I hope the 2nd year vet student from Murdoch University learnt some anatomy from his  observation of this surgery and find his anatomy of the canine back area more alive and interesting.

Anatomy is such a dull subject in 2nd year as cadavers are life-less and blood-less. The Pekinese X Pomeranian was said to be 13 years old. The dog was being looked after by the mother.

The married daughter in her late thirties consulted a vet as her mother was worried about the dog being "constipated." She waited patiently and did not show an angry face as she sought a second opinion from me. A soft spoken and gentle serene looking woman.

The first vet treated the dog for constipation some 19 days ago. Yet the mother still complained about the dog having constipation. This dog had a full coat and the backside swelling was not obvious. Palpation of the abdomen was empty and so I declared confidently: "No constipation."
"Why does my mother complain about "constipation?" the daughter asked.

"My mum said that the dog had difficulty in pooping," the gentle lady repeated herself. So, something must be wrong.

Taking the rectal temperature is a routine in such cases though the dog had an excellent appetite. The dog "yee yee" as if he was in pain. A strong gas shot out from the rectum fouling the air when his anal sacs were expressed.

Abnormal behaviour.  Why would a dog fart so vigorously and loudly when he had no constipation?

So, I examined the anal region for wounds. As there was too much hair, the clipper shaved off the area.  The huge right perineal swelling manifested! There was also a small left perineal hernia! Inside the right swelling, hard faecal lumps could be felt. Fluid too. When pressed, the lump disappears and this impressed anybody as it was like magic - "Here now and gone with a press of the finger"

"Your dog has a perineal hernia," I said to the serene lady. "The rectum has diverted and turned into this swelling. So the dog had difficulty in pooping. Probably had some problems peeing if the bladder gets trapped inside this perineal hernia."

The sole complaint was constipation.

"What should I do? " the lady asked as I told her that the old dog also had heart disease. He might die on the operating table as the heart failed. It would be a long operation lasting more than 45 minutes.

"You have to take the anaesthetic risk," I said. "If the dog can't poop, he will also die a painful death as the stools jam up and the toxins accumulate in his body."

The lady decided on surgery the next day. It would be Chinese New Year's eve. The vet student would be coming in the afternoon at around 3 p.m and I wanted to bring anatomy alive for him. Perineal hernia repairs are rare occurrences and he might not see another one during his undergraduate years. I wanted to show him the canine backside anatomy in a live dog.

He had a dead dog in the University shared by 4 veterinary students to learn about anatomy in Murdoch University. But nothing can be so fascinating as a live demonstration, in my opinion. 

This was Chinese New Year's eve. A Golden Retriever with diarrhoea came in at 3 pm. The owner could not locate the Surgery although she was supposed to be in before 2.30 pm. So I could not operate at 3 pm.

I had the reunion dinner to attend at 6.30 pm and I did not want to be late as there is the "mingling of raw fish and vegetables" for good luck and every member of the family must be present to do it.

The dog was operated past 4 p.m. The two sides of the skin cut were retracted by forceps and the student saw a lot of blood tinged fluid and gel and some pieces of yellow fat on exposure. This fluid was drained.

I showed the student the muscles but I doubted he could see them or name them. I had briefed him the anatomy of the backside before the surgery using the text book.

He has an excellent photographic memory. But how to motivate a student about backside anatomy?

I pushed back the hernia sac into a big gap of over 10 cm long and 1.5 cm wide. "Pelvic diaphragm" I pointed to the muscle defect. I doubted he understood. The whole surgical area was a bloody red area.

"Do you know what a diaphragm is?" I asked him. He knew about the diaphragm which is a muscle separating the lungs from the stomach area. But hell, what is a pelvic diaphragm?

"These are the anal sphincter muscles" I pointed my forceps to the prominent encircling rings around the anus. These were visible to him. A large blob of fat floated out of the hernia. I removed it.

"Look, these are the coccygeal and internal obturator muscles. They are atrophied unlike the beautiful illustrations in the Vet Surgery book," I commented as I sutured the muscles. 

It would be some years before this young man will see another perineal hernia repair. The dog was able to poop without problems the next 3 days and sent home to save on veterinary boarding expenses.

I reminded the owner to keep the Elizabethan collar on as the dog was discharged without the collar. Small omissions from my personnel made me angry as the dog may lick and open up the big wound. Somehow the person seems to think that there is no need to use the e-collar. I empahsized to the lady that the dog had to be confined for at least 7 days. No jumping around.

Now, there is the left perineal hernia which seems to swell and disappear now and then. The owner had been informed.

I advised neutering the dog some time later as the male hormone seem to be a cause of the hernia formation according to the book. I don't know whether she would remember as she does not live with the dog.

I did not neuter the dog at the same time as I wanted to shorten the anaesthetic time so as to be successful in bringing out a live dog at the end of surgery. The perineal surgery took more than 45 minutes.

The dog was given 8% gas and then maintained at 2%. For a short while there was some movement and he was given 2.5%. Other than that anaesthesia was surprising smooth flowing as if the dog had a nice nap. Without tranquilisers given as I did not want the heart to be affected. No pain killers were given after surgery as these depress the breathing system too. This dog recovered the next day uneventfully.  

It was extremely kind of the daughter to take the time to bring her mother's  dog to the vet before it was too late. Before the dog collapsed and becomes toxic and so sickly that the anaesthetic risk increases from the 40% to zero percentage of survival on the operating table!

A gentle dog owner is always much appreciated by any veterinarian. Vets will encounter nasty litigious pushy ones who think that "customer is always right and their cash is the king". It is always pleasant to operate on the dog whose owner is "kind to the vets". 

No vet can have all gentle clients all the time! But this case was a pleasant and happy case and the dog did not die on the operating table. He went back to a happy aged mother who must have loved him very much as to pester the daughter to take him to the vet for further treatment after 19 days of "constipation." 

As for the young vet student, he has 3 more years to go. I hope he would be inspired to excel in veterinary anatomy in Murdoch University by studying hard and become a very good veterinarian.

UPDATE IN JUN 21, 2010. I have not seen the dog since the perineal hernia repair in 2008 and I presume that everything has been OK after the surgery.