There is a need to be efficient and productive when vets operate at Toa Payoh Vets.
1. Name of file - 2012TPV Anaesthesia Record
TP Reference - 42373
Date of surgery - 24.2.12
Name of owner/representative: Mr ...
2. Patient
Name:
Age: 15 months
Weight: 5.8 kg
Temp: 38.6C
Microchip No.
3. Surgery
Procedure: Spay. Vet: Dr Sing Kong Yuen
Suture type: 2-0 Polysorb (Braided lactomer, Cutting 3/8 24 mm)
Suture packets used: One packet
Spay certificate No: 1675
4. Anaesthesia
Induction Drugs: Domitor + Ketamine IV
Dose calculation
Weight (kg)
Age
Dom
Ket
10
Young
0.4
0.5
5
Young
0.23
0.29
Given 50 %
0.1
0.15
One syringe with 0.25 ml. I added 0.15 ml normal saline = 0.4 ml IV
Top up
Isoflurane + O2 at 0.5-1
% for 21 minutes (C-B)
Isoflurane graph charting % at 5-minute intervals
Summary:
Isoflurane maintained at: 0.5 - 1.0% for 21 minutes
Route: IV
A. Time of injection of induction drug: 5.07pm
B. Time of isoflurane gas first given: 5.11pm
C. Time of isoflurane gas stopped: 5.32pm
D. Time of first skin incision: 5.17pm
E. Time of completion of skin stitching: 5.33pm
E-A = 26 minutes
E-D = 16 minutes
C-B = 21 minutes
MY AUDIT OF VETERINARY SURGERY IS BASED ON:
SURGICAL TIME TO SPAY A DOG IN THIS CASE
It took 16 minutes to spay this dog (E-D). I took 2 attempts to hook left the ovary out and had two ligatures (one transfixing and one normal) done on the uterine body. If I hook the ovary at the first attempt and ligate the uterine body once, the timing should be around 13 minutes. No bleeding seen in this case.
TIPS
The skin incision was around 1.8 cm long and the location was right, around 2 cm from the umbilical scar. The 4 legs were stretched very taut as I find this procedure much easier to hook out the left ovary. I used the scalpel to cut the ovarian ligament instead of fingers to snap it. Then I ligated the ovarian ligament area once. The dog's head was on my left. I raised the hydraulic table to suit my height as with too low the table height, I had to bend down and this would delay surgery. No swab was needed in this case. 2/0 absorbable suture x 1 packet was used. I seldom see the owner coming back for stitch removal as the stitches dissolve in 14-28 days. This saves the owner one trip and time.
5. OTHER MATTERS
Spay timing:
Skin incision: 5.17pm
Linea alba incision: 5.17pm
Left ovary hooked out: 5.19pm
Left ovarian ligament incised: 5.19pm
Left ovary clamped: 5.20pm
Left ovary ligated: 5.21pm.
Right ovary hooked out: 5.21pm
Right ovarian ligament incised: 5.22pm
Right ovary clamped: 5.22pm
Right ovary ligated: 5.23pm
Uterine body (UB) clamped: 5.24pm
UB transfixation ligature right side: 5.25pm
UB transfixation ligature left side: 5.26pm
UB 2nd ligation round UB: 5.27pm
UB incised: 5.29pm
UB checked for bleeding before putting into abdomen: 5.29pm
Linea alba stitched: 2 simple interrupted sutures: 5.29pm
Finger palpate linea alba (2 cm) for hole: 5.31pm.
Skin stitched: 5.31pm. First horizontal mattress
Isoflurane gas stopped: 5.32pm
Skin stiched: 5.32 pm. Second horizontal mattress
Uterus weight: 26 g. Owner said, not pregnant before
Spay certificate No. 1675
Dog's surgical wound bandaged, given baytril 0.6 ml and tolfedine 0.6 ml SC
E-collar. Home Baytril 50 mg x 2 (1/2 tab sid), Tolfedine 6 mg x 16 tab (4 tab sid)
6.30 pm phoned owner. Take dog home. Awake.
Website is at:
http://www.sinpets.com/F5/20120233SPAY-audit-surgical-anaesthetic-time-Singapore_ToaPayohVets.htm
Saturday, February 25, 2012
Friday, February 24, 2012
884. Anaesthetic & Surgical Record for Toa Payoh Vets
The following is to monitor the productivity of veterinary anaesthesia and surgery and for instructions and review
1. Name of file
TP Reference
Date of surgery
2. Patient
Name
Age
Weight
Temperature
3. Surgery
Procedure
Vet
Spay/Neuter Certifcate No:
4. Anaesthesia
Induction Drugs
Dose calculation
Route
Isoflurane graph charting % at 5-minute intervals
Review: Isoflurane maintained at: 0.5 - 1.0% for 21 minutes
A. Time of injection of induction drug
B. Time of isoflurane gas first given
C. Time of isoflurane gas stopped
D. Time of first skin incision
E. Time of completion of skin stitching
E-A = minutes
E-D = minutes
C-B = minutes
5. OTHER MATTERS
Vet signature:
Using dog spayed by Dr Sing as an example
1. Name of file - 2012TPV Anaesthesia Record
TP Reference - 42373
Date of surgery - 24.2.12
2. Patient
Name: Jo Jo
Age: 15 months
Weight: 5.8 kg
Temp: 38.6C
3. Surgery
Procedure: Spay
Vet: Dr Sing Kong Yuen
Suture type: 2-0 Polysorb (Braided lactomer, Cutting 3/8 24 mm
Suture packets used: One packet
Spay certificate No: 1675
4. Anaesthesia
Induction Drugs: Domitor + Ketamine IV
Dose calculation
Wt Age D K
10 young 0.4ml 0.5ml
5.8 young 0.23 0.29
@50% 0.1 0.15 given = 0.26 ml. Add 0.14 normal saline = 0.4 ml IV
Isoflurane graph charting % at 5-minute intervals
Isoflurane maintained at: 0.5 - 1.0% for 21 minutes
Route: IV
A. Time of injection of induction drug: 5.07pm
B. Time of isoflurane gas first given: 5.11pm
C. Time of isoflurane gas stopped: 5.32pm
D. Time of first skin incision: 5.17pm
E. Time of completion of skin stitching: 5.33pm
E-A = 26 minutes
E-D = 16 minutes
C-B = 21 minutes
5. OTHER MATTERS
Spay timing:
Skin incision: 5.17pm
Linea alba incision: 5.17pm
Left ovary hooked out: 5.19pm
Left ovarian ligament incised: 5.19pm
Left ovary clamped: 5.20pm
Left ovary ligated: 5.21pm.
Right ovary hooked out: 5.21pm
Right ovarian ligament incised: 5.22pm
Right ovary clamped: 5.22pm
Right ovary ligated: 5.23pm
Uterine body (UB) clamped: 5.24pm
UB transfixation ligature right side: 5.25pm
UB transfixation ligature left side: 5.26pm
UB 2nd ligation round UB: 5.27pm
UB incised: 5.29pm
UB checked for bleeding before putting into abdomen: 5.29pm
Linea alba stitched: 2 simple interrupted sutures: 5.29pm
Finger palpate linea alba (2 cm) for hole: 5.31pm.
Skin stitched: 5.31pm. First horizontal mattress
Isoflurane gas stopped: 5.32pm
Skin stiched: 5.32 pm. Second horizontal mattress
Uterus weight: 26 g. Owner said, not pregnant before
Spay certificate No. 1675
Dog's surgical wound bandaged, given baytril and tolfedine SC
E-collar. Home Baytril 50 mg x 2 (1/2 tab sid), Tolfedine 6 mg x 16 tab (4 tab sid)
6.30 pm phoned owner. Take dog home. Awake.
Vet signature:
1. Name of file
TP Reference
Date of surgery
2. Patient
Name
Age
Weight
Temperature
3. Surgery
Procedure
Vet
Spay/Neuter Certifcate No:
4. Anaesthesia
Induction Drugs
Dose calculation
Route
Isoflurane graph charting % at 5-minute intervals
Review: Isoflurane maintained at: 0.5 - 1.0% for 21 minutes
A. Time of injection of induction drug
B. Time of isoflurane gas first given
C. Time of isoflurane gas stopped
D. Time of first skin incision
E. Time of completion of skin stitching
E-A = minutes
E-D = minutes
C-B = minutes
5. OTHER MATTERS
Vet signature:
1. Name of file - 2012TPV Anaesthesia Record
TP Reference - 42373
Date of surgery - 24.2.12
2. Patient
Name: Jo Jo
Age: 15 months
Weight: 5.8 kg
Temp: 38.6C
3. Surgery
Procedure: Spay
Vet: Dr Sing Kong Yuen
Suture type: 2-0 Polysorb (Braided lactomer, Cutting 3/8 24 mm
Suture packets used: One packet
Spay certificate No: 1675
4. Anaesthesia
Induction Drugs: Domitor + Ketamine IV
Dose calculation
Wt Age D K
10 young 0.4ml 0.5ml
5.8 young 0.23 0.29
@50% 0.1 0.15 given = 0.26 ml. Add 0.14 normal saline = 0.4 ml IV
Isoflurane graph charting % at 5-minute intervals
Isoflurane maintained at: 0.5 - 1.0% for 21 minutes
Route: IV
A. Time of injection of induction drug: 5.07pm
B. Time of isoflurane gas first given: 5.11pm
C. Time of isoflurane gas stopped: 5.32pm
D. Time of first skin incision: 5.17pm
E. Time of completion of skin stitching: 5.33pm
E-A = 26 minutes
E-D = 16 minutes
C-B = 21 minutes
5. OTHER MATTERS
Spay timing:
Skin incision: 5.17pm
Linea alba incision: 5.17pm
Left ovary hooked out: 5.19pm
Left ovarian ligament incised: 5.19pm
Left ovary clamped: 5.20pm
Left ovary ligated: 5.21pm.
Right ovary hooked out: 5.21pm
Right ovarian ligament incised: 5.22pm
Right ovary clamped: 5.22pm
Right ovary ligated: 5.23pm
Uterine body (UB) clamped: 5.24pm
UB transfixation ligature right side: 5.25pm
UB transfixation ligature left side: 5.26pm
UB 2nd ligation round UB: 5.27pm
UB incised: 5.29pm
UB checked for bleeding before putting into abdomen: 5.29pm
Linea alba stitched: 2 simple interrupted sutures: 5.29pm
Finger palpate linea alba (2 cm) for hole: 5.31pm.
Skin stitched: 5.31pm. First horizontal mattress
Isoflurane gas stopped: 5.32pm
Skin stiched: 5.32 pm. Second horizontal mattress
Uterus weight: 26 g. Owner said, not pregnant before
Spay certificate No. 1675
Dog's surgical wound bandaged, given baytril and tolfedine SC
E-collar. Home Baytril 50 mg x 2 (1/2 tab sid), Tolfedine 6 mg x 16 tab (4 tab sid)
6.30 pm phoned owner. Take dog home. Awake.
Vet signature:
Thursday, February 23, 2012
883. Lateral saphenous artery - Golden Retriever tumour in front of knee
The case of the old Golden Retriever with a large knee tumour.
"Your vet quoted $300 for the operation," the mother said.
"Who was the vet?" I asked as the surgery to excise this large knee tumour will take a long time, at least one hour. I had quoted $500. The owner did not want blood test or histopathology of the tumour and that would save some money. Still, $500 for the whole procedure including drugs, e-collar and post-op care was very low.
ANAESTHESIA
50% of domitor + ketamine IV according to my guidelines written previously.
The dog was old and at 50% was really knocked out. A whiff of the isoflurane gas + O2 after 5 minutes of sedation enabled intubation.
SURGERY
I demonstrated the surgery to Dr Daniel by operating together as this would not be a simple surgery as removing a tumour from the side of the body where there is a lot of skin. Here, the tumour was massive at 7 cm x 8 cm x 5 cm and if the textbook advice is to be followed, a wide resection meant insufficient skin for stitching. A wide resection is important to remove all tumour cells but an big knee wound due to insufficient skin area to close is deadly for the dog post-op as bacterial infection comes in over time.
Use marker pen to know how to excise.
BLEEDING ARTERY
There is one spurting artery of around 2 mm in diameter from the skin surface lateral to the tumour. "It is the lateral saphenous artery," Dr Daniel said. I advised a "purse-string" suture with the 2/0 absorbable and he did it. The bleeding stopped. But profuse bleeding from all other tissues continued. Swab, swab, swab, swab.
"A bi-polar electrode will be most useful," he said.
"In old dogs, the faster the surgery is done, the safer it is for this 8-year-old. I excised the tumour fast and started stitching. The bleeding continue unabated as there were numerous veins and smaller arteries. In theory, the bi-polar electrode would be used to coagulate. I could also use the coagulation electrode by switching to it from excision electrode."
"Look, the tongue and gum colour of the Golden Retriever is getting purplish," I said. In theory, it is best to stop all bleeding. This prolonged anaesthesia and the dog dies.
In practice, I stitched up the wound and used bandaging. A live patient is what the owner wants, not a clean no-bleeding surgical wound. This is the good outcome that is what text books don't teach.
You can see pictures at www.toapayohvets.com now. Will update again.
"Your vet quoted $300 for the operation," the mother said.
"Who was the vet?" I asked as the surgery to excise this large knee tumour will take a long time, at least one hour. I had quoted $500. The owner did not want blood test or histopathology of the tumour and that would save some money. Still, $500 for the whole procedure including drugs, e-collar and post-op care was very low.
ANAESTHESIA
50% of domitor + ketamine IV according to my guidelines written previously.
The dog was old and at 50% was really knocked out. A whiff of the isoflurane gas + O2 after 5 minutes of sedation enabled intubation.
SURGERY
I demonstrated the surgery to Dr Daniel by operating together as this would not be a simple surgery as removing a tumour from the side of the body where there is a lot of skin. Here, the tumour was massive at 7 cm x 8 cm x 5 cm and if the textbook advice is to be followed, a wide resection meant insufficient skin for stitching. A wide resection is important to remove all tumour cells but an big knee wound due to insufficient skin area to close is deadly for the dog post-op as bacterial infection comes in over time.
Use marker pen to know how to excise.
BLEEDING ARTERY
There is one spurting artery of around 2 mm in diameter from the skin surface lateral to the tumour. "It is the lateral saphenous artery," Dr Daniel said. I advised a "purse-string" suture with the 2/0 absorbable and he did it. The bleeding stopped. But profuse bleeding from all other tissues continued. Swab, swab, swab, swab.
"A bi-polar electrode will be most useful," he said.
"In old dogs, the faster the surgery is done, the safer it is for this 8-year-old. I excised the tumour fast and started stitching. The bleeding continue unabated as there were numerous veins and smaller arteries. In theory, the bi-polar electrode would be used to coagulate. I could also use the coagulation electrode by switching to it from excision electrode."
"Look, the tongue and gum colour of the Golden Retriever is getting purplish," I said. In theory, it is best to stop all bleeding. This prolonged anaesthesia and the dog dies.
In practice, I stitched up the wound and used bandaging. A live patient is what the owner wants, not a clean no-bleeding surgical wound. This is the good outcome that is what text books don't teach.
You can see pictures at www.toapayohvets.com now. Will update again.
Myanmar tourism has exploded as at Feb 2012
On Feb 22, 2012, I spoke with my Myanmar travel agent partner about the latest in Myanmar tourism since the U.S has made contacts with the politicians and Aung San Sui Kyi is allowed to be in politics openly.
The following are the latest happenings in Myanmar tourism.
1. A sudden surge in tourist arrivals
2. Very difficult to find 4- and 5-star accommodation in Yangon's hotels due to the increase in businessman visitors from the Middle East and from Non-Governmental Organisations. The Middle East tourists rent the whole floor and pays 50% more, according to my partner.
3. Therefore, there is insufficient hotel rooms for tourists who want 4- and 5-star hotel. There are 2- and 3-star accommodation and they are safe, decent and clean too.
4. The administrators want to build a subway in Yangon and had approached the governments of Singapore and Japan as both have the experience.
The investors are given the land to build and both share the profits.
The following are the latest happenings in Myanmar tourism.
1. A sudden surge in tourist arrivals
2. Very difficult to find 4- and 5-star accommodation in Yangon's hotels due to the increase in businessman visitors from the Middle East and from Non-Governmental Organisations. The Middle East tourists rent the whole floor and pays 50% more, according to my partner.
3. Therefore, there is insufficient hotel rooms for tourists who want 4- and 5-star hotel. There are 2- and 3-star accommodation and they are safe, decent and clean too.
4. The administrators want to build a subway in Yangon and had approached the governments of Singapore and Japan as both have the experience.
The investors are given the land to build and both share the profits.
Tuesday, February 21, 2012
881. Blood in the guinea pig's urine again. Why?
"UTI" the owner said the previous vet had diagnosed UTI when her guinea pig had passed blood in the urine.
No urine test was taken by the first vet. She wanted another opinion from me.
"UTI is common," I said. "I need to ward it and do a urine collection to check the urine."
How to collect urine from a guinea pig? I remembered my sheep metabolic studies lectures in Animal Nutrition in the 3rd year. That was 4 decades ago. Improvise. I looked for a clean pan, not the usual pee pan. I found two. See images.
Will update later.
Tentative diagnosis is traumatic injury as the guinea pig still has good appetite and has not passed blood in the urine on 2nd day of hospitalisation after being treated with medication.
Image from link from toapayoh vets as blogger.com seems to have some problems in layout when images are posted directly to it.
No urine test was taken by the first vet. She wanted another opinion from me.
"UTI is common," I said. "I need to ward it and do a urine collection to check the urine."
How to collect urine from a guinea pig? I remembered my sheep metabolic studies lectures in Animal Nutrition in the 3rd year. That was 4 decades ago. Improvise. I looked for a clean pan, not the usual pee pan. I found two. See images.
Will update later.
Tentative diagnosis is traumatic injury as the guinea pig still has good appetite and has not passed blood in the urine on 2nd day of hospitalisation after being treated with medication.
Image from link from toapayoh vets as blogger.com seems to have some problems in layout when images are posted directly to it.
Monday, February 20, 2012
880. Sunday's interesting cases at Toa Payoh Vets
Feb 19, 2012
Bright sunshine day
CASE 1.
"My guinea pig has UTI. He passes blood in his urine," the young lady's GP carrier had two large spots of blood spread onto the white tissue paper. "He had passed blood before and recovered after antibiotics," she had the GP treated by 2 vets elsewhere a few weeks ago. The GP of one year old had excellent appetite and was bright.
"Was urine collected for analysis?" I asked as I shared the case with Dr Daniel. Seldom do vets collect urine from a GP. It is just not the thing to do. I mean, how do you collect urine from a 500g GP? Male dogs can be catheterised to collect urine. But a GP?
"No," she said.
"A urine analysis is most important," I said. "I need to ward the GP for 2 days to observe and collect urine."
How to do it? I used two clean plastic tray covers under the grated floor. See image.
Fresh red blood. Bright red as if there was some bleeding internally inside the bladder. Or kidney? More passed. I wondered if the GP would bleed to death.
1. UTI? That's the primary diagnosis. The other vets had diagnosed UTI and so the owner assumed UTI.
2. Certain types of food causing reddish blood. But this was pure red blood.
3. Coagulopathy? Dr Daniel suggested.
The GP passed more than 10 ml of blood. I collected 1.5 ml from the tray and sent to the lab.
URINE ANALYSIS
Blood+++. pH=9.0. Negative for bacteria, crystals, WBC.
The GP did not pass blood after 24 hours. He ate only fresh apples and vegetables.
Bright sunshine day
CASE 1.
"My guinea pig has UTI. He passes blood in his urine," the young lady's GP carrier had two large spots of blood spread onto the white tissue paper. "He had passed blood before and recovered after antibiotics," she had the GP treated by 2 vets elsewhere a few weeks ago. The GP of one year old had excellent appetite and was bright.
"Was urine collected for analysis?" I asked as I shared the case with Dr Daniel. Seldom do vets collect urine from a GP. It is just not the thing to do. I mean, how do you collect urine from a 500g GP? Male dogs can be catheterised to collect urine. But a GP?
"No," she said.
"A urine analysis is most important," I said. "I need to ward the GP for 2 days to observe and collect urine."
How to do it? I used two clean plastic tray covers under the grated floor. See image.
Fresh red blood. Bright red as if there was some bleeding internally inside the bladder. Or kidney? More passed. I wondered if the GP would bleed to death.
1. UTI? That's the primary diagnosis. The other vets had diagnosed UTI and so the owner assumed UTI.
2. Certain types of food causing reddish blood. But this was pure red blood.
3. Coagulopathy? Dr Daniel suggested.
The GP passed more than 10 ml of blood. I collected 1.5 ml from the tray and sent to the lab.
URINE ANALYSIS
Blood+++. pH=9.0. Negative for bacteria, crystals, WBC.
The GP did not pass blood after 24 hours. He ate only fresh apples and vegetables.
Sunday, February 19, 2012
Update on the Chihuahua had "died" article
876. The Chihuahua had "died"
Yesterday, Tuesday Feb, I did an unusual Chihuahua spay cum teaching session to Dr Daniel in the afternoon. In the evening, the mother phoned Dr Daniel and said the Chihuahua had died. I was shocked and very sad. However, the Chihuahua had given birth to 2 dead 52-day-old pups.
Today at 10 am, she phoned me to ask whether she should continue feeding egg yolk to the same Chihuahua. "Hold on," I said as I went to ask Dr Daniel as to what was happening. "She said the dog had died."
I asked the mother. "Oh, the dog was dying. She fainted but I could see her breathing. After 2 hours in this position, the dog woke up and is now OK."
This was incredible as I could not understand why the dog had died. Her death was on my mind this morning. She did have a cyanotic tongue on picture taking. She was taken home 2 hours after my surgery and Dr Daniel had checked she was OK.
BACKGROUND
Tuesday Feb 14, 2012 (Valentine's Day)
Home breeder Mr Lim phoned me to ask about Caesarean cost. I had charged $250-$300/Caesarean for breeders some 7 years ago and that was how he knew me as I was in the breeder Caesarean section business doing over 100 dystocias.
"The fees were too low," I had stopped servicing the breeders some 4 years ago. "It should be around $800 - $1,000."
VET 1 TREATMENT. Mr Lim was in Malaysia and so he sent his mum to Vet 1, a vet to get an IV drip first as his mum said the dam was dying since giving birth to two dead pups discovered on Monday morning. Now, it was Tuesday 1 pm and many hours had passed.
Vet 1 also did a blood test and ultrasounds. Possibly two dead fetus according to the ultrasound. I palpated the abdomen. There was a small firm lump of 8 cm x 8 cm which would be just the uterine body as a pup would be 2x larger. In any case, the mum said there were dead pups and so Caesarean was needed. But Mr Lim had instructed that I did it, and so the mum and daughter carried the Chihuahua and the IV drip bottle of 5% glucose saline, ultrasound and blood test from Vet 1 to my Surgery.
Home breeders want the least cost Caesarean sections and he just wanted Vet 1 to give the dog an IV drip first before sending to me. But he had the ultrasound and blood test. It was more costly now.
I spoke to Mr Lim by phone and advised spaying as the dog is 6 years old and had difficulty giving birth now. Mr Lim agreed and so I used this case as a demonstration of how I did a spay on a pregnant Chihuahua to Dr Daniel who had joined the Surgery after his recent graduation.
There was milk in the glands and so it was a surprise that Mr Lim said the pups born premature were 50-52 days. But he is a professional experienced home breeder and so I would accept his calculation.
The dog was severely dehydrated. She was extremely weak as she had not been treated by any vet after her premature births of 2 pups. Therefore Vet 1 had given the glucose saline drip as instructed by Mr Lim. It is a mystery as to why Mr Lim phoned me to perform a Caesarean section for his dog as I had not seen him for over 4 years after I had given up on providing $250-Caesarean section to the Pasir Ris dog breeders as I was barely making ends meet and had no time for pet owners unlike now.
5057 - 5066. How to operate on a very weak Chihuahua after 2 premature births
The ultrasound report from Vet 1 indicated one or two dead fetuses. This is where X-rays would be more useful as the skeletal features of the fetuses would be visible. Or there could be a mis-interpretation of the ultrasound by Vet 1. Abdominal palpation by me did not reveal any hard lump of dead pups. Yet, there was the ultrasound report from a "brand-name" veterinary practice stating the existence of one or two dead fetuses. I advised a spay. The dam went home 2 hours after the spay and two hours later, the mum had phoned Dr Daniel saying that the dog had "died." The next morning, I answered the phone and she asked whether she should feed the dog "egg yolk" or not.
So, this was an unusual case of a Chihuahua that had not really died and had been operated for some 10 minutes without the need of isoflurane anaesthesia, indicating that she was near death's door. Normal dogs and any person will need the anaesthetic gas as they will feel the pain of tying the ovarian ligaments, clamping and incisions.
She had a bottle of IV glucose saline before and after Caesarean section. As at Feb 19, 2012 as I write this report, she is OK. Chihuahuas are very fragile dogs and when stressed out or hypoglycaemia, many don't recover despite treatment. So, anaesthesia can be fatal in such situations. In this case, the vet has to make a judgment as to whether to operate or not. If the dog dies when a Caesarean section is requested due to dystocias, the vet is to be blamed for not operating. If the vet operates and the dog dies, the vet is also blamed sometimes. It is best to give the IV drip of glucose and antibiotics for some 15 minutes before surgery and get the whole surgery from start to finish in less than 15 minutes.
In this case, 19 minutes were taken but that was as fast as I could do as the dog did struggle when she woke up in the last part of surgery - ligating the uterine body. So there was a delay as she was given low doses of isoflurane at 1% and I stopped surgery for a while. Do not attempt to give 5% isoflurane in such situations as that could be fatal.
Updated webpage and more images at:
http://www.sinpets.com/dogs/20120232emergency-casaerean-section-chihuahua-Singapore_ToaPayohVets.htm
Yesterday, Tuesday Feb, I did an unusual Chihuahua spay cum teaching session to Dr Daniel in the afternoon. In the evening, the mother phoned Dr Daniel and said the Chihuahua had died. I was shocked and very sad. However, the Chihuahua had given birth to 2 dead 52-day-old pups.
Today at 10 am, she phoned me to ask whether she should continue feeding egg yolk to the same Chihuahua. "Hold on," I said as I went to ask Dr Daniel as to what was happening. "She said the dog had died."
I asked the mother. "Oh, the dog was dying. She fainted but I could see her breathing. After 2 hours in this position, the dog woke up and is now OK."
This was incredible as I could not understand why the dog had died. Her death was on my mind this morning. She did have a cyanotic tongue on picture taking. She was taken home 2 hours after my surgery and Dr Daniel had checked she was OK.
BACKGROUND
Tuesday Feb 14, 2012 (Valentine's Day)
Home breeder Mr Lim phoned me to ask about Caesarean cost. I had charged $250-$300/Caesarean for breeders some 7 years ago and that was how he knew me as I was in the breeder Caesarean section business doing over 100 dystocias.
"The fees were too low," I had stopped servicing the breeders some 4 years ago. "It should be around $800 - $1,000."
VET 1 TREATMENT. Mr Lim was in Malaysia and so he sent his mum to Vet 1, a vet to get an IV drip first as his mum said the dam was dying since giving birth to two dead pups discovered on Monday morning. Now, it was Tuesday 1 pm and many hours had passed.
Vet 1 also did a blood test and ultrasounds. Possibly two dead fetus according to the ultrasound. I palpated the abdomen. There was a small firm lump of 8 cm x 8 cm which would be just the uterine body as a pup would be 2x larger. In any case, the mum said there were dead pups and so Caesarean was needed. But Mr Lim had instructed that I did it, and so the mum and daughter carried the Chihuahua and the IV drip bottle of 5% glucose saline, ultrasound and blood test from Vet 1 to my Surgery.
Home breeders want the least cost Caesarean sections and he just wanted Vet 1 to give the dog an IV drip first before sending to me. But he had the ultrasound and blood test. It was more costly now.
I spoke to Mr Lim by phone and advised spaying as the dog is 6 years old and had difficulty giving birth now. Mr Lim agreed and so I used this case as a demonstration of how I did a spay on a pregnant Chihuahua to Dr Daniel who had joined the Surgery after his recent graduation.
There was milk in the glands and so it was a surprise that Mr Lim said the pups born premature were 50-52 days. But he is a professional experienced home breeder and so I would accept his calculation.
The dog was severely dehydrated. She was extremely weak as she had not been treated by any vet after her premature births of 2 pups. Therefore Vet 1 had given the glucose saline drip as instructed by Mr Lim. It is a mystery as to why Mr Lim phoned me to perform a Caesarean section for his dog as I had not seen him for over 4 years after I had given up on providing $250-Caesarean section to the Pasir Ris dog breeders as I was barely making ends meet and had no time for pet owners unlike now.
5057 - 5066. How to operate on a very weak Chihuahua after 2 premature births
The ultrasound report from Vet 1 indicated one or two dead fetuses. This is where X-rays would be more useful as the skeletal features of the fetuses would be visible. Or there could be a mis-interpretation of the ultrasound by Vet 1. Abdominal palpation by me did not reveal any hard lump of dead pups. Yet, there was the ultrasound report from a "brand-name" veterinary practice stating the existence of one or two dead fetuses. I advised a spay. The dam went home 2 hours after the spay and two hours later, the mum had phoned Dr Daniel saying that the dog had "died." The next morning, I answered the phone and she asked whether she should feed the dog "egg yolk" or not.
So, this was an unusual case of a Chihuahua that had not really died and had been operated for some 10 minutes without the need of isoflurane anaesthesia, indicating that she was near death's door. Normal dogs and any person will need the anaesthetic gas as they will feel the pain of tying the ovarian ligaments, clamping and incisions.
She had a bottle of IV glucose saline before and after Caesarean section. As at Feb 19, 2012 as I write this report, she is OK. Chihuahuas are very fragile dogs and when stressed out or hypoglycaemia, many don't recover despite treatment. So, anaesthesia can be fatal in such situations. In this case, the vet has to make a judgment as to whether to operate or not. If the dog dies when a Caesarean section is requested due to dystocias, the vet is to be blamed for not operating. If the vet operates and the dog dies, the vet is also blamed sometimes. It is best to give the IV drip of glucose and antibiotics for some 15 minutes before surgery and get the whole surgery from start to finish in less than 15 minutes.
In this case, 19 minutes were taken but that was as fast as I could do as the dog did struggle when she woke up in the last part of surgery - ligating the uterine body. So there was a delay as she was given low doses of isoflurane at 1% and I stopped surgery for a while. Do not attempt to give 5% isoflurane in such situations as that could be fatal.
Updated webpage and more images at:
http://www.sinpets.com/dogs/20120232emergency-casaerean-section-chihuahua-Singapore_ToaPayohVets.htm
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