Tuesday, January 31, 2017

3015. A 9-year-old female spayed Schnauzer X peed blood.

X rays no stones

blood test NAD
urine test pH 9, bacteria, protein and triple PO4 crystals.

Follow up
After antibiotics, no haematuria
Now on Urinary S/O

This case presents evidences via X rays, urine and blood test.
However, some owners have economic or time constraints and so x-ray or urine test is done. 

3014. A 13-year-old pekinese needs eyeball removal

Jan 31, 2017

Chinese New Year lst day is Jan 28, 2017. The young lady contacted me to get the enucleation done as she must have researched the internet for a vet to perform the surgery.

An old dog said to eat normally and booked for surgery on Jan 30, 2017. The first time I had seen this dog.  It would be risky as the eyeball had popped out for some weeks and could have been infected. Surgery should only be done on healthy dog. I suggested a blood test.

Blood test showed bacterial infection of the blood. So, I gave IV baytril and drip with amino acids and glucose and vitamins for 24 hours (2 bottles). Dr Daniel operated on Jan 31, 2017.
This is important as immediate surgery may lead to death on the operating table.

Gas anaesthesia only. The dog was alive at the end of operation and that was all the owner wanted even though she had been warned of anaethestic death. The dog had a small scar but lately, the eyeball had popped out and looked terrible.

Early vet treatment of corneal ulcers by tarshorraphy would have saved the eyeball and vision but it depends on the vet who may just advise eyedrops.  .

Thursday, January 26, 2017

3013. An 11-year-old male red-eared slider has swollen right eye and eye ulcers

Jan 26, 2017

Came in on Jan 15, 2017   not eating, right eyelids swollen

Hospitalised. Medication. 2 injection.

Eats little. Spit out usual Marsuri globular when observed feeding.
Jan 25 and 26. Prefers prawns.
Opened mouth - whitish plaques on sides of tongue and mouth. Fungal infections?

X-ray Jan 26, 2017

Jan 27, 2017  Chinese New Year's Eve. Going home at 12 noon.
Nibbles shrimps
Swallows and spits out pellets

X rays yesterday
Images taken today, 12th day of hospitalisation

3012. A 3-year-old female rabbit dislocates left hip X-rays


Jan 27, 2017  Rabbit goes home. Sling up left hind

Wednesday, January 25, 2017

Jan 25, 2017

A case study of the usefulness of Rimadyl in helping the old dog to walk

TP 45772
Jane, Golden Retriever, FS, 16 years (born 2001).
Lives in North Singapore

First consultation  Jan 14, 2015   Dr Sing Kong Yuen
24kg  anorexia 6days  vomit once, PD/PU
Thick reddish brown vaginal discharge past 4 days
Uterine horn 4 cm across palpated.
Open pyometra at 13 years of age.

Jun 14, 2016
Jane.  14 years old
Hip pain but can walk to bathroom.
Blood in the urine. I advised giving me a urine sample as dog is large breed
and inconvenient to come

Jun 14, 2016   Rimadyl 75 mg x 15 tab/   1.25 tab per day for 4 days on, 4 days off. To effect.
Sep 19, 2016    Rimadyl 75 mg x 10 tab
Dec 6, 2016         x 20 tab..
Jan 23, 2016.  Complaint WhatsApp   A lot of difficulties walking. More painkillers, what can we do to help her? she still has a good appetite.

Jan 24, 2017. Came to buy Rimadyl and a medium bag of C/D in case the dog cannot survive.
My advice: need to increase dosage and decrease weight. What is Jane's weight?  28 kg.
Rimadyl 28 x 4.4 mg = 1.5 tab/day for 4 days to effect. To review effect of drug first. .

Urine test
slightly turbid, pH 9 (alkaline), SG 1.045
Protein 4+, Ketone +, Blood 4+, Triple phosphate crystals occasional, bacteria 3+

Baytril x 2.5 tab x 4 days.   Trimax x 1/2 bid x 10 days
I advised acidification of the urine using prescription diet Hills' C/D.
From Jun 22, 2016 to Jan 25, 2017 - strictly on this diet. No complaint of haematuria.

2 cases of lame senior big breed dogs over 16 years old much loved by the owners.
In this case and another case of a X-bred 17years old, the dog is still eating but has bad hips.
So the kind owner did not elect euthanasia and has a lot of care-giving of aged dogs to execute..

3010. A 17-year-old X-bred has a right hip bed sore

Jan 24, 2017

The dog was adopted from a shelter on Jan 23, 2000 and so the lady owner declared that to be his birthday. He was probably 4 months old. 17 years flew by. He had greater difficulty getting up to go to the bathroom but the owner persevered in lifting him up to walk to the bathroom.

"Lately, his front toes curled inwards," the owner told me. "He barks at night and I had to calm him down."

The 4 cm x 3 cm oval left hip sore was weeping.
The treatment was to close the wound as it appeared fresh. The caudal edges were black and the pink muscles could be seen.

"Anaesthesia using gas is the safest," I said. "No injectables."
The owner signed the anaesthesia consent form with apprehension that the dog would die on the operating table.
The dog was weak and did not struggle when put on the nose cone to smell the gas.
"For very old dogs," I taught my assistant who had little experience in very old dog anaesthesia
and needed to be mentored.

Do not monitor his depth of anaesthesia as a young dog," I elaborated. "A young dog needs a longer time to be anaesthesized and is unlikely to die. For this oldie, the time taken is less than half. If you monitor as if he was a young dog, he might be dead.

A Z-plasty was done to close up the hole. All was OK and the dog went home.
The challenges of barking and needing to be carried or slung to go to the bathroom are stressful.

Total white cell count  *30.5  (6-17)
N  *97.6%  (60-70%)    Absolute  29.8
L  1.6%     Absolute  0.49
M  0.8%    Absolute  0.24 
 E and B normal

Red cell count  *4.7  (5.5-8.5)
Haemoglobin *10.3  (12 - 18)
Haematocrit PCV   *0.30  (0.37 - 0.55)
Platelets   409  (200-500)

ALT  79 (less than 59)<59 br="">
AST 85 (less than 81)<81 p="">
Bacteraemia and anaemia.    Advised antibiotics and anaemia treatment.

Saturday, January 21, 2017

3009. A 3-year-old cat has diabetes

Jan 21, 2016

Complaint of left hind limb lameness. Neuropathy or damage to the hind limb nerves can occur in feline diabetes. Cats present with hind limb paralysis or weakness.

Tel on Jan 26, 2016

Owner happy with outcome of insulin injections SC at 4IU/kg. Cat 5.3 kg

1. No limping
2. More energetic
3. Not so hungry for food as before
4. Drinks normal amounts but did not measure volume (home monitoring for diabetes). Advised to give 300 ml and see how much consumed per 24 hours.
5. Food divided into 2 portions and fed after CANINSULIN insulin injection at 7 am and 7 pm (working and therefore unable to give 2nd injection 8 hrs after first as advised by some experts.

1. Eats a lot
2. Drinks a lot
3. Pees a lot
4. Lose weight

Blood and urine glucose high.

Blood glucose  13.5 mmol/L
 (3.9 - 6.0) from Quest Lab
(5.5 - 10) from another report.

Hb  7.4   (9-15)
RBC  4.8   (5-10)

pH 7.0  (5-9)
SG 1.028  (1.005-1.030)
Glucose 3+  (normal should be 0)

Blood trace

White blood cells 5/uL
Red blood cells  4/uL

Normal glucose level  (3.9 - 6.0) Quest Lab
Normal urine  No glucose

Normal glucose level  100 - 180 mg/dl (5.5 - 10 mmol/L) in another report, not Quest Lab which is 3.9 to 6.0
Normal urine  No glucose

Normal glucose level  80 -120 mg/dl (4.4-6.6 mmol/L)
Normal urine  No glucose

Caninsulin SC 2x/day for this cat. But it lasts around 8 hours, not 12 hours.
ProZinc (protamine zinc recombinant human insulin) last 12 hours but are not available in Singapore.
The owner gives 12 hourly injection of Caninsulin as he works and has no time for 8 hourly. as recommended in cats. Caninsulin recommends around 8.30 am and 5.30 pm injections 2 x/day.

Dietary changes (low carbohydrate diet) - weight and 2 portions after insulin injection
May take a month or more to achieve good regulation

Unlike dogs, some cats may go into remission and therefore do not need insulin injections by eating a good quality low carbohydrate diet. This is because 80-95% of diabetic cats suffer from Tupe 2 (insulin resistance) diabetes and therefore dietary control will do.  Type 1 diabetes is due to lack of insulin and is common in dogs.

However, initial treatment is by insulin injection and dietary control and home monitoring of blood glucose levels using blood glucose meters.

Blood glucose meters are used to accurately monitor the blood glucose level but most owners do not want to do it.


3040. A 3-year-old cat is diabetic

The complaint was a big lump in the hind leg of this 3-year-old cat that was limping. Blood test showed high blood glucose. Urine test showed glucose. The lump would be due to hind limb neuropathy which is a symptom in diabetes mellitus in cat.

On further questioning, the owner said that the cat was always looking for food, drank and peed a lot.

After insulin injections, the cat's lump disappeared and she was no longer ravenous, thirsty or urinating a lot.


Thursday, January 19, 2017

2977. A 4-year-old Guinea Pig loses weight

May 8, 2016 
2 guinea pigs
Admitted GP Male, Not neutered, 4 years. 740g. 38.6C
Very thin. Eating less for past 1 month.
Overgrown lower front teeth. Only recently.
Other guinea pig Pash eats more, bully him.

Lower front teeth trimmed.

Sep 2016, Nov 2016. Wanted front teeth clipped. No examination.

Jan 17, 2016 (today)
483 g   36.3C   Diarrhoea   Weak    In-patient
Upper & lower front teeth overgrown (video) - trimmed.
Molar spurs (L and R upper Cheek tooth 1) - image - trimmed.
No stools passed for past 2 days

Jan 20, 2016
380g   38C  one well-formed stool pellet passed. Goes home with
Critcal care - oral feeding.

Molar spurs need to be checked. Some owners may just want front teeth clipping to lower costs.
If not eating much after trimming, review with your vet for molar spurs before your pet loses more weight. 

3007. An 11-year-old male Samoyed had septicaemia.

Circum-anal tumour. Scheduled for surgery after 2 Tardak injections to bring down the size.
The Samoyed had haematuria and was rushed to an emergency vet surgery. X-ray taken.

Many Singaporeans find it cruel to neuter a male dog. In this case, chances of circum-anal tumour and prostatitis are unlikely in a neutered dog. This dog had very high fever for the 2 days. Vomited blood on the 3rd day and passed away despite treatment. Septicaemia is confirmed by blood test. Urine test showed bacterial prostatitis.  X-ray showed enlarged prostate or tumour.

In retrospect, neutering your male dog would have prevented this situation. 


Blood test  Jan 11, 2017
Haematuria. Went to emergency vet at 1 am
X-rayed. No bladder stone.
circum anal mass due for surgery 2 days later with TPV  
39.9C.   Abdom palp slightly uncomfortable
pantotrazole, omepazole, tramadole, metronizole, ampicillin, active cooling therapy

Came to Toa Payoh Vets at 9.30am
ALT 176  (less 59)
Total WCC  24.2  (6-17)
N  97.3% (60-70)
N Absolute 23.6   ((3-11.5)
Platelets 126  (200-500)


Urine test
pH 8, SG 1.010    Protein 4+    Blood 4+   Bacteria +    No crystals

Lower urinary tract infection

Negative Babesia, Caniv-4


High fever next 2 days. Urine blood sometimes. ---------Vomited blood. Passed away.

Dorsal circum-anal tumour 1.5 x 1.5 x 1 cm  on Dec 23, 2016. Tardak on Dec 23 and 31. Neuter &
removal on Jan 10, 2017.

Had haematuria on Jan 10 and passed away from septicaemia on Jan 13.

3006. A 16-year-old female Jack Russell has a bluish "breast lump"

A rare case.


Tuesday, January 17, 2017

3005. Ruptured globe in a 3-year-old pug removed

The young 3-year-old pug wanted to play. She sniffed the backside of the older female dog and got a paw swipe injuring severely the left eye. Eyeball removal by Dr Daniel was done at Toa Payoh Vets.