I was surprised that the Shih Tzu recovered fully from having pus leaking out from his almost 100$% pigmented cornea in his right eye. This meant he was blind in the right eye.
He was 13 years old and was with the young man since he was 6 years of age. I did a 3rd eyelid flap under general anaesthesia to close up his eye ulcer and also removed all his rotten teeth. He was very thin. Surprisingly he survived the anaesthesia. That was 6 months ago. He looked and behaved as young as a 8-year-old dog. "He recovered completely," the young man said. "Just a white spot in the centre of his right eye. What's his problem?
6 months later, he had tearing in his right eye. Lots of tears and red sclera and conjunctiva. The eye was infected. He was rubbing his right eye. A white blob of tissue has protruded from the central ulcer. An eye infection. It could be from the inside of the eyeball. Antibiotics and eye drops are given.
P.S
1. Check your Shih Tzu'e eyes daily. Don't let the black or brown pigments grow till they cover the cornea 100% as the dog will not be able to see. Pigmentation is usually due to corneal irritation over several years. Singapore owners don't know that the hairs in the nasal fold grows and irritate the eyeball, causing pigmentation in some Shih Tzus and ultimately blindness. How would you feel if you can' see because your cornea is painted black? Prevention is better. Get your vet to snip off the nasal fold and no hairs will grow towards and irriate the cornea.
Tuesday, May 25, 2010
72. Male dog barking. 6 months. Success story toilet training
Barking male dogs
In Singapore, barking male dogs are commonly encountered. I describe 2 cases of male dogs I have just neutered in the last 2 days.
CASE 1
Problem: Social nuisance in the HDB apartment neighbourhood.
1. Jack Russell male, 5 years. Barking non-stop. When he sees another dog, he barks loudly at them, trying to get at them. In the surgery, he was to be vaccinated but he barked ferociously at the other dogs in the waiting room.
"This dog must be a noise nuisance at home," I said to the mother who is over 50 years old. "I know my neighbours for over 20 years. None has complained to me."
The domestic worker shook her head and said. "They are complaining about the barking." It is difficult for neighbours to sleep when this dog barks a lot. The mother agreed to neutering.
This male Jack Russell barked every second at the surgery where he was warded for 5 days for post-neutering care. Too good a chance to miss as there were other patients facing him.
CASE 2
Shih Tzu, Male, 6 months.
Problem: Barks loudly at 8 am nowadays. Owner bought him in for neutering.
Breakfast at 7 am. Pees and poop on grate + pee pan.
Put back into the playpen as lady has to work and he mum has to do house-work. Barks at 8 am. May disturb neighbours.
Male dog matures at 6 months. Starts to dominate
"He is mature now and knows barking will get him out of the playpen," I advised. "Neutering must be done together with obedience training."
Oral commands: "Quiet," or "No barking". The lady owner will grip the muzzle before saying one of the two commands.
Advice: "Just say 'No barking' in a firm voice, grip the muzzle and give a light tap." The gentle lady was not too keen on tapping the dog. For male dogs, a more assertive training is needed.
GRATE + PEE PAN TRAINING SUCCESS STORY
I could follow up this toilet training case because the lady owner told me that earlier, she had e-mailed to me for toilet-training advice. Her puppy was confined inside a playpen and given a grate + pee pan. Sometimes he would pee and poop outside the grate after one month. I had replied that the grate + pee pan would be soiled and so the puppy would not step onto it later. If she had no time to clean the soiled grate or remove the poop, she should buy a second grate + pee pan. She bought another one.
Secrets of success
1. Confinement for over 1 month in the playpen unless supervised.
2. 2nd grate + pee pan.
3. Immediate removal of morning stools and cleaning the grate with an enzymatic disinfectant. Nowadays, the dog seldom use the second grate + pee pan. He poops 2-3X/day and pees on the grate.
4. Sleeps inside the playpen at night. See floor plan in image.
5. Lots of training and patience.
6. When let out, watch for signs of elimination (turning, sniffing) closely. Pick up puppy quickly and put onto the grate.
7. Take leave to train the puppy in the first 2 weeks or ask mum to help.
8. Feed bowl put inside cage. Remove soon after eating. No free feeding.
9. Routine. Eats at am and 7 pm. Poops at 7.30 am, 11.30 am or 7.30 pm or 10 pm.
In Singapore, barking male dogs are commonly encountered. I describe 2 cases of male dogs I have just neutered in the last 2 days.
CASE 1
Problem: Social nuisance in the HDB apartment neighbourhood.
1. Jack Russell male, 5 years. Barking non-stop. When he sees another dog, he barks loudly at them, trying to get at them. In the surgery, he was to be vaccinated but he barked ferociously at the other dogs in the waiting room.
"This dog must be a noise nuisance at home," I said to the mother who is over 50 years old. "I know my neighbours for over 20 years. None has complained to me."
The domestic worker shook her head and said. "They are complaining about the barking." It is difficult for neighbours to sleep when this dog barks a lot. The mother agreed to neutering.
This male Jack Russell barked every second at the surgery where he was warded for 5 days for post-neutering care. Too good a chance to miss as there were other patients facing him.
CASE 2
Shih Tzu, Male, 6 months.
Problem: Barks loudly at 8 am nowadays. Owner bought him in for neutering.
Breakfast at 7 am. Pees and poop on grate + pee pan.
Put back into the playpen as lady has to work and he mum has to do house-work. Barks at 8 am. May disturb neighbours.
Male dog matures at 6 months. Starts to dominate
"He is mature now and knows barking will get him out of the playpen," I advised. "Neutering must be done together with obedience training."
Oral commands: "Quiet," or "No barking". The lady owner will grip the muzzle before saying one of the two commands.
Advice: "Just say 'No barking' in a firm voice, grip the muzzle and give a light tap." The gentle lady was not too keen on tapping the dog. For male dogs, a more assertive training is needed.
GRATE + PEE PAN TRAINING SUCCESS STORY
I could follow up this toilet training case because the lady owner told me that earlier, she had e-mailed to me for toilet-training advice. Her puppy was confined inside a playpen and given a grate + pee pan. Sometimes he would pee and poop outside the grate after one month. I had replied that the grate + pee pan would be soiled and so the puppy would not step onto it later. If she had no time to clean the soiled grate or remove the poop, she should buy a second grate + pee pan. She bought another one.
Secrets of success
1. Confinement for over 1 month in the playpen unless supervised.
2. 2nd grate + pee pan.
3. Immediate removal of morning stools and cleaning the grate with an enzymatic disinfectant. Nowadays, the dog seldom use the second grate + pee pan. He poops 2-3X/day and pees on the grate.
4. Sleeps inside the playpen at night. See floor plan in image.
5. Lots of training and patience.
6. When let out, watch for signs of elimination (turning, sniffing) closely. Pick up puppy quickly and put onto the grate.
7. Take leave to train the puppy in the first 2 weeks or ask mum to help.
8. Feed bowl put inside cage. Remove soon after eating. No free feeding.
9. Routine. Eats at am and 7 pm. Poops at 7.30 am, 11.30 am or 7.30 pm or 10 pm.
Monday, May 24, 2010
77. Injectable anaesthesia IM and IV for cat spay
SHARING KNOWLEDGE ON INJECTABLE ANAESTHESIA IN THE SPAY OF A CAT
1. IM
I find the following combination effective as one IM injection
1.1. 3 kg cat. Today, I spayed a raggamuffin, female, 1 year. 3 kg using injectable anaesthetic.
Xylazine 0.15 ml Ketamine 0.6 ml in one syringe IM
Duration of anaesthesia around 20 minutes in this case. I don't need isoflurane gas top up. This is the ideal situation as it means less operating time.
1.2 5 kg cat. I have used xylazine 0.2 ml and ketamine 0.8 ml IM without side effects.
2. IV
I don't use IV as I find it time consuming but it is one vet's favourite mode of administration and he following simple formula, easy to remember is shared with vets.
2.1 3-kg cat. xylazine 0.1 ml, ketamine 0.2 ml in one syringe, totalling 0.3 ml. Inject 0.1 ml IV first, then another 0.1 ml to effect.
2.2 5-kg cat. xylazine 0.1 ml and ketamine 0.4 ml, totalling 0.5 ml.
Note that you give 0.2 ml IV first. Then increase by 0.05 ml doses to effect. You don't need to use all 0.5 ml.
3. MY CONCLUSIONS
I prefer the IM method for ease of administration and permitting me to focus on surgery. I give isoflurane gas by mask for a few seconds to top up if necessary. However, the IV top-up method is excellent if you don't have isoflurane facilities. The cat is shaved 5 minutes after IM and I operate 10 minutes after injection. Many years ago, I used xylazine IM and then isoflurane gas for cat spay. Now, I don't use it as I find the IM method extremely effective in healthy cats.
1. IM
I find the following combination effective as one IM injection
1.1. 3 kg cat. Today, I spayed a raggamuffin, female, 1 year. 3 kg using injectable anaesthetic.
Xylazine 0.15 ml Ketamine 0.6 ml in one syringe IM
Duration of anaesthesia around 20 minutes in this case. I don't need isoflurane gas top up. This is the ideal situation as it means less operating time.
1.2 5 kg cat. I have used xylazine 0.2 ml and ketamine 0.8 ml IM without side effects.
2. IV
I don't use IV as I find it time consuming but it is one vet's favourite mode of administration and he following simple formula, easy to remember is shared with vets.
2.1 3-kg cat. xylazine 0.1 ml, ketamine 0.2 ml in one syringe, totalling 0.3 ml. Inject 0.1 ml IV first, then another 0.1 ml to effect.
2.2 5-kg cat. xylazine 0.1 ml and ketamine 0.4 ml, totalling 0.5 ml.
Note that you give 0.2 ml IV first. Then increase by 0.05 ml doses to effect. You don't need to use all 0.5 ml.
3. MY CONCLUSIONS
I prefer the IM method for ease of administration and permitting me to focus on surgery. I give isoflurane gas by mask for a few seconds to top up if necessary. However, the IV top-up method is excellent if you don't have isoflurane facilities. The cat is shaved 5 minutes after IM and I operate 10 minutes after injection. Many years ago, I used xylazine IM and then isoflurane gas for cat spay. Now, I don't use it as I find the IM method extremely effective in healthy cats.
76. Ventral dermatitis. Itchy dwarf hamster. Allergy?
A very itchy hamster.
Dwarf hamster, male, around 2 years old. Scratching ears non-stop, lower body hairless and red. Right leg, one hairless lump.
"You understand that the hamster has around 6 months of life left," the hamster bit my assistant through his fabric gloved hand when handled. He bits family members too. He pees everywhere unlike other hamsters who pees in a separate area.
My observations on Day 1 when the hamster came to the Surgery.
His cage:
He stays inside his food bowl and his sleep bowl (with tissue papers put in by the mother). "He takes the tissues and put in one right corner above the pelleted floor to sleep," the mother said.
"A new hamster costs $5.00. Veterinary charges will be more." I said.
"Should the hamster be put to sleep?" the mum asked. "I take care of the hamster. My daughter plays with him."
"New hamsters are free of charge," the mum replied.
"However, the younger generation will not want their pets to be put to sleep. Ask her."
The girl shook her head. So, the mum decided to get the hamster treated. I warded him for 4 days.
History
"Could he be suffering from allergy? His mother who lived separately had same red hairless lower body and itchiness. Vet 1 diagnosed allergy. The mother had died recently.
Any changes of the environment?
1. New litter in December 2009 - grey pelleted ones as the pet shop had stopped selling the white cottony litter which was used previously. Itchiness started for the mother and the son.
"Why don't you buy the coloured ones?" I asked. The owner did not like the coloured ones and so bought the grey pellets.
2. New sand bath in December 2009 too. No more sand bath for some weeks.
From the history, this seemed to be contact or ventral dermatitis due to irritation of the litter.
Treatment
Avoidance of irritating litter, sand and prevention of the hamster squatting inside the food bowl. I used a flat small food bowl. Wait and see for the next few days. On Day 2, I observed considerable less scratching and took some pictures.
Dwarf hamster, male, around 2 years old. Scratching ears non-stop, lower body hairless and red. Right leg, one hairless lump.
"You understand that the hamster has around 6 months of life left," the hamster bit my assistant through his fabric gloved hand when handled. He bits family members too. He pees everywhere unlike other hamsters who pees in a separate area.
My observations on Day 1 when the hamster came to the Surgery.
His cage:
He stays inside his food bowl and his sleep bowl (with tissue papers put in by the mother). "He takes the tissues and put in one right corner above the pelleted floor to sleep," the mother said.
"A new hamster costs $5.00. Veterinary charges will be more." I said.
"Should the hamster be put to sleep?" the mum asked. "I take care of the hamster. My daughter plays with him."
"New hamsters are free of charge," the mum replied.
"However, the younger generation will not want their pets to be put to sleep. Ask her."
The girl shook her head. So, the mum decided to get the hamster treated. I warded him for 4 days.
History
"Could he be suffering from allergy? His mother who lived separately had same red hairless lower body and itchiness. Vet 1 diagnosed allergy. The mother had died recently.
Any changes of the environment?
1. New litter in December 2009 - grey pelleted ones as the pet shop had stopped selling the white cottony litter which was used previously. Itchiness started for the mother and the son.
"Why don't you buy the coloured ones?" I asked. The owner did not like the coloured ones and so bought the grey pellets.
2. New sand bath in December 2009 too. No more sand bath for some weeks.
From the history, this seemed to be contact or ventral dermatitis due to irritation of the litter.
Treatment
Avoidance of irritating litter, sand and prevention of the hamster squatting inside the food bowl. I used a flat small food bowl. Wait and see for the next few days. On Day 2, I observed considerable less scratching and took some pictures.
Sunday, May 23, 2010
Teresa Teng's Chinese songs
I don't listen to Chinese songs. I got to know about Teresa Teng from an intern's mother in the following way. On the 10th day of Chinese New Year (CNY), the intern's mother invited me for a CNY lunch at a Novena Square Chinese restaurant to thank me. The intern had gone back to Australia to study. In the 15 days of CNY, Chinese people in Singapore might celebrate by eating "raw fish" with slices of vegetables. This eating of raw fish would be considered a ritual to symbolise get good luck and prosperity for the New Year. A brand new silver Mercedes 250 rolled outside my Surgery at 1 pm to pick me up for the lunch appointment. The intern's aunty had just got her new car on the eve of the New Year and had arrived with her sister (the intern's mother). My friend Khin Khin was visiting me at my Surgery. I asked Khin Khin to come out so that I could introduce a role model to her. I hoped that Khin Khin who wants to be a business woman would be able to see a successful business woman who was doing the type of business she was going to do. The aunty got out of the car, was introduced and shook hands with Khin Khin instead of saying "hello" inside the car. This act showed she had the proper manners and was one reason she was successful in her cut-throat trading business.
At the restaurant, the aunty of the intern who would be paying for the lunch said: "No raw fish today." It was impolite to ask why. The aunty said: "I am a vegetarian. So, all of you eat meat." She checked the menu and ordered meat for us while she ate as small amount of rice and vegetables as she could. She even offered me half of her small bowl of rice. No wonder she was as slim as a fashion model on the runway. She dressed in a glittering violet material and wore light brown long boots. The intern's mother, her friend and I would appear to be under-dressed. The aunty produced an National Trades Union Congress birthday voucher which entitled her to $100 off the price of lunch at this restaurant. She gave it to the Captain. "No, we don't accept this voucher today. It is for to be used for weekends and holidays like Valentine's Day and Mother's Day." "Today is the 10th day of CNY," the aunty replied. "In CNY, there are 15 days of celebration and so the 10th day is a holiday. The voucher did not specify that it was not for use for the 15 days of CNY." This cut no ice with the Captain. The aunty stood her ground on the basis of principles. The Captain rejected her. So the voucher was no use for this strong-willed woman. The aunty apologised to me after losing out to the Captain who had her instructions. The intern's mother said: "It is embarrassing for the doctor". After all, the aunty had bought a new Mercedes which would mean she was not in need of this discount voucher. "And in the presence of two accountants," I added. The mother said: "Two CPAs." The aunty did not retort. I don't think it was embarrassing. It was business. A free voucher was to be claimed. The intern's mother said: "Phone the (name of a Chinese newspapers). They give $50.00 if they publish such news." "At least you recover 50%," I said since her $100 voucher was not useful. What was there to talk to 3 career women who had seen at least 40 years of life? I asked whether the intern's mother had attended the ABBA show and heard their songs. "Who is ABBA?" the intern's mother asked. She said: "I listen to Chinese songs. My favourite singer is Deng Lijun." I had heard about this famous Taiwanese pop singer and asked: "Do you mean Teresa Teng?" The aunty nodded her head as the mum did not know. The lunch was fun as all could converse. The lunch crowd left. It was 3 pm when I returned to the Surgery. I checked out Teresa Teng on youtube.com and discovered that she had a large fan base and could sing English songs too. Some very good ones like Stevie Wonders' "I just called to say I love you" at: http://www.youtube.com/watch?v=FIc1aodkQk0 Unfortunately she died of an asthmatic attack at the age of 42 years. That was 15 years ago. One of her famous folk songs and romantic ballads is: "The Moon Represents My Heart". See: http://www.youtube.com/watch?v=97-GXzi6PPw From a website, a writer wrote: Well, it's always hard to do a word-by-word translation, but the following is roughly what the original lyrics mean: You ask me how deep's my love, and to what degree. My feelings 're true, my love is true, the moon reflects my heart. You ask me how deep's my love, and to what degree. My feelings won't ebb, my love won't change... the moon reflects my heart. The above translation of her song was not the complete lyrics but it would do. TIPS FOR STUDENTS Listening to her Chinese songs could help Singaporean students finding difficulty in studying Chinese. Pop songs in Chinese may help them to be motivated and to learn more about the Chinese language.
Thursday, May 20, 2010
75. An old cat's two puncture wounds would weep all day long
An old cat's two puncture wounds would weep all day long
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 08 June, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
Getting ideas from vet assistants is one way of improving oneself as they are in the front line of nursing and have many ideas to resolve veterinary challenges. I am constantly amazed that I have not encountered every situation even after 30 years of practice and therefore I do ask my assistants how they would handle certain cases. Vets cannot know everything because there are so many surprises in new situations in veterinary medicine and surgery, as you can see in this commonly encountered case of two puncture wounds in an old cat.
An 11-year-old female spayed cat came in with two puncture wounds on her left flank. The wounds would not heal because they erupted a light brownish red fluid every day. Just like an active volcano.
Yet this cat was not feverish. The two wounds in the skin were around 4 mm x 4 mm. But they just would not close.
"The bite wounds are not superficial on the skin only," I said to the father and two adult daughters. "I would need the cat to be put under anaesthetic and explore the inside of the skin for debris. Therefore the cat must be warded for treatment." I gave the old cat an antibiotic and the tolfedine painkiller injection and put her in the crate for one day of observation.
On the morning of Day 2, I noted that the wounds were still weepy. My assistant VA2 had sprinkled his favourite yellow antibiotic powder onto the two wounds after cleaning up yesterday. Yet on the next day, the wound wept and all his yellow powder would spill out and downwards onto the lower body of the cat. This cat's subcutaneous fat had been melted away by the bacteria introduced by the other cat's saliva and so there was loose skin. The muscle layers had torn out and the jagged edges were producing the brownish red fluid.
"Just flush the inside of the skin with a 20-ml syringe," Thomas replied when I asked him how this case ought to be handled.
"You know, the suction pump is perfect for this case," I said. Thomas had never seen a suction pump being used in his 20 years of assisting in veterinary surgery. It is rarely used but is useful in certain conditions like peritonitis after surgery and maybe in some Caesarean sections.
"No need to use this equipment. Just flush normal saline via a 20 ml syringe," Thomas replied. The suction pump seemed lie a piece of fancy equipment to Thomas. This would be the first time he would see how useful this machine could be.
TWO-STAGE SURGERIES AND TWO ANAESTHESIAS
All old cats are high anaesthetic risks. This cat was thin but she looked very young. She just did not have a large appetite normally and weighed 3.3 kg when a good weight for her size would be 5 kg. There would be 2 anaesthesias needed for two surgeries and the owner must be informed in advance as to the costs, to avoid misunderstanding.
The first one would be to debride and flush out the dead muscle and fat cells. Then, on the next day, the cat would be anaesthesized to stitch up the normal skin edges after snipping off the rotten edges of the puncture wounds. There was no other way and so the risks of the cat dying on the operating table would be doubled. Definitely, the owner should be asked to sign the surgery consent form and receive advices on the prognosis.
FIRST ANAESTHESIA.
Zoletil 100 @ 0.2 ml IV femoral vein was given. Isoflurane gas via the mask was given to supplement as over 30 minutes were needed. I needed to cut away dead skin and muscle cells from damaged layers. Thomas said: "The muscle layers need to be stitched up, otherwise the cat would continue to have fluid production. When stitched, there would be no problem."
I said: "This is a very old cat. Healing of the wound will be slow. To stitch up the torn flank muscles, I would need to cut a bigger skin incision to reach deep into the muscles layer near the belly. If the big wound does not heal, the cat would be in trouble. If this is a young cat, it will be OK."
I observe that the cat could walk normally and so I would not advocate stitching of the irregular torn flank muscles. In old cats and dogs, it is best not to create big skin incisions. About 1000 ml of normal saline were squirted into the big space between the skin and the left flank muscles. A big suction tube pulled out yellowish fat and dead cells. I used scissors to snip off jagged muscle edges.
After the suction was completed, I checked the cat half an hour later. The cat was on an IV drip of normal saline. She was shivering. "Take the rectal temperature," I said to my intern Teresa. She put the thermometer in the rectum and showed me 33.5 deg C. This was low and worrying. Her normal temperature should be 38.5. This old cat had not taken anaesthesia and flushing well. Thomas blew hot air onto the cat using the hair dryer and rubbed her with a towel. "Give 20 ml of glucose," I said. This was given. The cat was wrapped with a towel. 2 hours later, her temperature was 36 deg. She growled as she did not like temperature taking. By the next morning, her temperature was normal. What was the cause of this hypothermia? "Irrigation of the flank with normal saline," Thomas said. This was plausible. I would think it was more the after effects of Zoletil as well.
SECOND ANAESTHESIA
24 hours after the flushing, there was no more weeping wound. The flesh looked pink. I masked the cat and gave isoflurane gas and she did not struggle. Stitching was done using horizontal mattress sutures, walk-in-sutures onto the muscle before stitching the skin and 2 appositional sutures using 3/0 absorbable. The cat woke up fast and had no shivering. She ate and went home one day later.
CONCLUSION
Isoflurane gas would be the choice anaesthesia in old dogs and cats. However, this cat was not very happy with her puncture wounds being poked around. As I did not want to stress her, I did not give her isoflurane gas direct during the first anaesthesia. Zoletil was sufficient for flushing of the flank. The process took a long time as I wanted to be thorough. Next time, flank irrigation could be shortened to 5 minutes instead of 15 minutes after debridement for old cats as they develop hypothermia easily.
In the usual cat bite wound cases, antibiotics and cleaning of the wounds would be sufficient treatment. In this case, the muscles were torn and infected deep below the skin. That was why the two puncture wounds produced a sero-sanguinous fluid daily and would not close. My vet assistant poured antibiotic powder onto the wounds as is the usual practice. The powder would just lodge deeper into the lower abdominal subcutaneous tissue and the wound just would weep again. The only effective treatment was to flush out the dead tissues rather than pour antibiotic powder so that the wounds would heal within 14 days.
Veterinary Performance counts in private practice. If the vet gives the owner a bottle of antibiotic powder and medication expecting the wound to heal, the owner would be much disappointed as such wounds would never heal. The owner would have wasted much time in putting powder clogging up the internal loose cavities of subcutaneous tissue destroyed by the bacteria toxins. In the end, the cat still needed surgery and the owner ends up paying much more.
This was not the simple case of cat bite wounds and the costs would be much higher as it involved two anaesthesias and surgeries. However, the clinical outcome was excellent. And that is what the owner wants - her cat's problems resolved in the fastest time.
updates at www.toapayohvets.com
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 08 June, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
Getting ideas from vet assistants is one way of improving oneself as they are in the front line of nursing and have many ideas to resolve veterinary challenges. I am constantly amazed that I have not encountered every situation even after 30 years of practice and therefore I do ask my assistants how they would handle certain cases. Vets cannot know everything because there are so many surprises in new situations in veterinary medicine and surgery, as you can see in this commonly encountered case of two puncture wounds in an old cat.
An 11-year-old female spayed cat came in with two puncture wounds on her left flank. The wounds would not heal because they erupted a light brownish red fluid every day. Just like an active volcano.
Yet this cat was not feverish. The two wounds in the skin were around 4 mm x 4 mm. But they just would not close.
"The bite wounds are not superficial on the skin only," I said to the father and two adult daughters. "I would need the cat to be put under anaesthetic and explore the inside of the skin for debris. Therefore the cat must be warded for treatment." I gave the old cat an antibiotic and the tolfedine painkiller injection and put her in the crate for one day of observation.
On the morning of Day 2, I noted that the wounds were still weepy. My assistant VA2 had sprinkled his favourite yellow antibiotic powder onto the two wounds after cleaning up yesterday. Yet on the next day, the wound wept and all his yellow powder would spill out and downwards onto the lower body of the cat. This cat's subcutaneous fat had been melted away by the bacteria introduced by the other cat's saliva and so there was loose skin. The muscle layers had torn out and the jagged edges were producing the brownish red fluid.
"Just flush the inside of the skin with a 20-ml syringe," Thomas replied when I asked him how this case ought to be handled.
"You know, the suction pump is perfect for this case," I said. Thomas had never seen a suction pump being used in his 20 years of assisting in veterinary surgery. It is rarely used but is useful in certain conditions like peritonitis after surgery and maybe in some Caesarean sections.
"No need to use this equipment. Just flush normal saline via a 20 ml syringe," Thomas replied. The suction pump seemed lie a piece of fancy equipment to Thomas. This would be the first time he would see how useful this machine could be.
TWO-STAGE SURGERIES AND TWO ANAESTHESIAS
All old cats are high anaesthetic risks. This cat was thin but she looked very young. She just did not have a large appetite normally and weighed 3.3 kg when a good weight for her size would be 5 kg. There would be 2 anaesthesias needed for two surgeries and the owner must be informed in advance as to the costs, to avoid misunderstanding.
The first one would be to debride and flush out the dead muscle and fat cells. Then, on the next day, the cat would be anaesthesized to stitch up the normal skin edges after snipping off the rotten edges of the puncture wounds. There was no other way and so the risks of the cat dying on the operating table would be doubled. Definitely, the owner should be asked to sign the surgery consent form and receive advices on the prognosis.
FIRST ANAESTHESIA.
Zoletil 100 @ 0.2 ml IV femoral vein was given. Isoflurane gas via the mask was given to supplement as over 30 minutes were needed. I needed to cut away dead skin and muscle cells from damaged layers. Thomas said: "The muscle layers need to be stitched up, otherwise the cat would continue to have fluid production. When stitched, there would be no problem."
I said: "This is a very old cat. Healing of the wound will be slow. To stitch up the torn flank muscles, I would need to cut a bigger skin incision to reach deep into the muscles layer near the belly. If the big wound does not heal, the cat would be in trouble. If this is a young cat, it will be OK."
I observe that the cat could walk normally and so I would not advocate stitching of the irregular torn flank muscles. In old cats and dogs, it is best not to create big skin incisions. About 1000 ml of normal saline were squirted into the big space between the skin and the left flank muscles. A big suction tube pulled out yellowish fat and dead cells. I used scissors to snip off jagged muscle edges.
After the suction was completed, I checked the cat half an hour later. The cat was on an IV drip of normal saline. She was shivering. "Take the rectal temperature," I said to my intern Teresa. She put the thermometer in the rectum and showed me 33.5 deg C. This was low and worrying. Her normal temperature should be 38.5. This old cat had not taken anaesthesia and flushing well. Thomas blew hot air onto the cat using the hair dryer and rubbed her with a towel. "Give 20 ml of glucose," I said. This was given. The cat was wrapped with a towel. 2 hours later, her temperature was 36 deg. She growled as she did not like temperature taking. By the next morning, her temperature was normal. What was the cause of this hypothermia? "Irrigation of the flank with normal saline," Thomas said. This was plausible. I would think it was more the after effects of Zoletil as well.
SECOND ANAESTHESIA
24 hours after the flushing, there was no more weeping wound. The flesh looked pink. I masked the cat and gave isoflurane gas and she did not struggle. Stitching was done using horizontal mattress sutures, walk-in-sutures onto the muscle before stitching the skin and 2 appositional sutures using 3/0 absorbable. The cat woke up fast and had no shivering. She ate and went home one day later.
CONCLUSION
Isoflurane gas would be the choice anaesthesia in old dogs and cats. However, this cat was not very happy with her puncture wounds being poked around. As I did not want to stress her, I did not give her isoflurane gas direct during the first anaesthesia. Zoletil was sufficient for flushing of the flank. The process took a long time as I wanted to be thorough. Next time, flank irrigation could be shortened to 5 minutes instead of 15 minutes after debridement for old cats as they develop hypothermia easily.
In the usual cat bite wound cases, antibiotics and cleaning of the wounds would be sufficient treatment. In this case, the muscles were torn and infected deep below the skin. That was why the two puncture wounds produced a sero-sanguinous fluid daily and would not close. My vet assistant poured antibiotic powder onto the wounds as is the usual practice. The powder would just lodge deeper into the lower abdominal subcutaneous tissue and the wound just would weep again. The only effective treatment was to flush out the dead tissues rather than pour antibiotic powder so that the wounds would heal within 14 days.
Veterinary Performance counts in private practice. If the vet gives the owner a bottle of antibiotic powder and medication expecting the wound to heal, the owner would be much disappointed as such wounds would never heal. The owner would have wasted much time in putting powder clogging up the internal loose cavities of subcutaneous tissue destroyed by the bacteria toxins. In the end, the cat still needed surgery and the owner ends up paying much more.
This was not the simple case of cat bite wounds and the costs would be much higher as it involved two anaesthesias and surgeries. However, the clinical outcome was excellent. And that is what the owner wants - her cat's problems resolved in the fastest time.
updates at www.toapayohvets.com
coughing 4-month-old Mini Schnauzer
F, 4 m. 3.4 kg, 39.5 C
Bought 1 week ago. Harsh cough 3-4X/day but still eating.
Harsh lung sounds, anterior lobes. Start of pneumonia and fever.
As she can't be resting at home, I advised warding here for 2 days and given medication.
Day 2 warded. Much better. Less throat pain. Eating. Should go home on Day 3.
Complete cage rest is the secret to success but the dog at home will never rest as family members distract.
Bought 1 week ago. Harsh cough 3-4X/day but still eating.
Harsh lung sounds, anterior lobes. Start of pneumonia and fever.
As she can't be resting at home, I advised warding here for 2 days and given medication.
Day 2 warded. Much better. Less throat pain. Eating. Should go home on Day 3.
Complete cage rest is the secret to success but the dog at home will never rest as family members distract.
Subscribe to:
Posts (Atom)