1280. eyeball enucleation in a dwarf hamster - surgical illustration

Case had been written up. Intern Ms Toh had produced a video

1279. Swollen eyes in two terrapins - hospitalised

Recently I had 5 terrapins with swollen eyes. It takes a few days for the eyes to open, but not all will recover as much depends on the severity of the infections and the immune system.

The 2 cases here recovered after 7 and 17 days of hospitalisation. I will post the day 1 images later.
Chinese New Year's Eve is tomorrow Feb 9, 2013 and the terrapins are the last 2 to go home.

 is quite a joyous occasion to see patients recovering fully in both eyes. Owing to economics, some owners may want prompt results of a day or two to get the eyes opened, but this may not be possible.

1278. Rectal prolapse in terrapins and people -

Recently an 82-year-old man, sound mind and in good health brought in a terrapin with black and smelly prolapsed rectum. "No hope of repairing as the tissues are rotten and stinking," I usually push back the rectal tissues and suture up the anus for 10-14 days. If done early (within 1-2 days of rectal prolapse), the outcome is excellent. Euthanasia was done.

"Holding in the rectum"  - rectal prolapse where the rectum falls out of the anus. New surgical technique is providing relief. - Ventral Mesh Rectopexy. A mesh (plastic or biodegradaable material) is sutured to the pelvic floor muscles on both sides of the rectum. The top end is sutured to the spine to lift up the rectum. In women, the mesh is sutured to the top of the vaginal to prevent vaginal prolapse. At SGH, $5,000 - $25,000

Recurrences low.

Therapy to retrain pelvic floor muscles will not apply to animals!

REFERENCE:  The Straits Times Jan 17, 2013 pg 12-14 "Mind Your Body"

Reading what the human surgeons do and the latest advances in surgery may be of some use to veterinary surgeons.

1277. Update with video. Two itchy dogs - demodectic mites & ringworm

TOA PAYOH VETS toapayohvets.com Date:   06 February, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Case 1. Itchy Dogs.  Demodectic mange. In search of the anti-demodectic injection  Case 2. Itchy Dogs. Generalised ringworm Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written:  01 February, 2013 Date:   06 February, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2013-0131 Case 1. Itchy Dogs.  Demodectic mange. In search of the anti-demodectic injection  "I don't know why your vet does not give the old dog an anti-demodectic mite injection," I said to the mother who "inherited" the 15-year-old Shih Tzu from her daughter. The daughter, in her late 30s, had brought her to consult me for a second opinion on January 30, 2013 was the owner of the dog but had migrated to Australia. The mother said: "My daughter in KL asked me to consult you. My dog had skin diseases for so many years except for one year 3 years ago. I feed salmon and other good food. Every time, the itchiness would recur after some time after my vet had given a steroid injection. I hear steroids are not good for my dog." "I don't know why your vet has not or will not give the anti-demodectic injection," I said. "Did you ask him why? Did he do a blood test to screen the health of this old dog, esp. the liver and kidney functions? If these organs are not normal, he might not want to risk giving the injection. You can ask him to fax to me the blood test results." "Do you vets get along well with one another?" the mother had not asked her regular vet why he did not give the anti-demodectic injection. She also did not want to upset her regular vet by asking for clinical records for me to peruse and get a bigger picture of the dog's health. "All vets do fax or email copies of our client reports to the 2nd-opinion vets when requested by the owner to do so. There is no problem for any vet in Singapore to do that as every vet will have owners who want a 2nd or 3rd opinion for his pet that does not respond to treatment by the first vet."  As the mother was not comfortable to making the request, I did not insist and took her history of what happened to her dog from the beginning. She had brought some medication given by her previous vet. These included antibiotics, anti-mite cream and fatty acid oil supplements.   "Some skin diseases are not easy to cure unless the cause is known," I checked that this slim Shih Tzu did not have hair loss, little scales, four black paws with big skin warts, clean ears, teeth with little tartar despite no dental check up, a broken tail end with grey skin as if it had partial gangrene and very swollen anal sacs. "Now the paws are not so itchy," the mother showed me a "poisonous" white cream that her regular vet had given her maid who must wear gloves to apply to the paws. "After applying the cream, the mites die and so the dog does not bite his paws so much. He also does not have that red flush of the skin in the evening causing him to cry and whine now." The cream was formulated by her vet and so I would not be able to tell whether it included a steroid, hence accounting for the cessation of inflammation. "Listen carefully to the client," I said to my intern from 4th year the Vet University in Kuala Lumpur. "What she wanted was to get an anti-demodectic injection."  The mother had said that her vet had done skin scrapings and showed her "cigar-shaped" mites under the microscope. "These are demodectic mites," I referred to a chart drawing of demodex and her daughter took an image with her hand phone. The consultation was nearly one hour long as the mother wavered on whether to get another blood test done or get her vet to give me his results and thereby offending this good vet. "I have a bottle of 100 tablets of Eltroxin tablets," she showed me and I have given half of the bottle. My vet said my dog has low thyroid hormones." She was reluctant to get a thyroxin blood level test done. "A thyroxin test will show whether the medication is effective or not and on the status of the low thyroxin level," I said. "In fact, a repeat blood test is always advised to monitor the disease some 4 weeks after the first and the first blood test was 3 weeks ago."  It was hard knowing what was the situation since the mother did not want to upset her regular vet. So, this back and forth conversation took nearly an hour. "How to cure the demodectic infection?" the mum asked again and again. "Demodectic mites are normally present in the dog's skin," I said. "When its immune system is below normal or low as in puppies and old dogs like yours, the mites multiply and cause skin itchiness and disease. So, increasing the immune system would have helped considerably." "How about giving my dog the anti-mite injection?" she asked me. "A blood test is necessary to screen the health of your dog before I give the injection," I am not surprised that Singapore dog owners nowadays are sophisticated to know that some vets give regular anti-mite injections to kill the demodectic mites. However, this was a very old dog and the injection might kill him. "If the owner wants the injection, the vet ought to give it," I said. "But educating the owner is difficult. The best way is to boost the immune system of your dog. Why does your dog lick all four paws till they are black?" I had explained that the large skin warts on and above the paws irritate the dog as he tried to lick them off. "Continuous licking to get rid of the paw warts, cause the skin to break, become inflamed, infected and ulcerated. After some weeks, the melatonin skin pigments get inside the skin, causing blackness of the skin of the paws. Excising the warts would remove a stress for this old dog and hopefully the demodectic mites will not cause disease." "But my dog is so old and will die under the general anaesthesia," she replied. "A blood test will show whether this dog is fit for anaesthesia," I said. "The electro-surgery to excise      the skin warts off the paws takes less than 5 minutes and I can say that the dog has a very high rate of survival since anaesthesia is so short." The daughter seemed to know what I was talking about. The mother was pre-occupied with the possibility of recurrence of the red skin flush and loud whining in the evening, probably stressing her so much. So we were at different ends of the world. The dog was much better now due to the variety of medications, the skin cream and the fatty acid oil supplements but this skin flush and whining might recur. Her daughter would be going home to Australia in a few days' time. It needed a lot of patience. What the mother wanted was a treatment to cure the disease once and for all as she had spent a lot of money with so many treatments by her regular vet. What I proposed was to remove the stress factors as treatment involved steroids and anti-mite cream and/or injections which could harm this old dog.  "I will pay for the blood tests," the daughter suddenly volunteered. Chronic skin diseases are costly to treat and in this case, it was not only the recurrence of itchiness and whining but also money matters. Unless the cause can be identified and can be easily treated, skin diseases are hard to cure in some dogs. In this dog, the ventral groin area is no long black, due to previous steroid jabs. But the paws were still black. On detailed examination, I would say the big skin warts on the four paws would be due to the spread of these viral warts by the dog licking as the body seemed free of the warts unlike other old dogs. The dog's anal sac was voluminous with dark brown thick viscous oil. I asked my intern to express the glands and she managed to get 5% out. I showed her how to do it and expressed over 3 ml of the oil while another intern videoed the procedure. The broken tail needed to be amputated. This was another advice I gave and the mother said: "Earlier the tail was black. I massaged it till the colour returned." That meant the tail had become gangrenous and is now half alive. The hairless tip and broken angle of the tip would be an irritant to this dog, decreasing the immune system and encouraging the demodectic mites to overwhelm his body causing red flush and pain of whining. If only dogs can talk.       So, the first advice would be to remove the warts and in most cases, the dog would become much happier and no longer need to get rid of these "dangling" tumours. Simple solution if the dog was young and not an anaesthetic risk. "Warts seldom appear in young dogs," I said to the mother. "I had an old pug in which I removed 50 skin warts." "Is the pug OK?" the mother asked. "Yes," I said. Skin warts do irritate the older dog but many owners are oblivious to this discomfort of the old companion.  UPDATE ON FEB 6, 2013 A blood test to screen the dog's health and thyroxin levels were permitted by the owner. The test revealed a high level of liver enzymes. As there is a high risk of death on the operating table, the owner did not want any anaesthesia to remove the paw warts and the broken tail. The anal sacs were expressed (videoed by an intern) and its voluminous greyish oil disposed. As for the anti-demodectic mite injection, this dog would best not take  this injection. What the mother had sought in visiting me would best not be given by the vet.   Case 2. Itchy Dogs. Generalised ringworm A CASE OF GENERALISED RINGWORM IN A SIBERIAN HUSKY. The cure is permanent if the dog is given the correct medication for a duration of time and unless re-infected, it is usually a very satisfactory clinical outcome for the owner. No need to see the vet many times. In this case, the owner's brother came to me seeking some injections and medication as the dog was scratching and scratching non-stop every day for the past weeks. I checked the hairs under the microscope and showed him the ringworm on the hair strands. An intern from Melbourne University is tasked with making a video on this microscopic examination slides for the benefit of pet owners and vet students. 5914 - 5920. An injection & some tablets will not be sufficient to cure generalised ringworm in a very itchy Siberian Husky. Intern to produce video on microscopic exam 30 days after treatment - no itchiness The dog stopped being itchy 7 days after treatment for generalised ringworm and for the next 30 days. However the owner asked me why the ringworm lesions become black 30 days after treatment. The hairs also did not grow back. "The pigmentation would be due to the dog scratching and the application of your medication for some weeks before consulting me," I said. "The hairs should grow back but it takes a long time for some dogs."  Many small breeds grow their full coat within 1-2 months. In his case, the hairs seem not to grow at all except for some fine hairs near the upper neck! ADVICES & TIPS Seek veterinary advice promptly if your dog or pet keeps scratching for more than 2 days. Ringworm can infect people. Therefore, early treatment is important as it is a disease that can be cured. VIDEO - DERMAPHYTOSIS - PRODUCED BY TOA PAYOH VETS INTERNS. A very well researched piece useful for vet students and practising vets, commissioned by me,  has been done by 4th year Melbourne Univ veterinary student, Vanessa Sim and Raffles Institution JC student Gina Ng.  Many of the fungal spore and hyphae images are taken from the Siberian Husky (above) and photographed in my microscope installed with imaging software. It took a long time to produce this video but it is very well done. See: http://www.youtube.com/watch?v=SqclWgPXw10 Updates will be on this webpage; http://www.asiahomes.com/petshotline/20130131demodectic_mites_old_dog_toapayohvets.htm Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: February 06, 2013 Toa Payoh Vets

1276. A successful dog breeder in Singapore

Around 2005-2006, I was doing Caesarean sections at $300/dog at any time of day or night, for most dog breeders and $10/vaccination and so I am interested in the latest developments.

In 2013, at least one dog breeder with around 300 dogs was most successful. The reasons are:
1. Focus.
2. Hard work and long hours from dawn to dusk. Dams give birth at any time.
3. Sound knowledge of breeding. Purchase of good quality breeds e.g. Chihuahuas from Taiwan and not using the same sire.
4. Cheap C-sections. Two vets provide such services at $250/Caesarean.
5. Cheap vaccinations at $10/dog. It dropped to $7 at one time.
6. Own microchip with the vet certifying the record of microchipping. This brings down the cost more.

Challenges
1. Difficulty in maintaining proper records when there are 300 dogs free-roaming.
2. Sometimes difficulty in knowing which sire was responsible owing to free-roaming.
3. The need to get a male dog to discover heat in the bitches as manual examination is time-consuming.
4. It is possible to use a vasectomised dog to detect estrus in bitches as in the sheep industry but I believe nobody does this for dogs in Singapore. So, there is mis-alliance in breeders who have free roaming dogs owing to insufficient and high cost manpower. Dogs crated will not have this problem 

Size 15 e-collar for chihuahua's back to prevent leg scratching back

Feb 5, 2013

Unusual request from owner to buy a size 15 collar to fit around the abdomen so that the 14-year-old Chihuahua would not be able to use his left hind leg to scratch his wounds between the ears and on the spinal area. The husband brought the dog this morning as the dog vigorously scratched the back till it bled.

6 days ago, Vet 1 had prescribed antibiotic tablets, antibiotic powder to apply and Vitamin B to drink. Fluid therapy. The problem was that this dog scratched and scratched.

The skin lesions looked circular. Could it be ringworm? I did a microscopic exam of the hairs. It was ringworm. "It is best to clip the whole body, rather than just the neck area in case of other ringworm-infected areas. This dog was 14 years old and had a machinery heart murmur. I checked the medical records.  Dr Daniel had treated him for the heart disease (Grade 4 murmur) in Nov 13, 2012 as the dog was coughing for one week.

No more coughing now as the dog was still on heart medication. Intense skin itchiness. Blood oozed from the traumatised wounds.

"It is very hard to give tablets" the husband said. "He would turn his head away. I crush the tablets and syringe it in with Vitamin B  syrup." Now, he would have to give anti-fungal tablets for 20 days and antibiotic tablets. An anti-fungal wash. An anti-inflam inject was also given to reduce the intense leg scratching. The wife came to bring the dog back and wanted the size 15 collar as a prevention of the back leg scratching. "No need e-collar," I said. She insisted. We tried to put it round the abdomen. "How's the dog going to lie down?" she asked. "It is not practical and not necessary," I said. So, she did not take the size 15 e-collar.

"I expect the dog to recover in 30 days' time.
"Good idea," I said.    

Feb 3, 2013. Sunday's interesting case - A cat has entropion

The cat's eye starts tearing over the past 5 years






BE KIND TO PETS EDUCATIONAL VIDEO


"Can I drop by to buy a bottle of eye drops from you?" the lady phoned me on this cloudy Sunday morning of February 3, 2013. "I think my cat's eye is infected and my vet prescribed eye drops and she recovers. After a while, her eye has discharge again."  She had consulted two vets and they prescribed eye drops which was "effective" for a while.

"I am sorry I can't prescribe without examining the cat," I had confirmed that I had not treated her 7-year-old female spayed cat previously. "Your cat's eye may be ulcerated or be infected and this is hard to confirm without examination. Why don't you go to your vet to get the eye drops?"

"My vet is not opened today," she replied.  Many Singapore pet owners prefer to get repeat medication without review of the pet's condition and this is not in the interest of the pet. The lady brought her cat in to my surprise.

A general examination VIDEO  showed that the medial side of the right eye was swollen at the eyelid. Pus and discharge rolled down this bump. "There is an inrolling of the eyelid at the medial canthus," I pointed my iphone App "torchlight" at left eye and then at the right eye.  My regular torch-light was not so bright but this iphone App "torchlight" never fails to shine brightly (IMAGE OF IPHONE APP PHONE). 

"I am surprised that my cat permits you to shine such a bright light for so long," the lady said. The cat soon growled and that was the end of the examination.

VIDEO OF EYE EXAMINATION
AND CAT WARNING ME OFF BECAUSE EXAMINATION TAKES TOO LONG

"The diagnosis is medial entropion of the cat's left eye", I said.
"What's the treatment," the lady in her 30s asked me.
"Surgery to roll out the eyelid is a permanent solution," I sketched an illustration (ILLUSTRATION OF ENTROPION SURGERY).


"No way. My cat is so old," the lady preferred the eye-drop solution."

"I presume this right eye tearing starts when the cat was a kitten and for the past 7 years," I speculated.
"No," she replied "Not for the first 2 years as a kitten. I distinctly remember as the kitten was with me in China."
"This is a rare case of acquired entropion," I don't expect the lady to understand technical terms. Acquired entropion means that the eyelid rolls inwards later in life as contrasted to congenital entropion which is present from birth.

"This entropion is very rare in cat," I said. "I would think that your two vets would diagnose an eye infection and the eye drops with steroids worked very well. It is quite common in some breeds of dogs like the Shih Tzu and bulldogs.  The permanent solution is surgery."

If no surgery is done, the chronic conjunctivitis will cause dry eye and the nostril discharge (see the image) will continue.  It is best to diagnose correctly and get the entropion done early so that the cat does not suffer from eye infection and keeps on rubbing her eyes every day for the rest of her life. Eye drops with steroids are not a treatment option as they only alleviate the signs and symptoms.