Wednesday, April 18, 2012

947. Post-op lateral ear resection, spay female shih tzu 6 months old and stray cat with "FIV"

April 18, 2012

I was reviewing the poodle with the lateral ear resection case operated by me 24 hours ago. The ears were still bleeding. My assistant Min had changed a new bandage and the bleeding had stopped. It was a bright sunshine morning. So, I had some pictures taken for record.

1. There was some swelling below the neck seen at 9 am today. This was inevitable as the bandage had to be tight to stop the bleeding. My assistant Min had changed bandage overnight. I had the bandage removed.

2. Yesterday, I bandaged the ear 2 hours after the surgery at around 1 pm. The poodle had cyanotic tongue colour and so I loosened the bandage and re-bandage. No breathing difficulty. Why the tongue was purplish and the gums pale? This could be due to the bleeding and surgery as this was a small poodle. I gave the duphalyte and normal saline drip, Vit K1 2 ml SC and tolfedine and baytril. The dog was monitored closely and was OK.

1. Domitor and Ketamine at 10% IV. Normally 50% but this poodle looked weak. "Nothing wrong with the ears (to justify the ear surgery)," Dr Daniel examined the ears. He did not know the history. "You are seeing the ears after one week of medication," I said. "The dog had been scratching the ears for several months and there were vet treatments before."

2. Isoflurane gas top up via endotracheal tube. Minimal 1% anaesthesia as this dog needed >30 minutes of anaesthesia. At the last stitch, the dog woke up with some crying as the gas anaesthesia wore off fast. It is better safety as dog would be unlikely to die from isolfurane anaesthesia during and post-op, but the disadvantage is the crying at the last stitch. Tolfedine was given SC and the crying stopped.

Over one hour due to bleeding. If there was no bleeding, it would be faster but every case differs.

There was heavy bleeding on the right ear at the end of surgery. Ligation of the blood vessels in the region cranial to the lateral wall would be best. Some cases don't have bleeding as the main vessels were not electro-incised. In this case, I bandaged the ears overnight and the bleeding of the left ear had stopped.

The dog usually ate dry food, according to the owner. "It would be better to fed canned food as the dog could have pain in swallowing." The dog ate one can of A/D overnight.

"Do you want Dr Vanessa to operate on your dog?" I asked the young man as his dog had been vaccinated and attended to as recently as last week. He came in at 10 am and I was on duty. Dr Vanessa usually comes around 12 noon. "If not, I will do the spay and you come back at 12 noon." He opted to have me operate.

3 kg. very thin. Ate 3x/day by hand-feeding. Still hungry after feeding.

Domitor and Ketamine IV at 50%. Waited 5 minutes.
The dog was sufficiently sedated to intubate.
Large tonsils of around 8mm x 4mm. Normally, can't see tonsils. I took a pic to show the owner as this is abnormal. Could be due to eating stools? I had a long chat with the young man about his management of this dog (very thin and eating stools) at around 12 noon when he came for his dog.

"If you don't spend time training him not to eat stools now, she will eat stools as an adult for the rest of her life." I advised. The dog would wait till the owner goes to work before pooping and would eat the stools.

The dog is crated in a cage of around 3-foot wide. A yellow plastic pee pan (with small holes for urine to flow through but not stools) covers 50% of the grated area. The dog lies on the grated area and poops and pees on the yellow pan.

These are my recommendations to reduce poo eating:
1. Don't confine the dog inside the crate when the owner goes to work as the dog is adult and the crate is not big. So, the dog starts to eat stools due to lack of space to move about.

1.1 When the owner goes to work at 9 am, put the dog inside a bigger space e.g. bathroom. On one side, put the crate (cleaned and neutralised with white vinegar: water at 1:3), water and feed bowls. On the other end, put the pee pan. Get a baby gate.

1.2 The owner feeds the dog at 8 am, brings her down to pee and poop as a routine (except on weekends, 9 am). Bring newspapers to scoop up poo. Bring some poo in the newspaper and put on the grass to let the dog smell it as part of the training.

1.3 Feed 2X/day instead of 3. Now the owner hand-feeds the dog as she swallows all dry food within 30 seconds and begged for more.

1.4 Antibiotics to be given for the next 7 days and repeat. There is a possible urinary tract infection as the dog passed white urine (no smell) and yellow urine (very smellay) many times a day. Dogs at this age can control their bladder unless not trained or do urine marking (female dogs do urine marking but this is uncommon). Poo-marking is possible too.

1.5 Training may take more than 4 weeks. Patience and spend time doing the training.

See image. Both tonsils incredibily large. Bacterial infection or toxins from eating stoolsl over past 3-6 months?

Some vets believe that bones have not been fully formed. So don't spay at 6 months. I usually advise spaying 2 months after the end of the first heat. Sometimes, as in this case, the owner prefers the spaying to be done at 6 months. Singapore dog licence - $75 if not spayed at next renewal of licence. Otherwise $14 if spayed. There used to be $14 licence only if the dog is less than 5 months old but the AVA may have changed this.

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