17.10. 12
Mini-Maltese, Male, 1 year, 2 kg
Right testicle undescended
I used xylazine 0.2 ml IM, then isoflurane by gas and intubated.
Two separate incision of skin areas for removal of the testicles
A: Injection of xylazine 3.45pm
B: Isoflurane + O2 gas given 3.58 pm. Intubated
E: Completion of skin stitching 4.17 pm
PDS 3/0 x 1 pack
The whole process E-A = 32 minutes.
I wasted some time trying to shift the undescended right testicle to the skin incision made for the normal testicle but it was not possible and to avoid incising the urethra accidentally, I made a separate skin incision. So, the whole process takes longer.
As Domitor was out of stock, I used xylazine IM which I used to do for many years. Now the vets tend to use domitor + ketamine IV at 0.4 ml + 0l5 ml IV for a healthy young 10 kg dog, after being convinced by me that the combinaton formula was effective and safe esp. if given at 50% and then top up with isoflurane + O2.
Friday, October 19, 2012
1148. KPI - Spaying a ferocious caterwauling cat
Today, a Nepalese couple brought in a tricolour 7-month-old caterwauling cat adopted from the SPCA. "Will she stop making noises after spaying?" the wife asked. "Yes," I said.
For caterwauling cats, the ovarian and uterine blood vessels are enlarged and special care must be made to ligate well. I threw around 10 knots on each ovarian side and around 15 knots on the uterine body. I don't do transfixing ligatures on the swollen uterine body.
As the cat was ferocious after the owner left and was put inside the cage, my assistant Min was pawed at everytime he tried to take the cat out of the cage for me to do the sedation injection. He went to get a big rag. "Don't do it," I knew this cat would escape from his crutches if he tried to grip her scruff of the neck now that the cat was big eyed and hissing.
ANAESTHESIA
"I will inject the cage through the cage," I said.
Mr Min had his idea of lassoing the cat and then pulling one leg out for me to inject the back muscle. He tried and I injected partially as the cat twisted and turned, pulling back her leg. He attempted again and I managed to inject the 80% of the remaining sedation drug. So, there was not 100% given.
Normally at xylazine 0.15 and ketamine 0.6 = 0.75 ml IM combined would give a very good anaesthesia for me to spay. In this case, the cat was twitching her legs towards the end of spay and there was no need to top up with isoflurane + O2.
Skin stitched - first skin incision = 21 minutes. I hooked out the ovary at the first attempt. A caterwauling cat takes much longer to spay as I had to ligate the ovarian side with 10 throws of the knot each and the uterine body with 15 throws. 3/0 absorbable x 1 packet used.
I would expect 10 minutes will do for normal non-caterwauling cats. Will check out my other KPI cases of cat spay.
TOTAL TIME FROM INJECTION OF SEDATION DRUG TO SKIN STITCHED =
11.43 am - 11.10 am = 33 minutes. The cat was clipped after sedation but normally I get the cat or dog clipped before sedation, thereby reducing my surgery and anaesthetic time. It takes about 2 minutes to clip.
As at Oct 25, 2012, no complaint or news from the Nepalese couple.
For caterwauling cats, the ovarian and uterine blood vessels are enlarged and special care must be made to ligate well. I threw around 10 knots on each ovarian side and around 15 knots on the uterine body. I don't do transfixing ligatures on the swollen uterine body.
As the cat was ferocious after the owner left and was put inside the cage, my assistant Min was pawed at everytime he tried to take the cat out of the cage for me to do the sedation injection. He went to get a big rag. "Don't do it," I knew this cat would escape from his crutches if he tried to grip her scruff of the neck now that the cat was big eyed and hissing.
ANAESTHESIA
"I will inject the cage through the cage," I said.
Mr Min had his idea of lassoing the cat and then pulling one leg out for me to inject the back muscle. He tried and I injected partially as the cat twisted and turned, pulling back her leg. He attempted again and I managed to inject the 80% of the remaining sedation drug. So, there was not 100% given.
Normally at xylazine 0.15 and ketamine 0.6 = 0.75 ml IM combined would give a very good anaesthesia for me to spay. In this case, the cat was twitching her legs towards the end of spay and there was no need to top up with isoflurane + O2.
Skin stitched - first skin incision = 21 minutes. I hooked out the ovary at the first attempt. A caterwauling cat takes much longer to spay as I had to ligate the ovarian side with 10 throws of the knot each and the uterine body with 15 throws. 3/0 absorbable x 1 packet used.
I would expect 10 minutes will do for normal non-caterwauling cats. Will check out my other KPI cases of cat spay.
TOTAL TIME FROM INJECTION OF SEDATION DRUG TO SKIN STITCHED =
11.43 am - 11.10 am = 33 minutes. The cat was clipped after sedation but normally I get the cat or dog clipped before sedation, thereby reducing my surgery and anaesthetic time. It takes about 2 minutes to clip.
As at Oct 25, 2012, no complaint or news from the Nepalese couple.
Thursday, October 18, 2012
1147. KPI. The Golden Retriever has a painful golf-ball cheek
Sunday's interesting case
Oct 14, 2012
I was worried that I would not be able to operate on this golf-ball-sized cheek. The Golden Retriever was thin and had a low total white cell count of 3.3 (6-17) when Dr Daniel took a blood test as part of health check up and vaccination in June 4, 2012.
Why such a low TWCC? I took a blood test on Oct 15 before surgery. It was still low at 5.2.
The platelets were low at 110 in June but was normal in Oct 15 at 251. So, what was going on in this skinny dog, said to be a selective eater? At his age, he should weigh more than 27 kg. He was 24 kg in June and so would have gained weight.
The good-natured dog whined when I palpated the firm lump. He did not bite me. Could this be an abscess? A needle aspiration showed some blood-tinged fluid but nothing else. The lump was more solid. A tumour? A salivary gland cyst (submandibular and sublingual) but the location was inside the cheek tissues. Fortunately as it is a messy operation to remove the salivary gland cyst known as mucocoele. Too many nerves and blood vessels in this neck area.
Give some medication and wait and see? Well, this would not cure the dog. Could the pain be some chronic pain that made the dog not wanting to eat? The following is my management of this high-risk case
24-HOUR BEFORE OP
IV dextrose saline 2 bags + duphalytes + baytril
ANAESTHESIA
27kg
I used xyalzine 1.3 ml + ketamine 0.3 ml IV - at 50% of the calculated dose.
It was not effective but isoflurane gas mask knocked him down and allowed intubation
To benchmark for my other vets, the record showed:
Time of use of isoflurane gas + O2 = 85 minutes
First stitch to last stitch of skin = 57 minutes
The dog was not healthy and so the shorter the anaesthesia, the better the survival outcome
SURGICAL APPROACH
How to remove this large golf ball and still have skin to close up the left cheek?
Marker pen drawing of surgical lines
In the end I electro-incised a vertical line, excise the mass of cystic fluid and tissues from the dermis of the skin, sent the lumps to lab for histopathology
Ligated bleeders
Nylon 2/0 x 2 packets, PDS 2/0 X 1 packet to close up the wound and ligate
HISTOPATHOLOGY
Inflamed granulation tissue. No sign of malignancy.
I informed the owner. He asked what would be the cause?
"Possibly an infected abscess. Something sharp pierced the cheek and lodged inside."
"It could be chicken wing," he sighed.
This report is to set some benchmarks by me for my associate vets in veterinary surgery.
Obviously, I have over 40 years of surgery experience and I don't expect the younger vets to achieve the 57-minute surgery till they have more surgeries under their belt.
But there must be some bench-marks and this case is one of them.
All surgeries and anaesthesia records are nowadays written with the above-mentioned timing to upgrade the standard of veterinary surgery. Taking time to operate a pet is frowned upon by me and proper planning must be done to shorten anaesthetic and surgical time if Toa Payoh Vets is to be the top 5 veterinary surgery in Singapore.
Oct 14, 2012
I was worried that I would not be able to operate on this golf-ball-sized cheek. The Golden Retriever was thin and had a low total white cell count of 3.3 (6-17) when Dr Daniel took a blood test as part of health check up and vaccination in June 4, 2012.
Why such a low TWCC? I took a blood test on Oct 15 before surgery. It was still low at 5.2.
The platelets were low at 110 in June but was normal in Oct 15 at 251. So, what was going on in this skinny dog, said to be a selective eater? At his age, he should weigh more than 27 kg. He was 24 kg in June and so would have gained weight.
The good-natured dog whined when I palpated the firm lump. He did not bite me. Could this be an abscess? A needle aspiration showed some blood-tinged fluid but nothing else. The lump was more solid. A tumour? A salivary gland cyst (submandibular and sublingual) but the location was inside the cheek tissues. Fortunately as it is a messy operation to remove the salivary gland cyst known as mucocoele. Too many nerves and blood vessels in this neck area.
Give some medication and wait and see? Well, this would not cure the dog. Could the pain be some chronic pain that made the dog not wanting to eat? The following is my management of this high-risk case
24-HOUR BEFORE OP
IV dextrose saline 2 bags + duphalytes + baytril
ANAESTHESIA
27kg
I used xyalzine 1.3 ml + ketamine 0.3 ml IV - at 50% of the calculated dose.
It was not effective but isoflurane gas mask knocked him down and allowed intubation
To benchmark for my other vets, the record showed:
Time of use of isoflurane gas + O2 = 85 minutes
First stitch to last stitch of skin = 57 minutes
The dog was not healthy and so the shorter the anaesthesia, the better the survival outcome
SURGICAL APPROACH
How to remove this large golf ball and still have skin to close up the left cheek?
Marker pen drawing of surgical lines
In the end I electro-incised a vertical line, excise the mass of cystic fluid and tissues from the dermis of the skin, sent the lumps to lab for histopathology
Ligated bleeders
Nylon 2/0 x 2 packets, PDS 2/0 X 1 packet to close up the wound and ligate
HISTOPATHOLOGY
Inflamed granulation tissue. No sign of malignancy.
I informed the owner. He asked what would be the cause?
"Possibly an infected abscess. Something sharp pierced the cheek and lodged inside."
"It could be chicken wing," he sighed.
This report is to set some benchmarks by me for my associate vets in veterinary surgery.
Obviously, I have over 40 years of surgery experience and I don't expect the younger vets to achieve the 57-minute surgery till they have more surgeries under their belt.
But there must be some bench-marks and this case is one of them.
All surgeries and anaesthesia records are nowadays written with the above-mentioned timing to upgrade the standard of veterinary surgery. Taking time to operate a pet is frowned upon by me and proper planning must be done to shorten anaesthetic and surgical time if Toa Payoh Vets is to be the top 5 veterinary surgery in Singapore.
1146. The young guinea pig dies from respiratory distress
"What is the cause of death?" the woman in her 40s asked me as I phoned her to say her guinea pig had
Star tortoise passes red blood, shells ooze red blood
The case of the French-bean eating star tortoise
"I bought UV light and food as recommended by the pet shop, but my star tortoise just would not eat them," the owner said to me. "She eats only French beans and that was the only food she ate for the past 7 years."
The tortoise hospitalised the tortoise again but this time, I noted she had paler tongue and was purplish. Her shell borders ooze red blood. She passes red blood.
One week ago, the owner came as she was constipated for 2 weeks and was not eating. "Her shell is very thin," I said. "Not enough calcium. Eating French beans solely for 7 years has caused this problem. A tortoise should be eating a variety of food including shrimps and multi-vitamins and minerals."
But the tortoise just would not eat any other food. For 7 years. I asked Dr Vanessa to give her one ml of enema salts using a one-ml syringe. She pooped on the water and became more active. I gave an antibiotic injection IM. She went home but still would not eat.
So, this time, she was much weaker and her eyes closed most of the time. With so much blood leaking from her shell lines and fresh blood from her anus, the owner felt it was more humane not to let her suffer anymore. She was euthanased and cremated.
Another client with the jaw-abscessed rabbit saw the tortoise and told me how she successfully reared two tortoises now 8 years old. She showed me her i-phone images. The tortoises looked great. "I did a lot of research," she said. "I got one when she was a 50-cent coin size and then there was another one left at the pet shop. The operator asked me to take it and so I did."
"How do you train them to eat a variety of food?" I asked.
"I feed them by hand when they were young," she said. So, that was the solution to picky tortoises.
"I am more interested in how you toilet train them," I said.
"Star tortoises are not to be immersed in water as they are desert tortoises," she stated. "I put them into the water and they poop. Other times, I don't put them in the water." Normally, we don't immerse tortoises in water by use of a sloping platform for them to go up to be dry. However, medication and critical care powder was put into the water for this tortoise to drink. It was too late to cure her.
"It is excellent toilet training method," I said. "Are they still doing it now?"
"Now, the situation is haphazard since I have a domestic worker to care for them as I have a baby to care for." I requested her to write and share her knowledge as star tortoises are not common in Singapore due to a ban.
Intelligent owners nowadays know much more about the management of exotic pets than me if they have them as pets. Vets can't know everything. Now there are hermit crabs from Batam for sale and the pet shop operator has more knowledge of nutrition and husbandry than any vet in Singapore because we don't see hermit crabs in years. And today, an owner phoned me about his rat who chipped his tooth. What to do for sedation? Zoletil?
"I bought UV light and food as recommended by the pet shop, but my star tortoise just would not eat them," the owner said to me. "She eats only French beans and that was the only food she ate for the past 7 years."
The tortoise hospitalised the tortoise again but this time, I noted she had paler tongue and was purplish. Her shell borders ooze red blood. She passes red blood.
One week ago, the owner came as she was constipated for 2 weeks and was not eating. "Her shell is very thin," I said. "Not enough calcium. Eating French beans solely for 7 years has caused this problem. A tortoise should be eating a variety of food including shrimps and multi-vitamins and minerals."
But the tortoise just would not eat any other food. For 7 years. I asked Dr Vanessa to give her one ml of enema salts using a one-ml syringe. She pooped on the water and became more active. I gave an antibiotic injection IM. She went home but still would not eat.
So, this time, she was much weaker and her eyes closed most of the time. With so much blood leaking from her shell lines and fresh blood from her anus, the owner felt it was more humane not to let her suffer anymore. She was euthanased and cremated.
Another client with the jaw-abscessed rabbit saw the tortoise and told me how she successfully reared two tortoises now 8 years old. She showed me her i-phone images. The tortoises looked great. "I did a lot of research," she said. "I got one when she was a 50-cent coin size and then there was another one left at the pet shop. The operator asked me to take it and so I did."
"How do you train them to eat a variety of food?" I asked.
"I feed them by hand when they were young," she said. So, that was the solution to picky tortoises.
"I am more interested in how you toilet train them," I said.
"Star tortoises are not to be immersed in water as they are desert tortoises," she stated. "I put them into the water and they poop. Other times, I don't put them in the water." Normally, we don't immerse tortoises in water by use of a sloping platform for them to go up to be dry. However, medication and critical care powder was put into the water for this tortoise to drink. It was too late to cure her.
"It is excellent toilet training method," I said. "Are they still doing it now?"
"Now, the situation is haphazard since I have a domestic worker to care for them as I have a baby to care for." I requested her to write and share her knowledge as star tortoises are not common in Singapore due to a ban.
Intelligent owners nowadays know much more about the management of exotic pets than me if they have them as pets. Vets can't know everything. Now there are hermit crabs from Batam for sale and the pet shop operator has more knowledge of nutrition and husbandry than any vet in Singapore because we don't see hermit crabs in years. And today, an owner phoned me about his rat who chipped his tooth. What to do for sedation? Zoletil?
Wednesday, October 17, 2012
1143. Triple phosphate crystals in a young Shih Tzu X - health screening
Health screening is seldom done by Singapore pet owners esp. in young dogs in Singapore. A young lady wanted me to do a complete health check on her one-year-old Shih Tzu X Jap Chin, male. The complete blood test was normal but urinary analysis showed a tendency to formation of struvite urinary bladder stones as in my email to her below:
The analysis showed a likelihood of this dog forming struvite (triple phosphate) bladder stones.
A change to a diet that will acidify the urine to pH below 7.0 and monthly urinary analysis is recommended for the next few months. Pl contact me for further discussion.
Some info on struvite urinary stones are at:
1. http://www.bekindtopets.com/
2. http://www.kongyuensing.com/
Oct 17, 2012
HEALTH SCREENING OF A YOUNG DOG
Shih Tzu X Jap Chin, Male, 1 year old
The significant findings are alkaline urine (pH 8.0), the presence of triple phosphate crystals + and bacteria 3+, high specific gravity of 1.043 (1.005-1.030).
Shih Tzu X Jap Chin, Male, 1 year old
The significant findings are alkaline urine (pH 8.0), the presence of triple phosphate crystals + and bacteria 3+, high specific gravity of 1.043 (1.005-1.030).
The analysis showed a likelihood of this dog forming struvite (triple phosphate) bladder stones.
A change to a diet that will acidify the urine to pH below 7.0 and monthly urinary analysis is recommended for the next few months. Pl contact me for further discussion.
Some info on struvite urinary stones are at:
1. http://www.bekindtopets.com/
2. http://www.kongyuensing.com/
Friday, October 12, 2012
The 73-year-old flower seller and her 7-year-old Jack Russell
"My friend's dog vomited and died when sent to the vet," the 73-year-old flower seller from Geylang market limped badly yesterday (Oct 11,2012) and came by taxi at 8.30 pm. She was worried that her dog might die.
"Why are you still selling flowers?" I asked."Don't your children support you?"
"Why are you still selling flowers?" I asked."Don't your children support you?"
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