Blk 1002, Toa Payoh Lor 8, 01-1477,
Singapore 319074. Tel: 6254-3326,
9668-6468.
judy@toapayohvets.com
Focus: Small animals - dogs, cats, guinea pigs, hamsters,pet rats and mice, birdsand
turtles
January 23, 2019
Ventriculocordectomy
(debarking surgery) & alternatives in the dog
Dr
Sing Kong Yuen, BVMS (Glasgow)
First written: 1 May 2010
Update:
23 January, 2019
Non-stop barking affects the
neighbour's sanity and peace. In Singapore, over 80%
of the residents live in HDB (Housing and Development Board)
apartments. Residents who work shifts can't sleep,
pregnant mothers and babies don't have peace of mind due to the anti-social
noise nuisance of non-stop barking dogs.
After complaints are lodged,
the dog owner living in the HDB apartments gets a warning from the HDB to control the barking. If
complaints continue, the AVA (Agri-Food Veterinary Authority) may tell
the owner that the annual dog licence will not be renewed. Statutory fines of
up to $5,000 will be imposed if the dog owner keeps the dog without a
licence. The owner has to resolve the problem or euthanase the dog.
This report discusses the debarking surgery and the
alternatives to surgery.
PART 1.
VENTRICULOCORDECTOMY USING THE VENTRAL APPROACH
In the interest of dogs who will need debarking as an alternative to
death by lethal injection, I share knowledge of the devocalisation
surgery with new veterinarians who may need to de-bark the dog using
the ventral approach.
It is not a common surgery in my practice or in Singapore.
Debarking
is strongly discouraged as it
is deemed cruel. In my
over 40
years of practice, I had performed 5 surgeries using the ventral
approach. The main problem is the bleeding control.
Bleeding
obstructs the view of the vocal folds especially in using the less
expensive oral approach.
I use the ventral (laryngotomy) approach only. It is more effective
but costs more as it takes more time.
Anaesthesia
The surgical area where the vocal folds are located is not accessible
if I use isoflurane gas anaesthesia as the endotracheal tube obstructs
the view. Tracheostomy with the endotracheal tube has been mentioned in one veterinary book (Small
Animal Surgery - T W Fossum). I have never used it.
Nearly 100% of my surgeries is done with isoflurane gas anaesthesia
and it is very safe. But in this surgery, injectable anaesthesia is
preferred. I am recording one case of debarking using electro-surgery
and injectable anaesthesia as some vets may need such information and
may be researching the internet for such information.
Case study using injectable
anaesthesia
Patient: Bichon Frise, Male, 6 years.
Weight: 6.5kg
Barking non-stop since he was a puppy. Living in Canada was not a
problem, but now, he lives in an apartment in
Singapore and there were many complaints about his dog.
Two main challenges in debarking
1. Surgical anaesthesia using isoflurane gas is difficult to attain
due to the need to pull out the endotracheal tube to expose the vocal
folds in order to perform he surgery. The dog wakes up from the
anaesthesia in the midst of surgery and moves. The tube needs to be
re-inserted to get the gas back to anaesthesize the dog. Therefore,
injectable anaesthesia is preferred but the risk is higher if the
doses are not given just sufficient to maintain surgical anaesthesia.
2. Bleeding from surrounding muscles is a main worry as the surgical
view will be bloodied. Electro-cautery seals the blood vessels well in
this case. Without electro-cautery, there will always be continuous
bleeding, obstructing the views and increasing operation time.
The following procedure (ventral approach also known as the
laryngotomy approach) has been done successfully for this dog.
I/V drip Hartman.
Xylazine 20 @ 0.2ml + Ketamine 100 @ 0.1 ml in one syringe via the IV
catheter
Maintenance of anaesthesia
When there is movement during electro-surgery, Pentobarbital
(Nembutal) 6g/100 ml is used to maintain the anaesthesia. I gave 1.0
ml via the IV catheter. A total of 2.0 ml Pentobarbital was given in
this dog. There were no adverse effects.
Electro-cautery provided excellent bleeding control. I did not suture
the mucosa after excision of the vocal fold as advised in one
veterinary book (Small Animal Surgery - T W Fossum). It seems to be
an impractical advice as there is not much area to suture. I don't do
subcutaneous suture as advised in this book as more sutures mean more
irritation. I used absorbable sutures and so I don't get to see the
busy owner post-surgery for stitch removal.
Advantages of electro-surgery
Bleeding blood vessels in the neck muscles are cauterised.
A blood-less field.
Vocal folds pulled with forceps - around 5 mm in length is
electro-incised. Clear of blood in this case.
Day 1. Tolfedine 4% at 0.5 ml SC and Ciprobay 0.5 ml given via the IV
drip post-operation.
Day 2. Reviewed 24 hours after surgery. Dog had eaten and had no
fever. When I cleaned the surgical site, the dog did not object as the
pain-killer Tolfedine was effective. The dog went home on Day 4.
"The Bichon had been barking
as a pup," the young man said. "He barks the whole day and the
HDB neighbours are not happy."
"I seldom do this laryngotomy
surgery," I informed this owner. "How many surgeries
have you done?" he asked. "Around 5 cases
done in my 40 years of practice. "I don't do it unless it is in
the interest of the dog." In this case, the dog will be evicted
or euthanased as an anti-social nuisance if no debarking surgery
is done.
Notes:
Small Animal Surgery - Theresa Welch Fossum advises to be
careful to avoid disrupting the blood supply to the larynx and trachea
during surgery or necrosis may result during the ventral approach.
Dog World Nov 2008: Page 31. Training Topics. The Bichon Frise
has a high-pitched bark that test the owner's nerves and the
neighbour's patience. He barks at every new happening in the
neighbourhood. Training a Bichon to stop barking on command is
advised. The Bichon is not the easiest to housetrain and difficulty in
housetraining is the biggest reason it is turned over to the rescue
group.
P.S. I strongly discourage devocalisation (debarking) and advise
training. I reject debarking using the oral approach as it
is not very effective. However, it is a cheaper alternative and
some
owners opt for this approach.
In this case, using the ventral approach, I have no complaints from
the dog owner as regards the recurrence of barking, annoying
neighbours and leading to complaints to the veterinary authorities. It
is 6 months after the surgery.
PART 2. VENTRICULOCORDECTOMY USING THE ORAL APPROACH
For the benefit of the younger vets, I record the following oral
approach that has been done.
The oral approach is much less invasive. It is cheaper and faster.
However, it is not very effective in many cases and most vets prefer
not to use this approach since the dog's barking volume has not
been reduced considerably. This leads to complaints
about ineffectiveness. However, this approach is costs less and many dog owners prefer this.
Owners must be told that this approach may not be effective and an
informed consent and recorded advice must be obtained.
Jack Russell, Male, Neutered 10 years old.As last resort, the young girl had to de-bark her dog due
to complaints.
I noted a plastic spiked collar (with spikes facing the
neck).
1. Blood test done first on Jun 11, 2010.
Normal except that kidney shows in umol/L that urea is 3.9
(4.2 -6.3), creatinine is 61 (89 - 177). Dog was OK for
surgery
Jun 17, 2010, 6.5 kg, 39.2C
2 pm Surgery
IV drip
Domitor 0.2 ml IV, Zoeletil 100@ 0.1 ml IV
Atropine 0.5 ml IV. Anaesthesia insufficient. Needed to top up Zoletil 100 0.1
ml IV
General Anaesthesia
General anaesthesia using injectable anaesthetic like domitor and
ketamine IV at the correct dosage may be used. An i/v catheter may be
inserted for topping up of IV anaesthetic when the dog reacts. Or use
isoflurane gas to top up.
Surgery
The dog's head is held by an assistant who should not place his hands
under the throat. The vet pulls out the tongue to view the vocal
cords. There is a sideways movement of the vocal folds. An long curved
artery forceps clamp the vocal fold. A curved scissors with sharp tip
then snips off the upper and lower edges of the end of the artery
forceps as shown in the image below. In the image, the artery
forceps had clamped the vocal fold a bit too high up and would be
re-clamped again. Alternatively, a biopsy punch can also be used
instead of the artery forceps and scissors combination.
The oral approach
There will be some bleeding
depending on the extent and accuracy of the excision of the vocal
fold. A forceps with sterile cotton wool is pressed against the cut
area to stop the bleeding. Results vary depending on how accurately
the amount of vocal fold that can be cut off.
PART 3. ALTERNATIVES TO DEBARKING SURGERY
It is easy to advise training
when you don't have to face angry neighbours or are told to evict your
dog or get slapped with a $5,000 fine for keeping a dog that will not
be licensed or that its licence will not be renewed.
"Debarking is a rare operation," I said
to the lady on the phone. "We don't
encourage it." She had moved to a quiet neighbourhood and her
8-year-old neutered Schnauzer barked shrilly and frequently.
"I want to debark my dog to prevent the AVA from coming to see
me after neighbours complaint. The
alternative is to give up this dog but I do not want to give
him away."
Barking seemed to be her only solution and she googled for a
vet that will do debarking. "Do you need me to consult you
first and be counselled for debarking? My vet is at
.... Do you mind that?".
She was advised to try training and other alternatives.
"Will scars form after debarking, affecting the dog?" the lady
had read somewhere in the internet
"Scars are referred to operations after debarking. As the
vocal cords may not be excised by the long forceps 100% unless
done by the vet with lots of experience using this approach,
the scars will form. Barking sounds will return."
SUMMARY OF THE ALTERNATIVES
1. Get a dog trainer to train the dog not to bark will need
some time and patience. It may or may not work.
It is expensive.
2. Electric collars. It works according to feedback from one
owner.The use of electric collars
may be successful for some owners who have time or
inclination to do the training.
3. Citronella spray collars.Bark collars emitting an unpleasant scent when the dog barks are said
to be ineffective and expensive. Some dogs get rid of the collars and resume barking.
Feedback from some owners are not so positive.
4. Other methods like "Throw cans with
coins or pebbles when the dog barks, without him seeing you do
it," I advise puppy owners. "Squirt water from a water pistol
when he barks."One successful owner told me, "Grip the dog's muzzle and say 'no
barking'". This advice is mentioned in some doggy magazines.
5. For all puppy owners, spend time during the first 2-4 weeks to train
the puppy not to bark at all times. Otherwise, they grow up barking
for long periods of time. Success depends on the age of dog, the
personality of the dog, the training and the owner. It is hard
to be specific.
TOA
PAYOH VETS
