Dec 31, 2014
I was still in the surgery at around 5 pm. The rabbit had suddenly stopped eating and the lady owner came as her vet must have closed shop on this last day of New Year. Enjoyment was in the air and so many shop owners close early.
This was a new owner who had given critical care to this anorexic rabbit as I noticed some wetness in his mouth. She did not want any injection and this is a mindset of some of the younger generation pet owners and vets as regards injections of rabbits and guinea pigs, thinking they will suffer death.
They would dictate the type of treatment and had researched the internet..
"I am a doctor," she said when I explained that the rabbit would recover faster from injection.
"You heard a squeak when I palpated the abdomen," I explained that the rabbit had a swollen stomach which was painful on palpation. "As a doctor, you would know that it is best not to give oral medication to an upset stomach whenever possible. The stomach would get further irritated."
She reluctantly agreed to the injections which were 0.1 ml of baytril and 0.1 ml of painkiller meloxicam added to 0.4 ml of saline and given subcutaneously via fine needles. There was no painful squeal from the rabbit on injection.
"I want some antibiotics," she said.
"Be patient," I said. "Tomorrow morning, New Year's Day, I will be working in the morning. Giveme a phone call if the rabbit has not started eating. Antibiotics may irritate the stomach and intestines now inflamed."
Now it is 10.30 am on New Year's Day and no news from her.
This is a strange case in the sense that she lives in Toa Payoh but had never come to Toa Payoh Vets. So proximity was not her concern. She liked the service of the other vet south of Toa Payoh. This rabbit has a habit of licking wall paint and biting things compared to the other two roaming ones. So, the stomach could be upset by chemicals from the paint.
"Strict monitoring of the rabbit outside the crate would prevent a 4th occurrence," I said.
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I was at the pet shop to buy hamster food and had a chat with the operator. Her Primary 6 daughter had helped her in the shop. "I listened to what you said about having my children learn about the pet shop business," she told me. "So this 2nd daughter is here. The one in Seconday 1 will come another day."
"If you shield your 5 children from working in the shop, thinking that they better stay at home, you are bringing up your children to dislike the pet shop business and succeeding you later. You think you are protecting them from the smells and dirt of the pet shop animals. But this is a mistake. They will grow up self-centered and not assisting you at all, to keep their hands clean."
Thursday, January 1, 2015
1163. INTERN. SCRIPT. A dwarf hamster has an itchy lower elbow wart
The mother and pre-teen daughter complained that this 2-year-old dwarf hamster had a red bald patch on the right backside area and was itch scratching continually. I observed the hamster and saw the scratching (video) mainly on the right side.
Some vets perform physical examination which does not involve picking up the hamster to examine his lower body. After all, this is such a small creature and everything can be seen at one look.
I picked up this hamster. Surprisingly, there was a hidden lower elbow wart! This could be the irritating inflamed growing wart that caused the right sided itchiness including right ear scratching and the left backside biting wound. Biting and scratching provide instant temporary relief of pain. This was my hypothesis.
If my hypothesis is correct, electro-excision of this ventral wart would resolve the problem.
Now how to excise this wart which extends the whole width of the lower elbow? It is a gigantic wart if you imagine your lower elbow's width being occupied by a large wart. Should the vet use scissors to excise it and how to control the post-op profuse bleeding?
The hamster is aged, being 2 years old and has around 6 months of life generally. Would the hamster die under anaesthesia and therefore damage the vet's reputation?
What to do to resolve this problem without killing the hamster? Reputational risks are more important for a private vet. Nobody will refer cases to him if he or she has hamsters dead on the operating table.
I decided to give the hamster only isoflurane gas anaesthesia. I used the circular electric loop wire to electro-excise the wart in a split second when the hamster was just anaesthesized by the gas. I used forceps to lift up the wart and excise under it. There was some normal skin. The wart came off and there was just a 3 mm wound. Blood-less. See video.
The hamster went home on the same day and the mother and daughter were happy and satisfied.
In conclusion, if the vet does not examine the underside of the hamster, he or she would mis-diagnose as environmental cause of itchiness and this would not resolve the itchiness problem.
TIPS
Always examine the underside of the dwarf hamster by picking up the hamster and turning him upside down. This elbow wart would have been missed as it was not protruding. A correct diagnosis resolves the client's problem and bring in more referrals than slick advertising. Vets have to deliver results and perform like any service provider.
------------------------------------------------------
Jan 3, 2015
COMMENTS ON VIDEO PRODUCED BY INTERN JIA LING
1. A fast-paced concise video
To improve the quality of production
1. Not to publish the title of video as this is unnecessary
2. Subtitles to be on white text on a black band. White text not easily read in this video.
3. Subtitles are too rapid to be read
4. The BKTP image is flashed by too quick to be read
5. Weak concluding frames - same videos of hamster still scratching. Should have a post-op video or something similar rather than repeat the opening
6. The backside wound - main complaint was not emphasized.
7. Credits -- more videos at www.toapayohvets.com/videos.htm
Some vets perform physical examination which does not involve picking up the hamster to examine his lower body. After all, this is such a small creature and everything can be seen at one look.
I picked up this hamster. Surprisingly, there was a hidden lower elbow wart! This could be the irritating inflamed growing wart that caused the right sided itchiness including right ear scratching and the left backside biting wound. Biting and scratching provide instant temporary relief of pain. This was my hypothesis.
If my hypothesis is correct, electro-excision of this ventral wart would resolve the problem.
Now how to excise this wart which extends the whole width of the lower elbow? It is a gigantic wart if you imagine your lower elbow's width being occupied by a large wart. Should the vet use scissors to excise it and how to control the post-op profuse bleeding?
The hamster is aged, being 2 years old and has around 6 months of life generally. Would the hamster die under anaesthesia and therefore damage the vet's reputation?
What to do to resolve this problem without killing the hamster? Reputational risks are more important for a private vet. Nobody will refer cases to him if he or she has hamsters dead on the operating table.
I decided to give the hamster only isoflurane gas anaesthesia. I used the circular electric loop wire to electro-excise the wart in a split second when the hamster was just anaesthesized by the gas. I used forceps to lift up the wart and excise under it. There was some normal skin. The wart came off and there was just a 3 mm wound. Blood-less. See video.
The hamster went home on the same day and the mother and daughter were happy and satisfied.
In conclusion, if the vet does not examine the underside of the hamster, he or she would mis-diagnose as environmental cause of itchiness and this would not resolve the itchiness problem.
TIPS
Always examine the underside of the dwarf hamster by picking up the hamster and turning him upside down. This elbow wart would have been missed as it was not protruding. A correct diagnosis resolves the client's problem and bring in more referrals than slick advertising. Vets have to deliver results and perform like any service provider.
------------------------------------------------------
Jan 3, 2015
COMMENTS ON VIDEO PRODUCED BY INTERN JIA LING
1. A fast-paced concise video
To improve the quality of production
1. Not to publish the title of video as this is unnecessary
2. Subtitles to be on white text on a black band. White text not easily read in this video.
3. Subtitles are too rapid to be read
4. The BKTP image is flashed by too quick to be read
5. Weak concluding frames - same videos of hamster still scratching. Should have a post-op video or something similar rather than repeat the opening
6. The backside wound - main complaint was not emphasized.
7. Credits -- more videos at www.toapayohvets.com/videos.htm
Wednesday, December 31, 2014
1162. Advices from a pet shop operator - terrapins and pellet food for guinea pigs and rabbits
1. The terrapins imported from the USA are in better health and condition than those from Thailand and Malaysia. Shell quality and health are better. They are selling $4.00 to $5.00 and look like hatchlings, about the size of a 50-cent coin. See video.
2 Rabbits and guinea pigs should be fed pellets, not the mixture of seeds and pellets as given to hamsters. Otherwise they will not get the essential nutrients.
2 Rabbits and guinea pigs should be fed pellets, not the mixture of seeds and pellets as given to hamsters. Otherwise they will not get the essential nutrients.
1161. Four skin-diseased dogs on 30 Dec 2014 morning.
Unusual to get 4 skin diseased dogs in Case 1,2, 4 and 5 on this Monday morning, Dec 30, 2014. I thought it would be a quiet day.
The 3rd case was a Schnauzer going to Yangon in 2 days' time and needed a healthcheck. The brother of the owner had taken the dog to a vet for bladder stone removal. With 10 days of hospitalisation, the total bill was over $3,600.
I made 4 videos of the skin disease dogs for review next visit one month later. Three had a common disease- generalised ringworm. The other one was an overweight Jack Russell who bit her front paws and groin area till they become brown and black.
The 3rd case was a Schnauzer going to Yangon in 2 days' time and needed a healthcheck. The brother of the owner had taken the dog to a vet for bladder stone removal. With 10 days of hospitalisation, the total bill was over $3,600.
I made 4 videos of the skin disease dogs for review next visit one month later. Three had a common disease- generalised ringworm. The other one was an overweight Jack Russell who bit her front paws and groin area till they become brown and black.
1160. A cat spayed by a vet 2 years ago still caterwauls
"Is it due to the spay not properly done?" the mother asked me. "My cat makes a lot of noises, rolling on the floor and lifting up her tail. She went outdoors and attracted the male cats"
I checked the cat's vulval area. There was no discharge.
"Why didn't you let the vet know aboat this caterwauling 2 years ago after the spay? Or a few months after? It is now 2 years later."
"I thought this meowing was normal," the mother said. "The vet had said it was normal after spaying. Before, the cat was not making so much noise as she was indoors. Now she is outside and exhibits this type of noisy behaviour!"
"It is possible that there was some ovarian tissues left after spaying," I said.
"I want to give away the cat," the mother said.
"Take the Ovarid 20 mg tablet at 1/4 tablet per day for 4 days when there is caterwauling," I advised. "This will stop the caterwauling. Take for the next 3 months and let me know. It will be very difficult to look for the ovarian tissues now but that may be the only solution!"
I checked the cat's vulval area. There was no discharge.
"Why didn't you let the vet know aboat this caterwauling 2 years ago after the spay? Or a few months after? It is now 2 years later."
"I thought this meowing was normal," the mother said. "The vet had said it was normal after spaying. Before, the cat was not making so much noise as she was indoors. Now she is outside and exhibits this type of noisy behaviour!"
"It is possible that there was some ovarian tissues left after spaying," I said.
"I want to give away the cat," the mother said.
"Take the Ovarid 20 mg tablet at 1/4 tablet per day for 4 days when there is caterwauling," I advised. "This will stop the caterwauling. Take for the next 3 months and let me know. It will be very difficult to look for the ovarian tissues now but that may be the only solution!"
1159. Hernia repair mesh in human and canine surgery
Dec 31, 2014.
1159. Hernia repair mesh in human and canine surgery
omyra mesh sold
www.abdominalwallhealth.com
2 types of mesh.
Normal mesh causes intestinal adhesions from $80 --- intestinal obstruction -- strangulation -- death.
Adhesive prevention mesh $900 (10 cm x 15 cm).
Human hernias
USE OF ADHESION PREVENTION MESH
Incisional hernias (after surgery)
Umbilical hernias
USE OF NORMAL MESH
Inguinal hernia
METHOD
see www.abdominalwallhealth.com
1. The plug method (mesh cut diagonally half way and formed into a cone or funnel to close the hole) is NO longer used in human medicine. It requires the expensive adhesion prevention mesh. It has been described in a veterinary hernia repair book published by Europeans. .
VETERINARY SURGERY
1. The adhesion prevention mesh must be used if there is contact with the intestines for very large perineal hernias.
2. In hernias where the sides can be stitched up, use the normal mesh to cover the muscles after stitching. There must be a 3-cm margin to account for shrinkage of the mesh. For example, a perineal hernial opening of 12 cm x 12 cm will need a mesh size of 15 cm x 15 cm.
3. Plug method is no longer used in human surgery according to B Braun sales rep Alex.
Tuesday, December 30, 2014
1158. Left perineal hernia and right hip dislocation
This old Pom had a right hip dislocation and a big swollen left perineal hernia. The dog can pee and poop "normally" but cannot walk normally.
"The vet said that since the dog could pee and poop normally, I did not need to do any surgery on the perineal hernia. I had some financial considerations. But it has got much bigger in size! Now my Pom hops on 3 legs! What to do?"
"Perineal hernia repair is more important as it can be life-threatening when the herniated intestines or bladder get twisted."
"The vet said that since the dog could pee and poop normally, I did not need to do any surgery on the perineal hernia. I had some financial considerations. But it has got much bigger in size! Now my Pom hops on 3 legs! What to do?"
"Perineal hernia repair is more important as it can be life-threatening when the herniated intestines or bladder get twisted."
Monday, December 29, 2014
Perineal hernia repair surgery - queries
EMAIL TO DR SING DATED DEC 29, 2014
Hi
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EMAIL REPLY FROM DR SING DATED DEC 29, 2014
I am Dr Sing from Toa Payoh Vets.
1. The risks are mainly anaesthetic deaths on the operating table as the dog is old (more than 7 years in small breeds is considered old).
It is hard to predict the chances of survival as each dog is an individual with different outcomes. Generally, if the dog has a normal heart and lungs, is active and eating and drinking normally, with normal stools and urine, the blood tests show normal values, then the risks are less than 1%. Such dogs survive anaesthesia and perineal hernia repair. in my experience over the last 30 years.
2. The hernia gets bigger if you wait another year. The intestinal blood vessels may get twisted when the herniated intestines in the hernia turns and twists. This results in death or emergency surgery for painful obstruction of urine flow or intestinal gangrene. In such situations, the risks are much higher.
Presently, the dog has "no problems" passing urine and stools and show "no pain" although the hernia is much larger. Therefore, you have to make an informed decision as to whether you want surgery to repair the hernia.
Hernia now is the size of an orange. When it was small, a vet had advised that there was no need to operate as the dog could pee and poop. Over time, it mushroomed to the present size. I could feel a full bladder and the intestines could be pushed inwards, reducing the size temporarily. There was only slight pain on reduction of the hernia.
----------------------------------------
EMAIL TO DR SING DATED DEC 30, 2014
EMAIL REPLY FROM DR SING DATED DEC 30, 2014
Post-op care include wound cleaning and confined to a cage for at least 14 days so that the backside and inner stitches will not break down by jumping. A diet that does not cause hard stools to form. Can pee and poop after surgery in most cases if the intestines and bladder have not suffered inflammation and infection before surgery. Stools may be passed 2-3 days later. Pain-killers will be given for at least 4 days. Antibiotics given for 14 days generally.
Hi
I brought XXX to your clinic yesterday. He is the 8 year old mini Maltese with a hernia on the right. It
was recommended that we send him for surgery.
We love him very much and are concerned that he should not go through any suffering.
May we please know the following:
1. What are the risks of surgery and the likelihood of these risks occurring?
2. What will happen if we do not go for the surgery now? Is there an option to go for surgery later?
Thank you for your time.
Kind Regards
--------------------------------------------------------------------------------------------------
EMAIL REPLY FROM DR SING DATED DEC 29, 2014
I am Dr Sing from Toa Payoh Vets.
1. The risks are mainly anaesthetic deaths on the operating table as the dog is old (more than 7 years in small breeds is considered old).
It is hard to predict the chances of survival as each dog is an individual with different outcomes. Generally, if the dog has a normal heart and lungs, is active and eating and drinking normally, with normal stools and urine, the blood tests show normal values, then the risks are less than 1%. Such dogs survive anaesthesia and perineal hernia repair. in my experience over the last 30 years.
2. The hernia gets bigger if you wait another year. The intestinal blood vessels may get twisted when the herniated intestines in the hernia turns and twists. This results in death or emergency surgery for painful obstruction of urine flow or intestinal gangrene. In such situations, the risks are much higher.
Presently, the dog has "no problems" passing urine and stools and show "no pain" although the hernia is much larger. Therefore, you have to make an informed decision as to whether you want surgery to repair the hernia.
Hernia now is the size of an orange. When it was small, a vet had advised that there was no need to operate as the dog could pee and poop. Over time, it mushroomed to the present size. I could feel a full bladder and the intestines could be pushed inwards, reducing the size temporarily. There was only slight pain on reduction of the hernia.
----------------------------------------
EMAIL TO DR SING DATED DEC 30, 2014
Dear Dr Sing
Thanks for the reply. It is
really appreciated. We just have a few follow up questions - What sort
of care will Pickles require post surgery? Will he require special
attention? Also, will he be able to pass urine and stools immediately
after the surgery?
Regards
EMAIL REPLY FROM DR SING DATED DEC 30, 2014
Post-op care include wound cleaning and confined to a cage for at least 14 days so that the backside and inner stitches will not break down by jumping. A diet that does not cause hard stools to form. Can pee and poop after surgery in most cases if the intestines and bladder have not suffered inflammation and infection before surgery. Stools may be passed 2-3 days later. Pain-killers will be given for at least 4 days. Antibiotics given for 14 days generally.
Saturday, December 27, 2014
Saturday Dec 27, 2014 interesting cases - perineal hernias x 2, testicular neoplasia, facial swelling of a cat
This Saturday was unusual for me. Just non-stop consultation cases today. No time for intern Goh too.
3 most interesting cases will be made into a video by Ms Goh. They can be classified under tumours (neoplasia), inflammation and others.
1. Facial swelling in a cat is an example of inflammation.
2. Two perineal hernias in two dogs on one day are lucky for Intern Goh as this is rarely encountered. They are classified under "others."
3. Testicular neoplasia in a Japanese Spitz is an example of tumours. So Intern Goh gets to see 3 types of very interesting clinical conditions..
.
What is the treatment for this cat? Vet 1 extracted the tooth without anaesthesia as the cat is old. Vet 2 prescribed antibiotics and steroids but now the cat is not eating. The swelling had gone down.
The owner had done his internet research and consulted me on oro-nasal fistulas or carnaissal tooth abscess which he believed his cat had suffered from. Cats do get carnaissal tooth abscesses just like dogs.
I thought this was a case of nasal carcinoma or malginant nose tumours. Yet on examination and X-rays, there were no obvious signs of tumour. Based on the history of sudden yanking out of the left upper cheek tooth by the first vet, there could be traumatic damage to the area and residual remnants of the roots. X-ray of the maxillary sinus swelling (X) indicated inflammation and a possible fracture fragment (Y) of the maxillary sinus.
What is the solution? Which cheek tooth was extracted by Vet 1 the owner did not know. It was an upper left cheek tooth.
3 most interesting cases will be made into a video by Ms Goh. They can be classified under tumours (neoplasia), inflammation and others.
1. Facial swelling in a cat is an example of inflammation.
2. Two perineal hernias in two dogs on one day are lucky for Intern Goh as this is rarely encountered. They are classified under "others."
3. Testicular neoplasia in a Japanese Spitz is an example of tumours. So Intern Goh gets to see 3 types of very interesting clinical conditions..
.
The owner had done his internet research and consulted me on oro-nasal fistulas or carnaissal tooth abscess which he believed his cat had suffered from. Cats do get carnaissal tooth abscesses just like dogs.
I thought this was a case of nasal carcinoma or malginant nose tumours. Yet on examination and X-rays, there were no obvious signs of tumour. Based on the history of sudden yanking out of the left upper cheek tooth by the first vet, there could be traumatic damage to the area and residual remnants of the roots. X-ray of the maxillary sinus swelling (X) indicated inflammation and a possible fracture fragment (Y) of the maxillary sinus.
What is the solution? Which cheek tooth was extracted by Vet 1 the owner did not know. It was an upper left cheek tooth.
Friday, December 26, 2014
2-month-old guinea pig screams sometimes
The owner bought a pair of 2-month-old guinea pigs and housed them together. One was screaming now and then but both were eating.
"Do you have Revolution? Are they having skin mites?" the mum asked. I put the guinea pig onto a piece of white paper and rustled the body hair. No hair dropped off and 2 or 3 black specks. The black specks were not mites as seen under the microscope.
"No mites in the body," I put a thin cotton bud into Alice's ears. "Black dirty wax was seen and the guinea pig squealed." When I did this on the other pig, there was no pain response. Both were bought from different sellers.
"Do they use their hind legs to scratch the sides of the body?" I asked.
"Yes, Yes," mum said.
"This is due to ear pain or infections," I explained that cats and dogs with ear infections do it consistently.
I advised ear cleaning 3X/week with the ear ointment containing insectide and separation of the two for one month with a grated barrier such that they can smell and see each other, to prevent bullying.
Overall the guinea pigs look thin and so should be alone to put on weight
"Do you have Revolution? Are they having skin mites?" the mum asked. I put the guinea pig onto a piece of white paper and rustled the body hair. No hair dropped off and 2 or 3 black specks. The black specks were not mites as seen under the microscope.
"No mites in the body," I put a thin cotton bud into Alice's ears. "Black dirty wax was seen and the guinea pig squealed." When I did this on the other pig, there was no pain response. Both were bought from different sellers.
"Do they use their hind legs to scratch the sides of the body?" I asked.
"Yes, Yes," mum said.
"This is due to ear pain or infections," I explained that cats and dogs with ear infections do it consistently.
I advised ear cleaning 3X/week with the ear ointment containing insectide and separation of the two for one month with a grated barrier such that they can smell and see each other, to prevent bullying.
Overall the guinea pigs look thin and so should be alone to put on weight
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