Sunday, November 30, 2014

2 golden retrievers with closed pyometra (2012) and open pyometra (2014)

March 26, 2014
Open pyometra - blood tests

Golden Retriever, Female, 9 years

 

 

 

2 cases of Golden Retriever with pyometra in 2012 and 2014 

Case 1.  Friday, June 22, 2012


1046. Closed Pyometra - blood tests and x-rays

Golden Retriever, Female, 10 years

Not eating for 4 days. Lethargy. No fever.

History: Polydipsia and Polyuria

1.  Blood test:
Total WCC = 38 (6-17). N86%, L4%, M9%, E1%, B0%

2. X-rays: Uterine horns filled with pus
3. Ultrasound: Pus seen in both uterine horns. Cervix is closed.

Diagnosis: Closed pyometra

Surgery: 1 hour. Spayed.

Outcome: Good. Dog is back to normal.



Case 2. March 25, 2014  
Golden Retriever, F, 9 years.  Bloody vaginal discharge seen today. Lethargy, anorexia, shivering, panting. Vomiting today.

Blood test
1.  Blood test:
Total WCC = 57.3 (6-17). N82%, L9%, M9%, E0%, B0%
Absolute Neutrophil  47 (3-11)
Platelet 116 (200-500). Toxaemia.  I/V drip + tolefidine + baytril pre-op. 2 bottles Hartmann and Dextrose Saline.
Liver and kidney creatinine normal.

Diagnosis: Open pyometra
Spayed.
Outcome: Good. Dog is back to normal.
Today Dec 1, 2014.   Big infected ulcerated nasal area below nostrils. Keeps licking with tongue. So, not healing. Started with a small wound.  What to do now?  VIDEO







Open pyometra. Blood tests only.
1.4 kg uterus + red brown pus.


High total white cell count and history indicated closed pyometra. X-rays and ultrasound are useful to confirm pus in the uterus.

1120. Two big ear abscesses in a terrapin in Singapore


 
 
 

 
 

Saturday, November 29, 2014

1119. Script for Shan. Vertical ear canal ablation in a hamster and a dog

Nov 30, 2014

HOOK


INTRODUCTION


ANAESTHESIA
Old pets - high anaesthetic risk.  Reputational risk for the vet.


SURGICAL TECHNIQUES
Tumours deep inside the vertical ear canal. Recurrence if just removed the tumours at the entrance of the canal.  ANATOMY. ILLUSTRATIONS.

BLEEDING & INFECTIONS
Lots of bleeding
Owner's loving care. Dog bites. Hamster scratches as no e-collar.

OUTCOME
Dog needed to be in-patient and cared for. Granulation tissue.


Hamster well cared for by young lady with SMS updates. Blood face yesterday morning but clean next morning when I saw the hamster. Cut off the clotted tags of tissues which might have irritated the hamster.

.

1118. Sunday's interesting case. Second Opinion. The Shih Tzu has bladder stones 3 years after surgical removal

Nov 30, 2014

A referral case. The couple wanted to know whether the 13-year-old, female, spayed Shih Tzu would be able to survive anaesthesia if the operation to remove the recurrent calcium oxalate bladder stones is to be performed. A health screening was done as a routine by the family vet. X-rays show bladder and kidney stones. The dog had bladder stones of similar composition removed 3 years ago and had been on dry U/D diet since. But with dog biscuits fed daily and bread sometimes. After bladder stone removal, the urine was checked 3 months later. There were positive calcium oxalate crystals as the dog was still fed her usual dry food and not U/D. After switching to U/D, the urine were negative for 2 more times and there was no more urine check up since.

"There is no urine analysis report," I said on this fine Sunday morning at 9.10am. A client had referred this couple to me as regards the bladder stones. 

The husband phoned the clinic and the results were faxed over. "Urine pH is 6.0, few calcium oxalate crystals, red blood cells and white blood cells were present," I said. This low pH shows that the urine is acidic, favourable for calcium oxalate crystals to form.

I palpated the throat and the abdomen. The dog coughed and winced in pain when I palpated the whole abdomen. Yet the owner reported that the dog did not vomit but had lost 10% of appetite and that the night urine was in a small puddle nowadays, instead of one large amount.

"Based on the health reports of the dog 1.5 months ago from your family vet showing normal liver and kidney and blood cells,  and my examination of the heart and lungs, there is a high chance that your dog will survive anaesthesia" I said. "However, the pain in the throat and the abdomen shows that something is not right with the dog. Most likely a start of inflammation of the kidneys and bladder."

The dog was on antibioitc medication for 14 days and strictly no more dog biscuits. U/D canned food for the next 14 days and if the dog has normal appetite, instead of being coaxed to eat, the dog will be Ok for surgery. 






Conclusion
Feeding U/D prescription diet must be exclusive. No other dog biscuits, bread etc to be given to the dog. Urine test every 3-monthly and then 6-monthly will be advised but NO Singaporean dog owner ever bother to do this monitoring after bladder stone surgery.

 






Friday, November 28, 2014

Vertical ear canal ablation - hamster and dog - post-op bleeding

Unusual to do vertical ear canal ablation in a dog and hamster around the same period of time. 


1.  Jack Russell 13 years old - Day 12 - much better. Surgery by Dr Daniel Sing.

2.  Dwarf hamster, 22 months old - Day 7 - had profuse bleeding yesterday (Day 6).

Day 6 after vertical ear canal ablation







7 hours later, the hamster had cleaned himself, removing all traces of bleeding 







Surgery by Dr Sing Kong Yuen. SURGICAL TECHNIQUE Vertical incision into canal. Then electro-excision to remove whole veritcal canal with tumours inside.

Both had tumours inside the vertical canal. The top 2/3 of the vertical canal was cut out with the tumours. Bleeding was due to the scratching of the operation area.

In the dog, the e-collar was effective but the dog objected strongly to ear cleaning for the first 5 days at home. So the owner sent the dog here for me to clean. The wound was wet and Dr Daniel removed the stitches, letting the wound to heal by granulation (IMAGE). 

After 8 days of in-patient, he went home today. He is extremely hyper-active although he is an old dog. "Jack Russells are born high energy and will be active if they are healthy in old age, as in your dog." I explained to the couple. VIDEO


In the hamster, the neck was too short and in any case, e-collar is not effective as the hamster will take it off in a few seconds. So, today, I examined the wound. Around 5 clotted tags of skin were snipped off. A much bigger crate or high-walled plastic container with a standing exercise wheel was advised.  The hamster was still 52 g and ate more and peed more, due to the drug. His stools are normal in size. VIDEO.

Conclusion
Daily care of the ear wound by cleaning and medication giving is important for both the hamster and dog. It takes around 14 days for the granulation wound to heal and the blood clots to fall off. In the hamster, the owner cared for it at home and I saw him today only. The heavy clotted tags of skin around the wound were snipped off as they could be "heavy" and irritating to the hamster.  (VIDEO)

Thursday, November 27, 2014

1116. Younger generation does not follow instructions - terrapin with ear abscesses - post-op care

Nov 28, 2014

"Just focus on the terrapin," I specifically instructed the Sec 4 intern as I wanted to produce a veterinary educational video on "how to take care of the terrapin with two ear abscesses after operation". She had been interning for 9 days.

So I assumed she did the right thing. The lady wanted a copy of the video. I saw her appearing inside the video.

"I will phone her for permission," the young intern said.
"It is not as simple as that," I replied. "Permission must be in writing as her family members may object later and I will have to remove the video. Now more time is wasted having to edit the video to get the owner out of it!"

I note that the younger generation of interns and employees needs to be monitored as many do not want to follow instructions.

Spanish dancing videos

I was surprised that my canon can capture such sharp videos.

Canon EOS 70D, with zoom lens, from "circle" seats central back area.


 
 

 



PK, Dora, Wendy
Can anyone give me the real title of the dances?










Gibraltar.
The stressed tour leader dashed across the road. PK, Dora and Wendy were cool and calm. Mr and Mrs Mok took life easy. I was at the other side waiting for the group to capture a video of most of them.

Wednesday, November 26, 2014

Images for BKTP - gen skin diseases, ear surgeries, hamster ear surgery, vertrical ear canal ablation jack russell







Vertical ear canal ablation
Day 6













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Sunday, November 23, 2014

Ear haematoma in a Beagle

Nov 24, 2014

Questions asked:

1. To operate or not?
Operation is to remove the blood clot. If no operation, the swelling may become larger as the dog keeps rubbing his ear. Ear gets injured. Bacterial infection - smelly and bloody. Flies lay eggs - maggots in large numbers. Painful and smelly. Ear amputation may be needed. The medical costs would be much higher.

It takes several weeks for the swelling to subside and the ear becomes distorted. The dog has to endure weeks of pain.   

2. What if I use the e-collar?
The dog will still try to rub the painful heavy ear against the walls or chairs, sofas etc.

1112. The cleaner at One Fullerton burst out laughing loudly

On Nov 22, 2014, I went to the bathroom in One Fullerton. The slim cleaning lady in white blouse and black slacks advised me to put salt on my limping right lady to cure myself. "I have the oil from Japan," I showed her the bottle and she was satisfied.

"You look very young, without a strand of white hair," I said. "Yet you had lost some of your front teeth."

"I am 67 years old," she replied. "I do not dye my head black as my hairs are not greying. Unfortunately, I lost my teeth as I binged on chocolates after I retired. Day and night, I ate chocolates. My son bought chocolates when he came back from Australia. I was so fat that I had difficulty breathing and walking!."

I was most impressed at her losing so much weight. Now she is so slim that she would be a model for the advertisers of slimming saloons. But none would use senior citizens as advertising models as they prefer young celebrities.

The cleaning lady had Indian-Chinese parents and looked very much sun-tanned. She had worked as a happy cleaner foe the past 3 years and was chatty with anyone who would take the time to talk. Her old boss had referred her to this job. At 2.30 am, her husband of 75 years would drive by to take her home while she started work at 6.30 pm in this One Fullerton place, facing the Marina Bay Sands.

"So you walked like a duck when you ate too much chocolates," I demonstrated with my legs stretched out sideways and my left hand on my sore left hips. I was much surprised when she burst out laughing out loudly. It is always good to connect with the service providers and make them appreciated as the cleaning service line can be quite boring and repetitive. 

 

Saturday, November 22, 2014

1111. Testimonial for Ms Shan Ling Tan

Nov 23, 2014

TO WHOM IT MAY CONCERN

FROM: Dr Sing Kong Yuen, Founder and veterinarian, Toa Payoh Vets, www.toapayohvets.com, Singapore


Ms Shan LingTan had a short period of attachment in Toa Payoh Vets from July 8 - 24, 2014. To acquire more knowledge and skills required in the veterinary industry, she had actively looked into available veterinary-related attachment programmes. She was given an opportunity to be a student attached to Toa Payoh Vets Singapore since she followed up on her application.  

She is a well-mannered and diligent young lady who has shown a keen interest and aptitude in veterinary science as well as animal welfare.

During her attachment, she was given many opportunities to observe and assist in consultations, clinical examinations, diagnostic tests and analysis as well as in surgery and medication.

She pro-actively seized every opportunity given to try and assist in various procedures such as physical examination, dental care, medical treatment, surgery as well as educating and communicating with owners.

Despite the rigorous and heavy workload, she displayed a strong sense of responsibility and took pride in all tasks assigned with great professionalism and dexterity. She performed well in hands-on activities and delivered quality work.

Shan Ling was also tasked to research on several case studies and complete online videos meant to educate owners about the common diseases associated with their pets.


This e-mail confirms that Ms Shan Ling Tan had edited and created 3 veterinary educational videos of cases assisted by her, during her attachment at Toa Payoh Vets. I am most happy with the qualityof her videos which demonstrated her understanding of the surgical techniques and provide good veterinary information to vet students and pet owners.

Toa Payoh Vets provides a community education service to vet students and pet owners at the website www.bekindtopets.com for the past 10-15 years. These educational videos will be of great interest to the younger vet students as they prefer visual aids as compared to reading text.

Shan Ling's videos and the youtube links are as follows:

1. Vertical ear canal ablation
http://www.youtube.com/watch?v=CCjPtc0bQzc&feature=youtu.be


2. Rectal prolapse in a Roborovski hamster
http://www.youtube.com/watch?v=ha2PVrk9tYE&feature=youtu.be

3.  Spaying a cat and how to prevent stump pyometra
https://www.youtube.com/edit?o=U&video_id=W6MUKoweHv8


From my observations, Shan Ling was an effective team player who is humble enough to take criticism and mature enough to withstand the idiosyncrasies of others who might have a differing opinion from her. She had proven to be a highly driven individual who was willing to go the extra mile learning from our veterinarians as well as other staff regarding topics where she is uncertain of. 

Presently, she has picked up some basic knowledge about the common diseases and showed confidence in appropriate animal handling skills for domestic pets in Singapore. Her experience will help her explore into greater depths under the guidance of your esteemed group of lecturers and teachers.
The above shows that Shan Ling displays a strong personality and high standard of commitment. She is an exemplary benchmark for her generation and deserves every support possible to reach her potential ability. She is a far-sighted individual who keeps a clear mind for her vision, and she exemplifies this in both the academic and non-academic fields.

I am very optimistic that Shan Ling will add value to your university, using her intellect and bubbly personality to exert a positive influence in the community that she is in, touching and changing the lives around her. It is with these qualities of Shan Ling’s in mind that I wholeheartedly recommend her for your consideration.

I believe she will make a great veterinarian and I wish her all the best in her undergraduate studies. Please contact me drsing@toapayohvets.com, tel: +65 96686468 if you have any queries. 




Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Founder and veterinary surgeon
Toa Payoh Vets
www.toapayohvets.com

Sent by e-mail and by post
Nov 21, 2014

Dinner at 1 Fullerton Palm Beach

Dinner with 3 ladies from the X Generation and a couple from the Pioneer Generation (71 years old and fit to travel).
.
We met on a Spain-Portugal tour in October and PK, one lady organised a dinner to meet again.

The 3 X generation ladies were very hard working. As regards the tour, Poh Kuan is the type who would research the places visited or to be visited. Dora and I would not be bothered. I did not ask Wendy as she was seated further away. 

D said that it is harder to find printer for the images as she would print around 40. Disk storage could be not compatible in future and she would be deprived of the memories. I checked my hard disk and found some photos of D and a video of the 3.  





better not touch him








Wednesday, November 19, 2014

Rabbit has painful left hip


Nov 19, 2014
2-month-old dwarf rabbit was carried but fell. Reluctant to walk. Painful left hip on examination (video). I can see him hopping.





No fracture or dislocation of the left hip

A thin young Chihuahua has diarrhoea for 7 days

"He likes to eat anything on the floor?" I asked.
"Yes, yes," the lady said."Newspapers and even the cotton bud I dropped accidentally!"
Diarrhoea for 7 days as many as 6 times yesterday and 5 times today. No vomiting. Still eats.




The active dog whimpered when I palpated her back half of the abdomen which was filled with gas. The front half was full like a big bag of clothes. 

What's the cause of diarrhoea and what's the solution? 










James Herriot in one of his stories in "Vets In Harness" mentioned about the use of sedatives and tranquilisers to let the dog suffering from long periods of diarrhoea sleep and recover. He used Nembutal in one poodle successfully.