Old dogs with growing subcutaneous tumours may die under anaesthesia. Tumours keep growing to irritate the dog as they become infected. It is very difficult for the owner to take the risk as deaths on the operating table do occur in old dogs.
Different vets and doctors have different approaches to the treatment of tumours.
1. One approach is to do a fine needle aspiration and then a surgical biopsy of the tumour to be sent to the histopathologist to determine if the growth is cancerous or not.
If it is not cancerous, everyone is happy.
Unfortunately, the histopathologist takes time to reply the findings. In some cases, the fine needle aspiration is not useful. So, the histopathologist asks for a surgical biopsy. Time is needed and it may take two weeks to get the reply.
If the tumour is malignant but has not metastasized (spread to other parts of the body), the time taken by the histopathologist permits the tumour to spread.
2. Another approach is to excise the lump including a wide margin in case the lump is cancerous. This is known as radical excision. After surgical removal, the lump is sent to the histopathologist for a report as to whether it is benign, malignant or just an infection.
I prefer this method and have used it in this old Pomeranian. Fortunately she has a benign adenoma.
Monday, June 27, 2011
481. Sunday cases : Malignant fibrosarcoma in a 2-year-old cat
Sunday June 26, 2011. I was on duty the whole day as Dr Vanessa Lin was on leave. Usually I work from 9.30 am to 11 am on Sundays and Dr Vanessa Lin starts from 11 am to 5 pm.
BE KIND TO PETS
TIPS TO OWNERS
1. Malignant fibrosarcomas in a 2-year-old cat. The young couple came for a 2nd opinion as the cat came a few months ago for a right eye injury. Now the cat had multiple large firm hard lumps on the right side of the body mainly and the right eye is a white cloudy mass. The first lump appeared above the right shoulder blade. Then another one grew behind it. Today, the right front leg had a chicken egg's lump under the armpit (axillary lymph node metastasis). There were two smaller lumps to the left side of the midline near the left shoulder blade.
The owner had consulted Vet 1 who did the following:
1. Fine needle aspiration sent to the histopathology lab.
2. Surgical biopsy sent to the histopathology lab as the fine needle aspirate was not useful. Malignant fibrosarcoma was diagnosed.
3. Complete blood cell count indicated a high white cell count initially. X-rays were done.
MY ADVICE
The fibrosarcomas are malignant and grow aggressively to massive sizes. Surgical excision of the axillary lymph node is highly risky as the cat is not in good health (very thin now) and the tumour has spread to the muscles. The tumour will recur after surgery.
Chemotherapy is not well tolerated by the cat. Radiation therapy is not available for cats in Singapore. Therefore, it would be best to let the cat enjoy the expected one month of his life before the tumour ruptures causing infection and pain and requiring euthanasia. Also, the right front paw shows signs of swelling due to venous obstruction. The cat is thin and has difficulty walking on the right front leg.
CAUSES
A malignant fibrosarcoma is a cancerous growth of the fibrous connective tissue. It is one of the most common musculoskeletal cancers found in cats.
There are four possible causes of fibrosarcoma.
1. Older cats with usually a single, irregularly shaped mass found on the trunk, legs & ears.
2. Rare cases said to be vaccine induced sarcoma.
3. A mutant form of FeLV known as 'feline sarcoma virus' (FeSV). Usually happen in younger cats & occurs as multiple tumour masses.
4. Genetics? This has not been confirmed.
This young cat had the first lump appearing to the right of the midline, between the shoulder blades and had been vaccinated. It is possible that he could be suffering from a vaccine induced sarcoma. Could it be due to genetics? His right eye ball is no longer normal. Could it be the original site of the sarcoma inside the eyeball ? Could he be having FeLV too as this was not tested. It is hard to say.
RETROSPECTIVE
Cat owners with very small fast-growing lumps on the vaccination site or in any area may need to find a vet that will remove the lump immediately rather than do fine needle aspiration and surgical biopsy as these test takes time.
By fast-growing lumps, I mean that the lump "suddenly appears" or double in size every week.
Although malignant fibrosarcomas do recur in cats after surgery, early radical surgical excision with a wide margin and repeat surgeries when the lumps recur and are small may lead to an extension of more than one year of life.
By small lumps, I mean those that are less than 1 cm in diameter. Surgical plus chemotherapy prolong lives but chemotherapy is not well accepted by the cat. Radiation therapy has side effects too and is not available for cats and dogs in Singapore. Once the fibrosarcoma has spread, surgery is not advised as fibrosarcomas grow very big very fast and do spread elsewhere in the body.
Prognosis, cost and the welfare of the cat are important considerations in the treatment of fibrosarcomas in the cat. In this case, the owner opted for no treatment and asked me how long the cat would live. I expected one month of good quality life before the armpit tumour ruptures and become infected and painful.
In this young cat, early radical excision of the sarcoma and sending the tumour for histopathology would be my approach to the treatment of this case. This approach is to minimise the chances of metastasis (spread of the tumour).
The client would be advised that the fibrosarcoma will recur and repeat surgeries will be needed. There have been a report by a vet of success using this approach but not much details have been given as she only encountered 3 cases in 26 years and was successful in treating 2/3 cases with repeat surgical excisions.
From my experience, most pet owners in Singapore have a wait-and- see attitude. Only when the tumour is large will they seek veterinary advices. By then, the fibrosarcomas have spread and become inoperable.
Any updates will be at www.toapayohvets.com, goto Cats - Tumours in Cats
BE KIND TO PETS
TIPS TO OWNERS
1. Malignant fibrosarcomas in a 2-year-old cat. The young couple came for a 2nd opinion as the cat came a few months ago for a right eye injury. Now the cat had multiple large firm hard lumps on the right side of the body mainly and the right eye is a white cloudy mass. The first lump appeared above the right shoulder blade. Then another one grew behind it. Today, the right front leg had a chicken egg's lump under the armpit (axillary lymph node metastasis). There were two smaller lumps to the left side of the midline near the left shoulder blade.
The owner had consulted Vet 1 who did the following:
1. Fine needle aspiration sent to the histopathology lab.
2. Surgical biopsy sent to the histopathology lab as the fine needle aspirate was not useful. Malignant fibrosarcoma was diagnosed.
3. Complete blood cell count indicated a high white cell count initially. X-rays were done.
MY ADVICE
The fibrosarcomas are malignant and grow aggressively to massive sizes. Surgical excision of the axillary lymph node is highly risky as the cat is not in good health (very thin now) and the tumour has spread to the muscles. The tumour will recur after surgery.
Chemotherapy is not well tolerated by the cat. Radiation therapy is not available for cats in Singapore. Therefore, it would be best to let the cat enjoy the expected one month of his life before the tumour ruptures causing infection and pain and requiring euthanasia. Also, the right front paw shows signs of swelling due to venous obstruction. The cat is thin and has difficulty walking on the right front leg.
CAUSES
A malignant fibrosarcoma is a cancerous growth of the fibrous connective tissue. It is one of the most common musculoskeletal cancers found in cats.
There are four possible causes of fibrosarcoma.
1. Older cats with usually a single, irregularly shaped mass found on the trunk, legs & ears.
2. Rare cases said to be vaccine induced sarcoma.
3. A mutant form of FeLV known as 'feline sarcoma virus' (FeSV). Usually happen in younger cats & occurs as multiple tumour masses.
4. Genetics? This has not been confirmed.
This young cat had the first lump appearing to the right of the midline, between the shoulder blades and had been vaccinated. It is possible that he could be suffering from a vaccine induced sarcoma. Could it be due to genetics? His right eye ball is no longer normal. Could it be the original site of the sarcoma inside the eyeball ? Could he be having FeLV too as this was not tested. It is hard to say.
RETROSPECTIVE
Cat owners with very small fast-growing lumps on the vaccination site or in any area may need to find a vet that will remove the lump immediately rather than do fine needle aspiration and surgical biopsy as these test takes time.
By fast-growing lumps, I mean that the lump "suddenly appears" or double in size every week.
Although malignant fibrosarcomas do recur in cats after surgery, early radical surgical excision with a wide margin and repeat surgeries when the lumps recur and are small may lead to an extension of more than one year of life.
By small lumps, I mean those that are less than 1 cm in diameter. Surgical plus chemotherapy prolong lives but chemotherapy is not well accepted by the cat. Radiation therapy has side effects too and is not available for cats and dogs in Singapore. Once the fibrosarcoma has spread, surgery is not advised as fibrosarcomas grow very big very fast and do spread elsewhere in the body.
Prognosis, cost and the welfare of the cat are important considerations in the treatment of fibrosarcomas in the cat. In this case, the owner opted for no treatment and asked me how long the cat would live. I expected one month of good quality life before the armpit tumour ruptures and become infected and painful.
In this young cat, early radical excision of the sarcoma and sending the tumour for histopathology would be my approach to the treatment of this case. This approach is to minimise the chances of metastasis (spread of the tumour).
The client would be advised that the fibrosarcoma will recur and repeat surgeries will be needed. There have been a report by a vet of success using this approach but not much details have been given as she only encountered 3 cases in 26 years and was successful in treating 2/3 cases with repeat surgical excisions.
From my experience, most pet owners in Singapore have a wait-and- see attitude. Only when the tumour is large will they seek veterinary advices. By then, the fibrosarcomas have spread and become inoperable.
Any updates will be at www.toapayohvets.com, goto Cats - Tumours in Cats
Friday, June 24, 2011
480. Finding a good family for a young timid chihuahua
It is hard to find a good family for an adult dog. I had given up hope of finding a very good family for this timid Chihuahua who had been staying with an experienced and famous Chihuahua breeder for the last 8 months. The breeder gave the dog to me to find a good home as he did not want to breed a monorchid (one testes). I thought he would be giving me a puppy as he had done before but this was an 8-month-old handsome Chihuahua.
On July 22, 2011, a client phoned me to make an appointment the next day as her female Chihuahua had an "ant bite" in the backside. I happened to be taking phone calls like the receptionist. "Come before 11 am if you specifically want to consult me," I said. I am usually on duty before 11 am and after that my clients would be consulting Dr Vanessa Lin who works from 11 am to 7 pm usually.
So, time and space connected. The timid Chihuahua found a very good family and I am very happy for him. He needs a teenager who will have time for him and another Chihuahua who will be his playmate and make him grow up to be more confident. It was a coincidence as my client could have not be free to consult me before 11 am and therefore, would not be offered this Chihuahua by Dr Vanessa as the dog had nothing to do with her and I had not thought of asking her to look out for a family to adopt this dog. She had an older Shih Tzu whom she had found a new family to adopt and it took some time too. Mine took over 2 months.
It is just tough to find a family to adopt a dog unless one is the SPCA.
On July 22, 2011, a client phoned me to make an appointment the next day as her female Chihuahua had an "ant bite" in the backside. I happened to be taking phone calls like the receptionist. "Come before 11 am if you specifically want to consult me," I said. I am usually on duty before 11 am and after that my clients would be consulting Dr Vanessa Lin who works from 11 am to 7 pm usually.
So, time and space connected. The timid Chihuahua found a very good family and I am very happy for him. He needs a teenager who will have time for him and another Chihuahua who will be his playmate and make him grow up to be more confident. It was a coincidence as my client could have not be free to consult me before 11 am and therefore, would not be offered this Chihuahua by Dr Vanessa as the dog had nothing to do with her and I had not thought of asking her to look out for a family to adopt this dog. She had an older Shih Tzu whom she had found a new family to adopt and it took some time too. Mine took over 2 months.
It is just tough to find a family to adopt a dog unless one is the SPCA.
Wednesday, June 22, 2011
479. Dachshund neck abscess - microscopic exam
Dachshund Male Neutered 10 years had a large golf-ball swelling on the neck above and between the shoulders. What was it?
SURGICAL DRAINAGE
Blood aspirated and drained (see syringe).
Wound closed and healed in 2 days.
On day 3, a golf-ball swelling appeared.
SURGICAL DRAINAGE
I snipped off the stitches and opened up the wound.
Clear yellow plasma-like fluid flowed out, around 10 ml. What was it?
On day 2, reddish brown fluid seeped out. This continued for next 3 days.
Some yellow pus-like tissues.
MICROBIOLOGICAL EXAM. TISSUE FROM NECK
June 9, 2011, I did a bacterial culture. Results: Moderate growth of coagulase-negative Staphylococcus, sensitive to amoxycillin/clavulan, ceftriaxone, vancomycine, oxacillin.
Resistant to chloramphenicol, erythromycin, penicillin, bactrim, tetracycline and ampicillin.
I gave baytril for 3 days and metonidazole for 6 days. Irrigated the wound with hydrogen peroxide. The 71-year-old mum took back the dog on Day 3. Wound was left open. On Jun 22, 2011, I phoned the owner. All OK.
The owner was in Japan and was most worried. We communicated by phone. As to the cause, it was hard to say. Was it due to the tight bandaging or SC baytril injection? The sibling was given similar drugs SC below the neck and was OK, but he did not have tight bandaging.
Bacterial culture was needed in this case.
SURGICAL DRAINAGE
Blood aspirated and drained (see syringe).
Wound closed and healed in 2 days.
On day 3, a golf-ball swelling appeared.
SURGICAL DRAINAGE
I snipped off the stitches and opened up the wound.
Clear yellow plasma-like fluid flowed out, around 10 ml. What was it?
On day 2, reddish brown fluid seeped out. This continued for next 3 days.
Some yellow pus-like tissues.
MICROBIOLOGICAL EXAM. TISSUE FROM NECK
June 9, 2011, I did a bacterial culture. Results: Moderate growth of coagulase-negative Staphylococcus, sensitive to amoxycillin/clavulan, ceftriaxone, vancomycine, oxacillin.
Resistant to chloramphenicol, erythromycin, penicillin, bactrim, tetracycline and ampicillin.
I gave baytril for 3 days and metonidazole for 6 days. Irrigated the wound with hydrogen peroxide. The 71-year-old mum took back the dog on Day 3. Wound was left open. On Jun 22, 2011, I phoned the owner. All OK.
The owner was in Japan and was most worried. We communicated by phone. As to the cause, it was hard to say. Was it due to the tight bandaging or SC baytril injection? The sibling was given similar drugs SC below the neck and was OK, but he did not have tight bandaging.
Bacterial culture was needed in this case.
478. Sharpei websites
http://sharpeiforums.com/viewtopic.php?f=2&t=816
http://www.kavishi.freeserve.co.uk/
Dr Sing,
Thank you for treating (name of Sharpei).
The above are the two sites I frequently go to.
There are a few more which I have yet to locate.
Can you send me a photo or two of the photo you took of my dog
Sharpei could not see clearly as he did not respond promptly to objects as before.
So the owner consulted me.
The dog had lower eyelid medial entropion. His upper eyelids' entropion was well done by the UK vet and had everted the upper eyelid. I noted generalised superficial ulcerative keratitis (cloudy cornea over 80% in both eyes). This explained why he could not focus as sharply as before.
What caused this superficial keratitits? Eye rubbing + ear rubbing over several weeks. His left ear was infected as he growled to warn me not to continue touching his ear. So, there was a problem. His neck skin was infected as signs of scratching were seen.
Skin scrapings by Dr Vanessa - no demodectic mites seen. "This negative finding does not mean he is not suffering from demodectic mange," I said. The owner said he was molting and therefore had those bare moth-bitten patches in his body.
http://www.kavishi.freeserve.co.uk/
Dr Sing,
Thank you for treating (name of Sharpei).
The above are the two sites I frequently go to.
There are a few more which I have yet to locate.
Can you send me a photo or two of the photo you took of my dog
Sharpei could not see clearly as he did not respond promptly to objects as before.
So the owner consulted me.
The dog had lower eyelid medial entropion. His upper eyelids' entropion was well done by the UK vet and had everted the upper eyelid. I noted generalised superficial ulcerative keratitis (cloudy cornea over 80% in both eyes). This explained why he could not focus as sharply as before.
What caused this superficial keratitits? Eye rubbing + ear rubbing over several weeks. His left ear was infected as he growled to warn me not to continue touching his ear. So, there was a problem. His neck skin was infected as signs of scratching were seen.
Skin scrapings by Dr Vanessa - no demodectic mites seen. "This negative finding does not mean he is not suffering from demodectic mange," I said. The owner said he was molting and therefore had those bare moth-bitten patches in his body.
477. Training a 5-month-old puppy advices
E-MAIL TO DR SING DATED JUN 20, 2011
Hi Dr Sing,
I was surfing the net searching for solution to train my puppy and I found your blog.
I have a terripoo puppy which is now 5 months old. When he was young, around 2months old, we used to buy the pee pan for him but he will not stop biting the wee wee pad. Therefore, we tried to lock him in the crane when all of us went out to work but it creates another nightmare by non stop barking. This has caused inconvenience to my neighbours and some of them had complainted about it. Due to this, my mom has decided to let him out from his crane and he is allowed to walk around in the house even none of us are home.
When he is out and no supervision, he will bite our furnitures and also pee pee anywhere he likes. My mom and I used vinegar to clean but still, useless. Can you please advise what should we do?
Best regards,
Name of owner
E-MAIL FROM DR SING DATED JUN 22, 2011
I am Dr Sing from www.toapayohvets.com. Thank you for your email.
It is difficult to advise on what you should do as each puppy or dog has a unique personality. Below are my general guidelines.
1. Confine the puppy to a room e.g. kitchen instead of a crate when he is home alone. A baby gate is placed at the door entrance so that the dog will not feel isolated. Confinement to a small area (crate, room, leashed area) is the basic factor to success of all puppy training programmes for most puppies.
He will bark at the beginning and possibly neighbours will complain. Give him chew toys that contain food inside (ask pet shops). Such chew toys with his favourite food occupy his time to try and get the food out. This may or may not work with your dog.
2. Develop a Routine. Morning and evening exercise outdoors daily for more than 15 minutes after meals and pooping in the designated confinement room. Do not interact with him while he is eating. After exercise, put him in the room as part of the routine.
3. Somebody must be the "boss" in the family. Firm voice of "No barking" and rewards for performance of no barking (go out, treats). Read your dog obedience books to know what I mean.
4. Neuter him at 6 months of age.
5. Supervise him when he is let out to roam free in the apartment and use the firm voice to train him as mentioned in paragraph 3 for barking, chewing, indiscriminate peeing and pooping.
6. I have heard of cases of success (barking and obedience training) when the puppy is boarded at a trainer's place for two weeks or more. Consult a good dog trainer.
I hope the above tips will help. Best wishes.
Hi Dr Sing,
I was surfing the net searching for solution to train my puppy and I found your blog.
I have a terripoo puppy which is now 5 months old. When he was young, around 2months old, we used to buy the pee pan for him but he will not stop biting the wee wee pad. Therefore, we tried to lock him in the crane when all of us went out to work but it creates another nightmare by non stop barking. This has caused inconvenience to my neighbours and some of them had complainted about it. Due to this, my mom has decided to let him out from his crane and he is allowed to walk around in the house even none of us are home.
When he is out and no supervision, he will bite our furnitures and also pee pee anywhere he likes. My mom and I used vinegar to clean but still, useless. Can you please advise what should we do?
Best regards,
Name of owner
E-MAIL FROM DR SING DATED JUN 22, 2011
I am Dr Sing from www.toapayohvets.com. Thank you for your email.
It is difficult to advise on what you should do as each puppy or dog has a unique personality. Below are my general guidelines.
1. Confine the puppy to a room e.g. kitchen instead of a crate when he is home alone. A baby gate is placed at the door entrance so that the dog will not feel isolated. Confinement to a small area (crate, room, leashed area) is the basic factor to success of all puppy training programmes for most puppies.
He will bark at the beginning and possibly neighbours will complain. Give him chew toys that contain food inside (ask pet shops). Such chew toys with his favourite food occupy his time to try and get the food out. This may or may not work with your dog.
2. Develop a Routine. Morning and evening exercise outdoors daily for more than 15 minutes after meals and pooping in the designated confinement room. Do not interact with him while he is eating. After exercise, put him in the room as part of the routine.
3. Somebody must be the "boss" in the family. Firm voice of "No barking" and rewards for performance of no barking (go out, treats). Read your dog obedience books to know what I mean.
4. Neuter him at 6 months of age.
5. Supervise him when he is let out to roam free in the apartment and use the firm voice to train him as mentioned in paragraph 3 for barking, chewing, indiscriminate peeing and pooping.
6. I have heard of cases of success (barking and obedience training) when the puppy is boarded at a trainer's place for two weeks or more. Consult a good dog trainer.
I hope the above tips will help. Best wishes.
Monday, June 20, 2011
476. Red-eared slider - rectal prolapse - purse string suture
Sunday's Interesting Case. Jun 19, 2011. Bright sunshine day.
A red-eared slider owner had made an appointment to see me at 9.30 am on Sunday.
5-year-old red-eared slider
"How long has the rectum come out?" I asked the owner.
"7 days," he said. "It happened some weeks ago and a vet had stitched up the rectum. After 7 days, he took the stitch out and there was no problem. What is the cause?"
"Something has irritated the rectal area," I said. "Usually it is foreign bodies, parasites or diarrhoea."
"It was due to constipation," the gentleman said he kept the slider in a tank with dry and wet areas and had fed her pork meat, chicken meat and the green sticks of commercial turtle food. "I will stop feeding the green sticks," he thought these were the ones causing constipation.
5-year-old red-eared slider
"How long has the rectum come out?" I asked the owner.
"7 days," he said. "It happened some weeks ago and a vet had stitched up the rectum. After 7 days, he took the stitch out and there was no problem. What is the cause?"
"Something has irritated the rectal area," I said. "Usually it is foreign bodies, parasites or diarrhoea."
"It was due to constipation," the gentleman said he kept the slider in a tank with dry and wet areas and had fed her pork meat, chicken meat and the green sticks of commercial turtle food. "I will stop feeding the green sticks," he thought these were the ones causing constipation.
"The slider may not be drinking water in the tank if it is dirty and contaminated?"
"I change water every day," the man said.
So it is hard to know what causes this rectal prolapse as he seemed to have maintained the terrapin well for the last 5 years. The shell was in good condition with no cracks or abrasions on the shell and of good normal size. No peeling or discoloration. Active. She looked healthy.
ANAESTHESIA
Gas mask. Isoflurane gas at 5% in short duration to effect. There was some "clicking" noises of less than a second during anaesthesia. The turtle was anaesthesized just sufficient to put a purse-string suture to close up the anus after pushing back the rectum inside the anus.
PROCEDURE
1. An assistant puts the gas mask onto the turtles head and focus on her reaction.
2. A 2nd assistant holds the turtle upright but NOT upside down on her back, as the slider will suffocate.
3. I clean the rectal prolapse with normal saline and pushed it inside the vent. Then I insert a 2.5 ml syringe into the lumen of the rectum to prevent prolapse. The 2nd assistant held the syringe inwards as the slider may strain to cause prolapse
4. Stitch 3/0 nylon cireumference of anal opening, like a purse string.
DURATION OF STITCHING
7-10 days. The cause of the rectal prolapse must be known otherwise it will be difficult to prevent another episode.
I advised clean water (water left overnight to get rid of the chlorine and asked the owner to check whether the slider actually drinks by giving her the clean water directly.)
Antibiotics and anti-inflam oral for 7 days.
Stitches removed 7 days later. No more prolapse.
"I change water every day," the man said.
So it is hard to know what causes this rectal prolapse as he seemed to have maintained the terrapin well for the last 5 years. The shell was in good condition with no cracks or abrasions on the shell and of good normal size. No peeling or discoloration. Active. She looked healthy.
ANAESTHESIA
Gas mask. Isoflurane gas at 5% in short duration to effect. There was some "clicking" noises of less than a second during anaesthesia. The turtle was anaesthesized just sufficient to put a purse-string suture to close up the anus after pushing back the rectum inside the anus.
PROCEDURE
1. An assistant puts the gas mask onto the turtles head and focus on her reaction.
2. A 2nd assistant holds the turtle upright but NOT upside down on her back, as the slider will suffocate.
3. I clean the rectal prolapse with normal saline and pushed it inside the vent. Then I insert a 2.5 ml syringe into the lumen of the rectum to prevent prolapse. The 2nd assistant held the syringe inwards as the slider may strain to cause prolapse
4. Stitch 3/0 nylon cireumference of anal opening, like a purse string.
DURATION OF STITCHING
7-10 days. The cause of the rectal prolapse must be known otherwise it will be difficult to prevent another episode.
I advised clean water (water left overnight to get rid of the chlorine and asked the owner to check whether the slider actually drinks by giving her the clean water directly.)
Antibiotics and anti-inflam oral for 7 days.
Stitches removed 7 days later. No more prolapse.
CONCLUSION
Prompt vet treatment and slight prolapse give good chances of recovery to normal.
Sunday, June 19, 2011
475. Rare case of pyometra in a young female dog
After over 30 years in small animal practice, I thought I have seen all pyometras. Pyometra is an infection of the womb in the female dog, mostly in dogs over 5 years old.
Yet, this female dog just had her first heat 2 months ago. I checked her before spay and saw mucoid yellow vaginal discharge. "Is she really 10 months old?" I asked Mr Min, my assistant. She was as her teeth were all white as snow and her puppy canine tooth was still present and white.
I am happy to say she is OK after spay. Small animal veterinary medicine is full of surprises every day.
Yet, this female dog just had her first heat 2 months ago. I checked her before spay and saw mucoid yellow vaginal discharge. "Is she really 10 months old?" I asked Mr Min, my assistant. She was as her teeth were all white as snow and her puppy canine tooth was still present and white.
I am happy to say she is OK after spay. Small animal veterinary medicine is full of surprises every day.
Saturday, June 18, 2011
474. Watery pus in shar pei's eyes - entropion?
I have a 6 years old male Shar Pei and have been having watery
eyes and yellow sticky discharge.
I am cleaning him a few times a day with eye wash and the problem
keep coming back.
I understand that surgery on the eye lid is necessary to stop this problem.
Can I know what will be the total cost for this surgery. And how long do I
have to leave him there.
E-MAIL REPLY BY DR SING
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Estimated costs are around $600 - $700 for both eyes as general anaesthetic gas is used. Bring the dog in at 9.30 am and bring home in the evening. No food and water the night before after 10 pm. Phone 9668 6468 or 254 3326 for appointment.
Costs include all fees and medication.
Blood test to check whether the dog is healthy is not included and is advised. Cost is $150. However, this depends on the owner as to whether he wants the blood test or not.
E-MAIL TO DR SING DATED JUN 16, 2011
Can I make a appointment to consult Dr. Sing tregarding my dog's eye and to advise
if he needs entropion surgery.
Mon.11.30am or Wednesday, or Thursday 11.30am or but not Tuesday.
Please call me to confirm the appointment.
Thanks !
Ande Lai h/p xxxx
- Show quoted text -
eyes and yellow sticky discharge.
I am cleaning him a few times a day with eye wash and the problem
keep coming back.
I understand that surgery on the eye lid is necessary to stop this problem.
Can I know what will be the total cost for this surgery. And how long do I
have to leave him there.
E-MAIL REPLY BY DR SING
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Estimated costs are around $600 - $700 for both eyes as general anaesthetic gas is used. Bring the dog in at 9.30 am and bring home in the evening. No food and water the night before after 10 pm. Phone 9668 6468 or 254 3326 for appointment.
Costs include all fees and medication.
Blood test to check whether the dog is healthy is not included and is advised. Cost is $150. However, this depends on the owner as to whether he wants the blood test or not.
E-MAIL TO DR SING DATED JUN 16, 2011
Can I make a appointment to consult Dr. Sing tregarding my dog's eye and to advise
if he needs entropion surgery.
Mon.11.30am or Wednesday, or Thursday 11.30am or but not Tuesday.
Please call me to confirm the appointment.
Thanks !
Ande Lai h/p xxxx
- Show quoted text -
Friday, June 17, 2011
473. Deep eye ulcer in a 3-month-old Shih Tzu puppy
Yesterday, Jun 16, 2011, I operated on a 3-month-old Shih Tzu with corneal ulcers on both eyes. The owner was referred to me by the sister who had sent the hamster with the large cauliflower ear wart to me 3 days ago.
I am still much worried about anaesthesia of 3-month-old puppies as they are not strong enough.
"No injection?" Mr Min asked me as he has been used to vets giving sedation and then gas anaesthetic for the last 2 months or so. He had replaced Mr Saw and was new to the small animal veterinary world although he had some experience in Malaysia and had graduated some 10 years ago in Myanmar.
"Only isoflurane gas," I replied. "If you know how to do it." I showed him how to hold the puppy and give anaesthesia gas via the mask. "Hold the scruff of the neck, angle the head at 45 degrees and give the mask," I said. Yet he did it his way and when I corrected him, he said "I don't want the mask to touch the corneal ulcer!"
It needs a lot of impatience to teach the young ones and sometimes I feel that they just want to do it their own way. I said: "At 45 degrees, the puppy can breathe normally. At 90 degrees (to the mask), it is unnatural and the gas cannot flow through smoothly!". Teaching Min is important as he assists my two other associate vets who have their own styles. But there must be one standard operating procedure which is safe, efficient and least costly (wasting of the very expensive isoflurance gas).
My previous technician, Mr Saw had learnt what to do after 3 years of working with me, but he had decided to retire to greener pastures in Yangon where he was promised a "partnership" in a practice. So, a new technician had to be supervised and mentored again.
For this puppy, the owner is very worried, as do all owners of puppies and parents of babies. The anaesthetic risk is so much higher and it was no surprise that the vet near her apartment had prescribed just antibiotics eye drops and atropine eye drops and vibravet oral tablets. Then she was referred to the parent company's vet who was unfortunately fully booked. So, that was how the case came to me from my successful handling of the hamster with the large ear wart with Dr Vanessa 3 days ago. Well, if the hamster had died under anaesthesia, I doubt this referral would come. So much depends on the anaesthetic outcome in veterinary anaesthesia.
HOW THIS CASE WAS DONE
1. Isoflurane gas by mask at 5%. Observe signs of surgical anaesthesia by me. Don't depend on inexperienced vet technician Min. Proper angle of the neck and nose at 45 degrees.
2. Intubate just when the puppy was not fully anaesthesized. Be alert. There was a "vomiting" sound. I quickly pulled out the endo-tracheal tube but there was no vomiting. If negligent, the vomitus goes into the lungs.
3. Give 2% isoflurane. The temptation of the technician or vet is to give 5% via the tube as the puppy moves. Close the mouth with hands and be patient. It takes time for the puppy to be under surgical anaesthesia.
4. Flush hairs and debris off the eye thoroughly. Ensure the 3rd eyelid is opened up and irrigate all hairs trapped inside.
5. Check eye is clear of debri. I put in terramycin eye ointment and the atropine drops.
5.1 In infected eyes, I do inject subconjunctival gentamycin but not in this case as it was 4 days old.
6. A horizontal mattress suture, 3/0 absorbable sews up lower and upper eyelids. Eye-lashes must be completely shaved off.
7. E-collar. The puppy wakes up fast as if she has a short nap.
DISCUSSION WITH A 5TH YEAR VET STUDENT FROM MURDOCH UNIV
Each vet has his own approach. The student, Daniel said he would swab the ulcer, get a bacterial culture. Give appropriate eye drop antibiotics, atropine, e-collar and let the ulcer heal. NSAID pain-killers. Perhaps an eye patch.
IN REALITY
The first vet had essentially prescribed what Daniel had proposed except for NSAID. The owner had great difficulty putting eye drops on the puppy as the naughty one shifts right and left. Both corneas were ulcerated (will show images later). Puppy's sclera gets redder by the day. Itchy, rubbing eyes.
LEFT EYE
Deep ulcerative keratitis. The cornea ulcer of the left eye was deep. A red blood vessel forms at 11 to 2 o'clock above this ulcer.
RIGHT EYE
Superficial ulcerative keratitis from 6 o'clock to 11 o'clock.
So, the owner is worried that the puppy will become blind.
I am still much worried about anaesthesia of 3-month-old puppies as they are not strong enough.
"No injection?" Mr Min asked me as he has been used to vets giving sedation and then gas anaesthetic for the last 2 months or so. He had replaced Mr Saw and was new to the small animal veterinary world although he had some experience in Malaysia and had graduated some 10 years ago in Myanmar.
"Only isoflurane gas," I replied. "If you know how to do it." I showed him how to hold the puppy and give anaesthesia gas via the mask. "Hold the scruff of the neck, angle the head at 45 degrees and give the mask," I said. Yet he did it his way and when I corrected him, he said "I don't want the mask to touch the corneal ulcer!"
It needs a lot of impatience to teach the young ones and sometimes I feel that they just want to do it their own way. I said: "At 45 degrees, the puppy can breathe normally. At 90 degrees (to the mask), it is unnatural and the gas cannot flow through smoothly!". Teaching Min is important as he assists my two other associate vets who have their own styles. But there must be one standard operating procedure which is safe, efficient and least costly (wasting of the very expensive isoflurance gas).
My previous technician, Mr Saw had learnt what to do after 3 years of working with me, but he had decided to retire to greener pastures in Yangon where he was promised a "partnership" in a practice. So, a new technician had to be supervised and mentored again.
For this puppy, the owner is very worried, as do all owners of puppies and parents of babies. The anaesthetic risk is so much higher and it was no surprise that the vet near her apartment had prescribed just antibiotics eye drops and atropine eye drops and vibravet oral tablets. Then she was referred to the parent company's vet who was unfortunately fully booked. So, that was how the case came to me from my successful handling of the hamster with the large ear wart with Dr Vanessa 3 days ago. Well, if the hamster had died under anaesthesia, I doubt this referral would come. So much depends on the anaesthetic outcome in veterinary anaesthesia.
HOW THIS CASE WAS DONE
1. Isoflurane gas by mask at 5%. Observe signs of surgical anaesthesia by me. Don't depend on inexperienced vet technician Min. Proper angle of the neck and nose at 45 degrees.
2. Intubate just when the puppy was not fully anaesthesized. Be alert. There was a "vomiting" sound. I quickly pulled out the endo-tracheal tube but there was no vomiting. If negligent, the vomitus goes into the lungs.
3. Give 2% isoflurane. The temptation of the technician or vet is to give 5% via the tube as the puppy moves. Close the mouth with hands and be patient. It takes time for the puppy to be under surgical anaesthesia.
4. Flush hairs and debris off the eye thoroughly. Ensure the 3rd eyelid is opened up and irrigate all hairs trapped inside.
5. Check eye is clear of debri. I put in terramycin eye ointment and the atropine drops.
5.1 In infected eyes, I do inject subconjunctival gentamycin but not in this case as it was 4 days old.
6. A horizontal mattress suture, 3/0 absorbable sews up lower and upper eyelids. Eye-lashes must be completely shaved off.
7. E-collar. The puppy wakes up fast as if she has a short nap.
DISCUSSION WITH A 5TH YEAR VET STUDENT FROM MURDOCH UNIV
Each vet has his own approach. The student, Daniel said he would swab the ulcer, get a bacterial culture. Give appropriate eye drop antibiotics, atropine, e-collar and let the ulcer heal. NSAID pain-killers. Perhaps an eye patch.
IN REALITY
The first vet had essentially prescribed what Daniel had proposed except for NSAID. The owner had great difficulty putting eye drops on the puppy as the naughty one shifts right and left. Both corneas were ulcerated (will show images later). Puppy's sclera gets redder by the day. Itchy, rubbing eyes.
LEFT EYE
Deep ulcerative keratitis. The cornea ulcer of the left eye was deep. A red blood vessel forms at 11 to 2 o'clock above this ulcer.
RIGHT EYE
Superficial ulcerative keratitis from 6 o'clock to 11 o'clock.
So, the owner is worried that the puppy will become blind.
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