39. Pyometra in aged female dogs cause pain to the sister

Pet Shop Visit in December 2009
Three years had passed by. I seldom kept in contact with this pet shop girl till recently as I don't go to the shop to do puppy vaccinations. However, I visited to ask her to re-pack some Hill's Prescription d/d dog food for me as many owners want small packets.

Another aged female Cocker Spaniel of around 12 years old, belonging to her sister had open pyometra some months ago. The sister had put the dog on antibiotics for some time. "It is best to spay her," I advised. But the sister just would not want to. I don't know why.

Finally, the dog was operated by another vet and survived. "But I have to provide my dog (Golden Retriever) for blood donation as the platelet count was very low," the pet shop girl said when I visited her pet shop. That was good news. But there was a high cost involved.

Spaying the female dog early would have prevented pyometra in these two cases which were not handled by me or my Surgery. As an alternative, inspect your female dog monthly. Record her dates when she has her heat. Observe the colour and nature of the blood spots. If the blood looks brownish or yellowish and starchy, it is time to get her spayed. Unfortunately, in closed pyometra, there are no discharge. Just vomiting. Or loss of appetite and lethargy.

It seemed a repeat of history during this visit. There was the pyometra of her sister's dog. There was also a slim teenaged girl working as a part-timer busy cleaning up the kennels at 11 am when I visited. However, this short girl was not thin She was OK and could be considered "handsome". But she had a ring in between her nostrils. Her unique selling proposition.

She reminded me of the bulls I saw practice as a 4th year vet student some 30 years ago in Scotland in 1973. Such bulls have a ring between their nostrils if my long-term memory is still intact. Why would such a young teenaged girl with normal good looks put ring her nose I just cannot understand. She hung with her friends past midnight at the Junction 8 shopping mall in Bishan and was working part-time to earn some money.

"Do you want to employ her as a part-timer," the pet shop girl asked me. "She can try out for one day without payment first."

"I need a girl who knows how to write reports and use the Excel and Microsoft Word," I told the pet shop girl. It is difficult to find such part-timers. I can't employ any nose-ringed girl or boy as part-timers no matter how hard working they are. Buttons embedded in the girl's tongue. Well, I don't know how such girls do it. It must be very painful. However times have changed for some young adults.

As for pyometra in aged female dogs, things have not changed much in the treatment or cure. Prognosis is poor when the owner delays veterinary treatment and when there is vomiting. Spaying would not be of much help once the female dog has persistent vomiting for several weeks as the kidneys had been damaged. Some 10 years ago, I had an uneducated owner bad-mouthing me for not curing the dog after the spay of her persistently vomiting dog. The dog survived the spay but continued vomiting due to kidney disease, not to professional incompetence of spaying! The lady owner did not want any blood test but the cheapest veterinary cost. Sometimes it is best not to handle such personalities who want "cheap and good" veterinary services if the vet cares about the reputation built up over the years. They tend to bad-mouth the vet in the Singapore internet forum nowadays and this webpage will persist forever for people all over the world to see.



For aged female dogs with pyometra, family members may get is the pain or in this case, the younger sister felt the pain of the suffering of the aged female dog.

For those who believe in prevention of pyometra, spay your female dog early, 3 months after the first heat.

38. Stump pyometra

Dec 12, 2009
I searched www.google.com.sg for "pyometra+singapore+dogs" and my reports on pyometra listings (except for no.6) are as follows:
  
1. http://veterinarymedicinesingapore.blogspot.com/2008/06/3-pyometra-in-old-female-dogs-to-spay.html
2. http://veterinarymedicinesingapore.blogspot.com/2008/06/toxaemic-12-year-old-golden-retriever.html
3. http://www.bekindtopets.com/dogs/20080738Closed_pyometra_Lhasa_Apso_ToaPayohVets.htm
4. http://www.asiahomes.com/singapore-rent/1026Ads_Nassimwoods.htm
5. http://www.asiahomes.com/singaporetpvet/dogs/1220dangerousdogs.htm
6. http://answers.yahoo.com/question/index?qid=20091126232338AAqGi8u (stump pyometra). Not recorded by Dr Sing.
7. http://www.toapayohvets.com/surgery/20061024Pyometra_Toa_Payoh_vets.htm
8. http://www.bekindtopets.com/animals/tpvets_Jul1708.htm
9. http://www.toapayohvets.com/surgery/050609periodontal_disease_cat_dog.htm
10. http://www.sinpets.com/dogs/20090509Bones_Dogs_ToaPayohVets.htm
11. http://veterinarysurgerydrsing.blogspot.com/2009/06/21-mission-impossible-in-16-year-old.html
12. http://toilettrainingpuppy2.blogspot.com/2008/02/13-female-submissive-urination-dogs.html
13. http://www.angelfire.com/ks/singaporecondos/8251glamourousdanger.html
14. http://bekindtopets.blogspot.com/2007/09/48-is-spaying-necessary-e-mail-queries.html
15. http://veterinarysurgerydrsing.blogspot.com/2009/08/25-vaginal-prolapse-breast-tumours-in.html
16. http://www.sinpets.com/letters/tpvets_May705.htm
17. http://bekindtopetssingapore.blogspot.com/
I have seen only one case of stump pyometra in my 30 years of practice. Will edit later.

37. Declawing of cats in Singapore interview

On Dec 18, 2009, I agreed to an interview by Ms Amanda Wong, Media Journalist from the Straits Times Razor TV, www.razortv.com.sg. Here are her questions:

1. How is declawing done?
2. What are the reasons for it?
3. Is it harmful to the animal?
4. Are there many people who request for declawing to be done to their cats? Who are these people? How many to date? Is there an increase?
5. What is your personal view towards it? Why do you choose to provide this service?
Answers:
1. Surgery under general anaesthesia - remove the 3rd toe bone (phalanx). An illustration was given. Now, there are video clips of a cat being declawed in the webpage. This is NOT from Toa Payoh Vets but it would appear to be since it was included in the webpage. It was taken from the internet. I told Ms Amanda Wong that I had not done any declawing surgery for the past 9 years and I would not the appropriate interviewee. According to "My Paper", 6/10 vets reported an increase in request for declawing. Certainly, I do not have any request for declawing in the last 9 years as regards my area of practice. However, this was not mentioned in the webpage!

2. Two reasons I would do declawing as a last resort and after asking the owners to wait 1-2 weeks to re-consider. These are damage to property and injury to family and other pets. These are the two of various reasons cats are euthanased or sent to the animal shelter where they may be put to sleep.

3. Besides anaesthetic risks, post-operation complications, there is the worry from cat lovers that the cat will have behavioural problems like being more aggressive. However, there are owners who say that the cat becomes more gentle. The big worry is that the cat can't defend itself when attacked. This is unlikely in an indoor cat.

4. Nobody has requested for cat declawing in the pat 9 years in my practice. I can only remember one case where I advised buying a scratching post and clipping the cat nails regularly and the owner did not continue further. In fact, there is a trend for younger owners not to declaw as they are more knowledgeable. This answer did not appear in the webpage of www.razortv.com.sg

5. My personal view is that I will perform the surgery only when the cat-owner relationship is strained such that the cat will be sent to the animal shelter where it will be put to sleep or the cat owner will need to get the cat put to sleep.

Failure in training e.g. use of a solid scratching post, anti-clawing spray, nail caps, food treats for positive reinforcement training, balloons, noises, water guns, noisy paper wrapping over furniture and weekly nail clipping during the 1-2 week cooling off period.

If the owner still can't resolve the problem, declawing is preferred to euthanasia. Many young children feel distressed when the cat is euthanased due to parents having to do it if they don't have declawing as an option. In such instances, I will perform the surgery.

I had told Amanda Wong, I do not have any declawing surgeries in the last 9 years. I don't know whether she believed me.





Training needs time.
Get a strong scratching post for the new kitten. Train it to use the scratching post or give it an unwanted piece of carpet to declaw. Firm verbal commands when the kitten starts clawing furniture and give treats on success? Clip nails weekly for older cats.
"You have got the wrong vet to interview. You need to interview a vet who performs such surgeries recently," I said to her. She said she was interviewing other vets. She asked me whether declawing was a recent American concept. I said declawing had been practised for some 40 years or more but nowadays the younger generation in Singapore does not favour declawing as it is cruel. I was surprised that she said that there was an increase in demand for cat declawing. She asked why I did not have any cases since a newspaper dated Dec 14, 2009 said that 6/10 vets interviewed reported an increase in demand. "Maybe it is the type of cat owners in Toa Payoh and the surrounding neighbourhood," I said. "My clients do not buy expensive cats or I don't get their consultation. Or I don't have many feline cases. I don't know."

This is one of the subjects that vets don't want to be interviewed if they perform declawing as the animal rights activists will put them in the "declawing hall of shame" and there is one such website. It would not be good for business.

However, many cat owners need to be educated that regular nail clipping and the provision of a strong scratching post or training the cat to use the scratching post is the possible solution to destructive damage of expensive sofas, cupboards and curtains or scratching injuries to children and pets. I don't do declawing on demand.
I risk this interview of getting into "the declawing hall of shame" to bring out the issues in the open and to educate the younger Singapore cat owners as to the alternatives to declawing. Animal rights activists must understand that cats are family members and if the cats have to be put to sleep or sent to the animal shelter to be put to sleep and there is only one alternative to the lethal injection for the family to retain the cat, declawing may be needed.

P.S. The interview webpage is at:
http://www.razortv.com.sg/site/servlet/segment/main/news/41168.html

36. Anaesthesia - Giant Rabbit & 3-month-old German Shepherd puppy

Dec 11, 2009

I type the following 2 interesting cases I had while I visited the National Library at Victoria St at 5 pm while the details are fresh in my mind.

Sharing knowledge of anaesthesia for Giant Rabbits.
1. Usually, Singapore pet owners keep small rabbits of around 2-3 kg.
Giant Fleming Rabbit, 5.2kg
Extremely hyperexcitable. This type of temperament is a high anaesthetic risk

METHOD 1. One method is to use injectable anaesthesia of zoletil IM, 5 minutes later, give domitor IV via the ear vein.
However, this method seems to be unsuitable as restraint and injection causes the rabbit to move a lot.
Zoletil 50 0.2 ml IM
Waited 15 minutes
Wanted to give Domitor 0.2 ml IV, ear vein.
Still struggling. Abandoned this method in favour of Method 2.

METHOD 2
Zoletil 50 0.2 ml IM given. In around 7 minutes, the rabbit staggers and by the 15th minute, the rabbit was recumbent. However it exhibited excitation when the ear vein was pricked and moved away. So, I used isoflurane 5% gas by mask.
Isoflurane gas - mask - maintenance at 0.5% - 1% was excellent.

METHOD 3
Xylazine IM, Ketamine IM is another method I used for smaller rabbits.

CONCLUSION:
The interesting thing about this case is that my staff under-quoted the cost of neutering as we usually neuter the non-giant rabbits at $75.00/neuter! Life is full of surprises even after graduating 40 years ago!

Sharing knowledge of anaesthesia for 3-month-old German Shepherd puppy.

This is a high-risk age group as the puppy is still young.
However there was no choice as the domestic worker's hair band occupied the 100% of the stomach (seen during surgery) and would not be vomited out nor passed out with the stools. Surprisingly the puppy did not vomit at all.

No food and water after 10 pm yesterday.
No stools passed out. Only urine this morning.
Surgery started at 1.30 pm today (5th day after swallowing of the hair band).

IV dextrose saline drip given
Xylazine 0.2 ml IV via the drip.
5 minutes later, isoflurane gas by mask. Intubate. 2-3% maintenance. No problem.
Skin incision around 6 inches (15 cm long). Linea alba excised. The tip of brownish red liver was visible. The stomach was just below. It was swollen and looked "crumpled". Deep pink in colour suggestive of an inflammation going on due to the foreign body hair band being there for 5 days. I could exteriorise easily as it was impacted with the hair band inside.

Stomach incision 3-cm long. Between both ends at avascular area (no blood vessels).
Hair band covered with brownish green feed. I thought it was the dog feed. Would the hair band come out from this 3-cm incision? The shorter the incision, the better in this case.

I used the scissors to cut the hair band but did not manage to cut the rubber band inside. Surprisingly, the hair band could be manipulated out of this incision.

Suturing the stomach.
1. Mucosa. Quite thick. Reddish brown. Inverting suture - one layer closing the mucosa only.
2. Muscle layer. As in a Caesarean section, I stitch 2 layers of inverting suture.
3. Abdominal muscles - simple interrupted sutures one cm apart.
4. Skin - horizontal mattress suture.
5. IV baytril given. Dextrose saline drip is continued. Electrolytes for next 2 days. No solid food to permit the stomach to heal.









Best not to go home for the next 7 days. How long should the stomach not be given solid food? How long does it take the mucosa layer to heal? The answers vary. By the 3rd day, I give A/D diet. Antibiotics are given by injections. Careful monitoring. The owners were phoned to visit the puppy as this is a high-risk case and anything can happen.

3rd year vet student from Murdoch Univ saw the surgery. His job was to take pictures. During an earlier discussion, he had thought that the hair band would be easily passed out and therefore wait and see rather than operate on a high-risk puppy. What if the puppy dies on the operating table?

After seeing the hair band was large, he agreed that the only option was surgical removal. He found the surgery interesting as he was going into the 4th year. This operation would bring veterinary surgery alive during his lecture. I asked him to write a report. No way! He had enough of writing for his examinations. The young ones are a visual breed. Writing and recording help in archiving and understanding the process. One  can review the records at leisure or refer to them. Sometimes, what steps to improve for the next surgery can be forthcoming after the review.


More info at www.toapayohvets.com

35. Questions about Spaying A Dog

Thank you for your e-mail. Please see my reply in CAPITAL LETTERS below:

2009/12/5 <...@hotmail.com>

Hi Dr. Sing,

This is (Owner's Name). I have brought my toy poodle, XXX, to see you last month for her leg sprain, if you still remember. She has since recovered and is walking normally, thank you.

I would like to make an appointment for my dog to be spayed and have 2 of her puppy tooth to be removed at the same time (2 have since dropped on their own), since she has to be under general anaesthetic for these procedures respectively. My thought is that she need not go through general anaesthetic twice if done together.


She is currently coming to 9 months, weights around 4.3kg, has not have her first heat yet, and is not on heat at the moment. I hope to seek your advice on the following:

1. What is the main difference spaying her now at 9 months, before her first heat, compared to 3 months after the first heat? any major downside if I wish to spay her now?

SPAYING BEFORE HEAT AT 9 MONTHS OF AGE - The female dog is no longer a puppy. There is no problem in spaying if she is healthy. I recommend spaying 3 months after the first heat is to ensure that the surgery is much less bloody as the uterine, ovarian and omental blood vessels are not enlarged at this time. Therefore they are not so fragile when clamped and ligated. Most likely, your poodle may have her first heat with little vaginal bleeding, from 6-9 months, but you did not know.
You could observe a period of her cleaning her private parts for a week and that would be her first heat.

9 2. What are the things to observe with regards to food intake before her surgery?

NO FOOD AND WATER AFTER 10 PM the night before the surgery.

3. How long is the procedure and how soon can I pick her up from the clinic after the surgery?
ANAESTHESIA AND SURGERY TAKE AROUND 30 MINUTES normally.You can pick her up in the evening around 7-10pm during weekdays.

4. After surgery, any medications or special diet required? ANTIBIOTICS AND PAIN-KILLERS ARE GIVEN. NO SPECIAL DIET normally. Do i need to cage her to restrict or minimise her movement? RESTRICTION OF JUMPING FOR FIRST 7 DAYS WILL BE IDEAL.

5. How big/long is the incision usually? AROUND 2.5 CM USUALLY IF THERE ARE NO COMPLICATIONS.

6. What is the cost for spaying and removal of 2 puppy teeth? COST FOR SPAY IS ESTIMATED AT $200 excluding medication. PUPPY TEETH REMOVAL + ANAESTHESIA estimated to be around $100.

Thank you for your time, Dr Sing.






Pictures are not that of the dog mentioned in the e-mail.

34. Infected facial tumour. Dwarf Hamster

HAMSTER SURGERY
Dwarf Hamster, 1 year. Young lady
Dehydrated, Not eating
Facial swelling 2-3 weeks growing fast. Rounded, 1cm X 0.8 cm.
Abscess?

Zoletil 50 IM. Duration 5 minutes. Need to be prompt in surgery. But large tumour is not easy to remove in <60 seconds. Therefore I needed to use isoflurane gas to maintain the anaesthesia.

Tip:
Give isoflurane gas when it moves. If you continue without anaesthesia, the hamster will struggle and die of fright and pain.



1 cm incision. Watery pus drained. Multiple rounded fat-like cells of 1 mm globules widespread. Can't remove all without affecting nerves. Owner informed.
Hamster OK. Picture.
Advice: Removal will have been easy and effective when it is around 2-4 mm in diameter some 2 months ago.

Goes home on Day 3. It is likely that the tumour will recur as it is widespread inside the cheek.

33. Large infected skin tumour in an old dwarf hamster

In the dog or cat, this would be an easy surgery as general anaesthesia using isoflurane gas is very safe and predictable in these two species.

In a 2-year-old dwarf hamster, the successful outcome depends greatly on the anaesthesia. Insufficient anaesthesia may kill the hamster due to great pain and fright from surgery. Lots of movement hampered surgery. Death could be due to fright during restraint and not due to anaesthesia.

Pre-operation
In the dog and cat, pre-operation examination and blood tests are helpful. In the dwarf hamster, ask the owner about the amount of stools passed and water drank. In this case, the lady owner was very observant. The hamster was eating as faecal pellets could be seen. She noted that the hamster recently drank at least 3x more water than normal in a week by judging the amount of water in the water bottle drank per week. Based on her observation, the hamster was drinking 18 ml/day compared to the normal 5 ml/day. This polydispsia is abnormal.

Warded for 2 days
Oral Baytril antibiotic was given on Day 1 and 2. Surgery started on Day 3 as the hamster was suffering from a red itchy infected skin tumour.

Anaesthesia and Surgery
It is extremely difficult to see the signs of surgical anaesthesia in the hamster under isoflurane gas (gas into a plastic container with the hamster inside) and Zoletil sedation. A bit more will mean death. So, it is a matter of observation of anaesthesia to effect. What does that mean when the vet can't check the pedal and eyelid and other reflexes as in the dog? It is just not possible. "Count to 10" I advised my assistant when the hamster has been placed in the container. This is not scientific. We took the hamster out for surgery. When it moves, we put it in again. This happened 3 times. By the 3rd time, the hamster looked "dead".

"The hamster has died," I tried to revive it by rubbing the skin of its neck above the shoulder area. "Can give Biolapis," my assistant proposed. I was busy trying to revive this hamster. Blow air via a 3-ml syringe into its nose area may be useful.
Cardiac massage?



In this case, my assistant put a drop of Biolapis which is an oral electrolyte for small animals like rabbits and hamster. An oral respiratory stimulant and oxygen would be useful.

The hamster was still breathing as I could see its chest movements. I left it alone, under the warmth of light.

In around 30 minutes, it was up and alert. As if it had a good lunch-time nap. The Caucasian school teacher was very happy as she was prepared for the worst. Always examine your older hamster daily for small tumours. Small tumours less than 3 mm in diameter take less than 1 minute to remove and the chances of survival are very high.

Not all stories have happy endings as vets are not Gods.

P.S.
More pictures and update at www.toapayohvets.com, goto "Hamsters"

32. Retained puppy teeth in a Yorkshire Terrier

Yorkshire Terrier, Male, 8 months.

Most dogs have no more deciduous (temporary, puppy) teeth by 8 months of age. Yet in this rare case, this tea-cup Yorkshire Terrier had 14 puppy teeth that should have dropped off.

The permanent teeth erupts in an abnormal position as their place is occupied by the puppy teeth. He resisted strongly when I tried to open his mouth as he had a very painful mouth. If only he could talk. Tartar had formed in the retained canine teeth and soon, there will be tooth decay.

Many Singapore owners don't bother with such dental problems due to economic and anaesthetic risk reasons. What if the puppy dies under general anaesthesia?

This mindset is unfortunate for the puppy. General anaesthesia is safe in puppies over 3 months old. Much depends on the selection and experience of the veterinarian. Worried owners have to look for more experienced vets if they are worried about anaesthetic risks.



Timely removal of the retained deciduous teeth enable the permanent teeth to erupt in normal position and angle. In older dogs, food and dog hair get trapped between the permanent and retained teeth, leading to tartar formation. Bad breath. Painful mouth. But the uneducated owner just ignore such dental problems. Teeth start dropping off. So what? The dog gets his food and water. What more can a dog want?

The introduction of the internet has benefitted many puppies through education of the newer and younger owners. Compared to 10 years ago, more lady owners and young couples are aware of the future dental problems in retained puppy teeth and have got them extracted.

After checking that his heart is OK, I used general anaesthesia isoflurane gas prior to extraction of the puppy teeth. Intubation was done. Still it took >30 minutes to extract 14 teeth. After extraction, I note that it was not such a difficult struggle to open this Yorkshire's mouth for photography.





I am happy for this Yorkshire Terrier as he will be able to chew and bite without oral pain anymore. Tooth brushing ought to be done and should be easier nowadays.

His market value is S$2,500 as Yorkshires are very rare in Singapore. It sure was an expensive present given to this young lady owner.

TO REDUCE ANAESTHETIC RISKS
1. I don't use tranquilisers. Just isoflurane gas mask to induce.
2. Intubate
3. An assistant who just monitor anaesthesia and nothing else.
4. Minimal gas at 1% to effect.
5. Extraction of teeth as fast as possible.

A pre-anaesthetic blood test will be good but most owners are interested in least cost. Checking of overall health and heart will be the cheaper alternative but it is not ideal.

31. Electro-surgery in 3-day-old pups

The home-alone first-time-mother Shih Tzu bit off the ear lobes of her 3-day-old pups. "She must have scratched off the ears," the male owner would not believe that mothers would bite progeny. "The male dog may be responsible." The pups had full rounded abdomen showing that they had suckled well.

I showed him one puncture wound of 3 mm above the ear of one pup and one wound on the chin of the second pup. These wounds would heal.


Surgery: Stitching.
Four tattered ears in 2 pups. What should the vet do? The first thought would be to suture the skin and cover the ear cartilage. However the bite wounds were irregular in shape with more skin torn off in some parts of the ears and there would be insufficient skin to stitch up.

Cosmetic Surgery:
This was my first time in over 3 decades of practice to encounter two 3-day-old pups being presented with bitten ears and were still alive. In most cases, the dam just killed the pups by biting their skulls, neck and abdomen.

Lacerated ear wounds are usually treated by stitching. So, my assistant took out a rabbit anaesthestic mask to give isoflurane gas anaesthesia to the puppy after washing the ear area for surgery. He got out a small hair clipper which we use to clip the coat of hamsters.

"Puppy anaesthesia is high risk," I said. "The rabbit mask is not suitable for flat-nosed 3-day-old puppy. Use the plastic container. Some vets use plastic bags to contain the gas.

Electro-surgery
Stitching the torn ears would not present a good appearance for these Shih Tzus when they grow older. Buyers will notice that two ears of the pups are not symmetrical in shape and size. Therefore I decided on the use of electro-surgery. But can electro-surgery be performed in such a young pups? Would they die of heart failure due to the passage of electricity into their bodies? If you know the theory of electro-surgery, this does not happen as the electricity passes through the surgical area and incise and coagulate. But theory may not translate into practice. I could just incise the ears using scalpel. But the results would not be so good. Therefore I commenced electro-surgery.

Electro-surgery in 3-day-old Shih Tzus.
After cleaning the ears and after light gas anaesthesia, I placed the puppy's belly onto the saline-damped gauze which was placed on the indifferent electrode. This electrode was placed onto of a plastic tray which was then placed on the stainless steel operating table. Stainless steel does conduct electricity*

I used the artery forceps to clamp the remaining part of the ear, exposing the jagged ends. Electro-incision electrode cut off the tattered ends. Then electro-coagulation electrode sealed all bleeding. The results were 2 "ear-less" pups. When they grow up, their lack of ear pinnae is obvious but will not be distracting as one ear bigger and more irregular than another.







The dam was isolated. She was watched while she suckled her pups after 24 hours of my assistant hand-feeding the pups. The pups are then removed from her. Today is Day 5. The pups are OK and have had reduced their earlier puppy fat.

Conclusion

*Stainless steel operating table conducted electricity. Therefore do not place your elbows onto the table. At one stage, I had an electric shock during electro-surgery as my elbow touched the operating table.

Electro-surgery is safe in 3-day-old Shih Tzu pups. The use of saline-moist gauze on top of the indifferent electrode helps to conduct electricity better.

More pictures and final report will be at www.toapayohvets.com

30. What is the cure for tail gland hyperplasia in the male Husky?

Case: Male Siberian Husky, 9 years old.



History:
3 years ago, the Husky bit away all hairs of his backside and tail due to tail gland hyperplasia. The disease was controlled using steroids and antibiotics given by Vet 1. Then, the dog started biting his tail gland area again, as if possessed.

Is there a complete cure for the tail gland disease in dogs? Various treatments are proposed but the owner needs a complete cure. Here are my thoughts on this subject.

Surgery:
1. Tail Gland Skin area excised. Removal of the hyperplastic skin area. This is quite a large area of over 3 cm x 3 cm leaving a big hole and a very tight area to stitch up. If there is infection due to stitch breakdown, the result will be worse for the dog. Will electrosurgery do the job? Maybe, if the area is small and seen during the first time. There is no guarantee. In this dog, there seems to be another nearby area with the same problem.

2. Tail amputation. Will this method definitely resolves the problem of tail biting? Most likely since the tail gland area is removed. But the owner did not want a tail-less Husky.

3. Castration. Since this disease happens mostly in male dogs, testosterone hormone may play a part. The Husky is already 9 years old and his testicles were checked and found to be normal by palpation. No pain, nor enlargement or irregular lumps. The owner did not wish to have him neutered. I can't guarantee that neutering will resolve this problem too.

Now, in some skin disease cases in female dogs, spaying resolves the problem based on anecdotal evidence. In such cases, hormonal imbalances could be the cause of skin inflammation and itchiness. But not all cases are resolved and some skin disease occurs due to hormonal deficiency after sterilisation. Therefore sterilisation may or may not help.

This Husky was given a second intra-lesion steroid and we have to wait and see. Updated info will be at www.toapayohvets.com. Please accept my apologies. Not much time to update my blog.

28. Post-op irrigation of the bladder

SHARING SOME POST-OP MANAGEMENT EXPERIENCES

Poodle, Male, 5 years

Swollen painful abdomen, peeing dark red urine. Bladder about to rupture. Vomiting brown yellow fluid. High surgical risk. No choice but to do emergency surgery as dog would die soon. Cystostomy opened up the bladder to get spiky stones attached to bladder wall removed by using forceps. IV Hartman's 1 hour and blood collection.

In this case, the dog's bladder was thoroughly flushed. I used normal saline and a rigid catheter from bladder to flush out any spiky urinary stones in the urethra. Then I used a smaller sized catheter to flush urine from the penile opening.



Post-op

The following occurred.
1. DAY 1: Urine backflow from prepuce to under the penile skin. Swollen penile area. A catheter was not stitched earlier as the dog would usually pull it out despite wearing an e-collar. He would not pee normally, so urine collected in this way.
Solution: A catheter was inserted and the urine pool removed. One side near the penile opening was taped to the skin using elastoplast (see pic). Urine stained the elastoplast by Day 3. Elastoplast removed. No more catheter.

2. Irrigation of urine daily for 5 days to remove blood clots from the bladder. Urine still bloody. Small clots seen even on Day 2(Oct 6).

3. Acidify urine, antibitoics and close monitoring. Dog is eating and should recover. He could not pee normally due to pain. Pain-killers given.

Owner wanted the dog home after 5 days. Dog was still passing blood in the urine. No more complaints for the next 14 days. Updated info will be at www.toapayohvets.com

27. The right-nose sneezing dog

Sep 16, 2009

"No gas mask anaesthesia," I stopped my assistant from using the mask. "The dog may breathe in foreign bodies lodged in his right nose and get inhalation pneumonia and then dies."

Zoletil 50 at 0.25ml was given IV. The dog was recumbent. Saliva flowed out, as this was Zoletil's side effect. Not profuse salivation compared to IM injection. I gave atropine 0.5 ml IM. Salivation soon stopped.

Faint blood-tinged right nasal discharge. Not like some 2 weeks ago. Profuse red blood from right nose. Had medication and one nasal flushing via catheter.

5ml of oral antifungal solution were flushed into the back of the right nose where the foreign bodies were suspected to be located as seen in the X-ray. The dog sneezed our violently. On 2x1 cm piece of cartilage - snow white smooth surface encrusted by soft yellowish brown tissue presumed pus. Another 4 small pieces of pus were sneezed out. Little blood sneezed.

These could be fungal infected nasal tissues. The dog was warded for observation.

Recurring struvite stones in the dog - How to prevent recurrences

Many times, it is a death sentence when the pet dog produces urinary stones again as the average dog owner feels that the surgical treatment, hospitalisation, nursing care and medication from around S$900 at Toa Payoh Vets and over $1,500 elsewhere are "expensive". Unfortunately, urinary stones do recur in some dogs such as the Miniature Schnauzer.



Some tips to prevent recurrences of struvite stones are:

1. BREED. Breeds like the Miniature Schnauzer are prone to producing urinary stones. Urinary examination at least 3-monthly will be ideal. If not, during the yearly vaccination, ask your vet to do a urinary analysis.

2. DIET. No dry dog food definitely. No canned foods or treats. Special low stone prescription diet or home-cooked food.

3. URINE pH, S.G and Red and White Blood Cells measured weekly using dipsticks in collaboration with your vet.

4. WATER INTAKE. Measure diligently and scientifically 24-hourly water drunk in collaboration with your vet. Some sedentary dogs need to be encouraged to drink by more exercise or supervision.

5. ACIDIFICATION OF THE URINE if the urine pH is 7.0 and higher in collaboration with your vet.

6. BLADDER PALPATION. If stones or a crackling gassy sound are felt, it is bad news. Consult your vet promptly.

The objective is to prevent struvite crystal formation by ensuring that the bladder is free from bacterial infections and that the urine pH is alkaline. The guidelines apply to the prevention of struvite (triple phosphate) urinary stones only.

More info is at toapayohvets.com

25. Vaginal prolapse & breast tumours in a 15-year-old dog

Logically, one combined surgery to spay and remove the breast tumours under one anaesthesia would be economical for the dog owner and good for the dog as she does not need to have another operation.

That was what my assistant said to me. "Well, people are not so kind when the dog dies on the operating table when the vet does what is logical and the dog dies. They will just bad-mouth about the vet's incompetence to anyone who comes into contact with them. You have heard such remarks recently."

"A short surgery means a short duration of anaesthesia," I explained to the man who was very keen on veterinary medicine and surgery. "It is less risky for the old dog. I mean she is 15 years old. She would be equivalent to a 105-year-old woman now."

Surprisingly she still had the estrus cycle as vaginal prolapse is associated with the onset of the heat cycle. The owner agreed to a blood test which showed slight increase in liver enzymes. This dog was quite healthy and had a 60% chance of survival under a short anaesthesia and surgery. The owner had to decide. She gave the go-ahead.

The spay was completed in 15 minutes. Total time taken was 25 minutes of anaesthesia using isoflurane gas at 1-2% and intubation as the dog took some time to be given gas mask. Excellent anaesthesia. Before stitching, I had the gas switched off to 0%. The blood colour was excellent and bright red. However, the dog did not wake up as what other younger and normal dogs would do under such low anaesthesia. He took about 10 minutes to wake up and was very sleepy. 5% glucose IV drip was given during surgery and then a bottle of dextrose saline overnight. The dog was OK and the lady owner was happy.




Teamwork is important in old dog anaesthesia. My first assistant, Mr Saw monitored the anaesthesia like a hawk. My second assistant who had thought that this case should be 2 surgeries in one (spay and breast tumour removal) helped me in the surgery and that is the secret to a shorter 15-minute spay. Normally, I don't give myself unnecessary stress and a normal dog spay takes around 30 minutes.

It was great to see the old female dog alive. As for the breast tumour, it may be best not to operate. The spay showed that the uterine tissues had gone cystic - as in a closed pyometra case. The dog should not have any more vaginal prolapse as she would not by having heat. Do such old dogs still have estrous cycle? Apparently so in this case. Spay is the treatment to prevent any more recurrence of vaginal prolapse in female dogs and this is why I did the spay first. The complaint from the owner was vaginal prolapse and not breast tumour. Therefore, know what the client wants and don't get side-tracked. The dog did get her teeth scaled and four rotten teeth extracted under one anaesthesia but this did not take more than 10 minutes. She should have a better quality of life now, with clean mouth and not having to lick her protruding vaginal prolapsed mass.

24. The Cat Had "Kuru"

"What a load of rubbish," the 3rd year Veterinary Student commented when I described a case where the male neutered cat had no penis visible at all times. "Yet he could pee but how did he do it? Could this cat be suffering from a case of "Kuru?".

What is "Kuru?" the young man asked as his mum laughed when I told her about this case. It is funny when I described the case but I don't know how to translate the humour in this report.

"It is a Malay word for a human medical condition in which the penis disappears inside the body after eating pork," I speculated. "Suddenly the affected man loses his manhood!"

The student rolled his eyes upwards and said: "The cat's penile retractor muscles pulls the penis inside the prepuce, just as in the horse. When the retractor muscles relax, the penis will be visible." He did not say so, but he could not imagine a man having his manhood disappeared completely inside his body.

"It is hard to believe me," I said. "But 'Kuru' was reported in the Singapore newspapers when I was around 15 years old. My mum mentioned this report to me."

Although 4 decades had passed, I could vividly recall the name of "Kuru" as it struck adversely affecting manhood. At 15 years of age, I was impressionable and I was male. I could not remember whether I stopped eating pork when "Kuru" was rumoured to exist in Singapore in the 1960s.

Now, I encountered an equivalent case of "Kuru" in the animal kingdom and after nearly 4 decades of practice. This cat fell four storeys and had 3 wounds in his backside. No penis was visible at all. Maybe it was inside one of the holes. However, I operated to create a new hole as the urine was diverted into one hole and then into the thigh fascia and muscle areas.

So, was this a case of "Kuru" or not? I have some pictures to show readers. The only time I could barely see the penis was when the cat suddenly peed during my review before going home on the day of surgery. He just shot out his full bladder's urine, missing me by a few cm as I swerved. I grabbed my camera, switched it on and managed to capture a photograph for readers to see. Certainly, this cat could pee normally but he appeared to have "Kuru". In any case, the owners were happy with his newly created urinary hole and he no longer urine-stained his backside.

23. Spaying stray cats in Singapore

Caterwauling cats x 2


Cat 1. Around 6 months
Jul 3, 09. Caterwauling. Owner got Ovarid. Gave Ovarid 20 mg x 1. 1/4tab/day x 4 days.
Jul 12, 09. Spayed.
3.2 kg
Xylazine 20 @ 0.1 ml, Ketamine 100 @ 0.4 ml in one syringe IM
Insufficient time, cat growled. Top up isoflurane gas 5% for < 1 minute
Ovaries - Yellow corpus luteum.






Cat 2. Around 6 months
Jul 6, 09. Caterwauling 7 days ago.
Jul 13, 09. Spayed.
3.65 kg
Xylazine 20 @ 0.15 ml, Ketamine 100 @ 0.5 ml in one syringe IM
Excellent anaesthesia. I took note of the time for surgery in this case.

2.40 pm Injection xylazine & ketamine. Clipping after 3 minutes.
2.47 pm Incision started.
3.16 pm Skin suture (horizontal mattress) completed.
Duration: 29 minutes.

Surgery not under pressure as Cat 2 is in excellent anaesthesia.
Ovarian blood vessels large as in Cat 1. Around 3 mm in diameter
Uterine blood vessels around 3 mm in diameter
Ligate ovarian bv. Double ligate uterine body. In Cat 1, I had to transfixed ligature as well as double ligate the uterine body.

Ovaries - One cystic ovary?


Delays are caused by:
1. Too much time is spent in waiting (> 5 minutes in Cat 1 for the cat to be sedated before clipping hair and preparing the site for surgery).
2. Incorrect restraint. Experienced assistant like James Ang tended to forget the proper procedure. The correct restraint here is to hold the cat upwards by the scruff of the neck. I asked him to lift the cat off the table. I injected IM. There was no reaction from the injection unlike Cat 1. In Cat 1, James positioned incorrectly, gripping the cat on the table with his right hand across the shoulder of the cat from the right side of the cat, instead of being on the left side of the cat., so that his grip was not firm. The cat moved as I injected 60% of the anaesthetic. He got scratches on his hand, in earlier case of another cat spayed by Dr Teo.

Fierce stray cats
How to inject such cats?
1. Put cat inside small crate. Put telephone books and other books to push him into corner. Tilt the crate. Inject IM when the cat is distracted. Not really ideal as some cats reacted first during injection. Xyalzine 0.2 ml IM in local Singapore cats would be easy and quick for injection, but not the larger amount in xylazine:ketamine combinations. Isoflurane via gas mask is used in cases where xylazine 0.2 ml is given.
2. Lasso held the cat's pelvic area and back towards side of crate. Inject IM.
3. Do not give 2nd injections if the vet missed or gave insufficient amount as the cat may die of heart failure due to the stress. Postpone surgery to another day.

Conclusion
My assistant James said that I had performed the surgery faster in Cat 2. The dosage of injectable anaesthesia for cats 3.5 - 4 kg kg should be that for Cat 2.

SHARING MY EXPERIENCES ABOUT SURGERY - SPAY IN A CAT
The cat below was not spayed by me.

22. Electrosurgery in hamster wart removal

The hamster's nose wart had a stalk made up of normal skin. If I used the scalpel to cut off the stalk, there would be a lot of bleeding. Shooting blood spurting all over her face. If the hamster was a dog or had a longer stalk, I could ligate the stalk. The stalk was the passage for large blood vessels to supply nutrients to the fast-growing wart. A wart bigger than the hamster's eyes.

"She rubbed off the wart previously," the teenaged girl who was accompanied by her concerned parents told me. "But the wart came back." Now, I had to decide whether to do electrosurgery on this hamster or not.

Could the hamster survive electric currents coursing through her body? What happens if the electrical circuit did not close completely. Would this old hamster be burnt or die out of shock? I doubt many vets will perform electrosurgery on hamsters to remove a wart. It sounded too risky.

In theory, the hamster should not get electrical burns if the circuit was well connected. The electric current would flow from one electrode out of the machine, pass the hamster's stalk, incising and coagulating the tumour and back to the machine.

To ensure the smooth flow of electric current without burning harming the patient or doctor, the following must be done:
1. A plastic sheet on the operating table which is metallic.
2. Normal saline on the gauze which is then placed on top of the pad of the indifferent (neutral) electrode. Saline, unlike water, conducts electricity well so that the current goes home via the indifferent elctrode back to the machine.
3. The hamster's lower body must be in full contact with the gauze.
4. No saline should be present outside the indifferent electrode.
5. No explosive anaesthetic gas to be used.
6. The hamster must be fully anaesthesized, otherwise she would move about.
7. No sparks should be seen if the procedure is well done as there would then be no resistance to the current flow.
8. The lowest intensity should be used for electroincision and electrocoagulation modes. I intended to incise and then coagulate the wound.
9. An alternative is the use of the blending mode (known as "coagulation 2" in my machine). In the blending mode, the wart is incised and coagulated at the same time. It would be ideal in this case.

Anaesthesia
The hamster was given isoflurane gas in a container for a few seconds. When she was observed to be "sleepy", she was taken out, put on the saline-wetted guaze on top of the indifferent plate.

Surgery
I used forceps to lift up the nose wart. The electroincision wire cut the stalk. There was resistance to the cutting. So I had to increase the intensity of the current. The hamster woke up suddenly and seemed shell shocked just after the passage of the electric current.

That is the problem with using gas isoflurane. It enabled rapid recovery. I had cut 80% of the stalk. There was no return. Quickly I stepped on the foot switch and lanced off the last piece of skin attachment.

There was no bleeding. That was excellent. Previously, I had bloodied noses after excision of the wart with scalpel. This was great. I took the hamster to the consultation room and handed her over to the teenaged girl. She was very happy to see the wart gone.

The hamster was much awakened now. Suddenly the girl said, "My hamster rubbed her nose. It is bleeding a lot." This bleeding was profuse. As if a dam had burst. I took a piece of tissue and put pressure on the nose to stop the bleeding. I wiped the blood away with another tissue. Still there was bleeding.

The hamster moved away from my fingers. Suddenly she squeaked as I pressed the tissue paper in an attempt to stem the flood of bright red blood spurting all over the hamster's face.







"I have never heard my hamster squeak before," the girl sounded distressed. I realise that I had to take the hamster away from the girl, back into the operating room to treat the bleeding. This bleeding was not life-threatening but it was very traumatic for the owner to watch and hard to explain to the owner. "I will use potassium permanganate powder to cauterise the wound," I said to the teenaged girl. "Have you studied this chemical in your class?" She shook her head. Probably she was in Secondary Two and had not studied chemistry. So she had not heard of this chemical.

In the silence and peace of the operating room, I wiped off the blood from the hamster's nose, applied potassium permanganate powder. There was no bleeding. Now, the hamster had a purplish black nose. Later one, she would have her normal coloured nose.

In this case, the alternative blending or "coagulation 2" mode might be more useful in the electrosurgical excision of the big hamster wart. As very few hamster surgeries are done, I would have to wait for the next case. Not many hamster owners have problems with warts.

Life is a continuous learning and hands-on experience is the only way for the vet to hone his skills in electrosurgery of the hamster.

Full report is at www.toapayohvets.com

21. Mission Impossible in 16-year-old canine pyometra

"The surgery must be completed in 15 minutes if the dog is to survive," I said to my two assistants. They looked at each other with a grin. It was just not possible.

This 16-year-old dog had not been eating for 5 days. Dark coloured vaginal discharge in large amounts. Was this the end of her life? Without emergency surgery to remove her infected womb, she would die. She might die if she was operated.

"Please wait," the best friend said to me as the lady owner made some phone calls outside the surgery. Her eyes were red. 16 years in a dog would be equivalent to over 100 years old in a person. Too old to survive an operation. The lady finally consented to the surgery and knew that it could be the last goodbye when I asked her to go home.

However, if the operation could be performed in 5 minutes, she might survive. But pyometra surgery would take more than 5 minutes. The shorter the anaesthesia, the higher the chances of survival. The following were done:

Pre-operation
1. 20 ml dextrose saline with baytril, lasix and spasmogesic injections were given 1 hour ago. Her temperature was 39.5 degrees C, pulse was strong and respiratory rate was normal.

2. I/V dextrose saline drip given.

Anaesthesia
Isoflurane gas by mask, intubate, gas at 0.5 to 1% to effect. My assistant, Mr Saw was now much more experienced in assessing the depth of anaesthesia. I noted that the blood during my surgery was bright red instead of bluish and so I knew he was doing a good job. It was great surgical anaesthesia. "Keep lowering the % till the dog react" I advised him to check for pedal pain and eye blinking reflexes. Only during the end of surgery did the dog move a bit. Mr Saw increased the % to 5% but I told him that 2% would do.

Surgery
"More haste less speed" seemed to be presented when I incised the linea alba, the midline fibrous tissue connecting two halves of the abdominal muscles. I incised but found that the muscles did not separate. I saw the brown muscle fibres instead. The linea alba was faint in this region and my incision missed it by 4 mm. "Look further cranial," my second assistant advised me as he saw me looking for the linea alba which was faint at this area, around 6 cm from the umbilical area. I checked anteriorly and followed the direction of the linea alba backwards. Got it.

The muscles separated. I put my gloved finger into the abdomen. The small and large intestines were blocking my view. A few seconds passed. I hooked out the swollen uterine tubes.

Ligated the ovarian tissues. Then the uterine body. Time was passing by fast. The dog had not given me cause to worry as the bright red blood indicated that she had sufficient oxygenated blood and her heart was beating normally under general anaesthesia. Still I could not be complacent or slow. Anytime the heart could just stop beating and a dead dog would be presented.





After getting rid of the uterus, I quickly put 3 simple interrupted sutures at 0.8 cm apart to close the muscles. No fanciful subcutaneous sutures as this would take more time. I just stitched up the skin with 3 horizontal mattress sutures.

"Switch off the anaesthesia," I said to Mr Saw. He had already reduced the gas to 0.5% and the dog was still anaesthesized. This showed that the dog was very weak as normal dogs would need 2% to be knocked out. "Switch off," I said as I tied the 2nd of 3 skin stitches. Mr Saw did it. I completed the 3rd stitch. The dog just woke up suddenly.

"Take out the endotracheal tube," I said to Mr Saw who had by then, untied the four legs. "Put the dog's head to the side in case she vomits."

The dog just looked as if she had a nap. She wailed and wailed. This happened sometimes after isoflurane gas anaesthesia without any other tranquilisation or sedation. Why would a 16-year-old dog wail and wail, I cannot say. Neither do I many case of such old dogs with pyometra. I thought the old dogs had menopaused and would never get pyometra. This case proved me to be mistaken.

But such loud wailings are good signs of a dog being much alive at the end of surgery and were a joy to hear. I don't want to see a dog knocked out and still sleeping when the last stitch is completed as there is a risk that the dog may die
later.

"What time is it?" I asked Mr Saw as I completed my last stitch. "4.55 pm," he said. He was at the far end to my left and opposite me at the other side of the operating table, nearer to the isoflurane vaporiser. I looked at the clock, just above the door of the operating room and to my right. "It is 4.53 pm" I said. So, I had used up 18 minutes to perform the surgery. It was really Mission Impossible.

The naughty senior citizen was alert but refused to eat. Well, what do I expect? She had just completed a major surgery. Her temperature dropped to 36 deg C 30 minutes after surgery. She had the IV drip but I was worried. I phoned her owner. She could still die despite a successful surgery.

I phoned the lady owner to get the dog home to nurse. This would be a finicky dog and would not eat unless hand fed. The best friend had a car and the dog went home. Some one hour later, the lady phoned, "My dog passed blood. Is it normal?"

"Yes," I said. "The blood is from the vestibule of the vagina." I doubted that the lady knew what vestibule was about. In any case, she said that the dog ate and everything was OK.

20. Electro-cautery in a Jack Russell

Will electro-surgery kill the old Jack Russell who has a weak heart?

The Jack Russell needed to be unconscious so that the gigantic mouth tumour could be excised using electricity. Yet he had a weak heart. Anytime his heart could fail and he would be gone from this world. Therefore, general anaesthesia using isoflurane gas was kept to the minimum.

The gas was like the force shield in Star Trek's Enterprise, protecting the starship from powerful killing forces.

As the electricity shot through the electro-cutting bladder to slice off the tumour at the edges of the gum, the dog started to jerk. The protective force shield was insufficient to protect the dog's systems.

His tongue moved and he opened his mouth. His heart stopped pumping blood. I could see that his tongue changed from pink to purplish in colour.

"Increase the dose to 5%," I stopped the electro-surgery. The dog was feeling the pain. The force shield needed to be at its maximum. However, it could overload the dog's heart and kill him. There was a need to know how long the 5% had to be given. One minute or more? There was no formula. The longer, the higher the risk of death on the operating table.

The dog started to slip into unconsciousness. The electro-cutting blade transferred electric current into the tumour. Zap, zap, zap... the electric sparks flew.

"Smells like burnt meat," Intern 1 who had never seen electro-surgery probably thought of her barbecue parties. The 9-sq m operating room with 2 interns, 2 assistants and myself was packed.

The faster the operation was done, the better chances of survival it was for this old dog. 15 minutes had passed. Now the dog was unconscious at 1% gas anaesthesia. The 2nd tumour in the hard palate was zapped and removed. Now, the electro-cautery electrode was used. The blood flew profusely from the gum after the tumour had been cutting. The red light at the end of the electrode blinked indicating that electricity was coursing through. However, the bleeding continued.

"Turn the dial to higher intensity," I said. The assistant turned the knob to No. 3. I put the electrode onto the bleeding point. The steam rose as the electricity burned the blood vessel as I stepped onto the foot-switch. The surgical area was now dried. No more bleeding.

The dog moved suddenly and darted his tongue in and out of his mouth. His tongue changed to a deep purple.

I looked at Intern 2. "Is the indifferent plate still in contact with the dog?" She was to ensure that the dog's abdomen was in contact with the "indifferent plate" which had been moistened with a wet gauze swab in normal saline. This plate conducted the electricity away from the dog to the machine. A complete circuit.

"Yes," Intern 2 said. I checked. The interns were inexperienced students from the Junior College waiting to study veterinary medicine. They had never seen electro-surgery in their 18 years of living. Neither did the two Myanmar assistants. Electro-surgery is seldom performed as there are not many indications requiring this machine.

Therefore, I had to be extra vigilant and yet needed to educate the younger ones on the application of electro-surgery. Seeing is believing for them.

"OK," I said to my assistant. "Take out the endo-tracheal tube now. The operation is completed." There was not a single drop of bleeding from the gum. The dog got up as if he had a short nap. It took team-work to complete the surgery in 18 minutes.

The Jack Russell wagged her tail. She was a most friendly dog and would never threaten people unlike some crazy Jack Russells I had encountered. She was not able to communicate as a human being. But she appeared quite happy as the she could now close her right upper lip normally.








NOTE: Oral tumours form when there is poor dental hygiene in dogs. In old dogs, it would be best not to attempt surgical removal of the oral tumour and dental scaling and extraction at the same time. This increased anaesthetic time considerably and the risk of anaesthetic death. Therefore, do the surgery and forget about the dental for the time being if you want a positive and happy outcome.

19. Focal dystonia in a veterinary surgeon

FOCAL DYSTONIA IN A VETERINARY SURGEON



For the past year, sometimes, the 4th finger of my left hand curls inwards involuntarily and I have to uncurl it with my right hand to continue surgery. What's the cause of this sporadic problem?

I presume it was due to aging. After all, I am no spring chicken, being 58 years old.

Could this be carpal tunnel syndrome which is commonly diagnosed in people such as mothers holding babies?

This problem does not happen all the time and has never happened while I do typing or writing. I do use the keyboard a lot to write and create pictures for the "Be Kind To Pets" (www.bekindtopets.com) educational website everyday.

Today, I read in the Straits Times, March 12, 2009, Pg C6 "Back with two hands" that the famous Ameican pianist Leon Fleisher could not uncurl the last 2 fingers of his right hand for 30 years. So he could not play the piano with his right hand. His condition was correctly diagnosed in the late 1990s as "focal dystonia". This is a neurological disorder originating in the brain. Wrong impulses from the brain cause the muscle of the finger to contract and twist involuntarily inwards.

Apparently, focal dystonia affects musicians, writers and surgeons. I had found the correct diagnosis for my problem. Botox injections and regular hand exercises can treat the problem but there is no permanent cure as at 2009.

Or is there? More research needs to be done by me. Maybe I will be forced to stop doing surgery later. A new career as a licensed travel agent?

1. Post-spay complications - The "surgical signature" of a vet

The surgical signature

"Everything was OK for the past 2 weeks after spay," the cat owner I had not met before brought in a black cat with yellow pus in her spay wound matching the colour of her yellow eyes.

As I did spay a black cat with yellow eyes recently, I assumed that this was the cat I had spayed and there was the post-spay complications of wound breakdown or infection which do happen in rare cases.

In the black cat I spayed recently, the owner pressured me to charge him $35 for spaying as it was the fee offered by some vets. Spaying of a cat is a commoditised such that the lowest priced vet gets the most business (my presumption).

"The reason I do not pay $35 to the vet who charges much lower than you is that my cat's left ear tip must be snipped off after the spay."

It is difficult to sustain the profitability and upgrading of a veterinary practice if I compete on "lowest spay price". So I was prepared to let the case go as I don't want to lose money doing a surgery. I will become bankrupt providing loss-making services in time to come.

Unlike a human general practitioner, a veterinary practice has surgical and anaesthetic equipment to buy and maintain. The rentals and staff overheads are high. Therefore, going down the path of the being the lowest priced vet is not sustainable for profitability in the long term.



Back to the black cat on my consultation table, the owner said he did not know who had spayed his cat as he was not the one who brought the cat to the vet. One look at the cat's incision wound told me that my "surgical signature" would be around 1 cm from the umbilical scar. This cat's wound was at least 2 cm away. Therefore it was not me who had spayed the cat.

In any case, the owner said that there was no problem for the past 14 days. The cat I spayed was 7 days ago and I had never heard from the other owner with the black cat.

I noted some brown stains of an iodine-like antiseptic further away encircling the wound. I did not ask the owner whether he applied antiseptic which had been licked off. How could his black cat do it when she had worn an Elizabeth collar?

"Do you have another cat in the house?" I asked him.
"Yes,"
"It is likely that the other cat cleaned up the wound for this black cat," I said. The owner nodded his head.

So, what's the solution? The cat had a fever. It would cost the owner more money to get her treated. In times of recession, this post-surgical treatment is not kindly accepted by a pet owner.

I removed the stitches, warded the cat and gave antibiotic injections for 3 days at minimal cost of $50.00. For the last 7 days, I did not hear from the owner and presumed that the cat had resumed a normal life.



Other pets licking the wound of the spayed cat or dog are unexpected causes of post-spay complications. Vets seldom if ever ask the owner to separate the spayed pet from another as we never think of such situations.