531. A 14-year-old Chihuahua has a big breast tumour - IV anaesthesia

It is a difficult decision for the mother and daughter when the beloved 14-year-old Chihuahua had a big breast tumour. To operate and risk her dying on the operating table from anaesthesia or not to operate?

Or just wait and see. But the tumour on the left side of the mammary area had grown bigger. The other tumour on the right side had been excised by me just 2 months ago. The Chihuahua had survived the anaesthesia. Now, another tumour had popped up.

They came on a Saturday morning. Dr Jason Teo was on duty as I don't work on Saturdays. I happened to pop into the Surgery to check on a dwarf hamster with a very itchy face and they saw me. As the dog had eaten, Dr Teo could not operate on the same day and so I scheduled to operate on Sunday after the owners were well advised. "Must sign the form," Dr Teo reminded me quietly. This is the informed consent for surgery. I didn't ask them to sign a form although my associate vets do. I usually speak at length on the dangers of anaesthesia to make sure the owners are aware of what they are doing. Their pet may die under anaesthesia and will not be alive once they go to the operating room. Many times they understand. Some don't want to proceed with the surgery and go home.

Much depends on trust built up over the years but getting the owners to sign an informed consent for surgery and anaesthesia is wise and is practised by surgeons in the Singapore hospitals. To avoid nasty allegations of not being informed of the risks and alternative options by unhappy owners.

So, on a fine Sunday morning of July 31, 2011, I operated with much fear of anaesthetic death for this old companion who would be having her 3rd anaesthesia in 3 months. The second one was for the swollen right breast. The same one. Brown liquid dripped out from the nipple of this breast and the whole length of 5 cm was swollen. Antibiotics were taken and now the breast tumour had consolidated.

This time I used IV anaesthesia. Just sufficient to last for the surgery of less than 30 minutes and no more dosage. Just what is an adequate dosage of domitor and ketamine for IV anaesthesia for a very old dog? This is based on intuition and experience.

I have a domitor and ketamine IV dosage chart on my operating room cabinet which I refer to. This chart is shown in this webpage for the benefit of vets who need an alternative to isoflurane and oxygen anaesthesia.

MY CHART HAS THIS GUIDELINE
DOSAGE OF DOMITOR AND KETAMINE FOR A NORMAL HEALTHY YOUNG DOG 10 KG
FOR 30 MINUTES OF SURGERY

DOSAGE GUIDELINE
CALCULATED DOSAGE
10 kg, healthy young dog
Domitor 0.4 ml. Ketamine 0.5 ml = 0.9 ml in one syringe IV. No need isoflurane gas top up.
This Chihuahua is 4 kg. If she is young and healthy, the formula should be: Domitor around 0.15 ml + Ketamine 0.20 ml IV = 0.35 ml

DOSAGE GIVEN

Very old dog. Dosage should be much reduced. I gave the following much lower dosage:
Domitor 0.05 ml + Ketamine 0.15 ml = 0.20 ml in one syringe to be given via IV drip. I gave atropine 0.3 ml IM.

This formula worked effectively as it gave me around 30 minutes of surgical anaesthesia. The dog lifted her head just as I completed the last stitch. But she was drowsy. So, I gave her the antidote, Antisedan IM. She woke up within 2 minutes as fresh as a daisy. She went home 2 hours later. As the daughter now is an adult, she paid the bill. "No need to do histopathology if you don't want to," I said so as to reduce her cost. I had not asked for blood test. She did not want histopathology this time. The first time, the right breast grape-like tumours were benign adenomas and the blood test were normal for this old dog.



IV drip is advised for long surgeries. Domitor + Ketamine IV at the correct dosage and in healthy dogs give excellent analgesia without the need of isoflurane gas top up. Some countries may have difficulties getting isoflurane vaporisers and isoflurane and IV anaesthesia is an alternative option






Drowsy but is awake at the last stitch
Antisedan injection wakes the dog up fast
Surgery record for knowledge management
Although spayed dogs are said not to get breast tumours, there are a few that will get breast tumours after spay. There are some reports saying that female dogs spayed at less than one year of age will have lower chances of getting breast tumours but I don't find any scientific research to substantiate this. When was this dog spayed as I did not think it was done by me.

"When was this dog spayed?" I asked the daughter who has blossomed into a handsome looking tall lady.

"When I was in JC (junior college)," she put a finger on her chin to think. "It would be in 1998. She was 5 years old. Now, she is 14 years old. 8 years sure had breezed by and gone with the wind. The daughter now becomes the paymaster and the mother must listen to her. Still both bore the responsibility of giving the informed consent. The mum wanted me to operate although Dr Teo would be able to do it. So, that was how I landed with a surgery on a bright Sunday morning. It was a happy ending. But the more I do such risky surgeries, the more the minefields of deaths on the operating table will be stepped on.

So, I will prefer my younger associate vets to shoulder the heavy responsibilities of difficult surgeries and high-risk ones. That is the advantage of team work. There is just no escaping from the jaws of deaths for high-risk surgeries. It is a matter of statistics and probability when more of such cases are done.


updates and more images at:
http://www.sinpets.com/F5/20110806domitor-ketamine-dosage-Singapore-ToaPayohVets.htm

530. A dodgy doggy story from a flamboyant lady - Part 1

"I just can't believe her story," I said to my REA (Real Estate Agency) classmate, Mr Chua as we went into the subway train to go back to Novena after visiting another classmate at her office.
"She has no reasons to lie," he replied.
"No reasons at all," I said. "I mean that what she said was incredible. It is an unbelievable doggy story."
"A dodgy story," Mr Chua said.

Well, it was a fine Tuesday August 2, 2011 afternoon when we met up for lunch. A Caucasian agent who was marketing overseas properties, introduced to us by our REA lecturer met us for lunch to present his business. He had to take the REA examination although he does not sell or deal with Singapore properties and so that was how we met.

My lady classmate came late. "The most flamboyant lady in the class is here!" Mr Chua announced. I just can't understand why he said that. She was not offended nor make any comments.

Why did he say she was flamboyant? What does it mean? I googled "flamboyant" now. It said: "Being too showy or ornate, gaudy, flashy". This fair lady in her late 30s does dress up well. Today she was in plain grey with flowery high heels. I remember her as having well dressed in class in high quality clothing material and sporting tinted brownish red hair and showing red painted nail accessories. A bit on the big side. She was friendly and easy to converse. If flamboyance can make one stand out and be successful as well, you may also want to be flamboyant as she was certainly one of those successful estate agents with an office in downtown Singapore.

When she heard that I am a vet, my flamboyant classmate would consult me about her Siberian Husky getting thinner and thinner during lunch as she sat to my right at this oily Korean hotplate restaurant in Novena. "One day, my car had broken down. So I rented another," she said. "My Husky would howl all night long. The next morning, I wanted to drive the car to work. He would tug at my skirt," she said as she pulled her lower half of her grey dress outwards with her right hand. "He just would not permit me to get into the car."

"Do you think that the dog can see some spirits inside the car?" I tried to frighten her with demons and devils. "Once you drive the car, you will be possessed."

"I don't know," she said. "My dog just would not let his grip off my dress."

"Dogs have been known to warn their owners of impending dangers," I said. There was a story of a dog warning a Japanese lady of the impending tsunami wave and got her to move to higher ground. She was saved by her dog's action. So, was this a case of the dog sensing danger? A supernatural spirit or worse?

"So, did you brush away your dog?" I asked.
"No," she said. "I got the rental company to change the car."
"What happened after that?" I asked.
"My husky was just quiet and did not bother with me."
"Was there any bad odour or smell in the first car?" I asked. "A smell of blood from somebody who had died in the car? A smell masked by perfume? A fishy smell?

"Come to think of it," my classmate said. "There was a smell." She could not describe it.

Well, she is alive today and that was thanks to this dog she rescued from being abused by the previous owner.

And so, that was the end of the incredible doggy story, I thought. I asked Mr Chua to visit her office with me. To see a success story as she had an office in downtown Singapore. No realtor without success would open an office in this area.
Must be expensive, being downtown.

My classmate left first as she had to pick up a Japanese expatriate to buy condos. I could imagine her zooming in her 2-seater Maserati with this Japanese prospect in keeping up with her true image of success as a realtor. A lady realtor who knows Japanese, Mandarin and English plus flamboyance and high energy is a man-killer. The equivalent of the femme fatale. Backed up by protective canine spirits. Far fetched? Wait till you read her second incredible doggy story later in this article.

She had made time to network with us as the organiser had invited her to attend the lunch. She was not present during our first celebration lunch meeting. As she rushed off, I made an appointment to visit her. She said 4 pm and at 4 pm, Mr Chua and I were there. I hate being late for an appointment and so did Mr Chua. Mr Chua wanted to drink coffee badly but I told him to wait. Why pay for coffee when our flamboyant classmate has Nespresso coffee in her office? I don't drink coffee much but I know George Clooney was the face of Nespresso and therefore it must be good if one is susceptible to such advertisement. In any case, Nespresso is not cheap and therefore cannot be bad quality coffee. "Have you heard of George Clooney? He is the face of Nespresso in some advertisements." I asked Mr Chua who is a self-employed chemical trader. "No," he said.

So, we went to the office at 4 pm and had the Nespresso. That was where our classmate narrated her second doggy story. Being a vet, I get to hear doggy stories of the other parties but this second story was way beyond belief. I will continue in another time as it is 8.03 am and I have to go to work.

528. House-training a 6-week-old puppy in a Singapore apartment

Thank you for your email. Pl see reply in CAPITAL LETTERS below.

On Mon, Aug 1, 2011 at 10:24 AM, ...@gmail.com> wrote:

Dear Dr. Sing,

I have a 6 week old Japanese spitz puppy since 27th July, and have her for 5 days. I understand that 6 weeks is still to young for us to bring her back, but the Breeder, Uncle ...., allowed us to bring her back saying it's ok (Now i'm feel regretful for bring her back so early in her development.

I've attach a photo of the method you have been teaching for housebreaking in the apartment.

Her schedule is as follows: 7.30am - First Meal, 1pm - Second Meal, 7.30pm - Last Meal (All on eagle pro puppy kibble and mix a teaspoon of jerhigh can meat)
Playing time is 7 - 7.30pm

She has access to water for the whole day except after 7pm.

Her schedule is as follows: 7.30am - First Meal, 1pm - Second Meal, 7.30pm - Last Meal (All on eagle pro puppy kibble and mix a teaspoon of jerhigh can meat)
She has access to water for the whole morning except after 7pm.

Whenever she has an accident (Poo/Pee) outside of the pee tray, we clean the entire grate with vinegar and water (1:3)

Questions
1. She can pee and poo on the pee tray 50% of the time, and sleep on the right side of the cage. Is this the correct procedure?
YES. IT IS ONLY 5 DAYS. THE PUPPY WILL NEED TIME TO ADJUST TO THE PEE TRAY WHICH "FEELS" DIFFERENT FROM HER PREVIOUS GRATE (ASSUMING THE BREEDER USES METALLIC FLOOR GRATE WHILE YOURS IS PLASTIC HOLES).
MOST SINGAPORE BREEDERS AND PET SHOPS USE THE METALLIC FLOOR GRATE WITH A PEE PAN BELOW. WHEN THEY SELL YOU THE PUPPY, YOU SWITCH TO THE BETTER LOOKING PLASTIC PEE PAN. THE PUPPY NEEDS TO GET USED TO THE NEW FLOORING.


2. Can we still praise her for being calm and quiet while she's in the grate?
GRATE REFERS TO THE PEE PAN. CRATE REFERS TO CAGE. IF SHE IS CALM AND QUIET IN THE CRATE, SHE MAY MISTAKE YOUR PRAISE FOR WANTING SOME ACTION FROM HER.

3. Her pooping and pee-ing timing has been very irregular, and it is very hard for us to catch her in the act in order for us to praise her. What ca we do about it?
TOO MUCH ATTENTION FROM FAMILY MEMBERS AND THE ADULTS TO THE PUPPY DURING FEEDING AND ONE HOUR AFTER FEEDING. THIS DISTRACTION CAUSES IRREGULAR POOPING. PEEING WILL BE HARDER TO CONTROL AS THE PUPPY AT THIS AGE PEES A LOT OF TIMES.

IF YOU DON'T DISTRACT THE PUPPY WITHIN ONE HOUR AFTER FEEDING, IT WILL POOP WITHIN 15 MINUTES GENERALLY. THERE ARE EXCEPTIONS. DISTRACTIONS INCLUDE CHILDREN, PARENTS AND YOU WANTING TO PLAY WITH THE PUPPY AFTER HIS MEAL INSTEAD OF LEAVING HER ALONE. SO SHE DOES NOT POOP ALL AT ONE TIME AND YOU SEE "ACCIDENTS" INSIDE THE CRATE.

CATCHING HER IN THE ACT MAY NOT BE POSSIBLE IF THERE ARE TOO MANY DISTRACTIONS. THIS WILL TAKE PATIENCE AND TIME.


4. She has been constantly nipping our hands and wanting to chew on our hands, and we're still trying to correct it, are there any advice for this behaviour?
GIVE COMMAND 'NO BITING' IN A FIRM TONE JUST AS SHE NIPS OR CHEW. SOME WRITERS ADVISE 'GRIPPING THE MUZZLE' WHILE SAYING 'NO BITING' AS AN EFFECTIVE METHOD. OTHERS SAY NOT TO SCREAM WHEN NIPPED TO DISCOURAGE ATTENTION-SEEKING. MUCH DEPENDS ON YOU.

REWARD WITH TREATS AND PRAISE FOR OBEDIENCE. THIS TAKES PATIENCE AND TIME AND CERTAINLY NOT WITHIN 7 DAYS OF PURCHASE.


5. For Play time, i only allow her to have supervised play in the kitchen with the door close, is this ok?
A BABY GATE OR FENCING FROM THE PLAYPEN TYPE AT THE KITCHEN DOOR WILL BE BEST AS THE PUPPY NEEDS TO BE SOCIALISED.

IT TAKES BETWEEN 2 - 12 WEEKS TO GRATE-TRAIN A PUPPY, DEPENDING ON THE OWNERS' METHODS AND PATIENCE. AND PROBABLY THE INTELLIGENCE OF THE PUPPY.


Thank you so much, and i hope i could get a reply.

Best regards,




Updates will be at:
http://www.sinpets.com/F5/20110734house-training-spitz-puppy-apartment-Singapore-ToaPayohVets.htm

527. ANAESTHESIA. No e-collar for Chow Chow after spay

SHARING SOME TIPS ON SPAY OF A CHOW CHOW

One late evening, a slim young lady in career clothes walked into my surgery whiile I was doing some paper-work in the room. She wanted to see the operating room and had a tour of Toa Payoh Vets. No problem with me although I had never had so requests in my 30 years of small animal practice.

Soon her Chow Chow came to be spayed. I also had rarely spayed Chow Chows as they are rather rare dogs in Singapore as over 80% of the people live in public housing which prohibits any dog over 20 kg and certain height.

An e-collar prevents the female dog licking her stitches after spay. But it affects the coat around the Chow Chow's ears. Some dogs hate e-collars. Others get cut by the sharp edge of the Buster brand. As this dog is so pretty, an e-collar could ruin her neck coat.

So, I decided not to give an e-collar after the spay and used elastoplast and tolfedine pain-killers. The family members also did their part in nursing her, I am sure.

Date of spay: July 23, 2010
Chow Chow, Female, 17.6kg, 39.7 deg C. 1 year old
Had heat in Marcho 2010

Domitor 2.5 ml IV via saline drip
Isoflurane + oxygen gas maintenance of one hour
Spay surgery
2/0 absorbable suture X 1 packet

Post-op pain-killer NSAID
Tolfedine 60 mg x 5 tab (1/day), 6mg x10 tab (2/day)
tolfedine being available in 60 mg and 6 mg tab only. At 4mg/kg sid, should be getting around 70-80 mg which is 60 + 12 mg per day.
baytril x 6 tab (2/day) 8 am and trimaxzole liquid daily at 6 pm

Elastoplast to cover wound. As there was no need to remove stitches, I don't get to see the dog again.

No complaint from the owner at all. I spoke to her some weeks later and she said everything was OK.

526. Four packets of stitches to spay a female dog is extravagance

Best Time To Spay Your Female Dog
- A Dream Spay
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: 23 November, 2007
Update:  31 July, 2011

When the dog owner is well informed, a spay operation in the female dog can be a very smooth operation taking less than 30 minutes.

Today was such a day. The Miniature Schnauzer, born in Dec 3, 2005 was on heat 4 months ago. She was spayed today Nov 23, 2007 as the owner was advised to do so 3-4 months after heat and she made the appointment at the 4th month.

My assistant Mark talked to the dog as he put the face mask over her muzzle. She did not struggle and went to sleep under 8% gas anaesthesia within 10 minutes. No tranquilisation was needed. I inserted the endotracheal tube to connect her lungs to the anaesthetic machine, maintained the anaesthesia at 1.5%.

The incision was 2.5 cm from the umbilicus. A 1-cm cut into the skin and the linea alba to access the internal organs of the womb and ovaries. I inserted the spay hook into the abdomen by turning it towards my right at 45 degrees caudally.

It hooked out the left uterine horn. I pulled the left ovarian ligament. The dog started to breath much faster as she felt the pain. My assistant increased the gas to 8% for a minute so that the dog had more gas to remove the pain of surgery. The minimal amount of gas given will lead to no deaths and that was why I used 1.5%.

No more rapid breathing observed. I cut the ovarian ligament with the scalpel. Clamped the ovarian stump. Ligated the stump. Then I pulled the left uterine horn totally out of the body and saw the right uterine horn at the uterine body junction popping out. I used forceps to pull it out.

From there, I accessed the right ovarian ligament and repeated the same procedure as with the left. No bleeding. The blood was normal red with oxygen. The dog was breathing regularly. Finally, I took out the uterine body, clamped and ligated it. It was let go into the abdomen.

The skin and muscles were stitched up. The gas anaesthesia was switched off as I stitched the skin. No bleeding from the ovarian and uterine tissues at all as the dog was no longer on heat.

The dog woke up smoothly after 3 minutes. An Elizabeth collar was given to prevent licking of wound. Overall, this was a dream spay. It was the most satisfying spay I had ever done as everything proceeded smoothly, there was no bleeding and therefore the surgical time taken was less than 30 minutes. The dog woke up by the last stitch as I had the gas reduced to 0% during stitching which is usually one horizontal mattress stitch. She went home without complications post-operation as the owner did not phone me nor came for stitch removal, thus saving time for him.

QUESTIONS THE OWNER ASKED:
1. Bathe the dog? Yes, but make sure the plaster is not wet.
2. Can the dog eat any food? Yes.
3. When to come back to remove the stitches. No need. The absorbable stitches will dissolve and fall off in 14-28 days.
4. When to remove plaster? 7 days later.
5. Can give antibiotic and pain-killer tablets crushed and mixed with water inside a syringe? Yes.
UPDATE IN JULY 2011

ANAESTHESIA IN TOA PAYOH VETS
A new isoflurane vaporiser has been installed in July 2011. Maximum is 5%. The dog is usually sedated with xylazine or domitor before isoflurane gas is given by mask and then intubation.

USE OF SUTURES IN SPAYING A FEMALE DOG BY DR SING
For dogs in general, I find that one packet of 2/0 absorbable sutures is sufficient, even for big breeds like the Siberian Husky. From my over 30 years of spaying dogs, I find that there is no need to do a subcuticular sutures. One horizontal mattress suture closes the skin as shown below.

ADVICE TO NEW VETS
There are employee vets who use two packets to spay a female dog as they don't need to account for the bottom-line.

In July 2011, I discovered a vet who used 4 packets of sutures (2 packets of "0" chromic catgut and 2 packets of "3/0" absorbable monofilament) for pyometra surgery in a Maltese. This is extravagance from this vet who does not have to pay for the sutures herself. There is a need for a new vet to be prudent and to keep surgery simple and safe for the dog. In this case, 2 packets of sutures will be more than sufficient and that will be the industry's bench mark.

Keep spay simple for the dog by using minimal suturing. Less sutures mean less irritation and itchiness during healing. There is no need for subcuticular sutures. If you feel the need to impress the client by using "subcutaneous" sutures (sutures under the skin) so that the client does NOT see any sutures on the skin, you need to have excellent stitching skills. No point showing the sutures or stitching another appositional layer if you want to impress the client.






A RARE CASE OF PYOMETRA IN A VERY YOUNG FEMALE DOGPyometra in a very young female Silkie Terrier is very rare as this womb infection occurs usually in female dogs over 5 years of age. By spaying her, the owner prevents pyometra which can cause death in some female dogs.


Photos and more details at:
http://www.sinpets.com/stories/20090520Spaying_Female_Dog_ToaPayohVets.htm

524. Survey on post-op licking of wound by a male Yorkshire Terrier after neuter

Surveys are important to assess the efficacy of the pain-killer tolfedine which I usually prescribe for dogs after surgery e.g. neuter and spay. Tolfedine is a NSAID. It has anti-fever effects as well as pain-killer. Below is one survey by e-mail feedback from the owner.

E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 6:39 PM,

Dear Judy,
I have a one year old Yorkie that we want to neuter. Please advise how much will the procedure be and when is the earliest time that we can bring him down. You can reach me at .... if you need any further info.

Thank you.

Best regards,
Name of owner

E-MAIL REPLY FROM DR SING DATED JUL 12, 2011

Thank you for your email I am Dr Sing from toapayohvets.com

The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.

If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.

Best wishes.

E-MAIL TO DR SING DATED JUL 16, 2011

Hi Dr Sing,

Can I book an appointment with you this coming Thurs? I'll bring him down at 930am and pick him up later part of the day. Look forward to your confirmation.

Best regards

E-MAIL FROM DR SING DATED JULY 16, 2011

Thank you for your email. Thursday 9.30 am will be OK. Will see you this Thursday.

E-MAIL FROM DR SING DATED JULY 23, 2011

Hello
I could not contact you by phone to enquire the post-operation situation in your dog. Please let me know whether your dog is recovering well with no bruising trauma to his operation area and when you give the medication of tolfedine.

Best wishes.

E-MAIL TO DR SING DATED JULY 23, 2011

Hi Dr. Kong,

He is doing well except that he looks kind of tired which I expect from the op. Please advise when can we remove the plaster from the op area. Thanks.


Cheers.
E-MAIL FROM DR SING DATED JULY 25, 2011
Plaster can be taken out on Day 7 and clean wound. He should be OK, not tired after Day 3.

E-MAIL FROM DR SING DATED JULY 25, 2011

Further to my email, please let me know whether your dog has tried to lick his surgery area and the dosage of painkiller tolfedine and duration (at what time) you give to him as your sister was the one present at the Surgery. This is because I am gathering some info on the usefulness of tolfedine on Yorkshire terriers. If he does not lick his surgery area, then it is effective.

Best wishes

E-MAIL TO DR SING DATED JULY 25, 2011

Hi,

Even with the neck guard (not sure what is the term for it), he have managed to find ways to lick his wounds….He is recovering well but seems that the antibiotic did not work well as he does want to lick his wounds.. His plaster came off last night. Wound area seems to be quite okay.

Cheers
E-MAIL FROM DR SING DATED JULY 27, 2011

Can you let me know the estimated times per day and how long you gave him the tolfedine painkiller tablets?


E-MAIL TO DR SING DATED JULY 27, 2011

Estimated times per day in terms of licking the area? I am not too sure but based on what my maid told me… As much as possible when he can push the collar off in the position where he can lick it. The painkiller was given as instructed.


Cheers

E-MAIL FROM DR SING DATED JULY 28, 2011
Thank you for the feedback. I am glad he has no big problems.

CONCLUSION

Two Yorkshire Terriers of similar ages were neutered at around the same month. Both had normal testicles inside the scrotum. No post-operation complaint. As the dogs were given 2/0 absorbable stitches, I don't get to see them 14 days after operation as in the old days as the stitches will drop off after 21 - 28 days usually.
Tolfedine is given once a day for 4 days at 4mg/kg orally from Day 2. From Day 1, after the operation, the dog will be given a tolfedine injection as well as a baytril injection SC. In the above Yorkshire, I advised tolfedine oral twice a day for Day 2.

As for adult male dogs trying to lick the surgical area, this is a common post-operation behaviour. Tolfedine, an NSAID and anti-fever drug reduces the pain and inflammation and much less post-operation licking in most dogs, in my experience. Sometimes, the owner forgets to give on time, and this may result in vigorous licking and bleeding.

Surveys after surgery and from customers are very important for any enterprise. When I went to visit Malacca on a Saturday July 23, 2011, I noted that the tourists were given some survey forms. I post a picture of two pretty tourists writing their opinions on a form for readers to appreciate the beauty of the two English roses.


Updates and pic are at:
http://www.sinpets.com/F5/20110731survey-tolfedine-post-op-Singapore-ToaPayohVets.htm

Bilateral cryptorchidism surgery

On this bright Sunday, July 24, 2011 morning, I was preparing to operate on the Silkie Terrier with "the mother of all perineal hernias" as described in Perineal hernias in a Silkie Terrier repair pictures. Update on a Boston Terrier's perineal hernia. The dog had his hernias repaired 11 days ago. However, the skin where his herniated bladder and intestines had crushed had little blood supply and the cells started dying. This is called gangrene.

A young couple arrived promptly at 9.30 am as they had made an appointment with me. They wanted to neuter a good looking solidly built miniature 2-year-old "miniature" Bull Terrier.

A hyperexcitable dog, resisting handling and turning upside down to examine his testicles which were not present inside the scrotum as in normal male dogs.
 
"Listen to the whistling sounds," I handed the hearing piece of the stethoscope to the husband so that he could listen to the whistles. I could hear the heart sounds separately but the continuous whistling sounds blocked out the heart sounds. This sounds reminded me of a condition similar to the racehorse - laryngeal hemiplegia.

"They are heart sounds," the husband declared. I asked if he had medical training but he had none. He heard loud distinct whistles in the stethoscope and therefore deemed them to be heart sounds.

"Well, they are lung sounds," I said. The heart sounds were muffled and he could not hear them since he had no experience with dog heart auscultation.

SYNCOPE
It was in 1974 when I was in my 5th year of veterinary studies at Glasgow but I still remember the word "Syncope" mentioned in my veterinary lectures. At that time, syncope was a word meant to be remembered for the examinations. I seldom encountered this transient fainting and spontaneous recovery after a short while in dogs in my over 30 years of practice. This miniature Bull Terrier appeared to be suffering from this condition and more detailed heart examinations including the ECG will be needed.

The dog has a history of fainting when over-exerted. "When he plays vigorously with the bigger and younger 8-month-old standard Bull Terrier, he could just simply collapse, as if out of breath and lie down for a while. Then he would recover completely. As if he has caught his breath and behaves normally."

This bit of information from the husband is valuable. It indicates that this dog has a cardio-pulmonary problem. He is a highly risky candidate for anaesthesia. I checked the gums. Excellent pink colour. However, the left inside lip had a yellow ulcer and several holes. "Bitten by the other bull terrier?" I asked. "Probably," the husband said. "They bite each other."

Two undescended testicles. With the dog upside down, I could palpate the left one. The right one was barely felt as it slipped inside the body. "My advice is to prepare for general anaesthesia rather than just take out one. When the dog is down, his right testicle may just disappear inside. Under anaesthesia, I can open up the abdomen and locate and get it out. (Undescended testicle can become cancerous years later). Neutering was to reduce his hyperexcitability.

BLOOD TEST
The couple agreed to the complete blood test. The liver enzymes were high while the platelets were below normal.
"Why?" the husband asked.
"Did you feed herbal or other supplements?"
"Yes," he said. "One iodine capsule per day since he was a puppy."
"Is the dosage recommended for the dog?" I asked.
"I gave one capsule as recommended for adult people," he said.

HIGH ANAESTHETIC RISKS
Based on his history of syncope, the liver disorders and low platelet count, I advised against surgery for the time being. Another blood test can be taken 4-12 weeks later. Definitely, no more iodine or other supplements and wait one month for another blood test.

The liver could have had been damaged by the iodine and its other ingredients consumed over the past 2 years. "It is not just iodine alone inside the capsule," I said to the husband. "The manufacturer will add other substances. Over the years, the liver could have been damaged. As to why the dog was given iodine, I did not ask the owner. It was good that he agreed to a blood test.

UNDESCENDED TESTICLES if normally felt under the skin can be easily removed via skin incisions as shown in the case of the poodle below. In this miniature Bull Terrier, one testicle is barely felt.

To save on veterinary cost and the need for another operation to open up the abdomen to remove the hidden testicle, it is best to put the dog under general anaesthesia, open up the abdomen, locate and remove the abdominal testicle inside as well as to remove the inguinal testicle under the skin.

INFORMED CONSENT
If the dog is healthy, there should be no anaesthetic risk but this miniature bull terrier has some health problems. So, the owner has to take the risk and be given proper information of the risks and options (informed consent). It is best that this be recorded in the case files, in case of litigation and complaint when the dog dies on the operating table.

NEGLIGENCE AND REMOVAL OF THE HIDDEN ABDOMINAL TESTICLE NEEDS A LONGER SURGERY
In some practices, since the dog has only one undescended testicle felt under the skin, this is only one that will be removed during the traditional neuter while the abdominal one is not as that necessitates opening up the abdomen, prolonging anaesthesia and increasing the risks of dying on the operating table. This is not in the interest of the dog or owner as the hidden testicle inside the abdomen can become cancerous in old age and I had seen some cases (revealed by X-ray). A negligence litigation suit may result.

Therefore, the owner must be well advised and both testicles must be removed. Not just the one under the skin. The hidden testicle is usually seen located just below the mid-penile area and can be hooked up to be tied and taken off.

Cryptorchidism can be either bilateral or unilateral, and inguinal or abdominal (or both). This poodle has bilateral inguinal cryptorchidism. Therefore you can see both undescended testicles under the skin. In abdominal cryptorchidism, the testicles are inside and there is a need to open up the abdomen to take out the "hidden testicle."


 In the case of the miniature bull terrier, one testicle is in the inguinal and one is retracted into the abdomen when the dog is held upside down. Neutering or castration is strongly advised as there is a high chance of the undescended testicle becoming cancerous in older dogs.

Pictures of bilateral cryptorchidism are at:
http://www.sinpets.com/F5/20110730syncope-undescended-testicles-miniature-bull-terrier-Singapore-ToaPayohVets.htm