Sep 24, 2014
This evening, a young Indian lady had to rush to Toa Payoh Vets before it closes to get the heart drugs for her 14-year-old dog. She phoned as she might not be in time. I waited for her.
"Is the dog still coughing on heart medication?" I asked.
"Yes, a deeper cough," she replied.
"Did you feed the frusemide (1/2 two times a day) and Fortekor 5 (1/2 per day) as prescribed?"
"Yes," she said.
On further queries, she had more frusemide tablets than Fortekor 5. So, when the latter ran out, she would use frusemide but the dog's coughing worsened.
This case showed that the owner seldom knows about the efficacy and use of heart drugs. They gave the tablet not 12-hourly. They forget to give on certain days. They don't spend much time on complying with medical instructions. So they find that the old dog, while active and eating, starts to cough and cough, waking everybody up at night.
In this case, I advised her to increase the dose of frusemide for 1 week and let me know. She needed to have her dog needed dental check up for his bad breath as the bacterial infection of the mouth can cause infections leading to coughing. I prescribed 12 days of antibiotics and advised dental work at the end of the course. There will be anaesthetic risks but they are minimal on isoflurane gas anaesthesia.
Discussion on the effects of heart drug medication in aged dogs is needed when the owner wants repeat medication. Many owners do not bother.
It is sad that many old dogs do not get dental treatment from Singapore owners.
Thursday, September 25, 2014
Wednesday, September 24, 2014
Update: The 12-year-old Jack Russell with the large lacrimal sac swelling
Sep 24, 2014
Update
This is the 3rd case, part of the "trilogy" I saw recently. Or a "trifecta".
The other 2 cases also had swelling on the right side of the face. One is a case of facial cyst. The other is a carnaissal tooth abscess.
In this case, no more swelling as at 12th day after I electro-excised the lacrimal sac leaking out the brown fluid. I also electro-excised 2 pieces of tissue, possibly the sac, quite near the nasolacrimal canal. There was no contrast imaging done as that would increase the medical cost. Many Singapore owners want the least medical cost but the medical overheads keep going up nowadays as landlords keep increasing their rentals, knowing that Singapore, like Hongkong, has a shortfall of commercial units for rent.
This was done after aspiration of 2 ml of brown fluid earlier, using a 1-ml syringe.
LAB TESTS OF LACRIMAL SAC FLUID
1 ml of yellowish fluid.
Microscopic description
3 Pap and one Diff Quik stained smears show a paucicellular yield. Thin degenerate proteinaceous material. No epithelial or malignant cells.
Diagnosis
LACRIMAL SAC LESION, FNAC
Degenerate cyst contents. pl re-aspirate if there is a residual nodule.
Update
This is the 3rd case, part of the "trilogy" I saw recently. Or a "trifecta".
The other 2 cases also had swelling on the right side of the face. One is a case of facial cyst. The other is a carnaissal tooth abscess.
In this case, no more swelling as at 12th day after I electro-excised the lacrimal sac leaking out the brown fluid. I also electro-excised 2 pieces of tissue, possibly the sac, quite near the nasolacrimal canal. There was no contrast imaging done as that would increase the medical cost. Many Singapore owners want the least medical cost but the medical overheads keep going up nowadays as landlords keep increasing their rentals, knowing that Singapore, like Hongkong, has a shortfall of commercial units for rent.
This was done after aspiration of 2 ml of brown fluid earlier, using a 1-ml syringe.
LAB TESTS OF LACRIMAL SAC FLUID
1 ml of yellowish fluid.
Microscopic description
3 Pap and one Diff Quik stained smears show a paucicellular yield. Thin degenerate proteinaceous material. No epithelial or malignant cells.
Diagnosis
LACRIMAL SAC LESION, FNAC
Degenerate cyst contents. pl re-aspirate if there is a residual nodule.
A 16-year-old unspayed female chihuahua has a tense swollen abdomen
As the cost of living in Singapore, esp. rentals and labour, has shot up in 2014, many pet owners want the least medical costs. This means no blood tests before anaesthesia, no urine tests, no X-rays and no abdominal fluid tests.
Abdominal palpation may be useful.
Sep 23, 2014
This 16-year-old chihuahua had a large elongated inflamed breast tumour growing from the left MG4. Her abdomen was tense like a balloon about to burst. I percussed the abdomen. A fluid thrill from the sides was palpable. Heart murmurs on left side and owner reported occasional coughing which he had not really noticed.
Gas anaesthesia inside the carrier which is enclosed by a big plastic bag was the safest way. No direct handling with a gas mask as she might die from heart failure, being so old. No thick cataracts, still active.
I drained around 20 ml of the abdominal fluid - dark brown cloudy, reducing the abdominal swelling by 50%. I could palpate nodular masses - possibly abdominal tumours from the liver, ovaries, spleen or other organs. After giving frusemide injection SC, the dog peed clear watery urine, like drinking tap water, a few times. Active and running about.
Heart medication dispensed. H/D prescription diet given as the dog was on pumpkin diet. She was on those Caesar wet food previously. Toothless as all teeth had droppped out but looked and was energetic as a young as a 10-year-old with mild cataracts.
Abdominal palpation may be useful.
Sep 23, 2014
This 16-year-old chihuahua had a large elongated inflamed breast tumour growing from the left MG4. Her abdomen was tense like a balloon about to burst. I percussed the abdomen. A fluid thrill from the sides was palpable. Heart murmurs on left side and owner reported occasional coughing which he had not really noticed.
Gas anaesthesia inside the carrier which is enclosed by a big plastic bag was the safest way. No direct handling with a gas mask as she might die from heart failure, being so old. No thick cataracts, still active.
I drained around 20 ml of the abdominal fluid - dark brown cloudy, reducing the abdominal swelling by 50%. I could palpate nodular masses - possibly abdominal tumours from the liver, ovaries, spleen or other organs. After giving frusemide injection SC, the dog peed clear watery urine, like drinking tap water, a few times. Active and running about.
Heart medication dispensed. H/D prescription diet given as the dog was on pumpkin diet. She was on those Caesar wet food previously. Toothless as all teeth had droppped out but looked and was energetic as a young as a 10-year-old with mild cataracts.
Tuesday, September 23, 2014
1059. Continuing veterinary education
Sep 22, 2014
Attended a most interesting talk by an experienced vet.
"A new approach to utilizing lab diagnostics for the most challenging and misdiagnosed diseases"
Fred Metzger DVM, MRCVS, Diplomate ABVP, Metzger Animal Hospital, State College, Pennsylvania, USA, Oasia Hotel, Singapore, IDEXX Lab, Sep 22, 2014. Some points are:
1. Complete blood counts should be included in evaluations of every sick patient (anaemia, inflam disease, platelet disorders, monitoring for trending of data in progression or regression of the sick animal disease), patient with vague signs of diseases, every pre-anaethetic evaluation (get baseline data every couple of years), wellness and geriatric profile, recheck of patients with previous erythrocuyte, leucocyte or thrombocyte abnormalities. This is seldom done by some vets in Singapore to lower medical costs.
2. Start CBC at one-year of age to get the minimum database as reference.
3. A surgery release/preanaesthetic testing form
4. A cost estimate of CBC $38, $52, $84 for patients <2 2-7="" 5="" 7="" age="" and="" ask="" by="" client="" do="" health="" income="" increase="" it.="" keep="" low.="" nbsp="" of="" or="" over="" p="" patients="" practice="" preanaesthetic="" price="" questionable="" status.="" test="" to="" with="" years="">5.Trend in the USA. Vaccination income is dropping. Pharmacy income has dropped as clients purchased from the internet. This will happen in Singapore. Diagnostic income is 2.5 x more than vaccination income, more thanpharmacy income, outpatient services and treatment income, more than surgery income, hospitalisation and dentistry income combined.
6. Untapped profit center. Laboratory.
Pre-anaethetic testing. Wellness/preventive screen. Senior care. Monitor long-term meds.
7. Very few dentals are done by vets.
8. Quantative buffy coat analysis, impedance counting analyzers (not wanted in the US, sold to China and other countries), lasercyte and lasercyte DX, IDEXX procyte Dx (best of all) and sysmex XTV.
Attended a most interesting talk by an experienced vet.
"A new approach to utilizing lab diagnostics for the most challenging and misdiagnosed diseases"
Fred Metzger DVM, MRCVS, Diplomate ABVP, Metzger Animal Hospital, State College, Pennsylvania, USA, Oasia Hotel, Singapore, IDEXX Lab, Sep 22, 2014. Some points are:
1. Complete blood counts should be included in evaluations of every sick patient (anaemia, inflam disease, platelet disorders, monitoring for trending of data in progression or regression of the sick animal disease), patient with vague signs of diseases, every pre-anaethetic evaluation (get baseline data every couple of years), wellness and geriatric profile, recheck of patients with previous erythrocuyte, leucocyte or thrombocyte abnormalities. This is seldom done by some vets in Singapore to lower medical costs.
2. Start CBC at one-year of age to get the minimum database as reference.
3. A surgery release/preanaesthetic testing form
4. A cost estimate of CBC $38, $52, $84 for patients <2 2-7="" 5="" 7="" age="" and="" ask="" by="" client="" do="" health="" income="" increase="" it.="" keep="" low.="" nbsp="" of="" or="" over="" p="" patients="" practice="" preanaesthetic="" price="" questionable="" status.="" test="" to="" with="" years="">5.Trend in the USA. Vaccination income is dropping. Pharmacy income has dropped as clients purchased from the internet. This will happen in Singapore. Diagnostic income is 2.5 x more than vaccination income, more thanpharmacy income, outpatient services and treatment income, more than surgery income, hospitalisation and dentistry income combined.
6. Untapped profit center. Laboratory.
Pre-anaethetic testing. Wellness/preventive screen. Senior care. Monitor long-term meds.
7. Very few dentals are done by vets.
8. Quantative buffy coat analysis, impedance counting analyzers (not wanted in the US, sold to China and other countries), lasercyte and lasercyte DX, IDEXX procyte Dx (best of all) and sysmex XTV.
Monday, September 22, 2014
1058. The senior citizen cafe operator
Monday, Sep 22, 2014
I had a breakfast chat with this senior citizen at the coffee shop opposite Potong Pasir NTUC. His boss was late and so we had a good chat.
1. Charcot's Disease - bone deformation. He had custom-made shoes. "It costs me $468," he said. That is expensive for a senior citizen.
2. Getting business for his employer.
2.1 "Nowadays, no Singaporean wants to work in the cafe in this hotel. The younger ones don't stay long or don't know what to do to generate revenue to cover the operating cost of rental and salary. He was aware of that but he did not take advantage of the employer
.
"The younger man used to close shop and disappeared for lunch for 2 hours," he told me. "I don't close for lunch. If I am tired and there is no customer, I will rest on the chair. The young man will close shop at 6 pm but I do not close till 8 pm."
2.2 As this hotel has no seats in the lobby, people will want to sit in his area (32 seats) to study, to eat their own food and drink their own water. He recounted the story for the 3rd time today.
"There was one manager about your height but bigger in size eating his company buffet lunch on my table and chair without even purchasing a drink from me. The company had a management talk and there was a standing buffet lunch provided in the hotel lobby. I said to him: 'Excuse me, these tables and chairs are reserved for my customers."
The burly manager replied: "Ask the security to evict me."
The operator said: "These tables and chairs are purchased by my company. They are not bought for nothing. Repeat what you just said to me."
The manager stood up and left, much to the laughter of the female colleagues.
I had a breakfast chat with this senior citizen at the coffee shop opposite Potong Pasir NTUC. His boss was late and so we had a good chat.
1. Charcot's Disease - bone deformation. He had custom-made shoes. "It costs me $468," he said. That is expensive for a senior citizen.
2. Getting business for his employer.
2.1 "Nowadays, no Singaporean wants to work in the cafe in this hotel. The younger ones don't stay long or don't know what to do to generate revenue to cover the operating cost of rental and salary. He was aware of that but he did not take advantage of the employer
.
"The younger man used to close shop and disappeared for lunch for 2 hours," he told me. "I don't close for lunch. If I am tired and there is no customer, I will rest on the chair. The young man will close shop at 6 pm but I do not close till 8 pm."
2.2 As this hotel has no seats in the lobby, people will want to sit in his area (32 seats) to study, to eat their own food and drink their own water. He recounted the story for the 3rd time today.
"There was one manager about your height but bigger in size eating his company buffet lunch on my table and chair without even purchasing a drink from me. The company had a management talk and there was a standing buffet lunch provided in the hotel lobby. I said to him: 'Excuse me, these tables and chairs are reserved for my customers."
The burly manager replied: "Ask the security to evict me."
The operator said: "These tables and chairs are purchased by my company. They are not bought for nothing. Repeat what you just said to me."
The manager stood up and left, much to the laughter of the female colleagues.
Sunday, September 21, 2014
1507. A 5-year-old Chow Chow suddenly had fits and salivation
Saturday Sep 20, 2014
A female non-spayed Chow Chow came in recumbent, shaking all over the body and salivating thick sticky saliva. "These fits happened only 15 minutes ago. What is the cause? Can you do something to stop the fits"
I checked her medical records. No fits before. I gave IM 5mg diazepam. The dog stopped shaking one hour later. She was very thin and full of scales and oily skin. Her eyes had rolled in eyelids and were sticky with lots of pus. IV drip and medication were given. Blood test done.
Today, the dog had recovered and was eating. The whole body would be clipped and a bath given. Ears irrigated, nails clipped. The owner did not want entropion surgery.
BLOOD TESTS
History:
Mar 12, 2013. Skin disease and 6-month haematuria. Demodectic mange and ringworm.
Total white cell count 19.8 (6-17)
Neutrophils 82.5% (60-70%) Abs 16.34 (3-12)
Platelet clumping noted but within normal range.
.
Sep 9, 2014 Fits and salivation. Recumbent. Sudden onset.
Total white cell count 28.8 (6-17)
Neutrophils 90% (60-70%) Abs 25.92 (3-12)
Platelet within normal range.
Glucose 0.9 (3.9 - 6.0). Query glycolysis. Suggests to repeat.
Hypoglycaemic fits likely. No complaint of polydipsia, polyphagia and polyuria.
In fact, the dog is very thin. Skin diseases generalised, with ringworm and bacteria. The dog has recovered fully now.
CONCLUSION
A Chow Chow needs much more care than a Jack Russell. Skin diseases may need monthly reviews.
Most owners have no time. So the bacteria multiplies and infect the blood stream leading to a big increase in neutrophils which are white blood cells produced in large numbers to combat the bacterial invasion. Medical costs of treatment will be high.
Entropion is quite common in Chow Chows. The inward rolling eyelid's eye lashes irritate the cornea, causing infection and daily pus formation. The owner does not want any surgery to evert the eyelids, resolving this problem which has persisted for the last 5 years.
If the owner does not want euthanasia, the owner needs to plan and schedule regular clipping away of the long infested patchy hairy coat with the groomer and get skin reviews with the vet.
A female non-spayed Chow Chow came in recumbent, shaking all over the body and salivating thick sticky saliva. "These fits happened only 15 minutes ago. What is the cause? Can you do something to stop the fits"
I checked her medical records. No fits before. I gave IM 5mg diazepam. The dog stopped shaking one hour later. She was very thin and full of scales and oily skin. Her eyes had rolled in eyelids and were sticky with lots of pus. IV drip and medication were given. Blood test done.
Today, the dog had recovered and was eating. The whole body would be clipped and a bath given. Ears irrigated, nails clipped. The owner did not want entropion surgery.
BLOOD TESTS
History:
Mar 12, 2013. Skin disease and 6-month haematuria. Demodectic mange and ringworm.
Total white cell count 19.8 (6-17)
Neutrophils 82.5% (60-70%) Abs 16.34 (3-12)
Platelet clumping noted but within normal range.
.
Sep 9, 2014 Fits and salivation. Recumbent. Sudden onset.
Total white cell count 28.8 (6-17)
Neutrophils 90% (60-70%) Abs 25.92 (3-12)
Platelet within normal range.
Glucose 0.9 (3.9 - 6.0). Query glycolysis. Suggests to repeat.
Hypoglycaemic fits likely. No complaint of polydipsia, polyphagia and polyuria.
In fact, the dog is very thin. Skin diseases generalised, with ringworm and bacteria. The dog has recovered fully now.
CONCLUSION
A Chow Chow needs much more care than a Jack Russell. Skin diseases may need monthly reviews.
Most owners have no time. So the bacteria multiplies and infect the blood stream leading to a big increase in neutrophils which are white blood cells produced in large numbers to combat the bacterial invasion. Medical costs of treatment will be high.
Entropion is quite common in Chow Chows. The inward rolling eyelid's eye lashes irritate the cornea, causing infection and daily pus formation. The owner does not want any surgery to evert the eyelids, resolving this problem which has persisted for the last 5 years.
If the owner does not want euthanasia, the owner needs to plan and schedule regular clipping away of the long infested patchy hairy coat with the groomer and get skin reviews with the vet.
A young Shih Tzu X vomits and purges after a stay in a Pasir Ris chalet
Sunday's interesting case Sep 21, 2014
4 days ago, the dog went to the chalet. In Singapore, Pasir Ris chalets near the sea, are rented by the family to celebrate functions and have a BBQ.
"It was only the first night and the BBQ had not started till the next day," the dog vomited 6X and had diarrhoea 10X."
The family vet treated the next day but the dog continued vomiting and purging and so was brought to her the 2nd time. Blood tests and X-rays were "normal". 3 bottles of medication were given, but now she referred the dog to the parent branch. Ultrasound showed some inflammation in the liver, gall bladder, stomach and intestines. A foreign body in the full lumen could not be ruled out.
When the dog came to me this morning, he was most aggressive. Muzzling was done but he could take the muzzle out. "Hold by the scruff of the neck while I gave the injections," I said to my assistant. Just handling the dog with hands would not do as this male dog was very strong.
Vet 1 and the referred vet had prescribed 6 types of medications and had given injections. I palpated the abdomen. Empty except for a distended bladder. Some pain felt in the rectal area as the dog winced. Could there be bone fragments inside the rectum? X-rays may not show.
Based on the sudden onset persistent vomiting and diarrhoea in the chalet, this dog could have food poisoning. The treatment varies with different vets. For such serious cases, I would give the IV drip and anti-diarrhoea medication and let the intestines rest 48 hours, with electrolytes only for the first 48 hours. The other vets fed the dog chicken pieces and advised porridge. It may be better to advise fasting for 24-48 hours.
4 days ago, the dog went to the chalet. In Singapore, Pasir Ris chalets near the sea, are rented by the family to celebrate functions and have a BBQ.
"It was only the first night and the BBQ had not started till the next day," the dog vomited 6X and had diarrhoea 10X."
The family vet treated the next day but the dog continued vomiting and purging and so was brought to her the 2nd time. Blood tests and X-rays were "normal". 3 bottles of medication were given, but now she referred the dog to the parent branch. Ultrasound showed some inflammation in the liver, gall bladder, stomach and intestines. A foreign body in the full lumen could not be ruled out.
When the dog came to me this morning, he was most aggressive. Muzzling was done but he could take the muzzle out. "Hold by the scruff of the neck while I gave the injections," I said to my assistant. Just handling the dog with hands would not do as this male dog was very strong.
Vet 1 and the referred vet had prescribed 6 types of medications and had given injections. I palpated the abdomen. Empty except for a distended bladder. Some pain felt in the rectal area as the dog winced. Could there be bone fragments inside the rectum? X-rays may not show.
Based on the sudden onset persistent vomiting and diarrhoea in the chalet, this dog could have food poisoning. The treatment varies with different vets. For such serious cases, I would give the IV drip and anti-diarrhoea medication and let the intestines rest 48 hours, with electrolytes only for the first 48 hours. The other vets fed the dog chicken pieces and advised porridge. It may be better to advise fasting for 24-48 hours.
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