Tuesday, August 15, 2017

3123. A guinea pig has a "cyst" for the 4th time

In 2016,  Vet 1 used a needle to aspirate the swelling.
But the swelling recurred.

In                     , Vet 2 operated and removed the mass inside the swelling. Owner given the evidence and he posted on the Instagram. The owner declined histology of the mass. So it was not known whether this was a cancerous mass.


In July 2017, Vet 2 incised the swelling to release blood. Instagram posting filtered to black and white as Instagram does not permit gore and blood.


In Aug 15, 2017, the owner consulted me as the swelling is now extensive. "The swelling returned 2 weeks after incision by Vet 2 in July 2017," the owner said.


SURGERY
Lot of blood under the skin shot out.

Zoletil 100. 0.05 ml Zoletil + 0.05 ml normal saline IM. Effective analgesia. Top up with a few seconds of gas to effect.


Nearer to the neck, a mass of black spots embedded in the neck muscle. Excised lump. Stitch back the split muscle. Stitch skin.  To send for histology.











VIDEO

3122. Eyelid stye in a dwarf hamster that has a very painful eye.

Vet 1 referred owner to Vet 2 who diagnosed eyelid stye and prescribed eyedrops with steroid. But dwarf hamster still rubs his eye. So, came to me.

1. Evidence to show the owner. A good digital camera and lens collaborated with Vet 2's diagnosis.
However I provided the digital evidence to show the owner. This involved photoshop to enlarge the images.

Intense eye rubbing caused 90% of the corneal surface to be red due to bleeding. This was shown to the owner. Hence the eye is very painful. Home treatment applying eye drops was not effective. The hamster was hospitalised for 3 days to be treated with eye drops and painkillers and surgery (incision and drainage) if necessay.  



2. Corneal ulcers are painful. So I used fluorescein eye drops onto eye. No green stain on the cornea indicating no corneal ulcer.

VIDEO



TREATMENT
1. Antibiotic eye drops and oral painkillers for 2 days
2. Incise and drainage of eyelid stye as soon as possible, if the stye has not reduced.



CONCLUSION
Digital photography is very useful but it takes time and patience to acquire the skills to produce close up clear images to provide evidence to the worried hamster owner. The owner used her mobile phone to snap a picture but was not able to get the details as shown here. I used a Canon EOS 70D and macro lens.   








80% of the cornea is bleeding red, due to hard rubbing of the eye.

Eyelid stye (pimple) is also known as hordeolum. It is an infection of the oil gland of the eyelid. It can be inside the eyelid or outside. In this case it is inside. If the blocked oil gland is not infected, it is known as a chalazon which is not painful.  
.


Monday, August 14, 2017

3121. Overfeeding a red-eared slider

x ray on Aug 15, 2017






restless. no eggs


3120. A dwarf hamster bites his broken leg - amputation








Advised amputation












Hamster keeps licking fractured femoral/tibial area.  Amputation will 
prevent further trauma and infections


Friday, August 11, 2017

3119. A Siberian Husky has painful ears for the past 3 years

Dogs with erect ears rarely get ear problems as there is ventilation and drainage. This Husky came 3 years ago with pus and pain in his left ear. Now his right ear is painful. I suspected some foreign body or tumour stuck inside his horizontal canal. Despite ear irrigation and medication, his left ear could not be pain free. 

The left ear was very painful despite treatment. It contained pus again. Then the right ear was painful.
The old Husky's ears were operated and sent home on the same day. The owner was unable to clean his surgical wounds as the dog moved.

So on Day 15, the dog who went home after surgery, came to the Surgery for cleaning up around August 8, 2017. The owner found it difficult to clean his ear wounds. Under sedation of domitor and ketamine IV, the scabs were removed.  An image of the right ear is shown.



    Operation is successful. Note the intact drainage cartilage. In the left ear, the ear canal was
born twisted and that accounted for difficulty in drainage and ventilation. The drainage cartilage
fell off. There is some slight pain in the left ear but not the right on Day 15. Need to review after one month by phone.

Wednesday, August 9, 2017

3118. Mesh implant for gigantic perineal hernia repair











 

This mesh implant surgery is not commonly performed to repair the usual perineal hernia.
It is indicated for extremely large perineal hernias over 10 cm across as the usual repair of suturing the gap (simple herniorraphy) will lead to recurrence.

 

Tuesday, August 8, 2017

3117. A 5-year-old cat passes blood in the urine. He has kidney stones

2 years ago, on Sep 2015, this cat had urethral and bladder stones. Vomited and had difficulty urinating. Dr Daniel did a urethrostomy and prescribed Hills' C/D. Two years of no urination problem and no more check ups at Toa Payoh Vets.

Today, National Day. The owner now said the cat has haematuria and pees everywhere.
Palpation. No enlarged bladder.
X-rays.  Left kidney stones and sand in the bladder.












Strictly on K/D.
Needs urine tests
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ARCHIVES



Friday, July 17, 2015

2498. INTERN Bladder and urethral stone cat and kidney failure. Angel the cat who meows hello to me.

 DRAFT

Time lines





Thursday, July 2, 2015


A cat sits on the litter box

Jul 2, 2015

Cat, MN, 3 years
Vomiting 1 day. Dysuria, pollakiuria, haematuria, urethral obstruction (urethral stones).


"Have you encountered such cases?" the lady with a baby asked me about her cat having great difficulty in peeing, sitting on the litter box all day long. He vomited twice yesterday, July 1, 2015.

"It is quite a common problem in male neutered cats," I replied. This cat eats only dry food and lives with two other female cats.

I palpated no enlarged kidneys but a big swollen bladder as big as an orange. The cat dribbled blood-tinged urine on the consultation table.
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Under gas anaesthesia, the urinary cathether was not easily passed into the bladder, despite syringing normal saline. Some urine did flow out and the bladder was emptied 50%. I got the x-rays done and there were stones inside the bend of the urethra.








At home, 2 other female cats had no problem. One litter box and water bowl. Dry food only.

The owner gave permission for surgery. Dr Daniel did it in the afternoon. Body weight  4.8kg, temp = 38.3C.   Sedation xylazine + ketamine 0.1 + 04 ml IM. Maintenance with isoflurane and oxygen gas.
Cystotomy. Syringed saline into the urethra to get the 2 urethral stones into the bladder.

Warded. E-collar and urinary cathether. Antibiotics and pain-killers


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Tuesday, July 14, 2015


2495. Angel the cat is admitted for dysuria




1. Monday, Jul 13, 2015. The cat was admitted as the owner said he had difficulty in peeing. Bladder and urethral stones were removed some 7 days ago. The cat was given IV drips on Jul 10 and 11 and I discharged him on Saturday Jul 11, 2015 since he was eating. I took out his stitched urinary catheter as it is not good for the cat to have it for more than 3 days, in my opinion, as it irritates the bladder.  However, he ate little at home, the owner said and was worried.

Dr Daniel and I discussed his treatment. Perineal urethrostomy will be the last resort.

"There is bound to be inflammation in his urethra as he had urethral stones stuck at the bend of the urethra," I said. "The bladder is not much swollen as before, not as big as an orange. Pain killers and antibiotics will be needed."
The cat was given gas anaesthesia. Dr Daniel lavaged the bladder by sucking out the bloody urine (video). An injection of painkiller and antibiotic was given.

2. Tues July 14, 2015. The cat meowed when he saw me. His bladder was not swollen. He preferred to sit inside the litter box where there is sand, than outside the box. He ate when my assistant hand- fed feline C/D with water. The owner came to visit around 6 pm and was happy to see him.

 
This is a case of the intense inflammation inside the bladder and urethra as the owner had delayed seeking treatment, base on blood test result showing kidney failure and the much swollen and red bladder (image).




HISTORY

Ju1 2, 2015    Cannot pee, blood in urine. Surgery. urethral stones and bladder stones removed.
Jul  5             Dr Daniel sent home 2 days after surgery.

Jul 8              Vomiting and dysuria. Had kidney failure based on blood test of high creatinine and urea. Given 2 days IV drips

Jul 11            I sent home as he was eating.

Jul 13          Warded. Bladder lavage. urine analysis. Catheter not stitched. 

Jul 15          Bladder swollen 1/3 size of orange. Cat eats when hand fed dry feline C/D + water. Bladder lavage. urine analysis. Catheter not stitched.  Alert.

Jul 16          Bladder small like ping pong ball, painful. --------------------------------
July 18, 2015  10am

Another bright sunny morning

Jul 18, 2015. Angel meowed to greet me as I checked on him. I lifted him out of the sand litter box which he plonked himself on instead of being out. I palpated his bladder which was small and not painful now. He had eaten all his dry and moist feline C/D overnight and had pooped. So, he should be fully recovered.

HISTORY
Angel, Cat, MN, 3 years

Jun 2, 2015  Stranguria (painful frequent urination in small amounts by straining. Muscle spasms of the urethra and bladder) for 2 days. Vomiting.  I palpated a big swollen bladder the size of an orange. Urinary catheter could not be passed into the bladder.

X RAYS
I advised X-rays which showed urethral stones and bladder stones (video).
Sharp brown stones






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Jul 2, 2015
BLOOD TEST
Urea  19.8  (7.2-10.8)
Creatinine 285  (71-160)
Total white cell count  21.4  (5.5-19.5)
N  95%  (35-75%).  Absolute  20.3  (2.5 -12.5)
   
Platelets  131 (300-800)

Blood test show kidney failure and bacterial infections of the blood. So, this is not a simple cystitis or FIC (Feline Interstitial Cystitis) case.
   

Jul 2, 2015
URINE TEST
red, turbid. pH 7 (5-8)  SG 1.015 (1.005-1.030)  Protein 3+ (negative), Glucose + (negative), blood 4+ (negative). Bacteria (Occasional), Crystals Nil

Surgery by Dr Daniel. Cystotomy. bladder and urethral  stone removal. Urethral stones flushed into the bladder and removed.




Jul 14, 2015
URINE TEST
yellow, turbid. pH 6, SG 1.038. Protein 2+, Blood 4+, No bacteria or crystals.  Health improves.



STONE ANALYSIS
Owner did not want stone analysis.  Small sharp brown stones, biggest 4 mm across. Probably calcium oxalate?


Jun 5.  Cat goes home.
---------------------------

Jun 8. Cat admitted. Vomiting and dysuria. Bladder is swollen. I diagnose kidney failure.
Bladder catheterised and lavaged with normal saline. 2 days of IV drip of Hartmann and dextrose saline to flush out toxins. Meloxicam oral for 4 days


Jul 11. I sent the cat home as he was eating and drinking. He was vocal, meowing to greet me.
Urinary catheter was taken out.
Owner to continue with hand feeding A/D and dry feline C/D. Leave C/D overnight.

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Jul 19,  Ate food by himself. Sat outside the litterbox. That means he has recovered. Sent home.


FOLLOW UP FRIDAY JUL 24, 2015

I sms the owner as she did not answer the phone call:
10.36 am   "Is Angel back to normal urination? Dr Sing, Toa Payoh Vets?"

Her reply
10.58 am   "Hi Dr Sing, thank you for following up on Angel. He is coping well. Have a good day!"

11.24  I sms "Is he eating 100% the dry feline C/D and no other food or treats?"

11.37 am   "He is eating the CD mainly but I do feed him canned food once in a while."

11.46 am  My reply
"Try not to include other food as this affects the urine acidity and cause recurrence of urinary stones or cystitis."





Outcome good.
Case closed.               













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ANOTHER CAT  - NO URINARY STONES





Sunday, August 6, 2017

3116. A 12-year-old Maltese fell from the bed and dislocated his right hip. A rare case of caudo-ventral luxation











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Craniodorsal luxations are common

 A cross-bred dog


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Another case - cavalier king charles




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Closed reduction with Ehmer sling - around 50% success rate
Indications for open reduction if
1. recurrence after closed reduction
2. unstable joint
3. avulsion fractures femoral head
4. other orthopedic conditions





The Ehmer Sling is used for around 2 weeks. Success rate of closed reduction is 50%. If there is recurrence, open reduction is needed.  Success rate of open reduction is 80-90%.

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CONCLUSION
Closed reduction is less expensive
Open reduction - FHO usually gives near normal function in small breeds and non-obese dogs
THR is expensive and specialised surgery. Other surgeries involve pins.





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Subluxation of Golden Retriever. Right hip




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Pre-op blood test. Blood test is normal for this 12-year-old Shih Tzu X.
Anaesthesia.   Propofol IV, intubate, isoflurane gas anaesthesia at 5% closed and open circuit.
Oximeter is used to ensure oxygen level of blood is 100%.

Surgery caudoventral is known FHO (femoral head ostectomy) or FME (femoral head excision) in which the femoral head is cut off to remove the cause of pain. A false joint is created and the dog walks almost normally.
















Conclusion.
An unusual case of caudoventral hip luxation which is found in 5% of hip luxation cases. Usually, the dog spreads out his hind leg when he falls.  The femoral head is dislocated under the pelvis into the "hole" (obturator foramen).  Most dogs fall on their paws causing craniodorsal hip luxation which is in 95% of cases.

 
  




 


DAY 3 AFTER SURGERY   Blood test showed the 12-year-old dog was in good health and fit for anaesthesia.  Femoral head ostectomy. Propofol IV and isoflurane gas 5% in closed and semi-opened circuit to effect.


Dog is able to walk a bit. The right hind limb is in normal upright position instead of being splayed outwards. Owner wanted him home on Day 4.