1349. Questions regarding neutering a cryptorchid

April 1, 2014

I am Dr Sing Kong Yuen from Toa Payoh Vets. Below are my replies in capital letter to your questions.  

 2-year-old golden retriever with an unilateral undescended testicle who came down yesterday to your clinic. I had listed my dog for neutering next Saturday. However, I have some questions (mainly regarding neutering vs. removal of the undescended testicle, options which were offered to me) that I neglected to ask Dr. Sing during the consultation and was wondering if it is possible for them to be answered through email. I understand that it is ultimately on my informed decision that whichever operation will be carried out, but I would like to have a little more information to make that choice.

    1. What is the advantage of neutering a unilaterally cryptorchird dog over just removing the retained testicle?

I CANNOT UNDERSTAND YOUR QUESTION. RETAINED TESTICLES IN DOGS HAVE A HIGHER RATE OF TESTICULAR NEOPLASIA THAN DESCENDED ONES AND THEREFORE REMOVAL IS ADVISED BY VETS  

    I understand and accept the benefits of neutering in general, but this dog will not be bred, and is not allowed to mount and kept on a leash at all times when going out, and in which case, given that he is unlikely to pass on whatever defective genes to his offspring, is there any added benefit to neutering, especially when weighed with the loss of testosterone secretion and whatever health benefits it may bring with it?

OTHER THAN ANTI-SOCIAL BEHAVIOUR LIKE MOUNTING AND URINE MARKING, NEUTERED DOGS ARE LESS LIKELY TO DEVELOP PERINEAL HERNIAS, PROSTATE ENLARGEMENT AND INFLAMMATION AND CIRCUM-ANAL TUMOURS IN OLD AGE. 

    2. In your experience, is there an increased risk of testicular cancer in the undescended testes? I know that in humans with cryptorchirdism, the undescended testes itself is at higher risk of malignancy, but does this apply to dogs as well? I am unable to find any literature online with regards to this question.

THERE IS LITERATURE ON INCREASED RISK OF TESTICULAR CANCER IN UNDESCENDED TESTES. YOU MAY NEED TO SUBSCRIBE TO ONLINE VET DATA BASE

    3. What will be the effects of neutering on my dog's physique? He is very active and runs ~20km/week with me at quite a fast pace and I would like to retain as much muscle mass as possible. I understand that he is probably physically and sexually mature at 2 years with closure of the growth plates at this point in time, but will there be a detrimental effect on his lean mass? Further, anecdotally I know of dogs whose hair became coarser after neutering. Is this backed by evidence?

I HAVE NO KNOWLEDGE OR SCIENTIFIC RESEARCH TO ANSWER YOUR QUESTIONS

    4. Will there be any changes to his personality/increased risk of depression?

NEUTERED DOGS ARE GENERALLY LESS AGGRESSIVE AND TERRITORIAL IF NEUTERED AT A YOUNG AGE. SOME MAY STILL DO URINE AND STOOL MARKING AND MOUNTING AFTER NEUTERING.   AS REGARDS CANINE DEPRESSION, I DON'T HAVE ANY KNOWLEDGE ON THIS AREA. 

    5. Will there be histopathological examination of the retained testes?
YES, IF THE OWNER REQUESTS FOR IT.

    6. Is there a role for androgen supplementation in a neutered dog?

NOT A ROUTINE PRACTICE IN VET MEDICINE. I DON'T HAVE OWNERS REQUESTING THIS.


    I apologize for the questions and they must sound very tiresome, but I have thought over my options for a long time and feel that I must consult with you for further guidance. Thank you very much and sorry for any inconvenience caused.

1348. How to succeed as a new employee

Last week, I gave a lecture to 3 young people at my office. Two are young adults named Vanessa, Nicolas and one is a Myanmar employee Nyi Nyi. I asked Vanessa to write a report and this is given as follows:

How to succeed as an employee

1.     You must have a target

To be able to produce positive outcomes

2.     Perfomance

Time equals to money and performance equals revenue

3.     Creating a list

To set a target for yourself that can be achieved in the day itself

4.     Distractions

They come in the form of your phone, computer, customers etc. Try to minimize these distractions so that you can meet your daily target.

5.     Niche

Determine what you are talented in/good at doing/ excel at and further your knowledge/skill of it.

6.     Mindset

Change your mindset to suit your job.

E.g. I don’t like to network but I will do so for the sake of my company and to increase my performance.

7.     Best person to talk to

The best person is definitely not your boss. Talk to your co-workers. E.g. In the healthcare sector, talk to the stall holders in the staff canteen.

In the case of veterinarians, networking during dog shows or SPCA functions. However, it is not practical as a lot of time is wasted. It is slightly more applicable to senior vets.

8.     Added value to the company

Employees should provide timely performances with quick and efficient outcomes. It increases revenue as time is money. Cross-selling is a good method as it shows initiative.

9.     Upscaling

With more initiative, you can start doing your own research through data bases or networks to find clients/candidates or higher value.

10.                        Strong competition in any industry

80% of business = 20% of the employees. Employees must be motivated and be willing to take on hardship in order to succeed in life. 

Hyphema in a dwarf hamster in the USA

Mar 22, 2014
Email from a hamster owner in the USA

Hello Dr. Sing,

Thank you for your generosity and willingness to speak with me on the telephone today. I have typed up the history below and attached photographs of my dwarf hamster in this email.

Past medical history:

My pet is a 2-year 3-month old dwarf hamster. His past medical history includes trauma to left eye approximately 1 year ago, which was subsequently prolapsed and was surgically enucleated without complication (Enucleation procedure was performed within 15-20 min, and he recovered within a week), and significant osteoarthritis for which he currently takes oral meloxicam.

Current issue:

For approximately the past 9 months, he has had a worsening cataract in his remaining right-eye. He has been followed by a veterinary ophthalmologist, and based on exam he has had no reflex to light in the remaining eye and is likely blind (although he manages to navigate his habitat quite easily) I've noticed increased vascularization over the past month, and within the past 24 hours, he has developed worsening hyphema of the right eye. The hamster does not appear to be in acute pain or distress, but I've found it difficult to assess pain in a hamster.

I've followed your website for the past year and I noticed that you had posted some pictures on a hamster with bilateral hyphema.

Consultations:

I consulted my veterinary ophthalmologist and small-pets veterinarian today, and they are not certain what the best course of action is at this point. The ophthalmologist recommended diclofenac (NSAID) eye-drops and to see if the condition resolves. The other veterinarian recommended corticosteroid eye-drops. I decided to proceed with the diclofenac 1 drop every 6 hours. The general veterinarian mentioned that because the hyphema is secondary to a long-standing cataract, increased intraocular pressure may be the cause. She mentioned that eye-drops are palliative, but enucleation of the eye would be the ultimate solution. They seems to agree that enucleation of the remaining eye will not affect his vision, because he cannot see out of his remaining eye. However, because of his age, there is an increased risk with anesthesia and surgery. Surgery is scheduled for tomorrow morning.

I wanted to seek your thoughts and opinion on the case of my pet. I am not sure what is the best course of action. My concern is that he may have developed an acute glaucoma secondary his cataract, or that his longstanding eye disease may have led to neovascularization. I am concerned about what will offer him the best quality of life (less pain), and whether enucleation should be the solution at this point. NSAIDs have the risk of increased bleeding, and long term use of corticosteroids can increase intraocular pressure. I am also unsure of the cause of the hyphema, and therefore unsure if the hyphema may acutely worsen, leading to severe pain or prolapse.

I would greatly appreciate you opinion and thoughts. Thank you so much for your help,

Steve

The photographs are attached in this email. The IMG_ named photographs show his eye condition today. The other filenames dated with when they were taken. I will also send you a video I took today in a separate email.

REPLY FROM DR SING DATED MAR 22, 2014

Thank you for your email, images and videos. You have been most caring. My preferred course of action will be enucleation to eliminate the intense pain inside the eyeball. Drugs will not work. Anaesthetic risks are high as the hamster is aged. Best wishes. 

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

MARCH 23, 2014 EMAIL TO DR SING
Hi Dr. Sing,

Thank you again for your email and your time. I wanted to provide an update. Surprisingly, this morning I spoke with my veterinary ophthalmologist and took my hamster in to the senior general veterinary surgeon (specializing in exotics). Contrary to the junior vet I spoke to yesterday (who recommended surgery today), the senior operating vet examined my hamster this morning and decided that surgery was not indicated at this time.

The ophthalmologist told me he thought there was a reasonable chance that the hyphema may slowly resolve with diclofenac eye-drops. On pre-operative exam, the senior general veterinarian assessed that he was not in pain severe enough. He mentioned that hamsters usually stop eating when they are in pain, and based on my hamster's activity- he does not appear to be in severe pain. So, we decided to continue with the diclofenac drops, and the general vet added ciprofloxacin eyedrops as well. He recommended follow-up / re-evaluation in 2 weeks.

On my physical exam the hyphema appears to have settled at halfway filled up the anterior chamber of the lens. As of tonight the globe does not appear to be any more prolapsed relative to baseline. I will continue to monitor for any acute changes or worsening.

Are there any other particular signs or symptoms of pain (or specifically eye pain) in hamsters that I should pay attention to? I have read that these pets hide/tolerate their pain quite well, making it somewhat tricky to assess. My ultimate goal is to provide my hamster with the best quality of life.

I realize it's difficult without having examined the hamster, but if you have any input on whether this is a reasonable plan of action, I would love to hear your input.

Lastly, I wanted to thank you again for your generosity and time spent speaking with me yesterday. I truly appreciate it. I also want to add that your website may very well have saved my hamster's life when he had his first enucleation. My local vet who was less experienced had urged a 45min-1hour enucleation procedure, but after reading your website and learning about hamster anesthetic risks, I opted to search the entire city for a vet who had experience operating on exotics. The enucleation was performed swiftly and he concurred that a 45 minute operation would have likely been lethal. I just wanted to let you know that someone across the world was able to benefit from the wealth of information on your website. And not to mention, as a hamster owner, I find the info and pictures to be fascinating as well. Also, please let me know if your animal clinic accepts donations of any sort, as I would be happy to make a small-donation as a token of appreciation for your time.

Thank you again,

Steve

REPLY FROM DR SING DATED MAR 23, 2014

Thank you for your feedback and good news. I always tell my clients that each vet has a different approach to the treatment of diseases and so this results in conflicting advices to the pet owner. There may be more than one way to treat a disease.

In your case, I thought the hamster was suffering great pain and hence advised enucleation. This episode shows that long-distance telephone diagnosis without physical examination is not advised.


Since the hamster is not in pain, then enucleation is not necessary. Generally, frequent rubbing of the eye are signs of painful eyes or inflammation around the eye areas. There will be acute conjunctivitis and hair loss around the upper and lower eyelids.

The best indicator of the hamster's health (and lack of pain) is the number and size of faecal pellets passed per day. If he normally passes 40 large pellets per day for example and now passes less and in smaller sizes, then he is sick. The amount of water drunk per day is another good indicator of health. The owner must be disciplined to monitor 24-hourly and some owners do that.

 

I thank you for your offer of a donation. The service is free to all hamster owners. 

 

Are you an engineer or IT person as you are able to locate my hamster's hyphema images from the internet. How did you do it? 

Audit of KPI. Spaying a caterwauling Maine Coon 3.6 kg using IM anaesthesia

From my experience, the analgesic effect of the xylazine 0.15 ml and ketamine 0.6 ml IM will last around 30 minutes for a young 3.6 kg Maine Coon. Provided the vet is well organized.

Today Sunday Mar 16, 2014, the Woodlands family brought in the Maine Coon who had been rolling and yelling (caterwauling since 3 days ago). "But she is quiet now," the lady said.

The following are my performance indicators
Inj of xylazine + ketamine   10.13 am
No isoflurane gas
First skin incision  10.26 am
Completion of skin stitching 10.56 am
The cat started moving at around 10.55 am.

The cat was rather plump and I took some time to hook out the ovary as there was abdominal fat in the way of vision and obstruction was caused.
lst ovary hooked   10.34 am after 5 attempts.
2nd ovary hooked 10.41 am from the uterine body area
Uterus being ligated   10.43 am
Abdominal muscles stitched with 3 interrupted sutures  10.47 am 
Skin stitched  10.55 am

Cat started one movement when stitching muscle  10.49 am
Cat started more movements   10.54 am 
Skin stitched 10.56 am


Conclusion
For a 3.6 kg young cat, xylazine + ketamine at 0.15 + 0.6 ml IM in one syringe provides sufficient analgesia for spay provided it can be completed within 43 minutes from start of IM injection. There will be no need for isoflurane gas top up. If the first ovary can be hooked out at the first attempt, the duration of analgesia is more than sufficient for spay. One packet 3/0 absorbable polysorb is sufficient.  Incision length about 1.5 cm long. 2 horizontal mattresses close skin wound.

Dr Sing Kong Yuen

The paralysed cat has thick bloody urine again.

This cat wore pampers for the last 3 months after adoption as he was paraplegic, with back legs stretching forward.

As the paraplegic cat needs leg massage to pee, his bladder gets filled with urine last week but did not have any problem of urination for the last 3 months after adoption. Thick red urine from the infected bladder filled his bladder again, after the first clearing of the obstructed bladder. Now the cat vomited twice. The urine test had shown proteinuria 2+, lots of red blood cells and white blood cells.

I informed the owner of the costs of X-rays to check for bladder stones. The cat has poor chances of recovery of a normal bladder owing to urine stasis causing infections. The wife was most sad. Euthanasia.

A Ragdoll X had UTI in Oct 2013.

Saturday Mar 1, 2014

TP...472
Ragdoll X, MN, DOB Nov 12, 2013


This couple in their late 20s or early 30s love this Ragdoll X, bought from a Malay family that has many pedigree cats, producing pretty cross-breds.

"This cat is quite angry today," I said. "So I shall not take his rectal temperature." I asked the husband to talk to the cat and stroke his chin so that I can vaccinate without the cat getting furious.The cat was given the 2nd vaccination.

INTERESTING ASPECTS OF THIS CAT

1. Oct 23, 2013  Stranguria. Dr Daniel Sing sedated, catheterised and treated. Urine test showed pH 6.5, SG 1.049, Protein 3+, Glucose +, Blood 4+, WBC 126, Bacteria+
No crystals. No X-ray done.

I advised C/D x 10 cans and phoned on Jan 9, 2014. "The cat took 1 week to recover," the owner said.
FLUTD? Stress. 4th day after shifting to new house. For the past year, the owners were staying in a friend's house and shifted recently.

2. Today, no more urinary problem. Fed canned food. Will always groom himself after eating.
3. The owner wants to clip him bald (except for head and tail) as hairs fly all over the house.
"Regular brushing will do," I advised.
"The cat grips the brush and runs away," the husband said.
"If the comb is sharp like wire, it will be very painful," I advised buying round-tipped brush and give him his favourite treat while brushing from a small area initially. So, no need to clip bald for life.

4. Vomits around 1x/month. "Could be due to hair ball," I said.
"No hair seen in the vomitus," the wife said.
"Cats are very clean and will groom esp. if shampoo once weekly."
"He grooms after eating rather than the weekly bath."

5. This cat will poop only when the owner returns home at around 9 pm. Some friend's cats do the same.

6. "Nowadays, no more scattering of new litter and peeing a bit of urine on the litter," the husband told me. "He must be checking whether the litter is soiled  or not." 
"Male cats urine spray to mark the litter," I said. "You will note that there will be no more such behaviour after neutering."
The husband agreed as this cat stopped doing after neutering.

Yesterday, I was at Changi Airport and noticed those pink-jacketed customer service counter ladies.
The husband told me that many are from Myanmar, speaking good English and trained by SATS. I thought they were Singaporeans.   Nowadays Singaporeans don't want to work the shifts and weekends and so it is much harder to employ them. "There is a very high turnover with Singaporean employees," the husband said. Singaporeans job hop as there are many jobs available and so Singaporean customer service officers don't stay long in the job. 

Filipinos are hard to recruit too. Times have changed. An "S Pass" applicant must be earning $2400/month nowadays," the husband told me. "Rejection will be given if the salary is $2,200".  I guess Singaporeans must be paid $3,000 and given office hours and no week end roster before they will stay in the job.  

1343. Closed pyometra & uterine torsion & other images

Vomiting many times 2 days. Swollen abdomen. Yellowish vaginal discharge.




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