At 10 am, the 7-year-old Maltese dog that panted non-stop for 48 hours behaved as normal as any other dog. Groomer Clare was relieved of worries. I was happy for this now energetic companion of somebody. He ate a little and is as active as a puppy.
As to the cause of his medical problem, it is hard to say exactly.
"Don't need X-ray now that the dog has recovered," Clare said over the phone.
"As long as the owner has been advised that an X-ray is recommended," I said. "If the dog should die the next few days, the owner will demand to know why the vet did not recommend a simple chest X-ray."
Clare phoned the owner who is overseas and got the permission to X-ray. I told Dr Daniel and intern Mr Lim to get it done. The blood test result will come in soon.
The clinical outcome is what the owner wanted. Diazepam via a rectal tube did enable this dog to sleep and the other drugs helped her to recover. But what was the original cause of this sudden onset of continuous panting? Viral infection? Unlikely. I suspect it may be an allergic hypersensitivity reaction in the groomer's apartment affecting her. But this is pure speculation. Wait for blood test result.
Tuesday, March 20, 2012
913. Electro-surgery to excise the guinea pig's ear tumour
Will a guinea pig die or electrocuted when electro-excision of his ear tumour is being done? After all, he is only 800 grams and is small compared to dogs and cats where electro-surgery is well established as a procedure.
The critical point is the anaesthesia. Too Little, the GP may wake up and die of fright and pain when electrodes are applied. Too much, the GP may die. Just sufficient, the GP does not feel the pain and the surgery goes smoothly.
So what anaesthesia is to be used?
In this case study with Dr Daniel, I demonstrated the electro-surgical excision of the 3-year-old male GP with a large ear tumour. This would probably be one of those rare occasions to see such an electro-surgery for him as there are few cases in GP requiring such a method. I said that scalpel cutting would not make for a clean cut, unlike electro-surgery. Talk must be shown by action and so I did it today.
3 days of antibiotics and cleaning first. Today is operation day.
ANAESTHESIA
Zoletil 100. 800 g GP.
I drew 0.05 ml Zoletil 100. Added 0.05 ml normal saline. Injected 0.1 ml IM muscle backside.
Less than 5 minutes, the GP was done. He could still feel pain (forcep onto ear edge) and so isoflurane gas was given carefully for a few seconds. The trick her is to give not too much and yet not too little by mask. I checked the eye blinking reflex. Just at the point of no blinking and blinking. A twilight zone.
Isoflurane gas at 2% given to effect.
The electro-excision began. Some little noises from the GP when electro-surgery was applied but no waking up. All done within 2 minutes.
GP woke up after 30 minutes and was OK to go home to a happy gentleman owner who had brought him to Toa Payoh Vets on Saturday to see Dr Jason Teo, saying that the GP had a bite wound. It was not a bite wound but an infected ulcerated tumour.
Electrosurgery in GP and dwarf hamsters. I worry that insufficient analgesia may cause fright and heart attack. So I seldom use it too. But, in theory, the GP and dwarf hamster will not be electrocuted or die of heart attack if proper procedures and analgesia are adopted. The vet must know how to use the tools of his trade!
The critical point is the anaesthesia. Too Little, the GP may wake up and die of fright and pain when electrodes are applied. Too much, the GP may die. Just sufficient, the GP does not feel the pain and the surgery goes smoothly.
So what anaesthesia is to be used?
In this case study with Dr Daniel, I demonstrated the electro-surgical excision of the 3-year-old male GP with a large ear tumour. This would probably be one of those rare occasions to see such an electro-surgery for him as there are few cases in GP requiring such a method. I said that scalpel cutting would not make for a clean cut, unlike electro-surgery. Talk must be shown by action and so I did it today.
3 days of antibiotics and cleaning first. Today is operation day.
ANAESTHESIA
Zoletil 100. 800 g GP.
I drew 0.05 ml Zoletil 100. Added 0.05 ml normal saline. Injected 0.1 ml IM muscle backside.
Less than 5 minutes, the GP was done. He could still feel pain (forcep onto ear edge) and so isoflurane gas was given carefully for a few seconds. The trick her is to give not too much and yet not too little by mask. I checked the eye blinking reflex. Just at the point of no blinking and blinking. A twilight zone.
Isoflurane gas at 2% given to effect.
The electro-excision began. Some little noises from the GP when electro-surgery was applied but no waking up. All done within 2 minutes.
GP woke up after 30 minutes and was OK to go home to a happy gentleman owner who had brought him to Toa Payoh Vets on Saturday to see Dr Jason Teo, saying that the GP had a bite wound. It was not a bite wound but an infected ulcerated tumour.
Electrosurgery in GP and dwarf hamsters. I worry that insufficient analgesia may cause fright and heart attack. So I seldom use it too. But, in theory, the GP and dwarf hamster will not be electrocuted or die of heart attack if proper procedures and analgesia are adopted. The vet must know how to use the tools of his trade!
912. An old dog panted non-stop for 48 hours. Why?
Yesterday, Monday, Mar 19, 2012, at 10pm, I received a phone call from Clare who had cared for a Maltese, Female, spayed, 5 kg, 7 years old, in her apartment. The dog was Ok but started to pant non-stop for the past 48 hours. The owner was overseas and she had to get veterinary attention.
"The dog may be having a heart attack," she said to me. I drove down with Dr Daniel who had just completed his REA lecture on advertising at Toa Payoh Hub. We waited some time for Clare to come.
After the physical examination by Dr Daniel, I examined the dog and asked Dr Daniel: "What is the cause of this continuous panting? Is it a heart attack?" My assistant Min was helpful in suggesting that the dog's mouth be closed while his heart was being auscultated. An old dog like Min and I would know that.
"No," he said. I agreed with him. "So, what is the problem?"
"Pneumonia," he said. "Yes, the right lung sounds were harsh."
"What to do?" I asked.
ABC is the usual standard operating procedure taught by the vet professors.
A=Airway
B=Breathing
C=Circulation
The dog's tongue was cyanotic. "Check the rectal temperature again," I asked Min when he showed a 39.4 deg C in the thermometer. It was again 39.4 deg C. A dog that had panted non-stop for 48 hours should show a much higher temperature. Yet, she did not. She could eat. "Drank lots of water," Clare said. "But otherwise, passed normal stools and had appetite."
So, what causes the sudden-onset pneumonia?
"Kennel cough," Dr Daniel had elicited cough reflexes from the throat.
"It is possible," I said since this dog was boarded by the busy groomer who would have such viruses. "But the dog has regular vaccination," Clare said. But what type of vaccination? She did not know. Kennel cough vaccination is usually not done.
"It is possible that the virus has attacked the lungs," I said. "I need the blood test and the X-rays."
In the meantime, what to do?
"Oxygen therapy. That is for "A" of the ABC for respiratory distress lecture by the professors. Did the dog need oxygen now? I didn't agree.
"It would be better to reduce this incessant panting as the heart will fail if it continues," I said. Sedative diazepam rectal tube was given. Lasix was injected IM. A drip was given. Tolfedine and baytril with pred.
The dog's panting rate reduced by 50% after half an hour. The groomer went home quite relieved. At 8.20 am today, I checked the dog. She was panting much less. More observations needed to be done and the blood results should be known.
"The dog may be having a heart attack," she said to me. I drove down with Dr Daniel who had just completed his REA lecture on advertising at Toa Payoh Hub. We waited some time for Clare to come.
After the physical examination by Dr Daniel, I examined the dog and asked Dr Daniel: "What is the cause of this continuous panting? Is it a heart attack?" My assistant Min was helpful in suggesting that the dog's mouth be closed while his heart was being auscultated. An old dog like Min and I would know that.
"No," he said. I agreed with him. "So, what is the problem?"
"Pneumonia," he said. "Yes, the right lung sounds were harsh."
"What to do?" I asked.
ABC is the usual standard operating procedure taught by the vet professors.
A=Airway
B=Breathing
C=Circulation
The dog's tongue was cyanotic. "Check the rectal temperature again," I asked Min when he showed a 39.4 deg C in the thermometer. It was again 39.4 deg C. A dog that had panted non-stop for 48 hours should show a much higher temperature. Yet, she did not. She could eat. "Drank lots of water," Clare said. "But otherwise, passed normal stools and had appetite."
So, what causes the sudden-onset pneumonia?
"Kennel cough," Dr Daniel had elicited cough reflexes from the throat.
"It is possible," I said since this dog was boarded by the busy groomer who would have such viruses. "But the dog has regular vaccination," Clare said. But what type of vaccination? She did not know. Kennel cough vaccination is usually not done.
"It is possible that the virus has attacked the lungs," I said. "I need the blood test and the X-rays."
In the meantime, what to do?
"Oxygen therapy. That is for "A" of the ABC for respiratory distress lecture by the professors. Did the dog need oxygen now? I didn't agree.
"It would be better to reduce this incessant panting as the heart will fail if it continues," I said. Sedative diazepam rectal tube was given. Lasix was injected IM. A drip was given. Tolfedine and baytril with pred.
The dog's panting rate reduced by 50% after half an hour. The groomer went home quite relieved. At 8.20 am today, I checked the dog. She was panting much less. More observations needed to be done and the blood results should be known.
Saturday, March 17, 2012
A Myanmar fortune teller's accurate prediction
On Mar 15, 2012, I visited Khin Khin who operates the Khin Khin Employment Agency in Singapore. A fair lady in black with silky see-through on upper part was in sitting on a chair behind me in her room. "Can you remember her?" Khin Khin pointed her to me.
"Well, I do," I said. "She was the one working for an interior design company and wanted to quit within a few days of starting work because she had a hard time from the boss and her country-woman who did not want to teach her how to use the Auto-cad software."
Khin Khin always emphasized to employers the attractiveness of a prospective candidate looking for a job in Singapore. As if the physical appearance of a female job candidate counts and she considered this girl "pretty".
I had met this Myanmar girl in her office some weeks ago. She wanted to quit and I had advised her not to. "It is not easy getting an employer in Singapore," I said to her. Just wait. Your country-woman is going back for a holiday soon. Wait."
After that I did not see her till today.
As a picture is worth a thousand words, I have uploaded a picture of another lady whose facial features and fairness in complexion resembled this lady. A rectangular-shaped face, big eyes, porcelain complexion, beauty enhanced by a knowledge of how to use make up effectively to highlight the features. A black number of good quality dress material. Well groomed.
Khin Khin continued: "Her boss forced her to write a resignation letter. She cried in buckets of tears after that. Her mother took her to a fortune teller in Yangon. The fortune teller said that she would get a job in Singapore soon. She attended an interview. The new employer keyed in her details to MOM and she got the reply the next day. She got an S Pass within 24 hours."
I was much surprised as MOM does reject and delay applications for S Pass for many employers whose applications Khin Khin had submitted. Maybe these were "not strong" employers, according to Khin Khin.
I was more surprised that the fortune teller could predict so accurately.
"Well, she went to see Kuan Yin (Goddess of Mercy) in a temple in Bugis," Khin Khin said. "She promised to make an offer of $200 if she gets a job in Singapore."
"So was it the prediction of the fortune teller or the power of Kuan Yin?" I asked.
"Or both?"
Khin Khin is a Buddhist and does not believe in Kuan Yin's power. But she said: "It must be Kuan Yin."
The fair lady did not comment as I did not talk to her and she was in a hurry to go for another appointment. It was good news as it was practically impossible for her to work in the first employer's place without the depth of knowledge of Auto-cad and thereby needing the help of the incumbent. I could see that the incumbent would not teach her as that would mean being replaced by a lovely lady. Why should she? The working place is a ferocious jungle where good looks do count. So this young girl had no chance at all.
The boss forced her to resign possibly because the incumbent had threatened to quit. And it is not easy to find Singaporeans who can work in AutoCAD as employment is quite full in Singapore. Most young Singaporeans can find a job if they will work.
The next day, I phoned Khin Khin about other matters. She said: "The little girl asked me to accompany her to Bugis as she would be offering $200 to Kuan Yin. I went to pick up a stick from the container. Devotees throng this temple to ask the Kuan Yin for better business and health and would pick up a stick from the temple's container after praying.
The temple person said that it was "bad". What is "bad"?
"I don't know," I dared not say as I don't know the significance.
Khin Khin said: "I was asking for good reincarnation for my father." Her father of 82 years of age passed away last month.
"Since you don't believe in Kuan Yin," I said. "You don't have to worry about "badness" forecasted in the stick. Khin Khin had got a piece of paper from the temple and burnt it (to ward off the bad spirits?).
In any case, the story of this lovely girl getting an S Pass to work for another employer within the predictions of the fortune teller is true. If that fortune teller is so accurate, I should be flying to Yangon to consult him. But I rather not do that in case he predicted a bad future for me.
This is the 2nd incident I heard about an accurate prediction from a Yangon fortune-teller. The first involved a person having great difficulty in collecting a business debt in Singapore. He consulted the fortune teller who predicted that he would get his money back. When he came back to Singapore, the debtor agreed to pay him, by instalments.
In conclusion, is there any scientific explanations or do some Yangon fortune tellers have powers of predicting and changing the future?
"Well, I do," I said. "She was the one working for an interior design company and wanted to quit within a few days of starting work because she had a hard time from the boss and her country-woman who did not want to teach her how to use the Auto-cad software."
Khin Khin always emphasized to employers the attractiveness of a prospective candidate looking for a job in Singapore. As if the physical appearance of a female job candidate counts and she considered this girl "pretty".
I had met this Myanmar girl in her office some weeks ago. She wanted to quit and I had advised her not to. "It is not easy getting an employer in Singapore," I said to her. Just wait. Your country-woman is going back for a holiday soon. Wait."
After that I did not see her till today.
As a picture is worth a thousand words, I have uploaded a picture of another lady whose facial features and fairness in complexion resembled this lady. A rectangular-shaped face, big eyes, porcelain complexion, beauty enhanced by a knowledge of how to use make up effectively to highlight the features. A black number of good quality dress material. Well groomed.
Khin Khin continued: "Her boss forced her to write a resignation letter. She cried in buckets of tears after that. Her mother took her to a fortune teller in Yangon. The fortune teller said that she would get a job in Singapore soon. She attended an interview. The new employer keyed in her details to MOM and she got the reply the next day. She got an S Pass within 24 hours."
I was much surprised as MOM does reject and delay applications for S Pass for many employers whose applications Khin Khin had submitted. Maybe these were "not strong" employers, according to Khin Khin.
I was more surprised that the fortune teller could predict so accurately.
"Well, she went to see Kuan Yin (Goddess of Mercy) in a temple in Bugis," Khin Khin said. "She promised to make an offer of $200 if she gets a job in Singapore."
"So was it the prediction of the fortune teller or the power of Kuan Yin?" I asked.
"Or both?"
Khin Khin is a Buddhist and does not believe in Kuan Yin's power. But she said: "It must be Kuan Yin."
The fair lady did not comment as I did not talk to her and she was in a hurry to go for another appointment. It was good news as it was practically impossible for her to work in the first employer's place without the depth of knowledge of Auto-cad and thereby needing the help of the incumbent. I could see that the incumbent would not teach her as that would mean being replaced by a lovely lady. Why should she? The working place is a ferocious jungle where good looks do count. So this young girl had no chance at all.
The boss forced her to resign possibly because the incumbent had threatened to quit. And it is not easy to find Singaporeans who can work in AutoCAD as employment is quite full in Singapore. Most young Singaporeans can find a job if they will work.
The next day, I phoned Khin Khin about other matters. She said: "The little girl asked me to accompany her to Bugis as she would be offering $200 to Kuan Yin. I went to pick up a stick from the container. Devotees throng this temple to ask the Kuan Yin for better business and health and would pick up a stick from the temple's container after praying.
The temple person said that it was "bad". What is "bad"?
"I don't know," I dared not say as I don't know the significance.
Khin Khin said: "I was asking for good reincarnation for my father." Her father of 82 years of age passed away last month.
"Since you don't believe in Kuan Yin," I said. "You don't have to worry about "badness" forecasted in the stick. Khin Khin had got a piece of paper from the temple and burnt it (to ward off the bad spirits?).
In any case, the story of this lovely girl getting an S Pass to work for another employer within the predictions of the fortune teller is true. If that fortune teller is so accurate, I should be flying to Yangon to consult him. But I rather not do that in case he predicted a bad future for me.
This is the 2nd incident I heard about an accurate prediction from a Yangon fortune-teller. The first involved a person having great difficulty in collecting a business debt in Singapore. He consulted the fortune teller who predicted that he would get his money back. When he came back to Singapore, the debtor agreed to pay him, by instalments.
In conclusion, is there any scientific explanations or do some Yangon fortune tellers have powers of predicting and changing the future?
910. Guinea pig websites
http://www.theguineapigforum.co.uk/
http://www.guinealynx.info/
http://www.rngp.org/ Rabbit and guinea pig welfare
http://www.catandrabbit.co.uk/html/guinea_pigs.html
http://www.guinealynx.info/
http://www.rngp.org/ Rabbit and guinea pig welfare
http://www.catandrabbit.co.uk/html/guinea_pigs.html
909. Two guinea pigs not eating - white viscous urine, blood in the urine
Yesterday Mar 16, 2012 (Friday), I saw 2 cases of guinea pigs with urinary problems and reviewed the case with Dr Daniel as part of my mentorship program.
We had met an interesting and friendly experienced Australian banker who had travelled to all over the world to work, at Liang Seah Street at 11 am today. "How old are you?" he asked Daniel. He then told Dr Daniel that 20% of the young men of his age and new graduates are jobless in Ireland. He told me that my handshake was weak, compared to Dr Daniel. "Have you been to Timbuktu?" I asked him. "No," he said. "But I have been to various places in Africa. I was sad to see so many homeless children and the poverty."
P.S
I used to study English phases in primary school in the 1960s and there is a phase referring a distant place as Timbuktu which is actually present in Africa. I doubt I have a chance to visit it.
Case 1.
Not eating. Abdominal swelling obvious. The owner had seen me some months ago. "No more skin infection," she said. "My guinea pig is not eating."
Dr Daniel palpated the swollen abdomen. I did that after him. The swelling covered almost 90% of the abdomen. Soft distended bladder, in my opinion. I don't know what Dr Daniel thought. Was he thinking of ascites? Definitely, ascites present this pendulous abdomen.
Before I could speak further, the guinea pig squirted out white cloudy urine onto the stainless steel consultation table top. "The urine is not normal," I said. "I would take some for urine test." I took a new syringe to suck up some urine. The guinea pig voided much more urine. Thick cloudy liquid. As if the bladder had lots of white sand.
"Is it possible that my guinea pig has bladder stones?" the lady asked. "My other guinea pig had bladder stones. The vet removed it but then said another surgery had to be done."
"Why was there a need for a second surgery?" I asked.
"The first one was not done well," she said. "So, another one had to be done."
"What happened to the guinea pig after bladder surgery?" I asked.
"She lived for a few days and then died."
"In this case, the guinea pig might have or might not have bladder stones. We will wait for a few days and get the urinary tract infection treated first."
A follow up the next 2 - 7 days would be needed. X-rays would be needed to confirm bladder stones.
Case 2.
Not eating. Weight loss for 2 weeks. The owner had phoned me about bladder stone surgery. She had consulted Vet 2 recently and an X-ray had been taken. But two weeks ago, she consulted Vet 1 who gave a different diagnosis. Today she came with the X-ray as I had advised her to get it from Vet 2 to save her cost of the need to have another X-ray taken. Vet 2 had told her that the medical notes would be sent to me. "It is not the medical notes that is important," I said to the young lady. "It is the X-ray of the bladder stones and to see if there are other locations like kidneys and urethra where stones are lodged."
"The vet gave antibiotics for a gastric infection," the lady said. "But the guinea pig did not recover and was not eating. So I went to Vet 2 who took an X-ray and said there were bladder stones. She advised euthanasia."
"What was the original problem with your guinea pig when you saw Vet 1 as you said that your guinea pig was treated for stomach infection?" I asked.
"My guinea pig had passed blood in the urine."
"What did Vet 2 advise?" I asked. The lady was not so clear about this but she said: "I don't want the guinea pig to be put to sleep. She could not pee for the past few days and did not poop."
Smaller than normal 1-cm long faecal pellets were passed on the consultation table. I palpated the abdomen. "No swollen bladder," I said. "The guinea pig had passed urine and you might not have seen it."
"I saw a brown spot," the lady said. "Just that brown spot on the paper. I have separated her from the other guinea pigs"
"It is possible that you did not see the other spots if they are not coloured," I said. "Since I can't feel a swollen bladder despite you saying that the guinea pig had not peed, I would say that presently, the guinea pig had no urinary problem."
She phoned her mother regarding surgery to remove the bladder stones (> six of them). It was the cost of surgery quoted as $300. I advised against immediate surgery as the guinea pig was very thin and dehydrated. I asked her to syringe feed with the pink syrup, food and emergency care 6 times per day, as prescribed by Vet 2 for the next 2 days.
Doing bladder surgery today would have killed this poor-conditioned guinea pig. The antibiotics from Vet 1 and Vet 2 were working to clear the urinary tract infection for the time being. "Let her be much stronger to take surgery by nursing her the next 2 days," I said to her.
"In such cases," I said to Dr Daniel. "Immediate surgery is most likely to lead to death on the operating table." Sometimes, the guinea pig dies the next 2 days. So, it is better to get the pet stronger first.
A follow up 2-7 days is needed.
P.S. In Case 2, the worried owner did not say that the guinea pig had runny nose. I saw yellow fluid from the left nostril. "Your guinea pig has an upper respiratory infection and anaesthesia would be very risky. The guinea pig needs to recover from the infection." As you can see, an immediate operation would not be in the interest of the patient.
"Any death on the operating table is a very emotional affair for the owner and the operating vet," I said to Dr Daniel. "So, it is best to get the patient in the best possible health before any operation. Unless it is an emergency."
We had met an interesting and friendly experienced Australian banker who had travelled to all over the world to work, at Liang Seah Street at 11 am today. "How old are you?" he asked Daniel. He then told Dr Daniel that 20% of the young men of his age and new graduates are jobless in Ireland. He told me that my handshake was weak, compared to Dr Daniel. "Have you been to Timbuktu?" I asked him. "No," he said. "But I have been to various places in Africa. I was sad to see so many homeless children and the poverty."
P.S
I used to study English phases in primary school in the 1960s and there is a phase referring a distant place as Timbuktu which is actually present in Africa. I doubt I have a chance to visit it.
Case 1.
Not eating. Abdominal swelling obvious. The owner had seen me some months ago. "No more skin infection," she said. "My guinea pig is not eating."
Dr Daniel palpated the swollen abdomen. I did that after him. The swelling covered almost 90% of the abdomen. Soft distended bladder, in my opinion. I don't know what Dr Daniel thought. Was he thinking of ascites? Definitely, ascites present this pendulous abdomen.
Before I could speak further, the guinea pig squirted out white cloudy urine onto the stainless steel consultation table top. "The urine is not normal," I said. "I would take some for urine test." I took a new syringe to suck up some urine. The guinea pig voided much more urine. Thick cloudy liquid. As if the bladder had lots of white sand.
"Is it possible that my guinea pig has bladder stones?" the lady asked. "My other guinea pig had bladder stones. The vet removed it but then said another surgery had to be done."
"Why was there a need for a second surgery?" I asked.
"The first one was not done well," she said. "So, another one had to be done."
"What happened to the guinea pig after bladder surgery?" I asked.
"She lived for a few days and then died."
"In this case, the guinea pig might have or might not have bladder stones. We will wait for a few days and get the urinary tract infection treated first."
A follow up the next 2 - 7 days would be needed. X-rays would be needed to confirm bladder stones.
Case 2.
Not eating. Weight loss for 2 weeks. The owner had phoned me about bladder stone surgery. She had consulted Vet 2 recently and an X-ray had been taken. But two weeks ago, she consulted Vet 1 who gave a different diagnosis. Today she came with the X-ray as I had advised her to get it from Vet 2 to save her cost of the need to have another X-ray taken. Vet 2 had told her that the medical notes would be sent to me. "It is not the medical notes that is important," I said to the young lady. "It is the X-ray of the bladder stones and to see if there are other locations like kidneys and urethra where stones are lodged."
"The vet gave antibiotics for a gastric infection," the lady said. "But the guinea pig did not recover and was not eating. So I went to Vet 2 who took an X-ray and said there were bladder stones. She advised euthanasia."
"What was the original problem with your guinea pig when you saw Vet 1 as you said that your guinea pig was treated for stomach infection?" I asked.
"My guinea pig had passed blood in the urine."
"What did Vet 2 advise?" I asked. The lady was not so clear about this but she said: "I don't want the guinea pig to be put to sleep. She could not pee for the past few days and did not poop."
Smaller than normal 1-cm long faecal pellets were passed on the consultation table. I palpated the abdomen. "No swollen bladder," I said. "The guinea pig had passed urine and you might not have seen it."
"I saw a brown spot," the lady said. "Just that brown spot on the paper. I have separated her from the other guinea pigs"
"It is possible that you did not see the other spots if they are not coloured," I said. "Since I can't feel a swollen bladder despite you saying that the guinea pig had not peed, I would say that presently, the guinea pig had no urinary problem."
She phoned her mother regarding surgery to remove the bladder stones (> six of them). It was the cost of surgery quoted as $300. I advised against immediate surgery as the guinea pig was very thin and dehydrated. I asked her to syringe feed with the pink syrup, food and emergency care 6 times per day, as prescribed by Vet 2 for the next 2 days.
Doing bladder surgery today would have killed this poor-conditioned guinea pig. The antibiotics from Vet 1 and Vet 2 were working to clear the urinary tract infection for the time being. "Let her be much stronger to take surgery by nursing her the next 2 days," I said to her.
"In such cases," I said to Dr Daniel. "Immediate surgery is most likely to lead to death on the operating table." Sometimes, the guinea pig dies the next 2 days. So, it is better to get the pet stronger first.
A follow up 2-7 days is needed.
P.S. In Case 2, the worried owner did not say that the guinea pig had runny nose. I saw yellow fluid from the left nostril. "Your guinea pig has an upper respiratory infection and anaesthesia would be very risky. The guinea pig needs to recover from the infection." As you can see, an immediate operation would not be in the interest of the patient.
"Any death on the operating table is a very emotional affair for the owner and the operating vet," I said to Dr Daniel. "So, it is best to get the patient in the best possible health before any operation. Unless it is an emergency."
Thursday, March 15, 2012
908. Rimadyrl for an 18-year-old Chihuahua with pain in the hips?
Yesterday I saw one case with Dr Daniel. The owner had been my old client for at least 18 years since his chihuahua is 18 years old.
WHAT IS WORRYING THE CLIENT?
This is the crux of the matter. I spoke to him. He said: "My dog was whining and crying the whole night. She couldn't sleep and therefore I couldn't sleep. She had constipation."
The dog was limping and had pain on the right limb. During X-rays, on extension of the limb, the dog bit the handlers. So, there was no problem with the cause of pain.
Now, prescribing Rimadyrl tablets. This is standard practice. "But this is an 18-year old dog," I said to Dr Daniel. "She is equivalent to a 100-year-old man. Rimadyrl has side effects on kidneys."
"Side effects of Rimadyrl occur only after taking the medication for some time," Dr Daniel said. "Not overnight."
"In Australia, the dog owners you saw practice with other vets, usually bring in their dogs for Rimadyrl earlier than 18 years old and so the side effects of long-term medication can be seen over time. This Chihuahua is 18 years old and has come in for the first time. In Singapore, many owners don't see the vet till a crisis happens. In fact, the owner said that the dog had no problems other than constipation. What if the dog dies when the owner gives Rimadyrl over the next 3 days? His kidneys and livers may not be that great at 18 years of age. Blood tests would show but why take the risk?"
I said: "What if the dog has an adverse reaction to Rimadyrl and die soon after consultation at Toa Payoh Vets? You will be accountable for the death from oral Rimadryl as this will be what the owner will say."
It is best not to prescribe NSAID orally for hip arthritis till the blood test results come in. Even then, pred would be safer.
Many new graduates think that pred should be avoided in all situations. So NSAIDs but in this case, it is better to be safe than have a dead dog dying of kidney failure due to Rimadyrl. Each vet has his or her own prescriptions and if you consult 3 vets, you may get 3 ways to treat your dog for "constipation:.
WHAT IS WORRYING THE CLIENT?
This is the crux of the matter. I spoke to him. He said: "My dog was whining and crying the whole night. She couldn't sleep and therefore I couldn't sleep. She had constipation."
The dog was limping and had pain on the right limb. During X-rays, on extension of the limb, the dog bit the handlers. So, there was no problem with the cause of pain.
Now, prescribing Rimadyrl tablets. This is standard practice. "But this is an 18-year old dog," I said to Dr Daniel. "She is equivalent to a 100-year-old man. Rimadyrl has side effects on kidneys."
"Side effects of Rimadyrl occur only after taking the medication for some time," Dr Daniel said. "Not overnight."
"In Australia, the dog owners you saw practice with other vets, usually bring in their dogs for Rimadyrl earlier than 18 years old and so the side effects of long-term medication can be seen over time. This Chihuahua is 18 years old and has come in for the first time. In Singapore, many owners don't see the vet till a crisis happens. In fact, the owner said that the dog had no problems other than constipation. What if the dog dies when the owner gives Rimadyrl over the next 3 days? His kidneys and livers may not be that great at 18 years of age. Blood tests would show but why take the risk?"
I said: "What if the dog has an adverse reaction to Rimadyrl and die soon after consultation at Toa Payoh Vets? You will be accountable for the death from oral Rimadryl as this will be what the owner will say."
It is best not to prescribe NSAID orally for hip arthritis till the blood test results come in. Even then, pred would be safer.
Many new graduates think that pred should be avoided in all situations. So NSAIDs but in this case, it is better to be safe than have a dead dog dying of kidney failure due to Rimadyrl. Each vet has his or her own prescriptions and if you consult 3 vets, you may get 3 ways to treat your dog for "constipation:.
907. The veterinary prediction was inaccurate
One day in March 2012, I received a text saying that the rabbit was not eating or drinking. So I texted back that it needed to be examined. I thought it was a rabbit owner who had consulted Dr Daniel and me earlier. See the case of The Rabbit With A Tearing Eye at:
http://www.sinpets.com/F6/20120217cheek-teeth-ingrown-rabbit-eye-tearing-toa-payoh-vets_Singapore_ToaPayohVets.htm
She made an appointment via text. I confirmed similarly. A slim young lady in her early 20s came with a 5-month-old dwarf rabbit. She was a new client. "My rabbit is not eating and drinking. Could she be suffering from hairball? Could she be pregnant?"
Dr Daniel would be treating the case with me as the mentor. He palpated the abdomen. "Pregnant, with one (kit)," he declared. I palpated the abdomen and felt the soft 4x3 cm mass in the lower third of the abdomen. "Only an X-ray would tell how many kits there are," I said. "In an X-ray, you can see the number of foetal skeletons." And therefore the number of kits.
"When was the rabbit mated?" I asked the young lady who had said that there was a 6-month-old male rabbit living together with this rabbit. "Around 2 weeks ago," she said. "How long is the pregnancy?"
"Around 28 days," I said. In this case, the rabbit would be only 14 days pregnant.
"Should I get the rabbit X-rayed?" she asked me.
"No need to do it," I said. "Just wait for a few days. In the meantime, remove the male rabbit. Keep her in a quiet dark place by herself and give her newspaper pieces to make a nest."
"We still have to check the teeth," I said to the lady and Dr Daniel.
"Scruff the neck," he said. That is the usual method of restraint of a rabbit.
"No," I noted that the young lady was particularly concerned about her rabbit and would misconstrue that the vet was rough handling her dwarf rabbit. If you think about it, a dwarf rabbit is very small. Her mouth is also very small. Scruffing the neck with a man's hand would practically cover most of the forehead, leaving little space to open the mouth.
I imagine that this might not be the most appropriate method to open the mouth for the dwarf rabbit but it would be for the cat or dog.
"Just wrap the rabbit inside a towel, like wrapping a present," I said. The young lady was watching apprehensively and this method would be more gentle. Perceptions of a client as regards the vet's "rough handling of their pets" are made and remembered when the rabbit struggles or squeals during scruffing. Sedation was not necessary in this case and in this situation of a pregnant rabbit.
It was obvious that the cause of not eating and drinking could be due to pregnancy. But the teeth must be checked for malocclusion or overgrown as this is a most common problem in the rabbit when it does not eat.
So, I wrapped the rabbit in a soft white towel with the head showing. The lady was watching quietly. Then I got the artery forceps to open the rabbit's mouth. I asked Dr Daniel or the owner to shine the white light as the rabbit resisted the mouth opening. "See the back teeth," I said. "Are they overgrown or short?". It took some time and patience but the lady was able to see that the teeth on both sides of the cheek were short and trimmed. The rabbit was not co-operating but could not move much. She did not squeal.
I thought the rabbit was around 14 days pregnant since the lady said the mating was seen around 14 days ago. Life is full of surprises as you can see from the text message of thanks I got from her 3 days later when I texted her as a follow up. In fact, the rabbit stopped eating and drinking because she was about to give birth!
Dr Daniel predicted one kit on abdominal palpation. I was very cautious and said that only an X-ray would tell how many kits were there from the number of foetal skeletons visible in an X-ray.
Well, veterinary medicine is always full of surprises. In this case, the rabbit gave birth to two kits. So, you know why I never predict the number of kits, puppies or kittens just on an abdominal palpation! It is just unpredictable usually. Unless it is a "single pup" syndrome in a chihuahua!
http://www.sinpets.com/F6/20120217cheek-teeth-ingrown-rabbit-eye-tearing-toa-payoh-vets_Singapore_ToaPayohVets.htm
She made an appointment via text. I confirmed similarly. A slim young lady in her early 20s came with a 5-month-old dwarf rabbit. She was a new client. "My rabbit is not eating and drinking. Could she be suffering from hairball? Could she be pregnant?"
Dr Daniel would be treating the case with me as the mentor. He palpated the abdomen. "Pregnant, with one (kit)," he declared. I palpated the abdomen and felt the soft 4x3 cm mass in the lower third of the abdomen. "Only an X-ray would tell how many kits there are," I said. "In an X-ray, you can see the number of foetal skeletons." And therefore the number of kits.
"When was the rabbit mated?" I asked the young lady who had said that there was a 6-month-old male rabbit living together with this rabbit. "Around 2 weeks ago," she said. "How long is the pregnancy?"
"Around 28 days," I said. In this case, the rabbit would be only 14 days pregnant.
"Should I get the rabbit X-rayed?" she asked me.
"No need to do it," I said. "Just wait for a few days. In the meantime, remove the male rabbit. Keep her in a quiet dark place by herself and give her newspaper pieces to make a nest."
"We still have to check the teeth," I said to the lady and Dr Daniel.
"Scruff the neck," he said. That is the usual method of restraint of a rabbit.
"No," I noted that the young lady was particularly concerned about her rabbit and would misconstrue that the vet was rough handling her dwarf rabbit. If you think about it, a dwarf rabbit is very small. Her mouth is also very small. Scruffing the neck with a man's hand would practically cover most of the forehead, leaving little space to open the mouth.
I imagine that this might not be the most appropriate method to open the mouth for the dwarf rabbit but it would be for the cat or dog.
"Just wrap the rabbit inside a towel, like wrapping a present," I said. The young lady was watching apprehensively and this method would be more gentle. Perceptions of a client as regards the vet's "rough handling of their pets" are made and remembered when the rabbit struggles or squeals during scruffing. Sedation was not necessary in this case and in this situation of a pregnant rabbit.
It was obvious that the cause of not eating and drinking could be due to pregnancy. But the teeth must be checked for malocclusion or overgrown as this is a most common problem in the rabbit when it does not eat.
So, I wrapped the rabbit in a soft white towel with the head showing. The lady was watching quietly. Then I got the artery forceps to open the rabbit's mouth. I asked Dr Daniel or the owner to shine the white light as the rabbit resisted the mouth opening. "See the back teeth," I said. "Are they overgrown or short?". It took some time and patience but the lady was able to see that the teeth on both sides of the cheek were short and trimmed. The rabbit was not co-operating but could not move much. She did not squeal.
I thought the rabbit was around 14 days pregnant since the lady said the mating was seen around 14 days ago. Life is full of surprises as you can see from the text message of thanks I got from her 3 days later when I texted her as a follow up. In fact, the rabbit stopped eating and drinking because she was about to give birth!
Dr Daniel predicted one kit on abdominal palpation. I was very cautious and said that only an X-ray would tell how many kits were there from the number of foetal skeletons visible in an X-ray.
Well, veterinary medicine is always full of surprises. In this case, the rabbit gave birth to two kits. So, you know why I never predict the number of kits, puppies or kittens just on an abdominal palpation! It is just unpredictable usually. Unless it is a "single pup" syndrome in a chihuahua!
Wednesday, March 14, 2012
906. Starting a pet grooming business in Singapore - my observations
THE SINGAPORE PET GROOMING BUSINESS
It is relatively cheaper to start a pet grooming shop in Singapore as compared to a veterinary clinic. Still the following factors contribute to success or failure based on my observations of many groomers opening and closing shop in Singapore every year, for the past 30 years:
1. Location - convenient, easy to park
2. Capital - need a few thousand dollars to last one year to pay the high rentals.
Landlords have no mercy on tenants and will want more and more rentals esp. if the business is good. Assuming a small shop in a poor location rents around $3,000/month, the rental per year is already $36,000.
3. Clientele - new grooming graduate. No clientele of significant numbers to sustain the operations.
4. Marketing - not guaranteed but must be done. Cost money and time.
5. Pricing - cheap, will get many cases but can't make much. Market rates can be as low as $40 with transport and grooming/dog. Therefore, estimate maximum of 30 dogs, the maximum gross income per day is $1,200.
For new groomers without solid clientele, average 3 dogs per day, no dog transport provided, the income of $120/day x 25days worked = $3,000. This amount can't even pay the rent and utilities. Sales of dog food and puppies may attract walk-in but there is the additional cost and the need to go for a course and be certified by the AVA to sell puppies.
6. Skills - unproven for a new graduate. Therefore, no referrals of significance. Pet owners may have to try their luck.
7. Free Transport - Some groomers need to transport dog home as they can't afford drivers. Many competitors provide transport-grooming package.
8. Wrist pain. Limited number of pets to be groomed. I estimate that 20-30 dogs groomed will be the limit for each groomer. Hand sprain, tendinitis, back ache unless the groomer gets a proper table.
9. Administration. Make appointments, get payments, send dogs home etc. That means hiring one assistant whose pay is around S$1,500/month.
10. Intense competition. Many groomers have set up shop as Singapore develops. How many of those who opened 10 years ago are still around?
11. Work-life balance. Is the young groomer prepared to work the long hours and weekends?
Relationships, motherhood, financial strength, high energy levels and hard work and long hours. How many of the google generation Singaporeans can sustain through the years and be focused to build up a solid reputation and be able to survive when landlords start increasing rentals again and again? Singapore rentals just keep increasing because commercial shop spaces are seldom built and therefore in short supply, unlike in countries like Australia.
It is relatively cheaper to start a pet grooming shop in Singapore as compared to a veterinary clinic. Still the following factors contribute to success or failure based on my observations of many groomers opening and closing shop in Singapore every year, for the past 30 years:
1. Location - convenient, easy to park
2. Capital - need a few thousand dollars to last one year to pay the high rentals.
Landlords have no mercy on tenants and will want more and more rentals esp. if the business is good. Assuming a small shop in a poor location rents around $3,000/month, the rental per year is already $36,000.
3. Clientele - new grooming graduate. No clientele of significant numbers to sustain the operations.
4. Marketing - not guaranteed but must be done. Cost money and time.
5. Pricing - cheap, will get many cases but can't make much. Market rates can be as low as $40 with transport and grooming/dog. Therefore, estimate maximum of 30 dogs, the maximum gross income per day is $1,200.
For new groomers without solid clientele, average 3 dogs per day, no dog transport provided, the income of $120/day x 25days worked = $3,000. This amount can't even pay the rent and utilities. Sales of dog food and puppies may attract walk-in but there is the additional cost and the need to go for a course and be certified by the AVA to sell puppies.
6. Skills - unproven for a new graduate. Therefore, no referrals of significance. Pet owners may have to try their luck.
7. Free Transport - Some groomers need to transport dog home as they can't afford drivers. Many competitors provide transport-grooming package.
8. Wrist pain. Limited number of pets to be groomed. I estimate that 20-30 dogs groomed will be the limit for each groomer. Hand sprain, tendinitis, back ache unless the groomer gets a proper table.
9. Administration. Make appointments, get payments, send dogs home etc. That means hiring one assistant whose pay is around S$1,500/month.
10. Intense competition. Many groomers have set up shop as Singapore develops. How many of those who opened 10 years ago are still around?
11. Work-life balance. Is the young groomer prepared to work the long hours and weekends?
Relationships, motherhood, financial strength, high energy levels and hard work and long hours. How many of the google generation Singaporeans can sustain through the years and be focused to build up a solid reputation and be able to survive when landlords start increasing rentals again and again? Singapore rentals just keep increasing because commercial shop spaces are seldom built and therefore in short supply, unlike in countries like Australia.
Tuesday, March 13, 2012
904. Sunday's interesting cases. Mar 11, 2012 - Sedation to last stitch
Sunday, Mar 11, 2012
Sunday's interesting cases.
Sunday Mar 11, 2012
Singaporeans hate long waiting times at clinics to see a doctor and so I have started procedures to ensure that the waiting times should be less than 15 minutes. Many vets don't realise that clients hate to wait too long on Sundays.
For example, a neuter case on a Sunday can take up longer than 30 minutes (from sedation to last stitch) if the younger vet has no sense of time management. Or it could be done in 15 minutes with planning and pre-op preparation. Now I monitor the younger vets' efficiency in veterinary surgery by using time of sedation to last stitch and review the outcome of their surgeries (repeat stitching, stitch breakdown, infections etc).
Vets who don't make the mark will be asked to go. There is no other way because a higher standard of care must be achieved if Toa Payoh Vets is to be ranked by clients as the top 5 in Singapore. There are SOPs (Standard Operating Procedures) to be adopted and stuck to and I don't tolerate any lapse. AMA (Against Medical Advices) have to be recorded and medical records are to be written in greater detail than in the past.
A pug came in for neuter. I assigned the surgery to Dr Daniel and monitored the time he took. I ensured pre-op planning and preparation. Domitor and Ketamine at 50% and isoflurane gas. The sedation time to last stitch was around 30 minutes. It was OK but I said it could be shorter.
A dwarf hamster came in for left eye discharge and reddened left ear. Dr Vanessa was assigned the case. Not just some ear drops as the owner had been given such ear drops by the pet shop or Vet 1. Dr Vanessa scoped the ear. "A general anaesthesia had to be done to irrigate the ear," I said. The owner gave his consent. I asked Dr Vanessa to do a proper time management as she had other cases. In the end, I did the hamster myself with Dr Daniel as she other cases to attend to on this busy Sunday afternoon when clients came all together around 1-3 pm. I will have to follow up on this hamster.
A Schnauzer came in for a routine vaccination. Dr Daniel did it and told me that the dog had a black lump on the right of the backside and he had advised the owner to get it excised. It was good that he did a general examination and detected this lump. Some vets would just advise "wait till it grows bigger" but many tumours, if cancerous, grow bigger without the owner being aware of it, till it is too big.
The owner declined and wanted to wait and see. "The black lump is a melanoma," I said to the middle-aged couple with a teenaged daughter. "It has grown big but not that big yet. It is very black. Our advice to you is to remove it while it is easy to do so. And less expensive. You need not accept the advice. However, you cannot not say that the vets did not advise you during vaccination. When it grows bigger or spread to other parts of the body, you cannot blame the vets for not giving proper advice. Big tumours need big cuts and longer stitching. You have to pay much more. Older dogs like older people get tumours and it is better to get them cut away when they are small. Saves money and less worries of the tumours being cancerous and spreading later."
The couple was vacillating for some reasons. After all, they came to vaccinate their 5-year-old female Schnauzer. They were worried about the dog biting the wound and the lack of care-givers and wanted to wait later.
The vet's duty is to advise properly. "How much it will cost?" the father asked me. "$150 as it is a small tumour as anaesthesia will not be long and therefore the charges are less," I said. "Can surgery be done today?" he asked. "Yes," I said.
SURGERY
"This is a simple surgery," I said to Dr Daniel." It takes 5 minutes (from sedation to last stitch) to do the whole process." Dr Daniel looked at me incredulously. I was sure that he would adopt what the professors had taught him but that would be the traditional way. Sedate, intubate, use scalpel to make an elliptical incision with a wide margin. Undermine with scissors. Stitch up the two ends. How could the whole procedure take 5 minutes? I must be getting senile?
The dog was given Domitor and Ketamine at 50% IV. Isoflurane gas by mask was given though I would say it was unnecessary as you would see what I mean. From my experience, this dosage would be sufficient for a snip and a stitch.
"Pull up the elongated melanoma (1.5 cm x 0.5 cm, with a stalk) with forceps," I said to Dr Daniel. Snip it off with scissors around 3 mm away." Dr Daniel took a pair of curved scissors and snipped off the melanoma as advised.
The melanoma came off with about 50% of the dermis intact. There was the grey dermis but no subcutaneous tissues seen. "No need to stitch," I said as small bleeders ooze blood. "Just potassium permanganate powder to stop the bleeding. Cover the wound with plaster."
Dr Daniel had not seen such wounds being covered with plaster. This was the bulging backside area. Wouldn't the plaster just drop off, he must have wondered but did not speak his mind. I got two sticky plasters and covered the wound. The type you used when you cut your finger. They did not drop off.
This was one of those easiest surgeries in the world. Snip and stitch. But no need to stitch as the melanoma had a stalk and the skin was clear of melanomas by 3 mm. The owner did not want histopathology as they were also cost-conscious. So, none was done.
Veterinary surgeries present many variations. It is up to the vet to know what to do and how to do it efficiently. The surgery text book offers the standard method but there are better ways not described in the text book, as in this case.
Sunday's interesting cases.
Sunday Mar 11, 2012
Singaporeans hate long waiting times at clinics to see a doctor and so I have started procedures to ensure that the waiting times should be less than 15 minutes. Many vets don't realise that clients hate to wait too long on Sundays.
For example, a neuter case on a Sunday can take up longer than 30 minutes (from sedation to last stitch) if the younger vet has no sense of time management. Or it could be done in 15 minutes with planning and pre-op preparation. Now I monitor the younger vets' efficiency in veterinary surgery by using time of sedation to last stitch and review the outcome of their surgeries (repeat stitching, stitch breakdown, infections etc).
Vets who don't make the mark will be asked to go. There is no other way because a higher standard of care must be achieved if Toa Payoh Vets is to be ranked by clients as the top 5 in Singapore. There are SOPs (Standard Operating Procedures) to be adopted and stuck to and I don't tolerate any lapse. AMA (Against Medical Advices) have to be recorded and medical records are to be written in greater detail than in the past.
A pug came in for neuter. I assigned the surgery to Dr Daniel and monitored the time he took. I ensured pre-op planning and preparation. Domitor and Ketamine at 50% and isoflurane gas. The sedation time to last stitch was around 30 minutes. It was OK but I said it could be shorter.
A dwarf hamster came in for left eye discharge and reddened left ear. Dr Vanessa was assigned the case. Not just some ear drops as the owner had been given such ear drops by the pet shop or Vet 1. Dr Vanessa scoped the ear. "A general anaesthesia had to be done to irrigate the ear," I said. The owner gave his consent. I asked Dr Vanessa to do a proper time management as she had other cases. In the end, I did the hamster myself with Dr Daniel as she other cases to attend to on this busy Sunday afternoon when clients came all together around 1-3 pm. I will have to follow up on this hamster.
A Schnauzer came in for a routine vaccination. Dr Daniel did it and told me that the dog had a black lump on the right of the backside and he had advised the owner to get it excised. It was good that he did a general examination and detected this lump. Some vets would just advise "wait till it grows bigger" but many tumours, if cancerous, grow bigger without the owner being aware of it, till it is too big.
The owner declined and wanted to wait and see. "The black lump is a melanoma," I said to the middle-aged couple with a teenaged daughter. "It has grown big but not that big yet. It is very black. Our advice to you is to remove it while it is easy to do so. And less expensive. You need not accept the advice. However, you cannot not say that the vets did not advise you during vaccination. When it grows bigger or spread to other parts of the body, you cannot blame the vets for not giving proper advice. Big tumours need big cuts and longer stitching. You have to pay much more. Older dogs like older people get tumours and it is better to get them cut away when they are small. Saves money and less worries of the tumours being cancerous and spreading later."
The couple was vacillating for some reasons. After all, they came to vaccinate their 5-year-old female Schnauzer. They were worried about the dog biting the wound and the lack of care-givers and wanted to wait later.
The vet's duty is to advise properly. "How much it will cost?" the father asked me. "$150 as it is a small tumour as anaesthesia will not be long and therefore the charges are less," I said. "Can surgery be done today?" he asked. "Yes," I said.
SURGERY
"This is a simple surgery," I said to Dr Daniel." It takes 5 minutes (from sedation to last stitch) to do the whole process." Dr Daniel looked at me incredulously. I was sure that he would adopt what the professors had taught him but that would be the traditional way. Sedate, intubate, use scalpel to make an elliptical incision with a wide margin. Undermine with scissors. Stitch up the two ends. How could the whole procedure take 5 minutes? I must be getting senile?
The dog was given Domitor and Ketamine at 50% IV. Isoflurane gas by mask was given though I would say it was unnecessary as you would see what I mean. From my experience, this dosage would be sufficient for a snip and a stitch.
"Pull up the elongated melanoma (1.5 cm x 0.5 cm, with a stalk) with forceps," I said to Dr Daniel. Snip it off with scissors around 3 mm away." Dr Daniel took a pair of curved scissors and snipped off the melanoma as advised.
The melanoma came off with about 50% of the dermis intact. There was the grey dermis but no subcutaneous tissues seen. "No need to stitch," I said as small bleeders ooze blood. "Just potassium permanganate powder to stop the bleeding. Cover the wound with plaster."
Dr Daniel had not seen such wounds being covered with plaster. This was the bulging backside area. Wouldn't the plaster just drop off, he must have wondered but did not speak his mind. I got two sticky plasters and covered the wound. The type you used when you cut your finger. They did not drop off.
This was one of those easiest surgeries in the world. Snip and stitch. But no need to stitch as the melanoma had a stalk and the skin was clear of melanomas by 3 mm. The owner did not want histopathology as they were also cost-conscious. So, none was done.
Veterinary surgeries present many variations. It is up to the vet to know what to do and how to do it efficiently. The surgery text book offers the standard method but there are better ways not described in the text book, as in this case.
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