1260. Video: A blood-shot eyed rabbit. Practising evidence-based medicine

 http://youtu.be/YsUlZ-uqTNQ


PRACTISING EVIDENCE-BASED MEDICINE IN A RABBIT


The young rabbit's eye conjunctiva is dark red and swollen. Tears stream down the eye. In my experience, the grossly enlarged upper conjunctiva is cause by vigorous eye rubbing by the rabbit to relieve the pain and irritation. Something had fallen onto the cornea but on superficial examination, there seems to be no eye ulcer or abrasion caused by this foreign object.

The fluorescein eye stain test showed corneal ulcerations to be green. Almost 3/4 of the cornea is green with only the right sided cornea at 2-4 o'clock being clear.

Unfortunately Intern Clara edited and showed a very short clip of less than 2 seconds. She ought to show much more as this will illustrate clearly the evidence. The theme of this video is using evidence to aid in the diagnosis and the Intern must be aware of the theme and whenever possible, expands on this theme.

The raw footage of the green cornea clips is at another video. Goto:
www.toapayohvets.com/videos.htm   

1259. Videos: SOP for pregnant cat.

PREGNANT CAT SPAYED STANDARD OPERATING PROCEDURES (SOP)

http://youtu.be/E14zwal_yo4

Extra care is needed in operating a heavily pregnant cat. The ovarian and uterine blood vessels are much enlarged and if not properly ligated, there will be lots of bleeding in the surgical area and a possible bleeding to death post-op. A pre-op examination to ensure that the heavily pregnant cat is fit for surgery should be part of the SOP. This was done by me (Dr Sing Kong Yuen). Blood test was not taken owing to financial considerations. The dilemma is whether the heavily pregnant cat should be spayed or should she give birth first. it is extremely difficult to find new homes for the kittens and so spaying was the decision of the owner. The other concern of the owner was whether to starve the cat for 24 hours before surgery.

The cat had eaten 6 hours ago but there is no vomiting with the xylazine + ketamine IM sedation in my experience. No vomiting was present in this case. 

I advise the use of the 3-forceps method to clamp and ligate the uterine body with its engorged uterine blood vessels. The lowest 3rd forceps is clamped and then released, showing a grooved line caused by clamping. Ligate this groove and the ligature will not slip off as compared to ligation of the non-grooved smooth uterine body area. In this way, there is a guarantee of no haemorrhage. The uterine body is then incised between forceps 1 and 2, leaving a good area for the ligated stump to be released into the body.

This spay was done by Dr Daniel Sing using absorbable sutures.  Xyalzine 0.15 ml + ketamine 0.6 ml combined IM was given in this 3.6 kg cat. Isoflurane + oxygen gas top up was needed. There was no bleeding in this spay as the ligatures were properly placed and tight.  The cat was operated in the afternoon and went home in the evening.

A handing over inspection with the owner should be part of the SOP so that the owner can see that the skin stitches are properly tied. At that time, post-op instructions are given preferably by the vet to build good client relationships. Follow up 2 days later is advised by me but most vets do not bother. As at 7 days post-op, the cat is normal and the stitches should be taken out 14 days after surgery although they are absorbable monosyn.

Standard operating procedures are in place to maintain the highest standard of surgery. Handing over inspection of the surgical site with the owner is shown. The cat is OK as at 7 days post-op.

More instructional videos for vet students and pet owners are at www.toapayohvets.com/videos.htm..

This video was filmed and edited by Intern Clara Chua as part of her experiential learning at Toa Payoh Vets. Interns learn more by writing and making videos than by being an observer looking at the vet's working.

It appears to me to be well edited and has good music. My grateful thanks to Clara. I purchased the Corel software recently as the free Windows Movie Maker does not have many features.

1258. Follow through with rabbit owner on Day 3 by telephone

Dec 10, 2013
Rabbit, born Oct 22, 2013. , Male 1.5 months.

Right eye tearing and red upper conjunctiva - like intense eye rubbing had been done after some objects irritated the eye.

Video shows clearly the condition. 

Many vets do follow up but some don't bother to do so. Maybe the vet school has not emphasized this aspect as follow ups build good vet-client relationship. 

Dec 12, 2013 - Day 3 after consultation
By following up, the vet knows how effective his medication and injections are. In this case, I phoned the father and he went to check personally. He thought the upper conjuncitval swelling (blood-shot) was back to normal but soon phoned to say there was some redness. I asked him to email the images to me rather than WhatsApp.

E-collar not worn.
White stools yesterday but now brown stools as normal
Rabbit is active and eating all the past 3 days.

Owner had changed sharp bedding and ensure hay not sharp. I don't follow up all cases myself as some days are just too busy. But important cases ought to be followed through..

1257. Be Kind To Pets video image - flower in Paris + singkongyuen, niagara falls, flower, terrerir lame

1256, Saving a damsel in distress

Dec 10, 2013

"Many interesting case studies can be broken down into problems and solutions," I said to Intern Clara who had heard all the grass root stories of the Little India riots from my client who came to buy a bag of h/d for his wife's heart disease dog. She had writer's block in writing a good narrative for the Wired Haired Fox Terrier with a lame right fore limb.

"For example, what caused the Little India riots yesterday which was a Sunday? According to the client, it is the driver who drove over the worker and had not shown any concern."

"What's the solution?"
"The authorities want to ban the use of alcohol sales in Little India but he said that these could be purchased elsewhere to consume in Little India.  His solution is for the control of traffic entering this congested road. My solution is to close the road to traffic. He proposed closing to traffic on Sundays."

However, the memorable event was that this gentleman's wife was a 15-year-old young lady in distress some 10 years ago. "She remembered you for helping her Maltese who could not give birth," the gentleman said. "She was lost as she did not know what to do. You did a Caesarean section and saved her puppy."

"Yes, yes, I remember her," I replied. "Her Maltese had difficulty giving birth. She had a big pup. What's happened to the pup?"


"She gave it away. A very intelligent brown and white puppy. She was too young to take care of a puppy at 15 years of age!"

I saw the wife earlier when her other dog came for treatment, but she did not mention about this episode.

I could not recognise her now since she is an adult. 

Many of my old clients have disappeared as there are around 60 vet clinics and proximity will be important to most of them. This couple lived quite far from Toa Payoh and usually I don't have any clientele from that area.

Besides proximity, new attractive expensive renovations of a vet clinic attract the average Singaporean pet owner and Toa Payoh Vets cannot keep up with the new. There will be wear and tear and this clinic, being in existence for over 30 years does not look spring fresh as Spring time despite two renovations.

So I was very happy to have met her earlier after a separation of over 12 years or more and to know she is quite successful in her career, being seconded to freezing winter of 5 deg C in Germany for training now.

Syrian hamster, M, 19 months has a swollen abdomen

Dec 10, 2013

Owner wants to know cause of abdominal swelling. Normal, active, eating, drinking, peeing and pooping.


Abdominal palpation - no pain, no large mass
X-rays - intestines pushed to one side. May have liver enlargement

To observe 4 weeks

1254. Videos produced on Dec 10, 2013.

British shorthair vomits and loses weight
http://youtu.be/pXOHhT4CypY


The guinea pig has a large leg abscess
http://youtu.be/h2VBthR64T0



Spaying a pregnant cat - Part 3
http://youtu.be/O4gcxUXTDlo



Spaying a pregnant cat - Part 2
http://youtu.be/i6e3mAOKOYU



 
Spaying a pregnant cat - Part 1
http://youtu.be/jkXDAXSB-z8