INTERN. 2894. The rabbit had a big bleeding knee swelling

HOOK
A big bleeding left knee swelling after boarding in Pasir Ris. Bleeding for over a month. Blood stains on the apartment floor needed frequent cleaning..

WARNING

This BKTP video contains surgery. Viewer's discretion is advised.





Sunday Dec 27, 2015. Toa Payoh Vets
Rabbit, male, not neutered, 7 years
Left Knee Swelling
The lady suggested surrending him to the SPCA if surgery is too costly

 

"The lump fell off and disappeared at one time," the lady showed me her smartphone videos of the actual lump as she did not take images when the rabbit's lump had dropped off.


"Was the rabbit boarded alone or with other rabbits?" I asked. "Another rabbit could have bitten him if he shared kennel space."

"I was not permitted to see the kennel," she blamed the boarding operator for the appearance of the lump as the rabbit was normal before boarding. 

View of Pasir Ris kennels, Singapore

The operator got his vet to treat the swelling and paid around $100. The vet texted her the report.
saying that she could not confirm whether the swelling had cancerous cells from doing a FNA (Fine Needle Aspiration). Video footage (partial report).


The first vet did not do surgery and referred her to another vet in the practice. The boarding operator also referred her to a vet. But she had phoned Toa Payoh Vets. Dr Daniel patiently explained the probable causes and quoted her the cost of surgery. So she decided to come today but Dr Daniel had gone overseas.

"This swelling could be a lick granuloma," I told the two interns. "After many weeks of licking, the injured area developed into a hard lump. "It could also be an abscess or a tumour."

video footage close up


The rabbit was operated under isoflurane and oxygen mask anaesthesia. Electro-surgery and blunt dissection. (video). Two layers of stitching. A subcuticular and a skin horizontal mattress pattern. The rabbit wore an e-collar.
Images (text to be narrated slowly)

 


Edited Video footage of surgery with subtitles

I gave pain killers and antibiotics for the next 10 days.

The lady came back 3 hours later to bring the rabbit home.
(Video, post op)

"The lumps are multiple soft white fatty nodules under the skin of the knee," I showed the lady the cyst-like swellings measuring more or less 1 cm across (image).  "As you did not want the tumours to be sent to the laboratory for histopathology, I am unable to say whether they are cancerous or not. They may recur again." 

"So, you think that the boarding operator was not responsible for these?" the lady asked me.
"The left knee was not swollen when I boarded the rabbit for 6 days till November 26, 2015".

In my opinion, the fatty nodules would have developed and the boarding kennel operator was unfortunate not to have done a general physical examination for lumps before accepting the rabbit. The owner said that the rabbit had no swellings before boarding.


CONCLUSION

I am glad that the rabbit was able to survive the anaesthesia as he is considered old. Old patients have a much higher risk of dying under anaesthesia.

I am sure the 13-year-old daughter will be most happy to have her companion back. He will  not be given to the SPCA and will no more have a bleeding knee soiling the apartment. This rabbit is not allowed to roam freely for the next 2 weeks. Strictly cage confinement and an elizabeth collar to let the knee wound heal. 



TIPS AND ADVICES
Small tumours are easier to remove and the medical cost is much lower. Many pet owners shop around for a vet to get a quotation to fit your budget. Fees vary depending on the time taken to operate. In this case, the fee was around $300.   

2893. The terrapin has the largest ear abscess in Singapore

Dec 23, 2015

"I want to get rid of it," the mother told the two teenaged daughters who did not find her a terrapin vet to treat a terrapin with a gigantic ear abscess.

Surprisingly, this terrapin with scratched upper shell had an ear abscess as big as his head. The two girls quickly googled and the 3 ladies brought the terrapin came to Toa Payoh Vets.   They knew what was wrong from the internet - swollen ear abscess.

8 days as in-patient. The terrapin is very active, ate a lot and will be going home. It is a resilient type as many other terrapins with such a gigantic ear abscess will not be eating.

 

2892. A biting Hougang rabbit passes blood in the urine

Dec 23, 2015

Yesterday, I had a Caesarean section call before 9 am and then a rabbit passing blood in the urine appointment at 8 pm. Some days are long. 


The biting rabbit would snap at me and his family members when given a chance. I had to scruff him to feel his abdomen. A hard bladder lump around 8 cm across. I gave antibiotics and asked the owner to return the next day for X-rays.

The mother and young adult daughter showed me the image from their smart phone. "My rabbit had passed red blood in the urine this morning but clear urine at the 2nd time!" the daughter showed me the phone images.

Today, I palpated the abdomen. The rock-hard painful bladder was softer.

X rays confirmed bladder stones which could be dissolved by urine acidification.
I got a urine sample and will check for the crystals.

So, 2 years ago, the rabbit may have cystitis or bladder stones but the rabbit recovered fully after antibiotics. Till today, 2 years later. The presenting sign was fresh blood in the vaginal area. I thought there could be pyometra or uterine cancer as old female unspayed rabbits are prone to get. It is not possible to confirm pyometra but the main complaint was blood in the urine (haematuria). 

Pigs in Myanmar

Seldom seen except on rural roadsides. Usually one or two black pigs tethered. So, I was surprised to see pigs of all colours in this truck in the Ayeyawarddy region. I snapped a picture of this fast moving truck on the highway

2890. How long does it take to do a Dachshund 3-puppy Caesarean section? 32 minutes

Dec 22, 2015



Experienced professional dog breeder
Dachshund, 3 years, 6.1 kg, 39C, 62nd day pregnant. Pup born natually at 6.30 am. Dead.
Phoned me for C-section at around 9 am. Had given oxytocin 0.5 ml without success.

"How long does it take to do a Caesarean section in a dog?" one lady who came in to buy painkiller for her old X-bred having difficulty standing up, asked me.

"It depends on the number of puppies and experience of the vet."
For me, I had done over a hundred C-sections around 2005-2006 when most dog breeders used my services. The following is my timing for C-section of the above-mentioned Dachshund.


TP 42637
Dr Daniel on leave today Tuesday Dec 22, 2015.

Breeder phoned at 8.45 am and came at 9.15 am. Pup 1 was born naturally and discovered dead at 6.30 am today.


C-section
Isoflurane gas mask at 5%.  Intubate 7.0 tube.
Incise skin around 6 cm from umbilicus and incise 6 cm long.
Finger locate bifurcation of the uterus
Incise 1 cm from bifurcation for around 6 cm (width of head of Dachshund pup)
Took out 3 pups. Break water bag. 2 clamps on umbilicus. Incise in between clamps. Give pup to breeder to clean up. 3/0 absorbable stitch up uterus in 2 layers, parallel and across incision. Linea alba closed with interrupted and cross stitches 2/0 absorbable. Skin closed with 3 horizontal mattress 2/0. 

Pup 2 - placenta detached. Did not move. Drowned in amniotic fluid. Lungs filled with mucus. Did not cry.
Pup 3 and Pup 4 vigorous. Breeder said he saw the Pup 2 coming in and disappearing inside the vagina at after 7 am and said that the dam had no strength to push. He gave 0.5 ml oxytocin but the dam could not contract. So, he decided on C-section. 

At 6.55 pm, he visited me to settle the bill. He said that the dam ate and that was a good sign. Milk flowed to the 2 puppies who suckled vigorously. This was her first litter.

KPI
I kept a written record to research  how long I took to do this C-section.

A: Injection of Induction Drugs.  NO.
B: Isoflurane gas first given:  9.32 am
C: Isoflurane gas stopped: 10.17 am
D: First skin incision:  9.46 am
E:  Skin stitching completed: 10.18 am

E-D = 32 minutes
C-B =  45 minutes 
-------------------------------------------

Details
Isoflurane gas started: 9.32 am

Incise bifurcation of uterus:  9.47 am

Started stitching uterus: 9.53 am 

Uterus stitched and pushed back into abdomen after pulling out to examine for any pups:  10.07 am
(all 3 pups taken out and given to the breeder)

Speed, Accuracy and Completeness are important factors in surgery.
A c-section taking too long may lead to death of the dam so speed is most important as the anaesthetic risks are hovering around. The shorter the anaesthesia, the safer it is for the patient, as in this case. I think 32 minutes will be the shortest time possible for a vet with experiences in C-section. I had done over 100 c-sections in the years when most Pasir Ris breeders used my $300 c-section services almost exclusively. Now, younger vets who charge cheaper or give value have taken over.  

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

 Breeder said that this Dachshund has a small vaginal opening and therefore will be unable to give birth naturally. She had given birth to a dead pup seen at 6.30 am as the breeder had over-slept.


Breeder has experience with many vets
1. No-gloved vets - no infection.  So he said, it depends on the vet's body aura.
2. Vet who put Bactrim tablet inside uterus after C-section.  Dam became sterile.
3. Vet who always cause post-op infection attributed to his body aura.
4.  Foreign vet who was employed by a practice took out the ovaries of the dam, saying that the dam had uterine tumour. He found that his dams later did not come on heat. Complained to the owner of the practice that employed him. Vet was sacked.
5.  A vet who operated so fast that he had little time to revive the pups. His favourite vet.   

See caesarean section of 61 minutes to take out 7 Corgi pups at:

INTERN CLARA. Video: Aural haematoma in a Ragamuffin cat

 

 

This veterinary educational video shows surgical procedures. Viewer discretion is advised.
(narrate according to the image).


Pause
Then show the hook video of the cat pawing his side and ear being swollen. Narrate the action seen in the video. At least 10 seconds of footage.


HOOK

The cat has a very painful swollen ear (video). 
Video footage of the cat's hind legs keep moving when the vet fingers the ear.

What is the problem with this cat?





BKTP IMAGE

INTRODUCTION

On Dec 17, 2015, a young Ragamuffin cat came to Toa Payoh Vets. He lived in an apartment (2 images as shown below) in Singapore. He kept scratching his right ear. The ear bleeds and blood collects inside the ear flap. The right ear becomes much swollen (image) unlike the left ear (image). The cat lost appetite and meows frequently.


The owner's wife was much distressed. So the husband drove the cat to Toa Payoh Vets for treatment.

 

AT TOA PAYOH VETS, Dr Sing examined the cat.
The outer ear canal of both ears is packed with dirt. However, the one in the right ear became itchy and inflamed. This condition is called otitis externa (outer ear infection).

The cat keeps scratching the ear flap to relieve his itch. His claws hits the ear flap repeatedly. The blood vessels inside rupture and bleed. A large painful swelling in the ear flap appeared. The cat will not eat and feels miserable.





MIDDLE

What is the solution?

1. Large bore needle to drain out the blood.  (text/illus).  There will be recurrence and the owner will have to spend more money and time to do surgery.

2. Surgery. Incise, drain and stitch.


An ear surgery is presented. The procedure is as follows:

STEPS (narration) + subtitle for the video

The following is the footage of the surgery done by Dr Daniel of Toa Payoh Vets
1. Anaesthesia using xylazine and ketamine injection IM. The owner gives consent as regards the  anaesthetic and surgical risk

MOV 385.  The ear irrigation process of the normal other ear is shown in this video. The procedure is similar to the affected ear.


 

subtitle  0:19 - 1:52  Ear solution into the outer ear, massage, cotton swabs to clear dirt. Clear ear mites if any.

2:01 TO 2:25    Sedation is needed to clean ear thoroughly and to prevent the cat stressed out


MOV 354 + 357. Prepare for surgery. Cleaning and disinfection of the ear  flap and the ear canal


MOV 358  Haematoma due to ear scratching. Trauma ruptures blood vessels inside the ear flap. This swelling of the ear is called aural haematoma.


MOV 359.
Scalpel incises skin of concave side of the ear flap. The blood is drained. Blood clots are removed.





MOV 360. A narrow strip of skin on the concave side to cut to enlarge the incision wound. This enables drainage and prevents early closure of the wound and recurrence of the haematoma.

MOV 362.
0:34 to end.
After lancing and drainage, the stitching if from skin of the concave side into cartilage and out of the convex side of the ear. The stitches are parallel to the incision. Transverse stitches will ligate the ear blood vessels which run parallel to the incision and cause ear tissue cell death.






MOV 374. 
0- 0:38
Completion of surgery.
MOV 386. 
0:32 - 1:39.  Subtitle.    Interrupted sutures from skin of concave side into cartilage to skin of the convex side.  Elizabeth collar to prevent scratching. Injection of antibiotics and anti-inflammatory.

CONCLUSION

Dogs have aural haematomas. Similar surgical method as in this cat.
Skin incision can be S-shaped  (image) or straight (image) but outcome is the same.





Stitches can be through the skin of both sides of the ear. They can be into concave side and the cartilage only without coming out the other convex side skin.




WHAT HAPPENS IF YOU DO NOT SEEK VETERINARY TREATMENT
Your pet tolerates the pain, keeps scratching ear and lose appetite.
The ear becomes deformed as its blood supply is interrupted. Scarring and contraction of the skin and cartilage leads to the  formation of a cauliflower ear. VIDEO OF A CASE 17-year-old Silkie Terrier.

 

Many Singaporean pet owners work long hours.





Some do not know how to handle the un-cooperative cat and clean the cat's ears.  The cat runs away when the owner attempts to clean the ears. In such cases, get the groomer or vet to clean the ears before infection sets in.


Regular ear cleaning with ear drops or ointments will prevent ear haematoma. It saves you money and time. (elaborate) + pet suffers if the ears get infected for a long time (footage of cat scratching)
The pet will shake its head continuously, paw its ear flaps, cry in pain. The pet's body might smell because of the infection


Credits






Narrate as you show the images



(For more information:
contact judy@toapayohvets.com  +65 9668 6468.  www.toapayohvets.com)  Narrate from image below.