March 29, 2015
The vet's wife wanted to buy an Ap Alert sensor as her husband considered it very useful. If the dog stops breathing, there is the warning and if it breathes regularly, there is the regular beeping sound. She contacted another vet whose receptionist told her that she must wait till the product comes in from Australia. It would cost $35.
The supplier I sourced for her quoted $250. Her husband said to buy two as his wife did not answer the phone or called me back. I confirmed two but the wife said one would do. The supplier was angry at this change of mind and despite my confirming two, he would not sell.
"Some years ago, she ordered some equipment with price agreed at $580. My girl delivered it to her office," he said." She wrote a cheque of $500. My girl accepted it as she would have wasted her taxi fare in bringing it back. "This $58 meant a lot to me as I had few customers."
In another instance, she asked him to keep the equipment for her but did not buy it. He said another vet asked him for quotations and even asked him to inform other suppliers about the new premises. In the end, this vet did not buy anything from him nor inform him of his failure to secure any business.
Some vets would ask for quotations and buy elsewhere or directly from Australia but would phone him for repairs. One even used another telephone as he did not respond to her call.
Pet health and care advices for pet owners and vet students, photography tips, travel stories, advices for young people
Friday, May 29, 2015
2171. The guinea pig's head tilts left - review after 1 week
May 29, 2015
I did not expect to see the busy father after the treatment of the inappetant guinea pig with the left head tilt 7 days ago. The 3-year-old guinea pig was eating 50% of the food and was very thin at 700grams bodyweight.
He turned up with his two daughters today on May 29, 2015 and I was surprised as most owners do not bother or care for a review when their rabbit or guinea pig has head tilt.
"There is much improvement as she tilts her head less," he was glad that the bodyweight is now 752 grams and the guinea pig was eating. He fed Vitamin C tablet crushed in powdery form and bought wood and mineral blocks, but the guinea pig ignored them.
"No more left nostril pus after your antibiotic treatment, but the left eye is still cloudy." He cared for this guinea pig much despite his busy travelling. "After 3 days of ear drops, she would object strongly to any more ear cleaning."
"I need to irrigate the left ear under isoflurane gas anaesthesia," I advised this procedure as the guinea pig had had painful ears with black soot-like substances. "To flush out the black sticky dirt inside the ears as the guinea pig had no ear cleaning for the past 3 years. Did you give her more space to exercise?"
"This time, I extended the living space by placing her bottle at a far end of the pen. In this she's got to walk a longer distance to drink."
Under anaesthesia, I checked the molars using my fore-finger to feel for molar spurs. No sharp cheek teeth. The front teeth was trimmed 2 mm shorter.
The guinea pig's left eye cornea was cloudy but much less. She would rub her eyes whenever eye drops were applied.
As there is less head tilt, we will wait another 7-14 days after the ear irrigation and another type of ear drop dripped into the left ear to check whether the head will no more tilt to the left.
I did not expect to see the busy father after the treatment of the inappetant guinea pig with the left head tilt 7 days ago. The 3-year-old guinea pig was eating 50% of the food and was very thin at 700grams bodyweight.
He turned up with his two daughters today on May 29, 2015 and I was surprised as most owners do not bother or care for a review when their rabbit or guinea pig has head tilt.
"There is much improvement as she tilts her head less," he was glad that the bodyweight is now 752 grams and the guinea pig was eating. He fed Vitamin C tablet crushed in powdery form and bought wood and mineral blocks, but the guinea pig ignored them.
"No more left nostril pus after your antibiotic treatment, but the left eye is still cloudy." He cared for this guinea pig much despite his busy travelling. "After 3 days of ear drops, she would object strongly to any more ear cleaning."
"I need to irrigate the left ear under isoflurane gas anaesthesia," I advised this procedure as the guinea pig had had painful ears with black soot-like substances. "To flush out the black sticky dirt inside the ears as the guinea pig had no ear cleaning for the past 3 years. Did you give her more space to exercise?"
"This time, I extended the living space by placing her bottle at a far end of the pen. In this she's got to walk a longer distance to drink."
Under anaesthesia, I checked the molars using my fore-finger to feel for molar spurs. No sharp cheek teeth. The front teeth was trimmed 2 mm shorter.
The guinea pig's left eye cornea was cloudy but much less. She would rub her eyes whenever eye drops were applied.
As there is less head tilt, we will wait another 7-14 days after the ear irrigation and another type of ear drop dripped into the left ear to check whether the head will no more tilt to the left.
Thursday, May 28, 2015
2170. Video production for a FLUTD cat in Singapore
draft for intern to produce a video |
Recurring Feline Lower Urinary Tract Disease in a Cat in Singapore Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date: 28 May, 2015 HOOK Dysuria, pollakiuria and haematuria Recurrence of above signs after a vet has successfully cured him. Why? (VIDEO FOOTAGE OF CONSULTATION TO TOA PAYOH VETS) TITLE THEME Feline Lower Urinary Tract Disease in a cat in Singapore's apartment INTRODUCTION Pollakiuria, Dysuria and Haematuria can be present in the Feline Lower Urinary Tract Disease cases as follows: 1. Feline Interstitial Cystitis 2. Urethral Obstruction 3. Bladder stones 4. Other conditions such as parathryoid hormones MIDDLE Case 5-year-old male neutered cat had recovered from FLUTD after treatment by Vet 1 three months ago but now, same clinical signs of dysuria and going to the litter box many times again. "Did you see blood in the urine?" I asked the mother and adult son. "Can't see as he goes to the litter box to urinate!" she said. Diagnosis Physical exam. Bladder pain and enlargement, bladder pain and size, genital area for uethral plug and inflammation Urine test. pH, SG, crystals, bacteria, red and white blood cells, protein Blood test Urea & Creatine. Phosphorus and calcium. Leucocytosis. X-ray. Kidneys, bladder to urethral opening views Ultrasound Treatment Drip Pain control Antibiotics Catherisation Surgery - cystotomy and perineal urethrostomy Prompt treatment advised. Kidney failure or infections. Prompt veterinary treatment - stabilise and pain control with Diet - wet food, good quality protein Environment - Litter boxes, water intake, multi-cat household, change of diet or environment, male neutered cat Follow up and regular urine tests at half-yearly are rarely done by the owner. In this cat, painkiller and antibiotics were given. No urine or blood test or X-rays of the bladder and kidneys to lower medical costs this time as Vet 1 had done the first 2 tests 3 months ago and hospitalised the cat for 5 days. There was no pain or swelling in the kidneys which were not palpable. No painful or swollen bladder. No inflamed genital area or swollen purplish penis. Therefore, I would not push for the tests now. Overall, this cat could pee but frequently and with difficulty. Blood in the urine could not be ascertained as the cat peed in the litter box. FOLLOW UP ON DAY 3 The owners were happy as the cat was now "not moody". He was affectionate again and could pee with lesser difficulty. The mum had no complaints. Two litter boxes and separated sleeping rooms at night. This cat sleeps in mum's bedroom which has a bathroom where the litter box is. As for the new C/D diet, not eating. I advised slowly add 5% and hand feed. It will be successful if the owners persevere. Ideally, it would be best to test the urine for struvite or oxalate crystals, but in real life, the costs need to be lowered as much as possible. CONCLUSION Recurrence Diet - struvite or calcium oxalate? Look into Environmental Factors such as Stress. One more litter box than number of cats in the household. Privacy quiet area. Bullying. USUALLY SEEN IN Male neutered cat High rise indoor living Dry cat food --------------------------------------------------------------------------------------------------------------------------------------------- Setting Singapore - busy hectic city living for people Other cases A 7-year-old cat has bladder stone http://2010vets.blogspot.sg/2013/02/1303-bladder-stone-in-7-year-old-cat.html A 12-year-old cat in Turkey has bladders stones sinpets.com/F6/20130819bladder_stones_cat_Turkey.htm FLUTD in a male neutered cat http://2010vets.blogspot.sg/2013/07/1029-flutd-in-young-male-neutered-cat.html Case studies 1. A bladder stone cat followed up 79 days after surgery. No recurrence on C/D diet but no time for even one monitoring. 2. Urethral obstruction in a male neutered cat recurred 50 days later bekindtopets.com/stories/20130301cat_bladder_stones_toapayohvets.htm Prompt treatment of urethral obstruction means faster recovery this time- recurring FLUTD in a 3-year-old male cat. Feeding C/D only no recurrence. kongyuensing.com/folder5/20130116Recurring_FLUTD_cat_3years_toapayohvets.htm Cairo cat has stone-packed bladder http://2010vets.blogspot.sg/2014/12/email-from-cairo-cat-with-flutd-part-2.html Urethral obstruction cases http://www.asiahomes.com/singaporetpvet/0707cat_urolithiasis.htm Perineal urethrostomy as a final resort for recurrent urethral obstruction Feline Lower Urinary Tract Disease in Cats in Singapore Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date: 28 May, 2015 2015 cases May 2015 Recurring dyshagia and pollakiuria in a 5-year-old male neutered cat http://2010vets.blogspot.sg/2015/05/video-production-for-flutd-in-cats-in.html May 2015. A young cat still has haematuria after discharge by Vet 1 http://2010vets.blogspot.sg/2015/03/1157-kidney-disease-flutd-cat-passes.html Painful kidneys http://2010vets.blogspot.sg/2015/05/an-old-cat-has-painful-kidneys.html -------------------------------------------------------------------- A cat has bladder stone http://2010vets.blogspot.sg/2013/02/1303-bladder-stone-in-7-year-old-cat.html A 12-year-old cat in Turkey has bladders stones sinpets.com/F6/20130819bladder_stones_cat_Turkey.htm FLUTD in a male neutered cat http://2010vets.blogspot.sg/2013/07/1029-flutd-in-young-male-neutered-cat.html Case studies 1. A bladder stone cat followed up 79 days after surgery. No recurrence on C/D diet but no time for even one monitoring. 2. Urethral obstruction in a male neutered cat recurred 50 days later bekindtopets.com/stories/20130301cat_bladder_stones_toapayohvets.htm Prompt treatment of urethral obstruction means faster recovery this time- recurring FLUTD in a 3-year-old male cat. Feeding C/D only no recurrence. kongyuensing.com/folder5/20130116Recurring_FLUTD_cat_3years_toapayohvets.htm Cairo cat has stone-packed bladder http://2010vets.blogspot.sg/2014/12/email-from-cairo-cat-with-flutd-part-2.html Urethral obstruction cases http://www.asiahomes.com/singaporetpvet/0707cat_urolithiasis.htm BE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER. More case studies, go to: Cats or Dogs Make an appointment with your vet. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail judy@toapayohvets.com your requirements. |
Saturday, May 23, 2015
2169. Eye trauma in a young abandoned Persian cat
May 22, 2015
After 7 days of antibiotic and painkiller treatment as an in-patient, this rescued young Persian's damaged infected eyeball was removed by Dr Daniel.
After 7 days of antibiotic and painkiller treatment as an in-patient, this rescued young Persian's damaged infected eyeball was removed by Dr Daniel.
2168. VIdeo: A 16-year-old has an obnoxiously smelly armpit wound - 3rd opinion
The very old dog had an armpit wound. It is very risky to tranquilise this old dog. So Vet 1 prescribed medication. The 2nd opinion vet bandaged the left leg and anchored with Elastoplast to cover up the armpit wound. His antibiotic injection was said to last 2 weeks. The owner did not return every 3 days to change bandages.
There was a strong obnoxious smell when I removed the bandage and the swabs which contained a green discharge of rotten smell.
As this dog is very old, anaesthesia is not advised. My solution was to sedate the old dog, wash the wound thoroughly and let it heal by granulation. Potassium permanganate powder sealed up the bleeding.
Injection to bring down the swollen left limb due to tight bandaging. Antibiotics and sleeping tablet sedation to let the dog have peace and sufficient rest.
FOLLOW UP 3 DAYS LATER.
The old dog's limb was much less swollen and the wound was not smelly. "Sleeps a lot," the owner was satisfied with this open wound method to prevent stench of smelly bacterial infection.
In this old dog, the armpit wound is very difficult to stitch up as it is a mobile high tension area. In this video, I proposed 2 surgical approaches. The Z-plasty and making another new skin incision further behind the armpit wound.
Z-plasty is used to release tension and the stitched area looks like a "Z" after stitching.
In the 2nd approach, the newly created skin incision is left open. It releases tension so that the debrided armpit wound can then be stitched. The new skin incision is not sttiched but left to heal lby 2nd intention. Antibitoic cover. These are my 2 surgical approaches if the dog is still young. Otherwise, lit takes months to heal a large armpit wound as in this case..
There was a strong obnoxious smell when I removed the bandage and the swabs which contained a green discharge of rotten smell.
As this dog is very old, anaesthesia is not advised. My solution was to sedate the old dog, wash the wound thoroughly and let it heal by granulation. Potassium permanganate powder sealed up the bleeding.
Injection to bring down the swollen left limb due to tight bandaging. Antibiotics and sleeping tablet sedation to let the dog have peace and sufficient rest.
FOLLOW UP 3 DAYS LATER.
The old dog's limb was much less swollen and the wound was not smelly. "Sleeps a lot," the owner was satisfied with this open wound method to prevent stench of smelly bacterial infection.
In this old dog, the armpit wound is very difficult to stitch up as it is a mobile high tension area. In this video, I proposed 2 surgical approaches. The Z-plasty and making another new skin incision further behind the armpit wound.
Z-plasty is used to release tension and the stitched area looks like a "Z" after stitching.
In the 2nd approach, the newly created skin incision is left open. It releases tension so that the debrided armpit wound can then be stitched. The new skin incision is not sttiched but left to heal lby 2nd intention. Antibitoic cover. These are my 2 surgical approaches if the dog is still young. Otherwise, lit takes months to heal a large armpit wound as in this case..
2167. VIDEO. The obsessive compulsive cheek pouch storage dwarf hamster
Some people hoard things till the whole house or garage is cluttered. Do hamsters hoard food inside their storage compartment, known as cheek pouches inside the mouth on the right and left sides? They pack the cheek pouches to the maximum and sometimes the cheek pouches become injured by the sharp shells from the seeds and are painful. The hamster is unable to dislodge the contents and rubs his swollen cheeks hairless.
I have a handful of such cases, but the following one is most memorable. He is the teacher's pet.
The black hamster was obsessive in storing and packing his cheek pouch with food. The lady owner came 3 times for right cheek pouch impaction. This pouch was excised at the 3rd visit and there was no problem for the next few weeks.
Now, lthe hamster scratches his face till hair drops off the top and sides of the face, leaving his eye area still hairy. Clearing the left cheek pouch is done. The hamster will be restricted to around 5 seeds per day. No large seeds. Sunflower seeds are shelled out before feeding to him.
FOLLOW UP ON MAY 22, 2015. Around 1 week later. "No more creamy discharge from his eyes," the owner was happy to report. "No more wet face!". She fed around 5 seeds e.g. shelled sunflower seeds and corn. The hamster would store the seeds inside his left cheek and eat them later. So his pouch is never impacted causing itchiness when large seeds are stuck inside.
I have a handful of such cases, but the following one is most memorable. He is the teacher's pet.
The black hamster was obsessive in storing and packing his cheek pouch with food. The lady owner came 3 times for right cheek pouch impaction. This pouch was excised at the 3rd visit and there was no problem for the next few weeks.
Now, lthe hamster scratches his face till hair drops off the top and sides of the face, leaving his eye area still hairy. Clearing the left cheek pouch is done. The hamster will be restricted to around 5 seeds per day. No large seeds. Sunflower seeds are shelled out before feeding to him.
FOLLOW UP ON MAY 22, 2015. Around 1 week later. "No more creamy discharge from his eyes," the owner was happy to report. "No more wet face!". She fed around 5 seeds e.g. shelled sunflower seeds and corn. The hamster would store the seeds inside his left cheek and eat them later. So his pouch is never impacted causing itchiness when large seeds are stuck inside.
Friday, May 22, 2015
2166. The teacher's pet hamster looked like Lone Ranger
March 22, 2015
"How is your hamster now?" I asked the young lady who is a teacher.
"No more creamy discharge from her eyes," she was happy.
"That would be pus," I said. "Are the hairs growing back on her face. The areas around her eyes were all bald and so she looked like she was wearing a mask, like Lone Ranger!"
"It will take some time for the hairs to grow. Previously, her face was wet, wet, wet but now it is dry."
"Was it water from the water bottle?" I asked.
"No, I don't think so."
"It could be from the eye tears," I assumed.
Now she restricts the hamster to a strict die. Around 5 seeds like corn and peeled sunflower seeds. No coloured star pellets and others.So the hamster would not stuff her left cheek.\
I remember this black hamster very well because she had caused much distress to the teacher with the right cheek pouch impacted 3 times. The last time I had it excised and there was no more problem. Till this creamy eye discharge.
"How is your hamster now?" I asked the young lady who is a teacher.
"No more creamy discharge from her eyes," she was happy.
"That would be pus," I said. "Are the hairs growing back on her face. The areas around her eyes were all bald and so she looked like she was wearing a mask, like Lone Ranger!"
"It will take some time for the hairs to grow. Previously, her face was wet, wet, wet but now it is dry."
"Was it water from the water bottle?" I asked.
"No, I don't think so."
"It could be from the eye tears," I assumed.
Now she restricts the hamster to a strict die. Around 5 seeds like corn and peeled sunflower seeds. No coloured star pellets and others.So the hamster would not stuff her left cheek.\
I remember this black hamster very well because she had caused much distress to the teacher with the right cheek pouch impacted 3 times. The last time I had it excised and there was no more problem. Till this creamy eye discharge.
2165. A busy father spares time for the left head-tilting guinea pig
Mar 21, 2015
"No, you have not been prompt in consulting me," I said. "The head tilt has been present for 2 weeks."
What is the cause of this left head tilt in this pretty female 2-year-old guinea pig much loved by the daughter. "There is also pus from the left nostril," the father said. "And something white in the left eye."
The lungs had sounds on ausculation, more on the left side. The eye cornea did not stain green with fluorescein stain test and this white central elevated patch across the middle of the eyeball could be a scar. Everything seems to be on the left.
So, was there an injury or infection to the left side of the body? The guinea had lost 50% of the appetite and the rectal temp was 36.4 (hypothermia). The ears had never been cleaned and there was black soot in both ears. The creature squealed when I palpated her ears.
She weighed 700g. What was wrong with her?
Most likely a middle ear infection. Will need to follow up after antibioics.
"No, you have not been prompt in consulting me," I said. "The head tilt has been present for 2 weeks."
What is the cause of this left head tilt in this pretty female 2-year-old guinea pig much loved by the daughter. "There is also pus from the left nostril," the father said. "And something white in the left eye."
The lungs had sounds on ausculation, more on the left side. The eye cornea did not stain green with fluorescein stain test and this white central elevated patch across the middle of the eyeball could be a scar. Everything seems to be on the left.
So, was there an injury or infection to the left side of the body? The guinea had lost 50% of the appetite and the rectal temp was 36.4 (hypothermia). The ears had never been cleaned and there was black soot in both ears. The creature squealed when I palpated her ears.
She weighed 700g. What was wrong with her?
Most likely a middle ear infection. Will need to follow up after antibioics.
2164. Mammary adenomas in an American Cocker Spaniel
TOA
PAYOH VETS toapayohvets.com Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074 Tel: 6254-3326, 9668-6469, 9668-6468. judy@toapayohvets.com 22 May, 2015 Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits |
Mammary adenomas in an American Cocker Spaniel Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 21 September, 2012 Update: 22 May, 2015 "Why did you delay seeking surgery till the breast lump is gigantic in size, like two tennis balls combined?" I asked the Buddhist temple teacher who taught Buddhism and morals to over 800 children of devotees. "The breast lumps grow very fast in the last 2 weeks," she replied. "Nobody in the family wants to bring the dog for surgery. My brother said to let her die." The solution was surgical removal but the family did not want to pay the medical costs. She was kind to enough to bring in this old dog for surgery at Toa Payoh Vets. I tacked in "walk-in sutures" through the muscle layer and then the skin, using 2/0 sutures to ensure that the large long wound would not break down.. The dog came back 4 days later. There was a swelling at one end of the tumour. " "There's seepage at the left Mammary Gland 5 area," I said to Dr Daniel who is in charge of the case. "Just cut off two stitches," I said to him. "In this way, the serum can drain out. No need to re-stitch." After that, we had no more visit from the Buddhist teacher. I was glad that this dog was not abandoned when she had the tumours. Such incidents do occur in Singapore. It is best to spay the female dog when she is young as breast tumours are less likely to develop in spayed dogs. BE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER. More case studies, go to: Cats or Dogs Make an appointment with your vet. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail judy@toapayohvets.com your requirements. |
Thursday, May 21, 2015
2163. Recurring urolithiasis in a Shih Tzu - 5 surgeries to resolve the problem
TOA PAYOH VETS toapayohvets.com Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074 Tel: 6254-3326, 9668-6469, 9668-6468. judy@toapayohvets.com
21 May, 2015 Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits
Recurrent urolithiasis - 5 surgeries for a recurring bladder stone problem
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: January 7, 2013 Update: 21 May, 2015
Taking images of cases with the camera phone to document your cases and to do retrospective studies of your performance will make you a better veterinary surgeon.
There may be some parts of the anatomy changes which you might have missed during the examination but images taken will be there for you to review. This is time-consuming and that is why most doctors and vets don't bother as images must be taken and filed properly.
For example, in the complicated case of the Shih Tzu with 5 bladder surgeries.
He had 2 surgeries to remove the bladder stones several weeks ago. Two vets (Vet 1 and 2) removed the bladder stones in two separate surgeries.
However, the Shih Tzu had bladder stones and Vet 3 operated on him.
with perineal urine leakage after a bladder surgery by Vet 3 to remove urinary stones, an image of the swollen perineum (presumed with leaked urine from the traumatised perineal urethra) was taken by me. See image on the left.
This is one supporting evidence and there must be others to substantiate this urine leakage (ultrasound of scrotum filled with fluid), swelling of left inguinal area near where Vet 3 made a skin incision to access the bladder for urinary stone removal daily with blood-tinged fluid while the dog was catherised with a smaller sized urinary catheter
Note that the scrotal sac is also swollen and Vet 3 had said that ultrasound revealed fluid. According to the owner, the whole of the lower part of the inguinal area was much swollen and that was why the dog had to be hospitalised for 8 days by Vet 3 who then recommended a 2nd urethrostomy and scrotal ablation to resolve the problem of urine leakage.
This image was taken when the dog was seen at Toa Payoh Vets on Day 9 after Vet 3's bladder surgery which had removed all bladder stones (post-op X-rays showed no stones). The owner came to Toa Payoh Vets as his daughter was a classmate of my son. So, Vet 4 (Dr Daniel) was tasked with the resolution of the dog's urinary problem.
How to resolve this problem with the least cost to the owner? That is the tough part. Will a 2nd urethrostomy and closure of the first urethral stoma and scrotal ablation as suggested by Vet 3 resolve the problem for once and for all?
Dr Daniel (Vet 4) at Toa Payoh Vets was asked by the owner to neuter the dog and remove the large left inguinal swelling of the size of an egg. He stitched up the urethral stoma (first urethrostomy done by Vet 1) so that the dog could pee as a normal dog, from the tip of the penis. Would this resolve the problem?
Well, it did not appear to do so as the left inguinal swelling filled with blood-tinged fluid (I presumed it was urine leakage + blood) of around 30 ml per day for the next 4 days. Vet 3 had likely ruptured the urethra leading to leakage of urine and blood in the left inguinal area.
"Closing the urethral stoma so that the dog could pee normally from the tip of the penis is good for the dog," I said to Dr Daniel. "But there is the daily need to aspirate the 30 ml of blood-tinged fluid from the left inguinal area. It cost the owner around $7,000 to do the past 3 surgeries to remove the bladder stone and given time, your surgical approach may work. But time means money expenditure for the owner. "
As Dr Daniel had to go overseas, I became the Vet 5 as I took over the case and reviewed the complicated urine leakage problem. This involved talking to Vet 3 as to what had been done.
Vet 3 said: "We did an ultrasound and saw fluid inside the scrotum. This was not recorded in the case report as the owner was not charged."
Ultrasound can reveal fluid in an organ but will not be able to tell whether it i urine or blood or both.
This is where the perineal swelling in this image substantiated a possible urine leakage. I proposed a dye test but it is extremely expensive to do dye test to reveal the location of the perineal urethral leakage. The surgery at Vet 3 had cost $2,000 according to the owner.
So, what's the best economical solution now? What is in the best interest of the dog? If expenses keep mounting, the dog may be put to sleep by the owner. A solution must resolve the problem to the owner's satisfaction and to the dog being able to live a normal life without difficulty in urination.
What should I do? This is a complicated urinary tract problem due to urine leakage presumed to be from a tear in the perineal urethra (see image of perineal swelling above) and subcutaneous fluid presented daily along the left side of the penile length.
I thought hard. The dog had gone through 4 anaesthesias and surgery. Veterinary expenses were considerable.
My surgical approach was to extend the urethra stoma made by Vet 1. This had been closed by Dr Daniel as he wanted the dog to pee normally from the tip of the penis. Then I did a scrotal ablation (cut off the scrotal sac), close up the inguinal sheaths and stitch the urinary catheter to the prepuce to retain it in for around 4 days to let the perineal catheter to heal. This is the theory.
In practice, this worked as the dog is now peeing normally with no blood in the urine when it came back for stitch removal on Sep 28, 2012, around 14 days after my surgery.
UPDATE as at Jan 7, 2013
The dog pees through the first urethrostomy without any difficulty. The owner came to buy the C/D canned food. It is good news. Post-op urine and blood tests and X-rays are advised but owner compliance with regular monitoring will be difficult due to various reasons.
P.S. Urethrostomy = a hole is cut into the urethra (passage for urine from bladder to the tip of the penis).
Yearly blood and urine tests may detect early presence of bladder and kidney stones in your dog and cat. For urinary health screening appointments, tel: 6254-3326, 9668-6468
e-mail judy@toapayohvets.com
.
21 May, 2015 Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits
Recurrent urolithiasis - 5 surgeries for a recurring bladder stone problem
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: January 7, 2013 Update: 21 May, 2015
Taking images of cases with the camera phone to document your cases and to do retrospective studies of your performance will make you a better veterinary surgeon.
There may be some parts of the anatomy changes which you might have missed during the examination but images taken will be there for you to review. This is time-consuming and that is why most doctors and vets don't bother as images must be taken and filed properly.
For example, in the complicated case of the Shih Tzu with 5 bladder surgeries.
He had 2 surgeries to remove the bladder stones several weeks ago. Two vets (Vet 1 and 2) removed the bladder stones in two separate surgeries.
However, the Shih Tzu had bladder stones and Vet 3 operated on him.
with perineal urine leakage after a bladder surgery by Vet 3 to remove urinary stones, an image of the swollen perineum (presumed with leaked urine from the traumatised perineal urethra) was taken by me. See image on the left.
This is one supporting evidence and there must be others to substantiate this urine leakage (ultrasound of scrotum filled with fluid), swelling of left inguinal area near where Vet 3 made a skin incision to access the bladder for urinary stone removal daily with blood-tinged fluid while the dog was catherised with a smaller sized urinary catheter
Note that the scrotal sac is also swollen and Vet 3 had said that ultrasound revealed fluid. According to the owner, the whole of the lower part of the inguinal area was much swollen and that was why the dog had to be hospitalised for 8 days by Vet 3 who then recommended a 2nd urethrostomy and scrotal ablation to resolve the problem of urine leakage.
This image was taken when the dog was seen at Toa Payoh Vets on Day 9 after Vet 3's bladder surgery which had removed all bladder stones (post-op X-rays showed no stones). The owner came to Toa Payoh Vets as his daughter was a classmate of my son. So, Vet 4 (Dr Daniel) was tasked with the resolution of the dog's urinary problem.
How to resolve this problem with the least cost to the owner? That is the tough part. Will a 2nd urethrostomy and closure of the first urethral stoma and scrotal ablation as suggested by Vet 3 resolve the problem for once and for all?
Dr Daniel (Vet 4) at Toa Payoh Vets was asked by the owner to neuter the dog and remove the large left inguinal swelling of the size of an egg. He stitched up the urethral stoma (first urethrostomy done by Vet 1) so that the dog could pee as a normal dog, from the tip of the penis. Would this resolve the problem?
Well, it did not appear to do so as the left inguinal swelling filled with blood-tinged fluid (I presumed it was urine leakage + blood) of around 30 ml per day for the next 4 days. Vet 3 had likely ruptured the urethra leading to leakage of urine and blood in the left inguinal area.
As Dr Daniel had to go overseas, I became the Vet 5 as I took over the case and reviewed the complicated urine leakage problem. This involved talking to Vet 3 as to what had been done.
Vet 3 said: "We did an ultrasound and saw fluid inside the scrotum. This was not recorded in the case report as the owner was not charged."
Ultrasound can reveal fluid in an organ but will not be able to tell whether it i urine or blood or both.
This is where the perineal swelling in this image substantiated a possible urine leakage. I proposed a dye test but it is extremely expensive to do dye test to reveal the location of the perineal urethral leakage. The surgery at Vet 3 had cost $2,000 according to the owner.
So, what's the best economical solution now? What is in the best interest of the dog? If expenses keep mounting, the dog may be put to sleep by the owner. A solution must resolve the problem to the owner's satisfaction and to the dog being able to live a normal life without difficulty in urination.
What should I do? This is a complicated urinary tract problem due to urine leakage presumed to be from a tear in the perineal urethra (see image of perineal swelling above) and subcutaneous fluid presented daily along the left side of the penile length.
I thought hard. The dog had gone through 4 anaesthesias and surgery. Veterinary expenses were considerable.
My surgical approach was to extend the urethra stoma made by Vet 1. This had been closed by Dr Daniel as he wanted the dog to pee normally from the tip of the penis. Then I did a scrotal ablation (cut off the scrotal sac), close up the inguinal sheaths and stitch the urinary catheter to the prepuce to retain it in for around 4 days to let the perineal catheter to heal. This is the theory.
UPDATE as at Jan 7, 2013
The dog pees through the first urethrostomy without any difficulty. The owner came to buy the C/D canned food. It is good news. Post-op urine and blood tests and X-rays are advised but owner compliance with regular monitoring will be difficult due to various reasons.
P.S. Urethrostomy = a hole is cut into the urethra (passage for urine from bladder to the tip of the penis).
Yearly blood and urine tests may detect early presence of bladder and kidney stones in your dog and cat. For urinary health screening appointments, tel: 6254-3326, 9668-6468
e-mail judy@toapayohvets.com
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