Thursday, November 13, 2014
Wednesday, November 12, 2014
1099. SCRIPT FOR INTERNS RGS. How to take care of your sneezing dwarf rabbit
Nov 12, 2014
5 month old female rabbit
sneezing occasionally past 2 months and more sneezing recently
1. No pus. Just clear mucus from nose. Moderate amount. I used tissue to wipe the nose to check colour of nasal discharge.
2. Rapid breathing.
3. Lung sounds - harsh, generalised in both lungs.
DUST
1. Fine alfalfa hay with dust
2. Dry shampoo for bunnies - dust
3. Under the sofa - has dust
4. Pellets with seeds - dusty
HOUSING SPACE. Too cramped ---> breathes in dust
Crate too small now as she is 5 months old, weighing one kg. There is no space to turn. Length of body = half length of crate.
So owner took away the pee tray but the rabbit wanted the pee tray. Feed bowl.
Underside of back feet - decolourised with urine.
5 month old female rabbit
sneezing occasionally past 2 months and more sneezing recently
1. No pus. Just clear mucus from nose. Moderate amount. I used tissue to wipe the nose to check colour of nasal discharge.
2. Rapid breathing.
3. Lung sounds - harsh, generalised in both lungs.
DUST
1. Fine alfalfa hay with dust
2. Dry shampoo for bunnies - dust
3. Under the sofa - has dust
4. Pellets with seeds - dusty
HOUSING SPACE. Too cramped ---> breathes in dust
Crate too small now as she is 5 months old, weighing one kg. There is no space to turn. Length of body = half length of crate.
So owner took away the pee tray but the rabbit wanted the pee tray. Feed bowl.
Underside of back feet - decolourised with urine.
1098. SCRIPT FOR INTERNS RGS. How to prevent swollen eyes in terrapins in a city
Early detection & veterinary treatment saves eyes
1. Hook - Vet's dialogue with owner.
2. Be Kind to Pets - Theme
3. Introduction
Singapore in 2014. Mostly apartment living. Few landed houses. Harried life. Video clips.
Terrapins hatchlings from wet market or pet shop. Video.
Feeding. Most owners feed pellets. From Taiwan. Sample. Eat and poop in same water area.
Housing. Aquarium tank. set up. Sample. Illustration.
Water level low. No daily change of water. No filter.
Basking. Dry. Rocks. Floaters, Ramp. No UV light.
No sunlight.
Flooring tiled for bigger one.
4. Middle
Case studies
Eye metaplasia
Eye + respiratory problems
Eye + shell rot.
Eye + chlorinated drops
Position of UVL light to dry the shell
Water filter not washed
Daily change of water, very smelly stools - see one case of 2 healthy terrapins kept by one owner. No eye problem. Video.
5. Conclusion
Hygiene of water in tanks. Nutrition (expired, quality of pellets), no seafood, fishes or shrimps when young.
Early detection and treatment save eyes. Prevention. New terrapins quarantined 2 weeks.
6. Credits
Around 2 years old. Female. Active terrapin. Excellent shell quality.
Eyes swollen, closed and red for past 3 days.
Lethargic, not eating
Possible causes
1. Bacteria from new terrapin introduced into the tank around 2 weeks ago
2. Pellet quality has deteriorated over the year. Vit A deficiency.
3. De-chlorination chemicals inside the water given daily by the domestic worker.
4. No daily changes of water in the tank.
In-patient treatment at Toa Payoh Vets
Clean water daily. Eye drops and medication.
Eyes open in Day 3 but closed again.
Eyes fully open in Day 4.
Very good chances of success if treatment is given early.
The terrapin did not open her mouth to breathe and so did not have lung infections
Ey
Monday, November 10, 2014
A 7-year-old Shih Tzu cannot control her bladder and passes blood in the urine
> 3 days of haematuria and urinary incontinence. Owner said that this happened after her heat which was 2 weeks ago.
X-rays show no radio-dense urinary stones.
Sunday, November 9, 2014
141109. Lymphoma in a Miniature PInscher (2014) and Jack Ruseell (2011)
Saturday Nov 8, 2014
"I notice a large swelling below the right neck," the owner of this 9-year-old female unspayed Miniature Pinscher said.
"Actually, there is another one on the left neck," I examined the active dog that jogs with the owner.
"These are mandibular lymph nodes. The two popliteal lymph nodes behind the knees are much swollen too."
Advised:
TESTS to stage the cancer
1. Biopsy of lymph node
2. CBC (done)
3. serum chemistry profile
4. urinalysis
5. abdominal ultrasound (liver, spleen, intestinal lymph node, internal lymph nodes)
6. chest x-ray (lung, internal lymph nodes, intestinal tract)
7. bone marrow aspirate
Above tests are for STAGING OF LYMPOMA (to search for tumours in other locations)
BLOOD TEST 2 BY TOA PAYOH VETS ON NOV 9, 2014
Haemoglobin 20 (12-18)
Red cell count 8.8 (5.5-8.5)
Total white cell count 25.3 (6-17)
Neutrophils 24.4% (60-70) Absolute 6.17 (3-11.5)
Lymphocytes 74.5% (12-30) Absolute 18.85 (1-4.8)
Monocytes 0.4% (3-10) Absolute 0.1 (0.15-1.35)
Eosinophils 0.7% (2-10) Absolute 0.18 (0.1-1.25)
Basophils 0 (rare) Absolute 0 (rare)
liver and kidneys OK
BLOOD TEST NO. 2 ON NOV 11, 2014
Generalised lymphadenopathy including submandibular, prescap, inguinal and popliateal
Haemoglobin 19.2 (12-18)
Red cell count 8.77 (5.5-8.5)
Total white cell count 21.5 (6-17)
Neutrophils 21% (60-70) Absolute 4.5 (3-11.5)
Lymphocytes 60% (12-30) Absolute 12.9 (1-4.8)
Monocytes 18% (3-10) Absolute 3.8 (0.15-1.35)
Eosinophils 1.2% (2-10) Absolute 0.25 (0.1-1.25)
Basophils 0.2% (rare) Absolute 0.05 (rare)
Peripheral blood smear - shows normochromic normocytic erthroyctes. Mild leucocytosis, lymphocytosis, some reactive lymphocytes seen. Platelets adequate in number. Babesia -ve
FNA popliteal and prescap inconclusive.
Lymph Node excisional biopsy
Cytology (L and R prescap). Smear - mainly small to medium sized lymphocytes. Some lysed cells with no visible cytoplasmic boarder.
(L and R politeal). smears mainly small to medium sized lymphocytes. Some cells with a hand-mirror shape with cytoplasmic pseudopod.
Ultrasound of abdomen - possible liver infiltration. KIV FNA of liver.
X-ray chest - 3 views. No visible enlarged internal lymph node in chest
Urinalysis cystocentesis
pH 5.8 (5.5-8.5), SG 1.020 (1.015 - 1.045). Occasional RBC, WBC, epithelial cells, bacteria. Crystals variable.
creatinine, albumin, total protein tests
TENTATIVE DIAGNOSIS
Lymphoma
CAUSE - Unknown. Old age.
5 FORMS
1. External lymph nodes
2. Gastrointestinal tract
3. Mediastinal
4. Skin
5. Bone marrow
TREATMENT
Expensive. IV chemotherapy.
Remission. Recurrence. Most dogs after chemotherapy live for around one year if there is no recurrence.
REFERENCE:
http://www.vet.purdue.edu/pcop/canine-lymphoma-research.php
--------------------------------------------------------
LYMPHOMA IN A JACK RUSSELL IN 2011
"I notice a large swelling below the right neck," the owner of this 9-year-old female unspayed Miniature Pinscher said.
"Actually, there is another one on the left neck," I examined the active dog that jogs with the owner.
"These are mandibular lymph nodes. The two popliteal lymph nodes behind the knees are much swollen too."
Advised:
TESTS to stage the cancer
1. Biopsy of lymph node
2. CBC (done)
3. serum chemistry profile
4. urinalysis
5. abdominal ultrasound (liver, spleen, intestinal lymph node, internal lymph nodes)
6. chest x-ray (lung, internal lymph nodes, intestinal tract)
7. bone marrow aspirate
Above tests are for STAGING OF LYMPOMA (to search for tumours in other locations)
BLOOD TEST 2 BY TOA PAYOH VETS ON NOV 9, 2014
Haemoglobin 20 (12-18)
Red cell count 8.8 (5.5-8.5)
Total white cell count 25.3 (6-17)
Neutrophils 24.4% (60-70) Absolute 6.17 (3-11.5)
Lymphocytes 74.5% (12-30) Absolute 18.85 (1-4.8)
Monocytes 0.4% (3-10) Absolute 0.1 (0.15-1.35)
Eosinophils 0.7% (2-10) Absolute 0.18 (0.1-1.25)
Basophils 0 (rare) Absolute 0 (rare)
liver and kidneys OK
BLOOD TEST NO. 2 ON NOV 11, 2014
Generalised lymphadenopathy including submandibular, prescap, inguinal and popliateal
Haemoglobin 19.2 (12-18)
Red cell count 8.77 (5.5-8.5)
Total white cell count 21.5 (6-17)
Neutrophils 21% (60-70) Absolute 4.5 (3-11.5)
Lymphocytes 60% (12-30) Absolute 12.9 (1-4.8)
Monocytes 18% (3-10) Absolute 3.8 (0.15-1.35)
Eosinophils 1.2% (2-10) Absolute 0.25 (0.1-1.25)
Basophils 0.2% (rare) Absolute 0.05 (rare)
Peripheral blood smear - shows normochromic normocytic erthroyctes. Mild leucocytosis, lymphocytosis, some reactive lymphocytes seen. Platelets adequate in number. Babesia -ve
FNA popliteal and prescap inconclusive.
Lymph Node excisional biopsy
Cytology (L and R prescap). Smear - mainly small to medium sized lymphocytes. Some lysed cells with no visible cytoplasmic boarder.
(L and R politeal). smears mainly small to medium sized lymphocytes. Some cells with a hand-mirror shape with cytoplasmic pseudopod.
Ultrasound of abdomen - possible liver infiltration. KIV FNA of liver.
X-ray chest - 3 views. No visible enlarged internal lymph node in chest
Urinalysis cystocentesis
pH 5.8 (5.5-8.5), SG 1.020 (1.015 - 1.045). Occasional RBC, WBC, epithelial cells, bacteria. Crystals variable.
creatinine, albumin, total protein tests
TENTATIVE DIAGNOSIS
Lymphoma
CAUSE - Unknown. Old age.
5 FORMS
1. External lymph nodes
2. Gastrointestinal tract
3. Mediastinal
4. Skin
5. Bone marrow
TREATMENT
Expensive. IV chemotherapy.
Remission. Recurrence. Most dogs after chemotherapy live for around one year if there is no recurrence.
REFERENCE:
http://www.vet.purdue.edu/pcop/canine-lymphoma-research.php
--------------------------------------------------------
LYMPHOMA IN A JACK RUSSELL IN 2011
Monday, March 28, 2011
378. Sunday Case. "My Jack Russell suddenly can't see"
I HOPE THIS REAL CASE WILL HELP THE 5TH YEAR VET STUDENT WITH THOUSANDS
OF SUBJECTS TO REMEMBER AND BE EXAMINED BEFORE GRADUATION!
One look from my reception counter and I could see that this Jack Russell was suffering from Canine Lymphosarcoma. Some vets prefer to call it Canine Lymphoma. The two lumps of the size of ping-pong balls on the right and left lower jaws were too obvious to miss.
The owners were a young couple in their early 30s and an older woman and there was great emotions involved. The mum was distressed that the 8-year-old male Jack Russell walked into chairs and just could not see on this fine Sunday morning. Only the day before, the dog was zipping here and there when exercised outdoors. No accidents. No falls. No injuries. The dog just couldn't see! Why? What happened?
I decided to handle this case as the leading vet responsible for the outcome and together with my associate vet. Working as a team is a pleasure of veterinary medicine as we share our workload. I asked if she objected as she was on duty, but this was not her client. My associate said: "I am OK."
HISTORY
"What did Vet 1 say?" I asked when the owner showed me the report of a pre-scapular lymph node biopsy sent to the AVA lab.
"Vet 1 said that the AVA lab cannot confirm that the dog is suffering from lymphoma."
I read the report. It stated that it needed at least 2 biopsies from 2 lymph nodes and to relate to clinical signs. The presented biopsy cells could not confirm lymphoma.
So the owners must have concluded that the dog was not suffering from lymphoma!
No further treatment.
EYES
Blood inside both eyes preventing vision.
Note: In canine lymphoma, eye involved in 25% of cases). This can lead to bleeding within the eye, uveitis, glaucoma, retinal detachment and blindness.)
BLOOD TEST RESULTS OF DOG WITH LYMPHOMA OVER AT LEAST 1 MONTH
I was checking for infection (high WCC) or immune suppression (low WCC and platelets) or cancer (e.g. leukaemia with very high WCC), liver and kidney disorder.
Results are as follows:
Haemoglobin 13.9 (12-18)
Total WCC 11.8 (6-17)
Neutrophils 70.51 Abs 8.32
Lymphocytes 16.44 Abs 1.94
Monocytes 11.19 Abs 1.32
Eosinophils 0.09 Abs 0.01
Basophils 1.95 Abs 0.23
Red cell count 5.5 (5.5-8.5)
PCV 0.38 (0.37-0.55)
MCV 69 (60-77)
MCH 25 (20-25)
MCHC 36 (32-36)
RDW 14.1%
Platelets 90* (200-500). No platelet clumps seen.
LIVER PROFILE
ALT/SGPT 169 (<59 -3.6="" -="" 0.05="" 0.1="" 0.2="" 1.="" 138="" 2.58="" 2.="" 2="" 3.="" 4.="" 4047="" 4049.="" 4a="" 54="" 5a="" 5b="" 6.3="" 7="" 8.3="" a="" abdomen.="" abdominal="" acid="" active.="" acute="" affecting="" anaemia="" and="" anterior="" as="" asked="" ast="" be="" became="" been="" bite="" bleeding.="" bleeding="" blood="" bone="" both="" but="" bw.="" calcium="" canine="" cases="" causing="" cells="" central="" chemotherapy.="" chemotherapy="" class="separator" cost="" could="" count="" counts="" creatinine="" cure="" day="" decide="" depend="" depends="" developing="" did="" disease="" div="" do="" dog.="" dog="" domitor="" dose.="" drugs.="" due="" eating.="" eating="" enlarged.="" enlarged="" experience="" eye="" eyes.="" eyes="" for="" free="" from="" function="" generalised="" give="" guideline.="" had="" happened="" has="" highly="" his="" how="" hunched="" i="" impressed="" in="" infections.="" inside="" intense="" into="" involvement="" is="" it="" iv.="" ketamine="" kg.="" kidney="" life="" live="" liver="" long="" low="" lowest="" lymph="" lymphoma.="" lymphoma="" marrow="" may="" me.="" me="" means="" mild="" ml="" monitoring.="" months="" my="" nervous="" next="" no.="" no="" node="" nodes="" normal="" normally.="" not="" now="" of="" on="" one="" or="" other="" owner="" owners="" pacing="" pain="" palpated="" pancreatitis="" permanent="" platelet="" present="" problem="" profile="" prolonging="" quite="" quoted="" reading="" red="" relieve="" remission="" reports.="" reports="" risky="" rom="" rubbed="" rubs="" s="" said="" sclera="" sedation="" see.="" see="" seizures="" several="" shows="" situation.="" slept.="" solve="" some="" spleen="" stage="" stopped="" style="clear: both; text-align: center;" sunday="" syringe="" system="" tage="" test="" the="" there="" this="" to="" treatment.="" treatment="" two="" type="" urea="" uric="" varies="" very="" vet="" vigorously="" vision="" was="" were="" what="" whether="" which="" white="" will="" with="" without="" would="" yet="">
One look from my reception counter and I could see that this Jack Russell was suffering from Canine Lymphosarcoma. Some vets prefer to call it Canine Lymphoma. The two lumps of the size of ping-pong balls on the right and left lower jaws were too obvious to miss.
The owners were a young couple in their early 30s and an older woman and there was great emotions involved. The mum was distressed that the 8-year-old male Jack Russell walked into chairs and just could not see on this fine Sunday morning. Only the day before, the dog was zipping here and there when exercised outdoors. No accidents. No falls. No injuries. The dog just couldn't see! Why? What happened?
I decided to handle this case as the leading vet responsible for the outcome and together with my associate vet. Working as a team is a pleasure of veterinary medicine as we share our workload. I asked if she objected as she was on duty, but this was not her client. My associate said: "I am OK."
HISTORY
"What did Vet 1 say?" I asked when the owner showed me the report of a pre-scapular lymph node biopsy sent to the AVA lab.
"Vet 1 said that the AVA lab cannot confirm that the dog is suffering from lymphoma."
I read the report. It stated that it needed at least 2 biopsies from 2 lymph nodes and to relate to clinical signs. The presented biopsy cells could not confirm lymphoma.
So the owners must have concluded that the dog was not suffering from lymphoma!
No further treatment.
EYES
Blood inside both eyes preventing vision.
Note: In canine lymphoma, eye involved in 25% of cases). This can lead to bleeding within the eye, uveitis, glaucoma, retinal detachment and blindness.)
BLOOD TEST RESULTS OF DOG WITH LYMPHOMA OVER AT LEAST 1 MONTH
I was checking for infection (high WCC) or immune suppression (low WCC and platelets) or cancer (e.g. leukaemia with very high WCC), liver and kidney disorder.
Results are as follows:
Haemoglobin 13.9 (12-18)
Total WCC 11.8 (6-17)
Neutrophils 70.51 Abs 8.32
Lymphocytes 16.44 Abs 1.94
Monocytes 11.19 Abs 1.32
Eosinophils 0.09 Abs 0.01
Basophils 1.95 Abs 0.23
Red cell count 5.5 (5.5-8.5)
PCV 0.38 (0.37-0.55)
MCV 69 (60-77)
MCH 25 (20-25)
MCHC 36 (32-36)
RDW 14.1%
Platelets 90* (200-500). No platelet clumps seen.
LIVER PROFILE
ALT/SGPT 169 (<59 -3.6="" -="" 0.05="" 0.1="" 0.2="" 1.="" 138="" 2.58="" 2.="" 2="" 3.="" 4.="" 4047="" 4049.="" 4a="" 54="" 5a="" 5b="" 6.3="" 7="" 8.3="" a="" abdomen.="" abdominal="" acid="" active.="" acute="" affecting="" anaemia="" and="" anterior="" as="" asked="" ast="" be="" became="" been="" bite="" bleeding.="" bleeding="" blood="" bone="" both="" but="" bw.="" calcium="" canine="" cases="" causing="" cells="" central="" chemotherapy.="" chemotherapy="" class="separator" cost="" could="" count="" counts="" creatinine="" cure="" day="" decide="" depend="" depends="" developing="" did="" disease="" div="" do="" dog.="" dog="" domitor="" dose.="" drugs.="" due="" eating.="" eating="" enlarged.="" enlarged="" experience="" eye="" eyes.="" eyes="" for="" free="" from="" function="" generalised="" give="" guideline.="" had="" happened="" has="" highly="" his="" how="" hunched="" i="" impressed="" in="" infections.="" inside="" intense="" into="" involvement="" is="" it="" iv.="" ketamine="" kg.="" kidney="" life="" live="" liver="" long="" low="" lowest="" lymph="" lymphoma.="" lymphoma="" marrow="" may="" me.="" me="" means="" mild="" ml="" monitoring.="" months="" my="" nervous="" next="" no.="" no="" node="" nodes="" normal="" normally.="" not="" now="" of="" on="" one="" or="" other="" owner="" owners="" pacing="" pain="" palpated="" pancreatitis="" permanent="" platelet="" present="" problem="" profile="" prolonging="" quite="" quoted="" reading="" red="" relieve="" remission="" reports.="" reports="" risky="" rom="" rubbed="" rubs="" s="" said="" sclera="" sedation="" see.="" see="" seizures="" several="" shows="" situation.="" slept.="" solve="" some="" spleen="" stage="" stopped="" style="clear: both; text-align: center;" sunday="" syringe="" system="" tage="" test="" the="" there="" this="" to="" treatment.="" treatment="" two="" type="" urea="" uric="" varies="" very="" vet="" vigorously="" vision="" was="" were="" what="" whether="" which="" white="" will="" with="" without="" would="" yet="">
Friday, November 7, 2014
A wedding promise
A Myanmar lady getting married to a Spanish man today asked me to edit her speech at the wedding.
HER VOWS
First I want to say thanks you.. to my groom as you make my dreams come true. I am proud to be your wife and join my life with yours.
I promise to love and care for you and I will try in every way to be worthy of your love.
And wherever our journey leads us, living, learning and loving together for 2000 years.
-------------------------------
MY SUGGESTION
Today is my most important and happiest day of my life as I stand beside my beloved man of my dreams to exchange rings and promises.
Today, we begin a new journey that I pray will be filled with love, care and learning about each other till the end of our lives.
I promise to love and care for you in good times and in bad times, in health and in sickness, with joys and laughter, as we grow old together, as the dream girl you have married today.
I hope we can be forever as one united from today, till our hairs turn silver, still in love in our winter years.
HER VOWS
First I want to say thanks you.. to my groom as you make my dreams come true. I am proud to be your wife and join my life with yours.
I promise to love and care for you and I will try in every way to be worthy of your love.
And wherever our journey leads us, living, learning and loving together for 2000 years.
-------------------------------
MY SUGGESTION
Today is my most important and happiest day of my life as I stand beside my beloved man of my dreams to exchange rings and promises.
Today, we begin a new journey that I pray will be filled with love, care and learning about each other till the end of our lives.
I promise to love and care for you in good times and in bad times, in health and in sickness, with joys and laughter, as we grow old together, as the dream girl you have married today.
I hope we can be forever as one united from today, till our hairs turn silver, still in love in our winter years.
Thursday, November 6, 2014
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