Friday, July 28, 2017

3113. Fractures of femoral shaft, head and neck in a 10-month-old female guinea pig


Above X-ray was done by Vet 1. It appeared that the right hip joint was dislocated.


July 29, 2017
I requested X-ray of lateral view. Owner's vet had X-rays done by Vet 1







X-ray by Vet 2. Ventro-dorsal view only. No lateral view was taken as the guinea pig was in pain.








SUMMARY OF 4 X-RAYS.  3 FROM VET 1. 1 FROM VET 2














Thursday, July 27, 2017

3112. Single pup syndrome

There is such a condition as single pup syndrome. The single pup grows to a large size and usually need to be delivered by Caesarean section as in this case. Failing to do so will result in the pup's death.












Both dam and pup are OK on following up 7 days later.  

3111. Unusual case of 4 dead foetuses in one uterine horn - Caesarean Section

The breeder requested an emergency Caesarean section as there was some blackish green vaginal discharge.

4 dead mummified foetuses bathed in blackish green fluid were in the left uterine horn, but 3 normal Corgi pups were found in the right horn. They were rescued just in time.



Wednesday, July 26, 2017

3110. Urinary stone prevention diet. Does it work? 3 case studies

CASE 1. BLADDER & KIDNEY STONES
HISTORY
Shih Tzu, MN, born 2006
In Sep 2014, the dog had difficulty passing urine. Vet 1 palpated a "bladder stone" and advised surgery, saying X-rays were not necessary.
The owner consulted me at Toa Payoh Vets. X-rays showed one bladder and 2 kidney stones.



After bladder stone removal at Toa Payoh Vets in Oct 2014, the owner did not feed the prescription diet to prevent bladder stones regularly.

In April 2016, the Shih Tzu passed blood at the end of urination. Soft bladder swelling palpated 
Urine analysis. pH 6.5, SG 1.02, Protein 4+, Blood 4+, White blood cells 900. No urinary crystals.
suggestive of bladder stone or tumour with cystitis. 

X-ray showed more than 2 kidney stones and a soft bladder mass was palpated. 

The owner fed prescription diet regularly and there is only occasional turbid urine but no more blood in the urine or difficulty in urination.




FEEDING PRESCRIPTION DIET RECORD FROM TOA PAYOH VETS


Oct 7, 2014  bladder stone removal surgery

Sep 11, 2015  Urinary S/0 7kg
Dec 12, 2015  Urinary S/0 7kg

Mar 26, 2016  Urinary S/O 7 kg


April 20, 2016. blood in turbid urine. No large stones palpated in bladder.  Cystitis? Bladder tumour or non-opaque stone in X-ray. Switched to Hills' C/D/

April 27, 2016  C/D  17.6 lbs
Owner did not come to Toa Payoh Vets for C/D. 

Jan 31, 2017 C/D  17.6lbs
April 30, 207 C/D 17.6 lbs
Jul 27, 2017 C/D  17.6 lbs.

 Owner says that the Shih Tzu, MN, now 11 years old, has no urination problems and is fed C/D. The other dog, a younger Schnauzer eats commercial food and has no urinary problem. The Shih Tzu consumes the 17.6 lb bag every 3 monthly. 


Conclusion. Difficult to get the owner to do further tests like urine analysis or X-rays as the dog had no problem in 2017. He had been feeding the Shih Tzu solely on the Multicare C/D which is said to reduce oxalate and struvite reccurrence. No other dog food or treats. 

----------------------------------------
CASE 2   Miniature Schnauzer, M, N, 12 years. FEEDING OF PRESCRIPTION DIETS
The dog's urine pH is acidified by the feeding of Royal Canin Urinary S/0 as shown in the urine test on July 2017.  In Oct 2016, the pH was 8.0 (alkaline) and it had amorphous phosphate crystals.
However, the dog had dysuria in July 23, 2017 attributed to cystitis.
There was some urethral obstruction at the bend of the urethra during catheterisation, but no big stones are seen on X-rays. The dog has recovered. X rays are shown below. 




  The owner has 2 dogs as in Case 1. So, there may be eating of commercial diet of the other dog affecting urinary pH, causing cystitis. The dog is OK now.

CASE 3.
Shih Tzu, M, 11 years. ATTEMPTED DIETARY DISSOLUTION OF URINARY STONES
The owner attempted to dissolve the urinary stones diagnosed by Vet 1 some one year ago, by feeding Royal Canin Urinary SO. However in July 2017, the dog had great difficulty peeing. X-rays show 2 large urethral stones in the os penis. These 2 stones were flushed back into the bladder which was opened to take out the stones. The dog is OK now.  Stones are sent to the lab for analysis. X-rays are shown below.






Dietary dissolution of urinary stones can be done for struvite stones but these stones must be struvites and must be small.
X-rays of Vet 1 was requested, but the practice said it had no such client. .

Tuesday, July 25, 2017

3109. A difference of veterinary opinion. A hamster has hairless backside and ear area

My opinion may differ from another vet. This hamster had a right ear wart of 4 mm across and kept scratching his ear. His left backside is bald. So, I advised ear wart removal and lateral ear canal resection.

The other vet was the opinion that ear irrigation would do and it would be cheaper. However, the owner consulted me one month after the other vet's treatment as the itchy ear had not resolved. The left ear also had hairless bump and left ear itchiness.

Treatment:
Anaesthesia. Both lateral ear canal resected.  The right ear wart at the entrance to the ear's vertical canal was excise3d.

A follow up 8 weeks later will be good. If the backside and ear area hairs re-grow fully, the outcome is a success.







----------------------------------


 

Sunday, July 23, 2017

3108. A 10-year-old Beagle passes blood in the urine and has seizures.

Jul 23, 2017


X rays show "sand" in the bladder. 
The Beagle has seizures when brought downstairs for exercise recently.  



3107. A 12-year-old male Miniature Schnauzer has difficulty peeing

Air contrast bladder X-rays show no stones and no inflamed bladder wall.
Dog likely to have urinary tract infection.





Miniature Schnauzers are very prone to urinary stones, but in this case, there was none.
The owner had been feeding Royal Canin Urinary S/O, hence preventing struvite stone formation.
Follow up 7 days later, on the diagnosis of cystitis.
The dog lis back to normal now. 

Thursday, July 20, 2017

3104. Can the large urethral stones be removed via the bladder?

"Stones are large and inside the os penile urethra," I said to the senior vet. "Can they be flushed back into the bladder and removed via the bladder?"

A few hundred surgeries had been performed by the senior vet.
"Yes," he said confidently. "It can be done."

Urinary cathether + 20 ml syringe =
general anaesthesia
The syringe of water pushed the 2 stones into the bladder. They were removed.

Stones were about 5 mm x 5 mm and rough.
To be sent for analysis.

Shih Tzu is Ok and will go home on Day 3. 

3103 A Maltese has closed pyometra for one year

Dog in distress, panting.  Vaginal discharge over one year.
Stabilised with furesemide and IV drip for 1 day before spay.







One uterine horn
is bursting with pus. Unusual case.
The other one had partial pus swelling.











The dog had heart disease which gave rise to coughing without phlegm. Heart medication was given 24 hours before surgery. Furesemide IV was given. The dog was spayed the next day and survived. She went home on Day 3 and is OK.

Advice:
Do not delay spaying your female dog if she has slight vaginal discharge over the past year. This would be closed pyometra, with the cervix closed. So pus cannot discharge out normally and after one year, as in this case, the dog's right terine horn was about to rupture from overdistension with pus.. 

3102. An 18-month-old male hamster has swollen abdomen - Abdominocentesis

Within 7 days, abdominal distension. Active and was eating till yesterday. Consulted 2 vets. I advised abdominocentesis under gas anaesthesia, which is risky.

Body Weight  64 g
Body weight after aspirating >4 ml pinkish fluid from abdomen  54 g.
Lots of serosanguinous fluid flowed out. Palpated a solid mass or cyst 8mm x 8m
Hamster is much loved. Prognosis poor. May live for few more days unless the mass is not cancerous.



Wednesday, July 19, 2017

3101. Fashion designs

July 19, 2017


Reference: 50 Women's Fashion Icons that changed the world
Lauren Cochrane,
The Design Museum's mission is to celebrate, entertain and inform.


Helps you to wear something different


1. Debbie Harry (1945 -   )queen of downtown. Face of punk-pop band Blondie.
Her stage wear uses colour and texture to pack a punch.
Collaborate with designer Stephen Sprouse who was responsible for her asymmetric dresses.
Play with colour including the signature hot pink. Red thigh-high boots and matching red tunic. Peroxide hair and black kohl always present. Still performing. A key reference for young women who want to be a girl in a band and look the part.


2. Tina Chow. Jap mother X American father. Died of AIDS in 1992, aged 41. Lagerfield credited her with minimalism. Concentrate on designing jewellery, furniture and sculpture towards the end of her life. Her cult appeal continues. Photo shows her design -  her own bracelets (transparent plastic?),


3. Rei Kawakubo (1942 -  ). Her label, Comme des Garcons established in 1969 now at vanguard of fashion. Annual turnover 164 poungs. Dover Street Market dept stores in Tokyo, London and New York. She believes in creating a brand. Cult of her style continues apace.


 




Monday, July 17, 2017

Printing Images- what file size do you need

From: 
http://www.urban75.org/photos/print.html





Printing images - what file size do you need?
A guide to required file sizes for printing out photos [Updated Feb 2016]

Image size Pixels
(Virtual Size of Scans)
Megapixel
rating
Print size (inches)
at 200ppi
Print size (inches)
at 300ppi
640  x  480
0.3
3.2 x 2.4
2.1 x 1.6
1,024 x 768
0.8
5.1 x 3.8
3.4 x 2.5
1,280 x  960
1.2
6.4 x 4.8
4.2 x 3.2
1,504 x 1,000 1.5 7.5 x 5.0 5.0 x 3.3
1,632 x 1,224
2.0 3.3 x 6.1 5.4 x 4.1
2,000 x 1,312 2.6 10.0 x 6.6 6.7 x 4.4
2,240 x 1,488 3.3 11.2 x 7.4 7.5 x 5.0
2,275 x 1,520 3.5 11.4 x 7.6 7.6 x 5.1
2,272 x 1,704 3.9 11.4 x 8.5 7.6 x 5.7
2,590 x 1,920 5.0 13.0 x 9.6 8.6 x 6.4
3,008 x 2,000
6.0
15.0 x 10.0
10.0 x 6.7
4,256 x 2,848
12.1 21.3 x 14.2 14.2 x 9.5
4,536 x 3,024 13.7 22.7 x 15.1 15.1 x 10.1
5,782 x 3,946 22.8  28.9 x 19.7 19.3 x 13.2


Professional/online printing

Some professional services specify lower resolutions for image sizes, so you could get away with smaller image sizes.

Kodak, for example, suggests these resolution/file sizes:
For a 4" x 6" print, the image resolution should be 640 x 480 pixels minimum.
For a 5" x 7" print, the image resolution should be 1024 x 768 pixels minimum.
For an 8" x 10" print, the image resolution should be 1536 x 1024 pixels minimum.
For a 16" x 20" print, the image resolution should be 1600 x 1200 pixels minimum.
For a 20" x 30" print, the image resolution should be 1600 x 1200 pixels minimum.
For a Wallet-size print, the image resolution should be 320 x 240 pixels minimum.


Quality vs file size
This guide shows you the kind of quality you can expect when you're printing out your photos.

Digital camera resolution vs print quality
Capture Resolution
Video Display
Print Size
2x3"
4x5"/4x6"
5x7"
8x10"
11x14"
16x20"
20x30"
320x240
OK
Good
OK
Crap
Crap
Crap
Crap
Crap
640x480
0.3Megapixel
Good
Excellent
Good
Crap
Crap
Crap
Crap
Crap
800x600
Excellent
Photo Quality
Very Good
Reasonable
Crap
Crap
Crap
Crap
1024x768
Excellent
Photo Quality
Excellent
Good
OK
Crap
Crap
Crap
1280x960
1 MP
Excellent
Photo Quality
Photo Quality
Very Good
Good
Crap
Crap
Crap
1536x1180
Excellent
Photo Quality
Photo Quality
Excellent
Very Good
OK
Crap
Crap
1600x1200
2MP
Excellent
Photo Quality
Photo Quality
Photo Quality
Very Good
OK
OK
Crap
2048x1536
3 Megapixel
Excellent
Photo Quality
Photo Quality
Photo Quality
Excellent
Good
OK
OK
2240x1680
4 Megapixel
Excellent
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Very Good
Good
OK
2560x1920
5 Megapixel
Excellent
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Excellent
Very Good
Very Good
3032x2008
6 Megapixel
Excellent
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Excellent
Very Good
3072x2304
7 Megapixel
Excellent
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Excellent
Excellent
3264x2448
8 Megapixel
Excellent
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Excellent
10 Megapixel +
Excellent
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality
Photo Quality

Crap Horribly pixelated blocky mess, like something out of 1987
OK Looks reasonable enough, but nowhere near photo quality
Good Pretty good all round, with a fair bit of detail
Very Good This will be fine for most uses, unless you get up reeeeal close
Excellent As good as a photo for most purposes
Photo Quality Woohoo! Fantastic quality print, full of detail and perfect for your picture frame or for your showing off your very best shots.

Sunday, July 16, 2017

3100. A 16-year-old Maltese has a large left perineal hernia recurred some 7 years after repair.

Another case of a gigantic perineal hernia. The owners had consulted Vet 3 some months ago and was referred to a vet specialist who would be more costly.  So a friend referred them to me.

Some 7 years ago, Vet 1 had operated but the hernia recurred some months later. Vet 1 referred to Vet 2 who operated but the hernia recurred. So Vet 2 did muscle transposition surgery,cystopexy and colopexy. This last operation lasted around 6 years. The dog was neutered young and this is a rare case as 99% of the perineal hernias in male dogs are not neutered. The owners did not want to go back to Vet 2 for some reasons although his fees were reasonable at around $1,500 7 years ago.    


July 2017.
"Your dog is very old, at 16 years and has heart disease," I advised against any surgery to repair this hernia. "She can pee. She eats like a horse."
"But she cannot poop for the past 5 days," the mother and adult daughter said. "Her swelling is very painful too."
"She needs to be anaesthesized for me to evacuate the stools manually," I said there would be anaesthetic risks but the owner had no choice. She signed the consent form.  Anaesthesia would be short as I used fingers to extract the semi-hard stools from the rectum. Dog was OK and stayed one day inpatient.


X RAYS






NO SURGERY


"Your dog is not fit for surgery as he has heart disease," I said. "Surgery using mesh implant will take around one hour. He can live another 2 years or more if his heart disease is controlled by medication."


1. Reduce the swelling 6 times a day so that the rectum does not get trapped.
2. Give lactulose daily for 7 days, then alternate days for week 2 and 3.
3. Switch to Prescription Diet W/D as it has higher fibre content. If W/D works, no need to give lactulose.  
4. Heart disease medication daily for 2 weeks first and review.

FOLLOW UP
1. Much less coughing after heart medication is given
2. Oral 3 ml lactulose per day. Passed stools, not watery.
3. Swelling is there, but the dog is not constipated as before evacuation.

TIPS
The hernia had recurred some 6 years after the 2nd surgery but the dog was able to poop.
The vet refused to prescribe more lactulose without examination and so the dog got constipated after a while.

   

3099. An unusual Sunday emergency caesarean section - mummified foetuses.

Sunday Jul 16, 2017 


Emergency C-section phone call at 9 am. 2-year-old Corgi, 61st day pregnant, lst litter, passed out viscous blackish vaginal discharge.

So, rushed down to clinic. Breeder was there.
"This Corgi is the daughter of the Corgi that died after C-section by Vet 1," the Myanmar assistant told me. "This is her first litter. She was active yesterday, but today, passed out black vaginal discharge."  Breeders never forget any death after C-section and would avoid the vet. As for me, I had no deaths so far.


Unusual C-section.
The left uterine horn was filled with viscous black liquid enveloping 4 below-normal sized puppies. All 4 puppies were mummified and dead. One was very small in size. The right uterine horn had 3 well-formed pups but the placentas had "melted" and so the pups detach easily from the uterus. I gave them to the breeder who is hands-on and prefers to revive the pups himself as he said he is most experienced. Some vets would not permit him to do so.


Only isoflurane gas using cone first, before size 7.5 endotracheal tube intubation.




TIPS
The dam fought against cone anaesthesia vigorously. This is expected. "Take off the cone when the dam struggles, " I said to my assistant Judy. "Sometimes, the dam is choked. Let her breathe without the cone and put in again.  She did this. The dam was not struggling and became anaesthesized soon.


At my 2nd last stitch, the dam appeared to "choke". I said, "The endotracheal tube may be irritating the trachea, pull it out a bit." It is hard to know what causes this behaviour as she was on smooth anaesthesia. I stitched up the last stitch and got the tube out.

3 live vigorous crying puppies. The breeder saw the mummified puppies and was satisfied with having 3 live ones. As to the cause of 4 mummified puppies in one uterine horn, it is a mystery. In any case, the 3 normal puppies would have died if the breeder proscratinate another hour as the placentas had detached and melted especially for 2 of them. See video.  







 




Thursday, July 13, 2017

3098. A 9-year-old Maltese has a gigantic perineal hernia. Mesh implant.













Consulted 3 vets. Too large a hernia for perineal herniorraphy. Mesh implant was done by me. Owner advised to return for neuter 3 weeks later. It is safer not to prolong anaesthesia by doing the neuter in one surgery as the owner will never forget or refer her friends to the vet if the dog passes away on the operating table. Neutered dogs rarely suffer from perineal hernias and hence neutering is advised. Some vets do neuter at the same time.


Video of mesh implant surgery performed at Toa Payoh Vets