Friday, December 13, 2013

1260. Video: A blood-shot eyed rabbit. Practising evidence-based medicine

 http://youtu.be/YsUlZ-uqTNQ


PRACTISING EVIDENCE-BASED MEDICINE IN A RABBIT


The young rabbit's eye conjunctiva is dark red and swollen. Tears stream down the eye. In my experience, the grossly enlarged upper conjunctiva is cause by vigorous eye rubbing by the rabbit to relieve the pain and irritation. Something had fallen onto the cornea but on superficial examination, there seems to be no eye ulcer or abrasion caused by this foreign object.

The fluorescein eye stain test showed corneal ulcerations to be green. Almost 3/4 of the cornea is green with only the right sided cornea at 2-4 o'clock being clear.

Unfortunately Intern Clara edited and showed a very short clip of less than 2 seconds. She ought to show much more as this will illustrate clearly the evidence. The theme of this video is using evidence to aid in the diagnosis and the Intern must be aware of the theme and whenever possible, expands on this theme.









The raw footage of the green cornea clips is at another video. Goto:
www.toapayohvets.com/videos.htm   

1259. Videos: SOP for pregnant cat.


PREGNANT CAT SPAYED STANDARD OPERATING PROCEDURES (SOP)

http://youtu.be/E14zwal_yo4

Extra care is needed in operating a heavily pregnant cat. The ovarian and uterine blood vessels are much enlarged and if not properly ligated, there will be lots of bleeding in the surgical area and a possible bleeding to death post-op. A pre-op examination to ensure that the heavily pregnant cat is fit for surgery should be part of the SOP. This was done by me (Dr Sing Kong Yuen). Blood test was not taken owing to financial considerations. The dilemma is whether the heavily pregnant cat should be spayed or should she give birth first. it is extremely difficult to find new homes for the kittens and so spaying was the decision of the owner. The other concern of the owner was whether to starve the cat for 24 hours before surgery.

The cat had eaten 6 hours ago but there is no vomiting with the xylazine + ketamine IM sedation in my experience. No vomiting was present in this case. 

I advise the use of the 3-forceps method to clamp and ligate the uterine body with its engorged uterine blood vessels. The lowest 3rd forceps is clamped and then released, showing a grooved line caused by clamping. Ligate this groove and the ligature will not slip off as compared to ligation of the non-grooved smooth uterine body area. In this way, there is a guarantee of no haemorrhage. The uterine body is then incised between forceps 1 and 2, leaving a good area for the ligated stump to be released into the body.

This spay was done by Dr Daniel Sing using absorbable sutures.  Xyalzine 0.15 ml + ketamine 0.6 ml combined IM was given in this 3.6 kg cat. Isoflurane + oxygen gas top up was needed. There was no bleeding in this spay as the ligatures were properly placed and tight.  The cat was operated in the afternoon and went home in the evening.

A handing over inspection with the owner should be part of the SOP so that the owner can see that the skin stitches are properly tied. At that time, post-op instructions are given preferably by the vet to build good client relationships. Follow up 2 days later is advised by me but most vets do not bother. As at 7 days post-op, the cat is normal and the stitches should be taken out 14 days after surgery although they are absorbable monosyn.

Standard operating procedures are in place to maintain the highest standard of surgery. Handing over inspection of the surgical site with the owner is shown. The cat is OK as at 7 days post-op.

More instructional videos for vet students and pet owners are at www.toapayohvets.com/videos.htm..

This video was filmed and edited by Intern Clara Chua as part of her experiential learning at Toa Payoh Vets. Interns learn more by writing and making videos than by being an observer looking at the vet's working.

It appears to me to be well edited and has good music. My grateful thanks to Clara. I purchased the Corel software recently as the free Windows Movie Maker does not have many features.


Thursday, December 12, 2013

1258. Follow through with rabbit owner on Day 3 by telephone


Dec 10, 2013
Rabbit, born Oct 22, 2013. , Male 1.5 months.

Right eye tearing and red upper conjunctiva - like intense eye rubbing had been done after some objects irritated the eye.

Video shows clearly the condition. 

Many vets do follow up but some don't bother to do so. Maybe the vet school has not emphasized this aspect as follow ups build good vet-client relationship. 

Dec 12, 2013 - Day 3 after consultation
By following up, the vet knows how effective his medication and injections are. In this case, I phoned the father and he went to check personally. He thought the upper conjuncitval swelling (blood-shot) was back to normal but soon phoned to say there was some redness. I asked him to email the images to me rather than WhatsApp.

E-collar not worn.
White stools yesterday but now brown stools as normal
Rabbit is active and eating all the past 3 days.




Owner had changed sharp bedding and ensure hay not sharp. I don't follow up all cases myself as some days are just too busy. But important cases ought to be followed through..

1257. Be Kind To Pets video image - flower in Paris + singkongyuen, niagara falls, flower, terrerir lame

















Tuesday, December 10, 2013

1256, Saving a damsel in distress



Dec 10, 2013

"Many interesting case studies can be broken down into problems and solutions," I said to Intern Clara who had heard all the grass root stories of the Little India riots from my client who came to buy a bag of h/d for his wife's heart disease dog. She had writer's block in writing a good narrative for the Wired Haired Fox Terrier with a lame right fore limb.

"For example, what caused the Little India riots yesterday which was a Sunday? According to the client, it is the driver who drove over the worker and had not shown any concern."

"What's the solution?"
"The authorities want to ban the use of alcohol sales in Little India but he said that these could be purchased elsewhere to consume in Little India.  His solution is for the control of traffic entering this congested road. My solution is to close the road to traffic. He proposed closing to traffic on Sundays."



However, the memorable event was that this gentleman's wife was a 15-year-old young lady in distress some 10 years ago. "She remembered you for helping her Maltese who could not give birth," the gentleman said. "She was lost as she did not know what to do. You did a Caesarean section and saved her puppy."

"Yes, yes, I remember her," I replied. "Her Maltese had difficulty giving birth. She had a big pup. What's happened to the pup?"


"She gave it away. A very intelligent brown and white puppy. She was too young to take care of a puppy at 15 years of age!"

I saw the wife earlier when her other dog came for treatment, but she did not mention about this episode.

I could not recognise her now since she is an adult. 

Many of my old clients have disappeared as there are around 60 vet clinics and proximity will be important to most of them. This couple lived quite far from Toa Payoh and usually I don't have any clientele from that area.

Besides proximity, new attractive expensive renovations of a vet clinic attract the average Singaporean pet owner and Toa Payoh Vets cannot keep up with the new. There will be wear and tear and this clinic, being in existence for over 30 years does not look spring fresh as Spring time despite two renovations.

So I was very happy to have met her earlier after a separation of over 12 years or more and to know she is quite successful in her career, being seconded to freezing winter of 5 deg C in Germany for training now.









Syrian hamster, M, 19 months has a swollen abdomen


Dec 10, 2013

Owner wants to know cause of abdominal swelling. Normal, active, eating, drinking, peeing and pooping.


Abdominal palpation - no pain, no large mass
X-rays - intestines pushed to one side. May have liver enlargement







To observe 4 weeks

1254. Videos produced on Dec 10, 2013.

British shorthair vomits and loses weight
http://youtu.be/pXOHhT4CypY



The guinea pig has a large leg abscess
http://youtu.be/h2VBthR64T0



Spaying a pregnant cat - Part 3
http://youtu.be/O4gcxUXTDlo



Spaying a pregnant cat - Part 2
http://youtu.be/i6e3mAOKOYU



 

Spaying a pregnant cat - Part 1
http://youtu.be/jkXDAXSB-z8

1253. Why does the British Shorthair vomits and lose weight over the past 3 months?

A 5-year-old British shorthair vomits now and then for the past 3 months, losing weight. What's the cause? Evidence-based medicine using blood tests need to be practised, but sometimes the owner will not consent to blood tests owing to financial considerations or the misperception that it is not necessary. Vet 1 was consulted and had advised blood tests.




The owner came to me for a second opinion as the cat still vomits, before and after eating. In this case, he agreed to having blood test done. The test showed a high total white cell count indicating a bacterial infection of the blood. After a course of antibiotics and follow up, the cat does not vomit and is gaining weight.

This is an interesting case as vomiting is usually associated with hair balls in the cat. However hair ball vomiting does not lead to weight loss and this cat was thin. So the young couple was concerned.
It could be due to cat food allergies or kidney disease too. However, the blood test indicated a bacteraemia and eliminating this blood bacterial infection results in a happy outcome.

The Singapore pet owner is much more sophisticated than in earlier years. Some are interested in a doctor's youthfulness and energy. Others want an oldie with experience. Some prefer eye candy with good bedside manners. Yet another will check on the good house-keeping of the receptionist area and beautiful renovations of a modern clinic. For others, under-pricing influences his or her decision to retain the services of the vet! Underpricing deprives the clinic of funds for renovations and upgrading and payment of the high escalating operating costs. It is a tough new world for vets in developed countries nowadays.

I had written a report on the treatment of this interesting feline case in my blog or at www.toapayohvets.com

Monday, December 9, 2013

1252. Spaying a pregnant cat - standard operating procedures at Toa Payoh Vets

http://youtu.be/jkXDAXSB-z8

Case study with Dr Sing Kong Yuen. Videography by Intern Clara.


"Standard Of Procedure" should be "Standard Operating Procedure (SOP)."
Blood vessels to be properly ligated (not incised as stated in the video).

A final script may be needed for me to correct errors but perfection needs much more time and much fewer videos produced.  It is better for the intern to learn from mistakes as in this video. Overall, it is an excellent amateur video and I hope it educates the pet owner.



Handing over inspection between the vet and owner is important and should be part of the SOP.
The intern forgot to include the two clips  showing the stitched area and pale gums. I have inserted them as shown below:



1251. Fox Terrier limps for over 2 weeks. Why?


X-ray show no fracture but large swelling 4X normal of right fore digit 3. Possibly an abscess from traumatic injury (penetration wound). 





1250. New videos - roborovski siblings, poodle drooling

The young poodle has "locked" jaws
http://youtu.be/AiebDalZsvE






Two sick sibling Roborovskis
http://youtu.be/_fjyz7J0wIA


Sunday, December 8, 2013

1249. New YouTube Videos - urinary stones x2 and internship at toa payoh vets

Internship
http://youtu.be/VnukHRGkUfA




Pees blood yearly  -  Urine collection  Part 1
http://youtu.be/vKTU4_JckYc





Pees blood yearly - Overview of lab tests  Part 2
http://youtu.be/q9Ax4OzwMhs

Pees blood yearly - Urine test in Dec 2013  Part 3









1248. Transforming the small animal veterinary industry

Saturday Dec 7, 2013

On Saturdays, Dr Jason Teo takes over in the afternoon from me and sometimes we talk about the veterinary industry and sometimes we share ideas of clinic management.

There are around 60 small animal veterinary practices and so the caseload/practice is low while prices are undercut such that it is not possible to recover costs for some practices. "A top-end blood test machine costs $64,000. The test costs $150. There needs to be 427 tests to be done to cover the cost price of the machine. This works out to be around 1 test/day which is easily achieved in busy clinics. In some heartland clinics, there may be an average of 10 cases.day. The price-conscious pet owner does not want to pay for the tests and so there may be less than 3 blood tests/week as blood test costs add up to the total medical costs. The cost of the test kit rotor is $30 and so the vet is grossing $120 instead of $150. There is the maintenance cost of the machine as this is not free. My point is that the heartland pet customer will like to spend as little as possible on pet care, less than $100 per visit and will go elsewhere if the costs are higher. Blood tests and X-rays add to the costs and they do not want them.

"Intense competition is a fact of life," I told Dr Jason Teo that I had listened to the audio files of how a poor Italian immigrant became a powerful rich man in Europe. His son bought a almost bankrupt newspaper, "The National Enquirer" and made it very successful in the US by giving what the customer wants and not what the owner thinks that the customer should get. "At first, it published gory murders but later changed to positive inspiring family stories. He got the papers marketed in super markets. He paid journalists much more than the industry but would fire anyone whom he disliked."

In other words, he can transform the small animal veterinary industry if he knew how. "How about Dr Daniel doing it?" he asked me. "It needs money as this publisher suffered losses at the beginning. He does not make money immediately till later."          

Friday, December 6, 2013

1247. Locked jaw poodle, 15 months - Hyperplastic lymphoid polyps?

Developmental disturbances of the oral lymphoid tissue

1.  Hyplastic lymphoid polyps are composed entirely of lymphoid tissues. Can be found on the gingiva, buccal mucosa, tongue and floor of the mouth

These firm nodular masses are seen on the ventro-lateral sides of the posterior part of the tongue.

2. Reactive lymphoid hyperplasia are also firm nodular masses and found on the posterior part of the tongue at the dorso-ventral aspect. They are part of the lingual tonsil which is one of the largest oral lymphoid aggregate.







The reason for the young poodle locking his jaw is the intense pain due to ulcers below the tongue. What is the cure? Dr Daniel prescribed a repeat of the anti-inflammatory and antibiotics. The aged mother was happier that the dog's behaviour was better - more active and eats more. Not enough to eat normally.

INTERNSHIP
In this case, I asked the young lady to video while the tongue was elevated. "Take some images using the other setting, not directly from the video," I advised.
She ignored my advice as she could take images in the video mode. I would not do it.
To her surprise, her video clip of the underside of the tongue was not available as she had spent more than 60 seconds to video the action while I elevated the tongue. She videoed and took digital images in the video mode contra to my instructions. This is a common trait of the young interns and sometimes they do have better ways of working. But this time, her video clip was gone 99%!.
.
"It seems to be over-ridden," the slim 16-year-old little woman said.
"It is best to comply with instructions when working under a mentor," I said. "It is fortunate that I had personally videoed the underside of the tongue after you."

As there is more than one way of filming, she would open up the LCD screen and flip to the left side to film on manual mode. I would not flip it sideways but view directly as it is, positioned below the view finder.  I would use the viewfinder, set to Auto focus and see the right beam spotted on the subject's eye or spot. She would view the subject from the LCD and so could not get sharp focus on specific body parts.

I accept that the younger generation has minds of their own but many learn from mistakes and it is sometimes costly to the operations of the business letting them learn from mistakes, re-inventing the wheel when they could have sought advices from the oldies or spent time doing lots of research.   

The Schnauzer pees blood yearly



1246. Blood in the urine for the past 3 years



1245. Terrapin hibernates in Singapore?

Today, Dec 6, 2013, the mother came to take the terrapin home. The daughter who is a pre-school teacher had a list of questions.

"Just ask her to phone me if she has questions," I said. "Sometimes, the written questions get the wrong answers as she may be thinking of some situations and I have to write a detailed report like a Professor!"

"She researched the internet and thinks that the terrapin closed his eyes as he is hibernating."
"In Singapore, the climate is tropical. No terrapin can hibernate," I said as the mother laughed.

"The shell is cracked at one place," I said.
"The terrapin jumps when I change water, leading to cracks," she said.

"How to feed medication to the tertrapin?" she asked.
My assistant Niang showed her by pressing the nostrils of the hand-held terrapin. He opens his mouth.
"Repeat again," I said to Niang.
"Can't do it," he replied. "The head has withdrawn into the shell."
"Basically the causes are many. Dirty water, lack of Vitamin A, infections and management. The following is to be done for the next 7 days as the eyes have had opened according to my first video," I said to the mother.

"No sunshine from 9 am to 6 pm daily. It is too much. Surely, you will not want to be sunburnt for so many hours every day."
"How many hours? 4 hours?"
"That is good enough."
"The other tips are not to submerge this terrapin in water 24 hours. Just sufficient below mouth level for this period of time. Also, give a variety of brands of terrapin pellets, not just from one brand. Put eye drops once a day and take medication for 7 days. "

The terrapin went home with eye drops.

NOTE
The terrapin opened his eyes on Day 2 of hospitalisation and on Day 5 (yesterday) and Dr Daniel phoned the owner to take the terrapin home. However, today, the eyes are closed when the owner came, as you can see in this video!  It takes many days to get the eyes back to normal.

It takes as long as 2 weeks to get the eyes back to normal and some cases don't recover. As to the cause in this case, it is hard to say. Feeding one brand of commercial pellets which may be poorly processed may have led to Vit A deficiency. Best is to feed at least 2 reputable brands and provide good management.  

.

1243. A Schnauzer pass blood in the urine for the 3rd year. Owner does not want surgery

Dec 6, 2013

The Schnauzer dripped bloody urine on the consultation room floor for the 3rd year.
"Some antibiotics, no more blood in the urine," the owner in his 40s said.
"Since no X-rays were done in 2011 and 2012, it is best to take X-rays to confirm how many stones are in the bladder or in the kidneys as well," I advised. "I can palpate some small stones. The bladder is swollen like a small fishball."

The owner agreed to the X-rays. Last year, urine test results showed pH 6.0 and no crystals in the urine. The owner fed 12 cans of S/D diet and then went on to feed home-cooked and canned food. No "urinary problem" till today Dec 5, 2013.

"The dog's hind limbs tremble in the past 3 days," he said. "Maybe he has pain."
"Give the X-rays to the owner," I said to Dr Daniel. "So he knows what is happening to his dog although he does not want surgery!"  Education of the owner is important.

"X-rays shows intestinal stone too," Dr Daniel said to me.
There were two radio-opaque bladder stones. I suspect they are calcium oxalate stones as last year's urine test showed pH 6.0. It is not possible to diagnose the chemical composition of bladder stones based on X-rays.


1243. Review of 2 Videos: Surgery of a Roborovski with 2 large subcutaneous tumours at Toa Payoh Vets

Dec 6, 2013
I have progressed from producing lesser quality amateur videos using Windows Movie Maker to much better ones in 2013.  The narrative must be compelling so that viewers don't fall asleep or click off. Interns are left to create the videos with briefing and discussions with me. An entertaining script is important and interns find that very difficult to do as the Singapore schools teach them more on exposition type of writing (documentary) than on compelling story telling. 


Video 1 by Intern Clara Chua is at:
http://youtu.be/6aPEZO3isbs




The above video has been edited more thoroughly by Intern Clara and her friend who voiced over and so took a much longer time to produce. The fonts used are hard to read.  Much more instructive as it takes much effort and creativity from the two young ladies using Video Studio Ultimate X6. 

Video 2 has more raw footage with client-vet conversation is filmed by Intern Daniel Low at Toa Payoh Vets.
The video below is produced by Intern Daniel Low with Windows Movie Maker which is limited in features than the aforementioned Corel which is a commercial paid software.


http://2010vets.blogspot.sg/2013/12/1243-video-surgery-of-roborovski-with-2.html
URL of this blog is:


Wednesday, December 4, 2013

45. Two new warts

Singapore has reached a gracious level where hamsters are treated kindly by young people. The aging baby-boomers in Singapore generally view them as cheap pets and when they fall ill, good luck to them. After all, veterinary fees for treatment can buy a few new ones. But the children who are now growing up view hamsters as family members and sometimes, this lead to conflicts in the family since the parents ignore treatment.

Yesterday was a bright sunny Sunday. I was surprised to see the fat hamster again as I had operated some 2 months ago. My intern Tanya placed him in a bowl onto the weighing scale. The reading was 88 g. "Has he put on weight?" the couple in their 30s, asked me. To me, the hamster had looked less fat. So I had him weighed again as I noted that Tanya had put the weighing scale on a slope of the consultation table. The veterinary consultation table has a grove at the edge to drain off any urine or liquid, unlike the ordinary flat writing desk.

After placing the hamster on the flat part, the weighing scale read 76 g. "He has lost 5 g," I said. "But your dwarf hamster should eat less and weigh around 50-60 g." The tall man who is an IT professional said, "Whenever Hammie's cup is empty, my wife tops up with the Japanese hamster food. Hammie will just eat. He sleeps the whole day, but makes a lot of noise exercising in his wheel at night. Sometimes we have to put him in the kitchen as he is so noisy."

"Hamsters are nocturnal creatures," I explained. "They are active at night. You may have to oil the noisy exercise wheel. Your hamster should eat less. Reduce the amount of his feed bowl by 50%."

This time, the wife had conscientiously examined the hamster by feeling his body for warts and had discovered two hidden under the lush grey coat which was 5 mm long. One wart was 2mm x 2mm on his right side behind the rib cage and the other was 1 mm x 1 mm above his tail on his backside. They would not be spotted if the wife had not examined them.

I gave Zoletil anaesthesia and excised them with a pair of scissors. "Why not use the wart removal freezing method?" Tanya asked me. "There is no need to do it," I said. "The warts are very small." Tanya had not seen freezing of warts being done. The applicator to apply the freezing chemical is already 8 mm in thickness and it would freeze too large an area. Electro-surgery used previously was not necessary as the warts were very small. It was good to note that the other 4 warts (pictured here) did not recur.



In February 2010, four warts in the dwarf hamster were detected. Warts need to be excised by your vet early as they don't disappear on their own. Electro-surgery excised 4 warts. 2 new small warts were felt by the wife in April 2010 and I had them excised. They were well hidden in the thick coat.

IT people had more knowledge of useful software than the ordinary people and I asked the husband whether there is a software to help his wife in her hobby of cross-stitching. The wife is a home-maker and has done cross-stitching for friends, giving them as Christmas cards. Some friends order them just as some Singaporeans order home-made cakes. "Why will Singaporeans want to buy cross-stitching cards, half the size of A4 paper, for $20.00 from your wife?" I asked the husband as I know the majority of Singaporeans are penny pinching by nature. There is a business opportunity in cross-stitched Christmas Cards if the husband knows how to do it and if the wife can produce the high quality embroidery.

"How long does it take to produce one if your wife works full time at 8 hours per day?" I asked. "3 days," the wife estimated. "My eyes can focus after a while. And my fingers get painful." To take 24 hours to generate a $20 sale may not be worth the trouble for the wife's labour.

So, this handicraft can never be commercially successful unless the work is done by poor villagers. "Why do your friends want to buy the cross-stitched Christmas cards?" I asked the Indonesian couple again. "They can just send e-cards which can even talk or buy one card from the shop." The husband said, " Well, they send it to their bosses or put inside the hampers." This certainly make sense. If the boss receives a hand-made cross-stitched card, he will remember the employee as the card is not easy to make. "Is there a software to produce original patterns for embroidery? For example, portraits or even your hamster exercising on the wheel with the words, 'Eat less, exercise more'?". He does have the software which digitalises the picture. Well, his wife is still cross-stitching his landscape photo for the past one year and is still doing it.

There are many small business opportunities in handicrafts as you can see from this couple. "How about using your software to making cross-stitch patterns of famous people like Mr Lee Kuan Yew, get the work stitched by your wife," I asked. "Then you market them to tourists at the Integrated Resorts? Tourists like to buy a piece of the place they visit."

"No, no, we can't do it," the husband laughed as his booming voice filled the small consultation room. "Why?" I asked. "It is too sensitive. Maybe Sentosa's Universal Studios will sell well."

Brain-storming is important in getting business ideas. "How about the Merlion in Sentosa?" I asked. "Nobody likes it," the husband said. "When they take photos, they can only take the paws." The Merlion in Sentosa is a gigantic tall structure of 3 stories high.

The Indonesian couple told me that Jakarta has a business man who had several small branches for cross-stitching and other products. Apparently, the wife finds that the quality of cross-stitching work produced by the staff in this Jakarta business was not up to standard and so she could not buy them for sale in Singapore, as suggested by me. "They could be doing the cross-stitches not out of passion or they could be doing too many," I speculated. Even in a hobby such cross-stitching, there is the matter of quality control and excellence too.

For the benefit of readers, the husband gave me a website, http://cross-stitchers-club.com/

1240. Intern Clara - Produce video - A hamster with 3 gigantic chest tumours

Hook


Body


Conclusion
Early surgery saves lives




Video - Consultation & informed consent
MVI 6970.Mov






Be Kind To Pets Images at:
http://2010vets.blogspot.sg/2013/11/1212-video-dwarf-hamster-has-3-gigantic.html



Use these images for the Myanmar Vet Conference video prodution





   

1239. Social media in vet practice - hamster blogs - 18 blogs started in 2008. Results.


Inoperable tumours - massive chest tumours covering 50% of lower body. Deaths highly likely. No surgeries done as the hamster would lose much blood and die on the operating table. Medication to relieve pain and antibiotics. Owner is

http://2010vets.blogspot.sg/2013/11/1212-video-dwarf-hamster-has-3-gigantic.html
Produce a short video on this case study

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

I started blog in 2008 under 88pups@gmail.com. Then in 2010, I started another blog at 99pups@gmail.com

2008. lst blog on hamster cases at:
http://singaporehamsters.blogspot.sg/2008/01/1-hamster-surgery-at-toa-payoh-vets.html
18 hamster articles were written as follows:



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Top viewed article is:
http://singaporehamsters.blogspot.sg/2009/07/8-euthanasia-is-only-option-for-tough.html

1228. 2008 blogs

In 2008, I wanted to have blogs for separate species but this is too time-consuming and so the 2010 blogs replace the ones below:

2008 blogs

Veterinary Surgery articles
http://veterinarysurgerydrsing.blogspot.sg/

Singapore hamsters
http://singaporehamsters.blogspot.sg/

Singapore cats and kittens
http://singaporecatskittens.blogspot.sg/

toilet training articles
http://puppytoilettraining.blogspot.sg/

Create, Not Consume
http://puppytoilettraining.blogspot.sg/

1237. Femoral fracture in a cat

What is the solution?
Amputation or repair? Financial costs