Monday, May 26, 2014

1370. Caesarean section of a Corgi using xyazine + ketamine + gas

May 26, 2014.

Corgi, F, 3 years was said to be 63 days pregnant, being mated on Mar 24, 2014 and had no obvious uterine contractions today May 26, 2014. The attending vet took 2 X-rays which showed 5 or 6 pups as one pup "could be deep inside the rib cage area".

Her ultrasound showed 2 or 3 pups with strong heart beats. But she had no manpower to perform the elective Caesarean section. Uterine inertia has happened and the overdue pups may die if the home breeder waits longer. Little milk seen when I expressed the nipples. Dog had abnormal sized nipples as if she had given birth before. "Six puppies likely," I said as the swollen belly was symmetrically enlarged.

ANAESTHESIA
1. Isoflurane + O2 gas only. I had performed over 200 C-sections using this method. The disadvantage is that some dams struggled a lot on inhaling the gas and it takes a much longer time. Some vets think that the dam will die of heart attack. I would take off the mask when such dams struggle and re-mask. All this takes a lot of time.

2. Xylazine + Ketamine at 1 ml + 0.5 ml IV induction for a 20-kg dog as a guideline and depending on the dog's health. 0.1-0.2 ml + 0.05-0.1 ml for a 2-3 kg Chihuahua. Just sufficient to intubate.

No struggling of the dam. I decided on this method in this Corgi.
For this Corgi, 14.1 kg, 38 deg C, normal heart and lungs, I gave Xylazine 0.3 ml + Ketamine 0.15 ml IV at 50% of the calculated dose. It was insufficient to intubate the dog. The dog vomited food after 5 minutes.

She was masked, intubated and given the isoflurane + O2 gas. Maintenance of gas was at 2% initially to 1% to 0% at the stitching of the linea alba and skin. The dog opened her eyes wide just after my last skin stitch of the skin as if from a deep sleep.

TRANSPLACENTAL EFECTS ON THE PUPS
According to a senior vet who practises the Xylazine + Ketamine IV sedation for many years, there is no transplacental transmission to make the pups sleepy. Even for pentobarbitone which he used many years ago, a minimal amount was used. He said pups would take some time to cry loudly but he had pups who cried immediately. His tip was to wait for the dam to have uterine contractions before Caesarean section. This would decrease lots of bleeding even the surgery was done before contractions. As the Corgi had no contractions at 63rd day, possibly uterine inertia, I had seen much more bleeding during the C-section when I extracted the placentas.    

SURGERY

Skin incised around 3 cm from umbilicus. Length of incision around 8 cm long. Vet textbooks advised much longer incision to exteriorise the whole uterus, probably needing 15 cm in this Corgi as the pups were large and long, the longest being around 15 cm.
I located the bifurcation of the two horns, incised at right angles to the bifurcation, around 8 cm long and manipulated the 6 pups into this opening. I could exteriorise the uterus after removal of the pups to ensure no more trapped pups. One pup was deep under the rib cage and it took some time to extract him out. 

Six puppies were delivered. They appeared "dead". I held each with both hands, stood with my legs apart and swung it 5-6 times in an arc vigorously, to expel any water in the lungs. My assistant would massage the top part of the neck with the head downwards and stimulate the hard palate and cleaned the mucus off the nostrils. It took over 5 minutes to get faint cries and some movement. At an average of 10 minutes, the C-section took a long time. It was around one hour before loud cries from two pups were heard. The surgery started around 7.30 pm and ended around 9 pm.

Two pups wee not crying and their noses were cyanotic in colour, after completion of stitching of the dam. But they had tongue movements.

"No hope for this biggest pup," I said as >45 minutes had passed with the pup still gasping. "Some pups do recover with prolonged neck massage." I swung this pup 5 times and dislodged some lung mucus.  Then I put the pup into my mouth and blew into his lungs. I could hear the lungs opening up. The husband continued massaging this pup after he had successfully revived the other pup. (see video). Incredibly, this large pup cried (see video). The owners brought the pups home.

MEDICATION
Oxytocin 2 ml SC, Baytril 1.5 ml SC and Tolfedine 1.5 ml SC. On reaching home, the dam had milk for the pups and so there was no need for bottle feeding. 4 males and 2 females.  Sire and dam were brown/white. Mating was once, on Mar 24, 2014 by bringing the dam to the sire who belonged to the friend.







CONCLUSION
The home-breeders were happy as 6 pups and the dam were alive. It is not a guarantee that such the vet will get successful outcomes. Know how to swing the pups and massage them. Blow air into their lungs may be needed although some vets may not like to do this. In this case, the largest pup had air blown to inflate his lungs and he did survive.  The C-section took me, with experience, 1.5 hours as each of the 6 pups needed swinging and revival. Assuming each pup takes 5 minutes of my time with the assistant, 30 minutes had been spent on this. Fortunately, the dam did not die and was well anaesthesized at 1% - 1.5% maintenance.



For vets with no experience in C-sections or capable assistants, it is best to avoid doing this surgery as owners are just not happy to receive dead dams or pups, blaming the vets. Read up on how to revive distressed pups.  The anaesthesia and surgery was $900 but the stresses on delivery of "dead" pups were tremendous.      

X-RAYS BY THE FIRST VET.  Two weeks earlier (could see only 5 pups on ventral dorsal view) and yesterday (on lateral view, 2 skeletons).  Ultrasound (2 pups with strong heart beats, one with weak beats).

FOLLOW UP ON MAY 27, 2014, 10 AM.  
The dam had milk on reaching home at around 10 pm. The pups are suckling and active. A whelping box prevents pups from wandering. Vaccination advised 6-8 weeks. 3 vaccinations. Weaning to puppy food at 4th week.

Saturday, May 24, 2014

1369. Mountainous monasteries, Greece. Images of tourists































The group of 35 tourists got along very well with each other. Good weather, bright sunshine, blue skies, white clouds and beautiful sights when you visit Greece in May as it is off-peak season. During the peak season in July, you have no room in the alleyways to walk freely about, according to the local guide.




Monday, May 19, 2014

1368. An outstanding Greek tour guide - Irene

May 18, 2014. Athens

Irene, a Greek tour guide who has a personality and temperament that captivated the 34 Singaporean and Malaysian packaged tour group with her story telling of Greek mythology which mirrored real life affairs of mortals. For example, the "naughty god" Zeus who slept with various Goddesses.  Zeus promised to grant any wish and his wife instigated Zeus' mistress to reveal his true self. The mistress asked Zeus who appeared as thunder, thereby killing the mistress.

As she told us she was a Fullbright opera scholar, some of us asked her to sing. She did sing "Auld Lang Syne" suddenly and I was able to capture part of this most memorable experience of the tour to share with viewers.





Athens tour guide

Athens tour guide sings Auld Lang Syne







 The following are some Singaporean travelers on the "Blue Horizon" ferry, from Crete to Athens. We had beds in this ferry.















A tour guide in Crete explaining the history of the Minoan Palace.


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Friday, May 16, 2014

1367. Travel stories - Ferry to Santorin

Big rolling waves. So a bigger ferry came to pick us up at Mykonos Island to go to Santoriri Island. Hence half a day was "wasted". But in this Greek Island Tour, the main complaint from one senior citizen was too many "free and easy" tours of half days. "What's the point of packaged tours if one is left "free and easy?" for so many occasions? The younger ones organized taxi trips to visit other places nearby but not this senior citizen couple.



 

 

 

 
Black and white traveler at ferry point in Santorini


 
Backpackers
 
Strong rolling waves rock this ferry from Myokonos Island to Santorini Island although the skies look bright and calm. After the recent Korean ferry disaster, nobody complained about the change to a bigger safer ferry to go to Santorini Island, delaying the travel by half a day. I used zoom lens 55-250 mm and had a split second to focus on the lady's eyes and click.

1366. Travel stories - Crete

May 16, 2014, Galaxy Hotel, Crete, Greece. Room 430
A modern hotel with free wireless connections in the rooms unlike the other Greek hotels on this packaged tour, permitting only free access at the lobby. It has sufficient power points too.

We had a rare long-table dinner yesterday of 32 travelers.
My camera lens 18mm - 135mm was not suitable for such photography. Probably I need a lens of 18 mm - 200 mm or more research on how to get everybody in focus. Is it possible?

 
 
 






 



In Crete, the restaurant is still busy after 11 pm. The above restaurant closes at 12 midnight.

1365. Travel Stories - Santorini, Greece

May 16, 2014

Yesterday, I got sunburnt while on a boat cruise to the Volcanic Mountains and Hot Springs. The fees were 55 Euros/person as an optional tour. Some Singaporeans spotted the "Cheapest excursions" for the above tour, reduced from 20 Euros to 15 Euros and some snapped images.

"Did you pay 15 Euros?" the kind-hearted girl asked me as I was a belated participant. The others had paid up for this optional tour. "The tour leader has to earn a living as he is not paid a full salary," I just paid the same amount. "He spends time making travel arrangements and accompanying us."  It is a hard life for the tour guide as he has to coordinate and attend to complaints and changes and so I don't begrudge him the money.

This kind-hearted girl, in her late 20s, held the hand of a senior citizen lady crossing a busy road. The senior citizen asked her to take care of her husband. The husband said in the Mandarin equivalent: "I open the way for you all." I was shocked when the kind-hearted girl remarked in Mandarin: "Don't bullshit me!"  In Mandarin, it sounded "don't pass gas". This young Singaporean wife and another one are more frank in the treatment of their husbands.

As  for me, in the old school, I am not used to such frankness but this is the new age.


Yesterday was hectic.

Cable car ride, boat cruise to Volcanic Mountain where my left leg fell into the gap between two boats as I was boarding the boat after the walk up the Mountain. It is like walking into the gap between the subway train and the platform. Fortunately I did not suffer much injuries. One person slipped and fell walking up the pebbly Volcanic Mountain.

At the Hot Springs, I dared not jump in to swim but had a video.
Donkey rides for most of the younger Singaporeans while I took the cable car up.



In Greece and Dubai where my packaged tour travelers stay, usually only the lobby has free wireless internet. 
 
Today, I manage to post one interesting image from the cable car station.  I thought this lady wore an appropriate T-shirt as there were donkeys or mules in this part of Santorini. She said it was a coincidence as she did not get this T-shirt from Santorini. 
 
In Greek mythology, if you look at Medusa, you will turn into stone. Medusa is portrayed as having snakes in her wavy hairs. So, the image below reminds me of a modern Medusa in Greece.  Bright morning sunshine at around 10 am, near the cable car station. Donkeys pass by and poop on the cobble-stone streets.  

In this tour, some of the 33 travelers asked for emails to email pictures to each other.  Our Singaporean guide said that he could do it for us. I doubt it as most don't seem to have time to do it and so it is better to do it ourselves.  I also don't email pictures to fellow travellers when I am back to Singapore. I email this image at Hotel Galaxy in Greece as it reminds me of a modern Medusa in Greece.   
 
 
 
 


 
 

Monday, May 12, 2014

1364. Travel stories - Mountainous monasteries, Greece


May 13, 2014  6 am
Divani Palace Acropolis, Rm 356


Leaving for the Greek Islands at 6.15 am. Yesterday, visited two monasteries in the high mountains. We got a much bigger room with more power points than on arrival when we were given a smaller room on the 2nd floor. This hotel is said to be 5-star but the smaller room would be given to packaged tour travellers who are the mass market. So we use the lobby's free wireless rather than pay for use in the rooms.

Bright sunshine, blue skies and cool days.

I manage to post one good image of fellow travelers after the visit to the mountainous monasteries, one for the monks and one for the nuns. Red and white comes out well in this image if you can appreciate the contrast. A thin band of sunshine lit up the fair lady (2nd from right)

 




Yesterday, after the visit to the nunnery, outside waiting for the bus to move out at 11 am.
The sunlight was there and the red and whites make an interesting photo. I can't figure out what they aere looking at. Probably a stray cat?



Red and black. Rose gardens are rare in Singapore. 



 
In the prime but has imperfections. We need to embrace imperfections and changes in our lives as globalisation and unemployment adversely affect many of us. In Greece, around 28% of the young are employed. In Singapore, the young in general, job hops and does not want to work on week ends. In Dubai, the taxi drivers are young foreigners working 12 hours, 7 days a week for one to two years and then get a 45-day home leave. They don't get paid a retainer. Commissions are based at 35% for earnings over DH 12,000 and 30% for over DH 10,000 and 20% for less.