Sep 5, 2014
Meeting with an author who loves books at MOS Burger, Toa Payoh HDB Hub. Full of energy and has a good knowledge of publishing.
"Should 3 people run separate ways when chased by a bear to distract him?" I asked him as he narrated that a bear suddenly appeared during his camping trip with his professor in the US.
"No," he said. "They should run in a straight line. The bear will catch the slowest runner!"
He was 24 years old while his professor was 45 and was running far ahead of the other two..
"So, the poor professor was killed by the bear?"
"No, no," he replied. "The bear was interested in our food and did not chase us."
I told him, from my research, that US publishers are not interested in new authors as they have tonnes of manuscript. "Sex sells," I was saying that veterinary stories will not be best-sellers. "Romance novels sell well." He was not interested in this genre. He was into science fiction.
Tuesday, September 9, 2014
Monday, September 8, 2014
1488. A 11-month-old Dachshund has watery stools for 5 days
Sunday Sep 7, 2014. Fine sunny and hot day. Electricity for the industrial block was cut off for maintenance from 9 am to 1.45pm.
This young Dachshund passed watery stools for 5 days and so the young couple was worried.
I advised IV drip with anti-diarrhea and antibiotics given.
"The other vet gave an injection and the dog recovered the next day," the gentleman said that the other vet did not even examine the dog. I tried to wrestle the dog's mouth to open for examination of oral ulcers and the dog moved his head here and there Hard palate ulcers seen. Video to get the ulcers recorded. My assistant Naing said he got it. Abdomen full of intestinal gas. .
.
This young Dachshund passed watery stools for 5 days and so the young couple was worried.
I advised IV drip with anti-diarrhea and antibiotics given.
"The other vet gave an injection and the dog recovered the next day," the gentleman said that the other vet did not even examine the dog. I tried to wrestle the dog's mouth to open for examination of oral ulcers and the dog moved his head here and there Hard palate ulcers seen. Video to get the ulcers recorded. My assistant Naing said he got it. Abdomen full of intestinal gas. .
Saturday, September 6, 2014
1487. Ear tumours due to chronic infections
Case 1. For those who love their dogs, continuous head shaking in their pet dogs is a grave concern for them. These ear infections do not respond to treatment and so the owner gives up. As the dog grows old, the chronic infections cause ear tumours.
One example is the 13-year-old Siberian Husky. The tumour was not malignant as it was due to chronic infections. The lab test shows that it is a ceruminous cystadenoma. The solution was a vertical ear canal resection in this old dog. No more complaint of head shaking and smelly ears now 2 months after surgery. Dr Daniel did the surgery.
Case 2. In another case, I did a lateral ear canal resection and the tumours in the vertical canal were numerous.
Case 3. Greyish ear cells or nodules inside the oldl dog
One example is the 13-year-old Siberian Husky. The tumour was not malignant as it was due to chronic infections. The lab test shows that it is a ceruminous cystadenoma. The solution was a vertical ear canal resection in this old dog. No more complaint of head shaking and smelly ears now 2 months after surgery. Dr Daniel did the surgery.
Case 2. In another case, I did a lateral ear canal resection and the tumours in the vertical canal were numerous.
Case 3. Greyish ear cells or nodules inside the oldl dogFriday, September 5, 2014
1486. SCRIPT FOR INTERN RGS - Hypercalcaemia in a 15-year-old coughing dog
Sep 5, 2014
"I am the cheapest vet in Singapore in Singapore," a vet said to me as more than 65 vet practices have been set up in Singapore. "So, no other nearby vets can compete." At the end of the day, there is little net profits for purchase of new equipment or renovations.
In this 15-year-old dog, the family vet prescribed steroids to bring down the soft facial swelling of 5cm x 5cm. "Your dog is too old for anaesthesia. He may die on the operating table. Take some medication."
The dog became very hungry and thirsty but the facial swelling did not disappear. Old dogs do die under anaesthesia. So, the owner must give an informed consent.
In this dog, the facial swelling was a cluster of cysts. A rarity. He had some coughing earlier but the coughing became continuous and worse.
"He could not sleep on his neck," the lady said. "He could sleep with the head turned sideways." At one time, he could not sleep on his sternum. So what is the cause of this problem?
I advised X-rays. There were sinister findings of multiple nodules inside the lungs. Now the serum calcium is higher than normal. Why? A parathryroid tumour?
But neoplasia can lead to hypercalcaemia and this neoplasia is likely from the lungs. The dog keeps coughing and has. So, to give him a better quality of life. I prescribed low doses of pred. to stimulate his appetite and relieve some inflammation in the throat. The owner was much delighted.
"I am the cheapest vet in Singapore in Singapore," a vet said to me as more than 65 vet practices have been set up in Singapore. "So, no other nearby vets can compete." At the end of the day, there is little net profits for purchase of new equipment or renovations.
In this 15-year-old dog, the family vet prescribed steroids to bring down the soft facial swelling of 5cm x 5cm. "Your dog is too old for anaesthesia. He may die on the operating table. Take some medication."
The dog became very hungry and thirsty but the facial swelling did not disappear. Old dogs do die under anaesthesia. So, the owner must give an informed consent.
In this dog, the facial swelling was a cluster of cysts. A rarity. He had some coughing earlier but the coughing became continuous and worse.
"He could not sleep on his neck," the lady said. "He could sleep with the head turned sideways." At one time, he could not sleep on his sternum. So what is the cause of this problem?
I advised X-rays. There were sinister findings of multiple nodules inside the lungs. Now the serum calcium is higher than normal. Why? A parathryroid tumour?
But neoplasia can lead to hypercalcaemia and this neoplasia is likely from the lungs. The dog keeps coughing and has. So, to give him a better quality of life. I prescribed low doses of pred. to stimulate his appetite and relieve some inflammation in the throat. The owner was much delighted.
1485. Script for 15-year-old JR with carnaissal tooth abscess
Sep 4, 2014
HISTORY
Hi,
I think my 15-year old JRT has fistula with discharge from carnaissal tooth abscess on his right cheek. Can I check whether it is advisable to do scaling at this age? GA or sedation?
many thanks
------------------------------------------
HOOK
PROBLEM
A discharging facial wound below the right eye. Pus seeps out. Blood seems out. Wound does not heal. Why?
9316.MOV On August 25, 2014 - 10 days ago.
0 - 2:32 Right facial swelling. Left face is normal. Evert upper lip. Rotten foul-smelling tooth seen on right upper jaw below the facial swelling. On the left side, the tooth had dropped off long ago.
BE KIND TO PETS IMAGE
INTRODUCTION
Case TP 20970
13-year-old male Jack Russell - has a hole in the right side of the face for 2 weeks. The first vet had diagnosed a tooth problem.
What is this old dog suffering from? Why is the wound not healing?
9319.MOV.
0.18 - 1.05
Explain with medical illustration from a book. Malar Abscess.
Oro-nasal fistula (define this). Wound does not heal as the pus keeps coming out from the badly decayed root of the carnaissal tooth. It is the upper premolar tooth closer to the nasal sinus compared to other teeth. So, the nasal sinus becomes infected and rots. Pus comes out through the skin below the right eye. This is called oro-nasal fistula. Fistula means a connecting channel between two mucous membranes. In oro-nasal fistuala, the membrane of the mouth connects with the nasal sinus, discharging pus above the sinus, below the eye.
1.23 - 1.38 Actual fistula from this 13-year-old Jack Russell
2.40 - 3.19. In-patient Pomeranian. Had same medical problem 5 years ago. Now OK as wound had healed. Dog owner did not bother with dental check up in the past 5 years. So, you can see the teeth are crusted with black tartar.
4.15 - 5.15 Is the Jack Russell coughing? Yes. Check heart. Left heart murmur. High anaesthetic risk of heart failure during anaesthesia.
9320 MOV
4.19 - 4.53 First blood test taken on Day 1 (first day of visit) by Dr Daniel and put inside the blood tubes. Get some scenes.
BLOOD TEST RESULTS
Normal Total White Cell Count Neutrophils Absolute
6-17 60-70% 3-11.5
26.8.14 30.9 79.3% 24.5
4.9.14 13.8 69% 9.52
I had prescribed antibiotics trimaxazole syrup for 7 days from 26.8.14 to 2.9.14. The 2nd blood test showed it was effective as total White Cell Count and Neutrophils returned back to normal on 4.9.14, before surgery. But there is the bad breath still present as the owner came in for surgery on 10th day.
SOLUTION
ANAESTHESIA
1. Painful mouth - hard to mask and give isoflurane and oxygen gas. Struggle.
Some vets would give sedative injections as a routine to make it easier to operate.
But heart disease - can die of heart failure under general anaesthesia
SOLUTION Antibiotics past 7 days to kill bacteria in mouth and gums. Reduced inflammation and therefore pain. Gave I/V drip + antibiotic (baytril) + frusemide (clear lung of fluids)
9643.MOV 0 - 2:30
Pre-anaesthetic IV drip + medication. Dextrose saline 1 bottle 500 ml + 5% glucose for 5 minutes. The dog had no fever. Now the dog looks alert. A non-aggressive Jack Russell with the large facial swelling of 4 cm x 4 cm seen below the right eye. The oro-nasal wound is now dried up as compared to 10 days ago when there were yellow pus discharging out.
9720.MOV 0.0 - 1:50
No struggle when the dog is masked. The right upper carnaissal tooth (Premolar 4) is extracted out easily. This enable any pus accumulated inside the root area and sinus to drain downwards. Surprisingly no bleeding during extraction as you can see from the video. Another right upper Premolar 2 is extracted easily.
9723.MOV 0.0 - 2:03
The left jaw. The left upper carnaiissal tooth (Premolar 4) had dropped off earlier, so none was seen. Premolar 3 is extracted. Dog wakes up fast under gas. Mask dog to give gas so he can sleep and not feel the pain. Extract the other loose teeth. Scaling of teeth done on the canine teeth. Dog wakes up. Cries. Gives gas. Change to bigger mask as there is lots of bleeding after extraction of some teeth.
9734.MOV 0.0 - 0:46
One hour after anaesthesia and surgery. The dog is alert. The facial swelling below the right eye has almost disappeared. 11 decayed teeth in a plastic bag are put inside a plastic bag and given to the lady owner who took them home. The young lady is most happy with the outcome. Her mum is satisfied as it was her daughter who was much worried about the anaesthetic risk. I said it was 50:50 but this is only a guideline. Each old dog with heart disease reacts differently and so it is hard to predict. In many cases, the old dog survives if the anaesthesia is just gas and of short duration.
Not to operate was not an option as pus kept discharging from the wound (known as oro-nasal fistula) below the right eye.
POST OP E-MAIL FEEDBACK FROM THE OWNER
REPLY FROM DR SING
HISTORY
Hi,
I think my 15-year old JRT has fistula with discharge from carnaissal tooth abscess on his right cheek. Can I check whether it is advisable to do scaling at this age? GA or sedation?
How much is the cost of blood test, scaling,extraction and etc?
Look forward to your reply soonest.
------------------------------------------
HOOK
PROBLEM
A discharging facial wound below the right eye. Pus seeps out. Blood seems out. Wound does not heal. Why?
9316.MOV On August 25, 2014 - 10 days ago.
0 - 2:32 Right facial swelling. Left face is normal. Evert upper lip. Rotten foul-smelling tooth seen on right upper jaw below the facial swelling. On the left side, the tooth had dropped off long ago.
BE KIND TO PETS IMAGE
INTRODUCTION
Case TP 20970
13-year-old male Jack Russell - has a hole in the right side of the face for 2 weeks. The first vet had diagnosed a tooth problem.
What is this old dog suffering from? Why is the wound not healing?
9319.MOV.
0.18 - 1.05
Explain with medical illustration from a book. Malar Abscess.
Oro-nasal fistula (define this). Wound does not heal as the pus keeps coming out from the badly decayed root of the carnaissal tooth. It is the upper premolar tooth closer to the nasal sinus compared to other teeth. So, the nasal sinus becomes infected and rots. Pus comes out through the skin below the right eye. This is called oro-nasal fistula. Fistula means a connecting channel between two mucous membranes. In oro-nasal fistuala, the membrane of the mouth connects with the nasal sinus, discharging pus above the sinus, below the eye.
1.23 - 1.38 Actual fistula from this 13-year-old Jack Russell
2.40 - 3.19. In-patient Pomeranian. Had same medical problem 5 years ago. Now OK as wound had healed. Dog owner did not bother with dental check up in the past 5 years. So, you can see the teeth are crusted with black tartar.
4.15 - 5.15 Is the Jack Russell coughing? Yes. Check heart. Left heart murmur. High anaesthetic risk of heart failure during anaesthesia.
9320 MOV
4.19 - 4.53 First blood test taken on Day 1 (first day of visit) by Dr Daniel and put inside the blood tubes. Get some scenes.
BLOOD TEST RESULTS
Normal Total White Cell Count Neutrophils Absolute
6-17 60-70% 3-11.5
26.8.14 30.9 79.3% 24.5
4.9.14 13.8 69% 9.52
I had prescribed antibiotics trimaxazole syrup for 7 days from 26.8.14 to 2.9.14. The 2nd blood test showed it was effective as total White Cell Count and Neutrophils returned back to normal on 4.9.14, before surgery. But there is the bad breath still present as the owner came in for surgery on 10th day.
SOLUTION
ANAESTHESIA
1. Painful mouth - hard to mask and give isoflurane and oxygen gas. Struggle.
Some vets would give sedative injections as a routine to make it easier to operate.
But heart disease - can die of heart failure under general anaesthesia
SOLUTION Antibiotics past 7 days to kill bacteria in mouth and gums. Reduced inflammation and therefore pain. Gave I/V drip + antibiotic (baytril) + frusemide (clear lung of fluids)
9643.MOV 0 - 2:30
Pre-anaesthetic IV drip + medication. Dextrose saline 1 bottle 500 ml + 5% glucose for 5 minutes. The dog had no fever. Now the dog looks alert. A non-aggressive Jack Russell with the large facial swelling of 4 cm x 4 cm seen below the right eye. The oro-nasal wound is now dried up as compared to 10 days ago when there were yellow pus discharging out.
9720.MOV 0.0 - 1:50
No struggle when the dog is masked. The right upper carnaissal tooth (Premolar 4) is extracted out easily. This enable any pus accumulated inside the root area and sinus to drain downwards. Surprisingly no bleeding during extraction as you can see from the video. Another right upper Premolar 2 is extracted easily.
9723.MOV 0.0 - 2:03
The left jaw. The left upper carnaiissal tooth (Premolar 4) had dropped off earlier, so none was seen. Premolar 3 is extracted. Dog wakes up fast under gas. Mask dog to give gas so he can sleep and not feel the pain. Extract the other loose teeth. Scaling of teeth done on the canine teeth. Dog wakes up. Cries. Gives gas. Change to bigger mask as there is lots of bleeding after extraction of some teeth.
9734.MOV 0.0 - 0:46
One hour after anaesthesia and surgery. The dog is alert. The facial swelling below the right eye has almost disappeared. 11 decayed teeth in a plastic bag are put inside a plastic bag and given to the lady owner who took them home. The young lady is most happy with the outcome. Her mum is satisfied as it was her daughter who was much worried about the anaesthetic risk. I said it was 50:50 but this is only a guideline. Each old dog with heart disease reacts differently and so it is hard to predict. In many cases, the old dog survives if the anaesthesia is just gas and of short duration.
Not to operate was not an option as pus kept discharging from the wound (known as oro-nasal fistula) below the right eye.
POST OP E-MAIL FEEDBACK FROM THE OWNER
SEP 9, 2014
Hi Dr Sing
My dog had done the extraction of teeth on thursday by you. He is eating well and moving around normally. However, he has some involuntary movement on his cheek/mouth area.
Please take a look at the video that I took.
Kindly advice thanks
My dog had done the extraction of teeth on thursday by you. He is eating well and moving around normally. However, he has some involuntary movement on his cheek/mouth area.
Please take a look at the video that I took.
Kindly advice thanks
REPLY FROM DR SING
Involuntary
lip/mouth movements after surgery could be due to painful contraction
of holes in the gums after extraction of 11 teeth.
FOLLOW UP 2 WEEKS AFTER DENTAL EXTRACTION
The 15-year-old Jack Russell is back to normal, active and eating.
FOLLOW UP 2 WEEKS AFTER DENTAL EXTRACTION
The 15-year-old Jack Russell is back to normal, active and eating.
Thursday, September 4, 2014
1484. Third eyelid cyst or lump in a 2-year-8-month-old dwarf hamster.
"She weights 67 g," I said to th".
1483. The real carnaissal tooth abscess - 15-year-old Jack Russell
Sep 5, 2014
Today, the real carnaissal tooth abscess Jack Russell of 15 years of age was operated by me.
The owner was supposed to come back 7 days after my first consultation as I had prescribed 7 days of antibiotics and heart disease medication. But she came on the 10th day (today). The oro-nasal fistula was no longer seeping with pus and had closed. So, the young lady did not want the risk of anaesthesia and thought of not taking the surgery to extract the carnaissal tooth. The dog had bad breath now since the teeth were much rotten and the antibiotic (trimethoprim) had been consumed.
"But the facial swelling is still there," the girl's mum said.
"It will come back," I referred to the seeping wound.
It was hard for her. The younger ones are more caring of the old dog and worried more. She wanted to be present at the surgery. "No," I said. "I want to focus 100%, not to be distracted. In any case, I don't permit viewers as the operating room is so small."
She wanted me to inform her when surgery started. This was after the IV drip with baytril and furesemide. I told her she could wait outside the reception room but she did not turn up.
GAS ANAESTHESIA
The gentle dog was OK for mask anaesthesia as his mouth is not so painful after antibiotics for 7 days. The challenge is when to extract the teeth. Too soon, the dog would feel the pain. Too late, the heart failure might kill the dog. The right carnaissal tooth was loose and I could pull it out easily. The left one was missing as it had dropped out some time ago.
Four canine teeth had more than 50% gum attachment gone but they looked solid.
"Dental scaling would be done," my assistant Naing said.
"Actually they are loose at the roots," I gripped the canine tooth with the forceps and gave a twist. The tooth came out easily. A normal canine tooth cannot be twisted or dislodged so easily. It was best for the dog not to have scaled loose canine teeth as they would become infected again.
In all, 11 btownish black teeth were extracted and put inside the plastic bag for the owner as evidence of extraction. . One carnaissal, 3 premolars, 4 canines and 3 incisors. All easily extracted. Much better for the dog to have no teeth than decayed ones with lots of bacteria.
The owners would feel otherwise. "How is the dog going to eat food?" the mother asked. "With rotten painful teeth, the dog just swallows the food rather than chew or bite," I said.
The dog woke up from gas anaesthesia fast and I had to change to a bigger mask. Blood spilled from the holes of the extracted teeth into the mask and the connecting tubes of the anaesthetic machine. Blood came out from the extracted rotten teeth.
The dog survived and was alert as if nothing had happened within 10 minutes of the end of surgery. It was good news. A dead dog is no good for the vet or the owner.
Follow up 2 weeks later revealed that the dog is back to normal with no bad breath, active and eating. .
Today, the real carnaissal tooth abscess Jack Russell of 15 years of age was operated by me.
The owner was supposed to come back 7 days after my first consultation as I had prescribed 7 days of antibiotics and heart disease medication. But she came on the 10th day (today). The oro-nasal fistula was no longer seeping with pus and had closed. So, the young lady did not want the risk of anaesthesia and thought of not taking the surgery to extract the carnaissal tooth. The dog had bad breath now since the teeth were much rotten and the antibiotic (trimethoprim) had been consumed.
"But the facial swelling is still there," the girl's mum said.
"It will come back," I referred to the seeping wound.
It was hard for her. The younger ones are more caring of the old dog and worried more. She wanted to be present at the surgery. "No," I said. "I want to focus 100%, not to be distracted. In any case, I don't permit viewers as the operating room is so small."
She wanted me to inform her when surgery started. This was after the IV drip with baytril and furesemide. I told her she could wait outside the reception room but she did not turn up.
GAS ANAESTHESIA
The gentle dog was OK for mask anaesthesia as his mouth is not so painful after antibiotics for 7 days. The challenge is when to extract the teeth. Too soon, the dog would feel the pain. Too late, the heart failure might kill the dog. The right carnaissal tooth was loose and I could pull it out easily. The left one was missing as it had dropped out some time ago.
Four canine teeth had more than 50% gum attachment gone but they looked solid.
"Dental scaling would be done," my assistant Naing said.
"Actually they are loose at the roots," I gripped the canine tooth with the forceps and gave a twist. The tooth came out easily. A normal canine tooth cannot be twisted or dislodged so easily. It was best for the dog not to have scaled loose canine teeth as they would become infected again.
In all, 11 btownish black teeth were extracted and put inside the plastic bag for the owner as evidence of extraction. . One carnaissal, 3 premolars, 4 canines and 3 incisors. All easily extracted. Much better for the dog to have no teeth than decayed ones with lots of bacteria.
The owners would feel otherwise. "How is the dog going to eat food?" the mother asked. "With rotten painful teeth, the dog just swallows the food rather than chew or bite," I said.
The dog woke up from gas anaesthesia fast and I had to change to a bigger mask. Blood spilled from the holes of the extracted teeth into the mask and the connecting tubes of the anaesthetic machine. Blood came out from the extracted rotten teeth.
The dog survived and was alert as if nothing had happened within 10 minutes of the end of surgery. It was good news. A dead dog is no good for the vet or the owner.
Follow up 2 weeks later revealed that the dog is back to normal with no bad breath, active and eating. .
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