1248. Two interns: Electro-excision tumours in 2 dwarf hamsters

TOA PAYOH VETS toapayohvets.com Date:   17 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Electro-excision of a large ear wart or tumour in 2 hamsters  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   17 January, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 CASE 1. Ear wart or tumour Nowadays, Singapore's pet owners are much more sophisticated and educated. I got an e-mail (below) with 4 images of the hamster's ear wart or tumour from the young couple in a yellow car.   ...i@gmail.com> 12/9/12   to judy   Dear Sir/Mdm, I have just discovered a tiny growth on the ear of my hamster. Attached are the pictures for your reference. I would like to know if there is any treatment for my hamster and the cost of it. If so, pls advise on an appointment date and time. Thank you. Regards, Name of owner   Kong Yuen Sing <99pups gmail.com="gmail.com"> 12/9/12       I am Dr Sing from Toa Payoh Vets. Thank you for your email. The "tiny" ear tumour needs to be removed by surgery and under anaesthesia. The ear canals need to be examined for other growths. The approximate cost is $150-$200 for consultation, anaesthesia, surgery (+/- stitching) and medication. Appointment is by phone 6254-3326. Bring hamster at 9.30 am and it goes home by 4 pm usually. Best wishes.     Sent from my iPhone Although it is troublesome to set up the electro-surgery equipment just to excise a "small" ear wart, I am in favour of using electro-excision as the cutting needle is much more precise in cutting the skin. It takes time to sell my idea to Dr Daniel as he said it would be easier to snip off the wart with a scalpel. We did electro-excision and he is quite convinced it is a useful method as bleeding is minimal. In retrospect, I would have used the circular electrode needle to go under the ear wart and slice it away. The straight needle electrode was used in this case but both achieved the same results in taking out the "small" ear tumour.     Image from hamster owner in the e-mail   Remove distracting objects (right) to avoid wasting time on cropping the image   Cropping required to take out the distracting object     The rule of thirds for better image. The hamster's eyes or body should be at the intersection of 1/3 of 3 horizontal and vertical lines to produce interesting images for the viewer       Straight needle electrode used. I should have recommended a  circular one to loop off the tumour   Very little bleeding and more precise cut when electricity has been use to cut off the ear tumour CASE 2. A DWARF HAMSTER WITH A GIGANTIC TUMOUR NEAR THE LEFT HIP Yesterday, Jan 16, 2013, two older women from "Street 12" came with a 64-g female dwarf hamster aged 1 year and 6 months. She had a gigantic tumour near her left hip. "She's biting the lump", one woman said to me. There was a scab of 2 mm x 2 mm due to the hamster's bite. ANAESTHESIA & SURGERY Dr Daniel seems convinced that electro-surgery is useful and efficient as he  used electro-excision of the skin. He excised the tumour which had some abscesses. I weighed the hamster after surgery. She was 50 kg. A heavy weight had been taken out. It was a high risk anaesthesia as the hamster was quite plump and the tumour was massive. However the hamster was still eating. 3 drops of Zoletil 50 was insufficient. "Don't use a large volume of normal saline to top up the syringe," I said to Dr Daniel. "The back muscles of the dwarf hamster is very little. It will be like the doctor injecting 20 ml of liquid into you back muscles. I usually top up the 3 drops of Zoletil up to 0.05 ml in the 1-ml syringe with normal saline before injecting the back muscles of the hamster (see video). I had to use the mask to gas the hamster with isoflurane gas as the Zoletil 50 was insufficient in this plump hamster. Possibly 4 drops would be more effective in a 64-gram hamster or it could be too much and causes death. Much depends on the vet's judgment and experience. This is where the risks of death increase because it is not possible to monitor the hamster's breathing and heart rate (ECG etc not practical in a dwarf hamster). Any overdose of the isoflurane gas meant instant death. No such thing as resuscitation. So, I monitored the anaesthesia top up while Dr Daniel operated. It was touch and go. I had to make sure that the hamster was just below the surgical anaesthesia stage and so you would see some leg movement during stitching. It is NOT possible to achieve the ideal surgical anaesthetic stage as in the dog and cat. The dwarf hamster is so small. "Surgery must be speedy," I said to Dr Daniel. "Undermine the skin, isolate the tumour, clamp the base with a curved forceps, excise the lump and stitch the skin with 6/0 interrupted sutures. All these to be done in less than 3 minutes."  The slower the vet operated, the more the anaesthesia had to be given and this is where the hamster "dies" on the operating table.   CHECKING THE ACCURACY OF OWNER'S ADDRESS. The had written "Street 12" in the address. I asked whether she had left out "Bishan Street 12"? Vets must check the records of addresses. She said "Pasir Ris Street 12". I asked an intern to do this case study. She did a video and case report.     CONCLUSION The hamster took some time to wake up. Two female interns were present. One of them was a single child. She spent much time with this hamster. "Look, she is vomiting the seeds," this lady intern said to me as she observed the surgery and did some video filming of the operation. "The hamster is dislodging the food from her cheek pouch as she is stressed by the surgery and anaesthesia," I told her. "This is a common occurrence. She is not vomiting." Her parents allowed her to keep one cat. Yesterday I told the parents whom I knew from 20 years ago that this daughter  should adopt more stray cats in her apartment. The mother wanted to kill me. "Don't you dare to suggest this," the mother said to me. Many Singapore parents dote on the single child and will tolerate them bringing home stray dogs and cats or buy a puppy. In the end, it is the parents who have to care fore them. Yet yesterday, I met an aged mother, an old client, slim woman with white hairs at the side, from Bukit Panjang. Her 15-year-old Maltese X bought by her daughter long ago is so precious to the mother. The dog came in as she behaved aggressively when carried. The mother knew it was due to false pregnancy. Lots of white milk were present in the dog's swollen mammary glands. This dog still had estrus bleeding 2-3 months ago. At the age of 15 years which is equivalent to 105 years in a human being . This is in contrast to menopause in women at the age of 50 - 60 years. I asked permission for my intern to take pictures for her case study and she said OK. My intern would have written the case in 2013Vets blog.   "Don't feed her," I said to the single child as the hamster wanted to store the seeds. The plump hamster laid on her back and sipped water from the water bottle while lying on her back. The owner came in the afternoon to take the hamster home. The vet must deliver a hamster alive at the surgery. The anaesthesia is the killing part and this is where a vet's reputation is smeared if the hamster dies on the operating table. No deaths should occur if the anaesthesia is minimal and the surgery speedy, but this cannot be guaranteed. EDUCATION VIDEO ON ELECTRO-SURGERY IN THE HAMSTER I can't link this webpage to the video taken by the intern as the video is in another blog called 2013Vets. See www.toapayohvets.com for the link to 2013Vets and get the video.    Name of webpage: http://www.kongyuensing.com/folder7/ 201301117electro_surgery_hamster_toapayohvets.htm   More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes
All rights reserved. Revised: January 17, 2013
Toa Payoh Vets

1247. Miccroscope to show images on laptop screen to client

The instructio​ns for the microscope

	Inbox		x

Chen Yuying	Connect the microscope using the USB cable to the USB port Start Programs Sco...	Jan 4 (13 days ago)
Connect the microscope using the USB cable to the USB port Start Programs Sco...

These instructions are important for the vet. It is good to show the images to clients but the vet sometimes don't bother as it is too troublesome..  

Connect the microscope using the USB cable to the USB port
Start
Programs
ScopeTek
ScopePhoto
Acquire
Live Capture
ScopeTek DCM310

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

 

To take a photo:

Top left corner, click 'capture a frame' and another window box will appear. Click the red X on the new window and a pop up saying 'image has been modified. Need save?' Click yes.

To view one of the shots previously taken, click file on the top left hand. Click open image and then choose which image you want.

1246. Animal activism. An abandoned animal shelter

Straits Times Jan 11, 2013 report: 31 dogs rescued from 'abandoned' animal shelter.

In Singapore, the government had designated some land in Pasir Ris as spaces for dogs. Entrepreneurs bidded for the land and build the kennels or tanks to house the approved species of animals like dogs, cats and fishes. They developed the land and rent out the kennels to private individuals, some of whom operated animal shelters.

However rentals are very high compared to other countries with lots of land. Hence some animal activists find that they can't sustain their operations as they board more homeless dogs. After some years if they don't have financial donations if they could not manage their operations. This would be probably what happened when volunteers at Madam Yap's Shelter in Pasir Ris had not seen its operator for many week and 31 dogs were 'abandoned'.

In animal shelters, the dogs needed to be vaccinated against the serious viral diseases of distemper and parvoviruses. They needed heartworm disease and tick prevention. However, it is extremely difficult to do all these preventive disease program if the shelter has insufficient funds.

A few days ago, I met an animal activist who rented Pasir Ris kennels for $8,000 per month. She had given up this shelter and relocated the dogs or rehomed them.She said Pasir Ris kennels would be taken back by the government in 2014.

Madam Yap's shelter is reported to cost $4,000 a month to operate. This included rent, utilities and a full-time worker but not food and treatment for the sick dogs. Save Our Street Dogs has taken over the place. Their email is sostreetdog@gmail.com 

There is another shelter called Madam Wong's shelter which is still operational, according to my intern who visited Pasir Ris last Sunday, being driven there by her father who doted on her. I had asked her to write an essay on "Animal Activism in Singapore".

 

1245. Recurring FLUTD in a cat

TOA PAYOH VETS toapayohvets.com Date:   16 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits REVIEW A CASE OF A RECURRING FLUTD IN A CAT Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   16 January, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Jan 15, 2013 Recurring FLUTD (Feline Lower Urinary Tract Disease) can be very distressful to the cat and the owner. In one sad case, a couple’s cat with recurring FLUTD of more than 2 times died at a veterinary practice and the wife was very sad. This case was recorded reported in: http://www.sinpets.com/F6/20120218FLUTD-cat-death-toa-payoh-vets_Singapore_ToaPayohVets.htm The cat becomes more aggressive as he knows what the vet is going to inject and catherise him again and again. This was what happened to this 3-year-old, male, neutered cat. The brown-striped cat hissed at me as the lady owner placed him on the consultation table. His spinal hairs rolled upwards making a ridge. However, Dr Daniel appeared not to distress him as he spoke to him while the lady owner kept a close watch. Then he held the cat by the scruff of the neck while I injected his back muscles with xylazine and ketamine to sedate him for a proper examination without stressing him more. The cat was catherised and urine was collected. He was X-rayed as Dr Daniel wanted to eliminate the presence of bladder stones.  FOLLOW UP I phoned the young lady owner today at 11 am to remind her that the cat’s diet must be strictly canned C/D for the next 4 weeks to prevent recurrence of blood in the urine and difficulty in urination. DIET & URINATION “What did you feed him before his urination problems?” I asked the young lady who returned my phone call. “Dry cat food. Sometimes canned food mixed with dry food once a week.” “Do you feed cat treats?” “Yes, he loves them. I give him alternate days. Some reddish pellets. I can’t remember the name.” “Does he drink water?” I asked. “He seldom drinks. He will run away when I try to give him water.” URINE ANALYSIS & X-RAYS Date April 7, 2011 (22 months ago) Jan 11, 2013 URINE ANALYSIS Urine colour Red, turbid Yellow, turbid Urine pH 8.0 8.0 Urine SG 1.021 1.026 Urine Protein + + + Blood in urine 4+ 4+ White blood cells in urine 50 30 Red blood cells in urine >2250 1359 Bacteria in urine Occasional Occasional Crystals in urine* Nil Nil X-RAYS X-rays Not done No radio dense stones Outcome Treated by an associate vet of my Surgery. Given 2 cans of C/D. No complaint for the next 22 months Recovered as at Jan 15, 2013. Fed canned C/D for next 4 weeks and review. No treats or dry food strongly advised by me. CONCLUSION * No crystals in the urine does not mean there are no Struvites or other bladder stones inside the bladder. The cat was sent home on the same day after catherisation and irrigation of the bladder. The cat tore out the urinary catheter at home on the second day. On the 3rd day morning, the owner phoned me saying the cat had difficulty peeing. In the evening, the cat was normal and there was no blood in the urine. Owner compliance with the vet's instructions on medication and prescription diet is invariably poor and so the FLUTD recurs in many cases.  Is this case of FLUTD a case of interstitial cystitis (painful bladder) similar in human beings since there is apparently "no struvite stones" inside the bladder? The presenting sign was the cat having difficulty in urination but no urethral abstraction. Will hydro-distension of the bladder, DMSO and other drugs supplied into the bladder resolve the problem of recurrent FLUTD? Nobody knows as the causes of FLUTD in a cat are numerous. ADVICES 1. Owner adds 2 tablespoons of water into the C/D food. Cat does eat C/D but will not drink water given by the owner. “When he was sick in Jan 11, 2013, he drank a lot of water,” the lady said. “But now he turns his mouth away when I give him water!” 2. Continue C/D canned food for at least one month. Water added to the canned food. 3. No dry food and no cat treats anymore. Webpage: http://www.kongyuensing.com/folder5/ 20130116Recurring_FLUTD_cat_3years_toapayohvets.htm   More info of interesting case studies at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

1243. Mum's favourite dog died at the Surgery.

The "7-year-old" Silkie had difficulty breathing for the past 4 weeks. X-rays showed an enlarged heart. Two years ago, I had recorded harsh lung sounds on the right side of the lungs. Dental scaling and extraction of several loose teeth were just done in March 2012.

The dog wanted to bite me 4 days ago when she was put back into her carrier and the mum took her home after a day's stay in the Surgery for treatment of the lung condition. 1 day ago, the dog could not breathe normally again and was treated. For some unknown reason, the mum decided that the dog would be hospitalised. The dog was quiet and did not attempt to bite me when I checked at 8 pm. The next morning, the dog had passed away.

"I should have taken her home," the mum repeated. "He died of fright as he had never been away from hom at all."

"I did not expect him to pass away," I usually sent the dog home if I think the dog is very ill. "She died of heart failure as you can see the tongue is purplish."

This dog was mum's favourite, one son told me. "He would bite any one who goes near the mum. He is more than 7 years old as my brother got him back as an adult dog."
"Was she having difficulty breathing in the past months?"
"Yes," the girlfriend said. "She would be breathless when walked a short time."  

The dog's teeth were dark yellow and most were gone. So, this dog could be older than 7 years.

1242. A caterwauling and anal sac marking male cat

Saturday Jan 12  2013

A bubbly Malay lady from Woodlands came with her blue-eyed cat and a little boy. "Why do you come all the way from Woodlands? There are clinics near your home." It was her personal choice.
After the usual examination, I said she could come back in one hour to take the cat home.

"One hour?" the little boy with bright big eyes said aloud. He was most attentive
"Yes," I said. "Do you know what is 'one hour'?" I asked him.
He did not reply. Mum laughed.
Two hours later, the mum came with him for the cat.
"There is some bleeding from the operation site," the mum said."
"Disgusting," the little boy added. I was surprised that he uttered this word and wondered whether he knew what it meant. He was 6 years old as his mother told me later as I thought he was 4 or 5 years old. He was bright and would do well in life if given proper attention and if he studied hard.
The cat was left in the surgery till 5 pm when another adult came with 3 more children. Lots of joy and laughter with these young kids around. "I am the 5th sister," the mum said. "This is my 3rd sister."  Third sister was slim and more serious and drove a car. The cat was no longer bleeding and all went home happily.

As to why this 2-year-old cat was sent for neutering, it was because he was caterwauling.
"A stray pregnant female cat waits for him outside the door," 5th sister said. "He is on heat and wants to go out. That is why I want you to neuter him"
"Male cats do not stop meowing noisily immediately after neutering," I said. "It takes time for his male hormones to disappear.
"This male cat sprayed his urine and oil onto the neighbour's walls and they are so angry! That is why I want to neuter him!".

"In any case, why don't you get the pregnant female cat spayed?"
"She is my neighbour's cat," 5th sister replied. "Whe she heard it cost me $195," she did not want to do it.
"The cost of neuter is much less," I said to her. "You wanted the e-collar, the vaccination and the de-fleaing spot-on. This added up. The actual cost is around $125 with antibiotics and painkillers and surgery and anaesthesia@" 

   

1241. STANDARD OPERATING PROCEDURES. HOW LONG IT TAKES TO NEUTER A YOUNG POM?

Saturday Jan 12, 2013


STANDARD OPERATING PROCEDURES. HOW LONG IT TAKES TO NEUTER A YOUNG POM?
A young doctor came at 9.30 am on this fine Saturday morning, with a Pom as she had made an appointment for the neuter.

"Has he eaten?" I asked.
"Yes," she said.
"It is best not to feed the dog 10 hours before surgery as the dog may vomit during surgery."
"Your staff did not mention this when I phoned for an appointment," she said.

In the Singapore General Hospital where I went for surgery under general anaesthesia, surgery to remove a lump from my left wrist involved a consultation, blood test, X-rays, ECG and counselling on medical charges and anaesthetic risk and signing of informed consent after being informed of a possible risk of death on the operating table. A lot of time.

IV ANAESTHESIA
In veterinary medicine, such procedures would be costly. For this young dog, a general examination was done. The dog was deemed healthy and I operated 1 hour later. From my experience, the combined domitor + ketamine at 0.4 + 0.5 ml IV per 10 kg in a young healthy dog does not cause vomiting and permits short surgery without the need to top up with isoflurane gas.

My experienced vet assistant got the isoflurane gas ready. "If the vet is fast, there is no need for isoflurane gas top up because I gave 100% of the formula," I told Min. He was not convinced. As the dog would not permit shaving of the scrotal area, Min had to do it after I gave this formula.

Min recorded the time of the start of domitor and ketamine injection and the last stitch. It was 20 minutes which included shaving the scrotal area of around 2 minutes. It would be 18 minutes.

"What's the time between first skin incision and last stitch?" I asked Min to calculate. It was 10 minutes.

ANALGESIC EFFECTS
No isoflurane gas. Towards the 18th minute, the dog's leg moved a bit. As I started to stitch one horizontal mattress to close the skin, the dog moved a bit. "Standby for the isoflurane gas and mask," I said to Min.

 I completed the surgery in 20 mintues from IV injection of domitor + ketamine + normal saline in one syringe of 0.55 ml IV.

SURGERY
Three forceps method clamping the tunica enclosing the spermatic cord and blood vessels is the best. The lowest forcep is released. I ligated 3/0 absorbable polysorb on the groove from the released forcep one way and repeat the other way. I threw in 5 knots. I excise the area between the 2nd and 3rd forceps. No bleeding.

The skin incison of around 1.3 cm long was stitched with just one horizontal mattress using the same 3/0.

Bandage.

PAIN-KILLERS AND ANTIBIOTICS given..

No complaint today, Sunday, 24 hours after surgery. I will follow up tomorrow.

CONCLUSION   
I audit associate vets' efficiency. Surgery should be speedy, accurate and complete. Much time and resources are wasted when the vet is not well prepared by visualising the whole process. Pre-anaesthetic shaving saves a few mintues but this Pom would not have it done and so was shaved post-sedation.