An hour's drive from Royal Asia Veterinary Surgery, I visited a countryside of farms, saw a brick factory and a chilli sauce factory in Hlegu township, Yangon,Myanmar.
Flooded farms as July is a rainy month. Dry months are from October - January. Not so good lighting for photography.
River boats seen from the Royal Golden View Hotel on July 6, 2014. Looks like there is a need to pump out water from the boats. Are they overloaded or leaking?
The river is not overflowing on July 7, 2014. From my hotel restaurant, I can see monks cross the river by boat every morning.
Visited a medical diagnostic lab, Ni Ni, with CT scan, mammography X-ray and many equipment including a combined biochemistry and immunology test machine. Visited Crown Veterinary Resources, an excellent X-ray and lab facility for vets in Yangon.
I met the owner of the 13-year-old Siberian Husky this morning. The first vet referred him to two other practices as she does not perform the ear surgery. "Unable to examine the ear canal due to tumours." The owner had bad experiences with the first surgery recommended and did not go to the second.
The dog's left ear was full of pus. The vertical canal was hardened and painful. The right ear was OK.
"What caused this ear problem?" he asked me. "Was it due to ticks?"
"It is usually a small ear infection and the owner ignores it over several months. So the bacteria and yeast cause inflammation and the vertical walls hardened like tumours." I pressed the canal and the gentle husky winced in pain.
"Treatment would be surgery to take out the whole of the vertical canal," I said. "This dog is old and a blood test is needed."
"My dog is healthy," he said.
"You are likely healthy unlike an old man," I replied. "This dog is old and I don't know whether she has kidney or liver disease till a blood test is done."
He agreed to a blood test and 2 weeks of drug treatment to bring down the inflammation. I will see the dog in 2 weeks' time and do the vertical ear canal surgery if the wounds have had healed. "The cost of surgery is $1,000 as it takes a long time and the dog is bigger in breed," I estimated the cost.
It would be better if the owner had not delayed early ear infection treatment but he was overseas studying. Medical costs would be much less if there was no surgery.
The young man really turned up for the surgery done on Jul 17, 2014. The 2/3 of the vertical canal with an abscessed cartilage tumour 3 cm x 3 cm x 1 cm were excised. Lots of bleeding. 20 hours later, the wound is washed. The dog went home with pain killers and antibiotics on Day 2 of surgery.
So far, so good.
HISTOLOGY RESULTS:
The vertical canal right ear tumour, 2 cm x 1.5 cm x 0.7 cm, is compatible with ceruminous cystadenoma.
Vertical ear canal resection (VECR) is the solution. In Dr Daniel's opinion, the smelly ear tumour in the top 1/3 of the vertical canal seen only during VECR surgery might be cut off. This is a difference in opinion as 10 vets would have differing opinions on how to handle this case.
For example, the family vet advised total ear canal ablation and referred the owner to two other practices.
To lower medical costs, no X-rays were done. During VECR, the tumour at the upper 1/3 of the vertical canal could be seen. It was around 3 cm x 3 cm and rotting. If it was excised, the other parts of the surrounding areas may erupt a recurring tumour assuming this was malignant.
The better alternative is to excise the upper 2/3 of the vertical canal lessening the chance of recurrence. Not every vet will agree with me as this is part of the diversity of life and medical opinions in real life.
I got Intern Shan to edit the video and in that way, she would understand what the operation was all about.
The surgery images were quite confusing to her but she could understand after my illustrations. Once in a while I get to meet an intern much passionate in veterinary surgery. Shan would make a very good vet. It would take another 4 to 5 years to graduate. That would be 2019!
July 3, 2014 An uncommon case of a Siberian Husky with a growth on the top 1/3 of the vertical ear canal. The dog had been shaking his ear for the past 2 years. The family vet referred the owner to two other vet practices for a total ear canal ablation. He consulted me at Toa Payoh Vets. From my palpation of the vertical canal, there was pain and a hardened lump.
The vertical ear canal had a tumour and the family vet presumed that the whole ear canal (horizontal and vertical ear canals) were
full of tumours.
INFORMED CONSENT.
High anaesthetic risks for a 13- year-old. Dr Daniel operated and removed the vertical ear canal. There was a big tumour at the top 1/3 of the vertical canal.
It is hard to see inside the hairy vertical canal. The canal wall was hardened and painful. After medication for 2 weeks, 2/3 of the upper vertical canal is removed. The lower 1/3 was cut into two parts. One part was stitched downwards and the other part stitched upwards to allow the opening of the horizontal canal to drain out. The skin edges where the upper 2/3 of the veritcal canal had been excised were stitched.
As at 1 month after surgery, the dog is OK. This surgery is called vertical ear canal ablation (VECR). There was a big rotten tumour in the upper 1/3 of the vertical canal causing pain and infection. Hence there was pus inside the ear canal for the past 2 years.
There is another more common surgery called lateral ear canal resection (LECR). In this surgery, the side (latera) wall of the vertical canal is excised. It is an easier surgery. But this Husky had a tumour on the top 1/3 of the vertical canal and so it is best to do VECR in case the tumour recurs.
Sep 2, 2014. Acknowledgment
A big thank you to a bubbly young lady Shan
.
Video was produced by Intern Shan who is very keen on veterinary medicine and surgery. She posted this video from her University in Australia into my "Dropbox" and I download it to my hard drive before uploading it to Youtube..
LEARNING EXPERIENCE. The illustrations were too distant to be viewed. My explanation of the stages of the surgery could have been zoomed in.
Yesterday, I presented two talks on "Guidelines For the Treatment of Pyometra" and "Urolithiasis in Dogs and Cats - Diagnosis & Treatment" and met the committee members of the Myanmar Veterinary Association.
I was surprised to see several small animal practitioners as I expected 20. The Association limited to 75 participants for this continuing education and all get a certificate of attendance at the end of the 3 talks..
Yangon is much bigger in area than Singapore and around 100 small animal vets are practising as compared to 6 years ago. Pyometra is dogs and cats is common in Yangon as traditionally, the owners get their pets injected with a synthetic progesterone (Depo-M or Contracep) IM, every 3 months. Pyometra develops after some time.
I engaged a professional to prepare the power point slides for me and so presentation was much easier. More images of case studies and videos of cases - I hope these would not make the audience fall asleep. One young vet said my talk was easy to understand.
Another vet asked me about his case of pyometra in which the dog died after surgery - was it due to bleeding? It could be or it could be due to other reasons like septicaemia. The dog was not given pre-op I/V drip, antibiotics and analgesic.
We had a dinner at the Golden Duck Restaurant for around 18 vets and I was presented with a momento.
Power point presentations can be very boring for 45 minutes if only text and few images are shown.. Videos should be included in the talk.
P.S.
1. Many new hotels built. Room rates of downtown Traders' and Sedona Hotels have shot through the roof owing to acute shortfall. This Royal Golden View Hotel is brand new, has 38 rooms and fronts a beautiful river. Free wireless. I visited a "ship" hotel in downtown Yangon port area yesterday, Vintage Luxury Yatch Hotel with 1920s furniture. The beds can be adjusted for back pain guests.
An unusual case of ear scabies as this dog had anti-mite ear ointment applied inside the ear canals. In theory, there should be no ear mites. Then why is the dog scratching her ears till they bleed?
Quite a rounded active Maltese, F, 9 years. She came 3 months after spay for closed pyometra. Owner had been advised on dental scaling but she did not follow up as we did not do dental scaling and spay on the same day. The closed pyometra spay takes a long time and this dog could die from prolonged anesthesia.
The owner's mum remarked: "She has put on weight since the surgery for her infected womb!". The dog looks much more active and younger. Snow white coat. But both ears had wounds from scratching. On closer examination, the ear edges of both ears were crusted and had hair loss. So, was this scabies?
Skin scraping was negative for sarcoptic mites. But the owner had used an anti-mite ear ointment prescribed by us for the ear infections. There was no more pain on both ears. Yet, you can see the ear flap having skin ulcers and balding edges.
I treated for scabies although 2 skin scrapings were negative . Did the dental scaling. Plucked out ear hairs. Irrigated ears. Will wait 1 month to follow up. Should recover.
A couple adopted an 8-month-old dog from a home-breeder. A runt. The dog was boarded in a pet shop around 7 days ago before handing over. She became lethargic and ate less 3 days ago and was seen by Dr Daniel. On the next day, the dog was also lethargic. I palpated the abdomen and there was a lot of gas. The owner did not want blood test but X-rays were approved.
The next day, the dog had passed blood in the stools overnight.
I suspected canine parvovirus. Positive for CPV Ag test (2 bars) as seen in the image.
She was standing after I/V drips and antibiotics. Drank a lot of water but vomited all out. I asked the couple to spend time with her by bringing her home overnight. The dog drank and vomited all water. Lots of blood in watery stools.
My experience is that this dog would get worse and die as she had never been vaccinated. The home breeder did not vaccinate her dogs. As long as they are not exposed to other dogs e.g. in the pet shop, they are OK. But she was boarded in this pet shop around 7 days ago.
The dog would not eat. The owner decided it would be humane to put her to sleep as she passed bloody diarrhoea and was in pain.
This case shows the need to be thorough in veterinary examination of old female dogs presented as lethargic and having diarrhoea or loose stools. The instant diagnosis is a gastroenteritis. Just give the injections and medication to the dog. Ask the owner to return if he is not responding to treatment.
"It is not the money for spaying this dog," the man in his late 50s had waited for many years for his female dog to conceive. But the female dog was not interested in the male Jack Russell and now she is 8 years old. I had X-rays showing swollen uterine loops and had felt these loops using my left hand to palpate the abdomen. Some loops and abdominal discomfort but the dog did not bite me. She was just lethargic.
A blood test shows anaemia, low serum urea and creatinine. No leucocytocis as expected in pyometra. This blood test is not typical of pyometra.
I turned the dog upside down and squirted out some milk from one nipple and reddish discharge which shot to the owner's eye from another nipple. Both from the Mammary Glands 5, the most caudal of the nipples. It was bull's eye and the owner rubbed his left eye telling me he had been hit by the discharge.
I quickly got some eye drops to clear his blood shot eyes, probably a result of insufficient sleep or a stressful lifestyle. This incident was the first time in my 40 years of practice and I was concerned that this owner not be blinded by this reddish brown discharge (see image).
"No surgery" he reiterated.
"It is up to you," I told him that the dog needed an emergency spay and if he decided not to operate, it is his responsibility if the dog dies subsequently. He had been advised.
"I will ask my daughter to talk to you." he said. I explained to the daughter and did the illustration (video)
. An emergency spay by Dr Daniel (video) and the dog now is barking furiously at the 7th day as I write this report.
Our problem was pestering the owner to take the dog home as he would say he was coming and did not turn up. After a few days, he took the dog home.
My friend saw this stray cat was fine on 30 June 2014 morning but realised strange because of both eyes corner (in red circle) and wondering has it been hurt by some animal abuser when she saw the cat again the same evening?
Kindly let me know what causes the cat's eyes to be .....?
Thank you.
Mrs HUANG
REPLY FROM DR SING DATED JUL 2, 2014
I am Dr Sing Kong Yuen from Toa Payoh Vets. Most likely, somebody has sprayed chemicals onto the cat's eye and the 3rd eyelids get inflamed and protruded. this is based on image you sent. Diagnosis by long distance on affected site which is not focused by the photographer, is not advised but this is what appeared to be the case.
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