Further to my earlier case study of 2 GP with urinary tract problems, the results are as follows:
1. GP with blood in the urine for 2 weeks. X-ray by Vet 2 showed several bladder stones and advice given was euthanasia. When the GP came to me, he was very thin and weak. The young lady got permission from her mum to get the bladder surgery done by me.
I advised against immediate surgery as the GP was not fit to be under anaesthesia. He would just die on the op table. The owner was to hand feed and make him well first. On the 2nd day at home, he passed away. In this type of case, the interest of the GP is paramount rather than the bottom line of the surgery, since the GP practically had no chance of survival on the op table.
2. GP not eating, had a grossly swollen bladder. Dr Daniel and I palpated the abdomen. Looked so much like ascites although I could feel the faint outlines of a very full bladder as big as an orange. Suddenly whitish cloudy urine dribbled out. More and more urine was released like a storm flood. I got the urine inside a syringe and sent to the lab. Came back with struvite crystals +++, bacteria + and urine pH = 9.0. Evidence of urinary tract infection caused by amorphous phospate or struvites +++. So what to do now?
"In dogs, acidify the urine or give S/D diet," I said to Dr Daniel and Dr Vanessa. "What to do for a GP with struvites in the bladder?"
The lady owner returned my text message this morning. She had left all medication to the sister who stays at home. After 3 days, the sister stopped the antibiotics and the pain-killer as the GP was eating and drinking.
"But he sits in a corner," the young busy career lady said. "When can I send him down for another check up?" I scheduled next week. She has only one GP and believed that her sister had increased the intake of Vit C tablets to 1.5 tab/day causing the GP to stop eating.
Overdosage of Vit C can lead to kidney stones in people. In this case, the GP had a UTI
Tuesday, March 20, 2012
Follow-up on the 48-hour panting dog
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.
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.
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."
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