The dog needed to be revived during dental scaling. I had advised the quiet lady that the dog should not take "further general anaesthesia". I had noted this in my case record. Two years had passed and the dog now had pyometra.
Today, Friday Sep 26, 2008 was the day the Chihuahua was to be operated. She had antibiotics from me for the last 5 days and had seen Vet 1 six days ago. Pyometra was also diagnosed by Vet 1 who advised surgery and gave antibiotics and oral painkillers.
Antibiotics given some 3 weeks ago worked to stop the vaginal discharge. The owner was advised to get the dog spayed after one month. But at the end of 10 days of antibiotics, more "liver-coloured" vaginal discharge flowed continually. The dog had no appetite and needed hand feeding. She was losing weight and now had a fever. Therefore she was high anaesthetic risk. A type of case I would prefer to pass to other vets.
Anaesthetic deaths are so unpleasant events as vets get the blame. Newspapers loved to sensationalise the case too. There was a recent case of a Jack Russell that died on the operating table after being admitted for spay and dental scaling. I had not read this newspaper report but one complaint in the newspapers was that the vet still charged his fee even though the dog had died. No delivery of a good service, no payment?
I had spoken to the quiet lady and her husband for some time on the 2nd recurrence of vaginal discharge 5 days ago after cessation of antibiotics and the emergency visit to Vet 1. When was the optimal time to operate? It was hard to define exactly. I advised that once the dirty and sticky vaginal flow ceased, the dog should be operated. The time was 5 days after antibiotics.
So the dog was here now. She has fever. Still would not eat by herself and had lost 0.3 kg during the past 2 weeks. She still looked alert.
"I will wait at the surgery," the quiet lady said.
"It is best you go home," I said. "Waiting at the surgery is very stressful for me in such situations of high risk anaesthesia. I need to focus on the dog surgery and if you are hanging around, the atmosphere is very tense."
The lady went home. She might be seeing her pet alive for the last time. There was no way I could be less frank. "Do your best," the husband phoned some 30 minutes later to enquire about the dog but I had not operated yet. His wife was very upset at the thought of the dog not being able to be alive from general anaesthesia.
Anaesthesia and Surgery of this high risk anaesthetic case.
1. Dextrose saline 200 ml SC, antibiotics and anti-fever injections given.
2. Pre-operation shaving and washing of operation done. Let the dog rest for some minutes.
3. Gas mask anaesthesia starting at 5%. Reduce to 1.5% after intubation. The dog was too light as she moved. Increase to 2% but not more and wait to staablise.
4. Incise 2 cm from umbilical scar. Make incision 2 - 3cm caudally. Hook up left uterine horn which could be seen easily from this bigger incision. I used the scalpel to cut the tight ovarian ligament. Ligate ovarian blood vessel. Take out the right uterine horn and repeat same procedure. Get the uterine body out. 3-clamp method. Ligate below clamp 3 after clamping the horn. Ligate the crushed area after removing clamp 3. This meant that there would be two ligations.
5. Reduce gas to 0.5% to effect. Stitched linea alba. The dog reacted to pain. Increase to 2%. Reduced to 1% to effect.
6. Reduced gas to 0.5% when the skin incision is stitched. Switched off gas at the 2nd last skin incision.
7. Dog woke up without crying, as if from a deep sleep, after the placement of the last skin stitch.
8. Placed dog in a quiet cage. The cyanotic tongue was not a good sign. This dog did not have sufficient haemoglobin in her red blood cells according to a blood test some 3 weeks ago.
9. The owner took the dog home some 1 hour after surgery. She could care for the dog better at home.
Surgery can be shorter if one follows the Formula One teams where each person handles a specific task when the sports car comes to the pit stop. My assistant focused on the anaesthesia. Another assistant held the forceps to lift up the ovaries for me while I ligate.
In this case, the dog's heart did not fail and she recovered and went home. If she survived the next 48 hours, she should be regaining her appetite after the toxic womb had been removed and should live a long time as her care was excellent. As for her tartar in her canine and other teeth, I dared not suggest any dental scaling or did any scaling after the removal of the womb. I don't advise such procedures although it does save money for the owner. The shorter the anaesthesia, the better the outcome.
What the owner wants is a live dog at the end of anaesthesia. Pets are family.
If the vet cannot deliver, there will be much sorrow on the part of the caregiver of the pet. And unpleasantness from family members and sensationalism in the tabloids and internet forums.
