1125. Sunday's interesting cases - Sep 30, 2012

Sep 30, 2012

Bright sunny day
Case 1. Red-eared slider with "smaller and sunken" left eye. The husband and wife came for a review. "How many turtles have you treated?" she asked me.

"Around seven cases last year," I said. "Singaporeans seldom keep turtles to an older age like yours and there are not many."  Maybe Toa Payoh Vets get less turtle cases. Who knows?

"They release the turtles to the reservoirs," the slim wife with dark rimmed glasses said. "What type of cases you see?"

"Mostly eye problems like closed eyes. Rectal prolapse, cracked shells and not eating."

2 days ago, the husband brought the turtle for consultation as he observed the left eye sunken and smaller than the right eye. He is an observant man as his wife did not know any eye change.

I could see the haziness in the upper part of the cornea of the smaller left eye and took some images to document corneal ulceration (green flurosecein stain). Dr Daniel gave an IM injection in the back thigh muscle of an anti-inflam and antibiotics.

I advised cleaning up the turtle as it smelled fishy, giving eyedrops 3x/day and not letting the eye get wet unless eating time. After eating, wash the eye with boiled water. "Or tap water left overnight as there is chlorine in the water and that will evaporate overnight," I said.
However the husband said: "The tap water has only fluoride, not chlorine." I can't substantiate this and so said nothing.

Today, the husband was to bring the turtle for review and he did so. The turtle's left eye looked so much clearer. It is still sunken but lesser. How to prove it? It was difficult as the turtle did not permit me to take image head-on of both eyes on the reception counter. He was restless and moving. "Do it inside the consultation room after switching off the lights, as before," the husband advised. "Use ISO 3200."

"The images are not so good compared to natural light in the waiting room," I said. "I used ISO 6400 the last time." As I did not want to upset the owner, I took images inside the darkened consultation room. The turtle was calmer. The cornea looked much more transparent esp. in the 11 to 2 o'clock area where there was cloudiness 2 days ago.
Case 2.
 Shih Tzu, 1 year old, with red ear lumps in both ears but the lady in her 40s said that there was no scratching. The right ear was more painful when I palpated the vertical canal and the dog cried.
She had seen my associate vet for the past 3 times with the same problems. Antibiotics, injection and ear flushing again.
"I had spent much money in the eye ulceration treatment last time," she said to me when I advised lateral ear resection surgery. Now she trimmed the hairs around the eyes and put eye drops daily. No more eye ulcerations but this ear inflammation and pus could not be resolved since Jan 2012.
"It is usually the money matters," I said. "Ear surgery is the solution to open up the vertical canal to enable the horizontal canal to be ventilated and drained as the shih tzu's floppy ears covered up the canals 24 hours/day. But most owners will not accept the surgery due to its costs."

"How much?" she asked.
"I estimate $500 for one ear, including nursing care for around 7 days post surgery. It is just an estimate."
Now she had seen my associate vet 4 times and tried to clean the ears and give medication. The total costs and her time would be $600.
"It is just the luck of the owner," I said. "Some families have children with health problems and incur lots of medical expenses. I just have a case of a Shih Tzu dog owner who spent over $8,000 just for 5 bladder stones removal in the dog. Other Shih Tzu owners have no need to spend a cent."

Case 3.
An apricot seed inside the large intestine of the Maltese. I came back to the surgery at 3.30 pm to check whether my associate vet had operated on this Maltese. The owner had delayed operation but the dog kept vomiting and she decided on the operation on Friday. I advised against immediate operation for expediency as Saturday was the day off for my associate vet. The dog needed the IV drip and antibiotics to recover. Today, Sunday, the dog was in much better health but still vomited. My associate vet took out the apricot seed, put in interrupted appositional stitches to close up the wound. The large intestines were inflamed to 6 mm in depth of mucosa and serosa. The dog was alert and well after surgery. That was good.  
Case 4
The old Minature Schnauzer with the bloated stomach of closed pyometra came back for stitch removal as required by Dr Vanessaa. I asked Dr Daniel to remove the stitches. The pyometra surgery was done on 31 August. None of the nylon stitches were present now as it is past one month since surgery. This dog had pus in the hairy ears and dry skin problems in the forearm and body. At least she did survive the surgery as I thought the pyometra would burst if you see the images in my case studies.  



"Today, there is a white spot in the left eye," the wife said.