Tuesday, March 8, 2011

356. Monday's 10 am appointments

Two clients wanted to consult me and so made an appointment at 10 am.

CASE 1. Cairn Terrier, Female, Not spayed, 2 years.

SKIN ITCHINESS
Keeps scratching all over the body. "Why?," the pastor asked me. "Can it be due to the dog food? I buy various brands and mix them."

"It is possible," I said. "Dry dog food allergy does occur, making the dog itchy." The only area with black spots due to dried up blood from skin pustules and scratching was the inguinal area, near the vulva. The vulval lips were much swollen around 20X and the mammary glands were full.

FALSE PREGNANCY
"Your dog had heat 2 months ago," I said to the pastor. "She will be behaving strangely, like carrying an object in her mouth, loses appetite, get aggressive or withdrawn?"

"None of the behaviour you mention," the pastor said. "As you know, dogs like air-conditioned rooms but lately, she just go to the kitchen to sleep. Very strange behaviour!"

"She thinks she wants to give birth soon," I expressed minute drop of milk from her mammary gland. Too little to be seen when I asked intern Michelle and the owner to see. However, another swollen nipple produced some secretion.

"Your dog is suffering from false pregnancy," I presumed the dog was not bred as the owner did not mention about breeding and from his looks, was very astonished at seeing swollen mammary glands and a bit of milk. "Was she mated 2 months ago?"

"No, no," the pastor said. "How to prevent this from happening again?"

"The only solution is to spay her," I said. "Otherwise, the false pregnancy comes again. Did you want to breed her and get some pretty Cairn Terrier pups?"

"Yes, but I can't find any male."

I said: "Enquire from the dog breeders in Pasir Ris, your seller or the Singapore Kennel Club. You may have to pay a fee of a few hundred dollars without guarantee of success. Spaying her would be better as she is likely to get pyometra in later life. Do you know what is pyometra?"

The pastor had no clue and I explained that it was an infection of the womb with lots of pus inside. Sometimes the dog can die from toxaemia due to delays in seeking vet treatment.

As for the skin itchiness, I checked the ear canals. Dark brown ear discharge. I asked the intern to check on the microscopic examination. Nothing was seen. "The brown stuff keeps coming back after ear cleaning," the pastor said.

I advised ear irrigation and let the pastor tried. He squirted the 20 ml syringe of water and wetted me and the whole table. I did it for him and lots of brown wax flushed out from the left ear.

The ear infection and the anal sac impaction (black liquid in moderate amounts) and the hormonal imbalance of false pregnancy could cause the dog to be itchy. "Resolve the basic problems first," I advised. "Before you think of dog food allergy."

Ear ointment was given. "10 drops/ear/week." I said. "Excuse me for saying this to a man of religion - you must apply the ointment religiously for one month or two and let me know if there is still scratching. If not, then the infection has cleared."

The pastor asked me: "Are you retired?"
"No," I said. "It is better for a younger vet to continue the services of Toa Payoh Vets as I am 60 years old and if I don't plan to have a successor, all my clients will suffer in the long term. That is why I don't hang around every day as Dr Vanessa is experienced."

CASE 2.
BACK ACHE

The old Shih Tzu had seen me in March 2010 for a deep central corneal ulcer which had healed. Black pigmented central area with opaque ring. I tried taking pictures under the sunlight with my assistant holding the head and everting the eyelids of the right eye, but they may not turn out well. Need to practise how to do it.

"The dog seems to be walking lame," the mum said. Her daughter is in Melbourne studying Masters of Nutrition. I put the dog on the floor and observed. The dog walked ataxic as if drunk. The hind legs were slower in movement. This looked like a case of spinal disc prolapse. I put the dog on the examination table, pressed the T/L spinal area from the neck backwards. The dog winced in pain.

"It is not serious now, but this dog must stop jumping from the sofa," I said. The daughter had been encouraging the dog to jump from puppyhood and now, after 8 years, he has backache problems.

This seemed to be the 2nd recent case of back pain. The first one was th Chihuahua which went for extensive testing by Vet 1. So, will there be a 3rd one? Things do come in 3s.

Monday, March 7, 2011

355. Sunday Mar 6, 2011 interesting cases

Bright sunshine day. My assistant phoned to say I had 2 appointments at 10 am.

CASE 1. A slim mother came with a black and white rabbit and two slim pre-teen daughters. The mother said: "The rabbit has this roughness on his feet and ears. What is the cause and whether the disease will infect people?

"I felt itchiness in my elbows," the mother flexed her left arm and scratched her left elbow.

"It is scabies mite infestation," I said to the mother and took out the Hills' Vet book of illustrations to show the mites. "Rabbit scabies don't infect people. However, it is possible that the mites may try to bite you but will not be successful. Hence you felt the itchiness in your elbow."

But Hills' book has only the dog scabies. "The mites look similar to these in the pictures," I said. "Rounded bodies burrowing under the skin and causing itchiness and pain to the rabbits."

I asked my assistant to scrape the skin to get the mites after intern Michelle failed to find any. After 3 failed attempts, Mr Saw scraped deeper into one paw till the blood showed. He got ready the bottle of oil to put a drop onto the slide. I stopped him, "There is no need to use oil," I said. "Oil is recommended by professors in college but actually a drop of water will be better. Michelle, get a cover slip to put on top of the skin scraping."

As Michelle who just got 3As in her A-level results on Friday and would be eligible to study veterinary medicine in Australia looked blankly at me, I realised that she did not take Biology in her A-levels. So, I asked Mr Saw to get one. Mr Saw has the habit of putting another slide on top of the skin scrapings for some peculiar reasons. It is difficult to change his mindset sometimes.

This will also do but is not the correct way to do microscopic examination as a cover slip is much thinner and allow better viewing. I took over the viewing of the skin scrapings as the interns and assistants were taking some time and I dislike making other clients wait. There was an owner with a Beagle pacing outside.

I spotted one moving fat brown mite and asked the mum and 2 daughters to see. "You need to adjust the focus," I said to the be-spectacled elder sister who had some difficulty seeing anything. The 3 members of the family finally saw the mite and so were convinced.

"Where do I buy the Hills' book?" Mum asked me. "You can't buy it," I said. "It is given free to vets. But nowadays, the internet will give you all the pictures of rabbit scabies, and so you will get all the information." Elder daughter nodded her head vigorously.

Younger sister was afraid of seeing the rabbit being injected with ivermection 0.1 ml with saline and closed her eyes. "This daughter can't become a doctor," I told the mum. "Elder sister can as she is not afraid of such things," mum said. The thin 1-year-old rabbit squealed after injection. "It can be quite painful," I said to the mum as elder sister looked worried. "I will rub the skin to spread the injection. This rabbit is very thin and it is not good for his health. Feed more hay and pellets."

The younger rabbit at home had the same problem. I gave a Revolution syringe and advised one drop on the skin weekly for 2 weeks as the younger one would be too thin for the injection. "Usually one injection would kill all mites and skin crust will drop off in 7 days' time," I said to the mum. "As to where the rabbit got infested, it would be from another rabbit in the pet shop or breeder. It is a curable disease."

"What happens if I don't get the rabbit treated by the vet? Will the rabbit die?"
"If the rabbit is healthy, it may not die soon. The crusts on the paws, ear edges, nose and eyelids get thicker and thicker. I have seen some becoming cauliflower in shape. It is a painful condition as the rabbit can't get rid of the mites by itself and the mites keep burrowing under the skin and reproducing."

"What about the male scabies mite?" the mum noted that Hills' book stated that female mites burrow under the skin and lay eggs which hatch to become mites. "Male mites do burrow too but the Hills' book did not mention the males." Sometimes, the illustrator or writer can overlook the fact that male scabies mites still need to burrow inside the skin to survive being washed off or killed by sunlight. I have no doubt that the male scabies must burrow under the skin to mate with the female. Well, the book can't mention every aspect of the scabies mite's sexual behaviour.

CASE 2. The 15-year-old Beagle had his dental treatment more than one month ago but now, she had a problem. The man in his 50s took out his video camera and showed me what was happening in real life. He switched on the camera. The Beagle started to eat heartily. Then he made a gulping sound or movement as he tried to swallow the dry dog food. "As if he had a bone inside his throat," the owner said. "I did feed him pork knucle bones after the dental treatment. Could there be pieces of bones stuck inside the throat?"

I put the dog on the examination table, asked my assistant for a torch-light. "The beagle bites," the owner forewarned me. The Beagle refused to open his mouth. My assistant suggested that he opened the mouth while I shine the torchlight and said: "There is a swelling on the left side of the throat." I had not gone into palpation yet as I wanted to see the inside of the mouth. The Beagle didn't co-operate.

"It is unlikely to be a bone fragment or abscess inside the throat for the past 4 weeks," I said. "There is a 50-cent lump on the left side of the neck, where the thyroid gland is located," I said. "It is a painless lump but large. It may be a thyroid tumour or infection. Or possibly a traumatic wound caused by some sharp object into the side of the throat."

The owner did not want blood test or X-rays. So it was difficult to get a definitive diagnosis. "There is slight pain when I palpated the lump deeper," I said as the dog objected in mild pain. At the age of 15 years, this dog had survived anaesthesia during dental work at Toa Payoh Vets some 4 weeks ago. The owner would not want another anaesthesia or surgery as this may kill off his favourite companion. Antibiotics and an anti-inflammatory injection were given and we would wait 7-14 days to see if the lump of 10 cm x 10 cm disappears. I would think it is a thyroid tumour in view of the dog's age of 15 years which is equivalent to a person at 105 years.


CASE 3. I thought I had seen all hamster conditions thanks to various Singaporean hamster owners over the years. Yet this hamster puzzled me. His right hind foot was swollen 50X in two parts. The foot and ankle was swollen as one lump of 1 cm x 0.5 cm. Then there was a narrow normal width of tissue which spreads out to another similar big swelling of the leg muscle.

"How did my hamster get two big swollen lumps in his leg?" the young lady owner asked me. She had previous hamsters treated by me before but this one sure was puzzling.

"It looks like the hamster's leg had been strangulated by a rubber band, stopping blood flow to the foot and toe at first," I said as the lady told me that she observed a swollen right hind foot first some 2-5 days ago. Then, another swelling above the foot. "Then the blood flow above the strangulated thin area is interrupted and the area swells 10X! Now, the hamster starts licking the swollen areas to relieve its pain. The area becomes shiny and purplish."

However the lady disputed my hypothesis. In any case, there is no such small rubber band inside the hamster's crate. Therefore, what would be the cause of the strangulation?

Fortunately, there was a square piece of cloth with holes and loose threads. This was the clue. "This hamster likes to chew towels and cloth," the lady said. "He lives alone."

"It was possible that the leg got trapped inside the hole and the threads wound round the leg above the ankle when the hamster tried to get free," I postulated. "The more he struggled, the tighter the threads wound round his leg, stopping blood supply for some hours. That is why you see a normal thin strip of leg in between the two bulging masses."

The owner was not fully convinced, I think and thought she could take the hamster home. The hamster was warded for treatment and observation. He had a good appetite and even exercised on his wheel despite his handicap. Facts are stranger than fiction sometimes. However, this hamster must be treated or the swellings would be severely infected by bacteria. The swellings have become purplish and that meant gangrenous.

I told the owner that the hamster might not survive long as gangrene had set in. If the right hind was to be amputated, the hamster might die during anaesthesia and so it was not wise to suggest amputation which should be the course of action. If a hamster died during surgery, the vet costs would be higher and the outcome of death would be the same as when the hamster would be treated conservatively with drugs. In either case, the outcome would be the same. Therefore, I did not advise amputation as the risk would be very high.

Veterinary medicine throws up some challenging cases now and then. In most days, cases are routine but the Divine Powers, if you believe there are such existing, throws in a surprise to keep the vet on his toes.

Saturday, March 5, 2011

354. Chihuahua with Acute Abdomen.- Part 2

On March 4, 2011, Dr Vanessa and I discussed the case. The dog was Ok - active, eating and had passed stools and water. I noted that this dog had more dripping of urine on the floor of the consultation room as seen on March 2 when he was admitted and I. She phoned the owner to take the dog home.

The owner was reluctant to keep the dog in Toa Payoh Vets as Vet 1 charged around $35/day for hospitalisation according to the bill of over $75 for 2 days.

"We charge $15/day," I sensed that the owner just wanted treatment and bring the dog home. He had said that he could not afford Vet 1's veterinary bills. He was told by Vet 1 who had said: "Some owners had spent $3,000 - $5,000 and still the vet cannot tell what's wrong with his dog."

This was a case which had puzzled Vet 1 and so it would be in the interest of the dog to be warded for observation and urine testing via catheter.

There was no urine in the bladder (palpation) during admission as this dog urine-marked. In any case, he had urinary incontinence and was dripping large drops of urine on the floor of the consultation room when I placed him on the floor to assess his mobility. He could walk normally but was a bit depressed due to the effects of Tramadol given by Vet 1.

One has to be observant as the dog can't talk. I asked the owner: "Does your dog dribble urine onto the floor?" He said: "All the time, since young."

Now, if you take the owner's word at face value, you would think that there was nothing wrong with this dog. What the owner meant was that the male dog urine-marks, by spraying urine onto vertical areas since young. What I meant was that the dog has urinary incontinence which is not normal. It was a clue - a urinary tract infection which persisted despite 2 days of hospitalisation and treatment by Vet 1. Vet 1 had not performed a urine analysis but he had done blood test, X-ray with barium meal, plain X-ray without barium meal and an ultra-sound.

According to the owner, Vet 1 had said that nothing abnormal could be detected in his dog. After spending nearly $1,000 for 2 visits, the owner expected an answer as to why his dog was lethargic, not eating and had difficulty standing on his hind legs. His wife had remembered my vaccination card which was recorded for the puppy vaccination in 2003 and the husband phoned me to get a second opinion about his dog having a swollen "stomach" with no definitive diagnosis from Vet 1.

I had said: "Not all cases can give answers to the owner despite many tests. Such tests are expensive and therefore the vet bills can be high. Get all the records from Vet 1 if you can and let Vet 1 know one day in advance rather than taking the dog out immediately."

So, 2 days after hospitalisation at Vet 1, the dog came to me. Seeking 2nd opinions is a common occurrence and all vets do encounter such situations. It is best to provide the records to the owner directly. That was why I asked the owner to do it with kindness rather than abruptly taking the dog out from Vet 1 to cut costs.

When the owner came, I asked about the veterinary report. He said: "It will take a week for Vet 1 to write the report." I was surprised that Vet 1 would not provide him the report as is common practice. However, the blood test result, the ultra-sound and the CD of the X-rays were available and those were good enough. After all, Vet 1 had already said that he or she was puzzled by the case and so I let sleeping dogs lie.

I introduced Dr Vanessa to the couple and was also present as the couple wanted to consult me. Usual weighing and temperature taking, history taking and general examination were done by Dr Vanessa. I palpated the dog's abdomen after she had done.

During my palpation, the dog reacted in mild pain from the liver to the bladder and prostate area despite being given Tramadol (an opiate derivative) injection and tablets by Vet 1. I remembered my Glasgow Vet Professor calling the presenting sign as "Acute Abdomen". That was nearly 40 years ago and you can see how ancient I have become.

So, what are the differential diagnosis? This was a tough nut to crack as the dog had been given pain-killers by Vet 1 and was "eating" again according to the owner. He was also walking on 4 legs now. Except that he was dribbling urine onto the floor of the consultation room.

To make diagnosis more difficult, Vet 1's blood test showed an increase above normal of neutrophils and granulocytes (which consist of neutrophils, eosinophils and basophils) but with NO increase in white cell count. Normally in bacteraemia, the white cell count would have also increased. The L/N ratio was normal too. So, what was going on inside this dog's abdomen? Due to economic reasons, I did not suggest another blood test. I tried to diagnose this cost with as low cost as possible as the owner had said he could not afford to pay the vet fees anymore.

His wife would be giving birth soon and understandably there are much more expenses. "Will she be giving birth at Mount Elizabeth Hospital?" I asked as this is said to be the top dog in private hospital services. "No, no," he said.

Back to the dog. I tried to reduce as low as possible the costs.
Back to basic. I asked the owner again: "Was your dog unable to stand on his two hind legs?" He had said something to that effect but then all sick and anorexic dogs are lethargic and would not want to stand up at all or take a long time to stand up. But he had said "hind legs." So, that is one clue. It could be presented as a case of paraparesis.

On admission, the dog was walking and standing up on his two hind legs without problems! So, there was nothing to talk about. However, this dog had been given Tramadol pain-killers and since he had no pain, he would be standing on all legs. I was suspecting intravertebral disc lesions, normally at T/L or L or L/S spinal discs at this age. I would expect this Chihuahua to leap from sofa to floor for the past 8 years of his life and now would bear the consequence. Like joggers who pound the pavement when they are young. They get knee pain in middle age. So, this dog could have suffered IV disc prolapse but not on a serious mode yet.

With the dog standing on the consultation table, I pressed the spinal area from neck to tail. Despite Tramadol, the standing dog winced slightly when my two fingers depressed the lumbar area. I repeated the action and elicited the same reaction in front of the couple and Dr Vanessa. So, there was something wrong with this dog's spinal area and he might have got a painful disc. That was why he suffered paraparesis - an inability, temporarily, to stand up on his hind legs.

Pain diffused to cause his stomach to bloat as he could not pass stools normally. He also could not pass urine well and together with gas inside the intestines, leading to bloated stomach. Pain was diffuse causing acute abdomen as the pain of a partially slightly prolapsed IV disc hurt him badly. So, he did not feel like eating and moving. The owner's mother was worried and sent him to Vet 1.

All these hypothesis needed to be confirmed. As I was under the constraint not to add more vet cost to the owner, I asked Dr Vanessa to zoom in on the disc area of the X-ray of the dog's abdomen where barium meal was given and found in the large intestine.

Dr Vanessa put in Vet 1's CD in her lap-top. Suddenly Mandarin songs and music blasted out (Part 1 of the story) to our amazement. It was as if there was a bugle call to attention to soldiers for the forth-coming commander. It was unexpected and therefore quite funny.

In any case, the zoomed area showed some cloudiness over L1/L2 and L2/L3 IV area and slight narrowing of the IV space. With financial constraint, this was my approach to viewing this X-ray instead of a proper X-ray of the spinal disc. One has to be understanding of the owner's financial wishes as vet tests can add up.

However, the urine test was compulsory. It showed ph 8.0, bacteria ++, amorphous phosphate crystals ++, indicating an INFECTION-INDUCED STRUVITE UROLITH. Now, there was protein +++ in the urine which could indicate cystitis (thick-walled bladder felt by me during palpation before the dog goes home). This was another medical problem and needed to be followed up.

The dog was OK and went home with instructions of no more jumping from the sofa at all, antibiotics and advice to neuter (to prevent prostatic hypertrophy, infection or tumour). The dog needed urine analysis review. Old dogs need more care and annual health screeing if the owner wants the dog to live to a ripe old age and not to incur expensive vet bills. But sadly, most Singapore owners do not bother.

Thursday, March 3, 2011

352. Chihuahua with Acute Abdomen.- Part 1

It was 2003 when I vaccinated this Chihuahua puppy and 8 years later, the original owners phoned me to ask for a second opinion of not eating and a "swollen stomach".

Vet 1, during the 2nd consultation, had taken blood test, barium-meal X-ray, ultrasound. According to the owner, the Vet 1 could not find anything wrong with the Chihuahua.

"I can't afford the vet fees anymore," the husband said as he had spent around $1,000. He had kept my vaccination card of 2003 and so gave me a call to quote my fees.

"If all the tests are done and nothing can be found in the abdomen, I would propose a laparotomy to open up the abdomen. This is risky as the dog is ill. If the dog has abdominal tumours, twisted intestines or stomach, inflamed livers or spleen, then this surgery would let you know the cause of the swollen painful stomach and you can decide what to do next. However, this would be the last thing to do. The cost is around $500 but I can't say exactly.

To save money, you need to get the case reports and test results from Vet 1," I discouraged him from taking the dog out immediately as it was under I/V drip for only 2 days and he should give Vet 1 some time to close the case. I gave him an appointment at 12 noon the following day and did not expect him to turn up.

He came without the case reports saying "Vet 1 says he needs to take one week to write the report!".

"It is Ok," I said. "In one week, it will be too late for the dog if he is not eating."

The husband took out a CD from Vet 1. I would handle this case together with Dr Vanessa Lin as two heads are better than one. She put the CD into her lap top and suddenly loud Chinese songs blasted through the silence.

"Wow, your laptop can play Chinese music with this CD!" I tried to inject some humour in this serious situation and to break the ice as the couple expected only me to handle their case. Normally, no music would be heard on insertion of a CD and I was thoroughly surprised by this laptop's behaviour. I wondered whether Vanessa had a new model?

351. Rabbit anaesthesia - sharing knowledge via the internet

Very few rabbits are spayed as most owners in Singapore and in other countries don't bother to do it. Therefore most vets in most countries don't have much opportunities to use anaesthetics to spay rabbits unlike in cases of dogs and cats.

Vets who work in rabbit shelters seldom share their knowledge as there is no monetary incentive.

However, injectable anaesthetics used are safe in the spay of normal rabbits. Use isoflurance by gas mask for a few seconds to top up moving patients. If no gas, use injectable anaesthestics in half or quarter doses. Analgesia is very effective. I did record four rabbits being spayed and neutered in one case in www.toapayohvets.com at:

http://www.bekindtopets.com/animals/20081129Rabbit_Anaesthesia_Spay_Neuter_ToaPayohVets.htm


Today I got an email from a young Italian vet who spayed a rabbit after reading my blog. It was great to know that she had good success. That is good news for rabbits too as rabbits do develop uterine cancer in old age and spaying prevents such cancers.

EMAIL FROM ITALIAN VET MARCH 3, 2011
dear dr Sing,
i'm an italian young vet, dr ....., and i read your blog about anesthesia for rabbits..and i used premedication with atropina and your method n 2 with zoletil and isofluorane and than analgesia for a rabbit neutering....it was fantastic!

i was scared to anesthetize a rabbits cause i never learnt anything about this at university..but i tried!!

everything was good except her uterus....it was so fragile...it's normal in a rabbit or it was cause she was in estrus?
now she is ok, and she ate few hours later anesthesia..
thank you so much...i hope i have your reply...

EMAIL REPLY FROM DR SING DATED MAR 3, 2011

Hi

It is good to hear from you. I was in Italy in 13 December 2011 just as snow started. Beautiful countryside and people. I like Venice, Pisa, Rome and Florence.

1. In reply, very few vets do spays on rabbits because the Singaporean owners do not usually request rabbit spays and there is the perception that anaesthesia is risky in rabbits. .
2. The uterus is more fragile than in dogs and cats especially when in estrus.
2. Can you share with me the weight, dosage of zoletil used and analgesia for my knowledge?
3. What is the address of my webpage you saw?


E-MAIL REPLY FROM ITALIAN VET MAR 4, 2O11


oh i 'm so happy you reply me so soon!
in italy, there are very very few people that request to have their own rabbits spayed...maybe because the majority of Italians eat rabbits!
...i live in the southern of Italy, and not all animals have the possibility to be visited by a vet...cultural problems may be..there are few rabbits in the houses and not many people know they need a vet!
so your...or...may be not your site is: http://singaporerabbits.blogspot.com/2010/01/2-anaesthesia-giant-rabbit-and-guinea.html

i used atropina in 0.5mg/kg and than zoletil 100 between 5-25mg/kg IM (my white rabbit was 3 kg and i do first 0.15ml of zoletil...but it was quite calm...so i do inject another 0.15 ml. she started to be very quiet..eyes closed...and so, after a few minutes, i put on her face a isofluorane mask on 2%, than 1% during all the spay.
Before I start to cut her skin i gave flumixin meglumine in 1mg/kg, so i used Finadine in 0.02ml/kg, i read its effect will start just 2 hours after administration IM.
20 minutes after the end of spay, she cried nervously for few seconds...and then she sat calmly in her little cage..
in 2 hours she started to eat normally, and now, 2 days after spay, she can standing up and she is very sweet!
I do not use antibiotics after surgery...because i'm scared to do it..
she is very good...i nurse her every day, and she cleans her cut, with intradermical sutures, she can't put off it.

i hope i can ask you in future just to have your help!


COMMENTS

An excellent description by the Italian vet.
Due to lack of time, some of my webpages are at blogger.com and some at www.toapayohvets.com. In blogger.com, it is easy for me. No need to upload files and link it as in toapayohvets.com. I could just type, click "post" and the webpage is there! In toapayohvets.com, I need to FTP the file to the site. Then I need to get the hyperlink and put it into my front page which is www.toapayohvets.com. This takes a few minutes.

FOR THE BENEFIT OF READERS,
The website refered to by the Italian vet is in one of my blogs at blogger.com. I reproduce as follows:
2. Anaesthesia - Giant Rabbit and Guinea Pig
BE KIND TO PETS
bekindtopets.com community education
Sharing knowledge with veterinarians

Giant Rabbit Neutering
The vast majority of Singapore pet owners keep small rabbits of around 2-3 kg. So my staff quoted the normal prices of $75.00 for neutering of a rabbit. A price list is displayed prominently at the reception. It says: "Castration, rabbit, $75.00"

However, a giant rabbit was presented after the owner phoned for a quotation. Unfortunately, my staff had never thought of asking its weight, unlike the case for dog neutering. A Giant Fleming Rabbit of 5.2 kg turned up. He was extremely hyperexcitable. This type of temperament is a high anaesthetic risk.

METHOD 1.
One method is to use injectable anaesthesia of zoletil IM, 5 minutes later, give domitor IV via the ear vein.
However, this method seems to be unsuitable as restraint and injection causes the rabbit to move a lot.

Zoletil 50 0.2 ml IM
Waited 15 minutes
Wanted to give Domitor 0.2 ml IV, ear vein.
Still struggling. Abandoned this method in favour of Method 2.
METHOD 2
Zoletil 50 0.2 ml IM given. In around 7 minutes, the rabbit staggers and by the 15th minute, the rabbit was recumbent.

However it exhibited excitation when the ear vein was pricked and moved away.

So, I used isoflurane 5% gas by mask.
Isoflurane gas - mask - maintenance at 0.5% - 1% was excellent. The rabbit was neutered without problems.
METHOD 3
Xylazine IM, Ketamine IM is another method I used for smaller rabbits of around 2 kg. Isoflurane Gas top up may be necessary.
This Giant Rabbit recovered after 30 minutes and went home. Method 2 is the best method for me but each vet has his own preferences.

Guinea Pig Neutering
In a 4-month-old, 700-gram male Guinea Pig I neutered recently, Zoletil 50 0.1 ml IM was given. Then a few seconds of isoflurane gas at 1-2% provided excellent surgical anaesthesia when the guinea pig moved. The guinea Pig woke up within 1 minute after neutering was completed.

As rabbits and guinea pigs are not starved 10 hours prior to anaesthesia and surgery, unlike dogs, I neutered this guinea pig 4 hours after the young lady owner brought him in for neutering to prevent breeding. "It is much safer to neuter than to spay the guinea pig," the young girl told me. "You are correct," I replied. "Spaying takes a much longer time and require internal access inside the abdomen."

After Zoletil injection, a copious amount of yellowish-brown fluid came out of the guinea pig's mouth. This appeared to be "vomitus". His mouth was cleaned before the gas mask was applied. This could be a side effect of Zoletil injection.

toapayohvets.com
Be Kind To Pets
Veterinary Educational
Project 2010-0001


REPLY TO ITALIAN VET DATED MAR 4, 2011

Thank you very much for your sharing of knowledge and your interesting description of your rabbit spay. In Singapore, the majority of the population does not eat rabbits. Now, the pets kept are dwarf rabbits mainly as the big ones are out of fashion. If you have a picture of your spayed rabbit, do email the surgical site to me for record.

Pl email if you have other questions on veterinary matter. The blog you gave in the e-mail was written by me. For other interesting veterinary cases on rabbits, I usually post the reports at www.toapayohvets.com. Goto "Rabbits" to read the cases of relevance to you. Best wishes.

Wednesday, March 2, 2011

350. Dr Sing's Travel Stories: Education of Myanmar children

Today, the Straits Times (MPs: Help needy kids move up in life, A8, The Straits Times, Mar 2, 2011) reported that Singapore MPs, on the 2nd day of the Budget Debate, made "calls to reduce disparity in opportunities for rich and poor students". They wanted higher quality teachers and IT resources for neighbourhood schools as their parental background sets them back when competing to get into top secondary schools.

Some MPs quoted Minister Mentor's Lee Kuan Yew's January 2011 statistics that students of top secondary schools like Raffles Institution have >than 50% of fathers who are graduates nowadays compared to the <10% for neighbourhood schools. The MPs remarked that the neighbourhood school students will be disadvantaged in time as they cannot be competitive academically as they get less opportunities to get scholarships or university places and graduate to get high paying jobs. Less opportunities for neighbourhood school students mean a growing social stratification with the rich becoming richer. Is there a solution to this resolving problem of lower academic excellence in neighbourhood schools? I don't know. However, there is an interesting development in Myanmar's education system. In Feb 2011, I visited around 7 primary and secondary schools and was surprised to see that the Ministry of Education publishes yearly a calendar of photos of top 10 students in the final secondary year national examination(Grade 11). Schools and some villages display this page.

In Singapore, this will be considered putting "pressure" on the students and such ranking of students had been thrown out of the door by parental complaints in the past years.

MYANMAR SCHOOL SYSTEM
1. Kindergarten (Grade 1). 5 years old student.
2. Primary School (Grade 2 to 6). Final exam in Feb
3. Middle School (Grade ). Final exam in Feb
4. High School (Grade 11) - recent change. Students will be 15 years old. It was called Grade 10 last year but since kindergarten is Grade 1, Grade 10 becomes Grade 11. It is equivalent to "O" levels. Final exam. A national exam for all students in Myanmar in March.
5. University.

SCHOOL EDUCATION SYSTEM
According to one Myanmar lady in Singapore, Science and Math are taught in the English language. English is also taught. Other subjects are in Myanmar language.

READING SKILLS COMPETITION
There is such a competition in villages. I did hear loud recitals by students in schools and once I chanced upon a young girl of around 12 years reading loudly (in French according to my guide) while trekking in the Inlay Lake district. I had to walk past her school. She was just sitting on her chair and reading loudly and continuously.

SCHOOL HOLIDAYS
1. March, April and May
2. October 10 days
3. December 10 days.

TEACHERS
Government teachers and volunteer teachers in villages. Some village school have no desk or tables for the children.

I can see that even in Myanmar, there is strong interest in education of the young children.

Sunday, February 27, 2011

349. Veterinary Nurses Wanted

ADVERTISEMENT IN ST701.COM

Display logo in Job Postings
Company Description

March 1, 2011
Veterinary Nurses Wanted for dog and cat animal practice. Able to converse in Mandarin and English. Lives around Yishun to Toa Payoh area. N or O levels. Knowledge of Microsoft Word, Excel, Adobe Photoshop preferred. Able to work alternate weekends and loves dogs and cats, hamsters and rabbits. E-mail resume and two testimonials to judy@toapayohvets.com.
Company Website URL

http://www.toapayohvets.com
Company Map

Display map in Job Postings