Friday, September 9, 2011

598. A gentle Alsatian with painful right ear

Friday 5 pm. Sep 9, 2011

"I have an appointment at 5 pm. How long must I wait?" the busy lady asked. There were two more cases waiting for Dr Vanessa and she was consulting with one. I estimated it would take an hour but it would not be within 15 minutes of waiting time.

Appointment times are not always on-time. The 12-year-old 37.5 kg Alsatian had a left ear haematoma operated by Dr Jason Teo some months ago. "The ear is bent," the lady said that the vet had told her that the ear would be upright after the haematoma surgery. It is not always true, depending on many factors. In this case, the right ear was very painful. The dog also had ticks which did not respond to the Frontline spot on.

"Have you boarded the dog recently?" I asked. She said: "The dog was lost and was found by the SPCA. Can I get some ear drops from you?"

This was a case that the ulcerated itchy right ear ought to be thoroughly irrigated. That meant anaesthesia rather than syringe the dog's ears. I do that sometimes if the case of ear infection is not serious. But this ear was bad.

Ear drops and medication would be expedient but would not help the dog. I asked Dr Vanessa whether she could take the case. She said she could. But that mean waiting as there was the other clients of hers.

I took over the case as it is best not to make clients wait. Big dogs with ticks are best treated promptly as their ticks will infest the surgery too.

SEDATIVE USED

For a healthy 10kg young dog, the IV anaesthesia I use is as follows:
Domitor 0.4 ml
Ketamine 0.5 ml
Total 0.9 ml IV for 10 kg dog

This was a 37.5 kg dog, very old.
So at 37.5 kg
Domitor 1.5 ml
Ketamine 1.9 ml

But this is a very old dog.
5.36 pm, I gave
Domitor 0.8 ml
Ketamine 1.4 ml
Total in one syringe 2.2 ml IV for 37.5 kg dog ie. at around 50% of calculated dose.
I gave Atropine 1.5 ml IM first.
Put the dog on the table. He was gentle and laid on his chest.

5.57pm, The dog was well sedated as I vigorously rubbed his ear canal to dislodge debri and he did not mind. Lots of oil, rubbish, clotted blood and yellow wax. The ear irrigation was completed at 5.57 pm. I asked my assistant to help me while I inject Antisedan antidote 1.0 ml IV. The owner was shown that there is light pink blood-tinged tip of cotton bud in right ear but nothing in left ear. I asked her to smell the tip. Not much of a smell but she said: "There is a smell." I said: "Some smell as the ear infections had been so long and ulcers are there." I scoped the right ear and asked her to look at the ulcer. She saw redness in the ear canal.

6.07 pm, the dog lifted his head and was alert after an increase in breathing rate. But could not stand up. I had a feeling that the Antisedan might not have gone 100% IV as there was some obstruction during the IV as the needle shifted. Other younger dogs do get up and stand up within 5 minutes after Zoletil. In this case, the old dog could not stand up. I analysed that he was old and took a longer time to recover. Or that my combination dosage was high on the ketamine side. In any case, a dog alive is what the owner wanted and he was very much alive, to the delight of the lady.

I got the dog down from the table onto the floor. He was in front of the surgery and everybody could see what was happening. He laid sideways and his back legs extended straight for a while. "Why this is happening?" the lady owner asked me.
"It is the effect of ketamine," I said. "Not serious."

The dog was not fully alert but could lift his head and see us. We carried him to the car. The lady carried the head, I carried the chest and Min carried the back. "Head in first," I said.

Overall, this was a satsifactory case. The dog should recover well with medication and a new brand of anti-tick Advantix.

"It is best not to make clients wait a long time," I advised Dr Vanessa. Sometimes it can't be helped and I will intervene to help out. But the main bulk of the case load is hers from 11 pm to 7 pm. Mine is from 9 am to 11 am and at other times when needed.

Two days ago, an American came during lunch-time. My assistant was out for lunch but Dr Vanessa was in. "You are the Vet Tech," he asked me since I was manning the reception. I explained I am a vet and was covering the lunch period. Service is much more personalised when the Surgery does not have many lay people and helping hands.

"So you just manage the practice?" the American asked. "Yes," I said. "I do some difficult operations but the routine ones are left to my two vets."
I had more time talking to him about his day-trading and learning much about his business. "You make $400 in 2 hours from trading the S&P index," I said. "It is not that easy," he said. "You have to study the patterns of past trading and know which scenario to apply. Stop loss or continue along the curve?"

I learnt there is a bigger S&P index for the big players and smaller mirror one for the day traders. I guess it is hard work to earn an honest living in any profession and that past precedents and cases make a day trader or vet successful. There is no short cut to success in earning an honest livelihood. But I can't sit in front of the monitor to do day trading. I also can't be a dentist sitting on the chair to do dental scaling or work on the mouth of people.

I enjoy seeing the dogs or pets recover from their pain and various diseases from head to toe, not just the mouth and that is what veterinary medicine and surgery offer. It is a privillege and few people have this opportunity and I hope I can share some anaesthesia knowledge to bring vet medicine alive to the poor undergraduates studying for their final exam in Australia now.

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