Wednesday, January 31, 2018

3348. A 10-year-old Golden Retriever has anal sac discharge after 2 treatments by the vet

Feb 1, 2018

"I feel very peck chek (frustrated in Chinese Hokkien dialect) as my dog passes smelly bloody anal discharge for the 3rd time. She was treated by Vet 1 twice, within 10 days, and the problem returned. The vet had told me that a biopsy (over $500) will be needed if the discharge occurred at the 3rd time!

She had paid $3000 for her dog eyeball removal and was wary of veterinary fees.
Her friend referred her to me. Dr Daniel expressed smelly black anal sac oil via digital expression.
The owner wants a cure, not going to the vet the 4th time to express oil.

This is a case of a possible anal sac necrosis with or without a tumour. Medical therapy by expression of the sacs has not worked.

Possible treatments are:
1. Catheterise the sacs and irrigate with saline and antibiotics. Sedation is needed.
Medication after antibiotic sensitivity test. Wait and see if the bleeding recurs.
2. Biopsy. The owner wanted a permanent cure and this was not a cure.
3. Anal sacculectomy as medical therapy via anal sac expression for 3rd time (rectal digital expression) still shows bloody smelly discharge at Toa Payoh Vets.
The owner would consult her husband as one complication is faecal incontinence after removal of the anal sacs.

Owner wanted Option 1 which is scheduled 2 weeks later as the anal sacs now are inflamed.  She is worried about faecal incontinence and will have to clean the backside if that occurs.

E-collar, R/D diet to reduce weight from 25 kg to 22 kg and provide fibre.
Blood test normal findings.

Sunday, January 28, 2018

3347. A chihuahua jumps from the bed daily - r patellar luxation 2 days ago

Jan 29, 2018
Referral to Toa Payoh Vets for 2nd opinion 
Vet 1 did X-rays. Diagnosed Grade 3 patellar luxation.

8-year-old chihuahua
Jumps off bed daily - for past 8 years

Had been lame for a year
Overweight BCS 5/9

Grade 3. Dog can put RH paw on ground after putting patella in.
Heart and lungs OK. Abdomen OK. 
Apprehensive about anaesthesia.
To reduce weight for 4 weeks and see.

--------------------------better quality X-rays of another case

3346. A 16-year-old Jack Russell salivates profusely - nerve disease?

Jan 13, 2018

Jack Russell, FS, 15 years
hypersalivating only on right side of mouth. Why?


Pupillary reflex. R pupil constricts. L pupil dilates when bright light is shone.

Ulcer of 2 cm on R side of tongue, caudal edge.  R buccal mucosa ulcerations 

April 2018. Dental by Vet 1 .
Nov 2018. Not able to lap water from bowl. Water bottle OK
Drinks little

Urea  9.1  (4.2-6.3)
Creatinine 49  (89-177)
Platelets 595  (200-500)

Jan 13, 2018

No salivating only on right side of mouth. Some bubbles seen in right tonsillar area on GA examination.



Ulcer of 2 cm on R side of tongue, caudal edge.  R buccal mucosa ulcerations 

April 2018. Dental by Vet 1 .
Nov 2018. Not able to lap water from bowl. Water bottle OK
Drinks little
Treated at Toa Payoh Vets on Jan 13, 2018. Antibiotics and anti-inflam, neurobion.

Urea  13.5  (4.2-6.3)
Creatinine 87  (89-177)
Platelets  316  (200-500)

Was dental scaling done by Vet 1 the cause of the muscle atrophy?

Saturday, January 27, 2018

3345. A 9-year-old female spayed Shih Tzu passes cloudy vaginal discharge

The couple was concerned about this cloudy discharge seen "once" recently.

Lab tests done.

Also liver disorder

Thursday, January 25, 2018

3344. A 25-year-old red-eared slider vomits blood.

Fresh blood from the tongue ulcerations seen. Anoexia for a few weeks.

 DAY 1 of in-patient (Dec 26, 2017)

 DAY 3. Necrotic ulcers in tongue, over 50% tongue surface and bleeding. Not eating for a few weeks. At first, ate fish meat and prawn meat, instead of pellets. Soon stopped eating. "Vomiting blood" = consulted Toa Payoh  Vets

Pred and baytril plus 6 ml dextrose saline, Vit B12 given on Day 1 and 3 SC.

DAY 10 (Feb 4, 2018) shows tongue ulcers heal well as shown in images below.

The slider is still not eating the pellets on her own. Syringe fed 3x/day daily.
Weight on Day 1 - 1.85kg
                 Day 10 - 1.79kg
Lost 600 grams but tongue ulcers heal well.
It is a strange case as to why she got the oral ulcers in the first place. Could it be a sign of systemic disease like kidney disease?

DAY 13



DAY 16. Tongue ulcers are much smaller. Still anorexic on Day 16. Syringe fed.

Admitted Jan 26, 2018         1.8kg
Jan 27    1.8kg
Jan 28     1.8kg
Jan 29  - 31      1.76kg
Feb 1 & 2         1.8 kg
Feb 3 - 6            1.79kg
Feb 7 -11            1.8kg  Tongue ulcers heal almost 90%. Still not eating pellets.
Syringe feed 100 pellets + Critical Care +Nutripet per day (3 feedings).

Wednesday, January 24, 2018

3343. INTERN Femoral fractures in 2 Singapore apartment cats

High rise Singapore apartments
More than 80% of population live in apartments.
No wired netting in windows in most apartments with cats - cat jump off windows and fractures legs or dies from internal injuries

Case 1. A 4-month-old kitten fell down from the apartment

WEEK 4. Plaster of Paris removed

WEEK 10. Pin removed. Kitten can now bend knee but it is painful.

3342. Veterinary Surgery Stories: The breeder never forgets what the vet did to his dam

Jan 23, 2018

Veterinary Surgery Stories from Dr Sing Kong Yuen, Toa Payoh Vets
- The breeder never forget what the vet did to his dam

"8 puppies dead after Caesarean section," the breeder showed me his mobile phone image of a dam and 8 dead puppies. He was not going back to this vet for any surgery. He did not know what had happened but he expected no deaths of the dam and puppies in any Caesarean section. He was 85 years old and had been breeding dogs for over 40 years. Still active working hard when other breeders have retired and had knowledge of the competence of various vets performing Caesarean sections for him.  .

I had performed over 10 Caesarean sections for him without deaths of the dam and pups in the past 2 years. So he was satisfied with me though he tried to knock down my fees by saying: "I can get 3 to 4 Caesarean sections done by the other vet for the fee I pay you!"

Some 15 years ago, I was like the other vet, charging $300 for any Caesarean section of the breeder's dog at any time of the day and night. The usual vet was suspended from practice for around 10 months for selling vaccines to breeders who would do their own vaccinations. One big breeder used my services and others followed. I had performed over 200 Caesarean sections in around 3 years till a younger vet was favoured by the breeders.

I could devote more time to my private clients and had more sleep after midnight. On Jan 23, 2018, I was awake as I had been to a friend's house for dinner. The friend had an electrical blackout and it took time to locate the source in an external wall light being exposed to rain water. So, this breeder's phone call to me was received as I drove home.

"I was going to bed after delivering a second Dachshund pup naturally," he said. "I saw this Dachshund straining very hard. Her water bag had ruptured but no pups came out for more than an hour."

He had given 0.5 ml oxytocin but no pups came out. So he played safe and phoned me. I did the Caesarean section for him. The 2 pups were large. He was pleased that the spotted one was female. This Dachshund had a large single pup delivered by Caesarean section by me one year ago. Now, she could not give birth naturally and her swollen belly gave me the impression she had 4 pups or 6 pups. She had 2 large ones.

What the breeder expects is a happy outcome: "No deaths of the dam and pups."
I use solely isofluranne gas and achieve this outcome.
A good veterinary assistant monitors the anaesthesia closely.

Monday, January 22, 2018

3341. Veterinary Stories: Three sisters never forget what the vet did 15 years ago

Jan 23, 2018

Veterinary Anaesthesia Stories from Dr Sing Kong Yuen, Toa Payoh Vets
- Three sisters never forget what the vet did 15 years ago

"You said your anaesthetic machine would knock out my Golden Retriever fast as it delivered 80% gas unlike the usual machines used by vets," the eldest sister had invited me for dinner and now recalled a past-midnight service done by me to help her continuously vomiting dog some 15 years ago. "Yet my dog woke up when you tried to insert the stomach tube into his mouth!"

I did not bother to explain the technical aspects of veterinary gaseous anaesthesia to a layman.
She continued, "You stepped on the foot pedal and your operating table rose upwards. When you stepped to lower it, the table just would not come down!"

I needed a higher position to stomach tube this overweight Golden Retriever. My assistants were this lady and her two sisters who had transported the sick dog into the operating room on a large towel" stretcher" in the old spacious solidly built Mercedes 500 belonging to the eldest sister.

The "80%" referred to my anaesthetic vaporiser which delivered 8% of the isoflurane gas. 8% gas knocks down the dog faster than the 5%.

It was very useful for my over 200 Caesarean sections done past midnight with only the dog breeder and myself in the operating room. I did not need to inject the pregnant dams IV or IM. So I had purchased this 8% which the eldest sister recalled as 80%.

The 3 sisters could not help professionally as they were laymen. The dog raised his head as the anaesthetic effect had worn off. "Where am I?" she looked at the eldest sister who was the one who cared most for him, loved him to bits and worried when he was not eating. Whenever he fell ill, she would drop her work and got the dog to the vet.  

I tried to mask him again with the 8% gas vaporiser. It was past 1 am now and I had committed to help this dog instead of rejecting the plea for help. So, one sister held the dog's backside, The other put her hand on the body to steady him. The eldest sister tried to open the jaws and angle the dog's mouth for me to insert the tube.

I was the only vet to respond to her plea for help, without my veterinary assistant. The dog's abdomen was much swollen and auscultation revealed intestinal sounds. A judgment had to be made on the spot. I decided on stomach tubing to release the bloated stomach of its gas under gaseous anaesthesia.

I had told the eldest sister that the 8% vaporiser could deliver a knock out faster than the usual 5% vaporiser.  Now she mentioned "80%" as she knew nothing about the technical details of a vaporiser.

The 3 sisters were not of much help. The dog raised his head again and wanted to come down. I aborted this procedure and stepped on the foot lever of this expensive Shoreline operating table ordered from the USA. It cost as much as $5,000 at that time. I could get a simple table made for much less or purchased a second-hand human operating table.

"You stepped and stepped on the foot lever," the eldest sister was the one who had watchful eyes said. "But the table would not descend!"

She laughed so loudly as she recalled poor Edgar stranded high up. "The hydraulic mechanism had failed me," I replied. The 2 sisters were not impressed.

Then I gave the dog an antispasmodic and antibiotic injection.Four of us carried the around 50-kg dog down from the table. An average adult Golden Retriever weighs around 35 kg.

"I could see poor Edgar wobbling as he walked out of the operating room," the eldest sister laughed so loudly at the dining table where I had been invited for dinner earlier. Why was she so tickled with hearty laughter again?

"As I slided open the sliding door, it fell off my hands!"  The other 2 sisters at the dining table did not laugh so loudly but I am sure they would have advised this sister not to patronise me any more.

In 2018, I had a new Shoreline operating table and no more sliding door for my operating room. I had a proper swing door installed.

I should not have attended to this emergency but the other vets had not responded to the phone calls after midnight. Some 15 years ago, Singapore had less than 10 veterinary clinics compared to over 80 clinics in 2018. There were few emergency after midnight clinics. The eldest sister is most forgiving of the events as she had invited me to dinner and recalled this incident.  I am sure that the two sisters were not impressed with my poor outcome for Edgar and the falling out of the sliding door.
The next morning, I visited the home of Edgar. He was as bright as a sunny day and had dashed out of the main door to bark at me vigorously with his cautious brother trailing behind."He lived up to 16 years of age," the eldest sister said to me. "He had no health problems except for the need to have regular injections for his hip pain."




Tuesday, January 16, 2018

3339. A 30-month-old dwarf hamster has a large ear wart. What to do?

Jan 17, 2018

Internet query.
2.5 years old. Large wart. Sister worried. To operate or not, the lady emailed the image.
Much depends on her as the operation is less than 1 minute and gas anaethesia is very safe.
Cost? $150-$200. I asked her to email me the image.

The wart is irritating the hamster as evident by the clotted area due to scratching. Up to the owner to decide.

Thursday, January 11, 2018

3338. A rare case of gangrenous swollen cheek in a Syrian hamster

A young lady WhatsApp this image to me. 
Needle aspiration. No pus or fluid. It was possible a sharp seed had penetrated and infected the left cheek.
Diagnosis: A gangrenous infected swelling/tumour.
Overgrown lower incisor teeth suggested long duration of swelling
Hamster passed away 4 days later