936. Chronic Otitis Externa - Ear surgery

On Sunday, April 8, 2012, at 3 pm, I met an old client at Toa Payoh Vets. Nowadays, I seldom consult on a Sunday afternoon. But on this Sunday afternoon, I was around to do my "audit and trust" review of cases done by associate vets. This is to ensure a high standard of veterinary care to be provided by Toa Payoh Vets.

Mr Ong had come to pick up his poodle. My associate vet had told him that his poodle required a "medical bath" yesterday and somebody called him to pick up his dog at Toa Payoh Vets. The dog was at another place. When the dog arrived, I examined his dog. The sides of the ears were blackened due to continuous scratching over many years and the neck skin was bald.

"Your dog need an ear surgery," I said to him. I checked his dog's medical records and noted that he had sought itchy ear treatments since 2009. He told me about his poodle's continuous scratching since young. "You had advised an ear surgery before," he said to me. "I went to see Dr Jason enquiring about an ear surgery. He said that the ear surgery is very complicated. The cause of this poodle's ear problems could be genetic or food allergy. Therefore, he recommended a medical bath and medication."

The ear surgery is called lateral canal resection. It is described using images of an operation I did on a Miniature Schnauzer to educate dog owners.

Any updates on the poodle to be operated by me 8 days later will be at the Website:
http://www.kongyuensing.com/folder8/20120408ear-resection-surgery-smelly-ears-chronic_ToaPayohVets.htm

935. A hamster from Ireland - vaginal bleeding

E-MAIL TO DR SING DATED APRIL 8, 2012

Hello Dear Dr. Sing Kong Yuen,

I wish you were in Ireland, my hamster Gordita needs you. Please help me with an advice, we ll be grateful and pleased forever.

My hamster Gordita started bleeding from her vagina about a month ago. We didn't know what to do so we took her to the vet who said she had an infection and gave her an antibiotic. Since then she has had 11 injections of antibiotics, including a period of seven in seven days. She's also occasionally been given fluids.

The hamster's condition seems very up and down. Twice she has seemed to have recovered, on other days she has seemed very lethargic and in a lot of pain. She was very lively today, but she is still bleeding occasionally.

What should I do? She is very tough but we really think that she's had enough of injections (we've insisted on giving her the new dose with a dropper.) The vet seems very nervous at the idea of an operation. He's a bit more used to bigger animals we think.

Gorda walked into our lives when we lived in a basement flat in England. She walked into the bathroom and after the initial shock, we caught her and gave her a home when we couldn't find her owner. We only actually knew it was a she when this illness started. Because of the strange way we found her we're very attached and we want to do what's best.

Please tell us if it is worth continuing with the shots, should we ask for an operation or are we really on a hiding to nothing? Will the bleeding stop during treatment or at a later date after treatment?

Thanks in advance to you for your kindness to give us an answer,

E-MAIL FROM DR SING DATED APRIL 8, 2012
Thank you for email.
You did not specify the age of the hamster nor the vet's diagnosis, name and dosage of injections given. Any oral medication?. So, it is much difficult to advise by email. Pl provide above info and 3 images of bleeding area. Is it vaginal bleeding or tumour or what is the cause? Images are essential in email queries.

E-MAIL TO DR SING DATED APRIL 9, 2012

Hello again Doctor,

Thank you very much for your answer.
It is vaginal bleeding but the cause has not yet been 100% identified. The vet initially thought it was an infection in the uterus. Now he thinks it could be endometriosis. but now is not so sure. She received Baytril by injections in an insulin syringe in small quantities but I don't know the precise dose. At the beginning she had 4 injections during 1.5 weeks, due to she was not better, she had a period of seven in seven days. She also received some fluids to try and flush her system out. She is receiving baytril (2 drops/day during 5 days) now orally as the injections were causing some sores on her neck.

We don't know exactly how old she is because we found her. Well, she found us as one day she just walked into our apartment. This was roughly a year ago, and we estimate that she was 3-4 months old before this.

I've enclosed some photos, which are not of the best quality but may help you understand it a bit better.

Thank you very much for all your help.

Kind regards,


E-MAIL FROM DR SING DATED APRIL 9, 2012


Hi
It is difficult to see whether there are vaginal tumours as the images are not clear.

However, your vet would have checked. Most likely, there is an infected tumour of the female reproductive system. It is high risk to operate on the hamster to remove the tumour as the hamster is unlikely to survive.

My advices are:
1. Stop the hamster exercising in the ball for the next 4 weeks and be on a course of oral antibiotics at the appropriate dosage for 7 days.
2. Get your vet to do a bacterial culture and antibiotic sensitivity test of the vaginal discharge
3. Get your vet to get the lab to examine the cells of the vaginal discharge to check for tumour cells.

Best wishes

934. 2 guinea pig cases. Guinea pig with blood in the urine follow up and 2 GPs in a DBSS flat

CASE 1.
E-MAIL FROM DR SING DATED APRIL 4, 2012

I have checked the X-rays. No radio-dense urinary stones were present in the bladder. You will need the urine tests to confirm possible bacterial infections of one or more GP. Also increase water intake, don't give excessive Vit C tablets. Separate all 3 GPs since 2 have runny nose as they are likely to be bacterial infection. Vet check up and urinary tests as soon as possible, are advised

E-MAIL FROM OWNER TO DR SING DATED APRIL 4, 2012

Okay sure. Will collect the urine ASAP and bring them in for a check up. Thanks a lot Dr Sing

Sent from my iPad


CASE 2.
Yesterday, April 7, 2012, Saturday, I visited a young couple who had a one-month-old baby gathering. This was the first time I had visited a DBSS (Design Build Sell Scheme) apartment and so I was most interested to find out how a DBSS looks like. DBSS flat is built by private developers for HDB (Housing Development Board) applicants and come with better quality finishes.

I saw 2 guinea pigs and asked the owners how she maintained them during the past 7 years or so. The parental stock gave birth to 2 litters. Now, the dam (6 years old) and the daughter GP lived in the DBSS. "Too much hair loss and so we shift the GPs to the balcony from the rooms," the young wife told me. The local Chinese believe that hairs flying around the apartment are not good for the new baby.

I noted that the dam had sparse coat and asked why. "She sheds now and then. Sometimes, full coat. Ask my husband. He is the one caring for the GPs. The daughter has a full coat."

"Do you feed Vit C tablets?"I asked.
"No, we feed vegetables and the GP mixture for the past years."
I advised feeding Vit C tablet to the dam but the cause is surprising since the daughter GP has a full coat. Mites?

"When did the dam give birth? Before or after 8 months?" I asked.
"When she was one year old and she gave birth two times. No problem." So, this is a case where the GP book says that GPs must give birth before 8 months of age as the pelvis will close (fusion of the pelvic bones narrowing the pelvic inlet) has stated incorrectly.

For this couple, the husband had kept the GPs for the past 6 to 7 years and there were no health problems. The daughter and dam would rush back into the cage when let out, the wife told me. So, there was no problem.

This DBSS flat has a beautiful view of the surrounding flats. Breezing. DBSS flats come with air-conditioning in the bedrooms, bay windows, even in the master bathroom, narrowing the bathroom shower space to barely two body-width! The bay windows are not allowed to be demolished and so the owner had to cram into the master bathroom to shower since the bay window took up 30% of the width of the shower stall!

Sometimes, I think the architect of DBSS does not know what he or she is designing.

933. Follow up: Ear itchy in an old dwarf hamster - 2 year 8 months old amputee

The 3-legged hamster has itchy ears
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
07 April, 2012
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
"Her sibling died from ear tumours," the lady owner said to me. "This is why I am most concerned about Bean who had been scratching both her ears recently."

I had recorded this hamster's fascinating history in the following webpages:

HISTORY - FIRST CONSULTATION JULY 31, 2011
1. http://www.sinpets.com/F5/20110733three-hamster-surgery-follow-up-Singapore-ToaPayohVets.htm

2. http://www.sinpets.com/hamsters/20110808dwarf-hamster-break-a-leg-a-ear-Singapore-ToaPayohVets.htm
Hamster 2- A fast-growing bony leg tumour is being removed to save her life

Hamster 2 - The leg had to be amputated as the tumour involved the bone below the knee and above the hock. Surgical outcome was excellent.

This hamster's life was extended and as at 2 years 8 months of age, he looks normal (see pictures below) and weighs 26 grams (with careful management and feeding by her lady owner).
PRESENT DAY APRIL 4, 2012
The hamster is 2 years 8 months old, 26 grams, scratches both ears. Eyelid area bare due to rubbing. Ear edges a bit blackish due to rubbing.

"See, she is scratching her ears now," the lady said. The hamster used her front paws to rub vigorously. Before I could whip up my camera to take an image, she had stopped.

PROCEDURE ON APRIL 4, 2012
A very old dwarf hamster at 2 years 8 months. High anaesthetic risk. But no choice as the hamster did not like handling. Anaesthesia was required to examine the ears as the owner was worried about the hamster dying from restraint by the vet.

Isolfurane gas
Wax nodule seen in each ear. This nodule was deep inside the ear canal and would not be visible on general examination. I showed the nodule to the owner.
Forceps picked up nodule. Use appropriate-sized forceps.
Ear irrigation done on both ears
Ear drops to be used when necessary. The owner knows how to do it.
No medication given
To observe
Itchiness problem over the past 8 months was hard to resolve. Could it be from the nuts, the environment, dust mites, mites, fungal infections or others? Even ear wax nodule too?

DIET
"She is not as itchy as before. No more nuts eaten now," the lady said to me. There was prolonged skin itchiness some weeks ago and I had advised not feeding nuts at all and applied a spot-on insecticide on the body.

"The spot-on insecticide had worked," Dr Daniel said. Now only the ears are itchy, but this hamster could have been suffering from other allergies such as nuts. Since no nuts are fed, it is assumed that this hamster did suffer from at least, nut allergy. Bedding also had been changed to paper towels, exercise wheel had been elevated higher to prevent friction when the hamster hides under it. No sand bath anymore to prevent sand particles entering the ears and causing itchiness and infection. Yet ear wax formed in a clump in both ears and irritates the hamster.

CONCLUSION
This is a strange case of excessive ear wax in an old hamster.

Website for latest updates and more images:
http://www.bekindtopets.com/stories/20120406old-dwarf-hamster-ear-wax-itchy-ears-singapore_ToaPayohVets.htm

932. Schnauzer has shivering and high fever. Why?

On Saturday, March 31, 2012, I was off and the owner of the Miniature Schnauzer operated by me to remove an epidermal cyst on his upper neck area came to consult Vet 1. Vet advised the owner consult me on Sunday as I was the operating vet. No news from the owner. On Monday night, she went to the emergency after hours surgery as the dog had started shivering. Vet 2 referred her back to me. The owner came the next day, April 3rd.

"Why didn't Vet 2 treat the dog?" I asked.
"The consultation fee was very high and so the vet asked me to bring the dog to see you."
"Any injection given by Vet 1 or 2? Any medication?" I asked.
"None," she said.

Well, the dog was operated by me 10 days ago. So Vet 1 and Vet 2 must have presumed that the operating area was infected. This is logical. I felt the area by pressing on it. No pain or inflammation.

"Why is there the yellow powder?" I peeled off the scabs but found no pus.
"My grandpa applied the yellow lotion to prevent the dog scratching."
I had advised simple cleaning with cotton swab and plain clean water. Plus put a plaster on.

WHAT WAS THE PROBLEM OF THE DOG'S HIGH FEVER,RECURRING AGAIN DESPITE ANTIBIOTICS?

931. Vit C is very "safe" for guinea pigs, the groomer said.

Today, Wed Apr 4, 2012, after lunch, I visited a groomer with Dr Daniel who bought some dog treats.

"What is the daily requirement of Vit C for a guinea pig?" I asked this pet shop operator who sells guinea pigs of all colours and can be considered a local expert on guinea pigs.

"Vit C is essential for GPs since they don't manufacture Vit C themselves. So a daily intake is essential," she said. "Otherwise they loose hair and loose the shine in their coat.

"How much of Vit C should be given? How many mg/kg of body weight?" I reiterated

"I don't know the mg," she said. "Usually 1 tablet/day, hand-fed or 1/4 teaspoonful of the organic Vit C powder/guinea pig sprinkled onto their food. Vit C is very safe. You will not kill GPs with excessive dose."

She sells 90 tablets/bottle and the "holistic" organic powder in a bottle costing around $37.00.

"If you say Vit C is very safe, what if the GP owner gives 5 tablets/day? Give more to get a shiny coat."

As she was busy going for medical check up of a "trigger finger" in her left hand's middle finger, I did not detain her as her husband was about to drive her and her 3 children to the hospital. Her middle finger could not flex normally and fully. The doctor had given a steroid injection at the base of the 3rd finger some days ago and asked her to get an operation done. "My client asked me to try Chinese medicine," she said as she left for the appointment.

Later she sms me

"Hi dr song thanks for ur concern. Now waiting for my turn to go doc. Just FYI, excess vit c may cause a little bit stools but very seldom people wld give up to 5 tablets. So far, max is 3 tablets to ensure healthy shiny coat."
Some information from her:
1. Onset of maturity. Male 3 m. Female 4 m. Generally 1st mating is 5-6 months despite what GP books says about earlier age. Usually after 5-6mths

2. Breeding. 8-months limitation. Pelvic bones fused by this age, leading to narrow pelvic cavity, then dystocia. If breed after 8 months.   Dam and young may die.
If first litter is born before 8 months, the GP can continue breeding.

3. Signs of scurvy in GPs. Hair loss a lot initially. Dull coat. Bones weak.

4. Urinary stones in the bladder. Males get this problem. Mainly male GPs from 2 years onwards.

5. If give vegetables, some GPs get diarrhoea.

6. Vit C tablet. Owner must hand feed. Break into half piece. Aroma attracts GP to eat. Most customers give 3 tablets Vit C/day to get a nice coat. So 1 bottle of 90 tablets per month.

7. GP weight in Singapore's GP. Usually 900 g to 1.1 kg. Some weigh up to 1.4 kg. If GP is housed in a big crate or has garden exercise outdoors, it grows to 1.4 kg. If not, they are generally 900 g-1.1 kg.

I am surprised she type "dr song" as I am not "song". There is a dr song as a vet.

930. One or more than one of the 3 guinea pigs passed blood in the urine.

Which guinea pig passed blood in the urine? One had died and X-rays showed big urinary stones.

X-rays and urine tests are needed for the 3 young GPs. X-rays done by owner and the results are:

I have checked the 6 X-rays. No radio-dense urinary stones were present in the bladder. You will need the urine tests to confirm possible bacterial infections of one or more GP. Also increase water intake, don't give excessive Vit C tablets. Separate all 3 GPs since 2 have runny nose as they are likely to be bacterial infection. Vet check up and urinary tests as soon as possible, are advised

929. Productive cough 1 month - nocturnal cough?

Just phoned the owner who came yesterday Sunday at 10.30 am with a shih tzu, male, 5 years that coughed for past 1 month.

"Much better," she said. "Less white mucus coughed out."

HISTORY is quite interesting
Feb 2012 - Vet1 for eye ulcers, then Vet 2 as the eye ulcers did not heal. Vet 2 quickly referred her to Vet 3 as he does not deal with eye ulcers. Vet 3 tested eye with green fluorescein stain and gaave eye drops. Apparently ulcers healed. "My dog's tongue reacted, like curled up, wen I applied eye drops," she said.

Soon in March 2012, the dog started coughing white froth.
Went to Vet 3. X-rays taken. "Nothing wrong," Vet 3 and Vet 4 in the same practice was consulted soon. Drugs prescribed were pred, codeine, diphonxylatel, bromhexine.
"Less coughing," she said but then the coughing got worse. So she came to consult me.

I asked her to get the X-rays and history if possible. Whatever it is, the harsh coughing, sore and painful throat must be relieved. That is the challenge.
I took a blood test, heartworm checking was negative.

I gave the injections to relieve the coughing as white foam keep coming out of the dog's mouth. Heart sounds were not audible as harsh lung sounds and throat sounds overwhelmed and were noisy. I advised canned food, not dry food for the time being.

Today at 2 pm, I phoned this lady from Aljunied Road. She was quite happy as the dog was much better.

Any distress must be relieved. The owner can be as stressed out as the dog coughing all night long. The case is being investigated and I reminded her of the X-rays. and review 7 days later.

No second chances if the vet can't resolve the problem. So, was the coughing a reaction to the eye drops? Or something more sinister like heart problem? Need to investigate further. Coughing was said to be worst at night. Nocturnal cough?

928. Sunday Apr 1, 2012's interesting case

Sunday Apr 1, 2012

1. NO SECOND CHANCE
I had a few cases where the owner had been to a vet practice but their dog's problem still persist. There seems to be no 2nd chance nowadays.

In this case of the "dog with frothy vomitus and persistent coughing," X-rays were done by Vet 1 and Vet 2 of the same practice but the dog continued to cough. Cough medication and other tablets were prescribed and apparently the X-rays of the chest were normal. Why? is the dog still coughing ferociously?

"Bring me the X-rays for my review and 2nd opinion. Also, the medical records of Vets 1 and 2. This will save you some money," I said to the busy lady owner who wanted to do so immediately. In the meantime, I will check the blood test first.

The heart sounds were hard to hear as the lung sounds were harsh as the dog kept coughing. Ausculation of the throat and lungs revealed harsh long continuous coughing sounds. I told the owner that I would need to stop the coughing and follow up. It would be hard to diagnose immediately.


HOUSE-CALL - A 5-year-old male Golden Retriever slipped and his hips were very painful. He could not move and so could not come to the Surgery.

I could do the house-call but it was better to let Dr Vanessa do it to gain the operational experience. A systematic approach and efficiency are important in doing house-calls. Otherwise, the whole process will take 2-3 hours. I came to the Surgery to help clear one case of a Westie with black ears, black neck, black front paws and black scrotal inguinal area. The older woman diagnosed Westie skin disease and said: "I ought to get him treated by the vet earlier."

"Yes," I said. "Westie is well known for this skin disease."

I phoned Min at 7.10 pm. He had reached Bedok house with Dr Vanessa. "The dog is walking and the owner wants to walk him to the park to pee. It will take 20 minutes."

"The dog had a severe injury and should not walk," I said to Dr Vanessa. "In the middle of the night, he would whine with pain and it will cost the owner lots of worries and money to get the vet. Dogs have a high tolerance to pain. Educate the owner and deal as you deem fit."

Earlier, the owner had said that the dog could not move an inch and now, the dog wanted to walk to the park to pee. The dog ought to be sedated to rest - that was my plan.

ABANDONMENT OF DOGS
The owners of an old cocker spaniel and a Golden Retriever did not bring the dogs home despite phone calls. Could this be considered abandonment and what to do with the dogs?

927. E-mail from Kuala Lumpur hamster owner

Claire ...@gmail.com

April 1, 2012 12:23 AM (7 hours ago)


Hi Dr Sing,

I do not know if you will get this mail 'in time' or that I may be too late already.
Either way I feel that I would try anything right now to save my beloved hamster.
I am in Kuala Lumpur, Malaysia.

Ham is 25 months old, very ripe old age.
Started in Nov last year (he was about 18-19 months old), his health started to decline, I presumed due to old age. He suffered some fur loss, his skin had some small black spots and definitely a decline in activities. I did bring him to our local vet here, who did a skin scraping on the black spots to determine if mites or not, and nothing came about. Ham was then diagnosed with a mild Cushing disease, but was advise to just leave him as he is, since he had no problems living his life.

Fast forward to couple of weeks ago, I noticed Ham had some sores/wound on his belly. Large gaping sores, I brought him to a vet again, and was given an antiseptic cleaning lotion and antibiotics. I faithfully cleaned his wounds twice a day and fed him the antibiotics once a day as instructed by the vet. I noticed the sores healed, but not long after, another one popped up.

Early this week, his health took a rapid decline. I thought things were better since the antibiotics was working. But then I noticed he started to sleep daily, did not eat much and lost his eyesight. He became very weak, and frail, and when picked up, he weight very light and was very limp. He does not eat much and I feed him baby food as it is easy to swallow. He still pees, but have not seen him poo. I thought it was his time to come, as he is an old hamster.
What I did not know, I found out today. And I don;t know if I am too late already. I found he had a lump at his neck (throat area)

The thing was when he started to grow older, he developed loose skins around his neck. It was nothing alarming as it was expected when the hamster gets older, but it might have been these loose skin 'masking' the lump until it is affecting him.
The lump us not very large but visible.

My Q is - is it possible for operations? I am asking because I have been googling and found this site: http://www.sinpets.com/F6/20110323massive-neck-tumour-syrian-hamster-surgery-toapayohvets.htm

But I am in KL Malaysia, my Ham is weak and not as alert as this ham in the picture.
Please can you advise if surgery is even something to attempt in Ham especially in his condition right now. So far I have yet to properly find any vet here reliable and as caring as I have read in that article above..

If you have advise please help, I am willing to take opportunity if there is, to save him. Many thanks!

E-MAIL REPLY FROM DR SING
I am Dr Sing from Toa Payoh Vets. Thank you for your e-mail. It is very difficult to diagnose by e-mail as NOT all hamster lumps are the same.

In reply, from your description, your hamster is lethargic, not eating and has several skin infected areas (most likely owing to a poor immune system). He unfit for anaesthesia and is very likely to die on the operating table. Definitely he is much older than the Syrian hamster with the neck tumour operated by me.

In conclusion, hamster owners do need to check their hamster for skin lumps daily, even under loose skin or hairless skin. Weigh the hamster weekly to ensure no weight loss. Tumours that are small are easily excised.

However, you may need to find a vet who does operations on hamsters as some vets do NOT perform surgeries, but simply prescribe some medications in the hope that the "lumps" will disappear. Some hamster owners consult the pet shop operators who will sell a "cream" to "shrink" the tumours. Both practices usually do not work unless the lump is a small skin abscess.

Best wishes.


MOST OLDER HAMSTER TUMOURS CAN BE EASILY EXCISED IF THEY ARE SMALL BUT MOST HAMSTER OWNERS WAIT AND SEE OR USE PET SHOP MEDICATION.