Friday, July 29, 2011. Half a year had flown by! I am still practising but I sometimes still do the routine cases of spay and neuter at 9.30 am and handle the complex difficult cases such as the Silkie with the big backside perineal hernias as written in: Perineal hernias in a Silkie Terrier repair pictures. Update on a Boston Terrier's perineal hernia
I narrate two recent interesting skin disease cases I chanced upon as they seem to be associated with dog treats.
Yesterday, July 28, 2011, Dr Vanessa left at 6.30 pm as she had asthma the day before. Actually she had informed Min that she would be back 3 days later. I quickly informed her clients to postpone her appointments as I don't want them to be upset when they come.
Veterinary medicine at Toa Payoh Vets is much personalised and since she handles most of the day cases, most of my clients get used to consulting her since I seem to have "retired." Succession plan is taking place as I am over 60 years old and must leave space for the younger ones to bear the responsibility and learn from practising. I do intervene in my associate vets' cases when I need to.
One of her clients was looking for her today and she suddenly appeared after 11.00 am and so I passed the male cat couple whose daughter wanted her to neuter him. I was manning the reception counter while my assistant Mr Min went for dinner.
Suddenly, an old client with a 4-year-old Maltese X came in for vaccination. She was abandoned and was adopted by this man in his 40s as the 4th owner. The man reminded me that I had diagnosed some urination problem. "It is called submissive urination," I said. "She would empty her bladder when any person approaches her. Is she better now? Confidence build up will lessen her problem. Bring her out more often."
The busy printer owner said: "I only bring her out to pee and poop once a day. Then it is back to the apartment. She definitely has better control of her bladder. When she sees other dogs when we go out, she will bark loudly."
"Does she pee?"
"No, but she will run away after barking."
"You ran out of Hills' ZD diet and so I went to the pet shop to buy Hills' Skin Sensitive Diet since they can't sell Hills' ZD diet. My dog now no longer itches. Hills' brand is very good. Anyway, the ZD produces a very sticky dog poo and so it is not good for me. This Sensitive Diet produces well formed stools that do not stick to the floor as you can see!"
The dog pooped 2 lumps. I used a toilet roll tissue to pick up the two stools instead of ordering my assistant who had just come back from dinner.
"It is not any Hills' brand that resolve your dog's skin itchiness problems," I reviewed his dog medical records. I spayed the dog in June 2011 and prescribed Hills' ZD diet twice. He switched to the Hills' Sensitive Skin diet since I ran out.
Very little scratching except for some black ear wax. One of two scabs in the belly and chest sternum. He as very happy as his dog had this skin problem of itchiness and hair loss for over two years before spaying. She had received treatment for ringworm and had her shampoos.
To the owner, the dog no longer itches and he does not need to cook home-cooked food for the dog, an inconvenience. Just feed this Hills' brand.
In my experience, spaying sometimes do resolve the skin itchiness. As to why, I don't know but it has been reported by some vets and I had a small number of dogs recovering. However, this dog also is no more given the dog treats unlike last time. It is possible that she could be allergic to dog treats in the first place. Eliminating dog treats resolved the problem. Spaying to remove hormonal imbalance. Nobody knows scientifically why this dog has no more skin itchiness problem.
On the previous day, that is, Wednesday, July 27, 2011, I went to the Surgery at 8 pm to do a surprise check. It is a heavy responsibility being the licensee and founder, but such audits need to be done as the Toa Payoh Vets practice I founded is still a rebellious teenager and needs my personal attention.
Around 50 vet practices have sprung up in Singapore in 2011 and the old practices can be complacent and go bankrupt if poorly managed. Success is not a given in any business or medical practice just because the practice is established as competition becomes more intensive. Success depends much on the vets or doctors but the management of the practice (quality of veterinary services, over-ordering and unnecessary use of products by associate vets, clinical outcomes by vets, economics, human resources, strategic planning, amongst others) is extremely important
Dr Jason Teo was to be on duty at night. An adult daughter and her mother with a spayed female Maltese came in. They had consulted me 3 weeks earlier about itchiness in this dog's ears, elbows, armpits, groins, paws. Just scratching and scratching and I had asked for a review 3 weeks later. They don't mind consulting Dr Teo too as they had seen him earlier.
"Well, the dog started scratching 3 days ago, when your medication was finished," the daughter said. "So we come in for a review." As Dr Teo had not arrived, I checked the medical records. I examined this dog. Eyelids rubbed red. Ear pinnae flamingly reddish pink. Four paws itchy and licked. Elbow front show reddish bloodied streaks due to licking. Groins reddish. Armpits were OK for the time being. These were signs of allergies which had been present for the last two years. What is the cause?
Dr Teo arrived soon and I asked him to come in to collaborate on this case and to do a proper recording. He would be opening his own practice and it is good that he does so since he has been with me as an associate vet for at least 4 years.
"Do you give dog treats?" I asked the mother and daughter who expected more anti-itch medication, drugs and shampoos.
"Yes, I just bought a big bag of treats."
"No treats. Just switch over to Hills' D/D diet for 2-3 months," I said. "Not even one treat."
"My dog can't survive without any treat," the mother said. "What do I do with my big bag of treats?"
"After 3 months of feeding Hills' D/D diet and if the dog does not itch anymore, you can give the treats," I said. "If the dog starts being itching again, then you know it is due to the treats. Give 90% of the old dog food and treats for the first 3 days, then slowly change to 100% of D/D in 14 days," I advised.
As to whether the owners will comply, it is hard to say. This Maltese is definitely a case of generalised allergy. It was no longer generalised ringworm as in the past. Ringworm is also a very itchy skin disease for most dogs.
As to the exact cause, it is hard to say unless the vet knows all about the dog's lifestyle and environment. For starters, I advise an anti-allergic dog food and if this works, there will be much happiness and convenience as well as money saving for the owners.
These two cases are examples of allergies with one cause being the various brands of dog treats being given. Prescription diet for dry dog food allergy may be one way to elimination of the cause. Spaying may help too.