Thursday, July 31, 2014

1434. A ferocious cat has blood in the urine



1433. Images mother and child & others from adverts




Tuesday, July 29, 2014

1432. Talk to Vet students in Yesin University - An emaciated terrapin


July 29, 2014   Female terrapin, F, 2 years. A retiree said that this turtle is very intelligent and responsive and felt it would be a pity to abandon her in the reservoirs.

April 25, 2014. Seen by Dr Daniel. Came in for swollen eyes for 5 days. Inappetant for 2 weeks. Active.
Diagnosis: Eyes swollen. Baytril oral and Neodeca eye drops. Weight - Not done.

April 27, 2014. Bought Baytril oral.


Jun 10, 2014. Seen by me.Weight 405g. Lethargic. Anorexic occasionally. Eyes closed. Limbs swollen.
Respiratory distress. poor prognosis.  Inj baytril+ pred, fruesmide oral, mltivit, baytril + pred.

VIDEO
http://www.youtube.com/watch?v=lsVyOOHvJ9w&feature=youtu.be


http://www.youtube.com/watch?v=xrP8RXqZ15k

Jun 20, 2014. Bought Baytril + Pred oral.

Jul 29, 2014. Today. Very weak. Emaciated (shrunked abdomen seen inside shell). Eyes closed but not swollen. Right elbow ventral has necrotic wound. So, she can't walk. Excise necrotic tissue 5 mm x 5 mm x 3 mm. No gasping for breath.

ADVISED.
1. Insufficient feeding by hand twice a day. Turtle would eat when hand fed. Liked shrimps. I gave her a packet of turtle pellets to feed 8X/day, not 2x/day. Gave her a 1-ml syringe.

2. Sunshine to warm her and strengthen her immune system.
3. Water to swim.


This case shows that the turtle had recovered but was underfed. Emaciated but as she is young, she is resilient. 

1431. Talk to Vet Students in Yesin Vet University - Traumatic proptosis in a 15-year-old Chihuahua

DRAFT


Best of friends but 2 days ago, the cross-bred pounced on this 15-year-old Chihuahua. When the owner came home, the eyeball was dirty and the cornea was yellowish with pus (IMAGE).




Traumatic proptosis - Forward displacement of the eye with eyelids entrapped behind the eye, due to injury.

Video by Teri


TREATMENT
Dog is still eating
No injectable sedation as dog is so old
Atropine 0.2 ml IM and 0.2 ml SC
Anaesthesia gas isoflurane + O2 only.
Scissors cut lateral canthus 1 cm long, eyelids entrapped are released
2 catheter tubes  3/0 nylon
Inj pred + genta subconj.  Eye ointment into eye.
Push eyeball inward by pressing and pull stitches outwards
Stitched
Post op tolfedine + baytril

Dog woke up fast and made some vocalisation for 3 minutes. OK now.  4.30 pm

Try to save the eye by replacement of the prolapsed eyeball rather than take it out. Looks bad and had wanted to take it out.  . .











Eye injuries are emergencies and treatment is best done within 4 hours of injury. Now the dog has had rubbed her right eye severely till it looked horribly red and dry with pus.

"This is a very old dog. She may just die on the operating table," I informed the lady. "You have two alternatives. To replace the eyeball or to get me to remove it. I cannot guarantee that the dog will regain her normal vision as the eyeball looks infected with pus and so a second surgery may be needed to remove it if there is infection after replaement."

This procedure is "Informed Consent" and the lady must know the risks and sign the Consent to anaesthesia and surgery..

"What should I do?" the lady owner had to decide whether to replace or enucleate the eyeball.
"I can't decide for you," I replied. "If the eyeball had come out within 4 hours of injury, I will advise pushing it back to save her vision. But you waited too long. Over 24 hours and the eyeball looked badly infected with pus."

"What would you do?".
"If she is my dog, I would try to save the vision."

I could not guarantee that the replacement of the globe would result in the dog getting back her normal vision as the owner had delayed treatment by more than 24 hours.  Her big mixed breed dog had pounced on this 15-year-old Chihuahua and the eyeball had prolapsed. The diagnosis is traumatic proptosis.








Sunday, August 3, 2014. Stitches removed. Eyeball is white but had returned to the socket.  Owner informed. Vision is probably 10% but the dog has the eye.

Monday, July 28, 2014

1430. A 7-year-old Shih Tzu has a large wrist lump

Hari Raya Puasa on Jul 28, 2014. Around 10 cases seen as most vet clinics are closed.
Interesting one of a Shih Tzu, Male, 7 years coming in with a large wrist lump. "About one week," the owner said.
"If it is one week and growing so large at 8 cm x 6 cm x 6 cm," I replied. "It is not good news as cancerous cells grow very fast. I need X-rays to check whether the bones are infiltrated or involved."

X-rays show normal bones. So it was good news.
"Surgical excision may result in the dog being lame on the right fore limb," I warned. "Unless the lump is one solid ball sized and dissected out using electro-excision & cautery carefully."

Owner opted for anti-inflam injection into the lump and wait for 2 weeks.



2 pm Videoed by Teri
Sedate 50% D+ K IV
Needle aspiration - 0.1 ml of blood but nothing else. No pus or brown fluid. Likely tissues.
Intra-lesion inj of pred 0.5 ml
Bandage carpal area for 3 days


Sunday, July 27, 2014

1429. Yesin Vet Students Talk - Aug 11, 2014. Blood in the stools - check for parvovirus

As many Singapore dog owners do not vaccinate their older dogs, it is best practice to check for parvovirus when a dog passes blood in the stools. I have such adult dogs who have been to boarding purging with blood in the stools. They were positive for parvovirus.

It may be deemed negligent of the vet to overlook the test for parvovirus which is a fatal disease. Inform the owner about the test and if the owner does not want it, the vet should record this in his case notes. Should the dog be diagnosed with parvovirus by another vet when the dog continues passing bloody stools, the owner and his family may complain that the first vet was incompetent. Keeping good medical records on such advices protects the first vet against claims for compensation.

 .

Saturday, July 26, 2014

1428. Yesin Vet University talk to final year students. Aug 11, 2014 - tips on neutering

July 27, 2014

TALK TO FINAL YEAR VET STUDENTS - YESIN VET UNIVERSITY, MYANMAR



Employee vets
Each vet has his or her own way of doing surgery and using anaesthesia and sutures.

 Case study of post-op complications: Neutering of a poodle in Toa Payoh Vets.

MY SURGICAL TECHNIQUE
Day surgery
Age: 6 months and above
With-holding food and water: 10 hours before admission in the morning

1. Prepare for surgery, knowing the standard operature procedure as follows:

1. Physical examination, body weight and rectal temperature for fever.
2. Blood test to screen the health of the dog. Optional.
3. Palpate and express urinary bladder if it is full.
4. Pre-scrotal area clipped in preparation room.
5. I/V Domitor + Ketamine  based on Domitor 0.4 ml + Ketamine 0.5 ml for a young 10-kg dog.
6. Isoflurane + Oxygen gas top up if necessary.
7. Incise pre-scrotal area. Not too high up. Incision 1.5 -2 cm for small breed.
8. Expose testicle.
9. Clamp and cut cremaster muscle ligament.
10.3-haemostats clamping.  Ligate twice for spermatic vessels.
11. Stitch skin 3 stitches. Starting from the middle of the wound.

Illustration. 



Economics

Polysorb 2/0 or 3/0  one packet  S$12.80 = 9,216 kyats
Monosyn 2/0 or 3/0 one packet  S$12.40 = 8, 928 kyats
One S$= 720 kyats

CASE STUDY
3 weeks post-neuter. Complaint of vomiting now and then.
Dog is active, eats well, no fever.
No pain in surgical area of pre-scrotal.
Bites or growls when couple touches the pre-scrotal area
Sedate  D+K 0.05 + 0.06 ml IV
Clean
Prescrotal area preferred rather than over the bulb.  2/0 polysorb. Too tight?  Remove stitches
Deep and buried - stitch abscess? No pain on palpation but dog bites/growls owner who attempted to clean the wound.

Inguinal right. 3/0 monosyn filament. No inflammation. Stitches taken out.










VIDEO

CONCLUSION
Post-op complications like infection or stitch abscess do occur.
Economics is important as rentals and staff overheads increase yearly.
Much depends on

1427. Images of a young guinea pig



1426. Yesin Vet Univ Talk - Aug 11, 2014. An office rabbit stops eating for one day












Singapore has many rabbit lovers but the rabbits are no more the ordinary large sized white ones of many years ago. They are smaller and are dwarf rabbits. (VIDEO).

A young lady was very concerned about this one-and-a-half-year-old Broken chestnut male neutered Holland Lop rabbit who wandered around her office. He would eat anything including wires and had lots of pellets as he did not much like hay. Suddenly, on July 25, 2014, he stopped eating.

"He would not eat any food and just sat hunched up in a corner," the young lady said. "He passed less stools and they are 50% smaller in size. His urine is yellow. He was grooming himself a lot a few days ago"


"He weighs 1.85 kg and has a temperature of 37.6C and is leaking urine as well as his penile area is wet. "This means he may have a urinary tract infection. I need to test his urine. Does he drink from a water bottle as I need to ward him for urine collection."

"He drinks from the bowl," she said.  I put a clean tray under the grate and he soon peed thick cloudy urine of around 0.5 ml. It was insufficient and my assistant Naing would collect more overnight and send to the laboratory. 


The slightly turbid pale yellow urine was alkaline and had a pH of 8.0. A small amount of blood, nitrite and protein was present. Bacteria and amorphous phosphate crystals were 2+. So, there was a urinary tract infection causing pain in the bladder and hence the hunched back.





X-rays showed the stomach packed with food, hairs and wire pieces. "Would he be able to pass out the impacted food and wire pieces?" I gave him Fibreplex to move his gut.

VIDEO OF X-RAYS AND IMAGES OF X RAYS

He recovered after an antibiotic injection and high fibre-food to pass out the stools the 2nd day of in-patient treatment. Lots of stools passed out.

FOLLOW UP ON JULY 30, 2014  6 pm
The young lady was happy that the rabbit had recovered. No more urinary incontinence. She would continue with the antibiotics, feed more hay and less pellets. "Fed some apples and carrots without insecticide as well," I advised. It was good news.

REVIEW OF MEDICAL RECORD ON MAR 16, 2013
He was not eating and had a swollen prepuce and wet genital area. He passed less than faecal pellets and hid in dark places. He was lethargic and I diagnosed Urinary tract infection from the abdominal pain in the bladder and the swollen prepuce.  "NO WANDERING" I wrote in the case sheet. The rabbit recovered after antitbiotcs and Fibreplex.

CONCLUSION
Young rabbits are like toddlers. They need to be supervised or they would put anything inside their mouth and swallow them causing stomach upset.  In the recent episode, evidence of X-rays and urine test confirmed stomach impaction and uinary tract infection..



Friday, July 25, 2014

1425. Undescended testicles become cancerous

July 26, 2014

Undescended testicles in the dog are best removed as many do become cancerous or grow to large sizes as in this 12-year-old poodle.



Thursday, July 24, 2014

1424. Images of BKTP videos. An 8-year-old Shih Tzu has a bigger bluish breast lump

July 25, 2014

Groomer Clara popped in with a 8-year-old Shih Tzu. "She will bite if you pull her out of the crate," she warned me. "Other dogs don't do it."

So we weighed the dog + crate = 8.1 kg. She poured the dog out and the crate weighed 2.1 kg. Once out, the dog did not bite but she would hum a few soothing words and rub her shoulder when the dog got injections. Dog bites are groomer's risk.


"6 kg and normal temperature of 38.6C" I checked the vagina for discharge. There was none.
"When was the last heat bleeding?" I asked. Clara phoned the owner who said it was 4 months ago.





























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GUIDELINES FOR DIAGNOSIS & TREATMENT OF FALSE PREGNANCY & MAMMARY TUMOURS IN DOGS

A non-pregnant bitch shows signs of pregnancy and maternal behaviour in middle or late diestrus. Also known as Pseudopregnancy, Pseudocyesis, Phantom Pregnancy.

1.  SIGNS.
1.1 History.  1.2  Physical Examination Findings
3. DIFFERENTIAL DIAGNOSIS
4. CBC/BIOCHEMISTRY/URINALYSIS
5. IMAGING - Radiography or ultrasonography
6. DIAGNOSIS
7. TREATMENT. Medical/Surgical
8. CLIENT EDUCATION



1.  SIGNS.
1.1 History - Behaviour changes - self-nursing (suck own nipples), restless, nesting, mothering activity.
Vomiting, anorexia and lethargy. Abdominal distension and mammary gland enlargement.

1.2  Physical Examination Findings - Large mammary that secrete a brownish serous fluid or milk.

3. DIFFERENTIAL DIAGNOSIS

4. CBC/BIOCHEMISTRY/URINALYSIS. Usually normal. If not, reproductive or systemic diseases.

5. IMAGING - Radiography or ultrasonography. To rule out closed pyometra and normal pregnancy.

6. DIAGNOSIS is made by a history of estrus 2-3 months before clincial signs and clinical signs present.

6. TREATMENT. Medical/Surgical

Usually will resolve 2-3 weeks without treatment
Do not spay till the dog is in during anestrus will prevent recurrence.
Do not spay during false pregnancy as milk will still be present post-surgery requiring medical treatment.
Breed bitch during next estrus if puppies wanted.
Elizabeth collar

Synthetic progesterone - megestrol acetate. 1-2mg/kg/24 hrs PO, 8 days. May cause pyometra, mammary gland hyperplasia, diabettes mellitus, weih gain, diabetes melltus, increased weight gain, adrenal cortex atrophy

mild tranquilsers excepr phenothiazine which increase prolactin concentration.

Surgery - ovariohysterectomy (spay).

8. CLIENT EDUCATION. Important for family members as the dog is family and to explain medical costs. Vet can illustrate the location, size and number of breast tumours or make a video clip.