1047. Dwarf hamster with tumour/wart from Beijing

Hello Dr Sing,

Thank you for sharing priceless info regarding hamster's condition on the website. I found you on this site and I'm relieved to know that there is a possibility to address the condition.(http://www.

bekindtopets.com/animals/
20090122Hamster_Roborovski_Wounds_Warts_ToaPayohVets.htm).

I'm writing from Beijing and I seek some advise regarding a growth on my hamster which I now know is called a wart. My hamster is 2+ years old and he had this wart growing on the side of his toe since January this year. Occasionally there is pimple-like 'head' that pokes up, and I have tried to extracted it myself. We also did consulted a vet and she content is skin cells & sebum related.

The wart seemed to have steadied in size, but the pimple-like thing would come back after we extracted it.

I've attached a picture of the wart, and the size of it. Please have a look.

I would like to know if its possible to surgically have this removed safely - cut off at wart stalk?

Will there be a lot of bleeding and is it high risks?

I understand that we have to put him under gas isofluorane.

I appreciate your time and advise, and look forward to hear from you regarding this matter as I will talk to my local vet to have this administered.

I go to an international vet, but hamsters are not common patients here. So I would like to be informed and perhaps refer my local vet to your website for references as well.

Thank you in advance and I really hope to hear from you soon.

Regards,

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E-MAIL FROM DR SING DATED AUG 18, 2012

Thank you for your e-mail.
Surgical excision under anaesthesia is the solution.

1. If there is a stalk attached to the skin, the vet will just cut off the stalk, apply potassium permanganate powder to control the bleeding or apply pressure bandage. 
2. If there is no stalk, there will be a big piece of skin cut off, exposing the bone, muscles, ligaments and tendons. If the wound is <5mm after="after" be="be" br="br" cared="cared" for="for" infection.="infection." it="it" needs="needs" prevent="prevent" surgery="surgery" to="to" well="well">3. If there is no stalk and the tumour has invaded deep into the bones, then amputation of the 5th digit + tumour will be the solution. 6/0 stitching may be needed to close the skin wound.
4. Electro-excision, using electricity is an excellent procedure for this case. Electro- excision controls the bleeding.   

Overall, the surgery is low risk and is done in 2 seconds. The anaesthesia is the high risk in old hamsters. The bleeding in this surgery usually does not kill the hamster as the bleeding can be controlled. You may need to locate a vet who is comfortable in performing hamster surgery.

Please let me know the good news after surgery.   

Blogger.com has some software bugs as the above 2 images were uploaded in the correct position but appears in an abnormal position 

The article is at:
http://www.bekindtopets.com/animals/20081130Hamster_Anaesthesia_Surgery_ToaPayohVets.htm

1046. Female poodle, 4 years with mast cell tumour

"The dog had a lump on the junction of the upper and lower lip on the right side of the mouth. The owner went to Vet 1. He gave some medication. But the lump grows bigger," the friend of the Pom owner said to me. "It is just an abscess. An abscess. Just squeeze it will do." This friend had operated a pet shop before and was now thinking of doing a coffee business in Hainan where his ancestors lived. This young man had given up operating a pet shop and grooming business. He was looking for other ventures.

I palpated the lump on the right lip commissure. It was 8 mm x 6 mm x 6 mm and was firm. "It is not an abscess," I said. " It is a tumour. That is why Vet 1's medication did not work."

Dr Daniel excised the lump using electro-excision and anaesthesia. He stitched up the wound. Then he sent it to the lab for histopathology, after seeking the owner's permission.

It was a mast cell tumour, with some mitotic figures seen. In other words, a malignant tumour. It was likely that the tumour would spread or grow and the owner was informed.
 

1045. The vet "suspects pyometra"

A vomiting female dog. Gastritis or closed pyometra?

Miniature Schnauzer, Female, 8 years, not spayed. An old client of mine but I had not seen the dog for the past 7 years since the puppy vaccination. This is a common situation as the owner might have gone to other vets or just left the dog alone.


August 11, 2012
According to Vet 1's medical record,

Presented for vomting several times, abdominal disension was notes and "suspect pyo" was recorded. Blood test was recorded as the total white cell count and neutrophils as "moderately" increased. Advised spay.

The dog was warded for 3 days. Vomiting disappeared on the 3rd day and the owner (Sister 1) wanted to take the dog home on August 14.

August 15, 2012
I was at work in the evening of August 15 and saw Sister 1 with the dog. She said: "My dog is still vomiting." I checked the records and examined the dog. I put her on the consultation table, palpated the swollen abdomen.

The dog gave a yelp as I palpated. "There is a swollen abdomen which is also painful," I said. "The total white cells of 22.4 (normal 6-17) is high. The neutrophils are 96.3% which indicated a bacterial infection as normally they are around 70%. Based on the findings, this dog is suffering from closed pyometra. An X-ray is not needed unless you want it done."

However Vet 1 said an X-ray would rule out any foreign bodies inside the stomach or intestines as the one of the owners (Sister 2) had said that the dog ate some things.

August 16, 2012"How's the X-ray?" I asked Vet 1. "Does it show pyometra?"
"There is a lot of gas," Vet 1 did not think there was pyometra. "In any case, the owners agreed to the spay."
I saw Sister 1 in the evening at around 7.30 pm. She said: "Now the dog is eating and there is no vomiting, it will be better for the operation tomorrow since it is already late."
"We can still do surgery even at 8 pm," I said.

August 17, 2012The dog was operated. The dog's uterus was full of pus. So far, so good today August 17, 2012. The dog was on her chest and looking around. If vomiting returns, this will be bad news as the kidneys could have been severely damaged.

Conclusion
Time is of the essence in closed pyometra cases as toxins are being absorbed into the blood stream from the swollen uterus. The antibiotics given killed some bacteria and stopped the dog vomiting. So Sister 1 wanted the dog home.

But the toxins are not expelled as the cervix has closed. So the dog starts vomiting again. Toxins damage the kidneys and liver if the owners delay surgery further. Some older generation would not want surgery till the dog collapses.

Owners need to be properly educated. "Vet 1 says 'suspect pyometra'", Sister 1 remarked. Therefore, since the dog had stopped vomiting on Day 3, she wanted the dog home. X-rays or ultrasound should be advised and done during the 3 days of hospitalisation. The vet must be spot on in his or her diagnosis of closed pyometra based on history of heat around 6 months ago in around December 2011, (in this case, Sister 3 said the heat was in Feb or March 2012 throwing Vet 1 off track and thinking of gastroenteritis.)

VOMITING
An older unspayed female dog.
A swollen painful abdomen
A high total white cell count with high neutrophils and low platelet count
are clues to a tentative diagnosis of CLOSED pyometra. It is an emergency.

This case's blood test results are:
Total white cell count 22.4 (6-17)
N=96.3%   Abs = 21.7
L=3.6%     Abs = 0.81
M=0.1%    Abs = 0.02
E=0.1%    Abs = 0.02
B=0%    Abs = 0.00

Platelets 107 (200-500). No platelet clumps but few giant platelets present.


The vet must not confuse the owner with the wording "suspect pyo." as owners don't know the severity of this closed pyometra situation which could kill the dog if surgery is delayed.  

1044. The young generations prefers emails and sms

Hi Dr. Sing,

It has been awhile since I last emailed you. A lot has changed in the past few months and ........ has ceased operations due to a lack of clients. I did however, see that you are employing vet techs in your clinic. I was wondering if I am eligible to apply? I have extensive experience working with animals. Attached is my resume, maybe you can have a look and tell me what you think?

 

On Aug 15, 2012, at 9:21 AM, Kong Yuen Sing wrote:

Pl come for an interview at 9.30 am on weekdays this week as regards vet tech job or other collaborations. My phone is 9668 6468. Thanks. 

 

 

 

On Wed, Aug 15, 2012 at 2:32 PM, ...@gmail.com> wrote:

Thank you Dr Sing for the opportunity. I would like to know what the average pay is like as well as I have a sick father to support at home. To be honest, if it is too low I wouldn't want to waste your time as well. I hope you understand.

On 16 Aug, 2012, at 5:03 AM, Kong Yuen Sing <99pups@gmail.com> wrote:
Pl let me know what pay you expect and what hours you will put in.


On Thu, Aug 16, 2012 at 10:28 AM, ...@gmail.com> wrote:

Hi Dr Sing,

I am intending to work full time, any hours. My expected is salary is $2500 per month, but I really don't know what is the market norm. Do correct me of you think I'm expecting too much.

 

EMAIL FROM DR SING DATED AUGUST 17, 2012

If you are free, it is better to have an interview. Working "full time" and "any hours" has different meanings to different people. So, it is not possible to market yourself just via emails. Your resume shows that you don't have "vet tech" experience but there are other positions in Toa Payoh Vets.

Unfortunately, interviews cannot be avoided if you want no misunderstandings. A person can be worth every of the $2,500 salary if he or she can contribute and earn much more for the company with new ideas and concepts that vitalise a company and increases its revenue. Just talking about $2,500 salary expected for a "vet technician" position just does not have any meaning unless experiences, testimonials, duties and responsibilities and performance can be known. 

1043. The cat gives the four-digit draw to the owner

The mother and her young adult daughter adopted this cat as a stray kitten 3.5 years ago and came for the regular vaccination on receipt of the vaccination reminder card. So, I saw them today as they had booked an appointment for me to vaccinate.

"You were the one who spayed her when she was 10 months old," the mother said. "She was making a lot of noise and you charged $150." I checked my record. Yes, it was dated June 29, 2009. How time flies. The daughter had graduated and had worked for Jet Star as a cabin crew for 2 years. "

"The cat's receipt 4-digit draw number came out on Saturday (Aug 11, 2012) and Sunday (Aug 12, 2012)," the mum said to me. "On Saturday, it was 2nd prize for the number 5124 and on Sunday, 2415 was lst prize!"

"How much would you get for the first prize?" I asked.
"$2,000 for a $1.00 bet," she said.
"Did you get it?"
"No," she said. "I bought the number 2451". The cat's receipt number on the first visit 3 years ago was 12451. I know of one other owner who did make money buying the 4D on receipts from Toa Payoh Vets.

"Why didn't you buy all combinations of 2451?" I asked. "You would have won $2,000 on Sunday and some amount on Saturday!"
"I would have to pay $24 and it was too much. I usually buy $2.00. I had been buying other numbers as well."

In this case, there was a vaccination reminder. She made an appointment to see me whereas last year, it was Dr Vanessa. The Gods of Fortune came. This is a true incredible 4-D story. The cat was plump and well cared for. "Where does she scratch her paws?" I asked. "Onto the sofa," the daughter said that they bought older sofas and so this was ok.

"Why does your mum buys 4D?" I asked the equally slim be-spectacled daughter.
"She has a stall next to the 4D outlet," she said.
The mum fixed costumed jewellery only on Sundays by renting a small table space at the Lorong 7 market.
"I have regular customers," she had been in this line for 9 years. I was most impressed at her perseverance and success in this small business. "Now my eye-sight is not so good to do the repairs," she said she had to pay rental even if she did not turn up on Sunday.  I was happy that the owners take good care of the cat.

1042. x-rays of a dog's abdomen - peed dark brown turbid urine - grape poisoning?

1041. Seizures in a young Dachshund

 

 
E-MAIL REPLY FROM DR SING DATED AUG 14, 2012

On Tue, Aug 14, 2012 at 3:32 PM, ...> wrote:

Hi,

 

I've visited Toa Payoh Vets today with my dog.

 

Dog Name: ....

Breed: Dachshund

Problem: Seizure

Attached is his historial blood test results.

Do let me know if there's any problem noted from the results.

Many thanks.

XXX

 

E-MAIL REPLY FROM DR SING DATED AUG 15, 2012. I had asked the owner to email to me her earlier recent blood test report which she said was normal according to Vet 1 she consulted.
 

I am Dr Sing Kong Yuen from Toa Payoh Vets. Thank you for the blood test report from your vet. Lipase enzymes were high in your attached first report done by the other vet.

One blood test may not be sufficient to come to any conclusion of the cause of seizures. A CSF check and other tests may be needed.

I advise a 2nd blood test with the same vet if you are OK with it.

The cause of seizures in dogs can be varied and hard to pin-point in many cases. One of the causes could be canine distemper viral infections during puppyhood and sometimes there is evidence of "hard pads" in the recovered dog. Did your dog receive all the 3 vaccinations at the appropriate timing? Fevers of unknown origin are another cause. There are unknown causes in the majority of dog seizures.

Dr Daniel will contact you regarding your dog's recurring seizures follow up.  

1040. Dark blue-red blood from the bladder -- Grape poisoning?

On Sunday Aug 12, 2012 at 6 pm, a Maltese came in with blood in the urine. The young lady flashed the pool of reddish blood image from her handphone. "Will my dog die?" she asked.

1039. SOP - spaying a cat on heat

An example of the steps involved in spaying a young cat on heat (caterwauling was the reason for spaying) done by me is given as follows:

Record No. 155
Toa Payoh Vets Anaesthesia & Surgery Record
Patient's Name: Anja
TP Ref: 43711     Date: 13-8-12  Age: 10 m  Wt: 3.8kg*  Temp: 38.6*
Surgical procedure: Spay (on heat)
Type of suture: polysorb  Size:2/0   No. of packets used: One

DOCUMENTATION OF STEPS IN A SPAY OF AN AGGRESSIVE YOUNG CAT ON ESTRUS

1. Restraint. Owner to take the cat out of its carrier bag and put into the crate which has top and side doors. Do NOT put cat with its carrier bag inside the crate as in this case.
Use phone books to corner the cat or lasso if aggressive as it is not possible to sedate just by holding the cat, causing staff to be in danger of being scratched and cat escaping.

2. Sedation. For a 3.8 kg cat, I injected xylazine 0.15 ml + ketamine 0.6 ml combined IM left back msucles.

3. Pre-op clipping and cleaning was done 2 minutes later.
4. Surgery: A very bloody surgery as the ovaries and uterus were swollen with large blood vessels. More care in ligation is needed in such situations.

For younger vets, do make a larger skin incision of more than 2 cm long to get good exposure. In this case, I started the skin incision 1.5 cm from the umbilical scar, then made a 1.5 cm skin incision.

OVARIES. I hooked out the left ovary at the first attempt. I used 2 artery forceps to clamp the ovarian ligament and ligate cranial to the lower clamp. I ligate in one direction (5 throws of the knot) and then swung back to ligate in the opposite direction for the ovary. Then I used the scalpel to sever the ovarian ligament between the two forceps.

UTERINE BODY. I asked my assistant to loosen the front paws and in some cases to elevate the front half of the body (hand under the shoulders) to gain access to the uterine horn (right). Or I would extend my skin incision to 1.8 cm long to access the swollen and vascularised uterine body.

In this case, the uterine body was easily taken out after ligation of the right ovary. I clamped the uterine body with 2 artery forceps. Then I put the 2/0 suture below the lower forceps. I loosen the lower clamp to expose the grooved indentation. I slipped this suture into the groove and ligate 3 times. First in one direction, then in the other direction as for the ovarian ligament ligature. However, I ligate once more.

Normal cats not on heat. I ligate the ovaries and uterus twice only.

SPAY PROCEDURE TIMES
I asked Min to record:
Left ovary hooked out (first attempt)                   8.08pm
Right ovary taken out                                           8.15pm
Uterine body ligated started (with 3 ligatures)     8.21pm
Linea alba muscles stitched started                      8.26pm  (2 simple interrupted)




KPI
A: Injection of xylazine + ketamine 0.l5+0.6 ml IM     7.54pm
B: Isoflurane 5% given                                                   8.15pm
C: Isoflurane stopped                                                      8.17pm
D: lst skin incision                                                          8.06pm
E: Skin stitched up                                                          8.29pm (2 horizontal mattresses)

E-A = 35 minutes (whole spay procedure) excluding restraint of the aggressive cat.
E-D = 23 minutes (spay surgery)

As the cat was full of swollen blood vessels, extra care and time were needed to ensure that there would be no complications of bleeding to death. The left ovary was hooked out at the first attempt and the ovaries were unusually enlarged at around 8 mm x 8 mm x 6 mm (see images).

The above report serves as a benchmark for my associate vets. Elevate the op table to be comfortable doing surgery as each vet has his or her own height.


















*Cat aggressive. Lassoed and sedated inside crate. Rectal temp and weight were then recorded.

1037. More records and responsibilities

Yesterday, Monday, August 14, 2012 at 7 pm, I stopped any consultation and had another talk with Drs Daniel and Vanessa regarding the need to keep proper records in cases of complaints, investigation, litigation as Singaporeans are becoming more litigious. So, we have the inpatient, outpatient, surgical and anaesthetic records and the hospitalisation records.

"In the past, there would just be the one case card recording "everything", but now, this is not sufficient," I said. "The veterinary authorities do have public complaints when the pet dies and so proper records are a good defence. Otherwise, your licence may be suspended or revoked."

In management, it takes many times to speak to the associate vets about changes in the work process. Unfortunately, there is no other way to get new changes executed. Each vet now has his or her own anaesthetic records which they are responsible and will be documentary evidence in cases of litigation. So, the vet has to maintain meticulous records and I will be auditing them. This process improves the standard of care as human nature is such that, the less work, the better.