Thursday, August 10, 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.


Video of mesh implant performed at Toa Payoh Vets



 

Wednesday, August 9, 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.
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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





Monday, August 7, 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.



Sunday, August 6, 2017

3115. Review of 3 Caesarean section cases done at Toa Payoh Vets. Single pup syndrome

Saturday Aug 5, 2017

I visited the breeder farm to deliver 10 cans of canned canine A/D as one of his Corgi pup was not thriving though it ate a lot.

Review of 3 Caesarean seection cases showed all 3 dams and their pups OK except for two 5-day-old Dachshund pups not thriving.







Video


Thursday, August 3, 2017

3114. Breeding red-eared sliders in Singapore for export

August 3, 2017

1. License needed
2. TYPES OF RES

Albino
Caramel
Melanotic
Snow
Green



2. PRICES OF RES HATCHLINGS IN AUG 2017

Albino - $450
Caramel - $5500.  Adults at $25,000/kg
Melanotic - a "joker" as hatchlings can be other colours and no melanotic
Snow - $7500. Second most expensive.
Green - $1.40 wholesale. Pet shop sells $5.00
Market in China depressed pricing now as Albino now sells low at $450. 

3. BREEDING
Albinos   CCTV
Breeds at around 3 years of age.
lst year breeding, mostly infertile eggs.
Can palpate for eggs in sides in front of hind legs.
NOTE: Strictly use one bloodline to produce albinos. E.g. Bloodline A cross with Bloodline B
will not get albinos but green ones.
Clumpy sand or soil is needed. If not, will stop laying and lay in water.
Eggs get trampled when eggs laid in water (many other RES housed together)
Unknown if eggs laid in water will be able to hatch.
Around 1 week, torchlight to check on embryos but some embryos appear past 1 week.


Singapore can breed 4 batches/yr
US - 2 batches as there is hibernation.

4. INCUBATION
Temperature determines gender
Around 2 months to hatch
Female - 30-31deg C 50-55 days to hatch.
Male - 27-28deg C.   60-70 days to hatch
Hatchling with egg sac yolk absorbed, sell. It is about 1.2 cm shell length
Home-made incubators - fish tank with plastic and bit of water in enclosed room.
   Male - fridge with thermostat control.  


5. FEEDING
Marsuri and Roman lettuce
Marsuri pellets (mainly fish meat)
Hikari (vegetables).
Adult albinos RES will spit on Hikari as they grow older, preferring Marsuri.

6. WATER CHANGES
Daily changes
Albinos in tanks passes stools during water changes. Outflow slower than inflow to clear stools.
Abinos also in ponds. Need clumpy soil and sand or will not lay eggs but lay eggs into water.
No need de-chlorinated water.


7. VIRUS
Rana virus outbreak. RES  - 4 legs extended as in basking but paralysed. Need hand feeding and water. Many die. High mortality. Workers' hands not washed going into various tanks.  
Quarantine hence ineffective. Now assigned workers to specific tanks.