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      Date:   06 June, 2010  
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Open pyometra in an old Chihuahua
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
D
ate:  06 June, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
"Today may be the last day you will see your Chihuahua alive," I said. "She has heart disease and had one episode of heart failure during anaesthesia two years ago during dental scaling. She may die on the operating table."

Pyometra, fever, heart disease & old dog. Very High Anaesthestic Risk. Toa Payoh Vets.The dog needed to be revived during dental scaling. I had advised the quiet lady that the dog should not take "further general anaesthesia". I had noted this in my case record. Two years had passed and the dog now had pyometra.

Today, Friday Sep 26, 2008 was the day the Chihuahua was to be operated. She had antibiotics from me for the last 5 days and had seen Vet 1 six days ago. Pyometra was also diagnosed by Vet 1 who advised surgery and gave antibiotics and oral painkillers.

Antibiotics given some 3 weeks ago worked to stop the vaginal discharge. The owner was advised to get the dog spayed after one month. But at the end of 10 days of antibiotics, more "liver-coloured" vaginal discharge flowed continually. The dog had no appetite and needed hand feeding. She was losing weight and now had a fever. Therefore she was high anaesthetic risk. A type of case I would prefer to pass to other vets. Passing the buck saves a lot of explanations and unpleasantness.

Anaesthetic deaths are so unpleasant events as vets get the blame. Newspapers loved to sensationalise the case too. There was a recent case of a Jack Russell that died on the operating table after being admitted for spay and dental scaling.  A veterinarian's "stop at 8" spay policy. 3 case studies

I had not read this report but one complaint in the newspapers was that the vet still charged his fee even though the dog had died. No delivery of a satisfactory, therefore no payment. Not many Singapore owners are like that but there will be one.

Pyometra. High white blood cell count. Fever. Anorexia 2 weeks. 8-year-old Chihuahua female. Toa Payoh VetsI had spoken to the quiet lady and her husband for some time on the 2nd recurrence of vaginal discharge 5 days ago after cessation of antibiotics and the emergency visit to Vet 1. Sep 8, 2008 was the first consultation ---A veterinarian's "stop at 8" spay policy. 3 case studies

Now, the problem was to determine when was the optimal time to operate such that the dog would not die on the operating table?

It was hard to define exactly. I advised that once the dirty and sticky vaginal flow ceased, the dog should be operated. The time was 5 days after antibiotics.

So the dog was here now. She has fever. Still would not eat by herself and had lost 0.3 kg during the past 2 weeks. She still looked alert.

"I will wait at the surgery," the quiet lady said.

"It is best you go home," I said. "Waiting at the surgery is very stressful for me in such situations of high risk anaesthesia. I need to focus on the dog surgery and if you are hanging around, the atmosphere is very tense."

The lady went home. She might be seeing her pet alive for the last time. There was no way I could be less frank. "Do your best," the husband phoned some 30 minutes later to enquire about the dog but I had not operated yet. His wife was very upset at the thought of the dog not being able to be alive from general anaesthesia.

Anaesthesia and Surgery of this high risk anaesthetic case.


1. Dextrose saline 200 ml SC, antibiotics and anti-fever injections given.
2. Pre-operation shaving and washing of operation done. Let the dog rest for some minutes.
3. Gas mask anaesthesia starting at 5%. Reduce to 1.5% after intubation. The dog was too light as she moved. Increase to 2% but not more and wait to stabilize.
4. Incise 2 cm from umbilical scar. Make incision 2 - 3cm caudally. Hook up left uterine horn which could be seen easily from this bigger incision. I used the scalpel to cut the tight ovarian ligament. Ligate ovarian blood vessel. Take out the right uterine horn and repeat same procedure. Get the uterine body out. 3-clamp method. Ligate below clamp 3 after clamping the horn. Ligate the crushed area after removing clamp 3. This meant that there would be two ligations.
5. Reduce gas to 0.5% to effect. Stitched linea alba. The dog reacted to pain. Increase to 2%. Reduced to 1% to effect.
6. Reduced gas to 0.5% when the skin incision is stitched. Switched off gas at the 2nd last skin incision.
7. Dog woke up without crying, as if from a deep sleep, after the placement of the last skin stitch.
8. Placed dog in a quiet cage. The cyanotic tongue was not a good sign. This dog did not have sufficient haemoglobin in her red blood cells according to a blood test some 3 weeks ago.
9. The owner took the dog home some 1 hour after surgery. She could care for the dog better at home.

Surgery can be shorter if one follows the Formula One procedures. A team where each person handles a specific task when the sports car comes to the pit stop.

In this case, my assistant focused on the anaesthesia. He would pinch the dog's foot to assess the presence or absence of the pedal reflex, checked the tongue colour and eyelid blinking. He ensured the minimal use of gas.

I focused on completing the surgery as fast as Hamilton completed his laps to win the race in Singapore. His competitor was Massey while mine was the death devil.  

Another assistant held the forceps to lift up the ovaries for me while I ligate to speed up work.

In this case, the dog's heart did not fail and she recovered and went home. If she survived the next 48 hours, she should be regaining her appetite after the toxic womb had been removed and should live a long time as her care was excellent. As for her tartar in her canine and other teeth, I dared not suggest any dental scaling or did any scaling after the removal of the womb. I don't advise such procedures although it does save money for the owner. The shorter the anaesthesia, the better the outcome.

What the owner wants is a live dog at the end of anaesthesia. Pets are family and anaesthetic deaths are not an option.

If the vet cannot deliver, there will be much sorrow on the part of the caregiver of the pet. Some family members might create unpleasantness for the veterinarian. Tabloids and internet forums love such sensationalism. 

 

UPDATE IN JUNE 2010
Nearly two years have passed.  The beloved Chihuahua had one breast tumour excised one year ago. There was no recurrence. She eats well and is active.  I saw her in June 2010 because she had generalised ringworm. The lady had applied anti-fungal cream as prescribed by Vet 1 onto the diseased areas but more scratching occurred under the neck.
 
generalised ringworm, chihuahua, singapore, toapayohvets generalised ringworm, chihuahua, singapore, toapayohvets
Cream darkens ringworm spots Neck has two new ringworm areas

"You have no choice but to get the coat clipped very short," I said. "The whole body hair has been infected. Use an anti-fungal wash and oral medication for 20 days after the groomer had clipped the dog bald."

Anti-fungal cream is ineffective in a dog whose whole body is infested by fungus. Consult your vet promptly.

Angkor Wat, Cambodia. toa payoh vetsBE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER.  More case studies, goto:  Cats  or  Dogs

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Be Kind To Pets
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