Thursday, December 31, 2015

Visit to breeder's farm - follow up on 2 Caesarean section cases

Brought 2 interns to visit the dog breeder's farm. The Singapore government licenses dog breeding and he was legitimate. The oldest big dog breeder in Singapore. Probably 4 left.

My Corgi Caesarean operated the day before was happily nursing 5/7 pups (video).  2/7 pups were nursed by a poodle with her 2 pups (video).

The other Corgi's 5 pups had passed away before Day 5, being outsourced to other dams to nurse. This Corgi had no milk. The puppies were alive when they were brought home (video).   

Videos at toapayohvets.com

2900. New Year 2016 cases. A terrapin, dog and hamsters

Jan 1, 2016

I have 2 in-patients and 2 cases from 9.30 am to 3.30 pm .

Inpatient 1,
A terrapin with left ear abscess for the past 7 days. Eating and active. The left ear swelling has reduced by50%. Mainly blood clots and hardened tissues as the terrapin's abscess was present for many months. The two pre-teen daughters finally surfed the net to get a "terrapin vet" after the mum threatened to abandon it in MacRitchie Reservoir.

It was very difficult to get the younger generation to spare time to do things for the mum. With time, the abscess became gigantic.

Inpatient 2.
The other patient is a 14-year-old Silkie with a deep right eye corneal ulcer of around 8 mm. The first vet had advised eyeball removal as the dog kept scratching her eye. I suggested stitiching up the eyelids first to save the eyeball as it was not infected internally. The dog had to be an in-patient for at least 7 days. At home, she would wander and rub her eyes despite having an e-collar. Here, she eats and sleep like an old person.





Case 1

G.P. F. 1 yr 3 months. Head turned stiffly to the left of the neck, but no head tilt, this morning. In Aug 15, 2015, had left head tilt but recovered after my treatment

A guinea pig could not turn her head to the right. Stiff neck, not left head tilt as in previous treatment by me. Videoed. The owner had not cleaned the ears. The G.P looked recovered at the exam room.

Case 2
A new client.
G.P. M. 5 yrs. o fever. Anorexia 1 day, but often lethargic. V thin. "Chipping sounds".

The G.P was very thin and in poor condition with overgrown lower front teeth, scales dropping from body, dirty ears and body. Pus obvious in right nostril. In-patient for treatment of upper respiratory tract infection.


Telephone 1.
A telephone call came in from a dwarf hamster that had an overgrown tooth curled and embeded into the hard palate (video). Around 4 days ago, the first vet had not examined the mouth and prescribed medication which the owner had to syringe feed. The hamster was very weak, dehydrated and his lower neck was wet with oral medicine spilled onto it. I got the curled front teeth clipped. The owner phoned to ask why the hamster was soft and not moving. "If a hamster has died, he should be rigid," she said.
"She might have developed rigidity overnight," I explained that rigor mortis occurred a while. "After that the body softens."  

This was a very sad case. The owner surfed the net, came across a Toa Payoh Vets video of a hamster had "overgrown" teeth. She checked the mouth. She came to me and I confirmed her diagnosis. A young couple with a little girl lost a young hamster.

Wednesday, December 30, 2015

2899. A 7-year-old Maltipoo passes blood in the urine again

Dec 31, 2015

Maltipoo, female, not spayed, 7 years

"She passes blood in the urine again," the lady owner brought a sample of urine collected when the dog peed this morning. She had wondered how to collect urine as the female dog does not pee in her presence. The urine sample contained some bloody tissue fragments.

The dog had blood in the urine some 4 months ago and recovered with antibiotics.

I palpated the abdomen (video). The dog screamed as I palpated the cranial and then the caudal part. The owner witnessed this shrill voice and I stopped further palpation.

X ray showed a small radio-opaque stone, most likely in her ureter. She was screaming when I palpated her abdomen twice and so I did not continue.



Urine test by diptstick - Dec 22, 2015
pH 8
SG 1.0
Leucocyte Nil
Protein +
Urobilinogen +
Bilrubin 3+
Blood 4+


A crystal check is in progress.  An alkaline pH in the urine favours bacterial infection in some dogs. Acidifying the urine via diet may resolve this problem. The dog had been on heat 2 months ago and could have open pyometra as evident by the vulval swelling (video).





2898. Be Kind To Pets images for interns

















Tuesday, December 29, 2015

Visit to breeder's farm - follow up on 2 Caesarean section cases


Breeder can't decide but want me to stand-by.
All 7 pups delivered with no cries. As if they were dead.
First cry around 30 minutes later while I was still stitching up the dam. 
First C-section by another vet - skin incision 10 cm from the umbilical scar to pubis and took out the whole uterus.

I incised 1/4 of his length.  Sufficient to take out the uterine body with pup inside. It was not possible to locate the bifurcation of the uterus as there were 7 pups all squeezed tightly inside the abdomen. I incised the non-bleeding length of the uterine horn nearest to the bifurcation and milk out the 7 pups. 

Skin incised to skin sutured took around 1 hour! The breeder and 2 assistants just took over the 7 pups while I focused on the dam. I had performed over 100 C-sections in dogs and so this one-hour duration will be meant for experienced surgeons.  










Caesarean by me 7 days ago. No complaints by breeder. 



Monday, December 28, 2015

INTERN. Caesaean section of Corgi with 7 pups - how long does it take? 61 minutes





"No cries from the puppies," the breeder took over the 5th Corgi pup I had delivered by Caesarean Section. All 7 puppies had not moved when taken out. As if they were dead wood.

The breeder hoped that the dam would give birth naturally. I doubt it but it was the breeder's judgment that mattered. A life and death situation. He was a very experienced old breeder and he knew the consequences of procrastination.

"I may as well do Caesarean section at 9pm now as no vets will do it after midnight," he justified.
I did not put in my 2 cents' worth of reply. Singapore has nearly 70 veterinary clinics.  There will be vets. But all 7 pups will be delivered dead! He still needed to pay more for a Caesarean section to receive 7 dead Corgis!
 



I do an audit of my surgery to assess any area of improvement.

A: Injection of induction drugs: No
B: Isoflurane gas first given: 8.40 pm
C: Isoflurane gas stopped: 9.52 pm
D: First skin incision: 8.48 pm
E: Skin stitched up: 9.47pm



E-D = 61 minutes for 7 pups
The skin incision was 1/3 of what the first vet did and so the closing was faster. It would be faster if I had not done a continuous suture over the interrupted sutures of the linea alba and a subcuticular suture after that. Then the skin is stitched. In the other case of the Dachshund, I did only a continuous suture over the interrupted ones closing the uterine incision.

My assistant recorded the following:
Uterus incised: 8.58 pm
Uterus stitched up: 9.27 pm

First puppy taken out: 9.02 pm
Last puppy taken out: 9.13 pm. All 7 puppies handed to the breeder within 11 minutes. All not moving or crying.


FOLLOW UP  2ND DAY
All puppies and dam OK.  Dam nurses 5 pups. (video done) and a poodle nurses 2.

Everybody is happy with the outcome.
I made a sufficient incision length the width of the puppy's head (approx. 10cm long) and milk out the puppies from both uterine bodies. The incision was to one side of a uterine horn, near the bifurcation. I could not locate the bifurcation.



Saturday, December 26, 2015

INTERN. 2894. The rabbit had a big bleeding knee swelling





HOOK
A big bleeding left knee swelling after boarding in Pasir Ris. Bleeding for over a month. Blood stains on the apartment floor needed frequent cleaning..

WARNING
This BKTP video contains surgery. Viewer's discretion is advised.





Sunday Dec 27, 2015. Toa Payoh Vets
Rabbit, male, not neutered, 7 years
Left Knee Swelling
The lady suggested surrending him to the SPCA if surgery is too costly

 

"The lump fell off and disappeared at one time," the lady showed me her smartphone videos of the actual lump as she did not take images when the rabbit's lump had dropped off.


"Was the rabbit boarded alone or with other rabbits?" I asked. "Another rabbit could have bitten him if he shared kennel space."

"I was not permitted to see the kennel," she blamed the boarding operator for the appearance of the lump as the rabbit was normal before boarding. 

View of Pasir Ris kennels, Singapore


The operator got his vet to treat the swelling and paid around $100. The vet texted her the report.
saying that she could not confirm whether the swelling had cancerous cells from doing a FNA (Fine Needle Aspiration). Video footage (partial report).


The first vet did not do surgery and referred her to another vet in the practice. The boarding operator also referred her to a vet. But she had phoned Toa Payoh Vets. Dr Daniel patiently explained the probable causes and quoted her the cost of surgery. So she decided to come today but Dr Daniel had gone overseas.

"This swelling could be a lick granuloma," I told the two interns. "After many weeks of licking, the injured area developed into a hard lump. "It could also be an abscess or a tumour."

video footage close up


The rabbit was operated under isoflurane and oxygen mask anaesthesia. Electro-surgery and blunt dissection. (video). Two layers of stitching. A subcuticular and a skin horizontal mattress pattern. The rabbit wore an e-collar.
Images (text to be narrated slowly)









 


Edited Video footage of surgery with subtitles

I gave pain killers and antibiotics for the next 10 days.

The lady came back 3 hours later to bring the rabbit home.
(Video, post op)

"The lumps are multiple soft white fatty nodules under the skin of the knee," I showed the lady the cyst-like swellings measuring more or less 1 cm across (image).  "As you did not want the tumours to be sent to the laboratory for histopathology, I am unable to say whether they are cancerous or not. They may recur again." 

"So, you think that the boarding operator was not responsible for these?" the lady asked me.
"The left knee was not swollen when I boarded the rabbit for 6 days till November 26, 2015".

In my opinion, the fatty nodules would have developed and the boarding kennel operator was unfortunate not to have done a general physical examination for lumps before accepting the rabbit. The owner said that the rabbit had no swellings before boarding.


CONCLUSION

I am glad that the rabbit was able to survive the anaesthesia as he is considered old. Old patients have a much higher risk of dying under anaesthesia.

I am sure the 13-year-old daughter will be most happy to have her companion back. He will  not be given to the SPCA and will no more have a bleeding knee soiling the apartment. This rabbit is not allowed to roam freely for the next 2 weeks. Strictly cage confinement and an elizabeth collar to let the knee wound heal. 



TIPS AND ADVICES
Small tumours are easier to remove and the medical cost is much lower. Many pet owners shop around for a vet to get a quotation to fit your budget. Fees vary depending on the time taken to operate. In this case, the fee was around $300.   




Wednesday, December 23, 2015

2893. The terrapin has the largest ear abscess in Singapore

Dec 23, 2015

"I want to get rid of it," the mother told the two teenaged daughters who did not find her a terrapin vet to treat a terrapin with a gigantic ear abscess.

Surprisingly, this terrapin with scratched upper shell had an ear abscess as big as his head. The two girls quickly googled and the 3 ladies brought the terrapin came to Toa Payoh Vets.   They knew what was wrong from the internet - swollen ear abscess.















8 days as in-patient. The terrapin is very active, ate a lot and will be going home. It is a resilient type as many other terrapins with such a gigantic ear abscess will not be eating.



 

2892. A biting Hougang rabbit passes blood in the urine

Dec 23, 2015

Yesterday, I had a Caesarean section call before 9 am and then a rabbit passing blood in the urine appointment at 8 pm. Some days are long. 


The biting rabbit would snap at me and his family members when given a chance. I had to scruff him to feel his abdomen. A hard bladder lump around 8 cm across. I gave antibiotics and asked the owner to return the next day for X-rays.

The mother and young adult daughter showed me the image from their smart phone. "My rabbit had passed red blood in the urine this morning but clear urine at the 2nd time!" the daughter showed me the phone images.



Today, I palpated the abdomen. The rock-hard painful bladder was softer.

X rays confirmed bladder stones which could be dissolved by urine acidification.
I got a urine sample and will check for the crystals.

So, 2 years ago, the rabbit may have cystitis or bladder stones but the rabbit recovered fully after antibiotics. Till today, 2 years later. The presenting sign was fresh blood in the vaginal area. I thought there could be pyometra or uterine cancer as old female unspayed rabbits are prone to get. It is not possible to confirm pyometra but the main complaint was blood in the urine (haematuria). 

Tuesday, December 22, 2015

Pigs in Myanmar

Seldom seen except on rural roadsides. Usually one or two black pigs tethered. So, I was surprised to see pigs of all colours in this truck in the Ayeyawarddy region. I snapped a picture of this fast moving truck on the highway