1267. Metaplasia of a terrapin's eyes?

TOA PAYOH VETS toapayohvets.com Date:   30 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits A terrapin's eyes are swollen   Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 22 January, 2013 Date:   30 January, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129   METAPLASIA OF THE EYES DUE TO VITAMIN A DEFICIENCY?         5831 - 5837. Hypo-vitaminosis A. Metaplasia of the eyes? Not all cases of swollen eyes can be cured when the disease or deficiency of Vitamin A had progressed for a long time. In this case, it took a very long time and the eyes were not back to normal. Early cases of swollen eyes are curable provided there is no upper respiratory tract infection, pneumonia or chronic conjunctivitis. Hospitalisation for treatment is usually needed as most Singapore terrapin owners are not able to treat cases of swollen eyes. This webpage: http://www.asiahomes.com/petshotline/201301130terrapins_swollen_eyes_toapayohvets.htm See 3 other cases of swollen eyes in terrapins in a video:: http://www.youtube.com/watch?v=XO_kpCLGr0I   Jan 30, 2013   Dear Dr Sing,   Here is this link to the video that has been completed! http://www.youtube.com/watch?v=XO_kpCLGr0I   Cheers, Gina YouTube - Videos from this email COMMENTS BY DR SING Thanks for a good job done. You have favourable comments from a third party which shows that you produce an entertaining and educational video. However, please take note of copyrights to images. You will need to get permission to use images from other sources as there are issues of litigation for copyright infringement and we will then have to remove the video. It is best not to use them but create your own.  TumblingUpTheStairs 5 hours ago A very educational video · fmylife164 6 hours ago hi · in reply to imaphonyhehez (Show the comment) imaphonyhehez 6 hours ago Nice educational vid! Well made and entertaining! Keep up the good work. 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 30, 2013 Toa Payoh Vets

1266. Enucleation of the eye in a dwarf and a Syrian hamster

TOA PAYOH VETS toapayohvets.com Date:   30 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Veterinary Surgery: Enucleation of the eye in 2 hamsters  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 22 January, 2013 Date:   30 January, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 CASE 1. A DWARF HAMSTER HAS A POPPED OUT EYEBALL   Jan 22, 2013 "She is going to die," the young lady wiped her tears as her 2-year-old female dwarf hamster was sleepy unlike others. The hamster just would not move when held on the palm of her hands. She took her out several times and this would stress out the sleepy hamster which had not eaten and drunk water in the past 2 days and was in great pain. "Two days ago, the right eyeball just popped out," she said. "Before that there was a white spot in her right eye. I thought it was a cataract." The hamster's shoulder skin stood up when pulled indicating severe dehydration. The protruded eyeball must be very painful as the hamster can't talk. She just sat still most of the time. The owner was quoted $400 by another vet to do surgery. "I don't have that much money," the student said. "Normally I charge $100-$250" for hamster surgery depending on how complicated it is and the time it takes.   Eyeball prolapse 2 weeks after observation of "white" corneal ulcer Painful eye. Continuous rubbing of the right eye Lethargy & dehydrated. Subcutaneous injection of dextrose saline     Anaesthesia - isoflurane gas in a small container as required Illustration of Surgery to educate owner & for medical records Right eyelids snipped off and stitched. Excellent and fast recovery (video) 48 hours after eyeball removal. Owner's e-mail image of a bleeding wound to the left of the surgery area. "This could be due to self-inflicted rubbing before or after surgery as it is not possible to put on an e-collar for hamsters, unlike in the dog," I explained. "Bring the hamster down for examination." No further complaint from the owner as at Jan 30, 2013.  PRE-OP DEXTROSE SALINE "What are you injecting?" Dr Daniel saw me preparing a small injection of 0.05 ml in a 1-ml syringe and thought I was overdosing this hamster. "It is dextrose saline as he is so lethargic and weak." ANAESTHESIA "This is a very sick hamster," I said to Dr Daniel when we discussed anaesthesia. He proposed 1 drop of Zoletil IM. "The safest is just isoflurane gas," I said. "The vet needs to be very observant as it is hard to tell when the hamster is fully anaesthesized. We put the hamster inside a plastic container infused with 5% isoflurane gas. "Count up to 10 and take out. Repeat," I said. Dr Daniel did say 1,2,3...10!" once. The dosage was not enough. He tried again. "Use the mask," I said. But the mask was not effective as it was too big. SURGERY Basically the surgery of enucleation of the eyeball is similar to that for the dog. I incised a 4-mm area on the lateral canthus to enlarge the orbital area. Then I clamped the base of the right eyeball with curved forceps. The normal left eyeball suddenly popped out and the hamster squeaked. I ceased the procedure and gave the hamster more anaesthetic fas. I scrutinised the hamster inside the plastic container. Once she could not move, I quickly took her out within a second. I clamped the eyeball again and excised the base with scalpel. Unlike the dog, it was not possible to ligate the optic stalk and blood vessels as there was insufficient exposure in the dwarf hamster. Without ligation, profuse bleeding ensued. I swabbed off the blood and quickly cut off the upper and lower eyelids with scissors. Now, there would be two skin wounds which would heal well when I sutured with 6/0 sutures. The hamster was under gas anaesthesia which was just sufficient but would be short in duration. So, the hamster wriggled as she was waking up. I stitched the eyelids fast using 3 interrupted sutures. "Hold on to his front paws, the scruff of his neck," I said to Dr Daniel. The dwarf hamster is so small that there is no space for both of us with 4 hands manipulating the dwarf. Finally, I sutured the eyelids. The intern was trying to focus her camera to document the surgery. It was too cramped for the intern to take a video of the surgery. "The surgery needs to be very fast as the hamster's chances of survival on the operating table are good. Therefore, you can't video as this will delay the process." The intern left the operation room. However she videoed 30 minutes post op and the hamster was busy cleaning himself. This video would be shown in the production of the video. Surprisingly, the hamster became much more energetic after removal of the eyeball. It would be attributed to removal of pain and the dextrose saline. This was one of those cases which I think that the hamster would die on the operating table as he was not active and severely dehydrated.  So, the owner and I were glad to see him much alive. She took him home in the afternoon and was given medication. FOLLOW UP:  1 DAY AFTER SURGERY On Tuesday, Jan 22, 2013,  I phoned the young lady. She was most happy. "The hamster drinks a lot," she said. "She is much more alive." It was good news. PHONE CALL FROM OWNER 2 DAYS AFTER SURGERY Yesterday, Wednesday, Jan 23, 2013, the owner phoned me to say that there is a big hole. "Is it normal for hamster in such operations to have a big hole in the eye? What should I do? Can I send you the images of the eye by iPhone?" I said it was difficult to know what she meant and it is best to examine it as she thought there was a stitch breakdown exposing the eye wound. She brought the hamster to the surgery in the afternoon. I was out and some driver had suddenly swerved into my parked car opposite the church and public library, damaging the right fore lamp area. So Dr Daniel examined this hamster. "What happened?" I asked Dr Daniel. "The swelling was due to the bleeding after removal of the eyeball. It has become a clot. The owner did not give the pain killer and the hamster scratches the eye area. But the hamster is normal, very active, eating and running. Is it possible that you did not snip off the eyelids but had just stitched up the eyelids?" Dr Daniel was assisting me in this surgery to remove the eyeball but he was on the other side of the op table holding on to the hamster while I stitched up the "eyelids". As the hamster was a dwarf, he could not see me using a pair of scissors to snip off the upper and lower eyelids, as per standard operating procedure in eyeball removal surgery. In fact, it would be professionally incompetent not to do. SNIPPING OFF THE UPPER AND LOWER EYELIDS His palm is 4X in area compared to this dwarf and unlike the surgery in the dog or cat, he could not see much. He saw me using the scissors to cut off the 6/0 sutures after stitching the "eyelids". Actually, I had trimmed off the eyelids before putting in 3 stitches to close the eye. "I had cut off the eyelids, otherwise the eye would not seal off when the stitches dissolve," I said to him patiently.   CASE 2. A SYRIAN HAMSTER HAS A BLIND SHRUNKEN EYEBALL Sep 20, 2010   The same surgical procedure of eyeball enucleation is illustrated in a Syrian hamster below.  The 3rd eyelid is not so prominent in the hamster unlike in the dog but is should be removed if it can be seen.     Shrunken blind eye Illustration of surgical process to educate the hamster owner and for medical record Isoflurane gas anaesthesia given by mask Eyeball has been taken out. Eyelids snipped and the new wounds are stitched with fine sutures       Hamster wakes up fast when given gas anaesthesia Post-operation Stitches are absorbable. No need to return for stitch removal. No further visits or complaints from the owner since the surgery.   ADVICES & TIPS: 1.  Eye Injuries Are Emergencies in Hamsters. Consult Your Vet Immediately 2.  The vet must deliver a hamster alive at the end of surgery. Therefore, the vet must know what to do and complete the procedure of enucleation in less than 1 minute in order to deliver a good outcome. Sick hamsters can't survive long anaesthesia and surgery (>2 minutes usually).    3. EYEBALL REMOVAL SURGERY IN HAMSTERS  COMPARED TO THE DOG AND CATS The anaesthesia and surgery to remove the eyeball in the hamster can be completed in less than 5 minutes unlike in the dog or cat owing to the small size of the eyeball. The same principles of surgery apply to the hamster as to the dog and cat, only that the operation is on a miniature scale and the anaesthetic risk of death from isoflurane gas is 10x higher as it is difficult to monitor the depths of anaesthesia.    4. SAVING THE EYE USING TARSORRHAPHY This hamster had a "white spot" in the right eye earlier. The owner thought it was a cataract. This would be a corneal ulcer which tend to be painful and itchy. The hamster would have scratched so hard that her right eyeball popped out permanently and caused great pain. In the dog and cat, it is possible to "save the eye" if it is not badly damaged or infect. This is done by doing lateral canthotomy (which I did in this hamster) to enlarge the ocular space, push back the eyeball, give antibiotics and anti-inflammatory, stitch up the upper and lower eyelids (tarsorrhaphy) to protect the eyeball and keeping it moist. In 14-21 days review the eyeball and remove the stitches. In tarsorrhaphy, the eyelids are not snipped off. An e-collar is then worn. All these are not possible for the hamster esp. the post-op care as the hamster hates the e-collar and will get rid of it in no time. The hamster may not eat or survive after such a drastic surgery. So, removing the popped out eyeball is the practical option.     This webpage is: http://kongyuensing.com/folder7/201301123hamster_eyeball_enucleation_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 30, 2013 Toa Payoh Vets

1265. Video of 3 terrapins with swollen eyes

Jan 30, 2013

Dear Dr Sing,

Here is this link to the video that has been completed! http://www.youtube.com/watch?v=XO_kpCLGr0I

Cheers,

Gina

YouTube - Videos from this email

COMMENTS BY DR SING

Thanks for a good job done. You have favourable comments from a third party which shows that you produce an entertaining and educational video. However, please take note of copyrights to images. You will need to get permission to use images from other sources as there are issues of litigation for copyright infringement and we will then have to remove the video. It is best not to use them but create your own. 

• TumblingUpTheStairs 5 hours ago

  A very educational video

  ·
• 
  fmylife164 6 hours ago

  hi

  · in reply to imaphonyhehez (Show the comment)
• 
  imaphonyhehez 6 hours ago

  Nice educational vid! Well made and entertaining! Keep up the good work.

  ·

1264. The little boy's blue-eyed cat is naughty

Webpage is;
http://www.bekindtopets.com/cats/201301126male_cat_caterwauls_sprays_toapayohvets.htm

TOA PAYOH VETS toapayohvets.com Date: 26 January, 2013 Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The little boy's blue-eyed cat Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 22 January, 2013Date: 26 January, 2013 toapayohvets.com Be Kind To Pets Veterinary Education Project 2010-0129 Saturday, January 12, 2013 On Saturdays, I usually consult from 8.30 am to 11 am and then Dr Jason Teo will take over. On this early fine morning, a bubbly Malay lady from Woodlands came with her blue-eyed cat and a little boy. She was a new client. "Why do you come all the way from Woodlands?" I asked as most Singaporean pet owners prefer proximity. "There are clinics nearer to your home." "I want to come here to neuter my cat," she replied. After the usual examination, I said she could come back in one hour to take the cat home as I would operate immediately. "One hour?" the little boy with bright big eyes said aloud. He was most attentive unlike other small boys. I thought he would be 4 years old based on his height. "Yes," I said. "Do you know what is the meaning of 'one hour'?" I asked him. He did not reply. Mum laughed and both of them left. Two hours later, the mum came with him for the cat. "There is some bleeding from the operation site," the mum observed blood stains on the towel, originating from the horizontal scrotal wound. In cats, the scrotal wound is not stitched up, unlike in dogs. "Disgusting," the little boy added. I was surprised that he uttered this word and wondered whether he knew what it meant. "How old is he?" I asked the mother. "He is 6 years old," his mother said. "He is bright and would do well in life if he studies hard." His attentiveness to adult conversations, his power of observations and his English vocabulary is unusual for little boys of his age and that is why I assess this little boy as intelligent. Most little boys tend to be playful and not communicative at the veterinary surgery, in my observations. 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 cousins around. "I am the 5th sister," the mum said to me. "This is my 3rd sister." The third sister was slimmer and more serious when compared to the 5th sister. She drove a blue Toyota Alixo car similarly to the one I had rented as my own car had broken down, with the radiator and the piping ruptured. It cost me $85/day to rent this model and my car was in the workshop for 3 days. The blue car reminded me of the blue eyes of this handsome male cat. The cat was no longer bleeding now. Could the bleeding be due to the possibility that I did not ligate the spermatic cord and the blood vessels properly? No, as I usually knot 5 times. The reason was that I made a horizontal cut transversing and incising the two testicles. Blood would have accumulated inside the scrotal sac. Sometimes, I make a vertical incision and incise one testicle at a time and there would possibly be less bleeding as one testicle is incised and ligated at one time. The family took the cat home and in the past 14 days, I had not heard from the owner and this meant that the cat had recovered fully. . 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 (anal sac) 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. "When 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." The least cost for neuter is the basic surgery, anaesthesia and an injection of pain-killers and antibiotics. This would cost $125. In the earlier years of practice which has now spanned nearly 40 years, I did not give pain-killers and antibiotics as this would be possible with aseptic surgery. I believe in less antibiotics to reduce the incidence of bacterial resistance to antibiotics. The cost would be $75 and there were no post-op infections or problems. However, Singapore cat owners are more caring. One owner was most unhappy and she complained as to why I did not prescribe post-op antibiotics unlike other vets. So, nowadays, to give owners peace of mind, medication post-operation is routinely given. So the cost is higher. 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 26, 2013 Toa Payoh Vets

The economics of renal failure - 7-year-old male Maltese

Veterinary info can be overwhelming to many students.
This case study is to help vet students understand for their examinations, more about the treatment of kidney failure and the terms azotaemia, pre-renal azotaemia and post-renal azotaemia. 

PATIENT: Maltese, Male, 7 years

Jan 11, 2013
A Veterinary Clinic.
No appetite and vomiting for 2 days. Vet 1 did a blood test which revealed renal failure, hypoglycaemia, hyponatremia, hyperkalemia and hyperphosphatemia in this dog which has a lower than normal rectal temp of 37.2C.
He advised 10 days of drip as the dog had kidney failure. The owner would have to do the drips at home as well.
The owner consulted Toa Payoh Vets for a second opinion.

Jan 12, 2013
Toa Payoh Vets.
Dr Jason Teo hospitalised the dog for 5-7 days of IV driip and blood test after the drip. Dr Daniel took over the case. He put the dog on IV drip for 2 days. No blood test was done as the owner had said that there was one done earlier. No urine test was done, possibly due to owner's reluctance to spend more money. Urine analysis would be useful if done by Vet 1 to differentiate between pre-renal or post-renal azotaemia.

EXPLANATION.
Azotaemia refers to the increase of serum urea and creatiine as shown in the blood test done by Vet 1.
Pre-renal Azotaemia - Due to increase in protein intake
Renal Azotaemia - Kidney not filtering urine normally e.g. obstruction.
Post-renal A - Obstruction in the urinary tract after the kidney

No urine test was done. If done, the USG will be useful. If USG is normal, the kidneys will be normal and there will not be renal failure in the first place. If USG is below normal, it is kidney failure (renal azotaemia). If USG is high, kidneys are normal.

IN THIS CASE STUDY, the dog was eating on Jan 14, 2013 and went home with K/D and clavulox for 7 days. However on Jan 22, 2013, the mother phoned to say that the dog was not eating and had to be force fed. His weight dropped from 5.4 kg to 4.7 kg when the mother finally admitted the dog for IV drip as advised by me, on Jan 23, 2013. The rectal temp in this dog is unusually low, at 37 deg C on Jan 23 Jan and had not gone up to 38 deg even on discharge today Jan 25, 2013. Blood test showed no more azotaemia and the dog ate on 2nd day i.e. today Jan 25. The glucose was still below normal in the blood test as the dog was not eating.

TOTAL WCC
Blood test by Vet 1 - total WCC was normal.
Blood test on Jan 25 at Toa Payoh Vets - WCC 21.7 (6-17), N 85%   Absolute 13.4. L 4%, M11%, E 0% and B 0.6%. There was a bacterial infection but serum urea was normal. at 4.3 (4.2 -6.3). Creatinine was 66 (89-177).  As the dog ate a can of A/D, he was sent hme with different antibiotics.
CONCLUSION
Urine test would have been useful as there would be bacteria or not.     

1262. Schnauzer has bladder stones for the 3rd time

Jan 25, 2013.
Today Dr Daniel and I will be operating to remove the bladder stones. The lady owner came in with another dog, a male 9-year-old Golden Retriever that was eating less and was limping on his "left hind limb".

"He has a big lump below the chest," she said. "One lump had holes in which pus came out yesterday. Now he can walk. The past few days he was not willing to stand up and was not eating. Now he eats a little."

"Two gigantic lumps under the skin of the chest," I had the dog sleeping sideways on the floor of the consultation room and palpated two big lumps. The one in front has no holes but the bigger back one has a few holes "Likely to be tumours which have been infected. The dog has a fever of 40.7degrees C. Do you want a blood test to check the health of this dog before surgery?"

She consented to a blood test..
"Surgery will be in 2 days' time," I said. "The dog is not well now and needs the IV drips, antibiotics for the next 2 days, just like your Schnauzer with the bladder stones." 

Her Schnauzer to be operated this afternoon came in on Jan 20, 2013, with blood in the urine and recent vomiting. She looked very ill and her rectal temperature was below normal at 37.8 degrees even on the 2nd day after the IV drip. The blood test on this Schnauzer showed septicaemia with the white cells being high, the platelets being very low and the kidney function compromised.

Total WCC 21.4 (1-17), N=83%, Absolute 17.8. L=6%, M=9%, E=0%, B=2%.  Platelets <10 br="" large="" nbsp="" platelets.="" platelets="" present.="">
On day 2 of admission, Dr Daniel said of the life-less inactive dog, not eating or moving: "This dog is unlikely to survive."
"You will be surprised," I told him. "With IV drips, multi-vitamins, proteins and Vit K1 for the 2 days and glucose", some dogs respond well.
"If there is urethral obstruction, it is not advised to give IV drip," Dr Daniel said.
"The dog can pee," I replied. "I saw her peeing blood in the urine on the floor of the waiting room.A lot of small stones in the bladder plus one large one, in my bladder palpation, There is no wish to X-ray as the owner wants to save money."

On Day 3 after admission (yesterday), the owner came in the morning to visit her. The Schnauzer got up ready to go home and barked furiously. The lady owner was very happy. "The dog can pee," I mentioned about surgery in the afternoon. As the dog had eaten and would benefit an extra day of nutrition and rest, I phoned the owner to operate today (Day 4) giving the dog the higher chances of survival on the op table and post-op.

"The dog has not vomited at all," I told the owner. "That is good news.". I showed her the blood test of kidney disorder. The urea was 44.3 (4.2-6.3) and creatinine was 449 (89-177). Evidence-based medicine is the best.

AUDIT OF PREVIOUS 2 CASES DONE BY MY ASSOCIATE VETS.
According to the owner,  two bladder surgeries were performed in Oct 2010 and Oct 2011.After bladder stone removal, Vet 1 emailed to her a video and advised drinking lots of water while Vet 2 from Jurong gave some prescription diet. 

1261. Hamster with popped up eyeball

 

 

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Hams Eye Surgery Question

Inbox

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	3:51 PM (15 hours ago)
to judy

Hi Dr Sing, 

This is with regards to the hamster who had eye removal surgery. 

Attached is the photo of my hamster's wound and it seems to be bleeding. Pus could be seen in the morning so, i used NaCl to clean the wound. Is this a cause for concern? Also, would like to ask why is there a wound there if the surgery was in the eye? 

Thank you for tending to my hamster. 

Best Regards, 

Hams wound.JPG 1810K   View   Share   Downlo

 

 

 

 

Kong Yuen Sing <99pups gmail.com="">

	7:27 AM (3 minutes ago)
to Evie, bcc: me, bcc: jasonxll, bcc: daniel

Your image is not clear. I cannot comment as I can't see it. It may be a scratch wound as the hamster does scratch after surgery. It could be an infected wound from the time the hamster injured his right eye. Pl bring down for a proper examination.