2959. Looking for a "good" vet. Retained ovarian tissues

August 2, 2015

Hi Dr Sing,

She has stop passing gas now but she's been drinking a lot of water since yesterday (estimate 400-500 ml today). Her temp went from her usual 37.7-38.2 to 38.2 - 38.9, albeit it's within the normal range I find it quite peculiar the vast changes. She had some slight lethargy, weak legs, slow motion, panting, hiding under the bed/table/couch, restlessness on Yesterday. 

This is just so strange she was so well playful, no swollen tummy, normal water consumption on Wednesday till Saturday. 

I've now removed the water in case there's a stump and it builds up into pus. 

Here's the latest pix of the swollen stomach. I've also discovered a blood spot, which doesn't seems recent. 

She's on juroclav since yesterday (Sunday), she had to stop her antibiotic on Wed-Sat because she had severe rashes from it. 

Question:

What's the cost of x-ray? Do u have the facilities in your clinic?

Im not too sure if she has an infection, how do we determine that? In her previous urine test it showed her WBC was in the normal range, would that confirm any infection.

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This case shows the lack of confidence in all vets as the owner now does her own diagnosis. Vet 1 had spayed her dog (pyometra) saving the dog's life. However the dog showed signs of heat after the spay and passed some spots of vaginal discharge. Vet 2's ultrasound diagnosed ovarian remnant in the left kidney area and gastroenteritis.

The dog was not as active as before and seemed to be in pain. I advised her to get a review again with Vet 2. The owner decided on self-treatment with antibiotics and tramadol pain-killer. She looks for a "good" vet.
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In my reply, I wrote:

As each vet, like you, is an individual, you cannot expect perfections.

2958. Stray cat spay in 5 minutes

Aug 3, 2015

Youtube Video:
https://www.youtube.com/watch?v=ouUePbKDUdg

A stray cat is spayed in 5 minutes.

1. Short skin incision around 2.5 cm
2. Hook out uterine horn, exposing a longer length of ovary and ovarian ligament
3. Clamp on ovarian ligament twisted in a circle to include the tip of a part of the ligament when the ovarian tissues are cut. The tip of the clamp forceps then catch this tip and pull it inwards to "ligate" the ovarian blood vessels. No need to use stitches as in standard spay.  Repeat on the other ovary.
4. Uterine body is clamped and ligated as in standard spay.
5. Stainless steel suture is used to ligate uterine body, muscle layer (one cross stitch) and subcutaneous skin (horizontal mattress suture under the skin).  

Claimed that the cat can be released immediately. Any age from 6 weeks onwards. These are stray cats.  

Video time taken: Less than 5 minutes. Cat spayed was on heat and so the uterine horns are swollen and easily hooked.No need e-collars.

COMMENTS
For most vets, I will advise
1. A longer skin incision to ensure that the ovarian tissues are 100% taken out and seen. This is to prevent remnants of ovarian tissues remaining in the "spayed" cat.
2. Ligate  the ovarian ligament with absorbable sutures as in the standard spay.
3. Toa Payoh Vets use one separate suture packet per cat spayed, not from a reel of sutures as for stray cats.

2957. INTERN. Cystic Endometrial Hyperplasia

I have a rare case of CEH as evident by the image below.

What is CEH?

Who
Where
When

How

The female Maltese, 8 years, came in for removal of the breast nodules (Left MG3 nodules). I had advised spay earlier but the owner did not do it. This time he agreed to the spay.

The dog has a fully distended thin uterine horn filled with clear fluid. She was spayed as well as removal of the mastectomy.
She recovered fully and went home.

2956. Under-feeding a terrapin for 7 years

Monday, July 27, 2015.
"The 7-year-old terrapin does not have swollen eyes," I said. "However, he is underweight and has the shell length of a 1-year-old".

The owner wanted to prevent obesity. So he feed 5 pellets every 2 days and allow the terrapin, measuring 7 cm in shell length. The shell was bleached light brown. The terrapin loved to be submerged in water most of the time and would snap at the pellets eagerly. A calcium tablet in the shape of a terrapin was put in the water every 2 months, so the water is filled with this calcium.

Today, the terrapin's neck area has loose flabby skin, as if, swollen. "This swelling occurs in the past week," the gentleman said.

It is hard to know what causes this neck swelling. It could be calcium deposits near the thoracic inlet, nutritional imbalance with too much calcium or a tumour.



The back leg muscles and skin were normal and not flabby.

Removal of the calcium, allow more time to bask by not giving water all the time, a variety of food and sunshine, including medication dripped into the pellets for the next 14 days. We will need to follow up.  

2955, INTERN. Good Performance Counts - emergency Caesearean section

Sat July 25, 2015

I was surprised to see the poodle coming in for Caesearean section again as I have not seen the dog after the milk fever in the first emergency C-section around 2 years ago.

The lady showed me her mobile phone image of x-rays taken by another clinic, showing 2 puppies. She had decided not to go to this vet as I had a good outcome for her first surgery.  (Video clip of first C-section).


Jun 25, 2015.
C-section  - 2 large pups in one uterine horn.

1. Brown pup was nearer the cervix and had lungs clogged with mucus. Swinging saved her life as mucus in nose and mouth showed lungs were filled with mucus.

2. White pup took at least 5 minutes to cry. No need swinging.
   

Sunday. Jun 26, 2015 - good outcome as dam and puppies are OK. The parents are most happy.
Puppies came in for tail docking (SEPARATE VIDEO ON VET SURGERY OF TAIL DOCKING).





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How to extract videos from youtube

Dear Dr Sing,

to extract videos from youtube,

1.  all we need to do is visit the website: http://www.clipconverter.cc/

2. Under " media url to download" insert the url of the youtube video you want to extract

3. and press continue and convert.

The website is very user-friendly and actually shows the steps you need to take, it should be easy for the interns to use. Hope this helps.

Yours sincerely, 

Gin 

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go to toapayohvets.com for latest relevant videos as well.
puppies tail docked today. Make a separate video from above. TAIL DOCKING POODLES 

2504. INTERN The guinea pig with the left head tilt has left nostril discharge and pneumonia again

Jul 23, 2015

The guinea pig with the left head tilt has pneumonia again. Came in yesterday evening.
Owner was not able to treat previously the guinea pig at home. 
"Some vets don't like to give subcutaneous injection," I said to the man. "Sometimes the owner blames the vet for the painful reaction or death from the injection in seriously ill guinea pigs." I said. "The owner would say that the sick guinea pig was still alive but after the injection, he dies. So, it is due to the injection."


"I understand my guinea pig is seriously ill," he said. "I will not blame you if you give the injections."

Informed consent is important nowadays. I gave the guinea pig SC baytril and 2 ml of dextrose saline and Vit B + C at 6.30 p.m.  This morning, he is better and no longer pants so fast. I had given the same treatment last time and the guinea pig had felt better, according to the owner. He had seen my associate who prescribed him oral medication and I was around and so he asked me about the injection. I warded the guinea pig as he could not manage the medication administration.

So far so good.    

2503. INTERN Cat owner's education - religious retreat - giving medication to a clever roaming cat.

July 22, 2015

"I have to cancel my retreat as my cat needs two people to give him antibiotic and pain medication," the slim woman in her 50s had brought in her cat for cat bite wound stitching. "The retreat in this temple is for one week and is held only once a year." I had told her that the cat needed to be given medication for the next 7 days.

"I should have my cat treated when she had a small bite wound from the other cat," she said. "Now it is a very big wound, due to the cat continuous licking. He needs stitching."

After anaesthesia, cleaning and debridement of the wound and stitching, the cat was ready to go home. But the owner had to go for the retreat. "Living in the temple clears my mind," she had looked forward to this residential retreat which requires waking up at 4 am to chant. "I will go next year."

"A year is too long and many things can happen to our lives," I said.
"This cat is much loved as even my neighbour who hates cat, loves him," she told me. "He is like a human being. When my neighbour asks him to jump onto the chair, he does it. When she tells him to jump onto the table, he does it. He will meow in appreciation when given food unlike other cats who will be silent."

This was indeed a clever cat. He would not take medication unless the owner and his son do it together to coax him into taking the medicine via a syringe with water and medicine.

"Go for your Buddhist retreat tomorrow," I said. "This cat is not suffering from a life-and-death disease. The worst case is that his stitch breaks down, but he has an e-collar round his neck to prevent licking."

"Prepare the medication by crushing the tablet and mixing with milk.  Fill two 1-ml syringe with milk and one syringe with milk and medication.     Wrap the cat in a towel covering his four legs and put him on a table.  Make him hungry for dinner. Your son will give him the first two syringes with milk alone. He will like the milk syringed into his mouth. Then, the 3rd syringe with medication.

"Tonight, you and your son practise"  I said. "So you can go to your temple retreat tomorrow."


This 7-year-old cat came in for difficulty in peeing. Now he is OK.  However, he has tearing eyes and runny nose now. This is due to his lack of vaccination and his encounter with a stray cat that had bitten him, passing to him the cat virus. He should recover.

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Mimi  Cat MN  8 years   yellow brown. Allowed to roam outdoors daily. Used to return by climbing up 16 floors of steps to apartment. But would now wait at 3rd floor for the owners to come and pick him up.

Jul 14, 2015.
1. pollakiuria, haematuria, dysuria 1 week
2. Change sand litter to paper litter about 1-2 weeks ago.  Sand particles mess up the house.
3. Painful kidneys. Bladder not swollen. Cat growled when I palpated the kidney area and became unfriendly.
4. Fed dry food only past 8 years
5. One cat in household
6. One water bowl.

IV drip. medication.


Jul 14, 2015
BLOOD TEST
All normal except low platelets 69  (300-800) and high glucose 14.9  (3.9-6.0). Urine test was positive for glucose.  This high glucose level may be due to urinary tract disease rather than diabetes.

Below are normal values
Total WCC  13.3  (5.5 - 19.5)
N 76%   Absolute 10.11
serum  6.4  (7.2-10.8)
Creatinine 100 (71-160)


URINE TEST
Bladder has insufficient urine expressed into a bottle. But analysis shows no crystals.
Dipstick  blood 4+, glucose+, Protein 2+, WBC, pH 8. SG 1.005

X RAYS  Cat needed sedation Xyla 0.4 ml IM. Reversin 0.03 ml IM.
No radio dense stones.
Kidneys enlarged.  

FOLLOW UP

JUL 15.  Not eating much of feline C/D. Drinks a bit. Stay indoors. Little motion. Urinate more. No dysuria.

CONCLUSION
A change of litter type may stress this cat. FLUTD is caused by stress and other factors like not drinking water and dry food. Antibiotics. Painkillers.  Feline CD
Jul 24, 2015. No problem.

Outcome Good
Case closed.