Dec 31, 2014
I was still in the surgery at around 5 pm. The rabbit had suddenly stopped eating and the lady owner came as her vet must have closed shop on this last day of New Year. Enjoyment was in the air and so many shop owners close early.
This was a new owner who had given critical care to this anorexic rabbit as I noticed some wetness in his mouth. She did not want any injection and this is a mindset of some of the younger generation pet owners and vets as regards injections of rabbits and guinea pigs, thinking they will suffer death.
They would dictate the type of treatment and had researched the internet..
"I am a doctor," she said when I explained that the rabbit would recover faster from injection.
"You heard a squeak when I palpated the abdomen," I explained that the rabbit had a swollen stomach which was painful on palpation. "As a doctor, you would know that it is best not to give oral medication to an upset stomach whenever possible. The stomach would get further irritated."
She reluctantly agreed to the injections which were 0.1 ml of baytril and 0.1 ml of painkiller meloxicam added to 0.4 ml of saline and given subcutaneously via fine needles. There was no painful squeal from the rabbit on injection.
"I want some antibiotics," she said.
"Be patient," I said. "Tomorrow morning, New Year's Day, I will be working in the morning. Giveme a phone call if the rabbit has not started eating. Antibiotics may irritate the stomach and intestines now inflamed."
Now it is 10.30 am on New Year's Day and no news from her.
This is a strange case in the sense that she lives in Toa Payoh but had never come to Toa Payoh Vets. So proximity was not her concern. She liked the service of the other vet south of Toa Payoh. This rabbit has a habit of licking wall paint and biting things compared to the other two roaming ones. So, the stomach could be upset by chemicals from the paint.
"Strict monitoring of the rabbit outside the crate would prevent a 4th occurrence," I said.
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I was at the pet shop to buy hamster food and had a chat with the operator. Her Primary 6 daughter had helped her in the shop. "I listened to what you said about having my children learn about the pet shop business," she told me. "So this 2nd daughter is here. The one in Seconday 1 will come another day."
"If you shield your 5 children from working in the shop, thinking that they better stay at home, you are bringing up your children to dislike the pet shop business and succeeding you later. You think you are protecting them from the smells and dirt of the pet shop animals. But this is a mistake. They will grow up self-centered and not assisting you at all, to keep their hands clean."
Thursday, January 1, 2015
1163. INTERN. SCRIPT. A dwarf hamster has an itchy lower elbow wart
The mother and pre-teen daughter complained that this 2-year-old dwarf hamster had a red bald patch on the right backside area and was itch scratching continually. I observed the hamster and saw the scratching (video) mainly on the right side.
Some vets perform physical examination which does not involve picking up the hamster to examine his lower body. After all, this is such a small creature and everything can be seen at one look.
I picked up this hamster. Surprisingly, there was a hidden lower elbow wart! This could be the irritating inflamed growing wart that caused the right sided itchiness including right ear scratching and the left backside biting wound. Biting and scratching provide instant temporary relief of pain. This was my hypothesis.
If my hypothesis is correct, electro-excision of this ventral wart would resolve the problem.
Now how to excise this wart which extends the whole width of the lower elbow? It is a gigantic wart if you imagine your lower elbow's width being occupied by a large wart. Should the vet use scissors to excise it and how to control the post-op profuse bleeding?
The hamster is aged, being 2 years old and has around 6 months of life generally. Would the hamster die under anaesthesia and therefore damage the vet's reputation?
What to do to resolve this problem without killing the hamster? Reputational risks are more important for a private vet. Nobody will refer cases to him if he or she has hamsters dead on the operating table.
I decided to give the hamster only isoflurane gas anaesthesia. I used the circular electric loop wire to electro-excise the wart in a split second when the hamster was just anaesthesized by the gas. I used forceps to lift up the wart and excise under it. There was some normal skin. The wart came off and there was just a 3 mm wound. Blood-less. See video.
The hamster went home on the same day and the mother and daughter were happy and satisfied.
In conclusion, if the vet does not examine the underside of the hamster, he or she would mis-diagnose as environmental cause of itchiness and this would not resolve the itchiness problem.
TIPS
Always examine the underside of the dwarf hamster by picking up the hamster and turning him upside down. This elbow wart would have been missed as it was not protruding. A correct diagnosis resolves the client's problem and bring in more referrals than slick advertising. Vets have to deliver results and perform like any service provider.
------------------------------------------------------
Jan 3, 2015
COMMENTS ON VIDEO PRODUCED BY INTERN JIA LING
1. A fast-paced concise video
To improve the quality of production
1. Not to publish the title of video as this is unnecessary
2. Subtitles to be on white text on a black band. White text not easily read in this video.
3. Subtitles are too rapid to be read
4. The BKTP image is flashed by too quick to be read
5. Weak concluding frames - same videos of hamster still scratching. Should have a post-op video or something similar rather than repeat the opening
6. The backside wound - main complaint was not emphasized.
7. Credits -- more videos at www.toapayohvets.com/videos.htm
Some vets perform physical examination which does not involve picking up the hamster to examine his lower body. After all, this is such a small creature and everything can be seen at one look.
I picked up this hamster. Surprisingly, there was a hidden lower elbow wart! This could be the irritating inflamed growing wart that caused the right sided itchiness including right ear scratching and the left backside biting wound. Biting and scratching provide instant temporary relief of pain. This was my hypothesis.
If my hypothesis is correct, electro-excision of this ventral wart would resolve the problem.
Now how to excise this wart which extends the whole width of the lower elbow? It is a gigantic wart if you imagine your lower elbow's width being occupied by a large wart. Should the vet use scissors to excise it and how to control the post-op profuse bleeding?
The hamster is aged, being 2 years old and has around 6 months of life generally. Would the hamster die under anaesthesia and therefore damage the vet's reputation?
What to do to resolve this problem without killing the hamster? Reputational risks are more important for a private vet. Nobody will refer cases to him if he or she has hamsters dead on the operating table.
I decided to give the hamster only isoflurane gas anaesthesia. I used the circular electric loop wire to electro-excise the wart in a split second when the hamster was just anaesthesized by the gas. I used forceps to lift up the wart and excise under it. There was some normal skin. The wart came off and there was just a 3 mm wound. Blood-less. See video.
The hamster went home on the same day and the mother and daughter were happy and satisfied.
In conclusion, if the vet does not examine the underside of the hamster, he or she would mis-diagnose as environmental cause of itchiness and this would not resolve the itchiness problem.
TIPS
Always examine the underside of the dwarf hamster by picking up the hamster and turning him upside down. This elbow wart would have been missed as it was not protruding. A correct diagnosis resolves the client's problem and bring in more referrals than slick advertising. Vets have to deliver results and perform like any service provider.
------------------------------------------------------
Jan 3, 2015
COMMENTS ON VIDEO PRODUCED BY INTERN JIA LING
1. A fast-paced concise video
To improve the quality of production
1. Not to publish the title of video as this is unnecessary
2. Subtitles to be on white text on a black band. White text not easily read in this video.
3. Subtitles are too rapid to be read
4. The BKTP image is flashed by too quick to be read
5. Weak concluding frames - same videos of hamster still scratching. Should have a post-op video or something similar rather than repeat the opening
6. The backside wound - main complaint was not emphasized.
7. Credits -- more videos at www.toapayohvets.com/videos.htm
Wednesday, December 31, 2014
1162. Advices from a pet shop operator - terrapins and pellet food for guinea pigs and rabbits
1. The terrapins imported from the USA are in better health and condition than those from Thailand and Malaysia. Shell quality and health are better. They are selling $4.00 to $5.00 and look like hatchlings, about the size of a 50-cent coin. See video.
2 Rabbits and guinea pigs should be fed pellets, not the mixture of seeds and pellets as given to hamsters. Otherwise they will not get the essential nutrients.
2 Rabbits and guinea pigs should be fed pellets, not the mixture of seeds and pellets as given to hamsters. Otherwise they will not get the essential nutrients.
1161. Four skin-diseased dogs on 30 Dec 2014 morning.
Unusual to get 4 skin diseased dogs in Case 1,2, 4 and 5 on this Monday morning, Dec 30, 2014. I thought it would be a quiet day.
The 3rd case was a Schnauzer going to Yangon in 2 days' time and needed a healthcheck. The brother of the owner had taken the dog to a vet for bladder stone removal. With 10 days of hospitalisation, the total bill was over $3,600.
I made 4 videos of the skin disease dogs for review next visit one month later. Three had a common disease- generalised ringworm. The other one was an overweight Jack Russell who bit her front paws and groin area till they become brown and black.
The 3rd case was a Schnauzer going to Yangon in 2 days' time and needed a healthcheck. The brother of the owner had taken the dog to a vet for bladder stone removal. With 10 days of hospitalisation, the total bill was over $3,600.
I made 4 videos of the skin disease dogs for review next visit one month later. Three had a common disease- generalised ringworm. The other one was an overweight Jack Russell who bit her front paws and groin area till they become brown and black.
1160. A cat spayed by a vet 2 years ago still caterwauls
"Is it due to the spay not properly done?" the mother asked me. "My cat makes a lot of noises, rolling on the floor and lifting up her tail. She went outdoors and attracted the male cats"
I checked the cat's vulval area. There was no discharge.
"Why didn't you let the vet know aboat this caterwauling 2 years ago after the spay? Or a few months after? It is now 2 years later."
"I thought this meowing was normal," the mother said. "The vet had said it was normal after spaying. Before, the cat was not making so much noise as she was indoors. Now she is outside and exhibits this type of noisy behaviour!"
"It is possible that there was some ovarian tissues left after spaying," I said.
"I want to give away the cat," the mother said.
"Take the Ovarid 20 mg tablet at 1/4 tablet per day for 4 days when there is caterwauling," I advised. "This will stop the caterwauling. Take for the next 3 months and let me know. It will be very difficult to look for the ovarian tissues now but that may be the only solution!"
I checked the cat's vulval area. There was no discharge.
"Why didn't you let the vet know aboat this caterwauling 2 years ago after the spay? Or a few months after? It is now 2 years later."
"I thought this meowing was normal," the mother said. "The vet had said it was normal after spaying. Before, the cat was not making so much noise as she was indoors. Now she is outside and exhibits this type of noisy behaviour!"
"It is possible that there was some ovarian tissues left after spaying," I said.
"I want to give away the cat," the mother said.
"Take the Ovarid 20 mg tablet at 1/4 tablet per day for 4 days when there is caterwauling," I advised. "This will stop the caterwauling. Take for the next 3 months and let me know. It will be very difficult to look for the ovarian tissues now but that may be the only solution!"
1159. Hernia repair mesh in human and canine surgery
Dec 31, 2014.
1159. Hernia repair mesh in human and canine surgery
omyra mesh sold
www.abdominalwallhealth.com
2 types of mesh.
Normal mesh causes intestinal adhesions from $80 --- intestinal obstruction -- strangulation -- death.
Adhesive prevention mesh $900 (10 cm x 15 cm).
Human hernias
USE OF ADHESION PREVENTION MESH
Incisional hernias (after surgery)
Umbilical hernias
USE OF NORMAL MESH
Inguinal hernia
METHOD
see www.abdominalwallhealth.com
1. The plug method (mesh cut diagonally half way and formed into a cone or funnel to close the hole) is NO longer used in human medicine. It requires the expensive adhesion prevention mesh. It has been described in a veterinary hernia repair book published by Europeans. .
VETERINARY SURGERY
1. The adhesion prevention mesh must be used if there is contact with the intestines for very large perineal hernias.
2. In hernias where the sides can be stitched up, use the normal mesh to cover the muscles after stitching. There must be a 3-cm margin to account for shrinkage of the mesh. For example, a perineal hernial opening of 12 cm x 12 cm will need a mesh size of 15 cm x 15 cm.
3. Plug method is no longer used in human surgery according to B Braun sales rep Alex.
Tuesday, December 30, 2014
1158. Left perineal hernia and right hip dislocation
This old Pom had a right hip dislocation and a big swollen left perineal hernia. The dog can pee and poop "normally" but cannot walk normally.
"The vet said that since the dog could pee and poop normally, I did not need to do any surgery on the perineal hernia. I had some financial considerations. But it has got much bigger in size! Now my Pom hops on 3 legs! What to do?"
"Perineal hernia repair is more important as it can be life-threatening when the herniated intestines or bladder get twisted."
"The vet said that since the dog could pee and poop normally, I did not need to do any surgery on the perineal hernia. I had some financial considerations. But it has got much bigger in size! Now my Pom hops on 3 legs! What to do?"
"Perineal hernia repair is more important as it can be life-threatening when the herniated intestines or bladder get twisted."
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