Bright sunshine. Dr Daniel Sing started his first Sunday
of working life after graduation. As a mentor of my
associate vets, I was present in this case as in other
cases of associate vets. Trust and audit are my
management style to ensure a high standard of veterinary
care at Toa Payoh Vets and that is why I do intrude into
the consultation of my associate vets now and then and
review their case sheets. There is no short cuts to be
successful in work and life. "Associate vets in Toa
Payoh Vets must adopt a consistency in the treatment of
similar processes and system to ensure good clinical
outcomes," I said to Dr Daniel Sing and Dr Vanessa Lin.
Without a system or standard operating procedure, each
vet does his own treatment and may miss out on certain
steps. For example, in urolithiasis, a failure to send
urine for analysis or stone for analysis unless the
client objects to this steps due to economic reasons.
So, this is why I am around in some consultations of
associate vets.
On this fine Sunday, Dr Daniel had a rabbit which had
tearing eyes. A large bald area below the weepy eye. He
touched the lower part of this hairless area. I did so
too. The rabbit reacted by moving away its face. Abscess
or tooth pain?
I got a fluorescein strip from the box and Dr Daniel
stained the cornea. Show, not tell is the best in
veterinary practice. The rabbit had an eye corneal ulcer
as evident by the green 11 o'clock to 2 o'clock stain.
So there is an ulcer? What next? New vets tend to relate
a list of differential diagnosis to the client, as this
is what the vet professors teach them.
To me, this is OK
but some clients just have little time and just want to
know what's wrong and the solution. Since this rabbit
had an "on-off" eye tearing in the past few weeks and
felt pain at the lower maxillary cheek area, Dr Daniel
diagnosed teeth problem.
I advised warding the rabbit for one or two days. On the
next day, to get the rabbit anaesthesized to check the
mouth.
Monday, Jan 6, 2012
Dr Daniel used isoflurane gas mask to anaesthesize the
rabbit. Min helped. I was around to pull out the tongue.
Inside the left cheek, food and two long curved teeth of
around 1.5 cm long were stuck and causing pain. Dr
Daniel used the forceps to pull out the two teeth and
two broken fragments. I took some images. I quickly
irrigate below the 3rd eyelid with 5 ml of clean water
as Dr Daniel everted the 3rd eyelid, just in case debris
had gone inside it.
The rabbit should feel better now. Will observe on
Tuesday and update. Rabbit should be able to go home.
"This rabbit eats only pellets", said the gentleman
owner. "No hay." He had gone home to bring the rabbit
pellets.
Show not tell is the best advice for a vet in private
practice. In this case, it was not possible to show the
anaesthesia but there were two bone fragments and images
to show the owner to give him evidence of what happened
and what was done to ensure a good clinical outcome. I
don't expect any tearing. On the surface, this appears
to be a case of eye corneal injury as there is green
fluorescein staining. Veterinary medicine can be
challenging. Rabbits can't talk and owners can't tell
what's wrong. Therefore, it is up to the vet to palpate
(pain in the teeth area) thoroughly and in this case,
the primary diagnosis would be ingrowing cheek teeth
causing facial pain and irritation and eye rubbing to
relieve the pain. A hypothesis. If the rabbit has
recovered within 2 weeks, then my hypothesis is correct.
No need to spend money X-raying as visual inspection
under anaesthesia using gas mask and isoflurane and
oxygen is the method of choice and cheaper. "SC
anaesthetic drug injection can be used but not necessary
as the gas method is safer and the rabbit wakes up
fast," I said.
The cause of tearing of the eye would be due to the
rabbit rubbing its facial area to relieve tooth pain of
the right teeth cutting into its right cheek, not
corneal injury. "This rabbit has to be separated from
the other rabbit for some time," I advised the owner.
"This is to prevent the other rabbit from grooming or
licking its eye." The owner said: "It is difficult to do
so." Well, vets should advise but it is up to the owner
to accept it.
TOA
PAYOH VETS
