Friday, May 22, 2015

2169. Eye trauma in a young abandoned Persian cat

May 22, 2015

After 7 days of antibiotic and painkiller treatment as an in-patient, this rescued young Persian's damaged infected eyeball was removed by Dr Daniel.

2168. VIdeo: A 16-year-old has an obnoxiously smelly armpit wound - 3rd opinion

The very old dog had an armpit wound. It is very risky to tranquilise this old dog. So Vet 1 prescribed medication. The 2nd opinion vet bandaged the left leg and anchored with Elastoplast to cover up the armpit wound. His antibiotic injection was said to last 2 weeks. The owner did not return every 3 days to change bandages.

There was a strong obnoxious smell when I removed the bandage and the swabs which contained a green discharge of rotten smell.
As this dog is very old, anaesthesia is not advised. My solution was to sedate the old dog, wash the wound thoroughly and let it heal by granulation. Potassium permanganate powder sealed up the bleeding.
Injection to bring down the swollen left limb due to tight bandaging. Antibiotics and sleeping tablet sedation to let the dog have peace and sufficient rest.

The old dog's limb was much less swollen and the wound was not smelly. "Sleeps a lot," the owner was satisfied with this open wound method to prevent stench of smelly bacterial infection.
In this old dog, the armpit wound is very difficult to stitch up as it is a mobile high tension area. In this video, I proposed 2 surgical approaches.  The Z-plasty and making another new skin incision further behind the armpit wound.

Z-plasty is used to release tension and the stitched area looks like a "Z" after stitching.
In the 2nd approach, the newly created skin incision is left open. It releases tension so that the debrided armpit wound can then be stitched. The new skin incision is not sttiched but left to heal lby 2nd intention. Antibitoic cover. These are my 2 surgical approaches if the dog is still young. Otherwise, lit takes months to heal a large armpit wound as in this case..

2167. VIDEO. The obsessive compulsive cheek pouch storage dwarf hamster

Some people hoard things till the whole house or garage is cluttered. Do hamsters hoard food inside their storage compartment, known as cheek pouches inside the mouth on the right and left sides? They pack the cheek pouches to the maximum and sometimes the cheek pouches become injured by the sharp shells from the seeds and are painful. The hamster is unable to dislodge the contents and rubs his swollen cheeks hairless.

I have a handful of such cases, but the following one is most memorable. He is the teacher's pet.

The black hamster was obsessive  in storing and packing his cheek pouch with food. The lady owner came 3 times for right cheek pouch impaction. This pouch was excised at the 3rd visit and there was no problem for the next few weeks.

Now, lthe hamster scratches his face till hair drops off the top and sides of the face, leaving his eye area still hairy.  Clearing the left cheek pouch is done. The hamster will be restricted to around 5 seeds per day. No large seeds. Sunflower seeds are shelled out before feeding to him.

FOLLOW UP ON MAY 22, 2015. Around 1 week later. "No more creamy discharge from his eyes," the owner was happy to report. "No more wet face!". She fed around 5 seeds e.g. shelled sunflower seeds and corn. The hamster would store the seeds inside his left cheek and eat them later. So his pouch is never impacted causing itchiness when large seeds are stuck inside. 

Thursday, May 21, 2015

2166. The teacher's pet hamster looked like Lone Ranger

March 22, 2015
"How is your hamster now?" I asked the young lady who is a teacher.
"No more creamy discharge from her eyes," she was happy.
"That would be pus," I said. "Are the hairs growing back on her face. The areas around her eyes were all bald and so she looked like she was wearing a mask, like Lone Ranger!"
"It will take some time for the hairs to grow. Previously, her face was wet, wet, wet but now it is dry."
"Was it water from the water bottle?" I asked.
"No, I don't think so."
"It could be from the eye tears," I assumed.

Now she restricts the hamster to a strict die. Around 5 seeds like corn and peeled sunflower seeds. No coloured star pellets and others.So the hamster would not stuff her left cheek.\

I remember this black hamster very well because she had caused much distress to the teacher with the right cheek pouch impacted 3 times. The last time I had it excised and there was no more problem. Till this creamy eye discharge.

2165. A busy father spares time for the left head-tilting guinea pig

Mar 21, 2015

"No, you have not been prompt in consulting me," I said. "The head tilt has been present for 2 weeks."

What is the cause of this left head tilt in this pretty female 2-year-old guinea pig much loved by the daughter. "There is also pus from the left nostril," the father said. "And something white in the left eye."

The lungs had sounds on ausculation, more on the left side. The eye cornea did not stain green with fluorescein stain test and this white central elevated patch across the middle of the eyeball could be a scar. Everything seems to be on the left.

So, was there an injury or infection to the left side of the body? The guinea had lost 50% of the appetite and the rectal temp was 36.4 (hypothermia). The ears had never been cleaned and there was black soot in both ears. The creature squealed when I palpated her ears.

She weighed 700g. What was wrong with her?  

Most likely a middle ear infection. Will need to follow up after antibioics.

2164. Mammary adenomas in an American Cocker Spaniel

TOA PAYOH VETS   Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074   Tel: 6254-3326, 9668-6469, 9668-6468.  
22 May, 2015
  Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits
Mammary adenomas in
an American Cocker Spaniel

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 21 September, 2012
ate:  22 May, 2015
 "Why did you  delay seeking surgery till the breast lump is gigantic in size, like two tennis balls combined?" I asked the Buddhist temple teacher who taught Buddhism and morals to over 800 children of devotees.

"The breast lumps grow very fast in the last 2 weeks," she replied. "Nobody in the family wants to bring the dog for surgery. My brother said to let her die."
The solution was surgical removal but the family did not want to pay the medical costs. She was kind to enough to bring in this old dog for surgery at Toa Payoh Vets.
Breast adenomas grow rapidly to sizes of 4 large oranges in this American Cocker Spaniel.
After mastectomy, the dog was eating and normal
"Walk-in" sutures holding the skin edges tightly and the haematoma on the left MG5 was treated by opening up the area via removal of 2 stitches. Healing by granulation was uneventful. 
The 8-year-old dog was not spayed.  Mammary adenoma was diagnosed. No malignancy, according to the histology report. I was surprised as it was a massive tumour. Dr Daniel and I operated. I took over the stitching to ensure that the stitches were tight.

I tacked in "walk-in sutures" through the muscle layer and then the skin,  using 2/0 sutures to ensure that the large long wound would not break down..
The dog came back 4 days later. There was a swelling at one end of the tumour. "

seepage at the left Mammary Gland 5 area," I said to Dr Daniel who is in charge of the case. "Just cut off two stitches," I said to him. "In this way, the serum can drain out. No need to re-stitch."
After that, we had no more visit from the Buddhist teacher. I was glad that this dog was not abandoned when she had the tumours. Such incidents do occur in Singapore. It is best to spay the female dog when she is young as breast tumours are less likely to develop in spayed dogs.
More case studies, go to: 
Cats  or  Dogs

Make an appointment with your vet. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail your requirements. 

Copyright © Asiahomes Internet
All rights reserved. Revised: May 22, 2015
Toa Payoh Vets

Wednesday, May 20, 2015

2163. Recurring urolithiasis in a Shih Tzu - 5 surgeries to resolve the problem

TOA PAYOH VETS   Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074   Tel: 6254-3326, 9668-6469, 9668-6468.  
21 May, 2015
  Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits
Recurrent urolithiasis - 5 surgeries for a recurring bladder stone problem

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

Case written: January 7, 2013       Update:  21 May, 2015

Taking images of cases with the camera phone to document your cases and to do retrospective studies of your performance will make you a better veterinary surgeon.

There may be some parts of the anatomy changes which you might have missed during the examination but images taken will be there for you to review. This is time-consuming and that is why most doctors and vets don't bother as images must be taken and filed properly.

For example, in the complicated case of the Shih Tzu with 5 bladder surgeries.
He had 2 surgeries to remove the bladder stones several weeks ago. Two vets (Vet 1 and 2) removed the bladder stones in two separate surgeries.

However, the Shih Tzu had bladder stones and Vet 3 operated on him.   
 with perineal urine leakage after a bladder surgery by Vet 3 to remove urinary stones, an image of the swollen perineum (presumed with leaked urine from the traumatised perineal urethra) was taken by me. See image on the left.
This is one supporting evidence and there must be others to substantiate this urine leakage (ultrasound of scrotum filled with fluid), swelling of left inguinal area near where Vet 3 made a skin incision to access the bladder for urinary stone removal daily with blood-tinged fluid while the dog was catherised with a smaller sized urinary catheter

Note that the scrotal sac is also swollen and Vet 3 had said that ultrasound revealed fluid. According to the owner, the whole of the lower part of the inguinal area was much swollen and that was why the dog had to be hospitalised for 8 days by Vet 3 who then recommended a 2nd urethrostomy and scrotal ablation to resolve the problem of urine leakage. 

This image was taken when the dog was seen at Toa Payoh Vets on Day 9 after Vet 3's bladder surgery which had removed all bladder stones (post-op X-rays showed no stones). The owner came to Toa Payoh Vets as his daughter was a classmate of my son. So, Vet 4 (Dr Daniel) was tasked with the resolution of the dog's urinary problem. 

How to resolve this problem with the least cost to the owner? That is the tough part. Will a 2nd urethrostomy and closure of the first urethral stoma and scrotal ablation as suggested by Vet 3 resolve the problem for once and for all? 

Dr Daniel (Vet 4) at Toa Payoh Vets was asked by the owner to neuter the dog and remove the large left inguinal swelling of the size of an egg. He stitched up the urethral stoma (first urethrostomy done by Vet 1) so that the dog could pee as a normal dog, from the tip of the penis. Would this resolve the problem?

Well, it did not appear to do so as the left inguinal swelling filled with blood-tinged fluid (I presumed it was urine leakage + blood) of around 30 ml per day for the next 4 days. Vet 3 had likely ruptured the urethra leading to leakage of urine and blood in the left inguinal area.  

Large left inguinal swelling due to urine + blood accumulationProblem and surgical solution explained by illustration for the owner
Inguinal fluid and urine for lab analysis  Surgical plan from Dr Sing Kong Yuen
"Closing the urethral stoma so that the dog could pee normally from the tip of the penis is good for the dog," I said to Dr Daniel. "But there is the daily need to aspirate the 30 ml of blood-tinged fluid from the left inguinal area. It cost the owner around $7,000 to do the past 3 surgeries to remove the bladder stone and given time, your surgical approach may work. But time means money expenditure for the owner. "

As Dr Daniel had to go overseas, I became the Vet 5 as I took over the case and reviewed the complicated urine leakage problem. This involved talking to Vet 3 as to what had been done.

Vet 3 said: "We did an ultrasound and saw fluid inside the scrotum. This was not recorded in the case report as the owner was not charged."

Ultrasound can reveal fluid in an organ but will not be able to tell whether it i urine or blood or both.

This is where the perineal swelling in this image substantiated a possible urine leakage. I proposed a dye test but it is extremely expensive to do dye test to reveal the location of the perineal urethral leakage. The surgery at Vet 3 had cost $2,000 according to the owner.

So, what's the best economical solution now? What is in the best interest of the dog? If expenses keep mounting, the dog may be put to sleep by the owner. A solution must resolve the problem to the owner's satisfaction and to the dog being able to live a normal life without difficulty in urination.

What should I do? This is a complicated urinary tract problem due to urine leakage presumed to be from a tear in the perineal urethra (see image of perineal swelling above) and subcutaneous fluid presented daily along the left side of the penile length.

I thought hard. The dog had gone through 4 anaesthesias and surgery. Veterinary expenses were considerable.

My surgical approach was to extend the urethra stoma made by Vet 1. This  had been closed by Dr Daniel as he wanted the dog to pee normally from the tip of the penis. Then I did a scrotal ablation (cut off the scrotal sac), close up the inguinal sheaths and stitch the urinary catheter to the prepuce to retain it in for around 4 days to let the perineal catheter to heal. This is the theory.

The dog still had difficulty in urination after Vet 3's surgery. My surgical approach to post-op complications from Vet 3's surgery
which had removed the bladder stones
Open up the woundScrotal ablation
Enlarged Vet 1's  urethrotomy incisionEnsure urethra is patent
Healing of the surrounding areasGoes home with prescription diet S/D
Dog is able to pee via the original enlarged urethrostomy for the past 3 months and as at Jan 7, 2013. Dog eats prescription diet C/D. Urinary analysis and X-rays on a regular basis are recommended. Will the owner comply?  
In practice, this worked as the dog is now peeing normally with no blood in the urine when it came back for stitch removal on Sep 28, 2012, around 14 days after my surgery.

UPDATE as at Jan 7, 2013

The dog pees through the first urethrostomy without any difficulty. The owner came to buy the C/D canned food. It is good news.  Post-op urine and blood tests and X-rays are advised but owner compliance with regular monitoring will be difficult due to various reasons.

P.S.  Urethrostomy = a hole is cut into the urethra (passage for urine from bladder to the tip of the penis). 

Yearly blood and urine tests may detect early presence of bladder and kidney stones in your dog and cat.  For urinary health screening appointments, tel: 6254-3326, 9668-6468

Copyright © Asiahomes
All rights reserved. Revised: May 21, 2015
Toa Payoh Vets