This morning I had a chat with this operator of a small cafe in a hotel. How did he do it as a one-man-operator and with diabetes?
"There are a lot of procedures to do," he said. "From switching on the computers, taking out the ice-cream from the freezer, cleaning, sweeping, making coffee and serving. Closing accounts and preparing for the next day. I had to make sure that sandwiches are available for sale."
"How do you, as a one-man-operator serve so many people at lunch-time?" I asked.
"I will just shout e.g. sandwiches ready and the buyer will come to collect."
"Why don't you have a self-service sign?" I asked.
"Then all customers will bunch up in a queue. They can sit and wait while I call them." This was a good idea as the shop front is very short for this retail space of 200 sq. ft. Around 5 people will fill the queue.
There are educated people who would try to take advantage of this old man.
Example 1.
The insurance company held a standing buffet lunch in the hotel for its executives. This old man had rented a space where his clients could have tables and chairs to sit. One 40-year-old insurance manager sat on his table. When the old man said: "Please do not sit here as this table and chair are reserved for my customers," the manager said: "Call the security!"
"Repeat what you have just said," the old man challenged him as he was about to roll up his sleeve to sock him. The manager vacated his seat as the old man was about to grab him by his neck to yank him up.
The old man would usually ask those intruders whether they wanted to buy a drink when they sat on his chairs. "Sometimes they buy one drink and sat with their friends. I can't stop this."
Example 2.
A staff of the hotel sat on his seat without ordering any drink or food. When the old man said: "My company bought the tables and chairs for our customers," she replied: "I understand." She just would not budge.
"So what can you do?" I asked the old man.
"I went to see her manager. She must have a scolding as the next time, she put her head down whenever she passed by. I can understand that the staff may be tired, but if they ask me, I do not mind them sitting for a while to rest."
From these 2 examples, you can see that this old man is responsible in earning his keep.
"How much was the income from a younger man employed before you?" I asked.
"Around $40 per day. The store was losing at least a thousand dollars. He would close the shop for smoking or for his one-hour lunch. I don't close for lunch."
By being proactive and caring for his employer's need to get sales income, the shop now loses much less money as its income is around $150 per day. He works 6 days a week.
"Will your boss be renewing the leasing contract at the end of the year?" I asked.
"No," he said. "The hotel management wants to increase rentals." In Singapore.as in Hongkong, every retail landlord wants to increase rental on renewal. So it is hard for small operators.
I have no doubt that this old man could get a job easily and hope he would take good care of his diabetic control.
Friday, September 12, 2014
1495. A Shih Tzu put on diapers for one year
The maid stapled the diapers to make sure that the urine does not seep onto the floor. The dog came as he was not eating and was lethargic. This 11-year-old male intact Shih Tzu had been dribbling urine for one year and the diapers were the solution. The penile and preputial areas became swollen and infected. A strong urinary smell filled the air in the consultation room. The dog bit anyone who touched his belly area.
Urinary catherisation after muzzling. No urethral obstruction.
URINE TESTS
BLOOD TESTS
X-RAYS - bladder stones. What to do?
Spoke to owner
1. Thought urinary incontinence - dribbling of urine was due to old age and so did not consult vet
2. Whether bladder stone removal can cure the incontinence? he asked. "I can't guarantee as the dog has been dribbling urine for a year.
3. Wait one week and given treatment. When appetite returns, will operate.
4. Cost of bladder stone removal and anaethesia is around $800. In-patient expenses and nursing will increase cost to $1,200 at the lowest rate.
Urinary catherisation after muzzling. No urethral obstruction.
URINE TESTS
BLOOD TESTS
X-RAYS - bladder stones. What to do?
Spoke to owner
1. Thought urinary incontinence - dribbling of urine was due to old age and so did not consult vet
2. Whether bladder stone removal can cure the incontinence? he asked. "I can't guarantee as the dog has been dribbling urine for a year.
3. Wait one week and given treatment. When appetite returns, will operate.
4. Cost of bladder stone removal and anaethesia is around $800. In-patient expenses and nursing will increase cost to $1,200 at the lowest rate.
Thursday, September 11, 2014
1494. SCRIPT FOR INTERN A Cavalier King Charles has a "blackhead" in his eyelid margin. Suppurative meibomitis
"I press it and pus will come out," the lady told me. "It does not bother him but bothers me very much."
It refers to a swelling and lump on the eyelid margin of this 4-year-old Cavalier King Charles.
"It is suppurative meibomitis and usually the dog tries to rub it away, injuring the cornea and causing tearing," I explained that the eyelid margin has a phospholipid-producing sebacious gland called a meibomian gland. When it is blocked or infected, it swells.
"I don't see him rubbing his eye," the lady told me. "Why don't you just use a scalpel and cut it and let the pus come out?"
"It is not that simple," I replied. "Without anaesthetic, the dog could move a lot and my scalpel may cut into his cornea, blinding him. It is quite a big abscess and need to be excised by surgery and anaesthesia."
"How much?"
"Anaesthesia and surgery will cost around $200," I said. She said Ok.
"Has the dog eaten?"
"Yes," she wanted the surgery to be done today as she was too busy tomorrow.
"It is 10 am now. I will do it at 3 pm when the food has gone past the stomach."
Electro-surgical excision from inside the eyelid conjunctiva. Thick pus flowed out. There was a bigger lump under the palpebral conjunctiva and the electricity sealed the bleeding blood vessels leaving a black hole of 3 mm x 3 mm.
"Do you need to stitch it?" the lady asked when she came at 3 pm.
"No need to. It will heal."
AFTER SURGERY
It refers to a swelling and lump on the eyelid margin of this 4-year-old Cavalier King Charles.
"It is suppurative meibomitis and usually the dog tries to rub it away, injuring the cornea and causing tearing," I explained that the eyelid margin has a phospholipid-producing sebacious gland called a meibomian gland. When it is blocked or infected, it swells.
"I don't see him rubbing his eye," the lady told me. "Why don't you just use a scalpel and cut it and let the pus come out?"
"It is not that simple," I replied. "Without anaesthetic, the dog could move a lot and my scalpel may cut into his cornea, blinding him. It is quite a big abscess and need to be excised by surgery and anaesthesia."
"How much?"
"Anaesthesia and surgery will cost around $200," I said. She said Ok.
"Has the dog eaten?"
"Yes," she wanted the surgery to be done today as she was too busy tomorrow.
"It is 10 am now. I will do it at 3 pm when the food has gone past the stomach."
Electro-surgical excision from inside the eyelid conjunctiva. Thick pus flowed out. There was a bigger lump under the palpebral conjunctiva and the electricity sealed the bleeding blood vessels leaving a black hole of 3 mm x 3 mm.
"Do you need to stitch it?" the lady asked when she came at 3 pm.
"No need to. It will heal."
AFTER SURGERY
1494. Tail docking 2-day-old poodles
Sep 11, 2014
The owner brought the dam and 4 puppies now 2 days old. They were suckling vigorously. There seemed to be not much milk. There were worries of the dam having diarrhoea, having panting after midnight yesterday and one smallest puppy not putting on weight. The owner was worried he might die. The dam let go a big slushy pile of semi-wet stools on the consultation table as the owner had given the commercial milk powder (actually it is cow's milk) only recently, puppy kibbles, eggs, causing stomach upset..
WEIGHT AT 2 DAYS OLD
1. Male apricot 177 g
2. Male brown red 161 g
3. Female apricot 143 g
4. Male apricot 120 g.
"Check the abdomen of the puppy. If it is distended, the puppy has enough milk. Take away the 3 bigger ones and let the smallest one suckle. Milk is being produced but slowly." Not a big gush of white milk, just a thin white drop of 2 mm across from one nipple.
TAIL DOCKING
At 2 days old, it is much easier to cauterise the small blood vessels after tail docking using potassium permanganate powder. The surgical technique is to place the scissors at 45 degrees on the dorsal side of the tail. Push back the skin towards the anal area on the dorsal side. Cut. There is a skin flap on the dorsal side covering the tail bone as the retracted skin on the dorsal side springs backwards. See illustration.
"Not to let the pups suckle for one hour. Then supervise the suckling for the next 24 hours as the dam may try to lick off the powder. So far, so good.
The owner brought the dam and 4 puppies now 2 days old. They were suckling vigorously. There seemed to be not much milk. There were worries of the dam having diarrhoea, having panting after midnight yesterday and one smallest puppy not putting on weight. The owner was worried he might die. The dam let go a big slushy pile of semi-wet stools on the consultation table as the owner had given the commercial milk powder (actually it is cow's milk) only recently, puppy kibbles, eggs, causing stomach upset..
WEIGHT AT 2 DAYS OLD
1. Male apricot 177 g
2. Male brown red 161 g
3. Female apricot 143 g
4. Male apricot 120 g.
"Check the abdomen of the puppy. If it is distended, the puppy has enough milk. Take away the 3 bigger ones and let the smallest one suckle. Milk is being produced but slowly." Not a big gush of white milk, just a thin white drop of 2 mm across from one nipple.
TAIL DOCKING
At 2 days old, it is much easier to cauterise the small blood vessels after tail docking using potassium permanganate powder. The surgical technique is to place the scissors at 45 degrees on the dorsal side of the tail. Push back the skin towards the anal area on the dorsal side. Cut. There is a skin flap on the dorsal side covering the tail bone as the retracted skin on the dorsal side springs backwards. See illustration.
"Not to let the pups suckle for one hour. Then supervise the suckling for the next 24 hours as the dam may try to lick off the powder. So far, so good.
1493**. The kind 74-year-old retiree's strays cat no longer suffers from painful urination (dysuria)
Sep 11, 2014
TP 20973
The retiree is a healthy man as he does not have high cholesterol unlike many of his age.
Today, he took a bus to Toa Payoh Vets to replenish his stock of feline C/D can and dry for his beloved black and white cat, Kitty. She is 11 years old. He eats around 2 kg of dry C/D a month and the owner would come monthly to buy the 2 kg bag. Why would he do it? This is because the cat no longer suffers from blood in the urine or dysuria (difficulty in urination).
FLASH BACK TO NOV 3, 2011
Dr Vanessa unblocked the bladder as Kitty had blood in the urine. She recorded "advised urinary test" but the owner was not in favour. The cat recovered with antibiotics. No more dysuria till Jun 3, 2014. He wanted just antibiotics and no consultation. He came back on Jun 21 and Jul 18 for the antibiotics as the cat recovered after a dose.
"It is best to do a urine test," I advised. "The cat can't be taking antibiotics forever and they may not work. X-rays of the bladder for bladder and kidney stones will be better but urine test is less expensive." The urine test on July 19, 2014 showed pH 8, SG 1.041, Blood 4+, bacteria +, triple phosphate + crystals
I advised feline C/D and no other food, to acidify the urine and this will do away with coming for antibiotics every 2 weeks. This would cure the cat of dysuria. He trusted me and so he got a bag of 2-kg C/D dry and 10 cans of C/D. The cat really did not have dysuria and he came almost monthly to buy the prescription diet.
SEP 11, 2014
"She is very fussy," the man ordered 4 cans of C/D. "I give her half a can of C/D and puts the other half in the fridge. She will not eat that half!"
"It may be too cold," I said. "Warm it. What did you do with the half can?"
"I give it to the stray cat who eats anything." He showed me a picture of this old stray cat of 11 years old. Such is the life of a wandering stray cat. Can't pick and choose.
This case shows that time must be spent on client education of retirees and make a cat healthy.
This aircraft maintenance technician still feeds 4 stray cats including the one who eats anything. This poor cat walks very slowly. "He has arthritis," the man said.I asked him to snap some images of this cat standing up on his front shoulder as the man said he had painful shoulders. I prescribed tolfedine 6 mg at 2 tab/day for 4 days, rest 4 days and give 4 days. If this pain-killer works and the retiree's diagnosis is correct, this old stray cat who used to be the muscle man of the cat neighbourhood would lead a better quality of life.
He has 2 other cats at home. "One is forever a miniature," he said. "Never grow up." He showed me video images of a chimera cat (half face black and half brown) and other handsome cats. He used to feed stray cats at the airport but the manager warned him off.
I used software Waze to locate the retiree's home as it is extremely difficult to find the side street in Ang Mo Kio housing apartment. He looked very fit.
"I have just been exercising," he wobbled his lower legs and had advised me to do the same.
A bright sunshine Sat morning
I had Judy phoned him first as I left the house. He was already waiting with money to pay me.
"$120 for 2 bags," I told him that the US company had increased the price by $6.00. He paid up and left to go upstairs. I quickly grabbed my camera from my car and snapped a photo of this kind old man who cared for the other stray cat."
"The cat had great difficulty standing up," he said. "Just like me in old age"
"You can walk very well, without the tongkat (walking stick).
I promised to give him some medication for the stray cat but the cat was eating, drinking, peeing and pooping normally..
.A very kind old man as he bothered to place orders and feed the two cats including the stray cats for so many years.
REFER ANOTHER BLOG POST No. 1128 Dec 2014
TP 20973
The retiree is a healthy man as he does not have high cholesterol unlike many of his age.
Today, he took a bus to Toa Payoh Vets to replenish his stock of feline C/D can and dry for his beloved black and white cat, Kitty. She is 11 years old. He eats around 2 kg of dry C/D a month and the owner would come monthly to buy the 2 kg bag. Why would he do it? This is because the cat no longer suffers from blood in the urine or dysuria (difficulty in urination).
FLASH BACK TO NOV 3, 2011
Dr Vanessa unblocked the bladder as Kitty had blood in the urine. She recorded "advised urinary test" but the owner was not in favour. The cat recovered with antibiotics. No more dysuria till Jun 3, 2014. He wanted just antibiotics and no consultation. He came back on Jun 21 and Jul 18 for the antibiotics as the cat recovered after a dose.
"It is best to do a urine test," I advised. "The cat can't be taking antibiotics forever and they may not work. X-rays of the bladder for bladder and kidney stones will be better but urine test is less expensive." The urine test on July 19, 2014 showed pH 8, SG 1.041, Blood 4+, bacteria +, triple phosphate + crystals
I advised feline C/D and no other food, to acidify the urine and this will do away with coming for antibiotics every 2 weeks. This would cure the cat of dysuria. He trusted me and so he got a bag of 2-kg C/D dry and 10 cans of C/D. The cat really did not have dysuria and he came almost monthly to buy the prescription diet.
SEP 11, 2014
"She is very fussy," the man ordered 4 cans of C/D. "I give her half a can of C/D and puts the other half in the fridge. She will not eat that half!"
"It may be too cold," I said. "Warm it. What did you do with the half can?"
"I give it to the stray cat who eats anything." He showed me a picture of this old stray cat of 11 years old. Such is the life of a wandering stray cat. Can't pick and choose.
This case shows that time must be spent on client education of retirees and make a cat healthy.
This aircraft maintenance technician still feeds 4 stray cats including the one who eats anything. This poor cat walks very slowly. "He has arthritis," the man said.I asked him to snap some images of this cat standing up on his front shoulder as the man said he had painful shoulders. I prescribed tolfedine 6 mg at 2 tab/day for 4 days, rest 4 days and give 4 days. If this pain-killer works and the retiree's diagnosis is correct, this old stray cat who used to be the muscle man of the cat neighbourhood would lead a better quality of life.
He has 2 other cats at home. "One is forever a miniature," he said. "Never grow up." He showed me video images of a chimera cat (half face black and half brown) and other handsome cats. He used to feed stray cats at the airport but the manager warned him off.
- Ingredients to help manage stress
- Dissolves struvite stones in as little as 7 days (Average 28 days)
- Reduces the risk of struvite & calcium oxalate stones
- Recommended for lifelong feeding of adult cats
APRIL 28, 2018 9am
I used software Waze to locate the retiree's home as it is extremely difficult to find the side street in Ang Mo Kio housing apartment. He looked very fit.
"I have just been exercising," he wobbled his lower legs and had advised me to do the same.
A bright sunshine Sat morning
I had Judy phoned him first as I left the house. He was already waiting with money to pay me.
"$120 for 2 bags," I told him that the US company had increased the price by $6.00. He paid up and left to go upstairs. I quickly grabbed my camera from my car and snapped a photo of this kind old man who cared for the other stray cat."
"The cat had great difficulty standing up," he said. "Just like me in old age"
"You can walk very well, without the tongkat (walking stick).
I promised to give him some medication for the stray cat but the cat was eating, drinking, peeing and pooping normally..
.A very kind old man as he bothered to place orders and feed the two cats including the stray cats for so many years.
REFER ANOTHER BLOG POST No. 1128 Dec 2014
Wednesday, September 10, 2014
1491. SCRIPT FOR INTERNS Dropping of rectal temperature as a sign for elective Caesarean section
Tuesday Sep 9, 2014
Poodle, F, 1 year old mated once, now 64th day.
"The second vet asked me to come back for the elective Caesarean section when the rectal temperature dropped to a low level, as that means that the dam is about to give birth!" the gentleman said. "Then the nurse wanted to postpone the surgery to 2 days later as the vet was on compassionate leave. His mother had passed away. I know there are a few vets on leave at this clinic, but what about my dog? She can't wait. It is already the 64th day. Can she wait to the 66th day or 70th day?"
So he contacted Toa Payoh Vets and spoke to Dr Daniel about monitoring the rectal temperature.
At 5.00 pm today, I answered the phone as Dr Daniel was off, having his hair cut.
He asked whether the rectal temperature of 37.3C was due to the air conditioning and should he wait till night time to wait and see if the dam will contract. Only when there is contraction would he proceed with the elective C-section. I asked him to take the rectal temperature after 10 minutes. The reading was 37.3C and so had nothing to do with the air conditioning.
Nowadays, young Singaporean owners read much from the internet and may have more information than the vet. And much higher expectations of customer service and good outcomes.
But this man does not know that there is such a condition known as uterine inertia. In this condition, the dam does not show uterine contractions even when the puppies are due. As a guideline, most puppies are born between the 58th and 63rd day after mating and his dam showed no signs of contraction.
"Taking the rectal temperature is only a guide," I said. "You are supposed to take the temperature every 2-4 hours. Otherwise, you may miss the dropping of temperature signalling impending parturition."
AT TOA PAYOH VETS SEP 9, 2014 6 PM
My assistant Naing weighed the dog and took the temperature. The weight was 4.3 kg. Temp was , 37.5C.
"The temperature is rising and in theory you ought to take 2-4 hourly. Otherwise, you may miss the drop. In any case, you cannot rely on temperature alone. There is the clinical signs of uterine contractions, vomiting, nest-making. The gestation period of 58-63 days and your dam has reached 64th day. Overdue puppies may be dead."
I checked the dam. The belly was symmetrically enlarged. "Unlikely to be 3 pups," I said. "The belly will be lop-sided if there are 3. It could be 4 pups, but your ultrasound said 3. "
ANAESTHESIA. Gas only. Isoflurane + oxygen. The dam was quiet.
SURGERY. Dr Daniel came back and we did the surgery together. I was expecting the pups to be active and kicking on being taken out of the water bag. The first pup was as dead as a dead fish. No tongue movement. No cries.
Same for pup No. 2 and 3.
"Check the uterine horns carefully," I said. "Take out both uterine horns."
There was a 4th pup lurking far in the left uterine horn nearer to the ovary. He was much distressed and dead too.
EMERGENCY SWINGING
I swung the pups 5 times first. Mucus dripped out from the first pup in large drops. This pup was stuck and had breathed in the amniotic fluid. So had the other 3 pups. I rubbed the neck. My assistant rubbed. No cries for over 5 minutes. Normal pups cry in a few seconds. Were they dead?
I rubbed and pinched the neck skin, teaching my assistant to do so. Faint cries from the first pup after 10 minutes. The other 3 took longer time. After a long time, the 4 pups cried and that was OK for them.
PROBLEM No milk production even at 64th day. The dam is thin. Oxytocin 1.0 ml SC given after Caesarean section at 7 pm. Milk let down overnight. Puppies suckled vigorously.
POST OP"Tape over the C-section wound is too broad and covered the nipples," I got the new transparent tape narrower pasted onto the wound..
"E-collar is not practical as it may cut the puppies. In any case, the dam has to lick and clean the puppies' backside and belly. So, the e-collar will be inconvenient for her. Methone, a painkiller at 0.25 mg/kg had been given by Dr Daniel."
The owner's friend had his trousers sprinkled with blood clots when he carried the dam. "Bleeding is normal but not serious. Usually last 2 days."
CONCLUSION
When to do elective C-section? Too early, the puppies will be premature and stillborn. Too late, they are distressed and can't breathe. Swinging hard in an arc from over my head to the ground level shook out the mucus. Twice. The outcome was happy. The dam had no milk but with the 1.0 ml of oxytocin injection, the milk would flow.
SEP 10, 2014
The owner phoned to say he could not see milk.
"Are the puppies suckling?"
"Yes," he said.
"So, there is milk production."
He asked whether he could bottle feed the smallest deprived pup with a commercial milk brand. The dam curled her body and so the littlest pup could not get the back nipples commandeered by the 3 bigger siblings.
"Best not to do it," I said. "He might get diarrhoea and die. Just take away the 3 strong ones and let him suckle."
The second vet's X-rays could not reveal number of puppies as the skeletons were "hard" to see. Ultrasound then showed 3 puppies.
CONCLUSION
His usual vet (first vet) does not do C-sections and informed him early. The second vet did a good job giving an I/V drip during early pregnancy when the dam was vomiting. However, she or her senior was absent due to compassionate reasons (death in a family) and the nurse phoned to postpone the C-section 2 days later than today. This does not cut ice with him as there ought to be a replacement vet in the practice. I would have asked him to go to other vets if I could not provide the service.
The rectal temperature of the dam was dropping to below 38 deg C. This increased his anxiety of the fate of the puppies if he had to wait to the 66th day.
It can be quite stressful being a first-time home breeder with a first-time dam. This poodle was overdue at 64th day. Small breeds like the Chihuahua and poodle can produce distressed and dead pups if they are overdue.
The best time for an elective C-section in small breeds is 60-62 days, in my opinion and experience with over 300 C-sections done some years ago for the professional dog breeders. The date is counted from the date of first mating. No milk was present in this dam. With milk present, C-sections are confirmed.
This case shows that there is a large variety of presentation of impending parturition. Judgment of the vet can affect the life and death of the puppies as to when to do C-sections. The drop in rectal temperature is not a reliable indicator of impending birth if there is uterine inertia or the "single pup" syndrome.
INFANT DEATHS IN PEOPLE
According to the United States Central Intelligence Agency's World Factbook, Afghanistan, Mali and Somalia have the world's highest infant mortality rate of more than 100 deaths per 1,000 live births. High is considered to be 40. Singapore, Norway and Japan are among the lowest, with fewer than 3 deaths/1,000 births. Improved family and community care are important and inexpensive ways to prevent most infant deaths.
Poodle, F, 1 year old mated once, now 64th day.
"The second vet asked me to come back for the elective Caesarean section when the rectal temperature dropped to a low level, as that means that the dam is about to give birth!" the gentleman said. "Then the nurse wanted to postpone the surgery to 2 days later as the vet was on compassionate leave. His mother had passed away. I know there are a few vets on leave at this clinic, but what about my dog? She can't wait. It is already the 64th day. Can she wait to the 66th day or 70th day?"
So he contacted Toa Payoh Vets and spoke to Dr Daniel about monitoring the rectal temperature.
At 5.00 pm today, I answered the phone as Dr Daniel was off, having his hair cut.
He asked whether the rectal temperature of 37.3C was due to the air conditioning and should he wait till night time to wait and see if the dam will contract. Only when there is contraction would he proceed with the elective C-section. I asked him to take the rectal temperature after 10 minutes. The reading was 37.3C and so had nothing to do with the air conditioning.
Nowadays, young Singaporean owners read much from the internet and may have more information than the vet. And much higher expectations of customer service and good outcomes.
But this man does not know that there is such a condition known as uterine inertia. In this condition, the dam does not show uterine contractions even when the puppies are due. As a guideline, most puppies are born between the 58th and 63rd day after mating and his dam showed no signs of contraction.
"Taking the rectal temperature is only a guide," I said. "You are supposed to take the temperature every 2-4 hours. Otherwise, you may miss the dropping of temperature signalling impending parturition."
AT TOA PAYOH VETS SEP 9, 2014 6 PM
My assistant Naing weighed the dog and took the temperature. The weight was 4.3 kg. Temp was , 37.5C.
"The temperature is rising and in theory you ought to take 2-4 hourly. Otherwise, you may miss the drop. In any case, you cannot rely on temperature alone. There is the clinical signs of uterine contractions, vomiting, nest-making. The gestation period of 58-63 days and your dam has reached 64th day. Overdue puppies may be dead."
I checked the dam. The belly was symmetrically enlarged. "Unlikely to be 3 pups," I said. "The belly will be lop-sided if there are 3. It could be 4 pups, but your ultrasound said 3. "
ANAESTHESIA. Gas only. Isoflurane + oxygen. The dam was quiet.
SURGERY. Dr Daniel came back and we did the surgery together. I was expecting the pups to be active and kicking on being taken out of the water bag. The first pup was as dead as a dead fish. No tongue movement. No cries.
Same for pup No. 2 and 3.
"Check the uterine horns carefully," I said. "Take out both uterine horns."
There was a 4th pup lurking far in the left uterine horn nearer to the ovary. He was much distressed and dead too.
EMERGENCY SWINGING
I swung the pups 5 times first. Mucus dripped out from the first pup in large drops. This pup was stuck and had breathed in the amniotic fluid. So had the other 3 pups. I rubbed the neck. My assistant rubbed. No cries for over 5 minutes. Normal pups cry in a few seconds. Were they dead?
I rubbed and pinched the neck skin, teaching my assistant to do so. Faint cries from the first pup after 10 minutes. The other 3 took longer time. After a long time, the 4 pups cried and that was OK for them.
PROBLEM No milk production even at 64th day. The dam is thin. Oxytocin 1.0 ml SC given after Caesarean section at 7 pm. Milk let down overnight. Puppies suckled vigorously.
POST OP"Tape over the C-section wound is too broad and covered the nipples," I got the new transparent tape narrower pasted onto the wound..
"E-collar is not practical as it may cut the puppies. In any case, the dam has to lick and clean the puppies' backside and belly. So, the e-collar will be inconvenient for her. Methone, a painkiller at 0.25 mg/kg had been given by Dr Daniel."
The owner's friend had his trousers sprinkled with blood clots when he carried the dam. "Bleeding is normal but not serious. Usually last 2 days."
CONCLUSION
When to do elective C-section? Too early, the puppies will be premature and stillborn. Too late, they are distressed and can't breathe. Swinging hard in an arc from over my head to the ground level shook out the mucus. Twice. The outcome was happy. The dam had no milk but with the 1.0 ml of oxytocin injection, the milk would flow.
SEP 10, 2014
The owner phoned to say he could not see milk.
"Are the puppies suckling?"
"Yes," he said.
"So, there is milk production."
He asked whether he could bottle feed the smallest deprived pup with a commercial milk brand. The dam curled her body and so the littlest pup could not get the back nipples commandeered by the 3 bigger siblings.
"Best not to do it," I said. "He might get diarrhoea and die. Just take away the 3 strong ones and let him suckle."
The second vet's X-rays could not reveal number of puppies as the skeletons were "hard" to see. Ultrasound then showed 3 puppies.
CONCLUSION
His usual vet (first vet) does not do C-sections and informed him early. The second vet did a good job giving an I/V drip during early pregnancy when the dam was vomiting. However, she or her senior was absent due to compassionate reasons (death in a family) and the nurse phoned to postpone the C-section 2 days later than today. This does not cut ice with him as there ought to be a replacement vet in the practice. I would have asked him to go to other vets if I could not provide the service.
The rectal temperature of the dam was dropping to below 38 deg C. This increased his anxiety of the fate of the puppies if he had to wait to the 66th day.
It can be quite stressful being a first-time home breeder with a first-time dam. This poodle was overdue at 64th day. Small breeds like the Chihuahua and poodle can produce distressed and dead pups if they are overdue.
The best time for an elective C-section in small breeds is 60-62 days, in my opinion and experience with over 300 C-sections done some years ago for the professional dog breeders. The date is counted from the date of first mating. No milk was present in this dam. With milk present, C-sections are confirmed.
This case shows that there is a large variety of presentation of impending parturition. Judgment of the vet can affect the life and death of the puppies as to when to do C-sections. The drop in rectal temperature is not a reliable indicator of impending birth if there is uterine inertia or the "single pup" syndrome.
INFANT DEATHS IN PEOPLE
According to the United States Central Intelligence Agency's World Factbook, Afghanistan, Mali and Somalia have the world's highest infant mortality rate of more than 100 deaths per 1,000 live births. High is considered to be 40. Singapore, Norway and Japan are among the lowest, with fewer than 3 deaths/1,000 births. Improved family and community care are important and inexpensive ways to prevent most infant deaths.
Tuesday, September 9, 2014
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