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Toa Payoh
Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures |
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 toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129 |
LUXATED LENS AND INTERESTING CASES IN
JAN 3, 2011
Jan 3, 2011
My car's dashboard showed "check coolant level" again
after repair last month. The mechanic had replaced the
pump and had said the radiator was OK. It was a poor
diagnosis as now the problem re-surfaced. I had to send
the car down again. It was a radiator leak.
On the way, I visited my mentor, a senior vet to wish
him a Happy New Year. "Where's XXX?" he asked about the
4th year vet student who was supposed to do internship.
"He's got to re-sit his exam and has to study." I said.
I asked about his son who had started an ice-cream
production using artificial sweetener. He was already
producing the ice-cream. The nurse brought in two cones
in the vet's office where a fish tank of ordinary small
golden fishes were kept (to give life to the office, the
father said). "How's the ice-cream?" the son asked me
later. "Too sweet," I said. "That's strange. The others
said it was not sweet." I said: "Not as sweet as The
Magnum ice-cream but I prefer less sweet so as not to
over-work my pancreas and get diabetes at my age." He
asked: "Take a tub back to the vet office." I declined
as I did not have a big fridge there. I advised him to
accept investors and not worry about "dilution of the
brand." I said: "Cash flow is important. If investors
provide the cash flow, you can invest in better
equipment and retail stores." At the moment, he is
selling it online.
INTERESTING CASES
Case 1. The 12-year-old Silkie with two firm and enlarge
testicles.
"You removed his kidney stones 5 years ago," the young
couple said. "It cost us $600." I looked at the 2007
records and yes I did the surgery for $300. "Any
difficulty in peeing?" I asked. "No more. Sometimes we
see blood in the urine."
4 weeks ago, Vet 1 had treated the dog for fever. 2
weeks ago, Vet 1 gave some medication for the testicular
problem but the size of the two testicles did not
reduce. They were 3x the normal size. "Did Ve1 1 propose
surgery?" I asked. The couple went to Vet 1 as it was
nearer to their place but had wanted me to operate in
2007 as I was cheaper. "I think so," the young man said.
I scheduled the dog for surgery the next day. "No other
way to cure" I said. "Likely to be testicular tumours or
cancer. You need to pay for histopathology lab to check
out."
"What if I don't want the lab test?" the young man
asked. "It is a personal decision," I said. "What
advantages in having a lab test?" he asked. "If the
growth is not cancerous, the dog will live to its normal
life." I said. "If cancerous, medication may be needed."
"There are only 3 types of testicular cancer in the
dog," the young man said.
"No, there are more but 3 main types," I said. "Only a
histopathology will tell. In your dog, he is very old.
You may not see him alive again if his heart fails
during anaesthesia," I warned the couple. "I will try to
shorten the surgery. I still need to cut off the whole
black scrotum instead of just taking out the testicles.
It will take some time to stitch."
The young man asked: "Why?"
I said: "Just in case there is cancer and the scrotum,
if not removed, still harbours the cancerous cells."
I hope all will be well during the anaesthesia.
Blood and urine tests are done. "It costs $600 like last
time," the young man said. "You are fortunate that your
dog costs you so little over the last 12 years as he
needed only a bladder stone surgery," I replied. "For
some owners, they spend thousands of dollars for
treatment of their sick dog. The $600 include
histopathology, blood and urine tests which should be
done." I did not include consultation fees for this
couple. It was a joy to see the dog again. I do
recognise him now as he has that golden hair in his
head.
I was thinking sadly of the 12-year old Schnauzer Cross
admitted yesterday Sunday due to fits and recumbency. He
died at 4 a.m today. His owner had spent some money
trying to prolong his life and would be getting TCM
(Traditional Chinese Medicine) from Vet 1 today, Monday.
He had chronic kidney failure and was gasping and
recumbent and had fits and was hospitalised. He vomited
food and died around 4 am. "How do you know it was 4
am?" the owner asked when he came at 11 am to make
cremation arrangements. "My staff was on duty," I said.
Case 2. As regards a dog in recumbency (unable to
sit or stand up), an older man and a gentleman friend
brought in his Mini-Bull Terrier with pus in the eyes
and flat out. His dog was OK and was boarded at a
friend's place. Such old dogs are seldom vaccinated.
"Very high fever" I said. "Was he boarded in a dog
kennel?" I asked. "No," he said. "A laundry." I took the
blood test, gave the dog IV drip, anti-fever and
anti-antibiotics. The fever went down and the dog sat up
and looked around at around 6 p.m. I was glad he was OK
for the time being. As to the cause of his very high
fever, it is hard to tell.
Case 3. The 15-year-old Beagle with a painful mouth.
A couple in their late 50s asked: "Is it possible just
to give antibiotics every time the dog has painful mouth
instead of anaesthesia and extraction? We don't want the
dog to die on the operating table!"
"Antibiotics will not work over time," I replied. "They
will not be effective. The bacteria will spread all over
the dog's body. As he gets much older, his immune system
will not cope. He will die of toxaemia and bacterial
infections." Sounds dramatic? The husband showed me his
iPhone picture of the dog's teeth. They were clear
pictures and showed tartar and red ulcers at the gum
level. He lifted the dog's side and showed me the real
gum and teeth.
"You are aware of the high risk of anaesthesia in dogs
over 8 years of age," I advised. "This dog is 16 years
old." I checked the heart. He did not have serious heart
murmurs. "There is one swelling below his right eye and
a smaller one in his left," the husband pointed the
lumps to me. "Yes," I said. "They will be the starting
of the carnaissal tooth abscess. The bacteria from the
root of the teeth had punctured the facial bone and
abscess will pop out below the face some time later. It
is also called an oro-nasal fistula." I took out the
Hills' Anatomy book and showed the picture of the
carnaissal tooth abscess.
Anaesthesia and dental work would be done tomorrow. It
would be very high risk and the owners had expected a
good outcome.
Case 4. Pyometra? A very thin Shih Tzu female
around 1 year old had been vomiting for the past 6 days.
"What's the cause?" the owner asked. There were no
diarrhoea or abdominal pain or swelling or fever. The
owner did not want blood test. This was difficult. The
only finding was that the vulval area was inflamed and
wet. "When was the dog on heat?" I asked. "Some 4 weeks
ago." he said. So, the probable diagnosis was open
pyometra. I put the dog on IV drip and antibiotics and
kept her for 2 days. Owners don't like longer
hospitalisation.
Case 5. Luxated lens. The father did hit the dog
on the head 2 weeks ago. The dog had been rubbing his
left eyelid area and it was red. "Is it glaucoma?" the
owner asked me yesterday and pointed to a black spot in
the upper eyelid. I examined the dog properly under
general anaesthesia (domitor and isoflurane). There was
a slight increase in intro-ocular pressure in the left
eye. The main problem was that the lens had luxated into
the anterior chamber, causing pain and eye rubbing.
Surgery was advised. Much depends on the owner.
Case 6. 12-year-old dog with teeth extracted.
The young man and his father brought the old dog for
dental extraction (periodontitis Grade 4 - the worst of
the disease) and was boarded yesterday. They bargained
hard. "$400 is the lowest rate for everything including
hospitalisation, IV drips and antibiotics, anaesthesia
and surgery," I said. The dog survived the anaesthesia.
The 10 rotten teeth were kept but my man did not show
him at first. He phoned me as I was off work. "I pay
$400 just for some dental work and one day stay," he
said over the phone in an "taken for the ride" tone of
voice. This is the type of calculating client I dislike
a lot. This is not the way to conduct business.
I said: "The fees have been agreed. I cap it at $400 for
you so that you know the costs. It should be much more.
I charge $20/tooth extracted." I asked my assistant to
get the teeth out to show him. It is best to attach all
evidence next time. Later he text messaged me to
apologise. I text back "Thanks." All vets get all types
of personalities a day and some of them can be abusive
to staff.
As you can see, there is a variety of conditions
encountered today, even in one species, the canine. No
cats or hamsters came today. |
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 BE KIND TO OLDER DOGS & CATS --- GET TUMOURS
REMOVED EARLY --- WHEN THEY ARE SMALLER.
More case studies, goto:
Cats or
Dogs |
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To
make an appointment: e-mail
judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326 |
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129 |
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 Toa
Payoh Vets
Clinical Research
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Copyright ©
Asiahomes Internet
All rights reserved. Revised: January 04, 2011
Toa Payoh Vets |
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