Dec 12, 2011
Nervous silkie terrier. Slight pain in larynx.
Blood test - SGPT/ALT 109 (<59) but otherwise all normal.
Urine test bacteria +++.
Surprising to find bacteria in the urine of a male dog. Licks ventral area.
Calculated dosage 10 kg young dog D=0.4 K=0.5
This is old dog, 7.4 kg. Give 50% of calculated dose
Domitor = 0.15 Ketamine = 0.18 Total 0.33 IV sufficient
Teeth still strong. So only dental scaling
Noted tip of epiglottis red but tonsils normal.
Wednesday, January 18, 2012
Tibetan Mastiff sedation
"Do you do house-calls for a very big dog with itchy ears?" an old client and friend asked me the fees to treat a very big dog at the home of her friend.
"It will be a waste of your money," I said. "Ear disease diagnosis need a microscope and other assistants to help out."
Tibetan Mastiff, Male, 7 months, 53kg. Healthy. Ear canals with black wax seen daily. Had lots of ticks recently when walked outdoors.
EAR IRRIGATION & LICK GRANULOMA INJECTION
A gentle giant but still it is best not to traumatise him. My client said: "My friend's dog was hit by a car, bit the owner's arm later."
SEDATION
Do a proper calculation as follows:
My guideline IV anaesthesia
10 kg young dog Domitor = 0.4 ml, Ketamine = 0.5 ml combined IV
53 kg young dog D= 2.12ml K=2.65ml
I gave 40%, D=0.85 K=1.06 Total = 1.85ml IV as this would be a short anaesthesia of around 10 minutes needed for me to irrigate the ears and inject the 3 lick granulomas with prednisolone intra-lesionally.
"My dog will not get up on the table," the owner said.
"No dog will climb up a veterinary table," I explained to the gentleman. "I will carry his back half and you carry his chest. Talk to your dog while we carry or he will feel he is being murdered."
The dog was carried up on the table by the owner and my assistant Min without a protest.
Now, to find that leg vein as the coat is so thick. The foreleg was thick as this was a man-sized dog. I don't clip off the hairs to see the vein as it is not acceptable.
"Tighten the tourniquet," I said to Min who had not seen large a gigantic dog. Singapore's dogs are usually small breeds and Tibetan Mastiffs are as rare as snowfall.
I pressed the swelling and drew the blood into the syringe. I injected the 1.85 ml IV.
The dog slept at this 40% of calculated dosage. I taught the owner how to check the ear canal and insert the cotton bud, smell it and then I irrigated the ear canals.
After that I injected pred into the 3 lick granulomas. The dog did twitched a little on the 3rd lick granuloma being injected but was otherwise knocked out.
4949 - 4958. Itchy ears and three interdigital cysts/lick granulomas must be treated early - Tibetan Mastiff. If itchiness of ears and paws are not treated early by your vet, the dog self-mutilates to relieve himself of the intense itchiness. Hair loss and skin infections present themselves soon
"I need to wake up the dog," I said as I injected Antisedan 1.0 ml IM on the right hip muscles. He woke up 10 minutes later and that was great.
The above 40% dosage was sufficient for a short painless ear irrigation and lick granuloma injection of less than 10 minutes.
Know how to check the ears and prevent interdigital cysts and lick granulomas in a big furry breed as it is a high maintenance breed. Brush daily and inspect daily. Clean ears. It is extremely difficult to avoid ticks. Wear booties or check paws after a walk. "I avoid the grass," the owner just walked the dog in the evenings along the road.
The following advices to the owner who had bought a very strong hair blower for Tibetan Mastiff were:
1. Daily brushing of the coat with the slicker and another brush rather than hot air blowing everyday as the dog has some skin itchiness and eczema, probably due to the earlier tick bite infestations.
2. Daily inspection of the ears
3. No rough cotton wool to dig the ears
4. There is no need to pour his ear lotion by pumping into the ears every day if the ears are clean. He use to do it every day. Daily ear dropping had resulted in brown black wax being produced.
To check the ear canals as to whether they are clean or not, I taught him how to insert the cotton bud into the ear canal. See the colour of the tip and smell it. If the colour is clear, the ear has no dirt.
5. Washing of the paws with an anti-fungal solution and rinsing.
6. A long bath tub is needed if he wants to de-tick his dog.
7. Get a big table (as long as my surgery table) and put the dog on top of the table to do his grooming. This is easier on his back.
8. Avoid tick areas. Inspect the four paws when the dog is back from outside walks. He had used Frontline sprays and spots-on insecticides but these have become ineffective over time. Wearing of booties when going out for walks is not practical as the dog needs to wear out his nails. So, daily inspection of the paws for the smallest baby tick after exercise.
This was about the biggest dog in Singapore. As big as a young man. A very gentle giant. If he bites the vet, the vet's fingers can be crushed to pieces. So it is important that he be treated gently and to use sedation if there is pain during treatment, as there is, in the intra-lesion injection of his lick granulomas.
Overall, he was good and could walk back to the car. I helped to carry him onto the boot of the friend's SUV. The owner's BMW was probably not big enough! It was great to meet up with this old client who had consulted Dr Vanessa for the past times as I was seldom around in the afternoons. I asked her to make an appointment to let me check out her dog's skin condition when she said that "old" vets are more experienced. Every vet needs to start at the beginning but young vets need to gain the experience with time. Experience is gained not only be practising but by reading a lot of veterinary literature on relevant situations and consulting other vets for how they treat certain conditions. It may sound stupid to ask other vets but much can be learned from asking.
NINE more images are at:
http://www.sinpets.com/dogs/20120119Tibetan-Mastiff-lick-granulomas-ear-itchiness-singapore_ToaPayohVets.htm
"It will be a waste of your money," I said. "Ear disease diagnosis need a microscope and other assistants to help out."
Tibetan Mastiff, Male, 7 months, 53kg. Healthy. Ear canals with black wax seen daily. Had lots of ticks recently when walked outdoors.
EAR IRRIGATION & LICK GRANULOMA INJECTION
A gentle giant but still it is best not to traumatise him. My client said: "My friend's dog was hit by a car, bit the owner's arm later."
SEDATION
Do a proper calculation as follows:
My guideline IV anaesthesia
10 kg young dog Domitor = 0.4 ml, Ketamine = 0.5 ml combined IV
53 kg young dog D= 2.12ml K=2.65ml
I gave 40%, D=0.85 K=1.06 Total = 1.85ml IV as this would be a short anaesthesia of around 10 minutes needed for me to irrigate the ears and inject the 3 lick granulomas with prednisolone intra-lesionally.
"My dog will not get up on the table," the owner said.
"No dog will climb up a veterinary table," I explained to the gentleman. "I will carry his back half and you carry his chest. Talk to your dog while we carry or he will feel he is being murdered."
The dog was carried up on the table by the owner and my assistant Min without a protest.
Now, to find that leg vein as the coat is so thick. The foreleg was thick as this was a man-sized dog. I don't clip off the hairs to see the vein as it is not acceptable.
"Tighten the tourniquet," I said to Min who had not seen large a gigantic dog. Singapore's dogs are usually small breeds and Tibetan Mastiffs are as rare as snowfall.
I pressed the swelling and drew the blood into the syringe. I injected the 1.85 ml IV.
The dog slept at this 40% of calculated dosage. I taught the owner how to check the ear canal and insert the cotton bud, smell it and then I irrigated the ear canals.
After that I injected pred into the 3 lick granulomas. The dog did twitched a little on the 3rd lick granuloma being injected but was otherwise knocked out.
4949 - 4958. Itchy ears and three interdigital cysts/lick granulomas must be treated early - Tibetan Mastiff. If itchiness of ears and paws are not treated early by your vet, the dog self-mutilates to relieve himself of the intense itchiness. Hair loss and skin infections present themselves soon
"I need to wake up the dog," I said as I injected Antisedan 1.0 ml IM on the right hip muscles. He woke up 10 minutes later and that was great.
The above 40% dosage was sufficient for a short painless ear irrigation and lick granuloma injection of less than 10 minutes.
Know how to check the ears and prevent interdigital cysts and lick granulomas in a big furry breed as it is a high maintenance breed. Brush daily and inspect daily. Clean ears. It is extremely difficult to avoid ticks. Wear booties or check paws after a walk. "I avoid the grass," the owner just walked the dog in the evenings along the road.
The following advices to the owner who had bought a very strong hair blower for Tibetan Mastiff were:
1. Daily brushing of the coat with the slicker and another brush rather than hot air blowing everyday as the dog has some skin itchiness and eczema, probably due to the earlier tick bite infestations.
2. Daily inspection of the ears
3. No rough cotton wool to dig the ears
4. There is no need to pour his ear lotion by pumping into the ears every day if the ears are clean. He use to do it every day. Daily ear dropping had resulted in brown black wax being produced.
To check the ear canals as to whether they are clean or not, I taught him how to insert the cotton bud into the ear canal. See the colour of the tip and smell it. If the colour is clear, the ear has no dirt.
5. Washing of the paws with an anti-fungal solution and rinsing.
6. A long bath tub is needed if he wants to de-tick his dog.
7. Get a big table (as long as my surgery table) and put the dog on top of the table to do his grooming. This is easier on his back.
8. Avoid tick areas. Inspect the four paws when the dog is back from outside walks. He had used Frontline sprays and spots-on insecticides but these have become ineffective over time. Wearing of booties when going out for walks is not practical as the dog needs to wear out his nails. So, daily inspection of the paws for the smallest baby tick after exercise.
This was about the biggest dog in Singapore. As big as a young man. A very gentle giant. If he bites the vet, the vet's fingers can be crushed to pieces. So it is important that he be treated gently and to use sedation if there is pain during treatment, as there is, in the intra-lesion injection of his lick granulomas.
Overall, he was good and could walk back to the car. I helped to carry him onto the boot of the friend's SUV. The owner's BMW was probably not big enough! It was great to meet up with this old client who had consulted Dr Vanessa for the past times as I was seldom around in the afternoons. I asked her to make an appointment to let me check out her dog's skin condition when she said that "old" vets are more experienced. Every vet needs to start at the beginning but young vets need to gain the experience with time. Experience is gained not only be practising but by reading a lot of veterinary literature on relevant situations and consulting other vets for how they treat certain conditions. It may sound stupid to ask other vets but much can be learned from asking.
NINE more images are at:
http://www.sinpets.com/dogs/20120119Tibetan-Mastiff-lick-granulomas-ear-itchiness-singapore_ToaPayohVets.htm
Tuesday, January 17, 2012
824. Vet surgery - productivity - cat spay
I am sharing my 30 years of experiences of a cat spay with others interested and to assess my timing as a guide for associate vets
Cat, 1 year +, Female, 2.6 kg
Sent in for spay toeday Jan 17, 2012
Surgeon: Dr Sing
Suture: 2-0 Polysorb braided lactomer C14 cutting 24 mm 3/8
Preparation: Cat was clipped bald before sedation. This saves a lot of time.
Sedation:
xylazine 0.1 ml + ketamine 0.4 ml IM
Wait 10 minutes. Still alert
Need top up isoflurane for few seconds - good analgesia
Timing
10.33am xylazine + ketamine IM
10.43 am Isoflurane 5% start reducing to 0.5%
10.52 am Skin incision started
10.54 am lst ovary (left) hooked
10.59 am 2nd overy (right) hooked
11.02 am uterine body ligated. 2 ligatures
11.08 am stitch linea alba 3 simple interrupted
11.11 am stitched skin 2 horizontal mattress
11.12 am skin stitched up
Sedation to skin stitched 10.33 - 11.12 am = 39 minutes
Tolfedine and baytril injection SC
One bandage on wound to be replaced on Day 3 with new one. I usually don't prescribe e-collar as cats hate them
Baytril x 1 tab 1/4 tab/day
Total cost of spay $150
Cat, 1 year +, Female, 2.6 kg
Sent in for spay toeday Jan 17, 2012
Surgeon: Dr Sing
Suture: 2-0 Polysorb braided lactomer C14 cutting 24 mm 3/8
Preparation: Cat was clipped bald before sedation. This saves a lot of time.
Sedation:
xylazine 0.1 ml + ketamine 0.4 ml IM
Wait 10 minutes. Still alert
Need top up isoflurane for few seconds - good analgesia
Timing
10.33am xylazine + ketamine IM
10.43 am Isoflurane 5% start reducing to 0.5%
10.52 am Skin incision started
10.54 am lst ovary (left) hooked
10.59 am 2nd overy (right) hooked
11.02 am uterine body ligated. 2 ligatures
11.08 am stitch linea alba 3 simple interrupted
11.11 am stitched skin 2 horizontal mattress
11.12 am skin stitched up
Sedation to skin stitched 10.33 - 11.12 am = 39 minutes
Tolfedine and baytril injection SC
One bandage on wound to be replaced on Day 3 with new one. I usually don't prescribe e-collar as cats hate them
Baytril x 1 tab 1/4 tab/day
Total cost of spay $150
Sunday Jan 15, 2012 interesting cases - tonsillar tumours
Bright sunshine, blue skies, white cloud.
Case 1.
A 12-year-old well cared for female, Golden Retriever, drooling on the left side only.
Vet 1 did dental scaling and extraction. Dog then started "drooling on left side."
Vet 1 then smoothened left lower PM4 since the upper PM4 and others had been extracted. Still the drooling persisted.
Vet 2 was "thorough" according to the owner. He X-rayed and ultrasound the whole body. "How about the head and neck area?" I asked. The owner did not think this was done.
According to the owner, said a big lump was present on the left back of mouth and a spherical lump on left neck below the submandibular. He recommended steroids as an alternative to euthanasia and surgery. When the dog was on steroids, she was very hungry and drank a lot. When given Tramadol, the drooling stopped. The dog had lost a lot of weight.
The dog did not want the mouth to be opened but I managed to open it and showed the owner and her sister (anaesthetist) the large tonsillar tumour (at least 3 cm x 2 cm). Pain and ulcerations there would be the cause of drooling.
CASE 2
Surprising an 8-year-old small breed came in for review after this Golden Retriever. I had done dental scaling 4 weeks ago. The dog objected strongly to the mouth being opened, but I could see the right tonsil as reddish lump 0.5 x 0.5 cm. I had told the owner of this lump seen during dental scaling. It could be a tonsillar tumour. The owner would wait and see.
If dog owners regularly check the dog's teeth and keep it cleaned or scaled yearly or two-yearly, many oral tumours would not form. This is the same with human beings too. A poor hygiene in the mouth predisposes to oral tumours and this is commonly reported.
CASE 3
"See the lump under the right eye," I had pointed it out to her at the waiting area. Later, she gave me permission to take a photo. "That is the beginning of a malar abscess - infection from the root of the back tooth into the sinus and bulging out." She had come for advice as Vet 1 wanted her to sign an indemnity form for dental work in case the dog dies under anaesthesia.
"How many deaths were under you while you did dental scaling?" the young lady was very worried about her 8-year-old chihuahua who had Stage 4 periodontal disease (the worst stage) and asked Dr Vanessa who was handling the case together with me. She did most of the talking. Many times, I would see the case together with her and most of the time, she would be doing the talking. Some owners would think I am an assistant and know nothing and so why was I giving medical advices? I usually identify myself as a vet first.
"How many?" the young lady asked again. "Ask Dr Sing," Dr Vanessa replied.
"In my over 30 years of dental scaling and I can only speak for myself, I don't have any cases of dogs doing dental work dying on the operating table," I replied. "Dental work or scaling takes a short time of less than 15 minutes unlike long surgeries and therefore, anaesthetic deaths are uncommon in many senior dogs. A very close focus on anaethesia by the vet and his assistant is very important. In old dogs, I don't give IV sedation but just isoflurane gas only."
The young lady was already red-eyed but well read about anaesthetic deaths of dogs on the operating table. I could understand her concern for the Chihuahua which was in good bodily condition unlike those skinny ones. A bit plump is better as this indicated that this dog was well cared for and had a good appetite (meaning good health too.)
"A blood test is taken to screen the dog's health first," Dr Vanessa said as she examined the heart and lungs and found them OK.
"A 10-day course of antibiotics before dental scaling is what I recommend usually to clients," I said. "The dental scaling is done around 7-10 days later and the mouth would be free of bacteria."
The boyfriend asked the young lady (in her late 20s) to wait for the blood test. So, it was quite an emotional consultation.
This Sunday was an eventful one as my assistant Min fell sick with flu. He left at 10 am to see the doctor and had the day off. Ms Ong, a junior college student with an offer from Glasgow Univ for vet studies came for her first day and so she got to see all the cases since the other three interns (Kim quitted suddenly as she found that it was too costly to study vet medicine, Mr Lim was said to have denque fever, Grace, going to 2nd year vet student from Sydney Univ would come only on Monday.
It was a bright sunshine Sunday and we managed to close at 5.30 pm. I advised Dr Vanessa to record as she communicate to the client as this is what I do, but she had her own style of writing only after everything. So there was much delay. Record what the client said e.g. history on the spot. That would be the efficient way as many clients dislike waiting too long. Some of the clients had to wait more than an hour and from my view at the reception, many prefer short consultations and getting the problem resolved. Waiting more than 15 minutes at the doctor is not a happy event for any Singaporean on a Sunday when there are so many things to do!
Case 1.
A 12-year-old well cared for female, Golden Retriever, drooling on the left side only.
Vet 1 did dental scaling and extraction. Dog then started "drooling on left side."
Vet 1 then smoothened left lower PM4 since the upper PM4 and others had been extracted. Still the drooling persisted.
Vet 2 was "thorough" according to the owner. He X-rayed and ultrasound the whole body. "How about the head and neck area?" I asked. The owner did not think this was done.
According to the owner, said a big lump was present on the left back of mouth and a spherical lump on left neck below the submandibular. He recommended steroids as an alternative to euthanasia and surgery. When the dog was on steroids, she was very hungry and drank a lot. When given Tramadol, the drooling stopped. The dog had lost a lot of weight.
The dog did not want the mouth to be opened but I managed to open it and showed the owner and her sister (anaesthetist) the large tonsillar tumour (at least 3 cm x 2 cm). Pain and ulcerations there would be the cause of drooling.
CASE 2
Surprising an 8-year-old small breed came in for review after this Golden Retriever. I had done dental scaling 4 weeks ago. The dog objected strongly to the mouth being opened, but I could see the right tonsil as reddish lump 0.5 x 0.5 cm. I had told the owner of this lump seen during dental scaling. It could be a tonsillar tumour. The owner would wait and see.
If dog owners regularly check the dog's teeth and keep it cleaned or scaled yearly or two-yearly, many oral tumours would not form. This is the same with human beings too. A poor hygiene in the mouth predisposes to oral tumours and this is commonly reported.
CASE 3
"See the lump under the right eye," I had pointed it out to her at the waiting area. Later, she gave me permission to take a photo. "That is the beginning of a malar abscess - infection from the root of the back tooth into the sinus and bulging out." She had come for advice as Vet 1 wanted her to sign an indemnity form for dental work in case the dog dies under anaesthesia.
"How many deaths were under you while you did dental scaling?" the young lady was very worried about her 8-year-old chihuahua who had Stage 4 periodontal disease (the worst stage) and asked Dr Vanessa who was handling the case together with me. She did most of the talking. Many times, I would see the case together with her and most of the time, she would be doing the talking. Some owners would think I am an assistant and know nothing and so why was I giving medical advices? I usually identify myself as a vet first.
"How many?" the young lady asked again. "Ask Dr Sing," Dr Vanessa replied.
"In my over 30 years of dental scaling and I can only speak for myself, I don't have any cases of dogs doing dental work dying on the operating table," I replied. "Dental work or scaling takes a short time of less than 15 minutes unlike long surgeries and therefore, anaesthetic deaths are uncommon in many senior dogs. A very close focus on anaethesia by the vet and his assistant is very important. In old dogs, I don't give IV sedation but just isoflurane gas only."
The young lady was already red-eyed but well read about anaesthetic deaths of dogs on the operating table. I could understand her concern for the Chihuahua which was in good bodily condition unlike those skinny ones. A bit plump is better as this indicated that this dog was well cared for and had a good appetite (meaning good health too.)
"A blood test is taken to screen the dog's health first," Dr Vanessa said as she examined the heart and lungs and found them OK.
"A 10-day course of antibiotics before dental scaling is what I recommend usually to clients," I said. "The dental scaling is done around 7-10 days later and the mouth would be free of bacteria."
The boyfriend asked the young lady (in her late 20s) to wait for the blood test. So, it was quite an emotional consultation.
This Sunday was an eventful one as my assistant Min fell sick with flu. He left at 10 am to see the doctor and had the day off. Ms Ong, a junior college student with an offer from Glasgow Univ for vet studies came for her first day and so she got to see all the cases since the other three interns (Kim quitted suddenly as she found that it was too costly to study vet medicine, Mr Lim was said to have denque fever, Grace, going to 2nd year vet student from Sydney Univ would come only on Monday.
It was a bright sunshine Sunday and we managed to close at 5.30 pm. I advised Dr Vanessa to record as she communicate to the client as this is what I do, but she had her own style of writing only after everything. So there was much delay. Record what the client said e.g. history on the spot. That would be the efficient way as many clients dislike waiting too long. Some of the clients had to wait more than an hour and from my view at the reception, many prefer short consultations and getting the problem resolved. Waiting more than 15 minutes at the doctor is not a happy event for any Singaporean on a Sunday when there are so many things to do!
Sunday, January 15, 2012
822. A twitching eye. Acquired Oculomotor Nerve Palsy in a Golden Retriever
"Is the right sunken eyeball present since puppyhood?" I asked the lady owner who showed me a bottle of eyedrops prescribed by Vet 1. No other medication was given by Vet 1 who diagnosed eye infection and advised review if the eye condition did not improve.
Case of the Golden Retriever with a twitching eye
Golden Retriever, Male, 8 years. Weight below normal.
Complaint: Fits 2 days ago. I advised bringing the dog to the Surgery rather than a house-call which would waste money as the dog needed more detailed examination.
History: Right eye is smaller than left eye. Vet 1 prescribed eye drops.
Right eye: Drooping eyelid, retracted eyeball, twitching uncontrollably as if blinking at me when reviewed. Occasional twitching (videoed by Nicole).
3rd eyelid covered the right eyeball partially since it has sunken in.
Hospitalised. Blood and urine tests are minimum tests done.
Lumbar puncture for cerebrospinal fluid analysis, MRI scan of the brain are not done at this stage to lower vet costs.
Oculomotor nerve palsy and brain involvement leading to ptosis & fits
OCULOMOTOR NERVE is the 3rd cranial nerve. It innervates the muscles co controlling eye movements, the upper eyelid muscle and the muscles controlling pupil constriction.
In this dog, the Oculomotor nerve and its branches had been damaged or inflamed causing the eyeball to sink inwards, the eyelid to droop. However, since the dog suffered from fits, the lesion is likely to be inside the brain e.g. brain tumour or aneurysm near the Oculomotor nerve or inflammation.
Blood test - high serum urea
Urine test - proteinuria
Brain scan and lumbar puncture are costly options which need to be discussed with the owner.
Other contributing causes
Trigeminal neuralgia involving only the ophthalmic nerve? The trigeminal nerve has 3 branches - ophthalmic nerve, maxillary nerve and mandibular nerve. There does not appear to be facial spasm or dropped jaw and so, the maxillary and mandibular nerves are not involved. The ophthalmic nerve may be involved.
Diagnosis
Brain scan and lumbar puncture are needed for a definitive diagnosis of acquired Oculomotor nerve palsy in this dog but it is costly.
Treatment
Anti-fits and review. The dog can eat and drink and has no more fits when on anti-fit medication. Steroids were not prescribed. To review.
Updates and more pictures at:
http://www.sinpets.com/dogs/20120115oculomotor-nerve-palsy-golden-retriever-fits-singapore_ToaPayohVets.htm
Case of the Golden Retriever with a twitching eye
Golden Retriever, Male, 8 years. Weight below normal.
Complaint: Fits 2 days ago. I advised bringing the dog to the Surgery rather than a house-call which would waste money as the dog needed more detailed examination.
History: Right eye is smaller than left eye. Vet 1 prescribed eye drops.
Right eye: Drooping eyelid, retracted eyeball, twitching uncontrollably as if blinking at me when reviewed. Occasional twitching (videoed by Nicole).
3rd eyelid covered the right eyeball partially since it has sunken in.
Hospitalised. Blood and urine tests are minimum tests done.
Lumbar puncture for cerebrospinal fluid analysis, MRI scan of the brain are not done at this stage to lower vet costs.
Oculomotor nerve palsy and brain involvement leading to ptosis & fits
OCULOMOTOR NERVE is the 3rd cranial nerve. It innervates the muscles co controlling eye movements, the upper eyelid muscle and the muscles controlling pupil constriction.
In this dog, the Oculomotor nerve and its branches had been damaged or inflamed causing the eyeball to sink inwards, the eyelid to droop. However, since the dog suffered from fits, the lesion is likely to be inside the brain e.g. brain tumour or aneurysm near the Oculomotor nerve or inflammation.
Blood test - high serum urea
Urine test - proteinuria
Brain scan and lumbar puncture are costly options which need to be discussed with the owner.
Other contributing causes
Trigeminal neuralgia involving only the ophthalmic nerve? The trigeminal nerve has 3 branches - ophthalmic nerve, maxillary nerve and mandibular nerve. There does not appear to be facial spasm or dropped jaw and so, the maxillary and mandibular nerves are not involved. The ophthalmic nerve may be involved.
Diagnosis
Brain scan and lumbar puncture are needed for a definitive diagnosis of acquired Oculomotor nerve palsy in this dog but it is costly.
Treatment
Anti-fits and review. The dog can eat and drink and has no more fits when on anti-fit medication. Steroids were not prescribed. To review.
Updates and more pictures at:
http://www.sinpets.com/dogs/20120115oculomotor-nerve-palsy-golden-retriever-fits-singapore_ToaPayohVets.htm
Saturday, January 14, 2012
Educational Video from Toa Payoh Vets - Itchy joints in a dwarf hamster
http://www.youtube.com/watch?v=D3yl4GmBBU4&feature=youtu.be
UTI = Urinary Tract Infection
UTI = Urinary Tract Infection
820. E-mail case study. Basic principles in toilet training a puppy in Singapore
E-MAIL TO DR SING JAN 12, 2012
Hi Dr Sing Kong Yuen,
I really need help toilet training my new puppy. We have tried different things from fencing to open roaming and back to fencing.
She is a Female Tibetan terrier
Presently (3.5-4)months old
Born 20/09/2012 In Brisbane
where had lots of space to play and was fenced up with siblings
Came to Singapore from breeder in Australia when 2.5-3 months old
Flew with brother to new home in Singapore
When she flew over, she was confined to a small cage with brother
for over 10 hours so had to pee/ poo there while travelling
We stay in a 2 story house with a garden.
We have 2 young kids who adore her and who keep going into her fenced area to play with her or taking her out to run.
Kids laughing just seems to excite her and so confuses her when being told off by me bur kids giggling.
We have an 8 year old male Tibetan terrier who is an angel ( very passive) and is toilet trained to pee outside in garden twice a day when we take him out.
Fencing and toilet- training:
We brought her home and fenced her with collapsible fence(1.8 by 1.8)m.
During the day, she stayed in the fenced area downstairs.
One side had sleeping box & toys & water bottle and food served on other side. Newspaper with pee smell on side wall of fence (for soilage)as in photo. At same time,also, tried taking her to shower cubicle to pee/poo with pee tray or newspaper. Failed miserably. Would sleep there or whine. We would wait and cajole for over (15-20) min but she would not do her business and then soon after that she would come out and she wiuld pee on toilet floor or room floor/mat.
At night, Slept upstairs in bedroom in smaller fenced area (0.6 by 0.6)m with sleeping box and water bottle. When we suspected she needed to pee/poo, she was taken to a different upstairs shower cubicle but same result of sleeping / whining in there and peeing later outside.
Feeding:
Being Fed 3x/day since she came.
(7am/12.30pm/7pm)
For first week, Food was left in pen till finished and sometimes hand fed as figured puppy was getting used to new environment and separation anxiety.
About 2 weeks later, once started eating fairly well, we picked up food after one hour whether eaten or not. Tried a bit of cajoling if not eaten much but figured will learn to eat faster when realises food not there all the time.
Also, had to get water bottle as she had tendency to jump into water bowl and splash and play with water and bowl.
We would let her run around for a while on & off around the house and with kids and other dog and then re- fence her but she would soil anytime & anywhere.
2-3 weeks into her arrival, we changed strategies. We made mistake of letting her loose in house all day and only putting newspaper on outside balcony near garden. We thought we had confused her earlier with where to pee/ poo (too many options for locations to pee/poo including upstairs bathroom cubicle and paper in fence and downstairs bathroom cubicle, so we changed it to one location near balcony with paper and put a (0.6 by 0.6)m fence around. So when saw her sniffing we would put her there. But she would go to sleep in there and pee/ poo once out.
A while later,we changed to not confining/ fencing peeing area as we thought she was confused with fence also being used to punish her. But without fence she kept running off the newspaper and then of course she peed/ pooed in wrong place. As a punishment, we would make her see/ smell the pee/ poo and at same time say 'no no' and then place her in fenced area (0.6 by 0.6)m Would say' bad girl'or 'no, no' after pointing to the wrong location for soiling.
A month after she arrived, we have started smacking her bum for:
biting/ barking/ nipping people/ nipping other dogs/eating wrong things(ie: poo/ shoes) /running out of gate/ eating leaves in garden.
We also tried the loud noise ( old empty drink can with coins) to teach her it's wrong but seems to scare her quite a bit.
Is this correct? What's your opinion on this?
We are frustrated as now:
•She pees/ poos whenever she eats & everywhere and house smelling
•She refuses to pee when take her to newspaper with pee trainer smell and instead will sleep on the paper and whine softly but no pee/poo there and soon after being 'released' she will pee/ poo somewhere else ( no fixed place). No matter how long you wait.
•She might then eat/ play with her poo
•She whines/barks when confined / alone in punishment fence
Plays with her poo/ Tries to eat poo
Seems confused about toilet place
Sleeps in toilet confined area/ in toilet cubicle/ on newspaper with pee- trainer smell
When realize she wants to poo/pee so take her to open area with newspaper to pee/ poo she runs away or sleeps on newspaper and soon after does it somewhere else on floor/ carpet
. Sometimes chews newspaper
As of today, after reading some of your cases, we have decided to refence her (1.8 by 1.8)m with toys on one side and newspaper at other side and food placed near toys at meal time. Also decided to feed her earlier 7am/ 12.30 & 5pm so that has time to empty bladder before sleeping.
For example today,
She ate at 5pm and at 7.30pm still just sleeping on the paper. Not peed/ pooed.
So at 7.30pm i decided i will get her out to exercise and run and instead she ran to kitchen and peed there. We brought her back to the newspaper in fence and she went to sleep on it.
At 8pm kids went into fence to play for 20min. Then she peed just next to paper on wooden floor.
At 8.30pm, not pooed yet.
At 10pm plan to take her to sleep in fenced area in bedroom. ( does not like to sleep alone and once upstairs she goes to bed).
What do I do if she keeps peeing in fenced area but not on newspaper?
Do dogs poo after every meal? How long do I wait for her to pee/poo before allowing her to go to bedroom?
Also, aiming to slowly move to 2 meals a day by 6 months. Is that ok?
Please please help and advice me about toilet training her.
About to pull my hair out.
This is becoming a battle of wills.
I'm also worried she might be stubborn enough to not pee/ poo in fenced area on paper and may end up with kidney/ urine infections.
How long do I just let her not pee/poo in the fenced area? Basically, how long do I wait?
What if she does not do it on newspaper and does it in other parts of fenced area? What do I do?
Do I need to cover entire fenced area with newspaper?
Every time she pees on floor in fence, I spray the smell repellant and disinfectant and wipe it off. Is that correct?
Should elimination area be in/ out of playpen?
At night, can she sleep in fenced area in bedroom?
At what age can we take puppy for walk on leash?
Eventually want him to pee outside the house once toilet -trained like my older dog.
Does paper-training confuse or hamper that?
I was hoping to take her for walks with older dog in hope that would copy older dog when peeing/pooing but she tries to bite leash and lies on floor & refuses to walk and hates collar so unable to do that.
Will send you photos of the fenced area and her sleeping fence too.
Really waiting eagerly for your wise words as really quite lost & frustrated!!!
Yours sincerely,
Name of Owner
E-MAIL REPLY FROM DR SING DATED JAN 14, 2012
Thank you for your email and details. My reply focuses on toilet training as you will need to read up or get a dog trainer to answer the other questions. Books are available at the National Library and the info is in the internet.
In this reply, I can only provide you the concept and principles of toilet training a puppy in Singapore based on success achieved by other Singaporeans in my survey of over 600 puppies.
1. It takes 2-8 weeks of confinement of a puppy to achieve success. Much depends on the intelligence of the puppy, the hard work and time spent by the owner, the distractions of family members and friends. For example, a couple living alone with the puppy will have a higher rate of success within 2-4 weeks than a big family with so many interferences and distractions affecting toilet training.
2. Patience and perseverance and research of the owner. Many owners are sabotaged by their family members giving various instructions and treats affecting the success in toilet training.
3. Focus on one method of confinement e.g playpen fencing confinement.
4. My case studies would have given you some ideas of the successes of various types of housing plans for puppies. Basically, strict confinement 2-8 weeks is the main part of toilet training. Positive or negative reinforcement training and others are needed.
It is not possible for me to advise you in detail in your case as each puppy has different management.
Hi Dr Sing Kong Yuen,
I really need help toilet training my new puppy. We have tried different things from fencing to open roaming and back to fencing.
She is a Female Tibetan terrier
Presently (3.5-4)months old
Born 20/09/2012 In Brisbane
where had lots of space to play and was fenced up with siblings
Came to Singapore from breeder in Australia when 2.5-3 months old
Flew with brother to new home in Singapore
When she flew over, she was confined to a small cage with brother
for over 10 hours so had to pee/ poo there while travelling
We stay in a 2 story house with a garden.
We have 2 young kids who adore her and who keep going into her fenced area to play with her or taking her out to run.
Kids laughing just seems to excite her and so confuses her when being told off by me bur kids giggling.
We have an 8 year old male Tibetan terrier who is an angel ( very passive) and is toilet trained to pee outside in garden twice a day when we take him out.
Fencing and toilet- training:
We brought her home and fenced her with collapsible fence(1.8 by 1.8)m.
During the day, she stayed in the fenced area downstairs.
One side had sleeping box & toys & water bottle and food served on other side. Newspaper with pee smell on side wall of fence (for soilage)as in photo. At same time,also, tried taking her to shower cubicle to pee/poo with pee tray or newspaper. Failed miserably. Would sleep there or whine. We would wait and cajole for over (15-20) min but she would not do her business and then soon after that she would come out and she wiuld pee on toilet floor or room floor/mat.
At night, Slept upstairs in bedroom in smaller fenced area (0.6 by 0.6)m with sleeping box and water bottle. When we suspected she needed to pee/poo, she was taken to a different upstairs shower cubicle but same result of sleeping / whining in there and peeing later outside.
Feeding:
Being Fed 3x/day since she came.
(7am/12.30pm/7pm)
For first week, Food was left in pen till finished and sometimes hand fed as figured puppy was getting used to new environment and separation anxiety.
About 2 weeks later, once started eating fairly well, we picked up food after one hour whether eaten or not. Tried a bit of cajoling if not eaten much but figured will learn to eat faster when realises food not there all the time.
Also, had to get water bottle as she had tendency to jump into water bowl and splash and play with water and bowl.
We would let her run around for a while on & off around the house and with kids and other dog and then re- fence her but she would soil anytime & anywhere.
2-3 weeks into her arrival, we changed strategies. We made mistake of letting her loose in house all day and only putting newspaper on outside balcony near garden. We thought we had confused her earlier with where to pee/ poo (too many options for locations to pee/poo including upstairs bathroom cubicle and paper in fence and downstairs bathroom cubicle, so we changed it to one location near balcony with paper and put a (0.6 by 0.6)m fence around. So when saw her sniffing we would put her there. But she would go to sleep in there and pee/ poo once out.
A while later,we changed to not confining/ fencing peeing area as we thought she was confused with fence also being used to punish her. But without fence she kept running off the newspaper and then of course she peed/ pooed in wrong place. As a punishment, we would make her see/ smell the pee/ poo and at same time say 'no no' and then place her in fenced area (0.6 by 0.6)m Would say' bad girl'or 'no, no' after pointing to the wrong location for soiling.
A month after she arrived, we have started smacking her bum for:
biting/ barking/ nipping people/ nipping other dogs/eating wrong things(ie: poo/ shoes) /running out of gate/ eating leaves in garden.
We also tried the loud noise ( old empty drink can with coins) to teach her it's wrong but seems to scare her quite a bit.
Is this correct? What's your opinion on this?
We are frustrated as now:
•She pees/ poos whenever she eats & everywhere and house smelling
•She refuses to pee when take her to newspaper with pee trainer smell and instead will sleep on the paper and whine softly but no pee/poo there and soon after being 'released' she will pee/ poo somewhere else ( no fixed place). No matter how long you wait.
•She might then eat/ play with her poo
•She whines/barks when confined / alone in punishment fence
Plays with her poo/ Tries to eat poo
Seems confused about toilet place
Sleeps in toilet confined area/ in toilet cubicle/ on newspaper with pee- trainer smell
When realize she wants to poo/pee so take her to open area with newspaper to pee/ poo she runs away or sleeps on newspaper and soon after does it somewhere else on floor/ carpet
. Sometimes chews newspaper
As of today, after reading some of your cases, we have decided to refence her (1.8 by 1.8)m with toys on one side and newspaper at other side and food placed near toys at meal time. Also decided to feed her earlier 7am/ 12.30 & 5pm so that has time to empty bladder before sleeping.
For example today,
She ate at 5pm and at 7.30pm still just sleeping on the paper. Not peed/ pooed.
So at 7.30pm i decided i will get her out to exercise and run and instead she ran to kitchen and peed there. We brought her back to the newspaper in fence and she went to sleep on it.
At 8pm kids went into fence to play for 20min. Then she peed just next to paper on wooden floor.
At 8.30pm, not pooed yet.
At 10pm plan to take her to sleep in fenced area in bedroom. ( does not like to sleep alone and once upstairs she goes to bed).
What do I do if she keeps peeing in fenced area but not on newspaper?
Do dogs poo after every meal? How long do I wait for her to pee/poo before allowing her to go to bedroom?
Also, aiming to slowly move to 2 meals a day by 6 months. Is that ok?
Please please help and advice me about toilet training her.
About to pull my hair out.
This is becoming a battle of wills.
I'm also worried she might be stubborn enough to not pee/ poo in fenced area on paper and may end up with kidney/ urine infections.
How long do I just let her not pee/poo in the fenced area? Basically, how long do I wait?
What if she does not do it on newspaper and does it in other parts of fenced area? What do I do?
Do I need to cover entire fenced area with newspaper?
Every time she pees on floor in fence, I spray the smell repellant and disinfectant and wipe it off. Is that correct?
Should elimination area be in/ out of playpen?
At night, can she sleep in fenced area in bedroom?
At what age can we take puppy for walk on leash?
Eventually want him to pee outside the house once toilet -trained like my older dog.
Does paper-training confuse or hamper that?
I was hoping to take her for walks with older dog in hope that would copy older dog when peeing/pooing but she tries to bite leash and lies on floor & refuses to walk and hates collar so unable to do that.
Will send you photos of the fenced area and her sleeping fence too.
Really waiting eagerly for your wise words as really quite lost & frustrated!!!
Yours sincerely,
Name of Owner
E-MAIL REPLY FROM DR SING DATED JAN 14, 2012
Thank you for your email and details. My reply focuses on toilet training as you will need to read up or get a dog trainer to answer the other questions. Books are available at the National Library and the info is in the internet.
In this reply, I can only provide you the concept and principles of toilet training a puppy in Singapore based on success achieved by other Singaporeans in my survey of over 600 puppies.
1. It takes 2-8 weeks of confinement of a puppy to achieve success. Much depends on the intelligence of the puppy, the hard work and time spent by the owner, the distractions of family members and friends. For example, a couple living alone with the puppy will have a higher rate of success within 2-4 weeks than a big family with so many interferences and distractions affecting toilet training.
2. Patience and perseverance and research of the owner. Many owners are sabotaged by their family members giving various instructions and treats affecting the success in toilet training.
3. Focus on one method of confinement e.g playpen fencing confinement.
4. My case studies would have given you some ideas of the successes of various types of housing plans for puppies. Basically, strict confinement 2-8 weeks is the main part of toilet training. Positive or negative reinforcement training and others are needed.
It is not possible for me to advise you in detail in your case as each puppy has different management.
Friday, January 13, 2012
819. Performance of the vet surgeon: Urinary stone surgery
I am collecting data to improve the processes and system and the productivity of vet surgery by an associate vets at Toa Payoh Vets. Timings depend on the complexity of the surgical case and therefore there is no fixed period of time.
Ferocious biting Shih Tzu, Male, 8 years. 13 urinary stones inside the bladder
TP 16915
Op Date: Jan 12, 2012
Surgeon: Associate vet
A. Sedation injection 3.11 pm
Skin prep, Isoflurane gas
B. Skin incision 3.38pm
C. Skin stitched up 4.11 pm
B-A = 27 minutes. Dog was ferocious and therefore prep had to be done after sedation
C-B = 33 minutes. This is acceptable for an experienced vet doing cystostomy alone. All 13 stones were inside the bladder and accounted for. Therefore there was no need to do urethrostomy. The stones must have been flushed back into the bladder under anaesthesia by Vet 1 during the after midnight visit.
Blood test by Vet 1 - Significant findings, 12.40am Jan 12, 2012
MCV high 79 (60-77)
WBC high 26 (5.5 -17)
NEU high 21 (2-12)
MONO high 3 (0.3-2)
BASO high 0.16 (0-1)
PLT high 660 (175-500)
BUN high 31 (7-27)
ALKP high 233 (23-212)
K high 6.5 (3.5-5.8)
Ferocious biting Shih Tzu, Male, 8 years. 13 urinary stones inside the bladder
TP 16915
Op Date: Jan 12, 2012
Surgeon: Associate vet
A. Sedation injection 3.11 pm
Skin prep, Isoflurane gas
B. Skin incision 3.38pm
C. Skin stitched up 4.11 pm
B-A = 27 minutes. Dog was ferocious and therefore prep had to be done after sedation
C-B = 33 minutes. This is acceptable for an experienced vet doing cystostomy alone. All 13 stones were inside the bladder and accounted for. Therefore there was no need to do urethrostomy. The stones must have been flushed back into the bladder under anaesthesia by Vet 1 during the after midnight visit.
Blood test by Vet 1 - Significant findings, 12.40am Jan 12, 2012
MCV high 79 (60-77)
WBC high 26 (5.5 -17)
NEU high 21 (2-12)
MONO high 3 (0.3-2)
BASO high 0.16 (0-1)
PLT high 660 (175-500)
BUN high 31 (7-27)
ALKP high 233 (23-212)
K high 6.5 (3.5-5.8)
818. How many urinary stones?
An X-ray of the Shih Tzu with a recurrent urolithiasis and an X-ray. "How many stones?" I asked my assistant Min as part of my mentoring process.
"Eleven," he said. "Well there are 13," I showed him the 2 stones hidden near the pelvic bones.
"Better make sure that you don't flush the bladder or urethra too vigorously duringb cystotomy," I said to Dr Vanessa who would be operating. "13 stones are expected." She got 13 stones. Well done. All stones were inside the bladder and she had used a bigger catheter to ensure no more stones are left behind.
"The stones must be sent for analysis," I said. "The dog had a previous surgery 1 year ago and the stones had recurred."
"Eleven," he said. "Well there are 13," I showed him the 2 stones hidden near the pelvic bones.
"Better make sure that you don't flush the bladder or urethra too vigorously duringb cystotomy," I said to Dr Vanessa who would be operating. "13 stones are expected." She got 13 stones. Well done. All stones were inside the bladder and she had used a bigger catheter to ensure no more stones are left behind.
"The stones must be sent for analysis," I said. "The dog had a previous surgery 1 year ago and the stones had recurred."
817. The Golden Retriever has a twitching eye
Vet 1 treated this 8-year-old Golden Retriever with a bottle of eye drops and asked the owner to return if the right eye infection (eyes 3/4 closed) had not cured. This was what the owner said to me. "Is the sunken eyeball normal?" I asked the owner as the right eyeball had retracted (enopthalmos), the upper eyelid had drooped (ptosis) and the nictitating membrane (3rd eyelid) had covered the eye.
"The right eyeball was of same size and position as the left," the lady said. She had phoned for a house-call but I advised her to bring the dog dog. Her dog had developed fits.
"This is not a simple case of eye infection," I said to my assistant. It appeared to be a 3rd cranial nerve or brain problem. A blood test and urine test are done. X-rays are advised but this would be costly. The fits were controlled and the dog went home after 3 days.
I had the dog bathed one day before he went home. His ear canals were irrigated (no ear infections).
I told Nicole to take a video of the right eyelid twitching. Very rare. The dog was very thin. Proteinuria and high blood urea. Could also have kidney disorder as well as 3rd cranial nerve palsy. Is there a cure?
"The right eyeball was of same size and position as the left," the lady said. She had phoned for a house-call but I advised her to bring the dog dog. Her dog had developed fits.
"This is not a simple case of eye infection," I said to my assistant. It appeared to be a 3rd cranial nerve or brain problem. A blood test and urine test are done. X-rays are advised but this would be costly. The fits were controlled and the dog went home after 3 days.
I had the dog bathed one day before he went home. His ear canals were irrigated (no ear infections).
I told Nicole to take a video of the right eyelid twitching. Very rare. The dog was very thin. Proteinuria and high blood urea. Could also have kidney disorder as well as 3rd cranial nerve palsy. Is there a cure?
Subscribe to:
Posts (Atom)