32. Retained puppy teeth in a Yorkshire Terrier

Yorkshire Terrier, Male, 8 months.

Most dogs have no more deciduous (temporary, puppy) teeth by 8 months of age. Yet in this rare case, this tea-cup Yorkshire Terrier had 14 puppy teeth that should have dropped off.

The permanent teeth erupts in an abnormal position as their place is occupied by the puppy teeth. He resisted strongly when I tried to open his mouth as he had a very painful mouth. If only he could talk. Tartar had formed in the retained canine teeth and soon, there will be tooth decay.

Many Singapore owners don't bother with such dental problems due to economic and anaesthetic risk reasons. What if the puppy dies under general anaesthesia?

This mindset is unfortunate for the puppy. General anaesthesia is safe in puppies over 3 months old. Much depends on the selection and experience of the veterinarian. Worried owners have to look for more experienced vets if they are worried about anaesthetic risks.



Timely removal of the retained deciduous teeth enable the permanent teeth to erupt in normal position and angle. In older dogs, food and dog hair get trapped between the permanent and retained teeth, leading to tartar formation. Bad breath. Painful mouth. But the uneducated owner just ignore such dental problems. Teeth start dropping off. So what? The dog gets his food and water. What more can a dog want?

The introduction of the internet has benefitted many puppies through education of the newer and younger owners. Compared to 10 years ago, more lady owners and young couples are aware of the future dental problems in retained puppy teeth and have got them extracted.

After checking that his heart is OK, I used general anaesthesia isoflurane gas prior to extraction of the puppy teeth. Intubation was done. Still it took >30 minutes to extract 14 teeth. After extraction, I note that it was not such a difficult struggle to open this Yorkshire's mouth for photography.





I am happy for this Yorkshire Terrier as he will be able to chew and bite without oral pain anymore. Tooth brushing ought to be done and should be easier nowadays.

His market value is S$2,500 as Yorkshires are very rare in Singapore. It sure was an expensive present given to this young lady owner.

TO REDUCE ANAESTHETIC RISKS
1. I don't use tranquilisers. Just isoflurane gas mask to induce.
2. Intubate
3. An assistant who just monitor anaesthesia and nothing else.
4. Minimal gas at 1% to effect.
5. Extraction of teeth as fast as possible.

A pre-anaesthetic blood test will be good but most owners are interested in least cost. Checking of overall health and heart will be the cheaper alternative but it is not ideal.

31. Electro-surgery in 3-day-old pups

The home-alone first-time-mother Shih Tzu bit off the ear lobes of her 3-day-old pups. "She must have scratched off the ears," the male owner would not believe that mothers would bite progeny. "The male dog may be responsible." The pups had full rounded abdomen showing that they had suckled well.

I showed him one puncture wound of 3 mm above the ear of one pup and one wound on the chin of the second pup. These wounds would heal.


Surgery: Stitching.
Four tattered ears in 2 pups. What should the vet do? The first thought would be to suture the skin and cover the ear cartilage. However the bite wounds were irregular in shape with more skin torn off in some parts of the ears and there would be insufficient skin to stitch up.

Cosmetic Surgery:
This was my first time in over 3 decades of practice to encounter two 3-day-old pups being presented with bitten ears and were still alive. In most cases, the dam just killed the pups by biting their skulls, neck and abdomen.

Lacerated ear wounds are usually treated by stitching. So, my assistant took out a rabbit anaesthestic mask to give isoflurane gas anaesthesia to the puppy after washing the ear area for surgery. He got out a small hair clipper which we use to clip the coat of hamsters.

"Puppy anaesthesia is high risk," I said. "The rabbit mask is not suitable for flat-nosed 3-day-old puppy. Use the plastic container. Some vets use plastic bags to contain the gas.

Electro-surgery
Stitching the torn ears would not present a good appearance for these Shih Tzus when they grow older. Buyers will notice that two ears of the pups are not symmetrical in shape and size. Therefore I decided on the use of electro-surgery. But can electro-surgery be performed in such a young pups? Would they die of heart failure due to the passage of electricity into their bodies? If you know the theory of electro-surgery, this does not happen as the electricity passes through the surgical area and incise and coagulate. But theory may not translate into practice. I could just incise the ears using scalpel. But the results would not be so good. Therefore I commenced electro-surgery.

Electro-surgery in 3-day-old Shih Tzus.
After cleaning the ears and after light gas anaesthesia, I placed the puppy's belly onto the saline-damped gauze which was placed on the indifferent electrode. This electrode was placed onto of a plastic tray which was then placed on the stainless steel operating table. Stainless steel does conduct electricity*

I used the artery forceps to clamp the remaining part of the ear, exposing the jagged ends. Electro-incision electrode cut off the tattered ends. Then electro-coagulation electrode sealed all bleeding. The results were 2 "ear-less" pups. When they grow up, their lack of ear pinnae is obvious but will not be distracting as one ear bigger and more irregular than another.







The dam was isolated. She was watched while she suckled her pups after 24 hours of my assistant hand-feeding the pups. The pups are then removed from her. Today is Day 5. The pups are OK and have had reduced their earlier puppy fat.

Conclusion

*Stainless steel operating table conducted electricity. Therefore do not place your elbows onto the table. At one stage, I had an electric shock during electro-surgery as my elbow touched the operating table.

Electro-surgery is safe in 3-day-old Shih Tzu pups. The use of saline-moist gauze on top of the indifferent electrode helps to conduct electricity better.

More pictures and final report will be at www.toapayohvets.com

30. What is the cure for tail gland hyperplasia in the male Husky?

Case: Male Siberian Husky, 9 years old.



History:
3 years ago, the Husky bit away all hairs of his backside and tail due to tail gland hyperplasia. The disease was controlled using steroids and antibiotics given by Vet 1. Then, the dog started biting his tail gland area again, as if possessed.

Is there a complete cure for the tail gland disease in dogs? Various treatments are proposed but the owner needs a complete cure. Here are my thoughts on this subject.

Surgery:
1. Tail Gland Skin area excised. Removal of the hyperplastic skin area. This is quite a large area of over 3 cm x 3 cm leaving a big hole and a very tight area to stitch up. If there is infection due to stitch breakdown, the result will be worse for the dog. Will electrosurgery do the job? Maybe, if the area is small and seen during the first time. There is no guarantee. In this dog, there seems to be another nearby area with the same problem.

2. Tail amputation. Will this method definitely resolves the problem of tail biting? Most likely since the tail gland area is removed. But the owner did not want a tail-less Husky.

3. Castration. Since this disease happens mostly in male dogs, testosterone hormone may play a part. The Husky is already 9 years old and his testicles were checked and found to be normal by palpation. No pain, nor enlargement or irregular lumps. The owner did not wish to have him neutered. I can't guarantee that neutering will resolve this problem too.

Now, in some skin disease cases in female dogs, spaying resolves the problem based on anecdotal evidence. In such cases, hormonal imbalances could be the cause of skin inflammation and itchiness. But not all cases are resolved and some skin disease occurs due to hormonal deficiency after sterilisation. Therefore sterilisation may or may not help.

This Husky was given a second intra-lesion steroid and we have to wait and see. Updated info will be at www.toapayohvets.com. Please accept my apologies. Not much time to update my blog.

28. Post-op irrigation of the bladder

SHARING SOME POST-OP MANAGEMENT EXPERIENCES

Poodle, Male, 5 years

Swollen painful abdomen, peeing dark red urine. Bladder about to rupture. Vomiting brown yellow fluid. High surgical risk. No choice but to do emergency surgery as dog would die soon. Cystostomy opened up the bladder to get spiky stones attached to bladder wall removed by using forceps. IV Hartman's 1 hour and blood collection.

In this case, the dog's bladder was thoroughly flushed. I used normal saline and a rigid catheter from bladder to flush out any spiky urinary stones in the urethra. Then I used a smaller sized catheter to flush urine from the penile opening.



Post-op

The following occurred.
1. DAY 1: Urine backflow from prepuce to under the penile skin. Swollen penile area. A catheter was not stitched earlier as the dog would usually pull it out despite wearing an e-collar. He would not pee normally, so urine collected in this way.
Solution: A catheter was inserted and the urine pool removed. One side near the penile opening was taped to the skin using elastoplast (see pic). Urine stained the elastoplast by Day 3. Elastoplast removed. No more catheter.

2. Irrigation of urine daily for 5 days to remove blood clots from the bladder. Urine still bloody. Small clots seen even on Day 2(Oct 6).

3. Acidify urine, antibitoics and close monitoring. Dog is eating and should recover. He could not pee normally due to pain. Pain-killers given.

Owner wanted the dog home after 5 days. Dog was still passing blood in the urine. No more complaints for the next 14 days. Updated info will be at www.toapayohvets.com

27. The right-nose sneezing dog

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.

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

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.