Friday, August 1, 2014
Tuesday, July 29, 2014
1432. Talk to Vet students in Yesin University - An emaciated terrapin
July 29, 2014 Female terrapin, F, 2 years. A retiree said that this turtle is very intelligent and responsive and felt it would be a pity to abandon her in the reservoirs.
April 25, 2014. Seen by Dr Daniel. Came in for swollen eyes for 5 days. Inappetant for 2 weeks. Active.
Diagnosis: Eyes swollen. Baytril oral and Neodeca eye drops. Weight - Not done.
April 27, 2014. Bought Baytril oral.
Jun 10, 2014. Seen by me.Weight 405g. Lethargic. Anorexic occasionally. Eyes closed. Limbs swollen.
Respiratory distress. poor prognosis. Inj baytril+ pred, fruesmide oral, mltivit, baytril + pred.
VIDEO
http://www.youtube.com/watch?v=lsVyOOHvJ9w&feature=youtu.be
http://www.youtube.com/watch?v=xrP8RXqZ15k
Jun 20, 2014. Bought Baytril + Pred oral.
Jul 29, 2014. Today. Very weak. Emaciated (shrunked abdomen seen inside shell). Eyes closed but not swollen. Right elbow ventral has necrotic wound. So, she can't walk. Excise necrotic tissue 5 mm x 5 mm x 3 mm. No gasping for breath.
ADVISED.
1. Insufficient feeding by hand twice a day. Turtle would eat when hand fed. Liked shrimps. I gave her a packet of turtle pellets to feed 8X/day, not 2x/day. Gave her a 1-ml syringe.
2. Sunshine to warm her and strengthen her immune system.
3. Water to swim.
This case shows that the turtle had recovered but was underfed. Emaciated but as she is young, she is resilient.
1431. Talk to Vet Students in Yesin Vet University - Traumatic proptosis in a 15-year-old Chihuahua
DRAFT
Best of friends but 2 days ago, the cross-bred pounced on this 15-year-old Chihuahua. When the owner came home, the eyeball was dirty and the cornea was yellowish with pus (IMAGE).
Traumatic proptosis - Forward displacement of the eye with eyelids entrapped behind the eye, due to injury.
Video by Teri
TREATMENT
Dog is still eating
No injectable sedation as dog is so old
Atropine 0.2 ml IM and 0.2 ml SC
Anaesthesia gas isoflurane + O2 only.
Scissors cut lateral canthus 1 cm long, eyelids entrapped are released
2 catheter tubes 3/0 nylon
Inj pred + genta subconj. Eye ointment into eye.
Push eyeball inward by pressing and pull stitches outwards
Stitched
Post op tolfedine + baytril
Dog woke up fast and made some vocalisation for 3 minutes. OK now. 4.30 pm
Try to save the eye by replacement of the prolapsed eyeball rather than take it out. Looks bad and had wanted to take it out. . .
Eye injuries are emergencies and treatment is best done within 4 hours of injury. Now the dog has had rubbed her right eye severely till it looked horribly red and dry with pus.
"This is a very old dog. She may just die on the operating table," I informed the lady. "You have two alternatives. To replace the eyeball or to get me to remove it. I cannot guarantee that the dog will regain her normal vision as the eyeball looks infected with pus and so a second surgery may be needed to remove it if there is infection after replaement."
This procedure is "Informed Consent" and the lady must know the risks and sign the Consent to anaesthesia and surgery..
"What should I do?" the lady owner had to decide whether to replace or enucleate the eyeball.
"I can't decide for you," I replied. "If the eyeball had come out within 4 hours of injury, I will advise pushing it back to save her vision. But you waited too long. Over 24 hours and the eyeball looked badly infected with pus."
"What would you do?".
"If she is my dog, I would try to save the vision."
I could not guarantee that the replacement of the globe would result in the dog getting back her normal vision as the owner had delayed treatment by more than 24 hours. Her big mixed breed dog had pounced on this 15-year-old Chihuahua and the eyeball had prolapsed. The diagnosis is traumatic proptosis.
Best of friends but 2 days ago, the cross-bred pounced on this 15-year-old Chihuahua. When the owner came home, the eyeball was dirty and the cornea was yellowish with pus (IMAGE).
Traumatic proptosis - Forward displacement of the eye with eyelids entrapped behind the eye, due to injury.
Video by Teri
TREATMENT
Dog is still eating
No injectable sedation as dog is so old
Atropine 0.2 ml IM and 0.2 ml SC
Anaesthesia gas isoflurane + O2 only.
Scissors cut lateral canthus 1 cm long, eyelids entrapped are released
2 catheter tubes 3/0 nylon
Inj pred + genta subconj. Eye ointment into eye.
Push eyeball inward by pressing and pull stitches outwards
Stitched
Post op tolfedine + baytril
Dog woke up fast and made some vocalisation for 3 minutes. OK now. 4.30 pm
Try to save the eye by replacement of the prolapsed eyeball rather than take it out. Looks bad and had wanted to take it out. . .
Eye injuries are emergencies and treatment is best done within 4 hours of injury. Now the dog has had rubbed her right eye severely till it looked horribly red and dry with pus.
"This is a very old dog. She may just die on the operating table," I informed the lady. "You have two alternatives. To replace the eyeball or to get me to remove it. I cannot guarantee that the dog will regain her normal vision as the eyeball looks infected with pus and so a second surgery may be needed to remove it if there is infection after replaement."
This procedure is "Informed Consent" and the lady must know the risks and sign the Consent to anaesthesia and surgery..
"What should I do?" the lady owner had to decide whether to replace or enucleate the eyeball.
"I can't decide for you," I replied. "If the eyeball had come out within 4 hours of injury, I will advise pushing it back to save her vision. But you waited too long. Over 24 hours and the eyeball looked badly infected with pus."
"What would you do?".
"If she is my dog, I would try to save the vision."
I could not guarantee that the replacement of the globe would result in the dog getting back her normal vision as the owner had delayed treatment by more than 24 hours. Her big mixed breed dog had pounced on this 15-year-old Chihuahua and the eyeball had prolapsed. The diagnosis is traumatic proptosis.
Sunday, August 3, 2014. Stitches removed. Eyeball is white but had returned to the socket. Owner informed. Vision is probably 10% but the dog has the eye.
1430. A 7-year-old Shih Tzu has a large wrist lump
Hari Raya Puasa on Jul 28, 2014. Around 10 cases seen as most vet clinics are closed.
Interesting one of a Shih Tzu, Male, 7 years coming in with a large wrist lump. "About one week," the owner said.
"If it is one week and growing so large at 8 cm x 6 cm x 6 cm," I replied. "It is not good news as cancerous cells grow very fast. I need X-rays to check whether the bones are infiltrated or involved."
X-rays show normal bones. So it was good news.
"Surgical excision may result in the dog being lame on the right fore limb," I warned. "Unless the lump is one solid ball sized and dissected out using electro-excision & cautery carefully."
Owner opted for anti-inflam injection into the lump and wait for 2 weeks.
2 pm Videoed by Teri
Sedate 50% D+ K IV
Needle aspiration - 0.1 ml of blood but nothing else. No pus or brown fluid. Likely tissues.
Intra-lesion inj of pred 0.5 ml
Bandage carpal area for 3 days
Interesting one of a Shih Tzu, Male, 7 years coming in with a large wrist lump. "About one week," the owner said.
"If it is one week and growing so large at 8 cm x 6 cm x 6 cm," I replied. "It is not good news as cancerous cells grow very fast. I need X-rays to check whether the bones are infiltrated or involved."
X-rays show normal bones. So it was good news.
"Surgical excision may result in the dog being lame on the right fore limb," I warned. "Unless the lump is one solid ball sized and dissected out using electro-excision & cautery carefully."
Owner opted for anti-inflam injection into the lump and wait for 2 weeks.
Sedate 50% D+ K IV
Needle aspiration - 0.1 ml of blood but nothing else. No pus or brown fluid. Likely tissues.
Intra-lesion inj of pred 0.5 ml
Bandage carpal area for 3 days
Monday, July 28, 2014
1429. Yesin Vet Students Talk - Aug 11, 2014. Blood in the stools - check for parvovirus
As many Singapore dog owners do not vaccinate their older dogs, it is best practice to check for parvovirus when a dog passes blood in the stools. I have such adult dogs who have been to boarding purging with blood in the stools. They were positive for parvovirus.
It may be deemed negligent of the vet to overlook the test for parvovirus which is a fatal disease. Inform the owner about the test and if the owner does not want it, the vet should record this in his case notes. Should the dog be diagnosed with parvovirus by another vet when the dog continues passing bloody stools, the owner and his family may complain that the first vet was incompetent. Keeping good medical records on such advices protects the first vet against claims for compensation.
.
Sunday, July 27, 2014
1428. Yesin Vet University talk to final year students. Aug 11, 2014 - tips on neutering
July 27, 2014
TALK TO FINAL YEAR VET STUDENTS - YESIN VET UNIVERSITY, MYANMAR
Employee vets
Each vet has his or her own way of doing surgery and using anaesthesia and sutures.
Case study of post-op complications: Neutering of a poodle in Toa Payoh Vets.
MY SURGICAL TECHNIQUE
Day surgery
Age: 6 months and above
With-holding food and water: 10 hours before admission in the morning
1. Prepare for surgery, knowing the standard operature procedure as follows:
1. Physical examination, body weight and rectal temperature for fever.
2. Blood test to screen the health of the dog. Optional.
3. Palpate and express urinary bladder if it is full.
4. Pre-scrotal area clipped in preparation room.
5. I/V Domitor + Ketamine based on Domitor 0.4 ml + Ketamine 0.5 ml for a young 10-kg dog.
6. Isoflurane + Oxygen gas top up if necessary.
7. Incise pre-scrotal area. Not too high up. Incision 1.5 -2 cm for small breed.
8. Expose testicle.
9. Clamp and cut cremaster muscle ligament.
10.3-haemostats clamping. Ligate twice for spermatic vessels.
11. Stitch skin 3 stitches. Starting from the middle of the wound.
Illustration.
Economics
Polysorb 2/0 or 3/0 one packet S$12.80 = 9,216 kyats
Monosyn 2/0 or 3/0 one packet S$12.40 = 8, 928 kyats
One S$= 720 kyats
CASE STUDY
3 weeks post-neuter. Complaint of vomiting now and then.
Dog is active, eats well, no fever.
No pain in surgical area of pre-scrotal.
Bites or growls when couple touches the pre-scrotal area
Sedate D+K 0.05 + 0.06 ml IV
Clean
Prescrotal area preferred rather than over the bulb. 2/0 polysorb. Too tight? Remove stitches
Deep and buried - stitch abscess? No pain on palpation but dog bites/growls owner who attempted to clean the wound.
Inguinal right. 3/0 monosyn filament. No inflammation. Stitches taken out.
VIDEO
CONCLUSION
Post-op complications like infection or stitch abscess do occur.
Economics is important as rentals and staff overheads increase yearly.
Much depends on
TALK TO FINAL YEAR VET STUDENTS - YESIN VET UNIVERSITY, MYANMAR
Employee vets
Each vet has his or her own way of doing surgery and using anaesthesia and sutures.
Case study of post-op complications: Neutering of a poodle in Toa Payoh Vets.
MY SURGICAL TECHNIQUE
Day surgery
Age: 6 months and above
With-holding food and water: 10 hours before admission in the morning
1. Prepare for surgery, knowing the standard operature procedure as follows:
1. Physical examination, body weight and rectal temperature for fever.
2. Blood test to screen the health of the dog. Optional.
3. Palpate and express urinary bladder if it is full.
4. Pre-scrotal area clipped in preparation room.
5. I/V Domitor + Ketamine based on Domitor 0.4 ml + Ketamine 0.5 ml for a young 10-kg dog.
6. Isoflurane + Oxygen gas top up if necessary.
7. Incise pre-scrotal area. Not too high up. Incision 1.5 -2 cm for small breed.
8. Expose testicle.
9. Clamp and cut cremaster muscle ligament.
10.3-haemostats clamping. Ligate twice for spermatic vessels.
11. Stitch skin 3 stitches. Starting from the middle of the wound.
Illustration.
Economics
Polysorb 2/0 or 3/0 one packet S$12.80 = 9,216 kyats
Monosyn 2/0 or 3/0 one packet S$12.40 = 8, 928 kyats
One S$= 720 kyats
CASE STUDY
3 weeks post-neuter. Complaint of vomiting now and then.
Dog is active, eats well, no fever.
No pain in surgical area of pre-scrotal.
Bites or growls when couple touches the pre-scrotal area
Sedate D+K 0.05 + 0.06 ml IV
Clean
Prescrotal area preferred rather than over the bulb. 2/0 polysorb. Too tight? Remove stitches
Deep and buried - stitch abscess? No pain on palpation but dog bites/growls owner who attempted to clean the wound.
Inguinal right. 3/0 monosyn filament. No inflammation. Stitches taken out.
VIDEO
CONCLUSION
Post-op complications like infection or stitch abscess do occur.
Economics is important as rentals and staff overheads increase yearly.
Much depends on
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