Monday, June 6, 2011

467. Seeing is believing

"Doc, my Dachshund has a big lump behind his neck?" the lady owner phoned me regarding a big lump in her Dachshund. "It appears in the last 2 days. I think it is due to the tight bandage. What shall I do?"

"Is it as large as a ping pong ball?" I asked.
"Yes."
"It may be an abscess (pus inside) or a haematoma (blood inside)," I said. "It is hard to diagnose without examination."

She brought the dog in on Friday evening. "Well, there is no pain in this lump," I said as I pressed it. Firm and tense, around the 3/4 of the size of a table-tennis ball. I scheduled for surgery on Saturday, forgetting I had my day off on Saturday.

"I can't come on Sunday," the owner phoned me. "I have to travel overseas on Sunday. Can the lump wait till I come back 10 days later?"

"It is best not to wait. The lump could harden or the bacteria inside could spread to the muscles, making it very painful and hard to operate. Can you ask your husband to bring the dog in on Sunday at 9.30am so that I can operate first thing in the morning?"

I was surprised she was single as she had that essence of a combination of inner and outer beauty. "Well, I can arrange for a dog taxi man to bring the dog to the Surgery."

She said she would phone me and later made an appointment for Sunday morning 9.30 am. She was very punctual.

"There is no electricity," my assistant Min suddenly told me. The HDB management had given prior notice of no electricity supply till 9 am on Sunday morning but my staff did not inform me.

"What to do?" the lady owner asked me pleasantly. That is her personality. Not to get angry over unexpected circumstances beyond her control.

"Don't worry," I said. "The dog will go home at 11.00 am". My operation room has glass walls on one side facing the back door which brings in the morning light and a glass screen between it and the consultation room, bringing in daylight from the consultation room. It is not a windowless operating room as in most surgeries. We have torch-lights too.

I told Mr Min to clip as I had sedated it with 0.3% xylazine IM. Min said, "No electricity. You cannot use the gas anaesthetic machine."

I shook my head. "Do anaesthetic machine need electricity?" I asked Min shaking my head. Sometimes I can get very impatient with such feedback with no basis.

This was the Dachshund's 3rd anaesthesia and though nothing ought to go wrong, I did not want to tempt fate as old dogs are high anaesthetic risk. On the other hand, I could just sedate the dog and drain the abscess and cut off the hock melanoma spotted by the owner. It could be painful. A higher dose of sedation may also kill the dog.

Therefore a light sedation of xylazine and isoflurane gas is the best safest method of general anaesthesia. This was done and the dog was as awake as a normal dog when the happy owner came in a taxi to pick him up to go home.

"A lot of gas and blood with pus," I said to the owner.
"Really?" she replied.
"Min, take out the syringe with the blood and pus," I said.
I forgot to present the syringe but I did stick the melanoma from the hock to show her.
Min took out the syringe and the lady was convinced. Seeing is believing in veterinary medicine. I do not know why I had not shown the syringe earlier.

Emergency surgery lights can be installed. However, these must be maintained and tested weekly as they do fail if they are not tested.

This is the Dachshund's 3rd anaesthesia in 2 months. It is best not to tempt fate anymore.



http://www.sinpets.com/F5/201006252abscess-haematoma-Dachshund-old-ToaPayohVets.htm
has all the pictures. One of them is shown here.

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