DRAFT CASE REPORT
DAY 1
Thursday, Oct 20, 2011
English Cocker, Male, 2 years, 11 kg
Dog eating less. Not active. The friend suggested taking the dog to see me.
I saw small ticks all over the body. The dog had been to a dog park in Pasir Ris recently/
Very pale gums. Blood test - low haemogloblin, low RBC and low platelets. Blood smear on Giemsa stain showed Babesia gibsoni. Ehrlichia seen. 0.5 ml Imizole (imidocarb) SC given. Dosage is 0.5 ml/10 kg.
IV dextrose and baytril. Vit K1 2 ml IV. Doxycycline 5mg/kg twice a day for 21 days. 10mg/kg twice a day had been proposed by some vet books but this is 4x the standard dose. Multivitamin paste. Vit K1 tablets (1/4 tab/day).
DAY 2
Friday, Oct 21, 2011
Gums still pale. No appetite. Vit K1 2 ml IV and supportive therapy. However the dog barks loudly when the owner came, exhausting himself. Owner brought his liver treats. He ate one.
Blood test results before Imizole 0.5 ml SC treatment:
Liver profile= Normal
Kidney profile= Normal
Hematology=
*Hemoglobin- 7g/dL [Normal range: 12-18]
*Red Blood Cells- 2.8 x10^12/L [Normal range: 5.5-8.5]
White Blood Cells- 13.2 x10^9/L [Normal range: 6-17]
*Packed Cell Volume= 0.19 [Normal range: 0.37-0.55]
Platelets= 52 [Normal range: 200-500]
*Nucleated Red Blood Cells seen [Severe demand for RBC to be release from Bone Marrow]
No platelet clump seen
--------------------------------------------------------------------------------
Blood test results 1 day after Imizole 0.5 ml SC treatment:
Liver profile= Enzymes increased
Kidney profile= Normal
Hematology=
*Hemoglobin- 7g/dL [Normal range: 12-18]
*Red Blood Cells- 2.9 x10^12/L [Normal range: 5.5-8.5]
White Blood Cells- 9.6 x10^9/L [Normal range: 6-17]
Packed Cell Volume= 0.2 [Normal range: 0.37-0.55]
*Platelets= 64 [Normal range: 200-500]
No platelet clump seen but few giant platelets present
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What is the importance of platelets?
a) Numbers:
The platelet count gives a general indication of the clotting ability of the blood. If the number of platelets falls below a certain critical level, spontaneous bleeding may occur. A low platelet count may indicate a problem with platelet production in the bone marrow, or may signal the presence of disease that is causing the platelets to be used up or destroyed. An increased platelet count often reflects excitement, exertion, or an activated bone marrow. In rare cases, an extremely high platelet count may indicate there is underlying bone marrow cancer.
b) Size:
The size of a platelet is related to its age; young platelets are large and plump, and older platelets are generally smaller. This can be important if the platelet count is low; the presence of large, plump, young platelets in the blood indicates that the bone marrow is functioning well, and is responding to the need for more platelets.
c) Appearance:
Very rarely, bizarre giant platelets, or abnormal immature platelets may be found, and these may signal the presence of an underlying bone marrow disorder or cancer
[Reference: http://www.fetchdog.com/learn-connect/dog-resource-library/health/diagnostic-tests/Complete-Blood-Count-for-Dogs/D/300600/P/1:5:55:601:6103/I/AR000010025]
DAY 3
Saturday, Oct 22, 2011
4PM
The owner came, her friend and the godfather. 2-hour visit. Loud barks.
At 7 pm, the 3 visitors left. The dog panted, heart beat very fast, as if he had run a sprint. It was bad. Would he die? I should have allowed a 10-minute visit, not 120 minutes!
Connected IV - glucose 100 ml, then dextrose saline with duphalytes 500 ml. Gave lasix IV. Atropine 0.5 ml IM. By the time I went home, it was past 7 pm.
The owner was prohibited from visiting for the next few days. This dog had a keen hearing as he could hear the owner's voice at the reception area some distance away in the back of the Surgery and started barking non-stop for several minutes.
DAY 4
Sunday, Oct 23, 2011
Morning 10 am. Dog felt well. Barking for a while. Smelt food. Not eating. Hand fed A/D canned food and given water and electrolytes.
DAY 5.
Monday, Oct 24, 2011
IV drip. Blood looked reddish unlike bluish blood for past few days. Good news.
Passed normal stools when taken out.
DAY 6.
Tuesday, Oct 25, 2011
Deepavali. Public holiday.
Alert and standing in cage. I am relieved that the gum looks pinker. Blood test at another lab showed normal platelets but still very low Hb and RBC. I phoned owner to take the dog home at 6 pm to be nursed by owner.
DAY 7.
Wednesday, Oct 26, 2011
At home. With iron tablets and good food including egg yolk and liver.
DAY 8.
Thursday, Oct 27, 2011
At home. I phoned the owner at 6.30 pm
"My dog is very active, hungry and thirsty. I found two ticks, a grey one on her body. I put tick powder onto my bed area." One tube Advantix Spot on had been applied on Day 6. Yet he had two ticks stuck in skin. Otherwise appeared normal.
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Scheduled Appointments
DAY 9
Friday, Oct 28, 2011
DAY 11
Sunday, Oct 30, 2011
Scheduled for next Imizole (imidocarb) injection SC. Babesia and Ehrlichia seen on 2nd blood smear on Day 6. Possibly has anaplasmosis?
DAY 12
Monday, Oct 31, 2011
Urine to be collected by the owner for urinalysis.
Acute tick fever needs regular monitoring till negative blood test results 2 weeks after the previous test but most owners don't have the time to do so.
Thursday, October 27, 2011
709. Neoderm for 2 months thins the 6-month-old shetland dog's skin
Oct 27, 2011
SOME INTERESTING CASES
I was on duty today and the young man came with a 5 kg thin Shetland with a big right perineal swelling of 4 days. Firm but not painful. Around 3 cm x 3 cm. So, what was it? A perineal hernia? No, as it cannot be pushed in. A haematoma or abscess? Likely. Zoletil 50 0.1 + 0.4 ml saline ml IV sedated the dog.
No hyperextension and therefore no need atropine unlike the Westie (pus in ears, consulted Vet 1 with no success, owner referred by an old client to me) last week when I gave him the same Zoletil 0.1 ml IV. He had stiff limbs which relaxed when I gave atropine 0.5 ml IM and gave ear irrigation. Pus and debris esp. right ear. No head-shaking 3 days after treatment
"My shetland's skin disease did not get cured," the young man of 20 years with 4 months left of National Service said. "I read in the internet that he may be suffering from demodecosis. The vet scraped his nose skin but found nothing. He gave me a Neodern cream to apply."
Two front paws near the dew claws were bald. I could see thinning of the skin and the tendons and bones below. Other parts of both the front paw look moth-bitten with hairless squares and circles. Both lower elbows ventral surface were bald.
I saw redness in skin below the front paws but not the back paws, took a hair microscopic exam and showed the young man ringworm. The other hairless area did not have ringworm as Neoderm had killed any fungus and also thinned the skin.
"My dog licks away everytime I apply Neoderm," he said of the hairless elbow and armpits.
"How long you had applied?" I asked.
"Two months," he said. I asked him to stop Neoderm as it thins the skin when used too long. Prescribed anti-fungal tablets and wash and review in 2 weeks. Should recover. Demodex unlikely.
I showed Dr Vanessa the effects of Neoderm. "This is the reason I seldom prescribe Neoderm," I said. "The owner uses it for a long time, thinning the skin."
SOME INTERESTING CASES
I was on duty today and the young man came with a 5 kg thin Shetland with a big right perineal swelling of 4 days. Firm but not painful. Around 3 cm x 3 cm. So, what was it? A perineal hernia? No, as it cannot be pushed in. A haematoma or abscess? Likely. Zoletil 50 0.1 + 0.4 ml saline ml IV sedated the dog.
No hyperextension and therefore no need atropine unlike the Westie (pus in ears, consulted Vet 1 with no success, owner referred by an old client to me) last week when I gave him the same Zoletil 0.1 ml IV. He had stiff limbs which relaxed when I gave atropine 0.5 ml IM and gave ear irrigation. Pus and debris esp. right ear. No head-shaking 3 days after treatment
"My shetland's skin disease did not get cured," the young man of 20 years with 4 months left of National Service said. "I read in the internet that he may be suffering from demodecosis. The vet scraped his nose skin but found nothing. He gave me a Neodern cream to apply."
Two front paws near the dew claws were bald. I could see thinning of the skin and the tendons and bones below. Other parts of both the front paw look moth-bitten with hairless squares and circles. Both lower elbows ventral surface were bald.
I saw redness in skin below the front paws but not the back paws, took a hair microscopic exam and showed the young man ringworm. The other hairless area did not have ringworm as Neoderm had killed any fungus and also thinned the skin.
"My dog licks away everytime I apply Neoderm," he said of the hairless elbow and armpits.
"How long you had applied?" I asked.
"Two months," he said. I asked him to stop Neoderm as it thins the skin when used too long. Prescribed anti-fungal tablets and wash and review in 2 weeks. Should recover. Demodex unlikely.
I showed Dr Vanessa the effects of Neoderm. "This is the reason I seldom prescribe Neoderm," I said. "The owner uses it for a long time, thinning the skin."
Wednesday, October 26, 2011
708. Script for "skin disease in a dwarf hamster" video to educate pet owners
Skin Diseases In A Dwarf Hamster
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
26 October, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
THE HOOK - A ROBOROVSKI HAMSTER CAN'T STOP SCRATCHING
The 10-year-old caregiver asks mum many times: "Please go to the vet." Mum has no time. (Show busy Singaporean mum with two jobs at workplace if possible, taking MRT, bus etc)
Bringing Veterinary Knowledge Alive To Vet Students & Pet Owners - Sponsored by
Toa Payoh Vets --- toapayohvets.com
26 October, 2011
INTRODUCTION - hamster bites himself. More self-biting wounds - to treat or not to treat?
If not treated - consequences - cellulitis and death
10-year-old girl is worried.
MIDDLE - Picture of cage and home?
what the mother does, what the vet does, what the vet groomer does? Images show hamster has been clipped short by the groomer. Ready for bathing. How do you bathe a hamster?
HOW TO BATHE A HAMSTER - VIDEO
Will hamster drown? Hamsters are usually given sand-bath (picture of hamster doing a sand bath) by pet owners. But now, he needs a water bath. What to do? How to bathe him? Video "How-to"
POST-BATHING - GOES HOME. Medication, bathing and new bedding. Hygiene of cage.
Check out example at: Oro-nasal fistula in the dog
http://www.youtube.com/user/99pups#p/u/1/5AWHpWYWgy4
CONCLUSION - Pictures of other hamsters with skin diseases to be provided by Dr Sing
Early treatment of skin diseases means
earlier recovery, lower veterinary cost and more peace of mind to your child who cares for the hamster
For more information
please visit: www.toapayohvets.com, +65 9668-6468, 6254-3326, e-mail judy@toapayohvets.com
CREDITS.
Concept by: Dr Sing Kong Yuen
Video and narration by:
NO copyrighted music or audio to be inside this video
BE KIND TO DOGS & CATS --- GET EYE ULCERS TREATED WITHIN 4 HOURS --- IF YOU DON'T WANT THEM TO BE BLIND. More case studies, goto: Cats or Dogs
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
Webpage at:
http://www.sinpets.com/F6/20111037roborovski-dermatitis-skin-disease-singapore-toapayohvets.htm
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
26 October, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
THE HOOK - A ROBOROVSKI HAMSTER CAN'T STOP SCRATCHING
The 10-year-old caregiver asks mum many times: "Please go to the vet." Mum has no time. (Show busy Singaporean mum with two jobs at workplace if possible, taking MRT, bus etc)
Bringing Veterinary Knowledge Alive To Vet Students & Pet Owners - Sponsored by
Toa Payoh Vets --- toapayohvets.com
26 October, 2011
INTRODUCTION - hamster bites himself. More self-biting wounds - to treat or not to treat?
If not treated - consequences - cellulitis and death
10-year-old girl is worried.
MIDDLE - Picture of cage and home?
what the mother does, what the vet does, what the vet groomer does? Images show hamster has been clipped short by the groomer. Ready for bathing. How do you bathe a hamster?
HOW TO BATHE A HAMSTER - VIDEO
Will hamster drown? Hamsters are usually given sand-bath (picture of hamster doing a sand bath) by pet owners. But now, he needs a water bath. What to do? How to bathe him? Video "How-to"
POST-BATHING - GOES HOME. Medication, bathing and new bedding. Hygiene of cage.
Check out example at: Oro-nasal fistula in the dog
http://www.youtube.com/user/99pups#p/u/1/5AWHpWYWgy4
CONCLUSION - Pictures of other hamsters with skin diseases to be provided by Dr Sing
Early treatment of skin diseases means
earlier recovery, lower veterinary cost and more peace of mind to your child who cares for the hamster
For more information
please visit: www.toapayohvets.com, +65 9668-6468, 6254-3326, e-mail judy@toapayohvets.com
CREDITS.
Concept by: Dr Sing Kong Yuen
Video and narration by:
NO copyrighted music or audio to be inside this video
BE KIND TO DOGS & CATS --- GET EYE ULCERS TREATED WITHIN 4 HOURS --- IF YOU DON'T WANT THEM TO BE BLIND. More case studies, goto: Cats or Dogs
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
Webpage at:
http://www.sinpets.com/F6/20111037roborovski-dermatitis-skin-disease-singapore-toapayohvets.htm
707. Producing the educational hamster skin disease video - comments by Dr Sing
Oct 26, 2011
I am producing a video for the AVA Responsible Pet Ownership Roadshow 2011 in Nov 2011 and time is running out. Below is my comment on the production!
Thank you for your two videos. Good hands-on work done on both videos. It is only by doing that one can learn and improve and I am glad you did that. Below are my comments.
GENERAL COMMENTS FOR HAMSTER VIDEO WHICH IS ATTENTION-GETTING
1. Hamster video introduction. Excellent narrative of daughter and mother. It captures the attention of the viewer.
2. Sequence is not correct as your starting scene is that of a hamster with its hair already clipped. Then you show scenes with a hamster with hair. Then, hair clipped, then a hamster with hair. Correct sequence is shown in www.toapayohvets.com front page but I will give you a webpage address when I produce the draft.
3. The point of view is that of the little girl who is worried about her hamster with skin disease. Because she is little, she can't go to the vet by herself. So she need to ask the mother for help.
So, the introduction, middle (at least 5 messages on a hamster's skin diseases) and conclusion will be from the little girl's point of view and her actions. Did she achieve her mission?
If she fails to get her mother to act, the hamster's self biting wounds will become skin infections with pus-producing bacteria (show another hamster with cellulitis from one of my cases). By then, it will be too late.
Why did the mother act? One reason is that the examinations are on-growing. The daughter's worries distract her from studying. So she goes to the vet. "The hamster needs to be hospitalised for 3 days to be treated," I said. "That will be fine, as my daughter is having her examinations!"
The side characters are the mother, the vet (consultation by the mother, diagnosis and treatment) and the groomer (clipping coat, bathing time, bathing).
4. Try NOT to superimpose text onto the character (e.g. onto the labrador's body) as this spoil the enjoyment of viewing of the animal.
This is an example from me:
THE HOOK
A roborovski (with hair)
http://www.kongyuensing.com/cgi/20111083dwarf-hamster-roborovski-scales-dandruff-skin-ulcers-toapayohvets-singapore.jpg
e.g. narrative from little girl. Show hamster moving if you have the video before clipping the hair
http://www.kongyuensing.com/cgi/20111085dwarf-hamster-roborovski-scales-dandruff-skin-ulcers-toapayohvets-singapore.jpg
CONCLUSION. The daughter phones the vet two times after bathing: "When can my hamster come home?" After bathing, on day 4 after hospitalisation, the mother brings the hamster. The 10-year-old girl is very happy.
ADVICES FROM DR SING
1. "Do not use the sharp pelleted litter as bedding," I said. "Use the soft paper type". Show cage with pelleted litter usually used for cats, covering part of the floor. Show cage with paper bedding covering the whole floor.
"But the other vet said that it is best not to change the bedding as it will stress out the hamster!"
"No two vets offer the same advices," I said. "In this case, the active roborovski hamster's body could have been scratched by the sharp ends of those pellets and bacterial infection of the skin causes itchiness and scratching!"
2. "Keep the cage floor clean," I advised.
Generally, the story must flow smoothly with actions preferred. The "clock" scene needs to be removed as it does not help since the timing is still 12 o'clock every time you flash this scene. No time movement!
FOR THE EAR IRRIGATION VIDEO
1. Do not superimpose text onto the body of the dog as it makes it less enjoyable to view the video.
2. Repetition of same scene. I note that ear scoping scene has been shown twice.
3. The video needs a hook which I spoke to you about. An action of the dog intensely scratching.
I have spoken to you earlier about this production.
Keep up the good work.
ADVICES
Try to use similar light text and black background as in the "Attack The Block"
trailer at:
http://www.youtube.com/results?search_query=attack+the+block+trailer&aq=1&oq=Att
Also adapt some of the stories and sounds but not copy their sounds, the story telling and the hook.
e.g. "Better call the police," the girl said
"You are better off calling the ghost-buster!"
e.g. In this hamster video narrative,you may think of above lines and replace "police" with "groomer" and "ghost-buster" with "vet"
I am producing a video for the AVA Responsible Pet Ownership Roadshow 2011 in Nov 2011 and time is running out. Below is my comment on the production!
Thank you for your two videos. Good hands-on work done on both videos. It is only by doing that one can learn and improve and I am glad you did that. Below are my comments.
GENERAL COMMENTS FOR HAMSTER VIDEO WHICH IS ATTENTION-GETTING
1. Hamster video introduction. Excellent narrative of daughter and mother. It captures the attention of the viewer.
2. Sequence is not correct as your starting scene is that of a hamster with its hair already clipped. Then you show scenes with a hamster with hair. Then, hair clipped, then a hamster with hair. Correct sequence is shown in www.toapayohvets.com front page but I will give you a webpage address when I produce the draft.
3. The point of view is that of the little girl who is worried about her hamster with skin disease. Because she is little, she can't go to the vet by herself. So she need to ask the mother for help.
So, the introduction, middle (at least 5 messages on a hamster's skin diseases) and conclusion will be from the little girl's point of view and her actions. Did she achieve her mission?
If she fails to get her mother to act, the hamster's self biting wounds will become skin infections with pus-producing bacteria (show another hamster with cellulitis from one of my cases). By then, it will be too late.
Why did the mother act? One reason is that the examinations are on-growing. The daughter's worries distract her from studying. So she goes to the vet. "The hamster needs to be hospitalised for 3 days to be treated," I said. "That will be fine, as my daughter is having her examinations!"
The side characters are the mother, the vet (consultation by the mother, diagnosis and treatment) and the groomer (clipping coat, bathing time, bathing).
4. Try NOT to superimpose text onto the character (e.g. onto the labrador's body) as this spoil the enjoyment of viewing of the animal.
This is an example from me:
THE HOOK
A roborovski (with hair)
http://www.kongyuensing.com/cgi/20111083dwarf-hamster-roborovski-scales-dandruff-skin-ulcers-toapayohvets-singapore.jpg
e.g. narrative from little girl. Show hamster moving if you have the video before clipping the hair
http://www.kongyuensing.com/cgi/20111085dwarf-hamster-roborovski-scales-dandruff-skin-ulcers-toapayohvets-singapore.jpg
CONCLUSION. The daughter phones the vet two times after bathing: "When can my hamster come home?" After bathing, on day 4 after hospitalisation, the mother brings the hamster. The 10-year-old girl is very happy.
ADVICES FROM DR SING
1. "Do not use the sharp pelleted litter as bedding," I said. "Use the soft paper type". Show cage with pelleted litter usually used for cats, covering part of the floor. Show cage with paper bedding covering the whole floor.
"But the other vet said that it is best not to change the bedding as it will stress out the hamster!"
"No two vets offer the same advices," I said. "In this case, the active roborovski hamster's body could have been scratched by the sharp ends of those pellets and bacterial infection of the skin causes itchiness and scratching!"
2. "Keep the cage floor clean," I advised.
Generally, the story must flow smoothly with actions preferred. The "clock" scene needs to be removed as it does not help since the timing is still 12 o'clock every time you flash this scene. No time movement!
FOR THE EAR IRRIGATION VIDEO
1. Do not superimpose text onto the body of the dog as it makes it less enjoyable to view the video.
2. Repetition of same scene. I note that ear scoping scene has been shown twice.
3. The video needs a hook which I spoke to you about. An action of the dog intensely scratching.
I have spoken to you earlier about this production.
Keep up the good work.
ADVICES
Try to use similar light text and black background as in the "Attack The Block"
trailer at:
http://www.youtube.com/results?search_query=attack+the+block+trailer&aq=1&oq=Att
Also adapt some of the stories and sounds but not copy their sounds, the story telling and the hook.
e.g. "Better call the police," the girl said
"You are better off calling the ghost-buster!"
e.g. In this hamster video narrative,you may think of above lines and replace "police" with "groomer" and "ghost-buster" with "vet"
Tuesday, October 25, 2011
706. Practise defensive medicine? New puppy with blood in the stools
A NEW PUPPY WITH BLOOD IN THE STOOLS OR VOMITING AND DIARRHOEA
PROCEDURES AT TOA PAYOH VETS
When a new puppy has blood in the stools or vomiting/diarrhoea, the following will be the procedures at Toa Payoh Vets to provide the highest standard of care and to defend the vet in the event of litigation or complaint when the puppy dies later.
1. HISTORY. Record all vaccinations done and dates and by whom. Do not forget to do so. Record your epidemiological study to determine whether parvovirus is a likely cause.
2. GENERAL EXAMINATION. Demeanour. Weight, rectal temperature, pulse and respiratory rate. Abdominal pain, gas in the GIT and other observations.
3. DETAILED EXAMINATION. Parvoviral test, blood test (haematology or complete blood test), stool test. It will be a case for veterinary negligence if the parvoviral test is not done.
4. TREATMENT. According to symptoms. IV, SC or oral fluid therapy depending on situation. Antispasmodic, antibiotics, multivitamins, protein drip, Vit K1 when necessary. Times and amounts given will be recorded.
The vet in charge of the case is responsible for details of time, amount and other information will be recorded in the hospitalisation sheet.
5. COMMUNICATIONS WITH THE OWNER IN WRITING. A veterinary report explaining the significance of the tests and case must be given to the owner on discharge/death of the puppy. It is best to keep the owner informed daily of the health of the puppy. Such phone calls must be recorded in the medical case files.
Record under AMD (Against Medical Advice) the owner's rejection of advices of the test in your medical record. Failure to do so implies that the vet has not advised at all in cases of litigation/complaint. As Singapore is becoming a litigious society, I advise that the highest standard of care to be given at all times. An example of a case done by me is down shown in the images.
Updates and more pictures are at: TOA PAYOH VETS WEBPAGE:
http://www.sinpets.com/dogs/20111036puppy-blood-in-stools-diarrhoea-vomiting-singapore-toapayohvets.htm
PROCEDURES AT TOA PAYOH VETS
When a new puppy has blood in the stools or vomiting/diarrhoea, the following will be the procedures at Toa Payoh Vets to provide the highest standard of care and to defend the vet in the event of litigation or complaint when the puppy dies later.
1. HISTORY. Record all vaccinations done and dates and by whom. Do not forget to do so. Record your epidemiological study to determine whether parvovirus is a likely cause.
2. GENERAL EXAMINATION. Demeanour. Weight, rectal temperature, pulse and respiratory rate. Abdominal pain, gas in the GIT and other observations.
3. DETAILED EXAMINATION. Parvoviral test, blood test (haematology or complete blood test), stool test. It will be a case for veterinary negligence if the parvoviral test is not done.
4. TREATMENT. According to symptoms. IV, SC or oral fluid therapy depending on situation. Antispasmodic, antibiotics, multivitamins, protein drip, Vit K1 when necessary. Times and amounts given will be recorded.
The vet in charge of the case is responsible for details of time, amount and other information will be recorded in the hospitalisation sheet.
5. COMMUNICATIONS WITH THE OWNER IN WRITING. A veterinary report explaining the significance of the tests and case must be given to the owner on discharge/death of the puppy. It is best to keep the owner informed daily of the health of the puppy. Such phone calls must be recorded in the medical case files.
Record under AMD (Against Medical Advice) the owner's rejection of advices of the test in your medical record. Failure to do so implies that the vet has not advised at all in cases of litigation/complaint. As Singapore is becoming a litigious society, I advise that the highest standard of care to be given at all times. An example of a case done by me is down shown in the images.
Updates and more pictures are at: TOA PAYOH VETS WEBPAGE:
http://www.sinpets.com/dogs/20111036puppy-blood-in-stools-diarrhoea-vomiting-singapore-toapayohvets.htm
705. Post-op discharge 3 days after a breast tumour surgery
Yesterday, Oct 24, 2011, the lady owner brought her dog back as there was a "leakage" of reddish-brown fluid from the surgical wound. She had asked for advice over the phone but I told her that it would be hard to know what was happening. However the dog was eating.
"It is not possible for the dog to lick her wound," the lady said since her dog was wearing an E-collar post-operation. "I don't see my dog licking the wound when I am with her."
"I have seen cases where it has been done," I did now want to argue as most owners seem to think that the dog would lick the surgical wound in their presence. If not, then, the dog had not done it. Unless the e-collar is of a size so big, the dog can still lick its surgical wounds partly.
One of the stitches had a gap and post-op blood had leaked out. It was not serious. So, I hospitalised the dog for 3 days as she was walking at home. "Not much walking as she always lay down," the owner said.
"Any walking other than crate confinement will put tension on this long surgical wound," I said. "This is not a small 2-cm wound but more than 20-cm long. Good communication with the owner is important but sometimes it can test a vet's patience.
TIPS
In this case, I had not performed the surgery. However, I had discussed in my previous article that the "walk-in" sutures and horizontal mattress sutures on the skin would have given a tighter fit to control bleeding and prevent "leaking" of plasma. As each vet has his or her own skill and style in stitching up, it is difficult to say whether the subcutaneous stitching of the tissue and then simple interrupted skin sutures did permit "leakage" as there are many factors involved in a post-operation bleeding. In this case, the whole lower part of the dog's body was wet with the reddish brown plasma and blood. I asked Min to bathe the dog as her front leg skin and elbows had yellow flakes and this has nothing to do with the surgery. The dog had not been groomed.
"It is not possible for the dog to lick her wound," the lady said since her dog was wearing an E-collar post-operation. "I don't see my dog licking the wound when I am with her."
"I have seen cases where it has been done," I did now want to argue as most owners seem to think that the dog would lick the surgical wound in their presence. If not, then, the dog had not done it. Unless the e-collar is of a size so big, the dog can still lick its surgical wounds partly.
One of the stitches had a gap and post-op blood had leaked out. It was not serious. So, I hospitalised the dog for 3 days as she was walking at home. "Not much walking as she always lay down," the owner said.
"Any walking other than crate confinement will put tension on this long surgical wound," I said. "This is not a small 2-cm wound but more than 20-cm long. Good communication with the owner is important but sometimes it can test a vet's patience.
TIPS
In this case, I had not performed the surgery. However, I had discussed in my previous article that the "walk-in" sutures and horizontal mattress sutures on the skin would have given a tighter fit to control bleeding and prevent "leaking" of plasma. As each vet has his or her own skill and style in stitching up, it is difficult to say whether the subcutaneous stitching of the tissue and then simple interrupted skin sutures did permit "leakage" as there are many factors involved in a post-operation bleeding. In this case, the whole lower part of the dog's body was wet with the reddish brown plasma and blood. I asked Min to bathe the dog as her front leg skin and elbows had yellow flakes and this has nothing to do with the surgery. The dog had not been groomed.
704. Follow up on ptergium, glaucoma and enucleation of eye dog
Yesterday, Oct 24, 2011, I phoned the lady owner to enquire about her dog after eye enucleation. She was very happy as the dog was normal.
"Any bleeding from the eye?" I asked as there was some swelling of the stitched eye socket 3 hours after removal of the eyeball. In this case, I had stitched the conjunctival (upper and lower) tissues with 2/0 absorbable. Then I stitched the eyelid margins (as shown in the picture) with 3/0 nylon. So, there were two layers to prevent bleeding out of the eye.
"Some bleeding on the first day, but nothing serious. My dog is eating. I will see you 14 days later to remove the stitches."
Post-operation bleeding is one complication in any surgery. The dog had antibiotics and painkillers (tolfedine) and has no problem as evident by her normal behaviour and good appetite.
Toa Payoh Vets webpage
http://www.sinpets.com/F5/20111031old-dog-pterygium-glaucoma-anaesthetic-reactions-success-singapore-toapayohvets.htm
"Any bleeding from the eye?" I asked as there was some swelling of the stitched eye socket 3 hours after removal of the eyeball. In this case, I had stitched the conjunctival (upper and lower) tissues with 2/0 absorbable. Then I stitched the eyelid margins (as shown in the picture) with 3/0 nylon. So, there were two layers to prevent bleeding out of the eye.
"Some bleeding on the first day, but nothing serious. My dog is eating. I will see you 14 days later to remove the stitches."
Post-operation bleeding is one complication in any surgery. The dog had antibiotics and painkillers (tolfedine) and has no problem as evident by her normal behaviour and good appetite.
Toa Payoh Vets webpage
http://www.sinpets.com/F5/20111031old-dog-pterygium-glaucoma-anaesthetic-reactions-success-singapore-toapayohvets.htm
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