2925. Review of an Asiatic Bear 3 months after bilateral sublingual mucocoele marsupialisation by a wildlife vet

Sep 14, 2016
Room 304   Hotel Royal Golden View, North Dagon, Yangon
Last day of visit of tour of Myanmar from Yangon to Myitkyina and in between. Hectic.

Playful. put on weight.
Will run away when he sees Dr T T Aung who assisted a wildlife vet from the UK to operate on this bear for bilateral ranulas.
The wildlife vet was operating. An English Vet nurse assisted in anaesthesia. I was an observer.

 Fed dry dog food. Puts on weight.
Problem with one hind paw and limb edema and prolapsed penis which were present before the operation.

The sibling bear was normal in tongue and body and very playful too. Both bears appear to have reddish skin rashes or generalised pustular dermatitis



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2924. Myanmar Travels - jade and gemstones in Mohynin. Inle Lake images

Visited Mohnyin. A bustling town in Kachin State.

6 hours' drive to Hpakant which was famous for landslides killing several hundred itinerant miners. Met a restaurant owner who had worked in Hpakant for 14 years as a supervisor and met his wife there. His 2 sons and daughters are with him, now running this shop near Myitkyina University.

For young men who needed money, they just go to Hpakant to be a miner. Earned some money and come back to Mohnyin. When money runs out, go mining again. Diseases like malaria and typhus still exist. Malaria causes fever, muscle aches  and shivering chills - wrapped with blankets but drugs will cure this.

The Myanmar Gems Enterprise under the Ministry of Natural Resources and Environmental Conservation had issued a moratorium on new licences in July pending a review of mining laws after Hpakant landslides and calls for reforms.

321 jade mining jade and gems block  permits will expired in September and not renewed until by-laws to the Myanmar Gemstones Law have been passed. Licences are required for mining. Unlicensed operators will be arrested and in any case, do not have the heavy equipment to do the mining. Hpakant is jade rich but I cannot visit it as it has malaria. Other licences are in Mohnyin township, Sagain Region's Hkamti township, Mogok and Shan State's Mine Shu.

As a tourist, I travel on the main roads and villages and have not seen a glimpse of the mines which are deep in the jungles.


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Sept - rainy season
Millions of oranges including green ones unload at jetty and crated and loaded onto long lorries.

2923. Myanmar Travel Images - Sep 2016

Meiktila
Busy village. Pony carts seen. Too many bikes and scooters heading here and there.
Toilet break at roadside food stalls difficult to find. A thin sunburnt woman in her late 60s took Thin Thin and I past an alley between huts to her family's toilet sheds. Looks like a typical spritely lady farmer in her younger days. Saw her family's attap house, baby cot, wooden bed, family pics which I videoed.  Much love in this family.

Road filled with scooters and bikes. Shot 3 pic in succession. The 3rd one (this one) shows her smiling as she spotted me. Eye contact makes a great street photograph but it is hard to shoot one with a smile. Generally, the locals smile when I greet them.  

2922. INTERN. VETERINARY FILES FROM MYANMAR. A Yangon cat cannot pee again.

HOOK

VETERINARY FILES FROM MYANMAR

TITLE

INTRODUCTION

MIDDLE

CONCLUSION

CREDITS

FOR MORE INFORMATION

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

HOOK

In 2016,  more cats are being treated for difficulty in urination (dysuria) at the Royal Asia Veterinary Surgery. Male cats are mainly affected. Vets refer to the medical  condition as FLUTD (Feline Lower Urinary Tract Disease) or FUS (Feline Urological Syndrome). Vets report that stress as a main cause of this dysuria in most cases.


However, for the distressed cat owner, a permanent solution is needed to prevent his cat from not peeing normally. The cat keeps going to the litter box and either urinates blood in the urine in small amounts or not at all. The cat loses appetite and becomes lethargic. The cat may be treated by a vet and pees normally for a few days. Then, the cat cannot pee.

VETERINARY FILES FROM MYANMAR

TITLE

The Yangon cat cannot pee again

INTRODUCTION

1. Some vets will not perform surgery as it is a more complicated surgery. Some vets may have insufficient surgical experience.

Dr Sing Kong Yuen from Toa Payoh Vets ask Dr Thein Tun Aung of Royal Asia Veterinary Surgery to share his experiences with numerous surgical cases done by him for recurring urolithiasis in cats in Yangon.

VIDEO ABOUT T T AUNG AND HIS CASES

MIDDLE

VIDEO ABOUT T T AUNG ILLUSTRATING THE SURGERY AND CAUTION THAT THE OPENING MUST BE AT LEAST 0.5 INCHES WIDE TO PREVENT CLOSURE OF THE URETHRAL WOUND. If the wound closes as it is too narrow, the cat cannot pee again.

CONCLUSION

CREDITS

FOR MORE INFORMATION

2 VIDEOS FOR RI INTERNS - Cat tibial fractures and how to create BKTP Videos for future interns

Sep 8, 2016
From: Myitkyina, Myanmar
Hotel Madira, Room 303


Email instructions as below:

Pl review my 2 case reports in my blog 2010 and website and youtube. You may need to search "cat tibial fractures".

Use timelines of 2 cases.

1. CASE 1. A stray cat jumped down from sofa? X rays confirm fracture.

2. CASE 2. A cat fell from apartment. X-rays.

TREATMENT. Same. Use of intramedullary pin. Do more research on various types of fractures (google tibia fractures) e.g comminuted fractures etc. So, what type of fracture these 2 cats have?

Is it possible to use plates and screws? Why not?

OUTCOME

6 weeks post op.

CASE 1 did not go to the referral vet for pin removal 8 weeks after surgery. She phone me some 3 months later. I asked her to send video clip  (check my you tube). Cat is OK. No pin removal

CASE 2. Vet sent a reminder card to come 6 weeks post op for check. X-rays done. (see blog and download and comment with Dr Daniel). What decision did Dr Daniel make?

Do show more images of pin etc (in my websites).

USE BKTP images from my website

ALWAYS GIVE "Credits" and "FOR MORE INFORMATION....". See my other video done by RI intern recently.

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CASE 3.

HOW TO CREATE A BKTP Veterinary Education Video.

Create a video for me to present to all interns so that I have consisten format, structure and no more worries about copyright infrigement of music and images. I will get this video posted by your RI teacher for future interns as I spend so much time correcting mistakes.

See some videos done by other interns as regards this subject matter.

INCLUDE

1. Your Chow Chow video as A REAL  example of WHAT NOT TO DO and what to do.

Basically, the video should be:

1. An exciting hook. For example, the Chow Chow banging into doors as he can't see clearly and that is what the owner said. Do drawing and  illustrations with coloured pencils etc. Your hook is not so good and is too brief.

2. BKTP IMAGE

3. Title of the video and what is its objective.

4. INTRODUCTION

5. MIDDLE     3-6 POINTS  e.g. what happens if you don't do surgery, why must you do surgery. The 5Ws and 1 H. What evidence to support vet diagnosis

6. CONCLUSION     Outcome. Other similar cases

7. ADVICES TO PET OWNERS

    Advices to vet students

8. CREDITS preferably with a Singapoean  video scene

9. FOR MORE INFORMATION  (IMAGE)

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

FOR INTERNS

1. No copyright infringement esp.music and images and video

2. Subtitles  not to be all capitals

3. Subtitles to have black text on white background strip

4. Narration NOT to be monotonous

5. Narration to be loud if a point is to be heeded

6. Use of copy-right audio (from you tube) to make video more interesting

7. Around 10 minutes of content

8. Use hand drawn illustrations with colour to illustrate surgery  or procedures

9. Do more veterinary  research  on title of video and discuss with vet

10. Use mind maps, not just scribble notes on papers. It seems 99% of the interns in the past years  do not use mind maps and so waste a lot of time writing and re-writing.

11. Write script before producing video. Script in 2 columns. Left column is text. Right column is where you want to insert video, images etc in the relevant text

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Use this image:

2920. Cat - tibia fracture review 6 weeks after pinning

Sep 3, 2016

X-ray taken.
Cat with right hind leg tibial fracture
Pin was put in 6 weeks ago. The owner came to check whether pin can be removed.

Not fully healed at 6 weeks.
Repeat x-ray 2 months later

Cat can walk normally.

2919. 20 minutes to spay a caterwauling 7-month-old cat

Tuesday Aug 30, 2016


I was demonstrating spay to an RI Intern. RI sends 3 batches of Sec 4 interns to Toa Payoh Vets based on their interest in veterinary medicine.

Today, I demonstrated the pre-op and operation of a 7-month-old cat being spayed by me.  

How long does it take for an experienced vet to operate a 7-month-old caterwauling cat?
Incision to end of stitching = 20 minutes.

The time is longer as the cat was moving on incision and I had to top up with 3 minutes of isolfurane + O2 gas, hence prolonging the surgery.

I tried a tested anaesthetic formula used by the other vet who sterilize at least 20 stray cats per day.
the formula is as follows:

Cat 2.6 kg
Xylazine 20 = 0.26 ml IM. Wait 5 minutes.
Ketamine     = 0.16 ml IM 
Surgery with top up gas if necessary.

I tried this formula but combined in one syringe xylazine and ketamine IM instead of separately in 2 syringes. Waited 15 minutes. But the cat showed signs of movement on incision but the anaesthetic gas was effective.

A video is produced by my RI intern.

2918. Image to inspire a 16-year-old to study hard

A 16-year-old terrapin limpson right hind and has bruised right hind leg - x rays subluxated r hip

2916. Review of 2-year-old pug with urticaria

August 21, 2016

The 10-kg pug started to itch again. Pustules and red skin between the thigh and belly area (video).
Rashes in armpits. Several rashes at left and right sides of the body. Ears no longer inflamed and painful as the owner had used a steroidal ear ointment but the hair loss and shorter hairs of the flanks tell a story of ear itchiness.

"The hind legs start to hammer at the flanks when the dog has ear pain or itchiness," I told the young couple as this hair loss area is commonly seen in other dogs with ear canal infections. (video).

"The 4 paws are also itchy now," the lady said after the end of medication with the white tablets. These were anti-fungal tablets. In reality, the pug was itchy despite the Royal Canine Hypoallergic diet soley fed..

The allergy test report from the US had arrived 1 week ago. said that the dog is allergic to chicken, corn, oatmeal, malassezia but not allergic to beef, pork, turkey, carrots , milk, eggs or two dust mites.

PLAN
1. Home-cooked pork + brown rice + carrots
2.  E-collar 14 days 24 hours per day
3. Amitraz wash for the rashes
4. Review in one months
5. Medication for rashes
6. Ear ointment once a week and massage


ADVICES
1. Anal sac expression weekly before bathing (grey oil seen/expressed today)
2.Lateral ear canal resecetion and tail fold surgery advised in 6 months.
3. No treats and other food for next 3 months except the above-mentioned diet of pork + brown rick and carrots. 

2915. Throat X rays of the dog and cat - A 14-year-old Miniature Schnauzer has a large neck abscess

Aug 19, 2016

It is very important that old dogs get their dental work done and all rotten smelly loose teeth extracted. In this dog, in March 2014, I was consulted about a big lump on the dorsal part of the tail end. "It is a sebaceious gland tumour," I said. Surgery removed the tumour and no more visit from the dog.

Today, the old dog came in gasping for breath and crying. Panting a lot. "The dog cannot stand for the past 2 days. Not eating. He has a large swelling under the chin, also diarrhoea," the mum said. The daughter was working and so she brought the dog down.

A soft firm swelling across the neck below the chin. Around 3 inches x 4 inches x 3 inches. I got an X-ray done as I suspected an abscess. Lanced and reddish-brown pus flowed out. Around 100 ml collected.

No anaesthesia is given as the dog's tongue turned deep purple when restrained for examination. The dog had great difficulty breathing. Rotten teeth spread bacteria into the heart valves.

BLOOD TEST ON ADMISSION ON AUG 19, 2016
Glucose 2.6  (3.9 - 6.0). Dog was not able to stand up.

Liver enzymes   ALT/SGPT    117  (less than 59)<59 p="">
                           AST/SGOT    133 (<81 br=""> less than 81)                   
Urea                   15.3 (4.2-6.3) but creatinine is within normal range. Kidneys are normal in this case.
Total white cell count  39.8  (6-17)
Neutrophils  90%  (60-70%), Absolute 35.8  (3-11.5%)
Lymphocytes 10%  Absolute 3.98
Monocytes, eosinophils and basophils are zero.
Platelets 431 (200-500)

<59 p="">
<59 p="">
<59 p="">CONCLUSION
What the owner wants is a dog alive. Therefore, the diagnosis must be correct and X-rays are needed to provide the evidence of neck abscess. Aspiration of the neck swelling confirms pus. Incision of 2 cm drains out most pus. The next day, syringing the abscess and removal of the gelatinous pus which is formed due to the medication of baytril and a low dose of dexamethasone. 
<59 p="">
<59 p="">As you can see the video, the dog is much comfortable on Day 2 after treatment and no longer pants in great pain.  The outcome is good and the dog will go home on Day 3, after another IV drip today.<59 p="">Teeth scaling and check up every year for a senior dog would have had prevented such a condition of neck abscess and great pain in the neck. Owners need to spare some time to bring dogs older than 5 years old for yearly dental check up and vaccination.  However, a majority do not do it.
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<59 p="">

<59 p="">

<59 p="">

<59 p="">

<59 p="">OTHER X RAYS OF THE NECK

looking for bone inside the throat

normal throat and neck

normal throat and neck.  Normal oropharynx (No. 4)  is not swollen

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the cat has normal nasopharynx (throat)

cat has normal nasopharynx (throat)

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Submandibular Abscess causing great breathing difficulty. This 14-year-old Maltipoo had pus in the right ear for many weeks.The bacteria inside this area finally penetrated into the right neck area, forming a very painful right submandibular abscess. See lateral view of X-ray as evidence. The dog's abscess was lanced and drained under general anaesthesia. The dog is normal now. This is a case where ear canal infections can lead to right neck abscess. The owner had consulted a vet earlier for the ear infections but had not followed up when the infections had not gone away. The bacteria went into the neck via the eustachian tube and multipied, form a gigantic abscess.

BLOOD TEST

Dec 9, 2014

Abnormal

Total white cell count 68.5 (6-17)

 N 98%  (60-70%)       N absolute 67.13  (3-11.5)

L  1.6%    L Absolute 1.10
M 0.1%  Absolute 0.07
E  0.3%   Absolute 0.21
B  0%

Platelets  142  (200-500). 

Several abnormal lecuocytes seen. Occasional nucleated red blood cells seen. Large platelets present. 

HISTOLOGY report from 2 biopsy punches on side of submandibular swelling.

No malignancy

 

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heart disease (swelling in throat due to fluid from heart disease)

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

GR with premolar 4 abscess

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

special type of equipment is needed if you want to x-ray a terrapin's throat

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

do not copy this image into video

normal throat (no neck abscess) with a pellet inside the gullet. For illustration.

<59 p="">

<59 p="">-------------------------------------------------------------------

In dogs, an ear abscess is not obvious. But in a terrapin you can see a swelling of the ear to know that he has an ear abscess. Treatment is similar. Incise and drain the pus.  

<59 p="">

<59 p="">

2914. A 2-year-old multipoo passes bloody watery stools for 2 days - X rays

Aug 19, 2016

"My multipoo was passing bloody watery stools for the last 2 days," the lady owner was worried and showed the picture of the stools in her smartphone.
 No abdominal pain. X-rays show some spherical balls inside the colon and watery stools inside the descending colon. IV drip and sent home.

It was a puzzle as to what the spherical balls were. 
.