"She weighs only 3 kg. This is Dad's favourite dog," the young lady in black tooth braces and the brightest eyes said to me solemnly and worriedly as I had advised anaesthesia to pluck the big thick turf of ear hairs, clip the nails short, clip paw hairs, de-matt a few areas and do dental scaling. The dog just would not permit her to do it and now had red skin in the paws, legs, ears. She also had lots of dry scales or dandruff. So there was no grooming for this Chinese Crested and another Miniature Schnauzer but the other two dogs were well groomed by this lady. 

I knew this young lady when she was a teenager as her family used to bring their Miniature Schnauzers for treatment. Now she must be in her mid 30s as time had breezed by so fast that I had lost count of at least two decades that had flown me by. She is the type that has no problem attracting suitors, in my opinion.

"I wish she will marry a good man," her mum would say to me some years ago. We talked about our progeny and hope that they marry good spouses and live happily ever after.

To this mum, a good man means a highly educated and successfully rich Singaporean husband. But that was not meant to be for her daughter. This young lady does not need to marry into wealth. 

Her mum had commissioned a large painting of her done and I always appreciated the painting that hung on the wall of the living room. Like those paintings you will see hung on walls of rich people in Jane Eyre's days. If I ever did house-calls, I would compare the painting to the real person. The painting was good but did not bring forth the expressions of the eyes of this lively spirit of this lady, if you know what I mean.  

At the surgery, I noted that she was wearing tooth braces in her 30s. Really. It is incomprehensible to me as most ladies do that in their early 20s.

"Will you be the one doing the surgery?" she asked. "Yes," I said. The key to success in anaesthesia is to give the minimal dosage. And the vet must be vigilant and has experienced assistants who know anaesthesia very well. In this case, I ensure that I was in charge of anaesthesia as well.

I gave 50% of the calculated dosage of domitor and ketamine IV. I asked my assistant Min to get an electronic calculator and coached him on how the dosage is calculated. I wrote down on the paper the calculations to teach him the basics.

At 10 kg, a young healthy dog will be OK with domitor 0.4 ml and ketamine 0.5 ml combined IV in one syringe as an IV general anaesthesia.

But this is a thin Chinese crested, stressed out by skin itchiness over the years and not in top health as dandruff keeps peeling off her skin. I did not take a blood test this time as I deemed it not necessary from general physical examination and history. However, the anaesthesia must be lowest but effective. So, I gave 50% based on 3kg.

All went well with the iv domitor and ketamine anaesthesia. The 50% dosage was slightly insufficient as the two dogs struggled a bit towards the end of dental work. I gave the dogs a sniff of isoflurane gas + oxygen as they were was waking up. A sniff of less than 60 seconds. I observed the eye white being prominently rolled downwards soon. This indicated Stage 4 as the eyeball had rolled down and into danger territory. So, the gas was switched off. Everything went well. The dosage was sufficient for around 30 minutes which included all grooming and dental scaling without struggle or pain.

Just to be on the safe side nowadays, I gave the antidote - Antisedan. In less than 1 minute, the Chinese Crested stood up and looked as fine. Pooped green stools. Went home in the afternoon after ear irrigation and a bath as the father and daughter came to pick her up and the Miniature Schnauzer (9 years old with similar requirements but had 7 loose teeth extracted). Also 50% dosage based on weight. And antisedan.

"No steroids," the young lady said. In this other Chinese Crested dog which was really hairless in the body, I had prescribed Atopica for 2 months and anti-fungal medication. The young lady maintained with her special oil application to the skin and the dog was no longer having dandruff. Was it the application of oil?
 

The white Chinese crested keeps scratching herself day in and day out but would refuse regular grooming by the young lady unlike the other Chinese crested. So the young lady phoned me for advice and sedation was the only option if one does not want to grab the white Chinese Crested forcefully to pluck ear hairs, irrigate the ears and clip the paws. In any case, a dental scaling in 5 years was good for the dog. It ought to be done at the 3rd year but busy owners don't do it.

P.S. 1
The younger generation of clients is more knowledgeable. Steroids are not harmful if used carefully as some cases need a dose of steroid first to calm down the intense inflammation. The NSAID (non-steroidal anti-inflammatory drugs) can then take over. However, if my client does not want steroids, I don't give them but do communicate to them the usefulness of steroids for short-term use.

P.S. 2
A picture of the lady's neighbourhood I was driving while doing a house-call two days before August 9, 2011, the National Day of Singapore. I saw a woman in read and white visiting a house with the Singapore flag, took out my camera and snapped a picture of patriotism. Surprisingly, the picture turned out well!