1032. A pair of "conjunctivitis" cases - corneal ulcers

 

 

 

1031. Surgery: Tail docking of Poodles, Jack Russells and Schnauzers

Although animal lovers condemn tail docking as cruel acts, it is much more painful for puppies when breeders strangulate the tail with tight rubber bands to "dock" the tails in a do-it-yourself way. So, I offer this tail-docking service for home breeders who want the puppies' tail docked.

"Each vet has his or her own way to dock a less-than-4-day-old puppy's tail," I said to Dr Daniel. "You observe my method which is a fast and efficient process taking less than 1 minute/puppy docked and then do your own way. So, for 6 puppies, the whole process is completed in less than 5 minutes."  The Australian university professors will teach their methods or may not as Australia has an anti-tail-docking culture for all puppies.   

I asked him to stand beside me rather than opposite me and asked another person to position the poodle puppy for tail docking. He has to view from the point of the view of the operating vet rather than seeing from the opposite side.

1.  The assistant holds the puppy horizontally and firmly with his elbows resting on the op table. The puppy's head faces to the left of the operating vet.

2.  A narrow blunt-edge scissors is placed on the extended tail such that the upper blade is placed further backwards by 5 mm dorsally as compared to the lower blade. The upper blade grips the skin and is rotated cranially to the same plane as the lower blade.

3. The tail is cut in the same vertical plane. This results in the dorsal skin edge being 5 mm longer than the lower skin incision edge.

4. In this way, there will be no bone protrusion which may happen if the tail is docked just in one vertical plane by the two upper and lower bladder of the scissors.  The assistant needs to hold the puppy vertically to provide a good view.


5. The coccygeal bone may not be cut at its joint. So, I use the blunt ended scissor to undermine and cut the partial bone fragment away to reveal the shiny joint surface.
6. KMnO4 powder is pressed onto the bleeders. This is very effective when the puppy is less than 2 days old. There was no bleeding in the 6 poodles docked.
7. The owner is advised not to let the dam lick away the KMnO4 powder in the tail for 24 hours by ensuring the feeding is supervised. 

The above technique is not suitable for dogs over 4 days old as there will be too much bleeding post-op. Stitching the amputated ends will need to be done.

1030. Blood in the rabbit's urine

1.5-year old rabbit, obese, female.
"The rabbit is greedy for treats and ate a lot daily," the sister said.
"She also ate a lot of pellets. For the past 1 week, she has frequent urination. The sister and her friend took the rabbit to Toa PayohVets for a check up as the rabbit had become lethargic. The owner was busy at work and the sister and her aunt were very worried.

"Collect her urine without any stools," I advised over the phone. "Wash and clean the pee tray first."  This was the most practical way to collect urine. Urine must be analysed as part of the practice of evidence-based medicine rather than just giving antibioitcs.

URINE TEST on Jul 8, 2013
pH 9, SG 1.005, Protein 3+, Blood 4+, WBC 0, RBC 999, Bacteria 3+, Amorphous phosphate 3+.

What to do?

Dr Daniel had the scalded genital area washed. He prescribed medication and the owner came later to take the rabbit home. "No more treats," I said.

FOLLOW UP
It is important to follow up as many Singapore pet owners don't review the case. Perhaps it is due to lack of time or financial constraints.

On Jul 17, 2013, 9 days after treatment, I phoned the non-owner sister. Since she did not reply, I sms her: "Is the rabbit still passing blood in urine? Pl update. Dr Sing. Toa Payoh Vets."

Her reply: "The first 2 days of medication no blood. But past few days, the urine seems to have blood.  Not sure whether it is orangey or blood. The medication does not seem to have finished yet though. Is the medication supposed to be finished? But I have tried feeding her fresh veg (water cress) which she quite enjoyed. She seems to be a bit more hyper now."

My reply: "Do you still feed treats n pellets? U need to reduce at least 50% of dry food n treats."

In summary, I advised feeding as much fresh vegetables as possible without causing diarrhoea and monitor amount of water drunk. X-rays for bladder stones if there is still blood in the urine.

There is not much the vet can help the rabbit but to educate the owner by following up. Often, vets have no time to follow up. It is just not practical to follow up every case. In this case, there may be bladder stones but will the owner want to pay for X-rays of the bladder?  As in people, the over-consumption of certain food or treats can lead to ill health. I suspect the kidneys may be involved too.

Since X-rays were not consented, it is hard to tell whether there are bladder stones. Tablets to acidify the urine is being given as well as antibiotics.

 

1029. FLUTD in a young male neutered cat

The 3-year-old male neutered cat pees blood in the urine for the past couple of days.
Urine test showed no crystals.  No X-rays were done to lower medical costs for heartlanders. This may reveal bladder stones. Recurrence of haematuria will necessitate X-rays.

Follow up 5 days after bladder irrigation and antibiotics - no more blood in the urine. It seems more male cats who prefer dry food, as in this cat, tend to get an attack of haematuria compared to female cats.

As to the prevention, canned food is advised but this cat will not eat canned food. Much depends on the owner to re-train the cat to eat canned food.

1028. Update: Mum's ferocious old cat has runny nose and stops eating

"Just give an injection," the dutiful daughter working in the Singapore Turf Club phoned me. The 15-year-old cat had yellow runny nose and was dehydrated. His left ear was bleeding with scratch wounds. I had to sedate him to clean up his left ear and gave the SC drip and antibiotics as he was most ferocious in the previous runny nose treatment one month ago. Not just an antibiotic injection. Cat went home with medication.

As for the recurring nasal discharge, there could be an infection deep inside the nostrils. Being 15 years old, he was still mum's pet and the adult daughter and friends sent him down for treatment.

1027. A guinea pig's fur mites seen under the microscope

TOA PAYOH VETS toapayohvets.com Date:   17 July, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Fur mites in cats and guinea pigs    Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS 2003 case recorded in 20 January, 2003 Date:   17 July, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 2003 Mites (illustrated as seen under my microscope) cause hair loss, itchiness, scabs and open wounds and pain in the cat or any pet. Another white cat (left) 6 months old just after anaesthetic and spaying surgery. Goes out often. I saw lots of black dots on the hair shafts. They are fur mites. Bathe the cat with the anti-mite shampoo. May need to shave off all hairs. Consult your vet for the ivomec treatment if you can't shampoo the cat. Hair mites look like dirt Consult your vet quickly before the whole body is infested It is easier to see black fur mites on white-coated guinea pigs. Another type of insect may appear as white long wriggling insects on the hairs. It will be educational to show the pet owner the mites under the microscope. I have illustrated what I saw under the microscope. The above cases were recorded in Jan 20, 2003. I got the records out from my website, using Goggle Custom Search on "guinea pig mites" as I review my guinea pig fur mite cases.   2013 10 years have passed so fast and yet the guinea pigs still suffer from fur mites infestations! On Monday July 15, 2013, I was getting ready to send my rental Mitsubishi Lancer EX to the accident assessment workshop for insurance purpose. On Saturday, a driver with 3 children in another similar model hit my left bumper as she did not stop at the solid white line as I drove up from the basement 2 to basement 1 car park to exit the HDB Hub car park.   At 11 am, a lady brought in two guinea pigs with white wriggling insects of up to 4 mm in length, on the coat. I showed my assistant, Niang, how to pick out the fur insects from the guinea pig and examine under the microscope. I said to the young man: "You are a veterinary graduate from Myanmar. You have to be observant and work hard so that you become competent in diagnosis and treatment when you practise in Yangon in later years."  The owner did not want to see the moving mites under the microscope. There were brown and elongated and I have drawn one of them for the owner to see. I had the two guinea pigs clipped and bathed with an anti-insecticide wash. "Isn't that risky?" Dr Daniel had asked me. "Some vets apply ivomectin drops between the ears to resolve he problem." Each doctor has his or her own way to resolve the mite problem but in this case, the owner couldn't stand seeing her guinea pigs overwhelmed with crawling white insects in the coat. Clipping away the hairs will reduce the contamination and the insecticide bath will eliminate the mites. "The guinea pigs are rinsed with water after the bath," I said. "In my experience with other cases, the owners were satisfied. The environment, bedding and brushes have to be de-contaminated with hot water too, to prevent recurrences." It will be much more convenient for the owners and their domestic helpers if they do not need to bathe the guinea pigs as most city-dwelling Singaporeans don't have the farming background of agricultural countries to know how to handle the squeaky guinea pigs. Asking them to come for 3 weekly sessions of ivomec spot on the neck area may not result in compliance as the majority of owners seem to be time-pressed, a common situation for most Singaporeans including myself.   This lady owner also brought in a plump female Miniature Schnauzer which had been treated by "many vets" and had blood tests done. "When the Schnauzer is given medication, she does not scratch," she said. I had the dog clipped bald. There were several open wounds on the armpits and body due to self-scratching. The prominent findings were red itchy and painful ears filled with hairs, redness and hair loss on the elbows and multiple pimples on the belly. I told  Niang: "generalised pustular dermatitis" is present in the lower body. See the pimples in the hundreds of red spots with yellow pus on the skin. This is known as pustular dermatitis. 'Generalised' means 'widespread'. The cause may include demodectic mites." It will take time for Nia to understand the English language and see the varied conditions in Singapore's pets. Many clients complain they can't understand his "English". He seems afraid of handling cats, according to Dr Daniel. I need to give him time to get used to the English here and learn about the restraint of fierce clawing cats.. Myanmar's past decades of politics, student unrest and elimination of the learning of the English language in primary schools had resulted in a generation of graduates not proficient in the English language and the use of computers. But there is much progress in veterinary medicine nowadays and it will be good if I can help one graduate at a time to upgrade his veterinary diagnosis and treatment.       As for the Miniature Schnauzer, I advised weight loss and the lateral ear resection surgery to open up the ear canal for ventilation and drainage. Usually this operation results in no more ear scratching using the hind legs. A plump dog is a high anaesthetic risk. The owner was enlightened as I asked for past medical records from the many vets she had consulted as she said: "Take a blood test as the previous tests were taken a long time ago."    Updates will be on this webpage: http://www.asiahomes.com/singaporetpvet/1210hair_mites.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: July 17, 2013 Toa Payoh Vets

1026. Testicular tumour video production

TOA PAYOH VETS toapayohvets.com Date:   17 July, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits One undescended testicle becomes cancerous    Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   17 July, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Wednesday, July 10, 2013 1018. An undescended testicle becomes a large tumour   I was happy to see the two sisters again after over 5 years. One was taller and slimmer. Their male 10-year-old terrier X had one fast-growing large lump on the left inguinal area. The other undescended testicle was smaller and normal in size. "Why didn't you get the dog neutered when he was young?" I asked. "Undescended testicles are known to become cancerous in older dogs and men, like the famous cyclist. Now it is a gigantic tumour. Since it grows so fast within a month to become bigger than a hen's egg, it is likely to be cancerous. There is a high anaesthetic risk when an old dog goes under general anaesthesia resulting in death on the operating table." "We did not think about it," the elder sister said. "Is it OK to do the surgery now?" "Take a blood test to screen his health," I advised. "In any case, you have no choice but to get the massive testicular tumour taken out because the cells will rot as they expand in size, causing much pain. The dog will lick the area till the skin becomes thin and the rotting tumour drops out. Now he is licking his penile tip which is red." The owners brought the dog in because the dog kept licking his penile tip. A blood test showed abnormally high SGOT, around 8 X higher. The dog was scheduled for surgery after one day of antibiotics and painkillers.    "How do you know it is a testicular tumour?" Dr Daniel asked me as part of a discussion on this case. He would be thinking of an inguinal hernia which is more common a condition in this belly location called "inguinal". "It is hard and firm and does not go back into the abdomen unlike an inguinal hernia," I explained my diagnosis of the undescended testicle becoming a large tumour. The dog was neutered by Dr Daniel and went home in the evening. The sisters agreed to get the large tumour analysed by the laboratory to check whether it is cancerous or not. As for the high SGOT levels, it is hard to say whether this increase in enzymes is due to the testicular tumour or that the liver is affected. A blood test one month later will be useful to check whether the cells have gone back to normal levels and this would indicate that the cause of the rise is due to the testicular tumour. An educational video is being produced. UPDATE ON JUL 17, 2013. I phoned the owner. The mother replied saying the dog is OK and asked whether the testicular cancer has spread to other parts of the body. I told her it is not likely based on the histology report of the cancer being confined inside the tunica.  The epididymis is "unremarkable" according to the report. Sertoli cell tumours can metastasize but not all do so. This case appeared to be operated early and so there was no spread of the cancer cells to other parts of the testes esp. the epididymis and to the vas deferens. For the mother, I just told her that the cancer had not spread and this was good news for a family who loved this old dog.     Updates will be on this webpage: www.sinpets.com/F5/20130712testicular_tumour.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: July 17, 2013 Toa Payoh Vets

1025. Putting her best foot forward - graduates of Singapore Management University

Putting her best foot forward - after graduation. Some will succeed in their career.

1024. An eventful Saturday Jul 13, 2013

I was on duty in the morning of Sat Jul 13, 2013. The sky was cloudy and there may be some haze. Flooding in China and typhoon in Taiwan.
Case 1. Update on the old Shih Tzu from Bedok.
The 13-year-old Shih Tzu from Bedok with a stroke diagnosed.  The parents and the adult daughter and son brought the dog in early in the morning. The dog is mum's pet and it is nice to see two adult children caring so much for the old dog.

"My dog can walk normally," the mum was most happy as the dog was paralysed on 4 legs just around 4 days ago. I diagnosed stroke as the quadraparesis was sudden but a brain scan would be too expensive to confirm. X-rays did show some disc narrowing the lumbar 3/4 vertebra but the primary diagnosis from me was a stroke and prescribed some medication.  So it was a great surprise that this dog could now be ambulatory and do his own peeing and pooping.

"The ringworm in the belly seemed to have disappeared 99%," I showed the normal skin with just a small areas of scales. This belly ringworm took many months to cure and I had told the owner that this was not the fault of Vet 1 who had correctly diagnosed the disease but it was their management. Still it took at least 2 months to get a cure at 99%.

"The stools are much better with this dry Z/D diet," the mum showed me a smartphone image of well-formed solid stools. I had a Z/D diet trial in case the dog was also allergic to dry food. Nowadays, it is very expensive to test for allergies and the tests may not be of any use. So I tried this Z/D food trial on this old Shih Tzu whose immune system may be down, owing to old age.

Overall, the outcome was a happy one but I still advise confinement in a room for 3 months as the dog was walking all over the apartment. This is to give time for the spinal disc to heal as the dog was on anti-inflammatory medicine which would be tapered off in 4 weeks.

"He will bark if we confine him in the kitchen," mum said.  So there was this problem which I can't resolve.

"Put a fencing between the kitchen and living room," I said. "So the dog can see you all, at least for one month."

It is easy to advise. Home conditions are so much different.
Case 2.  Update on an old stray cat from the Turf Club.  The dutiful daughter asked if an antibiotic injection can be given since the 15-year-old cat now had yellow runny nose again and would not eat. He had recovered twice after my treatment but the runny nose would recur and he would not eat again.  On examination, the cat had a painful bleeding itchy left ear and was dehydrated. Yellow mucus flooded the two nostrils. The cat was weak and not so ferocious but my assistant was afraid. I gave a very low dose of sedation to irrigate the swollen left ear and give SC fluid.  Treatment was given.  Will need to follow up.

Case 3. The young cat came for dental scaling. The cat was ferocious when we wanted to sedate him although he was OK during consultation. "Why didn't you go to the vet so near your apartment?" I asked this new client.

"The vet said she does not do dental scaling."
"It is very strange," I replied. "All vets do dental scaling."

"My cat's jaws were fractured and dislocated," the young man said to me. "He went to Vet 2 who attempted to fix the jaws by wiring the canine teeth. But the jaws became normal again. A very rare occurrence, Vet 2 said to me.

We finally got the cat sedated but he was clawing till his claws bled. I explained the situation to the owner. "He nearly killed Vet 1 when I brought him for consultation on his fractured jaws. But at Vet 2, he was so 'manja' (affectionate in Malay language?) and refused to leave the place. Vet 2 is the one who told me that his fractured and dislocated jaws had become normal by going back to the joints again."   

So the real reason was that Vet 1 did not want to see this cat again. Even for dental scaling. As for Vet 2, I did not ask why he did not go for dental scaling there.

Case 4. Update on the kitten attacked by the dominant cat at a garbage dump. The kitten could eat but could not stand. The young Malay lady would bring him home on Monday. He is very thin and if nursing is good, may recover. Due to financial constraints, no X-rays are taken of his shoulder or spinal area to find out why he can't stand.

Case 5. A 3-month-old kitten would go home on Sunday. There was slight bleeding on the declawed digit 1 on the left foot but otherwise she was active. An e-collar would be worn. "Bandaging is not a good idea," I said to the owner who asked about it on Sunday. "The paw may become infected as there is no ventilation. Gangrene may set in as your friend may not know how to change bandages. The kitten had been bandaged for the past 3 days. As for pain-killers, she had 2 days. As the liver may not be as mature as in an adult cat, less sedation and pain-killer is safer."

Car accident. This Saturday was eventful because I was looking forward to seeing a dance performance at the Singapore Management University at 2.30 pm. Another car failed to give way as I drove uphill from HDB hub basement car park 2 to B1 and my left sided bumper was hit by another same model Mitsubishi Lancer. My car tire punctured at the side wall and I had a lame car driven up and out of the car park to the main road opposite the Toa Payoh Swimming Pool.


The "crunchy" sound made me stop the car and I phoned the emergency car repair mechanic. The tyre was replaced by a much smaller diameter tyre which, acccording to the renter company, was the original tyre of this Lancer.

So the car was unbalanced as I drove it for the weekend. The person who hit me was a mother of 3 children. The younger child and his sister in their primary school age came out from the mother's car after a wjo;e as we took images of the car accident. Both were crying as they were quite traumatised. I comforted the little boy. "Is this the first time they were in a car collision?" I asked the mother. "Yes," she said. I missed the dance performance which would be going to Italy for a competition.


In the end, I was at the the SMU seeing the School of Info System graduates throwing up their mortar hats and taking images as I was too late for the performance.