4. Inspect for your old dog for backside swellings - Perineal hernias

I hope the 2nd year vet student from Murdoch University learnt some anatomy from observation of this surgery and find his anatomy of the back area more alive and interesting.

DOG. Pekinese X said to be 13 years old. Or 10-13 years old.

Dog is being looked after by the mother. The married daughter in her late thirties bring in the dog for vet treatment but she does not stay with her mother. She waited patiently and did not show an angry face. A soft spoken and gentle serene looking woman.

I had 2 long cases. A French lady with her ear scratching Golden Retriever needing its ear flushed. This took some time. Then another man who needed time to decide about putting his old Cocker Spaniel with a swollen ascites abdomen.


COMPLAINT. Constipation. The first vet treated for constipation some 19 days ago, yet the mother still complained about the dog having constipation. This dog has a full coat and the backside swelling was not obvious. Palpation of the abdomen was empty and so I declared, "No constipation."

Yet the mother had said there was difficulty in pooping. So, something must be wrong.
Taking the rectal temperature must be done as a routine even though the dog has excellent appetite. In this case, the dog cried. He farted when the anal sacs were expressed. Abnormal behaviour.

So, the anal region was clipped to check for wounds. The huge right perineal swelling manifested! There was also a small left perineal hernia! Inside the right swelling, hard faecal lumps could be felt. Fluid too. When pressed, the lump disappears and this impressed anybody. Like magic.

"You have the diagnosis of what's wrong with your dog," I said to the serene lady. "The rectum has diverted and turned into this swelling. So the dog had difficulty in pooping. Probably had some problems peeing if the bladder gets trapped inside this perineal hernia."

The sole complaint was constipation.

"What do do?" the lady asked as I told her that the dog also had heart disease and might die on the operating table as the heart failed. It would be a long operation lasting more than 45 minutes.

"You have to take the anaesthetic risk," I said. "If the dog can't poop, he will also die a painful death as the stools jam up."

The lady decided on surgery the next day. It would be Chinese New Year's eve. The vet student would be coming in the afternoon at around 3 p.m and I wanted to show him something of the backside anatomy he would not see on a live dog. He has a dead dog in the University shared by 4 students to study anatomy. But nothing as alive as a real case.

On Chinese New Year's eve, a Golden Retriever with diarrhoea came in at 3 pm. The owner could not locate the Surgery although she was supposed to be in before 2.30 pm as I would operate at 3 pm. I had the reunion dinner to attend at 6.30 pm and I did not want to be late as there is the "mingling of raw fish and vegetables" for good luck and every member of the family must be present to do it.

The dog was operated past 4 p.m. The two sides of the skin cut were retracted by forceps and the student saw a lot of blood tinged fluid and gel and some pieces of yellow fat on exposure. This fluid was drained.

I showed the student the muscles but I doubted he could see them or name them. We had gone through the anatomy of the backside before the surgery. He has an excellent memory if he is motivated to learn. But how to motivate a student about backside anatomy?

I pushed back the hernia sac into a big gap of over 10 cm long and 1.5 cm wide. "Pelvic diaphragm" I pointed to the muscle defect. I doubted he understood. There is a diaphragm (muscle) between the chest and abdomen. But a pelvic diaphgram. What is a pelvic diaphragm?

He could see the anal sphincter mucle. The coccygeal and internal obturator muscles were atrophied unlike the beautiful illustrations in the Vet Surgery book. The defect was closed by suturing.

It would be some years before he will see another perineal hernia repair. The dog was able to poop without problems the next 3 days and sent home to save on veterinary boarding expenses.

I reminded the owner to keep the Elizabethan collar on as the dog was discharged without the collar. Small omissions from my personnel makes me angry as the dog may lick and open up the big wound. Somehow the person seems to think that there is no need to use the e-collar. I empahsized to the lady that the dog had to be confined for at least 7 days. No jumping around.

Now, there is the left perineal hernia which seems to swell and disappear now and then. The owner had been informed.

I advised neutering the dog some time later as the male hormone seem to be a cause of the hernia formation according to the book. I don't know whether she would remember as she does not live with the dog. I did not neuter the dog at the same time as I wanted to shorten the anaesthetic time so as to be successful in bringing out a live dog at the end of surgery. The perineal surgery took more than 45 minutes. The dog was given 8% gas and then maintained at 2%. For a short while there was some movement and he was given 2.5%. Other than that anaesthesia was surprising smooth flowing as if the dog had a nice nap. Without tranquilisers given as I did not want the heart to be affected. No pain killers were given after surgery for the same reason. This dog recovered the next day.



It is extremely kind of her to take the time to bring the dog to the vet before it is too late. Before the dog collapsed and becomes toxic and so sickly that the anaesthetic risk increases from the 40% to zero percentage of survival on the operating table! A gentle client is always much appreciated by any veterinarian who usually has some nasty litigious pushy ones who think that "customer and their cash is the king".

No vet can have all gentle clients all the time! But this case was a pleasant and happy case and the dog lived to go back to a happy aged mother whom I will never meet!

3. Mother teaches the children to be kind to animals

The mother plays a significant part in teaching the children to be kind to animals as she spends most time with them.

Esther is one such mother. The swamp dogs of Yishun would be put to sleep in batches by the animal shelter, Esther who brought her children to the Yishun Fishing Pond and swamp land told me. The Landlord of the Yishun Fishing Pond had not renewed the lease of the land.

At the animal shelter, somebody told her about NANAS, a no-kill animal shelter. She contacted Ms Lynda Goh who made the effort to rehome the dogs.



Now, 6 months later, I noted that the swamp dogs are thriving on my Jan 26, 2008 visit with two veterinary students.

I don't know whether the old man had visited his dogs as it was too emotional for him to part with them. He moved in with his daughter in an apartment.

2. Preventing dog bites in Singapore

PREVENTING DOG BITES IN SINGAPORE

1. CHILDREN
Animal behaviourists say that there is no such thing as a completely safe dog or a childproof dog. Any dog can bite under wrong circumstances. Children are usually bitten and though most dog bites are not fatal, children must be supervised anytime they interact with any animal. Children must be taught not to pet dogs they don't know at any time.

2. FEAR AGGRESSION
During their growing up years, some puppies get frightened during their fear imprint period by rough handling or abuse. They tend to growl, nip, snap and bite at certain people or situations. Often they growl first before they bite. Most owners don't realise this.

3. TUG-OF-WAR OR ATTACK GAMES encourage the puppy to be aggressive when they grow up. Chew ropes being pulled while the puppy is chewing it encourages a tug-of-war which is entertaining and fun. However this trains the puppy to be aggressive. He does not understand the difference of play and real life situations.

4. DOES NOT SOCIALISE YOUR DOG Some puppies never get out of the apartment to meet other people, children, neighbours and friends at all. They don't get trained to be obedient. They become territorial and bites people or running children.

5. TOO CRUEL TO NEUTER MALE DOGS. Many young Singaporeans believe that it is cruel to neuter the male dog no matter how aggressive he is towards family members. Dogs who have not been spayed or neutered are more likely to bite than neutered dogs.

6. PROFESSIONAL ADVICES. Many owners do not bother when the puppy growls, nips or bites, considering this animal behaviour is normal. Do seek professional advice from your veterinarian or a skilled dog trainer.

7. NEVER PET A DOG, without letting him see you first.

8. FOOD PROTECTION OR CARING FOR PUPPIES.
Some dogs growl when they are disturbed during sleeping time, or eating or caring for puppies. Do not disturb them in such situation.

9. DON'T RUN OR SCREAM when a strange dog approaches you. Some young girls in Singapore who have no experience will dogs will scream loudly. Stand still with your hands at your sides. Do not speak to or look at the dog. Teach children to stand still "like a tree" until the dog goes away. Practise with a stuffed toy dog.

10. If the dog knocks you down to the ground, curl with your hands over your ears, like a ball. Lie still and keep quiet until the dog goes away.

11. If the dog attacks, decrease your injury by "feeding" him your jacket, purse, bicycle or anything else that can serve as a barrier between you and the dog. It is tempting to run.

12. Trespassing/intruder into shop.
As dogs are territorial and protect their master's work place, some Singaporeans simply drive into their territory to see the boss. They may get bitten. Medical costs and liability claims can be excessive for the owner. The authorities may impound the dog for investigation and euthanasia. A loss of a good guard dog.

1. The Swamp Dogs of Singapore

June 14, 2007
9am - 11.45 am Yishun, Singapore

"Why do you throw stones at the monitor lizard?" I asked Esther (green T-shirt) as Lynda, our commander-in-chief's bumped her 'Land Rover' along the pot-holed and undulating meandering track from the main road, past the two open iron barriers, deep into the Yishun swampland few Singaporeans know of its existence. A paradise in highly urbanised and competitive city-state of Singapore --- no high rises and no crowds, fresh air and green rivers and mangrove trees all around a man-made fish pond



This was as close to 'Indiana Jones and Romancing the River Nile' adventure as I could experience in my life as the group embarked into the unknown world of swamp dogs. Only that the river was the Khatib-Bongsi River or some name sounding like Khatib-Bongsi.




Lynda's mission was to vaccinate 21 swamp dogs and 1 cat and then transport to NANAS (Noah's Ark and Animal Sanctuary)in 10 days' time. Nothing was mentioned about the puppies.

The military had taken over the premises, erecting red warning signs with soldiers carrying guns at the entrance to the swamp land. The tenants (a family and a 68-year-old man) had to vacate and the dogs put to sleep as nobody would adopt these stray cross-breds if they remain in Singapore. Or let them wander in the swamps and get shot as the premises become military grounds.

But Lynda from NANAS, a no-kill animal shelter had organised the vaccination and microchipping of the dogs today. So, on this fine bright blue-sky and white-cloud morning, I cancelled all my appointments to vaccinate the dogs and a cat.



In the car, Lynda had picked up a photographer and another volunteer dog catcher Esther and her two children. Esther showed me a picture of the giant monitor lizard in her handphone. Gigantic, thick-neck and wide strong tail around 1.6 metres long.

"We threw stones to frighten the monitor lizard away as he eats the puppies," Esther said. "Once a puppy fell into the fish pond, the lizard went into the waters to swallow him."

Puppies were born free in this swampland. Free as the birds flying in the sky, the butterflies and the breezes. Their mothers would not be watching over them like eagles once they were able to walk. Some of them would walk into the fish pond and not be seen again. Predators like pythons, monitor lizards and eagles would eat them as they were not mature enough to know about the risks of freedom.

"It is survival of the fittest," I heard Lynda trying to explain the laws of the jungle to Esther.



Esther continued:"Suddenly, the monitor lizard rushed towards me and the children as we tried to scare him away from the puppies." I thought this lizard was a smart creature. Offence is the best form of defence.

"Why he did not just jump into the river behind him?"

"He had nowhere to run as there was a fence behind him. So, he charged at us."

I could not believe her story. How could monitor lizard frighten an adult 2-legged?

"He is as big as me," Esther read my imaginative mind that monitor lizards are smaller than grown ups. "The monitor lizard is as tall as me, around 1.7 meters tall."

"If you include his tail, he is about my size." Esther saw my incredulous face. "The adult dogs could not go near the lizard because his strong wide tail just whacked them off!"

"What happened when the lizard charged towards you and your two children?" I did expect Esther to teach her children to stone wild life.



"We scattered in all directions as fast as our legs could carry us. The monitor lizard leaped into the green river behind us."

The pre-teen children had the fright of their life. What an unforgettable experience. Singapore children seldom interact with nature as they have lots of homework and tuition to do and their parents are too busy working long hours to take them to nature reserves. The Singapore Zoological Gardens and the Jurong Bird Park would be as close and safest contact to wildlife for most Singapore children.

Back to the stray dogs vaccination and microchipping. It was uneventful. I expected ferocious swamp dogs that had survived predators. The dogs were fit and trim. Snow- white strong teeth indicating most of them were less than 2 years old. Short orange brown coat. No skin disease as they do swim in the river and get good fish and sunlight. I did not ask what happened to the aged dogs as I did not see any. Were they eaten up by the creatures in the swamp?

Lynda got raffia strings from the owner to tie round the neck of the dogs that had been vaccinated and microchipped.



"It is safer to put dogs on a table," I advised as Lynda and Esther started to hold the dogs on the ground for me. The dogs were not stupid although they trusted the owner. Most were interested in the food (bread and pork) offered by the owner.

Almost all the dogs were enticed with bread and pork. Esther would throw the leash onto their necks as they ate the food. Lynda and Esther would carry them up the squeaky wobbly stone table as I did my job of vaccination and microchipping.



"It is safer to muzzle them," I advised Lynda as she held onto the dogs. I don't know whether she had sufficient dog handling experience but her handling of volunteers via communications were excellent. "You never know when a dog is going to bite you as I inject."

Once a dog bites, he sends out a 'smell and sound of fear'. The rest of the pack could sense the dangers and become uncontrollable. We would not accomplish the mission.

"Tell me how you do it?" Lynda asked as I looped the first dog's muzzle using one end of her leash and tying a knot. We did not bring a proper dog muzzle.

"Loop one end of the leash as if you are tying up a present," I said. "Slip this loop over the muzzle and tied up the nose. In this way, the dog becomes submissive."

There were no mass hysteria or fright as 21 dogs were vaccinated and microchipped. A nursing dam and a young wary male dog of less than a year old as judged from his gleaming white strong permanent canines or fangs were difficult to leash.

"I will bring the dam to your clinic another time," Lynda was considerate. She was worried that the 2 smart canines would take up too much of my time.

"I have cancelled all my morning appointments from 9 am to lunch-time," I said. "Persevere to catch the 2 dogs". In my heart, I know that the dogs not tagged today would miss the boat to go to an animal sanctuary called NANAS (Noah's Ark and Natural Animal Sanctuary). Voluntary organisations are always short of money and time. It was now or never.



The military wanted back the land soon. Lynda is a very busy volunteer for NANAS. She had her own profession. It was now or never, in my estimation. It was too much to expect of volunteers to have much time to save the errant dogs.

Fortunately Lynda managed to get the nursing dam. The wary male could not be enticed with food treats. He ran into the house and out, just 1 meter away from Ester and the owner who gave out food treats. Esther's daughter was very helpful giving bread to some dogs so that they could be leashed by her mum. The mother had transmitted her love of and kindness to stray dogs to this girl. The son was more interested in resting on the bench appreciating the countryside where no high-rise loom in the horizons.

I was glad that most of the adult dogs, twenty one to be exact and one cat would not be put to sleep as would be their fate if they were left in Singapore. All because of Lynda, an animal activist. She had taken a day off to get the volunteers organised. It would be 10 days before the animals reach NANAS in Johore. She had lots of paper work to do. She has the energy to do it.





Lynda's mission to get the vet to tag 21 dogs and 1 cat was accomplished. It was good that the swamp dogs would live their natural lives in NANAS --- a much bigger community said to have 650 dogs.
"They will adapt well to the communal living in NANAS," Lynda assured me. "Unlike dogs that live in apartments alone."



Would there be swamps and monitor lizards in NANAS too?