Thursday, January 30, 2014

1321. Periodontal Disease Grade 1 and 4 in 3 dogs

Puppy canine teeth usually drop off by 7 months of age. If not, they obstruct growth and development of the permanent canine teeth. In time, hair and food get stuck between the puppy and permanent canine teeth causing periodontal disease.
The Dachshund's upper left and right puppy canine teeth still have not dropped off but the lower ones are gone.


No periodontal disease at this age generally in all teeth. Gums are not inflamed. No pus. No periodontal tissue attachment loss in this left upper permanent canine tooth. But the right upper one has gingivitis and is classified as Periodontal Disease Grade 1.









In another dog, a 12-year-old Papillon with heart disease, there is periodontal disease in the upper canine teeth as shown in the images below.


 
 
--------------------------
 


 

 
 An educational video is produced by Intern Chiang Ling Ling as follows:
 
 
 
Chow Chow at 18 months now has Grade 1 periodontal disease
 

 
 
Miniature Schnauzer came in because she was lethargic and her front paws were swollen. When I tried to open her mouth, she exhibited a frenzied avoidance behavior turning her mouth away from me. Then she started to paw her mouth with her front paws inserted inside her mouth.
 



This would be a case of periodontal disease Grade 4 in her upper left canine rather than a case of lameness in the front paws as perceived by the owner. After dental work, the dog is active and does not have bad breath. This case can be easily mis-diagnosed as lameness when the cause of the lameness is bad teeth.

An educational video is at:




Wednesday, January 29, 2014

1320. A hamster has ear warts again. Lateral ear resection surgery

In July2013, the 8-month-old dwarf hamster has ear warts in both ears.








Around 6 months later, ear warts proliferate inside the ear canals again. I advised lateral ear resection surgery of both ears using electro-surgery. Dr Daniel operated. The video is at:

Tuesday, January 28, 2014

1319. Vomiting and more than 5-10X diarrhoea

Young Dachshund - vomiting and purging -10X despite emergency treatment at another practice.

Why?

Blood test agreed by owner shows that the liver is affected, platelets are low. However, total white cell count is normal.
Parvovirus test on faeces - negative.
"How about distemper?" the husband asked.
"Not likely to cause acute gastroenteritis."

Nowadays, young couples are much more sophisticated as the wife asked whether the dog had been infected with parvovirus. Treatment must be successful in acute gastroenteritis or the client loses confidence and goes to another vet.

As this dog went home purging non-stop, then the owner deems treatment unsuccessful. I did not board the dog. Neither did the first vet. 

FOLLOW UP

On 27.1.14
Diarhoea 2X, morning, afternoon and evening.
Vomited 2X at 6pm. Went to emergency treatment.
 After midnight, diarrhea 5-10X, wife keeps waking up to clean.

28.1.14
Admitted to Toa Payoh Vets
Treated and goes home at 8 pm
Only one diarrhea (a bit of watery stools) after midnight.

29.1.14 Phoned  to follow up.
9am - 12 noon. Active. Does not want to eat I/D canned. Drinks 50 ml of electrolyte + glucose from syringe. Water freely available. Crated.
No vomiting or diarrhea.  Advised 50 ml every 2 hours.

Diagnosis:
The dog had hepatitis and low platelet count. Owing to his habit of licking any human or object as well as being fed variety of new dog treats and canned food as well as being introduced to outdoor exercise as opposed to being in the HDB apartment for the last 10 months, the dog could have picked up or licked some toxic chemicals. The total white cell count was normal, therefore ruling out bacterial infection. Blood testing is the use of evidence-based medicine.

NB. The first vet prescribed "3 drontal tablets for cats". Vets must check the medication before dispensing as this may led to complaints. A lot of time must be spent on acute gastro-enteritis case follow ups. It may be too much to expect a vet to do so, but it is important.

Video:  

Friday, January 24, 2014

Follow up: A shivering Schnauzer

Jan 24, 2014 Follow up on yesterday's treatment

Yesterday, the "7-year-old Schnauzer" came in shivering. Vomiting and diarrhoea for 1 week.
Attended to by my associate vet who took a blood test. High total white cell count 20 v. 6-17 and neutrophils  95% v. 60-70%,, creatinine (447 vs 89-177) and urea 37 (4.2-6.3).  RBC 4.4 v. .5.5-8.5, Hb 10.7 v. 12-18.

I got the dog X-rayed.
I palpated the abdomen. No swollen uterus and no pain on the X-ray table after X-ray. X-rays did not reveal swollen uterus but gas in the intestines.

The owner did not want the dog warded for drip. One IV drip of Hartmann was given. However, when I spoke to the owner, she said the vet did not advise hospitalisation.  Medical advices should be in writing on the case record, I always advised young vets but this was not done.

Diagnosis was kidney failure and bacterial infections. Anaemia was present. The dog needed to be warded for treatment but this is advised and it is up to the owner to comply. The owner will bring the dog to Surgery today.

Much time is needed to follow up. The dog was adopted for 7 years at 3 years of age and should be 10 years old now!
"How about the heat period? When was the last bleeding?" I asked.
"Do you mean her menstruation? " the young lady owner did not know and asked her mum. "Last May or June. However, her menses come around 9 - 12 months' interval."  
"This is not normal," I said. "Most dogs cycle around 6 monthly."

It is possible that this old dog actually suffers from pyometra. Bacteria goes to the kidneys and blood causing vomiting and diarrhoea. Blood test shows kidney failure. The primary cause may be a womb infection. If the owner has spayed the dog young, this pyometra would not have occurred. Abdominal palpation may not reveal closed pyometra. I did feel swollen tubes around 5 mm in diameter on the lowe 1/3 abdomen. Only surgery will confirm but this dog is not fit for surgery now.

This is the type of case where any medical advices regarding hospitalisation ought to be recorded in the medical records to avoid misunderstanding.  




 

1315. Lateral ear canal resection 14 days later - stitch removal




There was scratching by the dog. Stitch breakdown on the left side of the wall. However, healing will be done by granulation. Now, the wound looks red. All stitches were removed and the dog was given pain-killers.

1314. The rare stray cat in Toa Payoh Industrial park, Lorong 8




Tuesday Jan 21, 2014 was an eventful day.
At 3.05 am I decided to drive to Toa Payoh Vets to take my laptop battery to charge my Samsung ultrabook at home. I woke up at 3 am to work on my veterinary educational You Tube videos and had forgotten to pack my battery.
The surgery is located at the corner of Blk 1002, Toa Payoh Industrial Park. As I drove along Lorong 8, Toa Payoh, at this time, the road was deserted. As I drove into the side road where underakers have coffin shops, a truck with yellow lights was behind my car. Coffins in the undertakers' shops could be seen to my right and a truck behind me would give you the shivers. I drove off fast round the bend. Why would there be a truck at this time? Probably a funeral truck?

At 3.35 am, I reached my Surgery. Outside, there was this yellow cat (image above) inspecting the closed sliding aluminium shutters. A ghostly cat? This Surgery is located in a corner of the block and this location is very quiet and deserted at this time. I opened the shutters and grabbed the battery fast. I dashed into my car. No human beings around. A cool breeze. Suddenly it appeared there were spirits as an eddy or wind vortex appeared in front of my car churning the waste papers around. This could be natural but in this area of coffin industry, there could be spirits of the dead not happy with me. I drove away fast and reached home safely.

1. Meeting with a new vet looking for a job. I invited her to Ya Kun coffeeshop in Toa Payoh Hub so that we could have a good interview. New vets still can find jobs in private clinics but the bigger practices have less vacancies. "I am looking for a prospective partner involved in the writing of veterinary educational stories in kindle direct publishing," I was surprised she studied literature. "Young vets nowadays just work as employees to gain experience and open their own practices as they have strong financial backing."  She had her own preferences and would think about my publishing offer. It is probably better to find a non-veterinary graduate for this venture as new vets want to practice, not practice and write articles. I doubt there are any.

2. Meeting with a Myanmar travel agent who was given an "unfair" dismissal by her boss. "She is a wicked boss," she told me. "Suddenly my employment pass is cancelled."  I know her boss. Much money is spent on this travel agency business. But it is a tough business although tourism is booming in Myanmar. Singaporeans want "cheap and good" tours and Myanmar does not appear to be favourite for the locals as evident in the paucity of travel advertisement for Myanmar in the Straits Times. Full pages of other countries but practically none on Myanmar. She bought a Myannmar couple (an engineer and wife) with no knowledge of the travel industry but was interested in opening a travel agency as they have connections in Myanmar. Nothing was finalized. "You better accept the administrative job of a new employer," I advised this lady in her late 40s. It is extremely difficult to find a job in Singapore nowadays."  On Jan 24, 2014, I passed by the old boss' office and noted that the office space had been halved. This indicated that rentals are high and business is poor. So, high-paying or non-performing staff are sacked. Is she a wicked boss then?

Politics had made the government harsh on foreign workers by increasing levies and disapproving hires such that many companies have to close down branches or relocate to other countries. In this way, it is hoped that the locals will have higher salaries and jobs. Yet jobs with good pay, no weekend work or long hours are not wanted by the locals.

3. Mentoring my 3 lady interns. Unusual for me to have 3 interns. One is 16 years old, another is 18 years old and the 3rd is around 20 years old. All have excellent academic grades. They have to write case studies and produce the videos within a short period of time. However, the young will chat when I am not around and so the output is not what I expected. I would brief them on the script and they would produce a video not what I wanted. So, there was the drafts and revisions. They learn from revisions and I hope they understand more of veterinary medicine and surgery than being just an observer. All 3 can produce videos as expected. lt is just that the Singapore schools don't teach them how to produce film scripts but only writing expositions and dcoumentaries. So, I have to teach them that producing videos is not the same as writing essays..    
  

    .      

Thursday, January 23, 2014

1313. Emma's two cats







1312. Follow up on Doberman Pinscher from Sin Ming Ave

Jan 23, 2014. 6 pm

I followed up on this intriguing case of the "5-year-old" spayed female Doberman Pinscher pawing her mouth with her front paws 2 days ago (video captured this behaviour). I was much surprised by this unusual behaviour after I tried to open her mouth and the dog fought me off tooth and nail as evident in the video.



Dr Daniel had extracted 5 rotten teeth and did dental scaling yesterday. Antibiotics and painkillers were prescribed.

"How's the dog today?" I phoned at 6 pm.
"She is sleeping when I come back," the elderly gentleman spoke in Cantonese. He asked his father.
"Much more active, running around," the father said.
"A few days ago, the dog could not stand properly, especially on the front legs," the gentleman continued. "That is why I brought her to you for check up." Two days ago, the dog also had pus in both eyes.
"How's the appetite, drinking, peeing and pooping?" I asked.
"Same as before the dental," the father said.
"Any bad breath now?"
"No," the gentleman replied.
The gentleman was most pleased and thanked me profusely.
"As to the dog sleeping now when you come home from work, she is probably tired out."

I gave an antibiotic injection on Day 1 when I was first consulted after seeing the unusual behaviour of pawing of the mouth. The senior citizen owner deduced that the dog had severe tooth ache too and consented to the dental work. On Day 2, in the morning, the dog was OK with me opening the badly infected ulcerated mouth as evident in the video below.





Early dental check up yearly would have prevented such intense pain during older age. This dog could be more than 8 years old.  

Tuesday, January 21, 2014

1311. Lyme Disease in a Golden Retriever with shifting leg lameness

Jan 21, 2014

I phoned the owner today. The left hind limb is back to normal but the right hind limb is swollen.
Shifting leg lameness is a characteristic of Lyme Disease in the dog.

















UPDATE ON FEB 16, 2014

The owner phoned to say that the dog has recovered and is no longer having back limb swellings since 2 weeks ago. She asked if the medicaion of vibravet and anti-inflammatory and k/d diet need to be continued. I advised a blood test as soon as possible and to maintain on the k/d diet for around 3 months. Without a blood test, it is hard to advise properly.  

1310. How your old dog can live longer? Bradycardia and mouth pawing (2 cases)

Jan 21, 2014

Case 1. 17-year-old Jack Russel goes home today. He could stand up and had eaten most of the canned food for the past 2 days. I advised going home as very old dogs are better with family at home so as to spend time with family. This is an unusual case of bradycardia. Financial considerations mean no ECG or any tests to be done to practise evidence-based medicine.

Jan 17, 2014. Emergency clinic. 8.30pm. Can't stand, fainting, drooling. Vet said glucose at 3.4 ml was normal. Owner did not want blood test at all. Heart rate was very "slow" at 40/minute.

Jan 18, 2014. Toa Payoh Vets. Dog was recumbent, 4.8 kg, 38.2C. Owner said blood test was done 1.5 years ago and was OK. Did not want blood test. "Has he any fits recently?" I asked. "Yes, a few days ago."

Treated with IV drips, heart disease medication and antibiotics. Dog able to stand, eat and went home. I strongly advised dental extraction of the rotten canine with exposed roots and other rotten teeth. "The bacteria inside the rotten teeth will return and the toxins damage the heart and lower the immune system."

Such advices may fall on death ears as the dog was 17 years old and the baby-boomer generation owner probably does not to incur more medical costs. This old dog was really old and had the decayed teeth been extracted, would have been in a better health. Fits could be caused by an extremely painful mouth and the dog would not eat if he was toxic. No blood test was permitted and so the health status of the blood, kidneys and liver cannot be known.



Case 2. At least 10 years old. The complaint was lameness in front paws. Swelling of lower paws and dampness due to paw licking.

The Doberman Pinscher strongly objected to me opening his mouth for examination. Few teeth remains. Once I managed to open, he pawed his mouth so vigorously and bad breath filled the room. My intern videoed this behaviour.





"It is not a lameness problem although it appears to be so," I said to the owners. The dog has terrible tooth ache and uses his front paws to try to relieve his pain by rubbing and rubbing. Dental extraction will cure this problem."

The old dog was not particularly lame and was limping now and then. His back paw pads were dry and scaly but the front were wet and swollen due to licking or mouthing. Dental clean up will enable him to live a much better quality of life.

"No more bad breath after your dental work ?" the two senior citizens ask me.
"No more," I guaranteed.
"Any discount?" the senior citizen asked. "The package of $300 is low," I explained. "There is general anaesthesia and dental extraction to be done and the cost is usually more."

I gave an antibiotic injection 24 hours before dental work. At 20th hour, I examined the dog. Her mouth was not so painful as she permitted me to open the mouth without getting worried as you compare the video below with the one above (before baytril antibiotic injection).





Audit - TP 17053. Bladder stone surgery outcome

TP 17053. Old client of Dr Sing Kong Yuen since 2005. From Woodlands, Singapore.

White Miniature Schnauzer, F, 6 years. 10kg, 39.3C.
Abandoned but adopted by kind lady in Woodlands.
Appetite good, no vomiting or diarrhoea, incontinent.
Dr Daniel palpated bladder stones on Jan 7, 2014.  Dental scaling done. Bladder stone removal 7 days later.

Blood test  Jan 7, 2014
Total cholesterol  8.03  (3.0 - 6.6)
Triglycerides  0.97 (0.3 - 3.3)
SGPT/ALT 285 (<186 p="">Total white cell count  23.9 (4-15.5)
Neutrophils 97% (60-70%)
Neutrophils Absolute 23.18 (3-11.5)



Urine test  Jan 8, 2014
pH 7, SG 1.008, Protein 2+, Blood 4+, Bacteria +, Crystals Nil


X-rays  2 large brownish yellow bladder stones. Looks very much like struvites in shape and colour






Jan 16, 2014.
Cystotomy. Dr Daniel Sing. Stone analysis being done.
 
Videoed by Intern Clara. Too gory as bladder was extremely red. .
Domitor 0.28 ml + Ketamine 0.35 ml IV & top up with isoflurane
Isoflurane gas+O2 (C-B)  39 minutes
Trimaxazole & rimadyrl oral

Educational video to be produced by intern.


FOLLOW UP
Jan 21, 2014
The lady owner returned my call at 6.30 pm.
"Everything is OK," she said. "Eat, drink, pee and poop". No more urinary incontinence!"
I advised cleaning of the wound as she had not done so.





Raw footage of my videos.  Intern to edit


Thursday, January 16, 2014

1307. The dwarf hamster has two itchy warty ears

http://youtu.be/7SneupKcX-4




1306. Was the Schnauzer abandoned because of blood in the urine?

http://youtu.be/a46ln542mhI




Part 2 shows the dog recovering very well 2 hours after surgery by Dr Daniel
http://youtu.be/LnAQ4dNZpyY



 
 
 
 
 
 
 
 
 
 

 
 

1305. A young terrapin has 2 ear abscesses.

http://youtu.be/fj_eBwMGtns

A young terrapin had two ear abscesses. Anaesthesia is required to lance the abscesses and drain away the pus. Without anaesthesia, the terrapin will just withdraw his head inside his shell and nothing can be done. Some do bite in self defence. Clean water is important to prevent ear infections.
As at 14 days after surgery, no news from the owner mean no problem after surgery.
.

 

Tuesday, January 14, 2014

1303. More videos

Dr Sing Kong Yuen, BVMS (Glasgow),
MRCVS 
Monday - Sunday and Public Holidays by Appointment. Mainly morning consultations By Appointment Only. 9 am - 12 noon usually daily & at other times Our 3 vets work as a team. All enquiries, house-calls & appointments:  tel: 6254-3326, 9668-6469.

Appointments are preferred as we may be doing surgeries. 

Please let us know your choice of the 3 vets early.
Dr Jason Teo E-Shen, BVSc (Queensland) Saturday By Appointment Only
11 am - 5 pm
Dr Daniel Sing Zongzheng, BSc, BVMS (Murdoch) Monday - Friday including Public Holidays 12 noon - 8 pm 
Walk-in & house-call
Sunday 9 am - 5 pm
   
 
6968. Video: A 17-year-old Shih Tzu vomits green stuff - Part 1 6969. Video: A 17-year-old Shih Tzu vomits green stuff - Part 2 6970. Video: A 17-year-old Shih Tzu vomits green stuff - Part 3 6971. Video: Travel Stories: Part 1: A Turkish guide entertain & educate 6972. Video: Travel Stories: Part 2: How to entertain the Singaporean tourists? 6973. Video: Travel Stories: Part 3: Gigolo jokes to wake up the Singapore tourists 6974. Video: Travel Stories: Part 4: Morning feedback from Singaporeans 6975. Video: Travel Stories: Part 5: Spice Markets' friendly sales people
6976. Video: Singapore Stories: Buying cakes for a 92-year-old grandma 6977. Video: Swollen  nose & wet tail dwarf hamster - Part 1 6978. Video:  Swollen nose & wet tail dwarf hamster - Part 2 6979. Video: Swollen nose & wet tail dwarf hamster - Part 3 6980. Video: Travel Stories: Istanbul's kindness to stray dogs 6981. Video: Travel Stories: How to be an excellent tour guide - Part 1 6982. Video: Travel Stories: How to be an excellent tour guide - Part 2 6983. Video: Travel Stories: How to be an excellent tour guide - Part 3
6984. Video: Travel Stories: How to be an excellent tour guide - Part 3 6985. Video: Travel Stories: How to be an excellent tour guide - Part 4 6986. Video: Travel Stories: The wooden horse of Troy, Turkey 6987. Video: Travel Stories: The ruins of Troy - Part 1 6988. Video: Travel Stories: The ruins of Troy - Part 2 6989. Video: Travel Stories: Ataturk Museum, Turkey. Changing of the guards - Part 1 6990. Video: Travel Stories: Ataturk Museum, Turkey. Changing of the guards - Part 2 6991. Video: Travel Stories: Kaymakli Underground City, Turkey - Part 1
6992. Video: Travel Stories: Kaymakli Underground City, Turkey - Part 2 6993. Video: Travel Stories: Kaymakli Underground City, Turkey - Part 3 6994. Video: Travel Stories: Searching for a cheap & good Spice Market shop, Turkey 6995. Video: Travel Stories: Checking out the prices at the Spice Market shop, Turkey 6996. Video: A Schnauzer passes blood in the urine 6997. Video: The hamster has a nose operation Part 1/3 6998. Video: The hamster has a nose operation Part 2/3 6999. Video: The hamster has a nose operation Part 3/3
7000. Video: Hamster's armpit abscess operation 1/8 7001. Video: Hamster's armpit abscess operation 2/8 7002. Video: Hamster's armpit abscess operation 3/8 7003. Video: Hamster's armpit operation  4/8 7004. Video: Hamster's armpit operation 5/8 7005. Video: Hamster's armpit operation 6/8 7006. Video: Hamster's armpit operation 7/8 7007. Video: Hamster's armpit operation 8/8
7008. Video: Social media not so important if products sell well 7009. Video: Social media not so important if products sell well 7010. Video: The Golden Retriever has a painful left shoulder 7011. Video: The hamster is irritated by two toe warts 7012. Video: Ear surgery resolves painful ear problem of the Cavlier King Charles 7013. Video: The bullied vomiting cat has painful rib cage and back 7014.Video: The wealth prophecy came true on New Year's Day 7015. Video: The Golden Retriever fell ill after boarding
7016 - 7020. Blog: An old dog has open pyometra & uterine torsion 7021. Video 1: Sale of leather dog muzzles 7022. Video 2: Sale of leather dog muzzles 7023. Video: The old Maltese has 3 years of dirty vaginal discharge
         
7024.Video: The old Jack Russell has a painful right knee - Part 1 7025. Video: The old Jack Russell has a painful right knee - Part 2 7026. Video: The old Jack Russell has a painful right knee - Part 3