Roxie's C-Section

"Have you picked up Dr. Katie?”

“No, she says I need to be patient. Hopefully she will be discharged before six. Can you keep the day open, I don’t feel like doing too much?”

”Its too late for those thoughts. We have a C-section coming in.”

“On what?”

“On Frenchie, a bulldog. Remember Dana Zubia?”

“Oh, the artificial insemination we never did? The stud dog was too scared to maintain an erection. I was sure it wouldn’t happen.”

“Well it did. You showed Dana how to do it, you gave her gloves, and the insemination equipment and she went home and tried again.”

“I guess she paid enough attention.” He sighed over the phone. “So, why does she think its time?”

“Frenchie's temperature dropped last night, and she’s scratching at her bedding, exhibiting nesting behavior.”

“Have you done a C-section before?”

“Twice,” she replied proudly.

“Well good, I'm glad to hear it.” He chuckled. “Make sure we have sterilized drapes and packs.”

“Well good, I'm glad to hear it.” He chuckled. “Make sure we have sterilized drapes and packs.”

“We do.”

“Okay, when will she be there?”

“She’s already here and wait till you see how big mama is, Doc. How long will you be?”

“About fifteen minutes.”

Honey and Dana had the bitch on the table. They had clipped her belly hair and were ready for the surgery when Rory came in. He was impressed Honey knew her stuff.

“Don’t forget to shave her arms. I want to give her drugs through a cephalic catheter.” After Honey finished vacuuming the hair off the belly, he collected his arm catheter, and a few more things; tape, flush, and a cap to keep it in the right place. He showed Honey how to hold the arm correctly and placed the catheter on the first attempt.

“Impressive, Doc.” Honey was proud of his skill.

“Thanks,” he said as he injected a low dose, pre-op sedative under the dog’s skin. This will give us ten minutes of prep time before induction. Now let’s make sure we have our places and everyone knows what to do. Have you done a surgical scrub before on your hands, Honey? I need you to be my assistant surgeon, and Dana will be the wet nurse.”

“I’m not sure what you mean by a scrub on my hands.”

“Oh okay. Here, put your hand against mine. I use size 8 gloves. You’re about the same, maybe a little smaller. Let's look for size 7. Oh, here’s some. They're sterile; they're still in the packaging. You also need a cap and facemask. Now, when you wash your hands you need to use this surgical scrub brush. Soap up each finger, and scrub a lot, first under each nail, then around each finger. Think of fingers having four sides, and make sure you run the scrub brush up and down each finger, getting here onto the web between each finger, like this. Good. Now scrub the top of your hand, the bottom, and each side down to your wrists. That’s right, you’re good to go. You need to repeat this when I’m ready for your help in the surgery.”

“Got it, Doc.”

“Now it’s time to quiz Dana and anesthetize the bitch. What experience do you have as a wet nurse, Dana?”

“I’ve done this before,” she replied, “but what would you like me to do?”

“I’ll be handing each puppy to Honey, who will carry it from surgery to you, here in the treatment room. I want you to strip off the membranes from the head and clear the nostrils. The normal delivery process automatically squeezes fluid from the lungs when the puppy is pushed through the birth canal. Because a C-section doesn’t do these types of compressions you may need to fling the puppy down fast while pointing its head to the floor. It helps drive fluid from the lungs. We can also have these small TB syringes ready to act as suction devices if you see persistent bubbles frothing from the nostrils.”

“I can do that.”

“Okay, she’s ready,” Rory said when he saw the bitch wretch up stomach contents. “The pre-op is working. Let me do a last check on the heart rate.” He placed his stethoscope in his ears to make sure the heartbeat was steady. It was. “Everything looks ready, let’s induce.”

“What is the white stuff, the anesthesia Doc?” Honey asked. “I’ve only seen Doc Collins use clear anesthetics.”

“This is propofol, it's an anesthetic. I don’t usually use it often because it’s short acting; it lasts only five or ten minutes. It’s good for C-sections because it doesn’t cross through the placentas. The babies are more alert when they are delivered because they aren’t doped up. The old medicine made them drowsy, and it was harder to stimulate the puppies to breathe. I need to show Dana how to give it through the catheter while we are in surgery.”

Rory injected half a syringe of the drug into the catheter, and waited about a minute for the bitch to really go to sleep. Her body slumped into a relaxed heap. He checked her jaw tone, and was able to open her mouth easily. “Ok, now we need to place the endotracheal tube in her windpipe.” He picked up a clear plastic tube a foot long, and squinted into the deep recesses of the oral cavity to make sure he was placing the tube in the right hole. “Got it,” he said, as he tied string around the tube and looped it around the dog’s nose, finishing the attachment in a bow tie. “Now we puff up the cuff on the tube to make all the anesthetic gas stay inside the tubes, and we're done with the prep.”

He rolled her upside down to do a final check on the shaved site and decided to proceed. “Let’s carry her to surgery.”

They placed the bitch on her back on the table, securing her legs with ties, and hooked up the ET tube to the anesthesia machine.

“What level of isoflurane do you want, Doc?” Honey asked.

“I don't want any right now. Just give her oxygen. I don’t want the anesthesia gas started until the puppies are out.” They hooked up the respiration monitor, and heard a reassuring beep every time the bitch inhaled. The breathing rate remained slow and steady.

“Ok Honey, you stay here, and finish her scrub. I’m going to gown up. As soon as I get back you can scrub in.”

A few minutes later he was back, dressed in a surgical gown, holding his gloved hands in the air. Do you see how I'm holding my hands? This is the way to keep gloved hands sterile. Never let them drop below the waist because bacteria float around down there. The feet and legs kick it up from the floor. So, when you get your gloves on, keep the hands high, right at head level. Just remember, the risk of contamination increases the closer one is to the floor. Okay, it's your turn to gown up.”

She left as he proceeded to drape the dog. He placed one sterile towel on each side and one at both ends of the surgery site to keep the area Honey disinfected clean and sterile. He unfolded a cloth drape and placed it atop the toweled off section. Because the big drape was three by three feet it gave him a large sterile field to play on, making surgery easier because he wouldn’t have to worry about contamination from hairs or other body parts. He started the surgery before Honey was back. He didn’t need an assistant at this early stage.

Grabbing a stainless steel surgical blade he set it just below the dog’s belly button and gently yet firmly made a clean incision right through the skin into the underlying fatty subcutaneous tissue. He made a straight line from her belly button towards her vulva and stopped when he had a six-inch long incision.

Honey returned, holding her hands up like a well-trained surgeon. Again Rory was impressed with her astuteness. She stood opposite him across the surgery table.

“Your gloved hands are