1406. Spaying a ferocious young cat

Today Friday Mar 1, 2013, morning, the young couple brought in a cat, born around Jan 2011, for spaying. In the presence of the owners, she was quiet. So I put her in her own carrier to be spayed in the afternoon. 

I thought the carrier door would open sideways as in all carriers. However, it was not working and one has to click open the two sides and front corners to open up the top half of the carrier. The sounds of clicking open the hinges were extremely loud, like a gun firing in a small room on the table top.. The cat was too angry and my assistant tried to hold her. She stretched out her claws. He took one step backwards.   leaped off and in the process some anal sac oil splattered in at least 6 spots on the top of my shirt. The smell was rancid oil. The cat landed on the floor and hid in a corner. What to do?

In short, I got a lasso to restrain her, put her inside a wired crate. Later I had to pack in newspapers and phone books. The cat snarled everytime the papers were put in. "She is cramped at one side," my assistant called me. I inserted the fine needle and the cat leapt up while inside the crate. My 27G needle bent and flew to the floor as I pressed the plunger. In short, the cat did not get the 100% of the sedation IM.

At the next time, more newspapers filled the crate and another helper pushed the cat towards the side, facing me. Ths time I could inject. Lots of time spent in just this case. Cats and dogs do get ferocious once the owner is away.

A: Sedation IM   2.19 pm
B: Isoflurane first given. No need.
C. Isoflurane stopped. No need.
D: First skin incision: 2.33 pm
E: Completion of skin stitching: 3.01 pm

E-A  = 42 min
E-D = 28 min.

The cat was in the middle of heat. So much time was spent to ensure that the big ovarian blood vessels were properly ligated. The ovaries were incised at least 5 mm from the uterus after ligation just in case some remnants of ovarian tissues were left in the body. There have been complaints of cats and dogs still having heat after spay and one reason is that some ovarian tissues were left behind during the spaying.

The best way is to incise the skin near to the umbilicus to expose the whole ovary plus suspensory ligaments. usually made an incision of 1 cm long starting 0.5 cm from the umbilical scar in cats. This incision is insufficiently long to access the bifurcation of the uterine bodies after hooking out the left ovary. Therefore I had to make the incision longer by extending another 1 cm caudally to expose the bifurcation of the uterine body..

For this cat on heat, the skin incision came to 2 cm long. For cats not on heat, I could open 0.8 cm long in the spay. Longer incision takes longer time. 28 minutes to spay this cat when a cat not on heat would take 10 minutes.

Surgical anaesthesia was sufficient at this dosage for 2.1 kg cat as there was no reaction .

 

Update: Feline S/D discontinued

UPDATE

The supplier told me today that Feline S/D had been discontinued by Hills since 9 months ago. I told him I saw a can being given by Vet 2 recently to the cat with bladder stones I operated on.

He said that feline C/D does dissolve struvites as well and is recommended for cats with calcium oxalate too, targeting the urine pH = 6.2-6.4.

Follow up: Stone analysis results for cat with bladder stone

Report received today.

Calcium, oxalate, magnesium positive.
Preventive diet will be C/D for life
Target urinary pH to be 6.2 to 6.4

1403. SOP - Urethral obstruction in a male cat

Written: Feb 28, 2013  10.49 am reviewing this case to compare to the cat with bladder stones operated.

Feb 28, 2013

Urethral obstruction in cats may be quite common. A lady phoned me near midnight about her cat's difficulty in urination 2 days ago but she did not want to go to the emergency clinic I referred her to. So, I presumed this 13-year-old male neutered black and white cat to be the owner who came on Feb 28, 2013 as he cat could not pass urine and had blood in the urine passed.

"No, I did not phone you," the lady in her late 40s said to me as I palpated a bladder the 50% the size of a Thai mango.

"How long had he been having this problem?" I asked.
"Two days."
"Did he vomit?" I wanted to ascertain the kidney involvement as owners seldom volunteer this info.
"He vomited 3 times yesterday."
"He must be eating dry cat food since young," I predicted.
"Yes," she said. I feed dry IAMS and ikan bilis since he was young."
"He seldom drinks water," I said.
"You are correct."

This was a gentle old cat. He did not like me massaging his penile area to loosen the urethral plug and hissed.

Standard Operating Procedure (SOP). Emergency treatment usually

1. Sedate the cat. Collect blood and urine if possible. Blood collected. No urine
2. I Injected SC baytril and tolfedine. I used xylazine 0.1 and ketamine 0.4 ml IM. Sufficient.
3. Collect urine via catheter. This was not possible as the urethra was severely blocked at the bend of the penile area.
4. Put saline into syringe and flush into catheter to unblock. This was successful. Do not force catheter inwards as this tramatise the urethra as I had seen a vet doing it. Sedate first.
5. Urine flows out. Collect for urine analysis.
6. Irrigate bladder with saline and suck out any sand and blood
7. Stitch 3 areas catheter with absorbable to anchor catheter for 2 days. Blood still flows out on Day 2 (today).
8. Hospitalised overnight and goes home next day.

BLOOD TEST RESULTS
Urea 59 (7-11)
Creatinine 1003  (7-160)
Platelets 93  (300-800). Cat's mucous membranes were pale. Nose looked pale as compared to normal cat.

URINE
pH 6.5  SG 1.012 (not reliable as saline was used to unblock obstruction)
Blood 4+, Bacteria 3+, no crystals
(No crystals does not mean no bladder stone. Palpation of bladder on Day 2 - no hard stones). No urethral obstruction as catheter is in place.

X-RAYS not done to reduce cost for this first occurrence. Will do if recur.

ADVICE
Change slowly to canned food. Urine analysis 1 month later. K/D for 10 days. Seldom gets followed up as most owners don't comply.    

1403. Update Key Performance Indicators for spay & SOP

TOA PAYOH VETS toapayohvets.com 01 March, 2013 Focus: Small animals - dogs, cats, hamsters, turtles, guinea pigs & rabbits
Toa Payoh Vets Clinical Research Standard Operating Procedures (SOP) & Key Performance Indicators (KPI) For other cases, goto: Dogs
One of the effective management systems is to ensure consistency of process and to execute Key Performance Indicators. To maintain the highest standards of veterinary practice and productivity as well as sharing knowledge, the Standard Operating Procedures (SOP) and Key Performance Indicators (KPI) are being implemented in Toa Payoh Vets from 2011. Good written records are a strong defence in the cases of litigation and complaints
Standard Operating Procedures (SOP)
5491 -5495. The internet connections open the doors...
5417. SOP: Eye corneal ulcer & tarsorrhaphy		5412. SOP: Veterinary Surgery Report format	5413. SOP: Urinary Tract Infections and struvite stones	SOP: A new puppy with blood in the stools
Key Performance Indicators (KPI) for an experienced vet E-D = Time from first skin incision to skin stitched up
5991. Feb 2013. KPI spay Maltese on heat. E-D=27 min. Isoflurane gas top up needed.
5448. KPI for spaying a dog with false pregnancy. E-D=19 min	5448. KPI for spaying a dog with pyometra. E-D=26 min	5615. KPI: Spaying a fat dog. E-D=28 min	KPI: Dog spay - Chihuahua. E-D=23 min	KPI: Dog spay - Fox Terrier E-D=26 min and Shih Tzu E-D=18 min
5545. KPI for spaying a Miniature Schnauzer with closed pyometra. E-D=41 min.				KPI: Neuter E-A=18 min and tarsorrhapy
Veterinary Management: Processes, Protocols, Procedures & Best Practices
5990. Best practices from a plastic surgeon
5286. A vision for Toa Payoh Vets to be a top 3 veterinary surgery in Singapore	5385. Procedure: Female dog urethral catherisation	5111. Pet grooming business success in Singapore	5288. Reversing the decline in horse racing - Part 2	5212. Veterinary clinic inspection
5142. A neat and good spay suture pattern is important	4980. Dressing casually at Toa Payoh Vets	4981. Character and competence of interns and young employees
Toa Payoh Vets Clinical Research Standard Operating Procedures (SOP) & Key Performance Indicators (KPI) For other cases, goto: Dogs This webpage is: www.bekindtopets.com/animals/20081201PG9standard-operating-procedures-vets_ToaPayohVets.htm
Copyright © Asiahomes All rights reserved. Revised: March 01, 2013 Toa Payoh Vets

1402. Digital images of 83g hamster now 77g after surgery

Make use of digital photography to show tumours excised, hamster recovering etc as the owner will be educated and happier to know what had happened. This hamster of 83 g was not knocked down by 3 drops of Zoelietil 50 IM today. I thought it was too little. After 5 minutes, he became drowsy. Clipped and excised the large left inguinal tumours and left ear wart. Weighed him. He was 77 g and pooped a lot. Owner was pleased.

1401. Abdominal cryptorchid in a dog

"Is the vet competent?" the owner asked me. The young male dog had been sent in for neutering. Two undescended testicles. So, just get on with the operation. Many times, there is no problem locating the two undescended testicles under the skin.

However veterinary surgery throws the vet a surprise. In this dog, one testicle was located. The only was nowhere under the skin!

Be meticulous. Make a thorough examination before any surgery. If the undescended testicle cannot be felt under the skin while the dog is standing, don't expect to find it when he is on his back! There will be a lot of doubts from the owner when the vet can't find this testicle as it is inside the abdomen.
Have an examination procedure. Verify gender. Verify presence of both undescended testicles under the skin. If not, let the dog owner know immediately and open up the abdomen. The abdominal testicle usually is located next to the bladder at the side.
Be humble if you don't know and ask your senior vet what to do.