Thursday, September 18, 2014

The Shih Tzu can't control his bladder for one year

Sep 18, 2014

The Shih Tzu came in for bladder stone removal as scheduled. His urine starts to smell. When the maid removed the diapers which are worn when he goes outdoors or sleeps overnight of 8 hours, I noted that the dog released a large amount of urine.

"He does urinate into the diapers," the maid showed me dark brown urine stain inside the diapers.
"What happened is that the dog will try not to pee when you put on the diapers overnight," I explained. "His bladder gets infected by stagnant urine as he keeps the urine overnight. This has been going on for one year and so now, he dribbles urine all the time."

The dog started with urine drops one year ago. He was hospitalised by a vet for one week.
"Did the vet do an X-ray or urine test?" I asked.
"I don't think he did an X-ray," the wife said. "He told me that this dog is old and old dogs cannot control their bladder. So, he must have long-term medication."

Instead, the owner got the dog to wear diapers when he is inside the apartment as his urine drops soil the whole apartment. But on Sep 11, 201, the dog was lethargic and not eating for 2 days. So he was brought to Toa Payoh Vets. X-rays showed 3 large bladder stones. Urine test show urinary tract infection with pH = 7.0, SG 1.030, positive protein, blood 4+, bacteria 2+ and no crystals. Blood tests showed total white cell count as 47.7 (normal 6 - 17), neutrophils at 96.4% (normal 60-70%) and absolute neutrophils as 46 (normal 3-11.5).  Blood urea was higher but creatinine was lower than normal.   .

Overall, this dog had a severe bacteraemia and that was why he was not eating for 2 days.

The dog was on antibiotics and today will be operated.
"Some owners will put the dog to sleep," I explained the high anaesthetic risks for old dog surgery.

In Singapore some owners do make the male dog wear diapers to prevent urine marking and soiling the apartment. This may lead to urinary tract infection as the dog withholds the urine for long time, allowing bacteria and crystals to form over several months.

SEP 18, 2014
Surgery to open the bladder. The stones had disintegrated. The testicles were swollen 5X and adhered to the scrotal sac. The testicles with pus inside the tissues and the scrotal sacs were removed.  

Wednesday, September 17, 2014

1502. Tail docking in 2-day-old puppies

Tail injuries happen in dogs and cats. Tail amputation or docking surgical techniques are shared in the video. It is best that your vet does the tail docking rather than use rubber bands.

   

Monday, September 15, 2014

1501. A 5-month-old cat has difficulty peeing. Why?

Sep 15, 2014

Cat, M, Not neutered, 5 m. Cannot pee normally.

"Did he try to mate with the female cat?" I asked the young lady who had adopted this cat 4 months ago and noted that he was peeing outside the litter box last month.
"No," she said. "But the 5-month-old female always lick his private parts."

A tense round swelling in which the centre is a preputial opening and in which urine would shoot out once I expressed the anaethesized cat's bladder.

My assistant aspirated over 15 ml of urine and some blood and we showed the container of urine to the lady. The swelling had shrank to a normal size.

When we showed the area to the owner, it swelled again back to its original size of 3 cm x 3 cm x 2 cm. It was as if there was a leak from the bladder deep inside the swelling. Aspiration by needle was not a solution to this problem. Could there be a hole in the penile urethra?  Hard to tell without more costly imaging.

I anaesthesized the cat with isoflurane and gas again. I incised 6mm midline from the preputial opening. Thick red granulomatous tissue under the skin. Red blood oozed out from the thickened tissues. Urine also seeped out. The swelling now shrank.

Hospitalised the cat overnight and gave anti-inflam and antibiotics. A rare case of possible urethral rupture juding by the hardened granulomatous tissue under the big preputial swelling. The female cat could have bitten him during mating. The owner may say no mating but she could not be around 24 hours a day to monitor this cat.  Female cats bite when mated, as part of the stimulus for ovulation and so this male cat could have got badly injured in his prepuce. There was infection and a some drops of pus oozing out during incision.  

On Day 3 of in-patient treatment, the cat's preputial swelling has gone down by 60%. He could pee inside his litter box and was very active and very playful. He went home to a happy owner. Mating does have hazards for the feline male as the female may bite when mated. In this case, the female cat had continually licked the injured male's preputial area.  

1500. A veterinary trilogy - swellings below the right eye

Sep 14, 2014 Sunday

A trilogy is a set of 3 works of art that are connected, commonly found in literature, films and video games. They are connected by characters, settings or theme.

In my veterinary example, the 3 old dogs have swellings below the right eye seen by me within a short period of time.

Case 1. A 15-year-old Cross-bred had facial cysts.
Case 2. A 15-year-old Jack Russell had carnaissal tooth abscess and oronasal fistula.
Case 3. A 11-year-old Jack Russell had chronic dacryocytitis

All 3 with different causes but the same surgical outcomes. They have recovered as at Nov 17, 2014

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1499. A 4-year-old terrapin has swollen eyelids

Sep 14, 2014  Sunday

"We went for holidays for 3 days," the Singapore school holiday week started in September for the 8-year-old and 4-year-old daughters.  They put the nameless terrapin in the little tank which now has no space for swimming since she has grown much bigger at 450 g. She is as big as the palm size of a big man and the tank was meant for a terrapin of a few weeks old.  

"When we came back, the turtle is not eating the shrimps. She would snap and eat the shrimps hungrily every day.  She also has swollen eyes!"

"The eyelids are swollen," I said. "The eyes could be infected as she was in the water for 3 days when you were away."




"It could be that she had no sunlight," the father said. "I will upgrade to a bigger tank and buy the lighting system."

"The shell quality is poor, with cracks and unevenness on the surface," I said. "If she eats shrimps only, she will not get good nutrition.  It is fortunate that she has not lung infection as she does not gasp for air, like the other terrapins I treated. That is because you come early for treatment."

 Medication, eye drops and multivitamins were prescribed. New bigger tank, a basking platform and sufficient amount of water to swim. Changing of water used to be once in 2 days. Variety of food like live guppies, egg yolk.  She dislikes vegetables.

UPDATE
Follow up the next day. Terrapin's eyelids much less swollen. Still not eating. New tank bought. I advised feeding shrimps and medication in the water.
Video shows terrapin snapping at shrimps.










FOLLOW UP ON SEP 15, 2014
"We bought a bigger tank and she would be swimming," the wife answered the phone. "There is also lighting. But she does not eat the shrimps."

"Are the eyelids swollen?"
"Much less than yesterday," she said.
Still too early to recover.

The 8-year-old daughter in Primary 2 can be trained to change water or take more care of the terrapin but most Singaporean parents just do it. The 4-year-old is too young.

FOLLOW UP ON SEP 17, 2014 when I sms to ask whether the turtle is eating shrimps.
"Yes, the turtle is eating dry shrimps in the water. We are trying to get her to feed on vegetables and turtle food (pellets). The swollen eye is better and we plan to consult you again when the eye drops are used up. Thank you."

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1498. Is it worth operating an old female dog with breast cancer?

Sep 15, 2014

Besides the risk of death from anaesthesia, owners do weigh the medical costs of removing the breast tumours from the 14-year-old Silkie Terrier. The total costs of removing all 7 breast tumours including anaesthesia was $700 in this case.

First I advised spaying to get rid of the ovarian hormones feeding the breast tumours.  Breast tumours to be excised 4 weeks later. But many Singaporean owners don't follow up with breast tumour removal.

HISTORY
Nov 2, 2013   Dog could not lie down on chest.  Large breast tumours grow large during last few days.  Large swelling of left MG5, right MG 1 +2. No blood tests, chest X-ray to check for metastasis nor biopsy to check for malignancy to lower medical costs.

Nov 5, 2013. Spayed.

Jul 3, 2014.  Left MG5 swollen and painful.  Other tumours did not increase in size. I advised removal of left MG5 2 weeks later after giving anti-inflam and antibiotics.

Sep 15, 2014. Owner wanted painkillers  + injections as the left MG5 is swollen to 6cm x 6 cm x 3 cm and was very painful. The dog was active but would not permit carrying.
I advised removal after 2 weeks. But the owner felt that the dog's lifespan was ending. "You said 6 months to live," the husband told me.

"I said 6 months based on the dog not spayed and the fast-growing breast tumours." It is best not to predict the life span as there could be mis communications.  



Friday, September 12, 2014

1497. A severely constipated cat. What to do?

Sep 12, 2014

The expatriate lady and her young daughter brought in a small sized cat that was straining to poop for the past 5 days with no stools. A male, neutered, 2 years old, stripped brown at 2 kg. Looks like a miniature domestic shorthaired.

He did not want to come out of the carrier. So I waited patiently. After some time, he came out himself, sniffed the air and walked on my consultation table edge, ready to leap away.

"He seldom meet strangers," the European lady said as this cat hissed several times.
"Just stroke his neck and talk to him," I said to the mother. "I can palpate his abdomen. I can feel a solid rock of 10 cm x 10 cm in his rectum. He is badly constipated."

What to do now?

"I need to sedate him to give him the enema," I said.
"I can wrap him in a towel and you can do it," the lady suggested.
"Not so easy as you think. When the tip of the enema tube touches his anus, he will claw and jump away!"

"I will need to sedate him," I prepared xylazine 0.1 ml + ketamine 0.4 ml to be given IM. My assistant would hold the scruff of the cat's neck. But he was not that keen to do so as the cat already warned us by hissing again.

"Quickly let him back into the carrier," I said. He faced the carrier and walked in for shelter and sat down.

"We must not excite him much as there is no 2nd chance once he is frightened."

"I want to see him sedated," the lady was not keen on scruffing the cat.

So, I got the cat carrier covered by a big black plastic bag. Anaesthetic gas pumped into the carrier inside the bag. It took around 15 minutes. Then Naing masked the sleepy cat to maintain the anaesthesia. I pumped in one tube of Microlax enema.

"You said two," the lady reminded me as she wanted the cat to go home after this procedure.

So, 2 tubes. I advised W/D cans and wait and see for 2 days. An injection of antibiotics. The young daughter covered her nose with the top of her T-shirt as the rectal gas was smelly. "If this works, no need surgery to take out the stools."

"How did he become constipated?" the lady asked.
"Some change of surroundings. Is there a new cat? He could be stressed and stopped drinking water."
"Yes, the neighbour brought in a new cat."
So, instead of FLUTD (feline lower urinary tract disease) usually due to eating of dry food. But this cat eats only wet food, he developed constipation.

Will wait and see. The cat went home in a taxi at 6 pm. An interesting case as this cat lives in a house with garden and has free access to peeing and pooping. But a new cat has come next door.

On Sep 13, 2014, I phoned the owner but there was no response.