can take as little as 20 minutes, and the pets can be discharged a few hours later with minimal analgesia and 24-48 hours of rest before a full return to exercise. 

 

Maximise histology results

To maximise histology results, the on-screen images can be saved and sent to the lab with the samples too. 

Robert Hamilton, BSc BVetMed GPCert(endo) PgC SAEE MRCVS, said: “In my experience, I have had some very unexpected outcomes after biopsy. For example, I have seen grossly irregular lobular lesions on ultrasound I would have instantly assumed were neoplastic changes that, after lap-biopsy, have confirmed chronic active hepatitis. 

“Conversely, I have diagnosed pathologies such as microvascular dysplasia from lap-biopsies on completely normal-looking livers at both ultrasound and laparoscopic examination.

“These results can favourably steer the medical management of these pets, not having to just rely on bloods that indicate raised liver enzymes without a specific diagnosis. No longer do we have to settle for liver-supportive supplements vs high-end imaging and invasive surgery.”

If you wish to have keyhole services provided within your practice, we can accommodate you. Clients are becoming more aware and informed about available options for their pets, and the number of requests for a procedure to be performed ‘keyhole’ are on the rise.

We can provide a regular ‘spay-day’ where we come in for routine lap-spaying or individual procedures, including laparoscopic liver biopsy.

 

Welcome to the team, Jo!

Our first year in business has seen us working on training and mentoring with veterinary practices across the country – and as we head into 2023 it is time for us to grow our team.

MSM Vets would like to introduce you to the newest team member – Operations Manager, Jo Wright.

Veterinary nurse career

Jo started her veterinary nurse career in 2000 and quickly moved into a Head Nurse role managing a dynamic and busy vet practice.

After 15 years and the completion of an Advanced Diploma in Veterinary Nursing, Jo decided to spread her wings working both within the charity sector in veterinary communications and at a new vet school supporting vet students in EMS placements and helping develop their clinical skills.

Delivering a great service

Our partner Rob Hamilton says: “It’s with our great pleasure that we welcome Jo to the team, where she will be utilising her communication skills and veterinary knowledge to help develop MSM and deliver a great service to our clients.”

MSM Vets was officially launched in 2022 with Rob and our other partner Ryan Davis, both award-winning veterinary surgeons, having the aim of keeping veterinary surgery in general practice.

Growing the team

Jo says: “I am really looking forward to working alongside Rob and Ryan and with the many veterinary practices across the region they are training and mentoring.

I looking forward to meeting new contacts over the coming months and helping to further grow MSM and the services it provides.”

For more information about the services MSM Vets provides visit our services page or contact us on info@msmvets.co.uk