Today Jun 15, 2012 Friday, I was at the Surgery the whole day from 9am onwards. This is the 3rd day I took the feeder bus and subway train and feeder bus to Toa Payoh Vets as I used to drive over the past years. It is a form of exercise and an experience to appreciate life, the morning sun and the heartlanders going to work. It is humid and sweaty but that is living.
I did my trust and audit cases of the associate vets. One of these cases involved eye problems in the rabbit. Many rabbits seem to have eye problems and some vets may not be keen on treating them. I assessed how my vets treat such cases in the "trust and audit" checks. I got the dwarf rabbit into the consultation room and did the examination together with Dr Vanessa.
"You don't need to be a licensed vet if you just prescribe eye drops for "eye cases," I said to Dr Vanessa. "Any owner can buy eye drops and treat themselves if the vet just prescribe eye drops!"
The young couple came with a male 2-month-old Netherland dwarf rabbit with a red itchy right eye and a red nose. "We went to Vet 1," the fair trim lady said. "But my rabbit is still scratching his right eye."
"What did Vet 1 do?" I asked.
"He gave eye drops. We have used up the eye drops now. But the rabbit is still scratching!"
"Your rabbit may have an eye ulcer," I said.
1. White light shone onto the cornea. Nothing. The cornea was as clear and transparent.
2. "Use the fluorescein eye stain," I said to Dr Vanessa. "It will stain the ulcer. This should be standard operating procedure but many vets don't do it. Just prescribe eye drops and send the rabbit home."
3. As the rabbit was frisky, I advised a gas anaesthetic by mask. Surprisingly, a green stain from 11 to 1 o'clock showed up the corneal ulcer. I asked the couple to go into the op room to see the ulcer.
CAUSE OF THE ULCERATION
The owner did not know. "Do you have hanging balls with sharp hay inside?" I asked. "The hay may have injured the eye."
"We have the ball with hay stuck inside, on the cage floor" the couple said.
1. Conservative. Irrigation of the 3rd eyelid. Subcon injection and e-collar. Cage rest in a dark place for around 30 days.
2. Stitching up the upper and lower eyelid. This would be my choice as the healing of the ulcer is much faster. But there is a lot of nursing.
As the young couple will be unable to do the nursing, I did the conservative way. I asked my assistant Min to give them an old carrier as they have been taking the rabbit in an open basket. The rabbit may suddenly jump up and fall and fracture his leg or back.
Solving the owner's problem should be the best practice. Otherwise the owner just go to another practice.