|
|||||||||||||
Saturday, August 31, 2013
1110. Myanmar stories - The pretty girl
TOA
PAYOH VETS
1109. HOW YOUR OLD DOG CAN LIVE LONGER. Follow up: Westie with bladder stone - 26th day post op
Saturday 31 Aug 2013 9.38 am
Wife who loves this 10-year-old Westie much more than husband came to get stitches out.
"26th day after op," she said. "Stitches still there." These absorbable PDS sutures are really lasting. Seldom dissolve early. The dog was active. Stitches taken out. A small skin haematoma at one end expressed. Video image.
The dog vomited on Day 16 to 21. The couple was much concerned and wanted antacid as he read on the internet that his dog was suffering from stomach ulcers. "It is hard to tell what he is suffering from without tests," I said. I gave him the antacid and changed antibiotic tablets to Vibravet paste.
"Stop the dry U/D diet."
No more vomiting two days later and today the stitches are taken out.
"He is still urine-marking a lot when outdoors," she said. "Every few spots, he will lift his leg. At home, he does it 3-4 times a day if he is not outdoors."
"Male dogs do that," I said. "Neutered ones may do less times or not at all. Holding back urine causes bacterial infection and then stone formation, leading to blood in the urine or difficulty in urination."
"Is it too risky to neuter him now?" she asked.
"Based on his blood test and examination, he is fit for anaesthesia. Neuter and dental scaling 3 months from now will be best. Get urine tested 3 monthly to check for infection of the bladder"
The owner wanted 24 cans of U/D and went home quite happy with this dog who keeps looking for the canned food by tapping on the feeding area. He has a voracious appetite and is now 8.1 kg making him heavy to be carried.
TIPS
Besides proper care of the older dog, get him health screening and urine tested. Prevent urinary stones by urine testing +/- X-rays regularly. In any case, urine test 3 monthly. To prevent urine marking, neuter him when he is around 6-8 months old so that the male dog does not retain urine, causing stagnant urine favouring bacterial infection and stone formation. Some dogs don't drink much water.
RETROSPECTIVE REVIEW OF CASE
TP 45123
Westie, M, Not neutered, Born Nov 16, 2003
Wanted 3rd opinion as Vet 1 took blood test for suspected poisoning and Vet 2 diagnosed bladder stones based on X-ray.
Blood test unremarkable
X-ray bladder stones
Urine test calcium oxalate crystals
Owner does not want stone analysis owing to financial constraints.
Bladder stones removed. Calcium oxalate.
On U/D diet.
As at 26th day after surgery, no complaint of surgical outcome.
Vomiting reported
UPDATE ON WESTIE
The wife came to buy 24 cans of U/D yesterday Sep 5, 2013 and said that the Westie is OK.
Wife who loves this 10-year-old Westie much more than husband came to get stitches out.
"26th day after op," she said. "Stitches still there." These absorbable PDS sutures are really lasting. Seldom dissolve early. The dog was active. Stitches taken out. A small skin haematoma at one end expressed. Video image.
The dog vomited on Day 16 to 21. The couple was much concerned and wanted antacid as he read on the internet that his dog was suffering from stomach ulcers. "It is hard to tell what he is suffering from without tests," I said. I gave him the antacid and changed antibiotic tablets to Vibravet paste.
"Stop the dry U/D diet."
No more vomiting two days later and today the stitches are taken out.
"He is still urine-marking a lot when outdoors," she said. "Every few spots, he will lift his leg. At home, he does it 3-4 times a day if he is not outdoors."
"Male dogs do that," I said. "Neutered ones may do less times or not at all. Holding back urine causes bacterial infection and then stone formation, leading to blood in the urine or difficulty in urination."
"Is it too risky to neuter him now?" she asked.
"Based on his blood test and examination, he is fit for anaesthesia. Neuter and dental scaling 3 months from now will be best. Get urine tested 3 monthly to check for infection of the bladder"
The owner wanted 24 cans of U/D and went home quite happy with this dog who keeps looking for the canned food by tapping on the feeding area. He has a voracious appetite and is now 8.1 kg making him heavy to be carried.
TIPS
Besides proper care of the older dog, get him health screening and urine tested. Prevent urinary stones by urine testing +/- X-rays regularly. In any case, urine test 3 monthly. To prevent urine marking, neuter him when he is around 6-8 months old so that the male dog does not retain urine, causing stagnant urine favouring bacterial infection and stone formation. Some dogs don't drink much water.
RETROSPECTIVE REVIEW OF CASE
TP 45123
Westie, M, Not neutered, Born Nov 16, 2003
Wanted 3rd opinion as Vet 1 took blood test for suspected poisoning and Vet 2 diagnosed bladder stones based on X-ray.
Blood test unremarkable
X-ray bladder stones
Urine test calcium oxalate crystals
Owner does not want stone analysis owing to financial constraints.
Bladder stones removed. Calcium oxalate.
On U/D diet.
As at 26th day after surgery, no complaint of surgical outcome.
Vomiting reported
UPDATE ON WESTIE
The wife came to buy 24 cans of U/D yesterday Sep 5, 2013 and said that the Westie is OK.
1108. Relocating from Ireland to Singapore - dog
Hello,
I am helping a client of mine who has just
relocated to Singapore from Ireland. They are looking for a veterinarian for their 23 kg setter. I had a few
questions about your office.
- How soon are you making appointments for new dogs?
- About how much does a general checkup with vaccinations cost?
- Is there anything they should know about moving their dog to Singapore?
- They are looking for dog boarding facilities as well, do you offer that service or could you recommend someplace?
I am so sorry
for all of these questions. Thank you so much for your time. I look
forward to hearing from you and referring your office to the
family.
Sincerely,
Margaret Hoffman
|
|
|
EMAIL REPLY DATED AUG 31, 2013
I am Dr Sing Kong Yuen from Toa Payoh Vets
Thank you for email. My replies are respectively:
Get import licence from the Singapore Government's Agri-Food & Veterinary Authority www.ava.gov.sg
.
Friday, August 30, 2013
Script for intern - Kidney disease
Date: Aug 30, 2013
TP 43996
Miniature Schnauzer
Black, F, spayed, 9 years
A vomiting and diarrhoeic dog.
8.8 kg, 38.4C.
Recent History
2 weeks no appetite
2 days of vomiting and diarrhoea
No abdominal pain
A simple case of gastro-enteritis?
Some injection and medication.
Not so fast. Review the previous history.
"Bladder stones removed 3 times", the owner said. "The first two times were in October 2010 and October 2011."
"How do you remember the dates so well?" I asked this groomer.
"October is her birthday and she missed the celebrations. I was happy to celebrate her October 2012 birthday. But she had the 3rd bladder stone surgery in January 2013!"
"Miniature Schnauzers are a breed prone to bladder stone formation," I said. "Struvite stones were analysed in Oct 2010. Did you still continue feeding the dry dog food after surgery?"
"Yes, but now I feed home cooked food, vegetables, rice and sometimes canned food"
Almost all Singapore dog owners do not follow up after bladder stone surgery as regards urine testing, X-rays and special diet for prevention of the struvite stones. So, the stones return and in this case, the dog had 3 bladder stone surgeries!
Blood test, urine test and X-ray advised.
Blood test was done in Jan 2013 and Aug 2013
INTERN TO HAVE DISCUSSION WITH DR DANIEL SING ON KIDNEY DISEASE.
.
TP 43996
Miniature Schnauzer
Black, F, spayed, 9 years
A vomiting and diarrhoeic dog.
8.8 kg, 38.4C.
Recent History
2 weeks no appetite
2 days of vomiting and diarrhoea
No abdominal pain
A simple case of gastro-enteritis?
Some injection and medication.
Not so fast. Review the previous history.
"Bladder stones removed 3 times", the owner said. "The first two times were in October 2010 and October 2011."
"How do you remember the dates so well?" I asked this groomer.
"October is her birthday and she missed the celebrations. I was happy to celebrate her October 2012 birthday. But she had the 3rd bladder stone surgery in January 2013!"
"Miniature Schnauzers are a breed prone to bladder stone formation," I said. "Struvite stones were analysed in Oct 2010. Did you still continue feeding the dry dog food after surgery?"
"Yes, but now I feed home cooked food, vegetables, rice and sometimes canned food"
Almost all Singapore dog owners do not follow up after bladder stone surgery as regards urine testing, X-rays and special diet for prevention of the struvite stones. So, the stones return and in this case, the dog had 3 bladder stone surgeries!
Blood test, urine test and X-ray advised.
Blood test was done in Jan 2013 and Aug 2013
INTERN TO HAVE DISCUSSION WITH DR DANIEL SING ON KIDNEY DISEASE.
.
Thursday, August 29, 2013
Wednesday, August 28, 2013
Video movie of uterine torsion & closed pyometra
The patient bites and so the interns were frightened. However, we need to wrap up the video making today as it is 7th day post-op. I got a lady who is not afraid of dogs to bathe, dry the dog and bring it into the consultation room for last video section.
So much time had been spent with the 2 interns to shoot this video and re-do. I hope it will turn up educational and fun.
So much time had been spent with the 2 interns to shoot this video and re-do. I hope it will turn up educational and fun.
Tuesday, August 27, 2013
1102. Follow up: The old Maltese with uterine torsion & closed pyometra still snapped at the vet
Aug 27, 2013.
The dog is alert and is hosptialised for 7 days after her surgery.
She ate all a/d. Still she would snap at my hand should I go near her. She never forgives or forget.
At 15 years of age, her blood test results were unremarkable. Except for a decrease in creatinine and an increase in neutrophils, she has normal values. No increase in total white cell count unlike other closed pyometra cases I encountered despite such a gigantic womb and being so old.
Around 90-100 years old in human age. Still strong and alert.
The dog is alert and is hosptialised for 7 days after her surgery.
She ate all a/d. Still she would snap at my hand should I go near her. She never forgives or forget.
At 15 years of age, her blood test results were unremarkable. Except for a decrease in creatinine and an increase in neutrophils, she has normal values. No increase in total white cell count unlike other closed pyometra cases I encountered despite such a gigantic womb and being so old.
Around 90-100 years old in human age. Still strong and alert.
1101. Stray cat activism. Soft masses inside abdomen in a stray cat
The kind teacher brought one of these stray cats that had lost weight and was not eating for the past 2 months to Dr Daniel on Aug 19, 2013.
Blood tests were unremarkable. X-rays show a circular mass in the abdomen. Exploratory laporatomy showed the lumps which are sent for histopathology.
"There seems to be a stalk," Dr Daniel said.
"They appear to be encapsulated abscesses, peritoneal tumours or some worm masses e.g. round worm larvae migrating from the mouth to the intestines causing such reactive masses."
Mine was all speculation. Histopathology may enlighten me. Stray cats eat hazardous materials as part of their life-style. Did this cat swallow fish bones and perforated her intestines. Then such masses form to wall off the holes in the intestines?
Blood tests were unremarkable. X-rays show a circular mass in the abdomen. Exploratory laporatomy showed the lumps which are sent for histopathology.
"There seems to be a stalk," Dr Daniel said.
"They appear to be encapsulated abscesses, peritoneal tumours or some worm masses e.g. round worm larvae migrating from the mouth to the intestines causing such reactive masses."
Mine was all speculation. Histopathology may enlighten me. Stray cats eat hazardous materials as part of their life-style. Did this cat swallow fish bones and perforated her intestines. Then such masses form to wall off the holes in the intestines?
1100. HOW YOU OLD DOG CAN LIVE LONGER? Bladder rupture
Case study
TP 44384. Maltese, Female, Not Spayed, 12 years. Vet: Dr Daniel
The old dog was still active but had lost appetite yesterday. No vomiting or diarrhoea. Rotten teeth. First consultation on May 7, 2013. Complaint of stranguria and haematuria. Given antibiotics. Advised urine test, dental, spay and X-rays but the owner did not accept these advices.
Then on May 14, 2013, dog came in and the following tests were done.
URINE TEST
Amber, turbid, pH 7.0, SG 1.026, Nitrite +ve, Protein 2+, Blood 4+, White blood cells >2250, RBC >2250. Bacteria 3+, Crystals Amorphous phosphate 2+
BLOOD TEST
Urea 62.6 (4.2-6.3)
Creatinine 882 (89-177)
Total white cell count 44.3 (6-17)
N=98.7%, Absolute = 43.7 --- very high
X-rays not done
52 minutes of isoflurane gas anesthesia after sedation
Ruptured bladder repaired.
Dog was vomiting post-op on 2nd day.
Owner decided on euthanasia
RETROSPECTIVE REVIEW
Relevant medical advices were given as regards urination problems.
HOW YOUR OLD DOG CAN LIVE LONGER?
1. Dogs over 7 years old - yearly health screening (blood & urine test) and dental work.
2. Urine test and blood tests & X-rays to be done when there is urination problem rather than wait and see.
TP 44384. Maltese, Female, Not Spayed, 12 years. Vet: Dr Daniel
The old dog was still active but had lost appetite yesterday. No vomiting or diarrhoea. Rotten teeth. First consultation on May 7, 2013. Complaint of stranguria and haematuria. Given antibiotics. Advised urine test, dental, spay and X-rays but the owner did not accept these advices.
Then on May 14, 2013, dog came in and the following tests were done.
URINE TEST
Amber, turbid, pH 7.0, SG 1.026, Nitrite +ve, Protein 2+, Blood 4+, White blood cells >2250, RBC >2250. Bacteria 3+, Crystals Amorphous phosphate 2+
BLOOD TEST
Urea 62.6 (4.2-6.3)
Creatinine 882 (89-177)
Total white cell count 44.3 (6-17)
N=98.7%, Absolute = 43.7 --- very high
X-rays not done
52 minutes of isoflurane gas anesthesia after sedation
Ruptured bladder repaired.
Dog was vomiting post-op on 2nd day.
Owner decided on euthanasia
RETROSPECTIVE REVIEW
Relevant medical advices were given as regards urination problems.
HOW YOUR OLD DOG CAN LIVE LONGER?
1. Dogs over 7 years old - yearly health screening (blood & urine test) and dental work.
2. Urine test and blood tests & X-rays to be done when there is urination problem rather than wait and see.
1099. To publish*****: Veterinary stories. The optometrist's 3rd daughter
|
|||||||||||||||
1099. Sunday's interesting case - The optometrist's 3rd daughter
"I work very hard to raise and educate 3 daughters," the 67-year-old optometrist used to work from 9 am to 9 pm said to me. "Now, two are married and I don't get a cent from them."
"Do you really expect the younger generation to give parents some money from their earnings every month?" I asked. "They have different values. If they don't need your money as adults, you should consider yourself fortunate!"
Nowadays he closes his shop whenever he likes because his rental in downtown Orchard Road is around $4,000 while the other shop rentals in other malls were charging $8,000 - $20,000 rental per month. "I do not charge clients who are poor," he declared to me. "There was one who asked me if he could pay by instalments. His family member has cancer and so I said that he could pay me when he was able to do so."
"Would you be giving free spectacles if your rental was $15,000/month?" I asked.
"Well, the clients who need free spectacles will not step into such posh shops."
His 3rd daughter in her late 20s had brought in a 13-year-old cat for me to remove an ingrown toe nail. She had phoned me at 10 am on Saturday as the cat's paw was bleeding and I suggested that she bandaged the foot and bring the cat in today, in order to save on after-hours costs which would come to over $300.
So, here she was, with her father. She would not bear to see her cat's ingrown toe nail being cut off.
"My cat claws me all the time at home," she warned me. So I expected a ferocious lion all ready to swing her claws at me. But she was very quiet and there was no need for a sedative. She just lied quietly and patiently and I got some images taken.
"Since you have worked for so many years, you must have lots of clients," I said to the father. "Is your children taking over your business?"
"No, my children are not interested," he had already given up on his 2 older daughters and this younger one was working happily in an events marketing company in publishing.
"I am interested," the 3rd daughter said she had spoken to him and would not mind attending the compulsory optometry course to be accredited. He had not groomed the 3rd daughter.
"Rentals will not stay at $4,000/month forever," he had no confidence in his children to compete and bring his goodwill and clientele business to a higher level.
"Have you got a website?" I scrutinised his name card as he said my spectacles were out-dated and old fashioned. I told him they were branded "Gap" and the thick black frames were admittedly, not modern looking.
His 3rd daughter laughed as she is from this internet generation who appreciates websites and know the levelling power of the social media. Maybe the father knows that one-man-operator optometrist practice is a dying business but I don't think so. Many such shops hire people who come and go and there is a niche for proprietors who provide personalised service and is available over the years as the family members grow up.
Of course, the internet generation may not be loyal clients and go for fanciful renovations and high prices. However I believe there is a place for a niche optometry personalised service with years of experience. It is very difficult to find such old veterans nowadays if you value experience over glamour.
"Do you really expect the younger generation to give parents some money from their earnings every month?" I asked. "They have different values. If they don't need your money as adults, you should consider yourself fortunate!"
Nowadays he closes his shop whenever he likes because his rental in downtown Orchard Road is around $4,000 while the other shop rentals in other malls were charging $8,000 - $20,000 rental per month. "I do not charge clients who are poor," he declared to me. "There was one who asked me if he could pay by instalments. His family member has cancer and so I said that he could pay me when he was able to do so."
"Would you be giving free spectacles if your rental was $15,000/month?" I asked.
"Well, the clients who need free spectacles will not step into such posh shops."
His 3rd daughter in her late 20s had brought in a 13-year-old cat for me to remove an ingrown toe nail. She had phoned me at 10 am on Saturday as the cat's paw was bleeding and I suggested that she bandaged the foot and bring the cat in today, in order to save on after-hours costs which would come to over $300.
So, here she was, with her father. She would not bear to see her cat's ingrown toe nail being cut off.
"My cat claws me all the time at home," she warned me. So I expected a ferocious lion all ready to swing her claws at me. But she was very quiet and there was no need for a sedative. She just lied quietly and patiently and I got some images taken.
"Since you have worked for so many years, you must have lots of clients," I said to the father. "Is your children taking over your business?"
"No, my children are not interested," he had already given up on his 2 older daughters and this younger one was working happily in an events marketing company in publishing.
"I am interested," the 3rd daughter said she had spoken to him and would not mind attending the compulsory optometry course to be accredited. He had not groomed the 3rd daughter.
"Rentals will not stay at $4,000/month forever," he had no confidence in his children to compete and bring his goodwill and clientele business to a higher level.
"Have you got a website?" I scrutinised his name card as he said my spectacles were out-dated and old fashioned. I told him they were branded "Gap" and the thick black frames were admittedly, not modern looking.
His 3rd daughter laughed as she is from this internet generation who appreciates websites and know the levelling power of the social media. Maybe the father knows that one-man-operator optometrist practice is a dying business but I don't think so. Many such shops hire people who come and go and there is a niche for proprietors who provide personalised service and is available over the years as the family members grow up.
Of course, the internet generation may not be loyal clients and go for fanciful renovations and high prices. However I believe there is a place for a niche optometry personalised service with years of experience. It is very difficult to find such old veterans nowadays if you value experience over glamour.
1098. Dicom software to read certain digital X-Ray images & 2 tips
|
|||||||||||||||||||
Subscribe to:
Posts (Atom)