Monday, January 13, 2014

Sunday Jan 12, 2014's interesting cases of 6 dental cases.

Sunday Jan 13, 2014

"You have 10 surgeries to do," I said seriously to Dr Daniel who took over at 12 noon while I went to attend the official lion dance opening of Dr Jason Teo's Telok Blangah Vet Surgery. It is difficult to do surgeries and consultation from 12 noon to 5 pm on Sunday if only one vet is working.

So I returned to work in the afternoon as well as in the morning when I had the following 6 dental scaling and check up to do.

Case 1. The deaf Jack Russell. He became deaf suddenly yesterday. The owner requested dental work as the foul bad breath got worse in the past month. "The sudden onset deafness is unlikely to reverse with dental work," I explained. "The origin would likely be in the brain. A blood test will be taken but more tests need to be done." Brain and ear canal scans need to be done but it would cost  more than $1,000.

Case 2. The 14-year-old Papillon came in for dental work. The lady was referred to me as the dog had fits. "Blood tests show kidney failure, likely to be aging as the dog is very old," I said. "Dental extraction of all the rotten infected loose teeth may stop his fits and reliance on anti-fits medication. I had only one case where dental work eliminated fits but most causes of fits are unknown."
"My dog was very wobbly yesterday but had not fits after being given a (30-mg phenobarb) tablet," she said.
"The medication causes drowsiness and incoordination," I replied. "It controls fits if taken but is not a cure."
"Will my dog die under anaesthesia?" she had never done any dental on this old dog before.
"There is a high risk esp. when he has fits, kidney failure and now a low rectal temperature of 37.1C," I replied. "Dental extractions do not stop the kidney failure in aged dogs," I made it clear to her to prevent misunderstanding. I got the teeth out under gas anaesthesia and the dog was OK.

Case 3. A young lady adopted a poodle from a Voices For Dogs and went to 2 vets. Her friend in a blue Volkswagon drove her to Toa Payoh Vets to consult Dr Daniel who was not yet at work. So I talked to them as they were referred to me by two Straits Times journalists whose pets were treated by me.

"The first vet says all teeth must be extracted. A second vet says that not all teeth need to be extracted. We are confused. We spoke to Ms A and she said to send the dog to Toa Payoh Vets and we have phoned Dr Daniel for an appointment."
"Dr Daniel will be here soon," I said. So, this was the 3rd dental case. When Dr Daniel came, I had a look at the dog's teeth. Due to poor nutrition or tetracycline drugs as a puppy, his teeth lost the enamel covering at the tips. I left this case to Dr Daniel so as not to confuse the two ladies. He estimated the dog to be 3-4 years old and extracted 2 black loose teeth.

Case 4. A young lady studying in Tasmania back on holiday in Singapore, came with her mother for a dental scaling for the old Miniature Schnauzer. "I cannot be bothered to spend time and money on this dog," the mum told me. "But she keeps pestering me and so I bring this dog in for dental scaling." The young lady was silent as mum was the paymaster. Dental scaling prevents bacterial in the tartar spreading toxins inside the mouth and spreading to the heart causing heart disease or oral tumours and loss of teeth. But there was no point educating the older baby boomer generation who feels that it was a waste of money and time doing dental health for an older dog. And probably thinking the vet would have personal interest in recommending dental.

Case 5. This working lady in her 30s was too busy to seek veterinary treatment for her 9-year-old Maltese who kept passing dark brown vaginal discharge in the past 3 years. Last week, the dog was not eating and I palpated nodular lumps in the dog's uterus. Small balls of around 2 cm x 2 cm of various sizes big and small. A blood test was done but no X-rays owing to economics.

"Do the dental at the same time as spaying," she said and so the dog had the appointment today for spay and dental scaling. So this was the fifth case of dental. The Maltese has mult-lobulated uterine horns and the surgery took a much longer time than a simple spay. "This could be uterine cancer," Dr Daniel said. I thought it was a case of chronic open pyometra not treated over a long period of 3 years. Surprisingly the blood test did not show a high total white cell count. No histology of the uterus was advised by me as the owner wanted the least medical costs. I showed her the 200-gram flaming purple-red womb asking my assistant Naing to retrieve them from the bin as he had discarded them. Nothing is more impactful as the real womb. Digital images are of no use in showing the seriousness of the infection of the womb. The lady was thankful that her dog survived.
"No dental work is done," I showed her the pale gums as she came one hour post-surgery to take the dog home. "My dog never leaves home," she said.

Case 6. Cellulitis. The 13-year-old Maltese had raw seeping ear flaps and neck skin due to many weeks of rubbing by the back legs. Previously she had ear canal infections and was treated but the owner failed to maintain ear cleaning. "The teeth are all rotten," I said to the lady. "Since the dog needs to be sedated to clip and clean the cellulitis areas of the ear flaps and neck. The dental was done by Dr Daniel and the dog went home the next day.

I usually schedule one or two dentals on Sundays as they take at least 30 minutes per dental. But on this Sunday, 6 prospective dental cases flowed in. So I had to work on Sunday afternoon and let Dr Daniel handle the dental and pyometra cases without the stress of doing consultations in between. 

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