26. Large toe granuloma. Just cut it off?

As part of my training, I asked my assistant what to do in this case of the Labrador Retriever with a large lick granuloma in his 5th toe? It is good to ask for ideas although one may be deemed incompetent in asking.

"Just cut off the toe from here and stitch up from there to here," my assistant outlined the approach of "de-clawing in the cat" to cut off the large granuloma that had existed for one month. The owner finally sought veterinary advice as the dog kept licking and licking. If only he had consulted the vet early, the treatment was so simple and effective as it would just be a simple wound.

"If you cut this large granuloma, you will have a very unhappy owner," I said. "The hole will be so big as the granuloma now covers the second and third phalanx too. For cat declawing, only the first phalanx is cut off. In this dog, the area is inflammed and infected. After cutting off, the wound will not heal well. The owner is going to spend more money and the dog is going to lick."

"We can hospitalise the dog and treat for him after surgery," my assistant suggested.

"No owner will be happy if the dog's wound does not heal after hospitalisation," I explained to him. "There is the money to be spent and the worries."

"The first method is to reduce the granuloma size using drugs," I explained to him. If the granuloma disappears, there is one happy owner. "If not, the size will be reduced and surgery to cut it off will be easier and the hole will be much smaller."

Toe and other lick granulomas are common in dogs. Owners neglect early vet attention. The instinct of the vet is to cut it off. Veterinary surgery is not always the answers to inflammatory granulomas in the toes.

25. Xylazine:Ketamine IV sedation and anaesthesia in dogs

There are many methods of anaesthesizing the dogs. One of them is the use of xylazine and ketamine IV. I believe this is seldom used as each vet has his own preferences. For example, I use xylazine tranquilisation IM and halothane and nowadays isoflurane gas anaesthesia over the past 20 years of practice and I find it to be very effective and safe, with rapid recovery.

However, old dogs can learn new tricks and I always ask other vets what anaesthesia they use. There is a great variety.

My associate vet loves to use Domitor pre-anaesthetic dosage, isoflurane and then Anti-sedan reversal. Another vet loves the xylazine/ketamine combination for anaesthesia. Another one loves zoletil injectable anaesthesia. The principal vet my god-daughter is seeing practice with in Perth never uses mask anaesthesia at all and therefore he does not have anaesthetic mask.

The following is my observation of xylazine:ketamine IV anaesthesia I used in one 26-kg, 5-year-old Labrador Retriever yesterday to treat a lick granuloma of the LH D5 toe.


THE GENERAL GUIDELINE FROM ONE VET
FOR XYLAZINE:KETAMINE IV ANAESTHESIA IN DOGS

FOR ANAESTHESIA
26kg, 5-year old dog
Xylazine 2% at 2.3 ml
Ketamine 100mg/ml at 0.3 ml
In one syringe, the total is 2.6 ml, IV

FOR SEDATION, the dosage is reduced as follows:
26kg, 5-year old dog

Xylazine 2% at 1.3 ml
Ketamine 100mg/ml at 0.3 ml
In one syringe, the total is 1.6 ml. IV
This was what I gave to the dog

After 1 minute, the dog was sedated.
After 5 minutes, I injected prednisolone into his large LH 5th digit granuloma. Slick flicker of pain reaction. He was sedated well.

Recovery
He took more than half an hour to wake up and more than 1 hour to stand up. I did not given any anti-xylazine reversal as ketamine is involved.

CONCLUSION
I prefer dogs to be standing up within 2 minutes of the end of a procedure or surgery. So, I will not be using this method. It will be good for cases where there are no gas machines. This is why I am recording this case for the benefit of vets who may not have anaesthetic gas facilities.

P.S.
From this practitioner who is experienced in this method of anaesthesia, there is a general formula for xylazine:ketamine IV anaesthesia in adult dogs.

For example, 26 kg, 5-year-old dog
Xyalzine 2.3 ml + ketamine 0.3 ml = 2.6 ml in one syringe.
This is a general formula and must be reduced according to health, age and weight.

24. Be proactive to save money - Telcos' confusion

Telcos all over the world confuse clients. Below is a excellent report on the situation in Singapore in April 20910 from one lady. She should be in the consulting and research field. All the time, I had the perception that Starhub who was the first mover in providing free in-coming calls was still the best value-for-money of the 3 telcos in Singapore.

Telcos rely on the "inertia" of people. People who have subscribed to the line will usually not want to switch to the better deal and they start giving various packages to confuse comparisons. Unless one has the time to research on this.

E-MAIL FROM DR SING

On Sun, Apr 11, 2010 at 4:24 PM, Kong Yuen Sing <99pups@gmail.com> wrote:

96640404 is not available. Can you recommend me whether I should subscribe to Starhub or Singtel and what plans? I will do it on Monday and get for you the tel no

E-MAIL TO DR SING

You can subscribe to corporate SunSaver Plus plan from M1 for a 3-months subscription period without handset.

Below is the details of this plan:
Corporate SunSaver Plus
- monthly subscription $48.15
- free local outgoing mins cap at 300mins
- free local sms cap at 500sms
- M1's free incoming calls is valid till 31 Dec 2012
- Excess local outgoing mins are charged 16.05¢ flat per min. Excess local sms-es are charged 5.35¢ per sms.

I estimated that the business calls usage would range from 400mins to 500mins so the monthly phone bill incurred is likely to ranged from $64.20 to $80.25. If one day you find that the monthly phone bill consistently exceeds $82.95 for months due to the business call usage exceeding 516mins and I would suggest an upgrade to SunMax plan (scroll down for details on SunMax plan). Meanwhile, you can subscribe to SunSaver Plan plan first.

Pls: scroll down below for explanation to the choice.

Thanks.

Regards,
Ling

------

Note: Though you told me to choose the plan, I think it's still right to explain to you the choice. Below is the rather lengthy explanation if you are free to go through:

The monthly subscription pricing of the free incoming calls corporate plans of the Starhub, M1 and Singtel are essentially the same. But Starhub's and M1's free incoming calls corporate plans comes with per second billing, which is more economical than Singtel which charges by an initial block of 1min and subsequent blocks of 6secs. For the validity date of the free incoming call, M1's free incoming call is valid till Dec 31, 2012 while Starhub's and Singtel's free incoming calls are valid till Dec 31, 2010.

The minimum subscription period without purchase of handset is 3-months for all the three mobile service providers.

If you plan to subscribe for 3-months or 6-months, for which the subscription would end before Dec 21, 2010, it wouldn't make a difference whether you choose to Starhub or M1. However, if you plan to subscribe for 1-year, I would suggest that you sign under M1 as Starhub's free incoming calls are not valid after Dec 31, 2010.

I estimate that the business calls minutes can range between 400 to 500mins.

If you intend to subscribe to Starhub, you can choose
- Corporate PowerValue 300
monthly subscription $48.15
free outgoing mins cap at 300mins
free sms cap at 500sms

- Corporate PowerValue 700
monthly subscription $82.93
free outgoing mins cap at 700mins
free sms cap at 500sms

If you intend to subscribe to M1, you can choose
- Corporate SunSaver Plus
monthly subscription $48.15
free outgoing mins cap at 300mins
free sms cap at 500sms

- Corporate SunMax
monthly subscription $82.93
free outgoing mins cap at 700mins
free sms cap at 500sms

To simplify, you can subscribe the corporate SunSaver Plus plan from M1 first. If you plan to renew the subscription in the future, you can still enjoy the free incoming calls which is valid till Dec 31, 2012. If one day you were to feel that the corporate SunSaver Plus plan is insufficient for your business calls usage, you can upgrade to the corporate SunMax plan.

23. Biosecurity in poultry farms - Part 2

E-MAIL TO DR SING
2010/4/11 ...@hotmail.com>


Hi Dr Sing!

Thank you for your comments. I have re-written my essay but i'm still not very sure if i'm on the right track. Should I put it as "I am the farmer" point of view, or a general point of view? And how do i link the different farm systems? Have i done it correctly?

Poultry Assignment 2010

“It is difficult for people to catch H5N1 bird flu, but when they do, it can be deadly, (Reuters, 2010).” Bird flu is one of the main concerns of the poultry industry leading to massive economic losses in farms. For example, in December 2008, authorities found H5N1 in a chicken at a poultry farm in Hong Kong, prompting the slaughter of more than 90,000 birds (AFP, 2009). Such diseases can be prevented by implementing biosecurity measures.

WHAT IS THE DEFINITION OF BIOSECURITY? Is it just purely disease prevention?

Diseases can be introduced to poultry farms through people, poultry, contaminated premises or equipment and vectors. The type of biosecurity measures to be implemented depends on whether I am operating a free range farm, barn layer system or a conventional caged farm. Some preventive procedures can apply to all systems, while others are specifically to one or two.



For any type of the three farm systems mentioned above, the following measures must be implemented. Firstly, newly arrived or sick birds must be quarantined to prevent transmission of diseases to the healthy flock.



Secondly, routine vaccinations will be given to all chickens to prevent a particular disease by triggering the bird’s immune system to produce antibodies that in turn fight the invading causal organisms (PoultryHub, 2009). For example, vaccines such as live (V4) vaccine and in ovo Mareks Disease Vaccination are commercially used.



Thirdly, I will oversee that visitor hygiene measures are strictly abided by. Signage and gates will be put up to discourage unauthorized individuals from entering the farm (PoultryHub, 2009). Visitors and service providers must wear overalls and boots that will be provided and foot washing baths will be available at the entrance of each shed for disinfection prior to entry (PoultryHub, 2009). I will also ensure that movement of people will be scheduled such that the youngest flocks are visited first and the oldest last (PoultryHub, 2009).



Fourthly, minimizing fear and anxiety in the birds to reduce their stress level will help the birds’ natural protective mechanisms to function optimally (PoultryHub, 2009). Also, using good quality feed is particularly important as bacteria and mould may be present in poor quality feed (PoultryHub, 2009).



Fifth, I will ensure that daily inspection is done on the birds; any sick or dead birds must be removed immediately to prevent the spread of bacteria or virus.



The following are measures related to specific farm systems. If I were to operate a conventional cage or barn layer systems, thus I will ensure that a good ventilation system is installed as birds are confined to a very small area and are thus very susceptible to any air borne diseases.



If I were to operate a free range farm system, I will wire net the barns to make them bird proof (PoultryHub, 2009), discourage wild birds from visiting by removing any spilled feed immediately (deGraft-Hanson, 2002) and by sanitizing water for bird consumption (Commonwealth of Australia, 2010). I will also ensure good fencing to prevent rodents from gaining access which may contaminate poultry feed.



In conclusion, it is important to know what type of farm system is used and implement the right measure to protect the birds against potential sources of diseases.

REFERENCES



E-MAIL REPLY FROM DR SING

Excellent report. Easy to understand and I don't fall asleep reading it. I think you have a gift for research writing.

You should look at the question and you will know the answer. I believe the question was "What aspects of the biosecurity program would you put in place to protect my poultry farm against the 4 potential sources of diseases? I don't know how many poultry housing systems there are in this world as I am out of the poultry line for at least 30 years. The only birds I see recently are those common black and white ones and crows in Perth.

I believe poultry has two types of housing systems - the indoor and outdoor (free ranging systems). How to link them? You have had done it.

I remember some points which may be relevant to biosecurity too.
1. Good record keeping of biosecurity measures and writing manual of standard operating procedures for hygiene controls.
2. Review of breaches of biosecurity and learn from them, sharing knowledge with managers.
3. Regular education program for new employees and staff on biosecurity measures
4. CCTV and alarm systems for expensive breeding stock?
5. Veterinary post-mortem of sick birds, blood test to check effectiveness of vaccination, health surveillance of random samples regularly.
6. Keep up research and good writing. Be hands on. Go and visit real poultry farms! Dog farms, fish farms, alpacca farms etc and you will see biosecurity in action. Study hard. Best wishes.

22. The girl with the clicking car

Undergraduate days are frugal days and possessing a car in the 1960s was a big thing as most Singapore undergraduates then and now cannot afford ownership of a car. Not in Perth. A$3,000 will buy you a moving car and many undergraduates drive.

But this small car was clicking every time the girl shifted gears to drive. "Click," she shifted to gear 1. "Click," she shifted to gear 2 and so forth for the rest of the journey to see the principal vet.

"Are you sure your car is safe to drive?" I asked the girl. "Will it crash?"

"The mechanic says there should be no problem," she clicked again. "The mechanic needs to dismantle the gear box to solve the problem." The girl has no priority for a clickety car and was too busy.

I have my doubts about the safety of a clicking car. Must do some research. Will not the clicking cause friction. Friction causes sparks. Sparks cause the car to catch fire? I mean, if a dog is coughing, will persistent coughing lead to some serious illness? Does this not apply to a car too? Prevention is better than cure.

I did not mention this to the girl's mother in Singapore. Otherwise, the mother would worry more.

21. TRAVEL STORIES. A 79-year-old war veteran with agile mind in Perth, Australia in 2010. KINDLE STORIES

TRAVEL STORIES.
Dr Sing Kong Yuen, BVMS (Glasgow), April 2010.

This one-week in Perth, Australia, far away from my practice in Singapore, gave me time to reflect and see life and matters in a new perspective. 

Be proactive is the topic I had been thinking.

Inertia is preferred as it is troublesome and uncomfortable to start something new. The status quo is what most people wanted and therefore, the "opt-out" system of organ donation is being used by governments. If you don't "opt-out" in writing, the law states that you have agreed. Being proactive may lead to undesirable consequences.

Two days ago, I asked a young man to drive me to visit a veterinary practice at 10 am as I would like to educate myself on how vets in other countries were managing their business.

This practice was equipped with laboratory equipment to test for cortisol and thyroxine, blood pressure monitoring, ECG and a breath-rate-monitoring alarm system during anaesthesia. I sat on the bench in the waiting room.

Within 1 minute, the receptionist attended to me. "He's out," the receptionist said. So, I was surprised. He came back soon. This vet was a dynamic successful man in his 40s as he has 2 practices. I was surprised that he has no anaesthetic masks in his practice. 

"No need," he said. "I induced them with drugs." This was a new perspective to me as face masks are part and parcel of practice. For example, I used anaesthetic mask in dogs in shock in emergency Caesarean sections without giving sedation injections. However, each vet has his own successful methods of anaesthesia.

I was surprised that he was allergic to rabbits. "How about horses?" I asked. "Yes," he said. I considered myself fortunate in not being allergic to animals for the past 30 years.

I checked out the ambience of the surroundings as this was necessary for me to assess for the mother of Alice, a vet student who would be doing internship in this practice, as to whether this neighbourhood was relatively safe. It was a typical suburb but unlike my rental unit in Willeton with its manicured lawns and rose gardens and overwhelming one-storey bungalows, this suburb has apartment blocks and low rises. Willeton is said to be a middle to upper class residential area of Perth.

I visited a beautiful lake near the veterinary practice. Many children and families were present on this weekday morning. Pelicans and water fowl were abundant. This was a surprise to me as most parks were quiet.

A 79-year-old war veteran passed by. He was a strong-looking tough man in dark sunglasses, walking a medium-sized Boxer-like dog in this beautiful park. I asked him about the plant with cones of yellow, white, pink, brown and black colours, so commonly seen in parks. It appears on the logo of Murdoch University too.

 

 

"You can suck the nectar from the small flowers of this banksia plant," he said to me and asked whether I wanted to do it. "No, thanks," I said. He walked dogs every morning and boarded them for people. "Do you charge for your services?" I asked. "No," he said. "Just whisky at the end of the walk."

He was 79 years old, had both eye lens replaced, a not so strong heart. But his mind was very active and alert. Many men in their 60s become senile, but he was so mentally alert and could tell me the species of various birds in the park and the whole history of coin-collecting. 

"How do you safeguard your coins?" I asked. I presume he was living alone. "I don't put all my coins in one place," he said. "Some in the bank, some in a safe." 

I asked him, "The thieves can just cart away your safe when you are out exercising the dogs." "My alarm system is connected to the security and in 5 minutes they will come." 

 "A clever thief will deactivate the system," I said. He had the answers, "My safe is underground and it will take a long time to haul it out." 

"The thief will just clear the safe by blowing it open," I said. "Not so easy," the war veteran who is an expert in explosives for the Australian army told me. "I have a steel door to the room." This was one man who was well prepared for all contingencies. He was an expert in old coins and all his expertise is inside his brain. 

"How do you sell your coins?" I asked. "There is a Phoenix auctioneer who charges a fee on successful sale," he said. This is a 79-year-old average man on a pension, but he certainly was not "one foot in the grave." He has daily exercise by taking dogs out for people free of charge. 

On knowing that I am a vet, he said, "In Australia, vets make a lot of money." 

An immigrant who owns the Bull Creek Hawker told me the same thing. "Why do you say that?" I asked the war veteran. "See the skin lump on this miniature pinscher," he pointed to a 1-cm lump on the left chest of the dog. "The vet charges A$50 just to tell me it is a skin lump." 

The successful boss of Bull Creek Hawker told me that it cost over A$100 to consult a vet when the dog has flu while a human being paid $27.00. "So, a man with no garden don't walk a dog," the boss referred to some Cantonese idiom, meaning that a poor man should not own a dog. 

While back from the park to Willeton, my driver who was an undergraduate at Murdoch University switched lanes from the right to the centre to the left suddenly, as he was on the wrong side of the road. 

"What to do?" he asked me as a police car had flashed him to stop. "Get onto a side road," I said. "And stop the car." He was having hand tremors. He was intimidated by the Australian police as they looked physically twice as big as him. The policemen were friendly and gave him a warning not to repeat the incident.

It is 17 Nov 2022 today as I read my article. Twelve years had passed. Was I proactive in the past 12 years of life? I would say I was, but not in the materialistic sense in that I don't own two veterinary clinics. I still have the original one at Toa Payoh Vets.

 

UPDATES AT:
https://2010vets.blogspot.com/2010/04/21-79-year-old-war-veteran-with-agile.html

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BANKSIA

Banksia is an Australian genus of shrubs and small trees that occurs on a wide range of soils including those that are so infertile, wet, or dry, that other woody species do not grow.

 Banksias for the Garden

Banksias usually grow best in well drained soils in a sunny position. Most respond to light pruning, and those which form a woody rootstock (lignotuber) can be heavily pruned. Only low phosphorus fertilisers should be used.

Species native to Western Australia are prone to root-rot fungus and generally do not grow well in parts of Australia which experience high humidity and rainfall in the summer.
Banksias range from low-growing shrubs to trees up to 25 m tall. Some species, for example Banksia ericifolia and Banksia menziesii , are known for their spectacular flower heads. The flower heads produce large volumes of nectar and attract many birds and small mammals to feed on them. Banksias are excellent plants to encourage native animals to the garden.

 

 

 

 

20. Red rice yeast to lower cholesterol?

Apr 9, 2010. perth. last day of visit.

Julia had high total cholesterol over past many years. Statin caused muscle ache and rapid heart beat. So, the doctor recommended lipantol for the past 3 years. Cholesterol reading never went below 200. Latest reading was 230 and liver enzymes were raised, indicating liver disorder after so many years of taking of drugs to lower cholesterol and high blood pressure. What to do?

"You can try nicotinic acid," the good doctor had diagnosed that Julia's high cholesterol was hereditary. No hope of reducing. Cholesterol continues to plug her arteries. But nicotinic acid has adverse side effects and may not work. "You can try red rice yeast," the doctor suggested. "But it is not scientifically proven nor arre the ingredients standardised or declared. It is like taking herbal medicine. You take it at your own risk."

Is there a solution for Julia's high cholesterol? The doctor had run out of drug options. "Dr Chua has excellent bedside manners," I said to Julia. "If I were him, I would tell you to stop eating fried food, oily noodles and go on a 90% vegetable and fruit diet. And a serious program of exercise daily." Julia disliked exercise. TV and movies in air conditioned rooms and her office manager's job were her sedentary life-style. She lives to eat and good food is definitely not vegetables, fruits and rice. She was not particularly worried about high cholesterol. So far, no sickness.

Many mothers in their late 40s and 50s start putting on weight. It is the mother's sedentary lifestyle but they seem not to be able to reduce their weight. How about red rice yeast? I went to Boorangoon in Perth. Only 2 bottles were available for sale. I bought them. I went to Southmall in Willeton. None available. "Why?" I asked the health food shop operator. "The demand spiked last 2 months when the red rice yeast was advertised on TV," he said. "TV advertisement sells the product very fast." That was why I could not locate any bottles for Julia. There must be many people in Perth allergic to the statins and/or using the herbal alternative.

I bought glucosamine and chrondition brand for the mother of another student studying in Perth. This particular brand was on sale in Sydney at A$49.00 for 200 capsules. But in Perth's Boorangon shopping centre, it was more. The girl did not want to buy it. It is again the lifestyle of the mother. She just could not reduce weight and now her knees were painful. "You know," I said to the gierl's mother, "You just reduce 10 kg over 1 year and your knees would not need to bear so much weight." Since this was not what she wanted, I bought the 200 capsules which was what she wanted.

Lifestyle changes seldom appear in intelligent women in their 50s. They are proficient and good in their careers. But good oily meat and salty food is so much tastier. And deadly for them. It is such a pity. As for red rice yeast, I did a bit of internet research at: http://www.cholesterolcholestrol.com/red-rice-yeast-cholesterol-cholestrol.html
It was statin in low doses! The statin is deadly to Julia. So in fact, julia has no herbal alternative. Two bottles down the drain.