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.

34. Infected facial tumour. Dwarf Hamster

HAMSTER SURGERY
Dwarf Hamster, 1 year. Young lady
Dehydrated, Not eating
Facial swelling 2-3 weeks growing fast. Rounded, 1cm X 0.8 cm.
Abscess?

Zoletil 50 IM. Duration 5 minutes. Need to be prompt in surgery. But large tumour is not easy to remove in <60 seconds. Therefore I needed to use isoflurane gas to maintain the anaesthesia.

Tip:
Give isoflurane gas when it moves. If you continue without anaesthesia, the hamster will struggle and die of fright and pain.



1 cm incision. Watery pus drained. Multiple rounded fat-like cells of 1 mm globules widespread. Can't remove all without affecting nerves. Owner informed.
Hamster OK. Picture.
Advice: Removal will have been easy and effective when it is around 2-4 mm in diameter some 2 months ago.

Goes home on Day 3. It is likely that the tumour will recur as it is widespread inside the cheek.

33. Large infected skin tumour in an old dwarf hamster

In the dog or cat, this would be an easy surgery as general anaesthesia using isoflurane gas is very safe and predictable in these two species.

In a 2-year-old dwarf hamster, the successful outcome depends greatly on the anaesthesia. Insufficient anaesthesia may kill the hamster due to great pain and fright from surgery. Lots of movement hampered surgery. Death could be due to fright during restraint and not due to anaesthesia.

Pre-operation
In the dog and cat, pre-operation examination and blood tests are helpful. In the dwarf hamster, ask the owner about the amount of stools passed and water drank. In this case, the lady owner was very observant. The hamster was eating as faecal pellets could be seen. She noted that the hamster recently drank at least 3x more water than normal in a week by judging the amount of water in the water bottle drank per week. Based on her observation, the hamster was drinking 18 ml/day compared to the normal 5 ml/day. This polydispsia is abnormal.

Warded for 2 days
Oral Baytril antibiotic was given on Day 1 and 2. Surgery started on Day 3 as the hamster was suffering from a red itchy infected skin tumour.

Anaesthesia and Surgery
It is extremely difficult to see the signs of surgical anaesthesia in the hamster under isoflurane gas (gas into a plastic container with the hamster inside) and Zoletil sedation. A bit more will mean death. So, it is a matter of observation of anaesthesia to effect. What does that mean when the vet can't check the pedal and eyelid and other reflexes as in the dog? It is just not possible. "Count to 10" I advised my assistant when the hamster has been placed in the container. This is not scientific. We took the hamster out for surgery. When it moves, we put it in again. This happened 3 times. By the 3rd time, the hamster looked "dead".

"The hamster has died," I tried to revive it by rubbing the skin of its neck above the shoulder area. "Can give Biolapis," my assistant proposed. I was busy trying to revive this hamster. Blow air via a 3-ml syringe into its nose area may be useful.
Cardiac massage?



In this case, my assistant put a drop of Biolapis which is an oral electrolyte for small animals like rabbits and hamster. An oral respiratory stimulant and oxygen would be useful.

The hamster was still breathing as I could see its chest movements. I left it alone, under the warmth of light.

In around 30 minutes, it was up and alert. As if it had a good lunch-time nap. The Caucasian school teacher was very happy as she was prepared for the worst. Always examine your older hamster daily for small tumours. Small tumours less than 3 mm in diameter take less than 1 minute to remove and the chances of survival are very high.

Not all stories have happy endings as vets are not Gods.

P.S.
More pictures and update at www.toapayohvets.com, goto "Hamsters"

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