Tuesday, June 14, 2016
58. Edited Video: Bear Ranulas
Around 5 months ago, in the jungles of Myanmar, the mother bear with two cubs rushed towards an approaching commercial poacher. He shot and killed her. Her two bear cubs dashed into the jungle and were rescued by the villagers. The villagers sent them to be safe and cared for at the monastery known as Thabawar Centre in Thanlyin, Myanmar.
But one of the two cubs had soft swellings of around 2 cm x 2 cm below the back of the tongue. The swellings were soft and filled with fluid. They began to grow bigger and bigger over the next 4 months. The cub had difficulty eating and swallowing solid food. He could drink only liquid - mainly milk with bananas only.
The swellings would get infected, the bear would die from malnutrition and loss of appetite if his tongue growths continued to expand to bigger than the size of oranges.
This bear cub's tongue growths were two ranulas. Ranula is a Latin word for "frog". The cystic swellings due to the obstruction of the sublingual salivary duct are soft and fluctuant resembling the underbelly of the frog.
A veterinary surgeon would be needed to help this bear before it is too late.
Is there a vet in Myanmar who has the skills and surgical expertise to operate on this bear? The zoo vet did not have experience in bear anaesthesia and surgery and so the bear carers looked for local vets. Where to find a competent Myanmar veterinary surgeon out of the 70 million people living in Myanmar?
(Narrate) This is a Be Kind To Pets Veterinary Educational Video
and Veterinary Case Files From Myanmar video sponsored by Toa Payoh Vets.
SUBLINGUAL MUCOCOELES (RANULAS) IN AN ASIATIC BLACK BEAR
Who in Myanmar can operate on the Asiatic Black Bear with two ranulas?
The monastery people contacted Dr Thein Tun Aung of Royal Asia Veterinary Surgery in Yangon.
Dr Aung is a skilled and experienced veterinary surgeon, having worked for over 10 years in Singapore's veterinary surgeries and now has a thriving Royal Asia Veterinary Surgery in Yangon started in 2012.
His caseload is heavy every day and the workalcoholic had performed various operations, mainly in dogs and cats. Bone fracture repairs, perineal urethrostomy for male cats not able to pee, Caesarean sections, spays and neuters, hernias and a diverse range of surgeries.
He had also operated on ranulas in dogs. But he has no bear veterinary anaesthetic experience. The operation in this bear cub on a 5-month-old male Asiatic Black Bear who had two gigantic soft tongue swellings below the tongue would not be a problem.
IMAGE OF RANULAS IN THE BEAR CUB
SUNDAY JUN 5, 2016 SURGERY - MARSUPIALIZATION
However, a vet qualified in zoo medicine and a vet nurse experienced in bear anaesthesia had volunteered to do the surgery and anesthesia earlier.They were the better choices and would operate on Sunday June 5, 2016.
I had already paid my airfares to arrive in Yangon on Friday, Jun 3, 2016 to assist Dr Thein Tun Aung on the invitation of Dr Thin Thin Soe.
I was redundant. So went sight-seeing in Myitkyina from June 3 to June 5 and go back to Singapore on June 6. The bear cub was in excellent hands and the 2-hour operation would be done on Sunday Jun 5, 2016.
There are 2 surgical treatments for ranulas
1. Excision of the sublingual salivary gland which is a more complicated operation.
Marsupialization in this bear involves the cutting away of a large piece of the swollen tongue tissue, creating a pocket (pouch, fistula) by suturing the edges of the gap of around 2.5 cm wide so that saliva will flow out freely.
ILLUSTRATION OF MARSUPIALIZATION BY INTERN
MON JUN 6, 2016
I visited the the bear on Jun 6, 2016 at 9 am at the Royal Asia Veterinary Surgery. He was energetic. and much of his tongue growths had been cut away. Around 80% of the sublingual mcocoele was cut off. There was still a swelling on one side.
VIDEO OF BEAR AT 9 AM .
MONDAY JUN 6, 2016
Around 3 pm, the bear vet and nurse came. I introduced myself to Dr Heather Jane Bacon, the bear vet and Ms Caroline Nelson, the bear anaesthetist. Dr Bacon wanted to operate on the remainder of the swelling on the left side. She did not remove 100% of the ranulas as they were extremely large.
"No point gong back to your downtown hotel to get the surgical and monitoring equipment as there will be massive traffic jams," I said. Dr Aung had the drugs and equipment they needed.
IMAGE OF TRAFFIC JAM IN DOWNTOWN YANGON
I videoed most of the anaesthesia and operation before I had to go to the airport to catch my Silk Air flight to Singapore. Dr Bacon shared her surgical experiences.
She injected the sedation in the backside muscle while Ms Nelson distracted the bear cub. The bear cub yelped when injected as you can see in the video. He was sedated in less than 60 seconds. Dr Bacon scruffed his neck and brought him to the operating table. Dr Aung assisted in anaesthesia while Ms Nelson monitored the vital signs.
IMAGES OF SURGERY.
POST-OP CARE BY DR AUNG FOR 6 DAYS
There is no Myanmar vet who is experienced in bear anaesthesia and surgery. However, I can say that Dr Thein Tun Aung has the necessary equipment, facilities for hospitalisation, skills and experience in veterinary anaesthesia and surgery to operate on the bear's ranulas if no bear vets are available.
His credentials are:
1987. Graduated from University of Veterinary Science, Yezin. Worked in Kachin State as a vet.
1992 - 2012. Veterinary Assistant for 4 busy veterinary surgeries in Singapore.
2012. Started his own practice, Royal Asia Veterinary Surgery, Yangon, Myanmar. The practice is very busy every day.
Dr Aung shares his experiences with local vets at lectures and in seminars despite his hectic caseload. In 2014, he devoted a day to demonstrate surgery to final year students at Yezin University of Veterinary Science.
Needless to say, the better choice is to get a bear vet and nurse in the best interest of the bear. I was glad that the bear cub can now eat solid food (dry dog food and others). He was malnourished as he had been drinking milk with bananas.
A big thank you to the following who helped to make this bear operation possible:
1. Maiken Fransisca
Co-founder and CEO
Giving A Future Animal Aid
2. Dr Heather Jane Bacon, BSc (Hons), BVSc. CertZooMed, MRCVS
Scottish Advanced Practitioner in Zoological Medicine
3. Ms Caronline Nelson, RVN, BSc
Vietnam Bear Rescue Centre
4. Dr Thein Tun Aung, BVS (Yezin)
5. Dr Thin Thin Soe, BVS (Yezin)
6. Dr Khyne U Mar, BVS, MPhil, MSc (Wild Animal Health), PhD, FRCVS
7. Staff and bear caregiver at Thabarwa Center
A BE KIND TO PETS
VETERINARY EDUCATIONAL VIDEO
& VETERINARY FILES FROM MYANMAR VIDEO
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS