Monday, August 31, 2015

2981. An 8-year-old Silkie has sterile struvite urolithiasis

Aug 29, 2015
SilkieXYorkshire, Female, 8 years
Consulted Toa Payoh Vets for right hindlimb lameness. Patellar bones luxate easily medially in both hind limbs. X-rays for sprained knees showed lots of bladder stones.
No complaint of blood in the urine or peeing problems.




URINE TEST
pH 8
SG 1.024
A trace of blood.
Crystals amorphous phosphate 3+
Little  white cells  3
No red cells.          0
No bacteria



Advised S/D to dissolve the stones.
X RAYS










A rare case of sterile struvite in a dog. Almost 99% are infection-induced struvites with microbial urease involved. Hence, the owners did not know about the bladder stones till X-rays for lameness. These stones can be dissolved by S/D diet and change to C/D diet later.

Sometimes, a rare case appears. Urine must be collected to test for crystals.  

Sunday, August 30, 2015

2980. Doing charity work in Vietnam

Sep 1, 2015

The Straits Times report headlined "ICA explains why some Viet woman turned away at airport".
The Immigration and Checkpoins Authority (ICA) had sent back several Vietnamese women at Changi Airport as they could not explain to officers why they wanted to enter Singapore. The Vietnamese Civil Aviation Authority wanted to know why. The Vietnam Embassy's second secretary Nguyen Cong Huan met the ICA officials and was satisfied with the explanations on entry procedures which applied to visitors of all nationalities and that ICAhas interpreters to help those who cannot communicate in English. 

"The ICA does not have interpreters. They don't care. No explanations are given. They just end the woman back," the Singaporean who married a Vietnamese wife said. Before he married her, the ICA had prohibited her from entering Singapore on two occasions. She was detained in a room and put on the plane home. She could not speak Mandarin or English. There was no interpreters."

"The ICA says they have interpreters," I referred to the Straits Times clipping he showed me. "Are you able to gather evidence like an investigative reporter? What do you want to get blacklisted now that your wife had been given a long-term pass to stay in Singapore?"

This man had to accompany his wife every month for 4 years to travel out of Singapore as she was given a monthly visitor stay. Four years. "According to the law, it should be 3 years," he said. "The ICA does not bother to check on whether mine was a sham marriage. They just give my MP the standard rejection letter."

"The ICA officers are overworked," I said. "It is up to the individual to persevere." He did and now his wife is on a long term pass. After 4 years and many petitions. 

CHARITY WORK IN VIETNAM

The man wanted to build 10 houses and repair leaking roofs and tile the flooring of houses in the villages. The village headman told him to get approval from the District Officer. He wanted to do the charity work by himself. The District Officer wanted him to deliver the cash and goods.

"Unless you have a trusted respected person in the District," I advised. "You will not be permitted to do charity work all by yourself. This is the reality. The other way is to stay in the country for many years and get the connections and respect or partner with a local of good standing as some Japanese donors have had done in building schools in Myanmar villages. No do-it-yourself. It is not the way."

"The District Officer even checked whether I was living in the villages without permission," he said.

Doing charity work in Vietnam, as in all developing countries, is not so straight forward. You need the locals of good standing and influence.     








Saturday, August 29, 2015

2979. A spayed female cat had recurrent breast tumour and died.

Sunday, Aug 30, 2015
Female spayed cat, 10 years old passed away at home. In the last 2 weeks, the breast tumour recurred and grew fast, the owner said.


HISTORY
Feb 16, 2015.
Mastectomy, Left mammary gland 1 enlargement,  8cm x 6 cm x 0.5cm excised.  Invasive ductal carcinoma. Lymphvascular invasion is seen.

Mar 7, 2015
Thin, vomiting. Painful kidney (left).  Total white cell count very low. Neutrophil % 24%, 0.55 absolute numbers low.  Platelet very low. Had used tiger balm ointment on cat or surroundings.

TODAY
Aug 30, 2015
Left mammary gland 1 and another nearby.

Spayed cats may develop breast cancer but rarely.

Thursday, August 27, 2015

2978. A cat has dislocated left hip


Aug 28, 2015. Yesterday, one 3-month-old rabbit dislocated his right hip. The owner wanted closed reduction rather than doing nothing as Vet 1 suggested. Vet 1 had said he could not reduce the hip joint and suggested doing nothing. The rabbit has a right hip sling after putting the femoral head into the hip joint. The owner did not want any surgery as the rabbit is only 3 months old.


Then another case of dislocation of the hip in a cat abused by somebody. He was missing and found to be lame.

The left hind leg was shorter than the right on extension. X-rays to confirm and taken today.
Sedation is necessary for proper X-rays as the hind legs must be extended.

In this cat, 4.4 kg bodyweight:

xyla 0.5+Ket 0.3 IM
Reverzin 0.05 ml IV (or IM) given to reverse xylazine.

The owner wanted closed reduction and a sling was applied. The cat stained his bandage after peeing. I asked the owner to wash it off. For other "looseness" of bandage or hairs stuck, I asked the owner to bring the cat down as it is impossible to "diagnose" and "advise" over the phone. So far, the Cavalier King Charles and the rabbit, both given slings, had no complaints.

X-rays for this cat are as follows:










Wednesday, August 26, 2015

Rabbit hip dislocation 3 months old


Closed reduction may be possible if done early.

Tuesday, August 25, 2015

Follow up: A 9-month-old Miniature Schnauzer cannot pee

Aug 26, 2015.

This case illustrates the typical challenges many Singaporean dog owners face.
Most vets have no time to follow up as it is time-consuming. Today, I followed up to find out whether this brown male Schnauzer stlll has difficulty in peeing. (Video done July 2015) since he was given dry Canine C/D, no dog treats and other food after 4 days of in-patient and catheterisation for urethral obstruction (small bladder stones around 4 mm across was flushed out). The owner did not want blood test or X-rays, but the clinic did a blood test free of charge.   

"He pees a lot now," the mother of 2 boys, 10 and 11 years old was happy. "Neighbours said he has put on weight."  That was good news. The stools are "nice" in a continuous roll when the dog was fed C/D.

FINDINGS
1. Jan 2015. Dog was purchased at 3 months of age. Fed dry food from pet shop.

2. May 2015. Changed to a different brand of dry food called Osbourne as pet shop operator said it is better, more protein. Dog vomited often after eating this dry food and the earlier brand. So added canned food. Owner thought the dog ate too fast, so vomiting occurred. 

3. Jul 2015. Dysuria. Blocked bladder. Catheterised. Small bladder stones sucked out.
    4 days of inpatient. Did not want x-rays or blood test.

4. Aug 26 2015. Follow up on dysuria and C/D diet.  No more problems. He peed a lot for the last 2-3 weeks. Stools are well formed and in a roll

5. Urine test
pH 7, SG 1.020. Nitre +, Protein 4+, Ketones +, Blood 4+. White blood cells 576/uL. Bacteria +. No crystals. Yet around 3 small crystals were sucked out during catheterisation.

6. Blood test
Liver enzymes ALT/AST  159/102   (<59 br="">Urea 49.5   (4.2-6.5)
Creatinine 691  (89-177)

Total WCC  37.3  (6-17)
N 83% (60-70)
N absolute 90.96 (6-11)
Platelets  78 (200-500).  The dog has sepsis and kidney failure.

DOG PYSCHOLOGY
1. The mother is the disciplinarian of the dog.  Would crate him for most of the do. He will bite things in the apartment including the crate playpen and the younger son.
 
2. The younger son, 10 years old is bullied by this dog. He complained to his mum that his leg is painful from the dog's bite. There are bruises. The son would run when the dog is let out. The dog would chase him as a prey and bite him. The boy is encouraging this attack bite behaviour.

I advise:

1. grip the dog's muzzle and say "no biting" when he chases the younger boy.
2. place him into the play pen when he starts "bullying" the boy in Primary 4 class. .
 
3. Now the dog is nearly 11 months old. Not neutered as the owner did not want to do it.
He pees many x a day, every 20 minutes. The mother will estimate the 20-minute interval and placed him inside the playpen bought 2nd hand from the pet shop. It has a pee tray which she lined with pee pad. This routine is still present as other family members feel that the mother is too strict on this young dog.

CONCLUSION

No recurrence on C/D diet. Strictly no other food or dog treasts.  Schnauzers are prone to urinary stone formation.
 
Early neuter will have prevented this need of the dog to urine mark. The owner has to place him into the play pen to pee every 20 minutes. She did not realise that he is urine marking.



2975. INTERN. A 17-year-old Shih Tzu barks all night long

Aug 25, 2015

The parents and the young adult son came in to euthanase this 17-year-old Shih Tzu who barks all night long. The parents have to work and have no rest. They used to bring the dog down the apartment to the grass to pee at 5 am and 10 pm but now, they had to do it at 2 am.. The dog would not pee at home even at 17 years of age. He was kept in a very good condition although he had difficulty standing up.

Vet 1 had prescribed heart, liver and joint disease medication. Most likely, Vet 1 did not want to put the dog to sleep.  The frequent night barking led to this decision to euthanase as the parents have to work.

"Take time to think about euthanasia," I do not advocate euthanasia for dogs that can eat. Is there another solution?

I advised:
1. No water after 6 pm so that the dog does not need to go downstairs.
2. Antibiotics for possible bladder infection due to holding of urine for long periods of time. No urine test is done to lower medical costs. 
3. Medication. Sleeping tablets adjusted for effect at 10 pm.

The owners decided to accept the medication and the dog barks less. The dosage is being adjusted and it is only 3 days since I saw the dog. This family loves this old dog very much to undertake this solution. 

2974. INTERN. . Time is running out - Case 3. A Maltese became comatose and had pyometra

The owner did not want the dog to be spayed nor the encrusted tartar in the teeth to be cleared when advised some 2 years ago.

The dog came to the clinic comatose and had fits (video). Blood test showed low glucose and extremely high total white cell count and neutrophils. The diagnosis was bacteraemia and sepsis. Based on the history of the dog having heat 4 weeks ago, a swollen vulval area with some discharge, a tentative diagnosis of pyometra was made by me.   

On the 2nd day of IV drips and antibiotics, the dog could stand up. On the 3rd day, she did. Reddish brown pus leaked out from the vagina. This was a case of closed pyometra.


Time has run out for this 9-year-old Maltese. A spay at a young age of 1 year old  would have permitted her to live much longer than the 9 years.


REFER TO POST NO. 2968.

2973. INTERN. An emaciated "anaemic" terrapin

This terrapin has loose flabs of skin in the thigh area and looks very pale compared to normal terrapins. The owner had confined him to a small plastic tank and he had stopped eating for some months. Antibiotics, tank hygiene, sunshine and a much bigger tank are advised.

Video

2972. INTERN. Time is running out - Case 2. A female Pekinese passes foul-smelling vaginal discharge

August 25, 2015

Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.

Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.

Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.

"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."

This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would  be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.

Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs.   This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence. 

Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.

 

 



 

Friday, August 21, 2015

2971. INTERN Time is running out - case 1. An 11-year-old Jack Russell has false pregnancy and 4 breast tumours

Aug 21, 2015

TIME LINE

10 years ago, I advised spay 2 months after the end of the heat bleeding. The owner did not turn up.

5 years ago, the owner noticed a small breast lump in the dog. His son told him to seek veterinary attention. He did not want the dog to suffer post-op pain. The dog had surgery to remove a pebble in the intestines by another vet and his wife had to take leave to care for her. So no more operations.



TODAY  Aug 21, 2015
The dog was not eating much. I examined her and found 4 breast lumps (video). I expressed some milk from one of the breasts. There was no vaginal discharge now. So, false pregnancy and/or pyometra is diagnosed. The hormonal changes of false pregnancy would affect the dog's appetite and behaviour.

"Did she carry a soft toy or blanket to a corner and was protective of it?" I asked. "As if she had a newborn puppy?"

"Yes," the owner said. "She carried a towel and went to a corner. What do you advise about the breast tumours? Do you advise euthanasia?"

"The decision for euthanasia is up to the owner," I said. "This dog is still active. She needs spay and breast tumour removal but at her age of 11 years old, you may want to think about her few remaining years, the medical costs and the post-op pain. Generally, most dogs do not suffer from post-op pain as they are given pain-killers."

The owner will decide with his wife.

Blood test, X-rays of the lungs, spay and breast tumour removal, high anaesthetic risks and post-operation complications and pain.  Whether it is worth doing the operation as the dog is near the end of the life span. These must be considered.

Aug 25, 2015
Blood test showed high cholesterol and very high liver enzymes.

"This dog cannot be spayed now as the risk of anaesthetic death is very high," I said. Five years ago, the dog had a single breast tumour but the owner chose to ignore this growing tumour. He said that his wife had to take leave to take care of this dog after a pebble was removed from the intestine. So, he did not want the dog to suffer post-operation pain again, if she had her breast tumour surgery.

Time is  running out now as the dog now has 4 growing and big breast tumours, 3 on the left side and 1 on the right side. Their sizes were more than 5 cm across. No biopsy was done to lower medical cost.  So, it was not possible to state that these tumours were malignant or not. I had advised a spay to remove the ovaries which produce hormones encouraging breast tumour growth in some cases.  Not every case as you can see in the case of the Pekinese that did not develop breast tumour after tumour removal and without the owner spaying her as advised.

"My dog recovered her energy and appetite after consulting you," the man said. On superficial appearance, the dog is normal, with good food like roasted pork pieces being fed when she had lost appetite a few days ago. A high cholesterol level and liver disorder now presented itself.

"My son noticed her elbows and her sternal area were yellowish," the man said.
"He is very observant young man," I told him I had noticed a yellowish strip of sternal skin on that day but had not pointed this to him. "I thought he had stained himself but this yellowish skin do look like jaundiced skin."

As the eye white was not yellowish, I ignored this finding and did not tell the owner. Usually jaundice presents itself as yellowish eye white. Now, the blood test had shown that this dog has a severe liver disease. The total white cell count was normal, but the neutrophils were higher. This could be a start of bacterial infection and my antibiotic medication had eliminated the bacteria based on the dog's rapid recovery of appetite.

"What can be done now?" the owner asked. Dr Daniel had advised him on a prescription liver diet for the next 1-2 weeks and he had come for the canned food. Unless the dog's health deteriorate, this would be the course of action. I agreed with him.

Time is running out for this dog. There is no point saying that she should have been spayed 5 years ago when she had only one breast tumour as in the case of the Pekinese with foul-smelling vaginal discharge.      

Tuesday, August 18, 2015

2970. A 10-year-old Chihuahua sleeps curled up

Aug 13, 205

Suddenly the 10-year-old female spayed Chihuahua slept curled on the right side worrying the owners. Much loved by the couple, esp. the wife.  Weight was 2.6 kg, looking rather plump.  Has an excellent appetite.

I palpated pain behind the right side of the rib cage, around the right kidney.




X-rays
right 9th rib appeared fractured.
multiple lung nodules, liver enlarged? spleen OK.






Were the liver and spleen enlarged?





Blood test
Only the kidney profile is not normal

urea 3.5  (4.2-6.3)
creatinine 63 (89-177).

Platelets  578  (200-500)







Treatment was painkiller rimadyl for 4 days and antibiotics. 

AUG 18, 2015
Follow up by tel. The dog sleeps in the usual sternal position since treatment and the husband was most happy. No more curled up in the foetal position when sleeping. He enquired about the W/D diet to reduce the weight.  No jumping up and down. 

Monday, August 17, 2015

2969. INTERN The 7-year-old Silkie passes strong smelly urine

Saturday, August 15, 2015

An unusual feast of cases this Saturday morning and morning at Toa Payoh Vets.
Outstanding cases include:



A 7-year-old female Silkie X passes very smelly urine, blood and pus for many times and had been treated by vets. The lady had consulted 3 vets in a practice but the dog passes smelly urine after a course of antibiotics. Blood tests and X-rays were done.

So, she brought the urine sample in a bottle to consult me for a 2nd opinion. The ammonia smell was overpowering.
"Was urine test done?" I asked.

I palpated a "fish ball " sized bladder. It could be a thick-walled bladder which had been inflamed for many months or there could be bladder tumours and small stones.There was pain in the kidney area (video).

I got a urine test done.
  pH 9, SG 1.03, Nitrite +, protein 4+, blood trace, bacteria nil, crystals  triple phosphate +,  amorphous phosphate 3+. 
There was no bacteria as the owner had given a course of antibiotics from the other vet.

Blood test
Kidneys were OK. No abnormal blood cell count or numbers.

Treatment
IV drip with antibiotics and painkiller. Trimax tablets at 1/4 twice per day for 14 days.


Follow up on Aug 18, 2015
No smelly urine as the dog was on trimax.
The dog is advised to go on C/D
Ultrasound advised to check for bladder tumours
X-rays from the other vet needed although the vets said no stones.
A blood test 2 months later.

Advised spay as the vulval area and ventral skin area in the groin were hyperpigmented black since the dog had been licking it for many years. Possibly the dog had open pyometra leading to licking and bacteria entering the bladder causing infection. I explained to the lady that in female dogs, the urethral opening can be easily infected from the pus passed out from the uterus.

"I do not want my dog to suffer from pain (involving spay surgery)", the lady said. So this advice that could save the dog's life in later years was given but not accepted.  Pyometra could worsen leading to septicaemia and death  2 years later. 

2968. A 9-year-old not spayed Maltese became comatose

Aug 18, 2015

This morning, I went to the pet shop to buy hamster food. The aunty at the pet shop asked what caused her niece's Maltese to die?  She had not asked the niece who was grieving over the death.

I told her that the Maltese was comatose and had fits when her niece brought the dog into my clinic 3 days ago. The dog had septicaemia as the total white cell count was 70 (5-17 being normal) and the neutrophil % was 98% (60-70% being normal). There was insufficient blood glucose.

The dog was recumbent and despite IV drip and glucose, the dog died after 2 days of in-patient. She was in heat 3-4 weeks ago and I suspected pyometra.

Brownish red blood oozed out from the vagina after she died and the niece saw it. The parents and the pre-teen children came to visit the dog. The niece got a man to cremate her.

This death could have been prevented by early treatment or by spaying the dog at 6 months of age. This dog would have lived much longer as her kidneys and liver were normal as shown in the blood test. Her teeth was encrusted with tons of tartar but the niece ignored my earlier advice to get dental work done.

Bacteria could have reached the blood stream via the mouth or infected uterus. It is hard to say where the bacteria in the blood originated.

I did not want to bring out this sad topic with the aunty as this was death that could have been prevented by spaying.

Sunday, August 16, 2015

2967. INTERN. A cat has dysuria and pollakiuria after boarding

Aug 17, 2015

Aug 15, 2015. Cat. 4 years. Female. Boarded last week. Dysuria and pollakiuria for the past 5 days.

Black and white cat. (video).


AUGUST 15, 2015

On August 15, 2015, I saw this 3-year-old male, not neutered cat. He peed with difficulty (dysuria) and dribbled urine all over the apartment (pollakiuria) for the last 5 days.

AUGUST 5-10, 2015
He was in a boarding cattery in Pasir Ris ing for 5 days over the National Day holidays (Aug 5-10). The owners were worried about his illness.

"Are there other cats in the house?" I asked.
"No," the wife said.  So this cat would not be stressed out by sharing litter boxes or bullied by other cats. As for toilet, he goes to the squatting toilet bowl to do his business. 

AUGUST 15, 2015
I palpated the kidneys. The cat reacted in pain (Video clip). X-rays showed enlarged kidneys (image).






The blood was collected from the jugular vein (video clip). Blood results showed normal kidneys and liver. Only that the platelet count was low at 33 (300-800). The low platelet  count could mean that this cat had licked some poisons during boarding. The owners said that the cat's body had a strong stench of urine and smell on return from boarding. These body stains would be toxic and the cat would attempt to groom himself, licking off as much of the toxic contaminants on his body. The toxins entered his blood stream. They  caused pain in the bladder and urination.

Treatment was by haemodialysis with IV drip to flush out the toxins in the blood. Antibiotics and painkillers. The cat was boarded for one day and went home on August 16, 2015.


AUGUST 18, 2015 TEL TO OWNER.
As at Aug 18, 2015, the cat is active and has recovered fully his bladder control. 

ADVICES TO OWNER
1. Lifestyle of the cat is as follows:
1.1  Daytime - free to roam in the apartment. Toilet would be the squatting toilet bowl and toilet floor.
Night-time - confined to a small carrier (video). This is to prevent noise nuisance and urine marking. Sometimes he would soil his body with urine and stools overnight.
1.2  Next morning, the cat's body would be washed and cleaned before letting out. Most likely, the boarding cattery would not bother to adopt this lifestyle of cleaning the cat daily.

2. Neutering the male cat would have prevented the caterwauling noises and urine marking.  For religious reasons, the owners did not want to do it. So, night confinement to the carrier and daily body cleaning would be performed.


In Singapore, some male dogs are similarly confined to a cage at night to prevent urine marking. Some owners put on pads to cover the back of the dog to contain the urine or prevent urine marking when they are not at home. 

The best advice is to neuter the cat or dog at 6 months of age to prevent urine-marking and noise nuisance.

FOLLOW UP ON SEP 30, 2015
No complaints from the owner as the cat is normal now.






Thursday, August 13, 2015

2966, A 10-year-old chihuhua has occasional pain in the back rib cage area - X rays

August 13, 2015

A 10-year-old female spayed chihuahua recently curled up to sleep on her right side. Sometimes she had her collar hairs standing erect. On July 21, 2015, I had performed dental scaling and extraction of loose teeth. A blood test showed higher number of red blood cells and haemoglobin.

"What's the problem with her appearing to have painful?" the couple asked me today. I palpated the back part of the rib cage with 2 hands inwards. The dog winced and attempted to bite me (video).
So, was there something wrong with the rib cage?


Video   Chihuahua

Tuesday, August 11, 2015

A cavalier king charles dislocates her left hip




August 11, 2015.

Unusual behaviour led to left hip dislocation.
For the past 7 years, this female CKC must jump up and hit the wall for a while before squatting  down to poo. She lives in an apartment and was not seen jumping up and down the sofa or had a fall from the table, according to the owner.

So, the hip dislocation was attributed to this behaviour.

The owner agreed to a closed reduction. In this procedure, Dr Daniel anaesthesized the dog, put back the femoral head into the hip and splinted up the dog's leg. The dog is at home now. If closed reduction does not work, then surgery is needed.

Thursday, August 6, 2015

2964. Internship

August 7, 2015. Thursday.

Today is a public holiday given by the government for  "Singapore Jubliee celebration" and forthcoming National Day on August 9.  Many Singaporeans just took the long weekend and extra holidays to go overseas. I am still open today.

Yesterday, spoke to the two RI interns and my assistant Naing on work matters.
1. Doing what they like - an attitude of the younger generation. However, the work process is short-cutted or amended, leading to inefficiency and waste of time.

2. Texting and video watching while at work. A common bad attitude as work does not get completed.

3. Not giving priority to important tasks given by the boss. So, long delay in project.

2963. Bladder stones in a 4-year-old female Silkie X


A gentle young female Silkie X
X-rayed at 6.30 pm.
"No staff," the Filipino assistant said as she opened the evening clinic. "I will X-ray the dog myself and will call you for help if necessary."
She was good and helpful. The X-rays are excellent. No kidney stones but at least 16 bladder stones.

Dr Daniel discussed the case  with the owner who cycled back to Bishan with the dog on the basket. He will discuss with the family. Looks very much like struvite stones. The dog is said to be eating mostly home-cooked food. 

2962. Birthday celebration. 76 years old.






Tuesday, August 4, 2015

A 1-year-old Border Collie dislocates her right hip


Aug 5, 2015

The Border Collie was limping on her right hind limb this morning. X-rays show the right femoral head has dislocated entirely out of the right hip joint. Surgery is advised. The chances of being back to normal without surgery are slim. Surgery and anaesthesia done. Femoral head was excised.

 Video
https://www.youtube.com/watch?v=AgtdpokwKuI



March 5, 2017
The owner came as the dog had swallowed a rubber toy.
I asked about the time it takes the border collie to recover normal gait after femoral head excision.
"She took 3 months to recover and walk normally!"

   





Sunday, August 2, 2015

2960. Client control

August 2, 2105

Client control refers to a client who dictates what is to be done in the diagnosis and treatment of the medical condtion.

I had a case where the client said that her Schnauzer suffers from allergies and therefore an anti-allergic injection is to be given. Yet this spayed Miniature Schnauzer had two flanks bitten bald, as in an endocrine alopecia case.

There was ringworm treatment given. UVL showed some fluroescence. The owner wanted control of the treatment and such owners are best avoided. She said the dog is allergic to chicken.

If the dog does not recover, more steroid injections are given on command. This may not be in the best interest of the dog.

There will be clients who want to control the treatment as they have surfed the internet and had some medical knowledge.

2959. Looking for a "good" vet. Retained ovarian tissues


August 2, 2015
Hi Dr Sing,

She has stop passing gas now but she's been drinking a lot of water since yesterday (estimate 400-500 ml today). Her temp went from her usual 37.7-38.2 to 38.2 - 38.9, albeit it's within the normal range I find it quite peculiar the vast changes. She had some slight lethargy, weak legs, slow motion, panting, hiding under the bed/table/couch, restlessness on Yesterday. 
This is just so strange she was so well playful, no swollen tummy, normal water consumption on Wednesday till Saturday. 

I've now removed the water in case there's a stump and it builds up into pus. 

Here's the latest pix of the swollen stomach. I've also discovered a blood spot, which doesn't seems recent. 

She's on juroclav since yesterday (Sunday), she had to stop her antibiotic on Wed-Sat because she had severe rashes from it. 

Question:
What's the cost of x-ray? Do u have the facilities in your clinic?

Im not too sure if she has an infection, how do we determine that? In her previous urine test it showed her WBC was in the normal range, would that confirm any infection.
-------------------------------------
This case shows the lack of confidence in all vets as the owner now does her own diagnosis. Vet 1 had spayed her dog (pyometra) saving the dog's life. However the dog showed signs of heat after the spay and passed some spots of vaginal discharge. Vet 2's ultrasound diagnosed ovarian remnant in the left kidney area and gastroenteritis.

The dog was not as active as before and seemed to be in pain. I advised her to get a review again with Vet 2. The owner decided on self-treatment with antibiotics and tramadol pain-killer. She looks for a "good" vet.
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In my reply, I wrote:

As each vet, like you, is an individual, you cannot expect perfections.

2958. Stray cat spay in 5 minutes

Aug 3, 2015

Youtube Video:
https://www.youtube.com/watch?v=ouUePbKDUdg

A stray cat is spayed in 5 minutes.

1. Short skin incision around 2.5 cm
2. Hook out uterine horn, exposing a longer length of ovary and ovarian ligament
3. Clamp on ovarian ligament twisted in a circle to include the tip of a part of the ligament when the ovarian tissues are cut. The tip of the clamp forceps then catch this tip and pull it inwards to "ligate" the ovarian blood vessels. No need to use stitches as in standard spay.  Repeat on the other ovary.
4. Uterine body is clamped and ligated as in standard spay.
5. Stainless steel suture is used to ligate uterine body, muscle layer (one cross stitch) and subcutaneous skin (horizontal mattress suture under the skin).  

Claimed that the cat can be released immediately. Any age from 6 weeks onwards. These are stray cats.  

Video time taken: Less than 5 minutes. Cat spayed was on heat and so the uterine horns are swollen and easily hooked.No need e-collars.

COMMENTS
For most vets, I will advise
1. A longer skin incision to ensure that the ovarian tissues are 100% taken out and seen. This is to prevent remnants of ovarian tissues remaining in the "spayed" cat.
2. Ligate  the ovarian ligament with absorbable sutures as in the standard spay.
3. Toa Payoh Vets use one separate suture packet per cat spayed, not from a reel of sutures as for stray cats.