Sunday, September 16, 2012

1099. Sunday's interesting cases Sep 16, 2012

Sep 16, 2012.

A wearied stress-out man whom I knew to be a tenant of Toa Payoh North industrial park came to my office at 9 am saying that "my dog was not fed and therefore barked all night long."  He said: "The barking noise is even louder at higher levels of the building esp. at 6.30 am!"

I showed him the crates and he could see bowls filled with dog food. We feed the dogs in the morning and evening. There was one particularly noisy Jack Russell whose owner went on holidays overseas to Delhi for more than 10 days and his friend did not want to help take over. His dog was spayed and he complained that she vomited 2 days after the spay. Actually he had applied tick insecticide wash on the dog. She was still eating and is normal but now the owner's friend did not want to look after her. Jack Russells are notorious barkers. My assistant Min just ignored them but actually, the caregiver should "scold" them with "no barking".

"I last consulted you 7 years ago," the man in his late 50s said to me. His cat was 8 years old and very itchy. Raw sores up to 2 cm in diameter esp in the neck and all over the body. As he came past 11 pm, I handled the case with my associate vet (Vet X). "What's your diagnosis?" I asked. "Possibly allergy," Vet X said.

The cat had multiple circular lesions, many of them black. "Did you check the hairs microscopically?" I asked. "Yes," Vet X said but was not convinced that this was primarily a ringworm case. Cat flea bite all"ergy was probably what Vet X thought of or other forms of allergy. This is what I mean when I say that each vet will give a different diagnois to the owner in many skin disease cases and confused the owner.

I took out the UV lamp, switched off the consultation room light. I asked the owner to see the green fluorescence from the UV light on the neck sores. I asked Vet X to be around too. The light was scanned onto the left neck area where the owner said was recently affected. A turf of bright green hairs appeared in one of the neck wounds, indicating a possibility of ringworm.

"The owner had been treating the cat's skin disease for over 2 months,": I explained to Vet X. "He can't cure and so he came to consult the vet. His medication and washes had removed much of the old ringworm areas where you see black circular spots. But he could not cure the cat as the ringworm has spread and is generalised ringworm."
It is not so easy as described in the textbook to find classical ringworm in any cat or dog as most of the owners will treat themselves with pet shop medication first. It is a long road to educate vets whose mindset is straight from the text books as in real life, diseases are not so clear cut as described in vet textbooks on ringworm diagnosis!

"4 years ago, you removed the abscess and bandaged the skin," the lady in her 30s had a young rabbit with abscess popping out of the skin of the left hind leg. "I had difficulty removing the bandage. Now the same area has abscess again."

"I remember you," I said. "You are a teacher. It is surprising that abscess come back again after so many years."

The owner had said he would take the dog back on Sunday (today) but he did not turn up. I took out the urinary catheter. There was some mucus. "Cathethers cannot be placed too long," I said to Dr Daniel as it irritates the bladder. In this case, I placed it for around 4 days as there could be a tear in the bend of the urethra and I did not want that area to close up. If it closes up, the dog can't pee. This was a much complicated case and is being managed on prescription S/D diet.

This was one of the few Sundays when the surgery closes "early" I was present and saw the crowd at 4.30 pm. Time management is important as wait times can be very long if everybody wants to see Dr Vanessa and comes at 4.30 pm. The closing time is 5 pm and I asked Dr Daniel to handle a vaccination case. No point making the lay staff work till 6.30 pm unless there is an emergency.

Associate vets should prepare the medication of spays etc early and not wait to do it when the owner comes at 4.30 pm. This is why there are delays and increasing wait times.

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