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.
Wednesday, September 16, 2009
Monday, August 31, 2009
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
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
Sunday, August 2, 2009
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.
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.
Monday, July 20, 2009
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.
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.
Wednesday, July 15, 2009
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.
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.
Saturday, June 27, 2009
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
"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
Sunday, June 21, 2009
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.
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.
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