Tuesday, February 25, 2014
Monday, February 24, 2014
1341. Exploratory laparotomy in an old dwarf hamster - recto-vaginal fistula - a rare case
Sunday Feb 23, 2014's interesting case.
TP 44844
Dwarf hamster, F, 2.5 years, 39 g
"My dwarf hamster passed blood in the stools for the last 2 days," the gentleman said.
"Did she pass the normal stool pellets?" I asked.
"None at all in the last 2-3 days. Maybe, a small pellet recently."
"Any urine passed?" I asked as this hamster had a swollen abdomen as if she was pregnant.
"I was overseas for the last 2 weeks and my family members fed her chym sim instead of the normal hamster pellets and seeds."
Blood appeared in the vulval area but the owner said the hamster passed blood in the stools. So, there should be blood in the anus. A case of wet tail well known amongst hamster owners. Yet I saw blood in the vulval area and the anal opening appeared abnormally small. After all, this was a dwarf hamster and I don't see anal openings in all hamsters I examined, unlike in the dog and cat. So, I did not think of atresia ani - the failure of the anus to open during development. This was a 2.5-year-old hamster with no complaint of stools or diarrhoa.
No stools were passed but bloody diarrhoea for the past 2 days. An old female dwarf hamster. Bleeding from the vagina. This would be a case of pyometra as in old female dogs not spayed.
The high risk solution would be to spay the dwarf hamster to stop uterine bleeding and death. I have never spayed a hamster. I doubt almost all vets do not spay dwarf hamsters. It is just too risky. I asked Dr Daniel if he would do it. "No," he said firmly. I told the owner that this hamster is old and the risk is just too high. She would die. He said to go ahead. I said this was inoperable.
The hamster's abdomen was very swollen. She would die if not operated. If operated, she might or might not die. Likely to die. An exploratory laparotomy to open the abdomen to check and remove the uterus. The anaesthesia must be just right. Not too little as the hamster would move. Not too much as the hamster would be dead. How much is not too little or too much?
I gave Zoletil 50 0.01 ml IM. Insufficient. Too little. The hamster looked at me. I put her under 5% isoflurane gas + Oxygen till she appeared drowsy. Not more than a few seconds. She did not struggle during the surgery.
The colon was over-distended, probably due to twisting. I massaged it and copious amount of red bloody stools flowed out (see image). I closed the abdomen with 6/0 sutures interrupted. The hamster was drowsy. I injected 0.2 ml Hartmann + glucose + baytril. It was already 5 pm on this fine Sunday afternoon of Feb 23, 2014. The hamster was alive but for how long?
On Monday, at 9 am, she was alert and walking. The tissue papers were blood stained in several areas. Those were bloody stools still passed out after surgery. I took videos.
.
TP 44844
Dwarf hamster, F, 2.5 years, 39 g
"My dwarf hamster passed blood in the stools for the last 2 days," the gentleman said.
"Did she pass the normal stool pellets?" I asked.
"None at all in the last 2-3 days. Maybe, a small pellet recently."
"Any urine passed?" I asked as this hamster had a swollen abdomen as if she was pregnant.
"I was overseas for the last 2 weeks and my family members fed her chym sim instead of the normal hamster pellets and seeds."
Blood appeared in the vulval area but the owner said the hamster passed blood in the stools. So, there should be blood in the anus. A case of wet tail well known amongst hamster owners. Yet I saw blood in the vulval area and the anal opening appeared abnormally small. After all, this was a dwarf hamster and I don't see anal openings in all hamsters I examined, unlike in the dog and cat. So, I did not think of atresia ani - the failure of the anus to open during development. This was a 2.5-year-old hamster with no complaint of stools or diarrhoa.
No stools were passed but bloody diarrhoea for the past 2 days. An old female dwarf hamster. Bleeding from the vagina. This would be a case of pyometra as in old female dogs not spayed.
The high risk solution would be to spay the dwarf hamster to stop uterine bleeding and death. I have never spayed a hamster. I doubt almost all vets do not spay dwarf hamsters. It is just too risky. I asked Dr Daniel if he would do it. "No," he said firmly. I told the owner that this hamster is old and the risk is just too high. She would die. He said to go ahead. I said this was inoperable.
The hamster's abdomen was very swollen. She would die if not operated. If operated, she might or might not die. Likely to die. An exploratory laparotomy to open the abdomen to check and remove the uterus. The anaesthesia must be just right. Not too little as the hamster would move. Not too much as the hamster would be dead. How much is not too little or too much?
I gave Zoletil 50 0.01 ml IM. Insufficient. Too little. The hamster looked at me. I put her under 5% isoflurane gas + Oxygen till she appeared drowsy. Not more than a few seconds. She did not struggle during the surgery.
The colon was over-distended, probably due to twisting. I massaged it and copious amount of red bloody stools flowed out (see image). I closed the abdomen with 6/0 sutures interrupted. The hamster was drowsy. I injected 0.2 ml Hartmann + glucose + baytril. It was already 5 pm on this fine Sunday afternoon of Feb 23, 2014. The hamster was alive but for how long?
On Monday, at 9 am, she was alert and walking. The tissue papers were blood stained in several areas. Those were bloody stools still passed out after surgery. I took videos.
.
Saturday, February 22, 2014
1340. Myanmar stories - The nursing aide shortage in Singapore
Saturday Feb 21, 2014
On Thursday, I met an employment agent at Khin Khin Employment Agency. Vitalline would be around 60 years old and specialises in placement of nurses and nursing assistants.
He came to get a letter from Khin Khin's company in Myanmar to apply for a business visa to visit Myanmar to interview nursing assistants. A business visa permits mulitple entries but he had not been to Myanmar for the last 2 years since he had a good supply. But in 2014, he has a drought as the government tightens the rules owing to social discontent with too many foreigners.
"When I asked the Myanmar agents, they would supply me one or none," he lamented. So, he sought Khin Khin's help, offering $600 in wages and $500 for accommodation. Khin Khin, being a Myanmarese, knows all the employment agents in Yangon and could communicate with them anytime. She said she could get at least 20 prospects. The veteran would meet the agents when he goes to Myanmar on Feb 27, 2014 but he needed a Myanmar company to sponsor him for the visa application. So, Khin Khin asked me to help write this letter and I had the draft to her manager Soe. .
I re-typed Soe's letter to inform the embassy that he would be invited to Myanmar for a business discussion as her assistant could not or would not learn how to type a business letter. His layout of the letter was bad. He typed Vitalline's name in Capital letters. Instead of wasting time, I just typed the letter for him.
"Your letter is written well, like a Singaporean," he complimented me. He was a busy man and any person in Khin Khin's office must be Myanmarese since they appear to speak Greek amongst themselves. English grammar is hard to master but the Myanmar language is even harder.
Singapore's population is aging and locals don't want to be nursing assistants. So, there is a great demand for such workers. Myanmar is prospering in the last 2 years and so only high wages would attract some to come. The worry is people trafficking and Vitalline could be charged for that offence if he goes toYangon to do his own interviews without licensed employment agents there. He can't just advertise and meet the prospects.
On the very next afternoon, I was at Khin Khin's office. Two ladies working in Singapore as nursing aides came to enquire about jobs. Khin Khin shouted at them for some reasons. "They are just wasting my time fishing and asking lots of questions," she told me.
"How do you expect them to get jobs if they don't ask questions. Be patient," I advised. "These are 2 prospects for Vitalline and you need not share the commission with your Yangon agent!" Sometimes, I think Khin Khin has no business acumen. Or she just want mega deals like the real estate development of $45 million dollars she had handled, taking so much time and not closing.
I talked to the 2 ladies asking them how much they are paid as work permit holder and how many years they had worked. "$350 with free food and lodging," the younger one had worked a few months.
"The offer is $600 and $500 for lodging," Khin Khin had a carrot for them. So they would be referred to Vitalline and would get better pay.
On Thursday, I met an employment agent at Khin Khin Employment Agency. Vitalline would be around 60 years old and specialises in placement of nurses and nursing assistants.
He came to get a letter from Khin Khin's company in Myanmar to apply for a business visa to visit Myanmar to interview nursing assistants. A business visa permits mulitple entries but he had not been to Myanmar for the last 2 years since he had a good supply. But in 2014, he has a drought as the government tightens the rules owing to social discontent with too many foreigners.
"When I asked the Myanmar agents, they would supply me one or none," he lamented. So, he sought Khin Khin's help, offering $600 in wages and $500 for accommodation. Khin Khin, being a Myanmarese, knows all the employment agents in Yangon and could communicate with them anytime. She said she could get at least 20 prospects. The veteran would meet the agents when he goes to Myanmar on Feb 27, 2014 but he needed a Myanmar company to sponsor him for the visa application. So, Khin Khin asked me to help write this letter and I had the draft to her manager Soe. .
I re-typed Soe's letter to inform the embassy that he would be invited to Myanmar for a business discussion as her assistant could not or would not learn how to type a business letter. His layout of the letter was bad. He typed Vitalline's name in Capital letters. Instead of wasting time, I just typed the letter for him.
"Your letter is written well, like a Singaporean," he complimented me. He was a busy man and any person in Khin Khin's office must be Myanmarese since they appear to speak Greek amongst themselves. English grammar is hard to master but the Myanmar language is even harder.
Singapore's population is aging and locals don't want to be nursing assistants. So, there is a great demand for such workers. Myanmar is prospering in the last 2 years and so only high wages would attract some to come. The worry is people trafficking and Vitalline could be charged for that offence if he goes toYangon to do his own interviews without licensed employment agents there. He can't just advertise and meet the prospects.
On the very next afternoon, I was at Khin Khin's office. Two ladies working in Singapore as nursing aides came to enquire about jobs. Khin Khin shouted at them for some reasons. "They are just wasting my time fishing and asking lots of questions," she told me.
"How do you expect them to get jobs if they don't ask questions. Be patient," I advised. "These are 2 prospects for Vitalline and you need not share the commission with your Yangon agent!" Sometimes, I think Khin Khin has no business acumen. Or she just want mega deals like the real estate development of $45 million dollars she had handled, taking so much time and not closing.
I talked to the 2 ladies asking them how much they are paid as work permit holder and how many years they had worked. "$350 with free food and lodging," the younger one had worked a few months.
"The offer is $600 and $500 for lodging," Khin Khin had a carrot for them. So they would be referred to Vitalline and would get better pay.
1339. Singapore stories. The girl with a tattooed "sleeve"
Saturday Feb 21, 2014 9.20am
I took the subway since my car is being borrowed by a young man whose friend is getting married. It is refreshing and good exercise to walk in the bright sunshine morning, taking bus and train to my office.
On the train, I saw a "red head" slim girl in bright green dress, fair complexion, eye lashes long, her reddish brown hair shining in the sunlight. Finger nails with the additional false patterned nails, except her forefinger. Blue shoulder bag on right shoulder and left shoulder has a black bag. Pink slippers. Toes painted green. I noticed Digit 4 on both legs were clubbed. From the right side, I thought she wore an unusual sleeved blouse with a fierce-looking skull and grinning teeth. It was a tattoo on her right upper arm. The left arm was bare. A tattoo appeared from the left cleavage, peeping from the neck line of her dress. 2 red ear pieces attached to her smartphone as she furiously scrolled the screen. Age around late 20s. Unlikelys to be going downtown to work. I alighted at Toa Payoh station and she was still scrolling.
On alighting from the bus 238 opposite the Hindu temple, I met one industrial park tenant who sells plumbing and pipes."What's happened to the old man book-binder?" This man wanted to retire and had asked me for $40,000 to take over. New HDB rulings say that the new tenant will have to return the shop and not assign. So we thought he would have no takers. He had an offer of $25,000 from the air-cond neighbour.
"Well, he does not open on Saturday. In fact he will close in July."
"How much did he sell his shop?" I asked.
"$45,000," he said. "Two lady realtors came and got him to close the deal."
The 75-year-old man got what he wanted and $5,000 more. He did not need to work and his children had asked him to stop work. He was working half-day anyway and had some orders from the government to bind books for funeral services of important people. There was no more apprentices like him to learn the trade and so all skills are gone. At least he has got $45,000 to smell the roses. Realtors who walk the neighbourhood can be quite successful in closing deals too.
I took the subway since my car is being borrowed by a young man whose friend is getting married. It is refreshing and good exercise to walk in the bright sunshine morning, taking bus and train to my office.
On the train, I saw a "red head" slim girl in bright green dress, fair complexion, eye lashes long, her reddish brown hair shining in the sunlight. Finger nails with the additional false patterned nails, except her forefinger. Blue shoulder bag on right shoulder and left shoulder has a black bag. Pink slippers. Toes painted green. I noticed Digit 4 on both legs were clubbed. From the right side, I thought she wore an unusual sleeved blouse with a fierce-looking skull and grinning teeth. It was a tattoo on her right upper arm. The left arm was bare. A tattoo appeared from the left cleavage, peeping from the neck line of her dress. 2 red ear pieces attached to her smartphone as she furiously scrolled the screen. Age around late 20s. Unlikelys to be going downtown to work. I alighted at Toa Payoh station and she was still scrolling.
On alighting from the bus 238 opposite the Hindu temple, I met one industrial park tenant who sells plumbing and pipes."What's happened to the old man book-binder?" This man wanted to retire and had asked me for $40,000 to take over. New HDB rulings say that the new tenant will have to return the shop and not assign. So we thought he would have no takers. He had an offer of $25,000 from the air-cond neighbour.
"Well, he does not open on Saturday. In fact he will close in July."
"How much did he sell his shop?" I asked.
"$45,000," he said. "Two lady realtors came and got him to close the deal."
The 75-year-old man got what he wanted and $5,000 more. He did not need to work and his children had asked him to stop work. He was working half-day anyway and had some orders from the government to bind books for funeral services of important people. There was no more apprentices like him to learn the trade and so all skills are gone. At least he has got $45,000 to smell the roses. Realtors who walk the neighbourhood can be quite successful in closing deals too.
Thursday, February 20, 2014
1338. The old Terrier from Bukit Batok could not stand on his hind legs for 2 days
I was surprised to see this 14-year-old Terrier X from Bukit Batok again, as many dog owners will go to the nearest vet and now there are 60 vet surgeries in Singapore.
The dog recovered the next day and I sms the young lady owner as she did not answer her phone. She sms back. We don't talk by phone nowadays, esp with busy young people.
1336. Myanmar stories: Tonsillolith. Fortune teller's prediction was accurate
Feb 19, 2014
Khin Khin had profuse bleeding in her mouth, with "large clots" coming out while she was in Myanmar for a few weeks to attend to her 92-year-old aged mother's affairs and business. She consulted the famous fortune teller whom I had met in Feb 2014 on a visit to his farm with Khin Khin. "He said not to worry, nothing serious."
I have an open mind. Some people may have the gift of telling the future. In Singapore, the kind-hearted Dr Chan from SGH's Otorlaryngoloy Department examined her early instead of Mar 19, 2014. She was worried about oral cancers growing in her mouth and sought my help to get an earlier appointment. "Nothing to worry about," Dr Chan told her. "If you wish, go for a neck MRI but it is not necessary. You have got a tonsillolith in your right tonsils." That is the diagnosis. For Khin Khin, the explanation was a "stone". A stone in the crypt of the tonsils causing bleeding which has stopped recently.
"Why is it that I can get a tonsil stone?" Khin Khin asked me.
"I don't know," I viewed the image of the tonsils taken by Dr Chan's nasal endoscopy to look for the stones. "Some people get bladder stones or gall bladder stones. I have not heard of anybody getting tonsillar stones. His report says it is on the right tonsil. Did you bleed from the right side of the mouth? "
"Yes," she felt her right mandibular area. "Right side."
Khin Khin had profuse bleeding in her mouth, with "large clots" coming out while she was in Myanmar for a few weeks to attend to her 92-year-old aged mother's affairs and business. She consulted the famous fortune teller whom I had met in Feb 2014 on a visit to his farm with Khin Khin. "He said not to worry, nothing serious."
I have an open mind. Some people may have the gift of telling the future. In Singapore, the kind-hearted Dr Chan from SGH's Otorlaryngoloy Department examined her early instead of Mar 19, 2014. She was worried about oral cancers growing in her mouth and sought my help to get an earlier appointment. "Nothing to worry about," Dr Chan told her. "If you wish, go for a neck MRI but it is not necessary. You have got a tonsillolith in your right tonsils." That is the diagnosis. For Khin Khin, the explanation was a "stone". A stone in the crypt of the tonsils causing bleeding which has stopped recently.
"Why is it that I can get a tonsil stone?" Khin Khin asked me.
"I don't know," I viewed the image of the tonsils taken by Dr Chan's nasal endoscopy to look for the stones. "Some people get bladder stones or gall bladder stones. I have not heard of anybody getting tonsillar stones. His report says it is on the right tonsil. Did you bleed from the right side of the mouth? "
"Yes," she felt her right mandibular area. "Right side."
Tuesday, February 18, 2014
1335. AUDIT. A female Sheltie had blood in the urine 6 years ago
TP XX761
Sheltie, F, Born Sep 28, 2006
Feb 18, 2014. Owner came to buy a small 2 kg bag of canine C/D. His last purchase of a small bag was in Nov 29, 2013. I met him and he explained that he purchases C/D from the associate vet in Jurong whose practice is near his office and only when there is no stock, he would come to Toa Payoh Vets.
So far the dog is OK but no urine tests have been done.
"It is difficult to collect the urine from a female dog," he said today when I advised urine test.
Some owners can do it but it needs patience. The vet could collect using urethal catheterization but most owners are not keen.
"Use a syringe to suck up the urine after she pees," I said since this was a compromise. "Will it be suitable for testing?"
"It is cheaper to buy the C/D diet," the man in his late 50s told me. "The operation done by your vet in Jurong costs me $2,000. A big stone of over 2 cm plus several small ones were removed and also seen in the X-ray." I got the clinic to send over to me the stone analysis and tests. The stones were struvites. The dog could not pee and so the owner wanted an urgent operation in April 5, 2013.
On review of the medical records, the dog had "smelly urine" in Aug 3, 2008. The owner had some antibiotics and did not have any complaints till April 2013 when the dog could not pee. It is hard to get owners to do the urine tests which will be best practice to check for urinary tract infection and pH.
They prefer just to buy the prescription diet and that's it.
Sheltie, F, Born Sep 28, 2006
Feb 18, 2014. Owner came to buy a small 2 kg bag of canine C/D. His last purchase of a small bag was in Nov 29, 2013. I met him and he explained that he purchases C/D from the associate vet in Jurong whose practice is near his office and only when there is no stock, he would come to Toa Payoh Vets.
So far the dog is OK but no urine tests have been done.
"It is difficult to collect the urine from a female dog," he said today when I advised urine test.
Some owners can do it but it needs patience. The vet could collect using urethal catheterization but most owners are not keen.
"Use a syringe to suck up the urine after she pees," I said since this was a compromise. "Will it be suitable for testing?"
"It is cheaper to buy the C/D diet," the man in his late 50s told me. "The operation done by your vet in Jurong costs me $2,000. A big stone of over 2 cm plus several small ones were removed and also seen in the X-ray." I got the clinic to send over to me the stone analysis and tests. The stones were struvites. The dog could not pee and so the owner wanted an urgent operation in April 5, 2013.
On review of the medical records, the dog had "smelly urine" in Aug 3, 2008. The owner had some antibiotics and did not have any complaints till April 2013 when the dog could not pee. It is hard to get owners to do the urine tests which will be best practice to check for urinary tract infection and pH.
They prefer just to buy the prescription diet and that's it.
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