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Date:   26 June, 2009  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.


tpvets_logo.jpg (2726 bytes)An intern learns how to bathe a puppy with diarrhoea. She needs to pony-tail her long hairs to do work.

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

Case 1. Do-It-Yourself Tail Docking
Case 2. Tail Amputation Using Electrosurgery

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: 28 November 2003
26 June, 2009

Case 1. Do-It-Yourself Tail Docking

Rottweiler 4 weeks old.  Rubber band strangulated tail 5 days ago. Tail dying. "Is it possible to amputate the Rottweiler's tail now?" Mr Alfonso asked as he showed me the deep strangulated wound near the 4-week-old puppy's anus. The coccygeal muscles showed through the gap between the yellowish white skin edges which are about to become gangrenous.

"How long was the rubber band used?" I asked.  Rubber bands are often used to dock tails of older puppies to save money and in many cases, most vets in Singapore don't want to perform tail docking. Therefore, the home-breeder had to resort to do-it-yourself. 

"5 days," Mr Alfonso replied. "My Rottweiler puppy has been licking this area for some time."

New skin edges cut in an attempt to stitch up Rottweiler's skin of tail"It is possible to cut off the tail," I said. "However, the skin stitches will not hold together, since the area is infected by bacteria and is full of bacteria toxins."  Mr Alfonso nodded his head.

I continued:  "Once the skin stitches break down, there will no more healthy skin to stitch. You will have to bear the responsibility for a big ugly hole in the tail for the rest of the dog's life. Will you accept this risk?"  

Mr Alfonso needed time to imagine the horrible complications.  Surprisingly, the puppy's rectal temperature was normal at 38.5 degrees Celsius.  I had asked Mr Rottweiler's dying skin edges stitched. Not much hope for healing.Alfonso to enter the operating room to see for himself the necrotic tissues of the tail so that he would understand that any skin repair surgery might be unsuccessful.

"I can try to stitch up the edges of the strangulation wound,"  I said. "Dying cells are white-yellow in colour and the skin is melting away. This area cannot heal properly. Do you still want the stitching to be done?"

What would be Mr Alfonso's response? He shook his head. He would not take the risk of tail amputation now. What was now the solution to this situation?  One solution was to stitch up the wound, using new skin edges.

He gave permission for tail skin to be stitched and a later surgery to dock the tail further away from the anal region. U Usually, the tail is docked at the area where the brown and black colours of the tail meet. This gives the Rottweiler some tail length.

At the present level, the Rottweiler would be tail-less as the rubber band had been placed too high up, too close to the anal area. I stitched up new skin edges as the puppy slept under general gas anaesthesia, unaware of the painful tail. 5 days later, skin stitches broke down. Tail end dying from loss of blood supply.

"You've got to pray that the puppy will not die," Nurse Ann said as she clasped her hands together and looked at the ceiling.  Nurse Ann was a devout Catholic. 

Puppies do die of infection subsequently although this one looked strong on the operating table. Nurse Ann had seen numerous puppy deaths over the years. Canine deaths happen in veterinary premises all over the world. 

I had advised that the puppy be kept in the surgery for a day or two for observation. However, Mr and Mrs Alfonso wanted the puppy home. There was no need to pray for divine help.

5 days later, the Rottweiler came with a shrivelled tail. Pus and hairs plastered the wound and all stitches had separated. As the puppy had been on antibiotics, the tissues and muscles were fresh red. No bacterial infection. I anaesthesized the puppy and removed the dying portion of the tail. A white coccygeal vertebral bone protruded from the exposed gap. There was insufficient skin to close this gap. What should I do?

Any stitching over the tail bone would definitely result in wound tension. The stitches would break down and there would not be a second chance.  Mr Alfonso would not be so happy. 

I had to get new skin further up. I cut off the protruding bone so that the new skin edges could cover.

I needed 14 days for the edges to heal strongly. Would there be infection and pain?  A painful puppy would try to rub its tail on anything to relieve the pain and the neck's Elizabeth collar will be ineffective.  The puppy was not much bothered. It had fever in the evening and recovered. It had a good appetite.

I asked his wife to care for the puppy at home to save further veterinary costs when she came to visit the puppy on day 3.  Low veterinary costs are much appreciated by pet owners all over the world.

The veterinary cost for two general anaesthesia and surgeries amounted to around $400.  A rubber band tail docking of an older puppy would not be costly but the puppy had to endure at least 10 days of a painful and infected tail while the tail dies from deprivation of blood supply and falls off. Some puppies may die from infections arising from the do-it-yourself tail docking.  In this case, the Rottweiler puppy was alive and that was most important to Mr Alfonso and his daughter. 

In 2003/2004, some vets in Singapore do not dock tails as they consider this surgery cruel. The animal rights activists have been asking for tail docking by veterinarians to be banned.

In the U.K, I believe that a law prohibits tail docking by any person other than veterinarians. Another law prohibits veterinarians from doing tail docking.  From the breeder's point of view, they have to do-it-yourself even if they don't want to! Recently, some Australian states appear to have banned tail docking and puppies such as the Doberman, imported to Singapore have long tails.   

Case 2. Tail Amputation Using Electrosurgery

In older dogs, the strict attention to prevent tail rubbing and  licking and prevention of bacterial infections must be adopted. Otherwise, there will be a big hole in the tale and a very unhappy owner.

Surgical procedure & post-surgical nursing
Tourniquet on tail using rubber bands. Use a marker pen to mark the skin incision lines.
The horizontal marker line in the upper part of the tail should be 1 cm more caudal (longer) than the lower part of the tail. A V-incision is cut, starting from the longer upper edge to
Tail Amputation requires close post-operation monitoring. Toa Payoh Vetsthe shorter lower edge when viewed laterally from the base of the tail.

Electroincision cuts off the skin and tail.

The dorsal incision should be 1 cm longer than the ventral incision so that the upper tail skin edge curls downwards and provides an excellent skin cover. If you incise perpendicularly, the skin edges do not heal well and there is a big ugly hairless bony stump seen later. Incise the tail bone at the joint so that there will not be remnants of tail vertebra which may become infected. I used a bone-cutter in this case to cut at the joint between the tail vertebra 1 cm cranial to the top skin edge.   

Electrocoagulation sealed all bleeders around the muscles of the tail. There was no bleeding seen.  I still ligated the major blood vessels with your absorbable sutures. However, by Day 3, there was accumulation of "blood". They were dead muscle cells and bleeding from the muscles (reddish brown liquid). These amounted to around 20 ml and were drained by pressing the tail stump. I checked the tail stump daily to ensure that the nurse had not overlook this important aspect of nursing.

Tail amputation wound on Day 10 heals well after intensive nursing care. Toa Payoh VetsBy Day 5, there was a small hole due to the drainage of dead cells. Antibiotic powder was applied. Antibiotics and pain-killers were given. The dog started to rub his tail on the floor of the crate. Mild sedation tablets were given. By Day 10, the dog was OK to go home for home nursing and to save on veterinary costs for the owner.

If the owner wants the dog back within a day of surgery (to save on veterinary costs), do not bother to do the surgery as the outcome will not be good for the dog or the vet as the owner would need to pay for resolution of a badly infected wound. Most owners don't know how to take care of the wound or the dog may not co-operate at home.

This surgery needs a lot of post-surgical veterinary nursing attention to prevent stitch breakdown. Despite pain killers,  the dog will try to lick the tail. An e-collar and mild sedation orally prevent licking but the dog can rub its tail hard on the surface of the floor to relieve his itchiness. Antibiotics are given for around 14 days.

It also needs the vet to provide strict supervision of the veterinary nurses as this category of surgery is rarely by vets in Singapore in 2009. Tail docking is considered cruelty to healthy dogs and vets discourage such cosmetic surgeries.

However, if the tail is injured and badly infected, tail amputation is the only option as the dog keeps biting the tail.  

In cases where the owner wants the dog back immediately after surgery, do not perform this surgery.  A big infected gaping hole with maggots in the tail will likely occur. This enables the unhappy owner to bad-mouth and disparage the veterinary surgeon who "could not do a good surgery."  Owners seldom blame themselves for poor nursing and many have high expectations of good surgical outcomes because they have paid for the services. Post-operation complications do arise if the owner insists on bringing the dog home early. They cost the owner more money to resolve the complications and many are just not happy to pay and pay.

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