July 17, 2020
Chloe.
Title : A GR had a large elbow "hygroma" twice the size of a Thai mango.
Do 3 good videos. Diagnosis, treatment, Follow up
This case study will teach you a lot of veterinary medicine and surgery if you know how to find the parts (e.g. laboratory aids to diagnosis - cytology by Vet 1 (see report), ultrasound (footage in You tube, download and use it),
radiography (2 images....learn how to describe it), histology..(read and show the slides of cancerous cells....),
surgery (complete excision not possible, what is complete excision? bone involvement etc. plasty to close such a big hole hence the other vets were reluctant to perform surgery and referring the owner to Vet 3 with CT scan). What is CT scan? Read up and write.
USE THE 3D'S FORMAT
1. Details (Hook and introduction). BKTP Images.2. Dialogue
3. Discovery (Include credits etc).
all wrapped in drama
I will write this case for you as an example. You need to reduce the word count by 50% (try).
DETAILS for Part 1
HOOK (with video footages and images)
Big breeds like the Golden Retriever do suffer from elbow swellings due to lying down on hard surfaces like hardwood floors, tiles or concrete. Repeated trauma causes the skin over the elbow joint to form a soft swelling to protect the elbow joint. This is an elbow hygroma. Many dog owners who do internet research will diagnose an elbow hygroma which is not cancerous. No big deal. No hurry to consult the vet.
However in this Golden Retriever, the elbow swelling started to grow bigger and bigger in March 2020. She phoned her vet, but was told that the Singapore lockdown from April to June 2020, to stem the spread of Covid-19 viral infections had not permitted surgery to remove "skin lumps". In July, the elbow swelling was twice as big as the Thai mangoes. She consulted 2 vets in July but they advised cytology, ultrasonography, radiography and then a CT scan at the 3rd Vet who will perform surgery (excision).
The medical costs were mounting. A quotation of more than $5,000 for the surgery caused her to seek advice from her Golden Retriever Club. A member referred her to Toa Payoh Vets.
DIALOGUE is by WhatsApp and phone conversations.
Jul 5, 2020The owner WhatsApp Images to Dr Sing Kong Yuen.
Owner went to Vet 2 who did ultrasound (video footage in Youtube) and X-rays (Images below)
Tuesday, 9 July 2020, Dr Sing advised bringing the dog to Toa Payoh Vets for examination.
Cytology report, ultrasound video clip, X-rays were submitted by Vets 1 and 2 to Dr Daniel.
(Chloe, to Interpret the documents).
The owner did not want a blood test for health screening before anaesthesia and surgery by Dr Daniel Sing. Dr Daniel had diagnosed a possible sarcoma. He would operate the next day.
July 8, 2020. Day 1 post-op. WHATSAPP BY DR SING TO OWNER.
Dog eating well and wanting to pee and poop.
Jul 17, 2020. All ok. Some stitch break down.
POST OP
DAY 1
DISCOVERY
1. Early treatment saves lives. Small tumour can be excised completely This means no cancerous cells at the margins.
2. Histology is important.
3. Delays - cancerous ones like sarcomas will not be completely excised. Recurrence. Leg amputation may be needed. Most owners against amputation.
4. Outcome for this dog. Follow up -- another video
POST OP IMAGES FROM THE OWNER
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SETTING (Singapore images and happenings) to be introduced in Part 1.
As it was not done, do it in Part 2. Intern to script a narrative using the following images in Jul 6, 2020 to introduce the setting (Singapore). Singapore Covid-19 lockdown - APR 7 to Jun 30, food couriers, mandatory mask wearing, 2020 elections
SETTING - Singapore high rises - a modern new Housing Development Board apartments
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| Funan Shopping Mall. Sg Malls closed for over 2 months |
2020 Elections
Progress Singapore Party vs. People's Action Party
 |
| Prime Minister Lee Hsien Loong of the People's Action Party |
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Male, neutered, 7-year-old Golden Retriever
Small elbow mass spotted in March 2020. Singapore lockdown starting from April 7, 2020 with devastating impact on this Golden Retriever as vets were prohibited to operate on tumours. This tumour did not stay small....grew explosively to be a gigantic mass. Vet 1 prescribed medication which was ineffective. Vet 2 did not operate and referred to another Vet for CT scan. (USE IMAGES WITHOUT TEXT - SEE BELOW)
Likely to be a sarcoma. Owner is happy that Dr Daniel will operate as Vet 2 did not want to perform such surgery.
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HISTOLOPATTHOLOGY REPORT
Tumour from the left front leg (arm). 1 x pot.
2.8 x 1.9 x 1.4 cm.
Summary of the report. Over 80% of the cutaneous mass, left front leg has undergone severe coagulative necrosis. Where is mass is still intact, there is no normal tissue present as cells are neoplastic.
Diagnosis:
Cutaneous mass: Poorly diferentitated sarcoma. Cells are consisttent with sarcoma. Diferentials include soft tissue sarcoma, histiocytic sarcoma or less likely a neoplasm arising from the bone. If the invasion or involvment is not from the underlying bone, this is likely a high-grade soft tissue sarcoma.
TIPS AND ADVICES
Early detection and surgical excision will be best if your pet has a small elbow lump. It may not be the benign hygroma (elbow swelling with fluid) as suspected by the owner in this case. Early surgery may permit complete excision of this malignant tumour.
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3 FINAL VIDEOS ARE COMPLETED BY THE INTERNS
1. Diagnosis by Chloe
2. Treatment by Chloe
3. Follow-up
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ORIGINAL IMAGES
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