1258. Follow-up hamster eyeball enucelation & eye salvage alternatives

TOA PAYOH VETS toapayohvets.com Date:   24 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The hamster has a popped out eyeball  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 22 January, 2013 Date:   24 January, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1256. Hamster with a popped out eyeball. Follow-up update and surgical procedures info.   Jan 22, 2013 "She is going to die," the young lady wiped her tears as her 2-year-old female dwarf hamster was sleepy unlike others. The hamster just would not move when held on the palm of her hands. She took her out several times and this would stress out the sleepy hamster which had not eaten and drunk water in the past 2 days and was in great pain. "Two days ago, the right eyeball just popped out," she said. "Before that there was a white spot in her right eye. I thought it was a cataract." The hamster's shoulder skin stood up when pulled indicating severe dehydration. The protruded eyeball must be very painful as the hamster can't talk. She just sat still most of the time. The owner was quoted $400 by another vet to do surgery. "I don't have that much money," the student said. "Normally I charge $100-$250" for hamster surgery depending on how complicated it is and the time it takes.   Eyeball prolapse   After eyeball removal PRE-OP DEXTROSE SALINE "What are you injecting?" Dr Daniel saw me preparing a small injection of 0.05 ml in a 1-ml syringe and thought I was overdosing this hamster. "It is dextrose saline as he is so lethargic and weak." ANAESTHESIA "This is a very sick hamster," I said to Dr Daniel when we discussed anaesthesia. He proposed 1 drop of Zoletil IM. "The safest is just isoflurane gas," I said. "The vet needs to be very observant as it is hard to tell when the hamster is fully anaesthesized. We put the hamster inside a plastic container infused with 5% isoflurane gas. "Count up to 10 and take out. Repeat," I said. Dr Daniel did say 1,2,3...10!" once. The dosage was not enough. He tried again. "Use the mask," I said. But the mask was not effective as it was too big. OK for the baby rabbit. SURGERY Basically enucleation of the eyeball is similar to that for the dog. I incise 4 mm on the lateral canthus. Then I clamp the base of the eyeball with forceps. The normal eyeball suddenly popped out and the hamster squeaked. I ceased the procedure and gave the hamster more case. I scrutinised the hamster inside the plastic container. Once he could not move, I quickly took him out within a second. Clamped the eyeball, excised the base with scalpel. Unlike the dog, it was not possible to ligate the optic stalk and blood vessels. Profuse bleeding. I swabbed. Then I cut off the upper and lower eyelids to create two wounds which I sutured with 6/0. The hamster wriggled and I stitched fast 3 interrupted sutures. "Hold on to his front paws, the scruff of his neck," I said to him. The dwarf hamster is so small that there is no space for both of us. Finally, I sutured the eyelids. It was too cramped for the intern to take a video of the surgery. However she videoed 30 minutes post op and the hamster was busy cleaning himself. Surprisingly, the hamster became much more energetic after removal of the eyeball. It would be attribute to removal of pain and the dextrose saline. So, the owner was glad to see him as she took him home in the afternoon. 1 DAY AFTER SURGERY On Tuesday, Jan 22, 2013,  I phoned the young lady. She was most happy. "The hamster drinks a lot," she said. "She is much more alive." It was good news. 2 DAYS AFTER SURGERY Yesterday, Wednesday, Jan 23, 2013, the owner phoned me to say that there is a big hole. "Is it normal for hamster in such operations to have a big hole in the eye? What should I do? Can I send you the images of the eye by iPhone?" I said it was difficult to know what she meant and it is best to examine it as she thought there was a stitch breakdown exposing the eye wound. She brought the hamster to the surgery in the afternoon. I was out and some driver had suddenly swerved into my parked car opposite the church and public library, damaging the right fore lamp area. So Dr Daniel examined this hamster. "What happened?" I asked Dr Daniel. "The swelling was due to the bleeding after removal of the eyeball. It has become a clot. The owner did not give the pain killer and the hamster scratches the eye area. But the hamster is normal, very active, eating and running. Is it possible that you did not snip off the eyelids but had just stitched up the eyelids?" Dr Daniel was assisting me in this surgery to remove the eyeball but he was on the other side of the op table holding on to the hamster while I stitched up the "eyelids". As the hamster was a dwarf, he could not see me using a pair of scissors to snip off the upper and lower eyelids, as per standard operating procedure in eyeball removal surgery. In fact, it would be professionally incompetent not to do. SNIPPING OFF THE UPPER AND LOWER EYELIDS His palm is 4X in area compared to this dwarf and unlike the surgery in the dog or cat, he could not see much. He saw me using the scissors to cut off the 6/0 sutures after stitching the "eyelids". Actually, I had trimmed off the eyelids before putting in 3 stitches to close the eye. "I had cut off the eyelids, otherwise the eye would not seal off when the stitches dissolve," I said to him patiently.   EYEBALL REMOVAL SURGERY COMPARED TO THE DOG AND CATG The surgery to remove the eyeball in the hamster can be completed in less than 5 minutes unlike in the dog or cat owing to the small size of the eyeball. The same principles of surgery apply to the hamster as to the dog and cat, only that the operation is on a miniature scale and the anaesthetic risk of death from isoflurane gas is 10x higher as it is difficult to monitor the depths of anaesthesia.    SAVING THE EYE This hamster had a "white spot" in the right eye earlier. The owner thought it was a cataract. This would be a corneal ulcer. The hamster would have scratched so hard that her right eyeball popped out permanently and caused great pain. In the dog and cat, it is possible to "save the eye" if it is not badly damaged or infect. This is done by doing lateral canthotomy (which I did in this hamster) to enlarge the ocular space, push back the eyeball, give antibiotics and anti-inflammatory, stitch up the upper and lower eyelids (tarsorrhaphy) and in 14-21 days review the eyeball and remove the stitches. In this case, the eyelids are not snipped off. An e-collar is then worn. All these are not possible for the hamster esp. the post-op care as the hamster hates the e-collar and will get rid of it in no time. The hamster may not eat after such a drastic surgery. So, removing the popped out eyeball is the practical option.     Eye Injuries Are Emergencies in Hamsters. Consult Your Vet Immediately       3785 - 3791. Enucleation of the eye in a Syrian hamster at Toa Payoh Vets performed by me. The 3rd eyelid is not so prominent in the hamster unlike in the dog. This webpage is: http://kongyuensing.com/folder7/201301123hamster_eyeball_enucleation_toapayohvets.htm     More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: January 24, 2013 Toa Payoh Vets

1257. Amputation of leg saved the rabbit's life, prevents septicaemia in a guinea pig.

Why amputate if fractures are multiple fragments?  Not possible to pin or screw. Economics.

Two case studies will give you the answers.

1. Recent fracture. GP. Big swollen swelling at fractured region.
Reasons:     

    1. Pain. Guinea pig feels the pain and licks the region to alleviate its pain
    2, Pressure sores due to dragging of foot, friction from floor, continual licking of area    
  3. Infection of the inner tissues including muscles over time - localized infection - generalized infection = septicaemia  ---> multiple organ failure ---> shock ---> death.

 4. Emaciation. Not eating much owing to daily pain of fractured area.  

Case 1. Amputation of the leg prevents septicaemia in the guinea pig in later months
Narrate slides. Include how it is anaesthesized and surgery briefly

Post op complications - infection- stitch abscess.

Include some video footage. Overall video should be around 5 minutes. Ask owner to send video footage of latest updae in Mar 18, 2020 to close the case. 

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

What happens if you don't operate but seek TCM? 

Case 2.  Amputation of the leg saved the rabbit from dying of septicaemia

narrate text

Amputation of leg saved the rabbit's life, prevents septicaemia in a guinea pig.

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

Old images. Do not use for video production.

1256. Hamster with a popped out eyeball

TOA PAYOH VETS toapayohvets.com Date:   23 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The hamster has a popped out eyeball  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   23 January, 2013	toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129
1256. Hamster with a popped out eyeball Jan 22, 2013 "She is going to die," the young lady wiped her tears as her 2-year-old female dwarf hamster was sleepy unlike others. The hamster just would not move when held on the palm of her hands. She took her out several times and this would stress out the sleepy hamster which had not eaten and drunk water in the past 2 days and was in great pain. "Two days ago, the right eyeball just popped out," she said. "Before that there was a white spot in her right eye. I thought it was a cataract." The hamster's shoulder skin stood up when pulled indicating severe dehydration. The protruded eyeball must be very painful as the hamster can't talk. She just sat still most of the time. The owner was quoted $400 by another vet to do surgery. "I don't have that much money," the student said. "Normally I charge $100-$250" for hamster surgery depending on how complicated it is and the time it takes.   Eyeball prolapse After eyeball removal PRE-OP DEXTROSE SALINE "What are you injecting?" Dr Daniel saw me preparing a small injection of 0.05 ml in a 1-ml syringe and thought I was overdosing this hamster. "It is dextrose saline as he is so lethargic and weak." ANAESTHESIA "This is a very sick hamster," I said to Dr Daniel when we discussed anaesthesia. He proposed 1 drop of Zoletil IM. "The safest is just isoflurane gas," I said. "The vet needs to be very observant as it is hard to tell when the hamster is fully anaesthesized. We put the hamster inside a plastic container infused with 5% isoflurane gas. "Count up to 10 and take out. Repeat," I said. Dr Daniel did say 1,2,3...10!" once. The dosage was not enough. He tried again. "Use the mask," I said. But the mask was not effective as it was too big. OK for the baby rabbit. SURGERY Basically enucleation of the eyeball is similar to that for the dog. I incise 4 mm on the lateral canthus. Then I clamp the base of the eyeball with forceps. The normal eyeball suddenly popped out and the hamster squeaked. I ceased the procedure and gave the hamster more case. I scrutinised the hamster inside the plastic container. Once he could not move, I quickly took him out within a second. Clamped the eyeball, excised the base with scalpel. Unlike the dog, it was not possible to ligate the optic stalk and blood vessels. Profuse bleeding. I swabbed. Then I cut off the upper and lower eyelids to create two wounds which I sutured with 6/0. The hamster wriggled and I stitched fast 3 interrupted sutures. "Hold on to his front paws, the scruff of his neck," I said to him. The dwarf hamster is so small that there is no space for both of us. Finally, I sutured the eyelids. It was too cramped for the intern to take a video of the surgery. However she videoed 30 minutes post op and the hamster was busy cleaning himself. Surprisingly, the hamster became much more energetic after removal of the eyeball. It would be attribute to removal of pain and the dextrose saline. So, the owner was glad to see him as she took him home in the afternoon. 24 HOURS AFTER SURGERY Today Tuesday, Jan 22, 2013,  I phoned the young lady. She was most happy. "The hamster drinks a lot," she said. "She is much more alive." It was good news.

1 day after surgery follow up. Hamster was OK.
3 days after surgery, no complaints from the owner. No news is good news in such cases.

1255. Toilet training a puppy who eliminates outside his den

 

On Fri, Jan 18, 2013 at 3:14 PM, Anna <,etrics.com> wrote:

Hi Judy

I am a first puppy owner, I am a mother of two. My kids are 9 and 16. I have tried putting him in one big cage to do all his business (eat, drink, sleep and play) but he seem not want to poop after food, yet he do it in the kitchen when I finally let him out to exercise.

I have read a lot from online but you are right that we are living in a HDB so we don’t have a garden for his eliminates.

I have read your article DR SING'S DRAFT REFERENCES & RESEARCH INTERVIEWS FROM 2005 - 2009
TOILET-TRAINING OF SINGAPORE PUPPIES

I am planning to try this

1. Small cage for sleeping with a pillow or blanket at night and when I think he need to sleep.
2. Bigger cage for eliminate. Keep him inside until he eliminate
3. Playing and Eating and drink in the kitchen

Not sure will it works? Please advise, thank you very much for your help. I wish to love my puppy and not to beat or short at him.

Regards,

Anna

 

EMAIL REPLY FROM DR SING DATED JAN 19, 2013
1255. Toilet training a puppy who eliminates outside his den

As each puppy is different in intelligence and behaviour, it is hard to give advices. Based on the fact that your puppy wants a clean sleeping and eating area but eliminates outside these areas,

I will propose that you continue as putting him in a crate (sleeping and eating area. Buy those panels of fences (used for playpen) to enclose this crate so that the puppy has an external "patio" to pee and poop. On this patio, put a pee tray with newspapers and his urine smell. This will be his toilet area. Slowly increase his patio and you may know he eliminates in his playpen and in 4-8 weeks' time, he will just use the pee tray and the fences can be removed..

I don't know whether you understand what I am writing about. Email me 2 images of existing cage and his surroundings if you want me to elaborate. Best wishes.
 

1254. Two young terrapins of 3.5 cm shell width Jan 17, 2013

Yesterday evening Jan 17, 2013, Dr Daniel had to go to a concert and so I was on duty from 7 pm to 8 pm. I was surprised to see two young terrapins coming for consultation as they were of around the same age and the probability of two terrapin patients in sequence  is very rare at Toa Payoh Vets. I have taken a video of them for readers.

CASE 1. "Puffing" terrapin
"She avoids water," the father said. "She seldom moves. She will raise her head, burp and a swelling appears below her neck."
Sure enough, the terrapin displayed this behaviour. As if this terrapin had difficulty breathing. She did not move at all.

As a monitor lizard would puff up to increase his size to frighten predators.
"Did you feed something causing throat obstruction?" I asked as another "balloon" below the neck swells up.
"I did feed shrimps," the father said. Most likely dyspnea. Inhalation pneumonia from swallowing too large a piece of shrimp?

I hospitalised her and gave her multivitamins in water. The next day, she was more active. Her head is still raised upwards and I have not seen her head on level horizontal. What is the solution? In cats and dogs, X-rays and sedation to check out the throat would be done. But this is a baby terrapin. I would observe. In any case, she was moving this morning when I took her out to sun and video at 10 am.

CASE 2.
"Right eye closed, so he is not eating," the father said. "Is it infection?"
I noticed a white plug covering the eyelids of the right eye. I hospitalised it and give multivitamins in the water. Changed water and bathed it. The next morning, the right eye was opened and the terrapin was overactive. See video. I put him in a shallow bowl and monitor. Once I turned my back, I saw him upside down as he had attempted to climb up the shallow bowl. I put him back on his side. He could go home and the young lady owner was most pleased.

 

Video: Oral tumours in older dogs in Singapore

http://www.youtube.com/watch?v=BKuotAsSRAA

Oral tumours in old dogs in Singapore
video to educate dog owners

Update: Large tumour video and case follow up - hamster's 14-g large tumour

TOA PAYOH VETS toapayohvets.com Date:   18 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Electro-excision of a large tumour in a dwarf hamster  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   18 January, 2013	toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129
Yesterday, Jan 16, 2013, two older women from "Street 12" came with a 64-g female dwarf hamster aged 1 year and 6 months. She had a gigantic tumour near her left hip. "She's biting the lump", one woman said to me. There was a scab of 2 mm x 2 mm due to the hamster's bite. ANAESTHESIA & SURGERY Dr Daniel is convinced that electro-surgery is useful and efficient as he used electro-excision to incise the skin (see video  http://www.youtube.com/watch?v=J6d03LrHZS8). He excised the tumour which had some abscesses. I weighed the hamster after surgery. She was 50 kg. A heavy weight had been taken out. It was a high risk anaesthesia as the hamster was quite plump and the tumour was massive. However the hamster was still eating. 3 drops of Zoletil 50 was insufficient. "Don't use a large volume of normal saline to top up the syringe," I said to Dr Daniel. "The back muscles of the dwarf hamster is very little. It will be like the doctor injecting 20 ml of liquid into you back muscles. I usually top up the 3 drops of Zoletil up to 0.05 ml in the 1-ml syringe with normal saline before injecting the back muscles of the hamster (see video http://www.youtube.com/watch?v=J6d03LrHZS8). I had to use the mask to gas the hamster with isoflurane gas a few times as the Zoletil 50 was insufficient in this plump hamster. Possibly 4 drops would be more effective in a 64-gram hamster or it could be too much and causes death. Much depends on the vet's judgment and experience. The tumour was 14 g in weight! This is where the risks of death increase because it is not possible to monitor the hamster's breathing and heart rate (ECG, blood pressure monitoring are not practical in a dwarf hamster). Any overdose of the isoflurane gas meant instant death. No such thing as resuscitation. So, I monitored the anaesthesia top up while Dr Daniel operated. It was touch and go. I had to make sure that the hamster was just below the surgical anaesthesia stage and so you would see some leg movement during stitching. It is NOT possible to achieve the ideal surgical anaesthetic stage as in the dog and cat. The dwarf hamster is so small. "Surgery must be speedy," I said to Dr Daniel. "Undermine the skin, isolate the tumour, clamp the base with a curved forceps, excise the lump and stitch the skin with 6/0 interrupted sutures. All these to be done in less than 3 minutes."  The slower the vet operated, the more the anaesthesia had to be given and this is where the hamster "dies" on the operating table.   CHECKING THE ACCURACY OF OWNER'S ADDRESS The had written "Street 12" in the address. I asked whether she had left out "Bishan Street 12"? Vets must check the records of addresses. She said "Pasir Ris Street 12". I asked an intern to do this case study. She did a video and the link is:     http://www.youtube.com/watch?v=J6d03LrHZS8. There is a problem with the  absence of sounds, using Windows movie maker. There appears to be no solution from the interns.   CONCLUSION The hamster took some time to wake up. Two female interns were present. One of them was a single child. She spent much time with this hamster. "Look, she is vomiting the seeds," this lady intern said to me as she observed the surgery and did some video filming of the operation. "The hamster is dislodging the food from her cheek pouch as she is stressed by the surgery and anaesthesia," I told her. "This is a common occurrence. She is not vomiting." Her parents allowed her to keep one cat. Yesterday I told the parents whom I knew from 20 years ago that this daughter  should adopt more stray cats in her apartment. The mother wanted to kill me. "Don't you dare to suggest this," the mother said to me. Many Singapore parents dote on the single child and will tolerate them bringing home stray dogs and cats or buy a puppy. In the end, it is the parents who have to care fore them. Yet yesterday, I met a mother, an old client, from Bukit Panjang. Her 15-year-old Maltese X bought by her daughter long ago is so precious to the mother. The dog came in as she behaved aggressively when carried. The mother knew it was due to false pregnancy. Lots of white milk were present in the dog's swollen mammary glands. This dog still had estrus bleeding 2-3 months ago. At the age of 15 years which is equivalent to 105 years in a human being . This is in contrast to menopause in women at the age of 50 - 60 years. I asked permission for my intern to take pictures for her case study and she said OK. "Don't feed her," I said to the single child as the hamster after surgery, wanted to store the seeds. The plump hamster laid on her back and sipped water from the water bottle while lying on her back, making her laugh. The owner came in the afternoon to take the hamster home. The vet must deliver a hamster alive at the surgery. The anaesthesia is the killing part and this is where a vet's reputation is smeared if the hamster dies on the operating table. No deaths should occur if the anaesthesia is minimal and the surgery speedy, but this cannot be guaranteed. FOLLOW-UP 24 HOURS LATER   1250. Follow up on plump dwarf hamster 64kg with large tumour   Jan 17, 2013 I phoned the Pasir Ris lady at 11.45 am and reached her on her home phone to ensure she does the proper post-op nursing and medication. Sometimes, vets are too busy and will not phone if the mobile phone does not answer. "She is eating and drinking water and active," the Indian lady said. "She is more active than before (surgery). I didn't know she has stopped exercising. I pushed the 1-ml syringe too much and spilled the medicine..." "It's OK as the hamster just needs 2 drops/day for the next 3 days and the syringe has more than sufficient." "Can I shampoo her?" she asked. "I do it every week. She was not happy at first but now she looks forward to the water bath as the weather is too hot nowadays." "No bathing for the next 14 days," I said. The instructions are: 1. Use a facial cotton piece, add clean warm water and clean the surgical wound 2x/day for the next 14 days. 2. Stitches will dissolve on their own in 21-30 days. No need to come for stitches being taken out. 3.  No wood shavings as bedding. 4. No exercise wheel. 5. Give medication 6. No bathing for 14 days A video on the surgery to excise this gigantic tumour by Dr Daniel Sing was produced by the interns:  http://www.youtube.com/watch?v=J6d03LrHZS8. I was the assistant and you can see me doing the IM injection.  There is a problem with the absence of sounds, using Windows movie maker. There appears to be no solution from the interns. Readers with solutions, please e-mail to me.
More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326
Toa Payoh Vets Clinical Research

False pregnancy in a very old Maltese - 15 years old

1250. Follow up on plump dwarf hamster 64kg with large tumour

Jan 17, 2013
I phoned the Pasir Ris lady at 11.45 am and reached her on her home phone to ensure she does the proper post-op nursing and medication. Sometimes, vets are too busy and will not phone if the mobile phone does not answer.

"She is eating and drinking water and active," the Indian lady said. "She is more active than before (surgery). I didn't know she has stopped exercising. I pushed the 1-ml syringe too much and spilled the medicine..."

"It's OK as the hamster just needs 2 drops/day for the next 3 days and the syringe has more than sufficient."

"Can I shampoo her?" she asked. "I do it every week. She was not happy at first but now she looks forward to the water bath as the weather is too hot nowadays."

"No bathing for the next 14 days," I said. The other instructions are:

1. Use a facial cotton piece, add clean warm water and clean the surgical wound 2x/day for the next 14 days.
2. Stitches will dissolve on their own in 21-30 days. No need to come for stitches being taken out.
3.  No wood shavings as bedding.
4. No exercise wheel.
5. Give medication
6. No bathing for 14 days

1249. Follow up on 3-year-old cat with recurring FLUTD

Jan 17, 2013

No news is good news. The lady owner didn't phone me. I phoned her at 10.47am to find out about her cat as part of my research on FLUTD treatment. It is best practice to follow up in any case, but many vets don't do it.

I tried to phone the Tampines girl whose male Miniature Schnauzer, born in 2004, had spikey bladder stones removed in August 17, 2007 by her young vet operating together with me. This case study was written by me as she was a veterinary clinic helper and her vet was a younger vet doing his first bladder stone surgery with me.

Her mobile phone seemed "dead". No answer and then a dying sound. I phoned her home and hIer mum said the dog is OK, took my mobile phone for her to call me. I asked her vet to call me. No response. The dog did not have recurrence of bladder stones despite being fed dry food! 



CASE OF THE RECURRING FLUTD CAT
"Totally normal," she said happily. "He was fully recovered yesterday, around 6 days after the problem." The cat was so aggressive when she brought him for treatment on Jan 11, 2013. This time, she was prompt in seeking treatment and so the urine did not look red as at 22 months earlier when FLUTD first manifested. "Continue feeding the C/D + water and no other food," I replied. So far so good.

Follow up provides the vet with feedback on the efficacy of his management and treatment. I sent the cat back home with in-dwelling cathether on the same day.  The cat ripped off the catheter the next day although he had an e-collar. The case is written in a blog a few days ago.

The X-rays do not show radio-dense struvites. Negative crystals in the urine doNOT mean that there are no struvites inside the bladder. In any case, with medication and irrigation of the bladder under sedation, the cat recovered fully 6 days after treatment and the lady owner is most happy. This time, she was prompt in seeking treatment and there was no need for fluid therapy and hospitalisation as occurred 22 months ago.

Many Singapore pet owners delay seeking treatment of difficulty in urination of their dogs or cats and the outcome may not be so favourable as much inflammation and damage to the bladder had been done owing to the delay in seeking prompt vet treatment.