Sunday, December 6, 2020

3928. How to stitch up a large facial tumour excision wound?

In 2005, I was a breeders' vet. During my rounds of puppy vaccinations at the Pasir Ris Farmway breeding kennels, I saw this sorrowful-looking Golden Retriever with a large facial lump.  It must have been there for some months. 













The licensed dog breeder had over 300 dogs and puppies.
He was kind enough to send the female Golden Retriever for
surgical excision of the facial tumour.  She was a quiet introvert because she avoided 
me when I saw her some weeks later. I took out the nylon stitches. I did not send the
tumour to check whether it was cancerous or not as the breeder would need to 
reduce costs with so many canine mouths to feed. 
 No more recurrence of the facial tumour indicated it was benign.


Saturday, December 5, 2020

3927. Stresses in cats can be many forms.

 1. Case 1. MOVING TO A NEW HOUSE RECENTLY. Painful urination and urethral obstruction recurred. 

https://www.youtube.com/watch?v=5ZKVPcXA4us


2.  Case 2. THREE TOM CATS live harmoniously together in this shophouse. Lots of space to wander. One litter box. The owner did not want any neutering saying the cats do not go out of the house. 

The dominant 8-year-old has his litter box and dislikes being touched by anyone. He sprayed on the owner's laptop after being bathed, destroying her database.  When her sister came and petted him, he hopped onto the table where the handbag was placed and sprayed on it. Look at his eyes. Does he mean business and want to be left alone. 

"This one-year-old cat needs to be handfed," the owner said when I visited her shophouse on Friday, 4 December 2020. This was the 2nd of the 3 cats. "He had a female kitten as a companion but I sold the kitten. After that he stopped eating!"

"How old was this female kitten when you sold her?"
"Around 6 months of age," the lady sat on her desk rubbing her left wrist  which was slightly swollen at the carpal tunnel area. "He eats only when I handfeed him!"
"The female kitten at 6 months is adult," I explained that the tom cat was attracted to her. "He is now lovesick."     

The 3rd tom cat was 8 months old. He liked to roam independently. Only the one-year-old cat was close to the lady.








Case 3. I recalled this case of the tom cat being a noise and odour nuisance to neighbours. He loved to spray on the walls of neighbours.


NEUTERING TOM CATS would have prevented such anti-social behaviour. 


3926. A male cat has difficulty peeing again. Cries in pain. FINAL VIDEO.

The cat has painful and difficulty in urination again, after 2 years. He lived alone. 

He had recovered after treatment. Now the same problem. Why?

The major change is a move of housing recently.  This can be a stress factor causing feline urologic syndrome (FUS). The owner said the cat had a urinary tract infection earlier in the year.  


Painful urination for the past 2 days. The owner promptly sought veterinary treatment.  

Examination showed a large distended bladder and urine leakage. The bladder will be catheterised to unblock the urethra. Urine showed bacteria and alkaline pH. Alkaline pH favours bacterial infection of the bladder. 


https://www.youtube.com/watch?v=5ZKVPcXA4us


Friday, December 4, 2020

3925. Advices For Young People - CREATE, NOT CONSUME - A case study of leaf hat sellers in Myanmar's famous beach

4 Dec 2020. 

There is the perception that the younger generation is not into hard work and sacrifices of time out of office hours to build up the business, especially inherited ones.


CREATE, NOT CONSUME 

1.  NEW SKILLS. 

If you are an employee, do know that your boss will hire a younger and less expensive replacement in time to come as intense competition makes pricing cut-throat.   

Make use of every second of your free time to acquire new skills by creating products or services, rather than spending a lot of time on computer gaming and watching movies. 

2.  TRAVEL INSIGHTS.  When you travel, be aware of the culture and businesses, rather than go from one point to another sight-seeing. 

For example, headwear sales in Chaung Tha Beach in Myanmar. The average tourist will do sight-seeing. 


However, if you look deeper, you will see the business aspects of the headwear sales---niche marketing.  How such sales person can earn a living. You have the sales strategy. Those people sells just one product or diverse products, doing cross-selling a related product and what customers are targeted.   


Young people to create, not just consume for their future 
when they are no longer young and strong to be an employee


Beach goer with children


Focus on one product to sell




More sources of revenue hopefully




Beach goers---younger generation and families




Different category of products for beach wear



Beach goers


Create your products to sell.
Focus on a niche market e.g. headwear in this example
Know who are your competitors and customers 
Product diversification
Cross-selling
Don't expect instant success. Many failures.
Hard work and perseverance


3884. Hypertrophy osteopathy in dogs and human

 

Hypertrophic osteodystrophy

From Wikipedia, the free encyclopedia
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Hypertrophic Osteodystrophy (HOD) is a bone disease that occurs in fast-growing large and giant breed dogs. The disorder is sometimes referred to as metaphyseal osteopathy, and typically first presents between the ages of 2 and 7 months.[1] HOD is characterized by decreased blood flow to the metaphysis (the part of the bone adjacent to the joint) leading to a failure of ossification (bone formation) and necrosis and inflammation of cancellous bone.[2] The disease is usually bilateral in the limb bones, especially the distal radiusulna, and tibia.[3]

The Weimaraner, Irish Setter, Boxer, German Shepherd, and Great Dane breeds are heavily represented in case reports of HOD in the veterinary literature, but the severity of symptoms and possible etiology may be different across the breeds. For example, familial clustering of the disease has been documented in the Weimaraner, but not in other breeds.[4] The disease in the Weimaraner and Irish Setter can be particularly severe, with significant mortality observed in untreated dogs. The classical age of onset is typically 8 to 16 weeks of age, with males and females equally affected.



Speculated causes of HOD[edit]

Causes have been speculated to include decreased Vitamin C uptake, increased vitamin (other than C) and mineral uptake, and infection with canine distemper virus(CDV).[1][5][6] Decreased Vitamin C uptake has been dismissed as a cause, but excessive calcium supplementation remains a possibility.[7] There is no evidence over-feeding is a significant cause.[8] In Weimaraners, recent vaccination with a modified live vaccine has been a suspected cause, partly because HOD often presents immediately after a vaccination, and partly because of the autoimmune nature of the disorder. The canine distemper vaccination in particular has been a suspected causal factor due to the significant number of overlapping symptoms observed between systemically affected HOD puppies and dogs suffering from distemper,[9] but to-date, no definitive linkage has been demonstrated.[10] The cause of canine HOD largely remains unknown. However, because of the familial clustering, HOD in the Weimaraner is suspected to have a genetic, or partly genetic, origin.


Clinical Features[edit]

Figure 2: Characteristic roaching in 4-month-old Weimaraner puppy with HOD.

A primary characteristics of the condition is lameness. This is generally due to the swelling of the metaphysis of the long bones that is observed. Other bones may be affected, particularly the ribs, the metacarpal bones, the mandible, and the scapula.[11][12][13] 


Lameness may present as mild limping or more severely as a reluctance or inability to stand. In some breeds and/or individuals, the stance of an HOD puppy as observed from behind has sometimes been described as “cow-hocked.” Shaking of limbs and a reluctance to put full body weight on the front legs is often observed. Sometimes the puppy will exhibit a characteristic “roaching” or arching of the spine when standing (see Figure 2).

Lameness is accompanied by pain upon palpation of affected bones, warmth in the limb as felt by the inside of the clinician's wrist, depression, and loss of appetite. Limb involvement is usually bilateral, typically involves the distal radius and ulna, and may be episodic.


There is evidence to suggest that most dogs recover after one episode, but some relapse.[3][11] Dogs suffering systemic manifestations of the disorder often have poorer prognoses. 

Systemic manifestations include fever, multiple body organ inflammation, nasal and ocular discharge, Diarrhea, hyperkeratosis of the foot pads, pneumonia, and tooth enamel hypoplasia (many of these symptoms overlap with symptoms of CDV).[11][12][13][14] Because early diagnosis must be based on clinical signs, to the extent possible, other disorders should be ruled out (e.g., nutritional bone disease, and osteochondrosis).

Radiographic Features[edit]

Figure 3: X-Ray image of HOD presentation in 4-month-old Weimaraner puppy. Note "moth-eaten" appearance of metaphyses.

Diagnosis relies on clinical signs and characteristic changes in radiographic images of the metaphyses. Bone changes can be observed on radiograph, and the disorder may progress to actual angular limb deformity.

In the early stage of the illness, the metaphyseal area on X-ray may be observed to have an uneven radiolucent zone parallel to the physis with a thin band of increased radiodensity directly bordering the physis. Early stage radiographic changes have sometimes been described as having a "moth-eaten" appearance (see Figure 3). As the disease progresses, the radiolucent line may disappear and radiodensity may increase in the affected area as the body attempts to repair damage. 

Relapses can cause new radiolucent lines. This area is often followed by a dark line at the metaphysis, which may progress to new bone growth on the outside of that area. This area represents microfractures in the metaphysis and bone proliferation to bridge the defect in the periosteum.[7]

Treatment[edit]

Treatment options have been controversial. Mild illness is often successfully treated with pain medication (usually NSAIDs) and supportive care. 

Dogs presenting with severe, systemic symptoms not responding to NSAID treatment require more intensive treatment. 

The Weimaraner and Irish Setter American Kennel Club (AKC) parent clubs advocate the use of immunosuppressive doses of corticosteroids, supplemented with antibiotics and antacids (to compensate for the decreased thickness of the stomach's mucosal lining as a result of the corticosteroids and to decrease the possibility of forming stomach ulcers).[15][16]

 More severe cases that are not recognized and treated early often require IV fluids, electrolytes, nutritional support, and significant nursing care to achieve successful results. 

AKC parent clubs have supported research into the genetic causes of HOD, and have reported fairly good success using this protocol, saving many puppies from unnecessary suffering, deformity, and death.

NOTE: Supplementation of Vitamin C is contraindicated due to an increase in calcium levels in the blood, possibly worsening the disease.[17]

Breeds at increased risk for HOD[edit]


-------------------------------------------------

Hypertrophic Osteopathy

Hypertrophic osteopathy (Marie's disease) is typified by palisading periosteal new bone, which appears to be perpendicular to the cortices and irregular in outline in the acute stage. It affects principally the diaphyseal and metaphyseal regions of long bones and spares the joints. In the early stages, very soft exposures must be used to avoid overexposing this relatively radiolucent bone. 


Later the margins of the new bone become more opaque and smoother, and the distinction between the original cortex and the new bone becomes less obvious. These bony lesions develop secondary to a tumor, abscess, or other lesion in the thorax or abdomen, or in association with diffuse granulomatous disease. The bony lesions may regress and model if the primary lesion can be identified and successfully treated.

-----------------------------------------------

https://radiopaedia.org/articles/hypertrophic-osteoarthropathy

HUMAN CONDITION - JOINTS


Hypertrophic osteoarthropathy

Hypertrophic osteoarthropathy (HPOA) is a syndrome characterized by periosteal reaction of the long bones without underlying bone lesion. There are a broad range of manifestations, although typically there is symmetrical involvement of the appendicular skeleton. Accompanying abnormal soft tissue proliferation is variable and may result in clubbing of the fingers and toes.

Hypertrophic osteoarthropathy is largely considered a secondary phenomenon, and nearly always (95-97% of cases) occurs in the setting of a wide variety of other cardiopulmonary, gastrointestinal, endocrine, hematologic, and inflammatory conditions 5. When associated with cancer, it is considered a paraneoplastic syndrome. A primary form, pachydermoperiostosis, is due to a heritable genetic mutation that results in similar clinical manifestations, although tend to have more soft tissue findings 5.

Hypertrophic osteoarthropathy has been given various names including Pierre-Marie syndromeBamberger syndromeosteoarthropatia hypertrophicaMankowsky syndrome, and Hagner syndrome.

"Hypertrophic osteoarthropathy" may refer to either the primary or secondary syndrome, although general usage implies the secondary form, given the rarity of primary hypertrophic osteoarthropathy (also known as pachydermoperiostosis).

"Hypertrophic pulmonary osteoarthropathy" specifically refers to hypertrophic osteoarthropathy in the setting of a lung disease, and not from other intrathoracic processes such as mediastinal or pleural disease 5.

Hypertrophic osteoarthropathy has a variable clinical presentation, ranging from asymptomatic morphologic and radiographic findings to pain accompanying the changes of the fingers and toes 5.

The primary form of hypertrophic osteoarthropathy is due to mutations in the genes encoding 15-hydroxyprostaglandin dehydrogenase and solute carrier organic anion transporter family member 2A1, resulting in abnormal accumulation of prostaglandin E2 5.

Although the cause of secondary hypertrophic osteoarthropathy is not established, a similar mechanism involving abnormally elevated levels of circulated hormones has been proposed as a potential etiology. Alternatively, neurogenic etiology has been proposed 5.

Associated disease states include:

Typically seen as long bone metaphyseal and diaphyseal smooth periosteal reaction.

With disease progression, periostitis becomes more prominent or multilayered and extends to the epiphyses 1.

  • symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones 4

  • tram-track sign

The success of treatment depends on whether the hypertrophic osteoarthropathy is due to a primary or a secondary cause.

Most success and rapid regression of hypertrophic osteoarthropathy is achieved in cases where the underlying cause is identified and treated;  such as in lung tumor treated by surgical resection, radiotherapy and/or chemotherapy.

The results are less successful in the presence of metastatic disease.

In primary hypertrophic osteoarthropathy (or in cases where the underlying condition could not be treated), symptomatic relief can be obtained by use of NSAIDs, corticosteroids or bisphosphonates 6,7.

General imaging differential considerations include:

Consider the differential for a smooth periosteal reaction.

On bone scintigraphy, differentials include:

  • normal variant
    • lateral cortices of the tibiae often appear with a symmetric linear uptake 
  • shin splints
    • can appear similar, but confined to the tibiae
  • chronic venous insufficiency 
    • can cause symmetrical periosteal uptake
    • usually confined to the lower extremities below the knees

Lymphedema on its own is not known to cause hypertrophic osteoarthropathy.

Wednesday, December 2, 2020

3924. Photography Tip. Cat pose like statue

 2015 CROATIA.  



Diocletian's Palace (CroatianDioklecijanova palačapronounced [diɔklɛt͡sijǎːnɔʋa pǎlat͡ʃa]) is an ancient palace built for the Roman emperor Diocletian at the turn of the fourth century AD, which today forms about half the old town of Split, Croatia. While it is referred to as a "palace" because of its intended use as the retirement residence of Diocletian, the term can be misleading as the structure is massive and more resembles a large fortress: about half of it was for Diocletian's personal use, and the rest housed the military garrison.

The complex was built on a peninsula six kilometers southwest from Salona, the capital of Dalmatia (Roman province), one of the largest cities of the late empire with 60,000 people and the birthplace of Diocletian. The terrain around Salona slopes gently seaward and is typical karst, consisting of low limestone ridges running east to west with marl in the clefts between them. Today the remains of the palace are part of the historic core of Split, which in 1979 was listed by UNESCO as a World Heritage Site.










3923. A stray cat has a swollen face with a hole. Malar Abscess.

MALAR ABSCESS IN OLD CATS. A few case studies are shown. These are parts of the consultation videos.


CASE 1FINAL VIDEO

2016 Case study.

A Stray cat has a gigantic facial swelling. Facial Abscess, Malar abscess, tumour. 
Factory, Facial swelling 4 days. Loss of appetite. A 10-year-old cat has a swollen face with a wound below the right eyelid. TREATMENT VIDEO.  Lance and drain malar abscess. This video is at: https://www.youtube.com/watch?v=FaFEm8dAt1c

CASE 2.  An 8-year-old male cat has a right malar abscess. Pt 1. Big hole below the right eye. Emaciated. Malar tooth abscess. Isoflurane anaesthesia only.

https://www.youtube.com/watch?v=CCQTBR32gJs

Jan 26, 2016 An old Siamese cat, said to be over 5 years old, has bad breath, was sneezing and a large swelling in The left face. Isoflurane gas anaesthesia only. This 8-year-old cat has bad breath, swollen left face and drools. He is very thin. The roots of the 3 left upper teeth have been rotting and destroying the bones of the jaw. Ear irrigation is being done now. 

UPDATES AT BLOG: 
https://2010vets.blogspot.com/2020/12/3923-stray-cat-has-swollen-face.html

CASE 3.  Malar abscess. A 30-year-old cat has a hole below the right face.Had dental 4 years ago.

Vet 1 had treated the facial swelling with antibiotics, but the facial swelling persisted. It is easy to mis-diagnose the facial swelling as an infection due to cat scratch or fights. Antibiotics will not resolve the swelling. Claire, the groomer saw the cat displaying a swollen 3rd eyelid swelling and eye discharge. She consulted Toa Payoh Vets. This video showed the consultation and examination. No treatment yet.


Diagnosis of the malar abscess is to look for the discharging wound in the right facial swelling below the right eye. Malar abscess is also known as oro-nasal fistula.   The owner didn’t want dental X-rays or blood test to confirm malar abscess. In the first video,  I diagnosed  malar abscess and advised treatment (see TREATMENT VIDEO). 
This is the CONSULTATION VIDEO: https://www.youtube.com/watch?v=55aMGaC7mIk