Tuesday, April 12, 2011

401. Give what the owner wants

April 12, 2011

9.30am. 1-year-old JackRussellXDachshund spayed dog was itchy all over. She arrived from US one month ago, quarantined at Sembawang for 10 days and had been boarded at a Pasir Ris boarding place where there were numerous rescued dogs.

"My dog is itchy all over the body and scoots her backside," the slim European lady said. She had consulted another surgery and the vet did press some tissue around the anal area. She was not shown what was expressed from the anal area.

I put the dog on he exam table and pressed the anal sacs. I showed her the greyish particles in the anal sacs to the owner. "The normal colour is like cooking oil - light yellow," I said and explained what the anal sac oil was used for by the dog. She was quite happy.

As for the ears, I palpated the ears. The dog yelped in pain at the horizontal and vertical canal junction. I scoped the ear but found no mites. A cotton bud tip showed light brown discharge. No smell. So what was the pain? "I am no ear-person," the woman in her 40s said to me when I asked if she knows the structure of the dog's ears. I remained professional by not cracking jokes about anatomy which may be offensive since I met her the first time. Some men are said to be attracted by certain anatomy of the female and therefore, cracking such jokes as a "butt" person may not be welcome unless the client has a sense of humour.

As for the itchy body, the lady said: "My friends asked me to examine the body for skin infections but there are none. Yet the dog keeps losing hairs eve1y day. What is the problem? Also she chews her 4 paws "

I examined the dog's skin. Good coat. Strands of brown hair fall out. The lady said: "She is also developing those long harder coarse hairs. Could it be the weather in Singapore being so hot?"

"There is no skin problem," I confirmed. "Those coarse hairs could be the result of the dog's parents being wire-haired Jack Russell. Now she is one year old, her adult coat is being formed."

It sounded logical to her. As for the cause of generalised body itch, it was hard to tell what was the cause. "It is most likely allergy from the food or environment. A skin patch test may not give you the answers but costs you some money." I advised her to get the ears and paws cleaned regularly and to go on a low-allergic prescription diet for 3 months. "No treats or other foods", I said. "After 3 months, you can test her with dog treats or your food and see whether the dog itches."

I said: "It is extremely difficult to let you know what is the exact cause of the dog itching all over and so we do the food trial first. In some cases, it could be due to the loss of hormones due to spaying but these are rare cases. Hot weather and stress can cause the dog to shed hairs too as the dog came from the US."

This dog has no skin or ear problems and so a dog food or human shampoo allergy is suspected at this stage. The dog uses her human shampoo. There are so many factors and so it is best to take time to explain and illustrations of the ear canal and anal sacs to show the anatomy.

In this dog, the owner even remarked that I could have gone deeper to express the anal sacs than Vet 1 who did not show her any oil (probably).

Nowadays, it is hard to be a vet. See the following case 2.

Case 2. "Has my dog got CCD?"
This was the 2nd case in the last 3 days that a client who had researched the internet asked me about the dog having CCD.

"My dog could not recognise me and knocked onto furniture," the man in his late 50s said to me. His dog had been examined by a vet and had blood and urine tests done. "Nothing wrong with the blood and urine tests, the vet said. Can you prescribe a drug so that my dog can be alert and active?"

I was on counter receptionist duty and so got this feedback. I was surprised that another dog owner had researched the internet and diagnosed CCD again and asked for the drug.

I said: "Nowadays, owners research the internet. Sometimes, they are better informed than the vet. There is a drug but are you sure that the dog has no other health problems?"

I continued: "Many cases, the old dog has painful mouth due to teeth decay. Poison from the bacteria goes to the surrounding areas including the eyes and brain. So, the owner diagnoses CCD and asks for the drug. In the end, the dog is still suffering from pain."

"My dog eats the same amount of food every day," the man said when I asked why the dog had dropped 1.5kg in weight when it had the same appetite and was less active, esp. for the last 2 weeks. He was positive that his dog ate the same amount and had no vomiting or diarrhoea.

So I asked to check the blood and urine test results. The significant finding was a high blood urea (12 instead of the maximun value of 6). So, there was an abnormality but his vet said it was normal as the creatinine was low, meaning the dog does not have kidney disease.

It is not normal to have high blood urea, I said to the owner. As to the cause, the vet said it could be due to disorders in the muscles and internal organs and possibly cancer but since an X-ray would be useless, an ultrasound was proposed. Multivitamins were prescribed for the time being.

As the owner stated that he was referred to me by his friend, I handled his case and asked the dog to be admitted for an examination as he did not bring his dog when he came to see me.

Old dogs that have not been given dental checkup for the last 5 years (his vet did not want to do it since the dog was 8 years old) would have bad breath and oral infections. These problems needed dentistry and not a drug for CCD. Then there is the ear problems as many of the old dogs are neglected. They just get fed.

Much will depend on what I find but dentistry under general anaesthesia is needed. I strongly advised the high risks and he ought to tell his wife. His wife phoned me and I explained the possibility that her dog could just die on the operating table. That is the reason why most vets don't want to do the dentistry. "How about half dose?" the man asked me. "I use gas only and it should be quite safe if given over a short time of less than 15 minutes, but no guarantees."

"How about no anaesthetic?" the man asked. I said: "It is extremely painful to extract decayed teeth. I had only done once in dental extraction of a 16-year-old Pomeranian. It survived. However, some dogs may die of fright. Did you read the Straits Times forum letter where the writer's dog was lost and found by the AVA? The AVA micro-chipped the dog but it died. What did it die of? The AVA is doing an autopsy to ascertain the cause of death." From this incident, I prefer not to do any dentistry without anaesthesia.

Case 3.
A Chinese National sought my advice about her Silkie puppy that had fractured his right fore leg. "What can be done?" she asked me as I was on counter duty. The dog's legs were cast by Plaster of Paris and the dog had come in for a change of the Plaster. I asked Dr Vanessa what was the outcome. She showed me the X-rays before and after the cast. The tranverse fractures of the radius and ulna had closed and the fragments were aligned. So, there was good news. I told the lady that the progress was good. She had phoned me earlier wanting no invasive surgery for the fracture as proposed by another vet and Dr Vanessa had done a good job. A second opinion would be better service for the client and I was glad that she appeared satisfied.

She was from Yunnan. I had seen paintings by Chinese painters of Yunnan and read about the refugee problems from Myanmar to Yunnan which is part of China. I would like to visit this place as it appeared to be the equivalent "wild wild West" of the USA after reading about drug lords and other news.

"The travel agent in Yunnan cannot be trusted. Contact your travel agent. Many Singaporean businessmen go to Yunnan for gold," she said to me.

I asked her about the presence of elephants in the Yunnan mountains after hearing a story of a Myanmar businessman whose truck driver impatiently sound the horn to quicken the mother elephant and baby to walk past faster along the mountain road. The dam rushed onto the truck and this businesman was flung deep into the ravine. A tree broke his fall and he was hospitalised for 3 months. When he went home after that, he said to me: "My family members sprinted fast and ran away as they thought I was a ghost." In the old days before the mobile phone, he could not inform his family and they thought the elephant had killed him.

So I asked this Yuannan lady about the wandering wild elephants which I could not imagine, being a frog in the well in the small island of Singapore.

It is just too expensive to travel and I prefer the off-the-tourist places which can be more expensive and dangerous.

"There are wild elephants in the mountains. Tourists can view the mountains from the tree top."

"How do I do it?" I asked. "Just sit on the tree?"
The young lady in the IT field said: "I will not advise you to watch the wild elephants. It is very dangerous. The elephants may bang the tree and knock you down!"

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