Wednesday, September 30, 2015

2320. A Fancy rat has a soft armpit mass

Sep 30, 2015

This rat had a gigantic breast tumour (left MG 3 to5) removed 2 months ago, but for the past month, she had a big right armpit swelling.

I could not palpate any breast nodule. Surgery showed a flat reddish soft tissue mass measuring 5 cm x2 cm which was unusual and rare. 





"This must be shown to the owner," I said. "Seeing is believing."



Even if the owner does not want to see it, the vet must show it.  The owner did not want hisopathology and this was written down, in case of complaints of incompetence and to satisfy the owner that the large mass had been excised..



The lady owner saw the mass kept inside a plastic bag.  Earlier, this specimen inside the plastic bag was discarded as Dr Daniel had said that the owner did not want to see it. I asked my assistant to retrieve it and show to the owner. I asked whether she wanted histology to check whether the tumour is cancerous or not. She declined. This advice was recorded in the case sheet.

 
Many young owners are internet savvy and some are suspicious of the veterinary competence.

2319. Follow up: The young neck-sxtended chihuahua develops more red spots on her shoulders.

Sep 30, 2015

The young lady in her early 30s came to buy 2 bottles of multivitamins for her Chihuahua who had presented with her nose pointing skywards some 4 weeks ago. (Another blog).

"How's the dog's neck extended posture now?" I asked.

"No more problem," she replied. "I have had stopped the heart medication for a week and she has no problem sleeping at nigh. A few soft coughs now and then."

"How about the ringworm on your wrist?" I asked.
"No more inflamed," she showed her right wrist. "I don't get ringworm now even when I held my dog. But more red spots appear on my dog's shoulder area!"

Some 2 weeks ago, the dog had generalised ringworm and she had her left wrist skin infected too.
I did not prescribe anti-ringworm medication as she was concerned about more medication since her dog was on heart drugs. I advised clipping bald to remove all contaminated hairs. She would be giving the anti-fungal wash and cream daily.
She had asked the groomer to clip the body but not the head. She clipped recently and saw more red spots.

Many owners do not bring their dog in for reviews and so what she said about the red spots could be ringworm or could be clipper burns or other reasons . A month had passed. Most of my cases of generalised ringworm had cured but this dog had more red spots.

"It is best for me to review and check on the multiple red spots, with the dog present," I explained.  

For various reasons, many Singaporean dog owners do not come for a review and in this case, she wanted to buy the multivitamins and do-it-herself treatment of the ringworm with the antifungal wash and cream.

She would bring the dog in for examination as it is not possible to confirm whether ringworm had spread or not.

2318. Ticks in Singapore dogs - email queries from one owner.

Sept 30, 2015
EMAIL TO DR SING


Hi
I've a mid sized dog (Singapore special 15kg)
Noticed she had black sesame seeds falling off her which had blood when burst on Sunday. Suspected ticks.
Searched online and apple cider vinegar wash was recommended.

Did it for 2 days. Seemed to repel the bugs. More fell off. Pet store recommended me carrington dog wash (which I diluted with more water - the instructions said 2 cap full to 1L water, I used 5 caps to 3L). I tried that, combed off some. Not all dead. Some articles mentioned dogs would salivate but she didn't.

I was told to put frontline plus 48 hours after carrington. Or should I take her in to see the vet? And is it necessary to test for tick disease?
All along she's eating well, active and alert without scratching much, only shakes body occasionally, so we didn't realize she has ticks.What do you advise?
Hope to hear from you soon.

Best Regards,
M


-----------------------------

EMAIL REPLY

Thank you for email. I am Dr Sing K Y from Toa Payoh Vets.

My advice is to get your dog examined by your vet, get a blood test done to screen the health of your dog. Another test to check whether your dog has tick-borne diseases.


Tick infestation is the most common ectoparasitic disease in Singapore dogs.

Tuesday, September 29, 2015

2318. Coincidences A Rottweiler and a cat - tibial fractures

Sep 30, 2015

Just 2 days ago, I had breakfast with a senior vet of over 70 years old at Potong Pasir. We ate laksa which is high cholesterol. I did not drink the soup. He drank every drop, ate the clams which I gave my portion to help and would leave the egg yolk uneaten. Yet he had no high cholesterol levels due to his medication.

 He mentioned that a Malaysian vet phoned him about infections in a Rottweiler with tibial fracture and what are the options? Amputatation of the leg?  Euthanasia?  I suggested Antirobe antibiotics.

Today a cat came in with tibial fracture. The stray cat activist is a woman in her late 50s and had been feeding stray cats for the past 20 years. Her monthly feeding bill using mainly Iams cat food, is around $800.


"I have 6 cats now. This cat is around 3 years old and came flopping down in front of me. I had no intention of adopting another cat."

Her cats would watch the birds from the windows every day. She had wire-meshed all her windows except the one in the kitchen. So, this newcomer fell 8 storeys down. Vet 1 had given this cat the painkillers, antibiotics and an IV drip. He had an abdominal X-ray which showed no ruptured bladder or kidney damage. The other 2 X-rays were emailed to me.

The solution was to insert a pin of appropriate diameter to join the 2 tibial fractures together.



 

"I can only afford to feed the stray cats," the retiree told me that her cat food bill was a large amount. "I can't help them when they are sick."
"I do have volunteers sometimes,": she mentioned one lady who would not contribute any money to buy the cat food.

"Is she working?" I asked.
"Yes,"
"It is hard to find volunteers and so you are fortunate," I said.
"She does not want to pay for the cat food, but she feeds a particular cat every day from my supply."

The commercial dog and cat food costs keep going up every year as Singapore faces higher labour and rental costs every year. The government also increases rentals of commercial premises every year and so these escalating costs eat into the savings of this retiree.

It is a difficult world for the stray cat feeders. This cat's fracture of the tibia was in mid-shaft. A pin was inserted and will be taken out 6 weeks later. A small 2 mm of the pin protruded


From the X-rays and observations on the 2nd day after surgery, the cat was normal. Hence, the kidneys and bladder were not affected by the cat falling 8 floors in a Singapore apartment.




AN ALBATROSS ROUND MY NECK

"Should I join my friends on a China tour?" the retiree caregiver asked me. "My family vet says that it will take months for the fractured tibia to heal."

She had not taken holidays for many years since she started caring for 30 stray cats and her own 6 cats  every day.

I had told her that the pin needed to be taken out 6 weeks after surgery but she had another opinion from her family vet who said a few  months. Her planned travel was 7 weeks from the surgery.

She was just worried about the 30 community cats in Tampines  being deprived of food.
"Can you get the other lady volunteer to help you?" I asked. The lady volunteer would only feed a particular cat with food provided by her. She must ask her and make it convenient for her to do it.

"As for your own stray cats including the one who fell 8 storeys, can you find a pet sitter?"
"Yes," she replied. "She charges $35 per day."
"Can you find somebody who charges cheaper?"

"Looking after so many cats is like an albatross round my neck," she had done a very good job. But she is from the earlier baby boomer generation who does not know how to use social media to get donations and volunteers. So she is all alone with no interest in travelling.

I assure her that her leg fractured cat will have healed by 6 weeks as her travel would one week later.  

"Take a break," I told her as she was worried about the stray cats.

2317. A cat stills caterwauls just after spaying

Sep 27, 2015
EMAIL TO DR SING


Hello Judy,

I spoke to Dr Sing on the phone this evening regarding Greedy's active meowing at night even after sterilisation.

Attached is a voice clip of her meowing that Dr Sing has asked me to send him, would he be able to tell if this meowing comes from the remaining hormones of being on heat?

It's disturbing my sleep daily.

Thank you so much!



A

-------------

REPLY FROM DR SING

Meowing is due to the effects of the residual female hormones in the cat. The cat had been caterwauling for a few nights before spay. Within a week, there should be no more meowing due to the heat period. Alternatively, come for the Ovarid tablet to stop the meowing.

2316. A 6-month-old cat has no scrotum but has nightly erections

Tuesday Sep 29, 2015

The young fair lady in her late 20s wanted her male cat to be neutered urgently. She did not say why and I did not ask. I thought it would be caterwauling as the male cat has matured. The loud meowing and crying would disturb her sleep and that of the neighbours.

I examined this greyish-white Persian X cat pre-op. He was a bit overweight and was fit for anaesthesia. He had a normal prepuce and penis but no scrotum. I asked my assistant to clip off the long hairs in the area between the anus and the penis. No developed scrotum and therefore no descended testicles. This was rare in cats. I checked the inguinal areas as sometimes, the testicles were lodged there. None were present.

So, there was no neutering unless the lady agreed to my opening the abdomen to take the abdominal testicles out.

"Is your cat making a lot of noises at night, wanting to go out?" I asked when she returned to pick up the cat one hour later.

"No, no," she said. "But over the past 2 weeks, I noticed that he humps the pillows and his penis is erect every night. That is why I wanted to neuter him."

In this modern age, she showed me her smartphone clip of the red and engorged penis. She had not told me earlier as this was not a topic for a young lady to talk about. It was only when I told her that the cat had no descended testicle that she volunteered the information.


"This nightly incident may be due to the cat licking his penis as he may be suffering from FIC (Feline Interstitial Cystitis). FIC is an inflammation of the bladder. The cause is said to be due to stress leading to bladder mucosal changes and painful and difficult urination."

"But I do not see him as having difficulty in urination," the lady said..
"You work the whole day and so you may not know. Has he got his own litter box since you have had got a younger male cat?"

"The younger male cat does not stress him," she said. "At first, he was hissing at the new arrival and so I separated them. Later, he befriended the younger cat and both share one litter box."

She showed me an image of the younger cat and also his scrotum which was obvious and well developed to around 1 cm across as compared to 3 mm across in this cat with no scrotum.She showed a 5-second video clip of both of them playing and biting each other.

"Stress could be due to the arrival of another cat," I said. "It could be due to the need to share a litter box and to share space. Cats are more sensitive than dogs to such matters."


The lady was doubtful.  However she said, "This cat is a very timid cat, just like the one my mother had in Beijing. He will freeze like a statute if I take him outdoors."

So, this was a nervous cat that would be more susceptible to stress than the normal one. Based on this history, I would say that he is suffering from the early stages of FIC. His bladder was full as well but then the owner said she had taken him out early to Toa Payoh Vets and therefore he had no time to pee. The sedated cat released pale clear urine on the consultation table and the lady took several pieces of tissues to wipe off the urine.

"It is a coincidence that you have a timid cat as well as your mother. Did your mother's cat suffer from difficulty in urination?" I asked.

"Yes, at one time, her cat had to be catheterised by the vet in Beijing so that he could pee."


As the lady did not want any abdominal surgery to take out the retained testicles, I prescribed meloxcam at 0.03ml/kg orally for 4 days to relieve the pain. This cat was 3.3 kg and so he will take around 0.1 ml per day for 4 days. The lady will phone me as regards the penile erection behaviour. The cat would be separated from the other cat and has his own litter box.

I will need to follow up 4 days later 





 
     


 

Monday, September 28, 2015

2315. Puppy training. Cocker Rage and the tug of war play

Sep 28, 2015
A working mother and her son in his early twenties, after National Service full time, came to get their 4-month-old female Cocker Spaniel vaccinated the 3rd vaccine.

"You phoned earlier to make an appointment to get the dog spayed?" I asked. The son had phoned but I advised spaying at 6 months or 2 months after the heat. "The dog's private parts will not develop to adult size if she is spayed at 4 months. She may have some difficulty in urination later. Since she is a house pet, it is best not to spay her at this age, although dog shelters and some sellers of pedigree dogs do that to prevent breeding."

As I opened the puppy's mouth to examine it, the Cocker suddenly snapped at me.
"This is a domineering female," I explained. "At this impressionable age, you need to train her to stop biting anyone. When she is in her rebellious adolescent age which is at 6 months, it will be very difficult to control her biting. She would have focused rage and anger and would bite anyone in the family if she does not like their petting. In Cocker Spaniels, there are male, not neutered dogs who will bite family members anytime when touched or when he does not like it. This is reported in some Canine magazines to be Cocker Rage."

The mother was surprised to know that there is a Cocker Rage condition. "My daughter used to tug at her toy from her mouth and she would growl," the mother said. "My daughter thinks it is fun to play tug of war."

"At 4 months of age, this behaviour must be stopped as she is receptive to training before the sexual hormones cause a dangerous killer adult dog. Dogs become adolescents at 6 months unlike people. If the puppy shows anger, grip her muzzle with your hand and say loudly "No."  I demonstrated (video).
Some people will smack the muzzle over their fingers as they train the puppy not to bite people."

After the demonstration, I cautiously open this puppy's mouth. She did not snap at me but protested with whimpering sounds. I asked permission for making an educational video with the son being the video-grapher.

As you can see in the video, the puppy did not bite me. But as I repeated this action, she did revert to her aggressive behaviour and snapped at me.

Training needs time, perseverance and rewards to show the puppy that she is loved but the family members are the pack leaders. So, the daughter has to stop the tug of war play.

Sunday, September 27, 2015

2314. The Maxi-cab driver brings in a dog with oral bleeding

"He loves his daughter more than me," the wife said of the Maxi-cab driver. "His daughter asked him to bring this dog to the vet and he does it. If I ask him to take me somewhere, he says he needs to earn a living." 

The husband remained silent. The dog had dental diseases. The oral bleeding was from rotten teeth dropping off. 13 loose teeth were extracted. 

I got the name card for anybody who wants a Maxi-cab driver for their dogs. "It is $55 one way," the husband said. 

2313. A 12-year-old Pekinese can't bear weight on the right fore leg 6 months after slipped disc surgery.

Sep 28, 2015

I received a phone call from the lady. Her 12-year-old Pekinese had intense right neck pain and was unable to put the right fore leg down. Vet 1 had x-rayed and found nothing wrong with the neck. Vet 1 referred her to Vet 2 who did a CT scan ($2,000) and a surgery ($5,000) some 6 months ago. The dog did recover. Now she said that the same symptoms re-appeared. 

"What did Vet 2 diagnose?" I asked her.
"Slipped disc in the neck. Common in Pekineses."

Now she was looking for alternative vets who performed slipped disc surgery.
"How do you know it is the same condition?" I asked.
"My Pekinese can't put his right fore leg on the floor. At least there is no pain now."
"Since Vet 2 did a good job, why not go back to Vet 2 as I don't know of any other vet doing spinal surgery."

She wanted a second opinion but Singapore does not have vets who specialises in spinal surgery as far as I am aware of.

"Try massaging her neck for the next 2 weeks as the neck is not painful," I advised as she did not want to incur more costs. "It may be due to blood circulation problems."

She thanked me emotionally. It is hard to know what causes the problem just by doing phone diagnosis. It may be a shoulder joint arthritis or tumour. 

 

2312. Continuing Education - FIC in French cats

Saturday Sep 26, 2015

I attended a talk sponsored by Age D'Or


Vetoquinol Global Companion Animal Technical Manger Dr Sergio Martins to provide the latest updates on Dermatology, Otology and Feline Idiopathic Cystitis (FIC).

FIC or FLUTD in cats appears to be common. At Toa Payoh Vets, we do see at least one case per week. I had a long telephone chat with Dr Martins today Sep 28, 2015 as regards FIC in North-Eastern France where his wife practises.  

He said that FIC (dysuria, haematuria, pollakiuria) is diagnosed based on history of environmental stress (change of residence, food, after boarding, aggression from other cats etc). The solution is to remove the stress and ensure that the cat has no more pain. He prescribes tolfedine inj and tablets. He does not prescribe meloxicam as he believes it causes kidney damage. No ACP for him. Just tolfedine. FIC is non infectious and so no need antibiotics.  He does not do blood, urine and X-rays unless necessary or recurrent.

He says that FIC is a chronic disease. It can be obstructive and non-obstructive. Prompt treatment is necessary to prevent non-obstructive becoming obstructive (urethral plugs, sand due to changes in urine pH on bladder mucosa from neuro-hormonal influences).

He phones the owner daily till the cat is cured. Environmental stress must be removed and pain removed so that the cat pees normally.   .




The Speaker is a Portuguese who lives in France. His wife is a practising vet in North-east France. In that area, the 25 practices work till 6 pm. The emergency clinic is provided by rotation by 1 of the 25 practices. So, there is work-life balance in this area. In Singapore, more vets open past midnight and this serves the needs of the working population. 

Many Filipino vets attend this talk on a Saturday evening. I am one of the two senior citizen vets attending this talk, Judy, a Filipino vet said to me. "The senior citizen vets over 60 years old are mostly retired and no longer practises," I told her. She won a veterinary book prize as there was a lucky draw at the end of the talk. 

It was a great time to meet with old friends and know more about the products of Age D'Or. Ms Tan, the pharmacist is now retired. She probably was a new graduate when she joined the company. One of her sons is a Pastor and she is a staunch Catholic.   


















Friday, September 25, 2015

2311. BKTP - Heart, kidney and prostatic diseases in a 13-year-old Chihuahua - the good brother

Sep 26, 2015

"This chihuahua keeps eating one hamburger a day instead of a careful kidney diet," I was told by the sister that the dog would not eat the Prescription K/D diet advised by Vet 1. "So, the kidneys will get worse and the twice weekly dialysis will need to be done. In addition, there is low red blood cell and haemoglobin.

"This dog has kidney failure as the recent blood test shows high levels of urea and creatinine. Kidney failure means that the dog kidneys are unable to remove waste products such as urea, from the blood. It is NOT the inability to make urine,


HISTORY
Sep 16, 2015. Vet 1 had treated by inserting the needle to aspirate 15 ml of urine. But the dog cannot pee this morning.

At Vet 1, heart murmurs Grade 4. Heart attack 3 years ago but revived.
               kidney failure SC drip every 3 days from Jun to Sep 2015.
               prostatic enlargement 2 weeks ago (see x-ray). Given Tardak inj. weekly.


ADMITTED Sep 16, 2015
SURGERY-  Urethrostomy
Atopine 0.5ml SC, Oral foretekor 5 (1/2 tab), Fursemide 1.0 ml SC.
Gas anasethesia.
Catether obstructed at front of os penis.
Incision behind the os penis. Stoine removed.
Press bladder to express the urine and to locate the  urethra which is 1.3 mm in diameter only. Anchor catheter into neary tissues.
4 mm stone across, removed from behind the os pens.








Urine test on Sep 17, 2015.
pH 6.0 (5-8)   . SG 1.012 (1.005-1.030). Protein 2+, Ketones +, Blood 4+_
white blood cells 10
red blood cells >1800.
Epithelia cells 15

Crystals Nil

Blood test on Sep 23, 2015
Glucose 9.3 (3.9-6)
Calcium 2.34 (1.5-3.6). Normal.

Urea 90.9  (4.2-6.3)
Creatinine 357 (89-177). Kidney failure. Fluid under the skin is needed twice  week.  

Haemoglobin 9.5 (12-18)
Red cell count  3.5  (5.5 - 8.5).  Anaemia


ADVICES

1. A low protein diet to reduce the workload on the kidneys. Prescription K/D diet is best but the owners have no perseverance to train the dog to eat it. So, a daily hamburger again.

2. A phosphate binder. Phosphorus increase in the blood due to impaired filtration by the kidneys. This makes the dog lethargic and has poor appetite. Certain drugs will bind excess phosphates in the intestines so that they are not absorbed.

3. Fluids given at home.
Presently, the first vet recommends twice a week 250 ml Hartmann's solution under the skin. This continually make the kidney function again via diuresis. This can be done at home once daily to once weekly depending on the degree of kidney failure.

4. A drug to regulate the parathyroid gland and calcium levels. If blood phosphorus increase, the parathryroid gland removes calcium from the bones to increase blood calcium level. This is to make calcium phosphorus ratio at 2:1 which is the normal ratio. Calcitrol can be used to reduce the function of the parathyroid gland and increase calcium absorption from the gut. This will be done if there is abnormal function of the parathyroid gland.

4. A drug to stimulate the bone marrow to produce new red blood cells. Blood test shows this cat now has low red blood cells and haemoglobin. Epogen, Procrit or synthetic forms of erythropoietin will correct the anaemia in most dogs. Some dogs' immune system make antibodies against the drug.

HOW LONG CAN A DOG BE EXPECTED TO LIVE.
Much depends on the disease and ability to perform the follow-up care. Possibly up to 4 years.



-------------------------------------------------

ANOTHER BLOG


Wed Sep 16, 2015


Unusual twos.  Two cases from the owners of a 13-year-old cat and a 13-year-old dog from the same neighbourhood in North Singapore in successive days. As Singaporeans prefer proximity, I rarely have one case from North Singapore during the past years. The location is a 30-minute drive away and it has nearer clinics than Toa Payoh Vets. 

Vet 1 from the same clinic in North Singapore treated both cases from owners unrelated and unknown to one another. So I was much surprised at the coincidences of two sick 13-year-olds. 


CASE 1 ON SEP 15, 2015
13-YEAR-OLD CAT
The first case was a cat not eating and lethargic. I got a blood test done as Vet 1 had done X-rays and ultrasound but was not given the permission to do X-rays. The cat did not recover and so the owner consulted me for a second opinion. She consented to X-rays which showed a low platelet count indicating toxicity causing the left kidney to be painful.




TREATMENT - Dental scaling (gingivitis on back teeth and tartar). Left ear irrigation. IV drip x 1 bottle Hartmans with antibiotic and painkiller. Overnight inpatient. The next day, the cat ate and was meowing happily. Went home.

In retrospect, the owner recalled a possible ingestion of commercial ear drops purchased from the pet shop as the owner noted that the old cat pawed at the ear drops after she had put inside the left ear. The cat could have been poisoned resulting in ear pain. This was not obvious without the blood test. Cats are very sensitive to chemicals.  


Lethargic and anorexic for 7 days. The owner had purchased ear drops  to treat the left ear discharge since April 2015. Treated by Vet 1. Ok. Problem came back in June and so she decided to buy the pet shop's ear drops which irritated the cat around 7 days before the sickness. The likely cause could be the chemical toxicity affecting the left kidney which has a radio-dense stone of 3 mm in diameter.

No hairball snacks and treats
Only First Choice For Senior Cats
Warned that the left kidney had a stone which could cause kidney pain and swelling later. As at Sep 17, 2015, the cat was eating and drinking and was active. There was no ear discharge.


CASE 2
The old dog's veterinary bills amounted to a large sum and so the brother who works in the same building as Toa Payoh Vets referred the sister to me.
"As the dog had heart, kidney and prostatic diseases, the bills will add up," I said to the brother today. "Chronic diseases tend to cost much to treat."  Many Singaporean owners only look at the absolute amount and would pronounce to the world: "This vet is expensive and cut-throat."

URETHROSTOMY DONE yesterday.
"Very high risk of death on the op table," I said to the brother and sister as the chihuahua had this loud heart murmurs of Grade 4 confirmed by Vet 1.
"50%?" the brother said.
"Hard to say it is 50:50," I would not be precise as the dog's bladder swelled up to a mango size.
Vet 1 had taken out 15 ml of the urine from the bladder by cystocentesis and given a Tardak injection to reduce the massive prostatic swelling which could cause urination problems. Two weeks ago, he had given one and the dog had no problem urinating.

On going home, the dog just could not pee and some urine dribbled out despite treatment by Vet 1. This appeared to have shaken the confidence of the owner and so the brother asked her to consult me. 

The bladder ballooned.
"It is death if you don't operate. It may be death if you opeerate," the brother told the sister. There was no time to waste. 


URETHROSTOMY
Weight 3.5 kg. T=37.8C. Cyanotic mucous membrane.

1. I gave 1/2 tablet Fortekor 5 orally and inject frusemide 1 ml SC and waited for 1.5 hours. The bladder had swollen to a ballon.

2. IV drip. IV baytril and tolfedine.
3. Atropine 0.6 ml SC
4. No sedatives
5. Isoflurane gas only.
6. Catether blocked from behind the os penis where the stone was lodged. Marker pen to draw the length of catether at the obstruction. This confirms that the enlarged prostate was not the cause of this anuria as the prostate could be having tumours. In any case, Vet 1 had given Tardak injection the day before.
7. I electro-incise behind the os penis and pre-scrotal for around 3cm length. A large 4mm x 4mm brown stone was seen. 3 smaller ones of 2 mm across were seen.
8. I located the urether which was around 1.3 mm in diameter as my assistant compressed the bladder, squirting out the urine.
9. I inserted the cat catheter into the narrow urethra and stitched up the 4 holes.
10. I stitch skin and muscles to either side so as not to close up the wound in front of the catheter.

The whole process of start of anaethesia by mask to completion of stitching took around 40 minutes. The dog was alive and woke up as soon as the gas was taken off. This was a big relief to me.

COMMENTS
A vet book mentioned sedation and local anaesthetic for dogs with kidney or serious health problems. In this case, the heart disease was bad. So, no sedation.

2. In normal urethrostomy, the catether can be seen as the urethra is incised 2-4 cm since it is placed inside from the penile tip. In this case, I had to open behind the obstruction and so was not able to view the very narrow 1.3 mm cathether of this chihuahua. I used the squirting urine to locate it and anchor the cat's cathether.

3. Today, 16 hours post-op, the dog is active and alert.


4. I advise neutering in case the prostate swelled up more to obstruct urine flow, instead of Tardak injections regularly. The anaesthetic risks of dying are there.

5. Urine test and stone analysis need to be done as a minimum. I did not ask for blood test as the owner was not in favour of additional medical cost.

6. As to the need for regular weekly SC dialysis by Vet 1, I told the brother that he ought to have blood test to check on the kidneys and whether there is still renal failure. In the meantime the dog is given Hartmann's 250 ml SC once a week.    


SEP 18, 2015
I sent the Chihuahua back on Day 2 but he licked his wound causing bleeding. There was another dog in the apartment wanting to play with him.

The dog came back and I saw a large pink purplish bruise on the right side of the scrotal area due to licking. As an in-patient, he had no distractions and was recuperating well. The owner wished to have him in-patient for the next 3 days. The catheter was still in place and the urine coming out looked clear. The dog is an in-patient now and will be given dialysis SC today.    

The prostatic enlargement will cause urination problem later and Tardak injections may need to be given regularly. A neuter would be best but the owners have their worries about anaesthetic risks and so did not accept my advice. The neuter surgery is much shorter than this urethrostomy but the risks are still there. If the dog had been neutered at a young age, there will be no prostatic hypertrophy which could cause obstruction to the flow of urine.

During surgery, I noticed that the urine from the distended bladder did not flow freely after I removed the 4-mm x 4mm urethral stone. My assistant had to compress the bladder manually to release the urine. So, it is possible that the enlarged prostate or prostatic tumour will cause dysuria.

Neuter will be the best advice but the owners think of anaesthetic risks and death and so, nothing will be done till another dysuria episode comes.

Thursday, September 24, 2015

2310. BKTP - story. Three children, a Westie and a Golden Retriever

Sep 25, 2015
First time that Singapore primary and secondary schools have been closed today as the haze became hazardous. The 24-hour PSI levels soared to 223-275  yesterday at 10 pm. Beyond 300, it is considered hazardous.V A Pollution Standards Index (PSI) eading over 350 is hazardous while 151-250 is said to be unhealthy.

Visibility was reduced by the forest fires from Sumatra, Indoensai. Buildings looked grey and the air is smog-like. Even the sun appeared reddish orange, being obscured by thick grey haze. No more the deep blue skies. People wear masks. An acrid smell in the air. Eyes become reddened and painful. 



So, the parents in their early 40s, came to me with the 3 children of primary school age, 7, 9 and 10 years old to the clinic to see he vet. The two dogs, 15-year-old trim Westie and a 3-year-old Golden Retriever that had had skin diseases. 


"Why is elder brother playing games in his handphone?" the younger 8-year-old brother interrupted our discussion on the 15-year-old Westie's skin problems. The elder brother was contently glued at the smartphone screen. The sister with her backpack was youngest at 7 years of age.

So I stopped the examination and let the father sort out the sibling rivalry. He permitted all children only one hour of surfing. The mother was outside the clinic and so she was called in to attend to the kids.

Children are a handful when more than 2. The younger brother jumped on the animal weighing scales in my consultation room. Up and down with a loud sound. The father stopped him.

The elder brother came in and washed his hands thrice in 10 minutes. "Has he got OCD for cleanliness?" I asked the father. "The other 2 children had not washed their hands once."

"No, no," the father said. "He has been taught to wash his hands after touching the dog!"

The elder brother was now interested in the Golden Retriever put on the consult table after weighing. His tail tip was bleeding and as he wagged his tail against the room's white gypsum wall, thousands of red spots dotted the lower wall. "He is a happy dog," I said. "He wags his tail letting it bang against the wall. That's how he got so many skin infections in the tail!"

"The flies attack his tail," the wife remarked. The whole tail needed clipping bald and washed. He also had pressure sores on his hip, shoulder and elbow areas. He bit his backside till there were hot spots of wet hairs sunken.

I expressed his anal sac. Out shot a bit of yellow pus,  like a bullet.
The elder brother felt something whizzed past his face as he was behind the dog as I expressed the anal sac. Since the owner said he does it every 3 days, I expected no fluid. But there was some oil, in small amounts, esp. from the right anal sac.

"You have to put the dog on the table to express the sac thoroughly," I said. "Not on the floor."

Skin diseases in both dogs. Last month, the dogs had ticks and that was prevented by changing to a salmon diet. "This diet must be good," the father said. "No more itchiness. A friend had done an allergy test saying that the Golden Retriever was allergic to beef. Using the salmon diet resolved the itchiness."

But now the dog is itchy again esp. at the tail area.

Wednesday, September 23, 2015

2309. Counting pennies after retirement

Sep 24, 2015

A couple came to get the spayed dog's stitch removed by Dr Daniel today. The husband has grey hairs and is slim. He had retired from a large multinational company. His wife looked some 10 years younger or had a happy disposition.

"How long has Toa Payoh Vets been in operation?" he asked.
"Since 1982," I said. 
"You must have a lot of clients," he stated.

"Many have had left for clinics nearer your home. Proxmity and convenience. There were only 5 clinics when I started but now there are over 70.  Where do you stay?"

"We live in Seletar," he said. He agreed that there were a few clinics around his neighbourhood but he had not been to them. He was loyal to a big clinic and only during retirement did he shop around for affordable vet fees.

"The reason I came to your clinic is because of your fees, much lower than the big clinic I used to go. They quoted me over $600 for spaying my Shih Tzu."

"Well, the fees could include blood test to screen the health of the dog before surgery. In case the dog is too sick and likely to die during operation. How much does this clinic charge for blood tests?"

"I don't like to be surprised with a big vet bill after treatment. The blood test is over $250," he had never asked for prices when he was busy working as a regional manager. Now he has to save.

"This clinic has such nice furnishings and it costs more," I said.
"Many people still go there," the retiree said.
"Yes, many people drive Mercedes even when they retire and they are not cheap cars. What car do you drive?"
"A Japanese car."
He was a frugal man as he still had 2 children schooling.
"Best not to send your children to study in Australia or overseas," I said. "If you want to save for retirement. Ask your daughter to get a scholarship or study in the local university. Some married foreigners and don't come home or they prefer to migrate and settle in Australia."

Retirement age in Singapore is 62. The man did not want to continue working as it is exhausting. Yet his 2 children are still schooling and he needs to be counting pennies. 
 

 

2308. A 16-year-old Maltese X cannot stand up overnight

Sep 24, 2015
Public holiday. Hazy sky.
This 7.8-kg Maltese X is 16 years old. Usual sleep whole day and ambled slowly.

"He needed to be hand fed by the owner because of painful mouth," I said. "No dental for the past 10 or more years.The toxins from the mouth bacteria could have passed via the blood to the brain and body causing lethargy and difficulty to stand up for the past 2 weeks. But overnight, he just could not stand on his hind limbs. He had paraparesis or paraplegia.   

"Is it common in old dogs?" the lady in her late 30s asked me.
"No," I said.

2307. No terrapin books in the Bishan library

Sep 24, 2015

The 11-year-old boy was responsible for the upkeep and health care of the adopted terrapin. For the past 2 months, the terrapin had lost appetite. He was very thin. So the father took him and the terrapin to consult me after checking out the Youtube. 

"Any stools muddying the water in the tank?" I asked since the boy said the terrapin did eat around 3 pellets.
"Quite clean," he said. "His left eye is swollen. He closes his eyes when he is under water."
"How long has this situation been occurring?"  I asked.
"Past 2 months."


Lethargy. No appetite for 2 months.
Severe weight loss - no fatty bulge under armpit and thigh area.
Breathing rapidly.

"Any basking area to dry out?" I asked as the owner had adopted the terrapin, tank and a mouldy wooden block from another person.
"The wooden block is small than him," the father said. "I threw it away as it was mouldy."
"So the terrapin had been submerged in water for the past year. How often do you change the water?"
"Once in every 3 days."

The terrapin had a good appetite after adoption, eating many dried shrimps and disliked the pellets. He was fed fresh prawns twice only in the past months. The father bought from the pet shop a bottle of medicine to eliminate flat worms, tapeworks and flukes in fish and poured into the tank. No improvement in appetite.

As for sunlight, recently he exposed the terrapin to direct sunlight for 4 hours. But the terrapin still would not eat any shrimps.  Lethargy.

As the boy was not permitted internet surfing to prevent addiction, I asked if he had loaned terrapin books from the public libray.
"None available," he said.
Actually, there was none available for loan when I asked again.
Terrapins are a popular niche pet and the library books would probably be borrowed or the boy had no time to persevere and does not know how to make a reservation.

"Usually it is the owner who is at fault when the pet is sick," the father said to me. "Same as for misbehaving children."  This is a rare parent who stopped his 11-year-old son from surfing to prevent internet addiction and deprivation of sleep gaming till 4 am every night. This is what happens to some young Singapore men even at the age of 30 years.

2306. A cat jumped from 5th storey - multiple right femoral fractures - x rays



SURGICAL TREATMENT
1. Pin plus wires around fragments.
2. Screws.

The cost would be from $2,000. The owner said he had paid $1,000 to a vet who smoothen the molar spurs of his rabbit, saying this was a large amount.

He took the cat home. 

2305. A cat and dog has difficulty peeing - follow up perineal urethrostomy in the cat

Thursday, Sep 24, 2015. Public holiday

I review the two in-patients

1. A 3-year-old male cat has dysuria after removal of the bladder and urethral stones around 2 weeks ago.
"He had never been able to urinate normally after the surgery," the owner said. Dr Daniel had prescribed the medication but the cat keeps going to the litter tray. The cat had been housed separately from the other 2 cats and had eaten his own Prescription C/D diet.

The cat came in 2 days ago. I palpated his bladder. It was swollen moderately, around the size of half an orange. Yesterday, Dr Daniel performed perineal urethrostomy and the cat now pees normally.








Urethral stricture was the cause of dysuria after bladder stone removal. The cat did not pee normally. The stone had lodged at the perineal urethra earlier and had caused obstruction. It was flush back into the bladder and removed with the bladder stones, but the cat had problems peeing post-op. So the solution was to do perineal urethrostomy and now the cat is OK.  

2. The 13-year-old Chihuahua had scrotal ablation and neuter yesterday.  He was seen by Vet 1 who had x-rayed which showed bladder and urethral stones. The urethral stones were packed tight behind the os penis (see x ray) and so the urine flow was obstructed. The bladder swelled to a mango size. The prostate also enlarged like a fish ball (see x ray). Too old for anaesthesia. Vet 1 inserted a syringe and sucked out 15 ml of the urine. But the dog still could not pee but dribbled urine.







Today, I checked on him. His urine was clear as seen at the catheter. No full bladder. His scrotum was cut away as they were swollen. The wounds are healing well.The dog goes home on Sep 27, 2015. Another dialysis SC before going home.

Sep 27, 2015
No problem peeing now. Cause of dysuria in the cat was urethral stricture. In the dog, it was urethral obstruction behind the os penis. X-rays



Monday, September 21, 2015

2304. BKTP story -- A little boy's 14-year-old dog is going to die soon

Sep 22, 2015

The little boy listened to every word but said nothing. He was 12 years old, trim and be-spectacled and studying  in Primary Six of the school. He comprehend what his father and the vet was saying.  If his best friend, a dog he had loved since babyhood, did not get operated upon within 2 days, she would die. If she were to be operated, she might die too as the odds were stacked against her. But she might live.

This Silkie Terrier was 14 years old.  If she was  an old lady, she would be 98 years old in human years. She was in poor health as her blood test showed she had sepsis with total white cell count and neutrophil count way off the charts of normalcy.  

I had examined her and  had told Mr Tan that there would  be an  anaesthetic risk of her dying during surgery. "What are the chances?" the father asked. "Less than 50% based on the two criteria of old age and septicaemia. The good news is that she is not suffering from kidney disease. You will need to sign  a consent form stating that you have been informed and  understand the risks."

Every dog owner knows the procedure of informed consent. Mr Tan would still have to pay the surgical fees even though his dog had died. He  was dealt a poor hand. The other party was the divine powers that had the good cards. The vet would represent the dealer in a casino.  He would earn his fees whichever party won.


What should Mr Tan do? His son was quiet as most boys of that age would be. His mother remained silent too. He did not voice his opinion as he deferred to the head of the household.

Mr Tan hesitated: "Why throw away good money after bad?  The dog had a poor chance of survival. She was aged, being 14 years old. He might not live another year. 14 years is a ripe old age for any small breed.

"There are many expenses such as the $300 tuition fees for my two  children. A baby is on the way. Why spend money to save a dog? The human beings need to survive in this harsh urban jungle of rising costs every year".

The bureacrats increase the fees to justify their existence while the private sector increases its fees to retain the loyalty of the job-hopping employees who will leave for a few dollars more.

But This Silkie was active although she had eaten much less and licked her back area to keep herself clean and not dirty the home. She was house-proud and would run to the papers on the toilet floor to avoid dirtying the den when she was doing her normal peeing and pooping. Now, she could not cope with the copious flow of brownish sticky pus dripping from her vagina as she tried to run to the toilet to pee. But it was not urine. It was bacterial pus from the womb.

Only during the last one week, she had this brownish-red vaginal discharge. Non-stop bleeding. Drip, drip, drip. She just could not cope with licking and swallowing the infected uterine discharge, poisoning herself. Now her blood had bacteria as shown by the high increase in white blood cells.

A dog soiling the floor of the apartment needed the mother to mop and clean up. So Mr Tan  had no choice but to consult the vet. Last year, this dog had breast tumours removed. Another vet had removed them and the fees opened a big hole in the financial pocket.

Now, there would be a medical cost of more than $500. There was a doubt that this dog would survive. So why throw good money after bad?

"Is there an injection and antibiotics to treat pyometra?" Mr Tan wanted this option. I gave the dog the IV drip, pain-killer and antibiotics as an in-patient for 2 days. She was barking wildly and loudly to greet the little boy and Mr Tan. She had no vaginal discharge.

"Her vaginal discharge has stopped temporarily due to the effects of the medication," I said to the father. "Soon, it will recur if the dog is not spayed." The father decided to bring her home.

Normally, I do not follow up as there would be considered soliciting. However, I could feel that the little boy's dog is going to die soon if there is procrastination in getting the surgery. I phoned Mr Tan.       
"My dog is now lethargic and not eating again," he said. I advised immediate surgery. As this was a little boy's best friend, I decided to lower my fees to the minimum. The dog recovered, stayed one night as an in-patient and as I walked the family to their small car, I asked the little boy: "Are you happy now?"

He nodded his head and gave me his widest smile. No words. This was one of the happy outcomes of pyometra surgery. Not every pyometra  case will survive an operation. Much depends on the progress of the disease. In  this case, this dog had not suffered kidney failure and was treated quite early before vomiting and collapse occurred. The dog was running out of time but not out of luck. Sometimes, luck plays a part in successful surgeries as in success in life and love.

Sunday, September 20, 2015

2303. Asking for $3,500 salary

Sep 21, 2015
Singapore has a very low unemployment rate as compared to Greece where it is said that 25% of the young people are unemployed. However, there is intense competition for business as rentals keep increasing every year and local employees asking for more pay and less work, preferably no work on Sundays and public holidays. Singapore appears to be going into economic recession as I notice more clients ask for discounts and delay treatment of their pets.

"My Chihuahua is 13 years old," one man said to me. "Unlikely to live many years. So, no need treatment."  But the dog could not pee and the alternative is to let the dog die from bladder rupture as the bladder swelled to the size of the  mango. The first vet had inserted a needle and withdrew some urine but the bladder continued to fill with urine. The dog just could not pee.

"Whether the dog is young or old," I explained. "If it needs treatment which can save its life, it must be done."  

The economy is bad but you will see that the Certificate Of Entitlement (government permit to buy a car)  of cars has not dropped. A permit is now around $60,000. "There are many rich people around," I said to a client who commented on this. The government is the one making the money and raising rentals amongst its own properties, increasing the cost of living every year. The private landlords raise the rent much more and so the government officers raise the rent too, but not to a greedy extent.

Yesterday, a  21-year-old new  polytechnic graduate with no veterinary experience asked me for $3,500 per month after the interview and tentative agreement of $2,000 and a one-year-contract. I was looking for a full-time veterinary assistant who can work weekends and public holidays and asked how much she was looking for. She said $2,000/month and for a one-year-contract. I was Ok with that.

She had been doing some weeks of paid internship to learn more about veterinary medicine. She wanted to become a vet.

I just cannot understand what made her ask $3,500. I just could not afford her and know that she would not be committed to work. I told her to shop around for employers who pay more than me as she will not stay long. She will be looking for jobs while working for me and there is a waste of time training her as a veterinary assistant.

Sometimes our impulse side makes us do things which are not realistic and honest. After gaining experience, we can job hop for a few dollars more.   

Saturday, September 19, 2015

You wasted your time. Work till you die?

Sep 20, 2015

Recently, I had two over 70s male retirees who spoke to me:

1. A man whose shares pay him a $9,000 interest a month and he lived in a big house. He had only a Secondary one education and became a police constable. He became a businessman selling what was needed in small undeveloped countries like Papua New Guinea. There was no future in the police force as he was not a graduate. He built relationships with the natives and travelled most of the time.

I met him because the breeder packaged her Schnauzer sale with 3 free vaccinations. Otherwise, convenience and proximity would mean he would go to the nearest clinic in North Singapore. 
"Anyway, the clinic there wanted me to pay more to consult the senior vet," he complained about the junior vets who were present to treat his other dogs.

"May I be frank with you?" he asked me in later visits after his female Schnauzer was spayed and I had drafted a letter for him to the Vietnamese embassy.  "I cannot write very well as I studied up to Sec 1," he said. This letter was to inform the embassy that the ICA (Immigration and Control Authority) at the Singapore Airport did not have interpreters as stated in the newspaper. His Asian wife who came to visit him, before he married her, was detained and sent back on the next plane. "She is a good girl but she could not speak Mandarin or English. So, the ICA put her in a detention cell at the airport overnight and sent her home by the next plane." 

He thanked me for drafting the letter and was frank with me about my practice at Toa Payoh Vets. Other vets have very long queues and waiting lines or several branches. My location in an industrial park did not inspire confidence and was inconvenient. So he said: "You wasted your time over the last 40 years at this industrial park, a god-forsaken place."


2. The retiree had worked for an airline dealing with stocks and shares on behalf of the airline. He came with his young adult daughter whose hyperactive dwarf hamster was losing weight and now was scratching her right face. It was an impacted pouch and right lip commissue ulcer. I evacuated the pouch and advised 10 seeds and pellets a day instead of a full bowl.  

"Do you intend to work till you die?" the father asked me. He was 63 years old but had retired to smell the roses.

"I am self-employed and I enjoy my work," I consulted usually in the mornings usually 7 days a week. I ought to be smelling the roses, wake up late on weekends.

Friday, September 18, 2015

2301. Lip commissure ulcers in a hyperactive dwarf hamster and a syrian hamster

Saturday Sep 1, 2015

Bright sunny day with clouds greyed by the haze coming from the forest fires in Sumatra. I dare not exercise in the public park for fear of breathing in the micro particles.

Today, I have another case of two. Coincidences. 2 hamsters with lip commissures  


CASE 1. 
2 sisters brought in Haku (white in Japanese), 4-month-old Syrian hamster.
"Sure does not look white at all," I said.  "It is more a tricolor."
"The sides of the mouth have bleeding. Sometimes they heal and come back again."
The hamster wriggled and turned and even bit the lady owner. She had to wash her hands.
"I need a bit of gas anaesthetic to check the mouth and trim the lower teeth," I asked permission from the owner as anaesthesia can be risky. "Without sedation, I can't do a proper examination and trim the teeth!"
She could see the hamster was extremely firsky.

Video:  Two lower divergent teeth trimmed off by 3 mm. Upper teeth trimmed 1 mm to even them.
             Lip commissures ulcerated at 3 mm across, cleaned with disinfectant.
             Cheek pouch surprisingly empty but clean and not inflamed.


CASE 2.
I saw this hyperactive dwarf hamster 4 days ago for a very itchy body. I got the hairs clipped and there was a big wound on the back spinal area. This could be bacterial or fungal infection. I gave the medication to wash the skin. Now, he is scratching his left cheek again. I call him the most hyperactive dwarf hamster.    

"He still weighs 40 g, same as 4 days ago," I said. "There is a yellow pus on the right cheek commissure."

The daughter had come. She phoned her mum which area was itchy. It was the right side under the neck. I could see inflamed skin around the right cheek pouch. There was an impacted cheek pouch. Lots of seeds were fished out.
"Ration the hamster to 10 'seeds and pellets a day," I advised. "He likes to hoard and his right cheek pouch was bulging full with seeds."  I got the seeds out.

Video
Lip commissures are common in some dwarf hamsters. As to the cause, it is hard to say. Traumatic injury from sharp sunflower seeds? Gripping iron wires or metallic things?

Thursday, September 17, 2015

2300. The 17-year-old Shih Tzu barked and barked the whole night.

Sep 17, 2015

The parents came yesterday after phoning me to confirm that the urn was ready the day after euthanasia and cremation. The dog was put to sleep as he barked the whole night every night. The parents had to work but they could not sleep.

"We tried your medication for the past 5 weeks," the mum said. "But he became groggy and could not go to pee. In any case, it was not very effective."

The young adult son, now 25 years old was very upset and wanted the urn as soon as possible. So the parents had phoned me twice.

"How old was your son when he got this Shih Tzu as a puppy?" I asked.
"He was in Primary 6," the mum said. "At 12 years of age."
"The dog has been his best friend for 17 years and he was very sad."

2299. Unbelieveable story. The sudden death of a retiree who was certified healthy

Sep 18, 2015




The Primary Production Department employee retired at 55 years of age in the old days some 20 years ago. He worked in the Extension Centre dealing with pigs and poulty. One day, he came to see the vet who had his practice in North Singapore.

"I have just passed my health screening test including threadmill. I am certified fit and healthy!". He was still interested in animal husbandry and borrowed a book from the vet.

As he left to go home, the vet joked: "Give me a 4-digit number to buy the 4-D lottery!"
"Nonsense, you may pass away first," he said to the private vet.
The next day, his son phoned the vet to say that his father had died at night.  
"It could be an aneurysm (rupture of the blood vessel)," I said. "He could have gone for the threadmill test and over-exerted." Nobody knows the cause of his sudden death. 

2298. Referral. A 13-year-old cross bred had a "water-melon" lump

Sep 18, 2015

I had laksa with this practising 76-yerar-old senior vet at Potong Pasir this morning. He would be opening a vet clinic in Johor and decided to focus on surgery.

"Many young vets do not want to perform complicated surgeries," he said. "So they will refer to others."

"That's true even in Yangon," I said. "One experienced vet who had worked in Singapore got all the surgeries referred to by the other vets. Even in Singapore too."

"Swee also wanted to refer one case of a dog with a very large cyst, as big as a water melon to other vets," he recounted a 13-year-old cross bred dog that the owner wanted him to treat. "I am an old vet and I refer to a young vet to do the surgery!"  This old vet practised vet surgery for over 50 years but this was the first time he encountered such a large abdominal cyst.

Once I saw him operating to remove a gigantic tumour on the submandibular area of an old dog. The tumour was the size of an orange. Electro-surgery and keeping a lookout for bleeders, he removed this tumour. But the abdominal tumour was a large water-melon size.

"Did you draw out any fluid after inserting a needle?" I asked.
"No fluid," he said. "There was a thick wall and it was enveloped by some lace-liked tissue (the mesentery).

"It is a matter of common sense. I dissect slowly using electro-surgery. I reached a drainage tube. Suddenly, thick viscous fluid shot out, deflating the lump!" 

"This would be an abdominal cyst that grows slowly over 10 years," I recalled my Taenia tapeworm from sheep to dog transmission lectures in Glasgow University some 50 years ago. "It could be a tapeworm cyst. Cysticercus species."

"There were many smaller cysts and it would be too risky to remove every one." he said. "The fluid inside the cyst was not clear but thick and cloudy."

"These would be the other younger cysts developing," I said.

"After the surgery, the dog was jumping and running normally," the vet laughed happily. "The owner was very happy!"


And to think that his senior nurse who had been with him for many years, asked him not to operated and to refer to other vets or the expatriate specialist. I just cannot understand. Some 50 years ago, when I was in National Service full time in 1977, this vet operated on a Patent Ductus Arteriosis in a SAF Provost Unit guard dog that would be put to sleep as it was lethargic and useless. There was no sophisticated hospital equipment like the automatic ventilator to prevent the lungs deflating when the chest is cut open.

I assisted by pressing the anaesthetic vet while he located the shunting blood vessel and ligated it. No young vet would do this surgery. He was 38 years old and had his own practice and at least 10 years of experience.  I was 27 years and doing my National Service, with no canine surgical experience.

A sound knowledge of anatomy is needed. The dog recovered and was back on guard dog duty.    




 

Wednesday, September 16, 2015

2297. A 13-year-old male cat and dog came from North Singapore

Wed Sep 16, 2015


Unusual twos.  Two cases from the owners of a 13-year-old cat and a 13-year-old dog from the same neighbourhood in North Singapore in successive days. As Singaporeans prefer proximity, I rarely have one case from North Singapore during the past years. The location is a 30-minute drive away and it has nearer clinics than Toa Payoh Vets. 

Vet 1 from the same clinic in North Singapore treated both cases from owners unrelated and unknown to one another. So I was much surprised at the coincidences of two sick 13-year-olds. 


CASE 1 ON SEP 15, 2015
13-YEAR-OLD CAT
The first case was a cat not eating and lethargic. I got a blood test done as Vet 1 had done X-rays and ultrasound but was not given the permission to do X-rays. The cat did not recover and so the owner consulted me for a second opinion. She consented to X-rays which showed a low platelet count indicating toxicity causing the left kidney to be painful. I palpated the left kidney and the cat meowed in protest, telling me that it is painful. For normal kidneys, the cat will not react to palpation.




TREATMENT - Dental scaling (gingivitis on back teeth and tartar). Left ear irrigation. IV drip x 1 bottle Hartmans with antibiotic and painkiller. Overnight inpatient. The next day, the cat ate and was meowing happily. Went home.

In retrospect, the owner recalled a possible ingestion of commercial ear drops purchased from the pet shop as the owner noted that the old cat pawed at the ear drops after she had put inside the left ear. The cat could have been poisoned resulting in ear pain. This was not obvious without the blood test. Cats are very sensitive to chemicals and pain.  


Lethargic and anorexic for 7 days. The owner had purchased ear drops  to treat the left ear discharge since April 2015. Treated by Vet 1. Ok. Problem came back in June and so she decided to buy the pet shop's ear drops which irritated the cat around 7 days before the sickness. The likely cause could be the chemical toxicity affecting the left kidney which has a radio-dense stone of 3 mm in diameter.

No hairball snacks and treats
Only First Choice For Senior Cats
I warned that the left kidney had a stone which could cause kidney pain and swelling later. As at Sep 30, 2015, the cat was eating and drinking and was active. There was no ear discharge.


CASE 2
The old dog's veterinary bills amounted to a large sum and so the brother who works in the same building as Toa Payoh Vets referred the sister to me.
"As the dog had heart, kidney and prostatic diseases, the bills will add up," I said to the brother today. "Chronic diseases tend to cost much to treat."  Many Singaporean owners only look at the absolute amount and would pronounce to the world: "This vet is expensive and cut-throat."

URETHROSTOMY DONE yesterday.
"Very high risk of death on the op table," I said to the brother and sister as the chihuahua had this loud heart murmurs of Grade 4 confirmed by Vet 1.
"50%?" the brother said.
"Hard to say it is 50:50," I would not be precise as the dog's bladder swelled up to a mango size.
Vet 1 had taken out 15 ml of the urine from the bladder by cystocentesis and given a Tardak injection to reduce the massive prostatic swelling which could cause urination problems. Two weeks ago, he had given one and the dog had no problem urinating.

On going home, the dog just could not pee and some urine dribbled out despite treatment by Vet 1. This appeared to have shaken the confidence of the owner and so the brother asked her to consult me. 

The bladder ballooned.
"It is death if you don't operate. It may be death if you opeerate," the brother told the sister. There was no time to waste. 


URETHROSTOMY
Weight 3.5 kg. T=37.8C. Cyanotic mucous membrane.

1. I gave 1/2 tablet Fortekor 5 orally and inject frusemide 1 ml SC and waited for 1.5 hours. The bladder had swollen to a ballon.

2. IV drip. IV baytril and tolfedine.
3. Atropine 0.6 ml SC
4. No sedatives
5. Isoflurane gas only.
6. Catheter blocked from behind the os penis where the stone was lodged. Marker pen to draw the length of catether at the obstruction. This confirms that the enlarged prostate was not the cause of this anuria as the prostate could be having tumours. In any case, Vet 1 had given Tardak injection the day before.
7. I electro-incise behind the os penis and pre-scrotal for around 3cm length. A large 4mm x 4mm brown stone was seen. 3 smaller ones of 2 mm across were seen.
8. I located the urether which was around 1.3 mm in diameter as my assistant compressed the bladder, squirting out the urine.
9. I inserted the cat catheter into the narrow urethra and stitched up the 4 holes.
10. I stitch skin and muscles to either side so as not to close up the wound in front of the catheter.

The whole process of start of anaethesia by mask to completion of stitching took around 40 minutes. The dog was alive and woke up as soon as the gas was taken off. This was a big relief to me.

COMMENTS
1.  A vet book mentioned minimal sedation and local anaesthetic for dogs with kidney or serious health problems. In this case, the heart disease was bad. So, I did not give sedation by injection.

2. In normal urethrostomy, the catether can be seen as the urethra is incised 2-4 cm since it is placed inside from the penile tip. In this case, I had to open behind the obstruction and so was not able to view the very narrow 1.3 mm cathether of this chihuahua. I used the squirting urine to locate it and anchor the cat's cathether.

3. Today, 16 hours post-op, the dog is active and alert.


4. I advise neutering in case the prostate swelled up more to obstruct urine flow, instead of Tardak injections regularly. The anaesthetic risks of dying are there.

5. Urine test and stone analysis need to be done as a minimum. I did not ask for blood test as the owner was not in favour of additional medical cost.

6. As to the need for regular weekly SC dialysis by Vet 1, I told the brother that he ought to have blood test to check on the kidneys and whether there is still renal failure. In the meantime the dog is given Hartmann's 250 ml SC once a week.    


SEP 18, 2015
I sent the Chihuahua back on Day 2 but he licked his wound causing bleeding. There was another dog in the apartment wanting to play with him.

The dog came back and I saw a large pink purplish bruise on the right side of the scrotal area due to licking. As an in-patient, he had no distractions and was recuperating well. The owner wished to have him in-patient for the next 3 days. The catheter was still in place and the urine coming out looked clear. The dog is an in-patient now and will be given dialysis SC today.    

The prostatic enlargement will cause urination problem later and Tardak injections may need to be given regularly. A neuter would be best but the owners have their worries about anaesthetic risks and so did not accept my advice. The neuter surgery is much shorter than this urethrostomy but the risks are still there. If the dog had been neutered at a young age, there will be no prostatic hypertrophy which could cause obstruction to the flow of urine.

During surgery, I noticed that the urine from the distended bladder did not flow freely after I removed the 4-mm x 4mm urethral stone. My assistant had to compress the bladder manually to release the urine. So, it is possible that the enlarged prostate or prostatic tumour will cause dysuria.

Neuter will be the best advice but the owners think of anaesthetic risks and death and so, nothing will be done till another dysuria episode comes.
     
FOLLW UP.
Sep 30, 2015
1.  The dog is at home. He had been neutered under a 2nd general anaesthesia. Dr Daniel did the neuter on Sep 27, 2015.  As this dog had swollen testicles, he did a scrotal ablation which involved removal of the scrotal sac as well and the testicles which may be having abnormal growth. Neuter removes the testosterone hormones which cause prostate enlargement (see X-ray) and require weekly Tardak injections. If the dog had been neutered at a young age, there would be no prostate enlargement but many young Singaporean dog owners believe it is "cruel" to neuter a dog.

There was the risk that this dog could die under the 2nd anaesthesia, being very old and in poor health. But he survived, much to the happiness of the young lady owner and family.  

2. The stone analysis of the urethral stone was calcium oxalate. The two big stones are inside the bladder.

3. The blood test showed high urea and creatinine levels and low red blood cell count and haemoglobin. This confirms that the dog has chronic kidney disease and would need the twice a week dialysis. The owner now understands that the dog needs to be given the K/D diet. The dog ate a whole can but 6 hours later vomited some food. I advised that the dog, being thirsty due to kidney failure, not be given large amounts of water to drink at one time.

4. This case illustrates the need to patiently communicate with the family members regarding the costs and treatment of the heart, kidney and prostate diseases in this old Chihuahua. Medical costs are high in chronic disesease due to the various tests and procedures required. A perseverance to train the dog owner how to give  the Prescription K/D diet to avoid more damage to the kidneys and to live longer finally pays off now. All the while, the owner feeds the dog hamburgers from McDonalds as he would not eat the K/D/

   

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URETHRAL OBSTRUCTION AND FIC IN CATS
May 10, 2015. The talk at M Hotel, on Sunday, a Mother's Day was limited to 50 pax and was full house. Dr Susan Little is co-owner of 2 cat clinics and an author of cat books, amongst other veterinary achievements
Here are some of her opinions.
1.  URETHRAL OBSTRUCTION
1.1 Stablise the cat by decompressing the bladder in some cases, before catherisation. Do cystocentesis. Insert 25-G needle at 45 degrees towards the neck of the bladder. Not at 90 degrees or into the apex of bladder as bladder shrinks away freom the needle when urine is collected.
1.2. Use 3-way stop valve to draw urine and collect it for urine analysis

1.3 Massage penile tip for some time  -around 10 minutes to express out the urethral plug and so avoid the need to catetherise. This does happen in some hh of her cases.

1.4. She uses warmed saline with sterile lubricant to flush the bladder. Apparently the lubricant is effective in cleaering the mucosa?
1.5 A commercial firm sells the appropriate cat cathether. An orange one which is softer for indwelling. The one with the stylet (costs more) but can be used for both purposes - flushing and indwelling. Has a butterfly for suturing to penile skin.
1.6. Pain relief is important. Suggested opiod and NSAID.
Medocab for cats (Boelinger?) is great as it is tasteless and given in the cat's food. She uses it.  Her opinion is that tolfedine is old school and not as good as meloxicam.  

1.7  ACP 2.5 mg/cat oral as anti-spasomodic and anti-anxiety is said to be effective.
1.8. Duration of indwelling catheter depends on lab analysis of urine and blood electrolytes.
1.9. Recurring cases. She did not mention perineal urethrostomy in her lecture.
1.10. Damage to pelvic urethra from catherisation rupture case - dye seen pooling in pelvic area on X-ray shown.
1.11. Blood test. Monitor for K+


2. FIC
2.1  Only 5% are due to bacterial infections. 60-70% idiopathic. Therefore she does not prescribe antibiotics.
2.2 Most cases are self-limiting according to her, whether treatment is given or not.
2.3 Litter boxes insufficient. Should be 4 boxes for 3 cats instead of lesser.
2.4  Pain relief is important. Opiod. Her favourite is given.
NASAL TUBE FEEDING OF CATS
She said it is easy in her practice with the nurse holding the cat. But given sedation if necessary.
Can email to her if you have queries.

Tuesday, September 15, 2015

2296. Eye injury in a pug and prosthetic eye - email diagnosis is unreliable

Hi, 

As spoken to you earlier regarding my dog eye.  I have attached an image of how bad his eye is, currently his eye is cover by blood clot as yesterday was in minor 

bleeding compare to his first time bleeding. please do let me know whether you  guys provide fake eye ball implant. By the way this coming Thursday morning he will

be going to remove his eye from a vet from jurong. If you do have solution to cure his eye, please don't hesitate, contact me asap. Thank you so much for your 

concern & time.  


Best regards, 
V
------------------------------------------------
EMAIL REPLY FROM DR SING K Y
Sep 15, 2015
 
I need a better front view (with good lighting) and a side view to be able to assess via email. Ideally, I should be able to see the dog but since you have had seen 3 vets, it will be difficult for you. Advices by email reference eye conditions can be unreliable sometimes.




2295. An 80-year-old book binder still works

Sep 15, 2015

He is 80 years old but still works. His 3 children of over 30 years, 2 single and 1 married, wanted him to stop. They bought him a small car. 
"One goes to NUS, one goes to NTI and the other one studies ACCA," he said to me today. "I did not even pass my primary school and so had to work very hard to educate them!"

He had to tolerate the bad tempers of his boss who was demanding. The boss lived up to 90 years of age and was a tough task master. He learnt the trade from him, from finding the best glue for the binding at least cost. In 1952, he imported his paper machine from Italy, a Priano which had two small bulbs and is still working. He had wired a short longer fluroescent lighting tube now.

Last year, an agent offered him $500 to get someone to assign the lease for $60,000. The deal fell through as the HDB disallowed any assignment for the new tenant. "At least I have till 2019," he told me. Many commercial shops have till 2016 to find an assignee if they want to quit. This is a policy to prevent rental hikes due to assignment fees increasing over the years. The HDB will police the trade and make sure that the tenant is really at work and not subletting.  So there is no incentive to take over and the old book-binder now works half a day.

"I can't tender for the business," he emphasized. "I don't even know my ABC!". He is the subcontractor.
"Did you print and bind the condolence book for Mr Lee Kuan Yew?" I asked.
"Yes," he showed me a page. He also showed me a cover for the Anaesthetic Record book of a local hospital.
"How do you manage all by yourself?" I asked as his wife of over 70 years of age had not turned up. She is ill.
"I don't accept more than I can handle," he said. "I will ask for part-time help if I need it."

A much loved father and a loving husband. Mentally sharp at 80 years of age. Cluttered shop full of left over papers and 3X5" cards.

"No use for such cards," I said. "Now, the records are computerised."
"The government forces the people to computerise," he said."Or they will lose their operating licence.. Even for btothels as I print their visitors' book."
"For brohels in Geylang?" I was surprised.
"Yes, yes. However, the old workers do not want to touch the computer. And it is hard to find young Singaporeans to work in brothels to use computers to keep visitors' records. The government wants it so that they can come in and grab the whole computer in cases of investigation! The owner had to learn how to computerise but the workers are aged and do not want to do it!"


Monday, September 14, 2015

2294. 2nd visit: A lovable dwarf hamster keeps losing weight - sand bath allergy?

Sep 15, 2015

This dwarf hamster, around one year old, is very active but he scratches his sides and bites his bely. His chest hairs have dropped by 50% and he has actually lost weight.

In Aug 30, 2015, the daughter owner consulted me saying he keeps losing weight. He keeps scratching his left ear when I saw him. He weighed 46 g, a ball of action. A big abscess in his scent gland was drained and his longer lower incisor teeth were trimmed.

In Sep 7, the owner took him to another vet as the hamster had not put on weight. A skin test on the chest showed no skin mites. Anti-fungal, appetite stimulant, baytril antibiotics and anti-histamine oral were prescribed. Yet the hamster did not put on weight. So the mother consulted me as the hamster was not putting on weight.

Findings: A large nose pimple (digging into pelleted bedding and sand?).
Hair loss on both sides of the cheek pouch (sharp seeds stored inside the pouches?)
Hair loss on chest and top half of lower body (sand bath of different fragrances used daily, according to the mother).

What is the solution to the continuous body scratching and biting?
An allergy is suspected but the cause is unknown. It could be the fragrant sand.

"A change of lifestyle is needed," I advised not giving the daily fragrant sand bath and switch to paper litter. I would get the hairs clipped bald. The lower front teeth were OK and the hamster is hyperactive and much loved. But he just did not put on weight as all his litter food intake had been burnt out by his continuous scratching. (VIDEO).

Will need to follow up.    

Sunday, September 13, 2015

2293. 2 days after the General Election

Sep 13, 2015

It seems that the bookies had forecasted more opposition wins as all 89 seats were contested. The large crowds at rallies held by the opposition supported the forecast. The PAP would lose more seats as it had lost to the opposition in by-election due to a PAP MP resignation from an affair around 2011. There was a pattern of favouring the opposition to check the powers of a dominant party. Some high-handed civil servants caused much unhappiness and these have had impact on the ruling party. 

But the PAP won with a bigger share of the votes. The PAP had more concern with the problems of the ordinary people, like job competition from foreigners, subway train breakdowns  and high cost of housing. These were bread and butter issues brought up by the opposition in 2011. These issues were tackled well and shown to be caring.

So, there was a general increase in PAP's votes across the 83 seats and now it has the majority, it has the support of over 70% of the population. The bookies may have lost money. As for me, I have always voted for the PAP as it has a record of good governance as evident by the progress seen in infrastructure and economy.

For example, in Potong Pasir. It looks much brighter under the PAP which won the seat only in 2011 when Mr Chiam See Tong left to campaign in Bishan-Toa Payoh, leaving his wife to rally the residents to vote for her in the 2011. She lost by around 118 votes. This time, she around 30% as the residents are happy with the hard working and persevering PAP MP whom I have not met. The election success speaks for his efforts. I predicted he would win in a video 7 days before the election as he had the advantage of being an incumbent and had worked hard. I am not in his constituency but I could see the improvements.

Where other countries have high employment, here in Singapore, the unemployment is probably 5%.  Therefore Singaporean employees are like kings as they are in great demand and many do not want weekend work. A work-life balance for them. So, who does the weekend and evening jobs in the private sector? Some employers need to close their operations. In 4 years' time, there may be a higher unemployment rate and the government gets the blame. Will the civil servants become more high-handed since they can't be corrupted with money? 

Many Singaporeans including myself have had suffered from some of these high-handed unsympathetic civil servants in the regulatory authorities. I gave two examples:


1. A friend who used to vote for the PAP told me he voted for the opposition to check the powers of the PAP. He had seen many financial hardship cases. In one case, the woman asked for financial help to treat her husband's cancer. The bureaucrat said she did not qualify as her son was working. By the time the government gave her the check, she told the officer to present it to the coffin where her husband was in. This friend said that the government has lots of money and in this case, could have helped out. So he stopped voting for the PAP.  

2. Some years ago, I did not meet the deadline for 100% completion of re-building of my veterinary premises.

The only fittings I did not have were no wooden cabinets and a receptionist table. There were the airconditioners, the water, electricity, the drugs, the anaesthetic machines, the lighting, the crates. The AVA officer, Dr Lau E K came to inspect and pointed to the absence of these items. He said I could sue the contractor for the delays. In any case, he would not license me to practise till I had these two items. He had the power and he exercise his power absolutely. Mine would be the first veterinary clinic that would not be licensed for lacking in wooden cabinets and a receptionist counter. Never mind that I had mobile cabinets and a table and chairs for the receptionist and clients. There was no mercy. Bad luck to me. He said no to my appeal to him to re-consider and walked out to go home after the inspection. 

I just can't believe his lack of concern whereas the HDB officers tried their best to expedite my construction at all times and these HDB officers were also regulatory government officers. I appealed to the Director of Primary Production, Dr Ngiam and he could see that my clinic was operational. He permitted my licence renewal.

It is a hard to believe story but it is a true life experience I share with readers as regards the high-handedness of some regulatory officers.

  




   

     

2292. The commercial palm tree sucked out all water

Sunday Sep 13, 2015

After more than 10 years in my small plot of back garden, the palm tree had grown in girth to over 3 feet in diameter. Centipedes nested inside the trunk and crawl into the kitchen. All the cow grass had withered and the soil is exposed.

I got a contractor to uproot and take it away before it cracks the retaining wall of my back garden. I just can't believe this palm tree could be so water thirsty and large as Singapore does not have palm plantations. The other type of palm tree you see in Singapore grows slim and tall. 

2991. Titan the cat has difficulty peeing

Sunday Sep 13, 2015

I have known Titan the neutered male cat for many years. He had difficulty peeing many years ago. The problem was the high litter tray lined with newspapers. Every time he gets into the litter tray, he bruised his lower belly and penile area leading to pain. I discovered this by querying the owner as I did not see the litter tray. No more problems.

Then today, he came in with difficulty in peeing. He had also been rubbing his backside on the floor, Mr Thiru, the father had said.   
"Has he been to the groomer?" I asked.
"Yes, last week." the Primary School teacher daughter said. Her father had sprained his left ankle and would wait outside the consultation room while I examined the fat Titan.
"Was he OK after grooming?" I noted that this lady groomer referred by me had done a great job (video).
"Yes," the daughter said. "He looked forward to grooming, but he is quiet when he sees the vet."
Titan was like a statute and did not claw or growl at me. Visiting a vet was not pleasant for him as he remembers me for giving him injections.
"He has stained anal areas as he had been licking it,": I expressed brown oil from the left anal sac. "He probably has an itchy backside, licking it to relieve his anal sac impaction. He needs to reduce weight as it is difficult to express his anal sacs with so much perianal fat tissues.

"His inflamed prepuce is swollen now and it is not possible to protrude his penis as in normal slim cats," I said. "That could be one reason he had difficulty in peeing. The reason I asked about a recent grooming visit is that the groomer may have had accidentally clipped his preputial area. This is unlikely as Clara is very experienced and the cat was OK for the past week after grooming."

"Titan loves the dry feline W/D food," the father said. "He would ask for more and my parents would pity him and give him."
"Give him a certain amount to achieve his weight of 6 kg," I referred the owners to a table of amount to be fed on the W/D bag to attain 6 kg.
"He will claw when he asks and no food is given," the father said.  "I will let my parents know."
Titan is 12 years old but he is as fit as a young cat, dashing after birds and lizards. However, the daughter could not film him in action.

I prescribed antibiotics and painkillers for the next 5 days. No urine was available. The bladder was not swollen but painful on palpation. So, I could not do urine test. No X-ray for the time being. 

I have a video of him for readers to appreciate his vitality and health.

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