DEATH IS NOT AN OPTION

Singapore is getting to be a litigious society. So, it is safer not to accept old dogs for anaesthesia. Why take the risk of putting a 14-year-old dog under general anaesthesia to perform a surgery. This dog was near the end of his life span. He was a bit on the plump side and would expect to live not more than 1 or 2 years as he had outlived his contemporaries although some do live to 20 years of age.

He needed an operation to remove the blood clots inside his left ear. But he is past 91 years old if he was a man.

Barely able to see through his cataract eyes. Why should a vet risk his reputation built up over many years of hard work?

"Will the dog die on the operating table?" the owners asked. He and his wife, in their late fifties did not know what to do. 2 vets had advised against anaesthesia and rejected them.

The second vet they consulted gave some medical treatment to relieve the pain. But the dog was still shaking his head and scratching his left ear till the blood swelling under the skin turned bluish-black. As if he was irritated with a heavy painful swollen appendage like being weighed down with a big marble.

This dog had not long to live as the average life expectancy of his breed was around 12 years. He could eat and do most things, except see clearly. But who knows? He could be around to 20 years of age if he had no health surgical problems. 

"Nobody knows whether he will live or die on the operating table," I said. "You will have live with your decision should you decide to let him be operated upon.

"I will check his heart first," I placed my stethoscope on the dog's heart.

"His heart is normal, surprisingly. Usually old canines have some heart problems as they age," I said.

"Do you want to take the risk?" I asked the couple.

It was Hobson's choice. If they said no, the dog could not live in peace and keep scratching his ear all night long. The ear gets infected and becomes very painful.

If they said yes, the dog might not wake up on the operating table due to heart failure from anaesthesia. 

"I will just use gas," I said. "No tranquiliser injections. This will at least be safer for aged canine but not a guarantee that he would not die on the operating table."

The couple whom I met for the first time gave their consent to undertake the surgery and left for home to await the results.

The old dog was given anaesthesia by gas mask. He fought hard wanting to bite.

"Take away the mask when he struggles," I spoke to the intern I was training. The intern was gripping hard and trying not to get bitten. The dog pawed the mask trying to get it off. A tranquilised dog would be much easier to anaesthesized.

But a tranquiliser and a gas anaesthetic might finish him off. Death is not an option when the vet undertakes this anaesthesia.

"Put at 8% gas first," I explained to the intern. I loved this 8% gas vaporiser which may be hard to find nowadays. It delivers a higher concentration of gas than the usual 5% vaporiser normally sold.

The old dog still struggled.

My vet assistant talked to the dog. The dog relaxed. The gas mask was put onto his face again to enable  him to sleep. His eyeballs rotated downwards as he went into deep surgical anaesthesia.

"Reduce the gas to 1%" I said. This would minimise risk.

My vet assistant clipped the hairs. It took some time. I washed the area. Started to incise the swelling to get the blood out from his swollen ear. The dog flinched and moved. He made noises as if he was crying. The anaesthesia was a bit below surgical stage and that would be good for the dog as the risks of death would be less.

"Increase the gas to 8% for a minute," I said.

The variation of gas based on response is the best way to minimise risk. The surgery will take a longer time. The dog would wake up. Increase the gas and observe the eyelids blinking. Once there is no eyelid blinking, reduce the gas. Check pad for pain after pinching it.

In this way of careful observation of gas dosage and response, the dog was operated and recovered.

Death under anaesthesia is not an option because family members badmouth and never forgive or go back to the vet once there is a canine death.

It is a sad fact of life. Litigation and complaint to the veterinary authority takes up so much time of the vet's time and is becoming more common in Singapore. In reality, around 1% of my clients are potential complainants for which I am thankful. 

It is foolish for a vet to undertake this old-dog anaesthesia. I don't look forward to it too. Sometimes, there is the interest of the poor suffering dog to consider.

The more of such cases attempted, the higher the chances of getting an anaesthetic death of aged dogs, whether gas anaesthesia is the sole method used or not. This was probably why the 2 vets did not want to accept this case.

In this case, the dog did not have any adverse anaesthetic reactions and went home to a happy owner. The one factor in his favour was that anaesthesia was short as this was a minor operation. Not all stories have happy endings.

Evaluate the personality of the dog owners in high-risk veterinary cases.  Avoid owners who don't have time even to bring their dogs to the Surgery. Such owners merely communicate by phone to give some instructions. They are too busy to meet the veterinarian. When the dog is warded, they don't come to see the dog. Just too busy.

Of course, there are exceptions to this generalisation and stereo-typing. A look at the facial and body expressions of and talking to the owner one-on-one can foreshadow a not infallible perception of a litigious personality in many cases. If the vet knows what to look for.

It is best for the vet to refuse surgery and anaesthesia if he assesses the personality to be the litigious type as no good will come out of the vet's efforts dealing with cases with poor clinical outcome. In this case, the owners appeared to be quite kind and not litigious.

Death is not an option for potential litigious personalities. They know only how to complain to the veterinary authority or sue in the event of loss of their dog on the operating table.  Why should the vet take on such cases and spend much time and money in responding to litigation or veterinary investigation?