Friday, August 27, 2010

diabetes mellitus and diabetes insipidus in a cat?

CASE FOR THE 4TH YEAR VETERINARY  VETERINARY STUDENT

The fat cat of over 8 years of age, male, neutered showed brown-yellowish urine stains and hair loss in the genital area some 2 years ago and had recovered. At that time, I suspected that he had to go in and out of the litter pan which was lined with newspapers. The newspapers flowed out of the sides of the pan. After making sure that the papers were placed inside the litter pan and antibiotics, the cat recovered. The genital area was no longer bald. Everyone was happy.

Now the daughter brought the cat in for grooming. The cat looked like Garfield.

"It is not normal for a cat to have stained genital area," I said to the daughter. "Get a blood test done." I did not ask for a urine test as there were some hesitation about costs and in any case, the cat was sent in for grooming and not for disease.

BLOOD TEST
High blood glucose. Liver enzymes were OK. No kidney disorder.

So is this a case of diabetes mellitus or diabetes insipidus without complications in a cat? Is it a case of diabetes at all? What do you think? How to confirm it?

HISTORY
The father said that the cat was very hungry and drank a lot. He would check on the amount of water drank.

URINE TEST
This would be done if not for economic reasons. Glucosuria will confirm diabetes mellitus. What about diabetes insipidus? Urine SG <1 .008="" 1.020="" a="" around="" as="" be="" br="" cat="" diabetes="" dilute.="" i="" indicate="" insipidus="" likelihood="" mr="" of="" ormal="" said="" saw.="" sg="" should="" the="" to="" urine="" very="" will="">

I had a review of the two types of diabetes with my assistant Mr Saw. Real case studies are best and this case is useful for Mr Saw as he has to go into differential diagnosis including diabetes mellitus and diabetes insipidus and the causes of high blood glucose. One condition is associated with the pancreas. The other with the kidney.

FOLLOW UP
More investigation needs to be done. Urine tests and blood tests will be needed. So far, the liver enzymes are OK. So this is a diabetes case without complications?

184. Poodle purchased 1.5 months ago still pees everywhere

TOILET-TRAINING CASE STUDIES

CASE 1. PEES EVERYWHERE WHEN LET OUT OF THE PLAY PEN

An Indian family with a daughter studying what she liked - coaching netball sports at the polytechnic brought in a small poodle for the 3rd vaccination as I had vaccinated it for 2 vaccinations at the Benji Pet Shop.

Discussing about toilet-training is a very interesting subject and if there is humour in the discussions, it will be fun and laughter. This puppy was paper-trained in her playpen. However, she pees everywhere when let out of the playpen 1.5 months after purchase. Why this poodle does not go to the newspaper when let out?

"Is the playpen closed up so that the puppy cannot get in to pee on the newspapers? Some owners do that," I said.

The mum said: "The playpen was open but the puppy does not go inside and pee on the newspapers."

"Is the paper changed often?" I asked.
"Yes," the homemaker mum said. "Every time she pees, I change the papers."

The mum said: "When the puppy pees outside the approved papers, I will pick her and put her inside the playpen so that she will pee inside."

"It is too late usually," I said. "The puppy does not know why."

"If you let go, then your puppy will let go too." The English language sometimes can be a source of humour as the mum and daughter laughed.*

*For readers who may not understand the complexities of the English language, I mean "If you let (the puppy) go (everywhere in the apartment), then your puppy will let go (pees and poop everywhere) too.

I advised: "The secret to success is to confine the puppy to a small area outside the playpen for another 1-2 weeks. In this way, the puppy knows that she must go to the papers to pee. Then increase the area to one room, then after 1 week or so, to two rooms and so on."

"By permitting roaming to the whole apartment, it is like putting your puppy onto a football field. Your puppy cannot detect the newspapers and pees in every bedroom."

I advised neutralising of all floors with white vinegar:water and 1 part to 3 parts respectively. Letting the puppy so much freedom after 1 week of confinement is a common practice in Singapore as many owners are puppy lovers. They feel sorry for the poor puppy being confined. But they have no time to observe the signs of elimination and put the puppy back onto the newspapers with oral commands and then praises.

In this case, the mother did do it but it could be too late (after the puppy had peed). Therefore the puppy would not know why. In addition, the apartment floor is full of urine smells and the puppy simply pees everywhere!

CASE 2. TOILET-TRAINING TWO PUPPIES
Date of Interview: 18 February 2010
Written by: Tanya Trevethick
Edited: Dr Sing

I did not do any editing. An excellent piece of writing by a vet intern who will be studying vet medicine in the UK soon.

Description

Two male salt & pepper Miniature Schnauzers around three years of age at the time of interview are owned by two men in their late 30s. They were house-trained as puppies at the same time by the current owners.

Equipment

At the time of interview, 3 pee trays were placed in the bathroom of an HDB apartment and shared between both dogs. The trays are near a wall; paper is not used. Neither dog has a preference for any particular tray.

Process

When the puppies started to eliminate, the owners carried them to the pee tray. The puppies were confined, with the confinement area gradually increased as the puppies got used to using the pee tray. Puppies were confined most of the day except when allowed out at a regular time each day to play.

Management

The owner washes out the pee tray and grate after every use. The grate has never needed replacing as it did not rust. The dogs pee two or three times a day and poop twice a day (once in the morning and once at night). The dogs are fed once a day on dry commercial dog food with very occasional treats.

Motivation

No treats were given after use of the pee tray. Puppies were spanked when they lifted their legs too high resulting in urine on the adjacent wall.

Difficulties

Training took a long time, two or three months instead of the usual two to four weeks. This could indicate that training two puppies together at the same time is harder than training just one. Also, the owners were at work during the day thus the puppies were not trained continuously throughout the day.

Success Rate

100% at time of interview. The dogs use the pee tray all the time, never soiling other parts of the bathroom or the house. The male dogs also do not lift their legs fully when urinating (one does not lift at all), as they get spanking and scolding when they do it. Thus no urine is sprayed onto the adjacent walls or floor area outside the pee tray. The owners noted that the dogs do not use the tray when it is unclean; this is the rationale behind their washing it after every use.


More toilet training cases are at: www.toapayohvets.com

183. Toilet training 2 puppies - written by intern Tanya

How to House-Train Two Puppies on the Pee Tray + grate



Date of Interview: 18 February 2010
Written by: Tanya Trevethick
Edited: Dr Sing



Description

Two male salt & pepper Miniature Schnauzers around three years of age at the time of interview are owned by two men in their late 30s. They were house-trained as puppies at the same time by the current owners.



Equipment

At the time of interview, 3 pee trays were placed in the bathroom of an HDB apartment and shared between both dogs. The trays are near a wall; paper is not used. Neither dog has a preference for any particular tray.



Process

When the puppies started to eliminate, the owners carried them to the pee tray. The puppies were confined, with the confinement area gradually increased as the puppies got used to using the pee tray. Puppies were confined most of the day except when allowed out at a regular time each day to play.



Management

The owner washes out the pee tray and grate after every use. The grate has never needed replacing as it did not rust. The dogs pee two or three times a day and poop twice a day (once in the morning and once at night). The dogs are fed once a day on dry commercial dog food with very occasional treats.



Motivation

No treats were given after use of the pee tray. Puppies were spanked when they lifted their legs too high resulting in urine on the adjacent wall.



Difficulties

Training took a long time, two or three months instead of the usual two to four weeks. This could indicate that training two puppies together at the same time is harder than training just one. Also, the owners were at work during the day thus the puppies were not trained continuously throughout the day.



Success Rate

100% at time of interview. The dogs use the pee tray all the time, never soiling other parts of the bathroom or the house. The male dogs also do not lift their legs fully when urinating (one does not lift at all), as they get spanking and scolding when they do it. Thus no urine is sprayed onto the adjacent walls or floor area outside the pee tray. The owners noted that the dogs do not use the tray when it is unclean; this is the rationale behind their washing it after every use.

Wednesday, August 25, 2010

"Debarking is a rare operation," I said to the lady on the phone. "Vets don't encourage it." She had moved to a quiet neighbourhood and her 8-year-old neutered Schnauzer barked shrilly and frequently. "I want to debark my dog to prevent the AVA from coming to see me after neighbours complain. The alternative is to give up this dog but I do not want to give him away."

Barking seemed to be her only solution and she googled for a vet that will do debarking. "Do you need me to consult you first and be counselled for debarking? My vet is at Clementi. Do you mind that?"

"Will scars form after debarking, affecting the dog?" the lady had read somewhere in the internet

"Scars are referred to operations after debarking using the oral approach. As the vocal cords may not be excised by the long forceps 100% unless done by the vet with lots of experience using this approach, the scars will form. Barking sounds will return. But the oral approach can be effective if all vocal cords can be pulled out and snipped off."


ALTERNATIVES
1. Get a dog trainer to train the dog not to bark will need some time and patience. It may or may not work. Why not try this method?

2. Electric collars. It works according to feedback from one owner.

3. Citronella spray collars. Feedback from some owners are not so positive.

Much depends on the age of dog, the personality of the dog, the training and the owner. It is hard to be specific.

3 male hamsters live together - stress causes warts?

Sire 1.5 years old and two siblings 1 year old

Only 1 sibling developed warts. Why?
"Did the father bully him only?" I asked.
"Yes," the young man said.
"What does the hamster do?"
"He lies flat exposing his tummy.


Electro-surgery to remove warts in right front legs (paws, pad, elbow area. No bleeding. Hamster recovered and went home. This may be one case where warts develop due to stress of being bullied by the sire. Left fore develops small wart that is too small to remove. Hard to prove my hypothesis.

Pictures taken.

Advised: Put this sibling in another cage.

Prostatitis

25.8.10 Goes home.
Shih Tzu, 8 years, male
4 pm. Can control bladder after Tardak inj and antibiotics yesterday. But still painful prostate on palpation. clindamycin 25 mg/capsule. 3 cap bd x 14 days

24.8.10
URINE TEST (2nd day)
Amber, Turbid, pH 6.5 SG 1.032, Protein 1+, Blood 4+. WBC >2550, RBC 126, Bacteria +. Possible haemolysis of RBC in urine.

DIPSTICK
pH 9, SG 1.00, Protein 2+. Blood 4+, WBC 4+.
Dipstick's yellow (instead of green) showed non-haemolysis of RBC in urine.
Lab analysis is more accurate.


6.30 pm. Dog goes home. Positive developments are:
1. Saw stray cat and barked
2. Poop twice as usual. Normal stools. Dog had been using stool to mark territory as he would poop in different areas for the past 7 years.
3. Urinate a few times as usual - urine marking. Colour yellowish.
4. Bladder control OK - therefore can urine mark.
5. Had excellent appetite.
6. Drank some water after urination. Not excessive thirst.
7. Prostrate should shrink now that treatment is given and the dog no longer produces testosterone.

Observe for next 14 days. No dry food. Canned food. Larger e-collar to prevent the occasional licking of prepuce

Tuesday, August 24, 2010

Urine colour of 2 dogs

EDUCATIONAL TIPS FOR VET UNDERGRADUATES
I write this case of contrasting urine colours for vet undergraduates who may be struggling to remember so much information for their 4th year examinations.

Date of report. Wed Aug 25, 2010 6 am

Dog 1 - Miniature Schnauzer, 2 years, male, not neutered. Dog was groomed one week ago but the house-call groomer prohibited the owner to see. However, he recommended one shampoo for the dog. A shampoo different from what he uses. The owner bought the shampoo from the pet shop and used it 2 days ago.

Dog 2 - Shih Tzu, 8 years, male, recently neutered and repair of right perineal hernia. 4 days ago, had fever and urinary tract infection was diagnosed. Dog was given medication of antibiotics.

Complaint
Dog 1 - Shivering for 2 hours yesterday. Vomited twice after consultation.
Dog 2 - Cannot control bladder. Bites when backside is touched. Tongue pale. Vomited once after consultation.

Presenting signs
Dog 1 - shivering
Dog 2 - urinary incontinence

Urine Test Report From Laboratory:
Dog 1 - Colour amber, clear, pH 6.5, SG 1.020, Blood Trace, WBC 25, RBC 5, Bacteria Occasional, Spermatozoa Occasional

Dog 2 - Colourless, slightly turbid, ph 6.5, SG 1.005, Blood Trace, WBC 25, RBC 5, Bacteria Occasional, Spermatozoa Occasional. Possibly haemolysis of RBC in the urine. That would account for the pallor of the tongue I saw yesterday. The low SG (Specific Gravity) of the urine is not a good clinical finding.

Blood Test Report From Laboratory:
For Dog 1, there is a high blood urea. This could account for the dog vomiting twice after going home. I did not give any treatment on the first visit of shivering complaint at 11 am. I just took urine and blood samples. The dog went home and vomited and came back at 5 pm.

For Dog 2, significant results are low haemoglobin and increase in total white cell count suggesting a bacterial infection in the urinary tract and prostate. Antibiotic treatment had been given for the last 3 days.

What's the problem and what's the cure?




Get the history of management and past illness, general examination of the whole body externally including genital area, abdominal palpation is very important, urine test, blood test at the first stage of consultation.

History taking can take a long time and patience. In Dog 1, I asked whether there was an anti-tick shampoo used by the house-call groomer as this dog had suffered shivering and tremors of the body some months ago after the use of an anti-tick wash by the groomer at the pet shop.

The answer was correctly no. I did not expect the owners to purchase a new brand of dog "shampoo" as I presumed incorrectly that the owners would stick to the old brand. Later, when the daughter brought the bottle for me to see, it was not a shampoo but a "silky coating brush spray" to detangle, soften and repel dirt.

The shampoo was applied on the coat without rinsing as the instructions on the bottle were to "spray directly on the dog's coat after bathing or when brushing daily."

Here, many Singapore owners would be thinking of this product as a "shampoo". The bottle had this caution - "For External Use Only. Avoid contact with eyes." The Schnauzer most likely disliked the perfume fragrance and licked all ingredients to get rid of the smell, as in a cat grooming. The product had 17 ingredients, two of which were chamomile flower and rosemary left extracts. This dog specifically disliked chemicals on his body and would have ingested the grooming products meant to keep the coat tangle-free and silky.

General examination and abdominal palpation. The whole body must be examined. Sometimes it is best to ask the young lady to look elsewhere when the vet examines the penile tip. Yesterday one lady in her late 30s, not related to the above 2 cases, screamed in surprise when I checked the penile tip of her old poodle as part of my general examination. She had sent the old dog for treatment of the skin diseases after her one-year-stay in Hong Kong. Her parents in their late 60s would not want to spend money treating this old dog with recurring scales did not bother and so she brought the old dog in.

For Dog 1, the penile tip was very red. I told the young lady that the dog had been self-stimulating. She did not believe me as the dog was behaving normally when the family members were around. Urine test showed "occasional spermatozoa".

For Dog 2, I could feel a hard globular lump of 3 cm x 3 cm. The dog reacted in pain. This was the inflamed prostate. As for the urinary incontinence, it would be due to prostatitis (narrowing or urethra and painful urination).

Tentative diagnosis:
Dog 1 - Poisoning from ingestion of grooming products.
Dog 2 - Prostatitis causing urinary incontinence

Treatment:
Dog 1 - IV drip to dilute the poison in the blood. The dog had a slightly elevated blood urea. He is young and so recover.

Dog 2 - Pallor of tongue indicated a more serious problem. The blood haemoglobin was low. The total white cell count in the blood and urine was high indicating a bacterial infection. The dog was given an anti-androgenic injection 1.4 ml Tardak yesterday, antibiotics, IV drip, Vit K1, antibiotics and was warded for treatment. Yesterday evening, his tongue colour returned to a normal pink. Much more investigation work needs to be done. All the young lady and mum want is a dog back to health. "Will this dog die?" It is hard to predict. Dogs do die when the vet thinks there will be a good clinical outcome. Some dogs with chronic diseases don't die although their deaths would be welcome by the owners!


More info and pictures are usually at www.toapayohvets.com

Vomiting associated with de-tangle shampoo

Monday 23.8.10 case

"Any de-ticking shampoo used?" I was presented with a Miniature Schnauzer, male, 2 years, shivering at home for 2 hours yesterday. The dog had insecticide poisoning some months ago after application of the tick wash and so this was the instant diagnosis.

"The house groomer does not permit us to watch him grooming," the daughter said. "He came last week."

"Has the dogs any ticks?" I asked.
"Yes, but we don't use tick wash or insecticide. We catch the ticks."

I told my assistant that it is best to take a blood and urine sample. The dog appeared OK this morning. No fever. No trembling.

BLOOD TEST
Urea high Creatinine below normal, Haemoglobin above normal

URINE TEST
amber, clear
pH 6.5, SG 1.020, Blood Trace.
White blood cells 25, Red blood cells 5, Bacateria Occasional, Spermatozoa Occasional


Cause: De-tangled shampoo poured onto the dog. Recommended by groomer to buy. But groomer used another brand. Dog licked off. Got poisoned. Advised: No more use.

"What shampoo to use?" mum asked.
"use the same shampoo for past weeks. Just remember to rinse as your dog dislikes all chemicals on his body.

A case of shivering poisoning from a herbal grooming shampoo to detangle hair? This time the shivering was due to a grooming shampoo, not an anti-tick product. The colour of the urine is amber (could be due to byproducts of herbal shampoo rosemary and ..)

Monday, August 23, 2010

Prostratitis in the old male dog

"I thought he had died," the mum said. The Shih Tzu, male, neutered, 8 years old was motionless. He had a right perineal hernia repair and then neutering 2 weeks ago and was Ok for a few days. Then he stopped eating for a few days and collapsed as if he had died. |

23.8.10
On examination, he on 23.8.10, I found that he had a high fever and was pale.

Palpation: Bladder felt firm and enlarged. Urine by catherisation.
Urine test: Urinary Tract Infection. The dog went home the next day. 3 days later, he came back as he was licking his private parts and urine kept leaking out. Cloudy urine.

Palpation: Bladder felt firm and painful. It could be an enlarged bladder wall, bladder tumour or prostrate enlargement.

2. Empty bladder using cathether. 15 ml of urine came out. Palpated the bladder. A little amount of urine came out but a rounded lump of 3 cm x 3 cm. This was the enlarged prostate.

3. Rectal digital palpation when the bladder is emptied. This confirmed that the prostate was enlarged.

To check the prostate:
1. Palpation. There was painful reaction. I diagnosed this as prostratitis and enlargement. Also epithelial cells seen in urine test.

BLOOD TEST
23.8.10 Creatinine was below normal. Red cell below normal. Total White Cell above normal. Neutrophils 97% (Absolute 17.2 x 10^9/L), Lymphocytes 2.5% (Absolute 0.45X 10^9/L).

URINE TEST
Colourless, slightly turbid. pH 6.5 (5-8), SG 1.005 (1.005 - 1.030). Protein - trace. Blood 4+, White blood cells >2250, Red blood cells 20, epithelial cells 0, Mucus Threads Occasional, Bacterial Occasional. Possible haemolysis of RBC in urine.


24.8.10
Vomited white froth overnight
"Tongue colour pinker," the mother told me. "At 7 pm yesterday when I saw him, his tongue was very pale."
Another urine test was taken. Owner was advised that an X-ray or ultrasound scan might be required. "The dog had never been sick for the last 7 years," she said. Now there were some veterinary expenses and worries. The dog is still incontinent and more work need to be done.

CONCLUSION
"Can a dog die of UTI?" the mother asked me.
"A dog can die of UTI or any infection if he is not treated," I replied. "Older dogs are more likely to die when they are sick as they have lower immune system. Your dog is 8 years old and is considered an old dog."

Neutering the dog when he was young would have prevented the worries but many owners feel it cruel to sterilise dogs. Annual vet examination and health check may be advised. Statistically, male dogs that are not neutered are likely to get perineal hernia and prostrate enlargement.

176. E-mail discussions to client (toilet training)

As the dog grows older, it is harder to change. Below is my plan for you

Pom, Female, 15-month-old. Came for vaccination (8-in-one and proheart). Vomited after injection, so kept in the Surgery fo 2 hours..
Will pee and poop on the newspapers when left home alone in the balcony.
Pees everywhere in the apartment when left alone.

PLAN
1. Confine to balcony and adjoining living room.
2. Neutralise all urine smell inside the apartment. Put white vinegar 1 part and 3 parts water in a spray bottle and spray clean the whole apartment.
3. Close all bedroom and kitchen doors for the next 2-4 weeks.
4. Newspapers to be placed in the living area too. Preferably with urine smell (2nd piece of newspapers from the balcony.)
5. No dry food for the whole day. Give with canned food. Dog is not skinny anyway. No water after 8 pm so she can control her bladder.
6. Feed 2x/day.
7. Remove all soiled newspapers (in the balcony and living room) immediately as dogs don't like to eliminate in soiled papers.
8. Praise when the dog pees on newspapers in the living area. Dog treats if the dog is motivated by treats.
9. Same routine for 2-4 weeks and let me know by e-mail 99pups@gmail.com

Sunday, August 22, 2010

175. Urine and blood tests important - 2 mum and daughter cases

"A vet cannot predict whether the dog will die or not." I said.
"Blood tests and urine tests are important in the aid to diagnosis."

Coincidental cases. Mum and young adult daughter

CASE 1
Mum brought in the dog. Daughter messaged while she was in clinic.
Shih Tzu keeps licking penile area. Urine incontinence. Had been treated for UTI and right perineal hernia repair. Yet he is not OK. Why? Needs blood test and urine test.

Urine - light yellow

CASE 2
Miniature Schnauzer, 2 years male, shivers for 1 hour yesterday. Working daughter brought in the dog. Why? Had a history of shivering after tick wash. A home groomer had come 2 weeks ago to the apartment as the dog had ticks. But the groomer refused to let the mum and daughter watch.

"He never humps or climbed our legs when we are around," the daughter said. I noted that the penile tip is red and inflamed. Pain in right ear horizontal canal, L/S spinal area (slight pain). Allergy to shampoo or environment? Excessive ear hairs trapping dirt and "ticks" inside the ear canal?. Head shaking for past 3 months, the daughter volunteered the new info.

Fits of unknown cause? Distemper encephalitis? So what is he problem?

Urine - orange yellow

I took pictures as they were contrasting.

Saturday, August 21, 2010

174. SUNDAY CASE. Hamster wart - what is the cause?

2 big brothers in their early 30s and one younger teenaged brother tanned and solid build e-mailed me a blurred picture. "Looks like a wart," I replied. Appointment by e-mail on today Sunday at 11 am. So they came. Sire hamster was 1.5 years old, the two sons were 1 year old. One had developed a wart but the other two were OK. All 3 in top shape weighting around 65 gm.

Took some pictures of the hamster with a wart.
"What's the cause of warts and should I use disinfectant to spray the cages?" the big brother asked me.
"Unknown causes," I said. " Disinfectants will not help stop wart formation. Warts are viral papillomas. They develop when the hamster's immune system is not normal. It could be due to stress with 3 male hamsters living together."

"He does not like bathing in the sand," the youngest brother said when I said that this hamster also suffered from ear infections with scabs and possibly small warts seen in the right ear canal opening. "He just went in and came out of the sand, unlike the sibling."


I need to anaesthesize the hamster, check for more warts and clean the ears. The hamter was warded for 2 days.




.











CASE OF THE SPAYING OF STRAY CAT.
2.7 kg. Gave 0.15ml xylazine and 0.6 ml ketamine IM.
Insufficient analgesia if spay is delayed >20 minutes. Top up with isoflurane gas in gas mask to effect very effective. I was delayed by spaying a stray cat that was showing abdominal fat coming out of the midline incision

Surgery was started 10 minutes post injection, but
I asked Mr Saw to give some isoflurane gas. He checked the eyelids. "Cat does not need the gas," he advised. Being a cautious assistant. However, the omental gut spilled out of the midline incision. I said: "You need to give 30 seconds of isoflurane gas as I can't hook out the uterus. I can see the bladder."

"The bladder is full," Mr Saw said. I manually massaged the bladder and urine squirted out. After a few more seconds, I hooked out the left uterine horn. It was easy after that.


INTERESTING DOG OWNER FROM TAMPENIS
"I need to bring in my dog for vaccination," Mr Lee who had worked in watch rep;air in the last 30 years as a happy employee persuaded me to wait for him. "The Pasir Ris groomer called Sam said that I must vaccinate the dog first, otherwise it will be risky."

Pasir Ris is the place full of dog kennels and viruses. So the groomer Sam was careful that his client's dogs don't die of viral disease. "OK," I said. "I will wait." Busy watch repairer in his 50s. High end watches but prefer to be an employee. "Less headaches," he said to me. "I can take leave unlike boss who had to entertain a government lawyer yesterday."

I asked him about a fellow tenant in the famous Orchard shopping mall. "Avoid him at all cost," he said. "Those who said they make millions of dollars and dress up well are to to be avoided," he advised me.

"Your specialty in fixing broken watches is rare," I said. "There are few competitors."

"Around 16. Golden Mile has many. I can dissemble the watch for repair but don't know how to put them back again. My boss's son does that." His boss was the founder who is now 86 years old.

"You know, I find great difficulty communicating with your receptionist James."

"James is 75 years old, but he should speak slowly. It seems that his brain is not so good."





HEARING IMPAIRED YOUNG LADY IN HER EARLY 30S suddenly appeared with a rescued a kitten with a hole in the belly.
We wrote in English on a piece of paper. I could not understand sign language. She could write English and so we communicated this way.

"Can save?" she wrote on a piece of pager and on "hearing impaired in her case card.
"Yes," I said.
"Can live?"
"You have to feed her," I wrote.
"How?"
"I can buy a ilk bottle plus kitten milk from the pet shop."
"Goat's milk?" she penned.
"OK," I said.
She drew a syringe," I said "OK".
"You have to go to the library to read on how to feed every 4 hourly." She nodded her head.

Friday, August 20, 2010

Old shih tzu with multiple warts

Blood test was useful as it showed a kidney disorder with high blood urea. Advised k/d diet for one month.

owner phoned as to whether can give dog treats and food as the dog keeps looking for more food to eat. A can of k/d is insufficient. I advised not to. Give some apples/carrots instead.

One month later, will check blood and urine.

172. Faucitis-Stomatitis cat goes home

Cat, 3.8kg. Eating. Ulcers in both fauces, base of tongue and midline of tongue is seen.

Advices to owner:

1. Immune disease with no permanent cure. Lifespan may be around one year if the steroidal drugs become ineffective.
2. Blood test taken on 17.8.10 shows high glucose and high liver enzymes (SGPT/ALT 642 compared to <121 and SGOT/AST of 309 compared to <67. Other blood results normal. Eosionophils is lower at 4.07%$ or absolute 0.37 x 10^9/L.
3. Canned food or fresh fish diet mainly. Multivitamin.
4. No stress but must interact with the other 2 cats.
5. Now to give immunosuppressive dose at 3 mg/kg every 48 hours from today. total should be 11.4 mg pred. Give 2 tablets of 5 mg every Friday, Monday and Wednesday for 1 month and observe. Increase pred when the cat is not eating.
6. To follow up 1 month later.

Thursday, August 19, 2010

171. Top 10 medical insurance claims for dogs in 2009

Veterinary Pet Insurance Co (VPI), the oldest and largest pet health insurance in the USA received >1 million claims from pet owners each year. For 2009, the top 10 canine conditions are:

1. Ear infection
2. Skin allergy
3. Skin inection/hot spot
4. Gastritis/vomiting
5. Intestinal inflammation/diarrhoea
6. Bladder infection
7. Arthritis
8. Soft tissue trauma
9. Non-cancerous tumour
10. Eye infection

Most of the conditions affect all dogs, regardless of age.

Wednesday, August 18, 2010

Swollen lump in the belly area of a Retriever

First report is at toapayohvets.com: Tumours in 3 male dogs - Sertoli cell tumour, circum-anal tumour and oral tumour

FOLLOW-UP
"The young intern has no experience in dealing with the submission of specimens for histopathology," I explained to the Laboratory girl who phoned me to tell me that the 7 testicular specimens must be correctly labelled as "right" and "left" testicle when I queried the report's findings. My histopathological samples are sent to a commercial laboratory that specialises in this subject.

How come there was a blunder? It was my policy of letting interns be more hands-on.
I had instructed my assistant, Mr Saw, to let vet interns have some hands-on experience rather than being an observer. In that way, they will learn from experience and mistakes. We all learn every day as we can't be perfect people.

Ms Lai, the intern, would be studying veterinary medicine next year and so we gave her the task of submission and filling out the forms. She had been with us for around 2 weeks and had seen submission of blood samples.

Well, the undescended testicle of this 6-year-old Retriever was enormous (half the size of a tennis ball) and would not fit into the usual container we used to submit samples for histopathology. So, I advised cutting it into 3 smaller pieces for the larger testicle (left) and 4 smaller pieces for the descended atrophied testicle (right).

I ought to have advised getting a bigger container. I did that eventually. Next time I asked my assistant to check before submission of the samples. Usually we submit one sample and it fits nicely inside the Lab-provided bottles.

Everybody learns from being hands-on. Young interns can't be spoon-fed all the time and will make some mistakes. It is part of growing up in life.

I was fortunate to have worked in the Vet Diagnostic Lab at Kampong Java Road (now the new Kandang Kerbau Hospital) as a new graduate in 1977 and so knew a bit about the work of histopathology. What had happened was that the intern put 7 pieces 1 big bottle and submitted the bottle and form without separation of the left and right testicle.

After receiving the histopathology reports, I phoned to clarify that there were two testicles submitted as the report had presumed I had submitted 7 pieces of one testicle. The report was then corrected as follows:

Specimens 1-4 are left undescended testicle. Specimen 5-7 are the atrophied descended right testicle. The histopathology results are as follows:


Takes a long time to pee. Painful enlarged prostrate when digital examined via rectum during light anaesthesia. Could this be purulent prostatitis as mentioned in: www.vet.uga.edu/vpp/clerk_anat
/sabatino/index.php.


Hyperpigmentation in the preputial area

Follow up 7 days later: Owner is happy. "No more limping now. We thought he had hip dysplasia."
I asked" Was the dog attracting other dogs during exercise outdoors?" The owner recalled that many dogs wanted to make friends with him (the effects of hyperestrogenism).
Left testis - Sertoli cell tumour (see comments below).

Right testis - Atrophy of the contra-lateral scrotal testicle resulting in aspermatogenesis.
Comments from the Histopathology Lab:
1. The left testis is extensively replaced by a tumour which is composed of closely packed tubules, trabeculae and nests of elongated spindly cells. A second interstitial (Leydig) cell tumour component cannot be excluded. Most primary testicular neoplasm in dogs are benign. The rare malignant Sertoli cell tumours have no good cytological or histological markers of malignancy. The vet needs to identify metastases in lymphatics, spermatic cord, lymph node or distant sites. Please correlate with clinical features.

Dr Sing's comments: The left testis will likely be a mixed tumour with Sertoli and interstitial cells involved). Much more details of the types of testicular tumour in the dog are in an excellent report at:
www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.

2. In the right testis, the parenchyma shows closely packed seminiferous tubes composed solely of Sertoli cells without spermatogonia, spermatocytes or spermatids. This is common in cryptorchid (undescended) testis. There is no tumour involvement.

CLINICAL FEATURES OF INTEREST TO VET UNDERGRADUATES
1. As the histopathologist is an independent service provider, he or she had not seen the real dog. The right testis was assumed to be an undescended or cryptorchid testis. It was a descended testicle, much shrunken.

2. Hyperestrogenism. The reason the descended right testes was atrophied and had no sperm production was due to the excessive production of estrogen by the large left testicular tumour. Estrogen is anti-androgenic and therefore cause the atrophy of the scrotal right scrotal testes.

3. Blood test results as shown below indicated a thrombocytopenia which can be a cause of death in the dog if the tumour had not been detected early and removed.
Golden Retriever, Male, 6 years. Left undescended testicular tumour and atrophied right scrotal testicle removed 5 days ago. Greyish-white, large sized and multi-nodular suggestive of a Sertoli cell tumour.

The owner asked about post-op management. This depended on blood test results.

Blood tests:
1. No disorders of liver and kidney function. Glucose is normal.
2. Haematology: Low haemoglobin and red cell count. Low PCV. Very low platelet count. Platelet clumping noted. (This indicated bone marrow depression). Effects are well written in:
www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.

Urine results
1. pH=7.0, SG 1.027.
2. Abnormal findings: Protein 2+, Glucose 1+, Blood 4+, WCC >2250/uL, RBC 900/uL, epithelial cells 1053/uL. Bacteria 3+

This indicated a severe bacterial infection of the bladder and prostate (painful and enlarged during rectal palpation). The infection is probably localised to the urinary tract as the total blood White Cell Count was OK. The dog had been given IV Vit K1 in drip earlier and appeared much more energetic the next day.

Advice to owner:
1. Had been fed meat, rice 1X/day in the past. Very thin. Increase feed to 2x/day.
2. Good quality premium dog food dry to be added. 1 egg/day for 14 days.
3. Antibiotics for next 14 - 20 days. UTI + prostatitis + bone marrow depression.
4. Review in 14 days.
4. More info of this case has been recorded at:
Tumours in 3 male dogs - Sertoli cell tumour, circum-anal tumour and oral tumour

5. An excellent veterinary report on canine testicular tumours is at: www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.

I note that the "Summary" stated that "the Sertoli cell tumour is the only known testicular tumour that commonly produces hormones with clinical effects." Some vet reports I read on the internet claim that estrogen is produced by two of the 3 common testicular tumours, namely the Sertoli cell tumours and Seminomas. In the "Introduction", there was this statement that "testicular neoplasms other than Sertoli cell tumours are rarely hormonal productive. Testicular neoplasms are often mixed-origin especially in cryptorchid testes". In this case, the histopathologist indicated that the undescended testicle could be a mixed type with Sertoli cell tumour and interstitial (Leydig) cell tumour.
Cryptorchidism in the dog can be unilateral or bilateral


Note that the report said that testicular tumour in the above-mentioned dog is found as early as 6 years of age (this case) but the median age is 10 years (photo of one of my cases, left).
Testicular Tumour in an undescended testicle of a 10-year-old Spitz in my 2001 case when I was new into digital photography. This picture is acceptable by me nowadays.

In 2010, many younger dog owners do not wish to have their male dogs neutered as they perceive the surgery to be cruel. However, undescended testicles may develop testicular tumours. Weekly check up of the dog's belly will detect their presence


Testicular Tumour in the undescended testicle of an 8-year-old Jack Russell.

Check the belly of your older dog every week if you do not wish to have your male dog neutered. Testicular tumours are seldom malignant but they do cause death due to bone marrow depression and thrombocytopenia and consequent overwhelming bacterial infections.










updates and pictures at www.toapayohvets.com

169. *Common toilet-peeing-everywhere situation in Singapore's apartment

HOW A VET WILL DISCUSS ABOUT TOILET TRAINING

Date: August 18, 2010. Came for annual vaccination and heartworm vaccination. Ate at 10 am but vomited canned food during vaccination at 3.30 pm. Surprising. Dog is nervous of vets, owner said. I kept the dog in the Surgery for one hour to observe. No problem.

Dog: Pom, red, 17 months, female, not spayed

Problem: Pees everywhere inside all the rooms of the HDB apartment when let loose. Pees on newspapers when confined to the balcony when the family is not at home. Family lives with this situation of having to clean up after her peeing.

Look at the routine and my explanation:

Sleeping area - balcony by herself. So she has an incentive not to soil her "den".

Feeding - 8 am & 7 pm. Canned food. However dry dog food is left available all the time. This is a mistake. Dog should be given food for 15 minutes as a puppy and food removed.

Drinking - Water anytime. I advised no water after 8 pm so she can control her bladder. Eating dry dog food anytime may make the dog thirsty too.

Pooping - 1-2x per day.
Poops after breakfast - Yes, usually around 30 minutes after eating.
2nd pooping time variable. Sometimes overnight in the balcony.

Peeing - 4-5X/day including overnight. Is this urine spraying? "Female dogs do urine-mark to stake out their territory inside the apartment," I said to the young lady. "To let the other family members know."

As the location of peeing was all over the apartment, this seemed to be a case of urine-marking. "Spaying at a young age may stop urine-marking," I said.

I will e-mail to the owner the proposed plan and hope she will provide feedback to me in 2 months' time.

PLAN
1. Confine to balcony and adjoining living room.
2. Neutralise all urine smell inside the apartment. Put white vinegar 1 part and 3 parts water in a spray bottle and spray clean the whole apartment.
3. Close all bedroom and kitchen doors for the next 2-4 weeks.
4. Newspapers to be placed in the living area too. Preferably with urine smell (2nd piece of newspapers from the balcony.)
5. No dry food for the whole day. Give with canned food. Dog is not skinny anyway. No water after 8 pm so she can control her bladder.
6. Feed 2x/day.
7. Remove all soiled newspapers (in the balcony and living room) immediately as dogs don't like to eliminate in soiled papers.
8. Praise when the dog pees on newspapers in the living area. Dog treats if the dog is motivated by treats.
9. Same routine for 2-4 weeks and let me know by e-mail 99pups@gmail.com







I advised for the next 2 weeks, confine dog to living area and balcony. Put newspapers on tray

Tuesday, August 17, 2010

Faucitis in a stray cat

August 17, 2010
Stray cat can eat as ulcers heal 80% as evident from digital photography taken today. Midline tongue ulcer re-appears. Ulcers at base of right side of tongue seen in one of the images.

Cat was more cooperative but he got fed up after I took over 50 images. It was difficult to take his inner mouth from a table in the waiting room with outside sunlight at 11 am. I did not shine a strong light into the mouth.

HISTORY:
Tuesday, August 10, 2010
Faucitis stray cat
August 10, 2010 review of eosinophilia in a stray cat.
Salivation is the presenting sign. Ulcers in fauces and lower tongue 2 weeks ago. Treated and went home. Came back again as the cat started to salivate.

Ulcers at fauces reduced by 80% today. Cat gentle but dislikes mouth being opened. Wanted to scratch intern Ms Lai. Will the condition relapses? Is there a permanent cure? Not according to the cat experts.

Monday, August 16, 2010

167. Stray cat - stomatitis

Stray cat, Male, Neutered, ginger, around 4 years old, 3.5 kg, very thin

HISTORY

Jul 18, 2010
Stray cat was picked up from the street and sent for treatment
Can't eat normally. Salivation, bad breath and mouth ulcers.

Jul 19, 2010
Blood test - Liver SGOT/AST high, Kidney Urea high, Total White Cell Count high
Neutrophils 80%, lymphocytes 10%, monocytes 4%, eosionphils 6%, basophils 0.2%
Full grooming, deflea, ear irrigation, treatment


Jul 20, 2010
1. FIV and FLV blood test - negative


Jul 21, 2010
Blood test - Liver SGOT/AST high, Kidney Urea normal, Total White Cell Count normal
Neutrophils 77%, lymphocytes 13%, monocytes 5%, eosionphils 5%, basophils 0.5%

Jul 23, 2010
Anaesthesia - xyalzine 0.1 + ketamine 0.4 ml IM + dental extraction of all loose teeth

Jul 28, 2010.
Goes home.

Aug 3, 2010.
Salivation and not eating normally Back to Toa Payoh Vets. Faucitis (ulcers at back of throat on left and right side).

Aug 4, 2010.
Pred 0.4 ml SC and antibiotics
Eats normally.

Aug 13, 2010
Mouth and tongue ulcers return
Pred 0.5 ml SC and antibiotics, omega 3 and 6 oil oral
Eats normally.

Aug 17, 2010
Eats normally. Puts on weight to 4 kg. Canned food only.
Blood test done.
Canned food only

166. Shih Tzu with urinary tract infection

"How he gets this UTI?" the mum asked. "Yesterday, I thought he was going to die." The dog just was lethargic for the past 3 days. He ate a lot after going home from neuter 7 days ago. The 8-year-old Shih Tzu had a right perineal hernia repaired by me just around 4 weeks ago.

I palpated a full bladder. There was no pain in his pre-scrotal lump which was the site of the neuter. Got a urine and blood sample taken and sent to the lab this morning.

The mum and daughter came to visit him at 5 pm. I explained to them that the dog had a severe UTI. Blood results - Total WCC was above normal, neutrophils was 97%, lymphocytes 3%. Abs neutrophils were 17 x10^9/L while lymphocytes were 0.5 x 10^9/L. "The results indicated a bacterial infection of the blood," I explained to the mum and daughter. "Luckily it is not a viral infection."

Urine results were very interesting:
pH 6.5, SG 1.039 considered normal

Abnormal:
Nitrite +, Protein 3+, Glucose +, Bilirubin +, Blood 4+, White blood cells >2250/uL and Red blood cells >2250/uL. Bacteria 3+. No crystals or cats or epithelial cells.

"How did the dog get UTI?" the mum asked.

"One reason could be the stress of surgery for perineal hernia and the neuter soon after" I said. "Is he the type of alpha dog who would urine mark every spot even when he has no urine?"

"Yes," the mum said. "I thought all male dogs do that."

"Not all male dogs," I said. "Usually only the dominant ones wanting to mark his territory."

"When a friend's female dog comes to the apartment, he will urinate over her peed area," the daughter commented.

"So, he might be withholding urine for the past 8 years to urine-mark. Urine that is kept for a long time inside the bladder would get bacterial growth," I said. The dog had an alkaline pH and this would encourage bacterial growth and possibly struvite stone formation in the theory of struvite stone formation in the dog. However, this dog ate mainly chicken, rice and carrots and therefore should not be getting struvite urinary stone formation.

After 500 ml 5% glucose saline, baytril antibiotics and spasmogesic, the dog looked active in the evening when the mum and daughter came. He would be given another treatment tomorrow and go home.

"For the past 7 years, he had never seen a vet," the mum said that the dog's veterinary cost was high.

"If you had neutered this dog at one year of age," I advised belatedly. "He would unlikely to develop perineal hernia which occurs mostly in non-neutered male dogs and therefore you need not spend money to cure him.

"In your case, it was lucky he developed only the right sided perineal hernia and so far, with all this jumping up to the daughter's bed and running around so soon after perineal repair, he had no swelling. Otherwise, he would need another repair job. The dog is to confine at home in one place for at least 4 weeks, not jumping about like a Jack Russell."

"My sister's Shih Tzu are so laid back," the mum said. "This dog even bites me." My assistant Mr Saw also warned me about his biting habit.

"After neutering, there will be less aggression and urine-marking over time," I said.
"Will his personality change?" the daughter asked.
"Yes, he will be quieter and not so obsessed with urine-marking like some men who are thinking of making money all day long. Much depends on whether your daughter will spend time playing with him.

"Let him eat more so that he would have the resistance to fight against diseases"
I said as this dog lost 1 kg after perineal hernia, neuter surgery. I could feel the spinal processes. He was now 6.5 kg.

Aug 17, 2010 4 pm
Dog reviewed for going home. No fever. Had a good appetite. Tongue was pink.
Took him out. First thing was to urine-mark a vertical surface.

Cheek tumour regrows in the old male dog

As the tumour recurs, the 11-year-old male dog did not eat again. He would not permit anyone to open his mouth. The lady owner had seen the tumour when the dog yawned and so was concerned. "Some white tissues," she said to me.

I used electro-surgery to cut as much of the tumour from the cheek as possible. It was 1.5 cm x 1.5 cm X 0.5 cm. Like a Singapore 10-cent coin with white plaques. Is it malignant or not?

The dog had to be under general anaesthesia to excise the lump and to get the right lower back teeth extracted too. The reason for extraction of this lower back teeth is to prevent any more irritation. I presumed it was due to the irritation of the lower tooth that caused the recurrence but this was a hypothesis. If this was correct, then the dog would not have another growth two months later and this procedure would save the young lady a lot of veterinary expenses.

"I feel the base for roughness to see if any tumour is left behind" I explained to my assistant Mr Saw. Complete excision of the lesion was done but I can't guarantee that it would be 100% as there was the cheek tissue

I sent the pieces for histopathology.

Pathology results:

Diagnosis:
Spindle and epithelioid cell proliferation.

Comments: The cells may be myofibroblastic/fibroblastic in origin. The differential diagnoses include nodular fasciitis, inflammatory myofibroblastic tumour or a low grade sarcoma, amongst others.


CONCLUSION
Dogs and people with poor oral hygiene (gum diseases,decayed teeth, bad breath) do develop oral tumours when they are old as many years of irritation leads to tumour formation. In this case, the lab report suggests a tumour which may not be malignant.

164. Using social networking to help rescue cats

Article: Breed Rescue 2.0 by Janiss Garza
Cats USA 2101 Annual Volume 17

Today, I met a National Library Board officer at the Toa Payoh Public Library. She does not like cats personally. However she spoke to me about her friend who pays money to caregivers to feed the stray cats and had adopted 4 strays. "She is a stray cat militant!" the single lady in her late 30s who loves to read Newsweek and Times magazine told me. "Actually, she is a stray cat activist who cares very much about the welfare and treatment of the stray cats in Singapore" I said. I asked whether this friend is using social networking to help find homes for stray cats. She would find out.

How does social networking help rescue cats? According to the writer Janiss Garza, these are the ways:

1. Facebook, Blogs, Twitter and You-tube reach more people than an ordinary website to raise awareness, do fundraising for medical treatment and food etc and find homes for the rescued cats.

2. Must update content and give follow-up of what has happened to the cats.

3. Facebook.com. Use "fan" pages and groups as an additional help to the main website. It has many applications to enhance experience of current andpotential supporters and volunteers. E.g. of a facebook group is http://co.siameserescue.org
E.g greatlakesbengalrescue.com received donations and one adoption because one of the volunteers has a blog and twitter account

4. www.blackcatrescue.com marketer, S. McDuffee has the following suggestions:

4.1. Your blog is part of a subdomain of your own website e.g. blog.blackcatrescue.com instead of using blogger.com or wordpress. Search engines love blogs and blogs may drive more traffic to your website

4.2 Connect with blogs for other rescues and interact.

4.3 "Create a page" link in facebook to set up a page on Facebook for your breed rescue that has no website.

4.4 Facebook fan pages are better than groups as they inspire dialogue between the rescue and its fans. The page's status updates will appear on the Facebook newsfeed of any befriender.

4.5 Integrate all together the blog posts, twitter blasts nto your facebook page. For your blog, do a search on facebook for "Blog RSS Feed Reader" to find the application to enable this for your blog and either the "Twitter" application or "selective Twitter" application to add Tweets to your rescue page. Add YouTube account for videos.Photos on Flickr.com.

Use a flip video camera. cheap and easy to use.

5. All these aim to get more cats adopted.


Terms
1. facebook.com
2. The wall: Known as "newsfeed". Where updates are posted.
3. Status update: Known as "What's on your mind".
4. Fan page: A regular facebook profile set up by you.
5. Twitter: micro-blog
6. Tweet: a twitter post
7. Application or app.: software to add to your facebook profile or page to make it more interactive.
8. RSS feed: automatic syndication posting to you blog or twitter, facebook or facebook fan page.
9. URL shorteners for long URL or link. e.g. it.ly and tinyurl

Saturday, August 14, 2010

Generalised ringworm - thin husky

Sometimes a thin dog takes a longer time to recover.
"My Husky has been itchy >2 months. He scratches. He bites his tail. Have you got an e-collar for him?"

"E-collar is no use if you don't solve his skin problem."

"Groomer had clipped him bald. I believe the groomer's equipment is dirty. My vet said ringworm and gave me one big white tablet a day for my dog for 3 weeks."

"What's the name of the tablet?"
"I don't know," the marketing man was as slim as his Huskie.
"Did you follow up with your vet?"
"No, he did not ask me to come back after one month."

Microscopic exam of hairs. - ringworm
Anal sac full of thick grey oil when Mr Saw expressed the gland. "What is anal gland?" I explained to him that the infected gland caused his dog to bite his tail and rub backside on the floor. "Sometimes I see blood on the floor," the man in his 40s said to m.


1. Clipped bald including the head.
2. Irrigate ears.
3. Review in 1 month's time unless he is happy with skin.

eyeball prolapse 10-year-old shih tzu

Sunday:

Shih Tzu, Female, 10 years, 7 kg
27.7.10 eyeball prolapse with extensive corneal ulcerations
Lateral canthotomy, eyelids stitched. Eyeball was pushed back.
Owner wanted to take home immediately despite advice.
At home, the dog could rub eye against cushion corners etc even though she wore an e-collar. Came back on Day 3 with all stitches loose. Re-stitch on 4.8.10.

Came back on 13.8.10. Eye all red. Dog bites. Warded 2 days til 15.8.10 (Sunday).
Corneal vascularisation seen at edge. Photo taken on 15.8.10. Eyeball no longer prolapsed but corneal ulcerations still not fully healed as this is an old dog. Need to explain to the young lady that old dogs, like old people, takes a very long time to recover from wounds. More than 4 weeks in many cases.

Owner advised that healing will take >4 weeks as the dog is old. In young dogs, healing will take <2 weeks normally. Owner will clip ear hairs as they irritate the eyeball (when enclosed inside the e-collar) in my observations. Since dog bites, it will be better if the gentle lady owner does her own clipping. She has a grooming set.
Continue treatment at home. Meloxicalm 0.5 ml/day oral as pain-killer. It will be difficult to review due to economic reasons.

16l. Sunday Case: Male dog with testicular tumour - seminoma.

14 days after neuter, the dog came for stitch removal. Lab report: Malignant tumour comptaible with a seminoma. W

Wednesday, August 11, 2010

160. What to do after surgery to remove testicular tumour?

Lab Retriever, Male, 6 years. Right undescended testicular tumour and atrophied right testicle removed 5 days ago. Greyish-white, large sized and multi-nodular suggested Sertoli cell tumour. To wait for histopathology on malignancy or no malignancy of cells.

The owner asked about post-op management.

This depended on blood test results. Significant findings are:
1. No disorders of liver and kidney function. Glucose is normal.
2. Haematology: Low haemoglobin and red cell count. Low PCV. Very low platelets count. Platelet clumping noted.

Urine results
1. pH=7.0, SG 1.027.
2. Abnormal findings: Protein 2+, Glucose 1+, Blood 4+, WCC >2250/uL, RBC 900/uL, epithelial cells 1053/uL. Bacteria 3+
Bad infection of bladder, prostate (painful and enlarged during rectal palpation), kidney localised as total blood WCC OK. Had been given IV Vit K1 in drip earlier.

Advice:
1. Had been fed meat, rice 1X/day in the past. Very thin. Increase to 2x/day
2. Good quality premium dog food dry to be added. 1 egg/day for 14 days.
3. Antibiotics for next 14 - 20 days. UTI + prostatitis + bone marrow depression.
4. Review in 14 days.

Rotting flesh smell of right ear in 12-year-old Shih Tzu

Surprisingly, a young couple brought in a Shih Tzu with multiple warts. One big bleeding wart on the left ear.

"My vet does not do surgery on weekends, so we come to see you." the busy couple has only 6.30pm to 7 pm to see me. But today is Wednesday.

This is the second case of a dog owner who had been to the vet for the past few years with ear infections, so stinking but no cure. I inserted a cotton bud which came out of the vertical ear canal with bright yellow pus and strong stink.

"My vet would clean the ears and in bad smell, give an injection. We spent a lot of money over the last 4 years. The dog keeps shaking his head daily."

"How long the smell return?" I asked. "Is it over 2 weeks."
"No," the wife said. "A few days."

"A solution will be ear surgery." I got the Sheltie inside for them to see the surgery which was done as it is hard for the couple to visualise the procedure. I showed the horizontal canal opening. The Sheltie's left ear was operated some 8 days ago and the ear canal was clear. No head shaking. However, there was still some pain in the ear canal as the Sheltie moved away as I touched the opening of the horizontal ear canal.

1. Clipped bald
2. Take blood and urine for tests.
3. Irrigate ears
4. Electosurgery to remove warts. Count the number of warts. Marker pen.
5. Goes home with antibiotics for 14 days.

6. 10 days later, right ear canal wall opened up.

Omega 3 and Omega 6 oil for cat with recurring mouth ulcers

Stray cat now adopted by a young couple. His ulcers at the "adenoid" areas have healed 80%. Given canned food only. He had suffered a chronic disease, leading to "indolent ulcers" of the mouth and a high eosinophil count.

He likes the Omega 3 and Omega 6 oil 1 ml 2x/day. If his immune system is back to normal, I presume that he will no longer have oral ulcers and drool. He will not need anti-inflam steroids. Too early to know. Wait and see.

157. Ear surgery Sheltie 11 years old

Sheltie, Female, 11 years. Head shaking and rubbing daily

"The vet advises me to keep the ears dry," the lady was often given this advice from several vets in a big practice she was referred to by her family vet. "How do I keep the ears dry? Her left " In fact, I did give such advices too by asking the owner to plug the ear opening with a piece of cloth during bath time.

The Sheltie's ears were full of dry crusts, as in a scabies mite infestation. Her eyelids were scratched bald.

I examined the dog's ears.

"Every time I see the vets, I am asked to keep the ears dry."

Tuesday, August 10, 2010

156. Tumours in older male dogs

On Aug 11, 2010. I reviewed the 3 cases to find whether they are linked to the male gender. Dogs over 6 years of age are more likely to develop tumours than younger ones. The following three cases are recorded to educate dog owners and help veterinary students in their studies.

1. Maltese, Male Dog, 18 years old
Circum-anal tumour above anus
One testicular tumour 3.5 cm x 2.5 cm x 2.0 cm was sent to the Laboratory for histopathology.

Due to economic reasons, I submitted the testicular tumour and not the other normal sized testicle.
Result: Malignant tumour compatible with a seminoma.
Interstitial Cell Tumours and Seminomas are reported to produce estrogen. Dog has a very good coat. Could it be due to excessive estrogen production?
The circum-anal tumour is more common in male, non-neutered dogs.

2. Labrador Retriever, Male Dog, 6 years.
Retained or undescended left testicle grew explosively to half the size of a tennis ball while the right testicle was shrunken (atrophied). Sent both for histopathology. The dog goes home tomorrow (5th day after neutering). Blood tests and histopathology in progress.







From the appearance, the testicular tumour is a Sertoli cell tumour. Sertoli cell tumours tend to grow very large. They are firm, white or greyish and multinodular. The rate of metastasis is reported to be less than 10%. Early removal will give the dog good chances of survival. I believe that this 6-year-old dog's testicular tumour had been detected at an early stage* by the father or family member. If the histopathology results show a diffuse subtype as contrasted to the intratubular subtype. We have to wait and see. A young lady owner is concerned.
* Around 1/3 of dogs with Sertoli cell tumours show signs of hyperestrogenism (feminization, gynecomastia, atrophy of the contralateral testicle, squamous metaplasia of the prostate and prostatitis, symmetrical alopecia from genital area to cranio-dorsally and bone marrow atrophy.

In bone marrow atrophy - initial transient increase in granulocytes and neutrophils followed by leucopenia, thrombocytopenia and non-regenerative anaemia and granulocytopenia. Death from overwhelming bacterial infections and bleeding.
This Labrador Retriever had atrophy of the contralateral testicle, prostatitis (ping-pong ball sized prostate and pain on digital rectal examination, takes a long time to pee). Will wait for blood test results.

A good report on testicular tumour is at: www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php

3. Miniature Schnauzer, Male Dog, 11 years.
Bad breath complaint in Jun 2010. I had excised large cheek tumour in Jun 2010. Extracted 15 teeth and dental scaling done. The case is recorded at:
toapayohvets.com/surgery/20100618cheek_tumour_old_dog_electrosurgery
_ToaPayohVets.htm
Some pictures are shown as follows:






"There is a white lump in the same area of his previous tumour," the young lady said today. "He would not allow me to open his mouth. I saw it when he yawned." The dog would not permit me and my assistant Mr Saw to open his mouth too. He jerked away suddenly when I gripped his upper jaw. No point fighting and getting bitten. I will sedate and check mouth and teeth. Recurrence of oral tumour likely. Did not send the previous tumour for histopathology to reduce the veterinary costs for the owner.

The dog had no fever but vomited and had diarrhoea 4 X yesterday. The dog will be treated for gastroenteritis first before any exploration of the mouth.

"Oral tumours are associated with the many years of poor dental hygiene," I said to the young and slim lady who does sales. "My advice to neuter him is not to prevent recurrence as this oral tumour. I have not heard of any scientific studies regarding neutering and oral tumours. However, any dog over 6 years of age is likely to develop tumours. Since your dog has a large cheek tumour, I advised neutering to prevent testicular tumours.

"it is well known that neutering of the male dogs do prevent or lower the incidence of circum-anal tumours and the development of testicular tumours in testicle that have not come down from the body into the scrotal bag."

I doubt that this young lady know what I am talking about. I elaborated: "Since this dog has developed such a large oral tumour, it is best to remove his testicles in case he develops testicular tumour. I am not guaranteeing that castration will prevent recurrence of the oral gum tumour and mouth ulcers."

The dog was warded, given the IV drip and medication for diarrhoea and vomiting.

I checked the anaesthetic records for the Jun 2010 cheek tumour (4.5 cm x 4.5 cm x 0.8cm) excised by electro-surgery for reference. Blood test normal results.

BW 12.3 kg
Domitor 0.2 ml IV
Zoletil 100 0.1 ml IV. Body tremors started. Gave Atropine 0.5 ml IV. Tremors stopped. Surgery done. Antisedan 0.2 ml IV. Dog woke up fast.
CONCLUSION

3 male dogs had tumours.

Case 1 - Maltese not neutered. Malignant Seminoma and Circum-Anal tumour. During his old age, he developed testicular tumour (malignant) seminoma and circum-anal tumour. Both were removed and the dog had no anaesthetic problems although he was 18 years old. I used isoflurane gas only. Neutering would have prevented such tumours from developing.

Case 2 - Labrador Retriever not neutered. Testicular Tumour. Surprisingly, at 6 years of age, he developed the testicular tumour so rapidly. Testicular tumours usually happens in dogs of 10 years. Studies have associated testicular tumours may form in undescended tumours (cryptorchidism) in man and male dogs.

Case 3 - Miniature Schnauzer not neutered. Oral tumour was large. Oral tumours develop due to poor oral hygiene in dogs and man, according to several medical reports. There is no association with neutering or no neutering. Teeth cleaning every alternate daily and yearly dental check up most important for your dog if you want to prevent oral tumours from developing in your dog.

goto:

http://www.asiahomes.com/angelfire/20100657testicular_tumours_oral_old_dogs_male_singapore_ToaPayohVets.htm

Latest info at www.toapayohvets.com

Faucitis stray cat

August 10, 2010 review of eosinophilia in a stray cat.
Salivation is the presenting sign. Ulcers in fauces and lower tongue 2 weeks ago. Treated and went home. Came back again as the cat started to salivate.

Ulcers at fauces reduced by 80% today. Cat gentle but dislikes mouth being opened. Wanted to scratch intern Ms Lai. Will the condition relapses? Is there a permanent cure? Not according to the cat experts.

August 10, 2010 review of a cat with urine all over his body.
Urinary incontinence and cystitis. Treated. Thick yellow urine. OK now. Goes home.

August 10, 2010 review of a black cat with red blood. Only 1.5 years old. Why he passes red blood? FLUTD with unknown cause usually. Treated, bladder irrigation 2 days. OK. Goes home. Neuter first.

154. Undescended testicular tumour

Aug 10,2010 report
REVIEW OF A CASE OF A TESTICULAR TUMOUR
DAY 3 AFTER NEUTER

Labrador Retriever, Male, 6 years, 17 kg.
A very thin gentle dog. Poor bodily condition and anaemic. High anaesthetic risk but surgery was necessary.

Complaint 2 days ago: Large lump in the left inguinal area
Noted: Preputial opening black and much swollen. Squatted and took over 1 minute to pee (suspect urethral obstruction, cystitis or prostrate enlargement/inflamation, tumour)

Blood test: Anaemia. Low haemoglobin, red blood cells and platelets. Kidneys and livers OK. No diabetes.

Urine analysis: Wait for lab results.
Urine dipstick by intern Ms Lai who collected urine today and wrote the following: No blood. Protein 1000 mg/dl, Glucose 100 mg/dl, pH 7.0 - 7.5, SG 1.015, leucocytes 500 WBC/ul

IV drip + Vit K1 in slow IV 2 hours
Isoflurane gas mask, neutered 2 days ago.
Prostate as large as a ping pong ball (digital rectal palpation while at the end of neuter anaesthesia) and dog reacted in pain.

Undescended testicular tumour, 4"X3" with multiple yellow nodules. Descended testicle appeared shrunkened and 1/3 normal size. Both sent to the laboratory for histopathology.

"Has the testicular tumour spread inside the body?" the father asked me. "It is hard to say without further tests, scans and X-rays." I replied. "Is it a testicular cancer? I had to wait for lab report.

Undescended testicle may develop into testicular tumour in man and dog. "Have you heard of Lance Armstrong who suffered the same condition as your Labrador?" I asked the father. "No," he said.

I am glad that this dog can now pee at one go. Will review tomorrow.

I gave him an anti-androgenic injection (Tardak). After 24 hours, at 5.30 pm today, Aug 10, 2010, he could just pee normally in one go in less than a few seconds.



Aug 10, 2010
HISTOPATHOLOGY RESULTS
A testicular tumour - sertoli cell tumour.
Comment from the histopathologist: A second interstitial (Leydig) cell tumour component cannot be excluded in this tumour. Most primary testicular neoplasm in the dog are benign. The rare malignant Seretoli cell tumour has no good cytological or histological markers of malignancy. The only way to determine malignancy is to identify metastases in lymphatics, spermatic cord, lymph node or distant sites. Pl correlate with clinical features.


Aug 10, 2010
URINE ANALYSIS
pH = 7.0, SG 1.027

Abnormal findings:
Prortein 2+, glucose+, blood 4+
White Blood cells >2250/uL, red blood cells 900/uL, epithelial cells 1053/uL, bacteria 3+

nephritis? + cystitis + prostatitis

Aug 10, 2010
BLOOD TEST
Total White cell count normal with neutrophils 82% (absolute 7.96), lymphocytes 12% (absolute 1.17), monocytes 5% (absolute 0.45), eosinophils 0.5% (absolute 0.05), basophil 0.4% (absolute 0.04)

but there is bone marrow depression as evident by:

Low platelets 90 (200-500)
Low haemoglobin
Low red cell count

Aug 17, 2010
Phoned owner to check on dog and post lab reports.
1. Yes, can take out the e-collar as it is one week.
2. "The dog no longer limps. We thought he had hip problems," the owner said. "It is the pain in the undescended testicular tumour as the cells are getting necrotic and dying.
3. "Does he attract other dogs to go near him when you took him out for walk?" I asked. "Many dogs would look at home or go near him," he said. "That is the result of excessive female hormone production - estrogen that caused him to be attracted by other dogs. Now, he should be getting less attention as he longer secretes the female sex hormones."

Friday, August 6, 2010

153. Fractured nail in Silkie (2nd case)

"It is uncommon for a dog that is groomed regularly to have fractured toe nails," I said. "Yours is the 2nd Silkie with the same problem in this week. I don't get such cases during the whole year and now there are two."

"Why didn't the groomer clip the nails short so that my dog will not have his nail caught inside the office carpet? He was suffering great pain and was bleeding." The husband took time off to phone me (apparently referred by his groomer who lives nearby his condo) to get his baby treated urgently.

As he wanted to be present, I did not object. He was bigger and more handsome than myself and my assistant and we squeezed inside the small operating room. Normally I disallow owners to view as they distract and disrupt.

Sedation:
Domitor 0.2 IV. Waited 2 minutes and then my assistant put the dog on the gas mask to give the isoflurane gas. "Take away the mask," I said when I saw the dog gurgling. He was about to vomit. Dogs seldom vomit when given Domitor IV but some do.

"I have to change groomer," the husband was upset.
"You can see that the groomer did clip all the nails properly," I showed the husband the other nails including the dew claws. There is no need to change groomers. You can trim the nails yourself in between the grooming session or teach the groomer how to do it."

As I type this record at 6.35 pm, Friday, Aug 6, 2010, I have this hypothesis: The deviated D3 and D4 claws had grown longer as they were not in contact with the ground and probably grew longer since there was no wear and tear. I did not ask when was the last grooming as I did not have time to consolidate my hypothesis.

I did not have time to explain this possibility as the husband appeared to be in a hurry. "Family comes first," he said to his wife. "The dog is the de-stressor in the office and so he is more like a child," the wife explained. When a child is in pain, emergency attention is required.

Dog vomited his food 5 minutes later. "The dog should be on empty stomach but this is an emergency and he vomited his yellow food and water," I explained. Having a husband inside the operation room took up some time. "Do you advise cutting off the deviated D4 claw? After all, the dog already has fractured stump of D3. What is your advice?"

"Just trim it for the time being," I showed how it is done. Imagine a line across the lower level of the pad when placed on the ground. Any claw longer and below this horizontal line (90 degrees to the pad) should be trimmed without pain or bleeding from the quick." I demonstrated by cutting. There was no blood. I illustrate for readers' benefit (see picture at www.toapayohvets.com, goto DOGS).

If the two deviated claws persist to deviate some 6 months later, I will remove them if you have thought over the matter. For the husband, nails are useless and if they cause problems, may as well remove both of them. That means no more overgrown nails and no more fractured nails. I advised waiting although I could have had done it on the spot as the dog was under anaesthesia and the owner was willing. This is one of the occasions that is hard to resist temptations to generate revenue.

Thursday, August 5, 2010

Dog: Teeth scaling and follow-up on an abscessed carnaissal tooth chihuahua

CASE 1. PREVENTING TARTAR BUILD UP IN THE DOG'S TEETH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 06 August, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

A mother with four children - 12 years, 15 years, 19 years and 23 years brought 2 Malteses that are 2 years old for their annual vaccination. She made an appointment for dental scaling. Dental scaling was done under anaesthesia. Lots of brown tartar in the canine and back teeth, but the teeth are still solid and strong.

Questions asked by the mum:

1. Yearly dental scaling? Not necessary if there is no tartar. Just ask the vet to check the teeth.

2. Must brush teeth daily? Yes, if practical. If not, every 3 days.

3. Dog does not like brushing. What to do? Use thumb brush or rag to rub back teeth. Use treats to motivate.

4. How to prevent tartar build up on the teeth? Presently the dogs eat chicken meat mainly. "Add dry dog food for the dog to chew," I said. "There are also chew ropes, but one way is to feed dry dog food and brushing of the teeth."

"My dogs will never eat dry food," the mother said.

"Even you will never eat biscuits if forced to," I said to the caring mother. "The trick is to add 5% to chicken meat, gradually increasing to 50% after one month. Delay dinner as the dog eats once a day."
As I had time, we talked about our experiences in bringing up children and she had four of them. "My 15-year-old is the naughtiest and always wants to go out."

"That's due to her hormones", I said. "She wants to meet boys. You need to spend some time with her, for example. exercising the two dogs together with her. Bonding with her, getting to know her better." I had thought that the 12-year-old daughter would be harder to manage as she should be having hormonal changes to become a woman. Yet it was the 15-year-old. I don't know much about daughters as I don't have any.

The mum said she used to take half-hourly walks when first diagnosed with Diabetes Type II. Now, she gave up exercising. "You need company," I said. "It is just too boring to walk by yourself and spouses are usually not available or interested.

"You have two dogs. Just take one dog down at a time since two dogs are noisy. If you don't take care, you may get diabetes Type I and then you will need to inject yourself everyday ", I advised the mum. She has to take care of herself as she has 4 children and 2 dogs and that is a heavy responsibility.
CASE 2. FOLLOW-UP 7 MONTHS AFTER I EXTRACTED THE ABSCESSED CARNAISSAL TOOTH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
06 August, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

What to do if you, as a vet do not feel comfortable in performing anaesthesia in old dogs which may only be cured if surgery is done?

I know of one vet who just simply refers all cases to another practice. "At least I don't lose clientele when I refer to this practice," the vet told me. This practice has several vets and if this vet believes that referring her difficult cases to this practice will not cause her loss of clientele, I find it hard to believe. I reserved comments. A practice with more vets has higher overheads and therefore needs the caseload to sustain the profitability of the big operation. Recently I asked my mentor about this vet's comments. My mentor who is in his late 60s said: "Once you refer a case, you lose your client."

Referring to other practices means losing clientele. There is no way to stem such losses if the vet does not want to perform risky surgeries that will harm his or her professional reputation.

Deaths on the operating table are very emotional and unpleasant issues. In this Chihuahua with an abscessed carnaissal tooth, the vet just advised conservative treatment for 12 months. This vet would not perform surgery knowing that it would be very risky. Anaesthesia in old dogs is going into areas where angels fear to thread as it is high risk. Yet, some surgeries cure the dog promptly. There is always a big dilemma for vets encountering such situations.

It was a joy to see this Chihuahua some 7 months after I extracted her abscessed carnaissal tooth and many other teeth. I tried my hand at making a short video with the help of an intern at: Abscessed Carnaissal Tooth Diagnosis and Treatment Video Education For Vet Students. Three follow-up pictures of the pretty Chihuahua are taken for viewers:


7 months ago
Dirty, wet itchy left facial area below the eye. The mum had to clean the non-healing wound for the previous 12 months. It was a daily chore for the old mother for 12 solid months.

7 months later
No pain and good looking and a happy mum. The grown up son had to seek a vet who would operate on the dog but he knew it was a high risk anaesthesia. It is not always a happy ending. Yearly dental check up by your vet will prevent so much dramas and worries for the family members who are care-givers to the dog.



More info at: Dogs or Cats
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


Pictures are at www.toapayohvets.com.

151. How to help search engines find your website

Pcworld.com Mar 2010

1. Determine priorities
Develop measurable goals and priorities
What you want visitors to do, buy or learn (products and services more important to promote). Google Analytics reveals which keywords visitors used and more.

2. Research keywords. Free Google AdWords Keyword Tool useful. How often keywords ae searched. Other paid tools offer Keyword Effectiveness Index (KEI)

3. Use keywords judiciously.
3.1 One page on a single subject
3.2 Use keywords in the page's HTML itle tage <65 characters incl spaces and punctuation
3.3 Add keywords in HTML h1 and h2 headings and in the body copy several times
3.4 Create a keyword-rich link elsewhere to each optimised page.
3.5 Add keywords to your site's URLs

4. Create "Linkbait"
from soomeone else endorsing your product or service. Useful if they include a keyword-rich link o your company's relevant page

Ensure your pages have exgtremely useful content (link-bai). Spread the word about a new blog post, page or article via social networks (search engines love blogs.

5. Make website search engine friendly. Bots primarily index text and follows links.
5.1 use a textg browser eg. Lynx to see how mosgt search engine bots see your site. Paste a URL into the Lynx viewer to find out how the page looked.
5.2 No duplicate content or multiple URLs pointing to the same page.
5.3 Creae an XML sitemap. Submit it to search engines.

Keep Going. Review.

Wednesday, August 4, 2010

150. Cat scratched the vet

White cat. 13-year-old. Not eating for past 2 days. Owner was free at 7 pm, so I waited for him.

"Open your mouth," the man in his 50s shouted at the cat. "Some bad breath". Surprisingly this cat growled and hissed but did not scratch him.

I open her mouth to examine for ulcers. No tongue ulcers. Gingivitis. In an instant the cat sunk her claws into my left middle finger. 2 deep wounds. My assistant got me the swab and tissue. I washed the wound well as some people do get cat scratch fever.

The claw outer sheath fell on the consultation table as the cat withdrew her claw. This was a cat that had given warnings but I had to open her mouth to check why she was not eating.

Dehydrated as neck skin stood up 30%. Gave IV drip. Will do dental tomorrow.

149. Rabbit with matted anal hairs and stools, eye discharge

5-year old dwarf rabbit

"Rabbit bites," the young lady warned me. She wanted the rabbit in a one-stop shop with vet and rabbit groomer.

My assistant held the rabbit's head in between the towel while the rabbit groomer clipped the hairs carefully. My intern Ms Lai held on to one leg to assist the groomer. The rabbit seemed quiet. Eye discharge removed. Paw hairs trimmed. "Trim the belly and scrotal area," I asked the groomer. Matted hair and big stool in hair clipped off.

Warm water in bath tub. Rabbit bathed. "The owner said that the noise of the hair dryer upsets the rabbit." So the groomer blew dry from far away. The rabbit did not panic.

Only the lower left incisor was normal size and overgrown. The other three were around 2 mm long. Why?

"Vet 1 clipped the two top teeth some months ago. The two teeth just fell off. This rabbit had no teeth problems in the past years."

Rabbit looked good. If the rabbit does not bite the family members, the rabbit can be groomed at home. Eye cleaning is important. Easily said than done.

148. Weighing hamsters

"It is important to weigh hospitalised hamsters daily," I explained to Ms Lai. The dwarf hamster with cellulitis had lost 4 grams since admission with a foul stench. A rotting flesh smell permeated the consultation room. On Day 1, 48g bodyweight , it was bathed.


Still has bad body smell. Now 44g. Lost 4g. Bathed on Day 3 (I took pictures of bathing hamster. He seemed traumatised but had to bathe him as he was very dirty and infected).

1.We bathed the hamster in warm water as he was still active. No cold water. A lot of dirty white flakes and hairs washed away.
2. Dried with tissue gently on ventral aspect. Do not be too heavy-handed as lower body skin is infected badly
3. Baytril and pred oral. Electrolytes.
4. Need to hand-feed.
5. Hamster ate the next day.

Day 4. Felt better. Given electrolytes every hour or so. Ate. Passed stools.
Day 5. More active. Liked to eat golden yellow flakes. Passed stools. Skin on shoulder not so red. Picture taken. Loose yellowish brown stools observed on photograph. Stop electrolytes. Now 41 g.
Got to hand feed him ground pellets every hour or so but he is eating too.

Tuesday, August 3, 2010

147. Advices on dental tartar

A mother with four children - 12 years, 15 years, 19 years and 23 years. 2 Malteses at 2 years old.

Vaccination. Done.
Dental scaling. Lots of brown tartar but teeth are still solid and strong.

Questions asked:
1. Yearly dental scaling? Not necessary if no tartar. Just check up.
2. Must brush teeth daily? Yes, if practical. If not, every 3 days.
3. Dog does not like brushing. What to do? Use thumb brush or rag to rub back teeth. Use treats to motivate.
4. How to prevent tartar? Presently the dogs eat chicken meat mainly. "Add dry dog food for the dog to chew," I said.
"My dogs will never eat dry food," the mother said.
"Even you will never eat biscuits if forced to," I said to the caring mother. Her 15-year-old is the naughtiest and always wants to go out." That's due to her hormones, I said. "She wants to meet boys. You need to spend some time with her, e.g. exercising the two dogs, bonding with her, getting to know her and reducing your weight too. Just take one dog down at a time since two dogs are noisy."
I said: "The trick is to add 5% to chicken meat, gradually increasing to 50% after one month. Delay dinner as the dog eats once a day."