She had a very high fever of 39.9 deg C two days before surgery. She was
not eating and had vomited a few times. Her abdomen was distended, as if
she was pregnant. She had passed "watery pinkish blood" in her vagina in
small amounts. I was consulted again because the bitch was not
eating for 5 days and had been vomiting.
The diagnosis was pyometra, an infection of the womb. The
recommendation was surgery to remove the womb as soon as the bitch was
stabilised with fluid therapy some six hours later.
"Doc,
are you sure you have the correct diagnosis just by touching her?"
Mr Lim was incredulous. "Just by using the fingers and palm of your
left hand to press the abdomen back to front? And you know what's
the problem with my mum's Silkie Terrier?"
"If you don't mind paying more money, around $200 more, there is the blood
test, the ultra scan and the X-rays to confirm the diagnosis of pyometra,"
I suggested, being used to such questioning.
"Or you can seek a second opinion from another veterinary surgeon, but you
have to do it immediately as your bitch is very sick."
Dog owners are more sophisticated nowadays and they ask many questions but
they are not willing to pay more for laboratory and other tests. In
2004,
Singapore was again mired in retrenchments and cost-cutting after the Severe
Acute Respiratory Syndrome (SARS) outbreak.
Every second counted in this case. I advised further: "If the bitch
is not operated, she will die soon. If she is operated, she may die
during or after the surgery."
The surgery was a simple operation, but the very poor health of the
patient made it a very high risk anaesthesia and surgical procedure.
Mr Lim was uncomfortable with the thought of death of his mother's best
friend and asked: "What are her chances of survival?"
"About 10% of survival after surgery in this case," I estimated.
Mr Lim frowned and wrinkled his fore head. 10% meant the dog had a very
low chance of survival.
To operate or not to? It was Hobson's choice for the dog owner.
Mr
Lim authorised the surgery to be performed. Two large uterine horns filled
with creamy yellow pus were removed. The ovaries were also removed.
Now, 20 hours after surgery, the Silkie Terrier was lethargic. She
ate a little, but that was not good enough to give her a good chance of
survival. She was not vomiting and that was a good sign.
I offered some food to her. She suddenly snapped at my fingers.
This was a "dangerous" dog. It was a good sign that she was more
active. However, it would be difficult to feed her the nutritious food
after surgery.
It was better that the family brought home the bitch to nurse her. "The
bitch used to growl at everyone when she first came to my residence," Mrs
Lim said. "She just does not like anyone to touch her mouth. She would
accept food from my hand." |
Would this Silkie Terrier recover better at home? If not, Mrs Lim would
still spend time with her rather than let the bitch die away from her
owners.
The Silkie Terrier just sat on her chest and looked at the family. She did
not wag her tail unlike yesterday when the family visited her five hours
after the surgery.
The family was not sure that the Silkie Terrier should go home as she
might not be receiving treatment.
"I have given the necessary treatment," I said. "She might be depressed
here as she associated me with the pain of surgery. She could be a "manja"
dog."
The family members looked at me blankly. What is a "manja" dog? Manja in
the Malay language means "seeking and loving attention".
Some small breeds will eat only if hand fed by the owner. They are so
intelligent that they know that if they stop eating for 2 days, the owner
will buy a different brand of food or offer other types of food to feed
them. Such dogs may starve if they stay away from the home for a few
days and I was not going to risk this happening.
"Take the Silkie Terrier out of the cage," I said. "Put her outside on the
grass."
The Silkie Terrier passed urine, walked a bit and stood still. Well,
at least she looked better. She was bundled with a towel and went
home with Mrs Lim.
A large family of 7 adults came to see her on this Christmas Day. The dog
sat in the front seat with Mrs Lim and the driver while the others hopped
onto the back of the lorry on this gloomy day.
Would she survive the next two days? I hope I would be proven wrong. It
was a miracle that this Silkie did not die on the
operating table as the owners had delayed seeking
veterinary treatment for a long time.
NOTES:
1. Vaginal discharge of a sticky type or bluish reddish colour over 10
days may be a sign of pyometra. The bitch usually cleans herself up and
you may not see the discharge. Do consult your veterinarian soon if
you spot any. High fever, vomiting and pyometra mean that the bitch
has poorer chances of survival. as in this case.
2. CLOSED PYOMETRA. The pus accumulates and swells the womb. There is
little vaginal discharge seen, as in this case. In OPEN PYOMETRA, the
vaginal discharge is copious and the observant owner may see the sticky
yellow or reddish stains on the floor or sleeping area.
3. Spaying of this bitch means the surgical removal of the womb and
the ovaries. This would have prevented the development of
pyometra in this Silkie. However, not every un-spayed bitch would develop
pyometra.
4. Hobson's choice
means a choice without an alternative; the thing offered or nothing.
"Hobson's choice" is said to have had its origin in the name of one Thomas
Hobson at Cambridge, England. He kept a livery stable and required every
customer to take either the horse nearest the stable door or none at all.
|
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