Sunday, January 9, 2011

294. Sunday Jan 9, 2010 interesting cases

Sunday Jan 9, 2010
Interesting cases

As Dr Vanessa Lin will be back on Monday, Jan 10 after 10 days' break, I will not be working usually from 9.30 am to 11 am and by appointment. Younger vets will need to take over so as to continue Toa Payoh Vets' vision and mission.

1. Open pyometra. Only isoflurane gas was given to the Jack Russell who had pus dripping from her vulva and was hospitalised for 2 days and given IV drip and antibiotics. "The faster the surgery, the better the chances of survival," I reminded my two assistants. "If the vet takes his time to operate an old or sick dog, the dog's heart may fail and the dog dies."

It is too easy to be complacent when the vet does such surgeries routinely. Pyometra is a serious illness and is not an ordinary spay. "No point using a spay hook," I said as my assistant looked for one. I noted that the vulval dicharge, though clearer (picture taken) was still copious. Therefore, the uterus must be quite swollen. Palpation could not reveal swelling. No x-ray was taken to save the owner some money. The history of recent heat and the purulent vaginal discharge of an unspayed female dog would confirm a diagnosis of pyometra.

Earlier I said a spay hook might create a smaller skin incision compared to the usual method of pyometra surgery which needed a big incision. The dog was spayed in 25 minutes. An incision sufficient to put a forefinger in to hook up one swollen uterine horn (3 cm wide, pic taken) was used. Double ligature of ovary with 1/0 catgut. Transfixing and ligature of uterine body. My assistant prepared sterile saline for me to flush the abdomen. "There is no need to do it," I advised. "All my pyometra surgery over the years are OK without this." I noted that some vets do irrigate the abdomen after pyometra surgery. It does not make sense. Why introduce something into the abdomen when there is no contamination and instead, the vet can introduce bacteria all over via the saline solution? Keep it simple and the dog will recover. After all, this dog had pre-op antibiotics and post-op.

The dog's anaesthesia was shut down when the muscles were stitched and only skin sutures remain. The dog woke up peacefully and fast. 15 minutes later, I could see her wagging her cropped tail, as if happy to see me. This was a very gentle Jack Russell and no wonder the daughter who had to work in the Shenzen area, China had come back to Singapore to get her admitted for surgery by a "cheap-po" vet as this was what Julia described me. Vets of my age should charge double due to some 30 years of experience but it does not work this way in veterinary practice. Lawyers and doctors in branded hospitals will be able to do it. The dog was alive and could go home the next day.

2. KIDNEY FAILURE. The thin 2-year-old Shih Tzu that vomited daily for the last 4 days died. Blood tests show very high creatinine and urea levels. X-rays showed enlarged kidney (left) and what appeared to be urinary bladder stone. But the main finding was the blood test.

"The dog could develop kidney failure when he grows older, due to hereditary reasons of not proper development. The kidneys could not cope with the clearing of the toxic urea waste anywmore and therefore becomes sick and vomits," I explained to the owner whose niece was sobbing. "That is the reason why this dog does not put on weight. It was a sad Sunday for me and everyone. Vets can't cure all diseases.

3. TOILET TRAINING A GOLDEN RETRIEVER. A nice family of two parents and two boys in primary school. The 2 boys were 2 years apart. "No online gaming for them or permit them one hour," I advised the young parents as I had not been strict on my two sons. "Online gaming is the heroin of young boys. They sleep late and fall asleep during school. My son's teacher has to phone up to tell me," I said. "They are permitted to play only during holidays." the mum said. "Read 10 books a week," I advised. The younger one did not do it. So his command of English was not so good.

As for toilet training, the father asked me advice. The puppy would pee on the pee grate but poop on the tile floor at the side when confined. The only solution is to increase the grate area by buying another grate if they want to do grate training. As for paper training, no use. The puppy shreds papers. As for going to the garden to poop and pee as for most big breeds, the parents did not want the grass to die from dog's urination. So the other solution would be to leash the puppy to a confined area. "But be aware that the puppy may get strangulated and die," I said. Buying a pee pan and putting some stool smells on the newspapers in the pee pan which is placed near the area where the puppy poops may be an alternative. That means the puppy will be trained to poop on the pee pan keeping the floor tiles clean. I wonder which solution the parents will use. Will ask them if we meet again.


"Milk seen but a tiny drop from one nipple," I said. The dog was spayed by me in May 2009. That was strange as spayed dogs usually don't show milk. But the owner did not complain about bleeding or heat. Their complaint was that the dog was biting the backside and inside thighs. The wife wore a bright green dress which is an uncommon colour. The husband was casual and a foreign trained lawyer. "She is in a cool job," he said. Working in NGO or voluntary organisation is always a better work than in money-making enterprises. The dog had anal sacculitis. Grey particles and oily grey anal oil in abundance.

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