Accuracy, completeness and speed in hamster surgery. The hamster cannot survive if anaesthesized for over 5 minutes, in my experience. How to achieve this? Prepare well in advance and plan the surgery. No distraction. Very short gas anaesthesia of less than 10 seconds. Be observant and alert.
The surgeon must review his case and see what improvements can be done in future surgeries. This means that the young surgeon must do more surgeries and be humble enough to get advices from experienced surgeons. He must read more about other surgeries. Unfortunately, very few vets like hamster surgeries as these little ones are high anaesthetic risks. From what I know, the vet universities in Australia devote 0.00000001% of the time to hamsters. I was told Australians don't keep hamsters at all and so our vet graduates from Australia seldom encounter any case.
Successes in veterinary surgeries give confidence to the client who may refer their friends to you. I spoke to one of my clients, an administrator in the Kandang Kerbau Hospital. She said: "The older specialists get overworked and therefore they leave the public service for the private sector."
"Why don't they farm their surgeries to the younger ones?" I asked.
"It is not possible," she said. "The clients are referred to them."
So the overworked old surgeons leave for the private sector and there is a dearth of experienced ones to teach the younger surgeons.
I anticipate that our hospitals will eventually be staffed by younger specialists since there is an exodus of senior doubles who are offerred double and treble their pay to join the private hospitals.
Referrals are an important source of clientele as this case of the Shih Tzu puppy with a deep ulcer shows. The client was referred to me by her family member as I treated the massive cauliflower ear wart in the niece's hamster successfully.
"There is a string hanging out from the ear!" the mother told me when I enquired about the hamster. "But no more warts."
She had brought in the Shih Tzu puppy 30 days after my tarsorrhaphy surgery on the left eye as the puppy was rubbing her left ear and face.
"The eye ulcer has healed," I said. "The problem is the infected left ear, not the eye. You can remove the e-collar nowadays."
"Will the white spot disappear?" she asked.
"No," I said. "It may become much smaller when the puppy grows bigger."
I took a picture of the eye for record. I should have used reflectors but did not. So I had the eye angled facing the sunlight and got a picture for readers.
In vet surgery, two types of referrals are important to build up a practice. One is the existing client. The other is the internet. Price under-cutting can also build up a good clientele.
Friday, July 22, 2011
508. Ear Canal Ablation in the dog - email query and google search
E-MAIL TO DR SING DATED JULY 21, 2011:
From: ...@yahoo.com>
Subject: Dog ear hard mass
To: david@sinpets.com
Date: Thursday, July 21, 2011, 3:04 PM
Hi Dr Sing,
I found you online. My dog is a 14 yr old shih tzu. He started with infections in his left ear for 6 months, seen 3 different vets, put on almost all kinds of antibotics available but did not help. Till sometime last year, i felt a hard lump. Then i went to another vet who did a minor surgery to laser off some masses on the surface (was able to see cauliflower-like masses in the ear hole). He said due to my dog's age, heart problems and failing kidneys he is not going to cut deeper into the ear. About 3 months later, i can see those cauliflower-like masses in the hole again. And the ear canal starts to feel hard. The vet put him on chemo (0.03ml, very small dose) but his kidney suffered. The last chemo was administered in April this year. I have since decided not to go for the chemo. Currently, the lump is growing, probably towards the middle ear? It is visible, growing down towards the jaws. The smelly pus and bloody discharge is present for almost 1.5 years. He does not appear to be in pain to me, because he is able to sleep lying on it. May i ask what would be your treatment since he is not in a condition for surgery, and i'll not take the risk. Thank you so much!
E-MAIL REPLY FROM DR SING DATED JULY 22, 2011
Hi
Thank you for your email. It was a pure coincidence that yesterday I had operated on a 2-year-old dwarf hamster with similar cauliflower-like masses inside and pus discharging from her right ear canal. A vet had given an antibiotic ear ointment for some time. It was ineffective. The right ear continued to emit an over-powering smell like rotten meat.
Anaesthesia was very high risk as this hamster is nearing the end of her life span of 2.5 years. The lady owner accepted the risk as medical treatment was ineffective. The hamster is OK and went home to be nursed by the owner yesterday. This surgery is called total canal ablation and I believe it is very rarely is done in old dwarf hamsters (compared to old dogs) as anaesthesia is very high risk.
I just googled "ear canal ablation" for you and came out with this URL:
http://www.google.com.sg/#hl=en&sugexp=bvre&xhr=t&q=ear+canal+ablation&cp=11&pf=p&sclient=psy&source=hp&aq=0&aqi=g5&aql=f&oq=ear+canal+a&pbx=1&fp=4246f7dc13410bc6&biw=1024&bih=545
In the googled page, the ear canal ablation surgery is described in
1. A website at:
http://www.2ndchance.info/earsurg.htm
2. Another website (my surgery at Toa Payoh Vets) at:
http://www.google.com.sg/#hl=en&sugexp=bvre&xhr=t&q=ear+canal+ablation&cp=11&pf=p&sclient=psy&source=hp&aq=0&aqi=g5&aql=f&oq=ear+canal+a&pbx=1&fp=4246f7dc13410bc6&biw=1024&bih=545. The 11-year-old dog survived the surgery. He lived for another 4 months with no pain and died in his sleep.
In your dog's chronic otitis externa with no cure from other treatments, surgical removal of the ear canal is the only option. This will be my advice to dog owners with similar problems as the condition and pain just get worse over time.
However, since your dog is very old and has heart disease. You will need to make a decision as to whether you will take the high risk of your dog dying on the operating table. If the dog survives and the surgery is without complications due to belated decisions for surgery and old age's poor healing, the dog will be pain-free and infection-free normally and may live for another 6 years to the age of 20 years (from the optimistic point of view).
In conclusion, I have no other alternative effective treatment to propose to you other than ear canal ablation surgery.
Best wishes.
GOOGLE SEARCH RESULTS "ear canal ablation" dated July 22, 2011 at 4.43 am in Singapore
Search Results
Ear canal ablation - Relax. Take a deep breath. | RightHealth.com
www.righthealth.com
We have the answers you seek.
►
Search Results
Ear canal ablation and bulla osteotomy
www.vetsurgerycentral.com/ear_ablation.htm - Cached
Below is an illustration demonstrating total ear canal ablation; the thatched area shows the part that is surgically removed; after the ear canal has been ...
YouTube - Advanced Vetcare Total Ear Canal Ablation
www.youtube.com/watch?v=ertUBPvc6wk1 min - 29 Jan 2007 - Uploaded by advancedvetcare
An overview of total ear canal ablation in the dog. Posted by Advanced Veterinary Care.
More videos for ear canal ablation »
Ear Surgery In Dogs And Cats
www.2ndchance.info/earsurg.htm - Cached
Total ear canal ablation is almost always successful while less extensive types of surgery often fail. The secret of this success is in choosing surgical ...
Vertical Ear Canal Ablation - 031208ASingapore Toa Payoh ...
www.kongyuensing.com/.../20080613Vertical_Ear_Canal_Ablation... - Cached
14 Jul 2010 – Vertical Ear Canal Ablation surgery in the dog - Part 2. Chronic thrombocytopenic purpura? toapayohvets.com ...
The URL is as follows:
http://www.kongyuensing.com/animals/20080613Vertical_Ear_Canal_Ablation_ToaPayohVets_Singapore.htm
From: ...@yahoo.com>
Subject: Dog ear hard mass
To: david@sinpets.com
Date: Thursday, July 21, 2011, 3:04 PM
Hi Dr Sing,
I found you online. My dog is a 14 yr old shih tzu. He started with infections in his left ear for 6 months, seen 3 different vets, put on almost all kinds of antibotics available but did not help. Till sometime last year, i felt a hard lump. Then i went to another vet who did a minor surgery to laser off some masses on the surface (was able to see cauliflower-like masses in the ear hole). He said due to my dog's age, heart problems and failing kidneys he is not going to cut deeper into the ear. About 3 months later, i can see those cauliflower-like masses in the hole again. And the ear canal starts to feel hard. The vet put him on chemo (0.03ml, very small dose) but his kidney suffered. The last chemo was administered in April this year. I have since decided not to go for the chemo. Currently, the lump is growing, probably towards the middle ear? It is visible, growing down towards the jaws. The smelly pus and bloody discharge is present for almost 1.5 years. He does not appear to be in pain to me, because he is able to sleep lying on it. May i ask what would be your treatment since he is not in a condition for surgery, and i'll not take the risk. Thank you so much!
E-MAIL REPLY FROM DR SING DATED JULY 22, 2011
Hi
Thank you for your email. It was a pure coincidence that yesterday I had operated on a 2-year-old dwarf hamster with similar cauliflower-like masses inside and pus discharging from her right ear canal. A vet had given an antibiotic ear ointment for some time. It was ineffective. The right ear continued to emit an over-powering smell like rotten meat.
Anaesthesia was very high risk as this hamster is nearing the end of her life span of 2.5 years. The lady owner accepted the risk as medical treatment was ineffective. The hamster is OK and went home to be nursed by the owner yesterday. This surgery is called total canal ablation and I believe it is very rarely is done in old dwarf hamsters (compared to old dogs) as anaesthesia is very high risk.
I just googled "ear canal ablation" for you and came out with this URL:
http://www.google.com.sg/#hl=en&sugexp=bvre&xhr=t&q=ear+canal+ablation&cp=11&pf=p&sclient=psy&source=hp&aq=0&aqi=g5&aql=f&oq=ear+canal+a&pbx=1&fp=4246f7dc13410bc6&biw=1024&bih=545
In the googled page, the ear canal ablation surgery is described in
1. A website at:
http://www.2ndchance.info/earsurg.htm
2. Another website (my surgery at Toa Payoh Vets) at:
http://www.google.com.sg/#hl=en&sugexp=bvre&xhr=t&q=ear+canal+ablation&cp=11&pf=p&sclient=psy&source=hp&aq=0&aqi=g5&aql=f&oq=ear+canal+a&pbx=1&fp=4246f7dc13410bc6&biw=1024&bih=545. The 11-year-old dog survived the surgery. He lived for another 4 months with no pain and died in his sleep.
In your dog's chronic otitis externa with no cure from other treatments, surgical removal of the ear canal is the only option. This will be my advice to dog owners with similar problems as the condition and pain just get worse over time.
However, since your dog is very old and has heart disease. You will need to make a decision as to whether you will take the high risk of your dog dying on the operating table. If the dog survives and the surgery is without complications due to belated decisions for surgery and old age's poor healing, the dog will be pain-free and infection-free normally and may live for another 6 years to the age of 20 years (from the optimistic point of view).
In conclusion, I have no other alternative effective treatment to propose to you other than ear canal ablation surgery.
Best wishes.
GOOGLE SEARCH RESULTS "ear canal ablation" dated July 22, 2011 at 4.43 am in Singapore
Search Results
Ear canal ablation - Relax. Take a deep breath. | RightHealth.com
www.righthealth.com
We have the answers you seek.
►
Search Results
Ear canal ablation and bulla osteotomy
www.vetsurgerycentral.com/ear_ablation.htm - Cached
Below is an illustration demonstrating total ear canal ablation; the thatched area shows the part that is surgically removed; after the ear canal has been ...
YouTube - Advanced Vetcare Total Ear Canal Ablation
www.youtube.com/watch?v=ertUBPvc6wk1 min - 29 Jan 2007 - Uploaded by advancedvetcare
An overview of total ear canal ablation in the dog. Posted by Advanced Veterinary Care.
More videos for ear canal ablation »
Ear Surgery In Dogs And Cats
www.2ndchance.info/earsurg.htm - Cached
Total ear canal ablation is almost always successful while less extensive types of surgery often fail. The secret of this success is in choosing surgical ...
Vertical Ear Canal Ablation - 031208ASingapore Toa Payoh ...
www.kongyuensing.com/.../20080613Vertical_Ear_Canal_Ablation... - Cached
14 Jul 2010 – Vertical Ear Canal Ablation surgery in the dog - Part 2. Chronic thrombocytopenic purpura? toapayohvets.com ...
The URL is as follows:
http://www.kongyuensing.com/animals/20080613Vertical_Ear_Canal_Ablation_ToaPayohVets_Singapore.htm
Tuesday, July 19, 2011
507. Giving neuter instructions by text and e-mail.
The google enables me to meet some of the interesting Y-generation I will never get to meet as there will be one of the 50 veterinary surgeries near their residences. Some 40 years ago, when I graduated, there were around 4 private practices but there was a Government Animal Infirmary doing a roaring "trade" as dog and cat owners came to consult the one or two vets employed by the Primary Production Department (now called the Agri-Food and Veterinary Authority). Usually, the X or Y-generation will e-mail to me as one example shows below:
E-MAIL TO DR SING DATED JULY 12, 2011
On Tue, Jul 12, 2011 at 6:39 PM, ....com> wrote:
Dear Judy,
I have a one year old Yorkie that we want to neuter.
Please advise how much will the procedure be and when is the earliest time that we can bring him down.
You can reach me at (phone) if you need any further info.
Thank you.
Best regards,
Name of owner
E-MAIL REPLY FROM DR SING DATED JULY 13, 2011
Hi
Thank you for your email I am Dr Sing from toapayohvets.com
The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.
If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.
Best wishes.
E-MAIL TO DR SING DATED JULY 12, 2011
Hi Dr Sing,
Can I book an appointment with you this coming Thurs?
I'll bring him down at 930am and pick him up later part of the day.
Look forward to your confirmation.
Best regards,
Name of owner
E-MAIL TO DR SING DATED JULY 19, 2011
Thank you for your email. Thursday 9.30 am will be OK. Will see you this Thursday.
E-MAIL TO DR SING DATED JULY 12, 2011
On Tue, Jul 12, 2011 at 6:39 PM, ....com> wrote:
Dear Judy,
I have a one year old Yorkie that we want to neuter.
Please advise how much will the procedure be and when is the earliest time that we can bring him down.
You can reach me at (phone) if you need any further info.
Thank you.
Best regards,
Name of owner
E-MAIL REPLY FROM DR SING DATED JULY 13, 2011
Hi
Thank you for your email I am Dr Sing from toapayohvets.com
The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.
If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.
Best wishes.
E-MAIL TO DR SING DATED JULY 12, 2011
Hi Dr Sing,
Can I book an appointment with you this coming Thurs?
I'll bring him down at 930am and pick him up later part of the day.
Look forward to your confirmation.
Best regards,
Name of owner
E-MAIL TO DR SING DATED JULY 19, 2011
Thank you for your email. Thursday 9.30 am will be OK. Will see you this Thursday.
506. The cat lady comes to the rescue
In one article I read, it stated that the Y-generation is the Google generation as it searches information via googling instead of asking for advices from the seniors. . It has the following characteristics:
1. It is a generation that does not take instructions as willingly as my baby-boomer generation. When I instruct this generation to do something, it will do anything its own way and therefore I need to watch out. For example, my assistant Min. I told him how to restrain a ferocious cat in a certain way by first placing the crated cat on a table and not from the floor. By placing on a table, the human is in a better and comfortable position to handle the hissing cat. It so happened that we had two hissing cats for spay yesterday as they are stray cats. Usually, Singapore's cats are quite gentle. There is a community of cat lovers who will get stray cats sterilised and released to the wild and manage them and so Toa Payoh Vets do get some of these kind souls.
Yesterday, he would do his style and tried to get the ferocious cat (after spaying) out of the crate by bending down to the floor level where the crate was placed. He would then use a towel trying to get the cat out and risk being scratched. He tried but no way would the cat come out. He would not ask me for help or advice. Min had been bitten on both hands by a dog some months ago and had cat scratches. This is the risk of working in the small animal veterinary practice. But such risks can be dispensed with if Min knows how.
In this situation, Min had asked for the owner to take the cat out. However, the owners (a Malay mother and teenaged boy) who sent the cat for spay stood outside the Surgery as there was a big Golden Retriever in the reception room waiting to be discharged (after being clipped and de-ticked off thousands of small ticks).
The mother waved her hand at her nose indicating that the dog's tick insecticide smell was too much for her and that was why I asked her and the boy to wait outside the Surgery where the air is fresher.
After the Golden Retriever owner left, I asked the boy and later the mother to come into the Animal holding area to get the cat out. They failed to get the cat out to transfer her to their own carrier. Many minutes passed. So what should I do? Dr Vanessa came out to help after vaccinating six stray cats brought in by a lady in her 30s. This lady had specifically made an appointment to see her and I presumed this was a serious cat lady as I did not see her smiling when she came into the receptionist room.
Well, she seemed to be a cat handling expert. I asked her for help and she did. "Put some food on the floor," she said to the Malay woman. "Once the cat comes out, I will be able to catch her and put her in the carrier."
The problem was that no normal cat owner would bring the cat's favourite food with them when they come to take the cat home. Dr Vanessa came to help too as this was the cat she spayed. The dog with the bleeding nostril (now no longer bleeding) was barking till his lungs would burst and I asked Min to quieten him by being near to him and let the cat lady do her job.
No cat food. I asked Min for the cat food from the Surgery. What happened next? Well, the overweight hamster with two large tumours of over 4 cm long and 1 cm wide x 1 cm deep came to take the hamster home. This was around 5.30 pm and so I attended to him as it was I who operated the hamster. I had to advise him how to take care post-operation and to show him the tumour. "It is large," he said. "What's the cause? Is it genetic?" So, I was engaged and did not see how the cat lady take the cat out from the crate. Somewhere I heard about taking the crate up onto the table.....In any case, the cat lady succeeded where Min failed and I was grateful for her help. I will ask Min what happened later today as I was in a rush to to somewhere after spending time with the young hamster owner whose wife found me by googling "hamster tumour" or something.
I asked the husband to stop feeding the hamster too much food. "Is it the melon seeds?" I asked again.
"No," he said. "My wife gives her a lot of bread as the hamster simply loves eating bread." The dwarf hamster was 81 gram in bodyweight as I asked Min to weigh the hamster in the presence of the owner. Her belly was as rounded as a soft toy and she looked really cute. I was surprised she survived the anaesthesia and surgery. I remembered her very well as her spleen came out of the 1-mm thin abdominal wall when I removed the big tumours (likely to be mammary tumour). I had to push back the spleen and sutured the muscle defect with one 5/0 nylon suture. The suture was transparent and so it was quite difficult to see it. However, the gap was stitched up and the hamster was OK some 4 hours when the owner came. As if she had a slimming session with one of those numerous spa operators in Singapore and was active as before when the male owner came.
"No more bread. Target to reduce weight to 65 gram," I said. So I was rather busy myself while Dr Vanessa had to get the cat out of the bag, the crate, I mean. To transfer her to the carrier to go home. She did it as the Malay woman and the boy went home while I was still consulting the owner. I could see the cat lady hailing a cab and put the 4 cat crates in the taxi's boot for the short ride to a cattery. I had no time to thank her as I had to teach the hamster owner how to give antibiotics to the hamster. This hamster squeaked when handled. As I picked her up from the cage with my bare hand to demonstrate, she squeaked suddenly and instinctively I had to let go, for fear of being bitten. I got Min to give me the cotton hand glove to restrain this hamster for demonstration.
Everything ended fine with the hissing cat and the obese dwarf hamster. It was a good evening.
1. It is a generation that does not take instructions as willingly as my baby-boomer generation. When I instruct this generation to do something, it will do anything its own way and therefore I need to watch out. For example, my assistant Min. I told him how to restrain a ferocious cat in a certain way by first placing the crated cat on a table and not from the floor. By placing on a table, the human is in a better and comfortable position to handle the hissing cat. It so happened that we had two hissing cats for spay yesterday as they are stray cats. Usually, Singapore's cats are quite gentle. There is a community of cat lovers who will get stray cats sterilised and released to the wild and manage them and so Toa Payoh Vets do get some of these kind souls.
Yesterday, he would do his style and tried to get the ferocious cat (after spaying) out of the crate by bending down to the floor level where the crate was placed. He would then use a towel trying to get the cat out and risk being scratched. He tried but no way would the cat come out. He would not ask me for help or advice. Min had been bitten on both hands by a dog some months ago and had cat scratches. This is the risk of working in the small animal veterinary practice. But such risks can be dispensed with if Min knows how.
In this situation, Min had asked for the owner to take the cat out. However, the owners (a Malay mother and teenaged boy) who sent the cat for spay stood outside the Surgery as there was a big Golden Retriever in the reception room waiting to be discharged (after being clipped and de-ticked off thousands of small ticks).
The mother waved her hand at her nose indicating that the dog's tick insecticide smell was too much for her and that was why I asked her and the boy to wait outside the Surgery where the air is fresher.
After the Golden Retriever owner left, I asked the boy and later the mother to come into the Animal holding area to get the cat out. They failed to get the cat out to transfer her to their own carrier. Many minutes passed. So what should I do? Dr Vanessa came out to help after vaccinating six stray cats brought in by a lady in her 30s. This lady had specifically made an appointment to see her and I presumed this was a serious cat lady as I did not see her smiling when she came into the receptionist room.
Well, she seemed to be a cat handling expert. I asked her for help and she did. "Put some food on the floor," she said to the Malay woman. "Once the cat comes out, I will be able to catch her and put her in the carrier."
The problem was that no normal cat owner would bring the cat's favourite food with them when they come to take the cat home. Dr Vanessa came to help too as this was the cat she spayed. The dog with the bleeding nostril (now no longer bleeding) was barking till his lungs would burst and I asked Min to quieten him by being near to him and let the cat lady do her job.
No cat food. I asked Min for the cat food from the Surgery. What happened next? Well, the overweight hamster with two large tumours of over 4 cm long and 1 cm wide x 1 cm deep came to take the hamster home. This was around 5.30 pm and so I attended to him as it was I who operated the hamster. I had to advise him how to take care post-operation and to show him the tumour. "It is large," he said. "What's the cause? Is it genetic?" So, I was engaged and did not see how the cat lady take the cat out from the crate. Somewhere I heard about taking the crate up onto the table.....In any case, the cat lady succeeded where Min failed and I was grateful for her help. I will ask Min what happened later today as I was in a rush to to somewhere after spending time with the young hamster owner whose wife found me by googling "hamster tumour" or something.
I asked the husband to stop feeding the hamster too much food. "Is it the melon seeds?" I asked again.
"No," he said. "My wife gives her a lot of bread as the hamster simply loves eating bread." The dwarf hamster was 81 gram in bodyweight as I asked Min to weigh the hamster in the presence of the owner. Her belly was as rounded as a soft toy and she looked really cute. I was surprised she survived the anaesthesia and surgery. I remembered her very well as her spleen came out of the 1-mm thin abdominal wall when I removed the big tumours (likely to be mammary tumour). I had to push back the spleen and sutured the muscle defect with one 5/0 nylon suture. The suture was transparent and so it was quite difficult to see it. However, the gap was stitched up and the hamster was OK some 4 hours when the owner came. As if she had a slimming session with one of those numerous spa operators in Singapore and was active as before when the male owner came.
"No more bread. Target to reduce weight to 65 gram," I said. So I was rather busy myself while Dr Vanessa had to get the cat out of the bag, the crate, I mean. To transfer her to the carrier to go home. She did it as the Malay woman and the boy went home while I was still consulting the owner. I could see the cat lady hailing a cab and put the 4 cat crates in the taxi's boot for the short ride to a cattery. I had no time to thank her as I had to teach the hamster owner how to give antibiotics to the hamster. This hamster squeaked when handled. As I picked her up from the cage with my bare hand to demonstrate, she squeaked suddenly and instinctively I had to let go, for fear of being bitten. I got Min to give me the cotton hand glove to restrain this hamster for demonstration.
Everything ended fine with the hissing cat and the obese dwarf hamster. It was a good evening.
Saturday, July 16, 2011
504. Dog ticks suck plant sap?
E-MAIL TO DR SING DATED JULY 15, 2011
Dear Sir(s) and Madam(s),
We are a group of students looking for dog ticks for research purposes. The research is based on whether it is possible for dog ticks to adapt to plant sap. Hence, we kindly request for your help, and if you have any dog ticks, please contact us at zlwang916@gmail.com. If not, then kindly reply to this email at bobyu12334@yahoo.com . Any help would be greatly appreciated.
Thank you very much!
Warmest Regards,
Mr Wang Zi Liang, Zi Wei and Ace Tay
E-MAIL FROM DR SING DATED JULY 15, 2011
I am Dr Sing from Toa Payoh Vets, www.toapayohvets.com.
You can more likely to get ticks if you contact some pet groomers and be present to collect the ticks on the spot. This is because most Singapore dog owners go to the groomers for de-ticking. Or they just buy the de-ticking spot-on medication or wash and do-it-themselves. Include your phone number as I doubt anybody will e-mail to you to collect live and biting ticks for you. But there may be kind souls. Bring along your bottles.
Dog ticks have evolved to suck canine blood. I have great doubts that they will even sip one drop of plant sap but please do your research as many conventional thinking is incorrect.
Dear Sir(s) and Madam(s),
We are a group of students looking for dog ticks for research purposes. The research is based on whether it is possible for dog ticks to adapt to plant sap. Hence, we kindly request for your help, and if you have any dog ticks, please contact us at zlwang916@gmail.com. If not, then kindly reply to this email at bobyu12334@yahoo.com . Any help would be greatly appreciated.
Thank you very much!
Warmest Regards,
Mr Wang Zi Liang, Zi Wei and Ace Tay
E-MAIL FROM DR SING DATED JULY 15, 2011
I am Dr Sing from Toa Payoh Vets, www.toapayohvets.com.
You can more likely to get ticks if you contact some pet groomers and be present to collect the ticks on the spot. This is because most Singapore dog owners go to the groomers for de-ticking. Or they just buy the de-ticking spot-on medication or wash and do-it-themselves. Include your phone number as I doubt anybody will e-mail to you to collect live and biting ticks for you. But there may be kind souls. Bring along your bottles.
Dog ticks have evolved to suck canine blood. I have great doubts that they will even sip one drop of plant sap but please do your research as many conventional thinking is incorrect.
Thursday, July 14, 2011
Celebrate small successes in life - a Singapore rose
On July 13, 2011, at 1 pm, I went to lunch organised by one of my realtor classmates to celebrate our passing of the first REA (Real Estate Agency) examination conducted by the CEA (Council for Estate Agencies) and to thank our old lecturer. This class mate initiated the celebration as the rest would not be bothered to make contacts.
Yet, networking is a very important part of real estate work and in life and yet most of all are inert. It was an excellent Korean BBQ lunch at a restaurant opposite Novena Church.
"Did the prettiest girl in our class pass?" I asked my classmates.
"You can phone her," my male classmate wanted to give me her phone number.
"I better not," I said. "Her name does not seem to appear in the 41 names of persons to collect the REA certificate, in the list at Informatics. Besides, she has a Caucasian male friend. I may be bashed up! I had only spoken around 10 words to her during the whole 3 months of class."
"No, no, he is not her boyfriend," my class mate volunteered to give me her phone number and to recruit her as my salesperson.
I said to the lecturer who had told me that all ladies in the class are pretty when I enquired by e-mail whether she had passed: "You were the one who scolded her for coming to class one hour or more late."
"I did not do that," he protested. "I just said 'good morning'" He was correct. He did not really scold her or shut her out for being late at most times.
She was one of the few classmates who just sauntered into class late and interrupted his lessons. No apologies. No greeting of 'good morning to the lecturer'. In fact, all my classmates don't say that to my lecturer except for me.
All eyes had to focus on the pretty young thing as she looked for a spare seat.
Probably in her late 20s. Slim or I would say, thin. A clear fair face, bright friendly eyes that talk to you, good clothing sense, possibly high heels and a steady cat walk. She exudes confidence. A Singapore Rose. Just as Princess Diana was the English Rose.
"Who is the prettiest girl?" another male classmate asked. "Is she the one with the long hair and dresses up in designer clothes and carry designer handbags?"
"Most of the younger lady classmates have long hair," I said. It is a pity that my 40 classmates did not socialise much as we rushed back from lectures three times a week for 3 months from 10 am to 1 pm and discarded our lecture notes immediately to earn our living.
There were two lady classmates sitting opposite me and I asked them who was the prettiest girl and why. I wanted the female point of view. They gave me the same name as the one I mentioned. Why? She is young. She is good-looking.
Well, I was not the only one who spotted a pretty woman. Beauty always command attention. If beauty is combined with brains, the combination is just killing. I mentioned her as part of communications during our lunch. No ulterior motives of recruiting her as I am sure she has many offers. Of realtor jobs I mean.
It is good to celebrate small successes in life. My male classmate sitting next to me complained that the police phoned me to ask whether he had taken home the REA examination paper 1. He scolded the policeman. "The policeman is doing his job," I said. "I also got a phone call from the police and I asked the policeman why he is doing this loss of an examination paper when there are so many more important murders and cheating cases to do?"
"I know who took the paper," my lady classmate said to me.
"How do you know?" I asked.
"Well, she was sitting next to me during the examination. However, the policeman did not ask whether I know of anyone who took the paper and so I did not say."
Another classmate who was scolding the Informatics girl who would not give him any extra piece of writing paper when requested had been called up by the CEA for an interview, probably on a complaint from Informatics for swearing.
"You were the first suspect," I said. He had used the "F" word when the Informatics staff came rushing out to a group of us loitering after the end of Paper 1 examination and simply asked: "Did you take out the examination question paper 1?" So, he said: "F... you" and got to be on the top list of suspect.
"Actually two examination papers of Paper 1 were taken home," one lady classmate told me. "Informatics staff phoned everybody." The policeman phoned subsequently. However, the papers were recovered. For Paper 2 and Paper 3, no examination candidate was allowed to leave till all examination question papers were collected.
It was a time of laughter and joy for the group and the lecturer who said that the Batch 2 and 3 classes were quiet and did not ask many probing questions. My classmates were more vocal. "It is the Korean classmate," I said. "He asked too many questions about investments."
I said to the lecturer: "You did not lecture about stray cats and rats. We had a question on how he should handle a complaint of the restaurant who created smoke, had stray cats and rats. I was forced to answer this question as the other questions were harder."
"Well, you are a vet and should know," the lecturer replied.
"But what is the right answer? Just contact the AVA? The police? The NEA?"
There was another examination question which we do not know what is the right answer too. It referred to land acquisition and asked which "3 persons" are interested parties. "3 person" in quotes. Two of my male classmates at the lunch said it was the owner, landlord and somebody. My female classmate said it was government departments. I had replied: "Singapore Land Authority, HDB and National Heritage Board." Why National Heritage Board? Preservation and conservation of buildings in land being acquired.
We don't know the correct answer and I suspect our lecturer does not. We can't expect our lecturer to know everything when examination questions are so tricky. "Well, they still can pass when they write landlord, owner and tenant," my serious lady classmate who avoided this question said to me. She was sure that the "3 persons" in quotes refer to institutions rather than living souls.
It was one of those lunches full of laughter and noise for two hours and the staff must be waiting impatiently for us to get going as the place closed after lunch. It is good to celebrate little successes in life. We will have set backs in life and I hope the Singapore Rose will re-take the examination and pass.
P.S
Greeting the lecturer is good manners but this does not seem to be part of the Singaporean culture. Definitely the lecturer remembers you better when you pay respect to his position. You can't expect him to know every subject in the syllabus. You just have to do your own reading and research to pass the REA examination comfortably. There was an examination question on "Professional Etiquette" which I don't know much as it was not in the lectures. However, I had to answer this question. Maybe, "good morning" should be part of the answer.
It is best not to be rude to service staff as they are just doing their duty. Rudeness resulted in a record in the CEA files for this classmate of mine, I would think so since he was called up by the CEA.
For examiners, each examination question paper should be written with the candidate's reference number. Therefore any missing examination question paper can be traced to the candidate, my classmate who is a lecturer in China said to me. In Informatics, no candidate is allowed to leave the class till everybody has handed in their examination question papers and they are accounted for.
Yet, networking is a very important part of real estate work and in life and yet most of all are inert. It was an excellent Korean BBQ lunch at a restaurant opposite Novena Church.
"Did the prettiest girl in our class pass?" I asked my classmates.
"You can phone her," my male classmate wanted to give me her phone number.
"I better not," I said. "Her name does not seem to appear in the 41 names of persons to collect the REA certificate, in the list at Informatics. Besides, she has a Caucasian male friend. I may be bashed up! I had only spoken around 10 words to her during the whole 3 months of class."
"No, no, he is not her boyfriend," my class mate volunteered to give me her phone number and to recruit her as my salesperson.
I said to the lecturer who had told me that all ladies in the class are pretty when I enquired by e-mail whether she had passed: "You were the one who scolded her for coming to class one hour or more late."
"I did not do that," he protested. "I just said 'good morning'" He was correct. He did not really scold her or shut her out for being late at most times.
She was one of the few classmates who just sauntered into class late and interrupted his lessons. No apologies. No greeting of 'good morning to the lecturer'. In fact, all my classmates don't say that to my lecturer except for me.
All eyes had to focus on the pretty young thing as she looked for a spare seat.
Probably in her late 20s. Slim or I would say, thin. A clear fair face, bright friendly eyes that talk to you, good clothing sense, possibly high heels and a steady cat walk. She exudes confidence. A Singapore Rose. Just as Princess Diana was the English Rose.
"Who is the prettiest girl?" another male classmate asked. "Is she the one with the long hair and dresses up in designer clothes and carry designer handbags?"
"Most of the younger lady classmates have long hair," I said. It is a pity that my 40 classmates did not socialise much as we rushed back from lectures three times a week for 3 months from 10 am to 1 pm and discarded our lecture notes immediately to earn our living.
There were two lady classmates sitting opposite me and I asked them who was the prettiest girl and why. I wanted the female point of view. They gave me the same name as the one I mentioned. Why? She is young. She is good-looking.
Well, I was not the only one who spotted a pretty woman. Beauty always command attention. If beauty is combined with brains, the combination is just killing. I mentioned her as part of communications during our lunch. No ulterior motives of recruiting her as I am sure she has many offers. Of realtor jobs I mean.
It is good to celebrate small successes in life. My male classmate sitting next to me complained that the police phoned me to ask whether he had taken home the REA examination paper 1. He scolded the policeman. "The policeman is doing his job," I said. "I also got a phone call from the police and I asked the policeman why he is doing this loss of an examination paper when there are so many more important murders and cheating cases to do?"
"I know who took the paper," my lady classmate said to me.
"How do you know?" I asked.
"Well, she was sitting next to me during the examination. However, the policeman did not ask whether I know of anyone who took the paper and so I did not say."
Another classmate who was scolding the Informatics girl who would not give him any extra piece of writing paper when requested had been called up by the CEA for an interview, probably on a complaint from Informatics for swearing.
"You were the first suspect," I said. He had used the "F" word when the Informatics staff came rushing out to a group of us loitering after the end of Paper 1 examination and simply asked: "Did you take out the examination question paper 1?" So, he said: "F... you" and got to be on the top list of suspect.
"Actually two examination papers of Paper 1 were taken home," one lady classmate told me. "Informatics staff phoned everybody." The policeman phoned subsequently. However, the papers were recovered. For Paper 2 and Paper 3, no examination candidate was allowed to leave till all examination question papers were collected.
It was a time of laughter and joy for the group and the lecturer who said that the Batch 2 and 3 classes were quiet and did not ask many probing questions. My classmates were more vocal. "It is the Korean classmate," I said. "He asked too many questions about investments."
I said to the lecturer: "You did not lecture about stray cats and rats. We had a question on how he should handle a complaint of the restaurant who created smoke, had stray cats and rats. I was forced to answer this question as the other questions were harder."
"Well, you are a vet and should know," the lecturer replied.
"But what is the right answer? Just contact the AVA? The police? The NEA?"
There was another examination question which we do not know what is the right answer too. It referred to land acquisition and asked which "3 persons" are interested parties. "3 person" in quotes. Two of my male classmates at the lunch said it was the owner, landlord and somebody. My female classmate said it was government departments. I had replied: "Singapore Land Authority, HDB and National Heritage Board." Why National Heritage Board? Preservation and conservation of buildings in land being acquired.
We don't know the correct answer and I suspect our lecturer does not. We can't expect our lecturer to know everything when examination questions are so tricky. "Well, they still can pass when they write landlord, owner and tenant," my serious lady classmate who avoided this question said to me. She was sure that the "3 persons" in quotes refer to institutions rather than living souls.
It was one of those lunches full of laughter and noise for two hours and the staff must be waiting impatiently for us to get going as the place closed after lunch. It is good to celebrate little successes in life. We will have set backs in life and I hope the Singapore Rose will re-take the examination and pass.
P.S
Greeting the lecturer is good manners but this does not seem to be part of the Singaporean culture. Definitely the lecturer remembers you better when you pay respect to his position. You can't expect him to know every subject in the syllabus. You just have to do your own reading and research to pass the REA examination comfortably. There was an examination question on "Professional Etiquette" which I don't know much as it was not in the lectures. However, I had to answer this question. Maybe, "good morning" should be part of the answer.
It is best not to be rude to service staff as they are just doing their duty. Rudeness resulted in a record in the CEA files for this classmate of mine, I would think so since he was called up by the CEA.
For examiners, each examination question paper should be written with the candidate's reference number. Therefore any missing examination question paper can be traced to the candidate, my classmate who is a lecturer in China said to me. In Informatics, no candidate is allowed to leave the class till everybody has handed in their examination question papers and they are accounted for.
502. Perineal hernia in a Boston Terrier one year ago
The Boston Terrier was operated one year ago. I review this case which was operated successfully (no anaesthetic deaths or complaint of recurrence) before I operate on the "mother of all perineal hernias" of the Silkie Terrier (described below) who is 10 years old and in a more risky anaesthetic position.
The pictures and more details of this record are at:
http://www.bekindtopets.com/animals/20100625constipation_perineal_hernia_old_Boston_Terrier_male_singapore_ToaPayohVets.htm
CASE 1
This Boston Terrier case was written: 25 June, 2010
Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
UPDATE AS AT JULY 11, 2011
No news from the owner since the surgery in Jun 2010. I presume all are OK as now news is good news.
CASE 2
ANOTHER MORE CHALLENGING CASE ONE YEAR LATER
THE MALE DOG HAD A VERY LARGE BACKSIDE SWELLING - PART 1
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case: Updated: 14 July, 2011
This Silkie Terrier case was written: 24 June 2011
Silkie Terrier, Male, Not neutered, 1- years, 6.5kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
I have not seen perineal hernias since I operated on the above-mentioned Boston Terrier one year ago. Surprisingly, on Sunday, July 10, 2011, my assistant Mr Min said that a couple insisted on seeing me. Normally, all cases go to Dr Vanessa Lin but I was around at the reception to get a pulse of the grass-roots from 9 am to 6 pm and to ensure that the waiting times are kept to the minimum. Only at the receptionist's counter can I know what is the situation of the waiting time like, rather than depend on the receptionist to enlighten me.
The couple said to me: "My vet said that no vets in Singapore would operate on my 10-year-old Silkie Terrier. He had said that the dog is old and to leave the swelling alone. But it kept growing bigger!"
He was not neutered and had a backside lump 3/4 the size of the biggest mango you can see in Singapore. The dog had difficulty in pooping and the older parents were concerned about his quality of life. The dog could eat, drink, poop and pee without difficulty and was active.
"There will be vets in Singapore that will operate on this dog," I said when the couple brought the dog in later for examination. "The main issue is that the operation will take a long time and the dog may just die on the operating table. No vets want to do a dog that dies on the operating table."
I had asked them to illustrate as they did not bring the dog down at first. A male dog, not neutered, big swelling from below the anus (in this case) instead of to the sides of the anus as in unilateral perineal hernias. The couple had actually diagnosed perineal hernias via the internet education and so they knew what was wrong with their dog. The problem was that their vet did not want to operate and put his reputation on the line when the dog dies on the operating table. What should I do?
This was the "mother" of all perineal hernias. Both left and right perineal hernias have "amalgamated" to form a large 3/4-Taiwanese mango-sized lump to the right, left and below the anus. Taiwanese mangoes are gigantic but are not sweet and they measure around 25 cm x 10 cm x 7 cm. So, you can imagine that the swelling was really gigantic.
The surgery will take over 1.5 hours and the old dog's heart may just stop beating. The dog needs to be operated as he has had been licking his skin thin. Continuous licking to relieve his pain and irritation as the intestines and omental fat prolapse through the pelvic muscular defect from both the left and right side. It was hard for him just to sit down too.
http://www.kongyuensing.com/pic/20110713perineal-hernias-bilateral-silkie-terrier-male-10-years-toapayohvets-singapore.jpg
"Do your parents know that they may not see the dog alive once he gets operated?" I asked. The aged parents are the care-givers. The couple said: "My parents say it is better to take the risk rather than let the dog suffer with such a big dangling mass. The groomer had nicked the lump earlier and discovered this hernia. Otherwise, we would not know it exists!"
The dog was in good body condition. I checked his heart. His heart was surprisingly normal. He was alive and active now. As if he has not a worry in this world while his caregivers bear the burden and surgical risks on their shoulders. Should I pass the buck? And to whom? To my two associate vets? This is the type of challenging cases that I prefer not to take on and it will be most unkind to pass the buck to my two associate vets as there is the possibility of post-surgical complications like infections, bleeding and nerve damages in addition to death on the operating table. So, I did not refer the case to them. It is a moderately difficult surgery but it will take a long time to do. The longer the time of anaesthesia and surgery, the likely that the old dog's heart will just stop and the dog dies on the operating table!
If the surgery can be completed in 15 minutes, the old dog is very likely to survive the anaesthesia. Unfortunately, this surgery will take a long time as both hernias seem to be required to be operated on at the same time since the intestines and omental fat have leaked and spread to each other's sides! That is why I say that this case is the "mother" of all perineal hernias.
The dog was operated on July 13, 2011. The whole process started from 9 am and ended at 12 noon. The surgery itself started from 9.30 am to 12 noon. It was the type of surgery that most vets would prefer not to be challenged to do as there were 3 hernias. The main one was the left perineal hernia with defect from above the anal area to the ventral most part of the backside. This would be at least 6 inches long, 3 inches wide and 5 inches deep. (1 inch = 2.5 cm). The right perineal hernia was two smaller holes separated by a band of muscle.
In the left perineal hernia, the bladder and large intestines had prolapsed. Over time, the intestines have had shifted from the left half of the backside to the right half. The dog licked the swollen area (mango-sized) over the months and the skin had become very thin and about to rupture. You can see the intestinal coils more prominent on the right side. So, I thought this was a right perineal hernia. Actually, it was a left!
Details of the surgery and anaesthesia done on June 13, 2011 will be recorded in Part 2 at:
www.sinpets.com/F5/20110714perineal_hernia_old_Silkie_Terrier_male
_dysuria_painful_backside_singapore_ToaPayohVets.htm
The pictures and more details of this record are at:
http://www.bekindtopets.com/animals/20100625constipation_perineal_hernia_old_Boston_Terrier_male_singapore_ToaPayohVets.htm
CASE 1
This Boston Terrier case was written: 25 June, 2010
Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
UPDATE AS AT JULY 11, 2011
No news from the owner since the surgery in Jun 2010. I presume all are OK as now news is good news.
CASE 2
ANOTHER MORE CHALLENGING CASE ONE YEAR LATER
THE MALE DOG HAD A VERY LARGE BACKSIDE SWELLING - PART 1
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case: Updated: 14 July, 2011
This Silkie Terrier case was written: 24 June 2011
Silkie Terrier, Male, Not neutered, 1- years, 6.5kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
I have not seen perineal hernias since I operated on the above-mentioned Boston Terrier one year ago. Surprisingly, on Sunday, July 10, 2011, my assistant Mr Min said that a couple insisted on seeing me. Normally, all cases go to Dr Vanessa Lin but I was around at the reception to get a pulse of the grass-roots from 9 am to 6 pm and to ensure that the waiting times are kept to the minimum. Only at the receptionist's counter can I know what is the situation of the waiting time like, rather than depend on the receptionist to enlighten me.
The couple said to me: "My vet said that no vets in Singapore would operate on my 10-year-old Silkie Terrier. He had said that the dog is old and to leave the swelling alone. But it kept growing bigger!"
He was not neutered and had a backside lump 3/4 the size of the biggest mango you can see in Singapore. The dog had difficulty in pooping and the older parents were concerned about his quality of life. The dog could eat, drink, poop and pee without difficulty and was active.
"There will be vets in Singapore that will operate on this dog," I said when the couple brought the dog in later for examination. "The main issue is that the operation will take a long time and the dog may just die on the operating table. No vets want to do a dog that dies on the operating table."
I had asked them to illustrate as they did not bring the dog down at first. A male dog, not neutered, big swelling from below the anus (in this case) instead of to the sides of the anus as in unilateral perineal hernias. The couple had actually diagnosed perineal hernias via the internet education and so they knew what was wrong with their dog. The problem was that their vet did not want to operate and put his reputation on the line when the dog dies on the operating table. What should I do?
This was the "mother" of all perineal hernias. Both left and right perineal hernias have "amalgamated" to form a large 3/4-Taiwanese mango-sized lump to the right, left and below the anus. Taiwanese mangoes are gigantic but are not sweet and they measure around 25 cm x 10 cm x 7 cm. So, you can imagine that the swelling was really gigantic.
The surgery will take over 1.5 hours and the old dog's heart may just stop beating. The dog needs to be operated as he has had been licking his skin thin. Continuous licking to relieve his pain and irritation as the intestines and omental fat prolapse through the pelvic muscular defect from both the left and right side. It was hard for him just to sit down too.
http://www.kongyuensing.com/pic/20110713perineal-hernias-bilateral-silkie-terrier-male-10-years-toapayohvets-singapore.jpg
"Do your parents know that they may not see the dog alive once he gets operated?" I asked. The aged parents are the care-givers. The couple said: "My parents say it is better to take the risk rather than let the dog suffer with such a big dangling mass. The groomer had nicked the lump earlier and discovered this hernia. Otherwise, we would not know it exists!"
The dog was in good body condition. I checked his heart. His heart was surprisingly normal. He was alive and active now. As if he has not a worry in this world while his caregivers bear the burden and surgical risks on their shoulders. Should I pass the buck? And to whom? To my two associate vets? This is the type of challenging cases that I prefer not to take on and it will be most unkind to pass the buck to my two associate vets as there is the possibility of post-surgical complications like infections, bleeding and nerve damages in addition to death on the operating table. So, I did not refer the case to them. It is a moderately difficult surgery but it will take a long time to do. The longer the time of anaesthesia and surgery, the likely that the old dog's heart will just stop and the dog dies on the operating table!
If the surgery can be completed in 15 minutes, the old dog is very likely to survive the anaesthesia. Unfortunately, this surgery will take a long time as both hernias seem to be required to be operated on at the same time since the intestines and omental fat have leaked and spread to each other's sides! That is why I say that this case is the "mother" of all perineal hernias.
The dog was operated on July 13, 2011. The whole process started from 9 am and ended at 12 noon. The surgery itself started from 9.30 am to 12 noon. It was the type of surgery that most vets would prefer not to be challenged to do as there were 3 hernias. The main one was the left perineal hernia with defect from above the anal area to the ventral most part of the backside. This would be at least 6 inches long, 3 inches wide and 5 inches deep. (1 inch = 2.5 cm). The right perineal hernia was two smaller holes separated by a band of muscle.
In the left perineal hernia, the bladder and large intestines had prolapsed. Over time, the intestines have had shifted from the left half of the backside to the right half. The dog licked the swollen area (mango-sized) over the months and the skin had become very thin and about to rupture. You can see the intestinal coils more prominent on the right side. So, I thought this was a right perineal hernia. Actually, it was a left!
Details of the surgery and anaesthesia done on June 13, 2011 will be recorded in Part 2 at:
www.sinpets.com/F5/20110714perineal_hernia_old_Silkie_Terrier_male
_dysuria_painful_backside_singapore_ToaPayohVets.htm
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