3140. INTERN. Lifestyle of a male stray cat and kidney disease

Sep 14, 2017


HOOK

Animal shelters will put the stray dog or cat to sleep after a few days
No kill shelters do not put them to sleep. E.g. NANAS, Yangon Golden Heart  (images, videos)

Many younger Singaporeans care for the stray cats. Some will feed them and bring them to the vet when they are sick. Others will get them neutered or spayed and look for them to be adopted. Most of these feeders have no means to provide them a safe sanctuary of the home and so the cat roams freely and suffers the consequences of abuse, infections from fighting and live a shorter life.  



This educational video shows a case study of a free-roaming stray 5-year-old male cat with difficulty in passing urine seen at Toa Payoh Vets.

5-year-old, male cat, not neutered, fed but allowed to stray
Brings to Toa Payoh Vets when the cat is sick. Cat fights.Infected wounds.  

 
On Sep 14, 2017
Pus inside the urine seen. Dysuria (difficulty in passing urine.) No urethral obstruction.
Catherised under gas anaesthesia, being ferocious. Urine sent for analysis. Bladder irrigated.



VIDEO WITH INTERN.




X rays - Enlarged kidneys.
Pyelonephritis with pus in the urine catherised. X rays enlarged kidneys. No urinary stones.
blood test. chronic kidney disease. Increased urea, creatinine and low platelet count. No leucocytosis.


urine test.

Urinalysis
Slightly turbid yellow urine
pH 8 (5-8)
SG 1.026  (1.005 - 1.030)

Nitrite Negative
Protein 4+  (proteinuria)
Glucose Negative
Ketones 1+
Urobilinogen Normal
Bilirubin Negative
Blood 4+

Bacteria 1+
White blood cells  over 900 (/uL)
Red blood cells over 1800 (/uL)
Epithelial cells 40 (/uL)
Casts, crystals Nil


No owner. One couple feeds him outside the apartment.

Stray cat's lifestyle is freedom to roam.   Not neutered by feeder. Fights. Eye injuries some 8 months ago and treated at Toa Payoh Vets.

Kidney disease affects cats after 5 years of age. Male cats more affected than female cats.   Health screening by blood and urine test will be best to pick up early kidney disease in cats over 5 years.  

3139. Continuing education. Dr Melanie Hicks and Abaxis S E Asia lecture at Suntec City Sep 15, 2017

Sep 15, 2017
Useful updated lecture on chronic kidney disease and blood testing equipment.

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Updated on chronic kidney diseases in dogs and cats

Dear Dr Sing and team, 

This year, we Alfamedic is proud to present you the first Abaxis South East Asia Lecture Series to Singapore. Everyone is invited! :)

Abaxis brought you and team Dr Melanie Hicks, Senior Professional Services

Veterinarian for Abaxis Global Diagnostics. In the past four years, she has lectured in clinical pathology topics at numerous veterinary schools and technical colleges, and has provided hundreds of in-hospital seminars on topics in clinical

pathology and practice management. Dr Hicks has been a Director or her provincial veterinary medical association for eight years, acting as President for 2011-2012. She has served as a national Director for the Canadian Veterinary Medical Association for three years, currently sits on executive and will become the national President in 2019.

The details for this half-day event are as below,

Date - 15th September 2017 (Friday)

Time - 10am - 2pm (Registration starts 930am)

Venue - Suntec Convention Center, Room 300/301

Topics -

1. Histogram and blood film interpretation

2. Leveraging diagnostics in your practice

3. Managing chronic kidney disease




QUERIES ON LOW BLOOD UREA AND CREATININE IN A COCKER SPANIEL WITH SUBMANDIBULAR TUMOURS

Pertaining to your queries, Dr Hicks suggested that a patient with low BUN and creatinine is not due to kidney disease per se (generally both tend to be high, along with potential other abnormalities in phosphorus, USG, urine microalbum and UPC etc). 

 

Low creatinine can be caused by a reduced lean muscle mass (most common cause).

Low BUN can be due to hepatic dysfunction. 

 

Both can be due to medullary washout (psychogenic polydipsia, excessively high IV fluid rate). 

 

Generally a slightly low BUN & creatinine is not significant if the above have been ruled out.

3138. INTERN. NON-COMPLIANCE. A Siberian Husky licks its tumour till it inflames and bleeds

Sep 15, 2017

HOOK
Above images and short video clip of tumour close up. Narrate.
 
 

Tumours grow bigger every day. Friction with the floor. Traumatised. Inflamed. Infected. Licked.
Bleeding. Soil apartment. What to do now?


This case study shows the dog had licked the itchy tumour till it becomes inflamed red and bleeds, soiling the apartment. The owner had been advised to come for tumour surgery 3 months ago, after antibiotics and anti-inflammatory injections.

"We were too busy," the owner noted that the tumour had shrunkened a bit and was not inflamed in the June treatment. Now, the tumour is red and bleeding. She wanted immediate surgery.

 Title: Not complying with veterinary instructions


"In such cases of infection, the skin wound after the surgery is unlikely to heal," I said. "The nearby skin is inflamed and infected. This results in a large open wound and more expenses." The dog was sent home on antibiotics for 2 weeks before surgery.


VIDEO OF CONSULTATION AND HISTORY.


CONCLUSION
Infected tumours need their infection to be treated by antibiotics before surgery. This ensures that the surgical wound after tumour removal will heal well. Otherwise, there will be a large hole which is hard to heal.

This case shows that compliance with veterinary instructions is less expensive than repeat treatments.  




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INTERN An unusual case. A 5-month-old Yorkshire Terrier has "kennel cough" for over 2 months

Sep 14  2017

HOOK



The owner showed a video clip of her puppy coughing and coughing 2 months ago.




Coughing like an old man with lung disease after purchase from a pet shop in Singapore. Hacking cough. Dry cough. Nothing coughed up.
 

Uncomplicated cases recover around 14 days. Complicated case in this Yorkshire Terrier - seen Vet 1 two times and given antibiotics and anti-histamine in the past 2 months. Still coughing daily when seen at Toa Payoh Vets in Sep 13, 2017.

What cause this Yorkshire Terrier puppy to cough and be itchy for over 2 months?

This video discusses an uncommon case of a puppy suffering from dry coughing for more than 2 months.  
KENNEL COUGH RESPIRATORY DISEASE and SKIN DISEASE.


PART 1. KENNEL COUGH RESPIRATORY DISEASE.


PART 2. SKIN DISEASE
This sister referred this her sister to Toa Payoh Vets to get the itchy skin disease treated.








CONCLUSION

Many new puppy owners are not aware of the need to do a post-purchase veterinary examination of their puppies. Some reputable puppy sellers in Singapore do advise a 24-hour veterinary examination after purchase of the puppy to check its health.

This Yorkshire Terrier puppy was purchased at 3 months of age. She was coughing and had been scratching her whole body since purchase. The owner had consulted Vet 1 twice to cure her coughing. Vet 1 took X-rays and said there was no pneumonia. Anitbiotics and anti-histamines were prescribed, but the cough persisted for over 2 months. The owner  
.

X RAYS by Vet 1
Cloudy areas around the lungs and heart indicate inflammation and fluid accumulation. This is known as pleural effusion. The inflamed lungs not as black as in normal lungs.

Auscultation at Toa Payoh Vets. No acute pneumonia. The following tests were done to assess the health of the puppy. 

1. BLOOD TEST
Leucocytosis with neutropenia and monocytosis.



IMAGE OF BLOOD TEST HAEMATOLOGY
There was an increase in total white cell count 2 months after purchase. (SHOW BLOOD VALUES).  So the dog had an infection for a long time.

2. INFECTIOUS DISEASE TESTING
2.1 DISTEMPER ANTIGEN TEST KIT
Distemper causes coughing. Test Kit. Negative.

2.2  PARVOVIRUS AND CORONAVIRUS TEST KIT. Negative.

CONCLUSIONS.
The puppy was not vaccinated against kennel cough. Other viruses like canine distemper, parvovirus and coronavirus could have had infected the puppy but did not cause disease. This is evident from negative test kits to the above-mentioned viruses. (VIDEO FOOTAGE).



 ADVICES
KENNEL COUGH VACCINATION SCHEDULE
SC or IM. Inactivated vaccine. Pneumodog.
Intra-nasal. Live modified vaccine. Broncho-Shield III


PUPPIES
2 vaccinations for puppies

1.  Puppies born from vaccinated bitches
First dose at 6th week
2.  Puppies born from non-vaccinated bitches
First dose from 4th week
Booster vaccination 2-3 weeks and yearly after the lst vaccination

ADULT DOGS for boarding. 7 days before boarding prevents respiratory infection. Some owners had complained that their dogs cough after boarding. Well managed boarding kennels in Singapore require current vaccination to avoid such complaints.

PART 2
Itchy skin  seen purchase 2 months ago. Why?
Ringworm and bacterial infections were present as evident by round skin lesions and bacterial pustules on the body. .

UVL - flourescence +ve
In-tray test. 7 days needed to confirm.

Enforced cage rest
Antibiotics
Good quality food







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2 types of vaccines are available at Toa Payoh Vets.  Pneumodog is an inactivated vaccine that is given under the skin or into the muscle, but no dropped into the nostril unlike Broncho-Shield III..

Broncho-Shield III
is a modified live virus vaccine
Nasal only. Not for injection SC or IM
lst vaccine from the 8th week. Repeat 2-3 weeks later. Annual booster.
7 days before boarding for adult dogs

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Diseases can be fatal to older dogs.
Dogs are family members.
PREVENT DISEASE BY VACCINATION.  Your dog lives to a ripe old age.

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Oct 2, 2017  Review Bailey. Still coughing
but less. 

3136. A long-standing corneal ulceration and pigmentation in a dog

Owner did not seek veterinary treatment for many weeks. Looks like a descemetocoele from close up images.

3135. INTERN, EOSINOPHILIC GRANULOMA COMPLEX. A very old cat has eosinophilic granuloma complex ? Evidence needed.

Sep 12, 2017. At Toa Payoh Vets, big bleeding granuloma now seen.

Thin. Gums are cyanotic and possibly anaemic. No mouth or gum ulcerations.
Only a large granuloma, 1.5 cm x 2 cm x 1.0 cm below the chin.
No heart disease. No blood test, so not possible to assess liver and kidney functions.

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Owner had handphone pictures. Asked to be sent to me.

Need dental scaling. Cat has periodontal disease.
No blood test to screen health. Heart and lung and abdomen OK. .

biopsy of granuloma - advised
Fine Needle Aspiration. Impression smear of granuloma - advised. See lots of eosinophils in the smear or biopsy
Check for FIV/Feline Leukaemia needed.

Megestrol acetate given instead of corticosteroid in this case. 5 mg/day for 7 days and then alternate days. Cat's granuloma no longer bleeds so much, according to the owner when phoned 8 days after treatment. See images.

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WHAT IS EGC?  3 presentations






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OTHER SUSPECTED CASES OF EGC BELOW:

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Diagnosis

DIAGNOSIS is best confirmed by a biopsy or fine needle aspirate of the eosinophilic plaque but the owner wanted to save money and permitted FIV and blood tests only as she has other stray cats to pay for expenses. In this case, the blood test show a higher % of eosinophils at 6% and the clinical signs of oral ulcers, plaques and an old leg wound now healed) indicated a likelihood of the EGC.
Blood Test Results - significant findings
1. Glucose elevated 11.0 (normal 3.9 - 6.0) - "stressed induced hyperglycaemia" in the cat.
2. Liver enzymes ALT & AST elevated --- clindamycin >15-20 days and other antibiotics and powders could affect the liver.
3. Urea below normal.
4. Platelets low 146 (300-800). Large platelets present --- toxic products from medications affecting the platelets?  

RBC and WBC are normal.
Differential count - % and absolute numbers are:
N 64%   8.69
L 24%   3.19
M 6%    0.77
E 6%     0.81
B 0.3%  0.04
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3. RODENT ULCERS IN CATS (feline eosinophilic granulomatosis). Salivation and ulcers are signs.

Eosinophilic Granuloma Complex (EGC)
Three distinct but related clinical syndromes comprise the granuloma complex:

3.1 Eosinophilic (or rodent) Ulcer. This may occur on the skin or in the mouth but usually affects the upper lips. The lesions are well-demarcated ulcers.

3.2 Eosinophilic Plaque. These are raised, moist, red eroded or ulcerated areas with a well demarcated border. Pruritus is usually severe. Lesions usually occur on the underside of the cat (abdomen, brisket or inside the thighs).

3.3 Linear Granulomata. These can occur at most sites, especially behind the hind legs and within the mouth. They are well-demarcated lesions which are raised and yellow to
yellowish-pink in colour. They are often thin, hence the name *linear* granuloma.

Treatment:
1. Allergy to fleas, mites, parasites, environmental,
Steroid, ivomectin inj.

2. Allergy to dry cat food.
    If food allergy, hypo-allergenic canned food 6 weeks