Thursday, May 31, 2018

3164. 10-year-old male not neutered dog passes blood in the urine for past 6 days

No urinary stones from X-ray. However, some stones are not radio-dense.
I palpated a swollen bladder the size of the golf ball but no pain
I did not palpate a swollen prostate which could also cause blood in the urine.

"Any humping on pillows or gripping people's legs?" I asked reference to the dog's behaviour at home since he was not neutered.
"No," the concerned lady replied.
"Does he lick his private parts?"
"Yes, daily."

This could cause injury to the penile area. Inflammation and blood showed in the urine.

3163. How to prevent recurrent urinary stones in an 8-year-old female, Japanese Spitz?

May 31, 2018

An internet query from a lady to Toa Payoh Vets. Vet 1 asked her to seek a vet as he or she does not do Voiding Urohydropropulsion which is a non-invasive treatment (ie. no surgery).

Treatment of uroliths in dogs are:

1. Medical dissolution for struvite stones
2. Cystotomy (surgical removal).
3. Lithotripsy for large stones of kidneys, liver or gall bladders.
4. Voiding urohydropropulsion.

An interesting case study of a possible case for medical dissolution and voiding urohydropropulsion is discussed below.

In this case, if the owner compliance is available, medical dissolution for 6 weeks and voiding urohydropulsion may be possible.

The dog had a cystotomy earlier. Now, she has recurrent urocystoliths. Early detection of small uroliths that can pass through the urethral lumen will avoid surgery as VU can be effective.
3-6 months after cystotomy - X rays are recommended.

The dog was fed Hills' C/D diet. But the dog got fed apples, strawberries, por or chicken meat, soup. So the urine was not acidified. The pH was around 7 - 8.


Chemical composition of the stone can only be confirmed by the laboratory, not based on physical appearance.
Stones may be compound mixture of struvites and calcium oxalates.

To prevent recurring struvite stones, feed an acidifying diet. No other food or treats. Ensure the dog drinks water and does not hold back urine for many hours.  Urine test for pH every 3 -6 months. X-rays yearly so that small stones can be flushed out using voiding urohydropropulsion.

Wednesday, May 23, 2018

3162. A 2-year-old rabbit dropped when carried by a person leading to pelvic fracture

May 23, 2018

Ref 50451
X-rays are important to verify site of fracture. The left hind leg was swollen at the hip area. There did not appear to be shortening of the hind legs which were extended. X-rays show left pelvic fracture. The owner did not want any treatment.

Tuesday, May 22, 2018

3161. Myanmar stories: May 22, 2018 visit to Peninsula Plaza - images

Peninsula Plaza was buzzing with crowds of Myanmar people daily some 5 years ago. Many employment and travel agencies, money remittance and supporting services did a thriving business.
Nowadays, there is little foot traffic during weekdays as the government clamp down on recruitment of foreigners.

Many Myanmar recruitment agencies have closed down.
Only on weekends will there be some crowds nowadays

Flowers are bought to place on altars of Buddhas. Shop has existed for many years
Myanmar provisions

A smaller provision shop in existence for many years

Aung San Su Kyi (picture, top right) is well loved by most Myanmar people

Some shops sell the Singapore Big Sweep

New money changer opens shop

Sells tickets only

Bigger travel agency with more services

Logistic company caters to those who want to send goods to Myanmar.
No foot traffic during weekdays nowadays

Many successful Myanmar ladies with degrees now work for large companies
and live in Singapore to enjoy the city life.
The longyi dress is part of Myanmar culture

Sunday, May 20, 2018

3160. ***Dog Stories: A 6-year-old male neutered poodle had difficulty in breathing after force fed medication

May 21, 2018
Review of this case. TP 50203.

In May 14, 2018, the dog was treated for lethargy, inappetance and vomiting for 3 to 4 days. A slight fever of 39.6C. The owner declined a blood test. IV drip and medication were given. The dog went home.

In May 19, 2018, the dog was not eating. He developed difficulty in breathing after the owner force fed medication. The owner had also syringe fed flaxseed oil for the coat for some time, as advised by the groomer. 

Harsh lung sounds on right lungs. Few harsh sounds on caudal parts of the left lungs. Aspiration pneumonia from medication or flaxseed oil into the lungs was a possibility in view of the sudden onset of dyspnoea (difficulty in breathing).

The dog's tongue was cyanotic. He was still barking loudly when the owner saw him during IV drip and wanted to bring him home.

The blood test showed the following abnormal findings:

Total cholesterol  11.08  (3 - 6.6)
Triglyceride  3.48  (0.3 - 3.3)
Total WCC 41.6   (6 - 17)
Neutrophils 95%  (60 - 70).  Absolute 39.5 (3-11.5). 

There was a bacteraemia. Platelet count was normal and so there was no septicaemia..

In the evening, the dog had breathing difficulties and passed away a few minutes after frothing.

What was the cause of death?

Was there a canine influenza infection since there was an outbreak in some Singapore kennels? There were no signs of eye discharge and coughing and no exposure to other dogs in dog runs.

Blood test was useful in showing that the dog had a severe bacteraemia, most likely from infections in the lungs.  This infection could cause death. As the owner was force-feeding, aspiration pneumonia was possible. 

I advised post-mortem to find out the cause. The owner declined.

3159A. Shaggy maned mushrooms in the backyard

May 19, 2018

In the backyard, with no frequent soil turning, the shaggy maned mushrooms flourish at various stages of growth as seen in the video and image.

The young ones appear as white buttons but I had not taken any pictures. You may see some in the video.

Isolated groups are seen in my garden in front as I till the soil frequently.

Saturday, May 19, 2018

3158. Audit of case. Liver disease in a 7-year-old Shih Tzu - ALT enzymes

May 20, 2018
Audit of case

Ref: 45074

On Mar 18, 2017, this Shih tzu, MN, 7 yrs old, 7.7 kg,  much loved by Filipino couple living in Pasir Ris, came for annual check up and vaccination. 
The dog is fed on vegetarian diet. Health screening by using blood test showed elevated ALT.
Dog was fed new dog treats recently.

Mar 18, 2018, 7.7 kg
Liver profile
ALT  1275 U/L   (<59 p=""><121 81="" nbsp="" p="">

Given Zentonil and canned Prescription L/D. Dog was usually fed vegetarian diet. 
<59 p=""><81 p="">
Review with ultrasound. Weight not taken.
Apr 22, 2018
Liver profile is normal
ALT  40 U/L   (<59 p=""><121 81="" br="">
Ultrasound - liver is normal in appearance. Ultrasound does not rule out liver disease.
Back to his usual diet.


May 1, 2014. Seen by me. Painful abdomen, bladder area. growls. Wt. 8.7 kg   38.1. Dipstick Protein +, no blood, pH 8  SG 1.005. UTI.

Oct 11, 2014. 8.5 kg. 37.5C
Fat lump 3 cm x 5 cm Subcut, above right hip excised
Histopath. Fat necrosis, organising granulation tissue and fibrosis.

Apr 29, 2015  8.9 kg  Overweight. Vaccination. To reduce weight by 1 kg.
Anal sac expressed.


Conclusion. The dog did lose 1 kg of body weight. 
<59 p=""><81 p=""><59 p="">It is possible that the elevated ALT could be due to the new dog treats causing liver disorder. The dog is OK now.  Dog treats are sold very cheaply and their quality may be absent. Purchase good quality ones.  

3157. ***Stray Cats Stories: Who neutered my stray cat?

May 21, 2018

Review of case Ref: 46140

Freedom to live and fight or security being confined to an apartment?
This male stray cat had a choice. Freedom anytime and anywhere. He would roam and come back  ravenously to gobble down his cat food inside the caregiver's house.  But on May 17, 2018, the cat would not eat for the past 2 days, despite treatment 2 days ago by Dr Daniel of Toa Payoh Vets. The worried community cat carer took him to consult me as I was on duty. .

May 17, 2018
His name was Ginger and he always had a ravenous appetite when he returned home from roaming. But on May 17, 2018, he was anorexic. "His right face is swollen," I showed the caregiver who did not notice this. "His right ear is filled with black secretions and it is very painful because he moved his head away when I touch his ear. Fortunately, he does not hiss or claw."  See video.

Blood test
May 17, 2018

FIV/FeLv negative which was good news.
Only abnormal finding was low platelet count. It was 279  (300 - 800)

"What causes his anorexia?" the caregiver was very worried. She said the cat had gone roaming yesterday.
"Most likely the intense pain in his right ear particularly and infection of his swollen right face from cat fights and clawing," I deduced from the cat's resentment to my palpating and scoping his right ear.

I reviewed another blood test done last month on Apr 24, 2018.
Blood test
Apr 24, 2018

The only abnormal finding was a very low platelet count. It was 90 platelets per microliter of blood.  (Normal range is 300 - 800). Dr Daniel had treated him for swollen front legs and limping on the left fore leg. He had a fever of 40.2C. He weighed 6 kg.

A low platelet count is known as thrombocytopenia. With not enough platelets in the blood, the body cannot form clot to stop bleeding when the skin or body is injured.   
Normally, the cat has 300,000 to 800,000 platelets per microliter of circulating blood.

Thrombocytopenia can be caused by 4 conditions:
It can be inherited. The spleen which fights infection and filters unwanted material from the blood traps the platelets. Decreased production of platelets can be due to viral infections like FIV, FeLv. Increased breakdown can be by severe bacterial infections in the blood (bacteraemia) or auto-immune diseases.

This cat developed a fever and probably had a mild viral or bacterial infection from cat fights.

May 15, 2018
Before I saw him, Dr Daniel had treated him on May 15, 2018 for lameness in his right hind and irrigated his dirty ears. He weighed 6.3 kg.  No fever. Rectal tempwas 38.5C.  But he would not take the oral medication and the owner came on May 17, 2018 when I saw him at 5.9kg, 38.0C and was anorexic for 2 days.

"He is still active, but will not touch the Fancy Feast canned food or the dry food, unlike his usual wolfing down the food given!" the caregiver was very worried.

The cat had severe painful ears and could not chew his food but a cat cannot tell the caregiver.
I sedated and clipped his right swollen face. A long white scar streaked from bottom to top (see image). He was battle tested and had a very thick skin such that the use of the blood collection needle had to be thicker.

"Why didn't you neuter the stray cat earlier?" I asked her.
"Very difficult to get him inside the crate," she replied. "But somebody had him neutered when he was missing from Apr 5 - 13 recently! Could this person be the other caregiver in the neighbourhood?"

"It is possible he could have strayed to another neighbourhood and got trapped," I said. "To prevent him from making other female cats pregnant or to reduce his urge to be territorial to fight with other tom cats. He has the built and bravery to fight other tom cats."

"He still has the urge to go out roaming," she said.
"Neutering will remove the male hormones but there is still the residual hormones which will decrease over the next 2 months. After that, he is more homely."
"He has less inclination to go roaming nowadays," she said.

I reviewed his history of treatment and this is as follows:
Aug 12, 2015. Wound cleaning.
Jul 27, 2017. Wound cleaning.
Apr 24, 2018  Swollen both fore limbs and limping left fore leg.
May 15, 2018. Right hind leg limping.
The right facial swelling is an old abscess. Scar shows the cat scratch injury.
May 17, 2018. Anorexia 2 days. Very painful ear and swollen right face.

On May 20, 2018, I text-messaged the caregiver. The cat had started to eat the wet food and she was relieved and happy. 

May 19, 2018  10.54pm      "Hi, Is Ginger eating today?" I texted-messaged the caregiver.
May 19, 2018 11.07pm       "Hi Dr Sing. Yes. Thank you so much. Ginger's appetite is much better today. Able to eat packet food. No dry food yet. Started ear drop and antibiotic today."

Started to eat wet food on May 19, 2018

I had prescribed the liquid antibiotic instead of the tablets and the cat should find this more acceptable.

With the neutering done by the kind soul, this cat should be healthier, safer at home and live to a ripe old age. No more wandering and getting poisoned by environmental toxins, causing a low platelet count. He could be killed by cars or cat haters.   

His left ear tip was cut, showing that he had been neutered when he was missing in April 2018

"I did research on the internet," the caregiver told me. "There are 2 types of feral or stray cats. One type avoids human contact as they don't trust people. The other type, like this ginger stray male cat is affectionate and will not claw people. Most likely, he was abandoned."

"How old is he now?" I checked his medical record of being treated for cat fight wounds for a few times.  "I don't really know," she replied.. "Dr Daniel estimated 6 years of age."

She or her friend would bring in the cat for wound treatment as the cat strays into her house for food.

Freedom comes at a price for stray cats. A shorter exciting life of cat fights and get infections with a contagious feline disease like Feline Immunodeficiency Viral (FIV) or Feline Leukaemia Virus (FeLv) for which he was tested negative.

The town council officials do engage pest control people to trap stray cats that are then put to sleep.
People wbo hate cats poison them. Car traumatic accidents may kill or injure the cat running across the road.

"Once, another tom cat came into my house and both of them fought, somersaulting and hissing," the caregiver said. She had to quickly separate them.

There are many risks in being a stray cat. However, many strays do not want to stay home alone. In this cat, the caregiver permits him to roam during the daytime and confine him home at night. That is his lifestyle nowadays.  


Friday, May 18, 2018

3156. Sunda Pygmy woodpeckers seen partially during my morning exercise

Only in 2 mornings, I saw these woodpeckers high up on the tree branches during my exercise.

May 14, 2018. I used zoom lens

On May 12, 2018, Mother's Day. The woodpeckers did not stay still pecking the tree facing me. Appeared to be cautious and flew away within 60 seconds. Zoom lens used. .