1254. Two young terrapins of 3.5 cm shell width Jan 17, 2013

Yesterday evening Jan 17, 2013, Dr Daniel had to go to a concert and so I was on duty from 7 pm to 8 pm. I was surprised to see two young terrapins coming for consultation as they were of around the same age and the probability of two terrapin patients in sequence  is very rare at Toa Payoh Vets. I have taken a video of them for readers.

CASE 1. "Puffing" terrapin
"She avoids water," the father said. "She seldom moves. She will raise her head, burp and a swelling appears below her neck."
Sure enough, the terrapin displayed this behaviour. As if this terrapin had difficulty breathing. She did not move at all.

As a monitor lizard would puff up to increase his size to frighten predators.
"Did you feed something causing throat obstruction?" I asked as another "balloon" below the neck swells up.
"I did feed shrimps," the father said. Most likely dyspnea. Inhalation pneumonia from swallowing too large a piece of shrimp?

I hospitalised her and gave her multivitamins in water. The next day, she was more active. Her head is still raised upwards and I have not seen her head on level horizontal. What is the solution? In cats and dogs, X-rays and sedation to check out the throat would be done. But this is a baby terrapin. I would observe. In any case, she was moving this morning when I took her out to sun and video at 10 am.

CASE 2.
"Right eye closed, so he is not eating," the father said. "Is it infection?"
I noticed a white plug covering the eyelids of the right eye. I hospitalised it and give multivitamins in the water. Changed water and bathed it. The next morning, the right eye was opened and the terrapin was overactive. See video. I put him in a shallow bowl and monitor. Once I turned my back, I saw him upside down as he had attempted to climb up the shallow bowl. I put him back on his side. He could go home and the young lady owner was most pleased.

 

Video: Oral tumours in older dogs in Singapore

http://www.youtube.com/watch?v=BKuotAsSRAA

Oral tumours in old dogs in Singapore
video to educate dog owners

Update: Large tumour video and case follow up - hamster's 14-g large tumour

TOA PAYOH VETS toapayohvets.com Date:   18 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Electro-excision of a large tumour in a dwarf hamster  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   18 January, 2013	toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129
Yesterday, Jan 16, 2013, two older women from "Street 12" came with a 64-g female dwarf hamster aged 1 year and 6 months. She had a gigantic tumour near her left hip. "She's biting the lump", one woman said to me. There was a scab of 2 mm x 2 mm due to the hamster's bite. ANAESTHESIA & SURGERY Dr Daniel is convinced that electro-surgery is useful and efficient as he used electro-excision to incise the skin (see video  http://www.youtube.com/watch?v=J6d03LrHZS8). He excised the tumour which had some abscesses. I weighed the hamster after surgery. She was 50 kg. A heavy weight had been taken out. It was a high risk anaesthesia as the hamster was quite plump and the tumour was massive. However the hamster was still eating. 3 drops of Zoletil 50 was insufficient. "Don't use a large volume of normal saline to top up the syringe," I said to Dr Daniel. "The back muscles of the dwarf hamster is very little. It will be like the doctor injecting 20 ml of liquid into you back muscles. I usually top up the 3 drops of Zoletil up to 0.05 ml in the 1-ml syringe with normal saline before injecting the back muscles of the hamster (see video http://www.youtube.com/watch?v=J6d03LrHZS8). I had to use the mask to gas the hamster with isoflurane gas a few times as the Zoletil 50 was insufficient in this plump hamster. Possibly 4 drops would be more effective in a 64-gram hamster or it could be too much and causes death. Much depends on the vet's judgment and experience. The tumour was 14 g in weight! This is where the risks of death increase because it is not possible to monitor the hamster's breathing and heart rate (ECG, blood pressure monitoring are not practical in a dwarf hamster). Any overdose of the isoflurane gas meant instant death. No such thing as resuscitation. So, I monitored the anaesthesia top up while Dr Daniel operated. It was touch and go. I had to make sure that the hamster was just below the surgical anaesthesia stage and so you would see some leg movement during stitching. It is NOT possible to achieve the ideal surgical anaesthetic stage as in the dog and cat. The dwarf hamster is so small. "Surgery must be speedy," I said to Dr Daniel. "Undermine the skin, isolate the tumour, clamp the base with a curved forceps, excise the lump and stitch the skin with 6/0 interrupted sutures. All these to be done in less than 3 minutes."  The slower the vet operated, the more the anaesthesia had to be given and this is where the hamster "dies" on the operating table.   CHECKING THE ACCURACY OF OWNER'S ADDRESS The had written "Street 12" in the address. I asked whether she had left out "Bishan Street 12"? Vets must check the records of addresses. She said "Pasir Ris Street 12". I asked an intern to do this case study. She did a video and the link is:     http://www.youtube.com/watch?v=J6d03LrHZS8. There is a problem with the  absence of sounds, using Windows movie maker. There appears to be no solution from the interns.   CONCLUSION The hamster took some time to wake up. Two female interns were present. One of them was a single child. She spent much time with this hamster. "Look, she is vomiting the seeds," this lady intern said to me as she observed the surgery and did some video filming of the operation. "The hamster is dislodging the food from her cheek pouch as she is stressed by the surgery and anaesthesia," I told her. "This is a common occurrence. She is not vomiting." Her parents allowed her to keep one cat. Yesterday I told the parents whom I knew from 20 years ago that this daughter  should adopt more stray cats in her apartment. The mother wanted to kill me. "Don't you dare to suggest this," the mother said to me. Many Singapore parents dote on the single child and will tolerate them bringing home stray dogs and cats or buy a puppy. In the end, it is the parents who have to care fore them. Yet yesterday, I met a mother, an old client, from Bukit Panjang. Her 15-year-old Maltese X bought by her daughter long ago is so precious to the mother. The dog came in as she behaved aggressively when carried. The mother knew it was due to false pregnancy. Lots of white milk were present in the dog's swollen mammary glands. This dog still had estrus bleeding 2-3 months ago. At the age of 15 years which is equivalent to 105 years in a human being . This is in contrast to menopause in women at the age of 50 - 60 years. I asked permission for my intern to take pictures for her case study and she said OK. "Don't feed her," I said to the single child as the hamster after surgery, wanted to store the seeds. The plump hamster laid on her back and sipped water from the water bottle while lying on her back, making her laugh. The owner came in the afternoon to take the hamster home. The vet must deliver a hamster alive at the surgery. The anaesthesia is the killing part and this is where a vet's reputation is smeared if the hamster dies on the operating table. No deaths should occur if the anaesthesia is minimal and the surgery speedy, but this cannot be guaranteed. FOLLOW-UP 24 HOURS LATER   1250. Follow up on plump dwarf hamster 64kg with large tumour   Jan 17, 2013 I phoned the Pasir Ris lady at 11.45 am and reached her on her home phone to ensure she does the proper post-op nursing and medication. Sometimes, vets are too busy and will not phone if the mobile phone does not answer. "She is eating and drinking water and active," the Indian lady said. "She is more active than before (surgery). I didn't know she has stopped exercising. I pushed the 1-ml syringe too much and spilled the medicine..." "It's OK as the hamster just needs 2 drops/day for the next 3 days and the syringe has more than sufficient." "Can I shampoo her?" she asked. "I do it every week. She was not happy at first but now she looks forward to the water bath as the weather is too hot nowadays." "No bathing for the next 14 days," I said. The instructions are: 1. Use a facial cotton piece, add clean warm water and clean the surgical wound 2x/day for the next 14 days. 2. Stitches will dissolve on their own in 21-30 days. No need to come for stitches being taken out. 3.  No wood shavings as bedding. 4. No exercise wheel. 5. Give medication 6. No bathing for 14 days A video on the surgery to excise this gigantic tumour by Dr Daniel Sing was produced by the interns:  http://www.youtube.com/watch?v=J6d03LrHZS8. I was the assistant and you can see me doing the IM injection.  There is a problem with the absence of sounds, using Windows movie maker. There appears to be no solution from the interns. Readers with solutions, please e-mail to me.
More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326
Toa Payoh Vets Clinical Research

False pregnancy in a very old Maltese - 15 years old

1250. Follow up on plump dwarf hamster 64kg with large tumour

Jan 17, 2013
I phoned the Pasir Ris lady at 11.45 am and reached her on her home phone to ensure she does the proper post-op nursing and medication. Sometimes, vets are too busy and will not phone if the mobile phone does not answer.

"She is eating and drinking water and active," the Indian lady said. "She is more active than before (surgery). I didn't know she has stopped exercising. I pushed the 1-ml syringe too much and spilled the medicine..."

"It's OK as the hamster just needs 2 drops/day for the next 3 days and the syringe has more than sufficient."

"Can I shampoo her?" she asked. "I do it every week. She was not happy at first but now she looks forward to the water bath as the weather is too hot nowadays."

"No bathing for the next 14 days," I said. The other instructions are:

1. Use a facial cotton piece, add clean warm water and clean the surgical wound 2x/day for the next 14 days.
2. Stitches will dissolve on their own in 21-30 days. No need to come for stitches being taken out.
3.  No wood shavings as bedding.
4. No exercise wheel.
5. Give medication
6. No bathing for 14 days

1249. Follow up on 3-year-old cat with recurring FLUTD

Jan 17, 2013

No news is good news. The lady owner didn't phone me. I phoned her at 10.47am to find out about her cat as part of my research on FLUTD treatment. It is best practice to follow up in any case, but many vets don't do it.

I tried to phone the Tampines girl whose male Miniature Schnauzer, born in 2004, had spikey bladder stones removed in August 17, 2007 by her young vet operating together with me. This case study was written by me as she was a veterinary clinic helper and her vet was a younger vet doing his first bladder stone surgery with me.

Her mobile phone seemed "dead". No answer and then a dying sound. I phoned her home and hIer mum said the dog is OK, took my mobile phone for her to call me. I asked her vet to call me. No response. The dog did not have recurrence of bladder stones despite being fed dry food! 



CASE OF THE RECURRING FLUTD CAT
"Totally normal," she said happily. "He was fully recovered yesterday, around 6 days after the problem." The cat was so aggressive when she brought him for treatment on Jan 11, 2013. This time, she was prompt in seeking treatment and so the urine did not look red as at 22 months earlier when FLUTD first manifested. "Continue feeding the C/D + water and no other food," I replied. So far so good.

Follow up provides the vet with feedback on the efficacy of his management and treatment. I sent the cat back home with in-dwelling cathether on the same day.  The cat ripped off the catheter the next day although he had an e-collar. The case is written in a blog a few days ago.

The X-rays do not show radio-dense struvites. Negative crystals in the urine doNOT mean that there are no struvites inside the bladder. In any case, with medication and irrigation of the bladder under sedation, the cat recovered fully 6 days after treatment and the lady owner is most happy. This time, she was prompt in seeking treatment and there was no need for fluid therapy and hospitalisation as occurred 22 months ago.

Many Singapore pet owners delay seeking treatment of difficulty in urination of their dogs or cats and the outcome may not be so favourable as much inflammation and damage to the bladder had been done owing to the delay in seeking prompt vet treatment.   

1248. Two interns: Electro-excision tumours in 2 dwarf hamsters

TOA PAYOH VETS toapayohvets.com Date:   17 January, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Electro-excision of a large ear wart or tumour in 2 hamsters  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   17 January, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 CASE 1. Ear wart or tumour Nowadays, Singapore's pet owners are much more sophisticated and educated. I got an e-mail (below) with 4 images of the hamster's ear wart or tumour from the young couple in a yellow car.   ...i@gmail.com> 12/9/12   to judy   Dear Sir/Mdm, I have just discovered a tiny growth on the ear of my hamster. Attached are the pictures for your reference. I would like to know if there is any treatment for my hamster and the cost of it. If so, pls advise on an appointment date and time. Thank you. Regards, Name of owner   Kong Yuen Sing <99pups gmail.com="gmail.com"> 12/9/12       I am Dr Sing from Toa Payoh Vets. Thank you for your email. The "tiny" ear tumour needs to be removed by surgery and under anaesthesia. The ear canals need to be examined for other growths. The approximate cost is $150-$200 for consultation, anaesthesia, surgery (+/- stitching) and medication. Appointment is by phone 6254-3326. Bring hamster at 9.30 am and it goes home by 4 pm usually. Best wishes.     Sent from my iPhone Although it is troublesome to set up the electro-surgery equipment just to excise a "small" ear wart, I am in favour of using electro-excision as the cutting needle is much more precise in cutting the skin. It takes time to sell my idea to Dr Daniel as he said it would be easier to snip off the wart with a scalpel. We did electro-excision and he is quite convinced it is a useful method as bleeding is minimal. In retrospect, I would have used the circular electrode needle to go under the ear wart and slice it away. The straight needle electrode was used in this case but both achieved the same results in taking out the "small" ear tumour.     Image from hamster owner in the e-mail   Remove distracting objects (right) to avoid wasting time on cropping the image   Cropping required to take out the distracting object     The rule of thirds for better image. The hamster's eyes or body should be at the intersection of 1/3 of 3 horizontal and vertical lines to produce interesting images for the viewer       Straight needle electrode used. I should have recommended a  circular one to loop off the tumour   Very little bleeding and more precise cut when electricity has been use to cut off the ear tumour CASE 2. A DWARF HAMSTER WITH A GIGANTIC TUMOUR NEAR THE LEFT HIP Yesterday, Jan 16, 2013, two older women from "Street 12" came with a 64-g female dwarf hamster aged 1 year and 6 months. She had a gigantic tumour near her left hip. "She's biting the lump", one woman said to me. There was a scab of 2 mm x 2 mm due to the hamster's bite. ANAESTHESIA & SURGERY Dr Daniel seems convinced that electro-surgery is useful and efficient as he  used electro-excision of the skin. He excised the tumour which had some abscesses. I weighed the hamster after surgery. She was 50 kg. A heavy weight had been taken out. It was a high risk anaesthesia as the hamster was quite plump and the tumour was massive. However the hamster was still eating. 3 drops of Zoletil 50 was insufficient. "Don't use a large volume of normal saline to top up the syringe," I said to Dr Daniel. "The back muscles of the dwarf hamster is very little. It will be like the doctor injecting 20 ml of liquid into you back muscles. I usually top up the 3 drops of Zoletil up to 0.05 ml in the 1-ml syringe with normal saline before injecting the back muscles of the hamster (see video). I had to use the mask to gas the hamster with isoflurane gas as the Zoletil 50 was insufficient in this plump hamster. Possibly 4 drops would be more effective in a 64-gram hamster or it could be too much and causes death. Much depends on the vet's judgment and experience. This is where the risks of death increase because it is not possible to monitor the hamster's breathing and heart rate (ECG etc not practical in a dwarf hamster). Any overdose of the isoflurane gas meant instant death. No such thing as resuscitation. So, I monitored the anaesthesia top up while Dr Daniel operated. It was touch and go. I had to make sure that the hamster was just below the surgical anaesthesia stage and so you would see some leg movement during stitching. It is NOT possible to achieve the ideal surgical anaesthetic stage as in the dog and cat. The dwarf hamster is so small. "Surgery must be speedy," I said to Dr Daniel. "Undermine the skin, isolate the tumour, clamp the base with a curved forceps, excise the lump and stitch the skin with 6/0 interrupted sutures. All these to be done in less than 3 minutes."  The slower the vet operated, the more the anaesthesia had to be given and this is where the hamster "dies" on the operating table.   CHECKING THE ACCURACY OF OWNER'S ADDRESS. The had written "Street 12" in the address. I asked whether she had left out "Bishan Street 12"? Vets must check the records of addresses. She said "Pasir Ris Street 12". I asked an intern to do this case study. She did a video and case report.     CONCLUSION The hamster took some time to wake up. Two female interns were present. One of them was a single child. She spent much time with this hamster. "Look, she is vomiting the seeds," this lady intern said to me as she observed the surgery and did some video filming of the operation. "The hamster is dislodging the food from her cheek pouch as she is stressed by the surgery and anaesthesia," I told her. "This is a common occurrence. She is not vomiting." Her parents allowed her to keep one cat. Yesterday I told the parents whom I knew from 20 years ago that this daughter  should adopt more stray cats in her apartment. The mother wanted to kill me. "Don't you dare to suggest this," the mother said to me. Many Singapore parents dote on the single child and will tolerate them bringing home stray dogs and cats or buy a puppy. In the end, it is the parents who have to care fore them. Yet yesterday, I met an aged mother, an old client, slim woman with white hairs at the side, from Bukit Panjang. Her 15-year-old Maltese X bought by her daughter long ago is so precious to the mother. The dog came in as she behaved aggressively when carried. The mother knew it was due to false pregnancy. Lots of white milk were present in the dog's swollen mammary glands. This dog still had estrus bleeding 2-3 months ago. At the age of 15 years which is equivalent to 105 years in a human being . This is in contrast to menopause in women at the age of 50 - 60 years. I asked permission for my intern to take pictures for her case study and she said OK. My intern would have written the case in 2013Vets blog.   "Don't feed her," I said to the single child as the hamster wanted to store the seeds. The plump hamster laid on her back and sipped water from the water bottle while lying on her back. The owner came in the afternoon to take the hamster home. The vet must deliver a hamster alive at the surgery. The anaesthesia is the killing part and this is where a vet's reputation is smeared if the hamster dies on the operating table. No deaths should occur if the anaesthesia is minimal and the surgery speedy, but this cannot be guaranteed. EDUCATION VIDEO ON ELECTRO-SURGERY IN THE HAMSTER I can't link this webpage to the video taken by the intern as the video is in another blog called 2013Vets. See www.toapayohvets.com for the link to 2013Vets and get the video.    Name of webpage: http://www.kongyuensing.com/folder7/ 201301117electro_surgery_hamster_toapayohvets.htm   More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

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