Taking a trip to South France from Jun 14 to 26, 15
The SIA plane had an "operational" delay of one hour. Apparently it was a door that could not align. Economy seats in this Boeing had no leg room. 13 hour flight Singapore to Milan. I stood up every 3 hourly to prevent muscle cramps. The Caucasian passenger at the window seat did not even go to the toilet for the whole duration.
Hotel Mercure in outskirts of Nice, in an industrial estate for the packaged tourists.
I do upload only good travel pics. Bright sunshine provided best images of beach.
Canon Zooms EFS 55-250mm P mode and autofocus
My favourite pic
is below:
Some beach pictures - Nice hotels are fully booked as some rich French people want suntan in summer
Nowadays, the younger generation thumbs messages via the phone and it is time saving as either party may be busy and not able to take phone calls.
SMS from a rabbit owner Jun 12, 2015 1.07 pm
"Hi Dr Sing, My rabbit T... appears to have a large growth or badly swollen area in his groin area. I dsicovered it only when washing his backside after he uncharacteristically peed on the floor instead of inside his cage. He usually doesn't like to be carried, so I am unsure of when the growth started.
SMS from Dr Sing Kong Yuen Jun 12, 2015 1.51 pm
"Need to check it. See u 4 p.m."
PATIENT
Rabbit: A shaded seal Mini Lop, male, 4 years old.
The swelling was a swollen bulging right testicle 10cm x 6 cm compared to 2 cm x 2 cm left testicle.
Neutering is the solution.
Lots of bleeding when the tunica of the right testicle was incised suggesting haemorrhage inside the testicle. Possibly a testicular torsion or tumour. The other testicle appeared under developed and did not bleed. The scrotal and anal areas were matted and the nails were long.
Sedation for 1.25kg rabbit Xylazine + Ketamine 0.2 ml + 0.3 ml IM in one syringe
Isoflurane gas 1% mask maintenance. Good analgesia to perform neuter.
Monosyn 3/0 absorbable. 2 incisions neck of scrotum.
Open castration. Blood seeped profusely from the tunica of the right testicle.
Recovery smooth - able to stand around 2.5 hours after injection. The lady owner stopped clipping the remaining matted hairs. This rabbit does not permit carrying and so it was difficult to comb the back area. He also does not eat hay from the hay ball but only from the ball. His front teeth were very short suggestive of grinding hard pellets and hay from Oxbow. Yet he is thin as spinal areas can be palpated.
Histology: The owner did not want it. It is hard to judge from inspection that the bigger right testes is not malignant. From general examination and the "sudden onset", the right testicle could be swollen due to torsion or traumatic injury of the spermatic cord
POST OP CARE
1. Wearing of e-collar with the ears inside the collar for the next 7 days.
2. Oral baytril and meloxicam to be given once a day for 5 days.
3. Wash wound and dry it once daily for 7 days.
4. Sutures will dissolve, no need to come for stitch out.
5. Groom the backside by putting rabbit on the floor and giving treats.
6. Increase amount of food daily.
Jun 10, 2015 The owner asked again whether the pus in the vagina of the Golden Retriever puppy was due to vaccination side effects. "I saw the pus the next day after vaccination," he said.
"No," I examined the thick yellow pus coming out from the vulval area. "Young female puppies do get vaginal infection. Did you see her licking her swollen vulval lips before the vaccination?"
"Yes, I saw her licking one day before vaccination."
So he was convinced that this infection was not due to vaccination. The dog was paper trained and so there was no problem with peeing all over the apartment.
June 11, 2015. t I attended a Rabies seminar organised by the AVA regarding rabies in Bali. Rabies was diagnosed in 2008 and mass vaccination of the dogs in various villages had brought down the numbers of infection in people but not completely eradicated this fatal disease. A group wanted all stray dogs to be culled and therefore no rabies would be present. But another group was against such acts as they are pets and are bred. The predominant culture is Hinduism and tourism is a big revenue earner. So rabies need to be eliminated.
The medical and veterinary department worked together to control rabies in Bali as tourism will be affected if rabies is endemic. The stray dogs are getting street wise and are difficult to net for rabies vaccination. Free treatment is given only to people bitten by dogs confirmed by lab test to have rabies as the 3-shot vaccine treatment or the use of immunoglobulin is very expensive.
Jack Russell, Female, spayed 13 years old, 13.7kg, 40.3 degrees C Complaint - left eye swollen
Overweight, skin disease ventral area as she sleeps a lot Lethargy for around past 5 years
The workmen was still installing a new operating light past 7.30 pm on this warm night. Dr Daniel had gone to play football while my assistant Naing finished work at around 7 pm.
I was available in the clinic to answer the phone call about the old Jack Russell having a sore right eye. The mother and adult daughter were worried that the right eyeball was protruding or swollen. There was a red spot in the depressed cornea of the right eye at the 3 o'oclock. This would be a descemetocoele. The eye white was reddish with blood vessel congestion. What was the cause of this swollen eyeball? Was it glaucoma?
"The good news is that it is not a recent corneal ulcer," I had applied fluorescein eye stain test onto the cornea and there was no green ulcer spots. "It is a descemetocoele or a bulging of the inner basement membrane of the cornea. In other words, it is an old eye ulcer.
"Jack Russells rarely get corneal ulcers and so this may be due to rubbing of the eye," I saw that the overweight dog was panting and black tartar encrusted teeth glinted in the white light of the consultation room. "It is possible that his cherry eye at the medial canthus was much irritating to him or he has tooth ache. So he had to rub his face and eye, clawing his right cornea."
"I did see him rubbing his eyes," the mother said.
"His cherry eye is inflamed and irritating," I explained. "In fact, he has another cherry eye on the left eye too. Why didn't you get them treated when he was younger?"
"The vet said that the cherry eyes would pop out after putting them inside the eyelid and therefore, no pointing in operating," the mother said.
"Yes, there is a risk of poor outcome in tacking the cherry eye into the 3rd eyelid and extra medical costs," I said. "The reason for tacking is that the dog will have adequate tear production during old age. An alternative is to remove the cherry eyes, relieving the dog of pain and irritation. Decayed loose teeth need to be extracted at the same time."
Now the dog is obese, the anaesthetic risk of dying on the operating table is very high. So, the mother and daughter will need to think about anaesthesia in the next 3 days as regards dental treatment.
Otherwise, the dog had a poor quality of life and his right eye might be scratched till it ruptured. In that case, anaesthesia to remove the eyeball is required." The dog can wear an Elizabeth collar for the time being to prevent eye scratching and antibiotics for the oral infections.
Sleeps a lot. Lethargic. Is this Jack Russell obese, suffering from hypothyroidism or being less active at her old age ? More investigation is needed to check the blood for hypothyroidism but the need to reduce medical costs is a factor in not ordering such tests.
The dog was treated for fever and given antibiotics.
FOLLOW UP ON JUNE 12, 2015
"The right eye is still swollen but not much," the mother was happy that the dog was much better and not scratcing. In practice, evidence-based medicine is best but there will be increased medical costs. The priority is to remove the bacterial infections from the black teeth and excise the two cherry eyes to let this old dog have a better quality of life. I will do the anaesthesia and dental this Saturday morning.
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 external ear canal near the right tympanic bulla. Is there a feline inflammatory polyp inside the external ear canal and the middle ear housed in the tympanic bulla?
Anaesthesia showed no ulcers or decayed teeth but some tartar in the upper premolars. The cat was given antibiotics and for the last 5 days, no complaints so far.
I got a phone call from the black and white cat owner. "You asked me to phone after 4 days of medication. My cat can pee at one go now, most of the time" the woman said. "It is much less stressful for me. He has his own water bowl and is kept away from the other cat. 4 days ago, I had wanted to put him to sleep as he had great difficulty peeing!"
This cat was catheterised by another vet around 2 months ago for dysuria and prescribed Royal Canine Urinary S/O. The cat did not take the S/O at all. Recurrence came 3 weeks ago. I gave antibioitcs and painkillers as there was no genital inflammation, bladder or kidney pain and advised separate water bowl and to live separately from the other cat. No X-ray for urinary stones would be done unless there was another recurrence. Also to feed canned C/D slowly.
The cat did not eat the C/D and the dysuria presented stressing the mum who wanted to euthanase he cat. 4 days of ACP at 2.5 mg twice a day and meloxicam at 0.05mg/kg oral.
CONCLUSION The cat was able to pee at one go at the litter box now. The meloxicam will be stopped as long-term use may cause kidney damage. The ACP will be given once a day. The mother would feed the canned C/D more and put dry C/D freely. No other dry cat food brand. Water bowl exclusively for this cat, not sharing with the other cat.
To phone me if there is dysuria. There is a need to X-ray the abdomen for urinary stones.
"My friend's Japanese Spitz has a tail wound," the man with the two ear rings said. "He bites my friend and so I dare not muzzle him."
This Spitz is 10 kg and well groomed. My assistant and I tried to muzzle him but he would turn his head away. He did not growl or show any warning signs of going to bite. For safety of the handlers and staff, I gave him an IM injection of Domitor and Ketamine at 0.2 ml and 0.25 ml. It was effective.
My assistant clipped the right side of the tail which looked bruised from self-inflicted bite wounds. "This is usually due to anal sac disease," I said. "The anal sacs get blocked with lots of anal sac oil and this is itchy to the dog. The dog bites the tail area, runs round in circles, chase the tail or scooter the backside on the floor."
"I don't see any of this," the man with the ear rings said. "How often you spend time with the Spitz?" I asked as he was working. "I will ask my friend."
My assistant expressed the anal sacs and several thick plugs of brown oil shot past him onto the wall. So, there was anal sac impaction.
A 3-year-old male neutered cat disappeared for 4 days. He came home not eating and weak.
Cloudy abdominal fluid could be blood. The cat was severely dehydrated but is now eating 2 days after the IV drips. The first vet examined him to be severely dehydrated and the bladder was tense on palpation. His blood test showed high serum urea. The cat had fever of 40C. The cat was warded 3 days and given antibiotic injection but the vet was not able to ascertain the cause of the high fever.
The owner took the cat to Toa Payoh Vets. I asked permission for an abdominal X-ray. Surprisingly, it showed radio-dense peritoneum ("X "on X-ray images). A haemo-peritoneum where there are blood clots blanketing the intestines such that they could not be visible as in normal cases. This bleeding could be due to the cat falling down from a high rise or thrown or kicked in the stomach area?
Sometimes an X-ray is deemed not necessary since the cat is not lame. After 2 days of IV drip, the cat eats the canned food provided by the owner. He is still defensive but not wildly ferocious.
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.
