Toa Payoh Vets Clinical
Research Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures
CLOSED PYOMETRA
AND TOXAEMIA IN A
DOG
Dr Sing Kong Yuen,
BVMS (Glasgow), MRCVS
First written:
24 January, 2010
Script for Ms
Daphne Low
Start a new video,
with the following picture as a
hook:
Vaginal
discharge for the past 2 days.
Lots of sticky brownish-red blood.
The dog's gum and tongue were pale
and bluish in colour. There were
signs of toxaemia. "The
chances of survival is 50:50," I
said to the father and son. It
meant 50% chances of dying on the
operating table from the owner's
point of view. This was not good
enough. It ought to be 80%. There
was a loss of confidence. Should
they send the dog to a famous
veterinary surgery? "Well," I
said. "It is not the name of a
practice that is important for
your dog's survival. It is the
expertise of the vet surgeon. Do
you have the vet's name to
transfer the case to him or her?"
It is best for me not to handle a
case where the owner has a loss of
confidence in me.
Now,
introduce the title:
CLOSED PYOMETRA AND TOXAEMIA
IN A DOG
Then 2 text slides
Then the following slides
with narration and
appropriate timing
Pale and cyanotic gums and
tongue were confirmed by
blood tests of very low red
and white cell counts. Very
low platelets. This was a
very high anaesthetic case
and 50:50 chances
given were optimistic.
I don't operate immediately
although some vet surgery books
advised emergency surgery before
the uterus ruptured, spilling pus
into the abdomen and killing the
dog. The fever
had dropped 20 hours after
admission. IV drips and
antibiotics had been given. The
dog had a better chance of
survival now.
Note the one breast tumour.
I would not prolong
anaesthetic time in removing
this tumour at the same time
as ovario-hysterectomy.
The shorter the surgery, the
less risk of dying. What the
owner wanted was a dog alive
to go home and not passing
out dirty blood. Performance
was demanded.
Swollen uterus taken out.
Know what to do to complete
the surgery in <15 minutes.
I used the scalpel to nick
the suspensory ligament of the ovary
before clamping
3-forceps cranial to ovarian tissues. Double ligation
with 2/0 absorbable sutures
The ovary and the
uterine body were taken. I
repeated the procedure on
the other ovary
Three-forceps method
posterior to the uterine
body. Double ligation. The ovary and
uterus were removed. Stitching of
muscles and skin to be done
Cyanosis of tongue and
uterus near the end of
surgery. Respiration slowed.
The dog would die soon. What
to do? I terminated
Isoflurane anaesthesia
before completion of skin
stitches. Oxygen gas given
quickly
Dog's tongue changed colour
from cyanotic to pinkish.
She woke up after 5
minutes of oxygen. Owners
visited soon. They saw her
shivering but were happy to
see her alive
Swollen uterus is cystic and
contains mucus and pus. This
would be a case of closed
pyometra. This dog would die
at the completion of surgery
if signs of deepening
cyanosis were not reversed
promptly
Dog ate within 24 hours
after surgery. She
went home after 3 days
of nursing. Not all pyometra
cases have happy endings.
Vets are not Gods. Now, the
dog has is another problem.
The breast tumour. What
should be done?
CONCLUSION:
The vet must
conduct thorough
research to know what to
do to reduce the
anaesthetic risk and
produce a favourable outcome. The owner never
forgives or forgets when presented with a dead dog on the operating
table. Therefore, know what to do if you want to handle such
high-risk cases. If not,
pass the buck to others.
Deaths on the operating
table are highly emotional
scenarios and they are not
pleasant encounters with
many owners who expect
Vets to be Gods.
2 text slides to follow.
Then,
CREDITS
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0008
Written by: Dr Sing Kong
Yuen, BVMS (Glasgow), MRCVS
Narrated and video by: Ms Daphne
Low
Veterinary undergraduate, Sydney
University, Australia