Surprisingly, two calls this morning Jul 25, 2011
1. Hamster 1 and 2, Female, 2 years old, lady owner phoned up. Day 3 of surgery. Hamster 2 (amputee) attempted to bite stitches. What to do? Plaster? Not practical.
Hamster 1 - Ear canal ablation. Hamster eating. Objected strongly to cleaning off blood from ear. So done once only. Advised to do more cleaning. Isolfurane gas anaesthesia only but very stressful ear canal removal. Took 2 days to recover.
Hamster 2 - Confirmed leg tumour was only 5 mm diameter 6 weeks ago but grew furiously big to 1.5 cm. Leg amputated. Starting exercise wheeling. 30 g before surgery. After surgery 19 g. Hates Biolapis.
Feedback from owner who noted the following.
1. Lowered water bottle. Can't drink as only one hind leg.
2. Food bowl too high now. Hard to climb out. Use bowl from those used in Chinese household for chilli and soya sauce. A bit of spillage but hamster could eat.
3. Tempted with favourite bean sprouts. Then give baytril oral.
This hamster needed sedation IM. First day, one drop Zoletil 50 IM. No effect. Just looked at me. So, suspend all operation till 24 hours later. 2nd day, 3 drops OK. Leg bone tumour extended to inguinal. Amputated. Quite active within 1 hour.
Advices
No exercise wheel. Stitches quite many. Blue nylon 5/0
Continue on paper litter. Not so rough. But hamsters loved to shred them.
2. Hamster 3 - 81 g - loves bread, husband rushed down. 2 5/0 nylon stitches bitten off today on Day 8. Bleeding. Wife phoned. OK at clinic. No bleeding. Cut off two entangled nylon stitches. 1 remaining. Husband did not want it cut off. To observe. To reduce weight further. 79 g.
Transparent 5/0 nylon taken out
Feedback, fully active and normal on Day 3 but would eat after operation. Daily exercise on wheel. Owner quite happy.
Monday, July 25, 2011
515. Anaesthesia & Surgery In Old Dogs - 13 years old
HIGH-RISK ANAESTHETIC CASES
AN EXAMPLE FOR VETS AT TOA PAYOH VETS
CASE STUDY FOR VERY OLD DOGS
HISTORY
On Oct 28, 2010. Not eating. Tense abdomen. Uterus thickened. High WBC count (44 compared to normal 6-17). Suspected closed pyometra. Operated by Dr Vanessa Lin. Recovered fully. Now, the owner requested dental work. Review medical history and make judgment as to the risks of another anaesthesia.
October July 25, 2011
Jack Russell, Female, Spayed, 5.6kg, 38.6 deg C. Excellent bodily condition
Today, 10 am, phoned gentleman owner to confirm request for dental checkup and extract loose teeth. 10.30 am Dental scaling & extraction of M1 (left upper, roots exposed), PM2 (left upper, roots exposed) & PM2 (right upper, roots exposed). Overall, teeth in good condition.
Last dinner at 7 pm yesterday
Sedation: Domitor 0.1 ml + Ketamine 0.2 ml IV. Shivering.
Others: Atropine 0.5ml IM. No shivering.
10 minutes: Isoflurane 0.2 - 1%
Dental scaling. 3 loose teeth with exposed roots extracted. Sleeps
Antidote: Antisedan 0.25 ml IM. Wakes up in 5 miniutes.
Antibiotic & pain-killer: Tolfedine 0.7 ml & Baytril 0.7 ml SC
Duration of anaesthesia: 15 minutes. No IV drip.
IV drip not given as the dog was eating and drinking with normal stools and urine for the past 3 days.
Dog OK. Goes home.
CONCLUSION
1. In weak and sick old dogs, IV drip should be given. Baytril via IV. Lasix IV if indicated in heart diseased dogs.
2. Blood test strongly advised. Record in case file if the owner objected to blood test.
3. Informed consent form must be filled up properly be the vet and signed by the owner. Case record should note risks and complications being explained.
4. Anti-sedan to be given to wake up the dog.
5. In dogs with heart disease, IV drip post-op.
6. Post-op pain-killer tolfedine + antibiotics SC as soon as possible after surgery
AN EXAMPLE FOR VETS AT TOA PAYOH VETS
CASE STUDY FOR VERY OLD DOGS
HISTORY
On Oct 28, 2010. Not eating. Tense abdomen. Uterus thickened. High WBC count (44 compared to normal 6-17). Suspected closed pyometra. Operated by Dr Vanessa Lin. Recovered fully. Now, the owner requested dental work. Review medical history and make judgment as to the risks of another anaesthesia.
October July 25, 2011
Jack Russell, Female, Spayed, 5.6kg, 38.6 deg C. Excellent bodily condition
Today, 10 am, phoned gentleman owner to confirm request for dental checkup and extract loose teeth. 10.30 am Dental scaling & extraction of M1 (left upper, roots exposed), PM2 (left upper, roots exposed) & PM2 (right upper, roots exposed). Overall, teeth in good condition.
Last dinner at 7 pm yesterday
Sedation: Domitor 0.1 ml + Ketamine 0.2 ml IV. Shivering.
Others: Atropine 0.5ml IM. No shivering.
10 minutes: Isoflurane 0.2 - 1%
Dental scaling. 3 loose teeth with exposed roots extracted. Sleeps
Antidote: Antisedan 0.25 ml IM. Wakes up in 5 miniutes.
Antibiotic & pain-killer: Tolfedine 0.7 ml & Baytril 0.7 ml SC
Duration of anaesthesia: 15 minutes. No IV drip.
IV drip not given as the dog was eating and drinking with normal stools and urine for the past 3 days.
Dog OK. Goes home.
CONCLUSION
1. In weak and sick old dogs, IV drip should be given. Baytril via IV. Lasix IV if indicated in heart diseased dogs.
2. Blood test strongly advised. Record in case file if the owner objected to blood test.
3. Informed consent form must be filled up properly be the vet and signed by the owner. Case record should note risks and complications being explained.
4. Anti-sedan to be given to wake up the dog.
5. In dogs with heart disease, IV drip post-op.
6. Post-op pain-killer tolfedine + antibiotics SC as soon as possible after surgery
Saturday, July 23, 2011
514. The "reasonable" man test
The following is related to an old dog with a chronic ear problem. An earlier e-mail was posted in Blog No. 508 at:
http://2010vets.blogspot.com/2011/07/508-ear-canal-ablation-in-dog-email.html
E-MAIL TO DR SING DATED JULY 22, 2011
Hi Dr Sing,
Thank you for your reply!
(Ear Canal Ablation surgery is the only cure in chronic otitis externa with growths)--- URL is:
http://www.sinpets.com/F5/20110722vertical-total-ear-canal-ablation-surgery-chronic-ear-infections-tumours-dog-toapayohvets-singapore.htm
I am not confident with the surgery. Although he had one last year to laser which i mentioned, the vet used gas (i think) and promised to take less than an hour to minimize the risks, (he woke up immediately on the table and stood up wagging tail) his kidney suffered about 6-8 months after that (BUN was 188+ & before surgery 38). I don't know for sure if it was related to the surgery (or chemo) but I've read that it is possible. I cannot help but wonder if your 11-yr old patient died from post surgery...
May i ask, (I've not dared to ask other vets face to face) do you think the ear tumor is going to kill my dog if i leave it as it is...? How is it going to develop...? Will it go into the brain or pressing on it?
Thanks a million.
E-MAIL FROM DR SING DATED JULY 23, 2011
Thank you for your reply. Old dogs are at the end of their life-span and therefore are very high anaesthetic risks.
Any outcome in a complaint is judged by a "reasonable" man test in a court of law. Will a "reasonable" man think that the death of my 11-year-old dog patient that had ear canal ablation and passed away in his sleep 4 months later was due to the surgery?
A reasonable man will think that the death of patient that dies during or within a day or two after surgery is due to the surgery. After 4 months, a reasonable man does not think that the death of this 11-year-old dog is due to the surgery especially when he has been eating and drinking normally after convalescence.
As every dog is an individual and the exact nature of his ear growths are not known due to no histopathology results (as to whether the growths are cancerous or not) being available from you, it will be difficult to predict what will be the final outcome of your dog.
With chronic otitis externa and ear canal growths, infections of the ear canal get more severe, leading to the rupture of the ear drum and spread of the infections to the middle and inner ear may occur. If the growths are cancerous, they may spread to other areas including the brain.
Best wishes.
http://2010vets.blogspot.com/2011/07/508-ear-canal-ablation-in-dog-email.html
E-MAIL TO DR SING DATED JULY 22, 2011
Hi Dr Sing,
Thank you for your reply!
(Ear Canal Ablation surgery is the only cure in chronic otitis externa with growths)--- URL is:
http://www.sinpets.com/F5/20110722vertical-total-ear-canal-ablation-surgery-chronic-ear-infections-tumours-dog-toapayohvets-singapore.htm
I am not confident with the surgery. Although he had one last year to laser which i mentioned, the vet used gas (i think) and promised to take less than an hour to minimize the risks, (he woke up immediately on the table and stood up wagging tail) his kidney suffered about 6-8 months after that (BUN was 188+ & before surgery 38). I don't know for sure if it was related to the surgery (or chemo) but I've read that it is possible. I cannot help but wonder if your 11-yr old patient died from post surgery...
May i ask, (I've not dared to ask other vets face to face) do you think the ear tumor is going to kill my dog if i leave it as it is...? How is it going to develop...? Will it go into the brain or pressing on it?
Thanks a million.
E-MAIL FROM DR SING DATED JULY 23, 2011
Thank you for your reply. Old dogs are at the end of their life-span and therefore are very high anaesthetic risks.
Any outcome in a complaint is judged by a "reasonable" man test in a court of law. Will a "reasonable" man think that the death of my 11-year-old dog patient that had ear canal ablation and passed away in his sleep 4 months later was due to the surgery?
A reasonable man will think that the death of patient that dies during or within a day or two after surgery is due to the surgery. After 4 months, a reasonable man does not think that the death of this 11-year-old dog is due to the surgery especially when he has been eating and drinking normally after convalescence.
As every dog is an individual and the exact nature of his ear growths are not known due to no histopathology results (as to whether the growths are cancerous or not) being available from you, it will be difficult to predict what will be the final outcome of your dog.
With chronic otitis externa and ear canal growths, infections of the ear canal get more severe, leading to the rupture of the ear drum and spread of the infections to the middle and inner ear may occur. If the growths are cancerous, they may spread to other areas including the brain.
Best wishes.
Friday, July 22, 2011
Neutering a second Yorkshire Terrier, male
I had an e-mail appointment to neuter a Yorkshire Terrier, 2.7 kg only. He was so well behaved. "But in the house, he lords over us," the sister with the brownest sun tan I had even seen in a Singaporean Chinese girl. Usually this tan is for Caucasians who sunbathe for hours.
Teeth scaling needed. Two lower puppy canine teeth were extracted as they accumulated food in between the permanent and puppy canines.
Xylazine 0.15 ml IM. Then isoflurane gas by mask and intubate. Smooth surgery. I was very surprised that there was very little bleeding from inside and from the skin suture. Only one ligation of the spermatic cord using 3-forcep clamp method and closed method of neuter. This was one of those very satisfying neuters. I advised tolfedine 4mg/kg oral for first 24 hours and then once daily. Tolfedine was given by SC post-op.
The other Yorkshire Terrier owner (also a lady) did not contact me at all after neuter. Similar suture. Similar query from my assistant Mr Min again: "No subcuticular suture?" when he saw me giving one 2/0 horizontal mattress. He must have had been impressed with seeing many subcuticular sutures done by my associate vets and so he was much surprised as to why I did not do it.
Good post-op outcome (lack of complications) counts. He had not seen any skin irritation complaint from my case if you ask him. "Subcuticular sutures are not necessary if you don't traumatise the surrounding tissues and close with horizontal mattress," I told Mr Min who is a veterinarian qualified in Myanmar. Well, he is new to Singapore veterinary surgery and he can see 3 vets with 3 different styles. So, it is up to him to learn the best practices from the 3 vets. And be a better vet.
There is no need to return for stitch removal and so I don't see the Yorkshire anymore. No news is good news.
Teeth scaling needed. Two lower puppy canine teeth were extracted as they accumulated food in between the permanent and puppy canines.
Xylazine 0.15 ml IM. Then isoflurane gas by mask and intubate. Smooth surgery. I was very surprised that there was very little bleeding from inside and from the skin suture. Only one ligation of the spermatic cord using 3-forcep clamp method and closed method of neuter. This was one of those very satisfying neuters. I advised tolfedine 4mg/kg oral for first 24 hours and then once daily. Tolfedine was given by SC post-op.
The other Yorkshire Terrier owner (also a lady) did not contact me at all after neuter. Similar suture. Similar query from my assistant Mr Min again: "No subcuticular suture?" when he saw me giving one 2/0 horizontal mattress. He must have had been impressed with seeing many subcuticular sutures done by my associate vets and so he was much surprised as to why I did not do it.
Good post-op outcome (lack of complications) counts. He had not seen any skin irritation complaint from my case if you ask him. "Subcuticular sutures are not necessary if you don't traumatise the surrounding tissues and close with horizontal mattress," I told Mr Min who is a veterinarian qualified in Myanmar. Well, he is new to Singapore veterinary surgery and he can see 3 vets with 3 different styles. So, it is up to him to learn the best practices from the 3 vets. And be a better vet.
There is no need to return for stitch removal and so I don't see the Yorkshire anymore. No news is good news.
512. Auditing Veterinary Surgery - Accuracy, completeness and speed
I do a surprise audit of veterinary surgery of my associate vets now and then to ensure that the standard of care and surgery is to a high standard as I am the licensee. Besides, good surgical outcomes mean more referrals and business.
SUTURES
All young vets want to use their own sutures and drugs. However, there is a need to be sensible in a young vet's demands and to be aware of the costs of veterinary practice.
In this audit I did today, I noted that 2 packets of 0 chromic catgut and 2 packets of absorbable 3/0 monofilament have had been used during the spay of a poodle. From my experience, the most is 2 packets of sutures. Not four. There was a need for an explanation as this is just a small breed. I would have used at the most 2 packets of 2/0 absorbable sutures. With suture placements at the optimal distance and the use of 3 horizontal mattress sutures of 0.8 cm placed at 0.8 cm apart, I could use just one packet.
I was quite surprised that 4 packets were used. One explanation was the need to use subcuticular sutures to seal off dead space. Another was 3 ligations on the uterine body and 2 ligations each on the ovarian stumps, totalling 7 ligations and therefore needing more suture lengths and time.
The skin incision and linea alba were closed with interrupted sutures. Still, there was a waste of one packet.
NO SUBCUTICULAR SUTURING NECESSARY
Excessive suturing does not mean better suturing. The dog gets irritated with the numerous subcuticular sutures. I have explained this many times to my associate vets but it seems they have had great difficulty accepting my advices.
There is no need to do this line as the dog keeps licking its skin wound during healing resulting in redness. And there are a few cases despite NSAID painkillers.
On my side, I don't get any complaint over my 30 years of practice as I use just one or two horizontal mattress suture and no subcuticular. Yet the two young vets don't agree with dispensation of subcuticular sutures. So, it is up to each vet to do what they have had been taught. The Australian professors of veterinary surgery still preaches SC sutures
HORIZONTAL MATTRESS V. SIMPLE INTERRUPTED
Horizontal mattress provide stronger bonding and is less easy to lick off. Interrupted sutures placed at 0.5 mm apart are too close and unnecessary. Read surgery suturing books yourself if you don't believe my experience. In small dogs, interrupted sutures at 0.8 cm apart will be OK and ideal in neuter and spay cases. In dwarf hamsters, I stitch the skin with interrupted at 0.3 cm apart. DEFINITELY NO subcuticular sutures.
E-COLLARS
In my experience, e-collars are unnecessary after spay and neuter in most cases. I protect the wound with a plaster bandage. NSAID painkillers must be effective and given by injection post-op. Tolfedine may need to be given every 12 hours for the first 2 days. Altogether 4 days. My associates use rimadyril.
CONCLUSION
As each vet has his or her own mindset, it will be best if they read more and find out for themselves the most cost-efficient way to perform stitching. Accuracy, completeness and speed are the 3 tenets for surgery. No point doing fanciful stitching esp. concealed subcuticular sutures to impress the client as most owners just want the least cost and least need to come back for stitch removal or complaint of licking and inflammation of the skin.
SUTURES
All young vets want to use their own sutures and drugs. However, there is a need to be sensible in a young vet's demands and to be aware of the costs of veterinary practice.
In this audit I did today, I noted that 2 packets of 0 chromic catgut and 2 packets of absorbable 3/0 monofilament have had been used during the spay of a poodle. From my experience, the most is 2 packets of sutures. Not four. There was a need for an explanation as this is just a small breed. I would have used at the most 2 packets of 2/0 absorbable sutures. With suture placements at the optimal distance and the use of 3 horizontal mattress sutures of 0.8 cm placed at 0.8 cm apart, I could use just one packet.
I was quite surprised that 4 packets were used. One explanation was the need to use subcuticular sutures to seal off dead space. Another was 3 ligations on the uterine body and 2 ligations each on the ovarian stumps, totalling 7 ligations and therefore needing more suture lengths and time.
The skin incision and linea alba were closed with interrupted sutures. Still, there was a waste of one packet.
NO SUBCUTICULAR SUTURING NECESSARY
Excessive suturing does not mean better suturing. The dog gets irritated with the numerous subcuticular sutures. I have explained this many times to my associate vets but it seems they have had great difficulty accepting my advices.
There is no need to do this line as the dog keeps licking its skin wound during healing resulting in redness. And there are a few cases despite NSAID painkillers.
On my side, I don't get any complaint over my 30 years of practice as I use just one or two horizontal mattress suture and no subcuticular. Yet the two young vets don't agree with dispensation of subcuticular sutures. So, it is up to each vet to do what they have had been taught. The Australian professors of veterinary surgery still preaches SC sutures
HORIZONTAL MATTRESS V. SIMPLE INTERRUPTED
Horizontal mattress provide stronger bonding and is less easy to lick off. Interrupted sutures placed at 0.5 mm apart are too close and unnecessary. Read surgery suturing books yourself if you don't believe my experience. In small dogs, interrupted sutures at 0.8 cm apart will be OK and ideal in neuter and spay cases. In dwarf hamsters, I stitch the skin with interrupted at 0.3 cm apart. DEFINITELY NO subcuticular sutures.
E-COLLARS
In my experience, e-collars are unnecessary after spay and neuter in most cases. I protect the wound with a plaster bandage. NSAID painkillers must be effective and given by injection post-op. Tolfedine may need to be given every 12 hours for the first 2 days. Altogether 4 days. My associates use rimadyril.
CONCLUSION
As each vet has his or her own mindset, it will be best if they read more and find out for themselves the most cost-efficient way to perform stitching. Accuracy, completeness and speed are the 3 tenets for surgery. No point doing fanciful stitching esp. concealed subcuticular sutures to impress the client as most owners just want the least cost and least need to come back for stitch removal or complaint of licking and inflammation of the skin.
511. Two squeaky sibling dwarf hamsters from the internet
The internet introduced me to two active sibling female grey dwarf hamsters on Thursday, July 21, 2011. They were no ordinary 2-year-old greyish dwarf hamsters in the sense that both gave angry squeaks whenever I tried to handle them. They would sprint away as fast as their legs would carry them. If cornered, they would stare at me ready to nip me if my finger ever touched them.
Hamster 1. Female. 28g. Her right ear was swollen and oily. As I got near her, she emitted a strong smell of rotten meat in the consultation. Body odour? Not from hamsters. Especially dwarfs as they groom themselves frequently.
"Is it your dirty glove?" I asked my assistant Mr Min. He wore a soiled cotton glove to handle the hamster to protect himself against being bitten. I had strongly advised him to change gloves when they get dirtied but he is the type that needed frequent reminders and wearing down my patience.
"No, no," the slim lady owner in black-rimmed glasses said. "She has this foul smell. My vet gave her this Panalog ear ointment to apply. But there is still the smell. Pieces of white pus comes out from the ear!"
Recently I had a hamster with a similar smell due to it being bitten. Smell of putrefying flesh. "Was this hamster bitten by the sibling?" I asked. "Well, yes," the lady said. "The sibling who is more aggressive bit her.
"Did your vet give any antibiotics?" I asked.
"No," she said. "Just the ear ointment."
This looked like a complex case. "I will have to put her under anaesthesia and check the ear," I said. "Normally, there should be no anaesthetic risk as she is very active and eating. I may have to irrigate the ear with hydrogen peroxide to get rid of the smelly bacteria and tissues."
As simple as that. Irrigate the ear under anaesthesia. What is so difficult when the hamster is not trying to bite you? Well, it was not to be. The ear was swollen with nodules piling one upon the other. Big growths. There was no time to phone the lady for permission as the hamster can't take long anaesthesia without dying off. Less than 10 minutes would be OK. I cut off the whole vertical canal with its tumours. I saw the parotid salivary gland - a small yellow white. Surgery in illustration. The hamster survived and went home the same night.
As for Hamster 2, the left leg had a big lump. "It was just a pimple, last month. I asked my vet. I was told to wait and see. Now the vet says the leg must be amputated.
It was a big bony hard tumour like a coin involving the bone from below the knee. Anaesthesia was Zoletil 50. 1 drop 1M given. The hamster was not sedated. So I phoned the owner to say I would do the next day. 3 drops IM. The hamster went down and looked quite dead. There was slow breathing. I got the tumour out. Leg had to be amputated above the knee. Stitched 5/0 nylon. Very weak. May die post-op. Tried to exercise with 3 legs still. What a strong hamster. Weighed her. Now 19 gram. And she was 30 grams befoe he surgery 2 days ago. "She drinks more, and is more aggressive," the young lady said to me. Well, 2 hamsters alive. That is what matters. The bony tumour must weigh 10 grams.
Hamster 1. Female. 28g. Her right ear was swollen and oily. As I got near her, she emitted a strong smell of rotten meat in the consultation. Body odour? Not from hamsters. Especially dwarfs as they groom themselves frequently.
"Is it your dirty glove?" I asked my assistant Mr Min. He wore a soiled cotton glove to handle the hamster to protect himself against being bitten. I had strongly advised him to change gloves when they get dirtied but he is the type that needed frequent reminders and wearing down my patience.
"No, no," the slim lady owner in black-rimmed glasses said. "She has this foul smell. My vet gave her this Panalog ear ointment to apply. But there is still the smell. Pieces of white pus comes out from the ear!"
Recently I had a hamster with a similar smell due to it being bitten. Smell of putrefying flesh. "Was this hamster bitten by the sibling?" I asked. "Well, yes," the lady said. "The sibling who is more aggressive bit her.
"Did your vet give any antibiotics?" I asked.
"No," she said. "Just the ear ointment."
This looked like a complex case. "I will have to put her under anaesthesia and check the ear," I said. "Normally, there should be no anaesthetic risk as she is very active and eating. I may have to irrigate the ear with hydrogen peroxide to get rid of the smelly bacteria and tissues."
As simple as that. Irrigate the ear under anaesthesia. What is so difficult when the hamster is not trying to bite you? Well, it was not to be. The ear was swollen with nodules piling one upon the other. Big growths. There was no time to phone the lady for permission as the hamster can't take long anaesthesia without dying off. Less than 10 minutes would be OK. I cut off the whole vertical canal with its tumours. I saw the parotid salivary gland - a small yellow white. Surgery in illustration. The hamster survived and went home the same night.
As for Hamster 2, the left leg had a big lump. "It was just a pimple, last month. I asked my vet. I was told to wait and see. Now the vet says the leg must be amputated.
It was a big bony hard tumour like a coin involving the bone from below the knee. Anaesthesia was Zoletil 50. 1 drop 1M given. The hamster was not sedated. So I phoned the owner to say I would do the next day. 3 drops IM. The hamster went down and looked quite dead. There was slow breathing. I got the tumour out. Leg had to be amputated above the knee. Stitched 5/0 nylon. Very weak. May die post-op. Tried to exercise with 3 legs still. What a strong hamster. Weighed her. Now 19 gram. And she was 30 grams befoe he surgery 2 days ago. "She drinks more, and is more aggressive," the young lady said to me. Well, 2 hamsters alive. That is what matters. The bony tumour must weigh 10 grams.
509. Accuracy, completeness and speed in hamster surgery.
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.
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.
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.
Subscribe to:
Posts (Atom)