Friday, September 11, 2015
Thursday, September 10, 2015
2989. INTERN VIDEO. Z-plasty in a very large wound
Sep 9, 2015
HOOK
BKTP
On Sep 8, 2015, the dog owner WhatsApp me an image of her bleeding 14-year-old Shih Tzu and asked whether she could treat the bleeding herself using the cream I had prescribed for the skin disease some 2 months ago.
"It is very difficult to advise you based on your smartphone image," I said. "It is best you bring in the dog for examination." Phone diagnosis can lead to a misdiagnosis. There are owners who lodge a complaint with the authorities if the dog develops sepsis and dies from bacterial infections of the blood due to a phone image mis-diagnosis.
The next morning on Sep 9, 2015, the owner brought in the dog. Thick dark red blood oozed out from below the armpit. This was not a simple case of bleeding. It was a large shoulder abscess. The dog turned his head to bite me when I tried to touch his painful right shoulder.
This is a very old dog. Sedation with anaesthesia is risky but the dog would bite or die from the stress of treating the abscess without anaesthesia. The owner reluctantly accepted the risk of anaesthestic death.
Sedation with IV domitor and ketamine at 0.15ml + 0.15 ml permitted my assistant to clip the wound area.
What are the other treatment options after debridement?
1. Let the wound heal by granulation. This wound is very big and the muscles below would become badly infected, causing pain and licking for months. The owner will need to clean the wound daily for many weeks. The dog cannot walk normally.
2. Stitching a large wound is best practice.
After debridement, the wound is gigantic. How to close this skin wound without the stitches breaking down 3 days later?
2. Z-plasty. It is best to close the wound to protect the muscles.
The procedure is described by me in:
One case done for removal of large skin tumour
https://www.youtube.com/watch?v=k_xgdWNKCi0
2. Then hydrogen peroxide was poured in to clean the wound further.
3. This wound was so large and under high tension. Simply stitching the ends together would not lead to healing as the stitches will break down in 3 days.
4. The solution was to use Z-plasty surgery and give painkillers and antibiotics.
See video footage.
As at Sep 10, 2015, the dog had been tightly bandaged to stop the subcutaneous bleeding. Antibiotics and painkillers are given.
Video dog standing with bandages on Day 2 post-op.
CONCLUSION
1. Early veteirnary attention by the owner prevented sepsis and death of the dog as bacteria would have travelled to the blood stream and infect the whole body. Blood test results.
2. Z-plasty takes a long time as compared to simple suturing of the two ends of the wound. In this case, there would be poor outcome making the owner very stressed out and unhappy. .
Monday, September 7, 2015
The challenges of a single mother in Singapore
Sunday Sep 6, 2015
"I am a single mother," the lady with the cat that has an itchy chin told me when I remarked that I had not seen her husband. Her two daughters are grown up to be young adults at college. Today, being Sunday, the younger daughter did not want to accompany her to the vet while the older one had something to do. Sometimes both came.
"Your daughters must be sleeping late," I said. "Playing multi-role computer games."
"No," the mother said. "Watching you tube videos."
The younger Singaporeans and the others in developed countries apparently do not sleep early.
"How do you cope being a single mother?" I told her I would be all exhausted raising 2 young daughters alone and having to work.
"I have a good domestic helper for the past 14 years," she told me. In recent years, the children had grown up. The maid woke up at 8 am and has every Sunday off. There was not much house work to do and so she even ironed the T-shirts. However, she was a good maid with no outside lovers. Her 17-year-old son wanted her to go home and so she resigned.
"Many maids do not save up," I said. "The husband does not work at home and always ask for money. He will entertain the villager friends drinking. The family members and relatives ask for money. Friends ask for loans which will not be paid." So they go home without savings.
"Her brother asked her for money to pay for his wedding," the lady told me she saw her maid crying because she had incurred a debt of 100% of the loan in 6 months. She had borrowed $1,500 for the wedding and the debt became $3,000 in 6 months.
This kind lady paid off her debt with instalments to be deducted from her salary. Since she wanted to resign to be with her teenaged son, the lady let her go. She did not need any maid and would have saved the US$450 monthly fee plus the government's maid levy.
Back home, the maid had to go for an operation for a cyst removal and phoned for money.
"How much?" I asked.
"15,000 pesos," she said.
"That is a lot of money."
"Well, it is S$400," the kind lady wired the money.
After 14 years working in Singapore, this domestic worker had helped considerably in looking after the 2 daughters and had sacrificed her motherhood as she left her 3-year-old son to work far away, seeing him, one month every 2 years. She was paid double as most maids got paid S$300 a month. The employer is good. I hope she will be happy with her family now.
"There's a single lady I know," I said to this lady. "She has two Primary School daughters by different men. The elder one was from a married man, but the younger one is from a single man. She will not marry him!
"She is self-employed and she is so thin now," I really cannot understand how single mothers cope.
Single mothers don't get the same maternal and housing benefits as married mothers and so it must be very tough for them.
"I am a single mother," the lady with the cat that has an itchy chin told me when I remarked that I had not seen her husband. Her two daughters are grown up to be young adults at college. Today, being Sunday, the younger daughter did not want to accompany her to the vet while the older one had something to do. Sometimes both came.
"Your daughters must be sleeping late," I said. "Playing multi-role computer games."
"No," the mother said. "Watching you tube videos."
The younger Singaporeans and the others in developed countries apparently do not sleep early.
"How do you cope being a single mother?" I told her I would be all exhausted raising 2 young daughters alone and having to work.
"I have a good domestic helper for the past 14 years," she told me. In recent years, the children had grown up. The maid woke up at 8 am and has every Sunday off. There was not much house work to do and so she even ironed the T-shirts. However, she was a good maid with no outside lovers. Her 17-year-old son wanted her to go home and so she resigned.
"Many maids do not save up," I said. "The husband does not work at home and always ask for money. He will entertain the villager friends drinking. The family members and relatives ask for money. Friends ask for loans which will not be paid." So they go home without savings.
"Her brother asked her for money to pay for his wedding," the lady told me she saw her maid crying because she had incurred a debt of 100% of the loan in 6 months. She had borrowed $1,500 for the wedding and the debt became $3,000 in 6 months.
This kind lady paid off her debt with instalments to be deducted from her salary. Since she wanted to resign to be with her teenaged son, the lady let her go. She did not need any maid and would have saved the US$450 monthly fee plus the government's maid levy.
Back home, the maid had to go for an operation for a cyst removal and phoned for money.
"How much?" I asked.
"15,000 pesos," she said.
"That is a lot of money."
"Well, it is S$400," the kind lady wired the money.
After 14 years working in Singapore, this domestic worker had helped considerably in looking after the 2 daughters and had sacrificed her motherhood as she left her 3-year-old son to work far away, seeing him, one month every 2 years. She was paid double as most maids got paid S$300 a month. The employer is good. I hope she will be happy with her family now.
"There's a single lady I know," I said to this lady. "She has two Primary School daughters by different men. The elder one was from a married man, but the younger one is from a single man. She will not marry him!
"She is self-employed and she is so thin now," I really cannot understand how single mothers cope.
Single mothers don't get the same maternal and housing benefits as married mothers and so it must be very tough for them.
Images and sayings: Negative thoughts
Don't sweat the small stuff?
Lock out negativity and drama
Light at the end of the tunnel
See light during dark moments
Lock out negativity and drama
Light at the end of the tunnel
See light during dark moments
Saturday, September 5, 2015
2986. Unbelieable story. The cat had high blood sugar and difficulty in urination
Sep 4, 2015
The woman who loves this stray cat very much came today to buy a bag of feline W/D. She had wanted to cancel her one-week monastery camp as the cat was suffering from dysuria. I advised her not to worry as this was important for her belief.
"How's is your Buddhism camp?" I asked. "It is good that you did not miss it. Otherwise you need to wait for another year."
"Actually, it will be 4 years for the next camp," she said. So, it was great that I had advised her not to miss it as the cat was treated and had medication.
"My cat is fine now," she declared. "After eating the feline C/D, I come to buy the W/D as her blood glucose level was high when she had urinary tract problems.
Feline W/D is said to help manage glucose and weight and improves digestion. This is done by:
1. It also promotes urinary tract health,
2. helps to metabolise fat and maintain lean muscle,
3. supports a healthy immune system
4. Helps maintain a healthy weight.
This stray cat eats any dry food and so there was no problem in switching food. This appears to be no ordinary cat as the lady narrated the following:
1. The cat would send departing visitors to the lift area.
2. The cat had walked 3 circles with the Buddhist friend who was practising the belief and chanting.
3. The cat had listened to a friend who told him to jump onto the shoe box and leapt into the open window.
This cat would appear to be a re-incarnation of a person as he is so clever, as if being able to understand human communication. It is hard to believe as I have not seen his actions but there is no reason for the lady to lie.
----------------------
Hamster full of warts. From St Georges' Road.
Aug 30, 2015
69g. Obese.
bilateral hair loss at the back area
1. Ear warts. right ear. Multiple.
2. Wart. right elbow. One at 3 mm across.
3. Flank wart. 5 mm across.
4. Left hind paw. Below paw. 8 mm across.
5. Left inguinal area. 5 mm across.
6. Left belly area 5 mm across.
I used electro-surgery to cut off all the warts. The hamster went home.
Follow up on Sat Sep 5, 2015 today.
No answer from mobile. I sms " Is Cici OK and eating? Need to slim down to 50g."
The woman who loves this stray cat very much came today to buy a bag of feline W/D. She had wanted to cancel her one-week monastery camp as the cat was suffering from dysuria. I advised her not to worry as this was important for her belief.
"How's is your Buddhism camp?" I asked. "It is good that you did not miss it. Otherwise you need to wait for another year."
"Actually, it will be 4 years for the next camp," she said. So, it was great that I had advised her not to miss it as the cat was treated and had medication.
"My cat is fine now," she declared. "After eating the feline C/D, I come to buy the W/D as her blood glucose level was high when she had urinary tract problems.
Feline W/D is said to help manage glucose and weight and improves digestion. This is done by:
1. It also promotes urinary tract health,
2. helps to metabolise fat and maintain lean muscle,
3. supports a healthy immune system
4. Helps maintain a healthy weight.
This stray cat eats any dry food and so there was no problem in switching food. This appears to be no ordinary cat as the lady narrated the following:
1. The cat would send departing visitors to the lift area.
2. The cat had walked 3 circles with the Buddhist friend who was practising the belief and chanting.
3. The cat had listened to a friend who told him to jump onto the shoe box and leapt into the open window.
This cat would appear to be a re-incarnation of a person as he is so clever, as if being able to understand human communication. It is hard to believe as I have not seen his actions but there is no reason for the lady to lie.
----------------------
Hamster full of warts. From St Georges' Road.
Aug 30, 2015
69g. Obese.
bilateral hair loss at the back area
1. Ear warts. right ear. Multiple.
2. Wart. right elbow. One at 3 mm across.
3. Flank wart. 5 mm across.
4. Left hind paw. Below paw. 8 mm across.
5. Left inguinal area. 5 mm across.
6. Left belly area 5 mm across.
I used electro-surgery to cut off all the warts. The hamster went home.
Follow up on Sat Sep 5, 2015 today.
No answer from mobile. I sms " Is Cici OK and eating? Need to slim down to 50g."
2985. Follow up: The hamster keeps shrinking in size and has a scent gland abscess.
Sep 5, 2015
I followed up the case seen on Aug 30, 2015. The lady from Ponggol kept several dwarf hamsters, each in a separate housing.
She said that her mother had given baytril antibiotic for the past 6 days but the hamster keeps losing weight. So, she consulted me.
If only dwarf hamsters can talk. The weight was now 46 g. (Video).
Compared toa white dwarf hamster with excellent appetite like the one with 6 areas of skin warts (Video) weighs 69 g. This hamster can be considered chubby.
The hamster was very active and scacthes her left ear occasionally. A hyperactive dwarf hamster. So I needed to give her a bit of the isoflurane gas to immobilise her to do a proper examination of the skin. I noticed that the scent gland at the belly area was full of brownish yellow secretion.
Surprisingly, after clearing the scent gland, there was a big yellow abscess around 8 mm across under the skin, in front of the gland. Lots of thick yellow pus. I drained it. Then, I checked the front teeth. The lower front teeth were longer than normal and I clipped it.
Today, Saturday 11. 30 am, I phoned the lady. She did not answer her mobile. I phoned the house. A man answered and happily announced that the hamster was eating more but would take time to recover her weight. He thanked me for calling.
Scent gland abscess is not common and if the vet does not clear the scent gland, he would have missed this abscess as it was hidden by the scent gland waxy excretions.
There is never a dull moment with dwarf hamsters' medical and surgical conditions.
I followed up the case seen on Aug 30, 2015. The lady from Ponggol kept several dwarf hamsters, each in a separate housing.
She said that her mother had given baytril antibiotic for the past 6 days but the hamster keeps losing weight. So, she consulted me.
If only dwarf hamsters can talk. The weight was now 46 g. (Video).
Compared toa white dwarf hamster with excellent appetite like the one with 6 areas of skin warts (Video) weighs 69 g. This hamster can be considered chubby.
The hamster was very active and scacthes her left ear occasionally. A hyperactive dwarf hamster. So I needed to give her a bit of the isoflurane gas to immobilise her to do a proper examination of the skin. I noticed that the scent gland at the belly area was full of brownish yellow secretion.
Surprisingly, after clearing the scent gland, there was a big yellow abscess around 8 mm across under the skin, in front of the gland. Lots of thick yellow pus. I drained it. Then, I checked the front teeth. The lower front teeth were longer than normal and I clipped it.
Today, Saturday 11. 30 am, I phoned the lady. She did not answer her mobile. I phoned the house. A man answered and happily announced that the hamster was eating more but would take time to recover her weight. He thanked me for calling.
Scent gland abscess is not common and if the vet does not clear the scent gland, he would have missed this abscess as it was hidden by the scent gland waxy excretions.
There is never a dull moment with dwarf hamsters' medical and surgical conditions.
Friday, September 4, 2015
2984. A lady who cares for terrapins
Thursday Sep 3, 2015
Many of the younger generation of Singaporeans cared very much for their terrapins. Yesterday, a young man brought in a terrapin with two ear abscesses and today, a lady in red dress came in with one of her 2 terrapins with a right ear abscess. (Video). One sibling was bigger than the other. The bigger one eats around 30 pellets a day while the smaller one eats 15.
"Usually he will eat around 15 pellets but the last two days, he hides under water and is not eating much," the lady noticed a right ear swelling and surfed the internet. "The other sibling terrapin is 25% bigger in size as he eats around 30 pellets a day. Both are fed 3-4 times a day. They eat only freshly sprinkled green pellets and no red pellets."
"Feeding the commercial pellets 4 times a day is not commonly practised by Singaporeans," I said. The terrapins were also given direct sunlight. The shells are green, hard and of good colour compared to another terrapin with ear abscess.
"He used to have white spots on his shell, but now no more," the lady in red dress said. "I change water twice a day.".
With such good feeding, this lady's terrapin had grown to the expected size of 4 months. The length of the upper shell from neck to the back of the shell measured around 15 cm at 4 months of age. A poorly fed one as shown in the video measured around 7 cm.
What is the cause of this right ear abscess in the lady's terrapins. The possible causes are:
1. Dirty water inside the small tank with two bigger terrapins. Urine, faeces, left-over food inside the water for the past 3 months. The lady had just purchased a bigger tank with filters and she showed me the image in her smart phone. Appropriate filters must be used.
2. Insufficient Vitamin A inside the formulated pellets? There were red pellets which the two terrapins disliked. Were they the ones with more Vitamin A? Feeding dark green vegetables and carrots will supply Vit A but the terrapins had never liked vegetables.
3. A variety of food. Healthy live feeder fish, shrimps, fish and prawn food.
4. UVB light bulb for the young terrapins if no time to give access to direct sunlight. UVA light is for warming. UVB light is to help the terrapin to absorb calcium from the food to form strong shells.
5. I advised feeding separately from the aquarium tanks and feeding twice a day. This may not be practical as the new tanks have filters and the lady is very busy in her property job. Despite changing water twice a day, the smaller terrapin still get ear abscess. This was surprising.
Many of the younger generation of Singaporeans cared very much for their terrapins. Yesterday, a young man brought in a terrapin with two ear abscesses and today, a lady in red dress came in with one of her 2 terrapins with a right ear abscess. (Video). One sibling was bigger than the other. The bigger one eats around 30 pellets a day while the smaller one eats 15.
"Usually he will eat around 15 pellets but the last two days, he hides under water and is not eating much," the lady noticed a right ear swelling and surfed the internet. "The other sibling terrapin is 25% bigger in size as he eats around 30 pellets a day. Both are fed 3-4 times a day. They eat only freshly sprinkled green pellets and no red pellets."
"Feeding the commercial pellets 4 times a day is not commonly practised by Singaporeans," I said. The terrapins were also given direct sunlight. The shells are green, hard and of good colour compared to another terrapin with ear abscess.
"He used to have white spots on his shell, but now no more," the lady in red dress said. "I change water twice a day.".
With such good feeding, this lady's terrapin had grown to the expected size of 4 months. The length of the upper shell from neck to the back of the shell measured around 15 cm at 4 months of age. A poorly fed one as shown in the video measured around 7 cm.
What is the cause of this right ear abscess in the lady's terrapins. The possible causes are:
1. Dirty water inside the small tank with two bigger terrapins. Urine, faeces, left-over food inside the water for the past 3 months. The lady had just purchased a bigger tank with filters and she showed me the image in her smart phone. Appropriate filters must be used.
2. Insufficient Vitamin A inside the formulated pellets? There were red pellets which the two terrapins disliked. Were they the ones with more Vitamin A? Feeding dark green vegetables and carrots will supply Vit A but the terrapins had never liked vegetables.
3. A variety of food. Healthy live feeder fish, shrimps, fish and prawn food.
4. UVB light bulb for the young terrapins if no time to give access to direct sunlight. UVA light is for warming. UVB light is to help the terrapin to absorb calcium from the food to form strong shells.
5. I advised feeding separately from the aquarium tanks and feeding twice a day. This may not be practical as the new tanks have filters and the lady is very busy in her property job. Despite changing water twice a day, the smaller terrapin still get ear abscess. This was surprising.
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