Wednesday, September 23, 2020

Diabetes - Realtor Gerald

Telemedicine. Gets virtual consultation and couriered  medication

 

 Diabetes  Metformin
 BP  Diovan 160 Novartis


Wednesday, September 16, 2020

3151. A 14-year-old female Labrador Retriever with multiple skin lumps and passing blood in the urine again. Two final videos.

Create 2 videos as they have separate topics


VIDEO 1. 
A 14-year-old female Labrador Retriever has so many large fatty lumps. What to do? 

HOOK





HOOK IS VIDEO FOOTAGE AS FOLLOWS:

0:00 - 0:23. Use audio in the video footage. "Today is 10 Sep 2020, This 14-year-old female, not spayed Labrador Retriever...."

1:14 - 1:31. (Narrate as you show various locations of the multiple skin lumps). The dog is underweight and has multiple skin lumps - armpit area, chest area, back area, using the following footages:  

2:58 - 3:10  armpit area lumps
5:30 - 5:38. lift up dog to see more lumps under the body. Owner said that the lumps appear after feeding her dog duck mean. That was around 5 years ago. 

6:30 - 6:46
7:00 - 7:14

BKTP




TITLE: 

  
SINGAPORE SETTING....
Short video clip of singaporeans working, buses, apartments, street scenes etc but NOT the same as your previous one.


"5 years ago, the lumps appeared after I fed her duck meat,"  Tan said. "I consulted a vet. He said to wait and see. If they grow much bigger and cause her irritation or lameness, he will remove them."

Today is 10 Sep 2020. The subcutaneous lumps have had increased in numbers and sizes. The dog had a fever 7 days ago and is underweight. Were the multiple skin lumps the cause of her poor health? Dr Daniel had taken blood and urine for examination. 

Are they really lipomas or the cancerous cells like liposarcomas, mast cell tumours or soft tissue sarcomas? Vet 1 had not performed any biopsy on these fatty lumps.




Lipomas are non-cancerous fatty lumps under the skin. They appear in the older dogs and on any part of the body. The cause is unknown. Older and obese dogs are said to be more likely to develop lipomas"










Most vets advise observation instead of surgery to remove the lipomas. When these lipomas are large and irritate the dog or causing the dog to be limping, they are removed.  However, the best practice is as follows: 

1. PHYSICAL EXAMINATION.
A physical examination is not good enough to diagnose that the lumps under the skin are lipomas. 

2. CYTOLOGY, FNA, BIOPSY.  It is important for the vet to use cytology to diagnose lipomas. Cytology is the examination of the cells under the microscope.

The vet collects the cells by using a fine needle to aspirate the cells (FNA) and transfer the collected cells to a slide to look under the microscope. 

Alternatively, the vet uses a biopsy punch to take out a sample of the lumps for the laboratory to check the cells.



CONCLUSION. 

Why do some dogs develop lipomas?  Not much is known. Older dogs and certain breeds past middle age and are obese develop these fatty lumps.

"This Labrador Retriever was never fed dry or canned dog food," Ms Tan told me. "She eats only home-cooked food!". 

"Did you give her a lot of fat and sausages?" I asked. "No," Ms Tan said.

"Did you feed her RAW DIET" as her total cholesterol is high, at 8.5 mmol/L. The normal range of  values are 3.4 - 6.5 mmole/L."

 "Yes" she said. "I feed her raw diet since she was a young dog."

Not all dogs with high total cholesterol levels develop fatty lumps. Hence, the presence of high total cholesterol is not a useful indicator.  


------------------------------------------------------------------------------
   

Lame on right hind (Video). 




BEST ADVICE FROM DR SING KONG YUEN

1. SURGICAL EXCISION AND HISTOLOGY by removing and sending the fatty lump to the laboratory to determine whether they are cancerous or not is my best advice to owners. This is because I had some cases of the Labrador Retriever misdiagnosed as lipomas when they are cancerous liposarcomas, mast cell tumours or soft tissue sarcomas.  
  
2.  OWNERS HAVE NO TIME. Many owners in Singapore do not have their lipomas checked YEARLY. The vet should use FNA or BIOPSY unless the large fatty lumps irritate the dog as they become ulcerated and infected or cause lameness. 

Example of one case study.


By then, such lumps may be cancerous mast cell tumours or soft tissue sarcomas that have had spread. The  large fatty lumps in right hind leg could be a cause of limping on the right hind leg. Ms Tan would have to decide on whether X-rays of the left hip to check for hip arthritis. Large lipomas at the righrt knee joint area can impede movement but Ms Tan has to decide on surgery to remove them.   


(Always narrate any text on any slide)    


















FINAL VIDEO:


5 Oct 2020.
Dr Sing Kong Yuen's comments on A labrador retriever with multiple skin lumps

An excellent educational video, very well created.  
  
1. The hook draws the viewer to learn more. 

2. The use of animations, illustrations, subtitles and images were co-ordinated, making sure viewers do NOT fall asleep. Be aware of copyright infringements as some animations appear to be copyrighted materials. It is best NOT to use them. You can always draw your own illustrations by hand. Not as nice, but free from Youtube warnings and removal of the video in the future. 

3. Monotonous narration. The narrator needs to vary the tone - louder and softer voices to keep the viewer more focused on certain key words like a much louder voice for "What is a lipomas?"

4. The pacing is good. Not to slow and not too fast narration. Keep up good editing. 




----------------------------------------------------





VIDEO 2. 
A 14-year-old female Labrador Retriever passes blood in the urine for the 4th time. 

 





HOOK
Use same footage as in Video 1.  The footage is 0:00 to 0: 40 only.


The owner consulted Dr Daniel 4 days ago as her dog had passed blood in the urine for the 4th time. The dog was losing weight. What can be done to help this beloved companion? 







TITLE 







HAEMATURIA IS THE PRESENCE OF BLOOD IN THE URINE.
(IMAGE OF BLOOD IN THE URINE - TEST TUBE FOR URINE TEST)

Haematuria is not normal in any dog, young or old. What is the cause and solution for this 14-year-old female Labrador Retriever?




SINGAPORE SETTING....
Short video clip of singaporeans working, buses, apartments, street scenes etc but NOT the same as your previous one.

CAUSES AND LABORATORY TESTS

INFECTIONS - BLOOD AND URINE TESTS
1. Upper urinary tract infection   
2. Lower urinary tract infection. 
   Pyometra (infection of the uterus) in the older female not-spayed dog is common condition. 

UROLITHIASIS - URINARY STONES - X-RAYS AND ULTRASOUND 
1. Upper urinary tract. Kidney stones.    
2. Lower urinary tract. Bladder and urethral stones.    


RENAL NEOPLASIA  
1. Upper urinary tract 
2. Lower urinary tract. Bladder cancer.


Dr Daniel performed a blood and urine test on 6 Sep 2020. 
Findings showed bacterial infections in the blood and urine. 

EXPLAIN THE TABLES
- BLOOD TEST AND URINE TEST - SEE BELOW         

Of great concern is the very high liver enzyme levels in the blood test. This indicated liver disease such as hepatitis and/or neoplasia.

No X-rays or ultrasound were performed as thhe owner wanted to wait and see. 




TREATMENT 
Dr Sing Kong Yuen recommended a therapeutic diet, Hill's l/D (IMAGE) to be fed as sole food for the next 3 months. No more home-cooked food or BARF Diet.

What is BARF Diet?

BARF is an acronym that stands for Bones and Raw Food, or Biologically Appropriate Raw Food. Some dog owners believe that adult dogs thrive on what canines ate before they became domesticated - Raw, meaty bones and vegetable scraps. 

As the owner did not feed dry dog food, this eliminates the possibility of the dog developing urinary stones in the kidneys and/or the bladder. The stones irritate the lining of these organs and cause bleeding. Blood in the urine in this dog is likely due to a urinary tract infection. 




FOLLOW UP ON OCTOBER 10, 2020. 
VIDEO FOOTAGE (Attached in email to you).

The dog is not passing blood in the urine and is eating 110% of the therapeutic diet and had gained weight. 
"How do you know that your dog has gained weight?" Dr Sing texted her.

"Her stomach" is visible. See the video footage sent by the owner. Footage emailed to Shyan. This stomach was present for the past 5 years. The owner will monitor if the swelling increases in size. 

Another blood and urine test will be done on 30 October 2020.    










BLOOD TEST (Shyan to put the data in a table)
------------------------------
BLOOD LIVER ENZYMES ARE ELEVATED, SHOWING LIVER DISORDERS

4 Jul 2018  VET CLINIC 1 
ALT                     168   U/L                                                                        Normal Range  (10-125)

6 Sep 2020   TOA PAYOH VETS
ALT        788 U/L                   Normal Range (less than 59)
AST        259 U/L                               (less than 81)


COMMENTS;  High liver enzymes indicate a liver disorder and/or infection.

--------------------------------------

BLOOD TEST

6 Sep 2020   TOA PAYOH VETS   (Shyan to put data in a table)

Total white cell count   
29.0 x 10*9/L  (6-17)
Neutrophils  96.1%   (60-70%)    Absolute  27.9 x 10*9/L (3-11.5).

This dog has leucocytosis and neutrophilia as evident in the increase in the total white cell count and neutrophils. This means that the dog's immune system is producing more fighters to get rid of the bacteria. The bacterial infections of the urinary tract lead to urinary tract infection and the presence of blood in the urine. 

Most likely, the liver has been infected. Hence the increase in liver enzymes. (Show above table).

COMMENTS: Total white cell count and high neutrophils indicates bacteraemia which is the presence of bacterial infection in the blood circulation. The dog had fever and weight loss.


-------------------------------------------

URINE TEST.


BLOOD, BACTERIA AND WHITE CELLS IN THE URINE, SHOWING URINARY TRACT INFECTION  

4 July 2018. VET CLINIC 1 URINE TEST

           Reference Range            
pH = 8             (5-8)
SG  1.010  (1.005-1.030)
Protein 3+ (Negative)
Nitrite 2+ (Negative)
Blood  3+ (Negative)
Prescribed antibiotics

2 Aug 2018   VET CLINIC 2 URINE TEST


pH = 8 (5-8)
SG  1.024  (1.005-1.030)
Protein 3+ (Negative)
Struvite & Bacteria Present (Negative)
Blood  1+ (Negative)
Prescribed antibiotics, acidurin and omeprazole

Latest urine test 
6 Sep 2020   TOA PAYOH VETS  URINE TEST
pH = 7 (5-8)
SG  1.020  (1.005-1.030)
Protein 4+ (Negative)

Ketones 2+ (Negative)

Urobilinigen Normal. Bilirubin Negative. Glucose Negative

Blood  4+
 (Negative)


White blood cells over 900 (/uL)
Red blood cells over 1800 (/uL)
Bacteria +
No casts or crystals. No crystals do NOT mean that the dog does not have urinary stones like struvites. 

Findings:  Urine test confirmed a UTI with haematuria. This is a urinary tract infection with bacteria present in the urine.  How serious is the UTI? 

Let's look at the blood test specifically, the total white cell count and neutrophil %. These values are high confirming bacteraemia. This means that the blood circulation has bacteria organisms which have had infected the liver as well as the urinary tract.  

COMMENTS:  Blood, bacteria, proteins and white cells inside the urine - urinary tract infection



URINARY pH IS ALKALINE


4 July 2018. VET CLINIC 1 URINE TEST
pH = 8 (5-8)
SG  1.010  (1.005-1.030)


2 Aug 2018   VET CLINIC 2 URINE TEST
pH = 8 (5-8)
SG  1.024  (1.005-1.030)

6 Sep 2020   TOA PAYOH VETS  URINE TEST
pH = 7 (5-8)
SG  1.020  (1.005-1.030)

No casts or crystals. No crystals do NOT mean that the dog does not have urinary stones like struvites. 

From the 3 urine tests, the dog has an alkaline urine which favours the growth of bacteria. The bacteria causes urinary tract infection.  In Vet Clinic 2, the urine contains struvite crystals. In Toa Payoh Vets' urine test, the urine does NOT contain crystals. The absence of crystals does NOT mean that the dog does not have struvite stones in the bladder or kidneys. 




CONCLUSION


The present solution is to do a feed trial for 3 months. 
The therapeutic diet (Hill's L/D) is recommended as the dog has liver disease. 

Liver Care This dog's liver is the largest internal organ with many functions, including the digestion and conversion of nutrients, the removal of toxic substances from the blood and the storage of vitamins and minerals. The liver has can repair and regenerate itself. Good nutrition plays a vital role in this process. 


Hill's® Prescription Diet® l/d® Canine is a complete and balanced food that provides all the nutrition your dog needs.


It is formulated to help protect vital liver function

How it works:

  • Moderate levels of high quality protein
  • High L-carnitine & L-arginine levels
  • Appropriate level of zinc
  • Low copper
  • Clinically proven antioxidants

How it helps:

  • Helps reduce liver workload allowing liver tissue to regenerate
  • Helps maintain normal fat metabolism in the liver
  • Helps avoid nutrient deficiencies commonly related to liver issues
  • Supports a healthy immune system
  • S+OXSHIELDTM: Formulated to promote a urinary environment that reduces the risk of developing struvite & calcium oxalate crystals

The owner needs to be educated to feed this therapeutic diet for around 3 months to help the liver to recover. 
--------------------

Acidification of the urine:

Will this diet  acidify the urine to stop bacterial infection, I have no data presently. If this dog does not suffer from liver disorders, I will recommend Hill's C/D which is proven to acidify the urine.     





The urine needs to be checked once in 2 months for the next 3 months. 

URINE TESTS

As you can see from the urine test, ketones were present in the urine. 

6 Sep 2020   TOA PAYOH VETS  URINE TEST
pH = 7 (5-8)
SG  1.020  (1.005-1.030)
Protein 4+ (Negative)
Ketones 2+ (Negative)


The urinalysis came back with no glucose but some ketones present in the urine. Ketones are acids that are a byproduct of fat break down. When enough of them built up in the blood, it becomes poisonous to the animal. 

This type of fat break down usually occurs when the animal can’t use glucose as a form of energy due to a lack of insulin. 

If the dog has a high amount of glucose and ketones in the urine, she will be suffering from diabetic ketoacidosis (DKA) – a potentially fatal condition if not corrected quickly. However, the urine has no glucose and therefore, there is unlikely to be diabetic ketoacidosis. Another urine test in one month's time will be done. 

As the owner was busy and did not come to collect the diet, Dr Sing Kong Yuen delivered the dog food personally. The dog's liver can recover as soon as possible but it needs the therapeutic diet. 















Shyan. You need to edit and structure the subtitles and text properly as what I give you is 90% organised. 


Monday, September 14, 2020

3150. How does a vet operate on a dog's limbal dermoid? Electro-surgery - superficial keratectomy







In this case, the video is about "How to excise a limbal  dermoid using electrosurgery".


 --------------------------------------

Shyan to re-make a new video, but note the following errors in the first video and use the amendments to create a really lively video. 

1. INSERT THIS VIDEO HOOK WITH MY NARRATION

https://www.youtube.com/watch?v=I1gp0HgUVZE&feature=youtu.be
Use footage approx  00:0 - 1:04 

2.  Then continue with your present introduction...and continue

3. At Video  01:21. Insert TITLE.  You narrated but did not insert the slide which would have been created by you.  Use the following slide.  It is important to show the title and narrate the text. 

4.  WHAT ARE OCULAR DERMOIDS AND WHAT TREATMENT WILL THE VET DO?

Dermoids are non-cancerous masses of fat, hair and skin found in an abnormal location of the body. Ocular dermoids are found in the eye. They are of two types.

Video  01:52. Replace the two dermoid slides with the following  3 slides and narrate them.   





There is the LIMBAL DERMOID. It is found in the limbus (junction of eye white and cornea).


The other type is the LIPODERMOID . It is located in the conjunctival tissues near the lateral canthus.

(Refer to the original video).


3. 2:05. Replace audio with the following: 

Sedation is by IV ketamine and xylazine. 
General anaesthesia is isoflurane gas and oxygen.  


CONCLUSION. 


TWO TYPES OF SURGICAL TREATMENT - SUPERFICIAL KERATECTOMY

3.1.  Electro-surgery. The process is shown in this video.  
3.2.  Excision using surgical blade No. 11 and scissors.

The following shows   

4.  2:57  Video footage of a Labrador Retriever puppy wearing an Elizabeth Collar after excision of the LIPODERMOID. The collar was won left for 14 days. 

Narrate: "This image shows a Labrador Retriever wearing an Elizabeth Collar for 14 days. He had a LIPODERMOID excised using scalpel blade and scissors. "  







14 days after surgical excision of the lipodermoid using scalpel blade

Show the following and a video clip at:https://www.youtube.com/watch?v=EUq423Djdwg  Use footage   0:00 - 0:09 around this clip section. Google how to download youtube video to get this video.


5. 
03:12  Replace POST SUGERY  with
POST SURGERY. 

From the corneal healing at Day 9 when Dr Sing saw the dog, the outcome is excellent. No complaints from the owner for some months after the surgery as no news is good news.

6. 

04:12  Create a proper attractive slide. For this video, use the following:



7. FINAL SLIDE.   Should be "FOR MORE INFORMATION"....

use this slide: Narrate the text. 



8. Good initiative. However, do not voice "thumbs up" as this is not in the script. Use video footage of Singapore scenes of HDB apartments and condos (instead of the two slides I gave you) using your smartphone to capture some clips if possible. 

Intern to wait  a day and view the video to catch such grammatical errors before submission to me.

---------------------------------------

THE FOLLOWING IS NOT PART OF THE SCRIPT.  THEY ARE RESEARCH NOTES.

Dermoids are non-cancerous masses of fat, hair and skin found in an abnormal location of the body. Ocular dermoids are found in the eye. They are of two types. One is the LIPODERMOID . It is located in the conjunctival tissues near the lateral canthus. The other is the LIMBAL DERMOID. It is found in the limbus (junction of eye white and cornea). The surgical excision using electricity of this limbal dermoid forms the case study in this video. Shih Tzu puppies appear to be the top species to suffer from ocular dermoids according to cases seen at Toa Payoh Vets over the past 30 years. Surgical excision by Surgical blade No. 11 or in this case, by electro-excision are options of treatment. In this case, the owner did not want to leave his dog for 14 days as an inpatient. He took the dog back at Day 4. From the corneal healing at Day 9 when Dr Sing saw the dog, the outcome is excellent. No complaints from the owner for some months after the surgery as no news is good news.


-----------------------------
SUMMARY GIVEN IN YOUTUBE VIDEO

Dermoids are non-cancerous masses of fat, hair and skin found in an abnormal location of the body. Ocular dermoids are found in the eye. They are of two types. One is the LIPODERMOID . It is located in the conjunctival tissues near the lateral canthus. The other is the LIMBAL DERMOID. It is found in the limbus (junction of eye white and cornea). The treatment is surgical excision using surgical blade No. 11 and scissors. I do not know whether other vets have had used electro-surgery as treatment.

The use of electricity to excise a limbal dermoid forms the case study in this video. Shih Tzu puppies appear to be the top species to suffer from ocular dermoids according to cases seen at Toa Payoh Vets over the past 30 years. Surgical excision by Surgical blade No. 11 or in this case, by electro-excision are options of treatment. In this case, the owner did not want to leave his dog for 14 days as an inpatient. He took the dog back at Day


----------------------------------------------

THIS IS PART OF THE NEW SCRIPT to be read together with the above mentioned amendments. Intern has to make a mind-map to connect all together in making a final script.


-----------------------------  

15 Sep 2020. Script for Intern to create a BKTP video


(HOOK)

VIDEO HOOK WITH AUDIO




1. INSERT THIS VIDEO HOOK WITH MY NARRAION

https://www.youtube.com/watch?v=I1gp0HgUVZE&feature=youtu.be
Use footage approx  00:0 - 1:04 

2.  Then continue witH.................. 


Eyes are the first objects we see in a person or an animal. 
Pretty big clear eyes are attractive.

Eyes and a chrysanthemum-hair cut face make the Shih Tzu the top 3 small dog breeds as pets in Singapore. 


From my Toa Payoh Vets case files over the past 40 years, the Shih Tzu breed has the most incidence of ocular dermoid.  







Dermoids are non-cancerous masses with skin, hairs and fat. They can be found in people as well as dogs and cats.


There are two types. They are the 
limbal dermoid, being located in the limbus (sclera and corneal junction) 


and the lipodermoid which is sited in the lateral canthal area (where the eyelids meet in the corner towards the ear). 







As the hairs of the ocular dermoids cause eye irritation, most dogs feel uncomfortable and rubs the eyeball. The cornea becomes ulcerated and very painful. 

What is the treatment?

Surgical excision of the dermoid. The procedure is known as superficial keratectomy



Before surgical excision of the limbal dermoid in a Shih Tzu


Day 9 after superficial keratectomy


  THIS IS A BE KIND TO PETS VETERINARY EDUCATIONAL VIDEO: 


(Intern - to narrate the text in the slides above and below)

This video shows surgical procedures. Viewer discretion is advised. 


SINGAPORE is a city state with more than 80% of the residents living in apartments. Small dog breeds such as the Shih Tzus are most popular as apartment pets. 



The Shih Tzus appear to be the breed that is most affected by ocular dermoids, in cases seen at Toa Payoh Vets. 









SUPERFICIAL KERATECTOMY - ELECTRO-SURGERY - (Narrate above slide) 

I do not know whether other use electro-surgery to remove ocular dermoids from the cornea. This video shows the electro-surgical procedure to excise the limbal dermoid using electricity


THE SURGICAL PROCEDURES ARE AS FOLLOWS:



This is a normal left eye of the Shih Tzu. It has no dermoids





A limbal dermoid is at the junction of 
the sclera (eye white) and the cornea as in this case





Sedation is by IV ketamine and xylazine. 
General anaesthesia is isoflurane gas and oxygen. 





The dermoid is excised using electricity





3/4 of the dermoid has been excised.





The dermoid inside the cornea is being excised





More dermoid is excised using the circular loop





Be careful not to enter the eye 
causing rupture of the globe. No more excision
after over 90% of the dermoid has been cut out.

Care must be taken not to enter the eye when excising the dermoid. In this case, the site where the dermoid lay was not covered by a piece of transplanted cornea.  

A 3rd eyelid flap for 14 days facilitates healing of the exposed corneal epithelium. Antibiotic eye drops are applied daily for 14 days. An Elizabeth collar for 14 days prevents scratching of the eye.  In young puppies and kittens of less than 2 months, anti-inflammatory eye drops must not be used to prevent swelling and scarring. 


POST-SURGERY.
The owner did not permit me to ward the patient for 14 days after surgery. He wanted the dog back by Day 4. So, I took out the eyelid stitches sewing the eyelids together to facilitate corneal healing on Day 4 instead of Day 14. 

On Day 9 after surgery, I followed up and saw the corneal healing taking place. 



As to whether there will be corneal scarring later, I was unable to follow up. I electro-excised over 90% of the dermoid but not 100% as I did not want to risk the corneal laceration, rupturing the globe. 


CONCLUSION. 
SUPERFICIAL KERATECTOMY USING SURGICAL BLADE NO. 11 is the other option is to excise the limbal dermoid. 

A stay suture to elevate the eyeball can be placed on the conjunctiva at the medial canthus area for easier surgery. 

The outcome of the superficial keratectomy surgery is usually good. Care must be taken not to cut into the cornea in the excision of the limbal dermoid!



----------------------------------------------

22 Sep 2020.

THIS IS THE PREVIOUS SCRIPT - do not use this script.

15 Sep 2020. Script for Intern to create a BKTP video


(HOOK)
Eyes are the first objects we see in a person or an animal. 
Pretty big clear eyes are attractive.



Eyes and a chrysanthemum-hair cut face make the Shih Tzu the top 3 small dog breeds as pets in Singapore. 



From my Toa Payoh Vets case files over the past 40 years, the Shih Tzu breed has the most incidence of ocular dermoid.  










Dermoids are non-cancerous masses with skin, hairs and fat. They can be found in people as well as dogs and cats.

There are two types. They are the
limbal dermoid, being located in the limbus (sclera and corneal junction) 






and the lipodermoid which is sited in the temporal area (where the eyelids meet in the corner towards the ear - lateral canthus). 




THIS IS A BE KIND TO PETS VETERINARY EDUCATIONAL VIDEO: 




This video shows surgical procedures. Viewer discretion is advised. 





SINGAPORE is a city state with more than 80% of the residents living in apartments. Small dog breeds such as the Shih Tzus are most popular as apartment pets. 







The Shih Tzus appear to be the breed that is most affected by ocular dermoids, in cases seen at Toa Payoh Vets. 






ELECTRO-SURGERY - EXCISION OF AN OCULAR DERMOID IN A DOG
Dr Sing Kong Yuen, BVMS (Glasgow), Toa Payoh Vets 

I do not know whether other use electro-surgery to remove ocular dermoids from the cornea. This video shows the electro-surgical procedure to excise the limbal dermoid using electricity


SURGICAL PROCEDURES ARE AS FOLLOWS:



This is a normal left eye of the Shih Tzu. It has no dermoids




A limbal dermoid is at the junction of 
the sclera (eye white) and the cornea as in this case




Sedation is by IV ketamine and xylazine. 
General anaesthesia is isoflurane gas and oxygen. 




The dermoid is excised using electricity




3/4 of the dermoid has been excised.




The dermoid inside the cornea is being excised




More dermoid is excised using the circular loop




Be careful not to enter the eye
causing rupture of the globe. No more excision
after over 90% of the dermoid has been cut out.

Care must be taken not to enter the eye when excising the dermoid. In this case, the site where the dermoid lay was not covered by a piece of transplanted cornea.  

A 3rd eyelid flap for 14 days facilitates healing of the exposed corneal epithelium. Antibiotic eye drops are applied daily for 14 days. An Elizabeth collar for 14 days prevents scratching of the eye.  In young puppies and kittens of less than 2 months, anti-inflammatory eye drops must not be used to prevent swelling and scarring. 


POST-SURGERY.
The owner did not permit me to ward the patient for 14 days after surgery. He wanted the dog back by Day 4. So, I took out the eyelid stitches sewing the eyelids together to facilitate corneal healing on Day 4 instead of Day 14. 

On Day 9 after surgery, I followed up and saw the corneal healing taking place. 



As to whether there will be corneal scarring later, I was unable to follow up. I electro-excised over 90% of the dermoid but not 100% as I did not want to risk the corneal laceration, rupturing the globe. 


CONCLUSION. 


SUPERFICIAL KERATECTOMY USING SURGICAL BLADE NO. 11 is the other option is to excise the limbal dermoid.

A stay suture to elevate the eyeball can be placed on the conjunctiva at the medial canthus area for easier surgery. 





The outcome of surgery is usually good. Care must be taken not to cut into the cornea in the excision of the limbal dermoid!