533. Break a leg? Break a ear?

"Break a leg" is used to mean "Good Luck" to a theatre performer. You don't say "good luck" to a theatre performer. Well, in two sibling hamsters I operated upon, I was surprised that I had to "break a leg" and "break a ear" literally!

See pictures below.

"Break a leg" is used to mean "Good Luck" to a theatre performer. You don't say "good luck" to a theatre performer. Well, in the two sibling hamsters I operated upon recently, I was reminded of the theatrical term "break a leg". Well, I really had to break a leg to save her life. Her sibling with foul smelly ear? I had to "break a ear" literally to save her life! Their lady owner now has no more worry lines since the two squeaky hamsters have behaved normally now and one does not have body odour anymore

See pictures of my follow-up of two sibling hamsters operated 14 days ago and reported in My 3 dwarf hamsters post-operation as follows:

BREAK A LEG

14 days ago, an explosive bony growth on her left hind leg



Leg amputation surgery



BREAK A EAR

14 days ago, bad body odour
Ear canal ablation surgery



4415- 4423. Two older sibling hamsters are normal and active 14 days after surgery. A much earlier veterinary treatment would have saved a lot of worries and reduced risks. But Singaporeans live in a hectic world and it is difficult to advise "early detection saves lives"! It so happens that there are two happy endings for the siblings. It is not a given that hamsters will survive the anaesthesias and handling surgical stresses.

More pictures are at:
http://www.sinpets.com/hamsters/20110808dwarf-hamster-break-a-leg-a-ear-Singapore-ToaPayohVets.htm

532. My 3 dwarf hamster post-operation follow up

Surprisingly, I got two phone calls regarding 3 dwarf hamsters this Monday morning Jul 25, 2011 after the hamsters had survived a high-risk surgery and had gone home for over 2 days.

1. Hamster 1 and 2, Female, 2 years old. The lady owner phoned up. Day 3 of surgery. Hamster 2 (amputee) attempted to bite stitches. What to do? Plaster? Not practical.
Hamster 1 - Ear canal ablation. Hamster eating. Objected strongly to cleaning off blood from ear. So done once only. Advised to do more cleaning. Isoflurane gas anaesthesia only but very stressful ear canal removal. Took 2 days to recover.


The ear canal was full of white "sand" particles as well as tumours (irritation due to sand?), pus and dead cells






Hamster 1. A rare ear canal ablation surgery completed in this dwarf hamster. This surgery is common in the dog. See: The "reasonable" man test in a court of law
Hamster 2 (amputee). The lady owner confirmed that the leg tumour was only 5 mm diameter 6 weeks ago. "Like a face pimple," she said. But it grew furiously big to 1.5 cm. I had to amputate the leg above the knee. The hamster started exercise wheeling. 30 g before surgery. After surgery, her weight was 19 g. There was a lot of blood loss









Hamster 2 - The leg had to be amputated as the tumour involved the bone below the knee and above the hock.

Feedback from owner who noted the following.
1. Lowered water bottle. Can't drink as only one hind leg.
2. Food bowl too high now. Hard to climb out. Use bowl from those used in Chinese household for chilli and soya sauce. A bit of spillage but hamster could eat.
3. Tempted with favourite bean sprouts. Then give baytril oral.
This hamster needed sedation IM. First day, one drop Zoletil 50 IM. No effect. Just looked at me. So, suspend all operation till 24 hours later. 2nd day, 3 drops OK. Leg bone tumour extended to inguinal. Amputated. Quite active within 1 hour.

Advices
No exercise wheel. Stitches quite many. Blue nylon 5/0
Continue on paper litter. Not so rough. But hamsters loved to shred them.

2. Hamster 3 - 81 g. Operated to remove two large breast tumours.
She loves bread and so the wife fed her more bread. She put on lots of weight. An average dwarf hamster weighs around 30-40 g. I doubt she could survive the anaesthesia and surgery. But she proved me wrong.






spleen seen




4326 - 4336. Surgery itself does have complications sometimes. The spleen pops out unexpectedly!  
Hamster 3. The two large breast tumours were excised. The spleen came out from the abdomen but was put back. The abdominal defect was stitched. The hamster survived as at Day 14 after surgery.
The husband rushed down to the Surgery. Two 5/0 nylon stitches bitten off today on Day 8. Bleeding. Wife phoned. OK at clinic. No bleeding. Cut off two entangled nylon stitches. 1 remaining. The husband did not want it cut off. To observe. To reduce weight further. 79 g now. The tangled transparent 5/0 nylon stitches were taken out

Feedback, fully active and normal on Day 3 but would eat after operation. Daily exercise on wheel. Owner quite happy.


Pictures and details are at:
http://www.sinpets.com/F5/20110733three-hamster-surgery-follow-up-Singapore-ToaPayohVets.htm

531. A 14-year-old Chihuahua has a big breast tumour - IV anaesthesia

It is a difficult decision for the mother and daughter when the beloved 14-year-old Chihuahua had a big breast tumour. To operate and risk her dying on the operating table from anaesthesia or not to operate?

Or just wait and see. But the tumour on the left side of the mammary area had grown bigger. The other tumour on the right side had been excised by me just 2 months ago. The Chihuahua had survived the anaesthesia. Now, another tumour had popped up.

They came on a Saturday morning. Dr Jason Teo was on duty as I don't work on Saturdays. I happened to pop into the Surgery to check on a dwarf hamster with a very itchy face and they saw me. As the dog had eaten, Dr Teo could not operate on the same day and so I scheduled to operate on Sunday after the owners were well advised. "Must sign the form," Dr Teo reminded me quietly. This is the informed consent for surgery. I didn't ask them to sign a form although my associate vets do. I usually speak at length on the dangers of anaesthesia to make sure the owners are aware of what they are doing. Their pet may die under anaesthesia and will not be alive once they go to the operating room. Many times they understand. Some don't want to proceed with the surgery and go home.

Much depends on trust built up over the years but getting the owners to sign an informed consent for surgery and anaesthesia is wise and is practised by surgeons in the Singapore hospitals. To avoid nasty allegations of not being informed of the risks and alternative options by unhappy owners.

So, on a fine Sunday morning of July 31, 2011, I operated with much fear of anaesthetic death for this old companion who would be having her 3rd anaesthesia in 3 months. The second one was for the swollen right breast. The same one. Brown liquid dripped out from the nipple of this breast and the whole length of 5 cm was swollen. Antibiotics were taken and now the breast tumour had consolidated.

This time I used IV anaesthesia. Just sufficient to last for the surgery of less than 30 minutes and no more dosage. Just what is an adequate dosage of domitor and ketamine for IV anaesthesia for a very old dog? This is based on intuition and experience.

I have a domitor and ketamine IV dosage chart on my operating room cabinet which I refer to. This chart is shown in this webpage for the benefit of vets who need an alternative to isoflurane and oxygen anaesthesia.

MY CHART HAS THIS GUIDELINE
DOSAGE OF DOMITOR AND KETAMINE FOR A NORMAL HEALTHY YOUNG DOG 10 KG
FOR 30 MINUTES OF SURGERY

DOSAGE GUIDELINE
CALCULATED DOSAGE
10 kg, healthy young dog
Domitor 0.4 ml. Ketamine 0.5 ml = 0.9 ml in one syringe IV. No need isoflurane gas top up.
This Chihuahua is 4 kg. If she is young and healthy, the formula should be: Domitor around 0.15 ml + Ketamine 0.20 ml IV = 0.35 ml

DOSAGE GIVEN

Very old dog. Dosage should be much reduced. I gave the following much lower dosage:
Domitor 0.05 ml + Ketamine 0.15 ml = 0.20 ml in one syringe to be given via IV drip. I gave atropine 0.3 ml IM.

This formula worked effectively as it gave me around 30 minutes of surgical anaesthesia. The dog lifted her head just as I completed the last stitch. But she was drowsy. So, I gave her the antidote, Antisedan IM. She woke up within 2 minutes as fresh as a daisy. She went home 2 hours later. As the daughter now is an adult, she paid the bill. "No need to do histopathology if you don't want to," I said so as to reduce her cost. I had not asked for blood test. She did not want histopathology this time. The first time, the right breast grape-like tumours were benign adenomas and the blood test were normal for this old dog.



IV drip is advised for long surgeries. Domitor + Ketamine IV at the correct dosage and in healthy dogs give excellent analgesia without the need of isoflurane gas top up. Some countries may have difficulties getting isoflurane vaporisers and isoflurane and IV anaesthesia is an alternative option






Drowsy but is awake at the last stitch
Antisedan injection wakes the dog up fast
Surgery record for knowledge management
Although spayed dogs are said not to get breast tumours, there are a few that will get breast tumours after spay. There are some reports saying that female dogs spayed at less than one year of age will have lower chances of getting breast tumours but I don't find any scientific research to substantiate this. When was this dog spayed as I did not think it was done by me.

"When was this dog spayed?" I asked the daughter who has blossomed into a handsome looking tall lady.

"When I was in JC (junior college)," she put a finger on her chin to think. "It would be in 1998. She was 5 years old. Now, she is 14 years old. 8 years sure had breezed by and gone with the wind. The daughter now becomes the paymaster and the mother must listen to her. Still both bore the responsibility of giving the informed consent. The mum wanted me to operate although Dr Teo would be able to do it. So, that was how I landed with a surgery on a bright Sunday morning. It was a happy ending. But the more I do such risky surgeries, the more the minefields of deaths on the operating table will be stepped on.

So, I will prefer my younger associate vets to shoulder the heavy responsibilities of difficult surgeries and high-risk ones. That is the advantage of team work. There is just no escaping from the jaws of deaths for high-risk surgeries. It is a matter of statistics and probability when more of such cases are done.


updates and more images at:
http://www.sinpets.com/F5/20110806domitor-ketamine-dosage-Singapore-ToaPayohVets.htm

530. A dodgy doggy story from a flamboyant lady - Part 1

"I just can't believe her story," I said to my REA (Real Estate Agency) classmate, Mr Chua as we went into the subway train to go back to Novena after visiting another classmate at her office.
"She has no reasons to lie," he replied.
"No reasons at all," I said. "I mean that what she said was incredible. It is an unbelievable doggy story."
"A dodgy story," Mr Chua said.

Well, it was a fine Tuesday August 2, 2011 afternoon when we met up for lunch. A Caucasian agent who was marketing overseas properties, introduced to us by our REA lecturer met us for lunch to present his business. He had to take the REA examination although he does not sell or deal with Singapore properties and so that was how we met.

My lady classmate came late. "The most flamboyant lady in the class is here!" Mr Chua announced. I just can't understand why he said that. She was not offended nor make any comments.

Why did he say she was flamboyant? What does it mean? I googled "flamboyant" now. It said: "Being too showy or ornate, gaudy, flashy". This fair lady in her late 30s does dress up well. Today she was in plain grey with flowery high heels. I remember her as having well dressed in class in high quality clothing material and sporting tinted brownish red hair and showing red painted nail accessories. A bit on the big side. She was friendly and easy to converse. If flamboyance can make one stand out and be successful as well, you may also want to be flamboyant as she was certainly one of those successful estate agents with an office in downtown Singapore.

When she heard that I am a vet, my flamboyant classmate would consult me about her Siberian Husky getting thinner and thinner during lunch as she sat to my right at this oily Korean hotplate restaurant in Novena. "One day, my car had broken down. So I rented another," she said. "My Husky would howl all night long. The next morning, I wanted to drive the car to work. He would tug at my skirt," she said as she pulled her lower half of her grey dress outwards with her right hand. "He just would not permit me to get into the car."

"Do you think that the dog can see some spirits inside the car?" I tried to frighten her with demons and devils. "Once you drive the car, you will be possessed."

"I don't know," she said. "My dog just would not let his grip off my dress."

"Dogs have been known to warn their owners of impending dangers," I said. There was a story of a dog warning a Japanese lady of the impending tsunami wave and got her to move to higher ground. She was saved by her dog's action. So, was this a case of the dog sensing danger? A supernatural spirit or worse?

"So, did you brush away your dog?" I asked.
"No," she said. "I got the rental company to change the car."
"What happened after that?" I asked.
"My husky was just quiet and did not bother with me."
"Was there any bad odour or smell in the first car?" I asked. "A smell of blood from somebody who had died in the car? A smell masked by perfume? A fishy smell?

"Come to think of it," my classmate said. "There was a smell." She could not describe it.

Well, she is alive today and that was thanks to this dog she rescued from being abused by the previous owner.

And so, that was the end of the incredible doggy story, I thought. I asked Mr Chua to visit her office with me. To see a success story as she had an office in downtown Singapore. No realtor without success would open an office in this area.
Must be expensive, being downtown.

My classmate left first as she had to pick up a Japanese expatriate to buy condos. I could imagine her zooming in her 2-seater Maserati with this Japanese prospect in keeping up with her true image of success as a realtor. A lady realtor who knows Japanese, Mandarin and English plus flamboyance and high energy is a man-killer. The equivalent of the femme fatale. Backed up by protective canine spirits. Far fetched? Wait till you read her second incredible doggy story later in this article.

She had made time to network with us as the organiser had invited her to attend the lunch. She was not present during our first celebration lunch meeting. As she rushed off, I made an appointment to visit her. She said 4 pm and at 4 pm, Mr Chua and I were there. I hate being late for an appointment and so did Mr Chua. Mr Chua wanted to drink coffee badly but I told him to wait. Why pay for coffee when our flamboyant classmate has Nespresso coffee in her office? I don't drink coffee much but I know George Clooney was the face of Nespresso and therefore it must be good if one is susceptible to such advertisement. In any case, Nespresso is not cheap and therefore cannot be bad quality coffee. "Have you heard of George Clooney? He is the face of Nespresso in some advertisements." I asked Mr Chua who is a self-employed chemical trader. "No," he said.

So, we went to the office at 4 pm and had the Nespresso. That was where our classmate narrated her second doggy story. Being a vet, I get to hear doggy stories of the other parties but this second story was way beyond belief. I will continue in another time as it is 8.03 am and I have to go to work.

528. House-training a 6-week-old puppy in a Singapore apartment

Thank you for your email. Pl see reply in CAPITAL LETTERS below.

On Mon, Aug 1, 2011 at 10:24 AM, ...@gmail.com> wrote:

Dear Dr. Sing,

I have a 6 week old Japanese spitz puppy since 27th July, and have her for 5 days. I understand that 6 weeks is still to young for us to bring her back, but the Breeder, Uncle ...., allowed us to bring her back saying it's ok (Now i'm feel regretful for bring her back so early in her development.

I've attach a photo of the method you have been teaching for housebreaking in the apartment.

Her schedule is as follows: 7.30am - First Meal, 1pm - Second Meal, 7.30pm - Last Meal (All on eagle pro puppy kibble and mix a teaspoon of jerhigh can meat)
Playing time is 7 - 7.30pm

She has access to water for the whole day except after 7pm.

Her schedule is as follows: 7.30am - First Meal, 1pm - Second Meal, 7.30pm - Last Meal (All on eagle pro puppy kibble and mix a teaspoon of jerhigh can meat)
She has access to water for the whole morning except after 7pm.

Whenever she has an accident (Poo/Pee) outside of the pee tray, we clean the entire grate with vinegar and water (1:3)

Questions
1. She can pee and poo on the pee tray 50% of the time, and sleep on the right side of the cage. Is this the correct procedure?
YES. IT IS ONLY 5 DAYS. THE PUPPY WILL NEED TIME TO ADJUST TO THE PEE TRAY WHICH "FEELS" DIFFERENT FROM HER PREVIOUS GRATE (ASSUMING THE BREEDER USES METALLIC FLOOR GRATE WHILE YOURS IS PLASTIC HOLES).
MOST SINGAPORE BREEDERS AND PET SHOPS USE THE METALLIC FLOOR GRATE WITH A PEE PAN BELOW. WHEN THEY SELL YOU THE PUPPY, YOU SWITCH TO THE BETTER LOOKING PLASTIC PEE PAN. THE PUPPY NEEDS TO GET USED TO THE NEW FLOORING.


2. Can we still praise her for being calm and quiet while she's in the grate?
GRATE REFERS TO THE PEE PAN. CRATE REFERS TO CAGE. IF SHE IS CALM AND QUIET IN THE CRATE, SHE MAY MISTAKE YOUR PRAISE FOR WANTING SOME ACTION FROM HER.

3. Her pooping and pee-ing timing has been very irregular, and it is very hard for us to catch her in the act in order for us to praise her. What ca we do about it?
TOO MUCH ATTENTION FROM FAMILY MEMBERS AND THE ADULTS TO THE PUPPY DURING FEEDING AND ONE HOUR AFTER FEEDING. THIS DISTRACTION CAUSES IRREGULAR POOPING. PEEING WILL BE HARDER TO CONTROL AS THE PUPPY AT THIS AGE PEES A LOT OF TIMES.

IF YOU DON'T DISTRACT THE PUPPY WITHIN ONE HOUR AFTER FEEDING, IT WILL POOP WITHIN 15 MINUTES GENERALLY. THERE ARE EXCEPTIONS. DISTRACTIONS INCLUDE CHILDREN, PARENTS AND YOU WANTING TO PLAY WITH THE PUPPY AFTER HIS MEAL INSTEAD OF LEAVING HER ALONE. SO SHE DOES NOT POOP ALL AT ONE TIME AND YOU SEE "ACCIDENTS" INSIDE THE CRATE.

CATCHING HER IN THE ACT MAY NOT BE POSSIBLE IF THERE ARE TOO MANY DISTRACTIONS. THIS WILL TAKE PATIENCE AND TIME.


4. She has been constantly nipping our hands and wanting to chew on our hands, and we're still trying to correct it, are there any advice for this behaviour?
GIVE COMMAND 'NO BITING' IN A FIRM TONE JUST AS SHE NIPS OR CHEW. SOME WRITERS ADVISE 'GRIPPING THE MUZZLE' WHILE SAYING 'NO BITING' AS AN EFFECTIVE METHOD. OTHERS SAY NOT TO SCREAM WHEN NIPPED TO DISCOURAGE ATTENTION-SEEKING. MUCH DEPENDS ON YOU.

REWARD WITH TREATS AND PRAISE FOR OBEDIENCE. THIS TAKES PATIENCE AND TIME AND CERTAINLY NOT WITHIN 7 DAYS OF PURCHASE.


5. For Play time, i only allow her to have supervised play in the kitchen with the door close, is this ok?
A BABY GATE OR FENCING FROM THE PLAYPEN TYPE AT THE KITCHEN DOOR WILL BE BEST AS THE PUPPY NEEDS TO BE SOCIALISED.

IT TAKES BETWEEN 2 - 12 WEEKS TO GRATE-TRAIN A PUPPY, DEPENDING ON THE OWNERS' METHODS AND PATIENCE. AND PROBABLY THE INTELLIGENCE OF THE PUPPY.


Thank you so much, and i hope i could get a reply.

Best regards,




Updates will be at:
http://www.sinpets.com/F5/20110734house-training-spitz-puppy-apartment-Singapore-ToaPayohVets.htm

527. ANAESTHESIA. No e-collar for Chow Chow after spay

SHARING SOME TIPS ON SPAY OF A CHOW CHOW

One late evening, a slim young lady in career clothes walked into my surgery whiile I was doing some paper-work in the room. She wanted to see the operating room and had a tour of Toa Payoh Vets. No problem with me although I had never had so requests in my 30 years of small animal practice.

Soon her Chow Chow came to be spayed. I also had rarely spayed Chow Chows as they are rather rare dogs in Singapore as over 80% of the people live in public housing which prohibits any dog over 20 kg and certain height.

An e-collar prevents the female dog licking her stitches after spay. But it affects the coat around the Chow Chow's ears. Some dogs hate e-collars. Others get cut by the sharp edge of the Buster brand. As this dog is so pretty, an e-collar could ruin her neck coat.

So, I decided not to give an e-collar after the spay and used elastoplast and tolfedine pain-killers. The family members also did their part in nursing her, I am sure.

Date of spay: July 23, 2010
Chow Chow, Female, 17.6kg, 39.7 deg C. 1 year old
Had heat in Marcho 2010

Domitor 2.5 ml IV via saline drip
Isoflurane + oxygen gas maintenance of one hour
Spay surgery
2/0 absorbable suture X 1 packet

Post-op pain-killer NSAID
Tolfedine 60 mg x 5 tab (1/day), 6mg x10 tab (2/day)
tolfedine being available in 60 mg and 6 mg tab only. At 4mg/kg sid, should be getting around 70-80 mg which is 60 + 12 mg per day.
baytril x 6 tab (2/day) 8 am and trimaxzole liquid daily at 6 pm

Elastoplast to cover wound. As there was no need to remove stitches, I don't get to see the dog again.

No complaint from the owner at all. I spoke to her some weeks later and she said everything was OK.

526. Four packets of stitches to spay a female dog is extravagance

Best Time To Spay Your Female Dog
- A Dream Spay
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: 23 November, 2007
Update:  31 July, 2011

When the dog owner is well informed, a spay operation in the female dog can be a very smooth operation taking less than 30 minutes.

Today was such a day. The Miniature Schnauzer, born in Dec 3, 2005 was on heat 4 months ago. She was spayed today Nov 23, 2007 as the owner was advised to do so 3-4 months after heat and she made the appointment at the 4th month.

My assistant Mark talked to the dog as he put the face mask over her muzzle. She did not struggle and went to sleep under 8% gas anaesthesia within 10 minutes. No tranquilisation was needed. I inserted the endotracheal tube to connect her lungs to the anaesthetic machine, maintained the anaesthesia at 1.5%.

The incision was 2.5 cm from the umbilicus. A 1-cm cut into the skin and the linea alba to access the internal organs of the womb and ovaries. I inserted the spay hook into the abdomen by turning it towards my right at 45 degrees caudally.

It hooked out the left uterine horn. I pulled the left ovarian ligament. The dog started to breath much faster as she felt the pain. My assistant increased the gas to 8% for a minute so that the dog had more gas to remove the pain of surgery. The minimal amount of gas given will lead to no deaths and that was why I used 1.5%.

No more rapid breathing observed. I cut the ovarian ligament with the scalpel. Clamped the ovarian stump. Ligated the stump. Then I pulled the left uterine horn totally out of the body and saw the right uterine horn at the uterine body junction popping out. I used forceps to pull it out.

From there, I accessed the right ovarian ligament and repeated the same procedure as with the left. No bleeding. The blood was normal red with oxygen. The dog was breathing regularly. Finally, I took out the uterine body, clamped and ligated it. It was let go into the abdomen.

The skin and muscles were stitched up. The gas anaesthesia was switched off as I stitched the skin. No bleeding from the ovarian and uterine tissues at all as the dog was no longer on heat.

The dog woke up smoothly after 3 minutes. An Elizabeth collar was given to prevent licking of wound. Overall, this was a dream spay. It was the most satisfying spay I had ever done as everything proceeded smoothly, there was no bleeding and therefore the surgical time taken was less than 30 minutes. The dog woke up by the last stitch as I had the gas reduced to 0% during stitching which is usually one horizontal mattress stitch. She went home without complications post-operation as the owner did not phone me nor came for stitch removal, thus saving time for him.

QUESTIONS THE OWNER ASKED:
1. Bathe the dog? Yes, but make sure the plaster is not wet.
2. Can the dog eat any food? Yes.
3. When to come back to remove the stitches. No need. The absorbable stitches will dissolve and fall off in 14-28 days.
4. When to remove plaster? 7 days later.
5. Can give antibiotic and pain-killer tablets crushed and mixed with water inside a syringe? Yes.
UPDATE IN JULY 2011

ANAESTHESIA IN TOA PAYOH VETS
A new isoflurane vaporiser has been installed in July 2011. Maximum is 5%. The dog is usually sedated with xylazine or domitor before isoflurane gas is given by mask and then intubation.

USE OF SUTURES IN SPAYING A FEMALE DOG BY DR SING
For dogs in general, I find that one packet of 2/0 absorbable sutures is sufficient, even for big breeds like the Siberian Husky. From my over 30 years of spaying dogs, I find that there is no need to do a subcuticular sutures. One horizontal mattress suture closes the skin as shown below.

ADVICE TO NEW VETS
There are employee vets who use two packets to spay a female dog as they don't need to account for the bottom-line.

In July 2011, I discovered a vet who used 4 packets of sutures (2 packets of "0" chromic catgut and 2 packets of "3/0" absorbable monofilament) for pyometra surgery in a Maltese. This is extravagance from this vet who does not have to pay for the sutures herself. There is a need for a new vet to be prudent and to keep surgery simple and safe for the dog. In this case, 2 packets of sutures will be more than sufficient and that will be the industry's bench mark.

Keep spay simple for the dog by using minimal suturing. Less sutures mean less irritation and itchiness during healing. There is no need for subcuticular sutures. If you feel the need to impress the client by using "subcutaneous" sutures (sutures under the skin) so that the client does NOT see any sutures on the skin, you need to have excellent stitching skills. No point showing the sutures or stitching another appositional layer if you want to impress the client.






A RARE CASE OF PYOMETRA IN A VERY YOUNG FEMALE DOGPyometra in a very young female Silkie Terrier is very rare as this womb infection occurs usually in female dogs over 5 years of age. By spaying her, the owner prevents pyometra which can cause death in some female dogs.


Photos and more details at:
http://www.sinpets.com/stories/20090520Spaying_Female_Dog_ToaPayohVets.htm