1098. SCRIPT FOR INTERNS RGS. How to prevent swollen eyes in terrapins in a city

Early detection & veterinary treatment saves eyes

1. Hook  - Vet's dialogue with owner.
2. Be Kind to Pets - Theme
3. Introduction
    Singapore in 2014. Mostly apartment living. Few landed houses. Harried life. Video clips. 
                                   Terrapins hatchlings from wet market or pet shop. Video.
                                   Feeding. Most owners feed pellets. From Taiwan. Sample. Eat and poop in same water area.
                                   Housing. Aquarium tank. set up. Sample. Illustration.
                                                  Water level low. No daily change of water. No filter.
                                                  Basking. Dry. Rocks. Floaters, Ramp. No UV light.
                                                  No sunlight.
                                                  Flooring tiled for bigger one.

4. Middle
                 Case studies
                 Eye metaplasia
                 Eye + respiratory problems
                   Eye + shell rot.
                   Eye + chlorinated drops
                   Position of UVL light to dry the shell
                   Water filter not washed
                   Daily change of water, very smelly stools - see one case of 2 healthy terrapins kept by one owner. No eye problem. Video. 


5. Conclusion





                Hygiene of water in tanks. Nutrition (expired, quality of pellets), no seafood, fishes or shrimps when young.  
                Early detection and treatment save eyes.  Prevention. New terrapins quarantined 2 weeks.



6. Credits





Around 2 years old. Female. Active terrapin. Excellent shell quality.
Eyes swollen, closed and red for past 3 days.
Lethargic, not eating

Possible causes
1. Bacteria from new terrapin introduced into the tank around 2 weeks ago
2. Pellet quality has deteriorated over the year. Vit A deficiency.
3. De-chlorination chemicals inside the water given daily by the domestic worker.
4. No daily changes of water in the tank.


In-patient treatment at Toa Payoh Vets
Clean water daily. Eye drops and medication.
Eyes open in Day 3 but closed again.
Eyes fully open in Day 4.

Very good chances of success if treatment is given early.
The terrapin did not open her mouth to breathe and so did not have lung infections








Ey

A 7-year-old Shih Tzu cannot control her bladder and passes blood in the urine

> 3 days of haematuria and urinary incontinence. Owner said that this happened after her heat which was 2 weeks ago.

X-rays show no radio-dense urinary stones.

Many older female dogs have urinary tract infections. It could be from continuous licking of the vulva during the heat period as the female dog was cleaning herself. Licking transferred bacteria to the bladder. Spaying when she was younger would have prevented this licking and infection to bladder.

141109. Lymphoma in a Miniature PInscher (2014) and Jack Ruseell (2011)

Saturday Nov 8, 2014

"I notice a large swelling below the right neck," the owner of this 9-year-old female unspayed Miniature Pinscher said.
"Actually, there is another one on the left neck," I examined the active dog that jogs with the owner.
"These are mandibular lymph nodes. The two popliteal lymph nodes behind the knees are much swollen too."


Advised:
TESTS to stage the cancer
1. Biopsy of lymph node
2. CBC (done)
3. serum chemistry profile
4. urinalysis
5. abdominal ultrasound (liver, spleen, intestinal lymph node, internal lymph nodes)
6. chest x-ray (lung, internal lymph nodes, intestinal tract)
7. bone marrow aspirate

Above tests are for STAGING OF LYMPOMA (to search for tumours in other locations)


 BLOOD TEST 2 BY TOA PAYOH VETS ON NOV 9, 2014
Haemoglobin 20  (12-18)
Red cell count 8.8 (5.5-8.5)

Total white cell count 25.3 (6-17)
Neutrophils 24.4% (60-70)    Absolute 6.17 (3-11.5)
Lymphocytes 74.5% (12-30)    Absolute 18.85 (1-4.8)
Monocytes 0.4% (3-10)    Absolute 0.1 (0.15-1.35)
Eosinophils 0.7% (2-10)    Absolute 0.18 (0.1-1.25)
Basophils 0 (rare)    Absolute 0 (rare)

liver and kidneys OK

BLOOD TEST NO. 2 ON NOV 11, 2014
Generalised lymphadenopathy including submandibular, prescap, inguinal and popliateal
Haemoglobin 19.2  (12-18)
Red cell count 8.77 (5.5-8.5)

Total white cell count 21.5 (6-17)
Neutrophils 21% (60-70)    Absolute 4.5 (3-11.5)
Lymphocytes 60% (12-30)    Absolute 12.9 (1-4.8)
Monocytes 18% (3-10)    Absolute 3.8 (0.15-1.35)
Eosinophils 1.2% (2-10)    Absolute 0.25 (0.1-1.25)
Basophils 0.2% (rare)    Absolute 0.05 (rare)

Peripheral blood smear -  shows normochromic normocytic erthroyctes. Mild leucocytosis, lymphocytosis, some reactive lymphocytes seen. Platelets adequate in number. Babesia -ve

FNA popliteal and prescap inconclusive.

Lymph Node excisional biopsy
Cytology (L and R prescap). Smear - mainly small to medium sized lymphocytes. Some lysed cells with no visible cytoplasmic boarder.
(L and R politeal). smears mainly small to medium sized lymphocytes. Some cells with a hand-mirror shape with cytoplasmic pseudopod.

Ultrasound of abdomen - possible liver infiltration. KIV FNA of liver.
X-ray chest - 3 views. No visible enlarged internal lymph node in chest
Urinalysis cystocentesis



pH 5.8 (5.5-8.5), SG 1.020 (1.015 - 1.045). Occasional RBC, WBC, epithelial cells, bacteria. Crystals variable.
creatinine, albumin, total protein tests


TENTATIVE DIAGNOSIS
Lymphoma

CAUSE - Unknown. Old age.


5 FORMS
1. External lymph nodes
2. Gastrointestinal tract
3. Mediastinal
4. Skin
5. Bone marrow

TREATMENT
Expensive. IV chemotherapy.
Remission. Recurrence. Most dogs after chemotherapy live for around one year if there is no recurrence.

REFERENCE:
http://www.vet.purdue.edu/pcop/canine-lymphoma-research.php


--------------------------------------------------------
LYMPHOMA IN A JACK RUSSELL IN 2011

Monday, March 28, 2011

378. Sunday Case. "My Jack Russell suddenly can't see"

I HOPE THIS REAL CASE WILL HELP THE 5TH YEAR VET STUDENT WITH THOUSANDS OF SUBJECTS TO REMEMBER AND BE EXAMINED BEFORE GRADUATION!

One look from my reception counter and I could see that this Jack Russell was suffering from Canine Lymphosarcoma. Some vets prefer to call it Canine Lymphoma. The two lumps of the size of ping-pong balls on the right and left lower jaws were too obvious to miss.

The owners were a young couple in their early 30s and an older woman and there was great emotions involved. The mum was distressed that the 8-year-old male Jack Russell walked into chairs and just could not see on this fine Sunday morning. Only the day before, the dog was zipping here and there when exercised outdoors. No accidents. No falls. No injuries. The dog just couldn't see! Why? What happened?

I decided to handle this case as the leading vet responsible for the outcome and together with my associate vet. Working as a team is a pleasure of veterinary medicine as we share our workload. I asked if she objected as she was on duty, but this was not her client. My associate said: "I am OK."

HISTORY
"What did Vet 1 say?" I asked when the owner showed me the report of a pre-scapular lymph node biopsy sent to the AVA lab.
"Vet 1 said that the AVA lab cannot confirm that the dog is suffering from lymphoma."

I read the report. It stated that it needed at least 2 biopsies from 2 lymph nodes and to relate to clinical signs. The presented biopsy cells could not confirm lymphoma.

So the owners must have concluded that the dog was not suffering from lymphoma!
No further treatment.

EYES
Blood inside both eyes preventing vision.
Note: In canine lymphoma, eye involved in 25% of cases). This can lead to bleeding within the eye, uveitis, glaucoma, retinal detachment and blindness.)

BLOOD TEST RESULTS OF DOG WITH LYMPHOMA OVER AT LEAST 1 MONTH
I was checking for infection (high WCC) or immune suppression (low WCC and platelets) or cancer (e.g. leukaemia with very high WCC), liver and kidney disorder.

Results are as follows:
Haemoglobin 13.9 (12-18)
Total WCC 11.8 (6-17)
Neutrophils 70.51 Abs 8.32
Lymphocytes 16.44 Abs 1.94
Monocytes 11.19 Abs 1.32
Eosinophils 0.09 Abs 0.01
Basophils 1.95 Abs 0.23

Red cell count 5.5 (5.5-8.5)
PCV 0.38 (0.37-0.55)
MCV 69 (60-77)
MCH 25 (20-25)
MCHC 36 (32-36)
RDW 14.1%

Platelets 90* (200-500). No platelet clumps seen.

LIVER PROFILE
ALT/SGPT 169 (<59 -3.6="" -="" 0.05="" 0.1="" 0.2="" 1.="" 138="" 2.58="" 2.="" 2="" 3.="" 4.="" 4047="" 4049.="" 4a="" 54="" 5a="" 5b="" 6.3="" 7="" 8.3="" a="" abdomen.="" abdominal="" acid="" active.="" acute="" affecting="" anaemia="" and="" anterior="" as="" asked="" ast="" be="" became="" been="" bite="" bleeding.="" bleeding="" blood="" bone="" both="" but="" bw.="" calcium="" canine="" cases="" causing="" cells="" central="" chemotherapy.="" chemotherapy="" class="separator" cost="" could="" count="" counts="" creatinine="" cure="" day="" decide="" depend="" depends="" developing="" did="" disease="" div="" do="" dog.="" dog="" domitor="" dose.="" drugs.="" due="" eating.="" eating="" enlarged.="" enlarged="" experience="" eye="" eyes.="" eyes="" for="" free="" from="" function="" generalised="" give="" guideline.="" had="" happened="" has="" highly="" his="" how="" hunched="" i="" impressed="" in="" infections.="" inside="" intense="" into="" involvement="" is="" it="" iv.="" ketamine="" kg.="" kidney="" life="" live="" liver="" long="" low="" lowest="" lymph="" lymphoma.="" lymphoma="" marrow="" may="" me.="" me="" means="" mild="" ml="" monitoring.="" months="" my="" nervous="" next="" no.="" no="" node="" nodes="" normal="" normally.="" not="" now="" of="" on="" one="" or="" other="" owner="" owners="" pacing="" pain="" palpated="" pancreatitis="" permanent="" platelet="" present="" problem="" profile="" prolonging="" quite="" quoted="" reading="" red="" relieve="" remission="" reports.="" reports="" risky="" rom="" rubbed="" rubs="" s="" said="" sclera="" sedation="" see.="" see="" seizures="" several="" shows="" situation.="" slept.="" solve="" some="" spleen="" stage="" stopped="" style="clear: both; text-align: center;" sunday="" syringe="" system="" tage="" test="" the="" there="" this="" to="" treatment.="" treatment="" two="" type="" urea="" uric="" varies="" very="" vet="" vigorously="" vision="" was="" were="" what="" whether="" which="" white="" will="" with="" without="" would="" yet="">

Posted by Be Kind To Pets at 4:26 PM

A wedding promise

A Myanmar lady getting married to a Spanish man today asked me to edit her speech at the wedding.

HER VOWS

First I want to say thanks you.. to my groom as you make my dreams come true. I am proud to be your wife and join my life with yours.

I promise to love and care for you and I will try in every way to be worthy of your love.

And wherever our journey leads us, living, learning and loving together for 2000 years.

 -------------------------------
 MY SUGGESTION 

Today is my most important and happiest day of my life as I stand beside my beloved man of my dreams to exchange rings and promises.

Today, we begin a new journey that I pray will be filled with love, care and learning about each other till the end of our lives.

I promise to love and care for you in good times and in bad times, in health and in sickness, with joys and laughter, as we grow old together, as the dream girl you have married today.

I hope we can be forever as one united from today, till our hairs turn silver, still in love in our winter years.

A drooling young rabbit

Drooling in rabbits is usually due to dental problems.

141104A Jack Russell dislocates her shoulder

Traumatic shoulder luxation

The 13-year-old Jack Russell was limping for more than 2 weeks. Recently, she was lethargic and had lost her appetite. Dogs have a high threshold to pain but this active Jack Russell probably could not stand the pain any longer.

Closed reduction by Dr Daniel using the . A sub-luxation of the right scapulohumeral (shoulder) joint. Will review 7 days later. 

141103A_An image of a movie called Wild

An interesting attractive movie poster

1423. How to minimise anaesthetic death risk in an old dog

1. How to minmise anaesthetic death in an old dog

Informed consent

History and physical examination
Blood test, ECG and X-rays
Sedation dosage 50% for dogs over 5 years old or not as healthy
Antidote to sedation
Emergency drugs
IV drip, antibiotics and diuretic
Intubation. Correct-sized endotracheal tube fitting trachea tightly, e.g. size 9 for this adult Sheltie
Duration of anaesthesia
Close monitoring of anaesthesia by experienced assistant
Duration of surgery
Antidote
Recovery. Not to go home immediately
Post op antibiotics and painkillers for extracted teeth


Oct 28, 2014.  A father and young adult daughter presented this gentle 7-year-old male Sheltie for dental scaling. A friend's Maltese had died after dental scaling by another vet and so the owners wbeere worried about anaesthetic death. "Dogs usually do not die under anaesthesia or after anaesthesia," I said to the father. "Unless the dog has heart disease or poor health."

A thorough physical examination showed that this Sheltie with bad breath was generally healthy in heart and lungs. The heart beats were irregular. 50% sedation  of domitor and ketamine IV calmed this nervous Sheltie.

Health screening including a complete cell count and X-rays of the chest is advised. No ECG is done.

In this case, I gave an IV drip, with IV baytril, frusemide and Vit B complex.  

It is very important to provide a very close monitoring of the maintenance of isoflurane gas at 0-2%, oxygen flow rate at 2 litres/minute to ensure that minimal anaesthesia is being given. The dog did wake up in the midst of dental scaling as the maintenance dose was 0.5%.

He was intubated again and maintained at 2%. The dog woke up fast and went home 3 hours later.  Follow up 2 days later showed that the dog is OK. The dog had been given dry dog food and milk since young. He likes only certain brands of milk. Well beloved family dog and in excellent body condition.


FOLLOW UP
Oct 28, 2014


A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling.  Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.

"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?"  The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet

No vet can guarantee no anaesthetic risk. Even people do die.

PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18).  The total red cell count was normal. The haematocrit was normal too.  Platelets were normal. What does it mean? Was he fed some supplements?


BLOOD TEST on 27.10.14  Abnormal values

Urea 12.3  (4.2 - 6.3)
Creatiine 65  (89-177)
Haemoglobin 19.1 (12-18)

All the other blood values within normal limits.

FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.

"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).

The dry dog food was  Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.


ADVICES 2 DAYS LATER
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.

This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.

Urine-marking and caterwauling male cat

Hi,
I have a male cat, 8 months old now. For the past few months he has been very good & well toilet trained.  Recently, for about almost 2 weeks now, he has been meowing loudly at night especially, as if he wants to go out. Also, he litters everywhere in the house when actually for the past few months he always do it in his litter box. Is it advisable to sterilize him? Will it reduce the litters? It is getting more frequent now. Also, may I know the quotations for sterilization in your clinic?
Thank you for taking time to answer my queries.

Regards,
Name of owner
Sent from my iPhone

-------------------------------------
REPLY FROM DR SING


Oct 30, 2014
Neuter will help stop urine marking n caterwauling meowing loudly. Cost is $150 including painkiller  antibiotics. Pl let me know or tel 62543326

Email query on guinea pig's vocalisation and urinary stones

Hello,

 

My husband and I have two male guinea pigs – Fred (2 ½ years old) and Alvin (1 ½ years old). About a week and a half ago, we noticed that Alvin (who is usually a very quiet piggy) started to become very vocal. Although there was nothing alarming about the noises he was making, we picked-up on the fact that Alvin was making the noises while he was going to the bathroom (usually while peeing).  Again, there was nothing concerning about the noises -  in fact, he makes the same noises when cuddling with us or while romping around the cage.  

 

Just to be safe, we decided to bring him to our local vet.  After examining Alvin, the Vet said he was likely suffering from a Urinary Tract Infection and gave us a 14 day supply of Baytril SA.  After being on the Baytril for 48 hours, we noticed that Alvin was making less noises while peeing.  We assumed the Baytril was working, but just to be sure, we brought a urine sample to the Vet (about 48 hours after Alvin started on the Baytril).

 

The urine results showed: a PH of 8.5, Blood at 3+; Calcium Carbonate Crystals at 11-20; and Amorphous Phosphate Crystal at 4-10.   I've attached a copy of the full urine analysis.

 

At first, we were told that the results had to be “re-run,” because the Vet’s staff entered in the wrong species and the lab could not properly test the urine.  Despite being told this, the Vet himself said that the results would be the same no matter what. 

 

The Vet concluded that Alvin did not have a Urinary Tract Infection, but instead had stones and would require surgery.  He called a specialist and made us an appointment for the very next morning.  It’s bewildering to me how he could come to such a conclusion, since he himself did not feel any stones and Alvin, to our knowledge, was actually doing much better.  It also begs to question why Alvin would respond to the Baytril altogether if he in fact did not even have a Urinary Tract Infection to begin with. 

 

The last three days specifically, Alvin has been 100% back to normal – he eats well, urinates without noises, poops without any problems and plays with his brother as usual.  There are no unusual urine smells (or color) and the urine itself does not feel gritty.  

 

Rather than immediately having him undergo more tests unnecessarily, we've decided to monitor him closely (my husband works from home and can watch him throughout the day).  Alvin (and Fred) are currently on a diet of Oxbow Pellets, Timothy Hay and leafy green veggies.  Admittedly, prior to this ordeal, I was feeding them far too many baby carrots (approximately 8 each – 16 total - for the entire day).  I know now those amounts were far too much and have now eliminated carrots altogether for the time being (despite having two very angry piggies on my hands).    Coincidentally, Alvin’s improvement seems to have happened at the same time as the elimination of carrots from his diet, in addition to an increase in the amount of Vitamin C he's fed. 

 

Although Alvin’s health is our top priority, and we will move mountains to ensure he is taken care of, I do not want to create any undue stress on him.  In addition to finding some fault in how the Vet handled the situation from the beginning, I also have very little faith in him, or anyone he recommends, at this point.  I have spoken with two Specialists (one of which the Vet referred us to) and they will not give us any information, let alone review the prior urine analysis, unless we pay $100+ for re-exams, plus the cost of another Urine Analysis and the cost of x-rays (that’s in addition to the $200 we've already spent going nowhere). 

 

Based on this information and the urine test results, what would you recommend is the best route to take at this time?  Any help you could provide would be so greatly appreciated. 

-----------------------------------------------------------------
REPLY FROM DR SING

Nov 1, 2014

I am Dr Sing Kong Yuen from Toa Payoh Vets. 
Are you from Singapore?
Each vet has his or her own way of diagnosis and treatment. However, diagnosis of urinary stones are best done on X-rays and/or ultrasound. Some urinary stones can be seen on X-rays. Were there any X-rays done by your vet who recommends surgery? If the guinea pig is "normal" now, it is best to wait and see.