I visited a vet whom I saw growing up as a little boy some 35 years ago. "His head was up to the level of the operating table," I said to the mother. His mother said: "His daughter's head is now up to that level!" How ancient I must be.
The vet uses xylazine IM, wait and then Zoletil IV (rubber band) in elbow cut off before injecting the Zoletil. This means two syringes and needles are needed and two injection sites. And a longer waiting time prior to surgery.
The vets find this method very safe and efficacious and so have no interest in my recommendation of xylazine + ketamine IM in one syringe. I find this much more efficient. Why change when nothing is broken?
I said: "I used to use xylazine IM and then give the cat isoflurane gas by mask previously." It was an excellent method but now I use xylazine + ketamine IM which is excellent and time-saving. Top up with isoflurane if my dosage is lower or there is some delay.
"Using isoflurane gas by mask onto the cat will also anaesthesize the vet," the mother laughed.
"Yes, yes," I said. "I fall asleep during surgery!" This is meant to be a joke. Sometimes vets must have a sense of humour too.
The two vets were not interested in my advice to save some money and be more productive. But their method of anaesthesia had worked well for so many stray cats and therefore, why take the risk? I can understand that.
It was great for me to meet them and exchange ideas on veterinary treatment of cases.
Wednesday, July 13, 2011
499. Neutering an adult Syrian hamster - information
E-MAIL TO DR SING DATED JULY 11, 2011
Hi Judy,
I saw a story about yr clinic on the web about hamster neutering.
How much do you charge for such an operation?
Pls kindly let me know. Thanks,
E-MAIL FROM DR SING DATED JULY 11, 2011
Around $75 for male hamsters neuter and anaesthesia. Add $30 for post-op antibiotics and medication
E-MAIL TO DR SING DATED JULY 11, 2011
Oh, ok. Mine is an adult Syrian male hamster of about 7-8 months.
I am hoping to sterilise it so it can keep the female company. Does that work?
E-MAIL FROM DR SING DATED JULY 13, 2011
Adult Syrian Male Hamster can be neutered. Pl note that there may or may not be surgical complications post-op in neutering adult hamsters as the surgical wound will be much longer than a 3-month-old dwarf hamster.
In the dwarf hamster, the wound is around 4 mm long. In your Syrian hamster, it will be around 8mm - 12 mm long depending on the size of the testicle. It is possible that the Syrian hamster may bite off the stitches and cause infections and distress to you as it is not possible for hamsters to wear e-collars around his neck unlike dogs and cats.
Anaesthetic risks for your young Syrian hamsters are low in my opinion. After neutering, your hamster needs 2 weeks to recover from the wound.
Then you will need to slowly re-introduce the hamster to the female by housing them separated by a grate for a 2-8 weeks so that they can see and smell each other but not bite. You need to be monitoring the reactions for the first 2-4 weeks. Give a bigger cage than the usual one.
The neuter cost of anaesthesia, surgery and antibiotics for an adult Syrian hamster is around $150.
Best wishes.
Hi Judy,
I saw a story about yr clinic on the web about hamster neutering.
How much do you charge for such an operation?
Pls kindly let me know. Thanks,
E-MAIL FROM DR SING DATED JULY 11, 2011
Around $75 for male hamsters neuter and anaesthesia. Add $30 for post-op antibiotics and medication
E-MAIL TO DR SING DATED JULY 11, 2011
Oh, ok. Mine is an adult Syrian male hamster of about 7-8 months.
I am hoping to sterilise it so it can keep the female company. Does that work?
E-MAIL FROM DR SING DATED JULY 13, 2011
Adult Syrian Male Hamster can be neutered. Pl note that there may or may not be surgical complications post-op in neutering adult hamsters as the surgical wound will be much longer than a 3-month-old dwarf hamster.
In the dwarf hamster, the wound is around 4 mm long. In your Syrian hamster, it will be around 8mm - 12 mm long depending on the size of the testicle. It is possible that the Syrian hamster may bite off the stitches and cause infections and distress to you as it is not possible for hamsters to wear e-collars around his neck unlike dogs and cats.
Anaesthetic risks for your young Syrian hamsters are low in my opinion. After neutering, your hamster needs 2 weeks to recover from the wound.
Then you will need to slowly re-introduce the hamster to the female by housing them separated by a grate for a 2-8 weeks so that they can see and smell each other but not bite. You need to be monitoring the reactions for the first 2-4 weeks. Give a bigger cage than the usual one.
The neuter cost of anaesthesia, surgery and antibiotics for an adult Syrian hamster is around $150.
Best wishes.
498. Neutering a Yorkshire Terrier at Toa Payoh Vets
E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 6:39 PM,...@bigfishes.com> wrote:
Dear Judy,
I have a one year old Yorkie that we want to neuter.
Please advise how much will the procedure be and when is the earliest time that we can bring him down.
You can reach me at ... if you need any further info.
Thank you.
Best regards,
Name of owner
E-MAIL REPLY BY DR SING
Hi
Thank you for your email I am Dr Sing from toapayohvets.com
The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.
If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.
Best wishes.
On Tue, Jul 12, 2011 at 6:39 PM,...@bigfishes.com> wrote:
Dear Judy,
I have a one year old Yorkie that we want to neuter.
Please advise how much will the procedure be and when is the earliest time that we can bring him down.
You can reach me at ... if you need any further info.
Thank you.
Best regards,
Name of owner
E-MAIL REPLY BY DR SING
Hi
Thank you for your email I am Dr Sing from toapayohvets.com
The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.
If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.
Best wishes.
497. The oldest candidate for the first Real Estate Agent Exam in May 2011
At the age of 60 years, I am most likely the oldest candidate for the first Real Estate Agent Exam conducted in May 2011. I can see the youthfulness of my 40 classmates who are on the average, estimated to be half my age and radiate the full bloom of roses. Not that I am withered and limping.
Of the 40 classmates, I estimated that around 20 or less took the brutal 3-evening examinations relating to the law, real estate matters and investments. The condition is that all 3 papers must be passed at one sitting. I considered the examinations brutal because of the 8 questions, I had to choose 5. I found that if I had to take all 8 questions, I would fail as many topics were not in the lectures or that the examiner had set some out of the syllabus questions. For example:
1. Write short notes on "market volatility".
2. What is the impact and implications if the income ceiling for eligible HDB flat buyers is raised from $8,000 to $10,000. Or increase government land sales. I attempted this question because I had read the newspaper reports and all the opposition's views on affordable public housing.
3. HDB QUESTION. Calculation of down payment and monthly less CPF contributions for an HDB flat including CPF contributions for a couple purchasing a 4-room flat. This was a killer as I had not practised any calculations nor done more than a handful of HDB sales transactions! But I did read about Minister Mah Bow Tan's illustration of a similar example in the Straits Times during the political hustlings as elections were held around April/May 2011. Unfortunately, I could remember probably 50% of his calculations.
4. What is the main grievance when the Land Acquisition Act was introduced. And what were the "three persons" involved in the Act. Apparently this info was in the CD given by my lecturer and though I had the CD printed to a 1,000-page book, I did not read and remember all the notes. I was forced to answer this question as the others were worse.
I had read 20 years ago that the main grievance was that the land was acquired below market price and so I wrote this. As for the "3 persons", I presumed it was not real people. My classmate wrote the Landlord, Tenant and Owner. I wrote "Singapore Land Authority, National Heritage Board and HDB". Up to now, I still don't know the correct answer.
5. Diversification of investments is bad. Comment. Fortunately, I have read a lot of financial matters as the Straits Times seem to publish endless articles.
6. Leverage, Hedge Against Inflation, Asset Classes, Types. I could write much more than the student who dislike reading the financial news.
7. Positioning of shop front in a shopping mall and the demand of rentals. I had not got any lecture on this. But I had to answer this question since the others would give me a failing grade. Nothing much to write about except human traffic, tenant mix, anchor tenant nearby and demand by competitors. Or maybe I did not know what to write.
8. My favourite question. Two daughters inherited a bungalow from their father and decided to rebuild to a "3-storey dwelling" which was built. One daughter migrated to Australia and gave up her Singapore citizenship. The other passed away in a car accident and her husband said that he inherits everything from her. The foreigner daughter disputed. What is the situation? The answers involved tenancy in common, joint tenancy, intestate, foreign ownership of Singapore Property and the relevant act and maybe more. In real life, the case is referred to a lawyer, my classmate told me!
Yesterday, July 12, 2011, I went to collect my "Real Estate Agent Examination" certificate issued by the CEA (Council for Estate Agencies).
I remember 6 of my younger classmates celebrate the ending of the 3rd examination at a McDonald's in Jurong, nearby past midnight.
I wrote to them as follows:
I am David Sing Kong Yuen, probably the oldest examination candidate in the first REA Exam May 2011. I have passed the exam.
I fondly remembered 7 of us celebrated the final day of exam at McDonald's in Jurong with a treat given by Mr Steven Koh.
I met our Korean classmate Mr Kang while collecting my REA Exam certificate yesterday. I was informed by Mr Kang that there would be a lunch organised by Mr Steven Koh of Hans and Boon 91509317 somewhere in Novena. Pl phone him for the place. I did not receive Steven Koh's sms for this lunch as I was changing phone cards and phone at that critical time. It will be safer to e-mail too but I do get a few hundred spam mails a day (not a few) and your e-mail may have gone to SPAM.
I hope all of you have had passed the exam. Please let me know the good news. My phone is 9668-6468 and I should be able to receive your sms.
There were 41 persons who passed. I estimated that at least 100 sat for the exam (in Paper 2). In Paper 1 and Paper 3, I estimated around 25 candidates were present. Not all were from our class as there were two REA courses being conducted. One of the courses was conducted by Spencer Ng of REMAX connections. I think the other course was conducted by the IEA. Those who failed CEHA courses could re-take the single paper they had failed. However, for the REA course, all 3 subjects must be passed at one sitting. If not, must take the 3 tests again.
Probably around 10 of our classmates of around 40 have had passed the exam. I am anxious to know all of six of you have had passed the exam. Our Korean classmate who was a Professor in undergraduate financial courses (MAS students etc) was scanning for the 41 names for the name of Margaret Liew and could not find her name of "Margaret".
Therefore, Margaret, please let me know if you have passed the exam. I hope to see all of you at the lunch on Wed. somewhere in Novena. Contact Mr Steven Koh for details. I know that Spencer Ng has been invited.
Best wishes to all of you in your KEO career.
Of the 40 classmates, I estimated that around 20 or less took the brutal 3-evening examinations relating to the law, real estate matters and investments. The condition is that all 3 papers must be passed at one sitting. I considered the examinations brutal because of the 8 questions, I had to choose 5. I found that if I had to take all 8 questions, I would fail as many topics were not in the lectures or that the examiner had set some out of the syllabus questions. For example:
1. Write short notes on "market volatility".
2. What is the impact and implications if the income ceiling for eligible HDB flat buyers is raised from $8,000 to $10,000. Or increase government land sales. I attempted this question because I had read the newspaper reports and all the opposition's views on affordable public housing.
3. HDB QUESTION. Calculation of down payment and monthly less CPF contributions for an HDB flat including CPF contributions for a couple purchasing a 4-room flat. This was a killer as I had not practised any calculations nor done more than a handful of HDB sales transactions! But I did read about Minister Mah Bow Tan's illustration of a similar example in the Straits Times during the political hustlings as elections were held around April/May 2011. Unfortunately, I could remember probably 50% of his calculations.
4. What is the main grievance when the Land Acquisition Act was introduced. And what were the "three persons" involved in the Act. Apparently this info was in the CD given by my lecturer and though I had the CD printed to a 1,000-page book, I did not read and remember all the notes. I was forced to answer this question as the others were worse.
I had read 20 years ago that the main grievance was that the land was acquired below market price and so I wrote this. As for the "3 persons", I presumed it was not real people. My classmate wrote the Landlord, Tenant and Owner. I wrote "Singapore Land Authority, National Heritage Board and HDB". Up to now, I still don't know the correct answer.
5. Diversification of investments is bad. Comment. Fortunately, I have read a lot of financial matters as the Straits Times seem to publish endless articles.
6. Leverage, Hedge Against Inflation, Asset Classes, Types. I could write much more than the student who dislike reading the financial news.
7. Positioning of shop front in a shopping mall and the demand of rentals. I had not got any lecture on this. But I had to answer this question since the others would give me a failing grade. Nothing much to write about except human traffic, tenant mix, anchor tenant nearby and demand by competitors. Or maybe I did not know what to write.
8. My favourite question. Two daughters inherited a bungalow from their father and decided to rebuild to a "3-storey dwelling" which was built. One daughter migrated to Australia and gave up her Singapore citizenship. The other passed away in a car accident and her husband said that he inherits everything from her. The foreigner daughter disputed. What is the situation? The answers involved tenancy in common, joint tenancy, intestate, foreign ownership of Singapore Property and the relevant act and maybe more. In real life, the case is referred to a lawyer, my classmate told me!
Yesterday, July 12, 2011, I went to collect my "Real Estate Agent Examination" certificate issued by the CEA (Council for Estate Agencies).
I remember 6 of my younger classmates celebrate the ending of the 3rd examination at a McDonald's in Jurong, nearby past midnight.
I wrote to them as follows:
I am David Sing Kong Yuen, probably the oldest examination candidate in the first REA Exam May 2011. I have passed the exam.
I fondly remembered 7 of us celebrated the final day of exam at McDonald's in Jurong with a treat given by Mr Steven Koh.
I met our Korean classmate Mr Kang while collecting my REA Exam certificate yesterday. I was informed by Mr Kang that there would be a lunch organised by Mr Steven Koh of Hans and Boon 91509317 somewhere in Novena. Pl phone him for the place. I did not receive Steven Koh's sms for this lunch as I was changing phone cards and phone at that critical time. It will be safer to e-mail too but I do get a few hundred spam mails a day (not a few) and your e-mail may have gone to SPAM.
I hope all of you have had passed the exam. Please let me know the good news. My phone is 9668-6468 and I should be able to receive your sms.
There were 41 persons who passed. I estimated that at least 100 sat for the exam (in Paper 2). In Paper 1 and Paper 3, I estimated around 25 candidates were present. Not all were from our class as there were two REA courses being conducted. One of the courses was conducted by Spencer Ng of REMAX connections. I think the other course was conducted by the IEA. Those who failed CEHA courses could re-take the single paper they had failed. However, for the REA course, all 3 subjects must be passed at one sitting. If not, must take the 3 tests again.
Probably around 10 of our classmates of around 40 have had passed the exam. I am anxious to know all of six of you have had passed the exam. Our Korean classmate who was a Professor in undergraduate financial courses (MAS students etc) was scanning for the 41 names for the name of Margaret Liew and could not find her name of "Margaret".
Therefore, Margaret, please let me know if you have passed the exam. I hope to see all of you at the lunch on Wed. somewhere in Novena. Contact Mr Steven Koh for details. I know that Spencer Ng has been invited.
Best wishes to all of you in your KEO career.
496. Export of dog to Bahrain
E-MAIL TO DR SING DATED JULY 12, 2011
On Mon, Jul 11, 2011 at 10:15 PM, ...@singnet.com.sg> wrote:
Hi Judy,
Good day to you.
I am in the process of relocating my pet dog from Singapore to Bahrain therefore would like to send my dog for the vaccinations that is required by the authorities in Bahrain and at the same time, have other procedures done as well.
According to regulations in Bahrain, our dog needs to have 2 sets of Rabies + DHLP (Distemper, Hepatitis, Parvovirosis, Leptospirosis) jabs before we can apply for documentation. In addition, we like to have him neutered and dental cleaning done. Can you kindly advise how much these will cost and what will be the best sequence for these to be done (e.g., Neutering and dental cleaning / 1 week later, 1st set of jabs / 3 weeks later, 2 set of jabs)?
Below are the details of my dog for reference.
Name: ............
Breed: Red Toy Poodle
Age: 3 years of age as of 2 October
Birthdate: 2 October 2008
Gender: Male
Medical: He gets yearly booster shots and his last visit to the vet was in May 2011. Health status is good
Weight: 5.2kg
Microchip: Yes
I am currently in Bahrain therefore it will be great if you can reply me soon so that I can make arrangements for my dog on the above.
Thank you.
Regards,
Name of Owner
E-MAIL REPLY FROM DR SING
On Tue, Jul 12, 2011 at 2:17 PM, Kong Yuen Sing <99pups@gmail.com> wrote:
Approximate costs as follows:
Rabies vaccination $65/vaccination
DHLP $40/vaccination at same time as rabies
2 weeks apart for 2nd set of jab
Estimated total = $210 for 4 vaccinations
Neuter and dental can be done at same time. Male dog of small size e.g. chihuahua - Maltese will be around $150 for neuter and $200-$250 depending on decay teeth condition for dental.
Vet exam certificate of health around $60 if needed.
Pl phone 9668 6468 for appointment
E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 4:08 PM, ..@singnet.com.sg> wrote:
Hi Dr Sing,
Thank you for your reply.
I will make necessary arrangements and have my family member bring my toy poodle to you.
Regards,
On Mon, Jul 11, 2011 at 10:15 PM, ...@singnet.com.sg> wrote:
Hi Judy,
Good day to you.
I am in the process of relocating my pet dog from Singapore to Bahrain therefore would like to send my dog for the vaccinations that is required by the authorities in Bahrain and at the same time, have other procedures done as well.
According to regulations in Bahrain, our dog needs to have 2 sets of Rabies + DHLP (Distemper, Hepatitis, Parvovirosis, Leptospirosis) jabs before we can apply for documentation. In addition, we like to have him neutered and dental cleaning done. Can you kindly advise how much these will cost and what will be the best sequence for these to be done (e.g., Neutering and dental cleaning / 1 week later, 1st set of jabs / 3 weeks later, 2 set of jabs)?
Below are the details of my dog for reference.
Name: ............
Breed: Red Toy Poodle
Age: 3 years of age as of 2 October
Birthdate: 2 October 2008
Gender: Male
Medical: He gets yearly booster shots and his last visit to the vet was in May 2011. Health status is good
Weight: 5.2kg
Microchip: Yes
I am currently in Bahrain therefore it will be great if you can reply me soon so that I can make arrangements for my dog on the above.
Thank you.
Regards,
Name of Owner
E-MAIL REPLY FROM DR SING
On Tue, Jul 12, 2011 at 2:17 PM, Kong Yuen Sing <99pups@gmail.com> wrote:
Approximate costs as follows:
Rabies vaccination $65/vaccination
DHLP $40/vaccination at same time as rabies
2 weeks apart for 2nd set of jab
Estimated total = $210 for 4 vaccinations
Neuter and dental can be done at same time. Male dog of small size e.g. chihuahua - Maltese will be around $150 for neuter and $200-$250 depending on decay teeth condition for dental.
Vet exam certificate of health around $60 if needed.
Pl phone 9668 6468 for appointment
E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 4:08 PM, ..@singnet.com.sg> wrote:
Hi Dr Sing,
Thank you for your reply.
I will make necessary arrangements and have my family member bring my toy poodle to you.
Regards,
Monday, July 11, 2011
Yorkshire Terrier 2.5 kg neuter to stop urine-marking
Sunday July 11, 2011
A young couple came on this bright sunny Sunday morning at 9.30 am with a one-year-old male Yorkshire Terrier to neuter. I was getting ready to neuter a 3-month-old dwarf hamster that Dr Jason Teo had passed to me to do.
"Why do you want to neuter him?" I asked the young couple. A Yorkshire Terrier puppy sells for $2,500 and it seems that it is a pity to neuter him. But most Singaporean pet owners don't breed.
The couple said: "He does urine-mark and we research the internet. It says that urine-marking can be stopped if the dog is neutered."
"Yes," I said. "In most cases, urine-marking will stop if the male dog is neutered at a young age."
"Has he eaten his breakfast?" I asked.
"Not really. He nibbled a bit of his dog food." No food and water ought to be given to the dog 12 hours before anaesthesia but in this case, the dog could or could not have eaten much. In such cases, I have to use my judgment as the couple may not be free during weekdays to bring the dog down for neuter. So, I decided to operate myself.
ANAESTHESIA & SURGERY
"Do you want IV?" my assistant Mr Min asked me as most of the time, my associate vets and I give IV.
"No," I said. "IM will do."
I gave the Yorkshire 0.1 ml xylazine IM. No vomiting seen. After 15 minutes, I gave him isoflurane gas by mask and then intubate. 2% isoflurane gas provided a perfect surgical anaesthesia in this case. I ligated twice/spermatic cord with 2/0 absorbable sutures. No problem of bleeding.
I complimented my assistant for good work. He is getting more proficient as he keeps working as he has not much experience in veterinary anaesthesia in his past work places. A good veterinary assistant during anaesthesia is worth his weight in gold as the vet can just focus on the surgery which is already a big responsibility.
The bleeding was more from the skin after I gave one horizontal mattress suture to close it.
"No need subcuticular sutures?" Mr Min asked me. My associate vets do subcuticular. "The less sutures the better for the dog," I gave this tip to Mr Min who is qualified as a Myanmar Vet but is working here as a Veterinary Technician. "From my 40 years of experience, I find that just one horizontal mattress suture and no subcuticular sutures method is the best. Less sutures means less irritation for the neutered dog and less licking."
Tolfedine 6mg at one tablet twice a day should be sufficient for this Yorkshire. Trimethoprim syrup post op. In all dog neuters, one packet of absorbable sutures will do. There is the fanciful wish to impress the owner with "hidden sutures" under the skin. In this case, another packet of finer sutures need to be used. What is best for the dog is the least number of sutures and least cost to the owner and the veterinary surgery. Not fanciful suturing patterns to impress the owner at the expense of the veterinary practice as some employee vets are prone to do so.
I gave an e-collar just in case he bites the surgical area. Also a plaster to cover and protect it. I expect no post-surgical complications of bleeding or infection. The young couple looked happy as the Yorkshire was as normal as can be when they came 3 hours later to pick him up to go home. As if he has a short nap.
That is the advantage of a very light sedation and isoflurane gas. Most owners just want to see their pet greet them as alive as can be when they come to pick him up. Not drugged, groggy and ataxic dogs sleepy for several hours after surgery due to intravenous anaesthesia.
A young couple came on this bright sunny Sunday morning at 9.30 am with a one-year-old male Yorkshire Terrier to neuter. I was getting ready to neuter a 3-month-old dwarf hamster that Dr Jason Teo had passed to me to do.
"Why do you want to neuter him?" I asked the young couple. A Yorkshire Terrier puppy sells for $2,500 and it seems that it is a pity to neuter him. But most Singaporean pet owners don't breed.
The couple said: "He does urine-mark and we research the internet. It says that urine-marking can be stopped if the dog is neutered."
"Yes," I said. "In most cases, urine-marking will stop if the male dog is neutered at a young age."
"Has he eaten his breakfast?" I asked.
"Not really. He nibbled a bit of his dog food." No food and water ought to be given to the dog 12 hours before anaesthesia but in this case, the dog could or could not have eaten much. In such cases, I have to use my judgment as the couple may not be free during weekdays to bring the dog down for neuter. So, I decided to operate myself.
ANAESTHESIA & SURGERY
"Do you want IV?" my assistant Mr Min asked me as most of the time, my associate vets and I give IV.
"No," I said. "IM will do."
I gave the Yorkshire 0.1 ml xylazine IM. No vomiting seen. After 15 minutes, I gave him isoflurane gas by mask and then intubate. 2% isoflurane gas provided a perfect surgical anaesthesia in this case. I ligated twice/spermatic cord with 2/0 absorbable sutures. No problem of bleeding.
I complimented my assistant for good work. He is getting more proficient as he keeps working as he has not much experience in veterinary anaesthesia in his past work places. A good veterinary assistant during anaesthesia is worth his weight in gold as the vet can just focus on the surgery which is already a big responsibility.
The bleeding was more from the skin after I gave one horizontal mattress suture to close it.
"No need subcuticular sutures?" Mr Min asked me. My associate vets do subcuticular. "The less sutures the better for the dog," I gave this tip to Mr Min who is qualified as a Myanmar Vet but is working here as a Veterinary Technician. "From my 40 years of experience, I find that just one horizontal mattress suture and no subcuticular sutures method is the best. Less sutures means less irritation for the neutered dog and less licking."
Tolfedine 6mg at one tablet twice a day should be sufficient for this Yorkshire. Trimethoprim syrup post op. In all dog neuters, one packet of absorbable sutures will do. There is the fanciful wish to impress the owner with "hidden sutures" under the skin. In this case, another packet of finer sutures need to be used. What is best for the dog is the least number of sutures and least cost to the owner and the veterinary surgery. Not fanciful suturing patterns to impress the owner at the expense of the veterinary practice as some employee vets are prone to do so.
I gave an e-collar just in case he bites the surgical area. Also a plaster to cover and protect it. I expect no post-surgical complications of bleeding or infection. The young couple looked happy as the Yorkshire was as normal as can be when they came 3 hours later to pick him up to go home. As if he has a short nap.
That is the advantage of a very light sedation and isoflurane gas. Most owners just want to see their pet greet them as alive as can be when they come to pick him up. Not drugged, groggy and ataxic dogs sleepy for several hours after surgery due to intravenous anaesthesia.
494. Sunday's most interesting case. July 10, 2011. The "mother" of all perineal hernias
This Boston Terrier case was written: 25 June, 2010
Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
UPDATE AS AT JULY 11, 2011
No news from the owner since the surgery in Jun 2010. I presume all are OK as now news is good news.
ANOTHER MORE CHALLENGING CASE ONE YEAR LATER
I have not seen perineal hernias since I operated on the Boston Terrier one year ago. Surprisingly, on Sunday, July 10, 2011, my assistant Mr Min said that a couple insisted on seeing me. Normally, all cases go to Dr Vanessa Lin but I was around at the reception to get a pulse of the grass-roots from 9 am to 6 pm and to ensure that the waiting times are kept to the minimum. Only at the receptionist's counter can I know what is the situation of the waiting time like, rather than depend on the receptionist to enlighten me.
The couple said to me: "My vet said that no vets in Singapore would operate on my 10-year-old Silkie Terrier. He had said that the dog is old and to leave the swelling alone. But it kept growing bigger!"
He was not neutered and had a backside lump 3/4 the size of the biggest mango you can see in Singapore. The dog had difficulty in pooping and the older parents were concerned about his quality of life. The dog could eat, drink, poop and pee without difficulty and was active.
"There will be vets in Singapore that will operate on this dog," I said when the couple brought the dog in later for examination. "The main issue is that the operation will take a long time and the dog may just die on the operating table. No vets want to do a dog that dies on the operating table."
I had asked them to illustrate as they did not bring the dog down at first. A male dog, not neutered, big swelling from below the anus (in this case) instead of to the sides of the anus as in unilateral perineal hernias. The couple had actually diagnosed perineal hernias via the internet education and so they knew what was wrong with their dog. The problem was that their vet did not want to operate and put his reputation on the line when the dog dies on the operating table. What should I do?
This was the "mother" of all perineal hernias. Both left and right perineal hernias have "amalgamated" to form a large 3/4-Taiwanese mango-sized lump to the right, left and below the anus. Taiwanese mangoes are gigantic but are not sweet and they measure around 25 cm x 10 cm x 7 cm. So, you can imagine that the swelling was really gigantic.
The surgery will take over 1.5 hours and the old dog's heart may just stop beating. The dog needs to be operated as he has had been licking his skin thin. Continuous licking to relieve his pain and irritation as the intestines and omental fat prolapse through the pelvic muscular defect from both the left and right side. It was hard for him just to sit down too.
"Do your parents know that they may not see the dog alive once he gets operated?" I asked. The aged parents are the care-givers. The couple said: "My parents say it is better to take the risk rather than let the dog suffer with such a big dangling mass. The groomer had nicked the lump earlier and discovered this hernia. Otherwise, we would not know it exists!"
The dog was in good body condition. I checked his heart. His heart was surprisingly normal. He was alive and active now. As if he has not a worry in this world while his caregivers bear the burden and surgical risks on their shoulders. Should I pass the buck? And to whom? To my two associate vets? This is the type of challenging cases that I prefer not to take on and it will be most unkind to pass the buck to my two associate vets as there is the possibility of post-surgical complications like infections, bleeding and nerve damages in addition to death on the operating table. So, I did not refer the case to them. It is a moderately difficult surgery but it will take a long time to do. The longer the time of anaesthesia and surgery, the likely that the old dog's heart will just stop and the dog dies on the operating table!
If the surgery can be completed in 15 minutes, the old dog is very likely to survive the anaesthesia. Unfortunately, this surgery will take a long time as both hernias seem to be required to be operated on at the same time since the intestines and omental fat have leaked and spread to each other's sides! That is why I say that this case is the "mother" of all perineal hernias.
The pictures of the surgery to repair the perineal hernia in a Boston Terrier is at:
http://www.bekindtopets.com/animals/20100625constipation_perineal_hernia_old_Boston_Terrier_male_singapore_ToaPayohVets.htm
Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
UPDATE AS AT JULY 11, 2011
No news from the owner since the surgery in Jun 2010. I presume all are OK as now news is good news.
ANOTHER MORE CHALLENGING CASE ONE YEAR LATER
I have not seen perineal hernias since I operated on the Boston Terrier one year ago. Surprisingly, on Sunday, July 10, 2011, my assistant Mr Min said that a couple insisted on seeing me. Normally, all cases go to Dr Vanessa Lin but I was around at the reception to get a pulse of the grass-roots from 9 am to 6 pm and to ensure that the waiting times are kept to the minimum. Only at the receptionist's counter can I know what is the situation of the waiting time like, rather than depend on the receptionist to enlighten me.
The couple said to me: "My vet said that no vets in Singapore would operate on my 10-year-old Silkie Terrier. He had said that the dog is old and to leave the swelling alone. But it kept growing bigger!"
He was not neutered and had a backside lump 3/4 the size of the biggest mango you can see in Singapore. The dog had difficulty in pooping and the older parents were concerned about his quality of life. The dog could eat, drink, poop and pee without difficulty and was active.
"There will be vets in Singapore that will operate on this dog," I said when the couple brought the dog in later for examination. "The main issue is that the operation will take a long time and the dog may just die on the operating table. No vets want to do a dog that dies on the operating table."
I had asked them to illustrate as they did not bring the dog down at first. A male dog, not neutered, big swelling from below the anus (in this case) instead of to the sides of the anus as in unilateral perineal hernias. The couple had actually diagnosed perineal hernias via the internet education and so they knew what was wrong with their dog. The problem was that their vet did not want to operate and put his reputation on the line when the dog dies on the operating table. What should I do?
This was the "mother" of all perineal hernias. Both left and right perineal hernias have "amalgamated" to form a large 3/4-Taiwanese mango-sized lump to the right, left and below the anus. Taiwanese mangoes are gigantic but are not sweet and they measure around 25 cm x 10 cm x 7 cm. So, you can imagine that the swelling was really gigantic.
The surgery will take over 1.5 hours and the old dog's heart may just stop beating. The dog needs to be operated as he has had been licking his skin thin. Continuous licking to relieve his pain and irritation as the intestines and omental fat prolapse through the pelvic muscular defect from both the left and right side. It was hard for him just to sit down too.
"Do your parents know that they may not see the dog alive once he gets operated?" I asked. The aged parents are the care-givers. The couple said: "My parents say it is better to take the risk rather than let the dog suffer with such a big dangling mass. The groomer had nicked the lump earlier and discovered this hernia. Otherwise, we would not know it exists!"
The dog was in good body condition. I checked his heart. His heart was surprisingly normal. He was alive and active now. As if he has not a worry in this world while his caregivers bear the burden and surgical risks on their shoulders. Should I pass the buck? And to whom? To my two associate vets? This is the type of challenging cases that I prefer not to take on and it will be most unkind to pass the buck to my two associate vets as there is the possibility of post-surgical complications like infections, bleeding and nerve damages in addition to death on the operating table. So, I did not refer the case to them. It is a moderately difficult surgery but it will take a long time to do. The longer the time of anaesthesia and surgery, the likely that the old dog's heart will just stop and the dog dies on the operating table!
If the surgery can be completed in 15 minutes, the old dog is very likely to survive the anaesthesia. Unfortunately, this surgery will take a long time as both hernias seem to be required to be operated on at the same time since the intestines and omental fat have leaked and spread to each other's sides! That is why I say that this case is the "mother" of all perineal hernias.
The pictures of the surgery to repair the perineal hernia in a Boston Terrier is at:
http://www.bekindtopets.com/animals/20100625constipation_perineal_hernia_old_Boston_Terrier_male_singapore_ToaPayohVets.htm
Saturday, July 9, 2011
493. How to detect pyometra in your dog?
In some female dogs, there is no vaginal discharge of pus after the heat period. The owner notices that the female dog just licks her vulval discharge daily for more than a week but thinks it is normal. Actually, it is the start of the pyometra (womb bacterial infection). The dog may vomit a bit or become lethargic but nothing more. Some owners note a swelling in the abdomen.
The womb closes and so the bacterial pus accumulates inside, bloating up the uterine tubes till the dog becomes toxic and not eating.
Below are two cases of closed pyometra I had operated upon. Closed pyometra are life-threatening to the dogs. Delays in seeking veterinary treatment have resulted in deaths that can be prevented by spaying your female dog when she is younger.
Cavalier King Charles, 6 years. Closed Pyometra. Survived. Singapore. Toa Payoh Vets Cavalier King Charles, 6 years. Closed Pyometra. Survived. Singapore. Toa Payoh Vets
Closed Pyometra in a 6-year-old Cavalier King Charles. Woke up <2 minutes at the completion of surgery. Went home to a happy family. Miniature Schnauzer, 9 years. Vomiting, Bloated Stomach. Closed Pyometra. Toa Payoh Vets Miniature Schnauzer, 9 years. Vomiting, Bloated Stomach. Closed Pyometra. Toa Payoh Vets
Closed Pyometra in a 9-year-old Miniature Schnauzer. Took >120 minutes to wake up after the completion of surgery. Intensive I/V drips and monitoring. Lethargy. Sleepy. She was in the twilight zone as she resisted the pull of the dark forces of death. Went home at Day 2.
If you do not wish to spay your dog, be observant of the older female dog (over 3 years of age) for the next 8 weeks after her heat period. Is her bleeding fresh red and clean which is normal? Normal bleeding of fresh red blood lasts around 7-14 days and return in around 6-monthly interval. This is just a guideline. Cases to be aware of are female dogs cycling every 4 monthly or irregularly.
passing pus from the vagina for the past 5 months. very old dog. surgery. pyometra. toapayohvets, singaporeWATCH OUT FOR THE FOLLOWING:
* Has she any brownish yellowish sticky vaginal discharge during and especially after two weeks of bleeding? You will need to use a clean piece of tissue to wipe against the private parts and check yourself.
* Is she licking her vulva daily and frequently? Consult your vet promptly.
* Has she got false pregnancy (milk in her nipples and enlarged nipples though she has never been pregnant, strange behaviour - aggressive, withdrawn, vomiting, carrying a toy around to a safe area)?
* Has she got tumours in her breast area?
Do seek prompt treatment when pyometra occurs instead of waiting till it is highly risky to operate as in the June 2011 case I operated on and described in Pyometra in a 16-year-old Maltese X.
Website and more pictures are at:
http://www.sinpets.com/F5/201006266closed-pyometra-cavalier-king-charles-miniature-schnauzer-toapayohvets-Singapore-ToaPayohVets.htm
The womb closes and so the bacterial pus accumulates inside, bloating up the uterine tubes till the dog becomes toxic and not eating.
Below are two cases of closed pyometra I had operated upon. Closed pyometra are life-threatening to the dogs. Delays in seeking veterinary treatment have resulted in deaths that can be prevented by spaying your female dog when she is younger.
Cavalier King Charles, 6 years. Closed Pyometra. Survived. Singapore. Toa Payoh Vets Cavalier King Charles, 6 years. Closed Pyometra. Survived. Singapore. Toa Payoh Vets
Closed Pyometra in a 6-year-old Cavalier King Charles. Woke up <2 minutes at the completion of surgery. Went home to a happy family. Miniature Schnauzer, 9 years. Vomiting, Bloated Stomach. Closed Pyometra. Toa Payoh Vets Miniature Schnauzer, 9 years. Vomiting, Bloated Stomach. Closed Pyometra. Toa Payoh Vets
Closed Pyometra in a 9-year-old Miniature Schnauzer. Took >120 minutes to wake up after the completion of surgery. Intensive I/V drips and monitoring. Lethargy. Sleepy. She was in the twilight zone as she resisted the pull of the dark forces of death. Went home at Day 2.
If you do not wish to spay your dog, be observant of the older female dog (over 3 years of age) for the next 8 weeks after her heat period. Is her bleeding fresh red and clean which is normal? Normal bleeding of fresh red blood lasts around 7-14 days and return in around 6-monthly interval. This is just a guideline. Cases to be aware of are female dogs cycling every 4 monthly or irregularly.
passing pus from the vagina for the past 5 months. very old dog. surgery. pyometra. toapayohvets, singaporeWATCH OUT FOR THE FOLLOWING:
* Has she any brownish yellowish sticky vaginal discharge during and especially after two weeks of bleeding? You will need to use a clean piece of tissue to wipe against the private parts and check yourself.
* Is she licking her vulva daily and frequently? Consult your vet promptly.
* Has she got false pregnancy (milk in her nipples and enlarged nipples though she has never been pregnant, strange behaviour - aggressive, withdrawn, vomiting, carrying a toy around to a safe area)?
* Has she got tumours in her breast area?
Do seek prompt treatment when pyometra occurs instead of waiting till it is highly risky to operate as in the June 2011 case I operated on and described in Pyometra in a 16-year-old Maltese X.
Website and more pictures are at:
http://www.sinpets.com/F5/201006266closed-pyometra-cavalier-king-charles-miniature-schnauzer-toapayohvets-Singapore-ToaPayohVets.htm
Thursday, July 7, 2011
492. Sixteen-year-old Maltese X with pyometra - euthanasia or not?
Sunday Jul 3, 2011
I thought this Sunday would be an uneventful Sunday with the usual veterinary conditions seen throughout the years.
I would work half a day and take the afternoon off. Then I would watch the movie "Jane Eyre" at 7 pm at the Shaw Lido cinema. Suddenly a young worried-looking young man in his early 30s and a lady came with a very thin Maltese passing pus from her vagina for the past 5 months. They had consulted my associate yesterday, Dr Jason Teo had given an anti-fever and antibiotic injection yesterday as the dog had high fever. However, she had no fever now.
"What do you advise?" the sister asked me. "Do you recommend euthanasia?" This was a very old female dog. Very thin and weak and would be a very high anaesthetic risk.
"It is up to the owner as to whether he wants to euthanase this dog or not," I replied. "I don't advise euthanasia or surgery. It is up to the owner as surgery has a high risk of death on the operating table for this very old dog. In human years, she would be over 100 years old!"
The young man was hesitant. "Please think it over," I said. "You may not see this dog alive once she enters the operating table."
To euthanase or not? As long as there is life, there is hope. It does not mean that a very old dog that is in very poor health will definitely die on the operating table. It is just that the probability of dying is over 90% in this case.
"In pyometra cases, there is no choice but to operate. Much depends on economics," I advised. "Pyometra surgery and anaesthesia will cost around $1,000 as it takes a longer time as compared to a normal spay which is much cheaper."
The young man could not decide. I said: "Please wait in the reception room and think about the surgery." Why did he wait for over 3 months of the dog passing pus in the vagina to seek treatment, I did not ask him. Most likely, he anticipated that the dog would die on the operating table and therefore procrastinated till the dog was very thin and unable to eat.
I don't relish operating on high risk dogs as I do get emotionally affected whenever a dog dies on the operating table. For whatever reason. Some 40 years ago, I would have advised euthanasia as that was the prevalent thinking of my baby-boomer generation. Not much hope of survival. So why spend money on doing surgery? Save the owner some money. The vet who advises euthanasia for very sick dogs becomes despised and deemed uncaring and incompetent.
This type of advice does not resonate well with the younger generation. So, nowadays, I let the owner make the final decision of euthanasia or surgery in serious pyometra cases of old dogs. This case would be my second case of a very old dog past 15 years of age, suffering from pyometra. There are only a handful of such such cases seen by me in my 40 years of practice and the other case was deemed a success.
Yet one swallow does not make a summer. I did not want to operate. Yet euthanasia would be unacceptable for me too. This would be a very high risk surgery. Why risk my reputation?
The young man finally said: "OK, do the surgery." He did not want any blood test to be done.
Below is the account of the surgery, anaesthesia and follow-up.
ANAESTHESIA
Isoflurane gas at 5% given by mask. No sedation. IV drip.
Intubated and give gas at 1-3%.
The dog was given just sufficient gas but this was insufficient to bring her deeper into surgical anaesthesia. The dog kept moving and I would stop the surgery while she inhaled more gas. This method prolonged the surgery which started from 10.50 am and completed at 11.35 am on this Sunday. In normal pyometra dog anaesthesia, the dog would be fully anaesthesized and the surgery could be completed in less than 30 minutes.
But this was a very old dog and life and death depended on the anaesthetic skills of the vet. My assistant Min wanted to increase the isoflurane percentage to 5% to get a deeper anaesthesia. "Don't do it," I told him off. "She is a very old dog and normally 2% is sufficient in normal dogs. Just wait a while at 3% maximum. Old dogs die when given 5% for some time as she is in a very unstable anaesthetic stage."
After removal of the womb and ovaries, the dog's anaesthesia was excellent.
SURGERY
"The blood is bright red," I said to my assistant. "It is a good sign as toxic blood is usually dark blue due to lack of oxygenation." An unusual bright red in this case as compared to the cyanotic blue of another case in a Golden Retriever I operated in 2008 (see hyperlink).
There are three significant aspects of this surgical case.
1. Cysts and swelling in parts of the uterine bodies, indicating a partial rupture of the uterus and spilling of the toxic pus into the abdomen.
2. This is shown in a very thick peritoneum of 3 mm thickness. Normally, the peritoneum is thinner than 1 mm. So, there was peritonitis.
3. A grossly swollen vagina and cervix was seen. I did not get a photo taken as I was in a rush to complete the surgery which was taking too long due to an unstable anaesthesia. This is extremely rare. Was there a tumour inside the vagina? Was there an abnormal hymen? I don't know. I put in 3 ligatures to prevent the pus from the vagina from leaking into the abdomen as I removed the uterine horns and ovaries.
BLEEDING. Lots of bleeding from the omental blood vessels which were fragile. Probably a result of cystic ovaries producing abnormal amounts of hormone. I checked carefully that there was no major blood vessel from the uterine body haemorrhaging as I had 3 ligatures around the uterine body. I swabbed off the blood.
SUTURE
After 3 ligatures of the uterine body, I closed the muscles with a continuous suture 2/0 absorbable. Normally, I don't bother with continuous sutures but just use simple interrupted sutures and I find that fine. After the continouous sutures, I stitched another 3 interrupted sutures. The skin incision was stitched horizontal mattress sutures as these hold well and are not easily licked off unlike interrupted sutures, in my experience.
POST-OP
The young man insisted on taking the dog home to nurse by himself. He was not experience in post-operation nursing. If owners are insistent, I would ask them to sign a discharge form saying that they want the dog discharged against medical advice. However, he agreed to let her rest overnight at Toa Payoh Vets and get the necessary drip.
POST-OP NURSING CARE DAY 1-3
1. Vomiting.
"The dog vomits when I feed her very small amounts of the A/D canned food and water," the owner phoned me on Day 1 and 2. I advised feeding separately at 6 times per day but he said the dog would vomit after a while. "What's the cause?" he asked. "My dog does not vomit before the surgery."
"It is hard to tell you the cause," I said. "You did not want blood test. It could be stomach ulceration due to kidney disorders and uraemia. Or liver disorders. It could be gastritis or any other reason."
2. Fits on Day 3.
On Day 3, the owner phoned me saying that the dog had a few seconds of fits. "What's the cause?" he asked. "It could be due to low blood sugar or kidney disorders. Come for an IV drip and review."
After dextrose saline and amino acid drips, the owner took the dog home with another bottle of drip which he would administer himself.
3. Day 3 - Day 6 (today). No more vomiting. The owner was told to feed the canned food and the multi-vitamin paste but not to give water. I had given a Baytril antibiotic and anti-inflam pred injection with the drip on Day 3 when he came for the fits.
CONCLUSION
The dog started to eat by herself from Day 3 to 6. That was good news. I advised giving water in small amounts at different times. So far, so good. This is one of my most unusual cases. As for the vulval swelling of 30x, I told the owner that the swelling had reduced by 80% on Day 3 when he came in for the review of fits.
The road back to good health is long. This is one of the rare cases where the owner does not opt for euthanasia as most will do so.
More pictures are at
http://www.sinpets.com/201006265pyometra-16years-MalteseX-swollen-vagina-toapayohvets-Singapore-ToaPayohVets.htm
I thought this Sunday would be an uneventful Sunday with the usual veterinary conditions seen throughout the years.
I would work half a day and take the afternoon off. Then I would watch the movie "Jane Eyre" at 7 pm at the Shaw Lido cinema. Suddenly a young worried-looking young man in his early 30s and a lady came with a very thin Maltese passing pus from her vagina for the past 5 months. They had consulted my associate yesterday, Dr Jason Teo had given an anti-fever and antibiotic injection yesterday as the dog had high fever. However, she had no fever now.
"What do you advise?" the sister asked me. "Do you recommend euthanasia?" This was a very old female dog. Very thin and weak and would be a very high anaesthetic risk.
"It is up to the owner as to whether he wants to euthanase this dog or not," I replied. "I don't advise euthanasia or surgery. It is up to the owner as surgery has a high risk of death on the operating table for this very old dog. In human years, she would be over 100 years old!"
The young man was hesitant. "Please think it over," I said. "You may not see this dog alive once she enters the operating table."
To euthanase or not? As long as there is life, there is hope. It does not mean that a very old dog that is in very poor health will definitely die on the operating table. It is just that the probability of dying is over 90% in this case.
"In pyometra cases, there is no choice but to operate. Much depends on economics," I advised. "Pyometra surgery and anaesthesia will cost around $1,000 as it takes a longer time as compared to a normal spay which is much cheaper."
The young man could not decide. I said: "Please wait in the reception room and think about the surgery." Why did he wait for over 3 months of the dog passing pus in the vagina to seek treatment, I did not ask him. Most likely, he anticipated that the dog would die on the operating table and therefore procrastinated till the dog was very thin and unable to eat.
I don't relish operating on high risk dogs as I do get emotionally affected whenever a dog dies on the operating table. For whatever reason. Some 40 years ago, I would have advised euthanasia as that was the prevalent thinking of my baby-boomer generation. Not much hope of survival. So why spend money on doing surgery? Save the owner some money. The vet who advises euthanasia for very sick dogs becomes despised and deemed uncaring and incompetent.
This type of advice does not resonate well with the younger generation. So, nowadays, I let the owner make the final decision of euthanasia or surgery in serious pyometra cases of old dogs. This case would be my second case of a very old dog past 15 years of age, suffering from pyometra. There are only a handful of such such cases seen by me in my 40 years of practice and the other case was deemed a success.
Yet one swallow does not make a summer. I did not want to operate. Yet euthanasia would be unacceptable for me too. This would be a very high risk surgery. Why risk my reputation?
The young man finally said: "OK, do the surgery." He did not want any blood test to be done.
Below is the account of the surgery, anaesthesia and follow-up.
ANAESTHESIA
Isoflurane gas at 5% given by mask. No sedation. IV drip.
Intubated and give gas at 1-3%.
The dog was given just sufficient gas but this was insufficient to bring her deeper into surgical anaesthesia. The dog kept moving and I would stop the surgery while she inhaled more gas. This method prolonged the surgery which started from 10.50 am and completed at 11.35 am on this Sunday. In normal pyometra dog anaesthesia, the dog would be fully anaesthesized and the surgery could be completed in less than 30 minutes.
But this was a very old dog and life and death depended on the anaesthetic skills of the vet. My assistant Min wanted to increase the isoflurane percentage to 5% to get a deeper anaesthesia. "Don't do it," I told him off. "She is a very old dog and normally 2% is sufficient in normal dogs. Just wait a while at 3% maximum. Old dogs die when given 5% for some time as she is in a very unstable anaesthetic stage."
After removal of the womb and ovaries, the dog's anaesthesia was excellent.
SURGERY
"The blood is bright red," I said to my assistant. "It is a good sign as toxic blood is usually dark blue due to lack of oxygenation." An unusual bright red in this case as compared to the cyanotic blue of another case in a Golden Retriever I operated in 2008 (see hyperlink).
There are three significant aspects of this surgical case.
1. Cysts and swelling in parts of the uterine bodies, indicating a partial rupture of the uterus and spilling of the toxic pus into the abdomen.
2. This is shown in a very thick peritoneum of 3 mm thickness. Normally, the peritoneum is thinner than 1 mm. So, there was peritonitis.
3. A grossly swollen vagina and cervix was seen. I did not get a photo taken as I was in a rush to complete the surgery which was taking too long due to an unstable anaesthesia. This is extremely rare. Was there a tumour inside the vagina? Was there an abnormal hymen? I don't know. I put in 3 ligatures to prevent the pus from the vagina from leaking into the abdomen as I removed the uterine horns and ovaries.
BLEEDING. Lots of bleeding from the omental blood vessels which were fragile. Probably a result of cystic ovaries producing abnormal amounts of hormone. I checked carefully that there was no major blood vessel from the uterine body haemorrhaging as I had 3 ligatures around the uterine body. I swabbed off the blood.
SUTURE
After 3 ligatures of the uterine body, I closed the muscles with a continuous suture 2/0 absorbable. Normally, I don't bother with continuous sutures but just use simple interrupted sutures and I find that fine. After the continouous sutures, I stitched another 3 interrupted sutures. The skin incision was stitched horizontal mattress sutures as these hold well and are not easily licked off unlike interrupted sutures, in my experience.
POST-OP
The young man insisted on taking the dog home to nurse by himself. He was not experience in post-operation nursing. If owners are insistent, I would ask them to sign a discharge form saying that they want the dog discharged against medical advice. However, he agreed to let her rest overnight at Toa Payoh Vets and get the necessary drip.
POST-OP NURSING CARE DAY 1-3
1. Vomiting.
"The dog vomits when I feed her very small amounts of the A/D canned food and water," the owner phoned me on Day 1 and 2. I advised feeding separately at 6 times per day but he said the dog would vomit after a while. "What's the cause?" he asked. "My dog does not vomit before the surgery."
"It is hard to tell you the cause," I said. "You did not want blood test. It could be stomach ulceration due to kidney disorders and uraemia. Or liver disorders. It could be gastritis or any other reason."
2. Fits on Day 3.
On Day 3, the owner phoned me saying that the dog had a few seconds of fits. "What's the cause?" he asked. "It could be due to low blood sugar or kidney disorders. Come for an IV drip and review."
After dextrose saline and amino acid drips, the owner took the dog home with another bottle of drip which he would administer himself.
3. Day 3 - Day 6 (today). No more vomiting. The owner was told to feed the canned food and the multi-vitamin paste but not to give water. I had given a Baytril antibiotic and anti-inflam pred injection with the drip on Day 3 when he came for the fits.
CONCLUSION
The dog started to eat by herself from Day 3 to 6. That was good news. I advised giving water in small amounts at different times. So far, so good. This is one of my most unusual cases. As for the vulval swelling of 30x, I told the owner that the swelling had reduced by 80% on Day 3 when he came in for the review of fits.
The road back to good health is long. This is one of the rare cases where the owner does not opt for euthanasia as most will do so.
More pictures are at
http://www.sinpets.com/201006265pyometra-16years-MalteseX-swollen-vagina-toapayohvets-Singapore-ToaPayohVets.htm
Wednesday, July 6, 2011
The hamster caring younger generation of Singaporeans compared to the baby boomer generation
On Jun 8, 2011, I attended the SAP Summit 2011 - The Future State. The 9.10 am topic for the panelists was "The Secrets of Making A Best-Run Government Run Better; The Changing Mandate; The Shocking Disasters; The Future State
The Panelists were: Dr Anthony M Cresswell, Deputy Director, Center for Technology in Government, University at Albany, NY, USA; Zaqy Mohamad, Member of Parliament, Choa Chu Kang GRC, Singapore and Adaire Fox-Martin, SVP, Industry Business Solutions, SAP Asia Pacific Japan.
Mr Zaqy spoke about the better use of social media by politicians to engage the segment of the public. Apparently this had not been done effectively in the recent General Elections in Singapore if I heard Mr Zaqy Mohamad correctly.
The other panelist, Dr Anthony Cresswell talked about President Obama's Open Government's initiatives in the US and the difficulty of evaluating the key performance indicators of the services provided. It was an eye-opener for me when he said that over 80% of government computerisation projects fail.
What is the relevance of social media to veterinary surgeons in practice? There is a segment of the pet owners who are younger and would only be engaged through the use of social media. They will search for topics of relevance to their pet's illness and want to know which vet has the ability and experience to treat their beloved pets. Their own vet may not provide such a service.
Social media using webpages or blog requires the content to be created daily. There is now the twitter novel (short novels of 140 words are popular with netizens of China). Whatever the form, the contents must be updated daily or weekly to get a stream of "fans". Writing is very hard work for those who prefer not to touch a pen as there need to be research to produce a useful article. There are so many distractions and better things to do than to create good content after a hard day's work at the Surgery!
To illustrate the amount of work involved to produce a useful article, I will let readers know how I produced the article, "What Makes A Horse Racing Club Profitable?" This article was written in 1989 and the scanned pages are at Horses, starting with the first page at: http://www.asiahomes.com/dev/Stc1.JPG
CASE 1. The hamster with a very large ear wart
On a recent encounter, 2 days ago on Jun 9, 2011, I met an aunty and her niece who brought a hamster with a large dangling ear wart to Toa Payoh Vets. This wart was initially very small but her vet said she would not operate due to the high anaesthetic risks. As the wart grew bigger over the last 4-5 months, her vet referred her to another vet whose location was quite far to her residence. So this aunty googled for "hamster, warts" and an asiahomes webpage, probably similar http://www.asiahomes.com/singaporetpvet/ popped out.
I was at the Surgery at that time and so I got the above-mentioned feedback from her. This episode demonstrated the culture and lifestyle of the younger generation. The aunty was around 30-40 years old. The niece was a teenager. I paid special attention to this case as I collaborated with Dr Vanessa to ensure that the outcome of anaesthesia was what the aunty hoped for. Signing an informed anaesthesia consent form is one thing. I don't usually request it but Dr Vanessa does.
What was important was that the hamster come out of the surgery room alive and biting (this hamster bites, the aunty had said). Obviously, I would bite if anybody messes around with my wart. The hamster was anaesthesized under isoflurane gas.
A good anaesthetic assistant is invaluable. However, he or she needs to be trained as vet schools don't teach much about hamster anaesthesias. I kept a close eye on my assistant Mr Min telling him not to be distracted by looking for sutures etc while anaesthesizing the hamster. At one time, his eyes and one hand were on a drawer to take out a packet of suture for Dr Vanessa Lin.
I told him off not to do it. "Hamsters die because there is no 100% focus on anaesthesia by one person or the vet." It is important that new vet assistants and new vets need to be mentored closely in hamster anaesthesia and surgery as such cases are high risk anaesthetic cases.
There is no other way to prevent anaesthetic deaths in hamsters when the vet does hamster anaesthesia. Deaths on the operating table damages the reputation of Toa Payoh Vets and I am very strict on anaesthetic training and procedures to ensure that no healthy pets should die on the operating table at all times.
Dr Vanessa Lin excised the wart and sutured the wound. I proposed no suturing as the wound in the ear was so small and that bleeding would stop with pressure. As each vet has his or her own ideas, I will not interfere whenever an associate vet operates in most cases but I do monitor the handwork - the post-operation complications and the complaints. This is my duty of care for Toa Payoh Vets clientele.
She decided to stitch up the wound. I recommended potassium permanganate to stop the bleeding. Each vet has his or her approach to a surgical case and there are several satisfactory outcomes on any approach. Bleeding still came back as I had predicted in this case. This bleeding was not life-threatening.
The hamster was now free of "shouldering" a burden. Actually, the wart of 1.5 cm x 1.2 cm x 0.5 cm looked so much like one of those big dangling ear rings worn by some ladies. The hamster scratched his left ear where the wound was. The aunty was concerned. So I proposed a paper e-collar. "The hamster hates it very much," I said to the aunty as she put the e-collar on. The hamster used all his two hands to pull out the hamster. Vigorously and angrily I think. So, no more e-collar. "Just use the clean tissue to wipe off the blood," I advised the aunty. "And take the medication." The niece did not say a word but I presumed she was the real owner of this beloved hamster and was happy.
P.S. What are the Secrets of Making A Best-Run Government Run Better? There were no clear list of secrets enumerated as far as I know. The political party who knows how to engage the Generation Y effectively will be the one to win their votes and get the increased mandate to govern if the Generation Y is the vote swinger. The Government is now said to be a business. So, the Government who provides "public value" to the citizens will be a better-run government.
CASE 2. The hamster with a small ear wart
On Sunday July 3, 2011, I visited a hamster, rabbit, guinea pig and chinchilla pet shop after work at 6 pm. It was a busy Sunday working together with Dr Vanessa Lin.
The pet shop owner, Agnes asked me: "Many hamsters develop tumours after one year of age, according to my customers. Do you see many cases" I said: "Yes, I do see some cases and tumours do develop in most hamsters after one year of age but they can be excised if they are small."
Agnes said: "The hamster owner thinks that he or she can buy 10 hamsters rather than paying the veterinary fees. So, some don't bother. I suppose that even if the fees are $50.00, such owners will not send their hamsters for surgery."
Agnes is licensed to sell dwarf hamsters and each costs $12.00. As Singapore develops into a modern society, there are many caring hamster owners who do want their hamster tumours to be excised by the vet. Some wait too late as they hope that the tumour will disappear or they are just too busy to go to the vet. Some are poorly advised by their own vets to "wait and see" after taking "medication."
Many vets all over the world do not like to perform surgery on hamsters as they die easily as it is extremely difficult to monitor the stages of anaesthesia unlike in the case of the dog and cat.
Be Kind To Dwarf Hamsters. Get your vet to excise his ear wart when it is very small as in this case compared to the hamster with a large ear wart. Smaller warts cost you less to remove as they take shorter time and do not usually require stitching.
CASE 3. The hamster with two large chest tumours
Anaesthesia in this Syrian Hamster in Jun 2011
The Syrian Hamster was very thin. I could feel the spines. So I told the owner that I would give oral antibiotics and electrolytes for 24 hours at 3 times before anaesthesia and surgery. This hamster had stopped eating as was evident in no stool production.
I told the owner orally that the anaesthetic risks were very high as the hamster was not in good health. She understood the risks. This communication should be recorded in the case sheet and informed consent form should be signed in theory.
There are at least two methods of anaesthesia in this case. Isoflurane gas alone is the first method. However I find that this surgery can be better performed if the hamster is sedated by Zoletil so that less gas anaesthetic is required and I do not need to place him into the gas container every few seconds. It would be a very painful surgery as the lumps were massive and there were two of them.
I used the 2nd method of Zoletil sedation and topping up with isoflurane anaesthesia gas. I took out a new bottle of Zoletil 100. A 5-ml diluent is advised to make up Zoletil 100. However, I added 10 ml diluent so this would be Zoletil 50. I injected two drops IM. This dosage would not be sufficient from my experience but this hamster was not healthy and that was why I reduced the dose. It is very hard to know exactly the dosage that would not kill the hamster. A healthy plump adult Syrian hamster should have no problem with
4 drops of Zoletil 50 IM but this hamster was skinny as a rake.
OBSERVATION AND CLOSE MONITORING
"Count up to 10 and take the hamster out of the container," I said to my assistant whenever he put the hamster inside the plastic container of 5% isoflurane gas. He was not used to such instructions as he had little experience of hamster anaesthesia. My job is to train him up to assist all Toa Payoh Vets in hamster anaesthesia and receiving excellent outcome. Only with excellent clinical outcome and not anaesthetic deaths do the vet get referrals.
Mr Min felt it stupid to count as he graduated as a vet from Myanmar where I presume hamsters were not part of the veterinary studies. Even talking to dogs while giving injections is alien to his culture. Finally he counted: "1-2-3-4...10". He took the hamster out and I continued with the excision of over 3 cm long. The hamster gave a squeaky sound and I put him back to isoflurane gas container to get anaesthesized. On and off. Finally, the surgery was completed and the hamster woke up. He was OK and went home 48 hours later with no complaints.
4267 - 4275. Massive tumours in a Syrian hamster
CASE 4. Was it a bruised area or a chest tumour?
The vet is ultimately responsible for the deaths on the operating table. Extremely close monitoring of the stages of anaesthesia is very important in hamster anaesthesia as the eyelid and pedal reflexes are impossible to do unlike in the dog and cat. A bit more gas. A distraction of a few seconds. Cold air-conditioning air. Dampness and wetness. The hamster just dies on the operating table. It is indeed a very stressful anaesthesia and surgery when large massive tumours are presented.
Morally and ethically, it is best for the vet who does not want to handle hamster tumours, to reject the case outright rather than to prescribe the owner some medication and advise "wait-and-see" when they present hamsters with tumours (hard, firm lump). Just ask the hamster owner to seek another vet rather than give false hopes of recovery from oral medication. I can understand that vets may not wish to refer to competitors who may not be competent and if the hamster dies at the competitor's place, there will be blame on the referral.
4283 - 4290. HAMSTER PATIENT. Roborovski's tumour was discovered when the hamster's nose got bruised due to traumatic injury. "Is it due to the bruise?" the owner asked her vet. "Yes," the vet said. Within two weeks, the growth exploded to a gigantic size and was not operable.
Many caring hamster owners are from the younger generation of Singaporeans and are well educated. They are also quite sophisticated in knowing that oral medication for tumour cases are a waste of their money. Not only that, this act delays the owner from seeking early veterinary surgery for the removal of the tumour, some of which may be fast-growing malignant tumours.
Pictures are at:
http://www.sinpets.com/F6/201006255government-social-media-veterinary-ToaPayohVets.htm
The Panelists were: Dr Anthony M Cresswell, Deputy Director, Center for Technology in Government, University at Albany, NY, USA; Zaqy Mohamad, Member of Parliament, Choa Chu Kang GRC, Singapore and Adaire Fox-Martin, SVP, Industry Business Solutions, SAP Asia Pacific Japan.
Mr Zaqy spoke about the better use of social media by politicians to engage the segment of the public. Apparently this had not been done effectively in the recent General Elections in Singapore if I heard Mr Zaqy Mohamad correctly.
The other panelist, Dr Anthony Cresswell talked about President Obama's Open Government's initiatives in the US and the difficulty of evaluating the key performance indicators of the services provided. It was an eye-opener for me when he said that over 80% of government computerisation projects fail.
What is the relevance of social media to veterinary surgeons in practice? There is a segment of the pet owners who are younger and would only be engaged through the use of social media. They will search for topics of relevance to their pet's illness and want to know which vet has the ability and experience to treat their beloved pets. Their own vet may not provide such a service.
Social media using webpages or blog requires the content to be created daily. There is now the twitter novel (short novels of 140 words are popular with netizens of China). Whatever the form, the contents must be updated daily or weekly to get a stream of "fans". Writing is very hard work for those who prefer not to touch a pen as there need to be research to produce a useful article. There are so many distractions and better things to do than to create good content after a hard day's work at the Surgery!
To illustrate the amount of work involved to produce a useful article, I will let readers know how I produced the article, "What Makes A Horse Racing Club Profitable?" This article was written in 1989 and the scanned pages are at Horses, starting with the first page at: http://www.asiahomes.com/dev/Stc1.JPG
CASE 1. The hamster with a very large ear wart
On a recent encounter, 2 days ago on Jun 9, 2011, I met an aunty and her niece who brought a hamster with a large dangling ear wart to Toa Payoh Vets. This wart was initially very small but her vet said she would not operate due to the high anaesthetic risks. As the wart grew bigger over the last 4-5 months, her vet referred her to another vet whose location was quite far to her residence. So this aunty googled for "hamster, warts" and an asiahomes webpage, probably similar http://www.asiahomes.com/singaporetpvet/ popped out.
I was at the Surgery at that time and so I got the above-mentioned feedback from her. This episode demonstrated the culture and lifestyle of the younger generation. The aunty was around 30-40 years old. The niece was a teenager. I paid special attention to this case as I collaborated with Dr Vanessa to ensure that the outcome of anaesthesia was what the aunty hoped for. Signing an informed anaesthesia consent form is one thing. I don't usually request it but Dr Vanessa does.
What was important was that the hamster come out of the surgery room alive and biting (this hamster bites, the aunty had said). Obviously, I would bite if anybody messes around with my wart. The hamster was anaesthesized under isoflurane gas.
A good anaesthetic assistant is invaluable. However, he or she needs to be trained as vet schools don't teach much about hamster anaesthesias. I kept a close eye on my assistant Mr Min telling him not to be distracted by looking for sutures etc while anaesthesizing the hamster. At one time, his eyes and one hand were on a drawer to take out a packet of suture for Dr Vanessa Lin.
I told him off not to do it. "Hamsters die because there is no 100% focus on anaesthesia by one person or the vet." It is important that new vet assistants and new vets need to be mentored closely in hamster anaesthesia and surgery as such cases are high risk anaesthetic cases.
There is no other way to prevent anaesthetic deaths in hamsters when the vet does hamster anaesthesia. Deaths on the operating table damages the reputation of Toa Payoh Vets and I am very strict on anaesthetic training and procedures to ensure that no healthy pets should die on the operating table at all times.
Dr Vanessa Lin excised the wart and sutured the wound. I proposed no suturing as the wound in the ear was so small and that bleeding would stop with pressure. As each vet has his or her own ideas, I will not interfere whenever an associate vet operates in most cases but I do monitor the handwork - the post-operation complications and the complaints. This is my duty of care for Toa Payoh Vets clientele.
She decided to stitch up the wound. I recommended potassium permanganate to stop the bleeding. Each vet has his or her approach to a surgical case and there are several satisfactory outcomes on any approach. Bleeding still came back as I had predicted in this case. This bleeding was not life-threatening.
The hamster was now free of "shouldering" a burden. Actually, the wart of 1.5 cm x 1.2 cm x 0.5 cm looked so much like one of those big dangling ear rings worn by some ladies. The hamster scratched his left ear where the wound was. The aunty was concerned. So I proposed a paper e-collar. "The hamster hates it very much," I said to the aunty as she put the e-collar on. The hamster used all his two hands to pull out the hamster. Vigorously and angrily I think. So, no more e-collar. "Just use the clean tissue to wipe off the blood," I advised the aunty. "And take the medication." The niece did not say a word but I presumed she was the real owner of this beloved hamster and was happy.
P.S. What are the Secrets of Making A Best-Run Government Run Better? There were no clear list of secrets enumerated as far as I know. The political party who knows how to engage the Generation Y effectively will be the one to win their votes and get the increased mandate to govern if the Generation Y is the vote swinger. The Government is now said to be a business. So, the Government who provides "public value" to the citizens will be a better-run government.
CASE 2. The hamster with a small ear wart
On Sunday July 3, 2011, I visited a hamster, rabbit, guinea pig and chinchilla pet shop after work at 6 pm. It was a busy Sunday working together with Dr Vanessa Lin.
The pet shop owner, Agnes asked me: "Many hamsters develop tumours after one year of age, according to my customers. Do you see many cases" I said: "Yes, I do see some cases and tumours do develop in most hamsters after one year of age but they can be excised if they are small."
Agnes said: "The hamster owner thinks that he or she can buy 10 hamsters rather than paying the veterinary fees. So, some don't bother. I suppose that even if the fees are $50.00, such owners will not send their hamsters for surgery."
Agnes is licensed to sell dwarf hamsters and each costs $12.00. As Singapore develops into a modern society, there are many caring hamster owners who do want their hamster tumours to be excised by the vet. Some wait too late as they hope that the tumour will disappear or they are just too busy to go to the vet. Some are poorly advised by their own vets to "wait and see" after taking "medication."
Many vets all over the world do not like to perform surgery on hamsters as they die easily as it is extremely difficult to monitor the stages of anaesthesia unlike in the case of the dog and cat.
Be Kind To Dwarf Hamsters. Get your vet to excise his ear wart when it is very small as in this case compared to the hamster with a large ear wart. Smaller warts cost you less to remove as they take shorter time and do not usually require stitching.
CASE 3. The hamster with two large chest tumours
Anaesthesia in this Syrian Hamster in Jun 2011
The Syrian Hamster was very thin. I could feel the spines. So I told the owner that I would give oral antibiotics and electrolytes for 24 hours at 3 times before anaesthesia and surgery. This hamster had stopped eating as was evident in no stool production.
I told the owner orally that the anaesthetic risks were very high as the hamster was not in good health. She understood the risks. This communication should be recorded in the case sheet and informed consent form should be signed in theory.
There are at least two methods of anaesthesia in this case. Isoflurane gas alone is the first method. However I find that this surgery can be better performed if the hamster is sedated by Zoletil so that less gas anaesthetic is required and I do not need to place him into the gas container every few seconds. It would be a very painful surgery as the lumps were massive and there were two of them.
I used the 2nd method of Zoletil sedation and topping up with isoflurane anaesthesia gas. I took out a new bottle of Zoletil 100. A 5-ml diluent is advised to make up Zoletil 100. However, I added 10 ml diluent so this would be Zoletil 50. I injected two drops IM. This dosage would not be sufficient from my experience but this hamster was not healthy and that was why I reduced the dose. It is very hard to know exactly the dosage that would not kill the hamster. A healthy plump adult Syrian hamster should have no problem with
4 drops of Zoletil 50 IM but this hamster was skinny as a rake.
OBSERVATION AND CLOSE MONITORING
"Count up to 10 and take the hamster out of the container," I said to my assistant whenever he put the hamster inside the plastic container of 5% isoflurane gas. He was not used to such instructions as he had little experience of hamster anaesthesia. My job is to train him up to assist all Toa Payoh Vets in hamster anaesthesia and receiving excellent outcome. Only with excellent clinical outcome and not anaesthetic deaths do the vet get referrals.
Mr Min felt it stupid to count as he graduated as a vet from Myanmar where I presume hamsters were not part of the veterinary studies. Even talking to dogs while giving injections is alien to his culture. Finally he counted: "1-2-3-4...10". He took the hamster out and I continued with the excision of over 3 cm long. The hamster gave a squeaky sound and I put him back to isoflurane gas container to get anaesthesized. On and off. Finally, the surgery was completed and the hamster woke up. He was OK and went home 48 hours later with no complaints.
4267 - 4275. Massive tumours in a Syrian hamster
CASE 4. Was it a bruised area or a chest tumour?
The vet is ultimately responsible for the deaths on the operating table. Extremely close monitoring of the stages of anaesthesia is very important in hamster anaesthesia as the eyelid and pedal reflexes are impossible to do unlike in the dog and cat. A bit more gas. A distraction of a few seconds. Cold air-conditioning air. Dampness and wetness. The hamster just dies on the operating table. It is indeed a very stressful anaesthesia and surgery when large massive tumours are presented.
Morally and ethically, it is best for the vet who does not want to handle hamster tumours, to reject the case outright rather than to prescribe the owner some medication and advise "wait-and-see" when they present hamsters with tumours (hard, firm lump). Just ask the hamster owner to seek another vet rather than give false hopes of recovery from oral medication. I can understand that vets may not wish to refer to competitors who may not be competent and if the hamster dies at the competitor's place, there will be blame on the referral.
4283 - 4290. HAMSTER PATIENT. Roborovski's tumour was discovered when the hamster's nose got bruised due to traumatic injury. "Is it due to the bruise?" the owner asked her vet. "Yes," the vet said. Within two weeks, the growth exploded to a gigantic size and was not operable.
Many caring hamster owners are from the younger generation of Singaporeans and are well educated. They are also quite sophisticated in knowing that oral medication for tumour cases are a waste of their money. Not only that, this act delays the owner from seeking early veterinary surgery for the removal of the tumour, some of which may be fast-growing malignant tumours.
Pictures are at:
http://www.sinpets.com/F6/201006255government-social-media-veterinary-ToaPayohVets.htm
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