1428. Yesin Vet University talk to final year students. Aug 11, 2014 - tips on neutering

July 27, 2014

TALK TO FINAL YEAR VET STUDENTS - YESIN VET UNIVERSITY, MYANMAR



Employee vets
Each vet has his or her own way of doing surgery and using anaesthesia and sutures.

 Case study of post-op complications: Neutering of a poodle in Toa Payoh Vets.

MY SURGICAL TECHNIQUE
Day surgery
Age: 6 months and above
With-holding food and water: 10 hours before admission in the morning

1. Prepare for surgery, knowing the standard operature procedure as follows:

1. Physical examination, body weight and rectal temperature for fever.
2. Blood test to screen the health of the dog. Optional.
3. Palpate and express urinary bladder if it is full.
4. Pre-scrotal area clipped in preparation room.
5. I/V Domitor + Ketamine  based on Domitor 0.4 ml + Ketamine 0.5 ml for a young 10-kg dog.
6. Isoflurane + Oxygen gas top up if necessary.
7. Incise pre-scrotal area. Not too high up. Incision 1.5 -2 cm for small breed.
8. Expose testicle.
9. Clamp and cut cremaster muscle ligament.
10.3-haemostats clamping.  Ligate twice for spermatic vessels.
11. Stitch skin 3 stitches. Starting from the middle of the wound.

Illustration. 



Economics

Polysorb 2/0 or 3/0  one packet  S$12.80 = 9,216 kyats
Monosyn 2/0 or 3/0 one packet  S$12.40 = 8, 928 kyats
One S$= 720 kyats

CASE STUDY
3 weeks post-neuter. Complaint of vomiting now and then.
Dog is active, eats well, no fever.
No pain in surgical area of pre-scrotal.
Bites or growls when couple touches the pre-scrotal area
Sedate  D+K 0.05 + 0.06 ml IV
Clean
Prescrotal area preferred rather than over the bulb.  2/0 polysorb. Too tight?  Remove stitches
Deep and buried - stitch abscess? No pain on palpation but dog bites/growls owner who attempted to clean the wound.

Inguinal right. 3/0 monosyn filament. No inflammation. Stitches taken out.

VIDEO

CONCLUSION
Post-op complications like infection or stitch abscess do occur.
Economics is important as rentals and staff overheads increase yearly.
Much depends on

1427. Images of a young guinea pig

1426. Yesin Vet Univ Talk - Aug 11, 2014. An office rabbit stops eating for one day

Singapore has many rabbit lovers but the rabbits are no more the ordinary large sized white ones of many years ago. They are smaller and are dwarf rabbits. (VIDEO).

A young lady was very concerned about this one-and-a-half-year-old Broken chestnut male neutered Holland Lop rabbit who wandered around her office. He would eat anything including wires and had lots of pellets as he did not much like hay. Suddenly, on July 25, 2014, he stopped eating.

"He would not eat any food and just sat hunched up in a corner," the young lady said. "He passed less stools and they are 50% smaller in size. His urine is yellow. He was grooming himself a lot a few days ago"


"He weighs 1.85 kg and has a temperature of 37.6C and is leaking urine as well as his penile area is wet. "This means he may have a urinary tract infection. I need to test his urine. Does he drink from a water bottle as I need to ward him for urine collection."

"He drinks from the bowl," she said.  I put a clean tray under the grate and he soon peed thick cloudy urine of around 0.5 ml. It was insufficient and my assistant Naing would collect more overnight and send to the laboratory. 

The slightly turbid pale yellow urine was alkaline and had a pH of 8.0. A small amount of blood, nitrite and protein was present. Bacteria and amorphous phosphate crystals were 2+. So, there was a urinary tract infection causing pain in the bladder and hence the hunched back.





X-rays showed the stomach packed with food, hairs and wire pieces. "Would he be able to pass out the impacted food and wire pieces?" I gave him Fibreplex to move his gut.

VIDEO OF X-RAYS AND IMAGES OF X RAYS

He recovered after an antibiotic injection and high fibre-food to pass out the stools the 2nd day of in-patient treatment. Lots of stools passed out.

FOLLOW UP ON JULY 30, 2014  6 pm
The young lady was happy that the rabbit had recovered. No more urinary incontinence. She would continue with the antibiotics, feed more hay and less pellets. "Fed some apples and carrots without insecticide as well," I advised. It was good news.

REVIEW OF MEDICAL RECORD ON MAR 16, 2013
He was not eating and had a swollen prepuce and wet genital area. He passed less than faecal pellets and hid in dark places. He was lethargic and I diagnosed Urinary tract infection from the abdominal pain in the bladder and the swollen prepuce.  "NO WANDERING" I wrote in the case sheet. The rabbit recovered after antitbiotcs and Fibreplex.

CONCLUSION
Young rabbits are like toddlers. They need to be supervised or they would put anything inside their mouth and swallow them causing stomach upset.  In the recent episode, evidence of X-rays and urine test confirmed stomach impaction and uinary tract infection..

1425. Undescended testicles become cancerous

July 26, 2014

Undescended testicles in the dog are best removed as many do become cancerous or grow to large sizes as in this 12-year-old poodle.

1424. Images of BKTP videos. An 8-year-old Shih Tzu has a bigger bluish breast lump

July 25, 2014

Groomer Clara popped in with a 8-year-old Shih Tzu. "She will bite if you pull her out of the crate," she warned me. "Other dogs don't do it."

So we weighed the dog + crate = 8.1 kg. She poured the dog out and the crate weighed 2.1 kg. Once out, the dog did not bite but she would hum a few soothing words and rub her shoulder when the dog got injections. Dog bites are groomer's risk.


"6 kg and normal temperature of 38.6C" I checked the vagina for discharge. There was none.
"When was the last heat bleeding?" I asked. Clara phoned the owner who said it was 4 months ago.

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GUIDELINES FOR DIAGNOSIS & TREATMENT OF FALSE PREGNANCY & MAMMARY TUMOURS IN DOGS

A non-pregnant bitch shows signs of pregnancy and maternal behaviour in middle or late diestrus. Also known as Pseudopregnancy, Pseudocyesis, Phantom Pregnancy.

1.  SIGNS.
1.1 History.  1.2  Physical Examination Findings
3. DIFFERENTIAL DIAGNOSIS
4. CBC/BIOCHEMISTRY/URINALYSIS
5. IMAGING - Radiography or ultrasonography
6. DIAGNOSIS
7. TREATMENT. Medical/Surgical
8. CLIENT EDUCATION



1.  SIGNS.
1.1 History - Behaviour changes - self-nursing (suck own nipples), restless, nesting, mothering activity.
Vomiting, anorexia and lethargy. Abdominal distension and mammary gland enlargement.

1.2  Physical Examination Findings - Large mammary that secrete a brownish serous fluid or milk.

3. DIFFERENTIAL DIAGNOSIS

4. CBC/BIOCHEMISTRY/URINALYSIS. Usually normal. If not, reproductive or systemic diseases.

5. IMAGING - Radiography or ultrasonography. To rule out closed pyometra and normal pregnancy.

6. DIAGNOSIS is made by a history of estrus 2-3 months before clincial signs and clinical signs present.

6. TREATMENT. Medical/Surgical

Usually will resolve 2-3 weeks without treatment
Do not spay till the dog is in during anestrus will prevent recurrence.
Do not spay during false pregnancy as milk will still be present post-surgery requiring medical treatment.
Breed bitch during next estrus if puppies wanted.
Elizabeth collar

Synthetic progesterone - megestrol acetate. 1-2mg/kg/24 hrs PO, 8 days. May cause pyometra, mammary gland hyperplasia, diabettes mellitus, weih gain, diabetes melltus, increased weight gain, adrenal cortex atrophy

mild tranquilsers excepr phenothiazine which increase prolactin concentration.

Surgery - ovariohysterectomy (spay).

8. CLIENT EDUCATION. Important for family members as the dog is family and to explain medical costs. Vet can illustrate the location, size and number of breast tumours or make a video clip.

1423. Subconjunctival abscesses in the dwarf hamsters seen at Toa Payoh Vets

Case 1. 

2 weeks ago, this Roborovski came for hair loss and was treated by a vet from Toa Payoh Vets. Some hair clipped and Revolution drop was applied. Medication given.

"The vet says that the hairs would grow back after 10 days," the young man told me. "But there is more hair loss."  

Subconjunctival abscess do exist in Singapore hamsters and are quite rare. In this case, a close inspection is needed as they can be overlooked since the eyelid is so small.  

Case 2. 

2.1  2008.  Water bowl as a cause of eyelid abscess
2.2  2015.  Eyelid abscesses in another dwarf hamster

SEE BLOG:

https://2010vets.blogspot.com/2020/11/3438-eyelid-abscesses-in-2-hamsters.html

 

Case 3.

5 Nov 2020.

Best practice. 

The vet must be interested in digital photography.

In this case, I used a Canon EOS 80, lens EFS 18 - 55 mm. I asked an assistant to hold the 

hamster's head down on the table at the reception and focus on the eyes.

1.  Take a close up photograph of the face. Mark the abscess locations (with arrows in the image).
2.  Record post-treatment and recurrences. 
3. A video will be good.

We will wait 2 days to permit the other smaller abscess to ripen before doing the lancing and drainage.  

1422. A Persian cat cannot conceive

July 24, 2014

 A Yishun cat owner brought in this Persian cat, female, 2 years for vaccination.
"She looked pregnant but then no kittens," he had a male Persian who mated with her around every 2 weeks when she came on heat. Weight 3.3 kg and temperature 37.6C. Gums were pink.

I examined the vulval area. It was swollen and wet.
"Has the cat been licking her private area below?" I asked.
"Yes," he said. "Last month, she had been passing blood in her stools but she recovered after 2 weeks."

"How do you know mating has been successsful?" I asked. 
"After mating, she would roll and make a lot of noise. She comes on heat around every 2 weeks."

"So how to make her able to conceive?" the gentleman asked.
"She may have a uterine infection. Clip the hairs around the anal and vulval area. We put her on antibiotics for 4 days and then wait 14 days and put her on antibiotics. Check the male cat to make sure he is healthy and clean. Keep him away in another place for one month to let the female cat rest for one month."

According to the behaviour, mating has taken place as felines need to be stimulated to ovulate and that happens during mating, leading to loud noises after mating. In theory, this cat should conceive. But abdominal discomfort during palpation was present, indicating some infections in the uterus or bladder. Antibiotics would help. 




. 

1421. A 9-year-old cat leaks urine on the floor for over 2 weeks

July 23, 2014

This gentle black and white, 9-year-old domestic shorthaired female spayed cat would leave urine on the floor for over two weeks.

"You had spayed her when she was young," the woman told me.  "I see urine on the floor where she lies down."

"How long has she been having urinary incontinence?" I asked.
"This homely cat would not go far out from the apartment door," the owner said. "She would not dare to venture far."

"Could she be stressed by the other younger cat, since both use the same litter box?" I asked.
"No way," she said. "The younger cat ignores her."

So, what's the cause of the urinary incontinence?
I palpated the bladder and the cat shook in pain.

Was there an infection, non-inflammatory cause or neoplasia of the kidneys?

BLOOD TEST.  Blood urea and creatinine were normal. Low haemoglobin and high platelets but nothing abnormal.

X-RAYS
Pleural effusions and ascites. Kidneys enlarged.

URINALYSIS
No urine available. The bladder was not full on palpation.

TREATMENT
1. Laxative via rectum - all stools passed out.
2. Frusemide inj - lots of urine passed on clumpy litter. Showed to owner when she visited on Day 2 of in-patient stay.
3. Low sodium, high protein diet like Feline K/D to be given.
4. Fortekor 5 tablets to reduce the higher blood pressure.

3 DAYS LATER
Cat not eating or drinking. Not eating the old food or K/D.
Gums pale - anaemic but no respiratory distress.  Owner does not want X-rays or blood tests. 

1420. An 11-year-old female cat passes blood in the urine for the 3rd time

July 23, 2014

"Is there discount for senior citizens?' the 74-year-old healthy retiree came to buy the special prescription diet C/D as advised by me. He had come 3 times for antibitoics and every time, at the completion of the course, his cat would pass blood in the urine. Also difficulty in urination, called dysuria.

"Your cat is a feline senior citizen, but he has no 'Pioneer Generation Medical Package' as he is not a person!" I was referring to a scheme whereby senior citizens of the human type get free medical treatment if they are born before 1949 and are referred to as "Pioneers".

"It is not good giving antibiotics forever," I reminded him and that was why he took a urine sample for analysis on the 3rd request for antibiotics. "The cat needs an X-rays for the bladder and kidney stones and a urine test to see whether she has bladder or kidney stones."

To save him money on X-rays, I got the cat's urine analysed. It was alkaline, had bacteria and triple phosphate crystals.  Although his cat, now on antibiotics, did not pass blood in the urine, she had dysuria.

"There may be bigger stones," I said.
"The urine test can't tell?"
"No, it can't tell the size and number of the urinary stones." I asked him to try feline C/D for one month. "However your other cat must eat the same food. No other food or treats to be given."

If the other normal cat eats the usual dry food, this black and white cat with haematuria would eat it too and defeats the purpose of buying Feline C/D to dissolve the phosphate crystals.

"How long will I know the effects" he asked.
"Around one month if there are no big urinary bladder or kidney stones which can only be seen on X-rays."
"How much for surgery to remove the stones," he showed me the smartphone clip of his black and white cat lying down with belly upwards. A rascal who connected well with him. Picked up from the streets as a kitten 11 years ago. Now he is 74 years old.  

"Surgery is estimated at $500 for bladder stone removal," I told him. There is a need to reduce medical costs for senior citizens and I try as much as possible.    

He bought 10 cans of C/D and a 2-kg dry C/D bag. He

1409. A 12-year-old turtle has one eye closed

July 21, 2014

A young man consulted me as his 12-year-old turtle has one eye swollen closed and the left eye with eyelid swollen. The neck skin appeared puffy as well as two back sides. What is the cause?
It is hard to take blood samples from turtles. Swollen eyes is a symptom of Vit A deficiency? What is the cause?