Sunday, August 10, 2014
1447. FINAL YEAR TALK 4 - July 31, 2005
toilet training, house training puppies
Community education supported by www.toapayohvets.com
About Me
- NAME: KONGSING
- LOCATION: SINGAPORE
A veterinary surgeon at www.toapayohvets.com and founder of a licensed housing agency for expatriate rentals and sales at www.asiahomes.com
SUNDAY, JULY 31, 2005
1. Be Kind To Pets Book 1: Toilet-Training Your BNew Puppy in Singapore
July 31, 2005.
Community Service by Toa Payoh Vets.
TOILET TRAINING YOUR FIRST PUPPY IN SINGAPORE - A Be Kind To Pets Book, published by www.sinpets.com
I am Dr Sing Kong Yuen, a veterinarian and founder of Toa Payoh Vets, a small animal practice Singapore. More information is at www.toapayohvets.com
I hope to write a book on Toilet Training Your New Puppy for Singaporeans, based on real life experiences of Singapore's puppy owners. It is so boring reading manuals and the real cases will be of great interest to real puppy owners all over the world. In Singapore,
Community Service by Toa Payoh Vets.
TOILET TRAINING YOUR FIRST PUPPY IN SINGAPORE - A Be Kind To Pets Book, published by www.sinpets.com
I am Dr Sing Kong Yuen, a veterinarian and founder of Toa Payoh Vets, a small animal practice Singapore. More information is at www.toapayohvets.com
I hope to write a book on Toilet Training Your New Puppy for Singaporeans, based on real life experiences of Singapore's puppy owners. It is so boring reading manuals and the real cases will be of great interest to real puppy owners all over the world. In Singapore,
1446. FINAL YEAR TALK 3. June 1, 2007. Cats
FRIDAY, JUNE 1, 2007
1. The cat of the night escapes the dog catcher but not his mistress?
"How did your cat survive being exterminated since I saw him with a leg bite wound 2 years ago?" I asked the slimmest young girl with a white head scarf and big-frame spectacles. "Now he has a big lump like a ping-pong ball below his left armpit. It would likely be a cat bite or scratch abscess. There is usually a big muscular tom-cat involved in territory control. Your neutered cat would not be so strong to fight back. Was he permitted to wander the concrete jungles of Singapore?"
"Yes," the girl said. "He will meow so loudly if he was not permitted to go out. So, he goes out in the evening or at 2 a.m."
"For how long?"
"Around 5 hours and he would come home."
The cat had lost some appetite. His rectal temperature was normal. The lump was hard --- an abscess which had not ripened yet.
"Yes," the girl said. "He will meow so loudly if he was not permitted to go out. So, he goes out in the evening or at 2 a.m."
"For how long?"
"Around 5 hours and he would come home."
The cat had lost some appetite. His rectal temperature was normal. The lump was hard --- an abscess which had not ripened yet.
1444. FINAL YEAR VET STUDENT TALK 1, YEZIN, AUG 15, 2014
Using blogger.com, I started first veterinary blog in 2008.
http://veterinarysurgerydrsing.blogspot.sg/
1. First blog started on May 21, 2008.
http://veterinarysurgerydrsing.blogspot.sg/2008/05/1-faq-dog-neuter-owners-point-of-view.html (see Fig 1).
2. Second blog is the main one being updated.
https://www.blogger.com/blogger.g?blogID=1070401363111682595#allposts
IMAGES
Fig. 1. FIRST BLOG STARTED ON MAY 21, 2008
http://veterinarysurgerydrsing.blogspot.sg/
1. First blog started on May 21, 2008.
http://veterinarysurgerydrsing.blogspot.sg/2008/05/1-faq-dog-neuter-owners-point-of-view.html (see Fig 1).
2. Second blog is the main one being updated.
https://www.blogger.com/blogger.g?blogID=1070401363111682595#allposts
IMAGES
Fig. 1. FIRST BLOG STARTED ON MAY 21, 2008
WEDNESDAY, MAY 21, 2008
1. FAQ. Dog Neuter - Owner's point of view
QUESTIONS ON NEUTER FROM THE OWNER'S POINT OF VIEW
--- On Tue, 5/20/08, Dog Owner wrote:
Subject: Hello
To: judy@toapayohvets.com
Date: Tuesday, May 20, 2008, 3:06 AM
Hi
May I check what is the price for sterilizing a male Shih Tzu dog about two years old... how many days for them to recover. . thanks
Warmest regards
Name of Dog Owner
----- Original Message -----
From: David Sing
To: Dog Owner
Sent: Wednesday, May 21, 2008 2:48 AM
Subject: Re: Hello, dog neuter
I am Dr Sing.
Cost of surgery is S$150 if it is less than 5 kg. $200 if more than 5 kg. Should be able to eat by day 2.
--- On Wed, 5/21/08, Dog Owner wrote:
Subject: Re: Hello, dog neuter
To: drsing_98@yahoo.com
Date: Wednesday, May 21, 2008, 12:30 AM
Thank you Dr Sing. Does he needs to be hospitalized? Any other charges...how many days do I need to book in advance the appt? May I have your clinic number and full address.
Name of Dog Owner
Dog neuter at Toa Payoh Vets
Wednesday, May 21, 2008 10:20 PM
From:
This sender is DomainKeys verified
"David Sing"
View contact details
To: Dog Owner
Thank you for your reply. Will not need to stay overnight. Come in at 9 am and goes home in the evening.
Additional charges may be $20 for e-collar (if you don't have one) and $15.00 for painkillers and antibiotics.
Book 1 day in advance. No food and water after 8 pm. the night before. Clinic tel no. is 6254 3326. Address: Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074.
--- On Tue, 5/20/08, Dog Owner wrote:
Subject: Hello
To: judy@toapayohvets.com
Date: Tuesday, May 20, 2008, 3:06 AM
Hi
May I check what is the price for sterilizing a male Shih Tzu dog about two years old... how many days for them to recover. . thanks
Warmest regards
Name of Dog Owner
----- Original Message -----
From: David Sing
To: Dog Owner
Sent: Wednesday, May 21, 2008 2:48 AM
Subject: Re: Hello, dog neuter
I am Dr Sing.
Cost of surgery is S$150 if it is less than 5 kg. $200 if more than 5 kg. Should be able to eat by day 2.
--- On Wed, 5/21/08, Dog Owner wrote:
Subject: Re: Hello, dog neuter
To: drsing_98@yahoo.com
Date: Wednesday, May 21, 2008, 12:30 AM
Thank you Dr Sing. Does he needs to be hospitalized? Any other charges...how many days do I need to book in advance the appt? May I have your clinic number and full address.
Name of Dog Owner
Dog neuter at Toa Payoh Vets
Wednesday, May 21, 2008 10:20 PM
From:
This sender is DomainKeys verified
"David Sing"
View contact details
To: Dog Owner
Thank you for your reply. Will not need to stay overnight. Come in at 9 am and goes home in the evening.
Additional charges may be $20 for e-collar (if you don't have one) and $15.00 for painkillers and antibiotics.
Book 1 day in advance. No food and water after 8 pm. the night before. Clinic tel no. is 6254 3326. Address: Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074.
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Saturday, August 9, 2014
1443. Neutering an aggressive Jack Russell
THURSDAY, JUNE 5, 2008
5. Restraining an aggressive Jack Russell for neuter
He curled his upper lips up and bared his fangs if any outsider wanted to touch him. I had encountered such aggressive Jack Russells. Usually males.
What to do in such a case?
When the owner brings him in for neuter, ask the owner to restrain him for tranquilisation. In this case, I injected 0.2 ml of xylazine 2% tranquiliser IM as the owner arm-locked the dog.
I put the dog into the crate. Normal ones would feel sleepy. This dog was fully alert and baring his fangs 30 minutes later.
"What should you do?" I asked my new vet assistant who has to learn on the job. He took out a dog muzzle. His usual way was to put his hand beside the dog's chest and slowly touch the dog, moving the muzzle up.
The Jack Russell eyed his hand movement and snapped in anticipation of being handled by a stranger.
"The muzzle is of no use," I said. "What to do if you don't want to be bitten?"
The assistant was silent. He had to get the dog out of the crate to the surgery room for neuter. The dog was a bright as daylight waiting to pounce onto his hand.
What to do?
There are 2 ways. Use a thick towel and cover his head. Use a lasso over his neck and get him out.
He had never seen a lasso before and we used this method. The dog was not as strong as before. Gas mask using 8% gas anaesthesia knocked him down. An endotracheal tube was put into his lungs to bring the anaesthesia to keep him pain free. Surprising 1% anaesthesia instead of the usual 2% kept him pain-free for neutering. He was put in the crate after his skin wound was plastered.
No dogs would be allowed to go home till around 4 hours after surgery. Preferably overnight but most Singapore owners want their dog home in the evening or earlier.
In this case, the owner said he had an elizabeth collar but he did not bring it with him. So he needed not purchase one from the Surgery and increased his veterinary cost of neutering.
30 minutes later, my assistant said: "The dog is bleeding a lot!" The dog's muzzle was stained bright red. The newspapers were stained bright red too. The Jack Russell's eyes stared directly at me, pupils dilated, fangs exposed, ready to attack.
What to do?
I did not expect the dog to lick vigorously his surgical wound. Blood flowed and seeped into his scrotum. It looked as if he was not neutered as his scrotum swelled to the full. It seemed to be a "con" job from an outsider's point of view as the scrotal bags should be deflated with the removal of two testes.
How to handle this bleeding episode?
In this case, the dog's adrenaline level was at all-time high. He should not be given any tranquiliser or painkiller injection in case his heart fails and he dies attributed to adverse drug injections.
"As long as you stand in front of him," I said to the vet assistant. "He will not lick his wound. He has to look at you and anticipate when you are going to nap him." So the assistant stood around him for a full hour while I asked the owner to come down.
"I can't come down now," the owner said. He was working.
"You need to come down," I said. "Your dog is bleeding and he is too aggressive. When you come, he quietens down."
The owner and his daughter came with the e-collar. They did not comment but the bleeding was a lot and the swelling of the neuter site and the scrotum was as big as it could be. A few bright red drops of blood trickled out of the stitched area.
"This 12.5-sized collar will not stop the dog from licking," I said. The owner put in the 15.0-sized collar from the Surgery.
What to do now?
So the dog be put under anaesthesia and the wound opened up to drain the blood out? This was one option.
Now, the vet has to be aware that any anaesthesia or tranquiliser in this highly strung dog may or may not kill him as he had anaesthesia recently. A dead dog is never appreciated by the owner no matter how clever the vet surgeon is.
I had to choose the safer option of maintaining the status quo. Not doing anything.
"Take the dog home and put him in a cage. No running around the house." I advised the owner. "Tel me if the swelling gets bigger or there is more bleeding. The bleeding is due to the dog licking the wound vigorously and not due to the bleeding from the neuter." I showed the owner the extensive bluish black skin discoloration of the whole penile area bruised by the dog's tongue.
Could the dog's licking cause the sutures to loosen and cause bleeding from the spermatic artery and veins?
In my experience, this was not the case. In any case, I had ligated the stump twice and ensured the stump had gone back into the inguinal canal and probably into the abdomen. I ligate quite near the testes so as to minimise trauma by not stretching out the cord and separating the spermatic blood vessels from the cremaster muscle as I used to do. This is the open method. There are two methods of neutering and I use the closed method ligating the whole sheath with the spermatic blood vessels and the cremaster muscle inside nowadays. If the first ligation broke down during licking, there would be a second one.
Experience gained
An appropriate-sized e-collar should be given to any dog after neutering or spaying.
This is our usual practice although large breeds are seldom given e-collars. In this case, the owner said he had one. Although he did not bring it, we did not expect the dog to be so vigorous in his licking of the skin wound as he had a xylazine tranquiliser.
What to do in such a case?
When the owner brings him in for neuter, ask the owner to restrain him for tranquilisation. In this case, I injected 0.2 ml of xylazine 2% tranquiliser IM as the owner arm-locked the dog.
I put the dog into the crate. Normal ones would feel sleepy. This dog was fully alert and baring his fangs 30 minutes later.
"What should you do?" I asked my new vet assistant who has to learn on the job. He took out a dog muzzle. His usual way was to put his hand beside the dog's chest and slowly touch the dog, moving the muzzle up.
The Jack Russell eyed his hand movement and snapped in anticipation of being handled by a stranger.
"The muzzle is of no use," I said. "What to do if you don't want to be bitten?"
The assistant was silent. He had to get the dog out of the crate to the surgery room for neuter. The dog was a bright as daylight waiting to pounce onto his hand.
What to do?
There are 2 ways. Use a thick towel and cover his head. Use a lasso over his neck and get him out.
He had never seen a lasso before and we used this method. The dog was not as strong as before. Gas mask using 8% gas anaesthesia knocked him down. An endotracheal tube was put into his lungs to bring the anaesthesia to keep him pain free. Surprising 1% anaesthesia instead of the usual 2% kept him pain-free for neutering. He was put in the crate after his skin wound was plastered.
No dogs would be allowed to go home till around 4 hours after surgery. Preferably overnight but most Singapore owners want their dog home in the evening or earlier.
In this case, the owner said he had an elizabeth collar but he did not bring it with him. So he needed not purchase one from the Surgery and increased his veterinary cost of neutering.
30 minutes later, my assistant said: "The dog is bleeding a lot!" The dog's muzzle was stained bright red. The newspapers were stained bright red too. The Jack Russell's eyes stared directly at me, pupils dilated, fangs exposed, ready to attack.
What to do?
I did not expect the dog to lick vigorously his surgical wound. Blood flowed and seeped into his scrotum. It looked as if he was not neutered as his scrotum swelled to the full. It seemed to be a "con" job from an outsider's point of view as the scrotal bags should be deflated with the removal of two testes.
How to handle this bleeding episode?
In this case, the dog's adrenaline level was at all-time high. He should not be given any tranquiliser or painkiller injection in case his heart fails and he dies attributed to adverse drug injections.
"As long as you stand in front of him," I said to the vet assistant. "He will not lick his wound. He has to look at you and anticipate when you are going to nap him." So the assistant stood around him for a full hour while I asked the owner to come down.
"I can't come down now," the owner said. He was working.
"You need to come down," I said. "Your dog is bleeding and he is too aggressive. When you come, he quietens down."
The owner and his daughter came with the e-collar. They did not comment but the bleeding was a lot and the swelling of the neuter site and the scrotum was as big as it could be. A few bright red drops of blood trickled out of the stitched area.
"This 12.5-sized collar will not stop the dog from licking," I said. The owner put in the 15.0-sized collar from the Surgery.
What to do now?
So the dog be put under anaesthesia and the wound opened up to drain the blood out? This was one option.
Now, the vet has to be aware that any anaesthesia or tranquiliser in this highly strung dog may or may not kill him as he had anaesthesia recently. A dead dog is never appreciated by the owner no matter how clever the vet surgeon is.
I had to choose the safer option of maintaining the status quo. Not doing anything.
"Take the dog home and put him in a cage. No running around the house." I advised the owner. "Tel me if the swelling gets bigger or there is more bleeding. The bleeding is due to the dog licking the wound vigorously and not due to the bleeding from the neuter." I showed the owner the extensive bluish black skin discoloration of the whole penile area bruised by the dog's tongue.
Could the dog's licking cause the sutures to loosen and cause bleeding from the spermatic artery and veins?
In my experience, this was not the case. In any case, I had ligated the stump twice and ensured the stump had gone back into the inguinal canal and probably into the abdomen. I ligate quite near the testes so as to minimise trauma by not stretching out the cord and separating the spermatic blood vessels from the cremaster muscle as I used to do. This is the open method. There are two methods of neutering and I use the closed method ligating the whole sheath with the spermatic blood vessels and the cremaster muscle inside nowadays. If the first ligation broke down during licking, there would be a second one.
Experience gained
An appropriate-sized e-collar should be given to any dog after neutering or spaying.
This is our usual practice although large breeds are seldom given e-collars. In this case, the owner said he had one. Although he did not bring it, we did not expect the dog to be so vigorous in his licking of the skin wound as he had a xylazine tranquiliser.
1442. Yezin Veterinary University Final Year Students Lecture - Dog neuter and spay - Draft
DRAFT
Case studies of dog neuter and spay over past 30 years at Toa Payoh Vets
A high standard of care to sustain the practice. Over 60 vet clinics in Singapore and many have very strong financial backing to build prettier clinics attracting more clients.
SPAY FOR NORMAL DOGS, PYOMETRA, PREGNANCY, SKIN DISEASES (HORMONAL).
NEUTER - Undescended testicles, go into abdomen for abdominal cryptorchid (beside bladder).
MONORCHID. Some vets just remove the inguinal one and leave the abdominal one - testicular neoplasia in old age and die (Rottweiler).
1. PRE-OP + INFORMED CONSENT (defence in case of litigation) + BLOOD TEST (AMA - Against Medical Advice).
Pre-op temperature check up before surgery. Check male or female. Do not trust owners as some cats have been spayed when they are males. Owners sue. Check pregnancy (hormonal tests?) v. pyometra - one complaint case. Be organised with an SOP (Standared Operating Procedure).
2. ANAESTHESIA + IV DRIPS + IV CATHETER (some vets do it).
3. SURGICAL TECHNIQUE - KEEP IT SIMPLE. ASEPSIS.
4. POST-OP - antibiotics, painkillers, nursing advices, stitch removal (absorbable stitches)
5. ANAESTHETIC & SURGICAL RECORDS properly maintained as a defence in case of litigation. Some vets do not bother to write down dosages, routes used. .
6. COMPLICATIONS
6.1 Bleeding. Scrotal swelling. Anti-inflammatory. Painful & infected. Scrotal ablation.
Especially in big breeds. Double ligation. Pain-killers for more than 4 days. Usually 4 days.
6.2 Pain. Intense scrotal bruising - painful or irritation
6.3 Infection
6.4 Bloody diarrhoea after spay and died. Dog had gone to boarding kennel, contacted parvovirus. Many Singapore owners not bothered to vaccinate the dog against parvovirus annually after puppyhood vaccinations.
SOLUTIONS
FAT FEMALE BIG CROSS-BRED DOGS. Can't find ovary to hook. 10 minutes pass quickly. Sweat.
Open big. Use fore-finger to feel for long thin uterine horn at lateral side of body. Insert hook under the finger to hook this horn and pull out. For new vets, use this method if can't hook.
7. INCOMPETENT SPAY
STUMP PYOMETRA - Vaginal discharge in cat given Ovarid to suppress caterwauling..
DOG/CAT IS STILL HAVING HEAT AFTER SPAY. Owner not happy.
8. SPEED, ACCURACY AND CORRECT SURGERY
9. EDUCATIONAL VIDEOS SPONSORED BY TOA PAYOH VETS
9.1 OTHER ANIMALS - RABBIT SPAY VIDEO
9.2 CAT SPAY VIDEO - 3-HAEMOSTAT METHOD
9.3 DOG SPAY VIDEO - PYOMETRA
9.4 DOG NEUTER VIDEO
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Some older male dogs feel the pain. I saw this case in 2005. Dog licking. Vet blamed. What to do?
INFORMED CONSENT FORM NOT GIVEN OR SIGNED.
http://www.asiahomes.com/singaporetpvet/0904Ads_castration_Silkie.htm
---------------------------------------------------------------------------------------
My case operated in
Client communication important.
http://www.kongyuensing.com/folder5/20110325Trauma_self-inflicted-scrotal-post-neuter-dogs-surgery-toapayohvets.htm
------------------------------------------------------------------------------------------
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CLIENT EDUCATION
Male dog - urine marking - lots of work for aged mother. Advised neuter.
- barking loudly. Neuter reduces pitch.
SYNTHETIC PROGESTIN USED IN MYANMAR FOR DOGS AND CATS appear to be quite common. Pyometra increases.
-------------------------------------------------------
BE KIND TO PETS VETERINARY EDUCATIONAL VIDEOS
1. Standard Operating Procedure in Spaying A Pregnant Cat
http://www.youtube.com/watch?v=E14zwal_yo4
Extra care is needed in operating a heavily pregnant cat. The ovarian and uterine blood vessels are much enlarged and if not properly ligated, there will be lots of bleeding in the surgical area and a possible bleeding to death post-op. A pre-op examination to ensure that the heavily pregnant cat is fit for surgery should be part of the SOP. This was done by me (Dr Sing Kong Yuen). Blood test was not taken owing to financial considerations. The dilemma is whether the heavily pregnant cat should be spayed or should she give birth first. it is extremely difficult to find new homes for the kittens and so spaying was the decision of the owner. The other concern of the owner was whether to starve the cat for 24 hours before surgery.
The cat had eaten 6 hours ago but there is no vomiting with the xylazine + ketamine IM sedation in my experience. No vomiting was present in this case.
I advise the use of the 3-forceps method to clamp and ligate the uterine body with its engorged uterine blood vessels. The lowest 3rd forceps is clamped and then released, showing a grooved line caused by clamping. Ligate this groove and the ligature will not slip off as compared to ligation of the non-grooved smooth uterine body area. In this way, there is a guarantee of no haemorrhage. The uterine body is then incised between forceps 1 and 2, leaving a good area for the ligated stump to be released into the body.
This spay was done by Dr Daniel Sing using absorbable sutures. Xyalzine 0.15 ml + ketamine 0.6 ml combined IM was given in this 3.6 kg cat. Isoflurane + oxygen gas top up was needed. There was no bleeding in this spay as the ligatures were properly placed and tight. The cat was operated in the afternoon and went home in the evening.
A handing over inspection with the owner should be part of the SOP so that the owner can see that the skin stitches are properly tied. At that time, post-op instructions are given preferably by the vet to build good client relationships. Follow up 2 days later is advised by me but most vets do not bother. As at 7 days post-op, the cat is normal and the stitches should be taken out 14 days after surgery although they are absorbable monosyn.
Standard operating procedures are in place to maintain the highest standard of surgery. Handing over inspection of the surgical site with the owner is shown. The cat is OK as at 7 days post-op.
More instructional videos for vet students and pet owners are at www.toapayohvets.com/videos.htm..
This video was filmed and edited by Intern Clara Chua as part of her experiential learning at Toa Payoh Vets. Interns learn more by writing and making videos than by being an observer looking at the vet's working.
It appears to me to be well edited and has good music. My grateful thanks to Clara. I purchased the Corel software recently as the free Windows Movie Maker does not have many features.
2. Time is Running Out - An old female pyometra dog will die from septicaemia
http://www.youtube.com/watch?v=J9WJqmVPfw8
When the vet (myself) said that the dog had a very low chance of survival on the operating table and the medical costs were high in this closed-open pyometra case, the owner probably felt that it would not be justified paying for such a high risk anaesthesia. He decided to bring the dog home to die.
But I noticed that there was this 12-year-old boy who cried his heart out. Some vets don't follow up as the owner had decided and they had no time to "solicit" for business and risk being rejected..
But this little boy loves this 14-year-old dog very much as tears streamed down his face when the father decided on no operation. He knew the outcome would be death from septicaemia (leucocytosis, neutrophilia, thromobocytopenia in the blood test).
I phoned the father (owner) the next morning. The dog was still passing bloody vaginal discharge and had become lethargic.
I reduced the surgical costs to give this high anaesthetic risky canine patient a chance to live.
Time was running out on her as she became sick again. Her serosanguinous vaginal discharge flowed out like a burst dam.
If she survived the operation, the little boy would get his companion back to health and that was what mattered to me in this case.
"Don't wait till you have finished work this evening to bring the dog down," I advised the father. "Bring her down now while she still has a fighting chance to live. Time is running out."
Dr Daniel operated immediately in the afternoon. The dog was warded one night. The little boy was most happy to have his companion back home the next day with his mother. "Are you happy now?" I asked him as he carried his friend carefully into the car. "Yes," he beamed to me his best smile..
This is a case where a vet can make a difference if he makes time to follow up before time has run out for a little boy's best friend. Happiness in the boy's face when the dog went home the day after surgery would be hard to describe. "Are you happy now?" I asked him as he sat at the back of the car with this old dog. "Yes," he nodded vigorously while his mummy was most happy too..
Time was running out as the bacterial toxins would cause permanent kidney damage. The father's decision to operate saved the dog's life. .
Now, as at Jun 25, 2014, around 2 months after spay, the 14-year-old dog is normal.
This case encourages the vet to care for the sick pyometra dog taken home by the owners who do not want spaying. I did this by following up with the owner the next day via telephone call. Reducing the medical costs would be needed in some cases where money was a concern. I reduced the medical costs by 50% so that the little boy's companion has a chance to survive and live to a ripe old age.
3. Judgment Day on closed pyometra - when to operate?
http://www.youtube.com/edit?o=U&video_id=ZykWoYi9imY
The old female dog had a bloated abdomen. Closed pyometra was diagnosed on history, palpation x-rays and blood tests.
The options for the owner were:
1. No operation. The dog will die from septicaemia.
2. Operation on the same day after I/V drip & medication of around 3 hours. Higher anaesthetic risk as the dog is lethargic and unfit for anaesthesia. But delay of several hours may result in the swollen uterus rupturing, spilling out the bacteria and toxins into the abdomen, killing the dog.
3. Operation on the next day after I/V drip & medication. This stabilises the dog's health as the drugs have time to take effect to kill off the bacteria inside the blood stream. However, the uterus is about to burst anytime and an emergency spay is strongly advised (Option 2) with its much higher risk of anaesthetic death on the operating table .
This is a judment call for the owner and the vet. The owner bears the responsibility for the dog's death. She selected took option 2. The dog survives the operation. She comes back on Day 11 for stitch removal. Everybody has a happy ending in this case but not all closed pyometra dogs survive. Many die as the owner delays several days seeking veterinary treatment or the vomiting dog has had been mis-diagnosed for gastro-enteritis when the owner does not permit blood testing and X-rays. Spaying your dog young would have prevented pyometra, higher medical costs and much emotional distress when closed pyometra occurs and remain neglected resulting in the dog's untimely death.
4. How to spay a cat and prevent stump pyometra
http://www.youtube.com/watch?v=W6MUKoweHv8
This video will be shown at the Yezin University, Veterinary Science Talk to Final Year Vet Students
TALK TO FINAL YEAR STUDENTS OF VETERINARY UNIVERSITY OF VETERINARY SCIENCE, YESIN, MYANMAR ON AUG 15, 2014 - Dr Sing Kong Yuen, Toa Payoh Vets
Topic: How to be a great vet? Belief, Passion, Drive, Perseverance & Focus. Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
A Be Kind To Pets Veterinary Educational video will be used for presentation to Final Year students at the Yezin Vet University, Myanmar on August 14, 2014 by Dr Sing Kong Yuen of Toa Payoh Vets..
Spay surgery was performed by Dr Daniel Sing, Toa Payoh Vets.
Incise about 1.5 - 2 cm from the umbilical scar to get good access to the ovaries, especially in dogs..
In cat spays at Toa Payoh Vets, we anesthesize the cat, using xylazine + ketamine IM with isoflurane gas + O2 top up if necessary. Monosyn 3/0 absorbable suture is used.
Stump pyometra is due to the release of an ovary or ovarian tissues into the abdomen by the vet who has had "spayed" the cat or dog. The stump of the uterine body becomes infected with pus after "spay", due to ovarian hormonal influences or synthetic progesterone (Depo-M, Contracep, Ovarid) given as birth control.
In July 2014, I had to prescribe antibiotics for a cat incompetenly spayed by a vet. The cat continues to caterwaul after spay. The owner had Ovarid before and found it to be useful in stopping this anti-social noise making by the "spayed" cat. The owner complains of a yellowish vaginal discharge after the use of Ovarid. This was a diagnosis of stump pyometra.
The owner was not keen on surgery to take out the ovarian tissue or ovary present inside the abdomen.
In Myanmar, Depo-M or Contracep IM injections are given to prevent pregnancy and there are many cases of pyometra in unspayed cats and dogs. This practice results in pyometra after a few or one injections and spaying is the solution.
In Singapore, pyometra is common but in the older female dogs not spayed as some Singaporean dog owners believe that it is cruel to spay a dog. Dogs do not "caterwaul" unlike cats and so there is no urgency to spay them. No Depo-M or Contracep injections or long-term Ovarid (synthetic progesterone) are given by any vet as the owners either spay or not spay their female dogs.
Case studies of dog neuter and spay over past 30 years at Toa Payoh Vets
A high standard of care to sustain the practice. Over 60 vet clinics in Singapore and many have very strong financial backing to build prettier clinics attracting more clients.
SPAY FOR NORMAL DOGS, PYOMETRA, PREGNANCY, SKIN DISEASES (HORMONAL).
NEUTER - Undescended testicles, go into abdomen for abdominal cryptorchid (beside bladder).
MONORCHID. Some vets just remove the inguinal one and leave the abdominal one - testicular neoplasia in old age and die (Rottweiler).
1. PRE-OP + INFORMED CONSENT (defence in case of litigation) + BLOOD TEST (AMA - Against Medical Advice).
Pre-op temperature check up before surgery. Check male or female. Do not trust owners as some cats have been spayed when they are males. Owners sue. Check pregnancy (hormonal tests?) v. pyometra - one complaint case. Be organised with an SOP (Standared Operating Procedure).
2. ANAESTHESIA + IV DRIPS + IV CATHETER (some vets do it).
3. SURGICAL TECHNIQUE - KEEP IT SIMPLE. ASEPSIS.
4. POST-OP - antibiotics, painkillers, nursing advices, stitch removal (absorbable stitches)
5. ANAESTHETIC & SURGICAL RECORDS properly maintained as a defence in case of litigation. Some vets do not bother to write down dosages, routes used. .
6. COMPLICATIONS
6.1 Bleeding. Scrotal swelling. Anti-inflammatory. Painful & infected. Scrotal ablation.
Especially in big breeds. Double ligation. Pain-killers for more than 4 days. Usually 4 days.
6.2 Pain. Intense scrotal bruising - painful or irritation
6.3 Infection
6.4 Bloody diarrhoea after spay and died. Dog had gone to boarding kennel, contacted parvovirus. Many Singapore owners not bothered to vaccinate the dog against parvovirus annually after puppyhood vaccinations.
SOLUTIONS
FAT FEMALE BIG CROSS-BRED DOGS. Can't find ovary to hook. 10 minutes pass quickly. Sweat.
Open big. Use fore-finger to feel for long thin uterine horn at lateral side of body. Insert hook under the finger to hook this horn and pull out. For new vets, use this method if can't hook.
7. INCOMPETENT SPAY
STUMP PYOMETRA - Vaginal discharge in cat given Ovarid to suppress caterwauling..
DOG/CAT IS STILL HAVING HEAT AFTER SPAY. Owner not happy.
8. SPEED, ACCURACY AND CORRECT SURGERY
9. EDUCATIONAL VIDEOS SPONSORED BY TOA PAYOH VETS
9.1 OTHER ANIMALS - RABBIT SPAY VIDEO
9.2 CAT SPAY VIDEO - 3-HAEMOSTAT METHOD
9.3 DOG SPAY VIDEO - PYOMETRA
9.4 DOG NEUTER VIDEO
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Some older male dogs feel the pain. I saw this case in 2005. Dog licking. Vet blamed. What to do?
INFORMED CONSENT FORM NOT GIVEN OR SIGNED.
http://www.asiahomes.com/singaporetpvet/0904Ads_castration_Silkie.htm
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Client communication important.
http://www.kongyuensing.com/folder5/20110325Trauma_self-inflicted-scrotal-post-neuter-dogs-surgery-toapayohvets.htm
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CLIENT EDUCATION
Male dog - urine marking - lots of work for aged mother. Advised neuter.
- barking loudly. Neuter reduces pitch.
SYNTHETIC PROGESTIN USED IN MYANMAR FOR DOGS AND CATS appear to be quite common. Pyometra increases.
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BE KIND TO PETS VETERINARY EDUCATIONAL VIDEOS
1. Standard Operating Procedure in Spaying A Pregnant Cat
http://www.youtube.com/watch?v=E14zwal_yo4
Extra care is needed in operating a heavily pregnant cat. The ovarian and uterine blood vessels are much enlarged and if not properly ligated, there will be lots of bleeding in the surgical area and a possible bleeding to death post-op. A pre-op examination to ensure that the heavily pregnant cat is fit for surgery should be part of the SOP. This was done by me (Dr Sing Kong Yuen). Blood test was not taken owing to financial considerations. The dilemma is whether the heavily pregnant cat should be spayed or should she give birth first. it is extremely difficult to find new homes for the kittens and so spaying was the decision of the owner. The other concern of the owner was whether to starve the cat for 24 hours before surgery.
The cat had eaten 6 hours ago but there is no vomiting with the xylazine + ketamine IM sedation in my experience. No vomiting was present in this case.
I advise the use of the 3-forceps method to clamp and ligate the uterine body with its engorged uterine blood vessels. The lowest 3rd forceps is clamped and then released, showing a grooved line caused by clamping. Ligate this groove and the ligature will not slip off as compared to ligation of the non-grooved smooth uterine body area. In this way, there is a guarantee of no haemorrhage. The uterine body is then incised between forceps 1 and 2, leaving a good area for the ligated stump to be released into the body.
This spay was done by Dr Daniel Sing using absorbable sutures. Xyalzine 0.15 ml + ketamine 0.6 ml combined IM was given in this 3.6 kg cat. Isoflurane + oxygen gas top up was needed. There was no bleeding in this spay as the ligatures were properly placed and tight. The cat was operated in the afternoon and went home in the evening.
A handing over inspection with the owner should be part of the SOP so that the owner can see that the skin stitches are properly tied. At that time, post-op instructions are given preferably by the vet to build good client relationships. Follow up 2 days later is advised by me but most vets do not bother. As at 7 days post-op, the cat is normal and the stitches should be taken out 14 days after surgery although they are absorbable monosyn.
Standard operating procedures are in place to maintain the highest standard of surgery. Handing over inspection of the surgical site with the owner is shown. The cat is OK as at 7 days post-op.
More instructional videos for vet students and pet owners are at www.toapayohvets.com/videos.htm..
This video was filmed and edited by Intern Clara Chua as part of her experiential learning at Toa Payoh Vets. Interns learn more by writing and making videos than by being an observer looking at the vet's working.
It appears to me to be well edited and has good music. My grateful thanks to Clara. I purchased the Corel software recently as the free Windows Movie Maker does not have many features.
2. Time is Running Out - An old female pyometra dog will die from septicaemia
http://www.youtube.com/watch?v=J9WJqmVPfw8
When the vet (myself) said that the dog had a very low chance of survival on the operating table and the medical costs were high in this closed-open pyometra case, the owner probably felt that it would not be justified paying for such a high risk anaesthesia. He decided to bring the dog home to die.
But I noticed that there was this 12-year-old boy who cried his heart out. Some vets don't follow up as the owner had decided and they had no time to "solicit" for business and risk being rejected..
But this little boy loves this 14-year-old dog very much as tears streamed down his face when the father decided on no operation. He knew the outcome would be death from septicaemia (leucocytosis, neutrophilia, thromobocytopenia in the blood test).
I phoned the father (owner) the next morning. The dog was still passing bloody vaginal discharge and had become lethargic.
I reduced the surgical costs to give this high anaesthetic risky canine patient a chance to live.
Time was running out on her as she became sick again. Her serosanguinous vaginal discharge flowed out like a burst dam.
If she survived the operation, the little boy would get his companion back to health and that was what mattered to me in this case.
"Don't wait till you have finished work this evening to bring the dog down," I advised the father. "Bring her down now while she still has a fighting chance to live. Time is running out."
Dr Daniel operated immediately in the afternoon. The dog was warded one night. The little boy was most happy to have his companion back home the next day with his mother. "Are you happy now?" I asked him as he carried his friend carefully into the car. "Yes," he beamed to me his best smile..
This is a case where a vet can make a difference if he makes time to follow up before time has run out for a little boy's best friend. Happiness in the boy's face when the dog went home the day after surgery would be hard to describe. "Are you happy now?" I asked him as he sat at the back of the car with this old dog. "Yes," he nodded vigorously while his mummy was most happy too..
Time was running out as the bacterial toxins would cause permanent kidney damage. The father's decision to operate saved the dog's life. .
Now, as at Jun 25, 2014, around 2 months after spay, the 14-year-old dog is normal.
This case encourages the vet to care for the sick pyometra dog taken home by the owners who do not want spaying. I did this by following up with the owner the next day via telephone call. Reducing the medical costs would be needed in some cases where money was a concern. I reduced the medical costs by 50% so that the little boy's companion has a chance to survive and live to a ripe old age.
3. Judgment Day on closed pyometra - when to operate?
http://www.youtube.com/edit?o=U&video_id=ZykWoYi9imY
The old female dog had a bloated abdomen. Closed pyometra was diagnosed on history, palpation x-rays and blood tests.
The options for the owner were:
1. No operation. The dog will die from septicaemia.
2. Operation on the same day after I/V drip & medication of around 3 hours. Higher anaesthetic risk as the dog is lethargic and unfit for anaesthesia. But delay of several hours may result in the swollen uterus rupturing, spilling out the bacteria and toxins into the abdomen, killing the dog.
3. Operation on the next day after I/V drip & medication. This stabilises the dog's health as the drugs have time to take effect to kill off the bacteria inside the blood stream. However, the uterus is about to burst anytime and an emergency spay is strongly advised (Option 2) with its much higher risk of anaesthetic death on the operating table .
This is a judment call for the owner and the vet. The owner bears the responsibility for the dog's death. She selected took option 2. The dog survives the operation. She comes back on Day 11 for stitch removal. Everybody has a happy ending in this case but not all closed pyometra dogs survive. Many die as the owner delays several days seeking veterinary treatment or the vomiting dog has had been mis-diagnosed for gastro-enteritis when the owner does not permit blood testing and X-rays. Spaying your dog young would have prevented pyometra, higher medical costs and much emotional distress when closed pyometra occurs and remain neglected resulting in the dog's untimely death.
4. How to spay a cat and prevent stump pyometra
http://www.youtube.com/watch?v=W6MUKoweHv8
This video will be shown at the Yezin University, Veterinary Science Talk to Final Year Vet Students
TALK TO FINAL YEAR STUDENTS OF VETERINARY UNIVERSITY OF VETERINARY SCIENCE, YESIN, MYANMAR ON AUG 15, 2014 - Dr Sing Kong Yuen, Toa Payoh Vets
Topic: How to be a great vet? Belief, Passion, Drive, Perseverance & Focus. Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
A Be Kind To Pets Veterinary Educational video will be used for presentation to Final Year students at the Yezin Vet University, Myanmar on August 14, 2014 by Dr Sing Kong Yuen of Toa Payoh Vets..
Spay surgery was performed by Dr Daniel Sing, Toa Payoh Vets.
Incise about 1.5 - 2 cm from the umbilical scar to get good access to the ovaries, especially in dogs..
In cat spays at Toa Payoh Vets, we anesthesize the cat, using xylazine + ketamine IM with isoflurane gas + O2 top up if necessary. Monosyn 3/0 absorbable suture is used.
Stump pyometra is due to the release of an ovary or ovarian tissues into the abdomen by the vet who has had "spayed" the cat or dog. The stump of the uterine body becomes infected with pus after "spay", due to ovarian hormonal influences or synthetic progesterone (Depo-M, Contracep, Ovarid) given as birth control.
In July 2014, I had to prescribe antibiotics for a cat incompetenly spayed by a vet. The cat continues to caterwaul after spay. The owner had Ovarid before and found it to be useful in stopping this anti-social noise making by the "spayed" cat. The owner complains of a yellowish vaginal discharge after the use of Ovarid. This was a diagnosis of stump pyometra.
The owner was not keen on surgery to take out the ovarian tissue or ovary present inside the abdomen.
In Myanmar, Depo-M or Contracep IM injections are given to prevent pregnancy and there are many cases of pyometra in unspayed cats and dogs. This practice results in pyometra after a few or one injections and spaying is the solution.
In Singapore, pyometra is common but in the older female dogs not spayed as some Singaporean dog owners believe that it is cruel to spay a dog. Dogs do not "caterwaul" unlike cats and so there is no urgency to spay them. No Depo-M or Contracep injections or long-term Ovarid (synthetic progesterone) are given by any vet as the owners either spay or not spay their female dogs.
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