No guarantee surgery

"I will never send my dogs to these two veterinary surgeries," Mr Formichelli said suddenly in the midst of my tour of his new kennels on a fine weekday morning with sea breezes and bright blue sky. I was getting out of the ivory tower of long hours at my surgery, to see what's happening with the outside dog world and whether there were any new government regulations and diseases affecting puppies. I had no dealing with Mr Formichelli. 

"The vets there tell the owners of the dogs with parvoviral infection never to buy dogs from me!"  I was shocked at his outburst as he explained that 30 parvoviral infections in 300 puppies cannot be considered bad. Puppies were imported from Australia and sourced locally. Inevitably, there would be viral infections and sometimes a large number of puppy deaths.
 
"The vets do not want the owners to suffer from sadness and loss of money." I explained. "I think they are usually new graduates who are idealistic."

"More unrealistic, you mean? Don't the vets like more business?" Groomer Ken asked. He was a marketing man although he was not a degree holder. He considers bad mouthing of pet dealers by vets as a wrong strategy as they should co operate with each other, being synergistic rather than antagonistic.

"The more parvoviral infected puppies, the more money to be made? These vets must be the ones not designated by the pet dealer to vaccinate his puppies."

I remembered "There was a vet who recommended euthanasia for all chronic or poor chances of recovery from diseases, thinking of saving the owners money from protracted treatments." In the end, some owners say that it would be best not to consult him as it meant putting the dog down.

Groomer Ken remember another vet. "He is very experienced and has lots of cases. His consultation will mean scolding if the owner has delayed in seeking treatment and the pet has hepatitis. Owners pay him to get scolded!" 

I better not comment further as the pet dealer was so angry. There was so much to appreciate in the clear blue sky and salty smell of the sea breezes.  Mr Formichelli's puppy cages were well positioned for the breezes to sweep away any smell or viral build up as they were not fully enclosed in air conditioned rooms like his competitors.  Air conditioned air accumulates viruses.

Suddenly too, the busy pet dealer pointed to a Cocker Spaniel puppy with a cherry eye and asked me to treat it. The "cherry eye" is a gland of the third eyelid which is present at the corner of the eye.  Normally, it is not visible. Some breeds like the cocker spaniels, bulldogs, beagles, bloodhounds, Lhasa apsos, and Shih Tzus, usually less than one year old, are affected.
occurs. Once the gland prolapses from the eyelid, it is exposed on the surface of the eye and becomes red, inflamed and swollen. 

Mr Formichelli knew that topical steroids and antibiotics would not solve the problem. The nictitans gland produces around 40% of the eye tears.  To remove or surgically reposition the nictitans gland? Removal may result in dry eye (keratoconjuncitivitis sicca).   In 5- 20% of the cases, the gland can prolapse after repositioning and requires a second surgery which may be harder as there will be scar tissues or removal.  This means more costs to the pet dealer or owner.  

Despite surgery, dry eye may develop later in life if damage occurs to all of the main tear glands (lacrimal glands) which produce around 60% of the tears. This damage is usually associated with an immune system dysfunction and its occurrence cannot be predicted.   

When a patient has dry eye, or a lack of the watery layer of the tears, the oil and mucus layer production is increased. The dog shows a thick, sticky greenish discharge. When the cornea is deprived of oxygen and food through the tear film, it deteriorates and there will be brown pigmentation, scar tissue growth, blood vessel growth and even ulcer development. The dog will not see clearly. 
The 3rd eyelid at the corner of the eye has a nictitans gland which produces around 40% of the tears. When it is loose from the connective tissues, it drops out, becomes inflamed and enlarged. It then blocks tear flow into the nose.    The day after surgical removal of the nictitans gland. Much less tear staining.

Left untreated, the  prolapsed gland becomes inflamed, cause eye tearing and obstruct
vision.

Under anaesthesia, the nictitans gland is grasped by forceps. Forceps clamp at its base to reduce bleeding. As little of the gland as possible is cut off as it is involved in tear production.. The gland is around 1 cm in diameter and a soft mass of tissue. Curved scissors for eye surgery are best for this surgery.
Day 2 after surgery. Antibiotic eye ointment is applied twice per day for 3 days. The nictitans gland is normal in the right eye. It has a T-shaped piece of cartilage in it and is  anchored to the tissues of the eye socket by ligaments. Some dogs
are born with weak ligaments, which allow the gland to pop out of its normal position and look like a pink roundish object in the inside corner of the eye.
What is the best treatment for this four-month old Cocker Spaniel puppy?

Ideally, I should re-position the nictitans gland inside the third eyelid and suture it. It is much more difficult and time consuming and costly to the pet dealer. There will be sore gland and tearing for the next seven days.  There is no guarantee of success and the gland may pop out again. The alternative is to cut it off. So, which procedure should I perform?

What is best for the dog may not be viable for the pet dealer.

The cost of the re-positioning surgery and a second surgery is more than the five hundred dollars he wished to sell the puppy. He might as well euthanase the puppy. He could not be a successful pet dealer if he had to be sentimental.

All young lives are precious. I decided to remove the nictitans glands. At least the puppy would still be alive and I  hope he would find a new owner during the weekend when over a hundred Singaporeans flock to this pet shop with a wide range of breeds.
Eye tumour left eye, dry eye right eye. Shih Tzu 13-year-old Singapore

Old dogs usually have heart problems. It is really risky to put them under anaesthesia as they may die. Yet, if the vet does not remove the tumour, the dog scratches at it and suffers a poor quality of life. 



Eye tumour left eye, dry eye right eye. Shih Tzu 13-year-old SingaporeMany old dogs have dry eyes as the tear glands stop the production of watery tears. There are drugs. Consult Your Vet promptly.