Friday, August 12, 2011

538. Z-plasty for a Syrian hamster?

This Syrian hamster was bitten through the vertical grate which separated two hamsters. A rotten-flesh smell leaked from a big black abscess on the left elbow. The abscess was drained by Vet 1 and the wound stitched up.





Two days later, the hamster came back as the stitches had broken down.

MY COMMENTS
1. Contaminated wounds are best not stitched. Give the hamster antibiotics for 3-7 days to get rid of the bacteria and to let the skin return to normal.

2. In this hamster, stitching the lower end to the upper end of the big wound will not permit healing as there is a high skin tension. This will lead to stitch breakdown.

3. Z-plasty and stitching up small areas in front of the elbow is one option.





4. I advised surgery but the owner did not accept. The chances of full cover of the skin wound are not 100% and the owner must be informed properly.

In dog bite wounds around this elbow, Z-plasty ought to be done as such big exposed areas are easily infected and itchy. It takes more than 3 months and does not heal as can be seen in one case handled by Vet 1 and observed by me earlier. In this case, the owner did not give permission for surgery and prefer simple nursing and treatment and that is where the vet's hands are tied.

It is not wise to keep such dogs for over 3 months inside the veterinary surgery to do simple nursing and treatment if owners do not want to permit surgery because keeping a dog hospitalised for such a long time is not good for the poor dog. The owner has to bear the responsibility of caring for the dog.

5. As for this Syrian hamster, I don't know what happen as the owner did not return for follow up. I prescribed antibiotics and anti-inflammatory oral and advised daily cleaning of the wound. I will be most surprised if this hamster survived the bacterial infection from the environment. But miracles do happen and the wound may close by granulation.


MORE DETAILS AND A DOG Z-PLASTY CASE IS AT:
http://www.sinpets.com/hamsters/201108012syrian-hamster-z-plasty-surgery-advised_singapore_ToaPayohVets.htm

537. Follow-up on the cat having urination difficulty - FLUTD again

I spoke to your husband and fax copies of blood and urine test results to him yesterday.

1. Significant finding of the blood test is the low platelet count and the high glucose level. The low platelet count is probably due to the cat ingesting some toxic chemicals via grooming his coat. There was some "fur vomited" too. Abdominal pain was present.

2. For the urine test, there are bacteria, epithelial cells, white cells and red blood cells and a trace of protein present. This indicated a urinary tract infection involving primarily the bladder. A trace of protein may not be serious at this stage.

3. There is no kidney disease based on the blood and urine tests. No urinary crystals are detected. As for the high glucose level, a 2nd test is needed in 2 months' time to assess whether he has diabetes.

4. A test 2 months later is advised.

5 Advice: Keep the cat indoors and away from eating grass and soil. He has lost weight and this may be due to the ingestion of toxic chemicals tainting his coat and paws when he plays in the garden outdoors. Toxic chemicals may include insecticide and fertilisers and mosquito fogging chemicals. Some cats love to nap under the car, staining themselves with engine oil etc. So, it is best to keep this cat indoors all the time.

Thursday, August 11, 2011

536. Text-message from a FLUTD cat owner

Yesterday, August 10, 2011, I met the FLUTD cat owner, a knowledgeable lady in her 30s. She had texted the following message to me the day before.

August 9, 2011 6.02 pm
Hi Dr Sing

TOMMY'S NOT PEEING AGAIN?!

It's been a few months since I updated you about Tommy. He was doing fine up till 2 days ago. Straining to pee and now vomiting after straining. Some fur in his vomit too. Very limtied appetite too, as if he's scared to eat lest he throws it up. I'll bring him to the clinic tomorrow morning. Hope you can see him and advise what's troubling him.

Happy National Day!

Names of husband and wife


I called her a knowledgeable lady as she had read all about FLUTD from the internet. She requested blood and urine tests, not just an injection and some antibiotics to go home. As vets, I would like to do the tests but some owners don't want to spend the money and so I try to give the basic treatment first and "wait-and-see" just to save the owner some money. This may not be a good way to practise veterinary medicine but Singapore owners go for the cheapest vet in town. All these tests add up to the costs and make me an "expensive" vet. However, to sophisticated and knowledgeable owners, failure to do tests indicate a vet not up to the mark! So, there must be a balance somewhere.

HISTORY-TAKING
"My cat can pee today!" the lady said.
"If your cat can pee," I replied. "There is no need to treat him."
Yet, on closer history-taking, the cat had difficulties peeing during the past 5 days, not 2 days.
"How do you know that your cat can pee normally?" I asked the lady.
"Well, he does it in front of me. He urinates a full stream of urine every morning in my presence."
An exhibitionist? I dared not say this loudly. Instead I asked when was the last time the cat could urinate without difficulty, namely a full stream of urine. It was 5 days ago, not 2 days as in her text message.

EXAMINATION
The significant finding was a painful abdomen and a weight loss of 1 kg compared to 2 months ago when I saw the cat (case report written, will get the URL). I could not palpate the left kidney. So, it would not be enlarged. His bladder was slightly full and contained some urine.

This is a 7-year-old male neutered cat that had FLUTD (feline lower urinary tract disease) some 2 months ago and had been on feline S/D diet for the past 2 months.

"Nobody tells me when I should stop the S/D diet. So two weeks ago, I had run out of S/D canned food and offered him ... (a commercial canned food).

"It is hard to say when the S/D canned food ought to be stopped. 2 months should be OK in some cases." I said. S/D is more expensive. This cat has been eating dry cat food over his past 7 years and just dislike canned food.

"Well, he has no choice, but to eat the S/D," the owner said when I asked her. The cat was losing weight.

"Could she be suffering from thyroid disease?" the owner asked me. This showed she had done her research in the internet. It is possible but the presenting sign is that of the urinary tract. So, I have to focus to check whether the cat has kidney disease or not first.

BLOOD TEST AND URINE TEST under sedation. I gave this 5kg cat xylazine 0.1 ml + ketamine 0.4 ml IM. With a few seconds whiff of isoflurane gas, he could be asleep with eyes open. The blood was collected from the big leg vein and his urine was collected from catherisation. About 20 ml of dark coloured thick urine. Claws were trimmed. No mouth ulcers or gingivitis. Pink tongue and mucous membranes. Some tartar on the teeth was scaled off.

After sedation injection, the cat vomited grass and dark yellow fluid (water and cat food likely, maybe some soil?). So the cat was not confined to inside the house as I presumed as he was supposed to me. He had access to the garden! To pee and be stressed out by neighbouring strays. This cat had lived in an apartment for the past 7 years till the shift to the parents' house temporarily. The cat had never seen other territorial cats before and now in this house, he met many. No wonder he was stressed out. He might be urine-marking too.

I will update readers soon as the case is being investigated. Like a detective story. Blood test and urine test results from the Lab will be in today.

535. My three dwarf hamster patients - body odour, amputee, breast tumours

Today, August 11, 2011, I post my summary case report of my 3 dwarf hamster patients as I had written smaller case reports in the past weeks on the follow-up nursing care by the owners after surgeries.







The website for hamster lovers is:
http://www.sinpets.com/F5/20110733three-hamster-surgery-follow-up-Singapore-ToaPayohVets.htm

We all love happy endings. Owners who diligently observe their older hamsters for lumps and bumps will be less stressed out and save money if they get such lumps and bumps excised by their vets early. If their vet says: "Wait-and-see", then it is wise to seek a second and third opinion. In my experience, tumours don't disappear spontaneously. I did have a report from a hamster owner that the big tumour on her hamster (one of my hamster reports) disappeared after dieting or change of food. That was the feedback. In reality, tumours don't disappear and need to be excised early.



Wednesday, August 10, 2011

534. Sunday's interesting cases

Aug 7, 2011
Tea cup poodle 3 months had diarrhoea. Young couple fed it something new after purchase. Started to vomit and became comatose on Saturday despite treatment. On Sunday, I switched to IV dextrose saline. He stood up, looked OK. Later in the evening he passed away. Stick to what the seller advised. No new food. Stresses


Aug 9, 2011 National Day
Maltese could not stop scratching frequently for the past month. "Shampoos, I used all types. What's the best?"


July 31, 2011
My assistant Min got his right thumb bitten by an old cat with kidney disease. He was transferring the cat out of the cage. As Dr Vanessa and I did not see him doing it, we were puzzled as to why the old cat sunk its canine deep into his right thumb. Dr Vanessa took him to a doctor. He said: "No need". But it is important as cat bites can be infectious.
He went and got 3 stitches to stop the bleeding.

Monday, August 8, 2011

533. Break a leg? Break a ear?

"Break a leg" is used to mean "Good Luck" to a theatre performer. You don't say "good luck" to a theatre performer. Well, in two sibling hamsters I operated upon, I was surprised that I had to "break a leg" and "break a ear" literally!

See pictures below.





"Break a leg" is used to mean "Good Luck" to a theatre performer. You don't say "good luck" to a theatre performer. Well, in the two sibling hamsters I operated upon recently, I was reminded of the theatrical term "break a leg". Well, I really had to break a leg to save her life. Her sibling with foul smelly ear? I had to "break a ear" literally to save her life! Their lady owner now has no more worry lines since the two squeaky hamsters have behaved normally now and one does not have body odour anymore

See pictures of my follow-up of two sibling hamsters operated 14 days ago and reported in My 3 dwarf hamsters post-operation as follows:

BREAK A LEG

14 days ago, an explosive bony growth on her left hind leg



Leg amputation surgery



BREAK A EAR

14 days ago, bad body odour
Ear canal ablation surgery



4415- 4423. Two older sibling hamsters are normal and active 14 days after surgery. A much earlier veterinary treatment would have saved a lot of worries and reduced risks. But Singaporeans live in a hectic world and it is difficult to advise "early detection saves lives"! It so happens that there are two happy endings for the siblings. It is not a given that hamsters will survive the anaesthesias and handling surgical stresses.

More pictures are at:
http://www.sinpets.com/hamsters/20110808dwarf-hamster-break-a-leg-a-ear-Singapore-ToaPayohVets.htm

Sunday, August 7, 2011

532. My 3 dwarf hamster post-operation follow up

Surprisingly, I got two phone calls regarding 3 dwarf hamsters this Monday morning Jul 25, 2011 after the hamsters had survived a high-risk surgery and had gone home for over 2 days.

1. Hamster 1 and 2, Female, 2 years old. The lady owner phoned up. Day 3 of surgery. Hamster 2 (amputee) attempted to bite stitches. What to do? Plaster? Not practical.
Hamster 1 - Ear canal ablation. Hamster eating. Objected strongly to cleaning off blood from ear. So done once only. Advised to do more cleaning. Isoflurane gas anaesthesia only but very stressful ear canal removal. Took 2 days to recover.


The ear canal was full of white "sand" particles as well as tumours (irritation due to sand?), pus and dead cells






Hamster 1. A rare ear canal ablation surgery completed in this dwarf hamster. This surgery is common in the dog. See: The "reasonable" man test in a court of law
Hamster 2 (amputee). The lady owner confirmed that the leg tumour was only 5 mm diameter 6 weeks ago. "Like a face pimple," she said. But it grew furiously big to 1.5 cm. I had to amputate the leg above the knee. The hamster started exercise wheeling. 30 g before surgery. After surgery, her weight was 19 g. There was a lot of blood loss









Hamster 2 - The leg had to be amputated as the tumour involved the bone below the knee and above the hock.




Feedback from owner who noted the following.
1. Lowered water bottle. Can't drink as only one hind leg.
2. Food bowl too high now. Hard to climb out. Use bowl from those used in Chinese household for chilli and soya sauce. A bit of spillage but hamster could eat.
3. Tempted with favourite bean sprouts. Then give baytril oral.
This hamster needed sedation IM. First day, one drop Zoletil 50 IM. No effect. Just looked at me. So, suspend all operation till 24 hours later. 2nd day, 3 drops OK. Leg bone tumour extended to inguinal. Amputated. Quite active within 1 hour.




Advices
No exercise wheel. Stitches quite many. Blue nylon 5/0
Continue on paper litter. Not so rough. But hamsters loved to shred them.

2. Hamster 3 - 81 g. Operated to remove two large breast tumours.
She loves bread and so the wife fed her more bread. She put on lots of weight. An average dwarf hamster weighs around 30-40 g. I doubt she could survive the anaesthesia and surgery. But she proved me wrong.






spleen seen




4326 - 4336. Surgery itself does have complications sometimes. The spleen pops out unexpectedly!  
Hamster 3. The two large breast tumours were excised. The spleen came out from the abdomen but was put back. The abdominal defect was stitched. The hamster survived as at Day 14 after surgery.
The husband rushed down to the Surgery. Two 5/0 nylon stitches bitten off today on Day 8. Bleeding. Wife phoned. OK at clinic. No bleeding. Cut off two entangled nylon stitches. 1 remaining. The husband did not want it cut off. To observe. To reduce weight further. 79 g now. The tangled transparent 5/0 nylon stitches were taken out

Feedback, fully active and normal on Day 3 but would eat after operation. Daily exercise on wheel. Owner quite happy.


Pictures and details are at:
http://www.sinpets.com/F5/20110733three-hamster-surgery-follow-up-Singapore-ToaPayohVets.htm