Wednesday, December 8, 2010

266. Eat, Love, Pray & Warts

"Are you waiting for Dr Vanessa?" I asked the couple who popped in today while I was about to operate on the old Shih Tzu with the open wound in a left neck lump of around 1.5 x 1.5 cm.

The lady owner had scheduled this surgery after the dog suddenly had this crazy scratching of the enlarged lump some 2 weeks ago. I had treated the swelling which was 5 times the present size. Much earlier I had advised surgical excision but she did not want to do it. The lump had swelled and gone down over the last 2 years and so it was nothing to worry about. Till two weeks ago, when it exploded like a volcano (see image). I was surprised too. This will be another story.

Back to the couple with the old Miniature Schnauzer limping and biting the owner should they touch his left fore limb. "Actually, we want to see a vet immediately," the young trim lady in make up and green dress said softly.

So I had to abandon my surgery case to attend to this dog.
"He must be suffering from an ingrown toe nail like last time," the man in his 40s said. "Remember, you need a tranquiliser to trim his toe nail." I checked the records. It was done by Dr Jason Teo and the limb affected was right fore.

"This dog has lots of ear hairs and his ears are painful. Did the groomer pluck his ear hairs?" I examined the ear canal after muzzling the dog and noted that the left ear was dirty with wax. "Mum is the groomer, and she cannot do it."

I got the groomer to clip the dog's left fore paw under domitor sedation. He has a puncture wound in his pad which contained pus.

The man had been flying for the past 20 years internationally. "Did you take any pictures of the various cultures and people you meet?" I asked. "People like me don't get to see the world as it is too costly and time-consuming. You have the opportunity to document the fascinating diversity of people and culture."

"I will get a SLR to do it," the man said he did not do photography. "Travel stories with pictures are fascinating to many people," I said. "You may become rich if you author an interesting travel story that is made into a movie. Have you watched the movie "Eat, Love, Pray"?

"Bali," the girlfriend said.
"Bali is the place where the writer found her true love. Italy is the place where she eats good food and makes good friends without bothering about her weight gain. India is where she meditates and clears her mind."

I hope the man will take pictures and document his travels. It is very rare for a person to write travel stories but buying a camera is a start to create memories.

As for the old Schnauzer, I got the dog's left elbow wart (blackest one I had seen) excised. A papilloma behind the left shoulder was excised. I asked the intern to write the "surgery" of this case plus the one on the Shih Tzu with the neck abscess. He can write but like most interns of 4th year, they prefer not to document. Writing will help him in his forthcoming examinations as he sees real cases. Books and lecture notes can be most boring.

As for the Shih Tzu, he saw the operation when he came in after 10 am. He was fortunate as I wanted to complete the operation before 10 am if the couple with the Schnauzer had not stepped in. So, he could see and understand the principles of tumour and growth excision. How it is done and what is the post-op care. I asked him to write this record.

As for post-op injection, I asked him where to inject the tolfedine l.0 ml with half IM and half SC said: "My professor teaches me to inject in the dog's neck for IM."

I said sadly to him and to my assistant: "Sometimes two of you make me so angry because you said something which cannot be done." Obviously, the dog's neck had surgery and was bandaged up. So, there was no possibility of neck IM injection. "I usually inject IM in the back muscles," I showed the intern the location. This is the first time I hear dogs being given neck IM injection for sedation. Since the intern's Murdoch University does it as a routine, it must be OK. In racehorses, I use IM neck injection as the neck is muscular and large.

"I know of a Filipino vet graduate who injects IM into the muscles above the knee joint," I said to the intern. "So the professor in her university must have taught her that way." There are many ways of IM injection in the dog apparently. I stick to the backside muscles.

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