Sunday, June 24, 2012

1051. Sunday Jun 25 12's interesting cases

Sunday Jun 25, 12 was a bright sunny morning. It was my nephew's wedding and it was the day my car's malfunction (battery warning sign) meant I had no car.

1. Rabbit with backside licking.
New client. The Hongkong mum and two pre-teen daughters living in Singapore wanted to consult Dr Vanessa.

I was at the counter service making sure that all clients get served within 5 minutes of waiting as there was a complaint of having to wait over an hour for one of my vets by a guinea pig owner whose guinea pig has eye ulcer in one eye and now had another eye ulcer.

Referrals from a pet shop as the owner of the rabbit had been twice to Vet 1 near her place but could not get resolved. Referrals are important but resolving the problem of the rabbit is more important. "Otherwise the owner will have to go to the 4th vet," I said to my vet. It is as simple as that. I would monitor this case.

2. Emaciate Bischon has no more hard "durian seed" in the abdomen compared to 2 days ago. The owner did not want any blood test and X-ray. I showed her how to feel the durian seed as the dog was skin and bones. She said she had paid $2000 at another vet for her dog treatment and would not want any test.  I gave the IV drip for past 2 days. Today, I palpated the abdomen and there was no more hard mass. The dog had passed hard greenish stools thick as the biggest German sausage. Will be sent home on Monday.

3. Eye ulcers are emergencies
One home-maker with a small daughter noticed that her Shih Tzu's eye was tearing and half-closed. She phoned her husband to abort his golf tournament. I handled the case and use the fluorescein eye stain test. The ulcer is obvious and my vets don't feel it necessary to do the test. I have to get them to change their mindset and adopt a SOP or treatment protocol.

"Eye stain of a bright green means a recent ulcer," I told my vets. "The other parts of the cornea with no obvious ulceration will show a lighter green as in this case." I showed the image to my vets. It is hard to change mindsets as most vets don't feel the need to demonstrate the presence of corneal ulcers. After all, it is obvious as the eye is itchy, watery and inflamed. This type of thinking is not based on evidence-based medicine. The picture of this case showed a deep central ulcer with other keratitis from central area upwards. Could this be due to the baby daughter pulling the dog's tail or scratching the dog's eye? She was with the grandma. "Nobody knows how the injury is caused," I said. "It is best not to upset the caregiver. As the eye injury is within 24 hours and the cornea is not perforated, chances of healing with tarsorrhaphy are good."  

4. Syrian hamster with scabs and crusts on face and spinal area. Probably scabies but hard to find the mites on microscopic exam. Given ivomec inj. Warded 4 days to get the scabs peeled out, otherwise, they irritate the hamster (84 g, lost weight for Syrian). Mother and Primary 6 daughter came to bring the hamster home today. She is very current on newspapers as I mentioned that females are very good at studies and work if they are motivated. "Like the two IT ladies mentioned in the Straits Times corruption cases. They can close deals but the way it was done was not the way." She knew what I was talking about but not her mum. She said: "Mum does not know." The hamster's skin needed to be treated properly at home and I would see it in 2 weeks' time.

5. Instant diagnosis. "A malar abscess" I told Dr Daniel when a Golden Retriever came in with a swelling below the eye.
"He needs an X-ray to see whether there is any tooth root fracture," Dr Daniel said.
"For economic reasons, the X-rays and blood tests are not wanted," I replied. So, we would give the IV drip and antibiotics and operate the next day.

6. "Dead dog smell" Shih Tzu looks better and scratches its lower body much less. I smelled the body as it is the only way to confirm the owner's complaint "dead dog decomposed smell."  Dry eyes. Under treatment. Bathed.

7. American cocker paw maggot wound finally closing. >30 maggots. "The exposed toe nail needs to be cut off," I said to the owner and Dr Daniel. Otherwise, it is irritating and painful."

8. The Beagle with the bladder cancer came in for dental work and ear irrigation under anaesthesia. He was quite active but I noted he has difficulty peeing in the morning when let out today (Monday 10 am). He would lift his leg against the tree trunk and not a drop of urine passed out. He had peed in his crate overnight though. Needs his anti-fits medication or his body will tremble.

9. Young Schnauzer still has nasal discharge and sneezing (cold?). Vet 1 was consulted and recommended "saline into the nose." This is unconventional treatment and so I don't know why. Conventional treatment by Dr Daniel. I phoned on Monday 11 am and the lady said the dog was not sneezing. Each vet has his or her way of treatment but in the end, the good clinical outcome counts. This is the reality of life.

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