From July 3 to July 7, 2014, I was in Yangon presenting two talks to the Myanmar Veterinary Association members. I stayed 3 nights in the Royal Golden View Hotel, North Dagon. This hotel has a beautiful view of the Ngamoeyeik Creek from the roof top.
Around 8 am, I saw monks crossing the river on a Sunday and Monday. I took images of one such scene.
The 3rd image reminds me of "Eight Immortals Crossing The River" in Chinese mythology. Are there 13 monks crossing the creek?
Construction workers come early at around 8 am to start work on building a retaining wall to prevent overflow of water from the Ngamoeyeik Creek into the grounds of the Royal Golden View Hotel.
A young female spayed Maltese passed blood in the urine. The owner was worried about bladder stones.
What is the cause of haematuria?
Vulval examination. No vaginal discharge but the vulval lips were red and slightly swollen.
Urinalysis and Survey Radiography are done. X-rays did not show radio-dense urinary stones in the kidneys or bladder. However, the dog did not poop and so the faeces hide any stones to be seen in the bladder. The dog had peed before X-ray at around 9.30 am and so the bladder is empty. There appears to be a "radio-dense" stone in the bladder area but it could be a small radio-dense bladder stone.
On urinalysis, triple phosphate crystals 2+ were present and probably the one seen on the X-ray (arrow). The owner is advised to use an acidifying diet to dissolve the crystals. Urinalysis after one month. and X-ray on 3rd month is advised.
CASE 2.
A 7-year-old male poodle had been having a stiff straightened left hind leg since adoption 3 years ago. "It is medial patellar luxation," I explained that this condition sometimes resolve after the dog is able to bend his left knee after some time. But yesterday, the dog whined in pain. "Left hip subluxation," I showed the X-ray to the owner. "Has he been jumping up and down the sofa?"
"No more jumping nowadays," the owner said.
"How about running up and down steps?" I presumed he lived in a maisonette where there are steps up and down the rooms.
"Yes," the gentlemen said.
"So he must have had slipped on his weak left hind and dislocated his left hip. That is why it is so painful!"
You can compare, in the X-rays, the normal non-luxated patellas of the Maltese in Case 1. In the Maltese, both normal patellas are in front of the knee. In this poodle, only the right knee has a normal positioned right patella.
Case study: The Singapore home-breeder does not believe in vaccinating her puppies.This female puppy was 8 months old but had not been vaccinated. She was lethargic around 7 days after being boarded in a pet shop before transfer to the new owners. Two days later, she passed blood in her stools. Abdominal palpation showed a lot of gas inside the intestines.||
The owner did not want a blood test. X-rays were done to check for any foreign bodies such as bones or pebbles inside her stomach and intestines. X-rays showed generalised ileus (gas all over the intestines). A parvoviral antigen test showed positive infection for canine parvovirus.
IMAGES OF X-RAY
Check for foreign bodies but there were none. Gneralised ileus. Gas forms from the stomach to the large intestines. I could feel the gas inside the intestines.
Supportive I/V drip was given. The couple was given a frank opinion that the unvaccinated dog has very low chance of survival. After 2 days of supportive treatment, the dog vomited all water and passed more bloody stools.
The couple sadly decided to stop further suffering by requesting euthanasia. This dog could have lived if the home-breeder bothered to vaccinate her. The couple informed her and she said she had not boarded the dog in the pet shop. She seemed to know about the possibility of parvoviral infection when the couple told her earlier that the dog had become ill. She denied the dog was ever boarded in a pet shop which is one of the places where parvoviruses are present. Grooming shops, dog runs and veterinary clinics are other places where such viruses may be present.
Always vaccinate your puppy. Vaccination saves lives.
The guinea pig was not eating for a few days and was not active. "Your guinea pig has thick yellow pus in his nose," I showed the lady owner. "He would be having a Upper Respiratory Tract Infection. So, he does not want to eat as he is not feeling well."
I hospitalized him for 3 days and gave him injections of Baytril and dextrose saline SC for 3 days. On the 2nd day, his left nasal discharge changed to blackish in colour. Then today, on the 3rd day, the discharge was light yellow and he was more active.
He had been syringe fed Fiberplex and electrolytes for the last 2 days and he passed out some stools. He needs nursing at home and be given antibiotics and food 3 X/day in small amounts.
Dirty ears, infected eyelids, long toe nails and smegma in prepuce means that he had never been groomed. Sometimes rabbits get such respiratory infections too. Maybe the cage hygiene or the food quality is poor.
It is hard to say what is the cause of the infection. The pellets and hay look great. One of my friends went to Yangon and stayed in a 5-star hotel. All 8 Singaporeans got vomiting and diarrhea eating good food of lamb, fish, chicken and vegetables. So, it is much the hygiene even in 5-star hotels.
"I better get the other guinea pig groomed," the lady had the impression that no groomers in Singapore groom guinea pigs. I introduced Agnes of Pet Gantry to her.
HOOK 7-year-old male poodle whines and can't stand on the left hind leg since last night. What's the problem?
BE KIND TO PETS
On Thursday, July 10, 2014, two young men brought in the poodle with a painful left hip area. He would not eat or drink.
1. SYSTEMATIC EXAMINATION OF LEFT LEG started from the toe. This involves Extension, Flexion, Abduction and Adduction of the joints. (VIDEO)
1.1. Joint manipulation. Very painful hip area (Dog cries - video). See X-rays
1.2 Hips extension and comparison. The dog's hips were extended to see whether the left limb is shorter or longer than the normal right limb. (VIDEO)
2. Check for anterior cruciate ligament rupture. Nil as the lower tibia did not slide backwards. No pain on manipulation.
3. Check for patellar luxation. Left hind has medial patellar luxation by feeling patellar medially when the left knee is extended. See X-ray of Left knee too.
2. IMAGING. Radiography Subluxation of the left hip joint. Right hip (R) is normal. VIDEO OF X-RAY ROOM and POSITIONING OF DOG FOR DEMONSTRATION ONLY. DOG HAD BEEN X-RAYED.
DIAGNOSIS Left hip subluxation.
TREATMENT 1. I manipulated the femoral head into the hip joint. 2. Confined rest for 3 months. No more walking down steps of the staircase of the maisonette. 2. Surgery - femoral head excision if still painful. Very good results. Costs from $600.
First day at work after presentation at Myanmar Veterinary Association Seminar on July 5, 2014 in Yangon. First case of Fluffy, Male, 3 years. He was caged alone as Muffin (now castrated) had bitten his nose in Sep 2011 when crated together.
"Fluffy is not eating and moving," the lady owner said. "Did he stop eating suddenly?" I checked the front teeth and put my finger into the mouth to feel for molar spurs. The teeth were normal. "There is pus coming out from the left nostril," I showed the lady by pressing the nostril. "In addition, the eyes are crusted with tears."
The guinea pig was given antibiotics and dextrose saline and warded for daily treatment. (VIDEO).
An hour's drive from Royal Asia Veterinary Surgery, I visited a countryside of farms, saw a brick factory and a chilli sauce factory in Hlegu township, Yangon,Myanmar.
Flooded farms as July is a rainy month. Dry months are from October - January. Not so good lighting for photography.
River boats seen from the Royal Golden View Hotel on July 6, 2014. Looks like there is a need to pump out water from the boats. Are they overloaded or leaking?
The river is not overflowing on July 7, 2014. From my hotel restaurant, I can see monks cross the river by boat every morning.
Visited a medical diagnostic lab, Ni Ni, with CT scan, mammography X-ray and many equipment including a combined biochemistry and immunology test machine. Visited Crown Veterinary Resources, an excellent X-ray and lab facility for vets in Yangon.
I met the owner of the 13-year-old Siberian Husky this morning. The first vet referred him to two other practices as she does not perform the ear surgery. "Unable to examine the ear canal due to tumours." The owner had bad experiences with the first surgery recommended and did not go to the second.
The dog's left ear was full of pus. The vertical canal was hardened and painful. The right ear was OK.
"What caused this ear problem?" he asked me. "Was it due to ticks?"
"It is usually a small ear infection and the owner ignores it over several months. So the bacteria and yeast cause inflammation and the vertical walls hardened like tumours." I pressed the canal and the gentle husky winced in pain.
"Treatment would be surgery to take out the whole of the vertical canal," I said. "This dog is old and a blood test is needed."
"My dog is healthy," he said.
"You are likely healthy unlike an old man," I replied. "This dog is old and I don't know whether she has kidney or liver disease till a blood test is done."
He agreed to a blood test and 2 weeks of drug treatment to bring down the inflammation. I will see the dog in 2 weeks' time and do the vertical ear canal surgery if the wounds have had healed. "The cost of surgery is $1,000 as it takes a long time and the dog is bigger in breed," I estimated the cost.
It would be better if the owner had not delayed early ear infection treatment but he was overseas studying. Medical costs would be much less if there was no surgery.
The young man really turned up for the surgery done on Jul 17, 2014. The 2/3 of the vertical canal with an abscessed cartilage tumour 3 cm x 3 cm x 1 cm were excised. Lots of bleeding. 20 hours later, the wound is washed. The dog went home with pain killers and antibiotics on Day 2 of surgery.
So far, so good.
HISTOLOGY RESULTS:
The vertical canal right ear tumour, 2 cm x 1.5 cm x 0.7 cm, is compatible with ceruminous cystadenoma.
Vertical ear canal resection (VECR) is the solution. In Dr Daniel's opinion, the smelly ear tumour in the top 1/3 of the vertical canal seen only during VECR surgery might be cut off. This is a difference in opinion as 10 vets would have differing opinions on how to handle this case.
For example, the family vet advised total ear canal ablation and referred the owner to two other practices.
To lower medical costs, no X-rays were done. During VECR, the tumour at the upper 1/3 of the vertical canal could be seen. It was around 3 cm x 3 cm and rotting. If it was excised, the other parts of the surrounding areas may erupt a recurring tumour assuming this was malignant.
The better alternative is to excise the upper 2/3 of the vertical canal lessening the chance of recurrence. Not every vet will agree with me as this is part of the diversity of life and medical opinions in real life.
I got Intern Shan to edit the video and in that way, she would understand what the operation was all about.
The surgery images were quite confusing to her but she could understand after my illustrations. Once in a while I get to meet an intern much passionate in veterinary surgery. Shan would make a very good vet. It would take another 4 to 5 years to graduate. That would be 2019!
July 3, 2014 An uncommon case of a Siberian Husky with a growth on the top 1/3 of the vertical ear canal. The dog had been shaking his ear for the past 2 years. The family vet referred the owner to two other vet practices for a total ear canal ablation. He consulted me at Toa Payoh Vets. From my palpation of the vertical canal, there was pain and a hardened lump.
The vertical ear canal had a tumour and the family vet presumed that the whole ear canal (horizontal and vertical ear canals) were
full of tumours.
INFORMED CONSENT.
High anaesthetic risks for a 13- year-old. Dr Daniel operated and removed the vertical ear canal. There was a big tumour at the top 1/3 of the vertical canal.
It is hard to see inside the hairy vertical canal. The canal wall was hardened and painful. After medication for 2 weeks, 2/3 of the upper vertical canal is removed. The lower 1/3 was cut into two parts. One part was stitched downwards and the other part stitched upwards to allow the opening of the horizontal canal to drain out. The skin edges where the upper 2/3 of the veritcal canal had been excised were stitched.
As at 1 month after surgery, the dog is OK. This surgery is called vertical ear canal ablation (VECR). There was a big rotten tumour in the upper 1/3 of the vertical canal causing pain and infection. Hence there was pus inside the ear canal for the past 2 years.
There is another more common surgery called lateral ear canal resection (LECR). In this surgery, the side (latera) wall of the vertical canal is excised. It is an easier surgery. But this Husky had a tumour on the top 1/3 of the vertical canal and so it is best to do VECR in case the tumour recurs.
Sep 2, 2014. Acknowledgment
A big thank you to a bubbly young lady Shan
.
Video was produced by Intern Shan who is very keen on veterinary medicine and surgery. She posted this video from her University in Australia into my "Dropbox" and I download it to my hard drive before uploading it to Youtube..
LEARNING EXPERIENCE. The illustrations were too distant to be viewed. My explanation of the stages of the surgery could have been zoomed in.
Yesterday, I presented two talks on "Guidelines For the Treatment of Pyometra" and "Urolithiasis in Dogs and Cats - Diagnosis & Treatment" and met the committee members of the Myanmar Veterinary Association.
I was surprised to see several small animal practitioners as I expected 20. The Association limited to 75 participants for this continuing education and all get a certificate of attendance at the end of the 3 talks..
Yangon is much bigger in area than Singapore and around 100 small animal vets are practising as compared to 6 years ago. Pyometra is dogs and cats is common in Yangon as traditionally, the owners get their pets injected with a synthetic progesterone (Depo-M or Contracep) IM, every 3 months. Pyometra develops after some time.
I engaged a professional to prepare the power point slides for me and so presentation was much easier. More images of case studies and videos of cases - I hope these would not make the audience fall asleep. One young vet said my talk was easy to understand.
Another vet asked me about his case of pyometra in which the dog died after surgery - was it due to bleeding? It could be or it could be due to other reasons like septicaemia. The dog was not given pre-op I/V drip, antibiotics and analgesic.
We had a dinner at the Golden Duck Restaurant for around 18 vets and I was presented with a momento.
Power point presentations can be very boring for 45 minutes if only text and few images are shown.. Videos should be included in the talk.
P.S.
1. Many new hotels built. Room rates of downtown Traders' and Sedona Hotels have shot through the roof owing to acute shortfall. This Royal Golden View Hotel is brand new, has 38 rooms and fronts a beautiful river. Free wireless. I visited a "ship" hotel in downtown Yangon port area yesterday, Vintage Luxury Yatch Hotel with 1920s furniture. The beds can be adjusted for back pain guests.
An unusual case of ear scabies as this dog had anti-mite ear ointment applied inside the ear canals. In theory, there should be no ear mites. Then why is the dog scratching her ears till they bleed?
Quite a rounded active Maltese, F, 9 years. She came 3 months after spay for closed pyometra. Owner had been advised on dental scaling but she did not follow up as we did not do dental scaling and spay on the same day. The closed pyometra spay takes a long time and this dog could die from prolonged anesthesia.
The owner's mum remarked: "She has put on weight since the surgery for her infected womb!". The dog looks much more active and younger. Snow white coat. But both ears had wounds from scratching. On closer examination, the ear edges of both ears were crusted and had hair loss. So, was this scabies?
Skin scraping was negative for sarcoptic mites. But the owner had used an anti-mite ear ointment prescribed by us for the ear infections. There was no more pain on both ears. Yet, you can see the ear flap having skin ulcers and balding edges.
I treated for scabies although 2 skin scrapings were negative . Did the dental scaling. Plucked out ear hairs. Irrigated ears. Will wait 1 month to follow up. Should recover.
