2458. The rat has stitch breakdown on Day 5

Jun 8, 2015

The young lady brought her rat for check up as she is worried about the big wound.
"It is very hard to put an e-collar on the rat as well as the hamster," I said. "They will try to pull it out and get stressed."

The rat weighed 306 grams on 6 days after mastectomy but weighed 385 grams with the tumour of 78 grams before mastectomy. Pre-op weight of 385 - 78 was 307 grams. So, it was good news as the rat was back to normal. Otherwise she would lose weight. 

The career lady showed me a video of a swelling where the stitches had been one day ago. It would be a haematoma. Some pink plasma seeped out. Now it is a gap as the two stitches had been bitten off.

Over 20 pieces of big round stools were in the carrier indicating that the rat was normal as she would not eat if she was infected. This was good news.

What are my advices?

1. There was no need to re-stitch as the rat may bite the stitches off. The rat may die under anaesthesia as she is older being 2.5 years old. A rat is said to live around 3-5 years.

2. An Elizabeth collar is not acceptable to the rat. She will be stressed getting it off. In any case, the wound will heal by granulation.  
3. Get a bigger plaster dressing to cover the wound instead of two smaller ones.

4. Clean the wound twice a day with chlorhexidine but rinse off the wash with clean warm water and dry the wound.

5. Antibiotics oral -  baytril and painkiller meloxicam for 2 days. Wait 4 days and repeat if needed.


TIME LINE
Day 1  Jun 2, 2015     mastectomy


FOLLOW UP BY SMS
Jun 3, 2015  6.30 pm
Dr Sing: Is you pet rat ok after op?

                     6.34pm
Owner: Yes, she is okay now. Started eating since this early morning and now running places.
                     7.54pm
Dr Sing: Thanks.

Jun 4, 2015  7.44am
Dr Sing: Give medicine for the next 4 days
                     8.17am
Owner: Thanks Dr. Will continue to give her medicine for another 2 days. The wound is quite dry. But she does chew a bit of the stitches off
                     8.21am
Dr Sing: Need to make an elizabeth collar with thin cardboard paper to wear around the neck for 7 days at least. No running around.  E-collar similar to what dogs wear. Do it before you go to work.
                   

                    8.22am
Owner: Will keep her in the tank and won't let her out. 

                   
                   8.22am
Dr Sing: Or bring her to office.

                  8.22am
Owner: Oh yah I saw that in the internet. Will make her one.

                  8.22 am
Dr Sing: Or tape wound with human dressing for wound protection. Urgent to do it before you go out.

                 8.23am
That's what we did yesterday with a plaster but it came off this morning.

                 8.24 am
Dr Sing: Need to keep replacing it for 10 days.  Pl email video of stitched area.  99pups@gmail.com

                8.46am
Owner: Sure I will.

Sat Jun 6, 2015        5.22 pm
Dr Sing: How is the patient?

                                          
Sunday Jun 7, 2015  10.57 am
O:  Hi. Pixie has a lump just to the left of the incision. She eats and drinks okay and still very active. Am wondering if it's water retention or internal bleeding. Will send you the video of it via email now.
                                  11.38 am  
Dr Sing:   Some bleeding in the area.

                                   11.39am
O: There was some pink trace of blood but the wound looks dry and neat.

                                   12.17pm
Dr Sing: The rat should be Ok.
                                   11.09pm
O: Hi, she pulled off the stitches. There's an open wound now. But not bleeding though. Will bring her in the morning

------------------------------------

Monday Jun 8, 2015. Inspection of the rat at Toa Payoh Vets

The fancy rat had an open wound as two stitches were taken out by the rat. Not serious. Advised bigger plaster and cleaning wound daily.  No need to re-stitch.  The wound will heal by granulation.

UPDATE Sunday Jun 14, 2015  6.18 am 
As I write this report, no news from the owner is good news.

2457. Two 8-year-old terrapins fought when transferred to bigger tank

Sunday, Jun 7, 2015

One of the 2 terrapins, 8 years old, was lethargic at home and was breathing fast. When he came to the clinic, he was most active while the other was quiet and had closed eyes. So what was wrong?

Both was housed separated by a barrier in a bigger tank as they bit each other when recently transferred to a bigger tank. "They are male terrapins and want their own territory," I said. "They pooped a lot and the water in a small tank needs to be changed at least once in 2 days. They need a bigger drying area to dry instead of being submerged 90% in water."

The filter was clogged and so was not functioning. The best is to change water daily as the tank is not very big, around 6 feet x 6 feet. A variety of diet, rather than just pellets from one brand from Taiwan had been fed for the past 8 years. "They don't eat vegetables," the mum said. 

I advised smearing the pellets with medicine, put them into a small amount of water and let them eat 25% first. Same with dried shrimps and meat. It will be difficult for the boy to open the terrapin's mouth to feed medicine as he was not even able to pull the tail to examine the terrapin. Both terrapins curled their tails inside the shell strongly. They were kept together in the blue basin and must have had been biting each other's tail although the mother said "they never bite" when house in the smaller blue basin.  Normally, terrapins don't curl their tails tightly. 

2456. Sunday Jun 7, 2015 - A cat with a painful enlarged right submandibular lymph node

A bright blue sky white cloud Sunday.  Pregger, an old cat with a few teeth left, was brought in  for anorexia 2 days. She was not drinking.

A very painful enlarged right submandibular lymph nodes and throat. Anorexia 2 days. Not drinking.  What is the cause? 

X rays show some opacity in the right tympanic bulla. Is there a tumour?

Anaesthesia   no ulcers or decayed teeth


http://www.kongyuensing.com/laws/TP41051WWPreggar_VD_painful_throat_Jun705.jpg

2189. An old cat is anorexic and has weakened purring

UPDATE
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2188. Bad breath and gum tumour in an 8-year-old Schnauzer

Sunday Jun 7, 2015

Miniature Schnauzer, Male, entire, 8 years

The consultation room stank of bad breath from this dog that had "dental scaling" 3 times by the dog groomer. Yet the bad breath did not go away. The owner came because the dog kept licking his front paws and the bad odour permeated into the hairs of the paws.  The dog drooled and vomited yellow stuff sometimes, esp. after eating.

"This dog has a fever," I checked the rectal temperature as 40.1C. "Has he lost appetite?"
"He has not been eating and drinking for the past 2 weeks."

"What is the cause of the fever?" the man asked.
"Bacterial infection."

An IV drip with medication will be given today. Blood test. Then, tomorrow, anaesthesia and dental work. Many exposed teeth and loose ones. The gums were reddish instead of pinkish.

Always get a yearly vet check up and do dental brushing if you want your dog to keep his teeth to old age.  Poor oral hygiene can also cause gum tumours to develop as in this case of a round gum tumour on the right upper jaw behind the right upper canine tooth. 

2187. A rare case of an ocular dermoid in a cat in Singapore

A rare case of ocular dermoid in a cat in Singapore.


Dermoids are ectopic eye tissues. They are non-cancerous tissues growing inside the conjuncitval, sclera or cornea or scleral-cornea areas.  It is congenital and is said to have familiar cause.

In this cat, the dermoid is present in the lateral canthus on the sclera and corneal tissues. it causes epiphora.

SURGICAL TREATMENT

1. Scalpel blade No. 11.

2. I have used electro-surgery to excise the dermoid off the cornea in a Shih Tzu (see video). It is very effective in stopping epiphora and conjunctivitis.

Dermoids are uncommon and is said to be rare in cats.  In general practice, vets will rarely see such cases unless they are from cat breeders. No seller can sell such kittens.

Use surgical blade No. 11

 A dermoid usually has hairs whereas a pterygium does not have hairs.


VIDEO

1.  cat dermoid
https://www.youtube.com/watch?v=5hwuWx4T83I

2186. Sibling hamster rivalry - bites neck of 4-month-old hamster

"If the bite wound is small, less than 5 mm, your hamster may not need stitching," I said to the man who phoned for advice. He decided to send the hamster for stitching.

 Zoletil 100 IM anaesthesia. Debride. Stitched with 4/0 absorbable monosyn.  Goes home on the same day.

2185. Pharyngeal X-rays

Pharynx

1. Recumbent lateral. The lateral view is most informative to locate foreign bodies. The dog lies on the side with forelegs retracted. Head and neck in lalteral position, in mild extension.Larynx shoulbe be clear of the mandible.

2. Upright lateral. Dog in upright position using the horizontal beam. Reduced time without producing too much contrast. This view to show the natural relationship between the epiglottis and the soft palate.

2184. KPI. How long it takes to neuter a cryptorchid dog?

I asked my assistant Naing to record the timelines for neutering a cryptorchid, starting from the IV injection and ending of stitching.

In a cryptorchid, the right testicle did not descend but was under the skin, further away from the scrotal bag. I pushed it towards the scrotal midline so that I needed just one skin incision instead of two. The descended testicle was pushed into this same incision. Time taken 21 minutes.

2.3 kg   8-year-old male Maltese. Thin.
A: Injection of Dom + Ketamine at 0.03 + 0.03 ml IV.
Isoflurane + oxygen gas used - 17 minutes.
B: End of skin stitching.

B-A = 21 minutes.
However, I ligated twice the cryptorchid testicle and the descended testicle. For the descended testicle I did a transfixed ligature and a normal one. So, one more minute is taken up.  Usually I do one ligature into the grove using 3-forceps method. The lowest forcep was removed and the ligature was tied at this grove.

Post op methone, baytril and tolfedine inj.
Home on 4 days of tolfedine and baytril. No complaints as at 3 days post op today.

2183. The recurring right perineal hernia

June 3, 2015.

"Most dog owners do not turn up for neuter after perineal hernia repair," I said as the parents and their young adult daughter brought in a Maltese that has a small golf-ball-sized right perineal hernia. "The reason for neutering is that male hormones favour development of perineal hernias as this condition is uncommon in neutered male dogs and female dogs."

I reviewed my medical records.

"The hernia was orange-sized last time and you were advised to have your dog neutered after the hernia repair, " I said. "We did the two separately to shorten the anaesthetic time and reduce the risks of death on the op table.  Some vets do both at the same time, but if the old dog dies, so be it. Deaths on the op table affects the vet too but it is the owners who are devastated."

"It is bad for the dog to have anaesthesia," the young lady presumed that brain cells must have been destroyed after any anaesthesia but did not elaborate. So no surgery to neuter and the hernia came back. . 

"They don't get any side effects if they are healthy," I said.
"When should the dog be neutered after the hernia repair?" the father asked.
"Around 2-4 weeks."
Some vets may have a different opinion from me as he said he was advised 3 months later. However, he did not turn up for neuter and now, 4 months after the repair, the hernia recurs. I advised neutering first and hernia repair 2-4 weeks later. A special gauze is needed in such cases as the muscles to stitch up have degenerated in this old thin 2.3kg dog. Hence it would be difficult to prevent recurrence without the gauze.