Monday, April 7, 2014

1351. Biopsy of breast tumour in an old cat

Female cat, spayed 12 years.

Right armpit area - a lump was detected and excised by Dr Daniel in Oct 2013. The owner stated it was a cyst. To me, it looked like a skin tumour and I recorded this down. No histology was done.

On April 5, 2014, the owner came with the cat not eating and a bigger lump. Now, around 4 cm x 2 cm x 1 cm. He wanted a biopsy done by Dr Daniel and sent to the lab.

Results from the lab
2 strips of tissue 1.0 cm x 0.4 cm x 0.2 cm.   

Diagnosis: Aypical ductal proliferation suspicious of low-grade ductal carcinoma.  What's App the report to the owner.

1350. Tarsorraphy in 2 Shih Tzus

Some vet books, vet professors and vets are not in favour of tarsorrhaphy. I encountered a recent Murdoch Univ vet graduate who said to me that it is a waste of time.

In this case, Shih Tzu (Shih Tzu 2), male, 10 years, first time corneal ulcer went home on the same day. Today, the 7th day, I noted that the tarsorrhaphy procedure seemed to be successful for the following reasons:

1. Early detection. Probably one to two days when the parents came back from overseas and saw the 10-year-old Shih Tzu with right eye closed. The dog was cared by the daughter.

2. Keratitis traumatic - 3 classifications. Superficial, penetrating and perforating. This case is penetrating unlike the first Shih Tzu (Shih Tzu 1) which is perforating as I saw some anterior chamber watery liquid squirting out and the red basement membrane bulging out, a Descemetocoele.
Both dogs were operated by Dr Daniel.

3. Shih Tzu 2 was closely supervised at home by the retiree parents unlike Shih Tzu 1 who was left alone. He was crated on the first day. Cried to get out. So, the next 6 days, the elderly parents stopped their taiji exercise to take care of him while he roamed around the apartment. They complied with nursing instructions to give eye drops 2- 3 x/day, painkiller tolfedine 60 mg (1/2 tab /day),  vibravet 100 mg (1/2 tab/day 14 days) and multi-vitamins.

4. So, today, they came for a review at the  7th day. Eyelids still closed (see video) by stitches. A 2-mm gap is seen rather than loose sutures.

5. The dog was examined and there was no pus inside the eye. A small gap on the medial side allowed eye drops to be instilled. I prescribed Rimadryl 75 x 2 tablets at 1/2 tab per day from tomorrow. Another bottle of eye drops. 2 bottles have been used.

6. The final proof of good surgical outcome will be at the 14th day. Another 7 days to wait. A video to be produced. 


In Shih Tzu 1, the dog was warded for 7 days and crated. Nursing care was given as above. The stitches came loose around the 7th day and were taken out. There was cloudiness in the central corneal ulcer part.

Monday, March 31, 2014

1349. Questions regarding neutering a cryptorchid

April 1, 2014

I am Dr Sing Kong Yuen from Toa Payoh Vets. Below are my replies in capital letter to your questions.  


 2-year-old golden retriever with an unilateral undescended testicle who came down yesterday to your clinic. I had listed my dog for neutering next Saturday. However, I have some questions (mainly regarding neutering vs. removal of the undescended testicle, options which were offered to me) that I neglected to ask Dr. Sing during the consultation and was wondering if it is possible for them to be answered through email. I understand that it is ultimately on my informed decision that whichever operation will be carried out, but I would like to have a little more information to make that choice.

    1. What is the advantage of neutering a unilaterally cryptorchird dog over just removing the retained testicle?
I CANNOT UNDERSTAND YOUR QUESTION. RETAINED TESTICLES IN DOGS HAVE A HIGHER RATE OF TESTICULAR NEOPLASIA THAN DESCENDED ONES AND THEREFORE REMOVAL IS ADVISED BY VETS  


    I understand and accept the benefits of neutering in general, but this dog will not be bred, and is not allowed to mount and kept on a leash at all times when going out, and in which case, given that he is unlikely to pass on whatever defective genes to his offspring, is there any added benefit to neutering, especially when weighed with the loss of testosterone secretion and whatever health benefits it may bring with it?

OTHER THAN ANTI-SOCIAL BEHAVIOUR LIKE MOUNTING AND URINE MARKING, NEUTERED DOGS ARE LESS LIKELY TO DEVELOP PERINEAL HERNIAS, PROSTATE ENLARGEMENT AND INFLAMMATION AND CIRCUM-ANAL TUMOURS IN OLD AGE. 

    2. In your experience, is there an increased risk of testicular cancer in the undescended testes? I know that in humans with cryptorchirdism, the undescended testes itself is at higher risk of malignancy, but does this apply to dogs as well? I am unable to find any literature online with regards to this question.
THERE IS LITERATURE ON INCREASED RISK OF TESTICULAR CANCER IN UNDESCENDED TESTES. YOU MAY NEED TO SUBSCRIBE TO ONLINE VET DATA BASE


    3. What will be the effects of neutering on my dog's physique? He is very active and runs ~20km/week with me at quite a fast pace and I would like to retain as much muscle mass as possible. I understand that he is probably physically and sexually mature at 2 years with closure of the growth plates at this point in time, but will there be a detrimental effect on his lean mass? Further, anecdotally I know of dogs whose hair became coarser after neutering. Is this backed by evidence?

I HAVE NO KNOWLEDGE OR SCIENTIFIC RESEARCH TO ANSWER YOUR QUESTIONS

    4. Will there be any changes to his personality/increased risk of depression?
NEUTERED DOGS ARE GENERALLY LESS AGGRESSIVE AND TERRITORIAL IF NEUTERED AT A YOUNG AGE. SOME MAY STILL DO URINE AND STOOL MARKING AND MOUNTING AFTER NEUTERING.   AS REGARDS CANINE DEPRESSION, I DON'T HAVE ANY KNOWLEDGE ON THIS AREA. 

    5. Will there be histopathological examination of the retained testes?
YES, IF THE OWNER REQUESTS FOR IT.

    6. Is there a role for androgen supplementation in a neutered dog?
NOT A ROUTINE PRACTICE IN VET MEDICINE. I DON'T HAVE OWNERS REQUESTING THIS.


    I apologize for the questions and they must sound very tiresome, but I have thought over my options for a long time and feel that I must consult with you for further guidance. Thank you very much and sorry for any inconvenience caused.

Saturday, March 22, 2014

1348. How to succeed as a new employee

Last week, I gave a lecture to 3 young people at my office. Two are young adults named Vanessa, Nicolas and one is a Myanmar employee Nyi Nyi. I asked Vanessa to write a report and this is given as follows:

How to succeed as an employee
1.     You must have a target
To be able to produce positive outcomes
2.     Perfomance
Time equals to money and performance equals revenue
3.     Creating a list
To set a target for yourself that can be achieved in the day itself
4.     Distractions
They come in the form of your phone, computer, customers etc. Try to minimize these distractions so that you can meet your daily target.
5.     Niche
Determine what you are talented in/good at doing/ excel at and further your knowledge/skill of it.
6.     Mindset
Change your mindset to suit your job.

E.g. I don’t like to network but I will do so for the sake of my company and to increase my performance.
7.     Best person to talk to
The best person is definitely not your boss. Talk to your co-workers. E.g. In the healthcare sector, talk to the stall holders in the staff canteen.
In the case of veterinarians, networking during dog shows or SPCA functions. However, it is not practical as a lot of time is wasted. It is slightly more applicable to senior vets.


8.     Added value to the company
Employees should provide timely performances with quick and efficient outcomes. It increases revenue as time is money. Cross-selling is a good method as it shows initiative.
9.     Upscaling
With more initiative, you can start doing your own research through data bases or networks to find clients/candidates or higher value.
10.                        Strong competition in any industry

80% of business = 20% of the employees. Employees must be motivated and be willing to take on hardship in order to succeed in life. 

Friday, March 21, 2014

Hyphema in a dwarf hamster in the USA

Mar 22, 2014
Email from a hamster owner in the USA

Hello Dr. Sing,

Thank you for your generosity and willingness to speak with me on the telephone today. I have typed up the history below and attached photographs of my dwarf hamster in this email.


Past medical history:
My pet is a 2-year 3-month old dwarf hamster. His past medical history includes trauma to left eye approximately 1 year ago, which was subsequently prolapsed and was surgically enucleated without complication (Enucleation procedure was performed within 15-20 min, and he recovered within a week), and significant osteoarthritis for which he currently takes oral meloxicam.


Current issue:
For approximately the past 9 months, he has had a worsening cataract in his remaining right-eye. He has been followed by a veterinary ophthalmologist, and based on exam he has had no reflex to light in the remaining eye and is likely blind (although he manages to navigate his habitat quite easily) I've noticed increased vascularization over the past month, and within the past 24 hours, he has developed worsening hyphema of the right eye. The hamster does not appear to be in acute pain or distress, but I've found it difficult to assess pain in a hamster.


I've followed your website for the past year and I noticed that you had posted some pictures on a hamster with bilateral hyphema.

Consultations:
I consulted my veterinary ophthalmologist and small-pets veterinarian today, and they are not certain what the best course of action is at this point. The ophthalmologist recommended diclofenac (NSAID) eye-drops and to see if the condition resolves. The other veterinarian recommended corticosteroid eye-drops. I decided to proceed with the diclofenac 1 drop every 6 hours. The general veterinarian mentioned that because the hyphema is secondary to a long-standing cataract, increased intraocular pressure may be the cause. She mentioned that eye-drops are palliative, but enucleation of the eye would be the ultimate solution. They seems to agree that enucleation of the remaining eye will not affect his vision, because he cannot see out of his remaining eye. However, because of his age, there is an increased risk with anesthesia and surgery. Surgery is scheduled for tomorrow morning.


I wanted to seek your thoughts and opinion on the case of my pet. I am not sure what is the best course of action. My concern is that he may have developed an acute glaucoma secondary his cataract, or that his longstanding eye disease may have led to neovascularization. I am concerned about what will offer him the best quality of life (less pain), and whether enucleation should be the solution at this point. NSAIDs have the risk of increased bleeding, and long term use of corticosteroids can increase intraocular pressure. I am also unsure of the cause of the hyphema, and therefore unsure if the hyphema may acutely worsen, leading to severe pain or prolapse.


I would greatly appreciate you opinion and thoughts. Thank you so much for your help,
Steve

The photographs are attached in this email. The IMG_ named photographs show his eye condition today. The other filenames dated with when they were taken. I will also send you a video I took today in a separate email.

REPLY FROM DR SING DATED MAR 22, 2014
Thank you for your email, images and videos. You have been most caring. My preferred course of action will be enucleation to eliminate the intense pain inside the eyeball. Drugs will not work. Anaesthetic risks are high as the hamster is aged. Best wishes. 



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

MARCH 23, 2014 EMAIL TO DR SING
Hi Dr. Sing,

Thank you again for your email and your time. I wanted to provide an update. Surprisingly, this morning I spoke with my veterinary ophthalmologist and took my hamster in to the senior general veterinary surgeon (specializing in exotics). Contrary to the junior vet I spoke to yesterday (who recommended surgery today), the senior operating vet examined my hamster this morning and decided that surgery was not indicated at this time.

The ophthalmologist told me he thought there was a reasonable chance that the hyphema may slowly resolve with diclofenac eye-drops. On pre-operative exam, the senior general veterinarian assessed that he was not in pain severe enough. He mentioned that hamsters usually stop eating when they are in pain, and based on my hamster's activity- he does not appear to be in severe pain. So, we decided to continue with the diclofenac drops, and the general vet added ciprofloxacin eyedrops as well. He recommended follow-up / re-evaluation in 2 weeks.

On my physical exam the hyphema appears to have settled at halfway filled up the anterior chamber of the lens. As of tonight the globe does not appear to be any more prolapsed relative to baseline. I will continue to monitor for any acute changes or worsening.

Are there any other particular signs or symptoms of pain (or specifically eye pain) in hamsters that I should pay attention to? I have read that these pets hide/tolerate their pain quite well, making it somewhat tricky to assess. My ultimate goal is to provide my hamster with the best quality of life.

I realize it's difficult without having examined the hamster, but if you have any input on whether this is a reasonable plan of action, I would love to hear your input.

Lastly, I wanted to thank you again for your generosity and time spent speaking with me yesterday. I truly appreciate it. I also want to add that your website may very well have saved my hamster's life when he had his first enucleation. My local vet who was less experienced had urged a 45min-1hour enucleation procedure, but after reading your website and learning about hamster anesthetic risks, I opted to search the entire city for a vet who had experience operating on exotics. The enucleation was performed swiftly and he concurred that a 45 minute operation would have likely been lethal. I just wanted to let you know that someone across the world was able to benefit from the wealth of information on your website. And not to mention, as a hamster owner, I find the info and pictures to be fascinating as well. Also, please let me know if your animal clinic accepts donations of any sort, as I would be happy to make a small-donation as a token of appreciation for your time.

Thank you again,
Steve


REPLY FROM DR SING DATED MAR 23, 2014

Thank you for your feedback and good news. I always tell my clients that each vet has a different approach to the treatment of diseases and so this results in conflicting advices to the pet owner. There may be more than one way to treat a disease.

In your case, I thought the hamster was suffering great pain and hence advised enucleation. This episode shows that long-distance telephone diagnosis without physical examination is not advised.


Since the hamster is not in pain, then enucleation is not necessary. Generally, frequent rubbing of the eye are signs of painful eyes or inflammation around the eye areas. There will be acute conjunctivitis and hair loss around the upper and lower eyelids.

The best indicator of the hamster's health (and lack of pain) is the number and size of faecal pellets passed per day. If he normally passes 40 large pellets per day for example and now passes less and in smaller sizes, then he is sick. The amount of water drunk per day is another good indicator of health. The owner must be disciplined to monitor 24-hourly and some owners do that.
 
I thank you for your offer of a donation. The service is free to all hamster owners. 
 
Are you an engineer or IT person as you are able to locate my hamster's hyphema images from the internet. How did you do it? 

Saturday, March 15, 2014

Audit of KPI. Spaying a caterwauling Maine Coon 3.6 kg using IM anaesthesia

From my experience, the analgesic effect of the xylazine 0.15 ml and ketamine 0.6 ml IM will last around 30 minutes for a young 3.6 kg Maine Coon. Provided the vet is well organized.

Today Sunday Mar 16, 2014, the Woodlands family brought in the Maine Coon who had been rolling and yelling (caterwauling since 3 days ago). "But she is quiet now," the lady said.

The following are my performance indicators
Inj of xylazine + ketamine   10.13 am
No isoflurane gas
First skin incision  10.26 am
Completion of skin stitching 10.56 am
The cat started moving at around 10.55 am.

The cat was rather plump and I took some time to hook out the ovary as there was abdominal fat in the way of vision and obstruction was caused.
lst ovary hooked   10.34 am after 5 attempts.
2nd ovary hooked 10.41 am from the uterine body area
Uterus being ligated   10.43 am
Abdominal muscles stitched with 3 interrupted sutures  10.47 am 
Skin stitched  10.55 am

Cat started one movement when stitching muscle  10.49 am
Cat started more movements   10.54 am 
Skin stitched 10.56 am


Conclusion
For a 3.6 kg young cat, xylazine + ketamine at 0.15 + 0.6 ml IM in one syringe provides sufficient analgesia for spay provided it can be completed within 43 minutes from start of IM injection. There will be no need for isoflurane gas top up. If the first ovary can be hooked out at the first attempt, the duration of analgesia is more than sufficient for spay. One packet 3/0 absorbable polysorb is sufficient.  Incision length about 1.5 cm long. 2 horizontal mattresses close skin wound.

Dr Sing Kong Yuen









The paralysed cat has thick bloody urine again.


This cat wore pampers for the last 3 months after adoption as he was paraplegic, with back legs stretching forward.

As the paraplegic cat needs leg massage to pee, his bladder gets filled with urine last week but did not have any problem of urination for the last 3 months after adoption. Thick red urine from the infected bladder filled his bladder again, after the first clearing of the obstructed bladder. Now the cat vomited twice. The urine test had shown proteinuria 2+, lots of red blood cells and white blood cells.

I informed the owner of the costs of X-rays to check for bladder stones. The cat has poor chances of recovery of a normal bladder owing to urine stasis causing infections. The wife was most sad. Euthanasia.