Wednesday, February 25, 2015

1124. Handphone caused an acoustic neuroma?

Thur Feb 26, 2015

I woke up at 6.45 am today as I had slept late. I had right calf muscle cramps yesterday and my left lower back ache had been present for some weeks. I decided to use the Japanese ointment applying directly onto the affected area. No more pain now.

Every morning, I discipline myself to go to the fitness park to exercise on the bar bender, abdominal trainer, cycling machine, standing push up and bar bender. Poor quality machines provided by the government as they are for the masses - free. The cycling machine is loud and squeaky waking up the neighbourhood. It has no resistance and I just simply pedal noisily. The abdominal trainer has no resistance too. The bar bender is the only one with resistance.   
At 6.45 am, the park's white lights were on. The sky was greyish blue and soon changed to light blue and then white. The park lights switched off at 7 am but the amber roadside lamps were still on. Today, I heard 3 types of bird sounds. One is tweet, tweet, tweet high above the trees on my left. One is like chirping twice. One is like coo-coo-coo.  At 64, I am sure I can hear such sounds clearly and am grateful.

A few days ago, I met an old friend from some 25 years ago, seeing her married, having a child, working hard in the corporate world in communications, divorced and is now a retiree. We did not keep in touch. Some 7 years ago, I was shocked to hear she had brain tumour but we were not close and so I did not pry.

However, she had recovered but must go for yearly MRI scans. "I still cannot smile normally," she said. "My left face was once paralysed after the surgery. Now, feeling has returned."

I did notice that she always look serious during the dinner organised to welcome another friend who came from Australia. This friend had breast cancer and has remission on chemotherapy.

"Is your tumour an auditory neuroma?" I asked her as I sent her home after dinner. She does not drive and wanted a lift to the subway to go home by herself. It would inconvenient me since I did not pass by her home but I said it was OK.

Peace had returned to her self as she sounded happier. "It is up to yourself to be positive," she told me. She was very fortunate to have found an experienced Australian surgeon who operated to remove the bigger than golf-sized tumour from her left brain. Her office colleague referred him to her and her office paid for the surgery. An American surgeon she found on the internet asked for US$500,000 and that was out of her budget.

"He drilled two holes in my brain. After the first hole, I went home to rest as staying in the Australian hospital cost $1,000 per day. The next hole, he removed the tumour but there is still a small piece left. He could not remove all as it would damage my brain. My left face was paralysed." A good friend housed her during her recuperation and had long walks and talks with her. 

It must be horrible for anybody. Some would have commited suicide. Must be a rough road to recovery, being jobless and "useless."

She discovered differences in hearing from an overseas phone call. The left ear could not hear well. She had lost her balance some time but did not think much about it. Some ear pain was ignored.

"Can you cycle now?" I asked as she takes long walks in the morning with a group of friends.
"I can, but I will fall down if I stop suddenly."
"What is the cause of the acoustic neuroma?" I asked. "What did your surgeon say?"
"He would not comment but I know it must be from my handphone radiation. Sometimes, I press the phone on my ear for 2 hours talking to people. Over the years, the neuroma developed."

"What about radiation as therapy?" I asked.
"My surgeon said surgical removal is best as the tumour recur after radiation. It is very difficult to operate then as the radiation had bombed the area into a mess."

I did some internet research. Surgical excision is the best. Radiotherapy does not eliminate 100%  of the tumours as some cells may be resistant.

With 7 years of survival, I am sure she has recovered. Acoustic neuromas are also known as acoustic schwannomas. These are slow-growing nerve sheath tumours. I had two schwannomas on my left wrist and left foot removed some 5 years ago. I ignored them as they grew bigger. The one on my left foot became 50% golf-ball size and I could not wear shoes and I decided to be operated. The left wrist's Schwannoma caused my left middle finger to suddenly contract, like a "trigger finger." I decided to be operated again.  They have not grown back. Much depends on the skill and expertise of the surgeon.

I had an experienced surgeon friend to remove them. He did warn me that the schwannomas may recur and he would have to chop off my left hand as he could not remove all without paralysing my hand. My left hand forefinger and middle finger was numb for some years but some feeling has returned now. As for the left foot, he said that it would not recur and I presumed he had got the whole nerve out.

She was fortunate and so was I, to get a very good surgeon and that our Schwannomas are not cancerous. There is much to be grateful in being healthy in autumn years. Many young men abuse their health. I saw one young man furiously gaming online with his legs at right angles to his body as he leant back to fight the computer demons. In a few years, he would have sore wrists and back ache. So what? Young men are invincible. Master of the Universe.

Monday, February 23, 2015

How to be productive and efficient in neutering a dog - injectable anaesthesia

Feb 24, 2015


The textbooks have all their information but the hands-on practice, recording and observation of anaesthesia hones a vet's skill and expertise in anaesthesia and surgeries at least cost and provide a high level of safety for the pet.

I produce two videos to share my over 30 years of experiences on neutering a dog safely and efficiently with my Myanmar vet assistant with injectable anaesthesia. No isoflurane gas was used if the surgery is started and ended within 21 minutes from injection to final skin stitching

Sheltie, Male, 7 months, 5.6 kg. 38.7C

For a young healthy dog, the formula is as follows:
10 kg, young    Dom = 0.4 ml   Ketamine =0.5ml in one syringe IV
Duration of analgesia (no pain, no movement) =  15 minutes 

This dog was given D=0.2 ml and Ketamine 0.25 ml IV. Very good analgesia and safety.

Clip surgical area first. This dog was excitable and so this was done after the injection of anaesthetic.

A: Injection of Dom + Ketamine    10.47am
D: First skin incision                       10.56 am
E: Completion of skin stitching       11.08 am

E-D = 12 min  (neuter took 12 min).
E-A = 21 min

Each testicle from incision to the final cut = 3-4 min
lst testicle  10.56 am - 10.59 am
2nd testicle  10.59am - 11.03 am

Antisedan given at 11.30 am. Dog stands up at 11.35 am. All OK.

3-forceps method
Suture Caprosyn /0   absorbable nylon type.

No isoflurane gas top up is needed if the vet knows exactly the effects of domitor and ketamine for young dogs in neutering. Many pet owners ask how long it takes to neuter a dog. In this case, the whole process will be around 30 minutes. The surgery itself is around 12 minutes in this case.

Saturday, February 21, 2015

1122. An old Miniature Schnauzer has a tail lump. What to do?

Feb 22, 2015. 4th day of Chinese New Year.

A tail lump in an old Miniature Schnauzer - what to do?

When faced with a skin lump, veterinary opinions differ. Some vets will advise "wait and see", prescribing some antibiotics. I will advise excision as it may or may not be cancerous. It will be up to the owner to make the final decision.

The vet should NOT advise "wait and see". Give the owner the option to excise or not to do it as the lump may be pre-cancerous or cancerous.

In this case, the old dog had a circular skin lump 8 mm x 8 mm x 3 mm. It looked very much like a ringworm. Dr Daniel said it could possibly by a result of licking or biting as the old dog had anal sacculitis, with thick brown oil expressed by me earlier.

I advise the owner to get the lump taken out by excision with a 1-cm resection margin ideally. A 1-cm skin margin would permit any present cancerous cells, if any, be removed, leaving little chance of recurrence.

This was not possible as there was insufficient skin and the tail would have to be taken out. The owner wanted to keep the tail stump. She gave informed consent to excise the lump without the margin. Histology was approved.

Dr Daniel operated. The lump was not cancerous based on histology. Dr Daniel's opinion was that this could be due to the dog's anal sacculitis itchiness and licking and that the lump could be inflammatory.

In an old dog, it is best NOT to wait and see. If the dog's lump is cancerous or turn cancerous later, there will be no good words for the vet's competence from family members.      

In this case, the skin lump was not cancerous. Everybody is happy. This could be a case of tail gland tumour based on its location. I had seen one in a Siberian Husky some years ago.

Friday, February 20, 2015

1121. Born free

Feb 21, 2015
6.30 am exercise

Feb 21, 2015. 6.30 am
3rd day of Chinese New Year

I exercised in a public fitness area
The Bar Bender burned my upper arm muscles as I bent the two bars inwards and counted 1, 2, 3
Could do 10 now.
The Standing Push ups - could do 20
The Abdominal muscle bender - could do 100
The cycling machine - too creaky and noisy. would upset residents and so I did less cycling.
Daily workout, one at 6 am and one in the evening
Better than going to the air-conditioned gym once a while.
Self discipline needed. Fresh air.

Can see dawn breaking. Black sky to dark blue to light blue.
Today, a bird high up in the tree "tweet, tweet, tweet..." 10 times for some time. Born free. Shorter life.
Like some men. Addicted to coffee and late night online gaming to 4 am. Every night if possible.
Unable to wake up. A mean-looking grumpy face at the office.
Can never function normally or be kind to any one when deprived of coffee in the morning.

A bird in the nearby terraced house sang a melody every time. Caged. No freedom. Safety. But no worries of predators or hunger.
Like some women. Cannot survive without air-conditioning.
Unable to appreciate the wild flowers and flitting butterflies in the hot and humid countryside
Admonition on travel to undeveloped areas with no electricity and with no air conditioning     


Wednesday, February 18, 2015

1120. Peri-anal fistula or haematoma, anal sacculitis, or circum-anal tumour?

Dogs can't talk. So evidence must be circumstantial.

In this Golden Retriever with a pair of gigantic perianal swellings, I reviewed the video again.

1. Thickened pigmented peri-anal skin indicative of chronic licking or rubbing (scootering). They remind me of elbow hygroma or elbow sores in some big breeds. These are caused by licking.

2. Peri-anal laceration wounds x 2. May be self-inflicted by biting canines to relieve itchiness.

3. Bilateral symmetrical swelling below the anus and in the vicinity of the anal sacs. Possible right and left anal sac impaction and infection.

4. Dark creamy pus oozed out of the anal sacs.

5. Peri-anal haematoma, secondary to peri-anal licking and fiction. A needle should be inserted to check or in this case, I got both ventral ends lanced. Bloody fluid oozed out continuously for several minutes.

So, are these two swellings due to circum-anal tumours? I doubt it and so did not do a biopsy but treated conservatively by lancing and medication. On Day 4, the swellings have had subsided 30% and do this may really be an exaggerated case of anal sacculitis resulting in gigantic swellings, rarely seen in Golden Retrievers.

1199. Three Chinese New Year inpatients.

Chinese New Year, Feb 20, 2015 is a cloudy day.

There will definitely be no cases as the owners celebrate.

I came to check on the Jack Russell that had recovered from vomiting and diarrhoea, the terrapin that swam sideways and the kitten that had diarrhoea for over a week.

1. The terrapin had been here for 2 days. Had lost 2 grams but is more active and no longer gasping as evident by the rapid throat movements of rapid panting. I noted the shell has had become greener instead of yellow green 2 days ago. He had not put on much weight as his two siblings, all originated from Florida, USA and sold by Pet Lovers' Centre. This batch looked good when I saw them some weeks ago at the pet shop. Now, the owner had a hideout which is a dome-shaped porcelain. Only 2 terrapins could hide inside as there is insufficient space now. Probably they bullied this 3rd one who is yellowish green in shell colour while the other two are dark green (see video).

Today, I tested this patient. He could swim with less frequency of right sided tilting after 2 days of inpatient treatment. He was exposed to sunlight as he never had ultraviolet light at home. The owner did phone yesterday but it takes time to recover from respiratory disease.

2. The Jack Russell had recovered from vomiting and diarrhoea some 2 days ago. The owner is very busy going all round Singapore to fix fibre-optic problems. He appeared on his bike at around 11.30 am and I saw him while I was monitoring this terrapin outside. He loves this Jack Russell and I offered to send the dog and him home in my car since he was riding his motorbike. He said he would drive his car here tomorrow. After much persuasion, he took the dog home on his motorbike (video). Some people work very hard for a living and I could see his weariness and bloodshot eyes. For the long hours he put in, he had no time to relax, let alone pick up his dog. Anyway, the dog went home today, on his bike.

4. The diarrhoeic kitten was still lethargy but still alive. Had drank water but did not want to eat. Handfeeding is done although he rejected after a few mouthfuls. Multivit, water and antibiotics are given.

Monday, February 16, 2015

Follow Up: A 7-year-old Shih Tzu 2 months post surgery to remove bladder stones. (Video)

Today, the Shih Tzu came in as he was limping from his left fore foot. A stitch still remains from his bladder surgery done on Dec 20, 2014 and I removed it.

This dog had blood in the urine in 2012 but the owner did not want surgery. The dog started vomiting once a month. X-ray showed numerous struvite stones inside the bladder and os penis. 

Now today, Feb 17, 2015, the dog is perfectly normal. Only home-cooked food.