1436. How to close a large peri-anal wound after a massive circum-anal tumour surgery

TOA PAYOH VETS toapayohvets.com Date:   02 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits How to close a large peri-anal wound  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   02 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1436. How to close a large peri-anal wound after a massive circum-anal tumour surgery Male Cross-bred, 10 years, not neutered, has several tumours. But circum-anal tumours were massive and extended around the anus from 12 to 6 o'clock. A cluster of tumours appeared at 10 to 11 o'clock. May 1, 2013 Tumour excision was done by Dr Daniel but the skin was under high tension after stitching as there was insufficient nearby skin to close the wound. After 7 days, the stitches broke down. The anal opening shrank deep into the big wound caused by the breakdown. Stools clogged inside the skin folds of the large wound. Flies appeared from nowhere and settled on the wound. I got the dog washed twice daily to clear the stools and keep the wound clean.  "This wound will never heal by secondary intention as the stools keep falling into the wound, contaminating it," I said to Dr Daniel. "There is a need for another operation to close it. The retained stools keep contaminating the wound. The owner's permission must be given." Dr Daniel said: "The dog is old and had difficulty in surviving the long anaesthesia. So I did not create a flap to close up." "In old dogs, to ensure survival from anaesthesia on the operating table, it is best to do a 2-stage surgery. Stage 1 to excise the wound. Stage 2 to create a skin flap to close the wound. However, the owner must be informed early and told of the financial costs in 2 operations."    I sketched two surgical plans for Dr Daniel to consider.  I phoned the owner who asked about the costs and gave permission to close up the big wound. May 17, 2013 The dog had been cleaned twice daily for the past 16 days. There was diarrhoea earlier and the wound would not heal.  Creating a flap to cover the wound was done by Dr Daniel on May 17, 2013. On the 3rd day, the dog went home as the wound was healing well.       6158 - 6164.  Massive circum-anal tumours in old dogs - 2-stage surgery advised UPDATE As at Jun 2, 2013, no complaints about the wound from the owner. I text-message her on May 28, 2013 and did not get a reply. Will follow up again.  Owing to financial constraints of the owner, some large wounds can be left to heal by secondary intention rather than using a skin flap. For example, large umbilical or sternal area tumours. Financial costs are much higher when tumours are massive and two-stage surgeries are advised in dogs over 7 years old to minimise anaesthetic deaths.    Updates will be on this webpage: http://www.sinpets.com/F6/20130602circum_anal _wound_closure_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: June 02, 2013 Toa Payoh Vets

1435. Myanmar stories - Same name but different destinies

Yesterday May 27, 2013, I visited Khin Khin's office. There was a plump Myanmar lady asking her to find her a better job earning more than the $500 per month she was paid for the last 4 years working as a nursing aide for the intellectually disabled. She loved her job as she showed me her mobile phone pictures of her favourite patient and of her cooking for over 200 people in the home and in the monastery.

It is very difficult for Khin Khin to get to know all prospective job applicants as several come in per day. I noted that this lady has exactly the same name as Khin Khin. Many Myanmar nationals seem to have same names but this was the first time I noticed the exactly identical names.

"Try and help her find a better job," I said to Khin Khin. "She has the same name as you and has a degree in Geography from the East Yangon University. She needs to support her family. If she has a better fate like you, she will not be earning so little. "

"She is too fat," Khin Khin was surprised that this lady has a similar name as hers. "Employers will think she is lazy and will not accept her."
The lady was not offended by this stereotyping of fat being lazy.    
"Where is your home in Myanmar?" I asked.
"In China-town in Yangon. My parents live there."
"Yes, I had been there. Are the people there speaking Mandarin?" I asked.
"No, they speak Hokkien," she enlightened me that the "Little India" street where vendors sell nuts I visited when I was in Yangon was Muslims from Blangladesh, not Indian nationals.
"Why don't you work in Yangon now that Myanmar is booming?" I asked.
"I like Singapore," she could converse in English well. She would prefer a job where she could earn $1,000 and stay out of the employment area.
"Will you get a good testimonial from the employer? You have worked for 4 years to the expiry of your contract."
"My officer is hospitalised with some shoulder pain," she replied. "They will give me the air ticket and testimonial at the Changi Airport tomorrow when I have to go back."
This was a lady who was mature in that she did not jump ship when a prospective agent offered her a $1,000 job and freedom to live away from the employer's premises as her contract had not expired.
"How old are you?" I asked.
"I am 38 years old." Certainly age and experience makes her responsible to complete her contract. But there are others who don't care and will job hop at any moment for a better pay. Now she is free to go to interview for the $1,000 job but will need to go home first.
As she left she asked Khin Khin in Myanmar language and Khin Khin told me: "What weight should I lose?"
"10 kg will be good," I replied. "You can always go jogging early morning as I see many Yangon people doing it near the lake.  Don't eat the fatty oily food. Just chicken, fish, vegetables and rice mainly."

It is very difficult to reduce weight on Myanmar cooking which is extremely oily in my observation. Oily food tastes good. In Singapore, the numerous slimming saloons ensure that our young ladies keep slim before marriage.

1434. Two cases of undescended testicular tumours in old dogs.

TOA PAYOH VETS toapayohvets.com Date:   28 May, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits High anaesthetic risks in surgery  of undescended testicular tumours in old dogs Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   28 May, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1434. Two cases of undescended testicular tumours in old dogs May 27, 2013 Case 1.  Anaesthetic risks are very high when an old dog is operated and all vets will have encountered deaths on the operating table. This case was one of them. A woman adopted a bigger Papillion cross-bred that has a left undescended testicle larger than the biggest hen's egg you will ever see in a supermarket. That was some weeks ago when she asked me to examine the dog and to age  him. I estimated the age to be over 6 years as the teeth were in good condition. She did not want any surgery to remove the large left undescended testicular tumour.   2 days ago, the lady brought in the dog as there was a few new lumps growing beside this tense skin testicular tumour, irritating the dog causing him to lick it. I warned the owner of the very high risk. The tumour was massive and the cancer cells would have destroyed much of the testicle based on this large size. "I met his ex-owner who came to me when I was walking the dog a few days ago. The person asked why I was so stupid to adopt a 12-year-old dog but did not acknowledge she was the owner."  The tumour and the cysts were removed. It was quite a bloody surgery. The dog survived the surgery but passed away probably from heart failure around 12 hours later as her tongue and gums were cyanotic.  The woman was understanding. Dogs over 7 years old are considered high anaesthetic risks and most owners and vets prefer not to operate on such categories of dogs as so much risks and emotions are involved when a dog dies on the operating table. Case 2. One day before this case, there was the 13-year-old Shih Tzu with the recurring ringworm in his belly. He had an undescended left testicle 3 x larger than the descended one and is much firmer. The dog came in for the generalised ringworm in April and had recovered in her face, legs and body. But the belly was itchy and red rings appeared. It was a new case of ringworm again.     Left undescended testicular tumour has been removed together with the descended right normal testicle in this 13-year-old Shih Tzu "Why didn't you tell me that my dog had testicular tumour the last time you saw her for ringworm?" the woman in her 50s asked me. She had brought in the dog for an itchy body which did not respond to anti-ringworm drugs prescribed by two vets consulted and by her self-treatment of over-the-counter lotion.  "At that time, the undescended tumour was not so big and hard," I advised neutering. This was done under general anaesthesia with little bleeding unlike case 1. The tumour had not grown fast and large yet. The dog is of a similar age as Case 1 but survived the anaesthesia and is well as at today (3 days after surgery).  Conclusion Annual health examination of your older male dog by your vet will have been best if you don't want him neutered. It is best to neuter dogs with undescended testicles as there is a high probability of them becoming cancerous. Although anaesthesia is safe nowadays, old dogs are always a high anaesthetic risk.    Updates will be on this webpage: http://www.sinpets.com/F6/20130528 undescended_testicular_tumours_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: May 28, 2013 Toa Payoh Vets

1433. Owner Education: Recurring ringworm on belly area

Sunday May 26, 2013

The 13-year-old had been to 2 vets. Vet 2 diagnosed ringworm. The owner started self-treatment since the skin disease was not cured. Cream and a blue lotion from over the counter was applied on the skin. Still the dog was itchy. The daughter sought an opinion from me in April 2013. I followed up with the mother and advised review but she did not come.



The mother went overseas for 4 days and came back to see the belly full of reddish rashes and ring-like lesions.

"Generalised ringworm is not easily cured if the environment is still contaminated," I said.
recovered after medication and treatment for generalised ringworm as evident by new hair growth and clear skin.

1432. Vesak Day Friday May 24, 2013 - availability and referrals

TOA PAYOH VETS toapayohvets.com Date:   27 May, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits A Vesak Day's availability and referral Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   27 May, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1432. Vesak Day Friday May 24, 2013 - availability and referrals The first case on this Vesak Day, a public holiday was from a family who wanted to euthanase their thin 14-year-old Miniature Schnauzer. The young lady had phoned me the previous night to make an appointment: "It will be Vesak Day, tomorrow. Not so good to put down my dog." But she came as the dog was not eating. Her vet closed today and so she came to me. Her father said to me: "I had worked in the tyre shop 4 shops away some years ago when the industrial park was set up in 1980." It was especially sad for a little girl of around 6 years old with two side pony tails as she cried loudly when she was not permitted to view the dog after euthanasia. The old dog was on Vetmedin and frusemide medication prescribed regularly by their vet (Vet 1). Most owners don't bother to bring their dogs for reviews and just get the heart medication. Proper dosage and review will prolong the dog's life till end-stage heart failure. "Why did you go to Vet 1 all these years when you live so far away and there are clinics nearby?" I asked. "My relatives go there."   In the last case, there was an emergency Caesarean section as the Chihuahua, mated to a larger Jack Russell X had the first puppy stuck and pulled out by the owner 3 hours ago. I palpated the abdomen and there was another one. No X-ray or ultrasound is necessary as palpation can confirm. This saves costs for the owner. "Is there another alternative to C-section?" the slim young lady asked me. "Yes," I said. "An oxytocin injection. Wait and see. However, by delaying C-section, now 3 hours later after the birth of the first pup, the 2nd pup will die if the dam can't push it out! It is up to you to decide." She decided on the C-section which would cost her around $1,000 as compared to an oxytocin injection. Dr Daniel operated while I assisted. There was only one pup, weighing 150 g. It cried and moved vigorously when the water bag was ruptured by me. This means that it would live. "It is not as big as the first pup," the young lady said. "The male dog was interested in her and we separated them till the end of her bleeding," she said to me. "Yet she became pregnant." "In female dogs, the fertile period is towards the end of bleeding," I said. "Unlike in the female person whose fertile period is before menses." So that was how the female dog got pregnant. "Why do you come so far for Caesarean section as you are living in Bedok and there are vets nearby?" I asked her.    "My friend whose poodle you treated recommends you," she said. As the young lady did not delay further, the pup was not suffocated inside the water bag. He was crying immediately. So, no problem of survival. I let him suckle the dam for 10 minutes. TIPS 1.  As the owners were away, I took out the pup and put it in a box instead of leaving it alone with the dam. The dam may bite it since she is a first-time mum and the owners will be most unhappy. I would not have time to monitor it. 2. Three hours after the birth of the last puppy would be the limit to vigorous survival (cries immediately on delivery) generally. If there is a delay of more than 5 hours, the pup will not be vigorous as fluid from the water bag clogs up the lungs. Such pups will need swinging (see other video of Toa Payoh Vets) to revive, not just hope for the best as they will die if not swung. Vets need to be the surgeon and the midwife when pups are distressed!   These two cases illustrate that referrals are most important in veterinary practice. So is being available when your services are required. It is difficult for vets to be available during public holidays but these are the days when owners need the services. Update will be on this webpage: www.sinpets.com/F6/20130527referrals_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: May 27, 2013 Toa Payoh Vets

1431. Mum's ferocious anorexic cat

TOA PAYOH VETS toapayohvets.com Date:   24 May, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Mum's ferocious anorexic cat Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   24 May, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Thursday, May 23, 2013 1431. Mum's ferocious anorexic cat I asked the daughter to sms me regarding the progress of her mum's cat as this was a ferocious cat that would not eat when hospitalised for the past 3 days. When he came in, he was quiet and I gave him an antibiotic injection as he had yellow nasal discharge. I warded him since the mum said that her cat had not been eating for some weeks. The mum had asked for some medicine 7 days ago, but the cat still would not eat. So I advised her to send the cat in for detailed examination including blood test and X-rays where relevant. After my first injection, the cat would attack any staff going near him. So my new vet assistant could not give him medication. How to solve this problem? "Mix the powdered medication with brown sugar and smear on his body," I said to my assistant. After 3 days, I phoned the daughter to take the cat home as the cat would be happier at home, be given antibiotics and recover. She was to let me know by phone but I did not expect any feedback as most owners don't do it if the pet is recovering. I got her SMS yesterday.   3.40 pm May 23, 2013 Hi Dr Sing. Gd afternoon. XXX from stc (Singapore Turf  Club) here. Updating you on d progress of YYY, my mum's cat. He is getting better, active n started eating whiskas (can food) not d ones fm ur clinic. She also can meow now. Thanks lots, 9.12pm May 23, 2013 I SMS back, short and sharp as I don't do long texting. Thanks for good news. He recovered from nose discharge? 10.56pm May 23, 2013 She SMS back Yes recovered. Tq Dr Sing Not a spoken word with the younger Singaporean clientele nowadays. But there was a happy clinical outcome and that was what matters. Vets have to deliver, to perform too, not only salespersons. A ferocious cat is a good experience for Dr Daniel and my new assistant to handle. I asked Dr Daniel to take blood for testing and give the drip. This was mission impossible if you see this ferocious cat pawing anyone going near him!  This is the reality of practice. In the University, the professors teach how to diagnose. But now how to treat a clawing ferocious anorexic feline that would die if he continues not to eat? "Sedate him lightly, take the blood for testing and give a SC antibiotic drip,"  I said to Dr Daniel.  This was done. Blood test showed a high total white cell count and this was indicative of bacterial infection. The daughter was satisfied with this evidence-based medicine being practised. The next day, I sent the cat home on medication as I felt he would do better at home ground. My intuition was spot on when the cat started eating and meowing, he is on the way to recovery. Update will be on this webpage: www.sinpets.com/F6/20130524ferocious_anorexic_cat.htm More case studies 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: May 24, 2013 Toa Payoh Vets

1430. Update: The young lady with a Terrier X with multiple bladder stones

Thur May 23, 2013  Toa Payoh Library 2.30 pm

I believe that the Terrier X was operated on Sunday,4 days ago by Dr Daniel and I. Thousands of stones. Millions if you count those peed out over the past 9 years!

http://www.kongyuensing.com/cgi/20130555Terrier_F_9years_bladder_full_stones.jpg

http://www.kongyuensing.com/cgi/20130522bladder_stones_female_terrier_toapayohvets.jpg

This morning, 9.49 am,  I phoned the lady owner of this Terrier X. No response. Could be sleeping or working. I sms her:
"May 24. Is C eating n normal now? Dr Sing Toa Payoh Vets"

At 12.19 pm, sms reply

"Hi yes she is...:) pee is clear and just passed motion today too...so she's recovering really well! Results for the stones will be out on Sun?

2.33 pm I reply:
"Not so soon. Will inform u."

Nowadays, it is better to text or send images of X-rays, lab reports by phone. Not a word needs to be spoken and no time wasting.