Kiba Travels Back To Motherland For Life-Saving Surgery

At just 8 months young, Kiba the Shiba Inu was diagnosed with a rare congenital heart defect known as Double-Chambered Right Ventricle. He was experiencing fainting spells almost every day and might not live to celebrate his 2nd birthday. But Juliana and Jonathan would not let that happen. They flew to Japan for open-heart surgery — giving their best friend his best chance at life.


what is Double-Chambered Right Ventricle?

Double-chambered right ventricle (DCRV) is a rare congenital heart defect characterised by abnormal fibromuscular bands or membranes within the right ventricle resulting in an obstruction to blood flow out of the right side of the heart.

This obstruction creates increased outflow pressure and workload for the right side of the heart, leading to thickening of the muscle as well as tricuspid regurgitation (back flow of blood through the tricuspid valves).

DCRV diagnosis and clinical signs

Kiba was 8 months young when he was first referred to veterinary specialist Dr Nathalee Prakash at Mount Pleasant Vet Centre (Gelenggang).

According to Juliana, “Kiba was fainting nearly every day (syncope) from anything that excites him, like daily occurrences of us reaching home. We had to quickly hold him firmly before he got too excited. Usually he would collapse on the floor for a few seconds. When it was a bad episode, he would scream and urinate uncontrollably.”

A full diagnostic work-up including radiography, electrocardiography and echocardiography performed by Dr Nathalee Prakash confirmed the diagnosis of DCRV. Clinical signs include exercise intolerance, coughing, panting and fainting.

medical management associated to poorer prognosis

Kiba was initially managed with medication to improve relaxation of the heart muscle and relieve the outflow obstruction which minimised the fainting episodes. However, medical management was associated to a poorer prognosis and meant he was medication dependent. There are also potential side effects such as slowing of heart rate and lowering of blood pressure. If the condition progresses, patients may develop signs of right-sided heart failure (which include fluid in the abdomen, enlarged liver, poor circulation) with increased risk of sudden cardiac arrest.

“Past publications show that in the small number of patients this condition has been documented in, surgery is the preferred option due to an improved lifespan. Furthermore, in the time leading up to Kiba’s surgery, there was some progression on repeated echocardiography, which gave further support that surgery was the right decision despite the risks involved,” says veterinary specialist Dr Prakash.

rigorous screening and quarantine 

There is no veterinary surgeon in Singapore qualified to perform the open-heart surgery on Kiba. His family thus made the huge decision to travel to Japan where Kiba will be operated on by Dr Masami Uechi of JASMINE Veterinary Cardiovascular Medical Center.

In the months leading up to surgery, Kiba had to fulfill export requirements and also go through rigorous screening to ensure he was a suitable candidate for surgery. Juliana explains, “There is a strict requirement for rabies vaccination and a 6-month quarantine before Kiba could travel to Japan. It was stressful to wait and not be able to do anything to improve his condition.”

 

29 June: Kiba with Dr Nathalee Prakash the day before his flight @kiba.shiba

off to japan for a fighting chance

Juliana and Jonathan had visited JASMINE Center in February to meet the team and view the facilities. “We are very relieved that Kiba is finally on his way for surgery after such a long wait. We have total confidence in Dr Uechi and the JASMINE team.”

30 June: “Heading back to my Motherland.” @kiba.shiba

Because love is about going that extra mile

Meeting new friends in Japan. The family arrived 10 days before the scheduled surgery, giving Kiba’s body time to adapt and reduce the level of stress before the procedure.

dcrv OPEN-HEART SURGERY

The aim of cardiac repair is to surgically remove the abnormal muscle bundles dividing the right ventricle into two cavities.  An incision is made in the right ventricle spanning the region of the defect and the location of the obstruction determined by visual inspection and palpation of the right ventricular wall. The fibromuscular membranes are then excised, taking care to avoid injury to the papillary apparatus of the tricuspid valve.

10 July: Open-heart surgery by Dr Masami Uechi and team went smoothly

11 July: “I’m doing pretty well for Day 1. Woke up in the middle of the night with a few drama screams. The surgeons took care of me and I slept through till morning.” @kiba.shiba

Kiba is very fortunate to be in a family who is able to go against all odds to save his life.

“Not every family can afford to give their pet the opportunity to correct a heart condition.  Take your time to do your research if you are purchasing a pet from breeders – ask around, speak with current owners, get to know the parents of the puppies – such congenital health issues should not be taken lightly.”

 

15 July: “I’ve been discharged! Everyone is amazed by my progress.” @kiba.shiba

“We feel extremely relieved that Kiba is no longer fainting. There have been moments when he got too excited and we held our breath and waited for the usual fainting spell – you can see sheer joy on his face when it didn’t happen. We are monitoring his progress closely – when the right time comes, we will know when he is ready for some off leash activity.”

“There is a worldwide community called the Mighty Hearts Project – fellow pet lovers who are there to support families seeking overseas open-heart surgeries for their furballs. It is good to know we are not alone.” ~ Juliana (extreme left) with Kiba

home sweet home

After 25 days in Japan pre-and-post-surgery, the family was ready to fly back to Singapore and continue Kiba’s journey to recovery.

“Mahatma Gandhi said, ‘The greatness of a nation can be judged by the way its animals are treated’. I hope we will continue to pursue better healthcare for our pets and have our very own cardiology specialist in Singapore!” 

26 July: “Good to be back home. My place of comfort.” @kiba.shiba

post-surgery review 

“DCRV surgery in humans is well-researched and published with a high success rate but there is very little data in the veterinary world. The vets at JASMINE Center will continue to monitor Kiba from a distance together with the ever-so-patient Dr Prakash at Mount Pleasant (Gelenggang). Without Dr Prakash’s help over the past months, Kiba might not have made it to Japan for his surgery.”

11 Aug: Post-surgery review and echocardiogram by Dr Nathalee Prakash. Clinically, Kiba has shown marked improvements with a better body condition score, higher energy level, no episodes of fainting.

Welcome home Kiba! L-R: Cash, Dr Keshia Beng, Dr Nathalee Prakash, Rose, Jonathan, Juliana

Juliana and Kiba with his favourite vet nurse Cash

“Kiba definitely has been a strong boy and is totally loving his new life. The journey to recovery is long but he is surrounded by family and friends who will give him much love and support.” Follow Kiba and his family at @kiba.shiba


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

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Kirin: Liver Shunt Surgery

4 months ago, a kind act by rescuer Benji and Purely Adoptions got a very sick puppy off the streets. Treatment and surgery by Dr Dennis Choi and Dr Nathalee Prakash provided the best chance for a long healthy life. Top it all off, Dr Gloria Lee and Victor changed Kirin’s future by giving him the best home any street dog could ask for!

When Kirin was found in a car workshop, he was very weak and showing signs of respiratory distress.

portosystemic or liver shunt

Our liver plays a role in most of the metabolic processes in the body. Normally, blood from the abdominal organs flows to the liver via the portal vein. The blood brings the liver nutrients and is cleansed of toxins and impurities.

In a puppy like Kirin, a portosystemic or liver shunt is an abnormal blood vessel that diverts blood around the liver instead of into it. The liver is deprived of necessary nutrients and fails to grow normally. Congenital shunts can be extrahepatic (outside the liver) or intrahepatic (inside the liver).

With Purely Adoption’s support, rescuer Benji took Kirin to Mount Pleasant Vet Centre (Mandai) for treatment.

Clinical Signs and diagnosis of Liver Shunts

Common clinical signs include stunted growth, poor muscle development, mental dullness, reduced appetite, vomiting, diarrhoea, blood in urine. Hepatic insufficiency combined with toxin build-up can result in hepatic encephalopathy – affecting the brain and causing neurological signs such as  ataxia, seizures, head pressing and behavioural changes.

Common clinical signs of liver shunts include stunted growth and mental dullness

Kirin was referred to Mount Pleasant (Gelenggang) for a full diagnostic work-up including blood work, urinalysis, liver function tests, ultrasound and CT scan with contrast to confirm and locate the portosystemic shunts.

medical management Before Surgery

Before surgery could be performed, Kirin was managed by veterinary specialist Dr Nathalee Prakash. The aim was to reduce the amount of toxins produced and improve Kirin’s health  to decrease the risk of anaesthesia and surgery. Kirin was placed on an appropriate hepatic diet, antibiotics to reduce intestinal bacterial overgrowth, and lactulose to encourage rapid transit of faecal matter and bacteria through the intestinal tract.

Kirin with veterinary specialist Dr Nathalee Prakash at Mount Pleasant (Gelenggang)

liver shunt Surgery 

Once Kirin’s condition is stable for general anaesthesia, surgeon Dr Dennis Choi performed a challenging procedure to close the shunt. The abdominal cavity is opened and the liver shunt identified. An ameroid ring constrictor is then carefully placed around the shunt, allowing it to close progressively over time and restore normal blood flow to the liver.

Gradual occlusion is important to prevent excessively high portal system pressure, called portal hypertension, which can result in death.

Dr Dennis Choi assisted by Dr Korn

After locating the shunt, Dr Dennis Choi prepares to place the ameroid ring constrictor around it.

Over the next few weeks, the casein absorbs fluids from the body and swells inwards, gradually compressing the shunt to restore normal blood flow to the liver.

Kirin was hospitalised for a few days and closely monitored

Kirin at his post-surgery review. Surgical site healing very well.

Kirin with Dr Korn, Victor, Dr Dennis Choi, Dr Gloria Lee

A month and half after surgery, Kirin is a healthy 19kg, playful and active.

post surgery care

It takes time for liver cells to regenerate and regain normal function as the shunt slowly closes in the weeks following ameroid constrictor placement.  Kirin  will continue on a hepatic diet and medications while returning for regular blood tests to monitor his recovery. Meanwhile, this sweet little boy is bright, active and happily annoying his big brother Tully — enjoy the video below!


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Coco: IVDD

Intervertebral disc disease (IVDD) or ‘slipped disc’ is most commonly seen in short-legged breeds such as Corgis and Dachshunds. It can be a very painful condition resulting in limb weakness or paralysis.


30 Jan 2018

Coco suddenly lost the use of her hind legs.

Our dog’s spinal column is made up of a series of bones called vertebrae and intervertebral discs which act as ‘shock absorbers’. When the discs degenerate, the inner contents (nucleus pulposus) herniate and press against the spinal cord or nerve roots, causing limb weakness or paralysis.
Neurological exam, myelogram and CT scan help our surgeon Dr Dennis Choi locate the ruptured disc and plan for surgery. For ruptured disc in the thoracic (mid back) or lumbar (lower back) spine, a specialised procedure called hemilaminectomy is performed to access the vertebral canal and remove the disc material compressing the spinal cord.

An incision is made along the back -> a ‘window’ is drilled through the vertebrae -> the extruded disc material is removed. The incision on Coco’s back healed very well.

While conservative management may be acceptable to treat patients with mild neurological deficits, dogs with paralysis or loss of pain sensations require prompt surgery for a positive outcome. After a week of close monitoring, Coco was discharged for home care.

15 Feb 2018

Following a delicate spinal surgery by Dr Dennis Choi, Mount Pleasant Vet Centre (Gelenggang), and strict home rest, Coco improved day by day. Gentle controlled exercise and physiotherapy will be gradually incorporated to help Coco build up strength and regain normal motor function.

“Coco is a sweet girl with a mild temperament. She loves Lele and always wants to be with him. Coco is coping much better than the humans. Her independent character makes her crate rest and recovery much easier for us. She doesn’t whine while being crated. She doesn’t complain about anything, she’s the best patient.️” ~ Coco’s family (Photo: @corgiandachshund)

“We learnt a lot about IVDD from IG furiends. Some recovered, some are on wheels permanently. Coco doesn’t jump on furniture at all. They have ramps to access the couch and bed but only Lele uses it. We place dog beds everywhere so they can stay comfortable on the floor. We have taken precautions but some things just happen. Here are some advice:

  • Discourage jumping up and down furniture.
  • Crate your dog and go to the vet ASAP if you suspect IVDD.
  • Crate rest after surgery, 6 to 8 weeks recommended.
  • Use a sling support to help your dog during toilet breaks.
  • Each dog’s recovery differs. Be very patient and do not rush your dog to walk.
  • Keep your dog at a healthy weight to reduce stress on spine and legs.
17 mar 2018

6-weeks post surgery review with Dr Dennis Choi and Coco’s recovery is excellent!

Coco used to go on adventures with Lele and we know she can’t wait to get out there and explore the world. So long as it is nothing strenuous or competitive, Coco can gradually resume normal walks and outdoor activities. As Dr Dennis Choi says, “Ultimately we want to live our life. And we want to be happy.”

Coco’s excellent recovery from IVDD is possible with a successful spinal surgery, wonderful home care by her family & moral support from Lele who always looks ‘deep in thought’ but is actually a very happy boy! 🙂


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Maggots In Pets

Maggots are fly larvae (an early stage of fly development). Flies are usually attracted to animals by their odour, especially for animals with urine or faecal staining (e.g. from diarrhoea), skin folds, severe skin problems, wounds, infected ears, hot spots etc. Weak and debilitated animals and those kept outdoors are at higher risk of maggot infestation.

Flies reproduce by laying eggs on the skin or wounds. When maggots hatch, they feed on surrounding tissues by producing proteolytic enzymes. These enzymes cause an enlargement of the wounds. As a result, surrounding tissues become severely inflamed, uncomfortable and painful for the pet. The maggots can also burrow underneath the skin.

Community cat Tiger was rescued with a huge maggot wound on his head.

In severe cases, surgery may be necessary under local or general anaesthesia.

Reconstructive surgery was performed by Dr Lesley Teo of Mount Pleasant Central (Whitley) with a single pedicle advancement flap elevated from the neck skin to stretch over the big wound.

Maggot wounds are common in warm and humid environments

These wounds are often noticed only when the animal shows discomfort or pain. Owners usually notice discharge and/or foul smell from the wounds, which frequently have a small circular opening with surrounding tissues becoming red and swollen.

If you find maggots on your pets, we recommend veterinary attention as soon as possible to shave and clean the affected area, remove the maggots, followed by topical wound treatment and oral antibiotic therapy, if required.

Maggot wounds can be prevented
  • Keep the environment clean and dry to prevent flies.
  • Keep your pets indoors if they have a tendency to attract flies.
  • Check your pet’s body regularly for any external wounds.
  • Clean up any parts of your pet’s body with discharges or staining.
  • Keep your pet’s coat short to prevent matting and soiling.

We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Sarge: Lung Lobe Torsion

When 3-year-old Sarge lost his appetite and started panting for two days even in an air-conditioned room, he was referred to our specialist surgeon Dr Patrick Maguire.

X-rays and CT scan revealed pleural effusion (fluid accumulation in the chest cavity) with a right lung lobe torsion (twisting). This is a life threatening condition that requires immediate stabilisation and surgical intervention.

Lung lobe torsion

When a lung lobe twists, it causes obstruction of the bronchus and vessels. The torsed lobe is identified through a lateral intercostal thoracotomy and surgically removed with a stapling device. 

Thoracotomy (open-chest surgery): performed by Dr Maguire via an incision on the side of the chest to visualise the affected lung lobe.

Lobectomy: the affected lung lobe is surgically removed and sent for histopathology and bacterial culture.

After the torsed lung lobe is surgically removed, a chest tube is placed to allow for removal and evaluation of fluid and air from the chest cavity during post-operative period.

Recovering at home

Don’t think Sarge enjoys this channel

“Sarge is doing great and back to normal. He coughs sometimes but otherwise everything is good.” Grateful for families who do all they can to give their best friends the best chance at health and happiness. Sarge is back to fun and games with his sweet little missy!

If your dog has a sudden episode of respiratory distress, please go to the nearest vet clinic immediately. For after hours and emergencies, take your pets to our Mount Pleasant After Hours Clinic located at 232 Whitley Road.

Flat-faced dogs such as Bulldogs and Pekingeses are at risk of upper airway abnormalities such as stenotic nares and elongated soft palate. More about brachycephalic airway obstruction syndrome (BOAS). 

We leave you with this super adorable photo taken by our vet nurse Gerren. You are a brave boy Sarge!


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Kuro: Mast Cell Tumour

“Kuro is quite adventurous – he loves going out! As soon as he sees his leash or knows he’s getting into the car, he gets ULTRA excited.”

“He literally quivers with excitement thinking we are going to the park or beach. So naturally he was upset when he realised it’s the vet instead!”

“The first time we saw the growth, it was about the size of his nipple. We didn’t think much of it as Kuro has a history of sensitive skin. We thought it was a reaction to some environmental irritant. However, it continued to grow and started to look red and angry.” ~ Denise

WHAT IS A MAST CELL TUMOUR?

Mast cells are present in large numbers in the skin and play a role in inflammatory and allergic responses. When they replicate in higher than normal numbers, mass cell tumours can develop.

  • Mast cell tumours (MCTs) are common cutaneous (skin) tumours in dogs.
  • Usually occur as solitary lumps, and occasionally as multiple masses.
  • Range from low grade (low rate of metastasis or spread) to high grade (malignant with an aggressive rate of metastasis).
  • Vary in appearance – just a raised bump or a swollen ulcerated mass
  • Vary in size –  from a few millimetres to a few centimetres in diameter.

MCTs vary in size and appearance. Kuro’s lump measured 10x5mm.

Fine needle aspirate and cytology: A sample of the cells is taken with a very fine needle and examined under a microscope to identify mast cells.

SURGical excision IS THE TREATMENT of choice FOR MASS CELL TUMOURS

Excision with wide margins to completely remove the tumour and surrounding neoplastic cells. The mass will be sent for histopathology for grading and to confirm if the tissue margins are clean and ‘free from cancer cells’. Dogs with low grade MCT have very good prognosis and further treatment is typically not necessary.

“Knowing that Kuro required surgery, we turned to Dr Sandhya Nair (Mount Pleasant North) as she has been taking care of Kuro’s surgeries since he was a puppy. She was professional and in-depth with her diagnosis, and clear in the steps we needed to take. It eased some of our worries.” ~ Denise

Kuro came back for suture removal. “The surgery went well and the lab result confirmed the tumour as Grade 1. We will monitor Kuro closely for any abnormal lumps.”

Chemotherapy

If the MCT is high grade, complete surgical excision cannot be obtained, or there is evidence of spread to lymph nodes or other tissues, chemotherapy may be recommended. Dogs and cats appear to tolerate chemotherapy better than humans. Side effects (such as vomiting, diarrhea, appetite loss) are minimal.

The goal of treatment is to kill and slow the growth of cancer cells, produce minimal negative effects on normal cells, and allow our patients to lead a good quality life for as long as possible.

EXAMINE YOUR DOGs REGULARLY FOR LUMPS & BUMPS

Run your hands all over your dog’s body, feel for unusual lumps and bumps and look out for fur loss, redness or swelling. Lumps and bumps, especially fast-growing ones, should be assessed by a vet. Dogs with a history of MCT should be rechecked regularly.

“Kuro is super stubborn. He doesn’t like people telling him what to do but will do anything for food.”

“For months, Kuro would just sleep on the floor next to the dog bed we bought. After surgery, the bed came in handy when he needed to rest on a comfy place. From then on, Kuro sleeps on his bed every night.”

“Kuro farts a lot, loves human company (doesn’t care about dogs or at least pretends he can’t be bothered), and communicates through snorts! He only barks at the vacuum cleaner or people coming through the gate and it’s literally just 1 bark. He’s very selfish with his barks!”


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Femoral Head Ostectomy (FHO)

The hip consists of a ball-and-socket joint. A normal hip joint is held in place by muscles, a deep socket and strong ligaments.

  • The ball or femoral head is the top part of the femur or thigh bone.
  • The neck is the narrow portion just below the ball.
  • The socket (or acetabulum) is the concave portion on each side of the pelvis.

Several conditions of the hip, e.g. canine hip dysplasia, can be corrected by a surgical procedure called Femoral Head Ostectomy (FHO). Hip dysplasia is caused by abnormal growth of the hip during puppyhood which results in looseness of the joint & development of painful arthritis.

Baby the Japanese Spitz had been limping & “bunny hopping” due to hip dysplasia – the ball of her femur did not fit properly into the hip socket.

signs of hip pain
  • Decreased tolerance to exercise
  • Stiffness
  • Limping
  • “Bunny hopping”
  • Difficulty climbing stairs
  • Difficulty lying down or standing up
  • Reluctance to run or jump
  • Shifting of weight to fore limbs
  • Loss of muscle mass on hind limbs
Physical Exam and x-rays

In severe cases, your vet can feel the hip “pop” in and out of the socket during a physical examination. X-rays will help to:

  • diagnose hip dysplasia, dislocation or fractures
  • identify if the acetabulum is shallow
  • check for bone spurs (a sign that the hips are degenerating)
  • determine if surgical correction is required
FEMORAL HEAD OSTECTOMY (FHO)

FHO is a surgical procedure to remove the femoral head – the ball and neck portion of the joint – to alleviate the pain of bone rubbing on bone. During healing, scar tissue will form and act as a “false joint”. The surrounding muscles continue to support the hip joint.

Dr Estella Liew proceeds to surgically remove the femoral head.

With the femoral head removed, your dog will no longer suffer the pain of bone rubbing on bone. During the healing process, scar tissue will develop to form a functional pain-free “false joint”.

After FHO, strenuous exercise is restricted but your dog is encouraged to use the limb as soon as possible, in a controlled manner. Your vet will advise on a strict physical therapy programme to ensure a good range of motion in the affected hip. Most dogs will start using the surgery leg within two weeks.

WATCH BABY’S VIDEO HERE.

Corkscrew Tail Amputation

Note: The following surgery images may be unpleasant for some readers.

Ingrown or corkscrew tail is an abnormal inward growth of the tail commonly seen in brachycephalic or flat-faced dogs such as Pugs and Bulldogs. Due to the tight and deep folds, a corkscrew tail often results in repeated skin infection that leads to irritation, pain and odour.

Dog breeds with corkscrew tails include Boston Terriers, Pugs, Bulldogs & French Bulldogs like 5-year-old Boris.

Dogs with screw tails are prone to itchy & painful skin infections, especially where the curls are very tight & the folds are deep.

The deeper the folds, the worse the skin fold dermatitis which typically manifests as moist, inflamed & painful skin. Mild dermatitis can be treated with daily cleaning & antibiotics. However, the warm moist conditions are a breeding ground for bacteria, making the infection difficult to treat medically.

If the case is severe & there is constant itch, pain & odour, amputation of the affected tail is necessary. Dr Dennis Choi, Mount Pleasant (Gelenggang), proceeds with a surgical resection of Boris’ infected corkscrew tail.

The tail & infected tissues are carefully removed.

Sufficient skin is left for the area to be stitched up properly.

Post-surgery: No more constant tail cleaning or bacterial infections to deal with.

2 months after surgery, the surgical site has healed nicely & fur has grown back. Boris is healthy & well with a clean rear end – no more itchy irritated butt – thanks to his family’s decision & good care!

Boris with his lovely guardian Zoan. We love the cheerful playful nature of Frenchies! However, many are predisposed to health issues such as brachycephalic airway obstruction syndrome due to their flat faces & pinched nostrils. Fortunately, Boris does not have breathing problems. If you are intent on purchasing a Frenchie puppy, choose only responsible breeders who understand the underlying health issues of the breed. Consider adoption.

Stenotic Nares In Flat-Faced Dogs

Brachycephalic dogs and cats such as Pugs, Bulldogs, Pekingeses and Persians are bred to have flat or short faces which puts them at risk of airway obstruction, heat stress and even death.

Brachycephalic airway obstruction syndrome (BAOS) refers to the upper airway abnormalities that affects brachycephalic dogs. They include stenotic nares, elongated soft palate, hypoplastic trachea and everted laryngeal saccules.

img_7494

Mon Mon, 2-year-old Pekingese: A dog with stenotic nares has abnormally narrowed nostrils that restrict the amount of airflow into the nostrils, making it difficult to breathe.

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Rasping breath and snoring is not always “cute”. Families with flat-faced dogs must be especially vigilant in our hot and humid climate, to catch the first signs of heat stress and respiratory distress.

Air passes from the nostrils through the nasal cavity and back of the throat, and into the trachea via the larynx. A dog with stenotic nares has abnormally narrowed nostrils that restrict the amount of airflow into the nostrils, making it difficult to breathe. Over time, increased airway resistance can cause the larynx to collapse.

Pinch your nostrils slightly with your fingers – experience how difficult it is to breathe. Then imagine breathing this way, 24 hours a day.

SIGNS OF STENOTIC NARES
  • Noisy breathing 
  • Snoring 
  • Disrupted sleep
  • Exercise intolerance
  • Cyanosis (blue gums due to lack of oxygen)
  • Occasional collapse especially after activity/excitement/excessive heat

The increased effort required for breathing can eventually put a strain on the heart.

keep dog at healthy weight
  • Dogs with mild symptoms can be managed by keeping them at a healthy weight
  • Avoid hot and humid conditions
  • Avoid situations of high stress and excitement
  • Use harnesses instead of collars to lessen pressure at neck area
“nose job”

If the stenotic nares are severe, rhinoplasty (“nose job”) can be done to widen the nostrils. A wedge of tissue is surgically removed from the walls of each nostril to open up the nasal passage.

barney

Dr Patrick Maguire, Mount Pleasant Vet Centre (Gelenggang), performed stenotic nares repair & soft palate resection on 5-year-old Barney the Frenchie. As seen in the photos, his nostrils are widened to improve airflow & help him breathe better.

img_2013

A wedge of tissue is surgically removed from the walls of each nostril to open up the nasal passage. (Ref: vet4bulldog.com)

Milton the Bulldog – another happy patient after successful stenotic nares surgery. “Milton recovered well & is obviously panting lesser.”

soft palate resection

Breathing difficulty in brachycephalic dogs or cats can also be caused by an elongated soft palate which obstructs the opening to the larynx.

french_bulldog

Your bulldog’s palate is located at the roof of the mouth – the front part is the “hard palate” & the back part is the “soft palate”. In brachycephalic dogs, their upper jaw has been shortened, forcing the tip of the soft palate into the laryngeal area & partially obstructing the airway. (Image Ref: veazievet.com)

Signs of elongated soft palate
  • Noisy breathing
  • Retching or gagging especially while swallowing
  • Exercise intolerance
  • Cyanosis (blue gums due to lack of oxygen)
  • Occasional collapse especially after activity/excitement/excessive heat

This condition can be corrected by a soft palate resection to remove excessive tissue and allow better airflow from the nose to the windpipe.

img_7496

“Mon Mon was not able to breathe properly when the weather is hot. She couldn’t go out for a walk even if it’s just 5 minutes. When she played with her mate, she was panting a lot. Few weeks ago, she was again struggling to breathe, her tongue turned pale. I rushed to the nearest vet where she received oxygen therapy. The vet advised us to bring her for a surgery which can help her breathe better. I took Mon Mon to Dr Dennis Choi.” [Evaluating the soft palate]

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After stenotic nares surgery & soft palate resection

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“I know Mon Mon definitely has to go through this surgery (to widen her nostrils) sooner or later or else, one day she might just passed on if she can’t catch her breath. She is recovering well. Now, she can play with her little boyfriend Fibio at home!”

Many brachycephalic animals experience significant improvement in their breathing and overall wellness after surgery.

Stenotic nares and elongated soft palates are congenital malformations. Dogs requiring surgery to correct airway obstruction should not be used for breeding. We recommend that these dogs be neutered or spayed during the surgical correction. 


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Kenny: Total Ear Canal Ablation (TECA)

Despite chronic ear infection and a foreleg crushed by a forklift, Kenny is such a dear boy. Today, his entire diseased ear canal is removed by Dr Simon Quek @ Mount Pleasant Animal Medical Centre (Clementi) in a procedure called TECALBO. A very rewarding surgery that offers Kenny a pain-free and better quality of life! Thank you Noah’s Ark CARES for watching over him.

IMG_6849

Chronic ear diseases can be very painful and extremely challenging to manage. When the condition is recurring or has become difficult for topical medication to be administered, surgery is recommended to remove the ear canal entirely.

What is a Total Ear Canal Ablation?

Total Ear Canal Ablation or TECA involves the removal of an infected ear canal when other treatment methods have failed. The full name for the procedure is Total Ear Canal Ablation with Lateral Bulla Osteotomy (TECA + LBO). 

figure-1-normal-ear-canal-internal-anatomy-mb

The moist and warm environment within the ear canal provides an ideal environment for bacteria and yeast to grow. Cocker Spaniels, with their long pendulous ear flaps, are very prone to ear infections. Image ref: willows.uk.net

WHAT ARE THE SIGNS OF EAR INFECTION?
  • Ear scratching
  • Shaking of head
  • Sensitivity to touch
  • Thickened ear canals
  • Foul odour from ear
  • Discharge from ear canal
  • Head in tilted position

If you notice these signs, have your vet examine your pet’s ears before the disease becomes chronic and irreversible.

WHEN DOES MY DOG REQUIRE TECA?

  • Severe or recurrent infection/inflammation of the ear canal (otitis externa) or  middle ear (otitis media) which is non-responsive to medical treatment
  • Narrowing of ear canals due to chronic ear disease (certain breeds like the Shar Pei and Bulldog tend to have narrow ear canals, predisposing them to ear infections)
  • Difficulty in administering ear medication (due to dog’s behaviour or owner’s time constraint)
  • Tumours in the ear canal
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As infection and inflammation progress, the walls of Kenny’s ear canal thicken, ossify (turn into bone) and become irreversibly narrowed. Topical medications can no longer reach the diseased portions. His middle ear chamber is filled with infected material.

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Contact or food allergens, parasites and foreign objects can cause inflammation of the external ear canal (otitis externa) which may lead to secondary infection of the middle ear cavity (otitis media). Image ref: willows.uk.net

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Robert and Cheryl prepare Kenny for TECA procedure

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Dr Simon Quek carefully dissects the soft tissues close to the ear canal, avoiding trauma to important structures such as the facial nerve. The entire diseased ear canal is then surgically removed.

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After removal of the ear canal, the tympanic bulla (middle ear chamber) is exposed by removing part of the bony wall. Any remnants of infected tissue attached to the bulla is removed. After surgery is completed, there will be no opening into the ear canal.

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The incision is flushed with sterile saline before closure and the area protected with a light bandage. Kenny will be hospitalised for a few days with antibiotics and pain relief medication.

can my dog still hear after the procedure?

Most dogs undergoing TECA already have reduced hearing due to severe changes in the ear canal so owners do not notice a significant difference in the dog’s hearing after surgery.

What we often do notice is a positive change in the dog’s behaviour and energy level after the infected ear canal is removed. No longer living with chronic pain, your dog will have a more active and  better quality of life.

** Kenny currently stays at an industrial area. Please contact noahsarkcares@gmail.com if you can give this sweet and undemanding boy a foster or forever home. Read Kenny’s rescue story