Sunday, June 30, 2013

Sunday's Interesting cases: Ventriculocordectomy (devocalisation) of a Beagle using the laryngotomy approach

Case 1. Devocalisation in a Beagle

"The Vet book makes it sound so easy," I said to Dr Daniel as I was preparing to operate on this rarely done surgery using the laryngotomy approach. "Pull out the vocal cords, cut it and suture the ends. There is a very small space to operate and after excising the vocal cords, the ends shrink and there is no possibility of suturing. I use electro-excision to control bleeding. But there is alway a lot of bleeding in this surgery."

Sometimes I wonder whether the author of the article in "Small Animal Surgery 4th Edition, Theresa Welch Fossum" has ever done this surgery in the dog and actually stitch up the ends of the excised vocal cords.

I have done this operation in racehorses with laryngeal paralysis  at the Singapore Turf Club when I was an equine vet. It was also a bloody surgery. 

For dogs, there is an oral approach which I don't do as there are complaints of ineffectiveness in many cases. For this Beagle, he was neutered but he still has a habit of barking the whole day long, disturbing the neighbours. It was either death by lethal injection or this surgery. I try to dissuade owners from doing it by training the dog but it is easier said than done.  After some weeks, the owner brought this dog in for the surgery.  In my 40 years in practice, I have had performed around 5 of such operations in the dog only in  cases of desperation by the dog owner. It is not a surgery I will do as it is deemed cruelty.

The operation is recorded to share my experience with other vets researching the internet for such cases.

ANESTHESIA
Domitor + Ketamine at 80% of the calculated weight via the IV drip.* 
Dom = 0.45 ml + Ket = 0.56 ml IV at 80%.  5 years old,  14 kg bodyweight.
Atropine 1 ml IM after that. Isoflurane gas + O2 via a smaller endotracheal tube (size 6) so that it can be pushed to one side to access one of the vocal cords for excision. 
Maintenance dose as high as 3.5%.
*Dog went rigid and head extended after Dom + Ket were given via the IV drip. Duration of a few seconds. Atropine 1 ml IM given. No recurrences of excitement.

SURGERY
Electro surgery
Dog's head under a bottle, extended neck.
Electro-excise skin and midline of the sternohyoid muscles retracted
Midline of thyroid cartilage electro-incised
Endotracheal tube could be seen taking up 50% of larynx
Assistant retracts thryoid cartilage so that the vocal fold can be seen. As space is so small, it takes experience to see the depression in which the vocal folds reside. View cranially. In the depression, use forceps to pinch out one tip of the vocal fold. Another forceps clamp below. Pull out as much as possible. I used the electro-incision to cut off the fold above the forceps and below the forceps whenever possible.

No stitching of the mucosa of the cut off vocal folds as stated in the Vet book as there is not much space to manipulate. This was not done by me in all my cases.

Lots of bleeding from the surgical areas. Unable to stem the bleeding as it was not possible to locate the bleeders. The less vocal fold area has lesser bleeding. This profuse bleeding has been present in all the past cases including the horse.

Stitch up thryoid cartilage, sternohyoid muscles and skin. Antisedan to wake up dog.       

UPDATE 12 HOURS POST OP
OK


     

Saturday, June 29, 2013

1490. $500 for an elective Caesarean Section in a poodle

Saturday Jun 29, 2013

"The vet at Serangoon charges only $500," the home-breeder came yesterday. He had already X-rayed and knew he had 3 puppies. Now he was looking for a lowest quotation for a C-Section.

In the first birth, the dam had difficulty giving birth and a puppy had died. He still needed a C-section for the other puppies.

I used to charge $300 for every Caesarean section for the Pasir Ris breeders around 2006, but there was a vet who charged only $250.

Low surgical costs attract more customers. The costings must be done carefully. Otherwise, the vet loses money for every Caesarean section done. In the end, there is no profits to buy new equipment or upgrade, leading to a poor impression of the Surgery. Young Singaporeans love the glitz and the decor and if the vet does loss-making surgeries, he or she will need the volume. But at the end of the financial year, the net profits may be a loss.

So I told Dr Daniel that it is best not to perform C-sections at $500 as the time taken and complexity of this surgery as compared to a spaying of a female dog is much longer. We let the home breeder go. The associate vets must be some economic sense in working in a private practice so as not to make loss-making operations.

1491. Unable to print out Post No. 1490. Testing Post 1489 with direct html copy of article


De-ticking services at Toa Payoh Vets
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Update: 30 June, 2013
TOA PAYOH VETS 
Be Kind To Pets
Veterinary Education
Project 2010-0129
 

DE-TICKING SERVICES FOR DOG OWNERS IN SINGAPORE

The most common complaint in Singapore is heavy infestation of ticks in a dog. Sometimes, the spot-on insecticide, Frontline, is not effective for various reasons. There may be a need to use another brand.
Ticks do cause fatal diseases like tick fever in dogs. Therefore, it is best to ensure that your dogs don't get tick bites.
Dog owners with tick problems can contact Toa Payoh Vets by phone at 6254 3326 to make an appointment to de-tick their dogs.

We need time to get the dogs clipped, bathed with tick wash, pluck out the ticks and advise on tick control at home. Bring the dog to the Surgery at 10 a.m. and take back the dog the next day in the evening. It takes around 2-3 hours to clip, bath and pluck out the thousands of ticks stuck into the dog's body.

The estimated cost of de-ticking a medium to large breed is $180 - $250. For small breeds, the estimated cost is $150 - $200.

An additional $50-80 is payable if the dog needs sedation for hair clipping as the heavily infested dog suffers from painful and inflamed tick bites will not stay still for clipping, esp. around the facial areas.  The cost of antibiotics and spot-on insecticides are additional optional costs.
 
 
Adult Siberian Huskies. Heavy tick infestations. Treated at toa payoh vets, singapore Adult Siberian Huskies. Heavy tick infestations. Treated at toa payoh vets, singapore Adult Siberian Huskies. Heavy tick infestations. Treated at toa payoh vets, singapore.
De-ticking heavily infested dogs at Toa Payoh Vets

 
 
6239 - 6244. How to de-tick a dog. A video of the Border Collie being de-ticked at Toa Payoh Vets is being produced in July 2013 to educate dog owners. 


TICKS IN MANY DOGS

E-MAIL TO DR SING DATED AUG 28, 2010
I read your very informative article here:  Ectoparasite control lecture. I have a question.  I have 9 Papillons which were heavily infested with adult ticks and "baby" ticks.  (At least that's what my vet said they were although they look like mites to me.)
 
After weeks of bathing and grooming, I finally applied FrontLine Plus Spray, which has worked very well at killing all the ticks which I could not remove by picking off.  Now, a week later, I am seeing a slight re-infestation of small (baby) ticks/mites.
 
I would like to use a Bayticol 6% rinse on them (10ml/15L water dilution = 40ppm). Is this safe?  My Papillons are all 3-4 kilograms. And I have a 10 week old puppy.  FrontLine Plus Spray was applied one week ago.
 
Thanks in advance for your help.
 
Name of owner
Thailand

E-MAIL REPLY FROM DR SING DATED AUG 28, 2010


I am Dr Sing Kong Yuen from Toa Payoh Vets, toapayohvets.com
Environmental control of ticks is very important. Most likely you have not been able to do it. Once you have just applied Frontline spot on, it is risky to apply another insecticide so soon. You need to find the source of your ticks as it appears to originate from the environment e.g. wall and floor cracks. Spray an anti-insecticide wash into the cracks.

Generally, I would advise clipping off the coat of all dogs with heavy tick infestations, apply de-ticking wash thoroughly over the body, pick off the dead ticks and check for live ones. Then house them away from their usual area but this may not be practical advice in your situation. Best wishes.
REFERENCES & CASES SEEN AT TOA PAYOH VETS
 

1.  Lecture: Control of Ecto-parasites in Singapore:  http://www.bekindtopets.com/dogs/20100196ectoparasites_control
_dogs_ToaPayohVets.htm


2. 
A Cocker Spaniel has tick fever in 2011
3 A Great Dane had tick fever in 2008
4.  A vet said that imizole is ineffective against Babesia gibsoni
5. Using non-chemical means to prevent tick infestation in your dog 
6. Babesia canis in a Samoyed in 2012

7. Tick fever case educational video of a Samoyed treated at Toa Payoh Vets. http://www.youtube.com/watch?v=RYhKxpbuZ3A

liver failure, kidney failure, babesia canis, samoyed, toapayohvets 8. Blog - A Samoyed has tick fever in 2012
8.1  http://2010vets.blogspot.sg/2012/07/tick-fever-in-singapore-dogs-from-drug.html

8.2  http://2010vets.blogspot.sg/2012/07/1074-sop-tick-fever-in-dogs.html

8.3  http://2010vets.blogspot.sg/2012/07/1062-acute-tick-fever-in-big-white-dog.html

UPDATES WILL BE ON THIS WEBPAGE:
http://www.asiahomes.com/army/2010067tick_control_bites_infestation-parasites-dogs-singapore-ToaPayohVets.htm
 

Update: De-ticking dogs at Toa Payoh Vets


tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   30 June, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

De-ticking services at Toa Payoh Vets
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Update: 30 June, 2013
TOA PAYOH VETS 
Be Kind To Pets
Veterinary Education
Project 2010-0129
 

DE-TICKING SERVICES FOR DOG OWNERS IN SINGAPORE

The most common complaint in Singapore is heavy infestation of ticks in a dog. Sometimes, the spot-on insecticide, Frontline, is not effective for various reasons. There may be a need to use another brand.
Ticks do cause fatal diseases like tick fever in dogs. Therefore, it is best to ensure that your dogs don't get tick bites.
Dog owners with tick problems can contact Toa Payoh Vets by phone at 6254 3326 to make an appointment to de-tick their dogs.

We need time to get the dogs clipped, bathed with tick wash, pluck out the ticks and advise on tick control at home. Bring the dog to the Surgery at 10 a.m. and take back the dog the next day in the evening. It takes around 2-3 hours to clip, bath and pluck out the thousands of ticks stuck into the dog's body.

The estimated cost of de-ticking a medium to large breed is $180 - $250. For small breeds, the estimated cost is $150 - $200.

An additional $50-80 is payable if the dog needs sedation for hair clipping as the heavily infested dog suffers from painful and inflamed tick bites will not stay still for clipping, esp. around the facial areas.  The cost of antibiotics and spot-on insecticides are additional optional costs.
 
 
Adult Siberian Huskies. Heavy tick infestations. Treated at toa payoh vets, singapore Adult Siberian Huskies. Heavy tick infestations. Treated at toa payoh vets, singapore Adult Siberian Huskies. Heavy tick infestations. Treated at toa payoh vets, singapore.
De-ticking heavily infested dogs at Toa Payoh Vets

 
 
6239 - 6244. How to de-tick a dog. A video of the Border Collie being de-ticked at Toa Payoh Vets is being produced in July 2013 to educate dog owners. 


TICKS IN MANY DOGS

E-MAIL TO DR SING DATED AUG 28, 2010
I read your very informative article here:  Ectoparasite control lecture. I have a question.  I have 9 Papillons which were heavily infested with adult ticks and "baby" ticks.  (At least that's what my vet said they were although they look like mites to me.)
 
After weeks of bathing and grooming, I finally applied FrontLine Plus Spray, which has worked very well at killing all the ticks which I could not remove by picking off.  Now, a week later, I am seeing a slight re-infestation of small (baby) ticks/mites.
 
I would like to use a Bayticol 6% rinse on them (10ml/15L water dilution = 40ppm). Is this safe?  My Papillons are all 3-4 kilograms. And I have a 10 week old puppy.  FrontLine Plus Spray was applied one week ago.
 
Thanks in advance for your help.
 
Name of owner
Thailand

E-MAIL REPLY FROM DR SING DATED AUG 28, 2010


I am Dr Sing Kong Yuen from Toa Payoh Vets, toapayohvets.com
Environmental control of ticks is very important. Most likely you have not been able to do it. Once you have just applied Frontline spot on, it is risky to apply another insecticide so soon. You need to find the source of your ticks as it appears to originate from the environment e.g. wall and floor cracks. Spray an anti-insecticide wash into the cracks.

Generally, I would advise clipping off the coat of all dogs with heavy tick infestations, apply de-ticking wash thoroughly over the body, pick off the dead ticks and check for live ones. Then house them away from their usual area but this may not be practical advice in your situation. Best wishes.
REFERENCES & CASES SEEN AT TOA PAYOH VETS
 

1.  Lecture: Control of Ecto-parasites in Singapore:  http://www.bekindtopets.com/dogs/20100196ectoparasites_control
_dogs_ToaPayohVets.htm


2. 
A Cocker Spaniel has tick fever in 2011
3 A Great Dane had tick fever in 2008
4.  A vet said that imizole is ineffective against Babesia gibsoni
5. Using non-chemical means to prevent tick infestation in your dog 
6. Babesia canis in a Samoyed in 2012

7. Tick fever case educational video of a Samoyed treated at Toa Payoh Vets. http://www.youtube.com/watch?v=RYhKxpbuZ3A

liver failure, kidney failure, babesia canis, samoyed, toapayohvets 8. Blog - A Samoyed has tick fever in 2012
8.1  http://2010vets.blogspot.sg/2012/07/tick-fever-in-singapore-dogs-from-drug.html

8.2  http://2010vets.blogspot.sg/2012/07/1074-sop-tick-fever-in-dogs.html

8.3  http://2010vets.blogspot.sg/2012/07/1062-acute-tick-fever-in-big-white-dog.html

UPDATES WILL BE ON THIS WEBPAGE:
http://www.asiahomes.com/army/2010067tick_control_bites_infestation-parasites-dogs-singapore-ToaPayohVets.htm
 

tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
 Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: June 30, 2013

Toa Payoh Vets

Friday, June 28, 2013

Update on Jack Russell with 10 small bladder stones - Ear scratching, paw biting whole night

I had sent the dog back with a bag of U/D dry. "We can't sleep as he keeps scratching his ears and body the whole night," the wife said. I examined the dog. His right ear is swollen and full of paw scratches. His left ear had a few such marks too. Other than that he was OK.

"I prescribed U/D dry instead of canned U/D to save you money," I gave the usual anti-allergic injection IM and SC. "Since he is allergic to it, stop the feeding."  

Coincidentally, a woman came in asking to buy 12 cans of U/D. She showed me a slip of paper with the case reference number.  "My daughter asked me to come and buy the food," she said.

"Usually I see a man coming to buy regularly," I said.
"He is my husband and is not free today."

As the dog had recurrent oxalate stones and had two operations. Now, with canned U/D, the dog has no urinary tract problems. "It is better not to eat dry food," the woman said. This case illlustrates that there is a younger adult who is alert and wanting to prevent a 3rd bladder stone operation and that is the daughter.

CASE OF RECURRENT CALCIUM OXALATE STONES
Cocker Spaniel, Male, born in 2002
Two bladder stone surgery at Toa Payoh Vets on:
Calcium oxalate
May 26, 2011
Sep 4, 2012

Before lst operation, the dog was fed dry food.
After lst operation,  fed cheap canned food

Now strictly on canned U/D. As at Jun 28, 2013 today, so far so good.

As for the Jack Russell, the wife said: "So troublesome."  I gave her 50% back for the opened U/D diet and advised her just to feed home-cooked food. She wanted the Canned U/D and took 12 cans. If there is allergy, I will take back the cans.  

Daughters of a Better Age

A good image will be well composed. Sunlight and contrast make it interesting.  Practise and practise. I was in a car and had a second to snap this image before the traffic light changes to green.  What do you mean by a "better age"? When is the age worse?


1487. Update on vasectomy German Shepherd X - Good surgical outcome

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   08 July, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The case for vasectomy   
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   08 July, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1487. Update on vasectomy German Shepherd X - Good surgical outcome

 
Saturday Jun 29, 2013. Vasectomy done 2 days ago by Dr Daniel and I.
The owner phoned at 10.40 am. "My dog does not allow me to change the plaster covering his wound."
"Is there any blood inside the plaster?" I asked.
"A bit of dried blood."
"The plaster may be tight," I said. "Is the dog licking the plaster?"
"No," the man said. "He can't as he wears an e-collar."
"Is the dog eating and drinking and being normal?"
"Yes," he said. So the 75 mg of Rimadryl tablet of one a day must be working.
"Wait another 2 days," I said. "It is good to check the wound. Usually I advise removal 7 days after surgery."

The owner phoned again as the plaster was loosened. He wanted to come to get the plaster changed.
"I am not in favour of sedation of the dog to change plaster unless necessary as there may be reactions and risks, although minimal," I know the man prefers spend least on medical costs. Nobody wants to spend more anyway. "Besides, it is going to cost you money."
"There may be flies attacking his wound," the man said.
"Put the dog on the table. Muzzle him. Get a bigger plaster to cover the loose plaster. In 2 days' time, the dog will not feel so painful and try again."

Vasectomy procedures
The theory is simple. The practice is harder as there is a need to be very careful that the vet does not incise any artery and veins. The spermatic cord is a snow white tube of 3 mm across in this big breed. Running parallel to it is an artery of 1.5 mm.

"It is not like the ordinary neuter," I said to Dr Daniel. "You don't even incise the tunica of the testes. You incise the area above the testes. Make sure you don't incise the urethra which is nearby.

It can be quite stressful to do this operation as compared to the ordinary neuter. Two vets will be better. One holds and pulls the testes caudally. The other identifies the spermatic cord and do blunt dissection of the tunica vaginalis carefully. Or use artery forceps to help you separate the vas deferens from the deferential artery which runs parallel to the vas deferens and is 3 mm across in the German Shepard, if you operate alone. The exposed surgical area is small but extend the skin incision longer if you cannot operate properly.

Once the tunica vaginalis of the  spermatic cord is incised, you can identify the contents of the cord. The vas deferens is a snow-white tube with a prominent deferential artery running next to it. The vas deferens is around 6 mm across in this German Shepherd. Carefully isolate the deferential artery from the vas deferens. Clamp both ends of a 1.5 cm length of the vas deferens.  Ligate the two ends and excise around 1.5 cm. Push the pampiniform plexus with its hidden testicular artery back into the inguinal canal gently. One simple interrupted suture closes the incised tunica vaginalis. The skin is sutured. No fancy subcuticular sutures. Keep surgery simple. Put a piece of plaster to cover the wound and give the usual antibiotics and painkillers. Do not incise the tunica vaginalis of the testes as you will have done in the traditional neuter of a male dog.

UPDATE ON JULY 8, 2013
No news from the owner is good news. The dog has recovered and the plaster has been removed. The owner does not want his dog's personality to be changed due to neuter and had asked a lot of questions about how the dog's personality will be changed after removal of his testes.

I proposed vasectomy which is considered neutering will serve his purpose of payment of a lower dog licence of $14 instead of $70. He had phoned to cancel the surgery and then appeared suddenly. The vet should not insist on neutering if the owner wants vasectomy which is a more difficult surgery. Vets are familiar with the neuter surgery and vasectomy is an unfamiliar surgical territory for most vets. Refer to other vets if you don't want to do it.  
 
Updates will be on this webpage:
www.sinpets.com/F5/20130708vasectomy_neuter_dog.htm



More info at: Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: July 08, 2013

Toa Payoh Vets