2916. Farm Visit with intern - Caesarean section of 3-day-old Maltese pups healthy

Jan 14, 2016

I find time to visit the breeder after Caesarean section to do a follow up. For home breeders, I phone them to enquire about the dam and puppies. Much can be learned by going to the grass root level instead of being in the ivory tower all the time.

In this visit, Breeder William Goh wanted subcutaneous sutures as the ends of the sutures will not prick the suckling puppies. I did use subcuticular sutures and two horizontal mattress sutures on the Dachshund and he had no complaint. He was not happy with the simple interrupted sutures done by Dr Daniel and said it was old school and outdated as the ends pricked the puppies trying to suckle.

He has a point. I use only horizontal mattress sutures in over 100 caesarean sections in dogs and had no complaint. He did not complain about my sutures being stiff and high risk to his puppies because I use Polysorb which is a braided absorbable while Dr Daniel used Monosyn which is monofilament absorbable closer to the "nylon" in composition. What he wanted was subcuticular sutures for all his Caesarean sections. This is not necessary and I seldom use this subcuticular sutures as they may break down. I used horizontal mattress sutures with the ends on one side of the incision, unlike monofilament simple interrupted sutures with ends on both sides..    

Horizontal mattress sutures may not look good but they are not crossing the incision line and may be stronger in holding the ends of the skin together. This is my experience in over 100 C-sections.

I hope the intern Su-en going to 3rd year of Melbourne University Vet School in 2016 learnt more on this farm visit than from textbooks and lectures.

2915. INTERN Rectal Prolapse in Turtles: 2 Cases - a Chinese Soft-Shelled Turtle and Terrapin

Case 1.  Jan 12, 2016

"I surfed the internet. My Chinese soft-shelled turtle has rectal prolapse," the young man's turtle had bloody tissues present in the tank and an "arrow-head" appendage hanging out from the backside of the turtle.  From afar, it looks like rectal prolapse with injury. Yet it is not the typical rectal prolapse as in the second case.

HOOK
Consultation Video part as hook.
Anaesthesia and slides first to explain.
Then go to video (merge all videos).

Chinese soft-shelled turtles are rarely kept as pets in Singapore. This is a case of penile traumatic injury and not rectal prolapse. As this turtle is not used to handling, the vet has to be careful not to stress it and cause it to die of stress.

Terrapins or red-eared sliders are most popoular and the second case is a true case of rectal prolapse.



Case 2. Mar 14, 2013

RECTAL PROLAPSE IN A TERRAPIN
Narrate from slides and make a video out of the slides. No actual video footage in 2013.

2914. A 13-year-old male, not neutered Silkie has a gigantic circum-anal tumours

Jan 12, 2016.

Male dogs not neutered do develop circum-anal tumours sometimes.
This 13-year-old Silkie, male, not neutered has a gigantic tumour above and left of his rectum.

The dog wanted to bite me when I palpated the abdomen. X-rays show lots of chicken bone fragments fed by the father.

As regards the circum-anal tumour, the dog is very thin and old. So Tardak injections 2 weekly are advised to shrink the tumour a bit as it is uclerated. E-collar and antibiotics and to review in 2 weeks.

There is a group of dog owners who are against neutering the male dog. However, when circum-anal tumours develop and are small, get them removed by your vet. In such situations, the dog is old and so the owner may worry about death from anaethesia. In this case, the tumour is gigantic and bleeding. There is a stench from the dog's body as the tumour had ulcerated. 

2913. INTERN. Caesarean Section according to the vet text book

Jan 11, 2015



WARNING

BKTP




The 80-year-old breeder saw the 3-year-old Maltese hunched and strained for 2 days, but did not give birth. He decided on Caesarean section as the Maltese was 58th day pregnant. From his experience, he knew the puppies of Maltese and Chihuahuas would be well formed at 58th day.

He phoned me. I had my afternoon off and was watching the Suffragette movie. Dr Daniel would be operating. The breeder requested my presence and as we had known each other for over 30 years, I returned to Toa Payoh Vets. 

It was a rare opportunity for 2 interns to see a Caesarean Section as I do not service the dog breeders in Singapore nowadays.

MEDICAL HISTORY
Maltese, 3 years old, 58th day. Uterine Inertia. 5 pups.

ANAESTHESIA
Toa Payoh Vets use only isoflurane gas and oxygen. No i njecti


SURGERY IN THIS CASE WAS PERFORMED
ACCORDING TO THE VET SURGERY TEXT BOOK
1. A longer skin incision is needed to take out the whole uterus
2. Exteriorise the whole uterus
3. Incise near the uterine bifurcation
4. Milk out the puppies

SURGERY DONE BY DR SING KONG YUEN AND SOME VETS
1. A skin incision around the size of the pup's head is made.
2. The whole uterus is not exteriorised (taken out of the abdomen).
3. The vet palpates for the uterine bifurcation
4. Incise near the uterine bifurcation
5. Milk out the puppies
6. Advantage of a much shorter skin incision 1/3 of the other procedure

Follow up visit to the breeder on Jan 14, 2016
Dam and pups were OK. The breeder was most happy. He said the selling prices of the Maltese puppies are now depressed owing to puppy smuggling from Malaysia and Thailand. The government had taken blood samples from some breeders and had asked them to show the dams to support the
existence of the puppies for sale. Possibly a DNA matching is being done.

The dam and 4 puppies look good. The smallest one or runt is struggling to suckle as the 3 bigger siblings were actively suckling and occupying the area.







CONCLUSION

A successful outcome for an elective Caesarean section depends much on the timing. That is the judgment of the dog breeder. Deaths of the dam and puppies do occur but are rarely encountered.
Isoflurane gas and oxygen provides safe anaesthesia

     

INTERN Inguinal hernia with strangulated uterine horns - Miniature Schnauzer

Miniature Schnauzer, Female, Not spayed, 7 years



HOOK

MEDICAL HISTORY
The owners were busy and delayed the scheduled operation. Within a week, the swelling became bigger. The black patch of skin became gangrenous. The dog was given antibiotics for 7 days before the operation.

PRACTISE EVIDENCE-BASED MEDICINE

1. Blood test was not done to reduce medical costs. However, I prescribed 7 days of spiramycin and metronidazole antibiotics (Stomorgyl) before surgery.

2. X-rays and ultrasound.
The owner went to another vet for a second opinion. The vet performed X-rays and ultrasound and confirmed inguinal hernia with pyometra and a bladder stone. X-ray is shown below:

SURGERY - OVARIOHYSTERECTOMY BY Dr Daniel Sing. Domitor and ketamine IV at 0.33 ml and 0.4 ml for an 8.5 kg old dog. This was  followed by isoflurane and oxygen gas. Antisedan IM was given to reverse the domitor effects. IV drip was given during and after surgery. Methone pain killer injection was given SC. The dog was not in pain post-operation. 

Gangrenous skin seen as black patch before surgery. This indicated blood supply to this area of skin was compromised, leading to death of skin cells. 

A foul rotting smell was present in the operating room as the gangrenous uterine horns were taken out.  

The time taken between first skin incision (12.59pm) and completion of skin stitching (2.12 pm) was
73 minutes. 2 packets of Monosyn were used.

The owner was WhatsApp the gangrenous uterus and omental tissues that packed the inguinal hernia. This would update her on how serious the dog's medical condition was. Gangrene can kill a dog after surgery as the toxins cause multiple organ failure. .

CONCLUSION

Surprisingly, this dog survived the operation and anaesthetic.






Hernias are best repaired when they are small. It will be much less costly and worrying about anaesthetic death on the operating table as in this case of a sick dog being operated upon.

If the dog had been spayed when she was young, she would not have got pyometra (pus in the uterus).

This is a very rare case of strangulated uterus being herniated through the inguinal ring and becoming a gigantic inguinal hernia. It is also a rare case with a happy ending. Much depends on the state of health of the patient, when to do surgery and the skills and experience of the veterinary surgeon and his or her team.