52. When to get a Caesarean section for your dog?

May 31, 2016

VIDEO CLIP AS HOOK     1:52 TO 3:42 CLIP USED

HOOK

If a person is in the wrong place and at the wrong time, he or she may be killed by a murderer.  Similarly for a pregnant dog that need a Caesarean section. If the breeder cannot find the vet in time or has delayed seeking timely treatment, the puppies will be dead. .   

BE KIND TO PETS VETERINARY EDUCATIONAL VIDEO - WHEN SHOULD A DOG GET A CAESAREAN SECTION

 This video provides some guidelines for your dog to go for a Caesarean section, based on more than 200 Caesarean sections for dog breeders in Singapore, performed by Dr Sing Kong Yuen over the past 10 years

1. NO SECOND PUP FOR 2 HOURS.  By the time the breeder reaches the veterinary surgery, 3 to 4 hours will have passed as in this Dachshund case. (Video clip above). 

The first pup was born naturally. The breeder waited for around 3 hours.  He reached Toa Payoh Vets 3-4 hours after the first pup was born.  Emergency Caesarean got him 2 distressed but live pups out. They were not crying loudly within 1 minute as in normal pups. All 3 passed away in the first 7 days. As to the cause of the deaths, it is hard to determine. The dam may not be in good health.




 


2. APPEARANCE OF THE WATER BAG OR GREEN VAGINAL DISCHARGE.  Do not wait any longer.

3. TOO MANY PUPPIES. OVER 4 PUPPIES IN SMALL BREEDS. An elective  Caesarean section for Chihuahua and Yorkshire Terriers saves lives as the dam will be too weak to contract. Delay leads to death of puppies.

A video is shown

4. CERTAIN BREEDS like English Bulldogs need Caeasarean section as their pelvis is too narrow for natural birth.

5.  EXPERIENCED VET will take a shorter time to operate and hence produce better outcome.

6.  59-63 DAYS.  According to some reports, the pups are formed at 59th - 63rd day of pregnancy.

7. NO UTERINE CONTRACTIONS AT THE 60TH DAY but there is milk and rectal temperature drop and rise within the last 12 hours. Take rectal temperature 3 hourly.

8. SINGLE PUP SYNDROME in some small breeds like the Chihuahua. Get an elective Caesarean section done by the 63rd day as the pup grows too big.

CONCLUSION

In Singapore, there are very few home breeders nowadays as compared to 10 years ago. Professional dog breeders are housed in a designated area in Pasir Ris and Seletar and much of the guidelines are for the professional dog breeder. However, NO two dogs in needing emergency or elective Caesarean section are alike. Much depends on the breeder's experience and judgment.





CREDITS

----


ACTUAL VIDEO PRODUCED. Intern Clara to use the 8 reasons for getting a Caesarean section and apply images or case study to substantiate the reasons. .

51. Follow up: May 23, 2016 visit to the breeder's farm - to see the 3 Caesarean patients ------ a Corgi and 2 Yorkshire Terriers

May 23, 2016
Today, I visited the breeder to check on the Corgi that had an emergency Caesarean section. 2 well developed puppies were delivered alive but one with the full-collar was much distressed and passed away. 

The dam had difficulty giving birth. This was the dam that the other vet had delivered 8 dead pups by Caesarean section and the breeder was not happy with the loss. The breeder claimed that this vet had used IV sedation before giving the gas. The sedatives killed the puppies.

For my Caesarean sections, I used only isoflurane gas + oxygen and all normal healthy puppies come out vigorous and crying loudly.

The Corgi dam was healthy and barking away as shown in the video.  Her surviving pup was given to the Cavalier King Charles dam to nurse. The King Charles had delivered naturally 2 puppies and so she was able to support the Corgi pup.


 

At the same time, I viewed the two Yorkshire Terrier dams I had performed Caesarean sections. The pups were thriving. One pup of one dam had suckled so much and became gigantic, being twice the size of the other pups.  The videos will show what I mean.

50. A 16-year-old Shih Tzu had a badly infected swollen left eye. Enucleation or exenteration?

May 29, 2016

Yesterday, the young lady brought her 16-year-old Shih Tzu for a review of the left eye operated by me as she said that the stitches were still there.


"These are absorbable stitches," I had told her that they will dissolve in around 30 days from the date of stitching and it was now 27 days on this sunny blue-sky May 28, 2016 morning. She would be free on Saturday and spared the time to take the dog in for me to review. The knots were still there but when I touched them, they fell off with the granulation tissues. The eyelid wound had healed very well.

This 16-year-old Shih Tzu had a left swollen badly infected eyeball and the owner took the dog to Vet 1 who advised enucleation as the only option.  Enucleation was my 2nd opinion. However, the dog was very old and the owner had to give informed consent. The surgery would need to be short so that anaesthetic death risk would be lower.

An old vet has the benefit of years of experience to operate speedily without compromising on accuracy and completeness of surgery.  All vets will reach this stage when they age. As this dog was so old, I decided to operate myself as speed is of the essence.

Now, this oldie may also have eye cancer but it would be very expensive to do all the necessary tests. He may not have eye cancer for the swollen left eye. The swollen eyeball could be due to the high intra-ocular pressure of glaucoma and infections inside the eyeball.

A judgment call is needed. To enucleate, that is to remove just the eyeball. To exenterate, that is to remove the eyeball and eye socket contents which is a more involved and bloody operation. Most vets would just do enucleation and be done with it.

What is this old companion had eye cancer cells inside the eye socket? Enucleation will not remove the cancer. So, I decided on exenteration which is deemed harder to do. I used electro-surgery. I ligated the optic stalk.  I electro-excised the eye socket contents. Surprisingly, there was not a drop of blood after taking out all the eye socket content electrically. I got the 3rd eyelid out too. Then I excised a 3 mm wide strip from the upper and lower eyelid margins, creating two incised wounds which are then stitched up. At the last stitch, I filled the eye socket with eye ointment.

Post op nursing by the owners were excellent as we kept in touch by WhatsApp images. There was some bleeding at home. There were lots of care by the owners, cleaning and feeding the dog patiently - the mother and daughter.

Now, 27 days later, the dog's left eye wound has healed very well and so there is a happy ending as post-op death and infections could have occurred, leading to unhappiness. I am grateful for the happy ending as I prefer not to operate on high risk cases.

   

49. Cloacal impaction in a red-eared slider

May 27, 2016

Not eating 4 days. Came at 9.30 am. X rays showed obstruction of cloaca. After extraction of over 50 stones and one broken egg shell by Dr Daniel, the terrapin felt good. She ate more than 30 pellets at 6.30 pm (see video).

 The terrapin has recovered her appetite. See video.





--------------------------------------------------------------------

She had egg binding earlier. I noted stones and pebbles inside her gut and informed the owner to remove all stones from the tank. But those inside the gut passed out and obstruct the cloaca, leading to difficulty in urination and pooping. So the terrapin stopped eating for 4 days from today, May 27, 2016 (see above images). 

48. A 13-year-old female Jack Russell passes brownish-red blood - X-rays of uterus

May 25, 2016

Many old female dogs that have not been spayed develop pus in their uterus. This 13-year-old Jack Russell had "white sticky" vaginal discharge for the past 5 days. Today, it is brownish red. The abdomen is swollen. I could palpate swollen uterine horns around 3 cm in diameter. Closed pyometra is the diagnosis confirmed by X-rays.

"It is open pyometra," my assistant Julia said to me.
"It is closed pyometra at first. The cervix was closed but later, the cervix opened a bit, discharging some pus.  The strict definition of closed pyometra means no vaginal discharge, but in this case, the disease progressed. The cervix had opened a bit, letting out some pus. X-rays show that the uterine horns are packed to the gills with pus and so my diagosis is closed pyometra initially. In open pyometra, the female dog passes pus without the uterus being so swollen.

In any case, this is a very high-risk anaesthesia for surgery. Spaying is the solution. No drugs can help this old dog.

"She had never been sick for the past 13 years," the owner said.
The dog was stabilised with 2 bottles of IV drip and antibiotics. She was operated 6 hours later and went home.

47. The breeder waited over 3 hours before seeking an emergency Caesarean section for his Dachshund

May 24, 2016

The breeder blamed me for the 2 inactive puppies delivered by an emergency Caesarean section today as I had used too much anaesthetic gas.  The puppies were delivered very quickly and they were alive when handed to him. They were still alive but not the vigorous crying types as seen in timely Caesarean section as in his Yorkshire Terrier with 3 puppies (another video).


The 3 pups occupied the right uterine horn only. All 3 jammed in a row. The first one came out with difficulty. The breeder had injected oxytocin 0.3 ml IV as I saw some hair clipped from the dam's right forearm and a needle prick.

"Be speedy," he requested. More like in desperation as he had suffered losses yesterday in the Maltese caesarean section with one dead smelly premature pup. He had asked for discount as there was the dead pup. It is difficult to deal with breeders who don't think that a vet has very high  overheads in Singapore. He had used many other vets who would do Caesarean sections for only $500 or less but I charged 3 times more regardless of the time and day or night or the number of puppies.

The dam's abdomen overfilled with clear perionteal fluid. A previous vet had done a C-section as evident by the long scar. The dorsal side of the uterine horn had scar about to burst as some areas were stretched. This vet had made a long incision and exteriorized the whole uterus. For me, I incised a small cut and incised the ventral aspect of the uterine horn. In this case, there was a weak scar on the horn from a previous surgery. I cut on the lower side of the right uterine horn, around 5 cm long and took out the horn and then the 2 pups jammed tightly in this overstretched horn. The first pup born naturally had also lived in this right horn and so there was really a big obstruction causing peritoneal effusion. The left horn was empty and not swollen, indicating no pups had attached there.

I used isoflurane gas only and maintained the dam at around 1-2% instead of 2.5 to 3% to effect.
The dam was definitely stressed too as evident by the difficulty in giving birth to 3 big pups. The breeder expected a live dam and pups and he got what was expected.

But the 2 pups were not active as they had been stressed by the more than 3-hour-delay. So, they do not cry loudly within 1 minute of delivery unlike the Yorkshire with 3 puppies I delivered by caesarean last week for the same breeder. (video)

   

In Caesarean section, the vet's reputation is at risk. If the dam and pups are alive at the end of the operation, the breeder is happy. If not, he may seek another vet.

46. A 9-year-old Shih Tzu passes blood at the end of urination. Why?

May 24, 2016

"Why did this 9-year-old male, not neutered Shih Tzu pass blood only at the end of urination?" the owner wanted to know.
"The causes are varied and could be bladder stones, tumour or infection."

X-rays show a spherical mass in the bladder or it could be the thickened walled bladder.

More test need to be done.

45. A Corgi has uterine inertia

May 19, 2016

ELECTIVE CAESAREAN SECTION

Around six months ago, the breeder said that the first vet did a Caesaean section on this Corgi and 8 pups were delivered dead. So he never went back to the practice again as he deemed the vet incompetent in causing him to lose $40,000 worth of sales. "The vet must have given the IV sedation, killing all 8 puppies," he declared and no excuses were acceptable to him.  

Now the 62nd-day pregnant Corgi had weak contractions and the breeder wanted an elective Caesarean section at 9 am.

2 pups delivered alive and given to the breeder. 1/2 died during during revival. It is very difficult for the breeder to know the optimal time for the Caesarean section.  If done at 7 am, this dead distressed pup might be alive.

 

"At least no pup died during Caesarean section," I told Dr Daniel. "Otherwise, I would be blamed. The pup did die of respiratory distress and the breeder blamed his Myanmar assistant for not being able to revive the puppy! That pup had a full collar and was most valuable unlike the other pup."

FOLLOW UP:

On May 23, 2016, I visited the breeder farm. The pup was fostered to a Cavalier King Charles and was thriving. See the video of the 4-day-old pup with the foster mother.  The Corgi dam was housed in a separate crate and was hale and hearty, with excellent appetite. She barked at me and looked very bright. It was wonderful to see the thriving puppies of the two Yorkshire terriers I had done Caesarean section. New lives, new beginnings and new day.  

  

44. How long it takes to do a Caesaean section - case studies

23.4.16
Yorkshire 59th day
5 active pups
Cry within 5 minutes
Elective C-section

No induction drugs
Isoflurane gas only

Gas first given:  
Completion of skin stitching: 

43. How to slim down the overweight Japanese Spitz

Sunday May 16, 2016

This 2-year-old spayed Japanese Spitz came for vaccination. She was much loved and the groomer bathed her every week. Hence her white coat which is appreciated by every passer by during her walk outdoors.

I had advised Science Diet r/d solely but the owner continued to feed home food and treats.  Hence, no weight loss!

I taught the owner how to use the r/d depending on weight to be achieved. 3 months later, she would be slimmer and healthier.

42. A 2-year-old cat passes pus - pyometra

Saturday May 14, 2015

Short thunderstorm and overcast skies. Dr Daniel operated on a pyometra cat which is a rare condition of cats in Singapore. Most home cats are spayed as their noisy caterwauling disturbs neighbours at night. Around 80% of Singaporeans live in apartments and this noise nuisance can cause bad relationships with neighbours. Some think that the female cat had been abused and hence screamed so loudly in the middle of the night.

This cat had passed pus in the vagina. The first vet was phoned but no consultation was made. The cat was brought to the second vet. An ultrasound showed either pyometra or mucometra. A quotation of $1,800 for the surgery was made with hospitalisation of $400 per day, according to the owner. She was advised to find a more "affordable" vet by the second vet. 

The cat was spayed by Dr Daniel at Toa Payoh Vets. It is best to check out the prices before sending the cat to emergency vets as prices can be very high.



 

 

41. The wrapped Yorkshire puppy is saved by an elective Caesarean section

Friday  May 13, 2016

The breeder has a heavy responsibility to decide on whether to go for elective Caesarean section. He would tell me that it is better to do before midnight as it may be too late. So he phoned me 2 days ago to stand by as he preferred me to do it. 6 months ago, a young vet in another practice delivered 8 dead Corgis by Caesarean section and he never went back to the practice. So he preferred an old vet with experience and I had to do it. 

Case of the wrapped around puppy

May 13, 2016  5pm
Yorkshire Terrier, 3.6 kg, T=38C. No panting or contraction
61st day. Full of milk.  T=37.1 this morning and so at 38C, this means the time is right for C-section as the temperature will drop and then go up, indicating the correct timing.

"5 puppies," the Myanmar assistant guessed. The Yorkshire certainly looked heavily pregnant.
A: Injection of induction drugs:  NA
B: Isoflurane gas firs given   5:15pm
C  Isoflurane gas stopped   6.16 pm
D: First skin incision: 5.41 pm
E: Completion of skin stitching  6:16 pm


E-D= 35 minutes to perform the surgery with the breeder taking care of the 3 puppies.
E-B = 1 hour for the whole process.   3 vigorous puppies and a happy satisfied breeder








CONCLUSION
The first pup had been wrapped around by the placenta and so I gave the whole pup to the breeder. The other 2 pups had the umbilical cords.

40. Follow up on a 15-year-old cat that had bladder stone removed

May 12, 2016

The 15-year-old cat had calcium oxalate stone in the bladder (blog written) on 11.1.2016 according to the Minesota Urolith Centre, USA. According to NUH Department of Laboratory Medicine, the stone has chemical composition of calcium oxalate and magnesium phosphate too.

The cat is OK now. I did advise canned food, but the cat now eats dry. I did advise urine test every 3 months but very rarely do Singaporean owners comply. 6-monthly X-rays for stones is advised but never complied with. 

Today I sms the owner regarding the cat and type of food eaten. She replied:

"She is not really eating much wet food lately. Mostly dry kibbles."

39. An 8-year-old Sheltie has a Sertolic cell testicular tumour

March 13, 2016

It is well documented that undescended testicle can develop into a cancerous testicle in old age. For dogs, 7 years and above is considered old.  Some vets do not remove the undescended abdominal testes for some reasons and will remove only those under the inguinal skin. Some Singapore owners believe it is cruel to neuter the male dog and so will not get retained testes removed.

In this case, the 8-year-old Sheltie was not neutered. He has a descended right testes and a left testes inside the abdomen. The abdominal testes become cancerous.The first vet advises removal before it becomes rotten and cause infections leading to death. The owner got the surgery done at Toa Payoh Vets.

ULTRASOUND

X RAYS

SURGERY - ABDOMINAL CRYPTORCHID NEUTER

HISTOLOGY
The owner did not want histology.  It looks like a Sertoli cell tumour