We met Obie, the World's (formerly) Fattest Dachshund, in the first interview of this series. In this interview, meet veterinary surgeon Dr. Alon Kramer DVM ACVS of Oregon Expert Vets who did the surgery to remove Obie's excess skin after shedding 40 pounds (18.2 Kg).

How involved were you in the pre-op preparations with Obie? (monitoring weight loss, setting "surgery goal weight,", etc.)

Dr. Kramer: I've seen Obie a 2-3 times in the months preceding his surgery.

I was not part of his weight loss plan, but rather served as a surgical consultant - assessing when and if surgery would be appropriate, and what surgery or surgeries may be needed.

Did you consult with a referring veterinarian?

Dr. Kramer: I've not been aware of a specific referring DVM.

Have you performed a tissue reduction surgery such as this before?

Dr. Kramer: I've performed extensive skin excision and reconstruction surgeries in association with tumors and traumatic injuries. I've not done such surgeries due to morbid obesity prior to Obie's surgery.

What were the special surgical considerations for Obie during the surgery? (anything from special anesthetic protocol-monitoring to planning drain placements to where/how much skin to remove)

Dr. Kramer: Obie had no specific heart condition or any significant CBC [Complete Blood Count] or biochemical abnormalities. However, his increase in abdominal fat was a concern for diaphragm mobility and proper pulmonary expansion [breathing]. Therefore, positive pressure ventilationand careful patient positioning were applied.

The skin and underlying fat were repeatedly assessed, and marked with surgical pen prior to surgery (excision/reconstruction map) to allow planning for proper excision of skin and fat, and to enable advancement flap reconstruction. Post operative pain was a concern due to extent of surgery, and fentanyl CRI [Constant Rate Infusion of Fentanyl, a pain management drug] was used during and post- surgery.

How was Obie's recovery from surgery?

Dr. Kramer: The recovery was much better than expected. Pain was well-controlled with fentanyl CRI; Drain fluid production was not significant; Obie became very comfortable within 24 hours post-surgey, and has had no significant complication since.

My concern was, considering the poor quality of the skin to be removed and its ventral [belly] location, that we may run into incisional irritation/infection, or even dehiscence. None occurred.

Has Obie suffered any other health consequences from the morbid obesity? (joints, back, etc.)

Dr. Kramer: Obie's ambulatory function was significantly compromised due to the physical constraints imposed by his obesity and excess skin and SQ fat. In addition, his skin was chronically inflamed, with long-standing bacterial and yeast infections irritating and affecting Obie's overall skin's health. The skin not only dragged on the floor, but also had contact folds at the axillary, antebrachial and umbilical [arm pit, forearm, and belly] regions.

By sharing Obie's story and return to health, what is your hope for other obese pets out there?

Dr. Kramer: I don't pretend to know whether Obie's story would make a significant change in the pet obesity arena. I worry pet obesity is an extension of our human deficiencies in the same arena. I suspect that at this point, Obie's story is a public curiosity more than a lesson to be learned.

Thank you, Dr. Kramer, for giving us insight into Obie's surgery and recovery.

Connect with Dr. Kramer:

• Oregon Expert Vets (OREV)
• OREV on Facebook

Keep up to date on Obie's progess:

• Obie on Facebook
• Obie Web Site