Wednesday, October 31, 2012

1166. Follow up on heart attack obese Tibetan Spaniel

Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.

She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it. "

"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."

"I gave him the dog treats which I had bought a lot," she did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.

If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that wel educated on this aspect.   

Tuesday, October 30, 2012

Struvite stone Schnauzer eats today

Oct 25, 2012

At 6.30 pm, I saw the Schnauzer licking vigorously the operation area till serum oozed out. I changed to a bigger e-collar.


Oct 30, 2012
In hindsight, the dog could have felt itchy in her op area as she was walked for more than 5 minutes every morning at around 9 am by my assistant Min. Movement affected healing and stretched the long skin incision. As at Oct 30, 2012, the dog was at home for the past 3 days and no problem is encountered. The vomiting had disappeared. Owner must follow up on urine analysis for the next 3 months, but most owners are time-pressed and fail to do so.  

1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel

Tuesday, October 30, 2012


1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel



REVIEW OF AN UNUSUAL CASE



"I paid over $700 and the vet does not know what's wrong with my dog!" the owner had to paid for the emergency treatment for continuous panting which started on Friday at around 6 pm. She brought him to the emergency practice at 10.15 pm and the next morning, the dog was still furiously panting.



"It is not easy to diagnose what's wrong in some cases of uncontrollable continuous panting," I told the owner. I auscultated the lungs and heart on this fine sunny Saturday morning of Oct 26, 2012 at 10 am. The lung sounds were harsh and loud - the rhonchi and the rales of bovine pneumonia as that was what was taught in my Glasgow vet school in my final year in 1974.



Basically these were descriptions of the crackling noises in the lungs obscuring the heart sounds. Dr Jason Teo closed the muzzle while I placed the stethoscope inch by inch on the cardiac area of the left chest. I heard a "machinery murmur" in the midst of rapidly beating heart. It was just impossible to hear anything.



The dog had been panting non-controllably since 12 hours ago.



HISTORY

Thursday, Oct 25, 2012 - Nothing wrong. As usual playing on his own. Excellent appetite as usual.

Friday, Oct 26, 2012 - Did not poop since Oct 24. Brought him downstairs to walk and poop in the morning at 10am. Walked for only 10 minutes in the car park, not hot. Dog wanted to go home. Ate t home.

Then at 6 pm, dog started to pant heavily and continuously and at 10.15 pm, owner brought him to the emergency centre.



EMERGENCY CENTRE BLOOD TEST ON OCT 26, 2012 AROUND 10 PM

Tibetan Spaniel, MN, 28.4 lbs, 3 years, 39.8C

RBC low 1.95 (5.5 - 8.5)

HCT low 13.2% (37-55)

Hb is normal



WBC high 20 (5.5-17)

N 50%, L 37%, M 10%, E 3.4%, B 0.5% all normal

But L is high 7.15 (0.5-4.9), Platelet is low 62 (175-500)



High values for glucose 154 (74 - 143), TP 8.5 (5.2 - 8.2), GLOB 5 (2.5-4.5), TBIL 2.8 (0-0.9)



CHOL 159 (110-320) is normal





TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM on admission to Toa Payoh Vets. The dog had been treated by Vet 1 on Friday evening and overnight and had done a great job. But the owner was not impressed as the dog was still panting continuously.

13 kg 39.3 C. The significant findings are shown below:



TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM

Tibetan Spaniel, MN, 13kg, 3 years, 39.3C



Lipid profile

High total cholesterol 6.27, HDL chol 4.26, LDL < cannot be estimated due to interference from elevated triglyceride level, triglyceride 8.68



Liver profile

ALT 236 (<59 3151="3151" ast="ast">


Total WCC 26 (6-17)

N 95%, L 4.7%, M 0.3%, E 0%, B 0%. PCV and platelets normal. The neutrophil count at 95% is very high, indicating that the body produced lots of neutrophils to fight the bacteria in the blood and body.



The relevant finding for Vet 1 and me is that the total white cell is very high. This indicated a bacterial infection of the blood. This bacteria was of the type that the antibiotics took more than one day to control it.



My hypothesis: The heart, lungs and liver were infected and the dog was in great pain and therefore panted continuously as part of the whole process of infection.





The problem for me on this Saturday morning and afternoon was that the dog kept panting after the sedation of dom + ket given at 50% IV wore off. Continuous panting started after 2 hours. Gave IV diazepam, lasix and usual IV drips. At times, the tongue turned cyanotic. The panting was still continuous throughout the night but at 50% lesser pace. Nothing seemed to control it.



SUNDAY

Panting still persisted esp. after the owner visited with her 85-year-old mum who was most worried. The dog tried to stand up despite sedation. The owner changed the water bowl and wiped the dog. I told her not to stay more than one minute as the dog got excited and panted again. But she would not listen. The dog had "recovered" but that was due to medication. Soon the dog started to pant continuously again. "The dog is very sick and should not be visited," I said to her. One of my other clients said to me: "You are harsh to her." I told him that I had spent my Saturday afternoon ensuring that this dog's health was deteriorating and it should not be excited by getting up to greet the owner. I understand that the owner was anxious and worried to see her dog but visits ought to be very short in the interest of the canine patient.



"Do you visit a person in intensive care and change the bandages?" I asked her. "Let the dog rest and recover. If you insist on visiting the sick dog, please consider another clinic." It was a busy Saturday afternoon for me, trying to stabilise this dog as his panting would return once the sedation wore off. This was an unusual case but not uncommon.



If this dog kept panting for many hours and days, his heart would fail and he would die. The owner must understand the situation and not insist on patting the sick dog for the first day at least.



MONDAY

Got owner's permission to do X-rays of chest and abdomen again, ultrasound of abdomen (no gall bladder obstruction or pancreatitis, liver enlarged, urinary stones x2) and ultrasound of the heart (one coronary artery blocked 30%, dilated cardiac myopathy right heart). Panted again when brought to X-ray but much less.



TUESDAY

On heart medication. Dog no longer panted and the owner came to bring him home. Panted when brought out of the cage.



ADVICES

Some bacterial attack in the blood causing such sudden onset continuous panting. This would be my tentative diagnosis. Ultrasound did show 30% blockage in one coronary artery and Vet 3 diagnosed dilated cardiac myopathy of the right heart. Acute bacterial pericarditis?



The dog is obese and so high cholesterol and triglycerides were found. The dog should stay at home. Not going out for one month. No greeting neighbour's dog. Heart medication and H/D diet. This is an unusual case as continuous panting had persisted for over 48 hours despite medication. I agreed with a poor prognosis from Vet 1 but veterinary medicine is full of surprises. The dog survives after intensive treatment.



My associate vet said to me: "Better not to handle this case." I understood his concern he did not want any litigation and complaints if the critically ill dog with no hope should die at Toa Payoh Vets. Dogs do die and many owners don't forgive the vet. So I understand his advice. Yet, for this owner, it is hard for her if she had to go to the 3rd vet as time was of the essence in treating a continuous panting dog.



Day 1 of panting Day 3 of panting Day 3 of panting

Dog was not furiously panting on Day 3, so the X-rays are clearer. Ultrasound of the heart & abdomen were done



Bacteraemia was present on Day 1 & 2. The dog was stabilised on heart medication on Day 4 and is OK so far

Wednesday, October 31, 2012

1166. Follow up on heart attack obese Tibetan Spaniel



Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.



She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it."



"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."



"I gave him the dog treats which I had bought a lot," the owner did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.



If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that well educated on this aspect.



In conclusion, the dog had short episodes of panting during walks and had recovered but this time, he just had uncontrolled continuous panting. A bacterial infection of the blood was present. As to the source of the bacteria, it could be from the dog treats or the soil during exercise.

    Update at:
http://www.sinpets.com/dogs/20121101Tibetan_Spaniel_continuous_panting_toapayohvets.htm

Thursday, October 25, 2012

1162. A 15-year-old Persian cat

"I went to Vet 1 twice and blood tests were done twice," the man in his late 60s said. "Nothing wrong. I was asked to give A/D by mouth daily and I have been doing it for 2 weeks. My cat is losing weight and not eating. She used to eat well till two weeks ago."

I did an abdominal palpation. The thin kidney meowed when I palpated the left kidney. I advised a blood test. The clues from the owner are important. He said: "My cat would look forward to the dry cat food but after one bite, would not eat."

"Is there mouth ulcers?" I asked. The cat clawed me and objected strenuously to her mouth being opened. I could see one left upper canine tooth gum was much bigger at around 5X the other. Was there a gum tumour causing pain? Was this swelling present at young?

What is the solution? I advised another blood test. But what is the diagnosis and the solution?
This is a difficult case. Dr Daniel said there was a big firm lump in mid-abdomen. Yes, there was one but it could be the kidney or bladder. He was sure they could be intestinal or abdominal tumours.  "An X-ray may show," I said.

I gave the cat an IV drip and medication. Will need to wait and see after the blood test results come in.

1161. A happy father

Hari Raya Puasa story

It is very rare to see a father sending the adult daughter and her dog to Toa Payoh Vets but this father did it. The daughter had bought a very small and thin Shetland collie from the pet shop without the father's knowledge.

"Children do that," I said to him. "They just buy the puppy and bring her home in case you object if she ask you for permission."

"I keep dogs," he said. "I don't object. But she has bought a stunted weak and thin Sheltie."
"Some  mothers do object," I said. "Could it be your wife?"
"Yes," he said. "In the end, the parents have to look after the dog. Why did she buy such a poor specimen?" He could easily have paid for a good quality puppy. In any case, this Sheltie was 9 months old and was at the kennel for some months, without a hope of a sale.

"Women are kinder to the disadvantaged and sick animals than men," I said. "What would happen to all the weaker dogs if every woman buys just the pick of the litter or nothing? I will examine her heart and lungs and do the blood test to check whether the kidney and liver are ok."

The Sheltie objected strongly to me examining her mouth. She even bit my assistant. "There's gingivitis. See the red line at the gum-tooth level. It is painful. There is tartar and the 4 puppy canine teeth which had not dropped off. Take antibiotics for 7 days and come for dental work."

So, today Hari Raya Puasa was the appointment date. I was taking pictures of the hamster patients (one with skin behind the head and above the neck very itchy and the other one with pus in the swollen right eye). The father and daughter came with the Sheltie.

"The dog is more active and eating after the antibiotics," the daughter told me. "The gums are less inflamed and the red line between the teeth and the gum had vanished by 90%". Under general anaesthesia, the 4 puppy canine teeth were extracted by Dr Daniel.
"Are you a happy father now?" I asked the gentleman who is probably the same age as me. "The blood test confirmed no liver or kidney or blood system problems. This Sheltie is just born small sized."

Yes," he nodded. I was most happy for the dog too. She had lived inside the pet shop for at least 9 months and had difficulty eating due to the obstruction and pain from the retained teeth. 



 

1160. Follow up: A happy Hari Raya Puasa. The constipated Hougang cat

Today, Freiday Oct 26, 2012 is Hari Raya Puasa, breaking the fast for the Malays. I was at the office at 8.45 am.

It was too early to phone but I would not have time later. I dialed the handphone of the well-groomed and well-dressed Malay lady with the 2-year-old Hougang cat that came yesterday evening. Her cat was spayed by Dr Daniel 5 days ago. But Nike was meowing and panting yesterday afternoon at around 4 pm. I could hear the sounds of the cat over her phone call. "She has not pooped since the spay," the lady said. "What shall I do? I am worried about this non-stop panting and panting."

"I advise coming to me for examination and to give an enema," I said. "If you wait and see, and if the cat's panting and meowing worsen after midnight, you will have to pay a lot of money for emergency treatment!"

At 7 pm, the cat came. She was normal and her panting had stopped. One cool cat not bothered with the dogs barking in the waiting room. "My husband is in the car outside," the lady said. "I am not afraid of dogs. Shall I go home since the cat is now normal?"

This was a tough question. If I said yes and the cat's symptoms returned past midnight, the lady would have to pay 3-4X normal vet fees. She would be more stressed as she loves this cat very much. Non-stop meowing is as stressful as non-stop panting for a cat owner. The neighbours may be disturbed too.
"It is better than I sedate the cat and put in an enema tube in her anus," I said. "If the cat is not fierce, I would not need to sedate. However, this cat scratches and if I give the enema without sedation, there will be no second chance."

So, the lady with her reddish brown silky Malay headwear and clothing held the cat, placed on my operating table,  tightly on the chest area. My assistant Min held the right hind leg while I squeezed into the narrow corner looking for the back muscle of the left hind leg and not intruding into the personal space of the lady. I injected. The cat jumped a bit but her owner held tight. "Put her back into the carrier," I said. In the owner's presence, the domestic cat seldom becomes frightened and attack the vet. I asked the lady to wait in the waiting area.

In 10 minutes, the cat was sedated. My assistant Min pressed the rectal area. A 1-cm brown piece of stool came out. There was no more. "Hold the cat's backside upright," I said to Min. "Pump in the enema fluid." I put the cat back into the carrier.

"All the stools have come out?" the lady asked while her husband patiently waited outside in his parked car.

"No," I said. "All systems including the intestines shut down during sedation. The stools will come out when the cat is awake."

"When?" she asked.
"Most likely next day."  Sedation:   Xylazine 0.15  Ket 0.6 ml IM, 2 year old



FRIDAY OCT 26, 2012 I phoned the owner.  Hari Raya Puasa. Her husband asked her to answer my phone call.

"How's Nike?", I asked. "What time did she wake up from sedation?"
"He woke up at 2 am. She vomited 5X. Food and water."
"What time did she wake up in the morning?"
"I woke up at 6am and I saw her walking around the apartment," the lady thought I was asking about her waking up. "I gave her food and you know what?"
"What happened?" I asked.
"She pooped a lot!"|
"What do you mean a lot?" I asked.
"A very long piece. From the end of my middle finger to my wrist! Jhard and solid. And two small pieces of the size of my thumb!"

"Was there any hair inside the long stool?" I asked.
"I did not check," she said. "But there was a big hairball when she vomited at 2 am."

"Does your cat groom a lot?' I asked.
"What do you mean?"
"I mean every few seconds, she would clean her fur."
"No, but she would groom for a long period of time when she is not playing with me."

This was a most happy cat owner on Hari Raya Puasa. She had agonised for 2 years as to whether to spay her cat or not and when she decided, the cat would not take the medication. She had asked her husband to collect some antibiotics and pain-killers as the cat threw out 50% of the medication. So the husband came on the 3rd day after spay. And on the 4th day, this cat meowed and panted in the afternoon, further worrying her.

It was a happy ending. If I had asked her to "wait and see", the constipation would be harder to treat as the stools would be very hard. The cat would feel the pain of passing motion and that could be why she panted. I had asked her to feel the hard long stools of the colon when the cat was sedated yesterday. She could feel it, but nothing as impressive as the passage of the hard stools this morning! 

As for the spay wound, it was very clean as the lady showed to me. Not a bit of inflammation as she had taken great care to give her cat medication and pain-killers as instructed. Most owners would just give up.










       

      

The Brazilian girl's hamster has a swollen eye

Dwarf hamsters are quite popular in Singapore in 2012 as Toa Payoh Vets see more hamster cases nowadays. Yesterday I asked a Japanese mother on how she selected Toa Payoh Vets.
"I google hamster vets," she said that not all vets treat hamsters. "I saw your webpage."
What she said is true in my backyard. One of my associate vets prefers not to perform hamster surgery at any time as they are such fragile anaesthetic risks.

"No, you did not," the pretty and fair 8-year-old Brazilian daughter said. "You google Singapore vet."
"I did not," the Japanese mother replied. "You saw Singapore vet. I type hamster vet in Singapore."
"Children nowadays are very observant and watch what mothers do," I was much impressed with this little girl's close bonding with the mum. "How old is your hamster?"
"We bought her in January 2010," she said.
"That would make her 2 years and 9 months old," I noted that this hamster with the left swollen eyelids was not so active.
"Dr Vanessa will examine the hamster with me," I said. "Does she bite people?"
"Sometimes."
Dr Vanessa wore her glove in her right hand to weigh and examine the hamster's swollen eye. She pressed down the lower eyelid. Pus oozed out.
"We have to hospitalise the hamster for one day, anaesthesized her to remove the pus from inside the eyelids," I said. "Anaesthesia will permit us to do a proper job of lancing the abscess."
Some vets will prescribe eye drops but it will not work in this case as the eyelid abscesses are large.      

It is best to equip yourself with the appropriate surgical tools for hamster surgeries as the ones for the dog and cat are too big. See pictures below.

Wednesday, October 24, 2012

1157. KPI - Uroliths surgery. Audit of one calcium oxalate case

Date of Audit: Oct 25, 2012
Urolithiasis - bladder stones calcium oxalate removed by an associate vet, Dr Vanessa

Owner has financial constraints
Oct 2.2012
Maltese, Male, 9 years, 3.1 kg, 38.5C
Straining to urinate. Blood in the urine

Anaesthesia & Surgery Record No. 207
Declined urine analysis
X-rays done
Cystotomy -  several uroliths
Stone analysis - Calcium oxalate
Sutures - monosyn 3/0 x 2 packets

C-B:  Isoflurane + O2 on to switched off  - 46 minutes
E-D: Skin stitched up from lst skin incision - 43 minutes
E-A:  Sedation injected to skin stitched - 66 minutes


COMPARISON TO ONE CASE OF EXPLORATORY LAPAROTOMY & CYSTOSTOMY DONE ON A MINIATURE SCHNAUZER BY ME (DR SING KONG YUEN) IN OCT 2012

ANAESTHESIA
A: Inject sedation drug 10.20am
B: Isofl first given 10.27 am. Mask, then intubate. Dog vomited again.
C: Isofl stopped 11.37 am
D: First skin incision 10.39 am
E: Completion of skin stitching 11.37 am

E-A = 57 min
E-D = 58 min (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min



No post-op complaints as at Oct 25, 2012. Phoned owner at 11.30 am today. No response from phone. Phoned home number. Spoke to a lady. Dog is OK. No urination problems. Had stitched removed. This urination problem existed for some months. Advised to see associate vet who operated on this dog, regarding the feeding of U/D diet and stop feeding dry food presently given.




Health check on a big-sized 13-year-old male Jack Russell

The lady owner was studying medicine in the US. When she came back for a holiday, her Jack Russell was scratching his eyes till the eyelids bled, his chest so that it was red and his penile skin till it was bald, the four paws with deep red blood in between the toes and on the toes. What was the cause? Yet the ears were spared but I saw crusty lumps on the edges of the left ear. Scabies? Allergy? Demodecosis?  Skin scrapings were negative.

Blood test - monocytes higher than normal at 11.2%.  Other values are normal.
Calcium and uric acid within normal range. Liver, kidney, joints normal.
Dental scaling done.





X-rays showed no radio-dense urinary stones but there is possibly one in the bladder area. It is hard to tell on the lateral view of the X-ray.
Urine showed calcium oxalate crystals
pH 6.5,  SG 1.022,  Protein 2+, Blood trace, Crystals calcium oxalate occasional, bacteria occasional.

The "occasional" presence of calcium oxalate does not mean there are no urinary stones. Absence of crystals does not mean there are no urinary stones. Much depends on the clinical signs of blood in the urine. The dog was furiouslylicking its penile length till the area was red and hairless. This was unusual. There could be difficulty in urination but nobody knows as the caregiver owner was studying in the US.

FEEDING OF U/D CANINE NON-STRUVITE URINARY TRACT HEALTH

Indications: Urolithiasis due to calcium oxalate, urate and cystine stones; end-stage kidney disease
Decreases purine intake and uric acid excrerion, which lowers the risk of forming urate crystals and uroliths

Monitoring Urine SG, urinarypH and BUN will let the vet know the food's effectiveness and owner compliance. Dogs fed on this diet commonly show unusual lab values like USG <1 .020=".020" bun="bun" dl="dl" mg="mg" p="p">
Long term use: Check for protein depletion as U/D is a low protein diet to decrease urea production,  but the protein level is suitable for maintenance of the adult dog. Advise a fasting serum chemistry profile and ECG every 6 months.









  

Tuesday, October 23, 2012

1155. A hamster from Italy


On Sun, Oct 14, 2012 at 7:21 PM, Valentina C...@gmail.com> wrote:
Dear Sir/Madam,

I am Valentina and I am writing from Italy. I have a one-year-old dwarf male hamster and he has got a problem; I only realized it yesterday. I follow from here all your surgery cases and your successes, the photos and the articles on the web site, so I thought it was better to write down a line to have an advice from you, because you are experts and I admire your job.


This is my first hamster and I do not what to do, really, I am desperate, because so far we had any kind of problems. The problem is related to its lower area of the body, and it's like an abscess or a tumor or something like that because it is a hard distended underskin lump near the penus.




Here in Italy the vets are closed on saturday and sunday so I medicated it as I could on my own, doing some chamomile hot packs.


Do you think he probably will go through a surgery? What am I supposed to do? Please help me, I'm sending you some photos. Talking about the hamster, he is acting as normal, it is not weak, he plays, eats, sleeps.... Thanks a lot, you really do not know how important is to me if you answer back. Sorry to bother you.

Your sincerely,
Valentina C.
 
EMAIL REPLY FROM DR SING DATED OCT 23, 2012

Thank you for your email. It is hard to see from your 2 images what is the affected area you mentioned. It is best to consult your vet.
 

1154. The urinary stone Schnauzer barks and eats at 6.47 pm

Tuesday Oct 23, 2012  6.47 pm
I asked Dr Daniel to bring JJ out for a walk at 6 pm. Evening sunset, tranquility. This dog had not wanted to eat since my surgery on last Saturday and I am most worried. The owners visited her every afternoon.

Dr Daniel said: "The owners say that this dog does not eat after surgery and it is common."
JJ walked out with a spring in her step. She peed outside and the urine was yellow and has no signs of blood unlike this morning.

Suddenly she barked at a jogger.  This was excellent news. A dog that barks suddenly at joggers is on the road to recovery. Dr Daniel took off her e-collar and gave her canned food. She ate and my worries of the post-op decline in health vanished. She walked up and down the back room looking for Dr Daniel. She sat on her back. "Put her back into the cage," I said.

Monday, October 22, 2012

1153. Retrospective study of the vomiting Schnauzer with urinary stones in kidney and bladder

Oct 23, 2012  8.56 am

The Schnauzer, F, 4 years is still not eating. But I had given her the IV drips including glucose and some hand feeding of the L/D diet. She would just lick a bit and not swallow, according to Dr Daniel who was assisting me in this case. She could sit up and look at me with sad eyes. The only good news is that she does not vomit anymore, unlike the 5 days and on the day of surgery.
I am now reading the voluminous records of previous vets and summarise the findings below:



1.  Nov 14, 2009
Health check and vaccination

2. Sep 28, 2011
Ear infections treated.

3. Feb 18, 2010
Intermittent cough when sleeping. Vomits mostly fluids. Spay and dental scaling done.
4. Nov 8, 2011
Urinating blood. Bladder stones palpated. X-ray. Cystotomy to remove stones
Stones removed digitally and by retropropulsion
Post-op X-ray - no stones in the bladder

5.  Nov 11, 2011
Cystostomy to remove bladder stones. Bladder entry swab c/s to lab.  Heavy growth of Coagulase-negative staphylococcus
Stone analysis to Minnesota. Stone and shell 100% magnesium ammonium phophate (struvite)

5. Nov 13, 2011
Discuss options
1. See if recurrence, then start food trial
2. start food trial

6. Nov 14, 2011
Follow up. Owner said dog vomited few times at night on the 3rd day afer surgery.
W/D canine dry

Nov 19, 2011
Review.  Owner says some vomiting on 3rd day of surgery might be due to eating something downstairs. No more vomiting. Advised owner to monitor for uroliths. Pet is female and there is the option of urohydropropulsion. To change from S/D to W/D as the breed is prone to pancreatitis or RC urinary s/o

Dec 2011, Feb, April & Jun 2012
W/D canine 8.5 lbs dry


Jul 22, 2012
Straining to urinate and leaking urine for 2-3 days
Bladder stones palpated and seen on X-ray
Unable to get urine for analysis
Treat UTI first, try to dissolve stones with 1 S/D can/day and review in 3 weeks.
Blood test. low RBC, HCT, HGB.
High total WCC 22.4 (5-17), N 18 (3-12), M 1.4 (0.16 - 1.1)


Aug 12, 2012
Multiple large bladder stones on X-rays. Vet 1 advised surgery. Owner did not accept advice. Went to Vet 2 who treated with antibiotics, acidifying tablets and then S/D

Oct 19, 2012
A few days ago, the owner asked me whether he could buy medication from Toa Payoh Vets as the Jurong vet was too far for him to collect medication and S/D.
I advised another X-ray and blood test as Vet 2's 2nd x-ray already showed multiple stones in August 2012 and the owner said that the urine was very smelly.

The dog started vomiting for 5 days before Oct 19, 2012. Test showed bacteraemia and toxiaemia with low platelets. Dog was operated on Oct 19, 2012. Around 13 stones removed from bladder.  Normally I don't do exploratory laparotomy in cases of bladder stones as this was the case. However, I checked the stomach and intestines for foreign bodies as there were radio-dense objects inside the
intestines on X-ray taken by me.


Oct 23, 2012.
Dog on drips and medication daily. Not eating. Alert.
At 10 am I asked Dr Daniel to take her out to have some sunshine. She peed red blood and pooped soft brown stools. No vomiting. The blood could be from the chronic cystitis of the bladder wall as stones were left too long. Also, possibly from the bladder bleeding.
So far, the dog is walking and alert. No fever. Just would not eat.

Oct 23, 2012  10.09 am
That was when I found a 3x enlarged purplish red left kidney with prominent blood vessels in its capsules and as big as a golf ball compared to the normal right kidney. Some bleeding spots near this kidney and brownish stained spot in the omentum. This was serious as the left kidney could be bleeding. There was anterior abdominal pain on palpation earlier.

She would walk about, drank water and sit on her backside. Some panting.









CONCLUSION
Each vet has his or her own advices on the management of struvite stones to prevent recurrence after surgery. Vet 1 advised S/D and W/D dry which is also indicated for struvites. For this dog, I have advised:

1. 2-3-weekly urine analysis
2. X-ray 2 monthly for 3 times
3. S/D canned food for 4 weeks followed by C/D canned food for 3 months with the usual urine tests and X-rays.
4. No dog treats or other food and no DRY dog food of any kind.
PROBLEM: What about the enlarged right kidney with the stone?
If the stones are small and packed in the renal pelvis, I hope they will pass down the ureter to the bladder and gets peed out. Wait and see as the dog is now active and starts to eat.

Due to economics, contrast radiography is not advised for the time being. Prevention is better than cure and for struvite stones in Miniature Schnauzers and other dogs, 2-monthly urine analysis and at least one X-ray of the abdomen for urinary stones are best done. Seldom do owners do it as monitoring requires discipline and planning.  
.

1152. A pet rat in Singapore fractures his tooth

Unusual case as I seldom see pet rats as Singaporeans don't keep pet rats.

October 18, 2012

This handsome black and white rat fractured the lower gum end of his low right incisor teeth as he chewed on the bars of his cage. Hamsters and rabbits commonly do that too. The tooth did not fracture completely and so he would be feeling the pain every time he tried to eat. His owner quickly took him to the vet and I was surprised to see my first pet rat patient in over 30 years of practice.


What is the solution? Clipping off both lower incisor teeth and levelling them.  Now, this young rat strenuously object to any human opening his mouth even to examine the teeth. So, I needed to put him under anaesthetic isolflurane + O2 gas and clip off both lower incisors to the same gum level. His fracture was at the gum level.




 
 
 
 
FEEDBACK FROM THE OWNER ON OCT 23, 2012
Dear Dr.Sing,
Thank you for the photos. S... is recovering well. Today - for the first time since the procedure - he was able to chatter his teeth (which he normally does when he's happy). He's also been able to start eating his regular Lab Blocks food again, albeit very slowly and with some difficulty as the teeth have just grown back a little bit. We're supplementing his diet with softer, easier to eat foods like vegetables and he doesn't appear to be losing an unhealthy amount of weight.

Sunday, October 21, 2012

1151. Kidney & stone Schnauzer not eating

Today is Monday, 48 hours after operation to remove the 13 stones and an exploratory laparotomy to find that the left kidney was 3X larger than normal, as big as a golf ball, congested and red, hepatititis and congested spleen with bleeding spots around the omentum of the right kidney and one dark brown patch on the omentum, an abnormal finding. Was the right kidney breaking down due to the long delay in getting the bladder stones removed since X-ray by Vet 1 had shown their presence in August 2012?

Some bleeding from the posterior end of the wound. Bleeding and infections are complications of surgery. No fever. Could it be infection? I needed to take out two stitches to drain.  A protein and glcouse drip will be given. Other than that, the dog looks alert.

Never delay bladder stone surgery. Best is to have routine urine analysis to detect presence of stones esp. in breeds prone to bladder stone, e.g. Miniature Schnauzer. The couple with their two young children visited yesterday Sunday and the dog wagged her tail and was wanting to go home yesterday. There was already redness in the cranial part of the stitch which I presumed was due to licking as the e-collar was smaller. "My dog is great at licking," the husband said. Today, fluid came out from this part and I review again with Dr Daniel. This is a teaching case for him as this dog could have right kidney stones as shown in the X-ray.

Vets usually take the bladder to check for stones and in nearly all cases, there will be no need to check for kidney stones. But this case shows that exceptions do occur. Now what to do with the right kidney stones?

The only good news is that this dog does not vomit for the past 2 days. She was vomiting daily before surgery for at least 6 days including the day of surgery.   

"It is due to infection," my assistant Min said. "Pus comes out."
"Since the area is so clean with no blood clots unlike the cranial part of the wound, I would say it was due to licking." But the dog does not lick in the presence of Mr Min or owners and so many assume that licking could not exist with an e-collar being worn. I got Min to change to a bigger collar and got Dr Daniel to take out two stitches. "Nothing inside the wound," he said as I followed up. So it was inflammation and swelling due to traumatic licking. We gave a drip. The cephalic veins had been bust due to previous IV drips at Vet 1 where the dog had one bladder surgery to remove the stones and another surgery to spay 2 years ago.

Prevention of diseases is cheaper than treatment as Vet 1 had quoted $1,200 for the bladder stone surgery for the 2nd time and the owner said he had paid $1,800 for the first bladder stone removal surgery. That would total at least $3,000. Yearly or half-yearly urine analysis would be much cheaper but no Schnauzer owner would ever do it.

 

1150. Rabbit biting herself passes away

The owner phoned to tell me that his 4-year-old rabbit with the jaw abscess in which I took X-rays and treated, passes away in her sleep.

The young couple had boarded the rabbit at a friend's place and she started to bite off her front paw fur and lately her back paw. She was drooling and wet. The jaw abscess was not present and so it was strange that she passed away. She was on pain-killers and antibiotics and had some appetite.

"She started to bite her front legs again," the husband said. "Also her front paws."

Could this be an allergic reaction or infection? It is a mystery.

1149. An Hougang cat scratches her owner

Monday Oct 22, 2012

"It is OK," the young Malay woman smartly dressed in grey, made up well and covering her head with a deep blue head scarf had made an appointment for her cat to spay. She was from Hougang.

She got her left hand scratched as Dr Daniel held the cat while I injected the xylazine+ketamine 0.2+0.8 ml IM.  She had asked me whether she ought to be around while I gave the anaesthesia injection as her presence would calm her cat.

"My cat starts being aggressive when she is taken out of the carrier at the other vet for her two vaccinations," she said.

"It is good idea," I said. "The other female cat I spayed recently went ferocious as a lion inside the crate when the owner left and when we wanted to take her out for injection. In front of the owner, she was OK and cool."

As predicted, her cat hissed. Dr Daniel had prepared the injection. He held the cat by the scruff while the lady talked to the cat. I injected the left side of the muscle quickly.

"Is it done?" the lady asked as the cat swiped her left hand and left a claw mark more than 3 cm long. "Is your hand bleeding?" I asked,
"No, no, it is only superficial."

I was relieved that the cat didn't scratch her face but her presence was most vital to the sedation as the cat was distracted. Dr Daniel put the cat back into the carrier.
"Just close the door," I said as the lady tried to push back the fabric bedding inside. Her cat hissed out and shot another claw at her. This was a 3-year-old cat and it took her 3 years to have the courage to spay her.

"Is she caterwauling?" I asked.
"No," she said. "She caterwauled last month."
Actually cats come onto heat by caterwauling at non-regular intervals and 4 weeks is about the time that ovaries would enlarge and caterwauling would come. During the spay, the ovaries and uterus were much enlarged as a cat on heat and so it took a longer time to spay.

Young cat owners like this lady are more well informed as she knows what caterwauling means and kinder to cats. That was why she did not want her spayed as that would be 'cruel'.


 "Since the cat scratches you so often, have you thought of declawing ," I advised as cat scratches can be infectious and can cause bad scars on a young lady.

"No declawing," she asked me what tool to buy to clip the sharp nails.
"Just buy one of those cutters used to cut chicken bones or hedges," I described to her the tools. "Use the sharp tips. I don't encourage declawing and almost 100% of the Singapore cat owners don't declaw their cats. 



OCT 25, 2012
The owner just phoned at 6.30 pm saying that her cat was panting and meowing. Earlier she could not poop. But the spay wound was OK. "Can she pee?" I asked. "Not today," she said. "My cat was OK this morning." I could hear the cat meowing in the background and asked her to bring the cat down the surgery for examination.

Compared to the cat of the Nepalese couple spayed around the same time and written in an earlier blog, this cat has some strange behaviour 3 days after spaying. The cat of the Nepalese couple was much younger.

1147. Barking dog upsets peace for 96-year-old mother-in-law

Today is Monday Oct 22, 2012. I was at the clinic at 8.30 am and an interesting phone call came in at 8.55 am.

"May I know what this telephone number 6254-3326 belongs to?" the man asked. "I checked the 'internet by typing "SPCA tel no.' and I got your phone number."
"It is Toa Payoh Vets," I said. "It provides veterinary services."

"I just wanted to ask SPCA advice about my barking dog. He disturbs the sleep of my 96-year-old mother-in-law by barking every time somebody walks past the door."
"Is he a male dog and what breed is he?"I asked. "Is he sterilised?"
"He's a Chihuahua cross, male sterilised dog" the man said. "He just keep barking and barking every time somebody passes by the apartment and my mother-in-law can't rest!"

"How come my clinic phone number is displayed when you google SPCA tel no."?" the man told me he was using yahoo.com and that there was another phone number 62875355 shown.

"Dogs are good pet therapy for old people," I said. "The dog keeps the senior citizens company as the adult children usually are away at work. My son's dog barks every time somebody passes by and he still does it if I am not around. I train him not to bark at passers by using a loud commanding voice and he will not do it if I am around. It takes time to train.

So, what was the problem with this owner? The vet must understand the situation. Probably there were neighbours' complaints esp. those who need to work shifts. But an aged mother-in-law may also need peace to rest.

What are his solutions?
1. Re-homing of a 3-year-old cross takes time and is difficult.
2. Giving to the SPCA means euthanasia after a few days if nobody adopts him. "Your wife will be very upset with this," I said as the dog sleeps on the mattress beside the wife. "My wife is unhappy about giving the dog away," the husband confirmed that women are generally kinder to animals than men.

"There is one last-resort solution which involves de-barking surgery," I said. He would talk to his wife.

Barking dogs need early training when they are young. Some older male dogs just can't be trained and they are discarded.    

.



1146. Kenny Rogers success tips

Monday Oct 22, 2012

Yesterday evening, I had an enjoyable evening listening to Kenny Rogers singing at the Indoor Stadium. Half the Stadium was used and I would say it was 90% full. No young people of less than 30 years were present as they were not born.  Kenny said that his fans were those born before 1960s and those born after 1960s do not know about songs of the 1960s.

Kenny knows how to connect with the audience and get audience participation and singing. If you watch some of you-tube videos of Kenny Rogers, you can learn some wise tips from him on his success and longevity as as singer. He said that you can never be rich as a singer if you think you want to make money. If you sing with your heart, focus and persevere and have some talents, you will succeed were similar advices he gave during his youtube interviews of his 50th anniversary.

The Indoor Stadium's sound system was very bad but the audience enjoyed his performance. "I am waiting for 'Lady'," I thought he would not sing this song as he was finishing his act from 8.15 pmn to 9.30 pm. He sang it last and the audience appreciated it very much.

Readers may like to watch this video at:
http://www.youtube.com/watch?v=4N-D-Yfisn0  


SUCCESS FOR YOUNG VETS
Vets can never be rich if they just operate one clinic and not be a manager-owner of several clinics. Kenny Rogers can sell millions of records but vets cannot operate on millions of dogs and cats. The important thing for young vets to build their name is to be available. If he or she keeps taking holidays or time off every month, more than usual, then owners just go to other vets who are hardworking. So, skills cannot be acquired or honed. Talents may be there, but the heart is not there for the pets and the clients.

So, being a successful vet practice operator is not easy too as there are high overheads of rentals, staff and stiff competition by younger vets who underprice their services and talents don't mean much to Singaporeans who are seduced by the brand name and modern external appearance of the waiting room. Kenny Rogers is an example of success as a singer but there are many more are not known. Young vets who want to be successful must be available most of the time. Work-life balance is difficult if you want to be successful in your field. It is good for employees who want time for themselves and their families and employ other vets to run their practices.






Saturday, October 20, 2012

1145. KPI Vomiting female Schnauzer - Cystotomy + Exploratory Laparotomy

Yesterday, Sat Oct 20, 2012, I performed the surgery on this vomiting 4-year-old female Schnauzer. Vomiting past 5 days. Not eating. Had 2 bottles of drips before surgery today.

Anterior abdominal pain - dull whimpering sound. Why?  X-ray - a left kidney stone or stomach stones?  Liver enzymes higher than normal.
Bladder pain - struvite stones known and seen on X-ray. Still vomiting prior to surgery white mucus or water and during mask anaesthesia.


ANAESTHESIA
A: Inject sedation drug   10.20am
B: Isofl first given           10.27 am. Mask, then intubate. Dog vomited again.
C:  Isofl stopped             11.37 am
D: First skin incision       10.39 am
E: Completion of skin stitching   11.37 am

E-A = 57 min
E-D = 58 min  (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min

SURGERY
1. Exploratory laparotomy. Big incision. Stomach empty. Intestines with some gas. Colon with black streaks inside. Spleen dark red. Liver dark red. Blood spots near to enlarged left kidney (3x normal right kidney - pic taken).  No foreign bodies inside stomach or intestines.  Kidney stones inside the right kidney?  To review X-ray again.

2. Bladder surgery. Bladder chronic cystitis.Wall >5mm thick, dark red, 9 big yellow bladder stones and four smaller ones. Previous bladder surgery scars. Bladder empty, size of quail's egg.
Incision 1 cm long. Stones massaged out. PDS 3/0 x.  1 apposing stitch closes mucosa. 2 layers of inverting sutures. Syringe of saline to flush out any sand.
 
UPDATE 24 HOURS POST OP (Sunday Oct 21, 2012)
Dog Ok. Drinks, not eat. Had passed water (brownish colour). On medication.
No vomiting as at 11.35 am

PROBLEM
Right kidney much swollen and congested capsule (pic taken). Kidney stones and infection?
Total WCC was high, platelets low indicating a septicaemia.
The liver and kidneys

Friday, October 19, 2012

1144. Struvite urinary stones?

Oct 17, 2012

In August 2012, Vet 1 x-rayed the 4-year-old female Miniature Schnauzer's bladder as she could not pee. "Bladder stones again," the vet recommended another bladder operation. The first operation was done. Updated report at:

http://2010vets.blogspot.sg/2012/10/1152-female-schnauzer-vomits-and.html

1152. The female Schnauzer vomits and dribbles urine

"Jurong is too far for me, I live in Hougang" the owner asked me whether he could purchase the medication for his vomiting Miniature Schnauzer in October  that had been treated by Dr Jason Teo in his Jurong clinic in August 2012. This dog had been X-rayed by Vet 1 at another practice and big urinary stones were seen in the bladder. Vet 1 advised surgery to remove the bladder stones.

As the owner had paid $1,800 to Vet 1 for a similar surgery 10 months ago, the bladder stones had recurred again. He did not want another surgery and so consulted Dr Teo at Toa Payoh Vets on a Saturday. He showed me the X-rays from Vet 1 and the stones were several and big.   

"Vomiting has many causes," I said. "Your dog's abdomen is bloated and there is pain in the anterior abdomen as well as in the bladder. I advise an X-ray and blood test."

"I had done the X-ray in August 18, 2012," the gentleman said. "Why don't you prescribe me some medication first?"

I understand that he had spent quite a bit and prescribed him reluctantly. The next 2 days, the dog continued vomiting some time after drinking water. Urine dribbled out whenever she sat down. So, was this a sure case of urinary tract infection involving the kidneys. Infected kidneys cause toxic blood and therefore vomiting. Urinary incontinence due to bladder stones irritating the bladder and infecting it as confirmed by the urine test. Easy diagnosis.
Yet there was this whole swollen abdomen, as firm as a full-blown balloon and causing the dog to wince when I palpated the anterior part as well as the bladder part. So I insisted on an X-ray. Results showed foreign bodies and gas in the intestines.

Tomorrow is Saturday and my day off. I still need to do the surgery to remove the FB as the dog continued vomiting and not eating. The IV drips for the past 2 days sustained her. The blood test showed increased white cell count and neutrophils and reduced platelets. A bacteraemia causing vomiting and possibly death if left untreated. Unfortunately surgery is the only option and highly risky in a sick dog. The man has a 6-year-old daughter.

"Is it possible her toys and possibly necklaces are thrown all over the floor and this dog had swallowed them." 

Tomorrow's surgery will provide the evidence. The wife was most furious, he said to me. I am most worried that the dog may die on the operating table. The owner knew the risks of death as the dog had been vomiting for 5 days and was having a blood borne bacterial infection. The rectal temperature was 37.6 on admission but today it was 38.5 C after IV drips and antibiotics. "I will be doing only the intestinal surgery to remove the foreign bodies," I informed the owner. "Removing the struvite stones will prolong the surgery and increase the risk of death on the op table." He understood.

Report written: Friday Oct 19, 2012  7.35 pm








Thursday, October 18, 2012

1151. KPI. Caesarean section - 3 poodle pups

Oct 13, 2012

Poodle, female, 4 years, 5.6 kg  38.5 C

A: No injection of sedation
B: Isoflurane first given                3.51 pm
C: Isoflurane stopped                    4.46 pm
D: First skin incision                     4.00 pm
E: Skin stitched up                           4.47 pm
Total process E-B = 56 minutes to deliver 3 pups
Surgery time E-D = 47 minutes. Assistant Min handled revival of distressed pups.
Isoflurane + O2 gas used  C-B = 54 minutes
 

1150. KPI. Neuter 5kg dog with normal testicles and xylazine

Oct 15, 2012
Chihuahua X, 5kg, 4 years old male, 2 descended testicles. 2/0 absorbable x 1 packet.

A: Injection of xylazine    9.50 am
B: Isoflurane gas first given  9.58 am     Intubate 10.02 am
C: Isoflurane gas stopped      10.12 am
D: First skin incision              10.07 am
E: Skin stitching completed    10.17 am

The whole process  E-A = 27 minutes
Surgery                    E-D = 10 minutes
Isoflurane used        C-B = 14 minutes

IV anaesthesia can be used but with this method, the lady owner was most impressed that her dog was alert and not dopey when she came to collect him one hour later. That is the beauty of using xylazine IM. The use of domitor and ketamine IV does make the dog dopey even some hours after surgery unless the vet gives the antidote Antisedan which my associate vets seldom do.

ECONOMICS
It is much more costly to use domitor + ketamine + isoflurane compared to xylazine + isoflurane but associate and employee vets don't bother about veterinary economics.  

1149. KPI Neuter one monorchid Maltese using xylazine

17.10. 12
Mini-Maltese, Male, 1 year, 2 kg
Right testicle undescended

I used xylazine 0.2 ml IM, then isoflurane by gas and intubated.
Two separate incision of skin areas for removal of the testicles


A: Injection of xylazine   3.45pm
B: Isoflurane + O2 gas given   3.58 pm. Intubated
E: Completion of skin stitching 4.17 pm
PDS 3/0 x 1 pack

The whole process  E-A = 32 minutes.
I wasted some time trying to shift the undescended right testicle to the skin incision made for the normal testicle but it was not possible and to avoid incising the urethra accidentally, I made a separate skin incision. So, the whole process takes longer.

As Domitor was out of stock, I used xylazine IM which I used to do for many years. Now the vets tend to use domitor + ketamine IV at 0.4 ml + 0l5 ml IV for a healthy young 10 kg dog,  after being convinced by me that the combinaton formula was effective and safe esp. if given at 50% and then top up with isoflurane + O2.

1148. KPI - Spaying a ferocious caterwauling cat

Today, a Nepalese couple brought in a tricolour 7-month-old caterwauling cat adopted from the SPCA. "Will she stop making noises after spaying?" the wife asked. "Yes," I said.

For caterwauling cats, the ovarian and uterine blood vessels are enlarged and special care must be made to ligate well. I threw around 10 knots on each ovarian side and around 15 knots on the uterine body. I don't do transfixing ligatures on the swollen uterine body.
As the cat was ferocious after the owner left and was put inside the cage, my assistant Min was pawed at everytime he tried to take the cat out of the cage for me to do the sedation injection. He went to get a big rag. "Don't do it," I knew this cat would escape from his crutches if he tried to grip her scruff of the neck now that the cat was big eyed and hissing.

ANAESTHESIA

"I will inject the cage through the cage," I said.
Mr Min had his idea of lassoing the cat and then pulling one leg out for me to inject the back muscle. He tried and I injected partially as the cat twisted and turned, pulling back her leg. He attempted again and I managed to inject the 80% of the remaining sedation drug. So, there was not 100% given.

Normally at xylazine 0.15 and ketamine 0.6 = 0.75 ml IM combined would give a very good anaesthesia for me to spay. In this case, the cat was twitching her legs towards the end of spay and there was no need to top up with isoflurane + O2.

Skin stitched - first skin incision = 21 minutes. I hooked out the ovary at the first attempt. A caterwauling cat takes much longer to spay as I had to ligate the ovarian side with 10 throws of the knot each and the uterine body with 15 throws. 3/0 absorbable x 1 packet used.

I would expect 10 minutes will do for normal non-caterwauling cats. Will check out my other KPI cases of cat spay.

TOTAL TIME FROM INJECTION OF SEDATION DRUG TO SKIN STITCHED =
11.43 am - 11.10 am = 33 minutes. The cat was clipped after sedation but normally I get the cat or dog clipped before sedation, thereby reducing my surgery and anaesthetic time. It takes about 2 minutes to clip.

As at Oct 25, 2012, no complaint or news from the Nepalese couple.

1147. KPI. The Golden Retriever has a painful golf-ball cheek

Sunday's interesting case

Oct 14, 2012

I was worried that I would not be able to operate on this golf-ball-sized cheek. The Golden Retriever was thin and had a low total white cell count of 3.3 (6-17) when Dr Daniel took a blood test as part of health check up and vaccination in June 4, 2012.

Why such a low TWCC? I took a blood test on Oct 15 before surgery. It was still low at 5.2.
The platelets were low at 110 in June but was normal in Oct 15 at 251. So, what was going on in this skinny dog, said to be a selective eater? At his age, he should weigh more than 27 kg. He was 24 kg in June and so would have gained weight.

The good-natured dog whined when I palpated the firm lump. He did not bite me. Could this be an abscess? A needle aspiration showed some blood-tinged fluid but nothing else. The lump was more solid. A tumour? A salivary gland cyst (submandibular and sublingual) but the location was inside the cheek tissues. Fortunately as it is a messy operation to remove the salivary gland cyst known as mucocoele. Too many nerves and blood vessels in this neck area.

Give some medication and wait and see? Well, this would not cure the dog. Could the pain be some chronic pain that made the dog not wanting to eat? The following is my management of this high-risk case

24-HOUR BEFORE OP
IV dextrose saline  2 bags + duphalytes + baytril

ANAESTHESIA
27kg
I used xyalzine 1.3 ml + ketamine 0.3 ml IV - at 50% of the calculated dose.
It was not effective but isoflurane gas mask knocked him down and allowed intubation

To benchmark for my other vets, the record showed:
Time of use of isoflurane gas + O2 = 85 minutes
First stitch to last stitch of skin       =  57 minutes
The dog was not healthy and so the shorter the anaesthesia, the better the survival outcome
SURGICAL APPROACH
How to remove this large golf ball and still have skin to close up the left cheek?
Marker pen drawing of surgical lines
In the end I electro-incised a vertical line, excise the mass of cystic fluid and tissues from the dermis of the skin, sent the lumps to lab for histopathology

Ligated bleeders
Nylon 2/0 x 2 packets, PDS 2/0 X 1 packet to close up the wound and ligate

HISTOPATHOLOGY
Inflamed granulation tissue. No sign of malignancy.

I informed the owner. He asked what would be the cause?
"Possibly an infected abscess. Something sharp pierced the cheek and lodged inside."
"It could be chicken wing," he sighed.

This report is to set some benchmarks by me for my associate vets in veterinary surgery.
Obviously, I have over 40 years of surgery experience and I don't expect the younger vets to achieve the 57-minute surgery till they have more surgeries under their belt.
But there must be some bench-marks and this case is one of them.

All surgeries and anaesthesia records are nowadays written with the above-mentioned timing to upgrade the standard of veterinary surgery. Taking time to operate a pet is frowned upon by me and proper planning must be done to shorten anaesthetic and surgical time if Toa Payoh Vets is to be the top 5 veterinary surgery in Singapore.

Wednesday, October 17, 2012

1146. The young guinea pig dies from respiratory distress

"What is the cause of death?" the woman in her 40s asked me as I phoned her to say her guinea pig had

Star tortoise passes red blood, shells ooze red blood

The case of the French-bean eating star tortoise

"I bought UV light and food as recommended by the pet shop, but my star tortoise just would not eat them," the owner said to me. "She eats only French beans and that was the only food she ate for the past 7 years."
The tortoise hospitalised the tortoise again but this time, I noted she had paler tongue and was purplish. Her shell borders ooze red blood. She passes red blood.
One week ago, the owner came as she was constipated for 2 weeks and was not eating. "Her shell is very thin," I said. "Not enough calcium. Eating French beans solely for 7 years has caused this problem. A tortoise should be eating a variety of food including shrimps and multi-vitamins and minerals."

But the tortoise just would not eat any other food. For 7 years. I asked Dr Vanessa to give her one ml of enema salts using a one-ml syringe. She pooped on the water and became more active. I gave an antibiotic injection IM. She went home but still would not eat.

So, this time, she was much weaker and her eyes closed most of the time. With so much blood leaking from her shell lines and fresh blood from her anus, the owner felt it was more humane not to let her suffer anymore. She was euthanased and cremated.
Another client with the jaw-abscessed rabbit saw the tortoise and told me how she successfully reared two tortoises now 8 years old. She showed me her i-phone images. The tortoises looked great. "I did a lot of research," she said. "I got one when she was a 50-cent coin size and then there was another one left at the pet shop. The operator asked me to take it and so I did."

"How do you train them to eat a variety of food?" I asked.
"I feed them by hand when they were young," she said. So, that was the solution to picky tortoises.
"I am more interested in how you toilet train them," I said.
"Star tortoises are not to be immersed in water as they are desert tortoises," she stated. "I put them into the water and they poop. Other times, I don't put them in the water." Normally, we don't immerse tortoises in water by use of a sloping platform for them to go up to be dry. However, medication and critical care powder was put into the water for this tortoise to drink. It was too late to cure her.

"It is excellent toilet training method," I said. "Are they still doing it now?"
"Now, the situation is haphazard since I have a domestic worker to care for them as I have a baby to care for." I requested her to write and share her knowledge as star tortoises are not common in Singapore due to a ban.

Intelligent owners nowadays know much more about the management of exotic pets than me if they have them as pets. Vets can't know everything. Now there are hermit crabs from Batam for sale and the pet shop operator has more knowledge of nutrition and husbandry than any vet in Singapore because we don't see hermit crabs in years. And today, an owner phoned me about his rat who chipped his tooth. What to do for sedation? Zoletil?

 


      


1143. Triple phosphate crystals in a young Shih Tzu X - health screening

Health screening is seldom done by Singapore pet owners esp. in young dogs in Singapore. A young lady wanted me to do a complete health check on her one-year-old Shih Tzu X Jap Chin, male. The complete blood test was normal but urinary analysis showed a tendency to formation of struvite urinary bladder stones as in my email to her below:


Oct 17, 2012
HEALTH SCREENING OF A YOUNG DOG

Shih Tzu X Jap Chin, Male, 1 year old

The significant findings are alkaline urine (pH 8.0), the presence of triple phosphate crystals + and bacteria 3+, high specific gravity of 1.043 (1.005-1.030).
 
The analysis showed a likelihood of this dog forming struvite (triple phosphate) bladder stones.
A change to a diet that will acidify the urine to pH below 7.0 and monthly urinary analysis is recommended for the next few months. Pl contact me for further discussion.

Some info on struvite urinary stones are at:
1. http://www.bekindtopets.com/animals/20081201PG7_Dog_Surgery_Anaesthesia_Urinary_Tract_Problems_ToaPayohVets.htm

2. http://www.kongyuensing.com/folder8/20120724struvite_stones_dogs_toapayohvets.htm

Friday, October 12, 2012

The 73-year-old flower seller and her 7-year-old Jack Russell

"My friend's dog vomited and died when sent to the vet," the 73-year-old flower seller from Geylang market limped badly yesterday (Oct 11,2012) and came by taxi at 8.30 pm. She was worried that her dog might die.

"Why are you still selling flowers?" I asked."Don't your children support you?"

1141. Blood in the stools or no?

"To be frank with you, I consulted another" vet yesterday," the lady gave me a container with mucoid stools and some tissues of blood. "atA very nice place. The vet was nice and checked the stools under the microscope. He said no blood in the stools and no parasites. But my dog still has blood in the stools."
The other vet also prescribed some liquid medication and gave assurances that there was no blood.

"To me, this pinkish tissue looks like blood. But the lady said she fed the dog beetroot.
"Could it be the colour of beetroot?" she asked.

Fortunately, I had studied in Scotland and am familiar with the purplish blue beetroot which is eaten by Westerners.

 "There will be very little blood," I said. "So, I will send this sample to the laboratory that specialises in blood and faecal tests as they will have the more sophisticated machines to detect it."

LAB RESULTS
STOOL FEME AND OB

Stool Analysis  
Appearance   Soft brownish stools
Microscopic examination (wet mount)  leucocyters, erythrocytes+ detected
Occult blood Positive    

The owner phoned at 10 am for the results. I told her. She asked me to fax a copy of the report to the other vet.   

1140. Management of practice: 2 growling big mongrels

Yesterday, I noticed that 2 mongrels (male and female) were kept in the room. As I opened the door, they growled. We don't have space to house big dogs esp. the male Great Dane Cross. In any case, the owner wanted the dogs back on the same day. We also had a Husky in for treatment of constipation for the next few days and one big dog is sufficient.

"Why are the dogs not sterilised?" I asked Dr A.
"I didn't know Min is off today."
"Don't accept big fierce dogs if you can't handle them. Phone the owner and ask her to take rthem back! The vet in charge has to take responsibility for the sedation, not Mr Min. I have two vets and must we wait for Min to do it tomorrow?"

I advised the two vets how to get the male dog sedated without being bitten.

Dr B went to the room to get the male dog out. Gently talking to them and as the dogs have leashes, he could just talk his way in and take the male dog out. I asked the clients with the Beagle to go out of the clinic first.

 "Muzzling is not possible," Dr B tried outside the clinic but the male cream dog would not accept it. "Why don't you try?"

I am no superman. Drs A and B managed to inject the sedatives IM behind the waiting room and so I did not see how they did it. I did advise blocking the chest and head with the door closed on this part of the body while Dr A injected the back muscles.

"What happens if Dr B gets bitten?" Dr A asked me during the post-op discussion.
"In the first place, Dr B should understand dog pyschology and body language and he would not be bitten in the first place. Most dogs give warning e.g. growling and if the vet ignores it, he deserves to be bitten.

It was 9.30 pm when the male dog was picked up by the owner. As the clinic manager, I have to ensure that the work processes are efficiently and effectively done. Otherwise, the practice loses money for every case handled. This accountancy is not obvious to the employee vets who still gets the salary anyway.

History of anaesthesia in dogs and cats

I just spoke to a senior vet to enquire whether he has domitor as my vets have run out of it. He does not use it. Some interesting history from this experienced small animal vet now in his 70s. He started practice some 50 years ago when Singapore had only 3 vet practices and the government Animal Infirmary. Now there are around 50.

1. Xylazine knock down. Nembutal IV to effect. "Despite the vet books claiming that Nembutal will cause drowsy puppies, I did not have any. Intubate and give halothane gas + O2 or just O2 will do." He did a few thousand dog Caesareans. Minimal dosage. Nembutal no longer available easily.

2. Now he uses xylazine + ketamine. It is better, easier to handle and cheaper. Does not need to have many nurses to assist in spay.

E.g. Shih Tzu which is bigge than a cat, xylazine 2% at 0.6 to 0.7 ml and ketamine at 0.4 to 0.5 ml IM or IV. The vet needs to experience the dosage. .

E.g. adult cat in Singapore    xylazine at 0.4 to 0.5 ml & ketamine at 0.4-0.5 ml IM.

3. His younger vet uses propofol

4. He does not use zoletil, diazepam or domitor for sedation.

This is good management as too many sedatives increase stock costs as they expire. Younger employee vets seldom know about the high overheads in a vet practice as they order various kinds of sedatives based on their likes and dislikes. When they open their practice, they may then understand.



Wednesday, October 10, 2012

An old wound in a hamster



On Wed, Oct 10, 2012 at 5:28 PM, ..@gmail.com> wrote:

Dear Ms Judy,

I think there is something wrong with my hamster. A few weeks ago, there seems to be some wound near the neck and shoulder area. Although it seems to be healing some days later, the wound reopened quite recently and now my hamster looks really weak and motionless. I do not know what else to do. May I please have some advice on how to make her better?

Thank you very much
 

EMAIL REPLY FROM DR SING DATED OCT 10, 2012
 You will need to send it to the vet for treatment as it seems to be long-standing wound.

Tuesday, October 9, 2012

1137. Email query on cost of spaying female cats at Toa Payoh Vets






On Mon, Oct 8, 2012 at 11:58 AM, ...inn@hotmail.com> wrote:
Hi Ms Judy,

I have 2 female cats, both about a year old. I would like to know what are the charges for stabilizing both of them and how soon I can get an appt with your doctors. Please advise. Thank you.

Regards,
K


E-MAIL REPLY FROM DR SING DATED OCT 10, 2012
I am Dr Sing. Pl accept my apologies for the late reply. The fees for spaying one female cat is from $120 - $180 (with painkillers and antibiotic medication and e-collar home). If the cat is pregnant, the cost is an additional $50.
Pl phone 62543326 for appointment or just come at 9.30 am on a weekday preferred. No food and water after 10 pm, the next before.

Monday, October 8, 2012

1136. Hamster food for the new Syrian hamster

On Mon, Oct 8, 2012 at 7:23 PM, J@hotmail.com> wrote:

Hi Dr Sing,

This is J... We spoke just now about the Vitakraft food for Syrian hamster. I got this ingredient info from the website. The brand originates from Germany. Is this acceptable?

Thanks!

Regards,

J

EMAIL REPLY FROM DR SING DATED OCT 9, 2012

to daniel, Joycelyn






Good research on your proposed purchase of the Vitacraft hamster food for your new Syrian hamster. The alloe vera concentrate and the "approved additives" are the parts I will not feed my hamster as I don't know what long-term effects they will produce.



It is your own preference. If I have to buy only from this Vitacraft manufacturer, I will choose





Emotion ® Nature Dinner Emotion ® Nature dinner

Artikelnummer: 24306 Item number: 24306



There is an English translation at:

http://translate.google.com.sg/translate?hl=en&sl=de&tl=en&u=http%3A%2F%2Fwww.vitakraft.de%2F



The following is copied from this website:

Mit Emotion® Nature Dinner bieten Sie Ihrem Hamster Natur pur im Futternapf! With emotion ® Nature dinner offering your hamster pure nature in the food bowl! Knackige Kürbiskerne, leckere Kolbenhirserispen, gesunder Dinkel ... Crunchy pumpkin seeds, Kolbenhirserispen tasty, healthy spelled ... Die Mischung enthält die reine Vielfalt der Natur — die Rohstoffe werden frisch geerntet und schonend verarbeitet. The blend contains pure natural diversity - the raw materials are freshly harvested and carefully processed.

Emotion® Nature Dinner ist mit vielen energiereichen Zutaten perfekt auf den natürlichen Speiseplan Ihres Nagers abgestimmt und enthält zudem wertvolle Omega-3-Fettsäuren zur Unterstützung eines gesunden Fells. Emotion ® Nature's dinner with many energy-rich ingredients perfectly adapted to the natural diet of your rodent and also contains valuable omega-3 fatty acids to support a healthy coat. Natürlich versorgt das Naturfutter Ihr Tier auch mit allen lebenswichtigen Vitaminen und Mineralstoffen — mit speziellem ACE-Komplex zum Schutz der Zellen. Of course, the natural food supplies your pet with all essential vitamins and minerals - with a special ACE complex to protect the cells. Für ein natürlich gesundes Hamsterleben! For a naturally healthy hamsters life!

Pure Nature: Mit hochwertigen Komponenten aus der Natur Pure Nature: With high quality components from nature

Vitamine : Enthält Vitamine und Mineralstoffe Vitamins : Contains vitamins and minerals

Omega 3: Essentielle Fettsäuren unterstützen eine gesunde Haut und ein gesundes Fell Omega 3: Essential fatty acids support healthy skin and a healthy coat

Cell Protect: Mit ACE-Komplex zum Schutz der Zellen Cell Protect: With ACE complex to protect the cells

Für alle Hamster For all hamsters

Von Tierärzten und Nagerexperten entwickelt Developed by veterinarians and rodent experts

Artgerecht, hochwertig, ausgewogen Arthritis, high quality, balanced

Zuckerfreie Rezeptur Sugar-free recipe

Ohne künstliche Aromastoffe No artificial flavors

Ohne künstliche Farbstoffe Free from artificial colors

Ohne künstliche Konservierungsstoffe No artificial preservatives

Inhalt: 600 g Content: 600 g





Complete food for hamster

Zusammensetzung: Composition:

Pflanzliche Nebenerzeugnisse Vegetable by-products

Getreide (Kolbenhirse 5%, Dinkel 5%) Cereals (millet 5%, 5% spelled)

Gemüse Vegetables

Saaten (Kürbiskerne 3%) Seeds (pumpkin seeds 3%)

Nüsse Nuts

Fleisch und tierische Nebenerzeugnisse Meat and other animal products

Mineralstoffe Minerals

Öle und Fette (Sonnenblumenöl 0,06%, Rapsöl 0,02%) Oils and fats (sunflower oil, 0.06%, 0.02% rapeseed oil)

Hefen Yeasts



Zusatzstoffe/kg: Additives / kg:

Ernährungsphysiologische Zusatzstoffe: Nutritional additives:

Vitamin A (E672) Vitamin A (E672) 11429 IE 11,429 IU

Vitamin D3 (E671) Vitamin D3 (E671) 875 IE 875 IU

Vitamin E Vitamin E 770 mg 770 mg

Vitamin C Vitamin C 638 mg 638 mg

Selen (E8) Selenium (E8) 010 mg 010 mg

Eisen (E1) Iron (E1) 14.215 mg 14,215 mg

Jod (E2) Iodine (E2) 406 mg 406 mg

Kupfer (E4) Copper (E4) 469 mg 469 mg

Mangan (E5) Manganese (E5) 4.334 mg 4334 mg

Zink (E6) Zinc (E6) 3.547 mg 3547 mg


Drinking and peeing a lot is not normal in your hamster. Be observant.



Updates & images will be at:
http://www.sinpets.com/hamsters/20121009hamster_food_quality_toapayohvets.htm

1135. Hamster with sticky rat glue on its body

Today I got a phone call regarding a hamster with sticky rat glue stuck on its body. "Will vegetable oil remove the glue?' the young man asked me as he had researched the internet. "I don't know," I said. "Apply a small part first and see."  

1134. A constipated star tortoise who eats only French beans

Oct 8, 2012
I was surprised that this 7-year-old star tortoise has eaten solely French beans and nothing else for the past 7 years. Now, he had not pooped for the past 2 weeks. His shell is very soft, due to poor nutritional balances.

What to do with a constipated turtle?
"Give one ml of the enema into his anus," I said to Dr Vanessa. "Put him in the blue tub with water inside."
"Is the enema contra-indicated for tortoises?" Dr Daniel asked.
Dr Vanessa gave one ml and the tortoise popped out 2 cm x 1 cm brown stools in the water.
The owner was most happy but as he had to work late, he would bring the tortoise home tomorrow.
"What to do to improve his shell?" he asked.
"You need to give a variety of food," I said. "French beans for 7 years cannot be good for the shell."

Case study of male cat's blocked bladder - struvites urolithiasis

Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home. 

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder
IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5  SG 1.05  Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Sediment:  struvites 4+, Bact +, RBC+, WCC+, yaline casts +
Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.
Owner was warned that bladder would be blocked in the next few days and the consequences of
cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written plans were:
Cat 4.9 kg, 39.2C
1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home.

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder

IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5 SG 1.05 Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Microscopy: Struvites 4+, Bact +, RBC+, WCC+, yaline casts +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written surgical plans were as follows:
Cat 4.9 kg, 39.2C

1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

2. Catherisation + lavage + indwelling
3. Baytril + tolfedine inj
4. e-collar
5. vibravet 50mg 1 tab sid x 10
6. multivit x 1 bot

Urethral obstruction
Cat has not urinated yesterday. .

UA.
pH 7.0 SG 1.015 Blood 4+, Protein 2+. , Urobilinogen Normal
Microscopy: Crystals Nil, Bact Occasional, RBC >2250, WCC 198, hyaline casts Nil, spermatozoa +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.


CONCLUSION
There have been a few cases of urethral obstruction in male cats seen by me recently. It is a common condition in cats. As to the cause, it is difficult to say.

In this case, struvite urolithiasis has the same conditions of alkaline pH, bacterial infection and struvite crystals. It can be prevented by the use of anti-struvite reduction diet like C/D but most owners are not educated sufficiently to get the cat to switch over to C/D for at least one month and then to maintenance C/D. For economy reasons, I advise C/D for at least one month and then canned food. No dry food at all times. This cat was fed dry food (Snappy Tom) since kittenhood as his dam is also eating the same. No urolithiasis problem for the female.

Follow up education for struvite urolithiasis is essential to ensure that the owner complies with the feeding of C/D. In this case, the cat rejected the C/D when given 100%. I had to educate the owner to give 5% of C/D + 95% of the commercial canned food and slowly increase to 100% over a period of two weeks. She was willing to listen as recurrence will involve costly vet treatment. She was able to medicate the cat with antibiotics given via the food. Many cats will not take antibiotics and many owners simply give up easily.

In strurvite cases, bacterial infection of the bladder needs to be eliminated and an acidic pH of the urine is maintained by feeding of C/D diet. It is extremely difficult to educate most Singapore cat owners and vets don't have much time to do so. Urine checks should be done monthly and 3-monthly but none will be done in most cat cases. The theory is sound but in reality, the Singapore cat owners generally are not interested in follow up urine analysis in 2012.

I noted that owners may buy one can of C/D and then no more news from them.








1132. Struvite urolithiasis in cats


.
Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home.

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder

IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5 SG 1.05 Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Microscopy: Struvites 4+, Bact +, RBC+, WCC+, yaline casts +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written surgical plans were as follows:
Cat 4.9 kg, 39.2C

1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

2. Catherisation + lavage + indwelling
3. Baytril + tolfedine inj
4. e-collar
5. vibravet 50mg 1 tab sid x 10
6. multivit x 1 bot

Urethral obstruction
Cat has not urinated yesterday. .

UA.
pH 7.0 SG 1.015 Blood 4+, Protein 2+. , Urobilinogen Normal
Microscopy: Crystals Nil, Bact Occasional, RBC >2250, WCC 198, hyaline casts Nil, spermatozoa +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.


CONCLUSION
There have been a few cases of urethral obstruction in male cats seen by me recently. It is a common condition in cats. As to the cause, it is difficult to say.

In this case, struvite urolithiasis has the same conditions of alkaline pH, bacterial infection and struvite crystals. It can be prevented by the use of anti-struvite reduction diet like C/D but most owners are not educated sufficiently to get the cat to switch over to C/D for at least one month and then to maintenance C/D. For economy reasons, I advise C/D for at least one month and then canned food. No dry food at all times. This cat was fed dry food (Snappy Tom) since kittenhood as his dam is also eating the same. No urolithiasis problem for the female.

Follow up education for struvite urolithiasis is essential to ensure that the owner complies with the feeding of C/D. In this case, the cat rejected the C/D when given 100%. I had to educate the owner to give 5% of C/D + 95% of the commercial canned food and slowly increase to 100% over a period of two weeks. She was willing to listen as recurrence will involve costly vet treatment. She was able to medicate the cat with antibiotics given via the food. Many cats will not take antibiotics and many owners simply give up easily.

In strurvite cases, bacterial infection of the bladder needs to be eliminated and an acidic pH of the urine is maintained by feeding of C/D diet. It is extremely difficult to educate most Singapore cat owners and vets don't have much time to do so. Urine checks should be done monthly and 3-monthly but none will be done in most cat cases. The theory is sound but in reality, the Singapore cat owners generally are not interested in follow up urine analysis in 2012.

I noted that owners may buy one can of C/D for a trial and then no more news from them. Unfortunately, most vets just don't have the time to educate their clients. The younger generation will be more sophisticated and educated by the internet and be more demanding for results and excellent outcome. Struvites are easier to dissolve by dietary management rather than surgery but it is up to the owners to accept vet advices for preventive check ups.