Today Friday Mar 1, 2013, morning, the young couple brought in a cat, born around Jan 2011, for spaying. In the presence of the owners, she was quiet. So I put her in her own carrier to be spayed in the afternoon.
I thought the carrier door would open sideways as in all carriers. However, it was not working and one has to click open the two sides and front corners to open up the top half of the carrier. The sounds of clicking open the hinges were extremely loud, like a gun firing in a small room on the table top.. The cat was too angry and my assistant tried to hold her. She stretched out her claws. He took one step backwards. leaped off and in the process some anal sac oil splattered in at least 6 spots on the top of my shirt. The smell was rancid oil. The cat landed on the floor and hid in a corner. What to do?
In short, I got a lasso to restrain her, put her inside a wired crate. Later I had to pack in newspapers and phone books. The cat snarled everytime the papers were put in. "She is cramped at one side," my assistant called me. I inserted the fine needle and the cat leapt up while inside the crate. My 27G needle bent and flew to the floor as I pressed the plunger. In short, the cat did not get the 100% of the sedation IM.
At the next time, more newspapers filled the crate and another helper pushed the cat towards the side, facing me. Ths time I could inject. Lots of time spent in just this case. Cats and dogs do get ferocious once the owner is away.
A: Sedation IM 2.19 pm
B: Isoflurane first given. No need.
C. Isoflurane stopped. No need.
D: First skin incision: 2.33 pm
E: Completion of skin stitching: 3.01 pm
E-A = 42 min
E-D = 28 min.
The cat was in the middle of heat. So much time was spent to ensure that the big ovarian blood vessels were properly ligated. The ovaries were incised at least 5 mm from the uterus after ligation just in case some remnants of ovarian tissues were left in the body. There have been complaints of cats and dogs still having heat after spay and one reason is that some ovarian tissues were left behind during the spaying.
The best way is to incise the skin near to the umbilicus to expose the whole ovary plus suspensory ligaments. usually made an incision of 1 cm long starting 0.5 cm from the umbilical scar in cats. This incision is insufficiently long to access the bifurcation of the uterine bodies after hooking out the left ovary. Therefore I had to make the incision longer by extending another 1 cm caudally to expose the bifurcation of the uterine body..
For this cat on heat, the skin incision came to 2 cm long. For cats not on heat, I could open 0.8 cm long in the spay. Longer incision takes longer time. 28 minutes to spay this cat when a cat not on heat would take 10 minutes.
Surgical anaesthesia was sufficient at this dosage for 2.1 kg cat as there was no reaction .
Friday, March 1, 2013
Update: Feline S/D discontinued
UPDATE
The supplier told me today that Feline S/D had been discontinued by Hills since 9 months ago. I told him I saw a can being given by Vet 2 recently to the cat with bladder stones I operated on.
He said that feline C/D does dissolve struvites as well and is recommended for cats with calcium oxalate too, targeting the urine pH = 6.2-6.4.
The supplier told me today that Feline S/D had been discontinued by Hills since 9 months ago. I told him I saw a can being given by Vet 2 recently to the cat with bladder stones I operated on.
He said that feline C/D does dissolve struvites as well and is recommended for cats with calcium oxalate too, targeting the urine pH = 6.2-6.4.
Follow up: Stone analysis results for cat with bladder stone
Report received today.
Calcium, oxalate, magnesium positive.
Preventive diet will be C/D for life
Target urinary pH to be 6.2 to 6.4
Calcium, oxalate, magnesium positive.
Preventive diet will be C/D for life
Target urinary pH to be 6.2 to 6.4
1403. SOP - Urethral obstruction in a male cat
Written: Feb 28, 2013 10.49 am reviewing this case to compare to the cat with bladder stones operated.
Feb 28, 2013
Urethral obstruction in cats may be quite common. A lady phoned me near midnight about her cat's difficulty in urination 2 days ago but she did not want to go to the emergency clinic I referred her to. So, I presumed this 13-year-old male neutered black and white cat to be the owner who came on Feb 28, 2013 as he cat could not pass urine and had blood in the urine passed.
"No, I did not phone you," the lady in her late 40s said to me as I palpated a bladder the 50% the size of a Thai mango.
"How long had he been having this problem?" I asked.
"Two days."
"Did he vomit?" I wanted to ascertain the kidney involvement as owners seldom volunteer this info.
"He vomited 3 times yesterday."
"He must be eating dry cat food since young," I predicted.
"Yes," she said. I feed dry IAMS and ikan bilis since he was young."
"He seldom drinks water," I said.
"You are correct."
This was a gentle old cat. He did not like me massaging his penile area to loosen the urethral plug and hissed.
Standard Operating Procedure (SOP). Emergency treatment usually
1. Sedate the cat. Collect blood and urine if possible. Blood collected. No urine
2. I Injected SC baytril and tolfedine. I used xylazine 0.1 and ketamine 0.4 ml IM. Sufficient.
3. Collect urine via catheter. This was not possible as the urethra was severely blocked at the bend of the penile area.
4. Put saline into syringe and flush into catheter to unblock. This was successful. Do not force catheter inwards as this tramatise the urethra as I had seen a vet doing it. Sedate first.
5. Urine flows out. Collect for urine analysis.
6. Irrigate bladder with saline and suck out any sand and blood
7. Stitch 3 areas catheter with absorbable to anchor catheter for 2 days. Blood still flows out on Day 2 (today).
8. Hospitalised overnight and goes home next day.
BLOOD TEST RESULTS
Urea 59 (7-11)
Creatinine 1003 (7-160)
Platelets 93 (300-800). Cat's mucous membranes were pale. Nose looked pale as compared to normal cat.
URINE
pH 6.5 SG 1.012 (not reliable as saline was used to unblock obstruction)
Blood 4+, Bacteria 3+, no crystals
(No crystals does not mean no bladder stone. Palpation of bladder on Day 2 - no hard stones). No urethral obstruction as catheter is in place.
X-RAYS not done to reduce cost for this first occurrence. Will do if recur.
ADVICE
Change slowly to canned food. Urine analysis 1 month later. K/D for 10 days. Seldom gets followed up as most owners don't comply.
Feb 28, 2013
Urethral obstruction in cats may be quite common. A lady phoned me near midnight about her cat's difficulty in urination 2 days ago but she did not want to go to the emergency clinic I referred her to. So, I presumed this 13-year-old male neutered black and white cat to be the owner who came on Feb 28, 2013 as he cat could not pass urine and had blood in the urine passed.
"No, I did not phone you," the lady in her late 40s said to me as I palpated a bladder the 50% the size of a Thai mango.
"How long had he been having this problem?" I asked.
"Two days."
"Did he vomit?" I wanted to ascertain the kidney involvement as owners seldom volunteer this info.
"He vomited 3 times yesterday."
"He must be eating dry cat food since young," I predicted.
"Yes," she said. I feed dry IAMS and ikan bilis since he was young."
"He seldom drinks water," I said.
"You are correct."
This was a gentle old cat. He did not like me massaging his penile area to loosen the urethral plug and hissed.
Standard Operating Procedure (SOP). Emergency treatment usually
1. Sedate the cat. Collect blood and urine if possible. Blood collected. No urine
2. I Injected SC baytril and tolfedine. I used xylazine 0.1 and ketamine 0.4 ml IM. Sufficient.
3. Collect urine via catheter. This was not possible as the urethra was severely blocked at the bend of the penile area.
4. Put saline into syringe and flush into catheter to unblock. This was successful. Do not force catheter inwards as this tramatise the urethra as I had seen a vet doing it. Sedate first.
5. Urine flows out. Collect for urine analysis.
6. Irrigate bladder with saline and suck out any sand and blood
7. Stitch 3 areas catheter with absorbable to anchor catheter for 2 days. Blood still flows out on Day 2 (today).
8. Hospitalised overnight and goes home next day.
BLOOD TEST RESULTS
Urea 59 (7-11)
Creatinine 1003 (7-160)
Platelets 93 (300-800). Cat's mucous membranes were pale. Nose looked pale as compared to normal cat.
URINE
pH 6.5 SG 1.012 (not reliable as saline was used to unblock obstruction)
Blood 4+, Bacteria 3+, no crystals
(No crystals does not mean no bladder stone. Palpation of bladder on Day 2 - no hard stones). No urethral obstruction as catheter is in place.
X-RAYS not done to reduce cost for this first occurrence. Will do if recur.
ADVICE
Change slowly to canned food. Urine analysis 1 month later. K/D for 10 days. Seldom gets followed up as most owners don't comply.
1403. Update Key Performance Indicators for spay & SOP
 TOA PAYOH VETStoapayohvets.com 01 March, 2013 Focus: Small animals - dogs, cats, hamsters, turtles, guinea pigs & rabbits | ||||
Toa Payoh Vets Clinical
Research
Standard Operating Procedures (SOP) & Key Performance Indicators (KPI) For other cases, goto: Dogs | ||||
One of the effective management
systems is to ensure consistency of process and to execute Key Performance
Indicators. To maintain the highest standards of veterinary practice and
productivity as well as sharing knowledge, the Standard Operating Procedures
(SOP) and Key Performance Indicators (KPI) are being implemented in Toa Payoh
Vets from 2011.
Good written records are a strong defence in the cases of litigation and complaints | ||||
| Standard Operating Procedures (SOP) | ||||
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| 5491 -5495. The internet connections open the doors... | ||||
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| 5417. SOP: Eye corneal ulcer & tarsorrhaphy | 5412. SOP:
Veterinary Surgery Report format |
5413. SOP: Urinary Tract Infections and struvite stones | SOP: A new puppy with blood in the stools | |
| Key Performance Indicators (KPI)
for an experienced vet E-D = Time from first skin incision to skin stitched up | ||||
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| 5991. Feb 2013. KPI spay Maltese on heat. E-D=27 min. Isoflurane gas top up needed. | ||||
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| 5448. KPI for spaying a dog with false pregnancy. E-D=19 min | 5448. KPI
for spaying a dog with pyometra. E-D=26 min |
5615. KPI: Spaying a fat dog. E-D=28 min | KPI:
Dog spay - Chihuahua. E-D=23 min |
KPI: Dog spay - Fox Terrier E-D=26 min and Shih Tzu E-D=18 min |
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| 5545. KPI for spaying a Miniature Schnauzer with closed pyometra. E-D=41 min. | KPI: Neuter E-A=18 min and tarsorrhapy | |||
| Veterinary Management: Processes, Protocols, Procedures & Best Practices | ||||
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| 5990. Best practices from a plastic surgeon | ||||
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| 5286. A vision for Toa Payoh Vets to be a top 3 veterinary surgery in Singapore | 5385. Procedure: Female dog urethral catherisation |
5111. Pet grooming business success in Singapore | 5288. Reversing
the decline in horse racing - Part 2 |
5212. Veterinary clinic inspection |
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| 5142. A neat and good spay suture pattern is important | 4980. Dressing casually at Toa Payoh Vets | 4981. Character and competence of interns and young employees | ||
| Toa Payoh
Vets Clinical Research Standard Operating Procedures (SOP) & Key Performance Indicators (KPI) For other cases, goto: Dogs This webpage is: www.bekindtopets.com/animals/20081201PG9standard-operating-procedures-vets_ToaPayohVets.htm | ||||
| Copyright © Asiahomes All rights reserved. Revised: March 01, 2013 Toa Payoh Vets | ||||
Thursday, February 28, 2013
1402. Digital images of 83g hamster now 77g after surgery
Make use of digital photography to show tumours excised, hamster recovering etc as the owner will be educated and happier to know what had happened. This hamster of 83 g was not knocked down by 3 drops of Zoelietil 50 IM today. I thought it was too little. After 5 minutes, he became drowsy. Clipped and excised the large left inguinal tumours and left ear wart. Weighed him. He was 77 g and pooped a lot. Owner was pleased.
1401. Abdominal cryptorchid in a dog
"Is the vet competent?" the owner asked me. The young male dog had been sent in for neutering. Two undescended testicles. So, just get on with the operation. Many times, there is no problem locating the two undescended testicles under the skin.
However veterinary surgery throws the vet a surprise. In this dog, one testicle was located. The only was nowhere under the skin!
Be meticulous. Make a thorough examination before any surgery. If the undescended testicle cannot be felt under the skin while the dog is standing, don't expect to find it when he is on his back! There will be a lot of doubts from the owner when the vet can't find this testicle as it is inside the abdomen.
Have an examination procedure. Verify gender. Verify presence of both undescended testicles under the skin. If not, let the dog owner know immediately and open up the abdomen. The abdominal testicle usually is located next to the bladder at the side.
Be humble if you don't know and ask your senior vet what to do.
However veterinary surgery throws the vet a surprise. In this dog, one testicle was located. The only was nowhere under the skin!
Be meticulous. Make a thorough examination before any surgery. If the undescended testicle cannot be felt under the skin while the dog is standing, don't expect to find it when he is on his back! There will be a lot of doubts from the owner when the vet can't find this testicle as it is inside the abdomen.
Have an examination procedure. Verify gender. Verify presence of both undescended testicles under the skin. If not, let the dog owner know immediately and open up the abdomen. The abdominal testicle usually is located next to the bladder at the side.
Be humble if you don't know and ask your senior vet what to do.
1401. Update on KPI spay Maltese
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1400. Follow up on bladder stone cat 7 days after surgery
Feb 27, 2013 - I phoned the busy gentleman owner of the cat with the bladder stones as I was reviewing the past few days' cases. All cases done by associate vets and be me are reviewed by me as much can be learned from cases done. But this takes a lot of time and time is not much when there are many other things to do.
"My cat is back to as good as normal," he said that the cat was jumping and his stools and urine were normal. He had told me the day before that the cat drank less. I explained that the cat was fed canned K/D diet and canned food has a lot of water.
"Does he eat on his own?" I asked this important question.
"He eats a bit and does not mind spoon-feeding by my maid." This was a moment of great joy to know that a surgical patient who was having kidney disease based on blood test by Vet 2 had recovered almost fully. The stitched bladder with a 8-mm cut by me to extract the 8-mm diameter stone must have healed well, otherwise this cat would be dead.
Follow ups are much appreciated and great learning lessons for any vet but we seldom have much time to do it. It creates an excellent customer service experience.
This owner loves his grandmother as he did bring her to take the cat home the day after surgery. Grandmothers are most loved as they usually spend most time with the grand children while the parents are out working and surviving in the corporate jungle. His grandmother was over 80 years old and her mind was sharp and alert.
"Remember the S/D can of food given by Vet 2?" I asked the owner. "It may not be useful as the cat's urinary pH is acidic at pH=5.0. That means that the bladder stones are unlikely to be struvites as S/D is for prevention and dissolution of struvite stones. Most likely, they are calciuum oxalate stones but we have to wait for the results of the stone analysis."
This info was obtained when I collected urine before opening up the bladder for stone removal. It is important that the vet performs this procedure as it may not be possible to collect urine from an angry non-sedated cat earlier. That could be one reason Vet 2 did not do a urine analysis and just prescribed S/D of one can. It is best to practise evidence-based medicine by doing urine analysis. In this case, there were no crystals in the urine.
A 4th year vet student from the top Portugal Vet University was with me and I asked Catarina Mateu : "No crystals in the urine test means no bladder stones. Many vets will come to this conclusion. What about you?"
"Yes," she replied. "I also think this way." She will be making a video for me.
"My cat is back to as good as normal," he said that the cat was jumping and his stools and urine were normal. He had told me the day before that the cat drank less. I explained that the cat was fed canned K/D diet and canned food has a lot of water.
"Does he eat on his own?" I asked this important question.
"He eats a bit and does not mind spoon-feeding by my maid." This was a moment of great joy to know that a surgical patient who was having kidney disease based on blood test by Vet 2 had recovered almost fully. The stitched bladder with a 8-mm cut by me to extract the 8-mm diameter stone must have healed well, otherwise this cat would be dead.
Follow ups are much appreciated and great learning lessons for any vet but we seldom have much time to do it. It creates an excellent customer service experience.
This owner loves his grandmother as he did bring her to take the cat home the day after surgery. Grandmothers are most loved as they usually spend most time with the grand children while the parents are out working and surviving in the corporate jungle. His grandmother was over 80 years old and her mind was sharp and alert.
"Remember the S/D can of food given by Vet 2?" I asked the owner. "It may not be useful as the cat's urinary pH is acidic at pH=5.0. That means that the bladder stones are unlikely to be struvites as S/D is for prevention and dissolution of struvite stones. Most likely, they are calciuum oxalate stones but we have to wait for the results of the stone analysis."
This info was obtained when I collected urine before opening up the bladder for stone removal. It is important that the vet performs this procedure as it may not be possible to collect urine from an angry non-sedated cat earlier. That could be one reason Vet 2 did not do a urine analysis and just prescribed S/D of one can. It is best to practise evidence-based medicine by doing urine analysis. In this case, there were no crystals in the urine.
A 4th year vet student from the top Portugal Vet University was with me and I asked Catarina Mateu : "No crystals in the urine test means no bladder stones. Many vets will come to this conclusion. What about you?"
"Yes," she replied. "I also think this way." She will be making a video for me.
1399. Identification of patient and operation area
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