Sunday, February 15, 2015
Unbelievable vet stories: Three couplets of Golden Retrievers with connected links
Sunday Feb 15, 2015
Some of my cases come in twos within a short period of time?
In the first couplet, two 13-year-old Golden Retrievers passing dark red vaginal discharge in December 2014 and January 2015. Both suffered from the same diseases called open pyometra.
Then yesterday, a second incident of timing occurred. Two Golden Retrievers came in one after another, one with lameness and the other with gigantic swollen anal sac areas. Being uncommon in urbanized Singapore where over 90% of the residents live in apartments, meaning that big breeds like Golden Retrievers are rare, I was surprised to see 2 goldies as my first 2 cases.
In addition, there are around 70 small animal practices and so this makes the chances of seeing 2 goldies in a row much less.
In the 3rd instance of couplets, it was as if some Divine powers gave me an opportunity to take images for my comparative anatomy of anal sacculities. The Golden Retriever in the 2nd incident has two bulbous anal sac areas - a very rare situation which I am sure most small animal vets would not have encountered came in. It was like finding treasure in medical research. I took images and a video to document this situation.
I was wondering how I could compare this dual swelling with another Golden Retriever with anal sac impaction but not with such a gigantic swelling. The next day, a Golden Retriever came in came in with anal and tail end skin inflammation.
This was a case of anal sac impaction as the smelly brown oil expressed by me from the anal sacs shot out with a buzzing sound. This presence of oil astounded the owner and splattered onto my white polo shirt sleeve. I had used tissue papers to cover up the anal area before expression of the sacs but still, the volume of dark brown thick smelly oil was copious and explosive. This Golden Retriever permitted me to take an image of anal sac impaction without the gigantic swelling as in the other Golden Retriever in the second occurrence of couplets.
These are true but unbelievable vet stories of Golden Retrievers cases in Toa Payoh Vets. I have the images and the videos to substantiate my findings.
Some of my cases come in twos within a short period of time?
In the first couplet, two 13-year-old Golden Retrievers passing dark red vaginal discharge in December 2014 and January 2015. Both suffered from the same diseases called open pyometra.
Then yesterday, a second incident of timing occurred. Two Golden Retrievers came in one after another, one with lameness and the other with gigantic swollen anal sac areas. Being uncommon in urbanized Singapore where over 90% of the residents live in apartments, meaning that big breeds like Golden Retrievers are rare, I was surprised to see 2 goldies as my first 2 cases.
In addition, there are around 70 small animal practices and so this makes the chances of seeing 2 goldies in a row much less.
In the 3rd instance of couplets, it was as if some Divine powers gave me an opportunity to take images for my comparative anatomy of anal sacculities. The Golden Retriever in the 2nd incident has two bulbous anal sac areas - a very rare situation which I am sure most small animal vets would not have encountered came in. It was like finding treasure in medical research. I took images and a video to document this situation.
I was wondering how I could compare this dual swelling with another Golden Retriever with anal sac impaction but not with such a gigantic swelling. The next day, a Golden Retriever came in came in with anal and tail end skin inflammation.
This was a case of anal sac impaction as the smelly brown oil expressed by me from the anal sacs shot out with a buzzing sound. This presence of oil astounded the owner and splattered onto my white polo shirt sleeve. I had used tissue papers to cover up the anal area before expression of the sacs but still, the volume of dark brown thick smelly oil was copious and explosive. This Golden Retriever permitted me to take an image of anal sac impaction without the gigantic swelling as in the other Golden Retriever in the second occurrence of couplets.
These are true but unbelievable vet stories of Golden Retrievers cases in Toa Payoh Vets. I have the images and the videos to substantiate my findings.
Friday, February 13, 2015
Two Golden Retrievers in a row
Friday, Feb 13, 2015
This morning, I had two Golden Retriever patients one after another. This is rare for me as Golden Retrievers are rare in Singapore, with the vast majority of dogs, about 99% being small breeds.
GOLDEN RETRIEVER NO. 1
The backside had two large swellings below and on the sides of the anus. "They appeared overnight," the owner said. "These are anal sac impaction with pus," I expressed yellow pus out from one side. "This case needs a finger to be inserted into the anus to expel the anal sac oil and pus. The dog needed to be sedated."
Dr Daniel expressed the pus digitally and the swellings shrunk. "No more anal sac oil," he said to me. "Flabby swellings now!"
"It is best to incise at the lowest point to release any remnants of the pus and dead cells," I said.
Dr Daniel excised 1 cm at the ventral area of both swellings. Blood oozed out for several minutes.
"Let the contents flow out," I said. Later, Dr Daniel would stitch up the two incisions and the dog went home.
GOLDEN RETRIEVER NO. 2
"He is lame again on the back leg. I think it is the left one. Or is it the right?"
I had the dog trotted outside the clinic. His right hind leg was up while his left hind leg was down as he was trotted by the maid who did not wear slippers.
"Looks like he is not bearing weight on his right hind," I said. "The only way to tell is to flex and extend the joints on the consultation table. The dog refused to trot anymore.
My medical records showed the dog had a spinal pain at one time and a left medial thigh swelling and pain at another time.
Now he had spinal pain and very painful left hip. "He wrinkled his muzzle and that is a warning that he would bite." I flexed and extended his left hip twice. The dog did wrinkled his muzzle and turned to face me. So the dog was in pain.
"He would go under the sofa every day," the owner said. Such a big breed would injure his back and sprain his hips on getting out. The sofa had a hollow just sufficient to squeeze in this dog.
"The solution is in your hands," I said. to the owner. "Close the gap or get worse hip pain next time!"
This morning, I had two Golden Retriever patients one after another. This is rare for me as Golden Retrievers are rare in Singapore, with the vast majority of dogs, about 99% being small breeds.
GOLDEN RETRIEVER NO. 1
The backside had two large swellings below and on the sides of the anus. "They appeared overnight," the owner said. "These are anal sac impaction with pus," I expressed yellow pus out from one side. "This case needs a finger to be inserted into the anus to expel the anal sac oil and pus. The dog needed to be sedated."
Dr Daniel expressed the pus digitally and the swellings shrunk. "No more anal sac oil," he said to me. "Flabby swellings now!"
"It is best to incise at the lowest point to release any remnants of the pus and dead cells," I said.
Dr Daniel excised 1 cm at the ventral area of both swellings. Blood oozed out for several minutes.
"Let the contents flow out," I said. Later, Dr Daniel would stitch up the two incisions and the dog went home.
GOLDEN RETRIEVER NO. 2
"He is lame again on the back leg. I think it is the left one. Or is it the right?"
I had the dog trotted outside the clinic. His right hind leg was up while his left hind leg was down as he was trotted by the maid who did not wear slippers.
"Looks like he is not bearing weight on his right hind," I said. "The only way to tell is to flex and extend the joints on the consultation table. The dog refused to trot anymore.
My medical records showed the dog had a spinal pain at one time and a left medial thigh swelling and pain at another time.
Now he had spinal pain and very painful left hip. "He wrinkled his muzzle and that is a warning that he would bite." I flexed and extended his left hip twice. The dog did wrinkled his muzzle and turned to face me. So the dog was in pain.
"He would go under the sofa every day," the owner said. Such a big breed would injure his back and sprain his hips on getting out. The sofa had a hollow just sufficient to squeeze in this dog.
"The solution is in your hands," I said. to the owner. "Close the gap or get worse hip pain next time!"
The second 13-year-old Golden Retriever with open pyometra
I had 2 Golden Retrievers with open pyometra recently. Both were very thin and in poor health, but the second dog was panting a lot for the duration of more than 15 minutes of consultation.
"She's frightened at the vet," the man said. "That is why she panted a lot."
"It is unusual for a dog to have such a fast respiratory rate, as if she had sprinted ," I said. "Such panting is a sign of very poor health. Her heart is failing. There is also the blackish-red vaginal discharge. She has open pyometra and should be operated the next day, after one day of IV drip and antibiotics."
"She is too old for anaesthesia," the man did not want any surgery and I prescribed some antibiotics for the dog. "Feed her 6 times per day to let her regain her weight."
But the dog shut her mouth tightly and it was extremely difficult to hand feed her. The vaginal discharge came out every day for the next 7 days and the owner texted me. "The solution is to remove the bleeding womb," I texted back. "But she is unfit for anaesthesia and would likely die on the op table."
The dog was not panting so fast but she would not want to eat. Her vaginal discharge came out thick and dark red, soiling the floor. The owner decided to get her operated. I told them that the chances of survival are slim as she had heart disease causing the continuous panting. She also would not want to eat.
The dog kept passing vaginal blood. The couple decided on the operation. The dog was inpatient for 2 nights and given SC and IV drip for 2 days. "Her pulse was not palpable," I told the owner. "That means she has very low blood pressure and should not be operated. Her gums are purplish and so there was some difficulty in getting oxygenated blood into the gums. Are you sure you wanted the operation?" He gave his informed consent by texting me.
The dog was operated using just isoflurane gas. The uterus had a big sac around 20 cm x 10 cm of darkish red blood. This reservoir released the dark red blood every day out of the vagina.
The surgery was done by Dr Daniel who had warned that the dog was unfit for anaesthesia. "The owner had given his informed consent," I said. I texted the owner that she had been operated but was panting a lot after surgery and sent him an image of the uterus with the cysts and the sac of dark red blood. Around one hour later, the dog panted much fasted and suddenly the dog passed away. There was heart failure. I informed the owner.
The parents and two daughters aged 10 years and 4 years came promptly. The 10-year-old felt the loss badly but the 4-year-old still could not understand that death was a permanent loss. "This dog is very old," I said to the 10-year-old. "Around 91 years in human age. She had lived a long life much loved by all in the family. Most Golden Retrievers don't live up to such an old age.. Many men alos die before they reach 70 years, not 91 years."
"Would it make any difference if she was operated on the first consultation?" the man asked me. "I don't know," I said. "She was already having heavy panting then."
"I doubt it would make any difference if my dog was operated earlier on the first consultation," he replied. "But the solution to this heavy vaginal bleeding and reluctance to eat was surgery and I told my wife."
If the dog survived the surgery, like the other 13-year-old Golden Retriever, she would live longer although she would need heart disease medication..
In conclusion, this dog was likely to live longer if she had been spayed at one year of age. There would be no pyometra leading to dirty continuous vaginal discharge. There was also a swelling of the left posterior two mammary glands, possibly a sign of breast tumours. Early spaying might have prevented such tumours from developing.
"She's frightened at the vet," the man said. "That is why she panted a lot."
"It is unusual for a dog to have such a fast respiratory rate, as if she had sprinted ," I said. "Such panting is a sign of very poor health. Her heart is failing. There is also the blackish-red vaginal discharge. She has open pyometra and should be operated the next day, after one day of IV drip and antibiotics."
"She is too old for anaesthesia," the man did not want any surgery and I prescribed some antibiotics for the dog. "Feed her 6 times per day to let her regain her weight."
But the dog shut her mouth tightly and it was extremely difficult to hand feed her. The vaginal discharge came out every day for the next 7 days and the owner texted me. "The solution is to remove the bleeding womb," I texted back. "But she is unfit for anaesthesia and would likely die on the op table."
The dog was not panting so fast but she would not want to eat. Her vaginal discharge came out thick and dark red, soiling the floor. The owner decided to get her operated. I told them that the chances of survival are slim as she had heart disease causing the continuous panting. She also would not want to eat.
The dog was operated using just isoflurane gas. The uterus had a big sac around 20 cm x 10 cm of darkish red blood. This reservoir released the dark red blood every day out of the vagina.
The surgery was done by Dr Daniel who had warned that the dog was unfit for anaesthesia. "The owner had given his informed consent," I said. I texted the owner that she had been operated but was panting a lot after surgery and sent him an image of the uterus with the cysts and the sac of dark red blood. Around one hour later, the dog panted much fasted and suddenly the dog passed away. There was heart failure. I informed the owner.
The parents and two daughters aged 10 years and 4 years came promptly. The 10-year-old felt the loss badly but the 4-year-old still could not understand that death was a permanent loss. "This dog is very old," I said to the 10-year-old. "Around 91 years in human age. She had lived a long life much loved by all in the family. Most Golden Retrievers don't live up to such an old age.. Many men alos die before they reach 70 years, not 91 years."
"Would it make any difference if she was operated on the first consultation?" the man asked me. "I don't know," I said. "She was already having heavy panting then."
"I doubt it would make any difference if my dog was operated earlier on the first consultation," he replied. "But the solution to this heavy vaginal bleeding and reluctance to eat was surgery and I told my wife."
If the dog survived the surgery, like the other 13-year-old Golden Retriever, she would live longer although she would need heart disease medication..
In conclusion, this dog was likely to live longer if she had been spayed at one year of age. There would be no pyometra leading to dirty continuous vaginal discharge. There was also a swelling of the left posterior two mammary glands, possibly a sign of breast tumours. Early spaying might have prevented such tumours from developing.
Thursday, February 12, 2015
Final Video: How I spay a cat using injectable anaesthetic
Apr 4, 2014 Singapore, Toa Payoh Vets
Spaying a caterwauling cat on a Sunday. Owners cannot stand the noisy caterwauling of the female cat and got her spayed.
I am Dr Sing Kong Yuen, veterinary surgeon from Toa Payoh Vets, www.toapayohvets.com.
In use xylazine + ketamine injectable anaesthesia for all my cat spays and neuters and find this combination to be effective and safe. The duration of analgesia is around 30 minutes, 5 minutes after the time of injection. Isoflurane + oxygen gas top up is given if necessary.
In this case, for a 3.6 kg Maine Coon, I used xylazine + ketamine 0.15 + 0.6 ml in one syringe IM to be effective. I always place two horizontal ;mattresses in the 1 cm skin incision.
I gave baytril and tolfedine inj SC after the spay and the cat goes home with 4 days of tolfedine and 5 days of antibiotics. Usually I don't prescribe e-collars but taped up the surgical wound. With post-op painkillers and antibiotics, I find that there were no complaints from the spayed cats as exemplified in this case.
I phoned the owner on the 18th day (April 3, 2014), to follow up as Intern Nicolas would be completing this video. He was most happy with the surgical outcome as there was no post-op complications.
More Be Kind To Pets veterinary educational videos are at:
www.toapayohvets.com/videos.htm
FINAL VIDEO: SPAYING A CAT AT TOA PAYOH VETS
http://youtu.be/KustPeoh5M8
Spaying a caterwauling cat on a Sunday. Owners cannot stand the noisy caterwauling of the female cat and got her spayed.
I am Dr Sing Kong Yuen, veterinary surgeon from Toa Payoh Vets, www.toapayohvets.com.
In use xylazine + ketamine injectable anaesthesia for all my cat spays and neuters and find this combination to be effective and safe. The duration of analgesia is around 30 minutes, 5 minutes after the time of injection. Isoflurane + oxygen gas top up is given if necessary.
In this case, for a 3.6 kg Maine Coon, I used xylazine + ketamine 0.15 + 0.6 ml in one syringe IM to be effective. I always place two horizontal ;mattresses in the 1 cm skin incision.
I gave baytril and tolfedine inj SC after the spay and the cat goes home with 4 days of tolfedine and 5 days of antibiotics. Usually I don't prescribe e-collars but taped up the surgical wound. With post-op painkillers and antibiotics, I find that there were no complaints from the spayed cats as exemplified in this case.
I phoned the owner on the 18th day (April 3, 2014), to follow up as Intern Nicolas would be completing this video. He was most happy with the surgical outcome as there was no post-op complications.
More Be Kind To Pets veterinary educational videos are at:
www.toapayohvets.com/videos.htm
FINAL VIDEO: SPAYING A CAT AT TOA PAYOH VETS
http://youtu.be/KustPeoh5M8
Monday, February 9, 2015
1190. The 8-year-old Schnauzer had a circular skin lump
This 8-year-old Miniature Schnauzer had a circular skin lump, 1.5cm across, located at the tail end. I advised removal as it could be a skin tumour growing bigger as this dog is old.
"It could be due to biting from anal sac infection," Dr Daniel expressed his view. "8 years is not old for a dog."
"Dogs over 7 years old are considered old," I said. "This skin lump may be inflammatory but nobody can tell. It may develop into a cancerous skin tumour later if not removed early. If you wish, do a biopsy to check."
I did not propose biopsy in this case as the owner was willing to get it cut off. Biopsy will take some time and cost money. Even if the tumour is benign from a biopsy, there is no guarantee that it will become malignant.
Dr Daniel operated and the lump was sent for histology on Monday Feb 9, 2015.
"It could be due to biting from anal sac infection," Dr Daniel expressed his view. "8 years is not old for a dog."
"Dogs over 7 years old are considered old," I said. "This skin lump may be inflammatory but nobody can tell. It may develop into a cancerous skin tumour later if not removed early. If you wish, do a biopsy to check."
I did not propose biopsy in this case as the owner was willing to get it cut off. Biopsy will take some time and cost money. Even if the tumour is benign from a biopsy, there is no guarantee that it will become malignant.
Dr Daniel operated and the lump was sent for histology on Monday Feb 9, 2015.
Referral - The Dachshund took revenge squirted anal sac oil onto the camera
Feb 8, 2015
Referrals are most important to vets but the vet must deliver. The owner of this itchy Dachshund came because of referral from another Dachshund owner that was treated successfully. Posh was this dachshund's name.
The present dog was itchy all over the body. I was teaching my vet assistant and video-taped the consultation.
The anal sacs were expressed 3 times and the yellowish oil with some white granules were stinking. Rancid vinegar smell of over 5 ml in volume. Quite a lot as evident in the video..
After ear irrigation under a slight sedation of Zoletil 100 ml at 0.2ml IV, I videoed again the anal sac. I videoed the expression of the sac. Suddenly another explosion of yellow anal sac oil squirted out and soiled the camera lens. Fortunately, I had a lens protector.
I assumed no more anal sac oil but the Dachshund exacted his revenge onto the vet for expressing his glands by shooting out the oil onto the lens and camera! Video footage is the evidence!
I spoke to Intern Phyllis who told me that vets at a certain clinic routinely use the rectal expression using the fore-finger and asked me whether I do it. "It depends on the breed. In some dogs like the French Bulldog, the anal sac opening are hidden deep inside the anus and the finger expression had to be used.".
https://www.youtube.com/watch?v=mS1aIsxPvXk&feature=youtu.be
https://www.youtube.com/watch?v=ntAA6oBDYVo
Referrals are most important to vets but the vet must deliver. The owner of this itchy Dachshund came because of referral from another Dachshund owner that was treated successfully. Posh was this dachshund's name.
The present dog was itchy all over the body. I was teaching my vet assistant and video-taped the consultation.
The anal sacs were expressed 3 times and the yellowish oil with some white granules were stinking. Rancid vinegar smell of over 5 ml in volume. Quite a lot as evident in the video..
After ear irrigation under a slight sedation of Zoletil 100 ml at 0.2ml IV, I videoed again the anal sac. I videoed the expression of the sac. Suddenly another explosion of yellow anal sac oil squirted out and soiled the camera lens. Fortunately, I had a lens protector.
I assumed no more anal sac oil but the Dachshund exacted his revenge onto the vet for expressing his glands by shooting out the oil onto the lens and camera! Video footage is the evidence!
I spoke to Intern Phyllis who told me that vets at a certain clinic routinely use the rectal expression using the fore-finger and asked me whether I do it. "It depends on the breed. In some dogs like the French Bulldog, the anal sac opening are hidden deep inside the anus and the finger expression had to be used.".
https://www.youtube.com/watch?v=mS1aIsxPvXk&feature=youtu.be
https://www.youtube.com/watch?v=ntAA6oBDYVo
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