18th Dec 2011

Case 1:

Procedures were recorded accordingly and some photographs are included.

Cat early pregnancy spay (3kg)

Start time: 9.45am

Start of surgery

9.59am

Cut the skin

10.02am

Left ovary hook out

10.07am

Scapel blade was used to cut off left ovary

10.08am

Front paws were untied and body lifted up, cat started meowing

10.09am

Right ovary cut out

10.10am

Scapel blade was used to cut off Right ovary

10.13am

Extend incision bleeding

10.16am

Slow breathing observed

10.17am

Ligate individual uterine twine

10.18am

Check breathing again

Extend incision around 5mm

Clamp Uterine body

Check bleeding

10.20am

Bleeding controlled

Suspect torn uterine blood vessel

10.23am

Transfixing ligature uterine body to control bleeding

10.27am

(Cat on heat)

Bleeding again from ovarian fat

10.28am

Swab blood

Cut off uterine body

10.30am

Simple interrupted suture

Bleeding stop

Linear alba 3 stitches 3cm

10.32am

Check linear alba for hole

Stitch skin using horizontal mattress 2 stitches

Skin incision estimated to be around 3cm

10.33am

End of suture

Excised organ



Surgical time: First skin incision –> last stitch = 9:59- 10:33= 32mins

Operation time: Sedation-> Last stitch = 9:45- 10:33= 47mins

Suture used: 3/0

Amount used: 1 packet

Sedation dose: Isoflurorane gas 2%

Case 2:

Shetland was brought into the clinic wrapped up with towel. Vet was presented with a shetland that have shedding skin just like humans with dandruffs. When asked about history of the pet, found that the skin problem was present since 4-5 years ago. The problem arises and disappears occassionally. Vet then noticed its swollen vulva and next ask about its menstrual cycle. Shetland had its menses few months ago (September 2011) but vulva is still swollen, which is unusual.

Although the owners brought the dog in to treat its skin problem, vet was suggesting that the primary cause might be due to hormonal imbalance, specifically a disorder known as hyperestrogenism. Hyperestrogenism is the overproduction of Estrogen, which is a type of hormone present in female dogs responsible for normal sexual behavior and development.
Advice was to sterilize the dog to get rid of the hormonal issues, which may indirectly lead to the recovery of it's skin problem.

Pink patchy skin

White flaky skin shedding

Swollen vulva

Admin stuffs completed:
- Bank statements for September and October 2011
-All vet's consult balance spreadsheet

Working hours:
10am- 5.15pm

27th November 2011

There isn't a case which i followed through today, therefore there are no case studies to write about. However to note, i have partial observations on some cases; dog with haematoma on it's paws (Picture below) and also another case where the dog have some skin problem (Picture is not available).



Dog with haematoma 


Admin stuffs:
- Income card bank statement printed
- Bank statement printed
- updated database

Working hours:
9.45am-5pm

20th November 2011

Case 1

3 year old male Cocker spaniel showed pinkish inflammed paws and underside of the body. Owner mentioned that the dog visited another vet and was given some medications. The problem was resolved for a few months but it recurred again. Firstly, the vet looked at its ears and suspect that the problem may arise from it. Therefore the vet proceeds to do a few procedures to check. When vet put a cotton bud into the left ear to check by turning clockwise and anti-clockwise, the dog displayed a scratching reflex (legs shaking). The same was done to the right ear and the dog felt pain.

Vet listed three possible causes of the inflammation:

1)      Deep ear infection: Primary cure is to undergo a surgery to remove the vertical canal so as to allow aeration.

2)      Allergy: Dog maybe allergic to current food so vet suggested a change of diet to low allergen food 

3)      Skin mites: Mites maybe the factor causing the dog to itch and scratch. Best way to improve its skin condition is to shave off all the fur. An anti-mite injection was also given

Dog was also prescribed with anti-fungal medication, meanwhile owner wanted to consider about the operation and get back to the vet later.

Case 2

Pug was presented with eye problem, fluorescein strip was used to test and found that there is roughness over the cornea of both eyes. There are presence of hair in the eye socket too. Prognosis is generalized keratitis, which is the inflammation of the cornea.  Antibiotic eye drop is prescribed.

Working hours:

10-5.30pm

Admin stuffs done:

-          Keyed in client details into database

-          Keyed in bankstatements for September 2011 and December 2010 and printed and filed. File can be found on “desktop/TPV expenses/bankstatement 2011/20111001_kim_2011 TPV bankstatement

30th October 2011

Updates of case from 23th Oct ‘11

Dog was sent home and follow-up check-ups were provided. Dog seems like it is recovering from the anaemic conditions, however tick problems still persist.

Results from the blood tests from the first few days after treatment were shown below.



Pinkish gums observed means recovering from anaemic conditions



Blood test results before treatment (20^th Oct ‘11):

Liver profile= Normal

Kidney profile= Normal

Hematology=

*Hemoglobin- 7g/dL  [Normal range: 12-18]

*Red Blood Cells- 2.8 x10^12/L [Normal range: 5.5-8.5]

Total White Blood Cells- 13.2 x10^9/L [Normal range: 6-17]

Differential Count:

Neutrophils: 59.62%

Lymphocytes: 26.36%

Monocytes: 13.18%

Eosinophils: 0.08%

Basophils: 0.83%

Packed Cell Volume= 0.19 [Normal range: 0.37-0.55]

Platelets= 52 [Normal range: 200-500]

Nucleated Red Blood Cells seen [Severe demand for RBC to be release from Bone Marrow]

No platelet clump seen



H&E staining of the blood smear and observed parasites

Blood test results after 1 day of treatment (21^th Oct ‘11):

Liver profile= Enzymes increased

Kidney profile= Normal

Hematology=

*Hemoglobin- 7g/dL [Normal range: 12-18]

*Red Blood Cells- 2.9 x10^12/L [Normal range: 5.5-8.5]

White Blood Cells- 9.6 x10^9/L [Normal range: 6-17]

Differential Count:

Neutrophils: 67.40%

Lymphocytes: 15.73%

Monocytes: 14.79%

Eosinophils: 0.62%

Basophils: 1.67%

Packed Cell Volume= 0.2 [Normal range: 0.37-0.55]

Platelets= 64 [Normal range: 200-500]

No platelet clump seen but few giant platelets present

Blood test results after 4 days of treatment (24^th Oct ‘11):

Hematology=

*Hemoglobin- 5.2g/dL [Normal range: 12-18]

*Red Blood Cells- 1.9 x10^12/L [Normal range: 5.5-8.5]

White Blood Cells- 13.8 x10^9/L [Normal range: 6-17]

Differential Count:

Neutrophils: 69.49%

Lymphocytes: 14.64%

Monocytes: 12.68%

Eosinophils: 0.29%

Basophils: 2.97%

Packed Cell Volume= 0.15 [Normal range: 0.37-0.55]

Platelets= 50 [Normal range: 200-500]

Blood test results after 5 days of treatment (25^th Oct ‘11):

Hematology=

*Hemoglobin- 4.7g/dL [Normal range: 12-18]

*Red Blood Cells- 1.8 x10^12/L [Normal range: 5.5-8.5]

White Blood Cells- 12.3 x10^9/L [Normal range: 6-17]

Differential Count:

Neutrophils: 50.49%

Lymphocytes: 47.80%

Monocytes: 1.71%

Eosinophils: 0%

Basophils: 0.08%

Packed Cell Volume= 0.13 [Normal range: 0.37-0.55]

Platelets= 50 [Normal range: 200-500]

No platelet clump seen but few giant platelets present

The tests had been confirmed by repeat analysis

Blood test results from IDEXX after 5 days of treatment (25^th Oct ‘11):

Hematology=

*Hemoglobin- 5.7g/dL [Normal range: 12-18]

White Blood Cells- 6.6 x10^9/L [Normal range: 6-16.90]

Differential Count:

Neutrophils: 1.57 x10^9/L [Normal range: 2.80- 10.50]

Eosinophils: 2.33 x10^9/L [Normal range: 0.50- 1.50]

Packed Cell Volume= 19.2% [Normal range: 37-55%]

Platelets= 259K/ul [Normal range: 175-500]

Note:

Neutrophils are usually increased in acute bacterial infection

Lymphocytes are usually increased in viral disease

Monocytes are usually increased in some bacterial infections and monocytic leukaemias

Eosinophils are usually increased in allergic conditions and when intestinal parasites are present

Basophils are usually increased in association with hypersensitivity and allergic responses

Working hours:
10am- 5.00pm

Admin stuffs completed:
- Updated Client's database

- Created a soft copy of Toa Payoh Vets Surgery Record form

23 October 2011

Case for the week:

1.      Process of Tick Fever

2.      History

3.      Examination

4.      Blood test and Blood smear

5.      Treatment

1)      Process:

Dogs get Ehrlichiosis (Tick fever) from the brown dog tick, which passes an Erlichia organism into the bloodstream when it bites. There are three stages of Ehrlichiosis, each varying in severity. The acute stage, occurring several weeks after infection and lasting for up to a month, can lead to fever and lowered peripheral blood cell counts due to bone marrow suppression. The second stage, called the subclinical phase, has no outward signs and can last for the remainder of the dog's life, during which the dog remains infected with the organism. Some dogs are able to successfully eliminate the disease during this time. In some dogs the third and most serious stage of infection, the chronic phase, will commence. Very low blood cell counts (pancytopenia), bleeding, bacterial infection, lameness, neurological and ophthalmic disorders, and kidney disease, can result. Chronic ehrlichiosis can be fatal.
[Reference: http://en.wikipedia.org/wiki/Ehrlichiosis_(canine)#Disease_overview]

Babesia canis are protozoal parasites that infect red cells and can produce hemolytic anemia. Transmission is primarily by the brown dog tick.

[Reference: http://en.wikipedia.org/wiki/Babesiosis]

2) History:

Dog have been exposed to ticks

3) Examination:

Presented with symptoms of lerthargic-ness and loss of appetite, signs of pale gums which signifies anemia



Pale gums signify anemia

4) Blood Smear:

Reveals pathogen such as Babesia Canis and potential Ehrlichia Canisa

Babesia Canis in blood smear
[Reference: http://ahdc.vet.cornell.edu/clinpath/modules/rbcmorph/b-canis.htm]

Ehrlichia Canisa in blood smear
[Reference: http://www.marvistavet.com/html/body_ehrlichia_infection_in_dogs.html]

Blood test results before treatment:

Liver profile= Normal

Kidney profile= Normal

Hematology=

*Hemoglobin- 7g/dL  [Normal range: 12-18]

*Red Blood Cells- 2.8 x10^12/L [Normal range: 5.5-8.5]

White Blood Cells- 13.2 x10^9/L [Normal range: 6-17]

Packed Cell Volume= 0.19 [Normal range: 0.37-0.55]

Platelets= 52 [Normal range: 200-500]

Nucleated Red Blood Cells seen [Severe demand for RBC to be release from Bone Marrow]

No platelet clump seen

Blood test results after 1 day of treatment:

Liver profile= Enzymes increased

Kidney profile= Normal

Hematology=

*Hemoglobin- 7g/dL [Normal range: 12-18]

*Red Blood Cells- 2.9 x10^12/L [Normal range: 5.5-8.5]

White Blood Cells- 9.6 x10^9/L [Normal range: 6-17]

Packed Cell Volume= 0.2 [Normal range: 0.37-0.55]

Platelets= 64 [Normal range: 200-500]

No platelet clump seen but few giant platelets present

What is the importance of platelets?
a) Numbers:
The analyzer counts the number of platelets in the blood, and the reported platelet count gives a general indication of the clotting ability of the blood. If the number of platelets falls below a certain critical level, spontaneous bleeding may occur. A low platelet count may indicate a problem with platelet production in the bone marrow, or may signal the presence of disease that is causing the platelets to be used up or destroyed.  An increased platelet count often reflects excitement, exertion, or an activated bone marrow. In rare cases, an extremely high platelet count may indicate there is underlying bone marrow cancer.
b) Size:
The size of a platelet is related to its age; young platelets are large and plump, and older platelets are generally smaller. This can be important if the platelet count is low; the presence of large, plump, young platelets in the blood indicates that the bone marrow is functioning well, and is responding to the need for more platelets.
c) Appearance:
 Very rarely, bizarre giant platelets, or abnormal immature platelets may be found, and these may signal the presence of an underlying bone marrow disorder or cancer

[Reference: http://www.fetchdog.com/learn-connect/dog-resource-library/health/diagnostic-tests/Complete-Blood-Count-for-Dogs/D/300600/P/1:5:55:601:6103/I/AR000010025]

5) Treatment:

Supportative therapy: IV-drip of Dextrose Saline

For anti-bacterial activity: Oral Vibravet 100mg twice a day for up to 21 days

For anti-protozoal activity: Imidocarb 0.5ml

Working hours:
9.45am- 5.30pm

Admin stuffs completed:
Updated Client's database and found several empty details in older records

16 October 2011

Case 1:

What should a vet do if a puppy that was recently purchased was brought in with complaints of blood in stools?

First few questions we should ask the owners are:

1. When is the onset of the blood in the stools?
2. When is the puppy vaccinated?
3. When did the breeder sell the puppy to the pet shop?
4. When did the pet shop sell off the puppy to the owner?

What the vet should consider:

1. Possible infections or reasons for the problem?
2. Type of tests to look into to find out, or rule out the possible reasons
3. Meanwhile, what should be done to the puppy

My mentor walked me through the case. Firstly, we need to find out the history of the puppy before it was purchased by owner and when the symptom was discovered.

1st Vaccination	13.09.11	Breeder in charge
2nd Vaccination	27.09.11	Pass on to Pet shop
3rd Vaccination	Due on 27.10.11	Owner’s responsibility
Date of purchase	09.10.11
Blood found in stools	15.09.11

Troubleshooting starts by stating the possible reasons for having blood in stools in puppies. Could it be a simple intestinal problem? Or bigger problem like parvovirus infection (Prone in puppies without complete dose of vaccination)? How did the vet think that it is parvovirus infection? According to the history, the puppy is moved from the breeder’s ground to the pet shop before the second vaccination shot was given. Puppy might pick up the virus during transport.

In order to rule out the possibility of being infected by parvovirus, a quick and simple canine parvovirus Antigen test kit was used by testing it with some blood samples. Result was revealed within minutes and showed negative for virus antigen.

So what can be the factor that causes the symptoms? Another blood sample was taken, this time it was sent for a more complete blood test. This test will focus on the cellular level, showing the activity of the immune cells.

Meanwhile, the puppy is required to be hospitalized. In order to re-hydrate the puppy, it was fed with oral electrolytes by syringe; twice a day. Furthermore, to prevent bacteria infection, it was given antibiotics and also multi-vitamins to boost its immune system.

Awaiting blood test results

Puppy under observation in the clinic



Medication provided

Short case of overgrowth frontal teeth of hamsters

A small procedure was done to alleviate the eating problem of the hamsters.



Front view of the teeth



Side view; more obvious cave-in of teeth towards the upper palette



Clippings of teeth after removal



Case 2:

An old dog (8-9 years old) was spotted with swollen paws with dry, scaly skin with the lack of hair coat. Ear edge was found to be crusty.

Possible problems:

1. Scabies mite infection
2. Fungus infection

Solutions:

1. Fur was plucked and analyzed on microscope slide for signs of mites
2. Inflammation injection was given to reduce symptoms on paws

Case 3:

On 11^th September, I met this client whom presented the dog to the vet with the complaint of fits. The pug was sent home with the idea that there is bacteria infection. Recently, the pug returned to the clinic with the same complaint.

History of the fit occurring as follows:

1^st fit occurred during hospitalization after urinary bladder stones removal

2^nd and 3^rd fit occurred at home

Another episode of fit (4^th) lasted 3-4mins on Thursday night (13.10.11)

Current 2 episodes appeared the day after on Friday night (14.10.11), which happens within an hour

Majority of the causes of fits are unknown, may be a metabolic cause, hereditary or induced by food. Need further analysis to rule out those possible reasons.

Admin work completed:

1)     Made electronic copies of bank statements for December 2010 for Toa Payoh Vets

Working hours:

9.45am- 5.30pm

02 October 2011

Case 1

Dog with a pair of eyes with a greenish blue tinge was brought in with a complaint of swollen right paw. Upon closer inspection of the right paw, the vet found that phalanx 3 of both digit 4 and 5 felt swollen. It was suspected that it is due to a sprain of the ligaments. Looking at the teeth, there are signs of periodontal disease which is of at stage 4.

How does periodontal disease develop? I have researched online and found a very informative passage (http://www.peteducation.com).
“Food particles and bacteria collect along the gumline forming plaque. If plaque is not removed, minerals in the saliva combine with the plaque and form tartar (or calculus) which adheres strongly to the teeth. Plaque starts to mineralize 3-5 days after it forms. The tartar is irritating to the gums and causes an inflammation called gingivitis. This can be seen as reddening of the gums adjacent to the teeth. It also causes bad breath.
If the calculus is not removed, it builds up under the gums. It separates the gums from the teeth to form "pockets" and encourages even more bacterial growth. At this point the damage is irreversible, and called "periodontal" disease. It can be very painful and can lead to loose teeth, abscesses, and bone loss or infection.”

	Grade	Plaque and Calculus	Gum Health	Radiologic Changes	Prognosis
Early Gingivitis	Grade I	Mild amount of plaque	Mild redness	No change	Reversible
Advanced Gingivitis	Grade II	Subgingival* plaque	Redness and edema	Little change	Reversible
Early Periodontitis	Grade III	Subgingival* calculus	Redness, edema, gums bleed with gentle probing, gum recession or hyperplasia	Subgingival calculus, 10-30% loss of bone support	Irreversible
Established Periodontitis	Grade IV	Larger amounts of subgingival calculus	Severe inflammation, gum recession, loose teeth and/or missing teeth, pus, gums bleed easily, deep pockets	Over 30% bone loss	Irreversible

Case 2

Looks like generalized ring worm throughout the body of a 7 years old dog, which started 3 weeks ago. Suspected auto-immune disease but was not able to take a closer look as client is only willing to be consult by his preferred vet.

Case 3

Shih tzu was suspected to have recurring scabies, this time round it occurred in the ears.



Scabies in ear

“Scabies is a skin disorder caused by infection with scabies mites (sarcoptes scabei). Those microscopic mites burrow in the dogs skin surface, storing their eggs in a trail behind them. The tunnels are visible as thin, scaly lines at the dogs’ skin. The itchy scalp and skin rashes of scabies occur because an allergy to the scabies mite. Scabies is one of the most itching skin disorders in dogs.”

[Reference: http://www.doggiesparadise.com/itching.shtml]

There are obvious ring worm infection on the hind legs and left cornea central ulceration too.



Cornea ulceration as recognized as a whitish patch in the centre of the cornea

Admin work completed:

1)     Made electronic copies of bank statements for months from January-September 2011 for Toa Payoh Vets

2)     Made electronic copies of both vet’s consultation and salary from January-September 2011

3)     Updated the client’s database

4)     Helped vet nurse with the tabulation of vet’s consultation for the month of September

Working hours:

9.45am- 5.30pm