On Dec 24 to 27, 2012, I will be taking a short break to see how Hongkongers celebrate Christmas. I will be visiting the Stanley Vet Clinic on Dec 27, 2012 from 11 am to 12 am and I am looking forward to meeting some Hong Kong vets and learning more.
Every vet practice I visit teaches me some angles and processes of veterinary practice. In this visit, I would like to know more about skin diseases in Hong Kong dogs and cats and the allergen testings.
Sunday, December 23, 2012
1225. New microscope at Toa Payoh Vets
Dec 22, 2012
A new microscope with software to take images for research and to show clients was purchased by me today. It is able to display the images on the laptop screen. Unfortunately, its software works only with Windows XP while my laptop has Windows 7.0.
So I had to find older versions and older laptops to use this software. My intern Vanessa going to Melbourne Univ 3rd year in 2013 was very hard working and keen in veterinary science. I hope she would be able to complete her "ringworm" project as her last day would be Dec 25, 2012. We had been working on this project and others for the past week. At first we used the iPhone but the images were not good.
Yet with this microscope under high magnification of 100X, the images were not clear. She used Photoshop on her own initiative and we could see the structures of the hyphae, microconnidia, macroconnidia and more. Wait for her report.
Digital imaging will not be taught in vet schools and this project broadened her skills and expertise and see some "cool" creatures of the fungal family in the Tricophyton genus.
A new microscope with software to take images for research and to show clients was purchased by me today. It is able to display the images on the laptop screen. Unfortunately, its software works only with Windows XP while my laptop has Windows 7.0.
So I had to find older versions and older laptops to use this software. My intern Vanessa going to Melbourne Univ 3rd year in 2013 was very hard working and keen in veterinary science. I hope she would be able to complete her "ringworm" project as her last day would be Dec 25, 2012. We had been working on this project and others for the past week. At first we used the iPhone but the images were not good.
Yet with this microscope under high magnification of 100X, the images were not clear. She used Photoshop on her own initiative and we could see the structures of the hyphae, microconnidia, macroconnidia and more. Wait for her report.
Digital imaging will not be taught in vet schools and this project broadened her skills and expertise and see some "cool" creatures of the fungal family in the Tricophyton genus.
1224. Dog transport man's service was undercut by a vet
Today, Sunday, Dec 23, 2012, I spoke to a dog transport man who had transported a Sharpei to be put to sleep due to the fact that the owner was a 70-year-old woman who got bitten whenever she tried to clean his ears. She has 2 Sharpeis and her children from the US were worried about her safety and ability to cope with 2 dogs since she would be in poor health.
I had spoken to her and said it was her decision as to whether she wanted to euthanase 2 Sharpeis or the biting one or none . We had not met before and so I could not say whether the biting Sharpei with the infected ears could be treated for once and for all or would need repeated treatments which would mean veterinary and transport costs. She decided to have the biting Sharpei put down and her son would accompany the ferocious dog to the vet to be euthanased.
According to the transport man, the vet who was handling this case at an outside practice that was not his, said that this Sharpei should not be euthanased as it was just an ear infection. The dog could be sent to the SPCA. Better still, he would treat the dog at his practice as he has a bigger veterinary practice and has his own transport man and facilities.
His remark of having his own transport man made the tranport man wonder why he would be "stealing" his business from him and the other practice. There are all sorts of characters in this world and from some characters, one expect such undermining practices.
I had spoken to her and said it was her decision as to whether she wanted to euthanase 2 Sharpeis or the biting one or none . We had not met before and so I could not say whether the biting Sharpei with the infected ears could be treated for once and for all or would need repeated treatments which would mean veterinary and transport costs. She decided to have the biting Sharpei put down and her son would accompany the ferocious dog to the vet to be euthanased.
According to the transport man, the vet who was handling this case at an outside practice that was not his, said that this Sharpei should not be euthanased as it was just an ear infection. The dog could be sent to the SPCA. Better still, he would treat the dog at his practice as he has a bigger veterinary practice and has his own transport man and facilities.
His remark of having his own transport man made the tranport man wonder why he would be "stealing" his business from him and the other practice. There are all sorts of characters in this world and from some characters, one expect such undermining practices.
1223. Eye specialist with defective software?
On Monday Dec 17, 2012, I was referred by my GP to an eye specialist in the Gleneagles Hospital as I told him I could see some "bubbles" floating in front of my eyes and an arc of white lights flashing in the left eye at the left side. It could be retinal detachment or worse.
The eye specialist was an experienced person of over 70 years of age. The nurses did the tests for glaucoma (eye pressure), macular degeneration (flashing lights and focusing on a bright central light) and dilated my pupils. Then the specialist put a ring to widen the eyelids and scan my eye retina.
I had asked to see an image of my retina and he said OK. He checked my eyes and said they were OK. What I saw would be floaters due to softness of the inner aqueous humour. I asked to see the images on his scan. I seemed able to see some retinal blood vessel branches when he scanned me.
They were all blurred, like a rose bud closing. He said that the images were blurred. Somehow, this made me wonder whether his software was defective or do all eye specialists have this problem of not being able to show the images of the retina in this modern world?
The eye specialist was an experienced person of over 70 years of age. The nurses did the tests for glaucoma (eye pressure), macular degeneration (flashing lights and focusing on a bright central light) and dilated my pupils. Then the specialist put a ring to widen the eyelids and scan my eye retina.
I had asked to see an image of my retina and he said OK. He checked my eyes and said they were OK. What I saw would be floaters due to softness of the inner aqueous humour. I asked to see the images on his scan. I seemed able to see some retinal blood vessel branches when he scanned me.
They were all blurred, like a rose bud closing. He said that the images were blurred. Somehow, this made me wonder whether his software was defective or do all eye specialists have this problem of not being able to show the images of the retina in this modern world?
1222. Internship - video production educational videos for vet students and owners
Internship at toa payoh vets
 | ||
Dec 23, 2012
Pl get some videos completed with Vanessa while I am in Hong Kong from Dec 24 to 27, 2012. Vanessa will be completing her internship in 1 day's time. Pl let Vanessa see this email.
VIDEOS NEEDED ARE:
1. Microscopic examination of ringworm in the dog.
Similar format and narration as to what has been produced in the video below:
That means Vanessa has to illustrate (draw) normal hairs and infected hairs as well as show magnified images (1000X) from the new microscope of both types with reference to the Siberian Husky case.
Include the following 4 images with your other images:
2. Swollen eyes in a red-eared slider in Singapore and the latest video on Dec 22, 2012.
DIAGNOSIS, DIFFERENTIAL DIAGNOSIS and TREATMENT of one case study must be clearly written and videoed. Seven images of feeding multivitamins to the slider by mouth are at: www.toapayohvets.com and they must be used as well as the videos. 4/7 are shown below:
OTHER CASES AT:
2.1 http://www.sinpets.com/F5/
2.2 http://www.bekindtopets.com/
Use the images
In the CONCLUSION, provide advices on prevention of swollen eyes and also on "How to tell whether the slider is male or female and its life cycle e.g. male matures at ... years and females at ... years. Some research is needed.
3. Electro-surgery in a hamster. TOOLS, PROS AND CONS COMPARED TO SCALPEL BLADE EXCISION. Most young people will find electro-surgery as a dull subject as they have so many more interesting distractions. Therefore, produce a video fascinating and compelling to educate vet students and pet owners with images, audio and a strong narrative.
USE THE FOLLOWING IMAGE AS A HOOK - THE HAMSTER WITH AN ARMPIT FULL OF TUMOURS
http://www.kongyuensing.com/
The case is at:
http://www.asiahomes.com/
There is another case of the nose swelling too. Use the images of electro-surgery.
How you are able to integrate the images and tell a good story depends on you.
TOOLS OF THE TRADE
PROS AND CONS COMPARED TO SCAPEL
CASE STUDIES OF INTERESTS (see URLs below) including a guinea pig case.
CONCLUSION. Electro-surgery will not electrocute the hamster or the persons involved. It is a safe technique for certain types of surgery where the scalpel blade cannot be used or used efficiently. If the vet knows how to use the equipment properly and has a sound knowledge of the electro-surgical process to avoid electrical burns and shocks to the persons or animals involved, electro-surgery is a very useful process in veterinary surgery.
URLs of cases done at Toa Payoh Vets
Cases and images should include:
3.1 A case to remove a hamster's ear tumour. Extract the essence of the technique and provide visual images. The case is at:
http://www.bekindtopets.com/
3.2 Another case at:
http://www.sinpets.com/
An example of electro-surgery In another animal is the guinea pig operated by me at Toa Payoh Vets. e.g. a guinea pig (illustrate with the following case study).
Electro-surgery in a guinea pig at Toa Payoh Vets.
http://www.sinpets.com/F5/
3.2 Other cases done by me at Toa Payoh Vets. Get the "relevant" images onto the video. The images are at:
3.2.1 Scalpel blade excises the tumour
http://www.sinpets.com/
3.2.2 Images of one case of electrosurgery at:
http://www.kongyuensing.com/
The case report is at:
http://www.sinpets.com/F5/
3.2.3 A recent case of ear tumour removed by electro-surgery by Dr Daniel is at:
Pl let me know by email if there are queries.
Wednesday, December 19, 2012
Building trust - an old poodle snored loudly making mum's sleep impossible.
Dear Gina
Narrate this case study - Building trust and use the video you had done for me so beautifully. Many thanks. Let Vannessa know and edit this article as I have no time and have to rush to the airport today Dec 24. Have a good holiday. It is very rare to have two interns who are so diligent and interested in veterinary medicine. Best wishes.
REVIEW - A loud snoring old poodle affects working mum's sleep. What to do?
The Patient
Male poodle, 14 years old, sneezing, snoring and difficulty in breathing
1. Jul 29, 2012. Toa Payoh Vets, associate vet reported glaucoma and cataract. Right canine tooth root abscess extracted under general anaesthesia. Most decayed teeth had dropped out. (In Dec 18, 2012, the mum said to me there was a smaller swelling below the left eyelid at this time).
2. Nov 2012. Consulted another vet at another practrice. He accepted medication but not advices on surgery and other tests.
3. Dec 15, 2012. The son consulted me. Blood from nose as he fell yesterday. Sneezing, snoring, breathing difficulty. Heart and lung sounds normal. Surgery advised but worried about risks.
"What are the chances of surviving the anaesthesia?" the young undergraduate was told it was slightly more than 50% after I examined the heart of his mum's very old poodle and found it to be in good state. He said: "50% is not good enough. The poodle could just die on the operating table. Would you say 20%? I have not got the dog operated because the other vet said the same 50% as you. My mum's dog is here today and gone tomorrow if he dies on the operating table! How about some medication?"
"As your dog has normal heart sounds, I assessed his survival as more than 50% but I can't say it is 80% as he is very old. He is blind and has fully developed cataracts in both eyes.
I believe that your dog's snoring is due to an infection of the sinuses near the left eye. Your dog has a large 'eye-bag' below the length of the lower eyelid. It is around 3 cm in lenght. It is most likely an infected tumour. An abscess in this left eye. It spreads the bacteria from there to the sinuses and to the back of the nostrils. The sinuses will be the maxillary sinuses which get infected and blocked as well." I said. "This obstruction and inflammation causes pain and snoring."
"How can that be?" the young man questioned my hypothesis. "The nose is quite far from the left eye!"
"The maxillary sinuses are connected to the nostrils. The inner side of the left eye connects to the nostrils through the lacrimal or tear gland ducts. Any bacteria from the left eye's lower eyelid will spread from there to the tear gland ducts and into the maxillary sinuses and into the back of the nostril. This causes sneezing and painful breathing difficulties."
The young man was not convinced. So I advised a blood test to screen the health of the old dog and if the dog is healthy, the blood test will show it. Then he can decide whether to permit anaesthesia or not.
"The dog did survive one anaethesia in July 2012 to extract the rotten right canine tooth," I said.
"I don't think he will survive another anaesthesia," he said.
"Surgery is the solution. I can give you the medication which would just be a waste of money." A vet can't build trust if he milks the patient just to make his money. But here, the issue is of anaesthetic risk and veterinary competence. Every vet will say this is extremely risky and so most owners will procrastinate till they can't wait any longer.
The blood test showed normal results and the dog was operated on Dec 18, 2012. The dog now objected strongly to direct isoflurane gas by mask before intubation. What to do? I decided on 25% of the dosage for domitor and ketamine IV. The dog needed just less than 5 minutes of isoflurane gas and he was knocked out. Electro-surgery acrosss the lower abscess shot out lots of yellow pus. I used the electrode to cut off as much of the tumour under the skin as possible. The tumour had 4 holes with pus leaking outwards. Pus also leaked out from inside the eye at the medial canthus but this was going on for some days (the owner wiped it off every day, she told me after my surgery but more pus oozed out again). The old dog did not wake up despite me switching off the isoflurane gas for some 5 minutes as I electro-excised the tumour. A spurting arteriole on the lateral canthus area sprayed me like a machine gun. I used the electrode to coagulate and quickly stitched up the cut with 3/0 absorbable sutures interrupted.
The tip for success in old dog surgery is to operate in as short a time as possible. In this case, the time had stretched to over 15 minutes. If more time is spent, the heart may fail as this is an old dog and other blood vessels may not be as strong as a young dog. Rupture of arteries may happen. The dog may die. So, surgery must be very fast. Bleeding was profuse. There was not much time to be wasted on catching all the bleeders. I closed the wound. As the dog could not get up, I gave 0.1 ml of the Antisedan antidote IM. He got up within 2 minutes with a profusely bleeding eye. I used a bandage to cover the wound. Still the bleeding continued. I used cold compress. However, such bleeding would be controlled by the closure of the wound and so I was not worried.
Today was a bright sunny morning of Dec 19, 2012. I phoned the mum. She sounded quite happy when I asked about the dog's snoring. "Will you say the snoring is less than 50% as compared to the night before surgery?" I asked. "Yes, yes," she said that the profuse bleeding had stopped, the dog had eaten and thanked me.
In private practice, building trust is important. But good surgical outcome and performance are still very important.
In old dogs, the client considers only one matter. His or her old companion is alive at the end of surgery. No excuses. There was no point doing a perfect surgery removing all bleeders and presenting a dead old dog with no post-op bleeding due to meticulous ligation and coagulation. In this case, the bleeding would stop by pressure control after stitching and it did so by the next morning when I phoned the owner to check on the bleeding status. I told the owner that it was not possible to remove 100% of the tumours and that only 80% of the tumours were electro-excised. As to whether the tumour below the eyelid was malignant or not, I advised sending the tumour to the laboratory as this is part of professionalism. The owner did not want histopathology but she had been informed and that is important for the veterinary surgeon.
Speed, accuracy and completedness are hall-marks of a good surgeon. In this case, speed is most important.
Narrate this case study - Building trust and use the video you had done for me so beautifully. Many thanks. Let Vannessa know and edit this article as I have no time and have to rush to the airport today Dec 24. Have a good holiday. It is very rare to have two interns who are so diligent and interested in veterinary medicine. Best wishes.
REVIEW - A loud snoring old poodle affects working mum's sleep. What to do?
The Patient
Male poodle, 14 years old, sneezing, snoring and difficulty in breathing
1. Jul 29, 2012. Toa Payoh Vets, associate vet reported glaucoma and cataract. Right canine tooth root abscess extracted under general anaesthesia. Most decayed teeth had dropped out. (In Dec 18, 2012, the mum said to me there was a smaller swelling below the left eyelid at this time).
2. Nov 2012. Consulted another vet at another practrice. He accepted medication but not advices on surgery and other tests.
3. Dec 15, 2012. The son consulted me. Blood from nose as he fell yesterday. Sneezing, snoring, breathing difficulty. Heart and lung sounds normal. Surgery advised but worried about risks.
"What are the chances of surviving the anaesthesia?" the young undergraduate was told it was slightly more than 50% after I examined the heart of his mum's very old poodle and found it to be in good state. He said: "50% is not good enough. The poodle could just die on the operating table. Would you say 20%? I have not got the dog operated because the other vet said the same 50% as you. My mum's dog is here today and gone tomorrow if he dies on the operating table! How about some medication?"
"As your dog has normal heart sounds, I assessed his survival as more than 50% but I can't say it is 80% as he is very old. He is blind and has fully developed cataracts in both eyes.
I believe that your dog's snoring is due to an infection of the sinuses near the left eye. Your dog has a large 'eye-bag' below the length of the lower eyelid. It is around 3 cm in lenght. It is most likely an infected tumour. An abscess in this left eye. It spreads the bacteria from there to the sinuses and to the back of the nostrils. The sinuses will be the maxillary sinuses which get infected and blocked as well." I said. "This obstruction and inflammation causes pain and snoring."
"How can that be?" the young man questioned my hypothesis. "The nose is quite far from the left eye!"
"The maxillary sinuses are connected to the nostrils. The inner side of the left eye connects to the nostrils through the lacrimal or tear gland ducts. Any bacteria from the left eye's lower eyelid will spread from there to the tear gland ducts and into the maxillary sinuses and into the back of the nostril. This causes sneezing and painful breathing difficulties."
The young man was not convinced. So I advised a blood test to screen the health of the old dog and if the dog is healthy, the blood test will show it. Then he can decide whether to permit anaesthesia or not.
"The dog did survive one anaethesia in July 2012 to extract the rotten right canine tooth," I said.
"I don't think he will survive another anaesthesia," he said.
"Surgery is the solution. I can give you the medication which would just be a waste of money." A vet can't build trust if he milks the patient just to make his money. But here, the issue is of anaesthetic risk and veterinary competence. Every vet will say this is extremely risky and so most owners will procrastinate till they can't wait any longer.
The blood test showed normal results and the dog was operated on Dec 18, 2012. The dog now objected strongly to direct isoflurane gas by mask before intubation. What to do? I decided on 25% of the dosage for domitor and ketamine IV. The dog needed just less than 5 minutes of isoflurane gas and he was knocked out. Electro-surgery acrosss the lower abscess shot out lots of yellow pus. I used the electrode to cut off as much of the tumour under the skin as possible. The tumour had 4 holes with pus leaking outwards. Pus also leaked out from inside the eye at the medial canthus but this was going on for some days (the owner wiped it off every day, she told me after my surgery but more pus oozed out again). The old dog did not wake up despite me switching off the isoflurane gas for some 5 minutes as I electro-excised the tumour. A spurting arteriole on the lateral canthus area sprayed me like a machine gun. I used the electrode to coagulate and quickly stitched up the cut with 3/0 absorbable sutures interrupted.
The tip for success in old dog surgery is to operate in as short a time as possible. In this case, the time had stretched to over 15 minutes. If more time is spent, the heart may fail as this is an old dog and other blood vessels may not be as strong as a young dog. Rupture of arteries may happen. The dog may die. So, surgery must be very fast. Bleeding was profuse. There was not much time to be wasted on catching all the bleeders. I closed the wound. As the dog could not get up, I gave 0.1 ml of the Antisedan antidote IM. He got up within 2 minutes with a profusely bleeding eye. I used a bandage to cover the wound. Still the bleeding continued. I used cold compress. However, such bleeding would be controlled by the closure of the wound and so I was not worried.
Today was a bright sunny morning of Dec 19, 2012. I phoned the mum. She sounded quite happy when I asked about the dog's snoring. "Will you say the snoring is less than 50% as compared to the night before surgery?" I asked. "Yes, yes," she said that the profuse bleeding had stopped, the dog had eaten and thanked me.
In private practice, building trust is important. But good surgical outcome and performance are still very important.
In old dogs, the client considers only one matter. His or her old companion is alive at the end of surgery. No excuses. There was no point doing a perfect surgery removing all bleeders and presenting a dead old dog with no post-op bleeding due to meticulous ligation and coagulation. In this case, the bleeding would stop by pressure control after stitching and it did so by the next morning when I phoned the owner to check on the bleeding status. I told the owner that it was not possible to remove 100% of the tumours and that only 80% of the tumours were electro-excised. As to whether the tumour below the eyelid was malignant or not, I advised sending the tumour to the laboratory as this is part of professionalism. The owner did not want histopathology but she had been informed and that is important for the veterinary surgeon.
Speed, accuracy and completedness are hall-marks of a good surgeon. In this case, speed is most important.
Sunday, December 16, 2012
New idea from Intern V
Sunday Dec 16, 2012
As part of her internship, I asked Intern V to illustrate the ringworm arthrospores etc. She came out with a new idea, using her iPhone to take images of the microscopic examination of the infected hair. I was most impressed. No more laborous inaccurate drawing.
I could use software to capture the images but I need a special microscope and this costs money. So her use of iPhone was great. Some images will be shown later.
As part of her internship, I asked Intern V to illustrate the ringworm arthrospores etc. She came out with a new idea, using her iPhone to take images of the microscopic examination of the infected hair. I was most impressed. No more laborous inaccurate drawing.
I could use software to capture the images but I need a special microscope and this costs money. So her use of iPhone was great. Some images will be shown later.
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