Sunday, July 16, 2017

3100. A 16-year-old Maltese has a large left perineal hernia recurred some 7 years after repair.

Another case of a gigantic perineal hernia. The owners had consulted Vet 3 some months ago and was referred to a vet specialist who would be more costly.  So a friend referred them to me.

Some 7 years ago, Vet 1 had operated but the hernia recurred some months later. Vet 1 referred to Vet 2 who operated but the hernia recurred. So Vet 2 did muscle transposition surgery,cystopexy and colopexy. This last operation lasted around 6 years. The dog was neutered young and this is a rare case as 99% of the perineal hernias in male dogs are not neutered. The owners did not want to go back to Vet 2 for some reasons although his fees were reasonable at around $1,500 7 years ago.    


July 2017.
"Your dog is very old, at 16 years and has heart disease," I advised against any surgery to repair this hernia. "She can pee. She eats like a horse."
"But she cannot poop for the past 5 days," the mother and adult daughter said. "Her swelling is very painful too."
"She needs to be anaesthesized for me to evacuate the stools manually," I said there would be anaesthetic risks but the owner had no choice. She signed the consent form.  Anaesthesia would be short as I used fingers to extract the semi-hard stools from the rectum. Dog was OK and stayed one day inpatient.


X RAYS






NO SURGERY


"Your dog is not fit for surgery as he has heart disease," I said. "Surgery using mesh implant will take around one hour. He can live another 2 years or more if his heart disease is controlled by medication."


1. Reduce the swelling 6 times a day so that the rectum does not get trapped.
2. Give lactulose daily for 7 days, then alternate days for week 2 and 3.
3. Switch to Prescription Diet W/D as it has higher fibre content. If W/D works, no need to give lactulose.  
4. Heart disease medication daily for 2 weeks first and review.

FOLLOW UP
1. Much less coughing after heart medication is given
2. Oral 3 ml lactulose per day. Passed stools, not watery.
3. Swelling is there, but the dog is not constipated as before evacuation.

TIPS
The hernia had recurred some 6 years after the 2nd surgery but the dog was able to poop.
The vet refused to prescribe more lactulose without examination and so the dog got constipated after a while.

   

3099. An unusual Sunday emergency caesarean section - mummified foetuses.

Sunday Jul 16, 2017 


Emergency C-section phone call at 9 am. 2-year-old Corgi, 61st day pregnant, lst litter, passed out viscous blackish vaginal discharge.

So, rushed down to clinic. Breeder was there.
"This Corgi is the daughter of the Corgi that died after C-section by Vet 1," the Myanmar assistant told me. "This is her first litter. She was active yesterday, but today, passed out black vaginal discharge."  Breeders never forget any death after C-section and would avoid the vet. As for me, I had no deaths so far.


Unusual C-section.
The left uterine horn was filled with viscous black liquid enveloping 4 below-normal sized puppies. All 4 puppies were mummified and dead. One was very small in size. The right uterine horn had 3 well-formed pups but the placentas had "melted" and so the pups detach easily from the uterus. I gave them to the breeder who is hands-on and prefers to revive the pups himself as he said he is most experienced. Some vets would not permit him to do so.


Only isoflurane gas using cone first, before size 7.5 endotracheal tube intubation.




TIPS
The dam fought against cone anaesthesia vigorously. This is expected. "Take off the cone when the dam struggles, " I said to my assistant Judy. "Sometimes, the dam is choked. Let her breathe without the cone and put in again.  She did this. The dam was not struggling and became anaesthesized soon.


At my 2nd last stitch, the dam appeared to "choke". I said, "The endotracheal tube may be irritating the trachea, pull it out a bit." It is hard to know what causes this behaviour as she was on smooth anaesthesia. I stitched up the last stitch and got the tube out.

3 live vigorous crying puppies. The breeder saw the mummified puppies and was satisfied with having 3 live ones. As to the cause of 4 mummified puppies in one uterine horn, it is a mystery. In any case, the 3 normal puppies would have died if the breeder proscratinate another hour as the placentas had detached and melted especially for 2 of them. See video.  







 




Friday, July 14, 2017

3098. A 9-year-old Maltese has a gigantic perineal hernia. Mesh implant.













Consulted 3 vets. Too large a hernia for perineal herniorraphy. Mesh implant was done by me. Owner advised to return for neuter 3 weeks later. It is safer not to prolong anaesthesia by doing the neuter in one surgery as the owner will never forget or refer her friends to the vet if the dog passes away on the operating table. Neutered dogs rarely suffer from perineal hernias and hence neutering is advised. Some vets do neuter at the same time.


Video of mesh implant surgery performed at Toa Payoh Vets

Thursday, July 13, 2017

3097. A male dwarf hamster urine marks causing itchy lower body.

July 13, 2017

PUDDING, male, dwarf hamster, born June 2016. 

Today, the young man consulted me and said: "My hamster still has an itchy armpit after you had operated on her left elbow wart 5 weeks ago!"  I was surprised and got my assistant to video the new medical condition.

"5 weeks ago, I removed the left elbow wart which was 2 mm across," I said. "There was no elbow problem."

The hamster squealed twice as I examined the sore right armpit using a small torch-light.
"It is the right armpit," my assistant pointed out.. "The wart was on the left elbow!"

A rough red inflamed patch of loose skin around 4mm x 4mm was present on the right elbow. So this was a new condition.

HISTORY

Dec 28, 2016
Lives alone. Overweight 63 g. Urine spraying on exercise wheel, food bowl, corner and litter. Sleeps on urine.
1. URINE SCALDING. Whole lower body has no hair. Inflamed and itchy.   Diagnosed: Ventral dermatitis. Advised neuter.



2. Left ear wart 4mm x 4 mm. Electro-excised ear wart.

Jan 17, 2017
63g
Lethargic
Scratches both ears, flanks and bites paws. Hair loss. Paws inflamed.
Ventral and flank dermatitis.
Otitis externa both ears.  

Open vertical ear canals, irrigate
Clip bald under anaesthesia
Cleaning scent gland

Jun 8, 2017
68g
Left elbow wart 4 x3 mm across electro-excised.
No bleeding.

Jul 13, 2017
69g
Right armpit skin inflamed and biting the area.  5 mm x 5 mm.


CONCLUSION
Owner did not neuter as the hamster no longer urine mark.
Did not manage to reduce weight. No more sand bath.

Tuesday, July 11, 2017

3096. 16-year-old Cocker Spaniel had swollen abdomen

Blood test showed liver disease.
X-ray showed liver tumours from mammary gland tumours.
The dog had a swollen abdomen due to liver tumours. Passed away today.




The dog was much loved. 

3095. Final Videos - Be Kind To Pets Veterinary Educational Videos

A list of "Final Videos" done by Toa Payoh Vets



1. https://www.youtube.com/edit?video_id=NQftA3fW-Ic&video_referrer=watch
Penile Prolapse in a caramel red-eared slider. Penile amputation.


2.  https://www.youtube.com/edit?video_id=MLjDPpBwoYE&video_referrer=watch
A 14-year-old Miniature Schnauzer has a large neck abscess.


3.   https://www.youtube.com/edit?o=U&video_id=ToXHgDjcXiY
Corneal ulcer fluorescein eye stain test in a dwarf hamster

4. https://www.youtube.com/watch?v=UiwehKVtAio
Intervertebral disc disease in a Schnauzer with hind limb trembling

5.  https://www.youtube.com/watch?v=GIsQvDBszH8
Thrombocytopenia in a 12-year-old cat with bloody diarrhoea.


Tuesday, July 4, 2017

3094. Property Management Contract

   

Property Management Contract

     Responsibilities of manager
          A. Exclusivity of services
          B. Rent collection
          C. Scope of manager’s expectations
Agency Appointment
Limitation of Liability
Insurance
Manager Compensation
Terms and Termination
Property Management Agreement

Responsibilities of manager

Under the terms of this property management agreement, [Client], hereby referred to as “Owner,” authorizes [Sender], hereby referred to as “Manager,” to perform business-related transactions on behalf of Owner for the property at [Number.Street] in [City], hereby referred to as “Property.” Manager is given full authority to carry out all lawful necessary steps to fulfill this agreement.

A. Exclusivity of services

Manager has the exclusive right to manage Property for the duration of this agreement. Both parties agree that Manager has sole cause of any management of Property, whether made in writing or orally.

B. Rent collection

Manager will collect from tenants rent payments by cheque, unless payments are by electronic transfer,  on or before the due date, and issue receipts to tenants, if applicable. Owner will pay Manager monthly a management fee of S$300 and expenses incurred in the management of the Property. Manager will provide a monthly accounting of all rent payments for Owner’s records. Manager assumes responsibility of any rent payment disputes with tenants.

C. Scope of Manager’s expectations
  • Coordinates and oversees repair services deemed necessary by Owner, or contractually required under a lease; pay for services with Owner’s funds. Owner shall deposit S$1,000 as petty cash reserved for such services. 
  • At Owner’s expense, serves legal notices to tenants when necessary on behalf of Owner, with Owner’s prior consent, and hires attorneys when needed for eviction proceedings or rent recuperation. Owner agrees to be an interested party in such legal action, and Manager has full authority to settle claims on behalf of Owner.
  • Collects rent from tenants when due, making no guarantees as to regular payment from tenants.
  • At Owner’s expense and permission, hires collection agencies when necessary.
  • Maintains an accounting of rent payment receipts, expenses, and charges on a quarterly basis for Owner.
  • Hires and supervises contractors to repair and maintain Property.


Agency Appointment

Manager shall be considered an agent of Owner, given full authority to perform necessary actions to evict tenants and/or collect unpaid rent. Manager has the right to enter Property at any time during the length of this property management agreement.

Limitation of Liability

Manager, and all employees or independent contractors hired by Manager, shall have no liability under this agreement, including such liability related to injury to persons or damage to Property under Manager’s supervision, except in instances of gross negligence or willful misconduct by Manager.

Insurance

Owner is responsible for obtaining and paying for general liability insurance and other necessary insurance to protect the interests of Manager and all associated personnel.

Manager Compensation

Owner agrees to pay Manager under the following conditions:
  • The greater of 10 percent of the gross rental income due to be paid by tenants under existing or future rental agreements, or a flat dollar amount of S$300. Payment will be due by Owner to Manager on the 1st of each month based on tenant commitments the preceding month.
  • If Manager conducts property reviews for publication on instruction of Owner, Owner shall pay S$150  per review. Such reviews will include a written overview of Property and recommended preservation projects, including a preliminary cost estimate for each project.

Terms and Termination

Manager and Owner enter into this property management agreement on [Contract.Start.Date]. This agreement shall automatically renew after one year unless Owner provides 60 days prior notice in writing to Manager.

Property Management Agreement

This property management agreement begins as of [Day.Month.Year] and is entered into by [Client.FirstName] [Client.LastName], and [Sender.FirstName] [Sender.LastName] for the Property at [Number.Street] in [City].



Owner
Signature
Name and NRIC No.
Mobile Phone No.
Email.


Manager
Signature
Name and NRIC No.
Mobile Phone No.
Email.
Witness
Signature
Name and NRIC No.
Mobile Phone No.
Email.