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.