1264. The little boy's blue-eyed cat is naughty

Webpage is;
http://www.bekindtopets.com/cats/201301126male_cat_caterwauls_sprays_toapayohvets.htm

TOA PAYOH VETS toapayohvets.com Date: 26 January, 2013 Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The little boy's blue-eyed cat Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 22 January, 2013Date: 26 January, 2013 toapayohvets.com Be Kind To Pets Veterinary Education Project 2010-0129 Saturday, January 12, 2013 On Saturdays, I usually consult from 8.30 am to 11 am and then Dr Jason Teo will take over. On this early fine morning, a bubbly Malay lady from Woodlands came with her blue-eyed cat and a little boy. She was a new client. "Why do you come all the way from Woodlands?" I asked as most Singaporean pet owners prefer proximity. "There are clinics nearer to your home." "I want to come here to neuter my cat," she replied. After the usual examination, I said she could come back in one hour to take the cat home as I would operate immediately. "One hour?" the little boy with bright big eyes said aloud. He was most attentive unlike other small boys. I thought he would be 4 years old based on his height. "Yes," I said. "Do you know what is the meaning of 'one hour'?" I asked him. He did not reply. Mum laughed and both of them left. Two hours later, the mum came with him for the cat. "There is some bleeding from the operation site," the mum observed blood stains on the towel, originating from the horizontal scrotal wound. In cats, the scrotal wound is not stitched up, unlike in dogs. "Disgusting," the little boy added. I was surprised that he uttered this word and wondered whether he knew what it meant. "How old is he?" I asked the mother. "He is 6 years old," his mother said. "He is bright and would do well in life if he studies hard." His attentiveness to adult conversations, his power of observations and his English vocabulary is unusual for little boys of his age and that is why I assess this little boy as intelligent. Most little boys tend to be playful and not communicative at the veterinary surgery, in my observations. The cat was left in the surgery till 5 pm when another adult came with 3 more children. Lots of joy and laughter with these young cousins around. "I am the 5th sister," the mum said to me. "This is my 3rd sister." The third sister was slimmer and more serious when compared to the 5th sister. She drove a blue Toyota Alixo car similarly to the one I had rented as my own car had broken down, with the radiator and the piping ruptured. It cost me $85/day to rent this model and my car was in the workshop for 3 days. The blue car reminded me of the blue eyes of this handsome male cat. The cat was no longer bleeding now. Could the bleeding be due to the possibility that I did not ligate the spermatic cord and the blood vessels properly? No, as I usually knot 5 times. The reason was that I made a horizontal cut transversing and incising the two testicles. Blood would have accumulated inside the scrotal sac. Sometimes, I make a vertical incision and incise one testicle at a time and there would possibly be less bleeding as one testicle is incised and ligated at one time. The family took the cat home and in the past 14 days, I had not heard from the owner and this meant that the cat had recovered fully. . As to why this 2-year-old cat was sent for neutering, it was because he was caterwauling. "A stray pregnant female cat waits for him outside the door," 5th sister said. "He is on heat and wants to go out. That is why I want you to neuter him" "Male cats do not stop meowing noisily immediately after neutering," I said. "It takes time for his male hormones to disappear. "This male cat sprayed his urine and (anal sac) oil onto the neighbour's walls and they are so angry! That is why I want to neuter him!". "In any case, why don't you get the pregnant female cat spayed?" "She is my neighbour's cat," 5th sister replied. "When she heard it cost me $195," she did not want to do it. "The cost of neuter is much less," I said to her. "You wanted the e-collar, the vaccination and the de-fleaing spot-on. This added up. The actual cost is around $125 with antibiotics and painkillers and surgery and anaesthesia." The least cost for neuter is the basic surgery, anaesthesia and an injection of pain-killers and antibiotics. This would cost $125. In the earlier years of practice which has now spanned nearly 40 years, I did not give pain-killers and antibiotics as this would be possible with aseptic surgery. I believe in less antibiotics to reduce the incidence of bacterial resistance to antibiotics. The cost would be $75 and there were no post-op infections or problems. However, Singapore cat owners are more caring. One owner was most unhappy and she complained as to why I did not prescribe post-op antibiotics unlike other vets. So, nowadays, to give owners peace of mind, medication post-operation is routinely given. So the cost is higher. 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 26, 2013 Toa Payoh Vets

The economics of renal failure - 7-year-old male Maltese

Veterinary info can be overwhelming to many students.
This case study is to help vet students understand for their examinations, more about the treatment of kidney failure and the terms azotaemia, pre-renal azotaemia and post-renal azotaemia. 

PATIENT: Maltese, Male, 7 years

Jan 11, 2013
A Veterinary Clinic.
No appetite and vomiting for 2 days. Vet 1 did a blood test which revealed renal failure, hypoglycaemia, hyponatremia, hyperkalemia and hyperphosphatemia in this dog which has a lower than normal rectal temp of 37.2C.
He advised 10 days of drip as the dog had kidney failure. The owner would have to do the drips at home as well.
The owner consulted Toa Payoh Vets for a second opinion.

Jan 12, 2013
Toa Payoh Vets.
Dr Jason Teo hospitalised the dog for 5-7 days of IV driip and blood test after the drip. Dr Daniel took over the case. He put the dog on IV drip for 2 days. No blood test was done as the owner had said that there was one done earlier. No urine test was done, possibly due to owner's reluctance to spend more money. Urine analysis would be useful if done by Vet 1 to differentiate between pre-renal or post-renal azotaemia.

EXPLANATION.
Azotaemia refers to the increase of serum urea and creatiine as shown in the blood test done by Vet 1.
Pre-renal Azotaemia - Due to increase in protein intake
Renal Azotaemia - Kidney not filtering urine normally e.g. obstruction.
Post-renal A - Obstruction in the urinary tract after the kidney

No urine test was done. If done, the USG will be useful. If USG is normal, the kidneys will be normal and there will not be renal failure in the first place. If USG is below normal, it is kidney failure (renal azotaemia). If USG is high, kidneys are normal.

IN THIS CASE STUDY, the dog was eating on Jan 14, 2013 and went home with K/D and clavulox for 7 days. However on Jan 22, 2013, the mother phoned to say that the dog was not eating and had to be force fed. His weight dropped from 5.4 kg to 4.7 kg when the mother finally admitted the dog for IV drip as advised by me, on Jan 23, 2013. The rectal temp in this dog is unusually low, at 37 deg C on Jan 23 Jan and had not gone up to 38 deg even on discharge today Jan 25, 2013. Blood test showed no more azotaemia and the dog ate on 2nd day i.e. today Jan 25. The glucose was still below normal in the blood test as the dog was not eating.

TOTAL WCC
Blood test by Vet 1 - total WCC was normal.
Blood test on Jan 25 at Toa Payoh Vets - WCC 21.7 (6-17), N 85%   Absolute 13.4. L 4%, M11%, E 0% and B 0.6%. There was a bacterial infection but serum urea was normal. at 4.3 (4.2 -6.3). Creatinine was 66 (89-177).  As the dog ate a can of A/D, he was sent hme with different antibiotics.
CONCLUSION
Urine test would have been useful as there would be bacteria or not.     

1262. Schnauzer has bladder stones for the 3rd time

Jan 25, 2013.
Today Dr Daniel and I will be operating to remove the bladder stones. The lady owner came in with another dog, a male 9-year-old Golden Retriever that was eating less and was limping on his "left hind limb".

"He has a big lump below the chest," she said. "One lump had holes in which pus came out yesterday. Now he can walk. The past few days he was not willing to stand up and was not eating. Now he eats a little."

"Two gigantic lumps under the skin of the chest," I had the dog sleeping sideways on the floor of the consultation room and palpated two big lumps. The one in front has no holes but the bigger back one has a few holes "Likely to be tumours which have been infected. The dog has a fever of 40.7degrees C. Do you want a blood test to check the health of this dog before surgery?"

She consented to a blood test..
"Surgery will be in 2 days' time," I said. "The dog is not well now and needs the IV drips, antibiotics for the next 2 days, just like your Schnauzer with the bladder stones." 

Her Schnauzer to be operated this afternoon came in on Jan 20, 2013, with blood in the urine and recent vomiting. She looked very ill and her rectal temperature was below normal at 37.8 degrees even on the 2nd day after the IV drip. The blood test on this Schnauzer showed septicaemia with the white cells being high, the platelets being very low and the kidney function compromised.

Total WCC 21.4 (1-17), N=83%, Absolute 17.8. L=6%, M=9%, E=0%, B=2%.  Platelets <10 br="" large="" nbsp="" platelets.="" platelets="" present.="">
On day 2 of admission, Dr Daniel said of the life-less inactive dog, not eating or moving: "This dog is unlikely to survive."
"You will be surprised," I told him. "With IV drips, multi-vitamins, proteins and Vit K1 for the 2 days and glucose", some dogs respond well.
"If there is urethral obstruction, it is not advised to give IV drip," Dr Daniel said.
"The dog can pee," I replied. "I saw her peeing blood in the urine on the floor of the waiting room.A lot of small stones in the bladder plus one large one, in my bladder palpation, There is no wish to X-ray as the owner wants to save money."

On Day 3 after admission (yesterday), the owner came in the morning to visit her. The Schnauzer got up ready to go home and barked furiously. The lady owner was very happy. "The dog can pee," I mentioned about surgery in the afternoon. As the dog had eaten and would benefit an extra day of nutrition and rest, I phoned the owner to operate today (Day 4) giving the dog the higher chances of survival on the op table and post-op.

"The dog has not vomited at all," I told the owner. "That is good news.". I showed her the blood test of kidney disorder. The urea was 44.3 (4.2-6.3) and creatinine was 449 (89-177). Evidence-based medicine is the best.

AUDIT OF PREVIOUS 2 CASES DONE BY MY ASSOCIATE VETS.
According to the owner,  two bladder surgeries were performed in Oct 2010 and Oct 2011.After bladder stone removal, Vet 1 emailed to her a video and advised drinking lots of water while Vet 2 from Jurong gave some prescription diet. 

1261. Hamster with popped up eyeball

 

 

2 of 1,999

 

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Hams Eye Surgery Question

Inbox

x

	3:51 PM (15 hours ago)
to judy

Hi Dr Sing, 

This is with regards to the hamster who had eye removal surgery. 

Attached is the photo of my hamster's wound and it seems to be bleeding. Pus could be seen in the morning so, i used NaCl to clean the wound. Is this a cause for concern? Also, would like to ask why is there a wound there if the surgery was in the eye? 

Thank you for tending to my hamster. 

Best Regards, 

Hams wound.JPG 1810K   View   Share   Downlo

 

 

 

 

Kong Yuen Sing <99pups gmail.com="">

	7:27 AM (3 minutes ago)
to Evie, bcc: me, bcc: jasonxll, bcc: daniel

Your image is not clear. I cannot comment as I can't see it. It may be a scratch wound as the hamster does scratch after surgery. It could be an infected wound from the time the hamster injured his right eye. Pl bring down for a proper examination.

1260. Video production at Toa Payoh Vets

TOA PAYOH VETS toapayohvets.com       Date:   25 January, 2013

Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits

Squamous papilloma in an older Cavalier King Charles - How does a vet diagnose & treat such a case? Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written:  26 October 201.  Updated: 25 January, 2013 toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 The following is my script for the video production 1.  THEME Be Kind To Pets - Oral tumours in A Dog   This video describes the processes of how  a vet diagnoses & treats a case of squamous cell papilloma in an older Cavalier King Charles. These processes form part of the Standard Operating Procedures at Toa Payoh Vets 2.  HOOK A large strawberry-like lump is spotted by the young lady owner one day. She informed her father and brought the dog to Toa Payoh Vets The Patient: Cavalier King Charles, Male, 10 years. Singapore History: Dog was not active, had difficulty eating. Excessive salivation. Sometimes, blood seen dripping from the mouth. What is the problem with this old dog?   Music & Insert the image into the video:  3.  INTRODUCTION An old dog is like part of the house furniture.  Family members, especially children who grow up with him love him very much. But they have not much time for him unlike the time when he was a new puppy (video of Cavalier King Charles puppies at the pet shop being sold).The older dog is a family member for most Singaporeans nowadays. Visits to groomers regularly, good food, dog treats of various brands and plenty of water available at all times. (video of regular visits to groomers) The dog's mouth is seldom examined by most dog owners and bad breath is usually tolerated by many Singaporean dog owners. Dental check ups are not usually done and the rotten teeth drop out. Many owners are not bothered when they see their old dogs dropping teeth. Oral tumours develop in some of these dogs. Their health is no longer a priority as they age.  The older dog is always happy to greet the owner and is a good companion to the senior citizen parents and retirees but many dog owners in Singapore do not have time to send the older dog for dental check up or annual health screening.  (video of dogs in apartments, being walked in Singapore). In 2010-2011, I note an increase in the number of younger Singaporeans seeking dental treatment for their older dogs. The younger generation of Singaporeans is better educated and more concerned about the welfare of the old pets and this is good news for the four-legged companions. Back to my case. One sunny day in August 2012, the owners of a male, 10-year-old Cavalier King Charles saw a pinkish lump appearing on the front of the lower jaw covering two of the front teeth. It grew bigger and bigger. The father and his daughter consulted me. Video of Singapore's blue skies and sunshine, families at the Pasir Ris beach and Toa Payoh Vets At Toa Payoh Vets, Dr Daniel Sing was on duty. I was present.  "Is it cancerous?" the owners asked Dr Daniel and me.  "If it doubles in size within a week, it is likely to be cancerous," I  said. 4.  BODY 4.1  Problem -- Is the dog suffering from a cancerous gum tumour or not?  "How to find out whether it is cancerous? What can I do to resolve the dog's oral tumour problem?" the father asked. The financial costs must be explained fully before any operation is done. There are several processes to be addressed to ensure a high standard of veterinary care and as a defence against negligence litigation. (Video of lawyers and subordinate court) But the owner must give his consent and that is where personality and financial conflicts come in. CONFLICT NO.1  Biopsy   as recommended by the vet professors during undergraduate studies will be adopted by most vets especially the recent graduates. This is the standard practice as taught in the University. A small piece of the oral tumour is cut out and send to the laboratory for analysis of its type - cancerous or benign? If the biopsy shows that it is not cancerous, then, there is "no" need to do any surgery. But biopsy takes time and involves anaesthesia. Sometimes as long as 7 - 14 days. Not much time is available in this case as the tumour was said to be fast growing. It may be malignant and must be excised within 24 hours.   Some vets do biopsy and find the tumour non cancerous. Some tell the owner there is no need for surgery. Some owners decide that they don't want surgery to remove the tumour since it is not cancerous. (Video of consequences of not early removal of an oral tumour - images of oral tumours in other dogs) As the weeks pass by, the tumour grows bigger. Excessive salivation, blood in the mouth, bad breath and difficulty in eating. Bacterial infection. By then, the owner has no choice but to get the gum tumour excised.     CONFLICT NO.2 X-RAYS should be done to find out whether the tumour has invaded the jaw bone and below the gums. Due to economic reasons, this was not done in this case as vet costs needed to be as low a possible.   CONFLICT NO.3 BLOOD TESTS Health screening is strongly advised before anaesthesia and surgery for all patients, esp. in the older dog. Anaesthetic risks are much higher in old dogs. There is always the possibility that the older dog may die on the operating table. When the owner hears that the dog may die on the operating table, he may decide not to get the surgery done. Some deem the vet incompetent and consulted another vet. A health screening should be suggested by the vet to let the owner knows whether the risks are high or not. "I advise a blood test to screen the health of the Cavalier King Charles," Dr Daniel said.  The owners must consent to take the anaesthetic risk if they give permission for the surgery as in this case. No surgeon can guarantee no risk in any anaesthesia, whether in people or animal.      The total WCC  17.8 (Normal  is 6-17) Neutrophils 81%, Lymphocytes 15%, Monocytes 3.2%, Eosinophils 0%, Basophils 0.4%. The platelets were below normal. This blood test indicates a bacterial infection. The liver and kidneys were functioning normally. "OK," the patriarch consented to the surgery. Antibiotics were given to the dog.     CONFLICT NO.4 IV Anaesthesia No  Intubation Anaesthesia. What type? IV anaesthesia, gas anaesthesia or both? IV anaesthesia is shorter acting than gas anaesthesia. Intubation (a breathing tube connects anaesthetic gas and oxygen to the dog) is usually done in dental scaling which will be performed after oral tumour removal surgery.   (Insert above images of a dog intubated, left and dental scaling, right) But this dog had a big oral tumour in the front of the mouth, obstructing the insertion of the endotracheal tube. "No intubation, as we need good access to the gingival tumour and to excise all, if possible. It is growing fast."    Domitor + Ketamine IV at 25% of calculated dosage for a young healthy dog was sufficient for electro-surgical excision. Dental scaling was done after that. The old dog survived the anaesthesia and that was what mattered most for the owners. It is not always possible for every old dog to survive anaesthesia during surgery. Therefore it is wiser to remove the tumour when it is smaller and when the dog is younger.    Informed consent form "This is an old dog. Explain in detail the anaesthetic risks of death on the operating table and operation and post-op complications. An informed consent needed. The form is to be signed by the owner. In any case, the vet must delivers a dog alive at the end of surgery but no vet can guarantee. Therefore assess the risk and get the informed consent.   CONFLICT NO.5 Gas Anaesthesia The teeth need to be extracted. Dental scaling need to be done. That means surgery will take longer than normal. Isoflurane gas top up anaesthesia to be delivered by an endotracheal tube is needed.  But this endotracheal tube blocks the operating view. "IV Anaesthesia is the best," I said to Dr Daniel. Will this be effective? Yes if you know how to use the appropriate drugs. The dosage must be just sufficient for surgery but safe for the older dog.  50% of the Domitor & Ketamine IV formula was used in this case. It was effective. No need topping with isoflurane gas in this case.    CONFLICT NO.6 Histology "Is the oral tumour cancerous or not?" the father asked. "Nobody can tell from the physical appearance," I said. "The tumour needs to be analysed by the laboratory and the tumour cells can be seen under the microscope if there are any. This is the process of histology.  Do you wish to get the tumour sent for histology?" It is best to get the owner's permission to send the tumour for histology to check whether it is cancerous or not, as some owners may have a budget or do not wish to spend more money.   Write "AMA" (Against Medical Advice) in the medical report if the owner is not in favour of histology, blood tests or any process advised by the vet. This record serves as evidence to protect the vet in the event of negligence litigation.   4.2  SOLUTION Electro-surgery, not medication   It is unprofessional to give medication to the owner to treat the oral tumour as some owners may insist on having them as an alternative to the high risk of anaesthesia during surgery. It will not disappear. Electro-surgical excision including extraction of 3 incisor teeth enclosed by the papilloma. Electro-surgery by Dr Daniel. "Transect at least 2 mm from the tumour and remove the entombed incisors," I said. "However this is not possible in this case. X-rays are not done to see whether the bone is involved to lower veterinary costs for the owner at this time."     Histology - a microscopic examination of the tumour to check its cells as to whether the tumour is cancerous or not. The owner consented for the gum tumour to be sent to lab for histopathology  (Image of microscope)   Squamous papilloma with reactive atypia and chronic inflammation. No definite dysplasia or malignancy. (Video of a microscope) Good news for the owner. However, the papilloma may return as it is extremely difficult to completely excise it. Lab Report:  Squamous papilloma. So it is not an epulis as I thought it would be except that it had various finger-like projections as in a wart. The owner was happy with the good news. Not cancerous.   5.  CONCLUSION Final Diagnosis from histology The diagnosis is squamous cell papilloma. The dog goes home 24 hours after surgery. There was no more gum bleeding.  BE KIND TO YOUR OLDER DOG.  EXAMINE YOUR OLDER DOG'S MOUTH WEEKLY FOR ORAL TUMOURS. SMALL TUMOURS ARE EASIER TO REMOVE AND THERE IS A MUCH LOWER ANAESTHETIC RISK.   6.  ADVICES & TIPS Post surgical management 1. POST-OP REVIEWS. THREE-MONTHLY NEXT 12 MONTHS. Owner need to be advised and reminded by the vet but this is seldom done by me. Dog has not returned as at Jan 4, 2013. 2.  Older dogs must be checked by the owner daily and any mouth tumour be removed when it is small. In this case, the tongue covered the papilloma till it became chronically infected and swollen. It could have existed for some weeks without the owner seeing it. 3. TIPS. Old and unhealthy dogs (>5 years) must be given 25-50% of the calculated dosage of IV anaesthesia for younger dogs to lessen risks of heart failure. CREDITS     Toa Payoh Vets' Be Kind To Pets video Veterinary Education for vet students and pet owners   Concept by: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Video and narration by: Video is at: (Insert the name of the URL): Date of video production: For more information: toapayohvets.com +65 9668-6468, 6254-3326, e-mail judy@toapayohvets.com The video produced by a vet intern is at: Video: Oral tumour electro-excision in a Cavalier King Charles Toa Payoh Vets Clinical Research   Copyright © Asiahomes All rights reserved. Revised: January 25, 2013 Toa Payoh Vets

eyeball prolapse in a dog with itchy eyes

http://www.kongyuensing.com/laws/20130188eyeball_prolapse_dog_itchy_eyes_toapayohvets.jpg