3186. Singapore cats. Trap, Neuter, Release program

Two cats from a loving home are sent for sterilisation by the vet. They are not stray cats. 

3184. Ah Boy JR blood in urine weak legs

M, not neutered, Jack Russell, 13 yrs    blood in urine   unable to get up normally on hind legs  "constipated" now Nov 10, 2017

Tense swollen abdomen when consulted 5 days ago.
Now, no blood in urine but still has difficulty standing up on hind legs.
Difficulty in giving medication. Will follow up.

3183. A 4-month-old kitten fractures her right hind limb. Salter-Harris fracture type 2 distal femur

INTERN. VIDEO PRODUCTION

HOOK

"Why do you bathe your adopted kitten weekly?" I asked the couple.
"She is adopted. She does not groom her backside after pooping," the husband said. "The cat will clean her backside for her!"
The husband held the kitten after bathing her in the kitchen sink. The kitten wriggled and fell onto the floor. Vet 1 took an x-ray and advised him to go to a vet for surgery to align the broken femoral bone.

Video of kitten before op.


 BKTP IMAGE AND TITLE
A kitten breaks her leg after bathing


PRE-OP VIDEO


SURGERY

Vet 1's X-ray.
Best practice is to take X-ray of both limbs for comparison. Sedation is needed.
I got another X-ray taken as shown:

Salter-Harris fracture Type 2.
Vet 1 said that the fracture was Type 1 but he was not sure whether it was Type 2.

ILLUSTRATION OF SALTER-HARRIS FRACTURES, NORMAL,  TYPE 1 TO 5 



 SURGERY
1. Some vets use short pins to anchor the fractured femoral head to the main shaft. This meant external pins and involvement of the joint.
2. In my case, I used intra-medullary pin and plaster of paris cast. (Intern to read text in X-ray)

POST-OP VIDEO

 Hospitalised for around 1 week
Antibiotics and painkillers daily.
Check for swelling of toes, infection of cast edges
To take out cast in 1 week to check the skin incision wound and replace cast.
 Cast removal 6 weeks post op.





VIDEO OF KITTEN ON DAY 3



CONCLUSION

"Will the kitten walk and jump normally 6 weeks later?" the couple asked.
With the cast to immobilise the femoral head part to the shaft, chances are good that there will be union and the kitten will have a normal leg again.

POST-OP 4 WEEKS LATER
Dec 5, 2017
Paw swelled overnight. Cast taken off. X-ray

Not fully healed. Needs to confine to cage for next 4 weeks. Pin removed after that.






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BELOW IS NOT FOR INTERN

Vet 1 had taken the X-rays twice and advised surgery for the Salter-Harris type 1 or 2 fracture.
The owner phoned me the next day, Nov 7, 2017. Surgery was done on the same day.


X-rays done by Vet 1. Only one leg was X-rayed

TIPS FOR VETS
x-ray should include the normal leg for comparison and as best practice.

Salter-Harris Type 1 fracture involves only the physis.
Type 2 fracture involves extension of the fracture to the metaphysis or epiphysis
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A cast is needed as this fracture near the joint is unstable. If the fracture is mid-shaft, there will not be any need for casting as the pin will hold the two broken bones together to heal.

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Be Kind To Pets Veterinary Educational Video
Salter-Harris Fracture Type 2 distal femur


X-rays need two normal femurs to be X-rayed, not only one injured femur as done by Vet 1.

Above X-rays done by Vet 1. Only one leg is X-rayed. The kitten was in pain and struggling.

Nov 13, 2017

6 days of hospitalisation. The left knee incision wound to insert the pin is not infected as there is no bad smell and the kitten is active and eating, pooping and urinating in the litter. See video.

The kitten goes home today, confined in small cage as in Toa Payoh Vets for the next 10 days. The kitten will need to come back for review and the cast taken out for checking whether the skin incision wound is infected or damp under the plaster of paris cast.

Strict confinement to the cage for the next 10 days is necessary to prevent movement of the pin away from the femoral head. 



Dec 6, 2017 update
The paw was swollen suddenly. The owner came. Cast was removed on Dec 5, 2017. X-ray done.

Goes home. Confined to crate for another 4 weeks. Pin will be taken out after that.

3182. Case study: Survival rate of hamster under anaethesia

Nov 9, 2017

EMAIL FROM A HAMSTER CARE-GIVER TO TOA PAYOH VETS

...@gmail.com

Nov 7 (2 days ago)

to judy

Hello Judy,

I was referred to your email through your website, and just heard about Toa Payoh vets through your Youtube videos. I have a male hamster who is currently 11 months old, but has a growth on his belly that has been significantly growing from slightly more than a month ago. We have gone to another vet previously, who prescribed the hamster with Meloxicam Oral Suspension (1.5mg/ml) and Enrotril Oral Solution but it did not have any effect on the growth. We did not go ahead with the surgery option as we were told that the success rate is extremely low, due to the use of anaesthesia and him still being very young. The lump also did not appear to be affecting his appetite and quality of life.


However, the lump has currently grown to quite a considerable size. My purpose for this email is to enquire on the survival rate of the hamster, if I choose to let him undergo surgery. I live pretty far away from where your clinic is located at, and is a little difficult to transport him as he has a big cage and gets stressed out easily if moved into a smaller container. It will be great if you are able to advise me on his situation, and I have attached some photos of the lump for you to get a better idea. I am acting as a caretaker for the hamster as his owner is currently living overseas. If she decides to let him undergo surgery, I will definitely make arrangements to bring him down to the clinic. 

Hope to hear from you soon, many thanks!

Regards,

Name of caregiver

REPLY FROM DR SING KONG YUEN

Thank you for email. Anaesthetic risk is very low if the hamster had been operated when the tumour was less than 5 mm in diameter over a month ago and the hamter was healthy and eating well.

All vets have to inform the owner about anaesthetic risks even if the risk is zero in practice. This is part of "informed consent" for surgery and some owners are worried and so delay surgery.

Now the hamster looks thin and the tumour is gigantic (meaning that surgery takes much longer to do, prolonging anaesthesia and increasing risks of death on the op table).

The risks are much higher. In general, the risks of anaesthetic death now may be around 50%.

As for transport of hamster to the vet, put him in a spacious big box if the carrier is too large and heavy. Many vets in practice do not do hamster anaesthesia and surgery as the risks are much higher compared to dog and cat anaesthesia. Some prescribe medication but this is not effective. Therefore, many owners have to find a "hamster" vet.

Please make appointment at 6254 3326 for surgery if the owner accepts the risks.  .

Best wishes.

Dr Sing Kong Yuen.

Toa Payoh Vets

3181. An 8-year-old adopted red-eared slider has no appetite for 2 weeks.

Nov 5, 2017

Thin flattened red-eared slider was adopted. Said to have 4 digits "9215" seen on the flat carapace and this number won first prize in 4 D. The brother bought this number for first 2 attempts but not the 3rd day. Prize came out first prize on the 3rd day.


X-ray on Nov 4, 2017.  11 eggs. Goes home.

 

3180. Travel stories. A lean and mean tanned Japanese Harley Davidson biker

I met him during my stopover place for a toilet break. He was kind enough to let me take his picture. A true Harley Davidson biker has leather outfit and matching handkerchief with shirt. Retired, 65 years old. Looks very fit and strong. Wired hair.

3179. A 4-year-old Exotic Shorthair has black pigmented corneal ulcer (sequestra) in the left eye

Right eye had similar black ulcer on upper half. A vet had removed it and replaced the area with a corneal graft.

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A few months ago, the right eye had a large black corneal ulcer. 
The left eye cornea did not have ulcerations or black pigmentation.

A vet did a corneal graft on the right eye.

3169. Dry eyes in a 14-year-old Jack Russell - keratoconjunctivits sicca (KCA)

Sunday Oct 29, 2017

"The dog was a puppy when we consulted you," the man said. That was in 2003. Today, he had a left ear haematoma and two painful half-shut eyes with thick mucus and pus. The eyes were dry eyes. I checked my medical records. This 14-year-old male Jack Russell who moved his head whenever I tried to examine his eyes had a left eye corneal ulcer in 2012 and was treated.

"We went to other vets for treatment of the eye," the owner did not follow up with me. "But there was no improvement. Now the dog is blind."

"He had been rubbing his eyes," I showed a large bald brownish hairless circular patch around both eyes. "He has dry eyes in which tears are not produced sufficiently or not produced," I said. "This is a case of keratoconjunctivitis sicca. Now the cornea had been damaged badly due to rubbing and the dog is blind."

The dog came in for treatment of aural haematoma and had dental scaling.
----------------------------  


KCA

Two basic causes
1.  Immune-mediated. Altered blood-tear barrier of lacrimal glands
2. Genetic.  Incorrect development of lacrimal glands e.g. Yorkshie terriers.

Signs
mucopurulent  strands of mucus, corneal ulcers, edema, melanisation and pruritus

Diagnosis and monitoring
Schirmer test
More than 15 mm/min - normal secretion
10-15                               suspected hyposecretion
Less than 10mm/min       hyposecretion
*In breeds with physiological ectoprion like Bulldog, a greater amount of tears is needed. Therefore high Schirmer test values may be insufficient. 

Treatment
1. Clear ocular secretions e.g. lactated Ringer's solution or low-mineral bottled water
2. Moisture the eye - based on carbomer or hyaluronic acid. Both give prolonged effect.
3. Stimulate tear secretion - Tacrolimus in severe cases below 5mm/min
                                              Cyclosporine where Schirmer test values above 5 mm/min
.                                              These two are immunolators, ocular lubicrants and have anti-inflammatory lacrimomimetic effect. Review after 2 months.