1278. Rectal prolapse in terrapins and people -

Recently an 82-year-old man, sound mind and in good health brought in a terrapin with black and smelly prolapsed rectum. "No hope of repairing as the tissues are rotten and stinking," I usually push back the rectal tissues and suture up the anus for 10-14 days. If done early (within 1-2 days of rectal prolapse), the outcome is excellent. Euthanasia was done.

"Holding in the rectum"  - rectal prolapse where the rectum falls out of the anus. New surgical technique is providing relief. - Ventral Mesh Rectopexy. A mesh (plastic or biodegradaable material) is sutured to the pelvic floor muscles on both sides of the rectum. The top end is sutured to the spine to lift up the rectum. In women, the mesh is sutured to the top of the vaginal to prevent vaginal prolapse. At SGH, $5,000 - $25,000

Recurrences low.

Therapy to retrain pelvic floor muscles will not apply to animals!

REFERENCE:  The Straits Times Jan 17, 2013 pg 12-14 "Mind Your Body"

Reading what the human surgeons do and the latest advances in surgery may be of some use to veterinary surgeons.

1277. Update with video. Two itchy dogs - demodectic mites & ringworm

TOA PAYOH VETS toapayohvets.com Date:   06 February, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Case 1. Itchy Dogs.  Demodectic mange. In search of the anti-demodectic injection  Case 2. Itchy Dogs. Generalised ringworm Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written:  01 February, 2013 Date:   06 February, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2013-0131 Case 1. Itchy Dogs.  Demodectic mange. In search of the anti-demodectic injection  "I don't know why your vet does not give the old dog an anti-demodectic mite injection," I said to the mother who "inherited" the 15-year-old Shih Tzu from her daughter. The daughter, in her late 30s, had brought her to consult me for a second opinion on January 30, 2013 was the owner of the dog but had migrated to Australia. The mother said: "My daughter in KL asked me to consult you. My dog had skin diseases for so many years except for one year 3 years ago. I feed salmon and other good food. Every time, the itchiness would recur after some time after my vet had given a steroid injection. I hear steroids are not good for my dog." "I don't know why your vet has not or will not give the anti-demodectic injection," I said. "Did you ask him why? Did he do a blood test to screen the health of this old dog, esp. the liver and kidney functions? If these organs are not normal, he might not want to risk giving the injection. You can ask him to fax to me the blood test results." "Do you vets get along well with one another?" the mother had not asked her regular vet why he did not give the anti-demodectic injection. She also did not want to upset her regular vet by asking for clinical records for me to peruse and get a bigger picture of the dog's health. "All vets do fax or email copies of our client reports to the 2nd-opinion vets when requested by the owner to do so. There is no problem for any vet in Singapore to do that as every vet will have owners who want a 2nd or 3rd opinion for his pet that does not respond to treatment by the first vet."  As the mother was not comfortable to making the request, I did not insist and took her history of what happened to her dog from the beginning. She had brought some medication given by her previous vet. These included antibiotics, anti-mite cream and fatty acid oil supplements.   "Some skin diseases are not easy to cure unless the cause is known," I checked that this slim Shih Tzu did not have hair loss, little scales, four black paws with big skin warts, clean ears, teeth with little tartar despite no dental check up, a broken tail end with grey skin as if it had partial gangrene and very swollen anal sacs. "Now the paws are not so itchy," the mother showed me a "poisonous" white cream that her regular vet had given her maid who must wear gloves to apply to the paws. "After applying the cream, the mites die and so the dog does not bite his paws so much. He also does not have that red flush of the skin in the evening causing him to cry and whine now." The cream was formulated by her vet and so I would not be able to tell whether it included a steroid, hence accounting for the cessation of inflammation. "Listen carefully to the client," I said to my intern from 4th year the Vet University in Kuala Lumpur. "What she wanted was to get an anti-demodectic injection."  The mother had said that her vet had done skin scrapings and showed her "cigar-shaped" mites under the microscope. "These are demodectic mites," I referred to a chart drawing of demodex and her daughter took an image with her hand phone. The consultation was nearly one hour long as the mother wavered on whether to get another blood test done or get her vet to give me his results and thereby offending this good vet. "I have a bottle of 100 tablets of Eltroxin tablets," she showed me and I have given half of the bottle. My vet said my dog has low thyroid hormones." She was reluctant to get a thyroxin blood level test done. "A thyroxin test will show whether the medication is effective or not and on the status of the low thyroxin level," I said. "In fact, a repeat blood test is always advised to monitor the disease some 4 weeks after the first and the first blood test was 3 weeks ago."  It was hard knowing what was the situation since the mother did not want to upset her regular vet. So, this back and forth conversation took nearly an hour. "How to cure the demodectic infection?" the mum asked again and again. "Demodectic mites are normally present in the dog's skin," I said. "When its immune system is below normal or low as in puppies and old dogs like yours, the mites multiply and cause skin itchiness and disease. So, increasing the immune system would have helped considerably." "How about giving my dog the anti-mite injection?" she asked me. "A blood test is necessary to screen the health of your dog before I give the injection," I am not surprised that Singapore dog owners nowadays are sophisticated to know that some vets give regular anti-mite injections to kill the demodectic mites. However, this was a very old dog and the injection might kill him. "If the owner wants the injection, the vet ought to give it," I said. "But educating the owner is difficult. The best way is to boost the immune system of your dog. Why does your dog lick all four paws till they are black?" I had explained that the large skin warts on and above the paws irritate the dog as he tried to lick them off. "Continuous licking to get rid of the paw warts, cause the skin to break, become inflamed, infected and ulcerated. After some weeks, the melatonin skin pigments get inside the skin, causing blackness of the skin of the paws. Excising the warts would remove a stress for this old dog and hopefully the demodectic mites will not cause disease." "But my dog is so old and will die under the general anaesthesia," she replied. "A blood test will show whether this dog is fit for anaesthesia," I said. "The electro-surgery to excise      the skin warts off the paws takes less than 5 minutes and I can say that the dog has a very high rate of survival since anaesthesia is so short." The daughter seemed to know what I was talking about. The mother was pre-occupied with the possibility of recurrence of the red skin flush and loud whining in the evening, probably stressing her so much. So we were at different ends of the world. The dog was much better now due to the variety of medications, the skin cream and the fatty acid oil supplements but this skin flush and whining might recur. Her daughter would be going home to Australia in a few days' time. It needed a lot of patience. What the mother wanted was a treatment to cure the disease once and for all as she had spent a lot of money with so many treatments by her regular vet. What I proposed was to remove the stress factors as treatment involved steroids and anti-mite cream and/or injections which could harm this old dog.  "I will pay for the blood tests," the daughter suddenly volunteered. Chronic skin diseases are costly to treat and in this case, it was not only the recurrence of itchiness and whining but also money matters. Unless the cause can be identified and can be easily treated, skin diseases are hard to cure in some dogs. In this dog, the ventral groin area is no long black, due to previous steroid jabs. But the paws were still black. On detailed examination, I would say the big skin warts on the four paws would be due to the spread of these viral warts by the dog licking as the body seemed free of the warts unlike other old dogs. The dog's anal sac was voluminous with dark brown thick viscous oil. I asked my intern to express the glands and she managed to get 5% out. I showed her how to do it and expressed over 3 ml of the oil while another intern videoed the procedure. The broken tail needed to be amputated. This was another advice I gave and the mother said: "Earlier the tail was black. I massaged it till the colour returned." That meant the tail had become gangrenous and is now half alive. The hairless tip and broken angle of the tip would be an irritant to this dog, decreasing the immune system and encouraging the demodectic mites to overwhelm his body causing red flush and pain of whining. If only dogs can talk.       So, the first advice would be to remove the warts and in most cases, the dog would become much happier and no longer need to get rid of these "dangling" tumours. Simple solution if the dog was young and not an anaesthetic risk. "Warts seldom appear in young dogs," I said to the mother. "I had an old pug in which I removed 50 skin warts." "Is the pug OK?" the mother asked. "Yes," I said. Skin warts do irritate the older dog but many owners are oblivious to this discomfort of the old companion.  UPDATE ON FEB 6, 2013 A blood test to screen the dog's health and thyroxin levels were permitted by the owner. The test revealed a high level of liver enzymes. As there is a high risk of death on the operating table, the owner did not want any anaesthesia to remove the paw warts and the broken tail. The anal sacs were expressed (videoed by an intern) and its voluminous greyish oil disposed. As for the anti-demodectic mite injection, this dog would best not take  this injection. What the mother had sought in visiting me would best not be given by the vet.   Case 2. Itchy Dogs. Generalised ringworm A CASE OF GENERALISED RINGWORM IN A SIBERIAN HUSKY. The cure is permanent if the dog is given the correct medication for a duration of time and unless re-infected, it is usually a very satisfactory clinical outcome for the owner. No need to see the vet many times. In this case, the owner's brother came to me seeking some injections and medication as the dog was scratching and scratching non-stop every day for the past weeks. I checked the hairs under the microscope and showed him the ringworm on the hair strands. An intern from Melbourne University is tasked with making a video on this microscopic examination slides for the benefit of pet owners and vet students. 5914 - 5920. An injection & some tablets will not be sufficient to cure generalised ringworm in a very itchy Siberian Husky. Intern to produce video on microscopic exam 30 days after treatment - no itchiness The dog stopped being itchy 7 days after treatment for generalised ringworm and for the next 30 days. However the owner asked me why the ringworm lesions become black 30 days after treatment. The hairs also did not grow back. "The pigmentation would be due to the dog scratching and the application of your medication for some weeks before consulting me," I said. "The hairs should grow back but it takes a long time for some dogs."  Many small breeds grow their full coat within 1-2 months. In his case, the hairs seem not to grow at all except for some fine hairs near the upper neck! ADVICES & TIPS Seek veterinary advice promptly if your dog or pet keeps scratching for more than 2 days. Ringworm can infect people. Therefore, early treatment is important as it is a disease that can be cured. VIDEO - DERMAPHYTOSIS - PRODUCED BY TOA PAYOH VETS INTERNS. A very well researched piece useful for vet students and practising vets, commissioned by me,  has been done by 4th year Melbourne Univ veterinary student, Vanessa Sim and Raffles Institution JC student Gina Ng.  Many of the fungal spore and hyphae images are taken from the Siberian Husky (above) and photographed in my microscope installed with imaging software. It took a long time to produce this video but it is very well done. See: http://www.youtube.com/watch?v=SqclWgPXw10 Updates will be on this webpage; http://www.asiahomes.com/petshotline/20130131demodectic_mites_old_dog_toapayohvets.htm Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: February 06, 2013 Toa Payoh Vets

1276. A successful dog breeder in Singapore

Around 2005-2006, I was doing Caesarean sections at $300/dog at any time of day or night, for most dog breeders and $10/vaccination and so I am interested in the latest developments.

In 2013, at least one dog breeder with around 300 dogs was most successful. The reasons are:
1. Focus.
2. Hard work and long hours from dawn to dusk. Dams give birth at any time.
3. Sound knowledge of breeding. Purchase of good quality breeds e.g. Chihuahuas from Taiwan and not using the same sire.
4. Cheap C-sections. Two vets provide such services at $250/Caesarean.
5. Cheap vaccinations at $10/dog. It dropped to $7 at one time.
6. Own microchip with the vet certifying the record of microchipping. This brings down the cost more.

Challenges
1. Difficulty in maintaining proper records when there are 300 dogs free-roaming.
2. Sometimes difficulty in knowing which sire was responsible owing to free-roaming.
3. The need to get a male dog to discover heat in the bitches as manual examination is time-consuming.
4. It is possible to use a vasectomised dog to detect estrus in bitches as in the sheep industry but I believe nobody does this for dogs in Singapore. So, there is mis-alliance in breeders who have free roaming dogs owing to insufficient and high cost manpower. Dogs crated will not have this problem 

Size 15 e-collar for chihuahua's back to prevent leg scratching back

Feb 5, 2013

Unusual request from owner to buy a size 15 collar to fit around the abdomen so that the 14-year-old Chihuahua would not be able to use his left hind leg to scratch his wounds between the ears and on the spinal area. The husband brought the dog this morning as the dog vigorously scratched the back till it bled.

6 days ago, Vet 1 had prescribed antibiotic tablets, antibiotic powder to apply and Vitamin B to drink. Fluid therapy. The problem was that this dog scratched and scratched.

The skin lesions looked circular. Could it be ringworm? I did a microscopic exam of the hairs. It was ringworm. "It is best to clip the whole body, rather than just the neck area in case of other ringworm-infected areas. This dog was 14 years old and had a machinery heart murmur. I checked the medical records.  Dr Daniel had treated him for the heart disease (Grade 4 murmur) in Nov 13, 2012 as the dog was coughing for one week.

No more coughing now as the dog was still on heart medication. Intense skin itchiness. Blood oozed from the traumatised wounds.

"It is very hard to give tablets" the husband said. "He would turn his head away. I crush the tablets and syringe it in with Vitamin B  syrup." Now, he would have to give anti-fungal tablets for 20 days and antibiotic tablets. An anti-fungal wash. An anti-inflam inject was also given to reduce the intense leg scratching. The wife came to bring the dog back and wanted the size 15 collar as a prevention of the back leg scratching. "No need e-collar," I said. She insisted. We tried to put it round the abdomen. "How's the dog going to lie down?" she asked. "It is not practical and not necessary," I said. So, she did not take the size 15 e-collar.

"I expect the dog to recover in 30 days' time.
"Good idea," I said.    

Feb 3, 2013. Sunday's interesting case - A cat has entropion

The cat's eye starts tearing over the past 5 years






BE KIND TO PETS EDUCATIONAL VIDEO


"Can I drop by to buy a bottle of eye drops from you?" the lady phoned me on this cloudy Sunday morning of February 3, 2013. "I think my cat's eye is infected and my vet prescribed eye drops and she recovers. After a while, her eye has discharge again."  She had consulted two vets and they prescribed eye drops which was "effective" for a while.

"I am sorry I can't prescribe without examining the cat," I had confirmed that I had not treated her 7-year-old female spayed cat previously. "Your cat's eye may be ulcerated or be infected and this is hard to confirm without examination. Why don't you go to your vet to get the eye drops?"

"My vet is not opened today," she replied.  Many Singapore pet owners prefer to get repeat medication without review of the pet's condition and this is not in the interest of the pet. The lady brought her cat in to my surprise.

A general examination VIDEO  showed that the medial side of the right eye was swollen at the eyelid. Pus and discharge rolled down this bump. "There is an inrolling of the eyelid at the medial canthus," I pointed my iphone App "torchlight" at left eye and then at the right eye.  My regular torch-light was not so bright but this iphone App "torchlight" never fails to shine brightly (IMAGE OF IPHONE APP PHONE). 

"I am surprised that my cat permits you to shine such a bright light for so long," the lady said. The cat soon growled and that was the end of the examination.

VIDEO OF EYE EXAMINATION
AND CAT WARNING ME OFF BECAUSE EXAMINATION TAKES TOO LONG

"The diagnosis is medial entropion of the cat's left eye", I said.
"What's the treatment," the lady in her 30s asked me.
"Surgery to roll out the eyelid is a permanent solution," I sketched an illustration (ILLUSTRATION OF ENTROPION SURGERY).


"No way. My cat is so old," the lady preferred the eye-drop solution."

"I presume this right eye tearing starts when the cat was a kitten and for the past 7 years," I speculated.
"No," she replied "Not for the first 2 years as a kitten. I distinctly remember as the kitten was with me in China."
"This is a rare case of acquired entropion," I don't expect the lady to understand technical terms. Acquired entropion means that the eyelid rolls inwards later in life as contrasted to congenital entropion which is present from birth.

"This entropion is very rare in cat," I said. "I would think that your two vets would diagnose an eye infection and the eye drops with steroids worked very well. It is quite common in some breeds of dogs like the Shih Tzu and bulldogs.  The permanent solution is surgery."

If no surgery is done, the chronic conjunctivitis will cause dry eye and the nostril discharge (see the image) will continue.  It is best to diagnose correctly and get the entropion done early so that the cat does not suffer from eye infection and keeps on rubbing her eyes every day for the rest of her life. Eye drops with steroids are not a treatment option as they only alleviate the signs and symptoms.

 



 

1273. The slider can't walk normally at home but is OK at the vet!

toapayohvets.com Date:   03 February, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The slider can't walk normally at home but is OK at the vet Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: March 29,  2004 Date:   03 February, 2013  toapayohvets.com  Be Kind To Pets Veterinary Education Project 2013-0203   Turtles are symbols of longevity and hard work to the Chinese. In Singapore, they are easier to keep in small apartments.  They are usually kept in tanks and don't smell bad or make a lot of noises unlike dogs. Many are much loved by the young owners but many have been abandoned into reservoirs or given up to the animal shelters.  Red-eared sliders or terrapins are the only approved species of turtles to be kept as pets in Singapore. This is because other turtles like Star Tortoises are prohibited by the government. They are bought as hatchlings in the wet markets and in certain pet shops for 50 cents in the 1980s and more in 2013. I seldom have terrapins as patients since they are not favoured as pets compared to dogs and cats. I may have a handful of cases per year.  Dog patients predominate as patients in all veterinary surgeries in Singapore and in my practice and when a terrapin patient comes in, it is a challenge to cure its disease.        One fine day in March 2004, a red-eared Slider was not walking normally and so the owner brought him in for consultation. "It tilts its body towards the left and lifted its right leg, when it walks," the teenager put his slider on my consultation table. Instead of neglecting it, the busy teenager who spent a lot of time text-messaging his friends on his mobile phone spared an hour to consult me.   "Let's see how it walks," I had a general examination of the big terrapin. "It walks straight now. I don't see any turning to the left side when it walks!"   At the veterinary surgery, it had behaved normally. "This is a common situation for many pet owners when the pet is at the veterinary surgery," I said. " Their pets look normal when they should be sick!" "What is the problem with this terrapin?" the boy asked. I lifted it up and examined every part of its body. I extended its four legs while it attempted to retract them. "Look at just below and in front of its right armpit," I said. " Embedded under the skin is a 4 mm-long wooden splinter. This condition is diagnosed as "foreign body". I used a pair of small curved scissors to cut off the foreign body from the skin of the armpit. "There is a little bleeding from the skin after snipping off the wooden splinter," I advised the owner. "However, it is not serious." The turtle was bleeding a bit. It felt good and energetic wanting only to zoom away from me when placed on the consultation table. "It wants to go to the most tranquil and scenic Singapore's Pierce Reservoir," I said. "No, no, no way!" the boy said. "It goes home to where it is a family member. Everyone is pleased with its good behaviour. It does not bark at all hours unlike the dog of my neighbour. It does not spray urine on the corridor walls unlike the cat of another neighbour. My whole family loves it." This turtle went home and now in 2013 when I chanced upon its images of the foreign body in this slider,  taken in 2004, time had really passed by. I had not seen it for the past 9 years and I presumed it is in excellent health and will be just 16 years old.  No news is good news for the vet!    BE KIND TO PETS.  The picture is captioned: "I want to swim in the Pierce Reservoir" sends a message to new pet owners to be responsible for their pets. It is  not meant to encourage turtle swimming in reservoirs. Its owners would never allow it to swim in any reservoir as it would swim far away and be lost.  It is very well cared for and never needed veterinary attention for the past 7 years. Till it had a foreign body. DON'T abandon the Red-eared Sliders in reservoirs and ponds in the Botanic Gardens, Mount Faber, ponds and parks.  When you have a pet, BE KIND. Take care of it for as long as it lives.     MORE INFO ABOUT THE RED-EARED SLIDER The top of the shell (carapace) is smooth and gently curved and is olive to black with yellow stripes and bars. It is a medium -sized turtle that is best identified by a red or sometimes yellow patch that is found just behind its eye. The Red-eared Slider is almost exclusively aquatic. It rarely ventures out of the water except to lay its eggs or to migrate to a new water body, should the need arise. As a water dweller, the adult turtle feeds primarily on aquatic plants. Young turtles are mostly carnivorous, gradually switching to vegetation as they age. This Slider is commonly seen basking in the sun, on logs or masses of vegetation. When basking sites are in short supply, they may even pile on top of each other, up to three turtles deep. The Red-eared Slider very easily is spooked and will slide directly into the water from its sunning spot at the least provocation. During the breeding season between March and July, the female may find herself swept away by a persistent suitor. The male Red-eared Sliders attempt to win over a female by engaging in courtship activities include swimming backwards in front of the female with their forelegs stretched out, palm side up. Red-eared Sliders may produce up to three clutches of four to 23 eggs in a single year. With each nest, the female will go on shore and dig a shallow hole that is three to 10 inches wide. She deposits her eggs in these excavations and subsequently covers them up with soil and materials to seal in the eggs for protection from predators and the elements. The young turtles hatch 60 to 75 days later, although they may spend the winter in the nest. Source: Texas Park and Wildlife  -  www.tpwd.state.tx.us/nature/wild/reptiles/slider.htm The above case was seen in 2004 and I have not seen this glider since then. It is 2013 now and two interns had produced an interesting video based on my story concept related to the case of 3 terrapins with swollen eyes hospitalised at Toa Payoh Vets in 2012. 5923.  A great video: Swollen eyes in terrapins by two interns in 2013 2013 Toa Payoh Vets Video:  http://www.youtube.com/watch?v=jqoEx4yBDrg More info: Male sliders are said to have a concave lower shell while the female has a horizontally flat lower shell. Female sliders are bigger in size. Male sliders have longer toe nails.  More interesting turtle cases seen at Toa Payoh Vets at: Turtles Updates will be at this webpage: http://www.asiahomes.com/dev/040529red_eared_slider.htm Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: February 03, 2013 Toa Payoh Vets

1272. Interns - Making great videos

This year, in 2013, I started making educational veterinary videos for www.bekindtopets.com community education of veterinary students and pet owners as the younger readers seldom read, are more visual and impatient. Videos cannot provide the depth and breath of knowledge unlike text in books but they suit the internet generation of Singaporeans, most of them growing up in an era of abundance and wealth.  

Learning a new skill demands time and practice and that is why I did not make videos in the past as I discipline myself to writing veterinary articles almost one a day and creating digital images for www.toapayohvets.com. Such articles take up around 30-60 minutes per article. Video making will take much longer time initially and so I did not do it for the last 10 years.

I use the Canon DSLR 650 and was surprised that the camera's video operations suddenly stopped after less than 1 minute. I thought it was the settings. I spoke to a camera seller who told me that I used the slow speed SD cards to produce high definition videos and so the camera stopped recording after a few minutes. I bought the high speed cards and there is no problem. Much time is needed to learn about good video production by practising and reseraching. .  

Lately I read the last printed copy of Canon's Dec Issue 26 BUZZ magazine and the following are some tips. 

Part 1. Five tips for making great videos.
1. Know your gear
2. Learn photography
3. See the light
4. Scout for location
5. Good pre-production precedes every good video

Many interns are not familiar with good photography as they just click the phone camera here and there. Sometimes in poor lighting. Good photography includes the rules of thirds, good composition and excellent lighting.

Details of the Part 1's 5 tips are at:
http://media.canon-asia.com/local/sg/live/buzz/buzz_26.pdf

Next 5 tips  will be at:
www.canon.com.sg/BUZZ

In Be Kind To Pets video production, the ADVICES & TIPS webpage is usually very dull, with white text on black background. You can see from the "Canon's 10 tips for Making Videos" how the writer inserts the Canon video camera inside the page to advertise this product which is relevant. The table, grass and flying birds makes this webpage more attractive than just plain text on black background.

There are young people who earn a very good income, better than a veterinarian, just by being good at the skill of video making for corporations at affordable prices. There are such people offering such services if you research the internet and see their websites.

But they are not present in Singapore as most young Singaporeans are distracted with other personal matters including multi-party gaming and watching movies from the laptop when they are free or at the office. Singaporeans tend to charge very high rates for  internet matters e.g. setting up websites. Then they disappear after a few years or earlier as they do not focus on their business or want to try other businesses. Or they have too many clients and their fees shoot up, out of the reach of the small business owner.

If you are really keen on video making, read the various magazines and practise making videos a lot. There is no short cut to success in real life