Haematuria - blood in the urine - in a 16-year-old Shih Tzu - penile fracture

Blood in the urine in a male dog - instant diagnosis is urinary stones as this is top of the list in so many cases of haematuria. I got the dog X-rayed today at 9 am.

Practise evidence-based medicine. X-rays are taken to check for radio-dense stones.
Is there something wrong with the kidneys, the kind vet nurse told me. There appears to be a radio-opaque kidney shaped area in the sublumbar region where the kidneys are located.  I kept an open-mind. Certainly, it looked odd.


Yet based on the fact that the dog is eating like a horse, I discounted that "kidney" problem.

I would say that there is the fracture of the os penis. I passed the urinary catheter. No problem passing into the bladder. Urine collected was clear. Still I had to get urinalysis done to check for UTI and stones.

I gave an enema as I believed that this dog could not poop owing to the painful fracture of the os penis. He passed out the stools and should feel better with pain killers and antibiotics.

In a thorough physical examination, I protruded the penis to check for pain and bleeding. The prepuce was swollen but the dog did not feel any pain. Only the penile tip was inflamed dark red.

VIDEO.  Graphic images warning.

 

1437. Poodle with elongated pelvic bones bites when anal sacs are touched

Sunday Aug 3, 2014

Poodle, MN, 4 years. Home breeder used him to produce 4 litters but did not take good care of him..Bites anybody. Finally a couple adopted him from SOSD (Save Our Singapore Dogs).

"Can't stop scootering," the man had googled "Toa Payoh Vets" and so found me.
A simple case, I thought.
"Sedation is required," I advised as the dog objected strongly to his anal sacs being touched.
"The other vet expressed his sacs last month," the wife said. "We could hear loud screaming inside he room."
"What did the vet tell you about the amount of anal sac oil?" I asked.
"Just fishy smell."
 
With permission, I sedated the 7 kg dog with Zoletil 100 at 80 mg. Not good to traumatise the 4-year-old again by grabbing him and expressing his glands..

He vomited 10 minutes later and kept moving his tongue in and out of his mouth. He salivated and vomited again, being fed fully.

I was surprised to see the poodle's anal area being 3 cm shorter than his pelvic bones. Dogs do have undershot or overshot jaws but pelvic bones being longer backwards than usual are rare.

I showed the couple how to express since the dog now trusts them and does not bite them.
Or will he?
Thick dark brown oil oozed out. Smelly. Around 2 ml. Not much. Still the room stenched. I switched on the fan. Red, dark red skin seen after expression. As if this is badly infected skin. 

As for surgery to anal sac removal to resolve this problem of intense scootering, I advised that the anal sacs may be much sunkened in an difficult to remove. The pelvic bones stretched back by 3 cm, depressing the anal area. There is a concave depression between the anus and the lower pelvic bone jutting caudally. So, surgery may be challenging as other normal dogs have anal sacs in line vertically with the posterior edge of the pelvic bones, not 3 cm forward. A rare case.

Medication to resolve the problem. No surgery to be advised as the sacs may not be easily located and the problem will remain. 

1436. TALK TO FINAL YEAR VET STUDENTS - Belief, Drive, Passion, Perseverance, Focus

Aug 2, 2014
DRAFT
YOUNG & INEXPERIENCED VETERINARIAN



FOCUS
Need to focus on the bigger picture.
End of the day, nobody in Myanmar know who you are if you are still young.
Office politics. Need to gain skills and experience. Not a household name unless well financed vet.
Client education e.g. Depo-M injections no longer used in other countries. -- pyometra
Stay the course to be a small animal vet   Engage children to be kind to pets. What is your mission?.

BELIEF
Something you believe in and you know you want to do and do it well.
You believe you can help in curing diseases of animals and you want to do it well. Money is secondary.  Playing politics with the officers and head nurse. 
What goals do you set for yourself in 5 years' time? Get married to a rich spouse. Be a homemaker?  Open up your own practice - >60 vet clinics in Singapore.  Rich parents.   100 in Yangon?

PASSION
Motivation (internal or instrumental?)
Internal - self motivated.
Instrumental - make more money.

PERSEVERANCE
Secrets of success. Persevere. Attracts referrals. Intense competition from deep pocketed, big practices. Your reputation of delivering results and good outcomes (e.g. no dogs dying under anaesthesia during spay) and referrals over many years sustain your practice.


DRIVE
Energy. Marketing. Pleasure enjoyment. Research read. Healthy. Social media.  Pet owners will mature and gain knowledge from the internet. ,.



Networking with successful and more hardworking entrepreneurs
Spend more time out rather than at home to watch Korean soap operas and gaming.
Attend courses,  travel to broaden your mind
Training


Networking. Make friends. Expand your interpersonal circle. Buy lunch for people who are richer than you, more knowledgeable than you or have had helped you in your career. Do that every month. After one year, big circle of valuable friends.

Continuous Learning.  Buy books to read about lessons and strategies of success, selling, marketing, social media etc.  Spend money to attend training courses.
 Library books
Internet

Reward yourself. Travel at least once a year cheap hostel. Many countries and different experiences.
Save. Do part-time jobs. Sales. Improve you skills. Art of selling. All successful entrepreneurs are good salespersons.

Always make yourself useful.

When you are poor, spend more time outside, spend money on others. When you are rich, stay at home more.

You need not be afraid of being poor. You need to know how o invest in yourself and increase your wisdom and stature.
. 
FEAR OF TECHNOLOGY


PROBITY


Professional misconduct
1. Obstetrician offered tampered records. The Straits Times Aug 2, 2014 Home B4
Dr Lee did a Caesarean section on a woman. She screamed when he made a cut on the patient's abdomen at around 8.20 am. .

Dr Lee asked the operating theatre manager to write the words "patient is in supine position after epidural anaesthesia at 0800 hours" on a copy of the nursing record. He offered this record as evidence.

Anaesthetist said that the epidural was given at 8.10 am. It would take at least 15 minutes to take effect.

The Court of Three Judges find that Dr Lee lacked probity.  The contested time was of "secondary importance."  Dr Lee was guilty of professional misconduct as he did not check whether the epidural had taken effect. 5-month suspension and a $10,000 fine. The Singapore Medical Council Disciplinary Committee had handed a 9-month suspension and a $10,000 fine but Dr Lee appealed. 

2. Royal College of Veterinary Surgeons disciplinary cases - suspend, warning, de-licensed.
Protect the welfare of the animals and uphold the reputation of the profession.

2.1  Violent, aggressive and intimidating behavior --- fitness to practice?
2.2  Falsely testifying the test results. Sign false certificate for sheep meant for export. In Singapore,  rabies vaccination not done 30 days as required. Certificate following clinical examination of a horse for a prospective purchaser.
2.3  Drunk-driving. Criminal conviction. Disqualified. Still drive employer's car.
2.4  Treatment short of standard to be expected in the profession. Had not removed a of glass inside the dog's stomach, abdominal contamination.
2.5  Illegal tail docking.
2.6  Failure to provide adequate and appropriate veterinary care or treatment. Motivated by financial gain. Caused actual serious injury to 4 animals over a prolonged period of time.
2.7  Clinical incompetence during the treatment of the CKC.

CHEAP CAESAREAN SECTIONS FOR DOG BREEDERS
University professor has no time to teach you the details of handling post-Caesarean puppy not breathing. What to do?



http://www.bekindtopets.com/dogs/20091194Distressed_Maltese_Pup_ToaPayohVets.htm

Case diary for every C-section done in 2004 - 2006. Take images. Now I take videos..

http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm



Acquire theoretical knowledge.
Read/buy/borrow books, borrowed from the National Library. Internet.
to be able to offer value-added services e.g. swinging the distressed puppy and save lives. Not just do the C-section and don't know what to do with the respiratory-distressed puppies  after that.


OFFICE BEHAVIOUR
Smile and Greet "good morning"  when you see your boss on reaching the office. but none do. Maybe the Asian culture

Myanmar Vet assistant and staff wearing slippers and clogs when I was on leave but turned up at the office. POOR IMPRESSIONS TO CLIENTS.  Some interns wear shorts and T-shirt.

HUMILITY AND HARD WORK - Ask head nurse or senior vets for help but make sure you do your research and reading first. It is hard work reading the vet books and magazines as young people prefer online gaming and texting. Pleasure is more important than pain of reading widely.

WORK LIFE BALANCE

NOT SO BUSY TIMES

The vet will watch online or streamed movies etc but not spending the hours paid to do office work. No consultation, so watch online movies or text or facebook. Bad attitude. Learn how to use Excel or read vet magazines, but this is hard work and a pain. So pleasure comes in. Time goes by. Still as ignorant as before.

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2014Travel_Myanmar_Feb

1. 20140209Hinthada

    MVI_1667

    bride & bridegroom monastery wedding     0.03 - 0:50

 PRACTICE MAKES PERFECT- Speedy and efficient for experienced vet.

    MVI_1903   4:18 - 6:34

How to give I/V drip to a dog. Dr Thein Tun Aung. Few thousands of dogs IV experience
clip, IV catheter, plug, tape No. 1 over catheter, put in IV drip, bend catheter, tape No. 2, adhesive tape.

  MVI 1905      0:42 - 1.31

Cat IV. Capable assistant vet May.

 PASSION IN THE JOB?

A TRISHAW RIDER GOES TO MARKET

MVI_2013    0:00 - 0:17  Smiles to photographer. Enjoys his work. 

DRIVE & DO CASE STUDY ON EVERY ONE OF THEM WITH CAMERA TO DOCUMENT

FOLLOW UP ON POST-OP. Build a portfolio like the artist in the TP website. Complaint to vet authority -- promoting C-sections!

  

24-HOUR SERVICE

7 DAYS A WEEK

$300 caesarean section for 2 years
Younger vet cheaper at $250 or less

YOUNG GENERATION USES SMARTPHONES TO RECORD 3RD EYELID FLAP BY DR AUNG - A cat clawed his own eye causing a descemetocoele. 

http://youtu.be/C2OPnin1Oj4

1435. A 14-year-old poodle has testicular cancer

1434. A ferocious cat has blood in the urine

1433. Images mother and child & others from adverts

1432. Talk to Vet students in Yesin University - An emaciated terrapin

July 29, 2014   Female terrapin, F, 2 years. A retiree said that this turtle is very intelligent and responsive and felt it would be a pity to abandon her in the reservoirs.

April 25, 2014. Seen by Dr Daniel. Came in for swollen eyes for 5 days. Inappetant for 2 weeks. Active.
Diagnosis: Eyes swollen. Baytril oral and Neodeca eye drops. Weight - Not done.

April 27, 2014. Bought Baytril oral.


Jun 10, 2014. Seen by me.Weight 405g. Lethargic. Anorexic occasionally. Eyes closed. Limbs swollen.
Respiratory distress. poor prognosis.  Inj baytril+ pred, fruesmide oral, mltivit, baytril + pred.

VIDEO
http://www.youtube.com/watch?v=lsVyOOHvJ9w&feature=youtu.be


http://www.youtube.com/watch?v=xrP8RXqZ15k

Jun 20, 2014. Bought Baytril + Pred oral.

Jul 29, 2014. Today. Very weak. Emaciated (shrunked abdomen seen inside shell). Eyes closed but not swollen. Right elbow ventral has necrotic wound. So, she can't walk. Excise necrotic tissue 5 mm x 5 mm x 3 mm. No gasping for breath.

ADVISED.
1. Insufficient feeding by hand twice a day. Turtle would eat when hand fed. Liked shrimps. I gave her a packet of turtle pellets to feed 8X/day, not 2x/day. Gave her a 1-ml syringe.

2. Sunshine to warm her and strengthen her immune system.
3. Water to swim.


This case shows that the turtle had recovered but was underfed. Emaciated but as she is young, she is resilient. 

1431. Talk to Vet Students in Yesin Vet University - Traumatic proptosis in a 15-year-old Chihuahua

DRAFT


Best of friends but 2 days ago, the cross-bred pounced on this 15-year-old Chihuahua. When the owner came home, the eyeball was dirty and the cornea was yellowish with pus (IMAGE).

Traumatic proptosis - Forward displacement of the eye with eyelids entrapped behind the eye, due to injury.

Video by Teri

TREATMENT
Dog is still eating
No injectable sedation as dog is so old
Atropine 0.2 ml IM and 0.2 ml SC
Anaesthesia gas isoflurane + O2 only.
Scissors cut lateral canthus 1 cm long, eyelids entrapped are released
2 catheter tubes  3/0 nylon
Inj pred + genta subconj.  Eye ointment into eye.
Push eyeball inward by pressing and pull stitches outwards
Stitched
Post op tolfedine + baytril

Dog woke up fast and made some vocalisation for 3 minutes. OK now.  4.30 pm

Try to save the eye by replacement of the prolapsed eyeball rather than take it out. Looks bad and had wanted to take it out.  . .

Eye injuries are emergencies and treatment is best done within 4 hours of injury. Now the dog has had rubbed her right eye severely till it looked horribly red and dry with pus.

"This is a very old dog. She may just die on the operating table," I informed the lady. "You have two alternatives. To replace the eyeball or to get me to remove it. I cannot guarantee that the dog will regain her normal vision as the eyeball looks infected with pus and so a second surgery may be needed to remove it if there is infection after replaement."

This procedure is "Informed Consent" and the lady must know the risks and sign the Consent to anaesthesia and surgery..

"What should I do?" the lady owner had to decide whether to replace or enucleate the eyeball.
"I can't decide for you," I replied. "If the eyeball had come out within 4 hours of injury, I will advise pushing it back to save her vision. But you waited too long. Over 24 hours and the eyeball looked badly infected with pus."

"What would you do?".
"If she is my dog, I would try to save the vision."

I could not guarantee that the replacement of the globe would result in the dog getting back her normal vision as the owner had delayed treatment by more than 24 hours.  Her big mixed breed dog had pounced on this 15-year-old Chihuahua and the eyeball had prolapsed. The diagnosis is traumatic proptosis.

Sunday, August 3, 2014. Stitches removed. Eyeball is white but had returned to the socket.  Owner informed. Vision is probably 10% but the dog has the eye.

1430. A 7-year-old Shih Tzu has a large wrist lump

Hari Raya Puasa on Jul 28, 2014. Around 10 cases seen as most vet clinics are closed.
Interesting one of a Shih Tzu, Male, 7 years coming in with a large wrist lump. "About one week," the owner said.
"If it is one week and growing so large at 8 cm x 6 cm x 6 cm," I replied. "It is not good news as cancerous cells grow very fast. I need X-rays to check whether the bones are infiltrated or involved."

X-rays show normal bones. So it was good news.
"Surgical excision may result in the dog being lame on the right fore limb," I warned. "Unless the lump is one solid ball sized and dissected out using electro-excision & cautery carefully."

Owner opted for anti-inflam injection into the lump and wait for 2 weeks.

2 pm Videoed by Teri
Sedate 50% D+ K IV
Needle aspiration - 0.1 ml of blood but nothing else. No pus or brown fluid. Likely tissues.
Intra-lesion inj of pred 0.5 ml
Bandage carpal area for 3 days

1429. Yesin Vet Students Talk - Aug 11, 2014. Blood in the stools - check for parvovirus

As many Singapore dog owners do not vaccinate their older dogs, it is best practice to check for parvovirus when a dog passes blood in the stools. I have such adult dogs who have been to boarding purging with blood in the stools. They were positive for parvovirus.

It may be deemed negligent of the vet to overlook the test for parvovirus which is a fatal disease. Inform the owner about the test and if the owner does not want it, the vet should record this in his case notes. Should the dog be diagnosed with parvovirus by another vet when the dog continues passing bloody stools, the owner and his family may complain that the first vet was incompetent. Keeping good medical records on such advices protects the first vet against claims for compensation.

 .