Microchip error from the vet?

--- On Sat, 4/24/10, Joanne Woo wrote:


From: Joanne Woo
Subject: Error in microchip number
To: judy@toapayohvets.com
Date: Saturday, April 24, 2010, 4:09 AM

Dear Dr. Sing,

We spoke on the phone earlier regarding the wrong microchip number given to me when I first brought my dog, Oreo to be vaccinated and microchipped at your clinic on 30 March 2008.

Basically, I found that the microchip implanted in my dog has a different number from the bar code that is pasted on his first vaccination form. I have attached a scanned copy of the vaccination form to this email for your perusal.

The microchip number in his body is: XXX6618
The microchip number on the bar code pasted on the vaccination form is: XXX6722

As a result of this misinformation, I have been licensing my dog under the wrong microchip number with AVA for the last 2 years. My next license renewal is due on 6 May 2010 and hence, I would like to rectify this mistake with AVA before I renew it. I would appreciate if you could assist me on this matter.

Thank you.

Yours sincerely,
Name of owner


E-MAIL REPLY FROM DR SING.

Thank you for email. There were several Border Collies siblings I microchipped together. I believe that the Seller gave you the wrong microchip paper. I need to scan your Border Collie and give you a report of the correct number.

EXPLANATION FROM DR SING
On the surface, the dog owner must have the misleading impression that I have lost my marbles or my mind. Instead of disputing over the phone, I asked her to email to me a scan of the microchip and vaccination certificate to save time and prevent miscommunications. She was very polite and helpful.

This mystery was solved when the owner emailed me the details of the case as there were more than 1 Border Collie siblings microchipped by me from a home breeder. He must have given any microchip certificate as Border Collies were all black and white and he had no microchip scanner prior to sale.

Hamsters on steroids

From:
To: judy@toapayohvets.com
Date: Saturday, April 24, 2010, 5:28 PM

Hi

My name is XXX, I have been to your place before and I have 2 hamsters that require some medical attention.

Both are about 2 years old, 1 male and 1 female.

Male suffers from having skin lesions and pus filled abcess in skin folds, I clean him regularly and he is on prednisolone, his conditions fluctuate between good and bad, my previous vet has suggested to keeping him in a high dosage of steroids to keep the inflammation and growth down since not much can be done and he is rather old. However recently he has been losing alot of weight and the situation is worse.

The female one has been very healthy for most of 2 years. However she likes getting into fights. She has a little wound above her right eye cause by a fight that simply wouldnt heal. However, the major problems that she has a pus filled growth in her mouth, it was originally very small and on the outside(with no pus), so I also started her on prednisolone. Only this week did I really she was walking weirdly and lethargic, upon further inspection I realized her her mouth sacs were swollen and there was solid pus on the growth. I cleaned off the pus with cotton wool. Also she has a deep red swell on her abdomen, near her right leg. I use the same syringe for both hamsters, but I wash it before feeding medication to each of them. Also, she bit me about 2 weeks ago while I was feeding her, as I pulled away she fell off from about half a meter on the back.

I was wondering if you will be free for a consult on monday evening.

I can be contacted via

Cheers
XXX


I am Dr Sing. From what you described, the infections have overwhelmed the hamsters due to your use of steroids. I will be available during office hours. If you wish, you can leave the hamsters in my Surgery for daily check and treatment rather than just do it yourself.

Grooming success

Today, I spoke to two experienced dog groomers today regarding their business successes as they brought their puppies for vaccination.. Their location is in middle-class areas.

GROOMER 1. Couple. Over 40 years old. Children. Vet surgery nearby.
Challenges.
1. Too many young unqualified groomers underprice
2. Not easier to hire good help.

Advantage:
A vet practice nearby. As the vet does not do grooming, this couple is in an envious position of getting grooming clients. Apparently, a tenant in the laundry business blocked the view of their signboard. I have not visited this shop.

GROOMER 2. A gentleman in his 30s. He was born into the pet shop business and I could see that he had developed the pet shop well. The mother is an experienced groomer. I knew the father for over 10 years and recently visited the shop and had a long chat with him. The father had an accident and was discharged from the general hospital on the same day. He became comatose at home and passed away recently. I was shocked as I had talked to the father about his high cholesterol levels.

1. Underpricing is not the way to sustain the profitability.
2. Quality clientele is the way to go.
3. Dog owners who go for the cheapest quote are not wanted.
4. Important point for growing the business is that the dog must look forward to grooming, not being abused and goes home happily.

CONCLUSION
It is the groomer's service that brings in the cases rather than the pricing.

37. Non-closing midline wound

Every vet will encounter non-healing of a long midline surgical wound. Stitch breakdown is one complications of surgery. This Cocker Spaniel is normal but the wound just will not close some 4 weeks after surgery to remove the stones in the intestines by Vet 1.

The dog went home and the stitch broke down. So Vet 1 had to stitch up the wound again. Yet, the wound just does not heal as the tension in this area is very great. I could see the stitches cutting through and the gap getting bigger.

The assistant applied antibiotic powder daily for the last 2 weeks. The wound was moist, as if exudate leaked from below the skin prevents granulation tissue from forming. Thus the long wound persists and the family members esp. children could not stand the sight of a long moist channel in the belly or underside of their dog.

What can be done to resolve the problem so that the dog can go home? This case study of the management of non-healing wounds in a normal dog would be good for Tanya, the intern.

1. Remove all stitches.
2. Wash the wound daily with clean warm water.
3. Use trimaxazole antibiotic powder. Do not apply cream.
4. Pack gauze onto surface of wound.
5. Bandage the lower chest and abdominal area to prevent exudate formation or irritation by the dog's paws. Although a big e-collar was in place, I suspect that there was some way the dog could lick the wound or the stitches were irritating.
6. Remove the bandage daily and repeat steps 1-5.
7. Antibiotics and non-steroidal anti-inflammatory would be given to effect.

Today April 22, 2010 is the first day of bandaging. I took a picture yesterday. I have told Tanya to expect granulation in 14 days if the above procedures were done diligently. Let's see.

Basically, a wound will heal by granulation if it is kept clean and dry. Somehow, this dog's wound had not healed and I suspected that the dog had been irritating it when nobody is looking. It is my hypothesis. Whatever it is, all the owner wants is for the wound to close and the dog to go home.

36. Exclusion of the mum at the award

"It is not the right thing to do," I said to my god-daughter. There would be an award presentation for her at the University. The top 2% of the cohort would be given awards and she asked mum not to attend. After so many years of bringing a child up as a single mum, I would say that this mum should attend since she could afford the fares. But the daughter said no as she had no accommodation for mum. "Most likely no time for mum," I said to her. "As your examinations are just round the corner and at least 3 of your friends had visited you recently, taking up much study time."

Mum was understanding and did not insist. Yet it is one of those very rare occasions in motherhood because out of 100 students, only 2 would be given awards for academic excellence. Maybe the awards should be given at the end of the examinations?

35. Looks can be deceiving. Circum-anal tumour

How to make internship interesting and entertaining? Young people can get bored easily. The following case had some elements of humour for the quiet and serious vet intern whom I tested her on her powers of observation. A 9-year-old male black Labrador Retriever was limping on right fore and walking on 3 legs yesterday. So the careful groomer brought him for consultation. He was to shave this dog bald every 2 months and was worried that if he lifted the leg to clip, the dog would get worse. Possibly he could be blamed for a lame dog after grooming. So, he pre-empted blame by consulting the vet first. This was smart of him.

EXAMINATION OF LAMENESS
How to make internship for Tanya interesting? One method is to ask her what the problem was and to ensure she is hands-on. In this case, I asked the groomer to walk the dog outside the surgery and then trotted as I would do as a racehorse veterinarian. The dog moved normally but suddenly collapsed on her left fore during running. This should make an unforgettable impression on Tanya as the dog was OK now, according to the groomer who had seconds thoughts of consulting me. He was busy and had many grooming cases and therefore he would prefer not to come.

To save time, I got the dog to lie down on the floor, muzzled her and palpated each digit and toe to the shoulder of the right fore. I flexed and extended all joints of the right fore limb, as I did when I was a racehorse veterinarian some 20 years ago.

LOCATION OF PAIN
Palpation at right fore, 4th digit, between phalanx 2 and 3. The dog reacted by withdrawing and whining in pain. So this was the pain location and the diagnosis was sprain of the ligaments in this area. Not a serious problem.

OBSERVATION
"Is that the dog's testicle near the tail?" I queried Tanya as the dog had a big swelling below the tail and near the anus. "Yes," she said immediately. The powers of observation need to be enhanced with age and experience and so Tanya's answer was expected.

"Are you sure?" I asked again. From general observation, it sure looked like one to the lay person. Tanya was sure. "It is in the wrong position," I told Tanya. She had just passed Junior College and so could not be expected to know dog anatomy. On first impressions, this looked very much like the scrotum. This was one of nature's tricks on interns who will be starting first year vet. Looks can be deceiving. A detailed hands-on examination on the table should be done in many cases. The vet or intern must be hands-on.



"The normal testicle is nowhere near the anus or tail in the male dog," I said. "Where is the anus actually? Please push the large spherical swelling to reveal the anus." Tanya used her hand to move the circum-anal tumour to the right as the dog was trying to sit down. There it was. "Is the tumour very near to the anal opening?" I asked. "Yes," she was convinced that this was no testicle.

IS THE MALE DOG NEUTERED?
The vet must be thorough in checking. This dog has no scrotal sacs. "This dog has been neutered," the groomer stated. This is another trick of nature. No scrotal sac does not mean that the dog is neutered. The vet has to be hands-on..

The dog was reluctant to stand for long. However, I had to get him standing and showed Tanya where to locate the two undescended testicles under the skin near the penile area. The groomer tried and felt nothing. The testicles had swollen in size but not excessively. These could be the start of testicular cancer. The only signs of a feminising testicular tumour were that this dog had put on weight and had a very shiny coat. I did not pursue the matter further as the owner was not interested. Undescended testicles do become cancerous and circum-anal tumours are best removed when they are small. But each dog has his own destiny. This dog had interesting teaching material for the vet intern but I don't know she will remember this case during her 4th year which will be in 2015.

CONCLUSION
Neutering of the 9-year-old male dog, especially removal of the two undescended testicles in this dog when he was young would have prevented testicular tumours and circum-anal tumours to develop, in most probability. It is not a guaranteed thing but removal of undescended testicles early will have been best for the older dog as no testicular cancers will be present in old age. Dog owners all over the world seldom give old dogs much notice or time unlike puppies and therefore neutering young ones may avoid much of the hormonal or gender-related tumours in our companion dogs. The vet's responsibility is to inform the owner via the groomer about the circum-anal tumour and a few black ones below the anus. The owner did not want any surgery.

31. Incredible but true Singaporean gangster story

Year: 2003 SARS (Severe Acute Respiratory Syndrome)
Location: Singapore, Desker Road Coffee Shop
Yang: Hokkien Peranakan. Late 30s. Retrenched. Jobless. Estrangement. No kids.
Big brother: Triad chief of Desker neighbourhood
Pig face: A look-out
Susan: Coffeeshop drinks operator


Setbacks in life occur for many people. For one of my old clients, this story was narrated to me some 2 days ago.

In 2003, the SARS virus affected the world economy and people like Harry lost his sales job and could not find any for several months. His marriage was on the rocks and his mum sided with the daughter-in-law. He had to move out.

He decided to open a food stall in a corner two-storey coffeeshop at Desker Road selling mee-siam and mee-goreng. As to why he set up a stall in this notorious red-light district, I forgot to ask him but I made him show me the real place. Not that I don't trust him. His tale was too incredible to be true.

I met him for lunch two days ago. I wanted to keep in touch and learn some secrets of his success as a sales person for a corporation. Learn from the best. Lately, I had been meeting men and women in dire straits and so meeting Harry was so much positive for the spirits.

During lunch at Hans eating his favourite sweet and sour fish , Harry recalled the setback in his life in 2003.

"One day, a young man on a bicycle beckoned him with a finger to come out of his stall to extort money. "Brother, I can give you free food," Harry said. "I have no money to give you." The extortionist was not pleased.

"Why so depressed?" Susan, the coffeeshop lady asked me one day. "Susan is the wife of Tenant and controls the drinks stall," Harry elaborated. "She will barter free drinks for my food. But no beer."

"I don't want to cause trouble," Harry told Susan what happened and Susan told him that he would see some fireworks soon.

"So, what happened?" I asked.

"The gangster chief came for dinner and I served him. Two eggs for his mee-goreng." And I thought the triads and secret societies were wiped out by the number "999" in Singapore since 1990. Many secret societies had numbers but somebody told me that the only gang in Singapore is "999" nowadays. Even in the red-light district of Desker Road. For the benefit of readers, "999" refers to the Singapore police force.

Harry said, "The gangster chief asked his man to get Pig Face (the extortionist on the bicycle).

The gangster chief cursed Pig Face with all the swear words in the Hokkien vocabulary. "When my mother does not cook my dinner, I come here to eat. Why are you harassing Yuan?"

Seeing me perplexed, Harry explained that "Yuan" meant "Handsome" in Hokkien. More expletives. Then his men kicked Pig Face. Pig Face fell and he was kicked more times. Harry is a Hokkien Peranakan and understood the Hokkien foul words well. "Every word from the gangster's mouth is a foul word as he reprimanded Pig Face," Harry did not repeat those expletives as he was the type who does not do it in my presence.

Extortion and violence are part and parcel of secret societies but I did not associate with such elements and this was the first time I had heard of the culture of the gangsters at Desker Road.

"I presume the gangster chief and his men get free meals from you for protection," I said to Harry.

"He always pay for his meals," Harry said to my surprise. "Do you know what Pig Face does for a living?"

"No," I said.

"Pig Face's job was to cycle up and down the alley between Desker and Rowell Road. Whenever he sees the police, he will sound the alarm or ram his bicycle into them. This will alert the sellers of pirated CDs and pornographic material." Since Playboy magazine is prohibited in Singapore, there must be a demand for such items amongst the young national servicemen."

Harry said, "Pig Face is a runner." But runners can be ambitious too to rise up the corporate ladder. Only that he picked the wrong person to extort. All the characters of 2003 had disappeared although the coffee shop, now taken by a new management, still exists.

Harry is now a very successful sales person and earns at least $5,000 per month. He still works for various corporations. But legal ones. He is the type who is afraid of starting up but he has the network and supporters over the past 10 years to support him if he knows how to be an entrepreneur. He has the guaranteed salary at the end of the month. So, why bother getting out of his comfort zone and being at risk of no income. He never takes kick backs when he works for the corporation. Nor does he go for the wine and women.

So, his reputation remains good and there is a great demand for excellent sales person in his industry. Gangsters still exist in Singapore but they are emasculated and not so fearsome as before. They used to be identified with tattoos but many young Singapore females tattoo themselves and therefore, we can't be sure who is the real gangster.

When the chips are down, Harry started a food stall rather than borrowing money from friends and strangers and conning Singaporeans of their money. He is the sort of rare person who is an asset to any business and a role model for young men.

33. Breast nodules in 6-year-old Maltese

As many Singapore dog owners want the cheapest veterinary surgery, many breast tumours in dogs are not sent for histopathology. In this 6-year-old female Maltese which I operated to remove the closed pyometra womb and recorded in:
http://www.bekindtopets.com /dogs/20100135Video_Education_Closed_Pyometra_ToaPayohVets.htm,

the nodules were analysed. The report is as follows:

GROSS DESCRIPTION. A piece of tissue measuring 1.7 cm x 1.5 cm x 0.7cm.
MICROSCOPIC DESCRIPTION. Section shows skin with a well circumscribed nodule in the dermis. It consists of elongated and dilated ducts lined by hyperplastic columnar epithelium with papillary infoldings and which join up to form lobules. A loose fibroblastic stroma is present within the vicinity of the lobules and other areas show lobules of mature cartilage. No malignancy is seen.

DIAGNOSIS
Breast tissue. Benign mixed tumour of the skin


I was surprised. I thought it was a breast tumour. The lab doctor said this was a skin tumour which happened to be over the breast. She would consult another doctor for a second opinion.












Human pathology is applied to this case as the lab does human. She gets dog and cat growth from various vets in Singapore. Mast cell tumours from the limbs in dogs from her experience. Overall, tumours are classified according to human medicine and she said there were differences.

"I believe a cancerous cell is the same, whether from the dog and cat or from human beings," I said.

"There was a vet pathologist I knew many years ago, I can't remember her name," she said. "You know, you can send your biopsy samples to a veterinary pathology lab in Singapore. I don't know why vets send samples to us. We are doing the vets a favour as we do human histopathology," the lady doctor said over the phone.

"I have never heard of a veterinary pathologist in Singapore," I said. "Vet pathologists are post-graduate specialists and I don't know of any vet who is this specialist. Pl let me know the name of the specialist."

"I will phone you back after I find it," she said.

Her text message: "The lab that accepts animal histo is CVL-AVA tel 6316 5172". The lab is in my "backyard!"

31. Old dogs take a longer time to heal

Young people recover fast. But old people take a longer time to recover from illness and surgery. Does this apply to old dogs? Yes.

Each vet has his or her own idea on whether to spay a dog presented with breast tumours and excise the tumours in one anaesthesia and surgery. I always advise spay first and tumour removal 2 weeks later so that the old dog had a higher survival rate during and after surgery. Spaying a dog would take some time. Breast tumour removal takes more time.

As most Singaporean owners are interested in economics, one procedure would satisfy the owner. If the dog does not die. If the dog dies, too bad for the owner. He still has to pay up as he has had signed a surgery and anesthesia consent form informing him of the risks involved.

What about the interest of the old dog? This ought to be paramount. Survival rates are much higher if the anaesthesia is not prolonged as the dog's health is not so good. But the owner has to be sophisticated and educated to understand. And many don't. I had a case of closed pyometra and breast tumours. After spaying to resolve the pyometra problem and not excising the breast tumours at the same time so as to shorten the anaesthetic time and enhance survival rate, the owner forgot about the breast tumour removal advices. That is the typical attitude of many dog owners of older dogs.

So, some vets may feel that it is better to spay and excise breast tumours at one go and this is OK if the dog does not die.

In one case I encounter, the dog had spay, breast tumour removal and dental scaling by a vet. This 13-year-old Pom just looked half dead the next day. I thought it was the end. A maroon redness spread over the breast area. The next day, the sternal area was also red maroon. That meant the whole belly and groin area was dark red due to scratching or licking. The dog seemed to feel very painful despite pain-killer medication.

The dog would not eat and had to be hand-fed with canned food for the next 7 days but she looked brighter on day 7. I/V drips were given. Medication too. Still the dog would not eat on her own.

"Was there any blood test done?" I asked the owner. Apparently not. The couple was lucky to have a dog alive. In such cases, much depends on the vet's decision and the consent of the owner to take the risk in a 3-in-one operation. If the dog lives, it is considered "lucky". If the old dog dies after surgery, it is considered "unlucky."

31. A Puppy & Old Dog with Itchy Backsides

Today is the second Sunday I came back from a break in Perth Australia. Last Sunday, I wrote about 2 related cases of house-breaking in two Cocker spaniels. Today, I saw two cases related to the anus of the dog. One in a 4-month-old Silkie and one in a 5-year-old Pomeranian.

CASE 1. OLD DOG. ANAL SQUAMOUS CELL CARCINOMA

History
Around 3 weeks before the surgery on March 23, 2010, Vet 1 diagnosed anal sacculitis, expressed the anal sacs and sent the dog home. As the dog was still licking the anal area, the owner came to me for a second opinion. "Vet 1 said it is anal sac infection," the personable lady in her 30s said. A wound that does not heal would need review.

KNOWLEDGE OF ANATOMY
In 99% of the cases, it will be anal sacculitis. But in this case, the lump was vertically below the anus, not at 4 or 8 o'clock position. This is where the vet student will find need to apply their knowledge of anatomy, a dull subject. Could this Pom be suffering from a chronic anal sacculitis?











Perianal (circum-anal) tumour resection in a Pomeranian. The anal sacs were normal. A lot of yellow oil was expressed out prior to surgery

Follow-up on Sunday, April 18, 2010
The daughter in her 30s together with her dad, came for a review, 3 weeks after the anal surgery of her male Pom, 5 years old. Many Singapore owners don't bother to come in for reviews as the dog's problems had resolved by surgical excision. The culture of Singaporeans is to be frugal and so they do not go for reviews of their dogs. But this attitude is at the expense of the older dog with tumours, some of which can be prevented.

"What's the result of the pathology report on the tumour?" she asked after I took out the stitches. The details of the histopathology report are as follows:
GROSS DESCRIPTION
The ellipse of skin measures 1.2 cm x 1.0 cm. It has a darkish lesion measures 0.7 cm x 0.6 cm. The underlying subcutaneous fat measures 0.4 cm thick.

MICROSCOPIC EXAMINATION.
The skin sections show ulceration of the epidermis. Beneath the ulcer is an infiltrative squamous cell carcinoma which is composed of irregular, closely-packed nests of atypical squamous cells. There is focal keratin pearl formation. Other areas show irregular anastomosing trabeculae of tumour cells. Most of the atypical squamous cells have voluminous eosinophilic calcification. There is surrounding desmoplasia and focal dystrophic calcification. The tumour reaches the resection margin. No lymphovascular tumour embolus is seen.

DIAGNOSIS
ANAL LESION, EXCISION BIOPSY. Well to moderately-differentiated squamous cell carcinoma.
ADVICES TO OWNER
1. Inspect anal region weekly for any hard lump as the tumour has spread past the resection margins. I explained that it was not possible to cut bigger as the wound will have difficulty in healing.
2. Get lump excised when it is small.
3. Get two retained testicles removed as soon as possible.

CONCLUSION
Many Singapore dog owners don't bother with the dog's backside tumours and so they grow larger. If this circum anal tumour was excised at 0.5cm x 0.5 cm when it was very small and Tardak (androgen inhibition drug) the prognosis is said to be good, according to the Tardak manufacturer.

A red ulcerated bleeding hard lump? I suspected it was a circum anal tumour due to its position. In my 30 years in practice, I had not seen anal sac discharge at the 6 o'clock position, ventral to the anus. This does not mean it will never happen. The probability is rare. So, the owner accepted my advice to get the tumour excised and sent for histopathology. It was a squamous cell carcinoma.

Circum anal tumours occur in old dogs. Dogs are said to be old when they are over 5 years of age. Hard swollen lumps even at the 4 and 8 o'clock position can still be circum anal tumours or perianal tumours. So, be vigilant and not be sued for misdiagnosis in this litigious age.


CASE 2. PUPPY - Clipper Burns. Silkie X, 4 months, male

"Do you think that the groomer was did not do a professional job?" the father of a 5-year-old daughter with big curious eyes asked me. "Before going to the groomer yesterday, he was normal. Today, he would rub his backside and lick it all the time. He was sleepy and did not want to eat. I felt that he has a fever."

The puppy had fever. His anal area had been shaved. His anus had a raised, reddish ring. His scrotal area was brownish for 75% of the area. 3 small brown patches of skin looked as if they were clipper burns.

"Talk to the groomer," I said. "Was the puppy having itchy backside prior to grooming?"

"This will be the last time I send my dog to her," he said. "Where do you find certified dog groomers?"

"Some groomers don't express anal sacs," I said to the groomer when the owner phoned her. "This is because some dogs feel the pain and the owner blames the groomer."

"But the course tells us to express anal sacs as part of the grooming services," the groomer said. "You know about this compulsory course conducted in the Temasek polytechnic?"

"I am only saying that some groomers learn from experiences similar to what has happened know and so, to avoid bad complaints, do not express the anal sac." I said to the young lady who must be a newbie.

"Does it mean groomers don't operate on the anal sac?"

"No, no," I answered. The owner was listening. "It is just that some dogs will experience intense pain after the groomer had expressed the anal sac. You may have to let the owner know after grooming, next time."

In this case, I suspected it was the clipper burns around the shaved anal area and near the scrotal area and subsequent application of a anti-bleeding purplish black potassium permanganate or iodine powder that burned the anal area and scrotum and caused the intense itchiness. The puppy just had to rub her backside to relieve herself of the itch.

The groomer's clipper had nicked the superficial skin of the anal area and below it and the groomer had dabbled he powder onto the wound, as this is the common practice in Singapore. I expressed the anal sacs. There was a very small amount of brown oil plus numerous specks of blackish powder which would be the potassium permanganate or iodine. But to prove it would require money and time.

So I better not instigate the owner who was already angry and would then had a big ugly fight with the poor groomer.

"Will you let me know how much it costs?" the groomer said. "OK," I asked my assistant to phone her after the owner had paid the bill.

This was a case where the vet could pour oil into the fire and made the owner extremely angry. Puppies are like babies. They are especially loved. This could lead to litigation and complaints to the veterinary authorities if the vet or his assistants played the game of running down other professions.

As for the fever, it could be a bacterial infection caused by clipper wounds. Or a viral infection as the dog vaccines protect against the major diseases. In any case, this puppy's primary complaint was an itchy backside and the problem needed to be resolved promptly with medication.