Tuesday, April 30, 2019

3311. Westie with metastatic squamous cell carcinoma


Mar 1, 2019
Region of right prescapular lymph node: Metastatic, squamous cell carcinoma. 
No normal lymph node tissue architecture is recognised. Metastasis to regional lymph node is most likely. Neoplastic cells extend ot some of the margins of the tissue evaluated. Prognosis is guarded/poor with evaluation for evidence of recurrence and additonal metastatic disease advised.






May 1, 2019
Image above. Recurrence 

3310. Onychocryptosis - Ingrown toenail - Chemical Ablation Matrixectomy

May 1, 2019


The side of the toenail grows into the soft skin nearby - ingrown toe nail or onychocryptosis

This case occurred over a year. No infection in this case. Painful when the toe is stepped upon. Recently, more painful after tour in Morrocco.

Specialist says that the ingrown toe nail will recur when he cuts it away. Not permitted to use chemical ablation in Singapore SGH.

Chemical Ablation Matrixectomy

Local anaesthesia
Tourniquet rubber tubing clamped by forceps.

Size 61 scalpel cuts strip 
Strip removed
Clear debri.
Cotton bud - phenol onto nail bed
Clear debris
Irrigate
Cotton bud - isopropyl alcohol to neutralise phenol.
Clean up
Strip of cotton cover up. Padding. Dressing up.












Chemical ablation without surgery
Chemical ablation with surgery


Consent for Surgery Form. 3 risks explained.
Risks
1. Local anaesthetic - allergies
2. Phenol chemical ablation
3. 95 to 97% success. 3-5% recur. Cannot repeat surgery. Just cut softer nail.


Day 2 &3. Change bandage yourself. Pannadol for pain relief if present
Day 4. Goes to podiatrist. She used curette to scrap for pus. Very painful. Applied iodine.

6-8 wks to recover


CONSERVATIVE TREATMENT
Clip toe nail yourself. Painful.
Worried about being stepped on.


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 Day 2. Post op

Saturday, April 27, 2019

3309. Lameness problems in dog. 4 cases. X-rays.

TP 46178  Milo

JR M 13yr   Limping  RH   Pain back



TP 46045  Cookie
Mini Schnauzer, M, 12yr
RH lame 2 days



TP 42793  Jewel

JR F 13yr
Limping LH



TP 22258 Ace
GR M 14 yr
Difficulty standing and walking



Friday, April 26, 2019

3308. A 15-year-old male, not neutered poodle has 2 large circum-anal tumours

Fri Apr 26, 2019'


It is high risk anaesthesia as the dog is very old at 15 years. The 2 family vets advised medication for the past months, but this does not resolve the problem of the tumour growing larger and soiling the pampers and flooring. The owner surfed the internet and consulted me. 
"It is high anaesthetic risk," I told the owner. "The dog does not have heart or lung problems on physical examination but he is aged."





Thursday, April 25, 2019

3307. Photography tips: Shoot perfect 'flat lay' still life images at home

Prctical photography Feb 2018

Natasha Breen. professional food, product and still life photogrpaher, shoots for stock agencies like Shutterstock, industry client.

www.breen-photo.com

Flat is trendy - Instagram
Camera  Canon 700D  EF 70-200mm f/4L/2.8 ens IS USM    Sigma 17-50mm lenses
Tripod no.  This is because she shoots with studio lights. The flash will freeze camera movement and gives crisp details.  Prefer handheld to make small adjustments. Live view makes composition easier.

Composition
Look for harmony for good results. Spend time arranging them. Objects, position, textures and light.

Lighting and flash gear
1. Usually a very simple one-light setup with or without a reflector depending on how much she wants to fill the shadows.
2.  Two flashes to imitate the look of sunshine or high-key, low-contrast look.
3. Important to soften the light to prevent too much contrast or distracting highlights and shadows.

Exposure settings to maximise sharpness of details and texture
1. Flat images are all about sharpness.  She aims to have enough depth of field ro keep everything in focus, from the closet details of the objects to the texture of the background.

2. Usually aperture of f/7.1 to f/14.  As she lights with flash, ISO setting is low. This provides best quality and minimal noise (which affect sharpness or hide fine details).

Tip
Objects m b the right kind for a flat lay image. Clear shapes, not too high. A lack of reflections help the overall harmony. Quality and texture of the background are important. Must complement or contrast with them.

3306. A tortoise has a closed right eye. Why?




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ORIGINAL FILES

















Saturday, April 20, 2019

3304. INTERN. How to treat a red-eared slider who has great difficulty laying eggs? 2 case studies



HOOK


"The red-eared slider digged 8 holes in the soil yesterday," the lady had brought the slider to the playground where there was soil." But no eggs were laid. "She also tried to dig the floor tiles at home. I know this behaviour is a prelude to egg laying and since no eggs were laid for the past 2 days, I haave to bring her to Toa Payoh Vets for injections."



BACKGROUND  Singapore is a small country with bright sunshine and blue sky weather most of the year. Many tourists love to visit Singapore to see the sights and appreciate the cultures.  Around 80% of the 5 million people live in apartments.

Singapore's financial district

Singapore has a bright sunshine blue sky weather most of the year


 
Singapore apartments         











The slider had been X-rayed 11 days ago and and had 5 eggs. The owner did not want any injection to stimulate her uterine contractions to lay the eggs. But now, without the injections, the slider would suffer and may die from egg binding. So the owner decided to have the injections. .


BE KIND TO PETS - slide



Theme - Dystocia in red-eared sliders




Oxytocin at the correct dosage is an effective drug to contract the uterus to expel the eggs. 



5 eggs were laid at Toa Payoh Vets. The owner went home happily. Surprise! She laid 7 eggs at home.

This is the X RAY ON APR 9, 2019 (11 DAYS AGO). The vet did not take the latest X-rays as this will incur additional medical costs. As the slider laid 12 eggs, this means that 7 additional eggs were formed after April 9, 2019. The slider had great difficulty laying the eggs, having dug 8 holes in the soil without any eggs laid. Hence oxytocin was needed and helped solved the difficulty in egg laying (dystocia).  

















VIDEOS



 





CONCLUSION

Prompt oxytocin injection during dystocia in April 2019 was effective if the dosage is in sufficient amounts. Some reports advise 5-10 IU oxytocin per kg bodyweight.


CASE 1.  RED-EARED SLIDER, F, 7 YRS had 2 episodes of dystocia

APR 2019 DYSTOCIA. Report given above.
This slider weighed 2 kg. She was injected with 20 IU oxytocin. This is equivalent to 10 IU/kg. She produced the first egg within 40 minutes. She laid 12 eggs.







JAN 2019 DYSTOCIA

During her first dystocia in January 2019, a similar dosage was successful. She laid 2 eggs naturally some 4 weeks later.






CASE 2. Red-eared slider, F, 16 years. Effective treatment using Oxytocin 10 IU/kg









TIPS.
Owners want results and a lower dosage may not be effective.     


















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 Email to Dr Sing dated Sat Apr 20, 2019
Apr 20, 2019

EMAIL TO DR SING

Dear Dr Sing 

We went back about 5pm and since you administered the injection she had laid 5 eggs. As we were travelling home she laid one egg in the car. 

When my wife reached home about 5.45pm she laid another 2 eggs. We went out and when my son reached home, he found 4 eggs in the plastic box (filled with water) around 6.45pm. 

In total she laid 12 eggs. Is it possible for her to form another 7 eggs in 11 days? 

She is very tired and now sleeping.   We are monitoring her closely if more eggs 🥚 to come. 

Please contact my wife for any clarifications.

Thank you. 

Best regards
Name of owner

REPLY FROM DR SING

This case study shows that the egg shells of the extra 7 eggs have had formed over the last 11 days. This red-eared slider is 7 years old and weights 2 kg.

To stimulate uterine contraction, the oxytocin given was 5 IU (0.5ml) by IM and 10 IU (1.0ml) by SC. Calcium injection (Theracalcium) was 0.2 ml IM. This combination dosage was effective this time and in January 2019 when this slider had 5 eggs.