Thursday, July 30, 2015

2957. INTERN. Cystic Endometrial Hyperplasia

I have a rare case of CEH as evident by the image below.

What is CEH?

Who
Where
When

How





The female Maltese, 8 years, came in for removal of the breast nodules (Left MG3 nodules). I had advised spay earlier but the owner did not do it. This time he agreed to the spay.

The dog has a fully distended thin uterine horn filled with clear fluid. She was spayed as well as removal of the mastectomy.
She recovered fully and went home.

Monday, July 27, 2015

2956. Under-feeding a terrapin for 7 years

Monday, July 27, 2015.
"The 7-year-old terrapin does not have swollen eyes," I said. "However, he is underweight and has the shell length of a 1-year-old".

The owner wanted to prevent obesity. So he feed 5 pellets every 2 days and allow the terrapin, measuring 7 cm in shell length. The shell was bleached light brown. The terrapin loved to be submerged in water most of the time and would snap at the pellets eagerly. A calcium tablet in the shape of a terrapin was put in the water every 2 months, so the water is filled with this calcium.

Today, the terrapin's neck area has loose flabby skin, as if, swollen. "This swelling occurs in the past week," the gentleman said.

It is hard to know what causes this neck swelling. It could be calcium deposits near the thoracic inlet, nutritional imbalance with too much calcium or a tumour.



The back leg muscles and skin were normal and not flabby.

Removal of the calcium, allow more time to bask by not giving water all the time, a variety of food and sunshine, including medication dripped into the pellets for the next 14 days. We will need to follow up.  



Saturday, July 25, 2015

2955, INTERN. Good Performance Counts - emergency Caesearean section

Sat July 25, 2015

I was surprised to see the poodle coming in for Caesearean section again as I have not seen the dog after the milk fever in the first emergency C-section around 2 years ago.

The lady showed me her mobile phone image of x-rays taken by another clinic, showing 2 puppies. She had decided not to go to this vet as I had a good outcome for her first surgery.  (Video clip of first C-section).


Jun 25, 2015.
C-section  - 2 large pups in one uterine horn.

1. Brown pup was nearer the cervix and had lungs clogged with mucus. Swinging saved her life as mucus in nose and mouth showed lungs were filled with mucus.

2. White pup took at least 5 minutes to cry. No need swinging.
   

Sunday. Jun 26, 2015 - good outcome as dam and puppies are OK. The parents are most happy.
Puppies came in for tail docking (SEPARATE VIDEO ON VET SURGERY OF TAIL DOCKING).





    ---------------------------------

How to extract videos from youtube

Dear Dr Sing,
to extract videos from youtube,

1.  all we need to do is visit the website: http://www.clipconverter.cc/
2. Under " media url to download" insert the url of the youtube video you want to extract
3. and press continue and convert.


The website is very user-friendly and actually shows the steps you need to take, it should be easy for the interns to use. Hope this helps.

Yours sincerely, 
Gin 


-------------------------------------------------

go to toapayohvets.com for latest relevant videos as well.
puppies tail docked today. Make a separate video from above. TAIL DOCKING POODLES 

Thursday, July 23, 2015

2504. INTERN The guinea pig with the left head tilt has left nostril discharge and pneumonia again

Jul 23, 2015

The guinea pig with the left head tilt has pneumonia again. Came in yesterday evening.
Owner was not able to treat previously the guinea pig at home. 
"Some vets don't like to give subcutaneous injection," I said to the man. "Sometimes the owner blames the vet for the painful reaction or death from the injection in seriously ill guinea pigs." I said. "The owner would say that the sick guinea pig was still alive but after the injection, he dies. So, it is due to the injection."


"I understand my guinea pig is seriously ill," he said. "I will not blame you if you give the injections."

Informed consent is important nowadays. I gave the guinea pig SC baytril and 2 ml of dextrose saline and Vit B + C at 6.30 p.m.  This morning, he is better and no longer pants so fast. I had given the same treatment last time and the guinea pig had felt better, according to the owner. He had seen my associate who prescribed him oral medication and I was around and so he asked me about the injection. I warded the guinea pig as he could not manage the medication administration.

So far so good.    

Wednesday, July 22, 2015

2503. INTERN Cat owner's education - religious retreat - giving medication to a clever roaming cat.

July 22, 2015

"I have to cancel my retreat as my cat needs two people to give him antibiotic and pain medication," the slim woman in her 50s had brought in her cat for cat bite wound stitching. "The retreat in this temple is for one week and is held only once a year." I had told her that the cat needed to be given medication for the next 7 days.

"I should have my cat treated when she had a small bite wound from the other cat," she said. "Now it is a very big wound, due to the cat continuous licking. He needs stitching."

After anaesthesia, cleaning and debridement of the wound and stitching, the cat was ready to go home. But the owner had to go for the retreat. "Living in the temple clears my mind," she had looked forward to this residential retreat which requires waking up at 4 am to chant. "I will go next year."

"A year is too long and many things can happen to our lives," I said.
"This cat is much loved as even my neighbour who hates cat, loves him," she told me. "He is like a human being. When my neighbour asks him to jump onto the chair, he does it. When she tells him to jump onto the table, he does it. He will meow in appreciation when given food unlike other cats who will be silent."

This was indeed a clever cat. He would not take medication unless the owner and his son do it together to coax him into taking the medicine via a syringe with water and medicine.

"Go for your Buddhist retreat tomorrow," I said. "This cat is not suffering from a life-and-death disease. The worst case is that his stitch breaks down, but he has an e-collar round his neck to prevent licking."

"Prepare the medication by crushing the tablet and mixing with milk.  Fill two 1-ml syringe with milk and one syringe with milk and medication.     Wrap the cat in a towel covering his four legs and put him on a table.  Make him hungry for dinner. Your son will give him the first two syringes with milk alone. He will like the milk syringed into his mouth. Then, the 3rd syringe with medication.

"Tonight, you and your son practise"  I said. "So you can go to your temple retreat tomorrow."


This 7-year-old cat came in for difficulty in peeing. Now he is OK.  However, he has tearing eyes and runny nose now. This is due to his lack of vaccination and his encounter with a stray cat that had bitten him, passing to him the cat virus. He should recover.

----------------------------

Mimi  Cat MN  8 years   yellow brown. Allowed to roam outdoors daily. Used to return by climbing up 16 floors of steps to apartment. But would now wait at 3rd floor for the owners to come and pick him up.

Jul 14, 2015.
1. pollakiuria, haematuria, dysuria 1 week
2. Change sand litter to paper litter about 1-2 weeks ago.  Sand particles mess up the house.
3. Painful kidneys. Bladder not swollen. Cat growled when I palpated the kidney area and became unfriendly.
4. Fed dry food only past 8 years
5. One cat in household
6. One water bowl.

IV drip. medication.


Jul 14, 2015
BLOOD TEST
All normal except low platelets 69  (300-800) and high glucose 14.9  (3.9-6.0). Urine test was positive for glucose.  This high glucose level may be due to urinary tract disease rather than diabetes.

Below are normal values
Total WCC  13.3  (5.5 - 19.5)
N 76%   Absolute 10.11
serum  6.4  (7.2-10.8)
Creatinine 100 (71-160)


URINE TEST
Bladder has insufficient urine expressed into a bottle. But analysis shows no crystals.
Dipstick  blood 4+, glucose+, Protein 2+, WBC, pH 8. SG 1.005

X RAYS  Cat needed sedation Xyla 0.4 ml IM. Reversin 0.03 ml IM.
No radio dense stones.
Kidneys enlarged.  






FOLLOW UP

JUL 15.  Not eating much of feline C/D. Drinks a bit. Stay indoors. Little motion. Urinate more. No dysuria.

CONCLUSION
A change of litter type may stress this cat. FLUTD is caused by stress and other factors like not drinking water and dry food. Antibiotics. Painkillers.  Feline CD
Jul 24, 2015. No problem.

Outcome Good
Case closed.



   

Sunday, July 19, 2015

2502. INTERN The dwarf hamster has right eyelid abscess and impaced left chhek pouch


July 19, 2015
Butter. Dwarf hamster. F, 2 yrs?

Scratching right eye and lame RH - looked like dragging his right hind foot. Some time.
1. R lower eyelid much swollen  - diagnosed subconjunctival abscess. To lance and drain. Owner to do it at home with opening the incision wound, cotton bud to express the pus, daily.












2. L cheek pouch hairless area nearer to the face - diagnosed impacted cheek pouch. irritation. rubs till hairless (see video).  To excise.
TREATMENT
1. V. thin. 30 g.  Informed consent. anaesthetic death likely.  Zoletil 100 IM. (video).
2. Surgery  (video). Hamster took >1 hour to recover and walk. Sent home.  Owner to express pus from eyelid daily without fail. Wound will close. Must keep it open to express the pus. Medication for 7 days.



FOLLOW UP
July 24, 2015  phone
Tone of voice of owner seems happier.
Hamster more active.
Eyelid abscess - still has pus coming out. Expressed pus.

Left cheek pouch. No more swelling.
RH leg still dragging. Been like that for some time.
Owner gave smaller pieces of seeds, vegetables. hamster is very thin now.
"Stool pellets more now?" I asked.  Can't say.

Advised exercise wheel and stop  medication at 7th day (this Sunday)

Asked her to email me a video clip of hamster. Will do.   

PREVIOUS VIDEO.
Right cheek pouch impaction 3 times. Excised.
seems to be an obsessive hoarder of food inside cheek pouch. Much loved by the lady owner.


Outcome Good.
Case closed.



------------------------------

EVERTED CHEEK POUCH

Like a grocery bag (image), the hamster can hoard his food inside this expandable thin bag inside his cheek. This is called cheek pouch. Similarly to a money pouch (image) for travellers. 

The cheek pouch can be a liability if it everts and hangs loose as in this dwarf hamster.
It is painful and irritating to the hamster. The hamster tries to pull the dangling pouch away but it cannot do it.

CONCLUSION

See toapayohvets.com for more cases of everted cheek pouch pre and post-op and get their images to present 




The treatment is surgery. A hamster vet will anaesthesize your hamster and cut it away. See video.


Get videos from youtube of toapayohvets.com

Saturday, July 18, 2015

2501. Unbelievable tale: The owner of the cat who climbed 16 storeys home

July 15, 2015

"He is still angry with me for bringing him to the vet," the lady owner visited me today to say that the cat no longer has difficulty in urination. This cat would never get into the car as he associated this with visit to the vet.

"That's good news," I explained the blood test results of her cat to her. She had to go for her Buddhist retreat and so she was worried about this cat.

"A famous Aljunied fortune-teller had told my father that one of his 8 children would become a Buddhist," she said. "I would have become a Buddhist nun if I was not married as I am into the Buddhist faith. At first I thought it would my younger son as he was interested in the Buddhist practices and would go to the temple often."

"What happened to him?"
"I took him out of the temple as there was a lot of swearing," she said. "In time, I converted to Buddhism."

This fortune teller had given her father an amulet or blessed cloth to keep him safe. Her father carried it with him every day.  "One day, a large truck smashed into the passenger side of his car, damaging the side door badly," she recounted. "Yet my mother was not injured a bit. My father took out his amulet and it was stained full of blood. Do you believe this story?"

"Blood appearing out of thin air?" I said. "This is not possible scientifically. But many things cannot be explained by science."  I recounted to her my experience of seeing blood drops appearing out of thin air when I helped a client to design a company logo. Only when the logo design was correct did blood stop appearing. She found this story unbelievable. 

"When I was a baby, I could not be wakened for 3 days," the lady said. "The doctor said I was dying or dead as I did not move. No baby could be alive without food or water. My father consulted several mediums. One gave him a packet of ash. He mixed it with water and put on my lips. I woke up.

"What was the cause?" I asked.
"It seemed that my father had cemented a big hole in front of our house. My shadow was covered up while cementing. So I could not wake up. After breaking open the cemented area, my shadow was freed."


This was an unbelievable tale. "Is the house still around? Where is it?" I asked.
"It had been demolished and is part of the PIE (Pan Island Expressway) now."