"Is the dog breathing?" I asked my assistant James whose sole job was to monitor the dog's breathing as evident in the expansion and contraction of the anaesthetic rebreathing bag and by checking the colour of the tongue. He would alert me when there was something wrong and he had at least 5 years of experience monitoring general anaesthesia in the dog. But age was catching up with him. But his mental faculties were still good.
"No, she is not bleeding," he said. With so many years of experience, he could still hear me incorrectly. But he did not have hearing problems. So, it must be my diction.
"Damn it. I mean 'breathing'...why would I ask you about the dog bleeding when I can see it for myself?". One has to be patient with senior citizens.
I noticed that the left ovary I had hooked out was blood-less. Attached to the left ovary, the uterine horn was not the usual bright red. A paler shade of bluish red.
Spaying a female dog is such a common operation. It could be done in less than 10 minutes. A vet could become complacent if he relied on his assistant. There was something not right.
"The dog stopped breathing," James reported.
I stopped the surgery. Yes, James was right. The dog's tongue had changed to light purple and soon become white. It was a few seconds to death's door.
This is where veterinary anatomy and physiology studies come in useful for the veterinarian and such subjects are boring for first-year vet students.
Without the knowledge of these 2 subjects, this dog would just die.
What must be done before it is too late? The heart has failed. No blood is pumped to the lungs. No oxygenation. The blood colour changes to purplish or cyanotic as seen in the tongue. Then no blood or less blood reaches the tongue as blood circulation is shunted to vital areas like the brain from peripheral areas.
First, get the heart pumping. No time for heart stimulant drugs. I used the fingers to compress the heart. 3 times massage. Stop anaesthetic gas flow. Blow air into the endotracheal tube to inflate the lungs 3 x. Connect emergency oxygen if necessary. The dog started breathing as her chest rib cage expanded and contracted. There was no more anaesthetic gas required as I completed the surgery.
The dog's tongue was still cyanotic. The Shih Tzu breed has been reported to have breathing problems and is an anaesthetic risk.
Still the dog would not wake up at the end of spay, unlike other dogs. Most likely, the xylazine tranquiliser had a sedative effect. Sometimes it would be best just to give straight gas to Shih Tzus for surgery.
I put the dog inside the crate and asked Mark to observe for another 30 minutes and give cardiac massage 3x intervals. The dog was sitting on her chest but that did not mean that one could be complacent. Suddenly the dog stopped breathing!
What to do? This dog was already awake.
Blow air into the mouth. Hang the dog upside down. Pull her tongue out as she might have obstruction of her airways. Cardiac massage. The dog revived within one minute of entering the twilight world between life and death.
A simple spay operation. The owner had instructed that the dog transport woman get an experienced vet to operate as soon as possible so as to get the dog licensed. A $5,000 fine with effect from Sept 2007 if owners are caught for not having a dog licence has sunk into many worried minds of Singapore dog owners.
Spays are urgently required nowadays as the dog licence fees for sterilised male and female dogs are around $14.00 compared to $70.00 per year with effect from Sep 1, 2007. No blue-blood Singaporean should be caught with his pants down, in this case, unsterilised dog whenever the authorities checked his four-legged companion at any time! This new law and financial costings highly motivated many owners to go for sterilisation even if the dog was into senior citizen categories. Some owners would just microchip and leave the pet in its natural state.
Now, this case was the standard picture of a healthy Shih Tzu. Young, fit, slim at 5kg. Only 2.5 years old. Not expected to pose any problem in anaesthesia. I thought: "Spaying her is a piece of cake. Won't take more than 10 minutes." I asked James to time my surgery so as to make myself more productive, since I was onto my staff to be productive and not spending time at www.facebook.com whenever I was not around.
This showed that Man proposes, God disposes. No matter how experienced one is, there will always be unexpected situations that teaches a vet not to be complacent during anaesthesia and surgery.
For a first-year vet student, anatomy and physiology are very important foundations for your future as a competent veterinarian. With such knowledge, you can understand about the workings of the heart and anatomic difficulties in breathing for a short-head (brachycephalic) breed like the Shih Tzu and take appropriate precautions and emergencies to prevent deaths during anaesthesia.
As for me, this spay took over 15 minutes. The dog was normal and went home to a happy owner whom I had never met. The middle man was the dog transport woman!
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