Sunday, May 9, 2010

56. Don't buy 2 sibling hamsters

Saturday, May 8, 2010

Hi doctor sing,

I'm the owner of the hamster who developed the tumour (armpit) who just pass away today. I just want to say thank Q to u. At least now my hamster passed away without the tumour.

Actually i thought of collecting her home today, but after i receive a call saying she had passed away i really feel so sad. I think if i bring her earlier to surgery she might survive. I really feel bad. Any way i just get a new hamster today. : ) take care doctor sing.


Best regards
Name of owner : )

As I was off on Saturday, May 8, 2010, I went to Marine Sands Singapore to visit the place for the first time and to visit the owner of the hamster. I was going to tell her not to buy sibling hamsters but her colleague told me she had bought two hamsters so that they have company.

The hamster's sibling had recurrence of chest tumour of a similar appearance and died on the operating table on the 3rd anaesthesia and surgery some 2 months ago.

This hamster was not eating and was in weak condition when the young lady owner brought her in to get the tumour excised. I told her firmly that the risks were very high as she had waited too long, weakening the hamster's immune system.

The hamster was warded for 2 days prior to operation so that she could regain her appetite. She did not eat. She was given hand feeding, antibiotics and electrolytes for one day. I needed to operate since time was of the essence and she was getting weaker (closed eyelids, lethargic, few pellets of stools passed).

I used isoflurane gas for a few seconds and she did survive the anaesthesia and operation. She was alive at the end of the surgery but I told Vet Intern Theresa that the chances of survival post-operation are very slim.

I asked the owner to take her back for nursing after surgery. But she asked me to care for it a few days. Her hamster passed away peacefully the next day.

She was a very high risk surgical case. She would die soon if she was not operated as she had problems drinking and eating. However, surgery would give her a chance to live longer. In this case, the post-surgical outcome was not good. Surgery gave her a chance. No surgery meant imminent death. So there was no choice but to operate with the owner's awareness of the great risk. She understood the risk but was glad that the hamster passed away without a large armpit tumour.

Friday, May 7, 2010

55. Sibling with same tumour

E-mail to Dr Sing dated May 4, 2010

Hi doctor Sing,
This is Ann. i bring my hamster down to surgery this morning. The Hamster who develops a tumuor at armpit. Is it successfull?? Is she ok now? i hope she do.. thanks a lot.

The young lady brought the sibling dwarf hamster with a large armpit tumour. Her other hamster had died on the operating table during the 3rd surgery to remove the recurring tumour and she was very upset some months ago. The armpit tumour was nearly 1 cm x 1 cm in size and the hamster was not eating much.

"Why don't you bring the hamster earlier for operation?" I asked her since she had the experience of belated surgery in her first hamster. "It is so much easier to remove a small tumour."

May 5, 2010
It is best not to operate immediately as the dwarf hamster, l.5 years old was not eating much. There were some stools passed.

May 6, 2010
Hamster was not eating as evidenced by no stools passed. Her two eyelids were closed. This was not a good sign of health. I put antibiotics onto the eye and my vet intern Theresa fed her orally using electrolytes 0.5 ml per time. "Likes the Biolapis electroylte but not the Fibroplex," Theresa said.

Now, should I operate or wait another day for the hamster. The hamster was not eating now and its skin stood up as a fold because it was dehydrated.

I decided on anaesthesia using isoflurane and cut off the armpit tumour. The hamster was very weak and I gave her a few seconds of isolurane gas 5%.

Surprisingly, the hamster survived. Theresa is very good at nursing and I expect the hamster to be able to survive and go home.

P.S. No Zoeletil must be given as the hamster was very weak. Surgery could not be delayed further as the hamster needed his hand to grab seeds to eat and the armpit tumour of his right fore caused pain and affected his eating.

Wednesday, May 5, 2010

54. Oral ulcers + Caudal stomatitis in a Burmese cat

Gingivostomatitis (inflammation of the gums and mouth) and Caudal Stomatitis (inflammation at the back of the mouth). I report an early case as the Danish owners are animal lovers. Burmese cat, Female, Spayed, 7 years. Fever.

Complaint: "The cat used his paws to scratch her commissure of lips one month ago," the gentleman said it was more to the right side of the mouth. The wife said it was both sides. In the last 2 days, the cat pawed on the right side of the mouth more than the left side and would not eat her dry food. What's the problem?

EXAMINATION
I suspect toothache due to decay and loose back teeth but when I examined the cat's mouth, the teeth were in excellent condition except for tartar on all the four 3rd premolars. I smelt the mouth. No bad breath or very faint.

ANAESTHESIA: 3.6kg. Xylazine 20 + Ketamine 100 0.1ml +0.4ml one syringe IM sufficient.

Ulcers back edges of tongue (white fibrous granules) both sides 3cm x 3mm. Why?

Owner says that this cat has no stress. The dominant of 3 Burmese cats.

Cause: Unknown. Virus or bacterial infections said to be involved.
More common in purebred cats like this Burmese.

Unusual report in this case: No bad breath (I smelt the mouth). No loose teeth at all. No serious gingivitis but tartar is present in all the premolars 3. Dental scaling done.

TREATMENT:
Tooth extraction is said to be most effective but this cat has no loose teeth at this stage.

ADVICE:
1. Baytril and predniosolone anti-inflammatory injections.
2. Oral baytril
3. Tolfedine for 3 days next week.
4. Medazole for 3 days.
5. Soft canned food for the time being as the ulcers are painful. But this cat is fixated on dry food for the past 7 years.
6. To check back of tongue weekly forever and let me know when small ulcers recur. I asked the husband to get the wife to come into the consultation room to see the ulcers on both sides of the back of the tongue while the cat is still under anaesthesia. I shone the torch-light for her to see. Red strips and white globular fibrous tissues lined the ulcerated areas of around 3 cm x 2 mm. Bilateral and equal in length. Is this an auto-immune disease?

A very interesting case. See picture of one similar case in a dog not vaccinated too as owners seldom vaccinate their dogs or cats after 5 years of age. Could these two be due to virus?

52. Hamster with large armpit tumour

Sibling, 1.5 years old. Small tumour became large. Her previous hamster died under operating table at the 3rd surgery to remove the chest tumour.

"Why don't you come earlier?" I asked the sales girl. "Now, the tumour is over 1.2 cm in diameter in the right armpit area. It is very risky to operate."

"I have to wait till I earn enough," the girl said. "Now, my hamster does not want to eat much and walks with difficulty. So,I brought in for surgery."

52. CASE STUDY: HOUSE BREAKING Toy Poodle

Problem: Not house-trained after 2 months with owner.
Dog: Male, toy poodle, 5 months. Thin.
Owners: Young man in late 30s, elder sister and parents
Housing: Apartment - Free to roam but crated at night. Eliminates everywhere.
Consult Vet: Pimples on flanks and thighs 5 days after proheart vaccination. "Is it due to the proheart injection?" the young man asked. "No," I said. "Puppy skin is easily infected by bacteria s it is not mature. Happens in many puppies."
"What is the medical condition?" the young man asked me.
"Is it Impetigo?" the young man showed me the name in his smartphone screen. He had researched the internet well.

House-breaking
"My friend told me it takes 1 month to house-train a puppy," the young man said. "Now, it is 2 months and the puppy pees and poops everywhere."

Confinement
"You let the puppy out after the first night," I said. "
"Yes," the young man replied. "He was barking and barking and may upset our neighbours."

Monday, May 3, 2010

51. The guinea pig with two loose front teeth

I was shocked. The young lady closed her eyes and lowered her head as I took her guinea pig to the operating room. This young lady was extremely upset as she did not accept my explanation that her guinea pig would not die on the operating table under gas anaesthesia. Her other 2-year-old guinea pig who was following her mum around every day had died despite treatment by Vet 1. The guinea pig was not eating and just died. Some causes of death are unknown unless autopsies are carried out and this was not done. So, she imagined the worst for this guinea pig.

She had heard so many stories of anaesthetic deaths and this 2.5-year-old guinea pig needed some gas anaesthesia. "The guinea pig always bite the BBQ wire fencing every morning to ask for her breakfast. Today, a loud banging noise frightened her and her teeth was broken when she tried to run off."

"Isoflurane gas anaesthesia is very safe for guinea pigs," I explained to her. She would not accept my explanation and wanted to be present. "No," I said. "You will stress yourself and everybody by being present at the operating room. I have to focus on the anaesthesia and you will be a great distraction."

So, the young lady had to wait in the waiting area. The guinea pig squealed when I touched her. My assistant took out the face mask as this was the standard procedure. He was on auto-pilot. "No face mask," I said. "The guinea pig has two loose front teeth and they are loose and bleeding. The usual small face mask will cause pain as it will touch the teeth. The best method is to use a bag and put the guinea pig inside this bag. Go and get a bag" Teaching my Myanamr vet assistant is part of my contribution to society. Once he is good, he will be in great demand and goes away. This can't be helped. In fact, competitors have tried to lure him away from my practice as he has 2 years of experience at Toa Payoh Vets. I accept that he needs to secure for himself a better future. No employee works long in a place and two years were great. What he needs is another 2 years and he can open his own vet practice in Myanmar, after learning the tricks of the trade from me and my assistant Dr Jason Teo. He could also learn by job-hopping. Maybe.

I made my assistant think. He went to look for a plastic bag. "Take this narrow vertical plastic corner and put the guinea pig inside," I showed him the gadget which was wide enough to fit the small guinea pig. It was slightly longer than the length of this little pig and was open at the top. I found this narrow transparent plastic container shop and knew it would be useful as an anasthetic chamber for the anaesthesia of guinea pigs and rabbits. Plastic bags are poor alternatives.

"What to do with the open top?" I asked my assistant. He got some towel tissue, made a central hole and taped the tissue at the sides, thereby covering the open top. It was OK. The hole would be where the endotracheal tube would be inserted to pipe in the isoflurane gas. This was what we do for hamster anaesthesia.

I was thinking too. Is there an alternative to this paper-top cover up which appeared flimsy? "Just get a thick white towel to cover the top," I said. At the side, put in the gas.

We did that. The guinea pig turned her head away from the incoming gas. But since the whole container was covered, she breathed the 5% isoflurane gas. Suddenly, the whole floor of this transparent container had a milky white discharge. She had peed. Within 5 mintues, she was dazed. I took her out, examined the front teeth. They were loose. I just extracted them and presented them to the happy lady.

Since I was free, I gave her a ride to Agnes' pet shop where she had bought her guinea pig and wanted to buy some hay or "emergency diet for guinea pigs". I don't sell pet food and so I drove her to Agnes and at the same time, see the new pet shop set up by Agnes.

Agnes had not told me about her new pet shop. Since she had no more rabbit scabies problems for the past 6 months, I did not have any referrals from her. I thought she had closed her half-shop in Ang Mo Kio as I just can't figure how she could survive.

This new pet shop set up one month ago was bright and pretty. Guinea pigs, hamsters and rabbits were sold here. In clean plastic containers. No puppies or kittens. I was glad that Agnes had prospered as I know that the pet shop business is a cut throat underpricing business in Singapore.

"The guinea pig's teeth will grow back in two weeks," Agnes said. "Use a file to file the lower teeth every day." This filing system was what I advised the guinea pig owner now that the two upper front teeth was broken at the gum level and the lower front teeth would grow and grow. I was told that the guinea pig's tooth grows 1 mm per day. In 14 days, it should be 1.4 cm if what I was told was correct.

"You don't think that guinea pigs are dumb creatures," Agnes implied to me when I told her that the dead guinea pig of the lady owner used to follow the mum around every day and was said to be more intelligent than the one with the loose front teeth. "I have a client who spends a lot of time with her guinea pig. When my client says 'bang' and points her forefinger and thumb, the guinea pig falls to the side and plays dead." Certainly, Agnes is an authority on guinea pig behaviour.

I was admiring the new pet shop. Suddenly, a mother and daughter came in with a scratching rabbit. The story continues

50. The rabbit 's neck became bald suddenly

I was at a pet shop when a mother and her pre-teen daughter came in with a 3-month-old rabbit with no more hairs on the neck between the shoulders.

"The rabbit keeps scratching the back of the neck non-stop," the mother had bought the rabbit recently. Agnes, the pet shop owner whom I knew for some years and had excellent working relationships introduced me as a vet. "Do you have a name card?" the mother asked. Before I could take one out, the guinea pig owner whom I treated her guinea pig for loose front teeth and had driven her to this pet shop where she bought the guinea pig, handed my namecard to the lady. I was surprised.

"It is best to bathe the rabbit," I advised Agnes. "But rabbits at 3 months of age should not be bathed or they will die."

"They will not die," I told Agnes who had applied a spot-on insecticide on the neck between the ears behind the neck and between the shoulders. "You need to wash off the spot-on insecticide as it is irritating the rabbit. Use very warm water."

"The owner can bathe the rabbit at home," Agnes was reluctant to do it. I asked her to do it as there was an opportunity to rectify what went wrong. The mother and daughter were first-time rabbit owners and would not be able to bathe it. "The rabbit may fracture its legs too, if the owner does it". I could take over the bathing but that would not be the right thing to do as Agnes could easily do it.

"Why don't you bathe the rabbit and if the rabbit still scratches the neck with its hind legs, I will treat it," I said to Agnes. Veterinary costs are much higher and I know most Singapore owners have this culture of "seeking the groomer first." Groomers are more affordable.

Later in the day, the mother and daughter came to see me. "Is there less scratching now after bathing?" I asked. "Yes," the mother said. "I paid $30 for the bath which took half an hour. But the rabbit is still using the hind legs to scratch the neck."

I gave an anti-inflammatory injection subcutaneous and tried to provide the least veterinary cost to the owner. "Let me know if the rabbit still scratches," I advised the stressed mother. No complaints for the last 2 days. I presumed all are back to normal.

P.S
Hypersensitivity to spot on insecticides may occur in animals. The rabbit had been bathed with an insecticide powder but since it was still shaking its head, Agnes applied a spot-on insecticide.

49. Mind Your Own Business

Chinese Wedding dinners are very boring obligations unless one sits with a talkative group. A vet whom I still remember as a primary school boy in his mother's practice was hosting a wedding dinner and his mum invited me. I had asked to sit with a group of friends so as to enjoy my dinner. The bridegroom's brother was very helpful and found me a table with 5 people though it was meant for 10. A Myanmar vet technician who told me he was sitting in this table suddenly disappeared but there was Mr Goh, a veterinary drug salesman I had known for over 30 years. Mr Goh, another vet and her friend were good conversationalists and we had some laughter when my old friend, a retired vet called Dr X, came to sit beside me. I had not seen him for several months and it was good to catch up with him. Soon a Filipino vet technician joined us. For some unknown reason, Mr Goh, asked Dr X to give a lift back home in front of everybody. Dr X said in his usual quiet voice, "OK". While Dr X went back to his table where his wife was seated, the veterinary technician who had left as his wife was at another table, came to our table again. Mr Goh asked the waiter for a glass of brandy for him. A second glass was drunk. 

 

 

For some unknown reason, Mr Goh bragged about his doing a good service of getting a free ride for the technician. The technician announced calmly, "I will be taking a taxi with my wife home after the wedding dinner. We have to go somewhere." 

Mr Goh said, "Where do you want to go with your wife after the wedding dinner? It is already 11 pm?" This is where Mr Goh should mind his own business. 

The technician raised his voice, "You think that Filipinos can't afford taxi fares and must take lifts home! In the Philippines, I can afford a Mercedes." 

Dr X who agreed to give him a lift home drove a Mercedes. I minded my own business and kept mum. Mr Goh could not keep his mouth shut, "Dr X is going home in the same area as you live." This was a fact. 

The technician's eyes looked bigger and he stood up and shouted as loudly as he could, "You will not survive if you live in the Philippines." The wedding dinner crowd was not the hard-drinking noisy type. 

The bride had changed from her white wedding dress to red and was going round the tables to take pictures. As the crowd was the conservative type, there was not much cheering and toasting the wedding couple. So the technician's shouting could be heard distinctly. 

Suddenly the technician's wife came over and spoke to him. Her forehead wrinkled and she pulled him away from the table. This was an unforgettable incident and reminded me that it is best to "mind your own business." 

I can't figure out why the drug salesman would impose on Dr X to ask him to give a lift home to the veterinary technician, causing the latter to feel that he was penniless and could not afford taxi fares. 

Dr X was a retiree and was most hospitable and happy when he came to chat with me and those at the table. Resentment surfaced in unexpected situations and one should mind one's own business as there are better and less stressful things to do in life than doing "match-making" car rides.

Sunday, May 2, 2010

48. Puppy playpen + 2 pee pans bought. What to do?

SUNDAY'S CASE

Pembroke puppy brought in for examination as the pet shop seller gives a 24-hour guarantee.

1. If the puppy is medicated against diarrhoea or kennel cough, the disease of parvovirus and kennel cough cannot be seen sometimes. The owner must be aware of this fact. Parvoviral diseases take several days to show the symptoms. A parvo-viral faecal test may be done.

2. Pembroke Corgi with long tail. This is normal, I said to the owner.

3. House-training. The pet shop sold the owner a playpen which can enclose a pee pan and a bottle of puppy training liquid. He also sold another pee pan. "What advices did the Seller give you?" I asked. "Why is there an extra pee pan?".

It is a pity that Puppy Sellers in Singapore don't co-operate to provide detailed information on how to use the tools sold to house-train the puppy. Puppy house-training books written by Caucasians are many but they seldom have the detailed relevant explanations as for this case.

This will be an opportunity for vets to create goodwill by providing the information but this is seldom done too as it takes around half an hour to explain how to do it and a long queue is waiting on a busy Sunday. Use drawings.

4. I had taken a photo of my illustrations and explanation. Will upload at www.toapayohvets.com later. Maybe a book will be better. But is there a demand for such a book?

Scratches mouh and saliva-stained front legs

SUNDAY'S INTERESTING CASE STUDIES

Mar 16, 2010
A young couple brought their dog came in for consultation of skin lumps on the back spinal area.

Why did this 12-year-old male Shih Tzu have purplish stains on the upper part of his front legs? Bad breath, Thin. Treatment with antibiotics and anti-fungal wash. Advised dental 7-10 days later as this would be ideal time as dog had antibiotics and his mouth would be free of bacteria.

May 2, 2010 (Sunday)
No saliva stains. I was surprised to see pure white hairs on front legs now. So, the dog had not been rubbing his painful mouth with his front legs. Dental scaling and extraction.

ANAESTHESIA
All 12-year-old dogs are high anaesthetic risks. Blood tests advised but not accepted. This must be recorded. Isoflurane gas anaesthesia is the safest method.

TEETH
15 loose teeth extracted. Dog goes home. Should be living longer now.

CONCLUSION
It is best to get your dog dental scaling from 2 years of age and every year or two, rather than live with bad breath and saliva-stained front paws. After the dental, he permitted his mouth to be opened as there was not much pain now.