We – my wife Pri and I - have
been at your clinic half a year ago with our two Huskies. Cleo - 6 years old,
the male Husky, had strained his back legs muscles, but slowly he can run again
after you had advised us what to do and how to treat him. It is still not
perfect, but we get him there.
Our female Husky Al, now 9 years old, has at her right
upper eye-lid an abscess since some years (please see image), but we get the
impression it is growing and causes her some problems, because sometimes she is
scratching it and the eye ball is inflamed.
We hope it is not malignant.
Nonetheless we think it must be removed now somehow.
Therefore we are asking you
to get us an appointment for Friday, 20th September, at any time, but
best would be in the morning. We are prepared to take all the time it would need
to stay with Al at your clinic. Please get us your answer by
Thank you for your attention
and I am looking forward to hear from you soon.
EMAIL FROM DR SING DATED SEP 16, 2013
Thank you for your email. Pl
bring Al in at around 11am on Friday. Surgery and anaesthesia will be done
using electro-surgery in the afternoon. She goes home at around 6 pm after
recovery from anaesthesia. No food and water after 10 pm the night before.
Please note that old dogs undergoing anaesthesia are at
risk of death from anaesthesia. In most cases, there are no deaths if the dog is
healthy and the surgery is short duration as in this case. The dog will be
examined before surgery as there is inflammation and infection in the eye. Pl
give antibiotic eye drops for at least 3 days before surgery as I don't advise
operating on an infected area.
REPLY TO EMAIL FOR SURGERY APPOINTMENT
Sep 16, 2013
Thank you for your email. Pl bring the Husky in at around 11am on Friday Sep
20, 2013. Surgery and anaesthesia will be done using electro-surgery in the
afternoon. She goes home at around 6 pm after recovery from anaesthesia. No food
and water after 10 pm the night before. Please note that old dogs undergoing
anaesthesia are at risk of death from anaesthesia. In most cases, there are no
deaths if the dog is healthy and the surgery is short duration as in this case.
The dog will be examined before surgery as there is inflammation and infection
in the eye. Pl give antibiotic eye drops for at least 3 days before surgery as
I don't advise operating on an infected area.
EMAIL REPLY TO OWNER
DATED SEP 16, 2013
Thank you for your energetic response. I am sorry that
I do not permit all clients to be present at the surgery as I need to focus 100%
on the anaesthesia of old dogs and thereby not getting anaesthetic deaths due to
distractions or conversations.
In addition, the surgery room is small
and you are welcome to inspect it.
The whole process takes around 30
minutes including pre-op preparation. It may take longer if there are
complications like cardiac emergencies in which I have to revive the patient.
With the owner present, there will be much emotional distress when such
emergencies occur and distract me from my resuscitation of the patient. No vet
can assume that the old dog will not have any cardiac or respiratory emergencies
during anaesthesia and surgery and so it is best that the owner not be present.
In my younger days, I permited one lady to watch her hamster being
operated for a small tumour as she requested. She fainted at the sight of blood
when I excised the tumour. From that experience, I do not permit any owner to be
present at surgery. Pl accept my apologies.
The dog needs to recover
fully from anaesthesia and this takes around 2-4 hours for old dogs. That is why
you pick the dog at around 6 pm.
Dear Dr Sing
This afternoon we have been at
your clinic and discussed with Dr Daniel the operation of Al’s eye lid tumour,
he took a blood sample and checked her general health which should be
Everything is clear and we
fully trust to be in good hands due to your experience. However, having in mind
yours and Dr Daniel's repeatedly mentioned remarks that Al could die due to the
anaesthesia, even afterwards, you may understand that we are still concerned
that the worst could happen to our precious dog Al.
Both our dogs are
like children to us. That’s why we are still reading everything about this
surgery and found the below article of a dog clinic from Washington
May we ask you, what is
your opinion regarding local anaesthesia after drug sedation and the described
“freezing” of the wound? Please forgive us our nervousness.
2. EYELID TUMORS.
Older dogs commonly develop eyelid tumours (cancer). As in humans, cancer
can be either benign or malignant. Fortunately, eyelid tumours in dogs are
usually benign and do not spread to distant tissues. However, eyelid tumours do
slowly or quickly grow, and can destroy the structure of the eyelid, in addition
to rubbing on the eye. It is usually best to remove them when they are still
Eyelid tumours are treated by surgical removal.
While there are many different surgical procedures possible, most eyelid tumours
in old dogs can be removed at Animal Eye Care without requiring general
anaesthesia. The patient is given a sedative, and then a local eyelid
anaesthetic is given to numb the eyelid. The tumour is removed and the site
frozen with liquid nitrogen (cryosurgery) to kill any remaining tumour
cells. Tumour cells are usually very sensitive to freezing, and normal eyelid
tissue is more resistant. After surgery, the eyelid margin turns pink
(de-pigmentation), but usually re-pigments within 4
EMAIL REPLY FROM DR SING DATED SEP 19, 2013
I can understand your concerns as the dog is old and thank you for your
research in the article on eyelid tumour removal by one vet practice which
claims that general anaesthesia is risky and the practices claims that it uses
sedation and local anaesthesia to avoid the risks. Sedation is used at that
practice and it does carry risks too. Even local anaesthesia has risks of
As the surgery, sedation and general anaesthesia
with isoflurane gas is very short (<5 30="" and="" are="" at="" based="" be="" blood="" br="" case="" chances="" death="" dog="" dogs="" don="" dying="" electro-surgical="" examination="" excision="" experience="" general="" have="" he="" healthy="" i="" if="" in="" is="" low.="" minute.="" minutes.="" minutes="" my="" not="" of="" old="" on="" operating="" over="" procedure="" risk="" short..="" since="" so="" surgical="" t="" table="" test="" the="" this="" tumour="" very="" when="" will="" years=""> Sedation and local anaesthesia can be
used as an alternative to remove the eyelid tumour. It is hard to achieve full
pain relief if sedation is not given at full dose.
In my case, sedation
is given at 50% of the dose and the isoflurane gas given for <5 3="" achieves="" analgesia.="" and="" br="" complete="" completely="" dog="" excised="" eyelid="" in="" is="" less="" minutes="" movement="" no="" pain="" properly="" s="" seconds.="" than="" the="" tumour="" with=""> Isoflurane
gas is very safe and many times, I have used it solely for over 100 Caesarean
sections of dogs stressed out by the breeder's delay in seeking prompt surgery.
Those dogs were operated WITHOUT sedation using just isoflurane gas anaesthesia.
None died from the anaesthesia.
Of course they were younger dogs but
they were under considerable stress. In brief, old dogs with very short surgical
procedures and anaesthesia ,<15 30="" died="" experience="" have="" in="" minutes="" my="" not="" of="" on="" operating="" over="" p="" past="" practice.="" table="" the="" years="">15>5>5>
I hope the above provides a satisfactory explanation. It is best not to
research too much the technical aspects of anaesthesia to get worried. Chances
of your dog surviving are excellent as your dog is eating normally and is
active. The surgery to remove the eyelid tumour will be over in 3 seconds and I
normally don't even inform some owners about anaesthetic risks as the risks are
minimal if I assess they are worried.
Dear Dr Sing
Thank you so much for your
comprehensive answer to our concerns! Appreciated.
Now we feel much more calm and
relaxed and can sleep better.
Finally, we do hope that the
tumour is not malignant which the analysis will show later.
Good night, and see you tomorrow.
UPDATE AS AT SEP 25, 2013
I operated on the husky on Sep 20, 2013 with
Dr Daniel doing the anaesthesia and Niang assisting. The wife was present during
IV sedation as this dog was "nervous" if the wife was not around during
sedation. I asked my assistant Niang to tie a tourniquet using the infusion drip
tubing looped over the elbow. However, the cephalic vein could not be seen as
the dog was quite plump. "Clip the hair around the cephalic vein to see it,"
suggested Niang. "No," I said as that would not be good for the dog's
"You didn't tighten the tourniquet sufficiently," I lifted up
the tubing. "I can put two fingers under it."
Niang said: "You do it
yourself." This behaviour was not good for a young man and I had counselled him
before as other employers would have terminated his services if he cannot
control his mood when his job incompetencies are pointed out on the
Dr Daniel palpated for the cephalic vein with his finger while
Niang still gripped the elbow area of the right leg. The wife was present all
the while. Dr Daniel inserted the needle in the region of the cephalic vein and
drew blood into the syringe at the first prick. He injected the sedative of
Domitor + Ketamine according to my formula and at 50%. I told the wife that it
was OK for her to leave her dog now.
She left the room and the driver
drove the couple home. The couple had been waiting since 11 am for Dr Daniel
who started work at 12.30 pm. They had first consulted Dr Daniel and so they
just would not want to leave the dog alone till it was time to operate and so
waited patiently in the waiting room. Usually I ask the owner to bring in the
dog at 11 am so that the dog would settle down but this couple wanted to wait.
The eyelid tumour was large and I made a large electro-excision so as to have
a wider margin in case it is a malignant tumour. "You are cutting off too big an
area," Dr Daniel commented as I took a pair of blunt-edge scissors to trim off
the jagged edge and undermine the skin before stitching with 3 interrupted
sutures of 3/0 absorbable sutures. The wound was large, around 2 cm at the base
of the triangle (see image below) and Dr Daniel must be wondering how I would
be able to stitch up the wound.
Overall, the isoflurane gas + O2 was
given for 24 minutes. This was not a 5-minute surgery as the tumour had expanded
as you can see in the images. The dog survived and that was what the owner
wished for. So it was a happy ending.
A vet in another practice had told
the owners earlier that there was no need to operate such a small eyelid tumour.
But it grew bigger and bigger and the dog started scratching the eyelid. So, the
owner decided to operate. However, I had to get "informed consent" which meant
letting them be aware of the anaesthetic risk of dying and this just was
worrisome to the couple. "Eyelid tumours are best removed when they are very
small," I said. "Your first vet may not like surgery and so advised to leave it
alone. Some vets just don't like to perform surgery and prefer medical cases.
You probably encountered one such personality."
It was great that there was a happy ending and the dog would be on a diet.
"No more beef jerkys from Italy," I saw the owner eating such treats (air-dried)
that were a specialty in the province of Italy and sharing with his Huskies. His
wife said it was too salty.
Another surgical approach is such that the apex of the triangle is uppermost
as contrasted to this approach where the apex was at the eyelid margin
UPDATE ON SEP 27, 2013
Histology reports indicated that this eyelid
tumour is a sebaceous adenoma. I phoned the owner on Sep 26, 2013. He is
happy that it is not malignant and asked me to email to him the lab report. The
dog is still wearing the e-collar and is normal and I presume, eating jerkys
Many Singaporean pet owners are worried about anaesthetic
deaths and so small tumours get ignored till they become massive and irritating
the dog, causing bleeding with blood soiling the floors and painful cries and
As this dog's eyelid tumour was large, it took around 24
minutes of general anaesthesia to complete the surgery. The dog was not given
Antisedan reversal as the owner wanted her to wake up slowly. Usually I gave the
antidote to get the dog to wake up early so as to restore the body systems to