Tuesday, September 30, 2014

1069. Amended C-section final script for video production - Phyllis Wong



Hook
VIDEO FOOTAGE CLIPS. Narrate by Phyllis according to the text below, whenever possible. Insert my voice if relevant and audible in some video footage.

Use Sub-headings and Edited Clips without the blurred footage whenever practical.







HOOK IS THE VIDEO OF C-SECTION

A PUPPY IS DELIVERED AT TOA PAYOH VETS BY DR DANIEL SING.
HE IS NOT MOVING OR CRYING AS EXPECTED. IS HE DEAD?



Give WARNING to viewers that the scenes may contain surgery.


Edited short video footage of C-section -- incision of skin, linea alba, uterine body at bifurcation, taking out the puppy, clamping umbilical cords with forceps, breaking down amniotic membranes and showing a "dead" puppy on the table.

Title / BKTP
WHAT IS THE BEST TIME TO DO TO AN ELECTIVE CAESAREAN SECTION? (Main heading. Bigger font on black background than sub-heading).






This is a case study of a 1-year old poodle, first-time dam, mated one time as witnessed by the owner 64 days ago. The gestational period is accurate as 64 days unlike most cases in which the owner is not sure about the first mating.

Image of “BKTP”. See blog
Intro
DEFINE C-SECTION (Sub-heading).
C-section can be emergency or elective. This is a case of elective C-section, meaning that the owner wanted a C-section at the most optimal timing based on his vet's recommendation.

The owner's first vet (Vet 1) had taken X-rays which were not clear and ultrasound which showed 3 puppies and foetal heart beats. However Vet 1 went on compassionate leave. His receptionist phoned to postpone the elective Caesarean section and had advised monitoring the drop in rectal temperature.
This postponement was unacceptable to the owner as he had monitored the rectal temperature. The rectal temperature had dropped to below 38 deg C.
 
 A TEMPERATURE DROP (Sub-heading)
The poodle's rectal temperature had dropped below 38 degree C, one day before consultation with Dr Sing. This indicated that birth was imminent but there were no signs of contraction.

Rectal temperature is only ONE of the signs of imminent birth 8 - 18 hours later, in around 80% of the bitches but this is not the sole indicator.
In relevant parts of the narrative, insert & subtitle

1. Video footage of consultation. As voices of discussion on the lowering of rectal temp is not audible, use sub-titles to summarise this discussion.




2. (VIDEO FOOTAGE OF EXAMINATION OF HEART, LUNGS, ABDOMEN ASUCULTATION FOR FOETAL HEART BEATS. 


Middle

 PRE-OP PHYSICAL EXAMINATION (Sub-heading)

The poodle was weighed, rectal temperature taken and examined (Video clip of poodle being given examination of the heart, lungs and abdomen with stethoscope)..

SYMMETRICAL ABDOMEN (Sub-heading). Image of poodle upsdie down). 



Dr Sing said that the poodle was unlikely to bear an odd number of puppies as stated in Vet 1's ultrasound of 3 puppies. From Dr Sing's experience with around 300 C-sections, he told the owner that the dam probably would likely have 4 puppies. 




PALPATION OF NIPPLES (Sub-heading) - no milk production. Dr Sing said that some first-time dams produce milk after C-section and oxytocin injections. So, this would not be a problem. But the owner had bought commercial milk for the puppies from the pet shop and was well prepared.


ANAESTHESIA and SURGERY (Sub-heading).

Relevant brief edited video footage already shown in the HOOK. .
.
The C-section was performed by Dr Daniel. Video shows briefly, gas mask, intubation, incision at bifurcation of uterine body, first puppy out, umbilical cord clamped and handed over to assistant.

BUT THE PUPPY WAS "DEAD" (Sub-heading). The other 3 neonates were similarly not moving or crying. What to do?




REVIVAL OF RESPIRATORY-DISTRESSED PUPPIES (Sub-heading). 

(In a frame, type in the following):
STEPS TO REVIVE THE DISTRESSED PUPPIES ARE AS FOLLOWS:
1. Dr Sing swings the puppy in an arc (show video) 5 times
2. Rub the neck skin vigorously with tissue paper with the puppy's head downwards
3. Pinch the neck skin to stimulate crying
4. Clear mucus from the mouth and nose with tissue paper after swinging
5. Repeat swinging when there is no crying or movement.

6. Blow into the puppy's nose and mouth to inflate the puppy's lungs as a last resort. This was not needed.


it took more than 10 minutes/pup. But after half an hour, the puppies cry (video footage of other parts to close this action video)



Video of anesthesia (mask and then endotracheal tube),

Ssurgical procedure (already in the hook but give a shortened version) 


Swinging of the neonates, rubbing of the neck, clearing of mucus from the nose, newborns upside down. Till the puppies cry.


You need to select relevant edited video clips and integrate with images 

Video to be in Part 1 and Part 2 of around 15 minutes max/video.

WARNING OF GLORY IMAGESConclusion

The use of lowering of rectal temperature as an indicator of imminent birth did not prevent the occurrence of distressed puppies in this case. The breeding date was reliable.

In retrospect, elective C-section in poodles and small breeds is best been performed at 62-63 days to get vigorous puppies without the need for intensive neonatal care.



TIPS AND ADVICES
The 4 main methods in predicting the birth of puppies in the bitch are:

1. BREEDING DATES

2. HORMONAL ASSAY
3. ULTRASOUND EXAMINATION
4. RADIOGAPHIC EXAMINATION

1. Breeding Dates. After the first mating, birth can occur from 57 - 72 days. Some text books give the guideline of 59-63 days. 
If elective C-section is performed too early, the neonates are not mature and will not survive.

In Dr Sing Kong Yuen's experience with around 300 C-sections of small breeds for professional dog breeders around 8 years ago , the best time for elective C-section of small breeds is 60-62 days from the date of first mating. This date must be accurate. 


These Singapore dog breeders had not wanted ultrasound or X-rays to lower production cost. They rely on breeding management. 







2. Hormonal Assay*
Estimate the time of LH (luteinising hormone) surge. LH peak is asssessed by monitoring serum progesterone levels every 12 hours. An accurate way to predict whelping as bitches reliably whelp 64-66 days post LH surge. Progesterone below 2ng/ml indicate imminent parturition within 18-36 hours.


This method is used only in breeders of expensive breeds. I know of a Thai breeder of British bulldogs using hormonal assay as each British bulldog exported to the U.K is worth a lot of money. In Singapore, this method is not available from the vets.


 




3. Ultrasound Examination*

The foetal heartbeat at 22-26 days was visible to the owner. Limb buds and foetal movement may be seen at 29-33 days.

Foetal heart rate: 200 beats/min (normal late pregnancy).
180 beats/min (foetal stress, ready for birth).
150 beats/min or below (foetal distress, urgent C-section to save the puppy).

Vet 1's ultrasound showed 3 puppies but 4 were delivered at C-section.







4. Radiographic Examination* at Vet 1. The X-rays were not clear and so the number of puppies could not be determined. If hormonal assay is done, the foetus can be seen on X-ray at 45-48 days post LH surge. The pelvis and 13 pairs of ribs are visible 9-13 days before birth. The scapula, humerus and femur are detectable 15-18 days before birth 




*Reference: Pregnancy Diagnosis and timing Elective C-Sectons by C.Scott Bailey, DVM, MS, DACT. 


CONCLUSION

The average veterinary practice in Singapore seldom perform elective C-sections. The rare well informed and educated Singapore owner researching the internet, expects only one outcome - live puppies to be delivered with the lowest medical costs.

Dogs are family members and their progeny is much more valued as babies by the younger generation.



It may be wise for the inexperienced vet to refer the owner to vets who performs more C-sections as this surgery and revival of distressed neonates takes up a lot of time. 




Video of Post-operative checkup, and slides of care after caesarean
Credits
CREDITS

Video done by:
Phyllis Wong

Producer:
Dr Sing Kong Yuen,
BVMS (Glasgow), MRCVS

Video software:
Windows Movie Maker

Toa Payoh Vets Oct 3, 2014

A Be Kind To Pets Veterinary Educational Video 
Veterinary Medicine & Surgery Come Alive to Vet Students and Pet Owners (Insert the following image)


For more information about elective C-sections, contact us at www.toapayohvets.com, tel 6254-3326, 9668-6469
For other educational videos, visit:
http://www.toapayohvets.com/videos.htm



TAIL DOCKING - SURGICAL TECHNIQUES

IS A SEPARATE VIDEO. Script at BLOG NO. 1494:
http://2010vets.blogspot.com.es/2014/09/1494-tail-docking-2-day-old-poodles.html. Adapt the narrative to include the surgical techniques. I will not be writing a full script.



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