February 4, 2025 • 20 mins
Discover the hidden complexities behind perineal hernia recurrence in dogs as we chat with Dr. Mandy Wallace and Abigail Hatch. Mandy and Abigail provide fascinating insights into the risks associated with hernia development and the challenges of fecal incontinence. Mandy and Abigail emphasize the crucial need for pet owner education. Their discussion offers a deep dive into the nuances of soft tissue surgery, contrasting it with the generally healthier cases found in orthopedic surgery, while sharing personal journeys that led them to this specialized field.
Our conversation also touches on the evolution of veterinary record-keeping, highlighting the shift from paper to electronic systems and how this impacts data collection for retrospective studies. Mandy and Abigail offer their perspectives on improving these practices, guided by their own experiences with scientific writing and mentorship. This episode promises a blend of serious insights and light-hearted moments with two passionate professionals in the veterinary world.
JAVMA article: https://doi.org/10.2460/javma.24.07.0487
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sarah Wright (00:01):
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode we chat abouthow dogs neutered prior to
perineal hernia or thatdeveloped fecal incontinence are
at increased risk for perinealhernia recurrence.
With our guests Mandy Wallaceand Abigail Hatch.
Lisa Fortier (00:19):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Mandy and Abigailjoining us, who are both on
clinic, so we really, trulyappreciate you taking time out
of your busy day to be here withus today.
Mandy Wallace (00:34):
Thank you so much for having us.
We're excited to talk about thepaper and have this opportunity
to discuss it more.
Abigail Hatch (00:39):
Yeah, we're really excited, thank you.
Sarah Wright (00:41):
All right, let's dive right in.
So, Abigail, your JAVMA articlediscusses how dogs neutered
prior to perineal hernia happyor that develop fecal
incontinence are at increasedrisk for perineal hernia
recurrence.
Please share with our listenersthe background on this article.
Abigail Hatch (00:57):
Yeah, of course.
So, as you know, perinealhernias, they occur when that
pelvic diaphragm muscles fail tosupport the rectal wall.
They're usually seen in intactmales, usually over five years
of age, among many differentbreeds.
Clinical signs usuallyassociated with perineal hernias
are swelling around theperineal region, constipation,
(01:21):
tenesmus, strange area, and themain way to correct perineal
hernias is through surgery.
Treatment of choice is aperineal herniography and
usually with the surgery, anypost-operative complications
that we typically see aresurgical site infections,
sciatic nerve injury, tenesmusand risk of reoccurrence, as
well as fecal incontinence.
There have been no previousstudies to this date to
(01:41):
determine any risk factorsassociated with these
complications.
So we decided to do this studywhere we looked at risk factors,
two of the main ones fecalincontinence and risk factors
associated with surgical siteinfection and recurrence.
So we just kind of found somestuff, some interesting things.
Mandy Wallace (02:02):
Yeah, and from a clinical perspective, you know,
perinatal hernias are somethingthat one of my mentors in my
residency was very excited aboutand I got to where I really
enjoyed doing the surgery, andso as a team we felt that, like
Abigail said, we just reallydidn't have great resources that
told us what the risk factorswere that we could talk to
(02:24):
owners about or to help us havebetter outcomes, and so that was
our goal was to see can we havebetter outcomes with looking
back through our cases andidentifying potential things
that we could do differently, orat least have things we could
warn owners about?
Sarah Wright (02:38):
And Abigail.
What are the importanttake-home messages from this
JAVMA article?
Abigail Hatch (02:42):
So the important take-home message is just that
letting owners know that dogsthat are undergoing perineal
hernia aphides.
If they have a dog that hadbeen previously castrated or
neutered, they should just betold that.
What we found is if they wereneutered prior to a surgical
correction of a perineal hernia,they are at an increased risk
(03:04):
of having reoccurrencepost-operatively.
That's no reason to not getyour dog neutered.
We definitely want our dogsneutered out there, but it's
just at least a talking pointduring that discussion
pre-operatively to let ownersknow that the risk is a little
bit higher.
And then also, if patientsdevelop fecal incontinence
post-operatively, there is alsoan increased risk of recurrence.
(03:24):
So just keeping your ownersinformed with all of these
things.
Lisa Fortier (03:29):
You may or may not know, I'm a equine orthopedic
surgeon and I remember the daywhen I was like this is for me.
I remember watching, as astudent, somebody do arthroscopy
and I thought that's thesexiest thing ever seeing all
the cartilage and the bones andhow the joints move together.
So I'm curious from each of youwhat sparked your interest in
yucky soft tissue surgery, likethe perineal region.
(03:51):
So, Abigail, how about we startwith you?
And then Mandy, love to hearwhat inspired you too.
Abigail Hatch (03:57):
Yeah.
So I guess to start like myinterest at least in veterinary
medicine.
I was always that kid that justwanted to do vet med for some
reason, like right from theget-go.
And then I, at one of thepractices, I worked at a
specialty hospital prior to vetschool and they had ER surgery
(04:17):
cardiology, ophthalmology, allthe things and I just I loved
being in the OR, I lovedwatching emergency surgeries
like GDVs and splenectomies andthings like that and I just the
intricacy and the soft tissuehandling and everything it's I
don't know, it's just sointriguing to me.
Lisa Fortier (04:33):
Very cool.
One of the things I do miss inorthopedic surgery there's not
much medicine that goes.
Most of them are pretty healthyright.
Especially in what I do issports medicine, so I do miss a
little bit of the.
We get plenty of emergenciesbut they're still usually
healthy.
So that that would be one part.
I think soft tissue surgerywould add to your puzzle.
Putting together Mandy, howabout you?
(04:55):
Sorry.
Abigail Hatch (04:56):
No, that's okay.
No, I was like I was agreeing.
There's a lot of casemanagement.
I'm currently on ortho for myrotations right now and, like
you said, all of our patientsare healthy and I do kind of
Mandy Wallace (05:07):
Yeah, I completely agree.
So, funny enough, I found anessay I wrote as a first year
vet student where I said Iwanted to be an orthopedic small
animal surgeon in academia.
And I reached most of thosegoals, except I switched roles
there and so for me it's exactlywhat you said.
I remember being a third-yearvet student and on my surgery
rotation walked into an openchest surgery and got to feel
the beating heart, got to seethe lungs moving, and it was
(05:35):
this immediate, like I have todo this forever.
So, I knew surgery was where Iwanted to go.
And as I progressed through therest of vet school and
internship and residency, I alsoreally love internal medicine
and so internal medicine waskind of almost like a secondary
thing for me.
And I realized in soft tissuesurgery not only would I get to
(05:56):
feel the beating heart on afairly regular basis which I
didn't think I could ever let goof but I also get to put those
puzzle pieces together, reallywork through cases and see some
really interesting things thatjust every day is kind of
different on soft tissue.
Every splenectomy is different,every foreign body is different
, and so that's what reallysparked my interest and keeps me
excited about it.
Lisa Fortier (06:14):
Excellent.
Every time we do a manuscriptof any sort, even if it's a
retrospective study, we findthings that we didn't expect.
So was there anything in thisstudy that you found surprising?
Abigail Hatch (06:34):
I mean, I guess the fact that previously
neutered animals having a higherrisk of recurrence that was
actually kind of surprising forme, just because always we talk
about neuter your animals Ifthey're not breeding it's better
for their overall health.
So just finding out the factthat it actually is a risk
factor for one of our surgicalcomplications, that was pretty
interesting.
Lisa Fortier (06:49):
Yeah, I thought that too, Mandy.
How about you?
Mandy Wallace (06:52):
I agree that that was really unexpected for us.
We really didn't think that wasthe case, because we do
recommend castration at the timeof perinatal hernia repair and
so most of the time they'realready, they're still intact,
and so when we found that,finding it really surprised us.
I mean I couldn't probablycouldn't have been more shocked
that that was real and it wasquite a large odds ratio.
(07:13):
So we feel pretty confidentthat it is real.
That was the most shockingthing.
We also the fecal incontinencefinding also shocked us.
Honestly, we were shocked byboth findings.
We were.
I think the thing that maybesurprised us more too is that we
didn't find more risk factorsfor surgical site infection.
So we thought startingantibiotics at the time of
(07:35):
surgery would have decreased oursurgical site infection risk,
and that was not something thatwe found.
So some of the non-findingswere maybe just as shocking as
the things we did find.
Sarah Wright (07:45):
So, now that you've completed this study,
Abigail, what are the next stepsfor future research on this
topic study Abigail?
Abigail Hatch (07:52):
What are the next steps for future research on
this topic?
So I guess, going off of ourtwo main points that we found,
the first being that if theywere previously neutered the
risk of recurrence is higher, Ithink it would be interesting to
look at like what age they wereneutered at, like compared to
the time of surgery, and see ifthere is a association with if
they were neutered earlier, doesthat increase their risk?
Or if they were neutered closerto surgery time, does that
increase their risk?
(08:12):
As far as fecal incontinencegoes, I think maybe looking at
how long the fecal incontinencelasted postoperatively to see if
there's any association withlength of time and incontinence
and risk factor or recurrence.
Excuse me.
Lisa Fortier (08:27):
Go a little off script.
If the dog was neutered alength of time and I don't know
what it is in dogs when theirtestosterone becomes T zero
would you consider testosteronesupplementation before fixing
them?
Or is it to an emergent surgery, like who we need to fix this?
We can't wait to get their T up.
Mandy Wallace (08:49):
Yeah, that's a great question.
So typically not emergency um.
On rare occasions it is so ifthey have the bladder um is
retroflex and they're obstructedor if they're really just
unable to defecate um despitemedical management.
But typically we wouldn'tconsider it a true emergency.
So I think that's somethingthat we could consider is to see
if we could determine if lengthof time made a difference or if
(09:11):
we could determine if therewere receptors in that area that
really truly responded to thistestosterone.
I think that could be apossible idea that would
potentially keep them fromhaving a recurrence.
Lisa Fortier (09:24):
Awesome
Sarah Wright (09:25):
Sounds like another project.
Yeah, exactly so anyonelistening?
You contact Abigail and Mandyso lately you've been talking
about like emerging technologiesand like the veterinary space,
and one of those is AI.
So, Abigail, do you see a rolefor AI in this area of research?
Abigail Hatch (09:47):
Specifically for perineal hernias?
Not sure I'm sure there is, butI guess, with it being a
retrospective study, Idefinitely think there's.
A AI would definitely be useful.
The amount of medical records Iwent through to get all of the
information and charting andeverything it was a lot and I
know that AI there's a lot oftools out there now to like
(10:08):
search through medical records,search for specific information,
so I think that would be veryhelpful to minimize, maybe even
like human error when lookingthrough medical records.
They might catch some things,cause I know we mentioned that
as part of one of possibleerrors in our manuscript as well
Just human error, we're allhumans, but yeah, so I think AI
would definitely be helpful inlooking through all of those
(10:30):
things.
Lisa Fortier (10:37):
I remember my first retrospective study and
being appalled at what wasmissing from medical records,
and especially, I'm old enoughthat we transitioned from paper
to paper, electronic.
And then you switch medicalrecord systems and you're like,
well now, where did that go?
So, for me at least, in myresearch animals, it inspired me
to rethink what we're asking onthose medical records.
(10:58):
Right, you shouldn't.
If you were a lawyer and yougot sued and there's a blank
space because you didn't commenton the integratory system,
right, did that cross your mindlike, wow, we need a better
physical exam form.
Abigail Hatch (11:14):
Um, I don't necessarily know.
With physical exam one spot Inoticed a lot like not a lot of
missing information, but like Iwould have to dig for it with
our anesthesia records becauseit's all handwritten um, and I
had not taken my anesthesiarotation at the time yet, so I
had not been through all of thatand there was just often times
where I'm like trying to figureout what was given, how long the
(11:36):
patient was under anesthesia,sometimes the post-op time
wasn't recorded, things likethat.
So when I was on anesthesia Iwas very, very laser focused to
get all that information.
So maybe on that aspect wecould maybe improve a little bit
.
But I think everything else waspretty much there, most of the
time.
Sarah Wright (11:56):
Yeah, we had those same handwritten forms too, and
I did my anesthesia rotation aswell during vet school and I
agree, definitely some room forimprovement, for sure, yeah.
Abigail Hatch (12:03):
And it's very easy to miss things because
there's so much going on.
So, it's not anyone's fault,but that's at least if there was
maybe a online way to doeverything.
But we'll see.
Sarah Wright (12:14):
For sure In the future.
That's why we asked thatquestion and, for those of you
just joining us, we'rediscussing what veterinarians
should know before performing aperineal hernia appy and a dog
after a prior castration withour guests Mandy and Abigail.
Lisa Fortier (12:29):
Abigail, you talked just a few minutes ago
about that you hadn't done youranesthesia rotation, so maybe it
made it a little more difficultto start with the record review
.
How did all the other trainingin your previous work prepare
you to finish this manuscript?
Abigail Hatch (12:44):
So I've been very fortunate to be a part of a lot
of research experiencesthroughout both my undergrad and
my time here in vet school, soI feel like seeing multiple
types of projects and thingslike that throughout my career
has helped me be better preparedfor this manuscript.
I also took a lot of scientificwriting courses in undergrad.
We were lucky enough to havethose at the university where I
(13:06):
went and I think that helpedstrengthen my scientific writing
.
And of course, I also had greatmentorship from Dr Wallace,
which is key when you're writinga manuscript so.
Lisa Fortier (13:16):
We love hearing that mentorship's alive and well
.
How about you, Mandy?
How is your experience built onhelping Abigail and really
getting this to the finish line?
Mandy Wallace (13:25):
For sure.
Well, Abigail made it easy.
She's fantastic, very on top ofthings, very detail oriented,
trusted that she was able to getthrough those records and
really trusted her data that shefound, so that she made it easy
to be her mentor.
She always has, since she was afirst year vet student.
For me, I think the moreretrospective studies that I do,
(13:47):
maybe the better I get atrefining what we need to get out
of those records.
And so I think at first yourecord so many data points that
it almost gets exhaustinginstead of really focusing down
on, okay, what are known orthought risk factors for
recurrence, what are known orthought risk factors for
surgical site infection, andreally being able to pare those
things down.
And so I think you know, as theyears go on, the more
(14:09):
retrospectives we do, we get alittle bit better every time at
just narrowing it down, reallyfocusing what we're looking for
and, in focusing that, makingsure that we're not getting some
data that just really itdoesn't make sense.
You know, focusing on thethings that do make sense from
the prior literature, and Ithink that's an area that you
get better at over time.
Lisa Fortier (14:31):
Yeah, very good advice.
I'm going to go off script forjust a second.
Abigail, are you a studentstill?
Abigail Hatch (14:35):
I am.
I'm a fourth year student.
Lisa Fortier (14:45):
Awesome.
Okay, back on script.
Oh well, off script.
But I think this is really coolthat we have Abigail,
fourth-year a veterinarystudent, not only completing the
study but again getting itacross the finish line.
And I hope you guys know aboutour journal awards.
Do you know about the awards wegive out?
Oh, Mandy knows, yay.
So, for the listeners, we'rethe only, probably only journal
I know veterinary or human andwe give out four awards for
JAVMA and AJVR, for students,interns and residents, for
(15:09):
manuscripts.
So, we really hope this is areally important article for our
listeners and our practitioners.
So, we really hope youself-nominate.
Sarah Wright (15:19):
Yeah, I think Mandy submitted.
You submitted some nominationslast year.
Is that correct Bird?
Mandy Wallace (15:23):
I did.
I've been fortunate.
We've had some interns andresidents and students get this
award and it means so much tothem.
I really appreciate y'all doingthat, because they all work so
hard and there's not a lot ofrecognition for that hard work
because it's hard to be astudent and writing a paper and
it's hard to be an intern orresident writing a paper, and so
I just it really is always soexciting for them, it's exciting
(15:46):
for us because we get to seethem be recognized.
So I really appreciate y'alldoing that.
I think it's it's awesome to toget to highlight their hard
work.
Lisa Fortier (15:53):
Yeah, we're really , really proud to do it.
The other, we train studentreviewers and associate editors
as well, and, as theeditor-in-chief, I had the
privilege of presenting to theHouse of Delegates just last
week, Sarah, maybe.
Sarah Wright (16:06):
Last week, yeah!
Lisa Fortier (16:08):
and advise them of the things that our journals
are doing that nobody else is,because we really believe in the
future of our profession.
Sarah Wright (16:19):
So, we're really excited Now going back to your
manuscript, so this next set ofquestions is going to be really
important for our listeners.
The first one is going to bemore centered around the
veterinarian's perspective.
So, Abigail, what is one pieceof information the veterinarian
should know before performing aperineal when you're happy and a
dog after a prior castration?
Abigail Hatch (16:37):
So in dogs that undergo surgical correction of
their perineal hernias, I dothink it's important to keep
that association that dogsneutered prior to surgery are at
a 4.4 times greater chance ofrecurrence postoperatively.
Again, like I said earlierthat's not to tell your patients
do not get neutered, because wedo want our patients neutered
out there.
(17:07):
But it's a very important pointto have with your owners during
that discussion and make thatvery clear that it does
unfortunately increase theirrisk of recurrence
postoperatively.
Sarah Wright (17:13):
and then, on the other side of the relationship,
what's something that these petowners should know?
Abigail Hatch (17:22):
Yeah, so, since we looked at recurrence being
one of the major complicationsand we found some risk factors
associated with recurrence, Ithink just informing owners on
what clinical signs and symptomsyou would see if their pet had
recurrence postoperatively, sothey would know when to look for
veterinary help, and thoseclinical signs would be similar
to what we mentioned before,like constipation, perineal
swelling, strange area, etcetera.
Lisa Fortier (17:42):
Fantastic, really really good take-home points and
nice succinctly stated.
So thank you, of course.
Thank you, guys Again.
As we wind down, we ask a funquestion of each of you.
Mandy, this is going to be atough one.
Sarah and I have a hypothesisfor this question, but really
curious what your answer is.
When you complete a puzzle, doyou begin with the interior, do
you do a middle section, middlesection by color, or do you do
(18:05):
the exterior border pieces first?
Mandy Wallace (18:09):
Yes, that's it.
That's a great question.
So I do the exterior borderpieces first.
So I, because I feel like I cansee the edges, so it allows me
to get going.
However, I do get a littledistracted and so if I find
pieces that look like they gotogether, I'll have little
separate islands of pieces thatI found that kind of go together
at the same time.
So I may make little piles orthat, but I try to get the
(18:31):
exterior border first.
Lisa Fortier (18:33):
All right, You're fitting our biomorph.
So we we predict that surgeonsdo the exterior and medicine
folks do the interior.
So you are, you're the perfecthybrid.
Mandy Wallace (18:44):
That is funny.
Oh, I love that.
Lisa Fortier (18:46):
We're going to actually do a retrospective on
this answer.
Mandy Wallace (18:49):
I love that.
Lisa Fortier (18:51):
And then maybe when we're interviewing folks
right, and you should like,would you have a student come
into your office?
You could have like a half donepuzzle and then like see where
they gravitate towards andyou're like I know what your
career is.
Mandy Wallace (19:03):
I love that.
Lisa Fortier (19:06):
And, Abigail, for you, even though you're a fourth
year veterinary student, whatis the oldest or the most
interesting item on your desk orin your desk drawer?
Abigail Hatch (19:14):
So I don't know how interesting it would be for
everyone else, but it means alot to me.
At my desk back home I have mysister.
When I went off to college shehand painted this like ceramic
fish and I've kept it on my deskthroughout college, throughout
vet school, and it's justsomething that if I'm having a
rough day it kind of reminds meof home.
Family's really important to me.
So it may seem kind of smalland just oh, it's a little
(19:38):
ceramic fish on your desk butit's something that kind of
eases me if I'm stressedstudying for exams or when I'm
writing a lot of discharges forpatients on clinics and things
like that.
It just kind of keeps megrounded and reminds me of where
I came from and stuff.
Lisa Fortier (19:53):
That's very awesome.
Maybe when you get back homeyou can send us a selfie of you
and what's your fish's name.
Abigail Hatch (19:59):
I didn't name it.
I should have
Lisa Fortier (20:01):
Fishy.
Abigail Hatch (20:02):
Fishy.
Lisa Fortier (20:02):
Do you pet it like a worry stone?
Abigail Hatch (20:06):
No, I have not.
It's very smooth, so I mean Iguess I could.
That would actually probablylike.
The smoothness would probablybe calming as well.
Sarah Wright (20:13):
But Very cool.
Thank you both so much.
We appreciate you being heretoday chatting with us, and also
for submitting your manuscriptto JAVMA.
Abigail Hatch (20:23):
Yeah, thank you for having us.
It's been so much fun talkingto you guys.
Mandy Wallace (20:27):
Yes agreed.
Thank you, we really appreciateit and thanks for highlighting
our paper and to our listeners.
Sarah Wright (20:32):
You can read Mandy and Abigail's article in JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweeks episode.
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode we chat abouthow dogs neutered prior to
perineal hernia or thatdeveloped fecal incontinence are
at increased risk for perinealhernia recurrence.
With our guests Mandy Wallaceand Abigail Hatch.
Lisa Fortier (00:19):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Mandy and Abigailjoining us, who are both on
clinic, so we really, trulyappreciate you taking time out
of your busy day to be here withus today.
Mandy Wallace (00:34):
Thank you so much for having us.
We're excited to talk about thepaper and have this opportunity
to discuss it more.
Abigail Hatch (00:39):
Yeah, we're really excited, thank you.
Sarah Wright (00:41):
All right, let's dive right in.
So, Abigail, your JAVMA articlediscusses how dogs neutered
prior to perineal hernia happyor that develop fecal
incontinence are at increasedrisk for perineal hernia
recurrence.
Please share with our listenersthe background on this article.
Abigail Hatch (00:57):
Yeah, of course.
So, as you know, perinealhernias, they occur when that
pelvic diaphragm muscles fail tosupport the rectal wall.
They're usually seen in intactmales, usually over five years
of age, among many differentbreeds.
Clinical signs usuallyassociated with perineal hernias
are swelling around theperineal region, constipation,
(01:21):
tenesmus, strange area, and themain way to correct perineal
hernias is through surgery.
Treatment of choice is aperineal herniography and
usually with the surgery, anypost-operative complications
that we typically see aresurgical site infections,
sciatic nerve injury, tenesmusand risk of reoccurrence, as
well as fecal incontinence.
There have been no previousstudies to this date to
(01:41):
determine any risk factorsassociated with these
complications.
So we decided to do this studywhere we looked at risk factors,
two of the main ones fecalincontinence and risk factors
associated with surgical siteinfection and recurrence.
So we just kind of found somestuff, some interesting things.
Mandy Wallace (02:02):
Yeah, and from a clinical perspective, you know,
perinatal hernias are somethingthat one of my mentors in my
residency was very excited aboutand I got to where I really
enjoyed doing the surgery, andso as a team we felt that, like
Abigail said, we just reallydidn't have great resources that
told us what the risk factorswere that we could talk to
(02:24):
owners about or to help us havebetter outcomes, and so that was
our goal was to see can we havebetter outcomes with looking
back through our cases andidentifying potential things
that we could do differently, orat least have things we could
warn owners about?
Sarah Wright (02:38):
And Abigail.
What are the importanttake-home messages from this
JAVMA article?
Abigail Hatch (02:42):
So the important take-home message is just that
letting owners know that dogsthat are undergoing perineal
hernia aphides.
If they have a dog that hadbeen previously castrated or
neutered, they should just betold that.
What we found is if they wereneutered prior to a surgical
correction of a perineal hernia,they are at an increased risk
(03:04):
of having reoccurrencepost-operatively.
That's no reason to not getyour dog neutered.
We definitely want our dogsneutered out there, but it's
just at least a talking pointduring that discussion
pre-operatively to let ownersknow that the risk is a little
bit higher.
And then also, if patientsdevelop fecal incontinence
post-operatively, there is alsoan increased risk of recurrence.
(03:24):
So just keeping your ownersinformed with all of these
things.
Lisa Fortier (03:29):
You may or may not know, I'm a equine orthopedic
surgeon and I remember the daywhen I was like this is for me.
I remember watching, as astudent, somebody do arthroscopy
and I thought that's thesexiest thing ever seeing all
the cartilage and the bones andhow the joints move together.
So I'm curious from each of youwhat sparked your interest in
yucky soft tissue surgery, likethe perineal region.
(03:51):
So, Abigail, how about we startwith you?
And then Mandy, love to hearwhat inspired you too.
Abigail Hatch (03:57):
Yeah.
So I guess to start like myinterest at least in veterinary
medicine.
I was always that kid that justwanted to do vet med for some
reason, like right from theget-go.
And then I, at one of thepractices, I worked at a
specialty hospital prior to vetschool and they had ER surgery
(04:17):
cardiology, ophthalmology, allthe things and I just I loved
being in the OR, I lovedwatching emergency surgeries
like GDVs and splenectomies andthings like that and I just the
intricacy and the soft tissuehandling and everything it's I
don't know, it's just sointriguing to me.
Lisa Fortier (04:33):
Very cool.
One of the things I do miss inorthopedic surgery there's not
much medicine that goes.
Most of them are pretty healthyright.
Especially in what I do issports medicine, so I do miss a
little bit of the.
We get plenty of emergenciesbut they're still usually
healthy.
So that that would be one part.
I think soft tissue surgerywould add to your puzzle.
Putting together Mandy, howabout you?
(04:55):
Sorry.
Abigail Hatch (04:56):
No, that's okay.
No, I was like I was agreeing.
There's a lot of casemanagement.
I'm currently on ortho for myrotations right now and, like
you said, all of our patientsare healthy and I do kind of
Mandy Wallace (05:07):
Yeah, I completely agree.
So, funny enough, I found anessay I wrote as a first year
vet student where I said Iwanted to be an orthopedic small
animal surgeon in academia.
And I reached most of thosegoals, except I switched roles
there and so for me it's exactlywhat you said.
I remember being a third-yearvet student and on my surgery
rotation walked into an openchest surgery and got to feel
the beating heart, got to seethe lungs moving, and it was
(05:35):
this immediate, like I have todo this forever.
So, I knew surgery was where Iwanted to go.
And as I progressed through therest of vet school and
internship and residency, I alsoreally love internal medicine
and so internal medicine waskind of almost like a secondary
thing for me.
And I realized in soft tissuesurgery not only would I get to
(05:56):
feel the beating heart on afairly regular basis which I
didn't think I could ever let goof but I also get to put those
puzzle pieces together, reallywork through cases and see some
really interesting things thatjust every day is kind of
different on soft tissue.
Every splenectomy is different,every foreign body is different
, and so that's what reallysparked my interest and keeps me
excited about it.
Lisa Fortier (06:14):
Excellent.
Every time we do a manuscriptof any sort, even if it's a
retrospective study, we findthings that we didn't expect.
So was there anything in thisstudy that you found surprising?
Abigail Hatch (06:34):
I mean, I guess the fact that previously
neutered animals having a higherrisk of recurrence that was
actually kind of surprising forme, just because always we talk
about neuter your animals Ifthey're not breeding it's better
for their overall health.
So just finding out the factthat it actually is a risk
factor for one of our surgicalcomplications, that was pretty
interesting.
Lisa Fortier (06:49):
Yeah, I thought that too, Mandy.
How about you?
Mandy Wallace (06:52):
I agree that that was really unexpected for us.
We really didn't think that wasthe case, because we do
recommend castration at the timeof perinatal hernia repair and
so most of the time they'realready, they're still intact,
and so when we found that,finding it really surprised us.
I mean I couldn't probablycouldn't have been more shocked
that that was real and it wasquite a large odds ratio.
(07:13):
So we feel pretty confidentthat it is real.
That was the most shockingthing.
We also the fecal incontinencefinding also shocked us.
Honestly, we were shocked byboth findings.
We were.
I think the thing that maybesurprised us more too is that we
didn't find more risk factorsfor surgical site infection.
So we thought startingantibiotics at the time of
(07:35):
surgery would have decreased oursurgical site infection risk,
and that was not something thatwe found.
So some of the non-findingswere maybe just as shocking as
the things we did find.
Sarah Wright (07:45):
So, now that you've completed this study,
Abigail, what are the next stepsfor future research on this
topic study Abigail?
Abigail Hatch (07:52):
What are the next steps for future research on
this topic?
So I guess, going off of ourtwo main points that we found,
the first being that if theywere previously neutered the
risk of recurrence is higher, Ithink it would be interesting to
look at like what age they wereneutered at, like compared to
the time of surgery, and see ifthere is a association with if
they were neutered earlier, doesthat increase their risk?
Or if they were neutered closerto surgery time, does that
increase their risk?
(08:12):
As far as fecal incontinencegoes, I think maybe looking at
how long the fecal incontinencelasted postoperatively to see if
there's any association withlength of time and incontinence
and risk factor or recurrence.
Excuse me.
Lisa Fortier (08:27):
Go a little off script.
If the dog was neutered alength of time and I don't know
what it is in dogs when theirtestosterone becomes T zero
would you consider testosteronesupplementation before fixing
them?
Or is it to an emergent surgery, like who we need to fix this?
We can't wait to get their T up.
Mandy Wallace (08:49):
Yeah, that's a great question.
So typically not emergency um.
On rare occasions it is so ifthey have the bladder um is
retroflex and they're obstructedor if they're really just
unable to defecate um despitemedical management.
But typically we wouldn'tconsider it a true emergency.
So I think that's somethingthat we could consider is to see
if we could determine if lengthof time made a difference or if
(09:11):
we could determine if therewere receptors in that area that
really truly responded to thistestosterone.
I think that could be apossible idea that would
potentially keep them fromhaving a recurrence.
Lisa Fortier (09:24):
Awesome
Sarah Wright (09:25):
Sounds like another project.
Yeah, exactly so anyonelistening?
You contact Abigail and Mandyso lately you've been talking
about like emerging technologiesand like the veterinary space,
and one of those is AI.
So, Abigail, do you see a rolefor AI in this area of research?
Abigail Hatch (09:47):
Specifically for perineal hernias?
Not sure I'm sure there is, butI guess, with it being a
retrospective study, Idefinitely think there's.
A AI would definitely be useful.
The amount of medical records Iwent through to get all of the
information and charting andeverything it was a lot and I
know that AI there's a lot oftools out there now to like
(10:08):
search through medical records,search for specific information,
so I think that would be veryhelpful to minimize, maybe even
like human error when lookingthrough medical records.
They might catch some things,cause I know we mentioned that
as part of one of possibleerrors in our manuscript as well
Just human error, we're allhumans, but yeah, so I think AI
would definitely be helpful inlooking through all of those
(10:30):
things.
Lisa Fortier (10:37):
I remember my first retrospective study and
being appalled at what wasmissing from medical records,
and especially, I'm old enoughthat we transitioned from paper
to paper, electronic.
And then you switch medicalrecord systems and you're like,
well now, where did that go?
So, for me at least, in myresearch animals, it inspired me
to rethink what we're asking onthose medical records.
(10:58):
Right, you shouldn't.
If you were a lawyer and yougot sued and there's a blank
space because you didn't commenton the integratory system,
right, did that cross your mindlike, wow, we need a better
physical exam form.
Abigail Hatch (11:14):
Um, I don't necessarily know.
With physical exam one spot Inoticed a lot like not a lot of
missing information, but like Iwould have to dig for it with
our anesthesia records becauseit's all handwritten um, and I
had not taken my anesthesiarotation at the time yet, so I
had not been through all of thatand there was just often times
where I'm like trying to figureout what was given, how long the
(11:36):
patient was under anesthesia,sometimes the post-op time
wasn't recorded, things likethat.
So when I was on anesthesia Iwas very, very laser focused to
get all that information.
So maybe on that aspect wecould maybe improve a little bit
.
But I think everything else waspretty much there, most of the
time.
Sarah Wright (11:56):
Yeah, we had those same handwritten forms too, and
I did my anesthesia rotation aswell during vet school and I
agree, definitely some room forimprovement, for sure, yeah.
Abigail Hatch (12:03):
And it's very easy to miss things because
there's so much going on.
So, it's not anyone's fault,but that's at least if there was
maybe a online way to doeverything.
But we'll see.
Sarah Wright (12:14):
For sure In the future.
That's why we asked thatquestion and, for those of you
just joining us, we'rediscussing what veterinarians
should know before performing aperineal hernia appy and a dog
after a prior castration withour guests Mandy and Abigail.
Lisa Fortier (12:29):
Abigail, you talked just a few minutes ago
about that you hadn't done youranesthesia rotation, so maybe it
made it a little more difficultto start with the record review
.
How did all the other trainingin your previous work prepare
you to finish this manuscript?
Abigail Hatch (12:44):
So I've been very fortunate to be a part of a lot
of research experiencesthroughout both my undergrad and
my time here in vet school, soI feel like seeing multiple
types of projects and thingslike that throughout my career
has helped me be better preparedfor this manuscript.
I also took a lot of scientificwriting courses in undergrad.
We were lucky enough to havethose at the university where I
(13:06):
went and I think that helpedstrengthen my scientific writing
.
And of course, I also had greatmentorship from Dr Wallace,
which is key when you're writinga manuscript so.
Lisa Fortier (13:16):
We love hearing that mentorship's alive and well
.
How about you, Mandy?
How is your experience built onhelping Abigail and really
getting this to the finish line?
Mandy Wallace (13:25):
For sure.
Well, Abigail made it easy.
She's fantastic, very on top ofthings, very detail oriented,
trusted that she was able to getthrough those records and
really trusted her data that shefound, so that she made it easy
to be her mentor.
She always has, since she was afirst year vet student.
For me, I think the moreretrospective studies that I do,
(13:47):
maybe the better I get atrefining what we need to get out
of those records.
And so I think at first yourecord so many data points that
it almost gets exhaustinginstead of really focusing down
on, okay, what are known orthought risk factors for
recurrence, what are known orthought risk factors for
surgical site infection, andreally being able to pare those
things down.
And so I think you know, as theyears go on, the more
(14:09):
retrospectives we do, we get alittle bit better every time at
just narrowing it down, reallyfocusing what we're looking for
and, in focusing that, makingsure that we're not getting some
data that just really itdoesn't make sense.
You know, focusing on thethings that do make sense from
the prior literature, and Ithink that's an area that you
get better at over time.
Lisa Fortier (14:31):
Yeah, very good advice.
I'm going to go off script forjust a second.
Abigail, are you a studentstill?
Abigail Hatch (14:35):
I am.
I'm a fourth year student.
Lisa Fortier (14:45):
Awesome.
Okay, back on script.
Oh well, off script.
But I think this is really coolthat we have Abigail,
fourth-year a veterinarystudent, not only completing the
study but again getting itacross the finish line.
And I hope you guys know aboutour journal awards.
Do you know about the awards wegive out?
Oh, Mandy knows, yay.
So, for the listeners, we'rethe only, probably only journal
I know veterinary or human andwe give out four awards for
JAVMA and AJVR, for students,interns and residents, for
(15:09):
manuscripts.
So, we really hope this is areally important article for our
listeners and our practitioners.
So, we really hope youself-nominate.
Sarah Wright (15:19):
Yeah, I think Mandy submitted.
You submitted some nominationslast year.
Is that correct Bird?
Mandy Wallace (15:23):
I did.
I've been fortunate.
We've had some interns andresidents and students get this
award and it means so much tothem.
I really appreciate y'all doingthat, because they all work so
hard and there's not a lot ofrecognition for that hard work
because it's hard to be astudent and writing a paper and
it's hard to be an intern orresident writing a paper, and so
I just it really is always soexciting for them, it's exciting
(15:46):
for us because we get to seethem be recognized.
So I really appreciate y'alldoing that.
I think it's it's awesome to toget to highlight their hard
work.
Lisa Fortier (15:53):
Yeah, we're really , really proud to do it.
The other, we train studentreviewers and associate editors
as well, and, as theeditor-in-chief, I had the
privilege of presenting to theHouse of Delegates just last
week, Sarah, maybe.
Sarah Wright (16:06):
Last week, yeah!
Lisa Fortier (16:08):
and advise them of the things that our journals
are doing that nobody else is,because we really believe in the
future of our profession.
Sarah Wright (16:19):
So, we're really excited Now going back to your
manuscript, so this next set ofquestions is going to be really
important for our listeners.
The first one is going to bemore centered around the
veterinarian's perspective.
So, Abigail, what is one pieceof information the veterinarian
should know before performing aperineal when you're happy and a
dog after a prior castration?
Abigail Hatch (16:37):
So in dogs that undergo surgical correction of
their perineal hernias, I dothink it's important to keep
that association that dogsneutered prior to surgery are at
a 4.4 times greater chance ofrecurrence postoperatively.
Again, like I said earlierthat's not to tell your patients
do not get neutered, because wedo want our patients neutered
out there.
(17:07):
But it's a very important pointto have with your owners during
that discussion and make thatvery clear that it does
unfortunately increase theirrisk of recurrence
postoperatively.
Sarah Wright (17:13):
and then, on the other side of the relationship,
what's something that these petowners should know?
Abigail Hatch (17:22):
Yeah, so, since we looked at recurrence being
one of the major complicationsand we found some risk factors
associated with recurrence, Ithink just informing owners on
what clinical signs and symptomsyou would see if their pet had
recurrence postoperatively, sothey would know when to look for
veterinary help, and thoseclinical signs would be similar
to what we mentioned before,like constipation, perineal
swelling, strange area, etcetera.
Lisa Fortier (17:42):
Fantastic, really really good take-home points and
nice succinctly stated.
So thank you, of course.
Thank you, guys Again.
As we wind down, we ask a funquestion of each of you.
Mandy, this is going to be atough one.
Sarah and I have a hypothesisfor this question, but really
curious what your answer is.
When you complete a puzzle, doyou begin with the interior, do
you do a middle section, middlesection by color, or do you do
(18:05):
the exterior border pieces first?
Mandy Wallace (18:09):
Yes, that's it.
That's a great question.
So I do the exterior borderpieces first.
So I, because I feel like I cansee the edges, so it allows me
to get going.
However, I do get a littledistracted and so if I find
pieces that look like they gotogether, I'll have little
separate islands of pieces thatI found that kind of go together
at the same time.
So I may make little piles orthat, but I try to get the
(18:31):
exterior border first.
Lisa Fortier (18:33):
All right, You're fitting our biomorph.
So we we predict that surgeonsdo the exterior and medicine
folks do the interior.
So you are, you're the perfecthybrid.
Mandy Wallace (18:44):
That is funny.
Oh, I love that.
Lisa Fortier (18:46):
We're going to actually do a retrospective on
this answer.
Mandy Wallace (18:49):
I love that.
Lisa Fortier (18:51):
And then maybe when we're interviewing folks
right, and you should like,would you have a student come
into your office?
You could have like a half donepuzzle and then like see where
they gravitate towards andyou're like I know what your
career is.
Mandy Wallace (19:03):
I love that.
Lisa Fortier (19:06):
And, Abigail, for you, even though you're a fourth
year veterinary student, whatis the oldest or the most
interesting item on your desk orin your desk drawer?
Abigail Hatch (19:14):
So I don't know how interesting it would be for
everyone else, but it means alot to me.
At my desk back home I have mysister.
When I went off to college shehand painted this like ceramic
fish and I've kept it on my deskthroughout college, throughout
vet school, and it's justsomething that if I'm having a
rough day it kind of reminds meof home.
Family's really important to me.
So it may seem kind of smalland just oh, it's a little
(19:38):
ceramic fish on your desk butit's something that kind of
eases me if I'm stressedstudying for exams or when I'm
writing a lot of discharges forpatients on clinics and things
like that.
It just kind of keeps megrounded and reminds me of where
I came from and stuff.
Lisa Fortier (19:53):
That's very awesome.
Maybe when you get back homeyou can send us a selfie of you
and what's your fish's name.
Abigail Hatch (19:59):
I didn't name it.
I should have
Lisa Fortier (20:01):
Fishy.
Abigail Hatch (20:02):
Fishy.
Lisa Fortier (20:02):
Do you pet it like a worry stone?
Abigail Hatch (20:06):
No, I have not.
It's very smooth, so I mean Iguess I could.
That would actually probablylike.
The smoothness would probablybe calming as well.
Sarah Wright (20:13):
But Very cool.
Thank you both so much.
We appreciate you being heretoday chatting with us, and also
for submitting your manuscriptto JAVMA.
Abigail Hatch (20:23):
Yeah, thank you for having us.
It's been so much fun talkingto you guys.
Mandy Wallace (20:27):
Yes agreed.
Thank you, we really appreciateit and thanks for highlighting
our paper and to our listeners.
Sarah Wright (20:32):
You can read Mandy and Abigail's article in JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweeks episode.
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