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
Wednesday, September 30, 2015
Tuesday, September 29, 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.
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.
Monday, September 28, 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.
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.
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.
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.
Saturday, September 26, 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.
"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.
Friday, September 25, 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.
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.
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