Sunday, January 2, 2011

287. Jan 2, 2011 (Sunday) cases

Bright sunshine day. Sunday. Most vet clinics are closed but Toa Payoh Vets has traditionally been open on Sundays. As Dr Vanessa is on leave till Jan 10, 2011, I work the whole day. If not, I will work from 9 am to 11 am on Sundays and weekdays.

INTERESTING CASES
CASE 1. GUINEA PIG NEUTER
A young man wanted his 2-day-purchased male 6-month-old guinea pig to be neutered. "The female is still with Pet Lovers' Centre," he said. "I don't want her to get pregnant. So I keep her there first." It is best not to neuter so soon after purchase.

"Is the guinea pig adjusted to your new home? Is he passing stools?"
"Yes," the man said. "Lots of stools. Too much. He is running around happily. In fact, I purchased the anti-stress powder as advised by Pet Lovers' Centre."

Since the guinea pig was OK, I agreed to neuter him. There is no point rushing to neuter newly purchased guinea pigs or pets as demanded by owners as they may be incubating diseases. After the surgery, the disease shows the symptoms and the vet gets the blame.

ANAESTHETIC RISK
This guinea pig weighed only 500g. What anaesthetic to use? The following was done successfully.

PER KG Bodyweight, Domitor 0.2 ml and Ketamine 0.1 ml in one syringe, totalling 0.3 ml.
I prepared the above and shook the syringe a few times. In this 500g guinea pig, I injected 0.15 ml SC. The guinea pig squealed during injection. 5 minutes later, surgical anaesthesia was excellent for the next 5 - 10 minutes. Neuter using 1 ligature (twice knotted) on the close tunica was done.

ANTIDOTE. Many guinea pigs will wake up slowly by themselves. As the guinea pig was young, I decided to wake him up after surgery. He was breathing but not standing. I gave Antisedan 0.1 ml (with saline) SC. Within 2 minutes, he was awake and squealed when carried to the crate.

When the owner came, the guinea pig was standing. Pain-killers, antibiotic and Fibreplex were given. This was the ideal treatment regime for this guinea pig.

CASE 2. 8-YEAR-OLD SCHNAUZER HAD FITS AND VOMITING. The young couple had been giving, at home, the Hartman and saline drips SC from Vet 1 who had diagnosed chronic kidney failure. Since Vet 1 was closed today (Sunday), I was consulted as the dog had 3 episodes of fits and was gasping for breath. Vomiting had occurred.

"Vet 1 would be giving TCM tomorrow," the couple said to me. I had to be frank with them that their dog will not live long once fits are seen as the toxic blood from the kidney failure causes uraemic fits. "It may be kinder to let the stop more suffering as some dogs die violently vomiting blood." It was bad news. In any case, I advised that the dog be given IV drips (glucose of 50 ml, dextrose saline, antibiotics, anti-fits, anti-diuretics and painkillers).

"Vet 1 had not given antibiotics but this is a matter of judgment," I said to the owners. "Each vet has his own way of treatment and I don't want to cause blame on Vet 1 nor do I want other vets to cause blame to me."
The dog was hospitalised and we would wait 24 hours. Economics play a great part. The couple did not want blood tests and so the present treatment would suffice. There is no kidney dialysis and transplant for dogs in Singapore and if there were, the costs would be too much for the ordinary folks. This was a very sad case.

CASE 3. The black cat bit the lady's nose.
A handsome couple. I noted the bespectacled fair lady had a 2-cm scratch on the left side of her pale white nose and kept quiet. She had came with her husband to visit the hissing black cat hospitalised and given treatment by my associate Dr Jason Teo yesterday (Saturday).

"How's the cat today?" the slim lady in her 30s asked me. "No more high fever," I replied. "She can go home to her safe environment as she looks stressed here."
There is no pure cat clinic in Singapore and some cats may not be happy to be hospitalised with dogs. I put sick cats in a different location away from dogs but still there are dogs around.

"What's the cause of the fever?" the young lady lawyer said that the cat was brought outdoors on a leash the day before. The cat was reluctant to go out and rushed to hide inside a shrub. She had been frightened sometime ago when a dog came towards her. She was perfectly happy in the apartment but the owners wanted to give her some outdoor exercise. "Is she suffering from a viral infection?" the young lady asked. The cat had her vaccinations.

"Some bacterial infection from the soil," I speculated. "Then you put more chemicals on her body by using body wipes and she tried to lick the perfumed smell away. Together, with the stress of outdoors, she developed fever as her immune system must be down."

As my associate did not take a blood sample, I did not confirm the bacterial infection but the sudden onset of high fever and outdoor exposure to soil would point to a bacterial infection rather than a viral infection.

"Did the cat scratch your nose?" I asked the lady.
"She bit me on the nose when I said hello to her," the lady laughed. "Just a gentle bite and she did not dig her teeth into my nose."
"Fortunately you are married," I presumed. "If not, your marriage prospects are poor!"
It would not be true as the lady had that innate inner beauty expressed through her communication, facial gestures, physical attributes and voice. It is hard to describe this inner beauty presented in some handsome young ladies. Charisma? You just feel the good and gentle vibrations.

The cat went home. Later the gentleman phoned: "The cat is not eating." I said: "Wait another 24 hours. She may be recovering from her stress."

CASES 4 & 5. BACK SPINAL AREA ITCHY IN 2 CATS. Two cats, with back spinal area itchy. One grey cat had grown a different golden brown patch of hair but was still itchy. I could not find any fleas as I thought it could be flea-bite allergy. The owner could have given treatment. I checked the anal glands. Dried, black grey particles of oil. This could be a cause. It is hard to say. I gave an anti-itch injection. As for the second cat, its back area was matted. It was fat and had dirty years. It was constipated despite being fed "hair ball diet" from Royal Canin. I got the groomer to clean her up, clip her coat and hospitalise her one or two days to treat the constipation and observe her.

CASE 6. PERIODONTAL DISEASE STAGE 4. The father and son tried to delay dental treatment but now the old 8-year-old Silkie had pus in the mouth and lost weight. "My cat must be in Stage 5," the son said when I showed them the pictures of Stage 4. "No more stage 5," I said. "The worst stage is Stage 4." I hospitalise the dog for IV drip and antibiotics treatment before doing dental work the next day (Monday).

CASE 7. TRAUMATIC INJURY IN LEFT EYE. "Can it be glaucoma? Do you do eye glaucoma test?" the lady presented me an old mixed terrier with a white cataract eye. The dog had been scratching the left eye as I noted that the eyelid areas were reddish.

"Did this acute conjunctivitis happen after the injury?" I asked. "Yes," she said. "In this case, it is best to check for traumatic injuries in the upper eyelid." The lady said: "There is a black spot inside the upper eyelid." Indeed there was if you evert the upper eyelid fully. I took some pictures. "This could be a foreign body stuck inside, making the dog crazy and painful in the eye. Therefore he rubs his eye trying to get rid of it."
I will be examining the dog under anaesthesia on the next day and cut off the black spot. Sometimes, the cause is not obvious and we think of glaucoma which may still be present.

I finished work at 6 pm and went to watch "Gullivers' Travels" at Ang Mo Kio Hub with my family. It was probably more interesting to a child.

No comments:

Post a Comment