Sep 15, 2014
Cat, M, Not neutered, 5 m. Cannot pee normally.
"Did he try to mate with the female cat?" I asked the young lady who had adopted this cat 4 months ago and noted that he was peeing outside the litter box last month.
"No," she said. "But the 5-month-old female always lick his private parts."
A tense round swelling in which the centre is a preputial opening and in which urine would shoot out once I expressed the anaethesized cat's bladder.
My assistant aspirated over 15 ml of urine and some blood and we showed the container of urine to the lady. The swelling had shrank to a normal size.
When we showed the area to the owner, it swelled again back to its original size of 3 cm x 3 cm x 2 cm. It was as if there was a leak from the bladder deep inside the swelling. Aspiration by needle was not a solution to this problem. Could there be a hole in the penile urethra? Hard to tell without more costly imaging.
I anaesthesized the cat with isoflurane and gas again. I incised 6mm midline from the preputial opening. Thick red granulomatous tissue under the skin. Red blood oozed out from the thickened tissues. Urine also seeped out. The swelling now shrank.
Hospitalised the cat overnight and gave anti-inflam and antibiotics. A rare case of possible urethral rupture juding by the hardened granulomatous tissue under the big preputial swelling. The female cat could have bitten him during mating. The owner may say no mating but she could not be around 24 hours a day to monitor this cat. Female cats bite when mated, as part of the stimulus for ovulation and so this male cat could have got badly injured in his prepuce. There was infection and a some drops of pus oozing out during incision.
On Day 3 of in-patient treatment, the cat's preputial swelling has gone down by 60%. He could pee inside his litter box and was very active and very playful. He went home to a happy owner. Mating does have hazards for the feline male as the female may bite when mated. In this case, the female cat had continually licked the injured male's preputial area.
Monday, September 15, 2014
1500. A veterinary trilogy - swellings below the right eye
Sep 14, 2014 Sunday
A trilogy is a set of 3 works of art that are connected, commonly found in literature, films and video games. They are connected by characters, settings or theme.
In my veterinary example, the 3 old dogs have swellings below the right eye seen by me within a short period of time.
Case 1. A 15-year-old Cross-bred had facial cysts.
Case 2. A 15-year-old Jack Russell had carnaissal tooth abscess and oronasal fistula.
Case 3. A 11-year-old Jack Russell had chronic dacryocytitis
All 3 with different causes but the same surgical outcomes. They have recovered as at Nov 17, 2014
.
A trilogy is a set of 3 works of art that are connected, commonly found in literature, films and video games. They are connected by characters, settings or theme.
In my veterinary example, the 3 old dogs have swellings below the right eye seen by me within a short period of time.
Case 1. A 15-year-old Cross-bred had facial cysts.
Case 2. A 15-year-old Jack Russell had carnaissal tooth abscess and oronasal fistula.
Case 3. A 11-year-old Jack Russell had chronic dacryocytitis
All 3 with different causes but the same surgical outcomes. They have recovered as at Nov 17, 2014
.
1499. A 4-year-old terrapin has swollen eyelids
Sep 14, 2014 Sunday
"We went for holidays for 3 days," the Singapore school holiday week started in September for the 8-year-old and 4-year-old daughters. They put the nameless terrapin in the little tank which now has no space for swimming since she has grown much bigger at 450 g. She is as big as the palm size of a big man and the tank was meant for a terrapin of a few weeks old.
"When we came back, the turtle is not eating the shrimps. She would snap and eat the shrimps hungrily every day. She also has swollen eyes!"
"The eyelids are swollen," I said. "The eyes could be infected as she was in the water for 3 days when you were away."
"It could be that she had no sunlight," the father said. "I will upgrade to a bigger tank and buy the lighting system."
"The shell quality is poor, with cracks and unevenness on the surface," I said. "If she eats shrimps only, she will not get good nutrition. It is fortunate that she has not lung infection as she does not gasp for air, like the other terrapins I treated. That is because you come early for treatment."
Medication, eye drops and multivitamins were prescribed. New bigger tank, a basking platform and sufficient amount of water to swim. Changing of water used to be once in 2 days. Variety of food like live guppies, egg yolk. She dislikes vegetables.
UPDATE
Follow up the next day. Terrapin's eyelids much less swollen. Still not eating. New tank bought. I advised feeding shrimps and medication in the water.
Video shows terrapin snapping at shrimps.
FOLLOW UP ON SEP 15, 2014
"We bought a bigger tank and she would be swimming," the wife answered the phone. "There is also lighting. But she does not eat the shrimps."
"Are the eyelids swollen?"
"Much less than yesterday," she said.
Still too early to recover.
The 8-year-old daughter in Primary 2 can be trained to change water or take more care of the terrapin but most Singaporean parents just do it. The 4-year-old is too young.
FOLLOW UP ON SEP 17, 2014 when I sms to ask whether the turtle is eating shrimps.
"Yes, the turtle is eating dry shrimps in the water. We are trying to get her to feed on vegetables and turtle food (pellets). The swollen eye is better and we plan to consult you again when the eye drops are used up. Thank you."
.
"We went for holidays for 3 days," the Singapore school holiday week started in September for the 8-year-old and 4-year-old daughters. They put the nameless terrapin in the little tank which now has no space for swimming since she has grown much bigger at 450 g. She is as big as the palm size of a big man and the tank was meant for a terrapin of a few weeks old.
"When we came back, the turtle is not eating the shrimps. She would snap and eat the shrimps hungrily every day. She also has swollen eyes!"
"The eyelids are swollen," I said. "The eyes could be infected as she was in the water for 3 days when you were away."
"It could be that she had no sunlight," the father said. "I will upgrade to a bigger tank and buy the lighting system."
"The shell quality is poor, with cracks and unevenness on the surface," I said. "If she eats shrimps only, she will not get good nutrition. It is fortunate that she has not lung infection as she does not gasp for air, like the other terrapins I treated. That is because you come early for treatment."
Medication, eye drops and multivitamins were prescribed. New bigger tank, a basking platform and sufficient amount of water to swim. Changing of water used to be once in 2 days. Variety of food like live guppies, egg yolk. She dislikes vegetables.
UPDATE
Follow up the next day. Terrapin's eyelids much less swollen. Still not eating. New tank bought. I advised feeding shrimps and medication in the water.
Video shows terrapin snapping at shrimps.
FOLLOW UP ON SEP 15, 2014
"We bought a bigger tank and she would be swimming," the wife answered the phone. "There is also lighting. But she does not eat the shrimps."
"Are the eyelids swollen?"
"Much less than yesterday," she said.
Still too early to recover.
The 8-year-old daughter in Primary 2 can be trained to change water or take more care of the terrapin but most Singaporean parents just do it. The 4-year-old is too young.
FOLLOW UP ON SEP 17, 2014 when I sms to ask whether the turtle is eating shrimps.
"Yes, the turtle is eating dry shrimps in the water. We are trying to get her to feed on vegetables and turtle food (pellets). The swollen eye is better and we plan to consult you again when the eye drops are used up. Thank you."
.
1498. Is it worth operating an old female dog with breast cancer?
Sep 15, 2014
Besides the risk of death from anaesthesia, owners do weigh the medical costs of removing the breast tumours from the 14-year-old Silkie Terrier. The total costs of removing all 7 breast tumours including anaesthesia was $700 in this case.
First I advised spaying to get rid of the ovarian hormones feeding the breast tumours. Breast tumours to be excised 4 weeks later. But many Singaporean owners don't follow up with breast tumour removal.
HISTORY
Nov 2, 2013 Dog could not lie down on chest. Large breast tumours grow large during last few days. Large swelling of left MG5, right MG 1 +2. No blood tests, chest X-ray to check for metastasis nor biopsy to check for malignancy to lower medical costs.
Nov 5, 2013. Spayed.
Jul 3, 2014. Left MG5 swollen and painful. Other tumours did not increase in size. I advised removal of left MG5 2 weeks later after giving anti-inflam and antibiotics.
Sep 15, 2014. Owner wanted painkillers + injections as the left MG5 is swollen to 6cm x 6 cm x 3 cm and was very painful. The dog was active but would not permit carrying.
I advised removal after 2 weeks. But the owner felt that the dog's lifespan was ending. "You said 6 months to live," the husband told me.
"I said 6 months based on the dog not spayed and the fast-growing breast tumours." It is best not to predict the life span as there could be mis communications.
Besides the risk of death from anaesthesia, owners do weigh the medical costs of removing the breast tumours from the 14-year-old Silkie Terrier. The total costs of removing all 7 breast tumours including anaesthesia was $700 in this case.
First I advised spaying to get rid of the ovarian hormones feeding the breast tumours. Breast tumours to be excised 4 weeks later. But many Singaporean owners don't follow up with breast tumour removal.
HISTORY
Nov 2, 2013 Dog could not lie down on chest. Large breast tumours grow large during last few days. Large swelling of left MG5, right MG 1 +2. No blood tests, chest X-ray to check for metastasis nor biopsy to check for malignancy to lower medical costs.
Nov 5, 2013. Spayed.
Jul 3, 2014. Left MG5 swollen and painful. Other tumours did not increase in size. I advised removal of left MG5 2 weeks later after giving anti-inflam and antibiotics.
Sep 15, 2014. Owner wanted painkillers + injections as the left MG5 is swollen to 6cm x 6 cm x 3 cm and was very painful. The dog was active but would not permit carrying.
I advised removal after 2 weeks. But the owner felt that the dog's lifespan was ending. "You said 6 months to live," the husband told me.
"I said 6 months based on the dog not spayed and the fast-growing breast tumours." It is best not to predict the life span as there could be mis communications.
Friday, September 12, 2014
1497. A severely constipated cat. What to do?
Sep 12, 2014
The expatriate lady and her young daughter brought in a small sized cat that was straining to poop for the past 5 days with no stools. A male, neutered, 2 years old, stripped brown at 2 kg. Looks like a miniature domestic shorthaired.
He did not want to come out of the carrier. So I waited patiently. After some time, he came out himself, sniffed the air and walked on my consultation table edge, ready to leap away.
"He seldom meet strangers," the European lady said as this cat hissed several times.
"Just stroke his neck and talk to him," I said to the mother. "I can palpate his abdomen. I can feel a solid rock of 10 cm x 10 cm in his rectum. He is badly constipated."
What to do now?
"I need to sedate him to give him the enema," I said.
"I can wrap him in a towel and you can do it," the lady suggested.
"Not so easy as you think. When the tip of the enema tube touches his anus, he will claw and jump away!"
"I will need to sedate him," I prepared xylazine 0.1 ml + ketamine 0.4 ml to be given IM. My assistant would hold the scruff of the cat's neck. But he was not that keen to do so as the cat already warned us by hissing again.
"Quickly let him back into the carrier," I said. He faced the carrier and walked in for shelter and sat down.
"We must not excite him much as there is no 2nd chance once he is frightened."
"I want to see him sedated," the lady was not keen on scruffing the cat.
So, I got the cat carrier covered by a big black plastic bag. Anaesthetic gas pumped into the carrier inside the bag. It took around 15 minutes. Then Naing masked the sleepy cat to maintain the anaesthesia. I pumped in one tube of Microlax enema.
"You said two," the lady reminded me as she wanted the cat to go home after this procedure.
So, 2 tubes. I advised W/D cans and wait and see for 2 days. An injection of antibiotics. The young daughter covered her nose with the top of her T-shirt as the rectal gas was smelly. "If this works, no need surgery to take out the stools."
"How did he become constipated?" the lady asked.
"Some change of surroundings. Is there a new cat? He could be stressed and stopped drinking water."
"Yes, the neighbour brought in a new cat."
So, instead of FLUTD (feline lower urinary tract disease) usually due to eating of dry food. But this cat eats only wet food, he developed constipation.
Will wait and see. The cat went home in a taxi at 6 pm. An interesting case as this cat lives in a house with garden and has free access to peeing and pooping. But a new cat has come next door.
On Sep 13, 2014, I phoned the owner but there was no response.
The expatriate lady and her young daughter brought in a small sized cat that was straining to poop for the past 5 days with no stools. A male, neutered, 2 years old, stripped brown at 2 kg. Looks like a miniature domestic shorthaired.
He did not want to come out of the carrier. So I waited patiently. After some time, he came out himself, sniffed the air and walked on my consultation table edge, ready to leap away.
"He seldom meet strangers," the European lady said as this cat hissed several times.
"Just stroke his neck and talk to him," I said to the mother. "I can palpate his abdomen. I can feel a solid rock of 10 cm x 10 cm in his rectum. He is badly constipated."
What to do now?
"I need to sedate him to give him the enema," I said.
"I can wrap him in a towel and you can do it," the lady suggested.
"Not so easy as you think. When the tip of the enema tube touches his anus, he will claw and jump away!"
"I will need to sedate him," I prepared xylazine 0.1 ml + ketamine 0.4 ml to be given IM. My assistant would hold the scruff of the cat's neck. But he was not that keen to do so as the cat already warned us by hissing again.
"Quickly let him back into the carrier," I said. He faced the carrier and walked in for shelter and sat down.
"We must not excite him much as there is no 2nd chance once he is frightened."
"I want to see him sedated," the lady was not keen on scruffing the cat.
So, I got the cat carrier covered by a big black plastic bag. Anaesthetic gas pumped into the carrier inside the bag. It took around 15 minutes. Then Naing masked the sleepy cat to maintain the anaesthesia. I pumped in one tube of Microlax enema.
"You said two," the lady reminded me as she wanted the cat to go home after this procedure.
So, 2 tubes. I advised W/D cans and wait and see for 2 days. An injection of antibiotics. The young daughter covered her nose with the top of her T-shirt as the rectal gas was smelly. "If this works, no need surgery to take out the stools."
"How did he become constipated?" the lady asked.
"Some change of surroundings. Is there a new cat? He could be stressed and stopped drinking water."
"Yes, the neighbour brought in a new cat."
So, instead of FLUTD (feline lower urinary tract disease) usually due to eating of dry food. But this cat eats only wet food, he developed constipation.
Will wait and see. The cat went home in a taxi at 6 pm. An interesting case as this cat lives in a house with garden and has free access to peeing and pooping. But a new cat has come next door.
On Sep 13, 2014, I phoned the owner but there was no response.
1496. A responsible old man
This morning I had a chat with this operator of a small cafe in a hotel. How did he do it as a one-man-operator and with diabetes?
"There are a lot of procedures to do," he said. "From switching on the computers, taking out the ice-cream from the freezer, cleaning, sweeping, making coffee and serving. Closing accounts and preparing for the next day. I had to make sure that sandwiches are available for sale."
"How do you, as a one-man-operator serve so many people at lunch-time?" I asked.
"I will just shout e.g. sandwiches ready and the buyer will come to collect."
"Why don't you have a self-service sign?" I asked.
"Then all customers will bunch up in a queue. They can sit and wait while I call them." This was a good idea as the shop front is very short for this retail space of 200 sq. ft. Around 5 people will fill the queue.
There are educated people who would try to take advantage of this old man.
Example 1.
The insurance company held a standing buffet lunch in the hotel for its executives. This old man had rented a space where his clients could have tables and chairs to sit. One 40-year-old insurance manager sat on his table. When the old man said: "Please do not sit here as this table and chair are reserved for my customers," the manager said: "Call the security!"
"Repeat what you have just said," the old man challenged him as he was about to roll up his sleeve to sock him. The manager vacated his seat as the old man was about to grab him by his neck to yank him up.
The old man would usually ask those intruders whether they wanted to buy a drink when they sat on his chairs. "Sometimes they buy one drink and sat with their friends. I can't stop this."
Example 2.
A staff of the hotel sat on his seat without ordering any drink or food. When the old man said: "My company bought the tables and chairs for our customers," she replied: "I understand." She just would not budge.
"So what can you do?" I asked the old man.
"I went to see her manager. She must have a scolding as the next time, she put her head down whenever she passed by. I can understand that the staff may be tired, but if they ask me, I do not mind them sitting for a while to rest."
From these 2 examples, you can see that this old man is responsible in earning his keep.
"How much was the income from a younger man employed before you?" I asked.
"Around $40 per day. The store was losing at least a thousand dollars. He would close the shop for smoking or for his one-hour lunch. I don't close for lunch."
By being proactive and caring for his employer's need to get sales income, the shop now loses much less money as its income is around $150 per day. He works 6 days a week.
"Will your boss be renewing the leasing contract at the end of the year?" I asked.
"No," he said. "The hotel management wants to increase rentals." In Singapore.as in Hongkong, every retail landlord wants to increase rental on renewal. So it is hard for small operators.
I have no doubt that this old man could get a job easily and hope he would take good care of his diabetic control.
"There are a lot of procedures to do," he said. "From switching on the computers, taking out the ice-cream from the freezer, cleaning, sweeping, making coffee and serving. Closing accounts and preparing for the next day. I had to make sure that sandwiches are available for sale."
"How do you, as a one-man-operator serve so many people at lunch-time?" I asked.
"I will just shout e.g. sandwiches ready and the buyer will come to collect."
"Why don't you have a self-service sign?" I asked.
"Then all customers will bunch up in a queue. They can sit and wait while I call them." This was a good idea as the shop front is very short for this retail space of 200 sq. ft. Around 5 people will fill the queue.
There are educated people who would try to take advantage of this old man.
Example 1.
The insurance company held a standing buffet lunch in the hotel for its executives. This old man had rented a space where his clients could have tables and chairs to sit. One 40-year-old insurance manager sat on his table. When the old man said: "Please do not sit here as this table and chair are reserved for my customers," the manager said: "Call the security!"
"Repeat what you have just said," the old man challenged him as he was about to roll up his sleeve to sock him. The manager vacated his seat as the old man was about to grab him by his neck to yank him up.
The old man would usually ask those intruders whether they wanted to buy a drink when they sat on his chairs. "Sometimes they buy one drink and sat with their friends. I can't stop this."
Example 2.
A staff of the hotel sat on his seat without ordering any drink or food. When the old man said: "My company bought the tables and chairs for our customers," she replied: "I understand." She just would not budge.
"So what can you do?" I asked the old man.
"I went to see her manager. She must have a scolding as the next time, she put her head down whenever she passed by. I can understand that the staff may be tired, but if they ask me, I do not mind them sitting for a while to rest."
From these 2 examples, you can see that this old man is responsible in earning his keep.
"How much was the income from a younger man employed before you?" I asked.
"Around $40 per day. The store was losing at least a thousand dollars. He would close the shop for smoking or for his one-hour lunch. I don't close for lunch."
By being proactive and caring for his employer's need to get sales income, the shop now loses much less money as its income is around $150 per day. He works 6 days a week.
"Will your boss be renewing the leasing contract at the end of the year?" I asked.
"No," he said. "The hotel management wants to increase rentals." In Singapore.as in Hongkong, every retail landlord wants to increase rental on renewal. So it is hard for small operators.
I have no doubt that this old man could get a job easily and hope he would take good care of his diabetic control.
1495. A Shih Tzu put on diapers for one year
The maid stapled the diapers to make sure that the urine does not seep onto the floor. The dog came as he was not eating and was lethargic. This 11-year-old male intact Shih Tzu had been dribbling urine for one year and the diapers were the solution. The penile and preputial areas became swollen and infected. A strong urinary smell filled the air in the consultation room. The dog bit anyone who touched his belly area.
Urinary catherisation after muzzling. No urethral obstruction.
URINE TESTS
BLOOD TESTS
X-RAYS - bladder stones. What to do?
Spoke to owner
1. Thought urinary incontinence - dribbling of urine was due to old age and so did not consult vet
2. Whether bladder stone removal can cure the incontinence? he asked. "I can't guarantee as the dog has been dribbling urine for a year.
3. Wait one week and given treatment. When appetite returns, will operate.
4. Cost of bladder stone removal and anaethesia is around $800. In-patient expenses and nursing will increase cost to $1,200 at the lowest rate.
Urinary catherisation after muzzling. No urethral obstruction.
URINE TESTS
BLOOD TESTS
X-RAYS - bladder stones. What to do?
Spoke to owner
1. Thought urinary incontinence - dribbling of urine was due to old age and so did not consult vet
2. Whether bladder stone removal can cure the incontinence? he asked. "I can't guarantee as the dog has been dribbling urine for a year.
3. Wait one week and given treatment. When appetite returns, will operate.
4. Cost of bladder stone removal and anaethesia is around $800. In-patient expenses and nursing will increase cost to $1,200 at the lowest rate.
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