Wednesday, April 17, 2013

1371. Tips for newly graduated vets and pet owners - closed pyometra

TOA PAYOH VETS
toapayohvets.com

Date:   17 April, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Against Medical Advices: Closed Pyometra  
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   17 April, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
SCRIPT FOR VIDEO
 HOOK

INTRODUCTION
Pyometra is an infection of the womb. There is the open pyometra where the owner can see brownish sticky vaginal discharge and the closed pyometra where the presenting sign may be a swollen abdomen.



TWO CASE STUDIES

Two closed pyometra cases from my case files, in two breeds of dogs of similar ages are presented. Both dogs had large swollen abdomens as the presenting sign.  The Miniature Schnauzer survived the anaesthesia and surgery but the Siberian Husky did not. The Siberian Husky was very thin when she was operated as an emergency case by me. She had been treated by Vet 1 with antibiotics but had not responded and there was a delay in seeking veterinary attention. . 

Miniature Schnauzer      
X-ray showed swollen uterine bodies X-ray showed swollen uterine bodies Uterine bodies swollen with pus Dog is OK after surgery
tpvets_logo.jpg (2726 bytes) 5618 - 5621.  Closed pyometra anaesthesia and surgery is highly risky compared to a spay and costs much more as it is a long surgery. The dog survived the surgery performed by Dr Vanessa. The owner was most happy as the dog survived the anaesthesia.
Siberian Husky      
Siberian Husky, Female, 6 years. Closed Pyometra. Thin, Not Eating, Fever. Toa Payoh Vets Siberian Husky, Female, 6 years. Closed Pyometra or Ascites? X-ray. Toa Payoh Vets Siberian Husky, Female, 6 years. Closed Pyometra. Thin, Not Eating, Fever. Toa Payoh Vets  
Weight loss and distended abdomen X-ray showed swollen uterine bodies Uterine bodies swollen with pus  
tpvets_logo.jpg (2726 bytes)2094 - 2906.  Spay your female dog when she is young as the younger Singaporean generation usually has to work long hours and has little time  for her when she is older.  In this case, pus had accumulated in the womb which weighed 4 kg.

The Siberian Husky had lost weight considerably and was only 18 kg when presented for surgery. Her net weight was 14 kg as the pyometra womb weighed 4 kg.

She was extremely high risk for anaesthesia and passed away on the operating table when an emergency spay was done by me.  For reasons unknown to me, Vet 1 had prescribed antibiotics for the swollen abdomen. There could be financial distress on the part of the owner as regards further testing for the swollen abdomen. The owner might just want some antibiotics. In such situations, the vet should record in writing his advices for evidence of close pyometra in his case file. 

In this Siberian Husky, there was a delay in seeking surgical treatment. The dog was too ill to survive the anaesthesia and there was much sadness, unhappiness and resentment by the family members towards Vet 1.
 
TIPS & ADVICES for the Dog Owner:

1.  SEEK PROMPT VETERINARY ATTENTION
when your dog does not eat around 4-8 weeks after her heat period. That is when pyometra develops. Many younger Singaporean dog owners feel that it is cruel to sterilise their dogs. As they become busy in their careers, they neglect their older dog's health. The dog is well provided for in food and there are the parents and the domestic worker to look after the dog. They don't have time to bring their dogs for walks and when their dogs are not well, they delay seeking veterinary treatment or second opinions.  

2. SPAY your female dog when she is young and healthy. Pyometra surgeries to remove the womb are high-risk anaesthestic cases since the dog is already very sick. Some do die during anaesthesia. TIPS & ADVICES for the newly graduated Veterinary Surgeon:
1.  DIFFERENTIAL DIAGNOSIS
Pyometra should top the list of differential diagnosis in female dogs presented with distended abdomen with or without vomiting. The onset of estrus should be asked and recorded in the medical case sheets. However, some owners give incorrect dates of estrus and this could lead to a mis-diagnosis of closed pyometra as gas in the stomach and intestines. In some cases, the owner's mother knows the onset but she is not present during consultation.   

2.  HIGH MEDICAL COSTS

Compared to a spay, pyometra surgery costs a lot more. If the owner desires the least medical costs, he will not want to pay for the blood tests and X-rays. I usually advise a spay to be done soon once the dog is fit for surgery. Evidence-based medicine should be practised but compassion will be needed for financial distressed owners.            

3.  AGAINST MEDICAL ADVICES

The vet should record "Against Medical Advices" on the medical records, if the owner declines blood tests and X-rays of the swollen abdomen. This written advice will be a defence in cases of complaints and litigation. A good vet will be meticulous in writing his case records and advices given to the owner. Write your advices as you talk rather than wait till the end of consultation as you will have omitted certain information.

 

CREDITS

FOR MORE INFORMATION

 
Angkor Wat kids, Cambodia. Bags of used canned drinks. Toa Payoh VetsUpdate will be on this webpage:
http://www.sinpets.com/F5/201304017closed
_pyometra_dogs_toapayohvets.htm


More info at:
Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: April 17, 2013

Toa Payoh Vets

Tuesday, April 16, 2013

1370. Khin Khin's birthday on April 15

I attended her birthday. She sms to all employment agents she knew and they came. Khin Khin has the Myanmar nationals source and Singaporean agents need her. I am more a friend. "Have you been to the PAP smear?" I reminded her as her report 11 months ago said: "Atypical abnomal cells. Review 6 months later."

Many working women neglect their health. Intelligent but ignorant about personal health. "You know, cervical cancer can be cured if detected early." She had asked me whether stress can cause cancer. "Some stresses can," I said.

1369. Visit to the wet market

At 7 am, I visited the Ang Mo Kio wet market. I have not been there for months. I saw a few terrapins being sold at the pet fish shop.

Wet markets in Singapore are quite "sterile" compared to the messy smelly ones in other countries. Yet few of the younger Singaporeans visit them as they prefer to shop at air-conditioned supermarkets, not knowing that fishes are fresher at wet markets.

My favourite fish-monger is a couple in their late 30s. "Where's the type of fish that women eat after birth?" I asked. "The one with the bone in the middle?"  Actually all big fishes have vertebral bones in the middle. I pointed to a mid-sized fish greyish in colour.

"No, no," the fishmonger's wife said. "This is the one." A bigger sized fish. I don't know as I don't cook. My Cantonese mother used to buy it and cook it with brown or black beans. I bought a red polka-dotted fish and a pomfret for steaming. Fishes can be very fishy and I dislike eating fishy ones.
"Any of those small fishes they sell with nasi lemak?" I asked.
"Not today. Quite hard to find."
"Do you put fishes in the freezer?" I asked.
"Of course," the wife said.
"Do you do it?"
"No need," the husband said. "We sell out the same day."

At my fruit seller called "Ah Pui" or "Fatty" in Hokkien, his neighbour did not open the fruit stalls. He was alone as there is a shortage of labour even for low end jobs.
"Why your neighbour did not open?" I asked.
"He has closed shop."
"You  must have killed his business," I replied. Ah Pui has a large variety of fruits from various countries and he is at the corner. He seems to have lots of clients while the neighbour has less.
"He has closed shop."
"How much is the rental of one fruit stall?" I asked.
"$5,000 for my 4 stalls," he said. "My monthly expenses is $10,000. The neighbours could have closed for various reasons."
"Did he offer the stalls to you?"
"No," he said. "But too many stalls can make me bankrupt. He has 6 stalls."
Competition exists everywhere. The bigger the business, the more difficult to survive if there are few clients. The same applies to vet pracices.

I also bought my favourite leafy vegetables from another stall. "Singapore grown," the man said. I thought Singapore farms are non-existent.

It is nice to visit the wet market now and then. I went there to buy the fruits. Didn't bring my camera.
   

1368. Follow up: The old rabbit with sarcoma above the left eyelid has 2 more lumps

April 15, 2013

Yesterday, the rabbit with sarcoma above the left eyelid was operated by Dr Daniel. "There may not be sufficient space to stitch after excision of the two lumps above the upper eyelid of the rabbit's left eye," he said. The lumps were growing fast and were 5 mm x 5 mm x 3 mm and the two ladies came early this time instead of "wait and see".

The first lump, diagnosed as a sarcoma by histology was 10 cm x 8 cm x 8 cm, in the front part of the upper eyelid. It was excised over one month ago. There seemed to be a recurrence as there was a sharp lump on the operation site. It turned out to be a bony prominence when Dr Daniel operated.

"If there is insufficent skin to stitch," I said. "Let the skin wound heal by granulation. It is better to excise a wide margin to get rid of the cancerous cells in the area."
This would be my approach. It is easier said than done.

As each vet has his or her own approach, much depends on the vet. Dr Daniel excised the two lumps and stitch up the skin wound. This time the two ladies seek veterinary surgery early but not early enough. I had told them to scrutinise for lumps daily. Apparently the first lump did not recur but only time will tell. The grey and white rabbit is 10 years old.

He had jaw abscesses (see my earlier case report somewhere in the blog) and now has fully recovered after drainage. The older baby-boomer generation would likely have abandoned this rabbit and euthanase it rather than spending money on surgeries.

1367. Veterinary jobs in Singapore





On Mon, Apr 15, 2013 at 8:41 AM, Suzanne Ou <ou.suzanne@gmail.com> wrote:
Dear Dr Daniel Sing and Dr Sing Kong Yuen,

I am Suzanne Ou, Chairperson of the Raffles Society of Biological Sciences in Raffles Institution (Junior College). As the largest Science Club CCA in RI, we aim to offer members a broad view of all fields of Biology, as such, we hope to invite you down to for a talk on veterinary sciences on 25th April 2013, Thursday, 5.30 - 6.30 pm.

As the seniors are preparing for A levels and choosing a career path, we hope that you will be able to share about what is it like being a vet as well as studying for it in university. One of our alumni, Gina Ng, mentioned that her internship with your clinic was very interesting, and we hope to know more about the surgeries you conduct and about the cases you encounter.

We sincerely hope that both of you will be able to come and we look forward to your favourable reply.

Thank you!

Regards,
Suzanne Ou
Chairperson of Raffles Society of Biological Sciences
--------------------------------

April 16, 2013

Thank you for your invitation. I am Dr Sing Kong Yuen, from Toa Payoh Vets, www.toapayohvets.com. It is a small animal practice. 

I have asked Dr Daniel Sing to be present and give a talk on the small animal practice if he agrees to it.

Briefly, some information is provided.

Veterinary science offers numerous opportunities for Singaporeans. The field of work involves the regulatory aspect (e.g Agri-foold and Veterinary Authority and other institutions), research (pharmacology companies, sales, laboratory animals), education (teaching and universities, case studies and research) and clinical work (avian, fishes, small animal, large animals practices e.g small animal practices, aquariums, the zoo and bird park). There are overseas work opportunities if the country's immigration laws accept that foreigner veterinarians are welcome. Some countries like the UK have closed the doors in 2013.

Renumeration as a new employee graduate in Singapore 2013 ranges from S$3,000 - $4,000/month. The cost of a 5-year overseas undergraduate veterinary education as in 2013 will be from S$300,000 - S$600,000. Academic excellence as a veterinary graduate, as in all professions, still opens doors to choice employers. There are over 50 small animal practices in Singapore in 2013 with more being opened. Vacancies for new graduates are low presently if the graduate wants to work in small animals (mainly dogs and cats).       

Singaporeans can only study in AVA-accredited vet universities overseas if they want to practise in Singapore as a licensed vet. The countries are usually Australia, New Zealand, UK and the USA.

I hope the info will be of use for your talk.

Monday, April 15, 2013

April 13, 2013. Saturday's interesting case: A transgender or bisexual Japanese spitz?

I work from 8.30 am to around 11 am on Saturdays and sometimes encounter interesting cases.

On this Saturday, April 13, 2013, the owner brought in the 2-year-old Japanese Spitz for vaccination.

"It is abnormal to see dark reddish hairs around the vulval area," I said to the lady owner and spayed the dog two weeks ago. 
"My other Spitz that had died had this too," she replied.
I noted that this dog had a much smaller vulval lips, almost hidden unlike normal female dogs. Why would this young female dog be continuously licking her private parts several times a day for many months? The saliva stains tainted the hairs around the region to a dark red brown.

"Is there a urinary tract infection (UTI)?" I asked the owner. "Does she pee a lot?"
"Not a lot, but she sometimes lie on her urine."
"If the dog keeps on licking for many years, the vulval area would become black and scaly like a crocodile skin," I said. "I had seen such cases in one old female dog."

I turned the dog upside down with the help of the owner and my assistant. I parted the vulval lips and there inside the vestibule was a large mass of around 1.5 cm x 1 cm. Was this the irritating cause of the licking? I had images taken. This appeared to be an enlarged clitoris. So was the dog self-stimulating or was she trying to lick away the abnormal sized organ?

Is this a transgender or bisexual dog? What's the solution?  I advised surgical excision of the swelling so that the female dog can pee normally. Surgery is scheduled 3 weeks later. Usually I don't perform a much more detailed visual examination of the inner parts of the vagina and I believe most vets don't do it too. So some of such cases are mis-diagnosed as UTI which was what I suspected.

Update: The Yorkshire wakes the owner up at 3 am - false pregnancy

TOA PAYOH VETS
toapayohvets.com

Date:   15 April, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
False pregnancy, retained deciduous canine and right flank lump 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   15 April, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Sunday, April 7, 2013

1354. Sunday's interesting cases. The yorkshire wakes up the owner at 3 am every morning

Two ladies in their 40s brought their 2-year-old Yorkshire Terrier to me as the dog would not eat again.

"There is milk from her breast," I showed the thick creamy white nipple discharge. "She has false pregnancy and the hormones affect her appetite."
"Are you sure it is not pus?" the lady asked.
"No, it is milk."

"But she is not pregnant!" the ladies protested.

"That is why the condition is called false pregnancy. You will observe that she will pick up and carry or protect a toy or piece of cloth for the past few days."

"Yes, yes," she said. "At 3 am for the past few days, she wanted me to wake up so that she could go out of the room to pick up the yellow toy crocodile. At one time, she would growl if I touch it. She would carry the croc upside down. Much earlier, she wolfed down the canned food she used to hate!"

"These are abnormal behaviour signs of false pregnancy," I replied.

The owner had brought along the toy croc and I took an image of it. The Yorkshire was not interested in it now and growled at me.

I advised spay later but the owner wanted a puppy from her.
"It is hard to find a sire," she said.
"I can introduce you to a breeder," I said. "You know that some dogs do die from giving birth or pregnancy, like people?"
She knew the risks and that Yorkshire requires Caesarean sections usually.

UPDATE:  Sunday April 14, 2013
The owner was more worried about the flank lump which appeared to grow bigger and bigger. So, today was scheduled for surgery. The Yorkshire was operated today by Dr Daniel to remove the right flank abscessed lump, four retained canine teeth were extracted. I was present at the surgery as a mentor.

 "Make a much longer skin incision more caudally," I said to Dr Daniel who told me that the "subcutaneous lump" was not located under the skin. It was deeper inside the muscles.

"A subcutaneous lump is a lump under the skin," I explained. "In this dog, it is not exactly under the skin. It had some parts under the muscles. That is why a longer skin incision is necessary. The vet needs to remove the whole lump or abscess, otherwise the owner can feel any remnant and will not be happy."

This lump was over 2 cm x 2 cm x 1 cm and was yellow in colour. "It is an abscess probably due to a subcutaneous injection," I said. Dr Daniel made a bigger incision and stitched up with horizontal mattresses using 3/0 nylon. The lump would shown to the owner later and as she did not want histopathology, this advice would be recorded..  

As for the false pregnancy, the solution to prevent further occurrences would be to spay the dog. As for the yellow crocodile, the Yorkshire has lost some interest in it.
  
Update will be on this webpage:

http://www.sinpets.com/stories/20130415false_pregnancy
_flank_lump_retained_teeth.htm

More info at:
Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: April 15, 2013

Toa Payoh Vets