FELINE DYSTOCIA AND CESAREAN SECTION

I am sharing some insights on the Feline Dystocia and C- Section in this segment .

Many times we get cats presented in advanced stage of dystocia. It is very important for the cat owners, Paravets to understand the stage of birth which clearly indicates the time for intervention by the vet.

Cat’s labour signs are very interesting and much more unique compared to canine labour stages .

STAGE -1 First stage labour begins with the onset of uterine contractions. During this stage the cervix begins to dilate open with clear , odourless discharge from the vagina - mucus plug during pregnancy sealing the uterus starts. As the first stage progresses, contractions will become closer and closer together.

STAGE -2 Second stage labour is characterised by contractions much stronger and closer together and the cervix becomes fully dilated. When the queen is ready , kitten moves down the birth canal. Pressure   on the cervix initiates an urge to push from the mother. It takes around three pushes for the kitten to be delivered. The queen will tear and lick the membranes from the face and body which will stimulate breathing. Second stage usually takes around 5 minutes to 1 hour.

MORE THAN ONE HOUR OF SECOND STAGE OF LABOUR NEED VETERINARY HELP!

STAGE -3 Third stage labour: Immediately following the kitten's birth, the placenta is normally delivered. Once the queen has cleaned the kitten and breathing has commenced normally the queen will chew the umbilical cord in two and quite often will eat the placenta.

CAUSES OF DYSTOCIA IN CAT

 There  are a number of causes of dystocia which can be classified as maternal or fetal. Maternal causes include  Narrow pelvis. Fractured pelvis ,Pelvic obstruction and Uterine inertia uterine torsion (twisting) or rupture. This may be primary or secondary . When the uterus fails to produce any contractions this is regarded as Primary inertia This can be from  poor health, obesity, age, stress.Fetal causes include abnormally presentation of  kitten, oversized foetus , Excessive fetal head size and malformed fetus, Fetal death.

A CASE OF UTERINE TORSION LEADING TO DYSTOCIA AND REVIVAL OF LIVE KITTEN BY CESAREAN SECTION 

PLEASE WATCH THE VIDEO BELOW .

                                      

We had handled a very challenging case of feline dystocia this week. three year old cat was presented on 71 day of gestation with history of delivering still born kitten 11 hrs prior to presentation of case 

.The case was tried to manage medically with oxytocin but the  total uterine inertia was evidentThe cat was very dull and depressed.  An abdominal ultrasound revealed two more kittens on the right horn. One dead and another alive. An emergency  C- Section was planned .

On laprotomy , uterine torsion of gravid  right horn and pale purple color of the uterine mass was suggestive of putrefaction . On opening the uterus a very foul smelling foetus was removed and  a live kitten was carefully taken. 

Upon removal the kitten had gone for apnoea which was successfully retrieved by cardio pulmonary resuscitation .

THE JOY OF SAVING A MOTHER AND A KITTEN WAS BEYOND WORDS TO EXPRESS .

SIGNS OF DYSTOCIA IN CATS

·         Gestation lasting longer than 70 days

·         Stage 1 labour lasting longer than 24 hours

·         Straining for 10 minutes if a fetus  is  visible in the birth canal

·         Acute depression and Fever (above 103°F)

·         Sudden discharge from the vagina of bright red blood  lasting longer than 10 minutes

·         Thick, black, foul smelling discharge from the vagina.

Significant gap between deliveries is very common in cats . If the fetus is stuck in the birth canal, apply gentle traction is needed . An ultrasound scan can precisely diagnose the live kitten in the abdomen . In my experience I had found that If the labour has been long, calcium levels may have depleted. When combined with oxytocin, calcium gluconate can result in contractions much more efficient than with oxytocin alone. Adequate hydration with Intravenous fluids is a must to combat the stress of dystocia.

And when the queen is not responding to medical treatment a Cesarean section is the only resort.

Anesthetic combination of Ketamine @ 15 mg / kg bw and diazepam @  0.6 mg/kg bw gives very good result during the procedure. Ketamine in a slight higher dose were found to be showing prolonged recovery period and catalepsy. In case of Dystocias delivering one dead foetus and mother still straining .. An ultrasound scan is an excellent tool to identify the live foetus if any and in that case only an emergency C  Section can save the life of the mother and kitten.

                                                   

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THE STORY OF INDIAN DONKEYS

As an Army Veterinarian I had spent my majority time with Horses and Mules , I had an impression that Donkeys are like horses and I can very well treat them when given a chance. All my convictions were proved wrong when I got the real life challenge to treat a donkey in advanced state of colic. Thanks to the the wonderful animal welfare organisations, Animal Rahat- PETA  and Donkey Sanctuary International (an International donkey welfare organization) which taught me much regarding this unique versatile creation of god. Donkeys are definitely not like horses. In many ways they have a complex psycho somatic difference and very high level of pain tolerance , making a vet very difficult to interpret the concealed symptoms of diseases . During my graduation days much less were taught regarding the care, management and diseases of donkeys. Even today the VCI syllabus addresses very less or nil regarding the donkeys.

I would like to dedicate this segment to the vets and animal welfare professionals who work for donkeys. I believe their work is indeed noblest of all . God has created donkeys with elements of extra dose of tolerance, resilience and much versatility.

Donkeys belongs to the class equidae . Much similar to the  domestic cousin- Horse and wild relative zebra, donkey possess its own individuality and  character making him poor man’s friend and ultimately “ beast of burden”. Donkeys are agile, firm and much resilient animals with a great deal of tolerance and complacence. The donkeys differ in horses in following ways . Chromosome number of a horse is 64, Donkey has 62 chromosomes (Zebra has chromosome number 46).

Donkeys are not like horses; they differ physically, mentally and emotionally.

More  stoical  in  their  behaviour  , donkeys  show  limited  fear  response  to  novel  situations  and  this  can  be  mistaken  for stubbornness rather than fear.

Donkeys (Equus asinus) are very efficient at metabolising their food . Donkeys form  very  strong  bonds  with other  donkeys  and  animals,  and even  short  term separation from a companion can be stressful.

Donkey ergots are more prominent  than for horses– Often look more like a digital pad

Donkey inferior check ligaments– Have an extension from the deep flexor tendon to the superficial flexor tendon in the front legs (not found in the mule).  No Inf Check Ligament  in the rear leg  

Laryngeal anatomy slightly differs from horses and nasal passages  are smaller than equal sized horses – Smaller NG tubes required

Gestation period of a donkey is 370 were as for horses it is 340. Average life span of donkey is 35 were as for horses it is 25.

Crossing a donkey with a horse produce Mules and Hinnies.

Mule- female horse bred to a male ass- 63 chromosomes

Hinny-  male horse bred to a female ass- 63 chromosomes also Both crosses are considered sterile even though there are documented cases of fertility in the female mule (Mare Mule or Molly Mule).

THE REAL LIFE OF INDIAN DONKEYS

I made a small clip about the life of donkeys in India from the collection of photographs that I gathered during all these days. 

YOU CAN WATCH THE CLIP BELOW

Large number of donkeys are bred and exploited as pack animals in our country especially in North India. Donkeys are mainly used in brick klins. In south you can see a great number of Donkeys in Maharashtra- Sangli and Solapur district and many areas of Tamil Nadu. Much compact body, a docile nature, a “no problem “,“no complaints” attitude makes a donkey -poor man’s friend and beast of burden.

When it comes to tolerance , heaven is the limit for donkeys . It is absolutely true when we say that India's infrastructure was built off their forced servitude in the brick industry. Donkeys are routinely overloaded; young, undersized and ill or injured animals frequently haul loads of more than 50 bricks with little to no padding between the load and their backs. As a result, donkeys can develop chafing wounds, bruises and abrasions which can become infected and infested with maggots. Their hooves can become painfully overgrown, cracked and sore, and lameness is exceedingly common.

Donkeys can suffer from a host of diseases, including rabies, trypanosomiasis, extensive dermatitis, ophthalmic infections and a wide variety of polythene impactive colics (which may not be prevalent outside India). Stoic and acquiescent, donkeys are easy targets for abuse, and their suffering often goes unnoticed. Impoverished people with little knowledge of humane husbandry methods perpetuate many cruel practices against these animals. Donkeys have their nostrils cut open, ostensibly to increase air flow, and their ears are also cut open to drain what's perceived as "bad blood" and to prevent tetanus. Most donkeys never see a veterinarian during their entire lifetime, and there is little scientific research pertaining to the health and welfare of donkeys in India. I was shocked to see donkeys been used for drawing sand from river bed . These " water donkeys" end up their life with irreparable hoof decay and wide variety of hoof ailments.

Illegal attempts to transport donkeys across the borders of Maharashtra and Karnataka to be killed for meat are still reported. As evidenced by the above, donkeys are among the most abused animals on Earth.

When I was working for PETA as Program Manager and Chief Vet Surgeon for the Animal Rahat , the largest working animal welfare program, as a team we learned a lot treating  wide ailments in donkeys. Understanding the socio economic structure of a donkey owners life is the first step in understanding the physical condition of donkeys. In majority of  brick klins of our country , It is a common scene to watch 3 year old kids grossly  malnourished leading a 2 year old donkey colt over loaded with bricks. If you go to his hut you can see his ailing carrying mother with five more hungry kids playing around in a filthy, totally unhygienic environment. What is the role of animal welfare in the place where human welfare is grossly compromised ?

Tetanus and Rabies are the most dangerous disease conditions in donkeys apart from plastic colics , gross worm infestations and wide range of wounds and hoof affections. The sight of the donkey with rabies is really horrific to watch and much challenging even to approach for  euthanasia. An average donkey needs regular deworming with broad-spectrum dewormers – Fenbendazole and praziquantel combinations , regular hoof cleaning and body grooming apart from  nutritious diet of plenty of green grass, chaffs , wheat bran and protein sources . But in real field scenario donkeys graze on road side eating plastics invariably leading to plastic colics.

Colic  in donkeys requires special attention as the only pain signs in donkey with colic will be anb increase in heart beat and respiration rate. The tolerance of this species is too high that many clinical signs get concealed.

Where ever we see donkey owners ,it is a mandate to advice them for tetanus toxoid injection and anti rabies injection annually.

A WAY FOREWARD

I strongly believe that Animal Welfare is the extension of Human welfare and this is more pronounced with donkey welfare. As the donkey owners are the poorest of all animal handlers who live with gross poverty , difficult and struggling to earn their  routine bread . It is a very common fact that  literacy rate is almost nil with donkey owners. Poverty breeds callous attitude and we can see animal welfare being compromised grossly in brick klins in the country. If we really want to make some difference to this condition of donkeys we need to work a lot at the community level and a great deal of society upliftment is the only way to bring welfare for this poor creatures. In a country were crores of money being pumped in the name of CSR, I believe it is the duty of every corporate, every building built on brick to address this sufferings of this beast of burden. In other way I would like to put as “ for every brick produced in a brick kiln we owe its share to the mighty donkeys who worked in the brick klins”.
A veterinarian role in community development  is much pronounced in practice of  donkey medicine.

I thank the wonderful team of Donkey Sanctuary India and UK, Animal Rahat PETA , Brookes India who laid foundation for this great initiatives for struggling donkeys in our country. The community development programmes by these organisations had literally made paradigm shift in the approach towards the donkeys . 

I salute all my fellow veterinarians and animal welfare staff in these organizations and in field who works hard to address the suffering of the donkeys. I am equally proud and honored to be one amongst you who care a lot for this wonderful creation of god .

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INGUINAL HERNIA IN A MONGREL PUPPY - A RESCUE STORY

I believe a lot in miracles. Nothing ever happen by chance and there is a time and reason for every single leaf falling on ground. Many times a single action of kindness bring back the most hopeless condition in an animal's life. I strongly believe that  all we need are eyes and heart which are " truly alive". The joy of bringing back a wagging tail to life is beyond words to express. 

This is another rescue story of a puppy. 

This homeless pup was found abandoned, crying with pain on road side with a huge painful swelling on the inguinal region. We rescued this pup and an emergency herniorrhaphy under a well planned balanced anesthetic regime saved the life of the pup. The puppy had an uneventful recovery . Inguinal hernia needs immediate attention. In pups this starts as a swelling on the groin and majority cases this will be congenital. As age advances the prognosis of the condition worsens. This puppy was identified with a congenital inguinal hernia. He responded well to the surgery.

You can watch this video below

The two important abdominal hernias in puppies are Umbilical hernia and Inguinal hernia. An inguinal hernia is a condition in which the abdominal contents protrude through the inguinal canal or inguinal ring, an opening which occurs in the muscle wall in the groin area.

 The muscles Sartorius ,Pectineus , Adductor and fascia of external abdominis obliques forms the external inguinal ring boundary. In congenital development defect, the inguinal ring will be ill developed making the intestine and viscera herniating through the  improperly closed external inguinal ring.

As the puppy start growing the hernia contents increases and strangulation at the level of the ring is a common sequelae. The condition is severely painful. Early identification of case and herniorrhaphy is the only treatment option.

Symptoms seen with a complicated inguinal hernia may include: Swelling in the groin area, which may become painful and warm to the touch, pain, frequent attempts to urinate, lack of appetite and depression, the situation can become life-threatening.

Inguinal hernias can usually be diagnosed by finding the swelling caused by the hernia on a physical examination. However, sometimes contrast radiographs (X-rays) or an abdominal ultrasound are needed to determine which abdominal contents, if any, are entrapped.

Herniorrhaphy is the only solution and the success of the surgery is more in young animals.

Interrupted sutures with chromic catgut or polyglactin 910 suture materials follwoed by a subcuticular sutures give sufficient tension handling of the inguinal ring. Balanced anesthetic protocol with premedication with triflupromazine followed by induction with a higher dilution of 12.5 % thio pentone soduim and maintenance with  isoflurane or sevoflurane anesthesia is the best to deal with inguinal hernia correction in puppies.

The joy of recovery is beyond words to express. The puppy got attached with me and all those budding vets ., the internees who took care of him very well till recovery. I feel blessed and whole heartedly thank god for making me capable to save innocent lives.  

The stain of pain and fear is rooted in all living beings . A little gesture and a thoughtful moment by our actions and deeds brings unbelievable difference in the lives of the animals. I am certain that every one who read this segment will definitely agree with me  and spread the small yet invaluable  message of kindness and compassion. 

Until he extends the circle of his compassion to all living things, man will not himself find peace.                                                                                                                     -Albert Schweitzer

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CESAREAN SECTION IN LABRADOR BITCH - REVIVAL OF NINE LIVE PUPS : A MEMORABLE CASE

In this post, I am sharing some blessed moments of my career  as a vet surgeon. 

Last week a case of 4 yr old biparous Labrador retriever in 64^th day of gestation was presented in total refractory state of complete uterine inertia with history of straining from past 24 hours . The owner brought this dog in a very late stage and the animal had severe dehydration, cachexia and stage of unconsciousness. After initial stabilization with fluid therapy , an emergency cesarean was performed which  saved the  animal and nine live pups were successfully revived

Even though this operation was done with out assessing the foetal position and number  by an ultrasonic scan due to the late night presentation of the case , the animal responded very well and the anesthetic ombination of propofol @ 6 mg/kg  and diazepam @ 0.5 mg/kg gave excellent results.

PLEASE WATCH THE VIDEO BELOW 

Dystocia can occur as a consequence of problems with the dam’s uterus or birth canal, or with the fetus.  An abnormally long time between deliveries of puppies,  prolonged period of labor with no puppies being born, delivery of stillborn puppies (born dead),presence of a puppy in the birth canal without obvious abdominal contractions or movement of the puppy, agitation in the dam, persistent nesting behavior (digging, circling),fatigue, exhaustion, Straining as if to defecate , suggests an obstruction in the birth canal or uterine inertia which demands a Cesarean section to save the mother as well as the pups.

The diagnosis of dystocia should be based on the presence of any of the following criteria:

Failure of the dam to initiate labor at term.  Bitches can be considered over term at >70-72 days from the first breeding, >58-60 days of diestrus, or > 66 days from the LH surge or initial rise in progesterone during estrus (All ovulation timing methods performed during the previous cycle).

Failure of the dam to enter Stage 1 labor, beyond 24-36 hours after a detectable drop in rectal temperature <99-100 degrees F or decline in progesterone level below 2 ng/ml, or failure to proceed from Stage 1 to Stage 2 labor within 24 hours.

Failure of the dam to complete delivery of all of the fetuses in a timely fashion.  Delivery of the first fetus should occur within 1 hour of active labor (with visible abdominal efforts) or 4-6 hours of intermittent labor.

Fetal distress (unborn puppies with slow heart rates, stillbirths).

Maternal distress (excessive pain or depression), green or copious vaginal bleeding.

Irreversible history of dystocia (pelvic canal abnormalities, mismatch fetal/maternal size, malposition)

In the present case the mother was totally non responsive and cachectic with

Severe straining. The owner did gross neglect to the mother leading to the presentation of case in advance stage.

Oxytocin injection can be given if the mother is in a position to initiate a contraction. In this case emergency fluid therapy stabilized the animal.

My previous post on  C-Section in a PUG can also be refereed in this context.

http://drssnairvet.blogspot.in/2014/12/clinical-veterinary-surgery-video.html

C- SECTION IN PUG

IMPORTANCE OF FLUID THERAPY

Patients who present for dystocia often will be dehydrated, so it is appropriate to fluid-resuscitate them before surgery. Electrolyte abnormalities should be corrected pre-operatively. Every animal must be evaluated for evidence of hypovolemic shock, and treated appropriately if necessary. The vast majority of animals, however, will require only one-third to one-quarter of their shock dose of isotonic crystalloid fluid (15-20 ml/kg), followed by a surgical rate of fluid administration (10 ml/kg/hr crystalloid unless complicating factors are present, such as heart disease or hypoproteinemia).

Nearly all analgesic and anesthetic drugs will cross the placenta and enter the fetal circulation. As such, it is important to minimize fetal exposure to cardiovascular depressant drugs by minimizing time from induction to delivery.

PROPOFOL -DIAZEPAM COMBINATIONS FOR ANESTHETIC MANAGEMENT IN C- SECTION.

Propofol is an anesthetic injection for use in dogs for induction and maintenance of general anesthesia for up to 20 minutes and for induction where maintenance is provided by inhalant anesthetics.
When using propofol, patients should be continuously monitored, and facilities for the maintenance of a patent airway, artificial ventilation and oxygen supplementation must be immediately available. Propofol contains no antimicrobial preservatives. Strict aseptic techniques must always be maintained during handling since the vehicle is capable of supporting the rapid growth of microorganisms.

Propofol works by binding to the GABA receptor (the primary inhibitory neurotransmitter binding site) CNS Effects Propofol produces CNS depression and unconsciousness. Propofol is considered “cerebral-friendly” because it decreases cerebral oxygen consumption, decreases cerebral blood flow (CBF), lowers intra-cranial pressure .Administration of other GABA agonists (e.g. benzodiazepines (diazepam/ midazolam)) immediately before propofol can decrease the amount of propofol needed by almost 50%. This is cost saving, and also decreases the cardiovascular and respiratory depression seen with bigger doses of propofol.

I thank my colleague Dr Nagaraj, the internees in Veterinary Surgery and the final B.V.Sc. students who helped me in this procedure.Hope this case has inspired the budding vets .

I am sure my  team will remember this case through out  the career  for the timely decision to cut open and the joy of taking live pups one by one and counting the heartbeats  reviving nine pups sequentially was beyond the words to express.  

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CASTRATION AND ITS EFFECT ON CANINE SERTOLI CELL TUMOR

In this segment I would like to share some experience with Canine testicular tumors-  sertoli cel tumor and seminoma  which is a testosterone dependent tumor seen in un-castrated old male dogs. Testosterone is the male hormone that is universal in all male species. When it comes to dogs, the hormone has multiple role in their behavior and also in their social order and structure.  As dogs grow, crosses his adolescence of 18 months, steep hike in the testosterone trigger secondary sex-related characteristics like  mounting, lifting of leg and higher levels of aggression.The causes for canine aggression are of great concern for many dog owners.

A male dog when presented with signs of feminisation like well developed teats, gyaenecomastia , bilateral alopecia and enlarged testicle, it is a sure case to be suspected for sertoli cell tumor.

Testicular tumors are common in dogs and account for 90% of all cancers arising from the canine male genitalia . Sertoli cell tumor is a testicular tumor arising from the Sertoli cells located within the seminiferous tubules. Several factors are believed to influence the development of testicular tumors, including cryptorchidism, age, breed and exposure to environmental carcinogens . German shepherd dogs, Afghan hounds, Weimaraners and Shetland sheepdogs appear to have an increased risk of developing primary testicular tumors. Both Sertoli cell tumors and seminomas are associated with intra-abdominal or inguinal cryptorchidism and these tumors develop the male feminizing syndrome, from the production of estrogen and estrogen-type hormones .

This six year old intact male GSD , had bilateral symmetric alopecia and hyperpigmentation with gradual weight loss three months prior to presentation of the case. On palpation and detailed examination , large pedunculated mass was found at the site of left testicle and the right testicle was absent on the scrotal sac. The animal had characteristic signs of feminisation with well-developed teats and subcutaneous cystic swelling seen close to the teats at the inguinal region

Signs of feminization , contralateral testicular atrophy, squamous metaplasia within the prostate gland, symmetrical alopecia, and bone marrow atrophy are common symptoms noticed in sertoli cell tumor. In the present case the animal had signs of feminisation as evidenced by  Gynecomastia and presence of cystic swelling near the inguinal teat which may be attributed to the excess estrogen . Cryptorchidism has been associated with testicular tumors in animals and human . Tubular arrangement of the neoplastic Sertoli cells with cord-like and diffuse pattern is regarded as a common histo-pathological findings in Sertoli cell tumors.  In the present case, the animal successfully recovered after the operation. The third month post-operative evaluation showed complete reversion of the feminisation and till date no re-occurrence of tumor was noticed.

 

YOU CAN WATCH A PRESENTATION ON SERTOLI CELL TUMOR IN THE GSD DOG BELOW

EFFECT OF CASTRATION

From the animal behavior point of view, there are two kinds of aggression seen in dogs , fear aggression and dominance aggression. Fear aggression results from previous experience of being attacked, or because they feel they are unable to escape a particular situation. As a Vet, I had encountered this response in some patients in the second visits.  

Many owners complain that the dog mounts on every one . Mounting behavior against humans is a land mark of  puberty. This is normal but demands castration if the dog shows the symptom even in adult stage.

Castration may be recommended where aggression between dogs is orientated towards other males and where fear aggression has been ruled out. Castration may reduce the desire to dominate and reduce overall aggression thresholds.

The advantages of castration can be enlisted in two headings

Behavioral advantage which includes

decreased roaming,

decreased aggression,

increased concentration

Well focused traits of army dogs may be attributed to the early castration

Medical advantages of castration  includes prevention of

Testicular tumors- seminoma and sertoli cell tumor

Perianal hernia

Perianal tumor

All male species suffer from begnign prostatic hyperplasia .An intact male dog shows the sign of difficulty in defecation and urination and the main cause will be that of an enlarged prostate.

Testosterone dependent prostatic enlargement needs castration and this for this reason Castration is recommended for all male dogs.