tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   01 July, 2009  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

 


tpvets_logo.jpg (2726 bytes)An intern learns how to bathe a puppy with diarrhoea. She needs to pony-tail her long hairs to do work.

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Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures
 

Operating On A Dangerous Dog
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: 08 April, 2002
Updated:
01 July, 2009

OPEN PYOMETRA IN A DANGEROUS DOG BREED - THE ROTTWEILER
A CASE WRITTEN IN 2002

"The eyes are still blinking by itself, as if the dog is getting up!" Nurse Ann warned.  The Rottweiler was under the gaseous general anesthesia and the operation to remove the womb and ovaries was half way. 

The Rottweiler was in deep general anaesthesia as her sclera or eye white was seen when Nurse Ann parted the upper and lower eyelids.  The cornea and pupil were further down, hidden by the lower eyelid. This was a classic textbook description of the stage of deep anaesthesia described in any veterinary anaesthesia book. 

The reason that the cornea and pupil was not visible was due to the fact that the eyeball had rotated downwards during the stage of surgical anaesthesia.  Therefore, only the top part of the eye, the white of the sclera was visible when Nurse Ann separated the eyelids. In deep anaesthesia, when Nurse Ann touched the eye lashes with her fingers, the eyes should not blink.

Now, these eyelids blinked automatically and continuously.  It should not happen at all.  A higher dose of the halothane gas managed to subdue the dog.  But the effect was not total.  The blinking commenced again, causing Nurse Ann to worry.  

It was like operating on a tiger. They may bite suddenly even when anaesthetized. This was an unusual anaesthetic case and occurred once in a blue moon. Suddenly, the operating room appeared hot and I dripped sweat from my eye-brow. The dangerous dog was about to be awake.  Nurse Ann was vigilant but would this petite Chinese girl of 4 feet 8 inches in height would not be strong enough to hold the Rottweiler's head down.

Dogs don't blink automatically during deep anaesthesia. This dog seemed to know what was going on.  Two big swollen ovaries of around 3/4-inch in diameter and 2 uterine tubes of 3/4-inch diameter and 8 inches long were taken out.  The womb tubes were fragile and full of thick sticky pus. This was an easy diagnosis of open pyometra as the thick pus exuded were seen dripping from the back end of the Rottweiler and had stained the owner's floor tiles. 

I had my ankle snapped by a Rottweiler who was displeased with being vaccinated. It was not muzzled and it was a big-headed big jawed male.  Would the female of the species be more dangerous?  Once bitten, twice shy? All dog vets get bitten by dogs. But this was the dangerous dog, as classified by the Agri-food Veterinary Authority and I was worried. Sometimes it would be better to get a male veterinary assistant for security reasons when operating a dangerous dog. 

"Last 2 stitches!" I gave Nurse Ann the assurance that the danger would be over. The skin incision was closed with nylon stitches 2/0.  The operating table shook as if there was an earthquake in Toa Payoh Vets. The big dog started to move his head

"Loosen the four strings!" The strings were holding the dog's feet to the operating table so that the abdomen could be positioned for surgery.  Within a wink of the eye, the Rottweiler just got up from the operating table in a daze wondering where she was. 

"Where is the muzzle?" I asked Nurse Ann. She slipped the muzzle to prevent the big Rottweiler's jaws from chomping on us. Nurse Ann was worried about being bitten. This was her first week at work. Nobody could guarantee that when the dog was anaesthesized, the dog would not bite. 

There was a continuous episode of bleeding from the stitched area. 

"The tongue looked pale", said Nurse Ann. Would the old dog die? Should she be operated at all?  The skin blood vessels do bleed and this can be quite frightening to the Owner if the dog is sent home immediately.  A bandage was applied to stop the bleeding.  Within 3 days, the dog was stronger and had put on weight. She was not the ferocious to Nurse Ann.

However, the veterinary surgeon was not welcome and it would be foolish for me to test her anger by going near her. If the female dog had been spayed when she was younger, she would not have suffered from pyometra and the risk of dying on the operating table. These are personal choices for the Dog Owner. In this case, the dog survived and lived to an old age.  

Diagnosis: Open pyometra
Bacterial infection of the womb in older female dogs
& and possible right hip sprain. The cause of the sprain could be the sudden jumping at every dog passing by, the slippery wet tiled floor and the fright from the loud midnight thunder 2 days ago.

At home, 20 days before surgery, the Owner complained that the 9-year old bitch was not eating for a few weeks and thought it was due to old age. She was emaciated with spinal bones seen and was not a good candidate for surgery.

I gave the dog a 10% chance of surviving the anaesthesia.

Rottweiler ill for several weeks.

When she was given antibiotics, her appetite returned.

She needed to gain weight and health before anaesthesia and surgery to minimize risks of death during or after surgery.

Thick lumps of pus were seen on the ceramic tiled floor indicating an infection of the womb.

Rottweiler: Pus discharged from uterus Rottweiler: Healthy and wants to bite her vet.

Before surgery - sticky  mucus from the vaginal discharge seen from the vulval lips.  A crescent strip adheres to the right hock. .

At home, 7 days after surgery, ready to pounce on me despite her dislocated right hip. I was happy to see that she had put on weight.


CLOSED PYOMETRA IN A VERY OLD DOG IN 2009.
Isoflurane gas anaesthesia is used at Toa Payoh Vets. There are still pyometra cases in dogs in Singapore in 2009 and throughout the years.   

Not all old female dogs survive pyometra surgery. Owners need to be educated that their delays in seeking prompt treatment or surgery would result in a high risk of their dogs just dying on the operating table. In such cases, some will not be happy as they have to pay for a dog that died, attributed to "the vet's incompetence".

Closed Pyometra. 16-year-old Shih Tzu after surgery. OK. Toa Payoh Vetsin June 2009, I encountered 3 cases of pyometra in dogs in a short period of time. Many events happens in 3s.

One of the cases was incredible. It was a case of a very old dog (16 years old) having closed pyometra is described at: A Mission Impossible.

I thought such old dogs would have had "menopaused", being equivalent to 96 years old in women. Women are said to have menopause at the age of 50.

Closed pyometra is due to the accumulation of pus and bacteria inside the womb, making the dog look "bloated".

The cervix would close due to the effects of progesterone in the heat cycle of the dog as the dog prepare for pregnancy. But a 16-year-old dog must have closed down the ovarian factory. Apparently, this dog did not. She did look young. No visible eye cataracts.

I took the young lady's word that this dog was 16 years old. Still having heat cycle at 16 years old?  And pyometra too? Sounds incredible? But true if the owner is honest and I have no reason to doubt her word about her companion's age. 

Normal uterus, NO pyometra. Female, young, dog. Singapore. Toa Payoh VetsNot every dog owner want to spay their female dogs as some believe it is cruel to deprive the dog of her reproductive organs. Yet, the old dogs don't receive much personal attention from the owner compared to the time when they were young and much fussed over.

So many cases of closed pyometra come to the vet at the doorway of death. The vet is supposed to perform a miracle and save the old dog.

Vets are not Gods, but they then get blamed for the deaths on the operating table by some unenlightened owners and family members. Some e-mail or post disparaging comments about the vet using the internet without considering the legal implications of being sued for libel since they believe that they can hide their identity anonymously in the web.   

Every dog's anaesthetic death on the operating table affects the vet personally too, in one way or another.  Better educated dog owners may consider spaying their female dogs when they are young unless they have the time to check their dogs regularly or go to veterinary examination every year. 

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 Clinical Research

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