281. Ear
problems and Injectable anaesthesia - xylazine & diazepam IV
Dec 29, 2010
I was on duty as Dr Vanessa Lin went on leave for the next 10
days. This was the 2nd day of work since I came back from the
holidays. I thought it would be a quiet Wednesday and brought
my laptop to do some writing and scheduled a house-call to
micro-chip and vaccinate some dogs at Pets Zone in Dunearn
Road at 4 pm. But it was a hectic day from 10 am to 8 p.m,
with one-hour break at lunch-time. The cases were the usual
ones of neutering and spaying, dental scaling, skin diseases,
ear problems, eye infections in two stray kittens. Some
interesting cases are as follows:
1. Animal activism in
Singapore. A young lady wanted to know how much it
would cost to hospitalise two stray kittens with flu for a few
days while she looked for new homes for them. Her father would
kill her if she brought these kittens home as she already had
several. She was looking for the least cost veterinary care
and dictating that the kittens should not be given
antibiotics. This is a common situation encountered at all vet
clinics. There is insufficient space at Toa Payoh Vets which
is a small surgery of 60 sq metres. I do help a few stray cat
cases but there is a limit in charitable work. A practice has
high overheads although it does not look obvious to the
average pet owner in Singapore. In this case of cat flu, home
nursing would be best. I advised her to nurse the kittens
herself as it would be better for the kittens.
2. Animal activism in Yangon.
An old friend started to help homeless dogs and cats in a
place in Yangon. This is his personal thing as he could better
spend his time and skill earning more money in the IT field.
However, the residents there wanted US$20,000 from him if he
wanted to continue his mission. I had advised him of the risks
of doing animal activism overseas as politics would become
dominant. This happens even in Singapore, as cat welfare
people tried in vain to get the Singapore Government to permit
cat ownership for the average person living in HDB apartments.
From this incident, you can see that it is difficult for a
Singaporean animal activist going across borders to help
change the world unless he has powerful political connections.
Politics and economics interact in animal activism and
business. Such are the facts of life.
3. Ear problems. One dog had red ear flaps for many
weeks. I did a microscopic examination of the hairs. It was
ringworm. "A follow-up one month later is important," I said
to the owner. Some owners blame the vet for not resolving
their problem when they don't follow up but went to another
vet.
4. Injectable anaesthesia. The following is one of many
metods of injectable anaesthesia used safely in practices and
countries with no access to isoflurane gas anaesthesia, unlike
fortunate Singaporean pet owners where the best anaesthetic
drugs are available for pets.
I am sharing this knowledge with vets working in such
locations. The above dosage is a general guideline. An IV
catheter is inserted so that top up injections can be given IV
should the dog need more anaesthesia. For a 10-kg dog, the
dosage of diazepam and ketamine in one syringe are
respectively 0.4 ml + 0.4 ml IV.
Case 1. At 50% of the above dosage, ie. 0.2 ml diazepam + 0.2
ml ketamine in one syringe IV for a 10-kg mixed breed dog, the
dog shows signs of head shaking sideways and salivation. It
was not under surgical anaesthesia. I top up with 5%
isoflurane gas by mask for a minute or two to effect and this
provided excellent anaesthesia for neutering.
Case 2. At 100% of the above dosage, the dog's body muscles
were tense. The dog's neck and legs were flexed. The eyes were
open and the pupils dilated. However, dental scaling was done
without pain or the need for top up.
CONCLUSION. Each vet has his own preferences in anaesthesia.
As long as it is safe for the dog, injectable anaesthesia
offers a cheaper alternative to isoflurane gas. The
anaesthetic machine and isoflurance are expensive compared to
the injectable anaesthetics. In an effort to lower veterinary
costs, injectable anaesthetics are used. As for me, I prefer
to use xylazine (or domitor) sedation and isoflurane gas
anaesthesia as I find that the dog sleeps relaxed (not with
tense muscles as in the diazepam and ketamine injectable
anaesthesia) and surgery can be done smoothly without the need
for topping up as the dog struggles when pain is experienced.
ECONOMICS OF PRACTICE. Each vet does what he prefers as long
as the dog is safe and alive at the end of the day. I am just
sharing my observations to benefit vets who may not have
access to isoflurane facilities as not the isoflurane gas
machine purchase cost and maintenance are very expensive.
There are more less sophisticated pet owners who just want
"cheap" veterinary anaesthesia and surgery and a veterinary
practice needs to sustain its profitability to be around the
next year. So, there is a need to reduce veterinary costs,
sometimes performing loss-making surgeries!
INTERESTING CASE OF BLACK EAR DISCHARGE
"The (pet shop owner's son) was not in a good mood and so I
talked to the counter staff," the matronly woman had brought
the 7-month-old female salt and pepper Miniature Schnauzer in
for his 3rd vaccination. Toa Payoh Vets had given the puppy 2
vaccinations earlier. She paid $350 for the dog which I
thought was too cheap as it had such good physical
characteristics. But older dogs are difficult to sell and only
puppies fetch a premium price in Singapore.
"The young man may be having some personal problem," I said as
the husband wanted the wife to complain that she was sold a
dog with black ear discharge. "His father had died while
delivering dog food and crashing his van. The hospital doctor
did not diagnose that he had a head injury and sent him home.
What ear drops have you been using to clean the dog's ears?"
"I use eucalyptus oil for the past few days," the lady said.
"The next day, the black ear discharge appears again."
"This is is a good looking dog and you had got it at a cheap
price," I could appreciate a Schnauzer with good conformation.
A good sized head, proportionate body length and not too long
legs. Not too bulky as Singaporeans prefer this type of size
although dog show people will consider this dog under-sized.
Female dogs of this size and shape are more valuable for
breeders as there is a demand for "miniature" Miniature
Schnauzers.
I took a cotton bud and spread some ear discharge on a slide
and put it under the microscope but saw no mites. "You must
have drowned all mites with oil," I said. "Not a mite can be
seen."
What caused the blackness and the black particles inside the
two ears? As black as black shoe polish. Ear discharge comes
in all colours but pure black is rarely seen by me in practice
over 40 years. It was as if the ear drops of oil were black in
colour. I did not ask the owner the colour of the ear drops as
it was an extremely hectic day and I still had not done the
3rd spay of the 3rd stray cat.
The owner who loves his 3 stray cats had brought in the 3rd
one for spaying today. Yesterday, he got two in and I had
neutered and spayed them. The 3rd one was "fierce" and was put
inside a cardboard box, taped up but with gaps for the cat to
breathe. It was as if he had a tiger inside the box and so we
did not dare open the box and transfer the cat to the crate
for the time being. The minutes ticked by and the whole
afternoon had gone and still I had no time to spay this cat.
Spending time with the owner is essential in practice building
but the other owners at the waiting room disliked waiting too
long unfortunately. Some owners want fast service. I could see
that the Schnauzer lady's husband was all ready to go to work.
But he was the patient type who would wait for his wife to get
the dog vaccinated. That was all she came for and vaccination
should be fast. But for the black ear discharge, the dog would
leave in 5 minutes.
I got the ears irrigated and taught the owner how to use the
medicated ear drops. The best would be another ear irrigation
the next day but I could sense that the husband was an
extremely busy man but his wife mentioned about him working in
an important post in a volunteer organisation. "You work for
the famous Red Cross," I said to him as I was thinking of the
excellent volunteerism and time it had done for so many
unfortunate people in countries all over the world.
"The infamous Red Cross," he laughed. Yes, there was a
newspaper report about some loss of money taken by a staff in
the Singapore branch but I was not thinking of this matter.
There will always be staff who steals money from the
organisation all over the world.
In one case of a famous cosmetic surgeon in Singapore, I was
shocked to read in the newspaper that he did not print his own
receipt books. He bought commercial ones. So, he had 3 copies.
The white for the client, the blue for audit and the yellow
for the case file. Now, his billing staff found a way to milk
him of over $100,000. She would buy another set of books. When
she billed the client, she would give the client the white
copy with say $1,000 and collected $1,000. Then she would
write, say $500 on the blue and yellow copy from her own
purchased set and discard the original blue and yellow copies
of the surgeon's book. She could also under-declare the income
by replacing the yellow or blue copies.
"How was she caught?" my wife asked me yesterday when I told
her that the famous surgeon did not print his own receipt
books which I found it hard to believe if not for this case in
court.
"Well, another staff discovered that the blueness of the blue
receipt was not similar to the blueness of the other
receipts." But over $100,000 had been misappropriated and this
sacked staff complained that the surgeon had not granted her
medical leave.
I digressed. Back to the Schnauzer's black ears. The husband
seemed appreciative when I asked the wife to use the medicated
ear drops herself to clean the ears for the next 7 days and if
the black discharge disappear, then there was no need to
consult me.
This was one of the 4 interesting ear problems. The other one
was the fiery red inside ear flap caused by ringworm
infestation in both ears mentioned above. The 3rd one in a
young cat with thick reddish black waxy ear discharge was even
more interesting in the sense that I managed to find one dead
ear mite under the microscope when I did an ear discharge
examination.
"See the mite," I asked the young lady to peer into the
microscope. "There is only one." The mite with a round body
and six short legs in the front half was clearly visible and
sharp under my newly purchased microscope. "Where's the mite,"
the lady asked. She was not into biology I presumed. I took
out the Hill's Atlas of Clinical History and showed her the
drawings. Maybe I should produce one myself. "See the book
drawing of the mite," I showed her the cat and ear mite
drawings inside the book. "What's the name of this ear mite in
the cat?" I asked Mr Saw, my assistant who is qualified as a
vet in Myanmar and would be returning home in April 2011. The
book did not mention any name. Mr Saw shook his head. "It
would be Otodectes cyanotis," I said. It was Greek to him and
to all vet students. I got the ears irrigated and gave an
anti-mite ivermectin injection. Follow up would be good.
It is 7.25 am and I have to get ready for work. The 4th ear
case was one in which the young man's cotton tip fell into
the dog's right ear canal while cleaning. The Pomeranian
would bite when he tried to retrieve it deep inside the ear
canal. "Surprisingly my dog did not shake his head. I would
rather get it removed before it infects the ear. How long will
it take?"
"That depends on whether the dog needs to be sedated," I said.
I got the dog inside the surgery, muzzled it and Mr Saw held
the dog properly. Mr Saw had wanted the ear scope to check out
the ears. "No point in doing it," I said. "The ear scope will
push the cotton bud deeper into the ear." Sometimes we have to
visualise the impact of a particular procedure.
In theory, all ear examinations must be scoped. Sometimes it
could even be considered negligent not to scope the ears as a
routine. In practice, the dog owner had already given us the
history that his cotton tip had dropped inside the right ear.
Using an ear scope would push the cotton into the horizontal
canal and that would be very difficult to extract.
I inserted a slim curved artery forceps into the right ear
vertical canal to the base, open and clamp. Fortunately I got
the cotton bud out at the first clamp. I showed the bud to the
owner who was quite pleased. "It's time I buy good quality
cotton buds to clean my dog's ears," he laughed.
So, in one day on Dec 29, 2010, I got at least 4 different
causes of ear problems in 3 dogs and 1 cat. There was a 5th in
a Westie. In this case, the Westie had itchy ears, paws and
body. It could be a Westie-related genetic disease or allergy.
So, there were actually 5 cases of variations of ear
problems in dogs and cats in one day. And I thought this
was going to be a laid-back day and smell the roses. At 8 pm,
I completed my house-call vaccination and microchip at Pet's
Zone in Dunearn Road apologising for the late arrival.
It was an unusual day of ears to remember. I record it to
remember it when the years go by. I hope you did enjoy reading
this rambling report.
TOA
PAYOH VETS