8. Old female unspayed dogs "on heat" bleeding

From: ...@singnet.com.sg>
Subject: Question re Dog Licking Herself More Often
To: drsing@toapayohvets.com
Date: Tuesday, June 24, 2008, 6:31 AM

Hi Dr. Sing,

It has been a while since we last corresponded.

Can I please get your advice as my dog Coco has been licking her private parts
more often recently? There's no discharge on the floor, and she's
eating per normal and active as usual. Normal urine and poo too. However when I
check inside her vulva, I see a clear discharge. It isn't much and
doesn't ooze or drip out of her body too.

Her vulva is not swollen or red; it is just normal in colour with one or 2
faint tinges of pink. When I check, her vulva feels soft to the touch, but the
part right after that, i.e. the area between the vulva and the anus, feels
firm/hard to the touch. Is that normal?

Is
there anything I should worry about? FYI, Coco is 9 years old and unspayed.

Could her licking be related to the possibility of her coming into heat soon?

My dog's last heat was in Feb 8 through 25. The one before that was in Sept
23 through Oct 11. It was 5 months or 20 weeks between last year's heat and
the most recent one in Feb. Do you think my dog is going on heat again soon?

When does a female dog start licking herself before her season? 2 weeks before
or?

Please advise. Thanks very much!

Best regards,
Name given


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Re: Question re Dog Licking Herself More Often - PYOMETRA
Tuesday, June 24, 2008 9:20 PM
From: "David Sing"
To:
...@singnet.com.sg
Cc:
drsing_98@yahoo.com


Most likely on-line diagnosis (which is not recommended or advised) is that your dog is suffering from open pyometra. In this condition, the womb of the old dog has been infected by bacteria. Large amounts of pus are produced inside the uterine tubes.

Toxins from the bacteria get into the bloodstream to damage the kidneys and other organs. In time to come, the dog cannot cope with the licking away of the copious flow of vaginal discharge. The dog gets septicaemia and starts vomiting more and more often.

The only treatment of pyometra is surgery to remove the womb and ovaries (spay). Pyometra can be an emergency in many cases as many Singapore owners delay treatment thinking that the unspayed female dog is just having heat.

I just had a 12-year-old Golden Retriever with "heat" 2 months ago. (I presumed the dog licked her vaginal discharge so the owner did not see any more discharge). 2 weeks ago, sticky yellow vaginal discharge attracted flies which would not be swatted away. She vomited 2 days before surgery. Would not eat.

Depending on its health status, some dogs die before, during or after surgery. As many Singapore pet owners consider spay as "cruelty" but are uneducated as to what is pyometra, they often seek surgical treatment very late and the vet sometimes gets blamed for the death of the dog during or after surgery.

In your case, you have no choice but to see your vet and get a professional examination and opinion. It seems that your unspayed dog has been infected for some weeks. Female dogs spayed when they are young will not get pyometra for obvious reasons - they don't have the womb. There are pros and cons of spaying.





SUNDAY JUNE 29, 2008

CASE: 9-year-old Lhasa Apso. Not spayed.
Presenting sign: Vaginal discharge.

History: Licking vulva for past few days.
Previous heat around 5 months ago.

Examination. No thick copious vaginal discharge at consultation. Dog could have cleaned herself.
Fever: No. Active and eating. Urine said to be clear although there may be cystitis from a recent urine analysis.Bladder wall not palpable nor is bladder full.

Palpation: Acute pain in bladder/uterine horn area.

Diagnosis: Pyometra (open) and possible cystitis (bladder infection). It is possible that the dog had been licking off the pus. Usually pyometra starts 4-8 weeks after the previous heat. The owner noted that the vulval-rectal skin area is thickened. This is due to continuous irritation by licking for some weeks.

1) On which day after surgery can we stop worrying about whether she jumps, stretches or runs, for fear that her stitches come apart? When can we rest assured that we can leave her to move around as normal?

10 DAYS WILL BE THE BEST. Most dogs move around with no problems (90%) on day 2 in my experience.


Since I will arrive in the evening to collect my dog, only after you have left for the day, would you be kind enough to give me a call on my mobile to let me know how she is after the surgery?

OK. Must ask my people to phone you and do this as a routine. Most times we don't phone when there is no bad news. NO NEWS IS GOOD NEWS?

Will there be any pain killers for her after the surgery?
YES


2) Wound.

Will there be visible stitches on both the nipple and abdomen areas? You mentioned in your blog that these will dissolve on their own, but when do they go away, so that we can't see them anymore?

STITCHES DISSOLVE IN 21-35 DAYS. YOU CAN REMOVE THEM OR WE REMOVE THEM AT DAY 14.

How long do you think the incision for removing her womb will be?
ESTIMATED FOR LHASA APSO LENGTH OF INCISON TO BE 4 CM. IN YOUR CASE, IF THE INFECTION HAD GONE AND THE WOMB IS BACK TO ALMOST NORMAL SIZE, I CAN HOOK IT UP. INCISION WILL BE LIKE THE USUAL SPAY INCISION. AROUND 1-1.5CM.

IT IS POSSIBLE THAT I CAN HOOK THE WOMB OUT IF IT REVERTS TO NORMAL SIZE AFTER ANTIBIOTICS. IN SUCH SITUATIONS, THE BEST TIME TO SPAY HER IS 1 MONTH LATER.

IF YOU CAN BE OBSERVANT, WAIT 1 MONTH AS THIS IS AN OPEN PYOMETRA CASE PROBABLY. THEN I WILL JUST SPAY HER AS AN ORDINARY SPAY. SKIN INCISION WILL BE 1.0 TO 1.5 CM IN THIS SITUATION. YOU NEED TO DECIDE YOURSELF.

IN CLOSED PYOMETRA (pus stuck inside the womb as the cervix is closed tight, pus accumulates), NOT ADVISABLE TO WAIT.


On which day after surgery can we bathe her without worrying about her wound/stitches?

FROM DAY 2 AS THERE IS A PLASTER COVERING INCISION.

3) Breast Lump

Will you be sending the minute breast lump to the lab to see whether it's benign or malignant? If you don't, since the additional cost may not be worth it, would you be able to tell from your professional perspective and experience your best opinion on the nature of the lump, just by looking at it?

CAN'T TELL WHETHER IT IS MALIGNANT OR BENIGHT, FROM LOOKING ESP. WHEN IT IS SUCH A SMALL TUMOUR OF LESS THAN 0.5 CM. DIAMETER. ONLY HISTOPATHOLOGY BY THE AVA LAB WILL CONFIRM.

4) E-Collar

On which day after surgery can we remove the E-collar? Do we need to keep it on her even at night when she sleeps? How many days must she wear it?

USUALLY NO NEED E-COLLAR IF GIVEN PAIN KILLERS. HOWEVER, KEEP IT ON FOR 2 DAYS. IF PLASTER IS NOT LICKED AWAY, AS SOME FEMALE DOGS DON'T BOTHER, THEN NO NEED E-COLLAR. THIS LICKING IS UNPREDICTABLE AS NO 2 DOGS BEHAVE THE SAME AFTER SURGERY.

YOU HAVE GOOD QUESTIONS FROM THE OWNER'S POINT OF VIEW. WILL NEED TO GO OFFLINE TO GET TO WORK. MANY QUESTIONS ABOUT SURGERY ARE BEST ANSWERED BY WRITING THAN BY PHONE. I will need to include the answers in my case study so that others in your situation may benefit.

IT'S 8.30 AM. NEED TO GO TO WORK. BYE.

Unclotted blood in a dog's ear. 3rd incredible but true story.

Things happen in threes. This is the first of the 3 "blood-related" incredible stories about my experiences in seeing blood with no apparent cause, within a period of 2 months in April and May 2008.




The old dog had been having ear pain and discharge and weepy left eye for some months. As the owner wanted to put the dog to sleep, I arranged for the dog transport man to bring the dog to my surgery. His wife did not want the dog to die by lethal injection. So, the dog was treated. The owner requested his skin growths to be removed. After that

I advised the owner to bring the dog back for the ear surgery in 7 days' time as that was the primary problem. At the 7th day, the gentleman phoned: "I will wait a few more days." I said OK.

A few days later, he phoned saying that there was blood inside the dog's left ear. I got the dog transport man to send the dog. Yes, there were fresh unclotted blood in the dog's left ear. The blood was red but would never clot. The dog must be scratching its ear and has self-inflicted damage to the ear. Yet, normally, there would be an aural haematoma - a swelling of the ear flap. This was just fresh unclotted blood inside the ear canal.

I sent the dog back on antibiotics and scheduled to operate 7 days later. This time the owner kept his appointment. Yet there was still unclotted blood inside the left ear. I took a picture for readers to see.

During surgery, I could see grey globules of cells inside the horizontal and middle canals. They could be ear cancerous cells. I did not do a histopathology as it would add up to the veterinary costs and it served no purpose for the owner. All owners want are least cost.

The vertical ear canal was removed. Hard as a rock. I had to use a bone cutter to split it.





An incredible but true story

The owner's wife came to visit the dog. She wanted the dog home after surgery. This was not advisable as the dog's ear needed careful nursing to prevent infection and stitch breakdown. Once the stitches break down, there would be a big hole and the owner would construe that the vet is incompetent, as owners seldom blame themselves for the poor outcome of a surgery.

In such a situation, I would advise that the husband be advised as the husband had not asked for the dog to be discharged. Ideally, the wound should be healed first and that would take 14 days at least.

However, to save on veterinary costs, the dog was discharged on day 9. After a few days, the owner sent the dog back as the dog had a swollen area in front of his surgery. The dog had been scratching and the horizontal canal opening had not been cleaned. The dog just would not permit the owner to do it.



So, another 10 days of stay and more veterinary expenses including the cost of several trips by the dog transport man. Fortunately, this was an owner who was able and willing to pay the expenses which could amount to a big sum in view of the to-and-fro of the dog and the transportation.

Vertical ear canal ablation needs a lot of nursing. It would have been cheaper to just let the dog stay at the surgery for 14 days and let the wound be cleaned daily by the veterinary assistant. The dog was quite fed up with the ear cleaning which must be painful for him. But he was muzzled and was more well behaved.




On the last day of nursing, before going home, I saw him wagging his tail as if he was happy to be free of his chronic ear pain. He never barked and was a dog of few barks.

6. Reaction to gas anaesthesia? Undescended testicle.

This Maltese looks healthy. Solid body. Good weight. He was much loved by the couple in their late 30s. We could spend lots of time talking about him just as parents loved to talk about their children if the world cares to hear.

"How was he toilet-trained?" I asked as this Maltese lapped up all attention. This was a case of paper-training in a confined playpen which can't be unhinged. The playpen has a door unlike most cheaper playpens sold at Singapore's pet shops. The newspapered floor area was 100% at first, reducing to a corner. The Maltese was given commands and praises to use the papers.

"How long does it take to paper-train him?" I asked.

"We can't remember. It was 3 years ago. A few weeks" the wife said.

The Maltese was coming in for neuter. Although not all undescended testicles become cancerous during old age, the owner heeded my advice to get the undescended testicle removed. Just in case they are not aware of the growth of the hidden under the skin undescended left testicle in later years.

I thought this would be a simple routine neuter. What is so difficult about neutering a docile Maltese that never bites and that looks as strong as any Maltese can be.
Gas mask 8% knocked him down fast. He was not the aggressive type so it was much easier to anaesthesize him.

I put in the endotracheal tube to connect the gas to his lungs as is my normal routine. It is best to intubate all dogs I always advise young vets. In this case, the dog stopped breathing and the tube could deliver emergency oxygen if required.






Anaesthetic complications do happen and intubation is important just in case of emergency. In this routine neuter case, gas mask will do. But it is hard to predict which dog will stop breathing. I would expect this Maltese to take gas mask anaesthesia with no problem. But he did stop breathing. Know what to do as there is not much time before death occurs.

The dog recovered well and the owners were most happy. Their e-collar was loose and had to be fitted so that the dog would not pull it out of the neck and lick his skin incision. Pain-killers are given as a routine in 2008. Just in case the dog licks the wound.

5. Restraining an aggressive Jack Russell for neuter

He curled his upper lips up and bared his fangs if any outsider wanted to touch him. I had encountered such aggressive Jack Russells. Usually males.

What to do in such a case?

When the owner brings him in for neuter, ask the owner to restrain him for tranquilisation. In this case, I injected 0.2 ml of xylazine 2% tranquiliser IM as the owner arm-locked the dog.

I put the dog into the crate. Normal ones would feel sleepy. This dog was fully alert and baring his fangs 30 minutes later.

"What should you do?" I asked my new vet assistant who has to learn on the job. He took out a dog muzzle. His usual way was to put his hand beside the dog's chest and slowly touch the dog, moving the muzzle up.

The Jack Russell eyed his hand movement and snapped in anticipation of being handled by a stranger.

"The muzzle is of no use," I said. "What to do if you don't want to be bitten?"

The assistant was silent. He had to get the dog out of the crate to the surgery room for neuter. The dog was a bright as daylight waiting to pounce onto his hand.

What to do?
There are 2 ways. Use a thick towel and cover his head. Use a lasso over his neck and get him out.

He had never seen a lasso before and we used this method. The dog was not as strong as before. Gas mask using 8% gas anaesthesia knocked him down. An endotracheal tube was put into his lungs to bring the anaesthesia to keep him pain free. Surprising 1% anaesthesia instead of the usual 2% kept him pain-free for neutering. He was put in the crate after his skin wound was plastered.

No dogs would be allowed to go home till around 4 hours after surgery. Preferably overnight but most Singapore owners want their dog home in the evening or earlier.

In this case, the owner said he had an elizabeth collar but he did not bring it with him. So he needed not purchase one from the Surgery and increased his veterinary cost of neutering.

30 minutes later, my assistant said: "The dog is bleeding a lot!" The dog's muzzle was stained bright red. The newspapers were stained bright red too. The Jack Russell's eyes stared directly at me, pupils dilated, fangs exposed, ready to attack.











What to do?
I did not expect the dog to lick vigorously his surgical wound. Blood flowed and seeped into his scrotum. It looked as if he was not neutered as his scrotum swelled to the full. It seemed to be a "con" job from an outsider's point of view as the scrotal bags should be deflated with the removal of two testes.


How to handle this bleeding episode?
In this case, the dog's adrenaline level was at all-time high. He should not be given any tranquiliser or painkiller injection in case his heart fails and he dies attributed to adverse drug injections.

"As long as you stand in front of him," I said to the vet assistant. "He will not lick his wound. He has to look at you and anticipate when you are going to nap him." So the assistant stood around him for a full hour while I asked the owner to come down.

"I can't come down now," the owner said. He was working.

"You need to come down," I said. "Your dog is bleeding and he is too aggressive. When you come, he quietens down."

The owner and his daughter came with the e-collar. They did not comment but the bleeding was a lot and the swelling of the neuter site and the scrotum was as big as it could be. A few bright red drops of blood trickled out of the stitched area.

"This 12.5-sized collar will not stop the dog from licking," I said. The owner put in the 15.0-sized collar from the Surgery.

What to do now?

So the dog be put under anaesthesia and the wound opened up to drain the blood out? This was one option.

Now, the vet has to be aware that any anaesthesia or tranquiliser in this highly strung dog may or may not kill him as he had anaesthesia recently. A dead dog is never appreciated by the owner no matter how clever the vet surgeon is.

I had to choose the safer option of maintaining the status quo. Not doing anything.

"Take the dog home and put him in a cage. No running around the house." I advised the owner. "Tel me if the swelling gets bigger or there is more bleeding. The bleeding is due to the dog licking the wound vigorously and not due to the bleeding from the neuter." I showed the owner the extensive bluish black skin discoloration of the whole penile area bruised by the dog's tongue.

Could the dog's licking cause the sutures to loosen and cause bleeding from the spermatic artery and veins?

In my experience, this was not the case. In any case, I had ligated the stump twice and ensured the stump had gone back into the inguinal canal and probably into the abdomen. I ligate quite near the testes so as to minimise trauma by not stretching out the cord and separating the spermatic blood vessels from the cremaster muscle as I used to do. This is the open method. There are two methods of neutering and I use the closed method ligating the whole sheath with the spermatic blood vessels and the cremaster muscle inside nowadays. If the first ligation broke down during licking, there would be a second one.




Experience gained
An appropriate-sized e-collar should be given to any dog after neutering or spaying.
This is our usual practice although large breeds are seldom given e-collars. In this case, the owner said he had one. Although he did not bring it, we did not expect the dog to be so vigorous in his licking of the skin wound as he had a xylazine tranquiliser.

4. Siberian Husky bit the experienced vet assistant

"Can you make a house-call?" the 5-year-old Siberian Husky owner asked. "My dog has some bleeding on the neck."

"It will be better and less expensive for you to bring the dog to the Surgery, using a pet transport person," I advised. "Your dog may need stitching. Your place may be not suitable for surgery."

"Why not bring your surgical instruments and do a house call?"

"Sometimes the dog may not be so easy to handle at the house and there may be more than one house-call needed. So, it will be most costly for you. I can get a pet transport man to bring the dog in."

When the Husky arrived, he had a line of five holes curving upwards in the right side of his neck. Dark brown blood trickled down. Some greyish things moved and appeared to peek out of the wounds. Like alien eyes staring at me.

They were maggot wounds. As the dog had a high fever, no tranquiliser was used to remove the wounds.

How to do it?



Muzzle the dog. Put him onto the table so that you can do the removal easily.

How the experienced vet assistant did it?

"The Husky bit my hand," the vet assistant showed me his left hand as one would show the battle wounds like a badge of honour. The new vet assistant was bitten too and showed his hand. The bites were not serious as they removed around 30 5-cm long maggots.

"You did not muzzle the dog," I shook my head. "You removed the maggots at floor level. You lease the dog in a corner and he was not in a position to escape. Don't you know dog psychology? If the dog is cornered and felt the pain of maggot removal, he will bite."

Siberian Huskies seldom bite people, in my observation. So, there was complacency even though the experienced vet assistant had more than 15 years of small animal practice.

I always advise the adoption of a safety procedure using muzzle to prevent being bitten. Sometimes, with years of experience under his belt, a vet assistant will take short cuts by not muzzling the dog or letting the owner do the muzzling.

It seems to be part of their daring personality. So they get bitten out of their complacency as they misjudge the docile behaviour of the Siberian Husky.