tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   15 July, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 3 Oct 2007
15 July, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Singapore is getting to be a litigious society. So, it is safer for a vet not to take risk putting a 14-year-old dog under general anaesthesia to perform a surgery. This dog was near the end of his life span. He was a bit on the plump side and would expect to live not more than 1 or 2 years as he had outlived his contemporaries.

Aural haematoma in a 14-year-old dog. Very risky patient. Toa Payoh Vets.He needed an operation to remove the blood clots inside his left ear. But he is past 91 years old if he is a man.

Barely able to see through his cataract eyes. Why should a vet risk his reputation for a $150 surgery and anaesthesia?

The second vet gave medical treatment but the dog was still shaking his head and scratching his left ear till the blood swelling under the skin turned bluish-black. As if he was irritated with a heavy appendage stuck in his left ear.

"Will the dog die on the operating table?" the owner asked. He and his wife, in their late fifties did not know what to do. 2 vets had advised against anaesthesia. This dog had not long to live as he was very old. But he could eat and do most things, except see clearly.

"Nobody knows," I said. "I will check his heart first." His heart was normal, surprisingly. Usually old canines have some heart problems.

"Do you want to take the risk?" I asked the couple. It was Hobson's choice for them.

"I will just use gas," I said. "No tranquiliser injections. This will at least be safer."

The couple was aware of the risk and gave their consent.

The old dog was given anaesthesia by gas mask. He fought hard wanting to bite.

"Take away the mask when he struggles," I spoke to the intern I was training. The intern was gripping hard and trying not to get bitten. The dog pawed the mask trying to get it off. A tranquilised dog would be much easier to anaesthesized.

But a tranquiliser and a gas anaesthetic might finish him off. Death is not an option when the vet undertakes this anaesthesia.

"Put at 8% gas first," I explained to the intern. I loved this 8% gas vaporiser which may be hard to find nowadays. It delivers a higher concentration of gas than the usual 5% vaporiser normally sold.

The old dog still struggled.

Groomer Mark was present and he talked to the dog in his usual soothing manner as he had this gift of dog communication. The dog relaxed. The gas mask was put onto his face. His eyeballs rotated downwards as he went into deep surgical anaesthesia.

"Reduce the gas to 1%" I said. This would minimise risk.

Mark clipped the hairs. It took some time. I washed the area. Started to incise the swelling to get the blood out. The dog flinched and moved. He made noises as if he was crying.

"Increase the gas to 8% for a minute," I said.

The variation of gas based on response is the best way to minimise risk. The surgery will take a longer time. The dog would wake up. Increase the gas and observe the eyelids blinking. Once there is no eyelid blinking, reduce the gas.

In this way, the dog was operated and recovered from several weeks of ear pain.

Death is not an option because family members badmouth and never forgive or go back to the vet once there is a death of a beloved companion. It is a sad fact of life. Litigation and complaint to the veterinary authority takes up so much time. It is foolish for a vet to undertake this old-dog anaesthesia. I don't look forward to it too.

P.S  Aural haematomas cause ear pain and discomfort to the dog. Surgery is required to open up the ear swelling to release the blood. Otherwise the dog keeps scratching his ear till it breaks down or shrinks after several weeks.

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Be Kind To Pets
Veterinary Education
Project 2010-0129
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