The mother and teenaged daughter adopted the abandoned Chihuahua. For the past 2 weeks, the dog was rubbing her eyes. Dirt and bacteria get trapped inside the eyes, irritating the dog. So, she rubbed more. When I was consulted, the eye cornea was deeply ulcerated. A 3rd eyelid flap would be the surgery and would have saved his eye sight if the owner had not delayed seeking vet treatment.
In addition, this Chihuahua had a serious heart disease. Panting when at rest. More panting when excited. A pre-anaesthetic sedation using Domitor might be too risky.
Therefore, I did not proceed with the surgery as she would likely just die on the operating table. A 90% chance of dying. The owner accepted the risk but since this is a very high risk, I did not want to risk my reputation in handling this case.
The dog went home with heart drug medication, antibiotics, eye ointment and an e-collar. It was better to have a live pet as the teenaged daughter was attached to her. No vet wants a dead dog as a result of anaesthesia. No owner wants that too.
One week later, the eye ulcer had perforated. A white plug of gel oozed out. What to do now? Bacteria would get inside the eye causing enopthalmitis. Uveitis was controlled by eye drops. There was one solution. Surgery to remove the whole eyeball (enucleation).
Performance counts. In this case, a good performance is a live dog at the end of the surgery. The following management of this case is shared with readers and vets:
1. Dog was already on Fortekor for the past 7 days. She was no longer panting but dislike direct mask isoflurane gas. Struggled. I did not risk masking her since she might just collapse of heart failure during the fight to get out of the mask. So, a sedation injection was needed. Domitor or zoletil? Which is safer? Does Domitor cause heart rate to slow down? How about xylazine? It causes hypotension. Eventually, I used Zoletil. But how little that can be effective is needed for this 2.5 kg dog?
2. Pre-anaesthetic dextrose saline 20 ml SC and antibiotics.
3. Weight was 2.5 kg. Thin.
Pre-anaesthetic dose of Zoletil 50 @ 0.2 ml IM.
Atropine 0.65mg/ml @ 0.2 ml IM to prevent salivation, neck twisting from Zoletil injection.
Isoflurane gas mask and then intubate.
4. The dog's eyelids were shaved fast. The eyeball was taken out in <10 minutes.
5. The teeth were scaled. 4 loose ones extracted.
6. The dog was on <1% isoflurane gas and was anaesthesized without problems. For a short period, I disconnected the gas and the dog was not awake. So, I could continue surgery. When the dog moved, I re-connect the gas. This close observation and not giving too much anaesthesia ensures the survival of the patient.
7. Post-op dextrose saline 20 ml SC, antibiotics and tolfedine painkillers.
8. Dog went home on Day 2. No problems. Everybody is happy when a dog is alive at the end of surgery and anaesthesia. If the dog had been operated earlier, she would have had died on the operating table as she never had been checked up for heart disease and was not stablised on heart medication. Pictures of the eye injuries are below.
Pic at www.toapayohvets.com
