Saturday, August 28, 2010

What to do if a fat cat has diabetes mellitus type 1?

TOA PAYOH VETS PTE LTD
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Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074.  Tel: +65 6254-3326, 9668-6468, judy@toapayohvets.com99pups@gmail.com
Focus: Small animals -dogs, cats, guinea pigs, hamsters, pet rats amand mice, birds and turtles      
November 29, 2020
 
Case written: August 28, 2010



WHAT TO DO IF A FAT CAT HAS DIABETES TYPE 1?

 

The male neutered 8-year-old fat cat displayed brown-yellowish urine stains and hair loss in the genital area for some 2 years, but now he no longer had stains. 

At that time, I suspected that he had to go in and out of the litter pan which was lined with overflowing newspapers.

The newspapers were spread out of the sides of the pan. After making sure that the papers were placed inside the litter pan and antibiotics, the cat's genital area was no longer bald due to licking of the stained area. Sometimes, the vet can come to a diagnosis from the litter mis-management. 

Many Singaporean cat owners still use newspapers inside litter trays instead of commercial litter; hence, the vet must understand the local practices.  Prescribing antibiotics and not resolving the litter mis-management would not resolve the urine leakage and staining.

Everyone was happy in this case. 

Today, the father and daughter brought the cat in for grooming. The cat looked like Garfield with turfs of matted hair on the neck, body and behind the ears.

He was as fat as Garfield and was very active in catching sparrows that landed on the window sill.

"It is not normal for a cat to have stained genital areas," I said to the daughter. "Get a blood test done." I did not ask for a urine test as there were some hesitation about costs and in any case, the cat was sent in for grooming and not for disease.

HISTORY
"Is he always looking for food and always thirsty?" I asked the father who was a bus driver. "He is always hungry and drinks a lot!" the father spoke while his young adult daughter listened respectfully.

BLOOD TEST
High blood glucose. Liver enzymes were OK. No kidney disorder.  So is this a case of diabetes mellitus or diabetes insipidus without complications in a cat? Is it a case of diabetes at all? What do you think? How to confirm it?


URINE TEST
This would be done if not for economic reasons. Glucosuria will confirm diabetes mellitus. What about diabetes insipidus? 

Urine SG <1.008
 will indicate a likelihood of diabetes insipidus as the urine will be very dilute. "Normal cat urine SG should be around 1.020" I said to my assistant Mr Saw.

I had a review of the two types of diabetes with my assistant Mr Saw.

Real case studies are best and this case is useful for Mr Saw as he has to go into differential diagnosis including diabetes mellitus and diabetes insipidus. One condition is associated with the pancreas. The other with the kidneys.

FOLLOW UP
The fat cat was prescribed Hill's W/D which is meant for management of weight and glucose level in cat diabetes Type 1.







He thrived on this therapeutic diet given to lose  weight and manage glucose level.

He was not hungry or thirsty after 3 months on this diet. Hence, I would say that he had type 1 diabetes which is said to be the more common type for cats.  The treatment is dietary management using therapeutic diet like Hill's W/D.


 

Toa Payoh Vets

184. Poodle purchased 1.5 months ago still pees everywhere

TOILET-TRAINING CASE STUDIES

CASE 1. PEES EVERYWHERE WHEN LET OUT OF THE PLAY PEN

An Indian family with a daughter studying what she liked - coaching netball sports at the polytechnic brought in a small poodle for the 3rd vaccination as I had vaccinated it for 2 vaccinations at the Benji Pet Shop.

Discussing about toilet-training is a very interesting subject and if there is humour in the discussions, it will be fun and laughter. This puppy was paper-trained in her playpen. However, she pees everywhere when let out of the playpen 1.5 months after purchase. Why this poodle does not go to the newspaper when let out?

"Is the playpen closed up so that the puppy cannot get in to pee on the newspapers? Some owners do that," I said.

The mum said: "The playpen was open but the puppy does not go inside and pee on the newspapers."

"Is the paper changed often?" I asked.
"Yes," the homemaker mum said. "Every time she pees, I change the papers."

The mum said: "When the puppy pees outside the approved papers, I will pick her and put her inside the playpen so that she will pee inside."

"It is too late usually," I said. "The puppy does not know why."

"If you let go, then your puppy will let go too." The English language sometimes can be a source of humour as the mum and daughter laughed.*

*For readers who may not understand the complexities of the English language, I mean "If you let (the puppy) go (everywhere in the apartment), then your puppy will let go (pees and poop everywhere) too.

I advised: "The secret to success is to confine the puppy to a small area outside the playpen for another 1-2 weeks. In this way, the puppy knows that she must go to the papers to pee. Then increase the area to one room, then after 1 week or so, to two rooms and so on."

"By permitting roaming to the whole apartment, it is like putting your puppy onto a football field. Your puppy cannot detect the newspapers and pees in every bedroom."

I advised neutralising of all floors with white vinegar:water and 1 part to 3 parts respectively. Letting the puppy so much freedom after 1 week of confinement is a common practice in Singapore as many owners are puppy lovers. They feel sorry for the poor puppy being confined. But they have no time to observe the signs of elimination and put the puppy back onto the newspapers with oral commands and then praises.

In this case, the mother did do it but it could be too late (after the puppy had peed). Therefore the puppy would not know why. In addition, the apartment floor is full of urine smells and the puppy simply pees everywhere!

CASE 2. TOILET-TRAINING TWO PUPPIES
Date of Interview: 18 February 2010
Written by: Tanya Trevethick
Edited: Dr Sing

I did not do any editing. An excellent piece of writing by a vet intern who will be studying vet medicine in the UK soon.

Description

Two male salt & pepper Miniature Schnauzers around three years of age at the time of interview are owned by two men in their late 30s. They were house-trained as puppies at the same time by the current owners.

Equipment

At the time of interview, 3 pee trays were placed in the bathroom of an HDB apartment and shared between both dogs. The trays are near a wall; paper is not used. Neither dog has a preference for any particular tray.

Process

When the puppies started to eliminate, the owners carried them to the pee tray. The puppies were confined, with the confinement area gradually increased as the puppies got used to using the pee tray. Puppies were confined most of the day except when allowed out at a regular time each day to play.

Management

The owner washes out the pee tray and grate after every use. The grate has never needed replacing as it did not rust. The dogs pee two or three times a day and poop twice a day (once in the morning and once at night). The dogs are fed once a day on dry commercial dog food with very occasional treats.

Motivation

No treats were given after use of the pee tray. Puppies were spanked when they lifted their legs too high resulting in urine on the adjacent wall.

Difficulties

Training took a long time, two or three months instead of the usual two to four weeks. This could indicate that training two puppies together at the same time is harder than training just one. Also, the owners were at work during the day thus the puppies were not trained continuously throughout the day.

Success Rate

100% at time of interview. The dogs use the pee tray all the time, never soiling other parts of the bathroom or the house. The male dogs also do not lift their legs fully when urinating (one does not lift at all), as they get spanking and scolding when they do it. Thus no urine is sprayed onto the adjacent walls or floor area outside the pee tray. The owners noted that the dogs do not use the tray when it is unclean; this is the rationale behind their washing it after every use.


More toilet training cases are at: www.toapayohvets.com

183. Toilet training 2 puppies - written by intern Tanya

How to House-Train Two Puppies on the Pee Tray + grate



Date of Interview: 18 February 2010
Written by: Tanya Trevethick
Edited: Dr Sing



Description

Two male salt & pepper Miniature Schnauzers around three years of age at the time of interview are owned by two men in their late 30s. They were house-trained as puppies at the same time by the current owners.



Equipment

At the time of interview, 3 pee trays were placed in the bathroom of an HDB apartment and shared between both dogs. The trays are near a wall; paper is not used. Neither dog has a preference for any particular tray.



Process

When the puppies started to eliminate, the owners carried them to the pee tray. The puppies were confined, with the confinement area gradually increased as the puppies got used to using the pee tray. Puppies were confined most of the day except when allowed out at a regular time each day to play.



Management

The owner washes out the pee tray and grate after every use. The grate has never needed replacing as it did not rust. The dogs pee two or three times a day and poop twice a day (once in the morning and once at night). The dogs are fed once a day on dry commercial dog food with very occasional treats.



Motivation

No treats were given after use of the pee tray. Puppies were spanked when they lifted their legs too high resulting in urine on the adjacent wall.



Difficulties

Training took a long time, two or three months instead of the usual two to four weeks. This could indicate that training two puppies together at the same time is harder than training just one. Also, the owners were at work during the day thus the puppies were not trained continuously throughout the day.



Success Rate

100% at time of interview. The dogs use the pee tray all the time, never soiling other parts of the bathroom or the house. The male dogs also do not lift their legs fully when urinating (one does not lift at all), as they get spanking and scolding when they do it. Thus no urine is sprayed onto the adjacent walls or floor area outside the pee tray. The owners noted that the dogs do not use the tray when it is unclean; this is the rationale behind their washing it after every use.

Wednesday, August 25, 2010

"Debarking is a rare operation," I said to the lady on the phone. "Vets don't encourage it." She had moved to a quiet neighbourhood and her 8-year-old neutered Schnauzer barked shrilly and frequently. "I want to debark my dog to prevent the AVA from coming to see me after neighbours complain. The alternative is to give up this dog but I do not want to give him away."

Barking seemed to be her only solution and she googled for a vet that will do debarking. "Do you need me to consult you first and be counselled for debarking? My vet is at Clementi. Do you mind that?"

"Will scars form after debarking, affecting the dog?" the lady had read somewhere in the internet

"Scars are referred to operations after debarking using the oral approach. As the vocal cords may not be excised by the long forceps 100% unless done by the vet with lots of experience using this approach, the scars will form. Barking sounds will return. But the oral approach can be effective if all vocal cords can be pulled out and snipped off."


ALTERNATIVES
1. Get a dog trainer to train the dog not to bark will need some time and patience. It may or may not work. Why not try this method?

2. Electric collars. It works according to feedback from one owner.

3. Citronella spray collars. Feedback from some owners are not so positive.

Much depends on the age of dog, the personality of the dog, the training and the owner. It is hard to be specific.

3 male hamsters live together - stress causes warts?

Sire 1.5 years old and two siblings 1 year old

Only 1 sibling developed warts. Why?
"Did the father bully him only?" I asked.
"Yes," the young man said.
"What does the hamster do?"
"He lies flat exposing his tummy.


Electro-surgery to remove warts in right front legs (paws, pad, elbow area. No bleeding. Hamster recovered and went home. This may be one case where warts develop due to stress of being bullied by the sire. Left fore develops small wart that is too small to remove. Hard to prove my hypothesis.

Pictures taken.

Advised: Put this sibling in another cage.

Prostatitis

25.8.10 Goes home.
Shih Tzu, 8 years, male
4 pm. Can control bladder after Tardak inj and antibiotics yesterday. But still painful prostate on palpation. clindamycin 25 mg/capsule. 3 cap bd x 14 days

24.8.10
URINE TEST (2nd day)
Amber, Turbid, pH 6.5 SG 1.032, Protein 1+, Blood 4+. WBC >2550, RBC 126, Bacteria +. Possible haemolysis of RBC in urine.

DIPSTICK
pH 9, SG 1.00, Protein 2+. Blood 4+, WBC 4+.
Dipstick's yellow (instead of green) showed non-haemolysis of RBC in urine.
Lab analysis is more accurate.


6.30 pm. Dog goes home. Positive developments are:
1. Saw stray cat and barked
2. Poop twice as usual. Normal stools. Dog had been using stool to mark territory as he would poop in different areas for the past 7 years.
3. Urinate a few times as usual - urine marking. Colour yellowish.
4. Bladder control OK - therefore can urine mark.
5. Had excellent appetite.
6. Drank some water after urination. Not excessive thirst.
7. Prostrate should shrink now that treatment is given and the dog no longer produces testosterone.

Observe for next 14 days. No dry food. Canned food. Larger e-collar to prevent the occasional licking of prepuce

Urine colour of 2 dogs

EDUCATIONAL TIPS FOR VET UNDERGRADUATES
I write this case of contrasting urine colours for vet undergraduates who may be struggling to remember so much information for their 4th year examinations.

Date of report. Wed Aug 25, 2010 6 am

Dog 1 - Miniature Schnauzer, 2 years, male, not neutered. Dog was groomed one week ago but the house-call groomer prohibited the owner to see. However, he recommended one shampoo for the dog. A shampoo different from what he uses. The owner bought the shampoo from the pet shop and used it 2 days ago.

Dog 2 - Shih Tzu, 8 years, male, recently neutered and repair of right perineal hernia. 4 days ago, had fever and urinary tract infection was diagnosed. Dog was given medication of antibiotics.

Complaint
Dog 1 - Shivering for 2 hours yesterday. Vomited twice after consultation.
Dog 2 - Cannot control bladder. Bites when backside is touched. Tongue pale. Vomited once after consultation.

Presenting signs
Dog 1 - shivering
Dog 2 - urinary incontinence

Urine Test Report From Laboratory:
Dog 1 - Colour amber, clear, pH 6.5, SG 1.020, Blood Trace, WBC 25, RBC 5, Bacteria Occasional, Spermatozoa Occasional

Dog 2 - Colourless, slightly turbid, ph 6.5, SG 1.005, Blood Trace, WBC 25, RBC 5, Bacteria Occasional, Spermatozoa Occasional. Possibly haemolysis of RBC in the urine. That would account for the pallor of the tongue I saw yesterday. The low SG (Specific Gravity) of the urine is not a good clinical finding.

Blood Test Report From Laboratory:
For Dog 1, there is a high blood urea. This could account for the dog vomiting twice after going home. I did not give any treatment on the first visit of shivering complaint at 11 am. I just took urine and blood samples. The dog went home and vomited and came back at 5 pm.

For Dog 2, significant results are low haemoglobin and increase in total white cell count suggesting a bacterial infection in the urinary tract and prostate. Antibiotic treatment had been given for the last 3 days.

What's the problem and what's the cure?




Get the history of management and past illness, general examination of the whole body externally including genital area, abdominal palpation is very important, urine test, blood test at the first stage of consultation.

History taking can take a long time and patience. In Dog 1, I asked whether there was an anti-tick shampoo used by the house-call groomer as this dog had suffered shivering and tremors of the body some months ago after the use of an anti-tick wash by the groomer at the pet shop.

The answer was correctly no. I did not expect the owners to purchase a new brand of dog "shampoo" as I presumed incorrectly that the owners would stick to the old brand. Later, when the daughter brought the bottle for me to see, it was not a shampoo but a "silky coating brush spray" to detangle, soften and repel dirt.

The shampoo was applied on the coat without rinsing as the instructions on the bottle were to "spray directly on the dog's coat after bathing or when brushing daily."

Here, many Singapore owners would be thinking of this product as a "shampoo". The bottle had this caution - "For External Use Only. Avoid contact with eyes." The Schnauzer most likely disliked the perfume fragrance and licked all ingredients to get rid of the smell, as in a cat grooming. The product had 17 ingredients, two of which were chamomile flower and rosemary left extracts. This dog specifically disliked chemicals on his body and would have ingested the grooming products meant to keep the coat tangle-free and silky.

General examination and abdominal palpation. The whole body must be examined. Sometimes it is best to ask the young lady to look elsewhere when the vet examines the penile tip. Yesterday one lady in her late 30s, not related to the above 2 cases, screamed in surprise when I checked the penile tip of her old poodle as part of my general examination. She had sent the old dog for treatment of the skin diseases after her one-year-stay in Hong Kong. Her parents in their late 60s would not want to spend money treating this old dog with recurring scales did not bother and so she brought the old dog in.

For Dog 1, the penile tip was very red. I told the young lady that the dog had been self-stimulating. She did not believe me as the dog was behaving normally when the family members were around. Urine test showed "occasional spermatozoa".

For Dog 2, I could feel a hard globular lump of 3 cm x 3 cm. The dog reacted in pain. This was the inflamed prostate. As for the urinary incontinence, it would be due to prostatitis (narrowing or urethra and painful urination).

Tentative diagnosis:
Dog 1 - Poisoning from ingestion of grooming products.
Dog 2 - Prostatitis causing urinary incontinence

Treatment:
Dog 1 - IV drip to dilute the poison in the blood. The dog had a slightly elevated blood urea. He is young and so recover.

Dog 2 - Pallor of tongue indicated a more serious problem. The blood haemoglobin was low. The total white cell count in the blood and urine was high indicating a bacterial infection. The dog was given an anti-androgenic injection 1.4 ml Tardak yesterday, antibiotics, IV drip, Vit K1, antibiotics and was warded for treatment. Yesterday evening, his tongue colour returned to a normal pink. Much more investigation work needs to be done. All the young lady and mum want is a dog back to health. "Will this dog die?" It is hard to predict. Dogs do die when the vet thinks there will be a good clinical outcome. Some dogs with chronic diseases don't die although their deaths would be welcome by the owners!


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