36. The Shih Tzu likes to grip women's legs

"Come in," I asked the 2 classmates of the dog owner to be present for the dog's annual vaccination. My consultation room of 80 sq ft would be crowded with 4 people but it would be good to make the veterinary visit interesting for the friends as well.

3 teenaged girls of around 18 years of age, wearing dull brown uniforms. Matching the colour as the brown of the Shih Tzu and contrasted with their sun tanned faces.

"Have you paper-trained the Shih Tzu?" I asked the lady owner.

"I was not able to catch him peeing," the girl said. "I shouted "Kenny, Naughty boy!. But he run away quickly!

"It is best not to shout when the puppy is starting to eliminate," I said. "He gets startled and stops peeing." Many owners do shout, but it may not work.

"I put newspaper over the urine spot," the girl said. "White vinegar:water does not seem to be effective in neutralising the urine smell. He pees onto the wall often. On the same spots."

"As this dog is a male and grown up, he is not having toilet training problems. He is urine marking to mark his territorial limits," I said. "He probably grips people's legs as well."

"Yes," the owner said. "He clings onto my legs and even when I walk away, he just get dragged. He goes for women's legs only."



"What happens? Do the women scream?"

"He also jumps and grips my leg," one friend laughed.

"My sister and I will pull him away but his grip is strong."

"Why don't you neuter him as this anti-social behaviour can be solved if he is neutered early."

"But he will be gay," the girl said. The new generation is much against neutering. So strict obedience training of male dogs must be done early. However, there will be female or other family members not able to control the male dog's dominating and sexual behaviour.

A risky canine surgery

Seldom will you find a dog "crying" under deep general anesthesia. This Golden Retriever Cross just could not stop whinining continuously on the operating table. "Her...her...her..." non-stop. Was he having a nightmare or in great pain? Would
his heart stop beating when he stopped whining? Should I have waited for 10 days before operating?

He was not an ideal candidate for surgery as he had steroids which reduced his immune system for over 4 weeks. Now he had fever as well. The hard as 3 tennis balls' lump under his skin. The steroids and antibiotics for over a month from a veterinarian had not reduced the size of the subcutaneous lump. Red blood was drawn out from the lump. So, was it a haematoma or a form of fat cell tumour? How did it arise? Nobody knew. What to do with it now? The dog had antibiotics for so many weeks but now had a fever. Was it an infectious fever or the toxins of the lump causing fever?

I suspected it was toxins. So, it would be better to operate and remove the lump. Waiting for another ten days would not be good for this dog. But he was not the ideal candidate for surgery as he had fever.

A very hard decision. If the dog survived, everybody would be happy. The risks were higher than usual.

Back to this whining on the operating table. It was very rare for any deeply anaesthesized dog to make any noise. I cut a big 15-cm curved incision above his right shoulder. As short as possible. The dog did not feel the pain.

Yet he was whining away. More like crying for help. Lots of white hard lumps of cells and blood clotted tissues were taken out with my hands. Lots of bleeding. I estimated at least 1 litre of blood lost. But there was no turning back. I rather not do this type of surgery as the outcome is unpredictable.

The subcutaneous fat under the skin was 3 cm normal white oily cells. The connective tissues below were all red and black, hard clumps here and there. I felt with my fingers the left shoulder area to remove all. I did not want to make a bigger cut.





I removed most of the abnormal tissues. I could feel the spine of the right scapula (shoulder blade). Blood seeped out continuously. A large mass of blood vessels seemed to be stuck to the tissues was removed. More bleeding. Slow bleeding.

Would this dog die from haemorrhage?

An intravenous drip was given. The dog could not stand up for 24 hours after surgery unlike other dogs. On the 3rd day he went home. He slept a lot. On the 5th day after surgery, he could eat.

Wound maintenance at home was important. He had a good owner who had medical training --- in human teeth. He was very well cared for. So far on this day 5, he was starting to eat and scratching his wound. So far, so good.






Such challenging surgeries in dogs with a long period of steroids and fever are best not done as outcome is very unpredictable. Steroids lowered his immune system considerably. Antibiotics over a long period of time might or might not have been effective. The owner had stopped the medication. So, was this dog having a bacterial infection or toxaemia?

The vet has to make an instant judgment in the interest of the dog. Could the dog get worse if the surgery was delayed further? The owner had to be informed of the risk and understand. In this case, an antibiotic injection was given 12 hours before the surgery. It was unlikely that this dog could wait another 7 - 10 days for surgery as he was not eating much and had vomited earlier.

Normally, I don't perform such surgeries till the dog's conditions are stable and ideal. There are always exceptions to the norm.

34. Record Your "Seeing practice"

Seeing Practice

This article is written for a young man who wished to be a vet.


I may be mistaken, but this slim beginning Year 4 veterinary undergraduate from Murdoch University typifies the "obsessive to-be-thin to be attractive culture" of young adult girls. The thin no-fat body is reinforced by in the various slimming advertisements of Singapore's newspapers almost every day.

Kitty needed to "see practice" for 2 weeks before starting Year 4 at Murdoch University. 4th year will be the most demanding stressful year. Real clinical and surgical work. Crash course compared to the honeymoon years of Year 1 and 2. It is a pity that the University could not spread out the clinical years of common surgeries to Year 2 and 3 so that the lectures become "alive" before the student goes to Year 4. I may stand corrected as I am out of touch with the undergraduate teaching.

"Castration, now called neutering of the male dog is a common surgery," I said. "Do you know the closed and open techniques?"

It was not a fair question as she had not started Year 4.

"I will demonstrate gas mask anaesthesia, but the vet must be extra vigilant. Endotracheal intubation to deliver anaesthestic gas is the preferred method for brachycephalic breed because oxygen can be given directly to the lungs via the endotracheal tube in an anaesthetic emergency.

"I will show you the 2 methods of neutering - the closed and open techniques," I said.

I might as well speak Greek to her.

Kitty put the face mask onto the tranquilised Shih Tzu. After a brief struggle at 8% gas anesthesia, he was anaesthesized. The gas was kept at 2%.

"When the anaesthesia is stable, you can hear the dog snoring loudly," I said. "The brachycepahlic (short nosed) breed has a regular snoring sound. This means that the anaesthesia is not too deep or too light."

The Shih Tzu was breathing as Kitty could see the rebreathing bag moving. But there was no sound. She put her head onto the chest of the dog. The only sound was the whirl of the air conditioner.

Was the anaesthesia too deep?

"Touch the eyelids with your fingers," I said. Kitty put one finger onto the eyelids.

"The eyes did not blink," Kitty said.

"See the eyeball's sclera (eye white). Is it rolled downwards so that you see more of the sclera?"

"Yes," Kitty said.

"Reduce the anaesthesia to 1%," I advised. Still no snoring. The dog was all right as his tongue colour was reddish, as seen through the transparent cover of the gas mask.

I started surgery. The open technique involved opening the sheath and separating the cremaster muscle from the spermatic cord. "One disadvantage is the slight bleeding from the cutting of the cremaster muscle," I showed her the clot."

Then I used the closed technique which involved tying up the whole sheath.




For brachycephalic breeds, monitoring the dog during the period immediately after surgery and ending of anaesthesia is important. Many have difficulty in breathing. Sure enough, this Shih Tzu's tongue turned purplish blue.

What to do?

"Pull the dog up by the hind legs with your hand. Pull out the tongue and massage the chest to stimulate the heart beating with the dog upside down," I advised.

I demonstrated. Kitty might need some weight training. The dog appeared too heavy.

What to do?

"Squat down. Put the dog onto your lap, with the head downwards and tongue pulled out and massage the chest."

This must be her first time. She squeezed the chest with the palm of her hand, but there was no breathing sound from the dog. It was important that the student gets hands-on experience when seeing practice. That was why she had to do things to gain the necessary experience.

The dog was not in danger at any time.

"Ok, stand up," I put Kitty out of her misery. "Put the dog on the operating table."

I showed her how to give cardiac massage. The dog gave a loud rasping breathing sound every 3 time I massaged the chest. The tongue took some time to change to a pinker colour. Kitty waited till the dog stood up before putting him into the cage.

"Don't you record your seeing practice experiences?" I asked Kitty. "When I saw practice in Scotland 30 years ago, I scribbled on small notebooks. In the end I had so many books!

"Now, the internet generation has the blog. It is so much easier to read the journal in a blog than for me to go through the hundreds of small books to refer to the cases."

Veterinary students in Murdoch University see practice with practising veterinarians from the beginning of the 4th year. But you should "see practice" as early as the first year so that the lectures comes "alive." However, you must record your experiences in a journal, so that you can refresh your memory and understand in depth when you go into the 4th and final years. Otherwise, when you see practice as an observer, you do not retain much information and skills. Nobody will tell you to record your "seeing practice" experiences.

32. An allergic reaction after Christmas

Jan 2 2006 is still a public holiday in Singapore.
Common cases would be diarrhoea and vomiting, due to the excess of the holiday season. This case of possible allergy could also be due to the feeding or use of some thing related to the festive season. Only the dog knows.

This dog had a very bad ear infection 12 months ago. He recovered. Put on home-cooked food. Well cared for by the maid. The owner (a keen golfer and karoke singer)entrusted her with the dog care. She did use ear drops but not thoroughly. Anal glands were impacted with copious yellow fluid.

But this dog is very itchy. Circular wound on right elbow and on the inside of the tail end. This could be due to the intense body itch. Scratches his ear when taken out to take a photo.



What is the problem? An allergy. As he was on home-cooked food for the past 12 months without problems, it is unlikely to be a commercial food allergy. The owner denied that he got any Christmas food treats.

The ears were clean, with just some brown wax and hairs. So, what causes this allergy? If only the dog can talk.