Thursday, November 29, 2018

3362. red eared slider has no appetite

anorexia  4 days

syringe feeding of Critical Care and pellets 3x/day is important for the in-patient

Sunday, November 25, 2018

3361. Oro-nasal fistula in a dog

This text describes the processes of how a vet diagnoses & treats a case of oral tumours with tooth root abscess and oronasal fistula in an older Chihuahua. These processes form part of the Standard Operating Procedures at Toa Payoh Vets.

Owner noticed that the dog had swelling on the right side of the cheek for more than two weeks and later brought the dog to Toa Payoh Vets.

The patient: Chihuahua, Male, 10 years old, Singapore

There was swelling on the right side of the cheek however the appetite was still normal. The swelling had been there for more than two weeks. It seems like the old dog had oronasal fistula and tooth root abscess.

Life has not ended for this old dog as it was given a second chance by its owner. He had once been abandoned and later he found home with this kind hearted Singaporean who flew him all the way from Australia. He had journey far to reach his home sweet home.

The dog’s mouth is seldom examined by most dog owners and bad breath is usually tolerated by many Singaporean dog owners. They also seldom pay attention to the mouth part of their pet as long as the dog is eating without a problem.

Dental check up is not usually done and tartar will usually build up and rotten teeth fall off. Many owners are not bothered or are ignorant that dogs also need to have regular dental check up and dental care. However, the younger generation of Singaporeans are better educated and more concerned about the welfare of the old pets.

Back to my case.

One fine day on late January 2013, the owner of a male, 10-year-old Chihuahua noticed a swelling on the right cheek and brought it to Toa Payoh Vets.

At Toa Payoh Vets, Dr Daniel Sing was on duty. I was present.
“This looks like a case of tooth root abscess as you can see that the teeth are rotten and filled with tartar. There may also be oronal fistula. It is an abnormal communication between the oral and nasal cavities involving the soft palate, hard palate, premaxilla, or the lip” said Dr. Daniel.

Is it a case of tooth root abscess and oronasal fistula?
“So what are the treatment options available?” asked the owner.   
“For this case, we would recommend to go through surgery to remove all the affected teeth and clean the abscess” explained Dr. Daniel.
“But then how would my dog eat without teeth” the owner said.
“Don’t worry, the dog can eat soft canned food or even boiled chicken breast and porridge”
The financial costs and risk must be explained fully before any operation is done. But the owner must give his consent and that is where personality and financial conflicts come in. He must also be aware of the risk involve especially in older dogs. 

Blood test

Health screening is strongly advised before anaesthesia and surgery for all patients, esp. in the older dog.

Anaesthetic risks are much higher in old dogs. There is always the possibility that the older dog may die on the operating table. When the owner hears that the dog may die on the operating table, he may decide not to get the surgery done. Some deem the vet incompetent and consulted another vet. A health screening should be suggested by the vet to let the owner knows whether the risks are high or not.

"I advise a blood test to screen the health of the Chihuahua," Dr Daniel said.  The owners must consent to take the anaesthetic risk if they give permission for the surgery as in this case. No surgeon can guarantee zero risk in any anaesthesia, whether in people or animal.    

The total WBC 16.6 (normal 6.0-17.0)
Neutrophils 50.8%, Lymphocytes 19.2%, Monocytes 24.6%, Eosinophils 1.1%, Basophils 4.2%. The platelets count is 520 which is slightly above normal (normal 200-500)
This blood test indicates that the liver and kidneys were functioning normally.
"OK," the owner consented to the surgery.

Antibiotics were given to the dog.
IV anaesthesia without Intubation.   

Anaesthesia. What type? IV, gas or both? IV anaesthesia is shorter acting than gas anaesthesia. Intubation (a breathing tube connects anaesthetic gas and oxygen to the dog) is usually done in dental extraction.

After the dog had been anaesthetised, I discover that there was a big tumour about the size of palm size dough growing from the soft palate. This tumour occupied the whole oral cavity and the plan now had changed. We had to remove the tumour and the teeth as well. Therefore we can’t intubate the dog as the tumour is obstructing the endotracheal tube.

“Call the owner and inform him about the tumour and the plan to remove it and ask for his consent”
The owner gave his permission to proceed and the surgery continued.

Dormitor IV at 25% of calculated dosage for young healthy dog was sufficient for electro-sugical excision. Dental extraction was done after that.

The old dog survived the anaesthesia and that was what mattered most for the owner. It is not always possible for every old dog to survive anaesthesia during surgery. Therefore it is wiser to remove the tumour when it is smaller and when the dog is younger.


“Is the soft palate tumour cancerous or not?” the owner asked.
“Nobody can tell from the physical appearance,” I said. “The tumour needs to be analysed by the laboratory and the tumour cells can be seen under the microscope if there are any. This is the process of histology. Do you wish to get the tumour sent for histology?”
It is best to get the owner’s permission to send the tumour for histology to determine its state, as some owners may have budget constrain or do not wish to spend more money.


It is unprofessional to give medication to the owner to treat the oral tumour as some owners may insist on having them as an alternative to the high risk of anaesthesia during surgery as it will not disappear.
Electro-surgical excision of the soft palate tumour including extraction of molar teeth.
“The tumour can be removed from its stalk by using electro-cauterizer to avoid losing too much blood,” said Dr. Daniel. Then after removing the tumour, the dog started to wake up from anaesthesia, so it had to be gassed with Isoflurane. When it was down, Dr. Daniel proceeded with dental extraction of the molar and drainage of the pus.

Histology Lab Result

The result of the histology came out and the nodule is covered by squamous epithelium with overlying parakeratosis. At the centre, there were irregularly-shaped trabeculae of woven and lamellar bone. There is no evidence of malignancy. So this is good news for the owner is it was not cancerous.


The final diagnosis from the histology is ossifying fibroma mass, with tooth root abscess and oronasal fistula. The dog was put on antibiotic and two days after surgery it was allowed home.


Tips & Advices:

Post surgical management.

1.      Owner need to come back for review every 3 months for the next 12 months. Owner needs to be advised and reminded by the vet but this is seldom done by me.
2.      The mouth of older dogs must be checked by the owner daily and any mouth tumour can be removed when it is small. In this case, the whole oral cavity had been filled with the tumour. It could have existed for some months without the owner seeing it.
3.      TIPS: old and unhealthy dogs (>5 years) must be given 25-50% of the calculated dosage of IV anaesthesia for younger dogs to lessen risks of heart failure.

Prepared by,
 Erica Chai Hui Ling

Friday, November 23, 2018

3360. Clouds in November 2018

Drizzling in Nov 23, 2018. Day after Thanksgiving
Faces in the clouds


Thursday, November 22, 2018

3359. Case study*****. A 2-year-old male rabbit has 4 long overgrown front teeth - dental extraction

Nov 22, 2018  Thankgiving Day

Dog for spay and a rabbit with 4 overgrown teeth.

DAY 1. 5 pm.  Sedation with Xylazine and Ketamine IM in 2 sites at 80% of the calculated dosage. Maintenance by isoflurane gas when necessary.

Dental equipment for rabbits

Isofluane gas anaesthesia when necessary

Molar extractor can be used to extract the incisor tooth.

An incisor luxator is used to loosen the front teeth

2 lower incisor teeth have been extracted

Molar extractor to extract a loosened upper incisor

DAY 2. 10am.  The rabbit had not eaten or pooped. He has a fever of 40.5 deg C and some nasal bleeding but is alert.  Dextrose saline 20 ml, baytril and meloxicam are given subcutaneous. The rabbit started eating in the afternoon.

The rabbit dental set used


Wednesday, November 21, 2018

3358. The adopted red-eared slider eats only chye sim vegetables and occasional pellets.

Nov 22, 2018  Thanksgiving Day.

This slider eats only chye sim vegetables. Swims lop-sided and was gasping (video by owner). Live separately from 6 adults sliders.

When turned upside down, not proactive in becoming upright. A water bubble appeared on one nostril. Respiratory infection.

Friday Nov 23, 2018

Given oral baytril 
More active, no gasping. Passed a large blot of stool  8mm in diameter (photo)
Observed yellowish pus-like thick phlegm from right side of lips and some on the left side. (photo).
Rotten end of shell (photo).

Ate pellets

Tuesday, November 20, 2018

3357. Day 3. A red-eared slider has swollen eyes and stopped eating

Nov 20, 2018.

The slider was adopted.  Now she is lethargic. Eyes were swollen when brought in 2 days ago but are now normal after treatment with eye drops and medication.

This slider eats only dried shrimps and so the owner had been feedly shrimps for the past 2 years. 

According to the owner, the slider had laid eggs 2 to 3 times in 2016 and had eaten them. She did not see eggs laid in 2017-2018. Owner did see 2 eggs last year.

Tank of water changed daily. 1-2x per week will be out on the floor.

We are syringe feeding with Critical Care and multivitamins. So far, she has no appetite.


Sunday, November 18, 2018

3356. Singapore fitness park - no cars seen - rare occurrence. Nov 19, 2018 9am

Monday Nov 19, 2018. 9am. No cars

3355*****. An 11-year-old Lab Retriever has a yellowish pus discharged from the vagina

Nov 19, 2018
I received a phone call early at 9 am.
Lab Retriever, F, 11 yrs
"Not eating for one week. Very thirsty. Passed  brownish stuff.  Is she going to die soon?"
The owner brought the dog in the morning today.  Not much pus seen at the consultation table. Abdominal palpation did not elecit pain. No abdominal swelling, uterine swelling or bladder stone. Small amounts of bright yellow pus is seen oozing out from the private parts on examination.

Small amount of yellow pus was seen leaking from the vagina in small amounts during examination. Not obvious in the images.

Overnight, the dog passed out copious amount of pus and blood.  Blood test show bacteraemia and lowered red blood cell count.

The dog is washed before sending home with antibiotics and pain-killers after 2 bottles of IV drips and antibiotics.

Day 2 images

Nov 27, 2018. Follow up .
Complaint of residual vaginal discharge being present.

I explained that Toa Payoh Vets usually spay the dog about 3 days after in-patient treatment   although ideally, it should be one month later when the dog is healthy and eating.

Many owners do not come back for spay once the dog has no more discharge. Till the  next heat when the pyometra recurs. The owner said she would be back.

Spaying your female dog when she is young will save medical expenses