522. A hamster's orange urine - ageing or illness?

E-MAIL REPLY TO DR SING DATED JULY 29, 2011
Hi Doctor Sing,

Hope this email finds you well.

I've another dwarf hamster (1yr 7mths old, male). Recently, i noticed that his urine turns darker in colour. Last week, it was kind of orange and this week slightly better as you can see in the attached picture.

When I flip him over, i noticed that his fur around belly & bottom area have also turned yellow/orange from the urine stains which cannot be removed with water.

Despite so, his appetite & bowel movement remains normal just that his breathing/heart beat seems a lot faster even while he's asleep.

Appreciate your advice if this is normal in aging hamster or could it be sign of any illness that requires medical treatment.

Enclosed is the picture for your review.

Thank you for your time and hope to hear from you soon.

Best regards,
Name of lady owner


E-MAIL REPLY FROM DR SING DATED JULY 29, 2011
Thank you for your email. It is very difficult to know what is the cause of the urine stains or change of colour unless a urine sample can be collected for urine analysis.

Your picture of urine colour shows some orange or reddish colour of urine as well as yellowish urine but no diagnosis can be made based on colour. The urine needs to be collected and analysed by the laboratory.

A change of urine colour may be due to a kidney disorder, urinary tract infection, urinary tract tumours, food colouring, traumatic injury (falling down from climbing cage) to the bladder and kidneys or other reasons.

I advise
1. collecting a urine sample via a plastic bag or come to the Surgery for me to collect a urine sample.
2. Let me know how much water he is drinking. Is it more than normal?

With best wishes.

With best wishes.

Sunday's interesting cases - stitching up a big backside gap

Sunday at 9.30 am was scheduled for me to stitch up the poor Silkie's big backside holes. He had a big Taiwanese mango lump in his backside some 10 days ago. The intestines and bladder popped out from his pelvis and rubbed against the skin. He licked till the skin became paper-thin and you could see the intestines just lying under. The blood supply and the subcutaneous fat and skin dermis layers were almost wiped out. No blood flowed. So, the area became white as snow (see pictures).

After I repaired the 3 hernias, the thin skin became gangrenous. So, the skin died day by day and 3 big hole appeared. I took 1 hour to re-do and re-stitch. If not done, the stools just drop into it.

520. Sunday's interesting case. The whistling Bull Terrier

Sunday

A young couple wanted to neuter a good looking solidly built miniature 2-year-old Bull Terrier and came at 9.30 am on Sunday July 24, 2011.
A hyperexcitable dog, resisting handling and turning upside down to examine his testicles.
"Listen to the whistling sounds," I asked the husband to listen to the stethoscope. I could hear the heart sounds separately but there was a continuous whistling sound, as if the dog has a condition similar to the racehorse - laryngeal hemiplegia.

"They are heart sounds," he said. Loud distinct whistles. "Well, they are lung sounds," I said. The heart sounds were muffled. Well, the dog had a history of fainting when over-exerted. When he played vigvigorously with the bigger standard Bull Terrier, he could just run out of breath and lie down for a while, as if to catch his breath.

A highly risky candidate for anaesthesia. I checked the gums. Excellent pink colour. However, the left inside lip had a yellow ulcer and several holes. "Bitten by the other bull terrier?" I asked. "Probably," the husband said.

Two undescended testicles. With the dog upside down, I could palpate the left one. The right one was barely felt as it slipped inside the body.
"My advice is to prepare for general anaesthesia rather than just take out one. When the dog is down, his right testicle may just disappear inside. Under anaesthesia, I can open up the abdomen and locate and get it out. (Undescended testicle can become cancerous years later). Neutering was to reduce his hyperexcitability.

BLOOD TEST
The couple agreed to the complete blood test. Fortunately, this was done as the liver enzymes were high while the platelets were below normal. "Why?" the husband asked.
"Did you feed herbal or other supplements?"
"Yes," he said. "One iodine capsule per day since young."
"Is the dosage recommended for the dog?" I asked.
"One capsule is for adult people," he said.

I advised no surgery, no iodine or other supplements and wait one month for another blood test. The liver could have had been damaged by the iodine and its other ingredients. "It is not just iodine alone inside the capsule," I said to the husband. "The manufacturer will add other substances. Over the years, the liver could have been damaged.

519. Advantix spot-on for dogs only, not for cats - update

The following has been updated today as there was an error in the earlier article stating that imidacloprid is toxic to cats. Bayer Thailand pointed out this error, namely that imidacloprid is safe for use in cats but it is permethrin that is toxic in cats. Since Advantix contains imidacloprid and permethrin, it is NOT safe for use in cats e.g. in the treatment of FAD (flea bite dermatitis).

On March 13, 2010, I attended a continuing education programme "Canine Vector-Borne Diseases in Pet Practice - Focused on Singapore" conducted by Dr Susanne Siebert. The contents were mainly on diseases transmitted by ticks, fleas, mosquitoes and sand flies. Heart worms and intestinal worms were discussed too.

For 4th & 5h year students, veterinary parasitology and pharmacology can be very boring as there are so many names and drugs and their efficacy, safety, ease of application, treatment schedule and ability to only treat or treat and prevent. How is the lecture relevant to the real world? I hope the following summary of my comments on "Bayer Parasite Solutions" may make their studies more enjoyable and in case they get tested at oral examinations in their final year.

1. Drontal Plus - One-dose dewormer
2. Advantix - Kills and repels. Not to be used in Cats.
3. Kiltix collars - Long-acting specialist against ticks
4. Bayticol - Anti-tick dogwash
5. Negasunt - Anti-maggots.

1. Drontal Plus (synergistic febantel and pyrantel formulation with praziquantel). Broad spectrum against round, hook, whip and tapeworms, nematode larvae and (when given daily for 3 consecutive days) Giardia which is a zoonosis. Safe in puppies, pregnant and nursing bitches. Strategic deworming is 4x/year with one dose. It seems that puppies as young as 2 weeks old can be dewormed. Note that Giardia treatment needs 3 consecutive days instead of one dose. Puppy can be given at 2 weeks of age and 2-weekly till they are part of the strategic deworming 4X/year.

2. Advantix Spot On (synergistic imidacioprid 10% and permethrin 50%). Kills fleas/larvae, ticks, mosquitoes, lice, stable/biting flies. Repels ticks, mosquitoes, sand flies, stable/biting flies. Repellency (anti-feeding) means that the parasites do not bite or attach to the body on contact with the dog. Explain this to the owner who may see one or two ticks on the body after application. Remove all ticks.

Safe in puppies over 7 weeks old, pregnant and nursing bitches.

NOT FOR CATS (imidacioprid is safe for use in cats but it is permethrin that cannot be metabolised by cats. Therefore Advantix is contra-indicated in cats). Ensure that cats do not groom the dog's skin that have had been applied Advantix.

Do not apply earlier than 1 day after bath and do not bathe earlier than 2 days after application. This advice does not seem practical for Singapore dog owners who usually bathe their dogs more than 1X weekly). If Singapore's dogs are usually bathed >1x/week, application of Advantix every 2 weeks instead of 4 weeks is needed.

Advantix is said to have acaricidal and repellent efficacy against tick infestations (Rhipicephalus sanguineus and Ixodes ricinus for 4 weeks, and Dermacentor reticulatus for 3 weeks). It kills fleas within 1 day following treatment and prevents further flea infestations for 4 weeks and so can be used as part of a Flea Allergy Dermatitis (FAD) treatment in dogs. But it is NOT to be used for FAD in cats (due to the permethrin component being toxic in cats).

Apply in 3 or more spots along the back of the dog. 5 spots are better.

In heavily infested dogs, use Bayticol dog wash first, apply Advantix and also treat the environment to prevent reinfestation (vacuum, wash bedding, clean tiles, apply Bayticol at 1 ml per 1.5 litres of water to tiled/concrete areas, not grassy areas). Remove all ticks still attached to the dogs after the use of Bayticol dog wash.
3. Kiltix collars (2.25% flumethrin and 10% propoxur). Spectrum of activity is 6-7 months. Longest lasting tickicide. Works within 24 hours reaching even remote parts of the body like the tail of the dog. Flumethrin has some repellency efficacy. But not comparable to Advantix's repellency. So, cannot claim that ticks, if trying to attach to the treated dog, will die very soon.

Does not lose its properties when it is wet. But take off collar before bath or swimming frequently. Also, you cannot use Advantix with collar as the collar will be affected. I don't see much interest in Singapore compared to the spot-ons like Frontline being available freely in the pet shop and convenient to use. I may try Kiltix collars but they are rarely available and so inconvenient for Singaporean dog owners who are city dwellers.

4. Bayticol 6% emulsion. (flumethrin 6%). Used as dip, spray, wash, environmental treatment. Efficacy against tick (40ppm), flea, lice, mite (30ppm) and environmental control (40ppm).
Larvicidal effect, inhibits oviposition (check label claims).
Residual efficacy: 7 days after application of 30 ppm, 3 ppm are still present on the hair.
How do vets apply Bayticol 6% emulsion?  In heavily infested dogs, use this onto dog to kill ticks first. Pull out all dead attached ticks. Then give Advantix 24 hours later to dog as spot on for 5 spots. Goes home with Advantix to be given 2-weekly for 2 months. De-contaminate the environment.

In one example of 4 Siberian Huskies with heavy infestations of ticks. I got the dog's coat clipped. Then I inject 1.0 ml ivomectin SC. After 12 hours, I applied Frontline Plus spot on. The dogs were sent home. However on Day 3, the owner returned the dogs as they have "ticks". All ticks were still attached to the body but they were dead. My assistants plucked out the ticks. An anti-tick solution (e.g. Bayticol 6% or Carrington Dog Wash) may be too risky for these dogs since they have got ivomectin and Frontline Plus.

However, spot-ons should be applied 2-4 weekly. This may be costly when the owner has 4 big dogs. There was a reinfestation because the owner's workers had neglected to apply the spot-ons or check the 4 dogs in his factory. The pictures of the de-ticking of one Husky case are shown below:



De-ticking heavily infested dogs at Toa Payoh Vets
Salivation: Obviously, if the dog licks the wash before it is dry, the dog will salivate and the owner may not be happy. Salivation will also occur even when the wash is dried, as I have seen such cases. Owners are worried, although the literature in "Promeris" - a competitor's spot on product claims that there is no need to worry as the dog is not poisoned but is showing "hyper salivation". In practice, the vet or groomer has to care about the owner's worry after application of the wash. One smart groomer advised me that she gets the dog to wear an e-collar and she has no such problems after tick wash with the Carrington Dog Wash (another competitor). The amount used is 1 ml per 1.5 liters of water. Check the label.

5. Negasunt powder (coumaphos, propoxuf, sulfanilamide). Dust thinly on wounds cleaned from dirt, pus and tissue debris. Maggots will crawl out.

Protects wound against bacterial infection and infestation with fly larvae, kills flies and fly larvae (larvicidal, repellent, anti-bacterial, adhesive, dying, deodorant, scar tissue forming activities.

CONCLUSION. Indoor and outdoor dogs, use Drontal plus with Advantix, Kiltix, Negasunt and Bayticol when necessary against all ecto-parasites.

Bayticol - Heavily infested dogs. Wash dog to remove parasites. Then apply Advantix or Kiltix 24 hours later for prevention.
 
Advantix. Heavily infested dogs. Use Advantix and Kiltix 24 hours later. Next Advantix application should be 5 cm apart from the Kiltix collar as the latter is affected. Negasunt. Can be applied together with Kiltix if wounds are not too close to collar. Same as for Advantix spot-on area.

IN TOA PAYOH VETS DE-TICKING PROGRAM FOR HEAVILY INFESTED DOGS, we clip the dog's coat, apply Bayticol 6% emulsion wash. Then 24 hours later, we pluck out all ticks before sending the dog home with Advantix spots-on to be applied every 3 weekly. We check the dogs for tick-borne diseases.

P.S
Tick infested dogs can get sick with tick fever or other diseases and some do die. Owners wanting to de-tick their dogs, tel: 6254 3326, 9668-6469, e-mail judy@toapayohvets.com
for appointment.

The website with pictures are at:
http://www.bekindtopets.com/dogs/20100196ectoparasites_control_dogs_ToaPayohVets.htm

Sunday's interesting cases

Sunday, July 24, 2011
I showed to my assistant Min the importance of proper recording for blood samples being sent to the lab from the example on this Sunday. Some assistants and employees take a much longer time to understand the significance of advices and this is the biodiversity of the human species.

A new client brought in a dog called Ted. I was going to operate on another dog called Tedi. "If you don't write the reference number, but just Ted or Tedi in the blood collection bottles of two dogs, the Lab may make mistakes in giving you the results. To them, they think Ted and Tedi are the same dog.

From now on, I told Min that he has to let the associate vets check the names and reference number before submission. The responsibility will be the vets, not his.

Baytril oral to hamsters and rabbits

Baytril comes in 10% bottle. I taught my assistant how to dilute it for hamsters and small mammals.

1 ml Baytril + 4 ml water = 2.5%
0.01 ml/25g twice a day for dwarf hamsters.
0.2ml/kg twice a day for rabbits etc.

3 hamster surgery follow up today

Surprisingly, two calls this morning Jul 25, 2011

1. Hamster 1 and 2, Female, 2 years old, lady owner phoned up. Day 3 of surgery. Hamster 2 (amputee) attempted to bite stitches. What to do? Plaster? Not practical.
Hamster 1 - Ear canal ablation. Hamster eating. Objected strongly to cleaning off blood from ear. So done once only. Advised to do more cleaning. Isolfurane gas anaesthesia only but very stressful ear canal removal. Took 2 days to recover.

Hamster 2 - Confirmed leg tumour was only 5 mm diameter 6 weeks ago but grew furiously big to 1.5 cm. Leg amputated. Starting exercise wheeling. 30 g before surgery. After surgery 19 g. Hates Biolapis.

Feedback from owner who noted the following.
1. Lowered water bottle. Can't drink as only one hind leg.
2. Food bowl too high now. Hard to climb out. Use bowl from those used in Chinese household for chilli and soya sauce. A bit of spillage but hamster could eat.
3. Tempted with favourite bean sprouts. Then give baytril oral.
This hamster needed sedation IM. First day, one drop Zoletil 50 IM. No effect. Just looked at me. So, suspend all operation till 24 hours later. 2nd day, 3 drops OK. Leg bone tumour extended to inguinal. Amputated. Quite active within 1 hour.

Advices
No exercise wheel. Stitches quite many. Blue nylon 5/0
Continue on paper litter. Not so rough. But hamsters loved to shred them.


2. Hamster 3 - 81 g - loves bread, husband rushed down. 2 5/0 nylon stitches bitten off today on Day 8. Bleeding. Wife phoned. OK at clinic. No bleeding. Cut off two entangled nylon stitches. 1 remaining. Husband did not want it cut off. To observe. To reduce weight further. 79 g.

Transparent 5/0 nylon taken out

Feedback, fully active and normal on Day 3 but would eat after operation. Daily exercise on wheel. Owner quite happy.

515. Anaesthesia & Surgery In Old Dogs - 13 years old

HIGH-RISK ANAESTHETIC CASES
AN EXAMPLE FOR VETS AT TOA PAYOH VETS

CASE STUDY FOR VERY OLD DOGS

HISTORY
On Oct 28, 2010. Not eating. Tense abdomen. Uterus thickened. High WBC count (44 compared to normal 6-17). Suspected closed pyometra. Operated by Dr Vanessa Lin. Recovered fully. Now, the owner requested dental work. Review medical history and make judgment as to the risks of another anaesthesia.


October July 25, 2011
Jack Russell, Female, Spayed, 5.6kg, 38.6 deg C. Excellent bodily condition
Today, 10 am, phoned gentleman owner to confirm request for dental checkup and extract loose teeth. 10.30 am Dental scaling & extraction of M1 (left upper, roots exposed), PM2 (left upper, roots exposed) & PM2 (right upper, roots exposed). Overall, teeth in good condition.

Last dinner at 7 pm yesterday
Sedation: Domitor 0.1 ml + Ketamine 0.2 ml IV. Shivering.
Others: Atropine 0.5ml IM. No shivering.
10 minutes: Isoflurane 0.2 - 1%

Dental scaling. 3 loose teeth with exposed roots extracted. Sleeps
Antidote: Antisedan 0.25 ml IM. Wakes up in 5 miniutes.
Antibiotic & pain-killer: Tolfedine 0.7 ml & Baytril 0.7 ml SC

Duration of anaesthesia: 15 minutes. No IV drip.
IV drip not given as the dog was eating and drinking with normal stools and urine for the past 3 days.
Dog OK. Goes home.

CONCLUSION
1. In weak and sick old dogs, IV drip should be given. Baytril via IV. Lasix IV if indicated in heart diseased dogs.
2. Blood test strongly advised. Record in case file if the owner objected to blood test.
3. Informed consent form must be filled up properly be the vet and signed by the owner. Case record should note risks and complications being explained.
4. Anti-sedan to be given to wake up the dog.
5. In dogs with heart disease, IV drip post-op.
6. Post-op pain-killer tolfedine + antibiotics SC as soon as possible after surgery

514. The "reasonable" man test

The following is related to an old dog with a chronic ear problem. An earlier e-mail was posted in Blog No. 508 at:
http://2010vets.blogspot.com/2011/07/508-ear-canal-ablation-in-dog-email.html


E-MAIL TO DR SING DATED JULY 22, 2011

Hi Dr Sing,

Thank you for your reply!
(Ear Canal Ablation surgery is the only cure in chronic otitis externa with growths)--- URL is:
http://www.sinpets.com/F5/20110722vertical-total-ear-canal-ablation-surgery-chronic-ear-infections-tumours-dog-toapayohvets-singapore.htm


I am not confident with the surgery. Although he had one last year to laser which i mentioned, the vet used gas (i think) and promised to take less than an hour to minimize the risks, (he woke up immediately on the table and stood up wagging tail) his kidney suffered about 6-8 months after that (BUN was 188+ & before surgery 38). I don't know for sure if it was related to the surgery (or chemo) but I've read that it is possible. I cannot help but wonder if your 11-yr old patient died from post surgery...

May i ask, (I've not dared to ask other vets face to face) do you think the ear tumor is going to kill my dog if i leave it as it is...? How is it going to develop...? Will it go into the brain or pressing on it?

Thanks a million.

E-MAIL FROM DR SING DATED JULY 23, 2011

Thank you for your reply. Old dogs are at the end of their life-span and therefore are very high anaesthetic risks.

Any outcome in a complaint is judged by a "reasonable" man test in a court of law. Will a "reasonable" man think that the death of my 11-year-old dog patient that had ear canal ablation and passed away in his sleep 4 months later was due to the surgery?

A reasonable man will think that the death of patient that dies during or within a day or two after surgery is due to the surgery. After 4 months, a reasonable man does not think that the death of this 11-year-old dog is due to the surgery especially when he has been eating and drinking normally after convalescence.

As every dog is an individual and the exact nature of his ear growths are not known due to no histopathology results (as to whether the growths are cancerous or not) being available from you, it will be difficult to predict what will be the final outcome of your dog.

With chronic otitis externa and ear canal growths, infections of the ear canal get more severe, leading to the rupture of the ear drum and spread of the infections to the middle and inner ear may occur. If the growths are cancerous, they may spread to other areas including the brain.

Best wishes.

Neutering a second Yorkshire Terrier, male

I had an e-mail appointment to neuter a Yorkshire Terrier, 2.7 kg only. He was so well behaved. "But in the house, he lords over us," the sister with the brownest sun tan I had even seen in a Singaporean Chinese girl. Usually this tan is for Caucasians who sunbathe for hours.

Teeth scaling needed. Two lower puppy canine teeth were extracted as they accumulated food in between the permanent and puppy canines.

Xylazine 0.15 ml IM. Then isoflurane gas by mask and intubate. Smooth surgery. I was very surprised that there was very little bleeding from inside and from the skin suture. Only one ligation of the spermatic cord using 3-forcep clamp method and closed method of neuter. This was one of those very satisfying neuters. I advised tolfedine 4mg/kg oral for first 24 hours and then once daily. Tolfedine was given by SC post-op.

The other Yorkshire Terrier owner (also a lady) did not contact me at all after neuter. Similar suture. Similar query from my assistant Mr Min again: "No subcuticular suture?" when he saw me giving one 2/0 horizontal mattress. He must have had been impressed with seeing many subcuticular sutures done by my associate vets and so he was much surprised as to why I did not do it.

Good post-op outcome (lack of complications) counts. He had not seen any skin irritation complaint from my case if you ask him. "Subcuticular sutures are not necessary if you don't traumatise the surrounding tissues and close with horizontal mattress," I told Mr Min who is a veterinarian qualified in Myanmar. Well, he is new to Singapore veterinary surgery and he can see 3 vets with 3 different styles. So, it is up to him to learn the best practices from the 3 vets. And be a better vet.

There is no need to return for stitch removal and so I don't see the Yorkshire anymore. No news is good news.