1451. Update on a Yorkshire with breast tumours & video produced

TOA PAYOH VETS toapayohvets.com Date:   09 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits A Yorkshsire Terrier has 5 breast tumours Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   09 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Thursday, May 16, 2013 1422. Yorkshire is too light-weight for breast cancer surgery "The big one grew very large only in the last 2 months," the lady owner had not wanted the 5 small breast nodules removed in July 2012 fearing that the dog might die on the operating table. The dog is now 13 years old.   "Did my associate vet advise removal?" I asked. "Yes, but since the dog is old and light weight, being 2.5 kg, I did not want the surgery done. What to do now?" "Since the 5 nodules have now become large, with the biggest one growing so fast, it is likely that the nodules have had become breast cancers. Most likely the tumours may have spread to the lungs and an X-ray will be needed to find out  You have two choices. To operate or not to." "What happens if I don't?" she asked. "The biggest one will keep growing. The dog is licking it now as you can see a shiny bald spot. Soon there will be skin ulcers and bacteria infection comes in. The tumour grows bigger and smelly. The dog will stop eating as she is in pain." "Spaying the dog when she is young will have reduced the chances of her getting breast cancer. It is not guaranteed but dogs spayed early seldom get breast cancers." I explained. "What is your advice?" "If you take the anaesthetic risk of the dog dying on the op table, surgery is advised. Short surgeries rather than a long one will minimise but not prevent anaesthetic deaths." The owner wants to think about it for a day. Surgery to remove the largest breast lumps first and then another surgery to spay the dog to deprive the tumours of the hormones and to remove the 3 small ones further forward. However, if the lungs have cancers, that will be a separate matter." The dog is now active and eating. If only the owner had agreed to removal of the small nodules 7 months ago and to spay the dog, this emotional situation will not happen. "It is not a matter of whether the dog is 2.15 kg or 10 kg that is important in anaesthetic risks," I said. "It is the health of the dog and the use of safe anaesthetics and the duration of surgery. If a vet takes a longer time to operate as he or she wants to remove all 5 tumours at one surgery, it will take a much longer time and this is when the dog's heart may fail. Short surgeries minimise but do not eliminate the risk."    UPDATE ON JUN 9, 2013 AFTER SURGERY ON MAY 17, 2013 The dog came for stitch removal 10 days after surgery. The owner was very happy as the dog was active and normal. I noted that the left MG 5 tumour is consolidated and can easily be removed with excessive loss of skin and the need of a skin flap to close the wound. The left tumour between MG 1 & 2 can be excised easily. Then spaying ought to be done at the same time. However, I advised the owner that the dog might die on the operating table as she is old and took some time to recover from anaesthesia unlike young dogs. The owner decided not to operate. After all, the dog is 13 years old and towards the end of her life span. I advised that should the left MG 5 grows fast and large, she would have to make a decision to operate or wait for the tumour to rot and ulcerate, leading to pain and infections. TIPS:  Spaying the female dog when she is young will most likely not result in breast cancers during old age. It is definitely much cheaper to spay a dog than to operate on large breast tumours. Recently there was publicity of actress Angelina Jolie having mastectomy and removal of her ovaries to reduce her chances of developing breast cancers later in life.   .   6181. Video: Breast tumours in old dogs - dilemmas Update will be on this webpage: http://www.sinpets.com/F6/20130517yorkshire_ breast_cancer_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 09, 2013 Toa Payoh Vets

1450. Shih Tzu with bladder stones and urethral stones - urine test

TOA PAYOH VETS toapayohvets.com Date:   09 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits A Shih Tzu has urinary stones in the bladder & urethra Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   09 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1450. Shih Tzu with bladder stones and urethral stones - urine test   UPDATE AS AT JUN 5, 2013 Stones have been removed on Jun 4, 2013. The stones in the urethra behind the os penis were flushed back into the bladder. All stones were removed via the bladder by Dr Daniel. There was no more difficulty in passing the catheter which was put in place for 2 days. The dog went home on on the 3rd day after surgery to save money for the owner. Some cases may need to stay longer for observation and confinement.   S/D diet recommended for 1-3 months and then C/D diet to acidify the urine. Regular urine tests and X-rays should be advised in writing. Urine test on Jun 4, 2013 pH 8.0 (5-8), SG 1.015(1.005-1.030), Protein +, Blood 4+, WBC >2250, RBC 351, Bacteria 2+, Crystals Amophous phosphate +. Shih Tzu will go home tomorrow with S/D and C/D diets for 1-3 months and urine tests every 3 monthly is advised. Many Singapore dog owners ignore the vet's advices to follow up on monitoring tests. Recurrence of urinary stones do occur in some dogs.  Stone analysis is being done.It is best practice to get the stone analysed, although struvite crystals are found in the urine. I expect the chemical analysis to confirm struvite urinary stone.  Video is: http://www.youtube.com/watch?v=D4Z2cYoz1UM&feature=youtu.be Update will be on this webpage: www.sinpets.com/F6/20130608 urinary_stones_struvites_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 09, 2013 Toa Payoh Vets

1449. Vet surgery: The steps in bladder stone removal in the cat and dog

TOA PAYOH VETS toapayohvets.com Date:   05 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Surgical Process in bladder stone removal & economics (video) Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   05 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Vet surgery: The steps in bladder stone removal in the cat and dog I surfed the net and found the following: http://www.youtube.com/watch?v=6nnIHqEoDVI This is a good surgery video done by the Silsistra Veterinary Clinic in Bulgaria. The process of surgery must be systematic so that a high standard of care is achieved. 1. Bladder is taken out and is packed and surrounded by gauze swabs so that there is no backflow of urine into the abdomen (seen in the video). 2. Two anchor sutures on either side of the incision. (I don't find this process necessary). 3. A syringe to take out a urine sample for analysis (done by me) if no urine sample had been collected earlier. 4. Bladder incision below the apex of the bladder. 5. Stone removal using forceps. 6. I do a 360-degree sweep of the inside of the bladder using artery forceps to feel for more stones. A gritty feeling.  (However, X-rays will show most stones). 6. Irrigate bladder with normal saline (via urinary catheter or syringe in saline). 7. Pass a catheter from inside the bladder into the urethra to ensure no stones obstruct the urethra, especially in the female cat (seen in the video). 8. 2 layers of inverting sutures. I find that artery forceps to anchor one end of the first continuous layer which is knotted at both ends. Then another artery forceps to anchor the other end of the 2nd continuous layer. These forceps are useful in providing traction in tightening the continuous sutures. *9. A syringe of saline is injected into the cat's bladder to ensure that there is no leak from the sutured area (seen in the video). Or syringe in saline from the penile urethra end catheter in male cats or dogs. Dogs with stones behind the os penis may need to be syringed with a 20-ml syringe of saline to push the stones into the bladder so that they are removed via the bladder incision. 10. I account for all stones removed as shown in the X-rays. The stones are shown to the owner and the numbers are recorded in the medical records. Unless there are thousands. It will be good to take digital images for recording. 11. Some clinics do another X-ray of the bladder after stone removal to prove that no stones are present. This is an additional cost but may be wise in defensive medicine. X-rays show include the kidneys. 12. I make it mandatory for all my vets to send the stones for chemical analysis even if the owner does not agree to it.  13. Advices on the regular monitoring of urine and special diet are ignored by most owners for various reasons. So, some cases of bladder stones do recur.  P.S. 1.  I have a video produced on the cost of bladder stone surgery in the dogs and cats in Singapore. The video is at: Video: Costs of bladder stone surgery. The costs just for anaesthesia and surgery are from $800 to $2,000 depending on the time taken to do the surgery. P.S 2. It is like feast and famine. Sometimes bladder stone cases come together to Toa Payoh Vets.  Images of 4 recent bladder stone surgeries done by Dr Daniel at Toa Payoh Vets are shown below: 6138 - 6141. Bladder stones 6149 - 6156. A bladder stone in a Jack Russell. Video: Costs of bladder stone surgery   6135 - 6136. Bladder rupture in a 12-year-old Maltese. The urethra had been obstructed with stones for some weeks. Owing to financial constraints, no detailed tests have been done. Blood tests in the vomiting dog showed kidney failure.  6170. Urinary stones in a Shih Tzu. The surgery was done yesterday, June 4, 2013. The bladder mucosa was 1-cm thick as the owner procrastinated on doing X-rays and surgery for many weeks. The big stone was >2 cm across. A fifth case of a pug with calcium oxalate bladder stones is scheduled. Practice makes perfect is applicable for surgeries too.  Updates will be on this webpage: www.sinpets.com/F6/stone_surgery_cat_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 05, 2013 Toa Payoh Vets

1448. White deposits on the dorsal cornea of a 5-year-old rabbit.

"For the past week, the rabbit has a white tissue covering his eye," the young man said. The 3rd eyelid covers up one corner of the eye permanently.

Under sedation, I was surprised to see thick white deposits on the 1 to 3 o'clock surface of the cornea edge. So the 3rd eyelid shoots up to protect the eye.

Electro-excision will be needed to remove the plaque but the owner is not in favour of it. 

1447. Dermaphytosis --- Diagnosis of ringworm using ultraviolet light

TOA PAYOH VETS toapayohvets.com Date:   09 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Dermatophytosis: Diagnosis using UV light Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   09 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129   1447. Dermatophytosis --- Diagnosis of ringworm using ultraviolet light Hairs, nails and superficial skin surface of the dog are areas affected The cause is usually Microsporium canis, M. gypseum or Trichophyton mentagrophytes,   DIAGNOSIS 1. Fungal culture with macroconidia identification Microscopic exam of the macroconidia is necessary to confirm the genus and species 2. UV light - Hairs that show a positive apple-green fluorescence under ultra-violet light (Wood's lamp) examination. M.canis on hair shaft will show apple-green fluorescence. But keratin with epidermal scales and sebum may also produce a false-positive fluorescence.   3. Microscopic examination of hair This often produce false negative results and so the vet may mis-diagnose as the absence of ringworm. Wood's lamp may be used on positive cases to show fluorescence on the fungal hyphae in the hair shaft  EDUCATIONAL VIDEO OF UVL FLUORESCENCE In a case of a white Pomeranian with itchiness and hair loss, I diagnosed ringworm visually, using the microscope and the UV light as shown in the image above.   In a case of an old poodle with multiple warts, the owner complained about generalised itchiness and skin dandruff. The dog had circular areas of skin loss and patches which fluoresces in light green. Anti-fungal cream and washes and steroids had been used earlier. I switched off the room light and asked Ms Toh, my intern to film the fluorescence but the skin fluorescence results are not satisfactory.  Most likely I have used the incorrect lens which can't focus well. The lens is not able to focus. However, I will put up this video to serve as a learning experience. Yesterday, on Saturday, Jun 8, 2013, I consulted the camera vendors. I was told that my lens were not appropriate for video. I needed a lens suitable for video production and this lens came with the Canon 700D model available just 2 weeks ago. I have this lens now and hope that future videos will be better quality. Video 1 - ringworm - ultraviolet light is at: (NOT AVAILABLE YET) Video 2 - ringworm - microscopy is at: http://www.youtube.com/watch?v=SqclWgPXw10 Update will be on this webpage: http://www.sinpets.com/F5/ 20130609ringworm_UV_light_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 09, 2013 Toa Payoh Vets

1446. Sunday's interesting case. A Ragoll's eye tears for 3 days.

I hope that Intern Terrance who is in National Service and works only on Sundays learns much about this case and produce a video. Train and teach are better done by making videos and writing case reports rather than watching.  

1445. Saturday's interesting case - Jun 1, 2013

On a bright sunny morning of Saturday Jun 1, 2013, I was on duty in the morning. I answered a phone call from a lady making an appointment for her dog vaccination. Distemper viral infections have affected some dogs recently and there is an interest in dog vaccinations from some owners who might have read newspapers.
 
"Which vet you want to consult?" I asked. "There are 3 vets."
"The one who said he would be writing a book."
That was 6 years ago. I met the family of parents and the pre-teen daughter, sun-tanned and wearing black-rimmed glasses and being taller than her slim mum.
The son was very good at illustrations and that was why I was telling her I would be writing a book and needed an illustrator.

I vaccinated the 8-year-old Miniature Schnauzer. A gentle dog. Salt and pepper.
"Her breath is smelly," I showed the thick tartar enveloping the dog's teeth. She also has milk in her breast (false pregnancy) and a small breast nodule of 5 mm across and I asked the mum to feel it.

It was just a vaccination but health problems had been presented. Next week, there will be dental work after 7 days of oral antibiotics. Spaying and removal of the breast tumour have been advised and it is up to the owner. 

"I want to breed her as she has a good temperament," the mum said. "But the few male dogs available are rather aggressive."

"You should have bred her before she is 6 years old," I said. "That time, she is in her prime."
The mum now studies a diploma in cooking as the children are now grown up as teenagers. She showed me her handphone of the boy and the girl in primary school when I saw them 6 years ago. Time has flown by. The father came back after going around the industrial park to find a glass window maker. It is nice to meet up after 6 years.

1444. Email reply: A pug in Yangon

A...gmail.com>	3:16 PM (15 hours ago)
to me

Dear Dr Sing Kong Yuen,
                                  Thank you for your offer but I am not asking you for your medical opinion. There is nothing between you and me to discuss whether its bladder stone (according to the previous vet and the ultrasound result) or UTI and Stone swallowed by my dog (according to Dr. XXX) because my dog was already dead. The important point is my dog died the next day after Dr. XXX’s IV injection (Glucose+B6+B12 as he mentioned) because he gave injection within a minute with 25ml syringe and she had shock and fell down right after his injection.

The next point is he had never told us to take x-ray or ultrasound and he just decided what he thought. After shock without giving treatment he kept on pressing out the intestine and taking out the stone from her anus. When nothing came out, he told us that it will come out with her poops as he put suppositories. Anyway, there is a lot left for me to say about his lack of his treatments.

I just expect that he need to apologize for his fault but instead of that his wife called us from Singapore and said your clinic and their clinic in Yangon are linked officially to do business.

So, I am just asking you whether it is right or they are just using your name as a stepping stone? If they are correct what is their job and responsibilities in your Singapore clinic? Are they doing as vet at your clinic or just helpers? From my experience Singapore Medical Society is really strict for foreigners to accept as professionals easily.
Sorry for your inconvenience. I hope that you can feel my lost. I am waiting for your reply.
Thank you
Owner of 7 years Old Pug

Kong Yuen Sing <99pups gmail.com="">	6:42 AM (0 minutes ago)
Jun 3, 2013

Please accept my condolences for the death of your pug.

In reply to your query, I have known Dr XXX for over 20
years as a good friend. During these years he was in Singapore, he has
worked for other Singapore vets with employment pass approved by the
Singapore Government.

I have not employed him at Toa Payoh Vets in all the years he was
working in Singapore. We are friends in the sense that he was never my
employee and so he has no obligations to me for his salary. When he
starts a new practice in Yangon, I am most happy for him and offer him
free advices on how to manage the practice based on my around 50 years
of experiences as a veterinarian in practice.

Toa Payoh Vets is a practice started by me in 1980 and Dr XXX has no
shares or interest in my practice..

I have no shares in his practice nor am I employed by his practice. I
give free advices to him on veterinary matters whenever my advices are
needed as I wish to see him successful in his new practice.

This is a time of great sadness for you. Please accept my condolences
again and let me know if I may be of any help.