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SURGERY HOURS:
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*10 a.m - 5 p.m (Mon - Sun,
except Sat). Dr Sing Kong Yuen. By Appointment Only.
*6 p.m - 10 p.m (Mon - Fri). 10am - 5pm (Sat). Dr
Jason Teo. House-calls available.
Appointment preferred.
Tel: 6254-3326, 9668-6469 |
EMERGENCY
11 p.m to 6 a.m
Dr Teo
Tel: 9853-1315,
9668-6469, 6254-3326 |
judy@toapayohvets.com
Fax: +65 6256 0501 |
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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 |
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UMBILICAL
HERNIAS IN THE SHIH TZU
Case written: Mar 18,
2003
Case updated: Sep 20, 2008
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS. |
SOLUTIONS AND ADVICES
HERNIA
SURGERY IN THE SHIH TZU PUPPY
Hernias in the Shih Tzu Puppy -
Sharing the experiences of Dr Sing's interesting cases with the community of
pet lovers and dog breeders all over the world
BREEDERS: BE KIND TO PUPPIES - A puppy's life is
precious.
The puppy can't
talk but it feels the pain of the intestinal loops and
liver lobes
scraping the skin which becomes thinner.
The puppy eats less and becomes a
dwarf by week 12 and is unsellable.
In 99% of the surgical
cases, the normal puppy does not die from the anaesthesia or
surgery. Large hernias over 1-2 cm are best repaired as some
of them do split to become bigger. There is the possibility of
the intestines stuck inside the hernia being twisted and the puppy
dying consequently, especially if the hernia is large. |
Toa Payoh Vets - Dr Sing's advice to breeers - Recommended time to repair the large umbilical hernia is at 6 weeks of age.
Some puppies do not grow well if the hernia is not repaired.
However, general anaesthesia in puppies younger than 12 weeks
old is reported to be high risk.
Consult your vet for his or her advices as the anaesthesia is
high risk. Work closely and happily with your own vet in the
best interest of your pet.
In 2007/2008 there are rarely any cases of umbilical hernias
seen in the Shih Tzu as the breeder's get educated and don't
breed from affected lines.
The pictures in this webpage and its links were taken during the years of 2003 - 2006
when
Dr Sing's worked with some of the "biggest" professional dog breeders
in Singapore.
It was a fun time but very interesting and educational.
Altogether 7 cases of umbilical hernia repairs done by Dr Sing
are recorded in this webpage and its links.
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HERNIA
CASES IN DOGS IN SINGAPORE |
CASE 1.
The
breeder decided to repair the hernia as it would be difficult
to sell the puppy with such a large umbilical hernia.
The hernia extended to the rib cage. It was immense.
This gold and white Shih Tzu was operated at a young age as
any puppy over 12 weeks old are harder to sell since most
Singapore buyers seem to fall in love with young ones only and
don't mind paying a premium for younger puppies.
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CASE 2.
During the
spay, the owner can request that the small umbilical hernia to
be repaired. In the above Shih Tzu, the owner just wanted a spay
and no repair was done.
In any case, the hernia was a small one, less than 1 cm long
and usually would not be a problem in the dog.
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CASE 3.
Occasional breathing difficulty in this Shih Tzu puppy might
be due to the acute pain in the partially twisted intestinal
loops which had dropped into the big umbilical hernia. It
might be due to other reasons too. So, should the vet operate
or not?
If the operation was postponed and the puppy died of
intestinal blood vessel twisting and strangulation, it would
be the wrong decision. If the vet operated and the puppy died
on the operating table, the vet might be sued or blamed for
its demise. So, what would be your decision as an owner?
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CASE 4.
The Shih Tzu has a large belly button
"It is only six weeks old!" I said. "It is too young
to go under the operating table!" I pulled up
the Shih Tzu puppy and looked at his belly. A large
circular belly popped out from inside his abdomen.
Could I say "no" to Mr Formicelli?
Mr Formicelli wanted to me to repair the large
umbilical hernia in his Shih Tzu puppy. I was not
keen to operate such a young puppy as his liver was
not mature enough to metabolise the anaesthetic
drugs and he might then die.
Mr Formicelli knew the risk of death. He could delay
the surgery later but the hernia was really large.
There were more benefits of an early operation. The
puppy had more time to recover and would still be
attractive to buyers even two to four weeks later.
If he was operated at the 12th week as recommended
by most veterinarians, he would be much bigger and
less attractive to buyers at the 14th - 16th week.
It took about 2 - 4 weeks to recover.
Should I operate or not? The breeder was
willing to risk his puppy. Was I willing to risk my
professional reputation? The death of a puppy
stinks the reputation and I was not willing to do
the surgery.
I should focus on the welfare of this puppy. The
intestinal loops were visible under the thinned skin
of the hernia causing much pain to the puppy
(picture, right). Not as serious as another of Mr
Formicelli's case, but delays would lead to the same
situation.
"Is the puppy active and eating well for the past
two days?" I asked Mr Formicelli. The puppy looked
as plump as his two mates. Maybe slightly
smaller but not much difference yet. In another four
weeks, he would lose out in weight gain as he would
eat less as he feels the pain of the intestinal
loops and liver lobes rubbing against the skin.
The puppy looked healthy. It should be a good
anaesthetic patient. Now, when should the puppy be
operated on? Should it be eating 6 hours
before surgery?
His belly button was more than 8 cm wide and I could
see the intestinal loops impinging on the side.
There was no protective muscle layer under the skin
as in normal puppies. Somehow, the skin looked
paper-thin when there are no muscle and subcutaneous
fat layers below it.
Mr Formicelli wanted the surgery to be done. He was
a most successful dog breeder of years of
experience. He was successful in this business
of live animals because his puppies grew up plump
and healthy. They were marketable by week 8
and look much bigger than their contemporaries at
week ten. Puppies at 8 weeks old fetch a
premium and would be sold first compared to older
ones. He would make more money to sustain his high
cost of operations.
If the surgery enabled him to increase his revenue,
just get a vet whom he could trust to do a good job.
No more waiting till week 12 as recommended by the
professionals.
Shih Tzus with large umbilical hernias are rarely
seen in Singapore and I estimated one is seen in
1,000 puppies. A few of them have small umbilical
hernias of less than 2.5 cm diameter. This condition
seemed to be common in Shih Tzus compared to other
breeds.
"Umbilical hernias are present in brachycephalic
breeds only," Mr Formicelli stated. "Pugs and
Pekinese have such hernias. You don't see them in
Golden Retrievers and German Shepherds."
The Shih Tzu has a shorter nose and he considered it
brachycephalic which means "short head".
Actually, umbilical hernias are inherited.
I took the puppy back to the surgery at 10 am. I
operated on him at 4 pm so that his food would no
longer be in his stomach. His belly defect stretched
up to the liver lobes area. I could see the
chocolate brown liver lobes under the hole. A lot of
omental fat oozed out of the hole. Mr Formicelli
really knew how to rear his puppies to make them
fatter than the average ones you see in the pet
shop. I pushed back the fat, looked for the
right and left muscle layers far away from the
midline. I stitched the layers together. Around ten
stitches were placed.
It was nearly six o'clock when the surgery was
completed. It was a minimal anaesthetic routine.
When the puppy was moving, he was given more
anaesthetic gas. This took a longer time to operate
but was safer for the patient.
I rushed him back to Mr Formicelli's kennels. Mr
Formicelli had left the kennels for dinner.
He returned when he saw my car going to his kennels. I made sure
that the Shih Tzu was not sleeping in a cold windy kennel and
that Mr Formicelli gave him some food. The puppy was
a bit groggy. He had cried a few minutes in the car.
It must be the pain. But now, he was all
right.
The next morning, he was eating. Mr Formicelli felt that the wound would heal better
without the bandage. He had his magical special
wound spray from Taiwan. This spray reduced inflammation and killed
viruses and bacteria. And it seemed to work very
well as you can see from the picture of the 6-day
operation puppy below.
Six days later, his wound healed well and he was as
active as his two siblings. Mr Formicelli always recognised his puppies as
he inspected them every day, 7 days a week. He fed them and nursed them
when they fell sick.
The breeder looked at the 3 puppies. He really could not differentiate
the affected sibling from the
other two. The pup was now not thin or had poor weight
gain. He picked up the puppy on the extreme
left of the 3-puppy picture below for me to check on
its wound. No, it was the wrong party!
Where's the real McCoy?
The benefit of an early operation was that the puppy
had not experienced the internal pain of the
intestinal loops twisting and strangulating their
blood supply. The puppy would not be able to
complain,
but it would eat less and lose out to its siblings
in body weight gain. It would become a runt as
its growth rate dropped considerably. It would be
very hard to sell it.
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CASE 5 & 6.
Umbilical hernia repair in a 8-week-old Shih Tzu - 2
cases.
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CASE
7.
2003 umbilical hernia repair: A stitch in time
saves nine. |
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TOA
PAYOH VETS
