Follow up: Rabbit with large cheek abscess

E-MAIL TO DR SING DATED Jun 19, 2012
Dear Dr Sing,

here are the photos of Huihui and Ban Ban's most recent photos. No 18 is to let you see how they are housed currently, normally no partition only cos Huihui needs to be separated from Banban currently.

Thanks a lot for helping explain many things to us also and all the advice and recommendations.

Just to inform you that Huihui has started eating the pellets slowly and had drank at least 10mls of apple juice.


E-MAIL TO DR SING DATED Jun 24, 2012

I want to ask when should I stop pumping in the chlorohexidine wash into his face as the hole actually closes up every morning and evening and I have to poke through the sealed hole each time I wash..... The swelling has gone down considerably but the area around the hole is quite hard so I am not sure if there's anything wrong. I am not sure if there is still any pus inside although I thought I see some whitish stuff inside. His appetite has gone back to normal and his speed of eating has returned to normal. He also started to lick me after each treatment, which I considered as a good sign as he hasn't did that since the swelling started. He has also regained his energy, running and jumping up and down his toilet, standing up frequently to beg for treats/pats. So can you please advise me if I should continued poking through the hole to wash or just leave the hole to closed up?

Sorry for the long letter but I thought I should let you know how he is doing


E-MAIL FROM DR SING DATED Jun 24, 2012

I am glad to see one of your two rabbits after over 5 years. I am still checking my website the original picture taken when I neuter and spay your two rabbits.

You have written an excellent post-op nursing report. Good detailed report from the owner is very rare and is useful as a follow-up on the operation (lancing of the abscess done by Dr Vanessa before the X-ray as advised by me).

You need to flush out as much pus from deep inside the abscess and therefore continue irrigation till you don't see any "white" pus inside the cavity.

1. From the X-rays, the abscess from the elongated impacted molar is very deep and molar tooth extraction should be the solution to prevent recurrence of the abscess. However, this procedure is not so easy in a rabbit compared to the dog and cat.

2. The rabbit needs to be checked for molar spurs every 4 weekly. Trimming of the spurs to the gum line may be necessary in malocclusion.
3. Make an appointment next Sunday morning July 1, 2012 to check on the molars and the abscess. I am in the midst of writing a case report of your rabbit X-ray. It takes lots of time to do it. Best wishes.

1047. Permission to use image of cat with rectal prolapse

On Sat, Jun 23, 2012 at 5:52 AM, Hannah Lieberman wrote:


Hi there,

I run a non-profit foundation mobile veterinary clinic that we take to low-income neighborhoods in Los Angeles, CA three days a week to perform veterinary surgeries on pets belonging to low-income residents. All services are completely free.


I am currently building a new website, and including photos of ailments that we're able to treat in our clinic. Since we treat rectal prolapses, I'd like to include a picture of one.

I really like the picture of the cat with the rectal prolapse you have your website, and would like to include it on ours. May we get permission to do that, please?

E-MAIL REPLY FROM DR SING DATED JUN 23, 2012
I am Dr Sing from Toa Payoh Vets. Which picture hyperlink is that? Please let me know.


You can use the picture of the cat with rectal prolapse if you use it without deleting "toapayohvets.com" acknowledgement. Good luck.

1046. Closed Pyometra - blood tests and x-rays

Golden Retriever, Female, 10 years

Not eating for 4 days. Lethargy. No fever.

History: Polydipsia & Polyuria

1.  Blood test:
Total WCC = 38 (6-17). N86%, L4%, M9%, E1%, B0%

2. X-rays: Uterine horns filled with pus
3. Ultrasound: Pus seen in both uterine horns. Cervix is closed.

Diagnosis: Closed pyometra

Surgery: 1 hour. Spayed.

Outcome: Good. Dog is back to normal.

High total white cell count and history indicated closed pyometra. X-rays and ultrasound are useful to confirm pus in the uterus.

1045. Example of a veterinary report

From Jun 23, 2012, all veterinary surgeries will be recorded in the following format:

http://www.bekindtopets.com/animals/20120613veterinary-report-format-adenocarcinomasingapore-ToaPayohVets.htm

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From Jun 23, 2012, all vets at Toa Payoh Vets will record the veterinary surgeries done in the following format and e-mail to Dr Sing. This e-mail will be stored in the "cloud". An example is given below:



Veterinary surgery report - excision of bladder adenocarcinoma on May 14, 2012 & follow up 38 days later on Jun 21, 2012



Date of Veterinary Surgery Report: Jun 22, 2012

Name of Veterinary Surgeon: Dr Sing Kong Yuen & Dr Daniel Sing



Case seen on May 14, 2012 by Dr Daniel Sing

1. History & Complaint: TP 43355, (Name of Dog), Beagle M, 13 years, attended by Dr Daniel Sing



2. Presenting Sign & Symptoms: Incontinent with bloody urine dripping all over the floor and passing blood clots for > 4 weeks. Haematuria + Anaemia



3. General Examination: Abdominal pain



4. Tests done & significant findings of tests:

4.1 Blood tests

May 10, 12. RBC low 5.1 (5.5-8.5), Total WCC 12.4 (6-17), N 75%, L12%, M7%, E5%,B1%

Jun 21, 12. RBC 5.6 (5.5-8.5), Total WCC 12.1 (6-17), N 77%, L16%, M7%, E0%,B1%



4.2 Urine tests

May 10, 12. pH 5, SG 1.005, Protein 3+, Ketones 1+, Blood 4+, WBC 90, RBC>2250, Bacteria 3+



Jun 21, 12 pH 7, SG 1.008, Protein 1+, Ketones -ve, Blood 3+, WBC 48, RBC 351, Bacteria 3+



4.3 Histopathology: Moderately differentiated adenocarcinoma



5. X-rays: Radio-dense "stones" seen in bladder area.



6. Anaesthesia: May 15, 12. Body weight: 16 kg. At 50%, Dom 0.32, Ket 0.4 ml IV. Isoflurane gas maintenance. Surgery time: 2 hours. Polysorb absorbable sutures 2/0 x 3 packets, 3/0 x 1 packet



7. Surgery: May 15, 12. Excision of hard gritty tumour, 1.8cm x 1.5cm x 0.5 cm, near the neck of the tumour. Sent for histopathology. Operating surgeon: Dr Sing K Y. Assisted by: Dr Daniel Sing



Follow-up dates: May 22, 12 7.35 pm, Dr Sing K Y phoned owner. No response.

Jun 22, 12, Dr Daniel Sing informed owner of the 2nd blood and urine test results



Signature of Veterinary Surgeon: Dr Sing K Y

Date of this report: Jun 22, 2012



Attached and owner has acknowledged receipt:

Blood tests given to owner: No

Urine tests given to owner: No

X-rays given to owner: No

Ultrasound report given to owner: Not Done.

Histopathology report given to owner: No

Sterilisation Certificate No. .... given to owner: NA

Others given to owner: NA



Anaesthetic & Surgical Record No. ........(Form is not printed yet).

Ear Scope: NA

Skin scraping: NA

Opthalmoscopy: NA

Urinary stone analysis report: NA

Others: NA



Comments by Dr Sing K Y

Another two attempts to phone the owners were not successful. On Jun 21, 12, the owners came with the complaint of painful left hip and re-stocking of anti-seizure medication which must be given daily to prevent seizures. Jun 21, 12 was 38 days after the surgery.



Outcome of surgery: Good. On Jun 21, 12, the couple is very happy that the dog is active and no longer drips dark brown blood and passes blood clots everywhere. They said the urine is clear and has no blood. The dog is able to control his bladder during the daytime but not at night. The dog weighed 15 kg compared to 16 kg during first visit but is putting on weight. Bladder palpation by Dr Sing elicited a painful whine from the Beagle. The bladder was around the size of the tennis ball. Catherisation by Dr Daniel Sing did not produce urine. The wife came later in the afternoon with a bottle of urine collected directly from the dog.



Results: This 2nd urine test indicated UTI and demonstrated the presence of blood. The lab reports will be given to the owner at the next visit.



2nd urine test: Jun 21, 12 pH 7, SG 1.008, Protein 1+, Ketones -ve, Blood 3+, WBC 48, RBC 351, Bacteria 3+



baldder adenocarcinoma seen during surgery. beagle, male, 13 yearsCase report at Toa Payoh Vets:

tpvets_logo.jpg (2726 bytes)5301.

Trust & Audit in a Case of an old Beagle with fits and bladder cancer



http://www.sinpets.com/dogs/20120440veterinary-audit-cystotomy-carcinoma-bladder-toapayohvets-singapore_ToaPayohVets.htm

1044. Veterinary surgery report will be recorded for every surgical case in the following format

A veterinary report will be recorded for every surgical case with the following format and filed on the discharge of the pet:

Date of Veterinary Surgery Report:
Name of Veterinary Surgeon

1. History & Complaint
2. Presenting Sign & Symptoms
3. General Examination
4. Tests done & significant findings of tests
5. Diagnosis - tentative and confirmed
6. Treatment
7. Anaesthetics, Surgical procedures, Sutures & No. of packets used (Record No. )
dates
8. Date admitted: Date discharged:
9. Clinical outcome 3 & 14 days or later - Follow-up dates:

Signature of Veterinary Surgeon
Date of this report

Attached and owner has acknowledged receipt:
Blood tests given to owner
Urine tests given to owner
X-rays given to owner
Ultrasound report given to owner
Histopathology report
Sterilisation Certificate No. given to owner
Others given to owner
Anaesthetic & Surgical Record No. ....................
Ear Scope
Skin scraping
Opthalmoscopy
Urinary stone analysis report
Others

Comments by Dr Sing K Y

1043. The cat bit his tongue - need for thorough exam of the mouth

Two cats fought on the ledge of the 7th storey HDB flat. Both fell at 10 pm yesterday. The stray cat died. The home cat came for treatment as she has blood stained chin.

Simple case. A horizontal lacerated wound. Stitched up 3/0 nylon for chin lacerated wound. 5/0 nylon for tongue vertically lacerated wound (lower and upper area) . I advised nylon instead of dissolvable as the area was infected due to trauma and cat fight.

After the surgery, I took some pictures and saw the lice running around the face. Also tartar in the teeth of this 3 year old cat. I phoned the owner to advise dental scaling and he said OK. During scaling, the vet noted a big laceration of the tongue. The owner was phoned to give permission to stitch up. I advised 5/0 nylon and 3 simple interrupted stitches on top and 2 below the tongue surface.

Always examine the whole mouth from end to end as vet medicine springs surprises.

1042. Failure to keep a proper record: $5,000 fine for senior cardiothoracic surgeon

Straits Times Jun 20, 2012
I showed the article to Dr Daniel and Dr Vanessa to illustrate the importance of meticulous recording to protect against litigation.

The cardiothoracic surgeon of the National Heart Centre was fined $5,000 by the Singapore Medical Council. He was censured and to give an undertaking that he would not repeat the clincial error and pay the cost of the legal proceedings.

What he did not do:

1. Failed to keep a proper record of his discussion with a patient's operation. Fined $5,000 for professional misconduct.
2. Failed to note the patient's consent to the operation (lobectomy).
3. Needed to maintain a higher standard as a senior doctor of 22 years so as to be a role model for junior doctors.

The Committee said that keeping proper medical records is part of patient treatment and these records avoid disputes between doctor and patient. The patient had given his informed consent but the surgeon had not recorded the informed consent given in this case. This is different from not obtaining informed consent.

FOR VETS
1. Patient to sign the informed consent form
2. Vet must record in writing that the patient has given informed consent (time, date).

The practice is usually to get the informed consent form signed by the pet owner.