2953. A 16-year-old Shih Tzu has a painful swollen left eye - Pictures as prompts in writing a chapter of a story

In March 2010, I documented a surgical case to share with dog owners and vet students as part of my "BE KIND TO PETS" veterinary educational project.  At that time, I dared not use video, considering it to be a very time-consuming subject to do and upload as compared to posting images online. So I posted the above 3 pictures and never saw the dog again. The owner did not come for a follow up and this is to be expected.  Did his corneal ulcer heal?  Probably. Or the owner could have sought a second opinion as the outcome was bad.





In April 2016, I connected with this Shih Tzu after not seeing her for the last 6 years. The owners had sought emergency treatment for her bad left eye which was suddenly swollen. The vet advised removal of the eyeball but warned that this old dog might die under general anaesthesia. To do or not to do? The owners discharged the dog and brought her to see me. "You operated on the right eye and recorded the surgery," the lady in her late 20s said to me. I could not recall.  She retrieved the above 3 images for me. I was most surprised that I had even illustrated my operation procedures.


Did the operation produce an excellent outcome? Yes, as you can see the 2016 image below. No inflammation of the cornea or eye white. Just a brown circular spot of around 3 mm diameter where the deep corneal ulcer had existed and had healed. It was a descemetocoele treated surgically. "I did not return to you for stitch removal as you used dissolvable stitches," the young lady informed me.
"However, the left eye suffered a similar injury in 2010 and was treated by another vet. This vet prescribed just 2 types of eye drops. The eyeball seemed to have sprouted water outwards and sunk but had recovered its shape. Then another attack in 2013 and I applied eye drops twice daily for the past years.





   

A 8-year-old Chinese girl dislikes Chinese

Sat Apr 12  2016

It is extremely difficult for a 30- year old single mother to earn a living in Singapore.  She was the boss of a pet shop and had as many as 4 groomers at one time. She opened pet cafes in petrol kiosks.The landlord increases the rental during the boom if past 3 trs.

A 2-year-old female hamster has an irritating interdigital wart

April 14, 2016

Anaesthetic death is always a worry for the Thai lady owner and her husband. So, when she came to take back the hamster post-op, she snapped a picture from her handphone to show her husband that Spiky 2 had survived the anaesthesia.

Isoflurane gas + oxygen anaesthesia for a few times as it is hard to assess the depth of anaesthesia. The hamster reacted to the electrosurgery twice when I started cutting. So, she needs gas again. Finally, I managed to get out the wart which is friable and measured 3 mm across. See video.

The hamster has such a thick coat. On her right chest, there was a tumour around 1.3 cm across. To operate or not?

2950. A 7-year-old male Shih Tzu is totally blind

Mar 24, 2016

The male 7-year-old Shih Tzu is totally blind and now has a severely infected eyeball.
"Your vet said to put him to sleep," the owner told me.
"Are you sure? Dr Daniel will never suggest that. The dog is blind but is still active."
"Maybe it was my friend who suggested it as the dog is blind in both eyes."

He brought the dog in for eyeball removal since his 80-year-old father is against euthanasia.
Blood test showed high total white cell count at 22.6 (6-17) and high neutrophils 89% (60-70%) and high absolute numbers 21  (3-11.5).

Dr Daniel did the op, warded the dog for 2 days and gave medication. The dog is OK now. Blindness is surprising but the owner had not requested detailed check up.

A 40th day pregnant Corgi vomits twice and has no appetite - acute kidney failure

Mar 18  2016
I got a tel call at 8am from the breeder. The 2-year-old Corgi is heavily pregnant. Vomited once yesterday and today  yellow vomitus. No appetite. Why?

Blood test.
High blood urea and creatinine. Leucocytosis - a higher than normal number of total white cell count indicating a possible bacterial infection.

"Acute kidney failure," I gave the breeder the bad news. The sudden onset of uraemia causing vomiting led me to diagnose acute kidney failure in contrast to chronic kidney failure. 

"Why and how the Corgi suffers from kidney failure?" the breeder asked. "She is only 2 years old and this is her first litter."

"There are many causes," I explained. "Infections, dietary management, toxicity, kidney injury, kidney pressure on the ureters due to too many foetus (the Corgi was later found to have 10 foetuses). It is possible that there is a kidney infection based on leucocytosis."

I gave IV therapy and antibiotic. The IV therapy was continued at the farm for the next 3 days. The dog still vomited after drinking and had no appetite for the next 3 days.

Mar 20, 2016
The dog miscarriaged with 2 premature puppies born. I gave oxytocin as the others would be dead too. There were 10 puppies in total. Most of the 10 placentas came out the next day. The dam was more alert but had no appetite. "The IV drip for the next 3 days is critical. It is for dialysis to clear out the waste products of urea by the functioning glomerulus cells of the kideys to filter the toxic waste.  It provides the dextrose energy and fluid to prevent dehydration," I explained to the breeder. 

Mar 23, 2016
I phoned the breeder. He said that the dam started eating yesterday and is ok.  He was most happy. "Breeders will not be happy with the vet if the dam dies during Caesarean or treatment as they tend to blame the vet for being incompetent for achieving a poor outcome," I said.
"Well," he replied. "If the factory is shut down, there will be no production."
I had never thought of the dam as being a factory but this analogy is realistic.

2949. A red-eared slider does not have red ears - evidence

2947. First vaccination of 11 pups - one good image out of over 20

8.5x11 in 300 ppi    16.67% 31.5M/42.3M

8.5x11 in 300 ppi    16.67% 28.9M/32.9M


Bright sunny 9.30 am   Breeder's farm one day after vaccination of 11 puppies.
Puppies put inside a styroform box but difficult to get all to pose together.

A greenish-black Caesarean section - Breeder could hear only one puppy's heart sounds

March 15, 2016


9am 

Visit to Farm to check whether my Dachshund patient had given birth naturally. She had not been eating on Mar 8, 2016 and recovered on Mar 10, 2016 being very active. Had visited on Mar 11 (video, very active running about, eating)

Dachshund in whelping crate. The Dachshund looked at me. She was quiet with slight increase in respiratory rate.  I noticed a greenish-black vaginal discharge on the towels.
Temperature 37.9C was below normal. Breeder showed that she had milk Plenty of it.

But she looked bad. "The big abdomen had shrunk," I had seen her since 10 days ago. "That is not good".  In retrospect, this meant that the two puppies had died and the water bag had ruptured. Shrinkage of the abdomen.

He decided on an emergency Caesarean section saying: "I can only hear one loud heart beat of one puppy," the breeder said. "The others have had died."

10 am
The way she responded to anaesthesia showed she was very weak.

Masked and given isoflurane gas + O2 gas. Intubated. Tongue pale. Eyeball rotated downwards, pupils dilated - very deep anaesthesia. Surveillance. No gas at all unlike normal procedure of connection to gas directly. Dog took around 1 minute to recover. 

Thick greenish-black liquid flowed out from incision instead of the usual colourless water bag. 2 dead pups drowned in melted placental material pulled out.

Third pup at the brink of death. Still in the normal water bag with the clear colourless fluid. Placenta had separated and not wholesome. Melting. No sound. Gave to the experienced breeder.

Closed up the dog as fast as possible.
Dog only on 0.5% isoflurane gas  + O2. (normal strong dam needs at least 2% to be painfree)
Death on the operating table - not good for the vet's reputation no matter what is the cause.

Recovered. Cleaned up. Given IV drip (baytril, vitamins, amino acids). Puppy went home first. 





8pm  tel breeder. Dam and puppy OK.

2945. An 11-month-old poodle has hind limbs rotated outwards - medial patellar luxation

Mar 14, 2016

While jumping up the playpen 2 months ago, this poodle's right back leg was caught inside the fencing. Now the poodle is unable to walk upright, with both lower legs pointed at right angles to his body. He would paddle on his hind legs.

I flex and extend the knees. The gentle poodle wanted to bite me when I extended his right knee. He also reacted in pain to extension of his left knee. Could there be fracture of the tibial growth plate leading to patellar luxation (bilateral) or just lateral patellar luxation and what to do to cure this dog?

X rays Mar 14, 2016

                                          BILATERAL MEDIAL PATELLAR LUXATION


X-rays on Mar 24, 2016

The above X-rays shows the patellas in the groove as the vet had manipulated them. Hence there is no patellar luxation.

                                          BILATERAL LATERAL PATELLAR LUXATION                                        

 The above mentioned x ray showed clearly that the patellas have had luxated laterally
and there appear to be no tibial growth plate fracture from this general view. On close up, there appears to be growth plate fracture

April 15, 2016
The owner brought in the dog for surgery. Need to check for cruciate ligament rupture.

2944. A cat vomits more hairballs than usual

HOOK
In March 2016, a young lady consulted the vet as her cat had been vomiting hair balls more frequently.

Video clip of consultation


This is a Be Kind To Pets Veterinary Educational Video
sponsored by Queens Vets

A CAT VOMITS MORE HAIR BALLS THAN USUAL

CAUSES
The cat grooms excessively and ingested more hairs. Why does the cat groom excessively?
1.  Usually it is due to an environment that is not clean. The cat walks and lie down in this environment, getting contaminated with the dirt or floor cleaning chemicals.
The cat is naturally a clean creature. So he grooms his contaminated paws and body more times to get rid of the contaminants. He swallows the hairs, leading to more hair balls filling his intestines.

2.  The other cause is impacted and inflamed anal sacs. The anal sac oil accumulates and cause pain and discomfort. The cat licks the anal area more frequently to relieve himself of the pain, ingesting more hairs.

SOLUTION
1.  In this case, the cat lives with other cats and all share a common bathroom floor. There is no litter box used. The cats pee and poop on the toilet floor. The owner  may be very busy, being a working lady. She may have clean the floor with stronger detergents and may have forgotten to rinse the floor thoroughly. The owner is advised to keep the toilet floor well rinsed with water after disinfection. 

2.  This cat also has anal sac impaction and infection (video clip). Expressing the anal sacs remove the thick oil.


FOLLOW UP
No more complaint from the owner for the past two weeks.