tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   24 January, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

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

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written:  24 January, 2010

Script for Ms Daphne Low  
Start a new video, with the following picture as a hook:

Vaginal discharge for the past 2 days. Lots of sticky brownish-red blood. The dog's gum and tongue were pale and bluish in colour. There were signs of toxaemia.  "The chances of survival is 50:50," I said to the father and son. It meant 50% chances of dying on the operating table from the owner's point of view. This was not good enough. It ought to be 80%. There was a loss of confidence. Should they send the dog to a famous veterinary surgery? "Well," I said. "It is not the name of a practice that is important for your dog's survival. It is the expertise of the vet surgeon. Do you have the vet's name to transfer the case to him or her?" It is best for me not to handle a case where the owner has a loss of confidence in me.  
Now, introduce the title:
Then 2 text slides
Then the following slides with narration and appropriate timing  
Pale and cyanotic gums and tongue were confirmed by blood tests of very low red and white cell counts. Very low platelets. This was a very high anaesthetic case and  50:50 chances given were optimistic.
I don't operate immediately although some vet surgery books advised emergency surgery before the uterus ruptured, spilling pus into the abdomen and killing the dog. The fever had dropped 20 hours after admission. IV drips and antibiotics had been given. The dog had a better chance of survival now.
Note the one breast tumour. I would not prolong anaesthetic time in removing this tumour at the same time as ovario-hysterectomy.

The shorter the surgery, the less risk of dying. What the owner wanted was a dog alive to go home and not passing out dirty blood. Performance was demanded.
Swollen uterus taken out. Know what to do to complete the surgery in <15 minutes.
I used the scalpel to nick the suspensory ligament of the ovary before clamping
 3-forceps cranial to  ovarian tissues. Double ligation with 2/0 absorbable sutures
The  ovary and the  uterine body were taken. I repeated the procedure on the other ovary  
Three-forceps method  posterior to the uterine body. Double ligation. The ovary and uterus were removed. Stitching of muscles and skin to be done
Cyanosis of tongue and uterus near the end of surgery. Respiration slowed. The dog would die soon. What to do? I terminated Isoflurane anaesthesia before completion of skin stitches. Oxygen gas given quickly
Dog's tongue changed colour from cyanotic to pinkish. She  woke up after 5 minutes of oxygen. Owners visited soon. They saw her shivering but were happy to see her alive  
Swollen uterus is cystic and contains mucus and pus. This would be a case of closed pyometra. This dog would die at the completion of surgery if signs of deepening cyanosis were not reversed promptly  
Dog ate within 24 hours after surgery.  She went  home after 3 days of nursing. Not all pyometra cases have happy endings. Vets are not Gods. Now, the dog has is another problem. The breast tumour. What should be done?

The vet must
conduct thorough  research to know what to do to reduce the anaesthetic risk and produce a favourable outcome. The owner never forgives or forgets when presented with a dead dog on the operating table. Therefore, know what to do if you want to handle such high-risk cases. If not, pass the buck to others. Deaths on the operating table are highly emotional scenarios and they are not pleasant encounters with many owners who expect Vets to be Gods.  

2 text slides to follow. Then,
Be Kind To Pets
Veterinary Education
Project 2010-0008
Written by: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS  
  Narrated and video by: Ms Daphne Low
Veterinary undergraduate, Sydney University, Australia
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
More cases are at: Rabbits & Guinea Pigs

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