Jun 14, 2012, a young man came to buy the green shampoo again as his CKC is still scratching his body after his groomer clipping the coat short a 1-cm length as requested by his mum. That is, no balding look.
"The dog's ears are OK. No more ear odour," he told me that the lateral ear resection canal had been effective. I took out the thick file of 27 medical records from Jul 18, 2009 to Apr 20, 2012.
SIGNIFICANT CLINICAL FINDINGS FROM CASE FILES
CKC, Blenheim, Male, DOB Apr 2, 2008
Jul 20, 08 Neuter
Apr 3, 10 2 years old. Two ears infection
May 3, 09 Pus in ears. Ear irrigation
Jul 11, 10 Ear discharge
Jul 11, 10 Left ear canal resection. Dr Sing
Sep 6, 10 Right ear canal resection. Dr Vanessa
Sep 20 10 Ear infection
Oct 18, 10 Ear scratching and head shaking
Oct 19, 10 Lab test. L ear swab Candida krusei isolated after 2 days of incubation
Jun 6, 11 Ear ointment x 1
Oct 21, 11 Ear ointment. Smell from the rear
Apr 6, 12 Generalised skin infections
Jun 14, 12 Came for anti-fungal wash for skin rashes which develop when the coat is long. However, he is very satisfied with the ear surgeries done as there is no more foul ear smells.
CONCLUSION
Many dog owners don't bring their dogs for further check-ups for skin infections and prefer to take medication like drugs or shampoos in the belief that these will be sufficient. I advised actual examination as the dog may still have a generalised skin fungal and yeast infection.
Thursday, June 14, 2012
1023. Adopted young cat with low platelet count spayed
On Wed, Jun 13, 2012 at 9:18 PM, <...@gmail.com> wrote:
Hi Dr Sing,
XXXi appears almost recovered from surgery already.
Her appetite is tremedous, and she has finally pooped tonight.
A lot !
Attached is a picture of her belly.
Sorry we couldn't get a more overt and clear one.
She appears & behaves normal.
Are there any signs we should look out for, that might indicate otherwise ?
We were also wondering when we can remove the e-collar, and also when can we let her out of confinement ?
She is getting progressively faster in trying to escape.
Like a game !
Thank you so much, and looking forward to your reply.
EMAIL REPLY FROM DR SING DATED JUNE 14, 2012
Hi
I was quite busy past 2 days. Thanks for 2 emails. Low platelets and low total white cell count indicate that the cat had some toxicaemia a few days ago. It is hard to say what it is but the eosinophils of 5.5% is high. There is the eosinophila granulomatous complex in cats (mouth ulcers, salivation) but this may not be the disease in your cat.
Your cat was FIV negative and that is good news.
Blood tests are an aid to diagnosis and the clinical signs are much more important. Presently, she is in good health and so that is the present status.
Can't see anything in your image of the surgical wound area. Please clean it and apply a new plaster for the next 10 days. E-collar can be taken out after 7 days if the stitches are strong and if the cat is not bothered. Best wishes.
Total WCC 5.3 (5.5 -19.5)
N 63%
L 28%
M 3.5%
E 5.5%
B 0.1%
RBC 6.8 (5-10)
Platelets 38 (300-800)
No platelet clumps seen
Large platelets present
Fed on Barf Diet changing from canned commercial diet and was losing weight compared to previous check up at 2nd vaccination.
E-MAIL TO DR SING DATED JUN 15, 2012
Hi Dr Sing,
Thanks for the comforting reply. Good to know that there's nothing to worry about.
Hopefully, the next time she has to see u is when she is due for her annual vaccination.
Once again, thanks very much.
Sunday, June 10, 2012
1022. Sunday June 10, 2012 interesting cases
Sunday June 10, 2012
Bright sunshine, blue skies.
Case 1. Golden Retriever shakes and trembles after Antisedan IM injection.
As the electricity supply to Toa Payoh Vets and nearby tenants was cut off due to the need to maintenance by the Landlord, it was too dark to do 3rd eyelid irrigation and right elbow granuloma injection.
So I did it outside. This was not ideal but the lighting from the morning sun was good.
At 10.15 am, the 28kg GR was given Dom + Ket at 50% IV by Dr Daniel. The dog fell asleep fast. I got the table outside the surgery where there was bright sunshine. Time was of the essence and I hurried my assistant Min, intern Sally and Dr Daniel to move on with the preparations. There was no isoflurane gas back up now as we were outside the surgery and the couple (owners) were watching.|
The GR was still asleep. So I decided to give Antisedan 1.0 ml IV. But Dr Daniel and then I could not locate the cephalic vein. Around 4 clients with barking dogs and a cat came and there was no time to waste. I gave the Antisedan IM. Nothing happened for 2 minutes. "It takes a longer time to wake up when IM injection is given," I said to the concerned wife. Then the dog inside the waiting room held his head up. There was much barking from other dogs. A contractor across the block was using his machine to drill something.
The GR started to shake and tremble non-stop. He panted. He could not get up to walk. "He is excited by the barking and the machine noises," I said. I rushed into the Surgery to get the atropine injection and gave him IM. Still his whole body was trembling.
"Put the dog inside the boot of the SUV," I said. "He needs to be far away from the barking dogs." The owner drove the dog to the other end of the block and parked the car there. The dog was still trembling but much less. I brought a bowl of water. He did not want it, as if afraid of water. "His head keeps turning right and left," the wife said. "It is part of the excitation effects of the ketamine," I explained. "Normally, the dog should wake up in a quiet place at the back of my surgery, but this morning was unusual in that there was so much barking from the other dogs."
After 30 minutes, the dog had stopped trembling, drank his water and was sent home. This side effect of excitation by ketamine after Antisedan reverses domitor, during recovery is rare but does occur. The vet must know what to do as it can be quite stressful to the owner. It is best to let the dog wake up in the back of the Surgery, away from the crowds and barking dogs.
Case 2. "The Westie's skin disease is much better due to a change of diet," the man in his early 30s said to me as he did not want any steroid injection. He had been to Vet 1 to treat the Westie's lacerated interdigital D3-D4 left hindpaw. Vet 1 had given injections and the paw wound is much less inflamed. "What injection did Vet 1 give?" I asked. "I don't know," he said. "My Westie has much steroid to cure his skin disease (lower body) and I don't want him to have any."
"It is because of the steroid that his skin disease is under control," I said.
"No," the man said. "It is due to a change of diet."
"If it is due to the change of diet, then the Westie should not have any steroids for the last 6 months. Just purely the diet. Has he got the steroid in the last 6 months?"
"Yes," the man said. "But not much."
"I am just trying to educate pet owners. Steroids are to be used carefully and they help to relieve the dog of itchiness and injuries due to licking and scratching. Many owners and younger vets seem to think that steroids are to be avoided at all cost as they suppress the immune system. Many diseases, even in people, need careful dosage of steroids to live a normal life."
As he just wanted antibiotics for the lacerated wound and washes, I gave him what he wanted and a wash. The dog had an e-collar and should recover after many days. However, the lacerated wound between Digits 3 and 4 was long and between the digits, stitching up would be best option but it was declined. Healing by granulation could work.
Case 3. The 5-year-old Jack Russell passed fresh blood copiously yesterday. The owners wanted Dr Vanessa but she was off duty on Saturday. So it was Dr Jason Teo and myself. Anyway, I got them to see Dr Vanessa in the consultation room since she was present. "Dr Vanessa would not know anything about this case," I said. "The dog is more active and has not passed blood due to the drug injection. Blood test and stool test results would be known tomorrow. I did not feel any abdominal pain or foreign body and so no X-ray is done. It will take 3-5 days to know whether the dog has recovered from ulcerative colitis (bleeding from the colon).
"Did the dog eat chicken bones?" I asked again.
"No," the wife said. The husband and young adult daughter came.
"He eats wood, plastic and anything," the husband said. "Could this be the cause of the bleeding?" The dog had vomited once and passed stools followed by red fresh blood yesterday. This seemed to indicate that there was a foreign body lacerating the rectal area, causing large amounts of bleeding at the anus. Parvovirus test was negative and that was good news.
We had 2 or 3 cases of dogs passing blood in the stools recently. My ideal treatment would be IV drip with IV to prevent dehydration and antibiotics and anti-spasmogesic in the drip to give more effective and prompt cure. Other vets may prefer antibitoic and anti-spamogesic SC as in this case. "The dog bites," the owner had warned Dr Jason Teo and I on Saturday (yesterday).
"Muzzle the dog and give IV glucose saline 500 ml as it is more effective," I said when Dr Jason suggested drip SC. The dog was quite lethargic and would not bite when muzzled. The dog had stayed overnight. "I am worried that the dog may feel home-sick," the wife had told me as she wanted an injection and take the dog home. But the mucus and tissue from the rectum had red blood and we collected a sample to send to the lab for check up of parasites and abnormal cancer cells.
"Well, it is not the dog that is worried. He is already so sick and will prefer to rest quietly. It is the owner who feels it. If the dog goes home after the drip and wanders around the apartment, he cannot rest and recover fast. Worse of all, he may pass more blood and then there will be extra after-hours emergency costs." So, it is best to hospitalise the dog with bloody stools at least overnight. This dog was much active today on Sunday and the wife had great difficulty in muzzling him so that my assistant Min could remove the IV cathether. The dog had been eating all wood and other things from a young age. So, there could be chronic damage to the colon and ulcers form, leading to ulcerative colitis with profuse bleeding on Saturday yesterday.
UPDATE Jun 15, 2012. 6 days later.
"My dog is passing black stools, once a day instead of twice a day," the daughter said today. "He doesn't poop more than twice a day as before. The stools are black. Why?"
"Your dad says your dog eats wood, chews wood and any plastic. Some of the big chewed pieces would have cut the small and large intestines. The small intestines bleed and the blood becomes black when it arrived at the anus. Hence you can see black stools."
"But my dog was passing lots of red blood," she said. "So scary. What is the cause of this red blood?"
"Most likely the rectum or the area near the anus had been injured by a large piece of wood or object. So the bleeding is fresh red blood and lots of it."
The dog had recovered from anal bleeding. "Stool sample showed RBC and WBC. That means there is infection in the intestines." I said.
The dog had been chewing wood from young. How to stop him is a problem. Lifestyle changes are needed. The owner bought canned food for the dog for the time being.
Bright sunshine, blue skies.
Case 1. Golden Retriever shakes and trembles after Antisedan IM injection.
As the electricity supply to Toa Payoh Vets and nearby tenants was cut off due to the need to maintenance by the Landlord, it was too dark to do 3rd eyelid irrigation and right elbow granuloma injection.
So I did it outside. This was not ideal but the lighting from the morning sun was good.
At 10.15 am, the 28kg GR was given Dom + Ket at 50% IV by Dr Daniel. The dog fell asleep fast. I got the table outside the surgery where there was bright sunshine. Time was of the essence and I hurried my assistant Min, intern Sally and Dr Daniel to move on with the preparations. There was no isoflurane gas back up now as we were outside the surgery and the couple (owners) were watching.|
The GR was still asleep. So I decided to give Antisedan 1.0 ml IV. But Dr Daniel and then I could not locate the cephalic vein. Around 4 clients with barking dogs and a cat came and there was no time to waste. I gave the Antisedan IM. Nothing happened for 2 minutes. "It takes a longer time to wake up when IM injection is given," I said to the concerned wife. Then the dog inside the waiting room held his head up. There was much barking from other dogs. A contractor across the block was using his machine to drill something.
The GR started to shake and tremble non-stop. He panted. He could not get up to walk. "He is excited by the barking and the machine noises," I said. I rushed into the Surgery to get the atropine injection and gave him IM. Still his whole body was trembling.
"Put the dog inside the boot of the SUV," I said. "He needs to be far away from the barking dogs." The owner drove the dog to the other end of the block and parked the car there. The dog was still trembling but much less. I brought a bowl of water. He did not want it, as if afraid of water. "His head keeps turning right and left," the wife said. "It is part of the excitation effects of the ketamine," I explained. "Normally, the dog should wake up in a quiet place at the back of my surgery, but this morning was unusual in that there was so much barking from the other dogs."
After 30 minutes, the dog had stopped trembling, drank his water and was sent home. This side effect of excitation by ketamine after Antisedan reverses domitor, during recovery is rare but does occur. The vet must know what to do as it can be quite stressful to the owner. It is best to let the dog wake up in the back of the Surgery, away from the crowds and barking dogs.
Case 2. "The Westie's skin disease is much better due to a change of diet," the man in his early 30s said to me as he did not want any steroid injection. He had been to Vet 1 to treat the Westie's lacerated interdigital D3-D4 left hindpaw. Vet 1 had given injections and the paw wound is much less inflamed. "What injection did Vet 1 give?" I asked. "I don't know," he said. "My Westie has much steroid to cure his skin disease (lower body) and I don't want him to have any."
"It is because of the steroid that his skin disease is under control," I said.
"No," the man said. "It is due to a change of diet."
"If it is due to the change of diet, then the Westie should not have any steroids for the last 6 months. Just purely the diet. Has he got the steroid in the last 6 months?"
"Yes," the man said. "But not much."
"I am just trying to educate pet owners. Steroids are to be used carefully and they help to relieve the dog of itchiness and injuries due to licking and scratching. Many owners and younger vets seem to think that steroids are to be avoided at all cost as they suppress the immune system. Many diseases, even in people, need careful dosage of steroids to live a normal life."
As he just wanted antibiotics for the lacerated wound and washes, I gave him what he wanted and a wash. The dog had an e-collar and should recover after many days. However, the lacerated wound between Digits 3 and 4 was long and between the digits, stitching up would be best option but it was declined. Healing by granulation could work.
Case 3. The 5-year-old Jack Russell passed fresh blood copiously yesterday. The owners wanted Dr Vanessa but she was off duty on Saturday. So it was Dr Jason Teo and myself. Anyway, I got them to see Dr Vanessa in the consultation room since she was present. "Dr Vanessa would not know anything about this case," I said. "The dog is more active and has not passed blood due to the drug injection. Blood test and stool test results would be known tomorrow. I did not feel any abdominal pain or foreign body and so no X-ray is done. It will take 3-5 days to know whether the dog has recovered from ulcerative colitis (bleeding from the colon).
"Did the dog eat chicken bones?" I asked again.
"No," the wife said. The husband and young adult daughter came.
"He eats wood, plastic and anything," the husband said. "Could this be the cause of the bleeding?" The dog had vomited once and passed stools followed by red fresh blood yesterday. This seemed to indicate that there was a foreign body lacerating the rectal area, causing large amounts of bleeding at the anus. Parvovirus test was negative and that was good news.
We had 2 or 3 cases of dogs passing blood in the stools recently. My ideal treatment would be IV drip with IV to prevent dehydration and antibiotics and anti-spasmogesic in the drip to give more effective and prompt cure. Other vets may prefer antibitoic and anti-spamogesic SC as in this case. "The dog bites," the owner had warned Dr Jason Teo and I on Saturday (yesterday).
"Muzzle the dog and give IV glucose saline 500 ml as it is more effective," I said when Dr Jason suggested drip SC. The dog was quite lethargic and would not bite when muzzled. The dog had stayed overnight. "I am worried that the dog may feel home-sick," the wife had told me as she wanted an injection and take the dog home. But the mucus and tissue from the rectum had red blood and we collected a sample to send to the lab for check up of parasites and abnormal cancer cells.
"Well, it is not the dog that is worried. He is already so sick and will prefer to rest quietly. It is the owner who feels it. If the dog goes home after the drip and wanders around the apartment, he cannot rest and recover fast. Worse of all, he may pass more blood and then there will be extra after-hours emergency costs." So, it is best to hospitalise the dog with bloody stools at least overnight. This dog was much active today on Sunday and the wife had great difficulty in muzzling him so that my assistant Min could remove the IV cathether. The dog had been eating all wood and other things from a young age. So, there could be chronic damage to the colon and ulcers form, leading to ulcerative colitis with profuse bleeding on Saturday yesterday.
UPDATE Jun 15, 2012. 6 days later.
"My dog is passing black stools, once a day instead of twice a day," the daughter said today. "He doesn't poop more than twice a day as before. The stools are black. Why?"
"Your dad says your dog eats wood, chews wood and any plastic. Some of the big chewed pieces would have cut the small and large intestines. The small intestines bleed and the blood becomes black when it arrived at the anus. Hence you can see black stools."
"But my dog was passing lots of red blood," she said. "So scary. What is the cause of this red blood?"
"Most likely the rectum or the area near the anus had been injured by a large piece of wood or object. So the bleeding is fresh red blood and lots of it."
The dog had recovered from anal bleeding. "Stool sample showed RBC and WBC. That means there is infection in the intestines." I said.
The dog had been chewing wood from young. How to stop him is a problem. Lifestyle changes are needed. The owner bought canned food for the dog for the time being.
Saturday, June 9, 2012
1020. Caterwauling cat with low platelet count spayed
Case study on this Sat Jun 9, 2012 morning at Toa Payoh Vets.
Cat spayed yesterday against medical advice. The cat had been caterwauling noisily for the past week and the owner took the risk to spay despite my advice that a cat losing weight (from 2.55kg on April 29, 12 to 2.40 kg on Jun 8, 12, day of spay, Friday).
Blood test reviewed and the owner informed.
BLOOD TEST RESULT - Significant results
Total WCC 5.3 (5.5 - 19.5) & very low platelet count.
I was surprised to see the very low platelet count of this adopted young female cat, around
10 months old. The owners came for Vit K1 tablets to be given for a week.
SUNDAY JUNE 10, 2012 3 pm. I phoned the owner at his home as both he and his wife had not answered their handphones. "The cat is active. Eats, drinks, pees but has not pooped." So, it is good news.
As to the cause of the low platelet count, it is a mystery. Could it be the "Barf diet"? The owners had changed to this diet instead of the commercial canned cat's food. There was really a weight loss over the period of time stated above. To be safe, I advised using commercial canned food for a month. The cat was losing weight and the spay was done with informed consent of the risks of dying.
Cat spayed yesterday against medical advice. The cat had been caterwauling noisily for the past week and the owner took the risk to spay despite my advice that a cat losing weight (from 2.55kg on April 29, 12 to 2.40 kg on Jun 8, 12, day of spay, Friday).
Blood test reviewed and the owner informed.
BLOOD TEST RESULT - Significant results
Total WCC 5.3 (5.5 - 19.5) & very low platelet count.
I was surprised to see the very low platelet count of this adopted young female cat, around
10 months old. The owners came for Vit K1 tablets to be given for a week.
SUNDAY JUNE 10, 2012 3 pm. I phoned the owner at his home as both he and his wife had not answered their handphones. "The cat is active. Eats, drinks, pees but has not pooped." So, it is good news.
As to the cause of the low platelet count, it is a mystery. Could it be the "Barf diet"? The owners had changed to this diet instead of the commercial canned cat's food. There was really a weight loss over the period of time stated above. To be safe, I advised using commercial canned food for a month. The cat was losing weight and the spay was done with informed consent of the risks of dying.
1019. Old Border had a large ear tumour
"I will operate for free to cut off the 1/3 of the ear," I said to the owner of the 12-year-old Border Collie. The ear tumour was 2 x 3 cm, disc-shaped wart-like and there were two other warts in the face and I had advised sectioning off the ear with the tumour on the first consultation on May 13, 2012.
Surgery would be in 7 days after a course of antibiotics. However, Dr Daniel saw the case. As each vet or doctor has his or her own way of handling a case of an ear tumour and my way was not the other way, Dr Daniel decided to excise the ear tumour when he was presented the case and I was not around. Blood test was declined.
The owner's daughter agreed to a histopathology. Diagnosis was squamous cell carcinoma.
WHY I ADVISE SECTIONING OF THE EAR?
Old dog, the ugly-looking large ear tumour looked cancerous. The owner wanted the least cost treatment and that meant no blood test or biopsy of the tumour or histopatholgoy.
Cutting off the 1/3 of the ear would ensure that any cancerous cells would be cut off by a wide margin. Healing would be easier. Excising off the wart would leave a big wound and lead to long healing. This was the case.
Each vet has his or her own mindset and experience. There is no one surgical approach in ear wart surgery. Usually the warts are excised but not a portion of the ear. In old dogs, it is best to cut off part of the ear to ensure no spread of the cells and early recovery. A large hole after a large tumour excision of the ear is hard on the old dog as it is itchy. Healing by granulation takes a longer time, since the dog is old and the healing is slow. But the dog still has his ear shape!
Surgery would be in 7 days after a course of antibiotics. However, Dr Daniel saw the case. As each vet or doctor has his or her own way of handling a case of an ear tumour and my way was not the other way, Dr Daniel decided to excise the ear tumour when he was presented the case and I was not around. Blood test was declined.
The owner's daughter agreed to a histopathology. Diagnosis was squamous cell carcinoma.
WHY I ADVISE SECTIONING OF THE EAR?
Old dog, the ugly-looking large ear tumour looked cancerous. The owner wanted the least cost treatment and that meant no blood test or biopsy of the tumour or histopatholgoy.
Cutting off the 1/3 of the ear would ensure that any cancerous cells would be cut off by a wide margin. Healing would be easier. Excising off the wart would leave a big wound and lead to long healing. This was the case.
Each vet has his or her own mindset and experience. There is no one surgical approach in ear wart surgery. Usually the warts are excised but not a portion of the ear. In old dogs, it is best to cut off part of the ear to ensure no spread of the cells and early recovery. A large hole after a large tumour excision of the ear is hard on the old dog as it is itchy. Healing by granulation takes a longer time, since the dog is old and the healing is slow. But the dog still has his ear shape!
1018. Two eyes tearing young Schnauzer
| Today Sat Jun
9, 2012, another bright and
blue-sky morning, I came to
Toa Payoh Vets at 9.30 am
for a trust and audit check
and an appointment of a lady
owner who had a rabbit with
a red nose. I phoned a Miniature Schnauzer lady owner from Punggol at 9.15 am but her phone was switched off. I left a message of the blood test done on 2 days ago. "Blood test for XXX. A high cell count indicates bacterial infection. Are eyes still tearing? Please tel me". My i phone displayed: "Message failure" The lady owner wanted to consult me specifically on Jun 7, 2012, as her Miniature Schnauzer, female, 1 year 2 months old, has tearing eyes for the past 4 days. No fever. Still eating and drinking but pus in the eye discharge for 4 days. There are two Dr Sings in Toa Payoh Vets and sometimes, there is a confusion. She confirmed she wanted to consult me. Red eyes. Pus in tearing areas for 4 days. Swollen submandibular and adjacent lymph nodes on both sides. I diagnosed the dog as having "glanders" and told Dr Daniel who was assisting me that this is a rare case nowadays. "Usually puppies and treatment is effective."  The submandibular lymph nodes were enlarged like 10-cent coins on both sides and I taught the owner how to palpate them. She was surprised. They should not be felt at all in normal dogs, including young ones. "Glanders is a bacterial infection of puppies," I said. "However, this dog is still young. Your dog must have an active lifestyle!"
Yes," she said. "He loves to do that when we take off the lease at the park." "Why do you bring her to the Bishan Dog Park since you live in Punggol?" "The Bishan Dog Park is the place where the dog can run around without a lease," she replied. "Any construction nearby?" Dr Daniel asked. "Yes," she said. There are new HDB flats being built in this pretty new town with waterfronting views, so there was dust all around. "The soil bacteria could have gone into the eyes, nose and mouth and then the submandibular lymph nodes," I said. " A blood test will be important to help in the diagnosis." I got permission for a blood test. BLOOD TEST RESULTS - Significant findings were: Total white cell count 17.4 (6-17) N=71%, L=23%, M=6%, E=0.2%, B=0.6% Urea 10.5 (4.2-6.3) Use evidence-based medicine to come to a diagnosis if the owner can afford the blood test as it tells a lot of causes but the vet must know how to interpret them in relation to the clinical signs. In this case, glanders was confirmed by the increase in total white cell count in the blood test as a result of a systemic bacterial infection. What is the significance of increase in monocytes? This could mean a long-standing chronic infection and well, this young dog had an active outdoor digging and eating soil and so, the infection from the soil had been going on for some months. Hence, an increase in monocytes. Based on clinical signs, blood test helps in coming to a correct diagnosis of "glanders". The owner would know simply that her dog had a bacterial infection. I tried phoning the owner again to close the case by giving her the blood test results. As I typed, the happy owner phoned me and said that the dog was still eating and drinking as before and had the following improvements as compared to 2 days before treatment "Both eyes are still tearing but much less," she said. "No more redness in the eyes." She was referring to the acute conjunctivitis which she saw when I pulled down the eye lids. "How about the size of the submandibular lymph nodes?" I asked. "I don't know whether it is psychological but I feel them as being much smaller than on that day." "You are correct in finding that the size had gone down considerably due to the injection," I said. "Continue the antibiotics and change his life-style". So, no more soil digging and eating grass for the active pet as the soil bacteria had infected her. P.S The owner got the dog treated early and so the total white cell count had not reached a much higher level and the young dog was still eating and drinking. The submandibular lymph nodes could have expanded bigger and ulcerate. The owner was worried about the dog having pus in both eyes for the last 4 days and made an appointment to see me. The bacteria had gone to the eyes as well but antibiotics and anti-inflammatory injections I gave had nipped the infection in the bud. So, the owner was happy with the recovery when I phoned 2 days later. This was good news for everyone. Except for the Schnauzer as he has to change his free soil digging and eating life-style. P.S "Glanders" is more a disease of horses in the older days. It is rare to get a case in the young Singapore dogs and puppies nowadays as the standard of hygiene is much higher in Singapore kennels. I remember my professor's lecture about this disease and that was in 1973 as a final year vet undergraduate. I did see a few puppy cases from breeders some years ago but no more. This is not just a case of acute conjunctivitis. Just prescribing some eye drops will not help to resolve the problem. P.S It is best to follow up on the owner 2 days and do a blood test. UPDATES AT: http://www.sinpets.com/dogs/20120609glanders_young_Schnauzer_singapore-ToaPayohVets.htm |
Friday, June 8, 2012
"Red eye" in a dwarf rabbit
E-MAIL REPLY FROM DR SING DATED JUNE 6, 2012
Hi,
I pondered upon your vet webpage and would like to make a appointment for consultation for my pet rabbit.
It is a Netherland dwarf, about 2 months old. Recently it has eye dirt found on its eyes and one of the eye is seemingly reddish around it and opening not as wide as the other eye. Is it sick or suffering from eye infection?
Warmest Regards,
Name of owner
5359 -5363. Blood inside the anterior chamber of the right eye
E-MAIL REPLY FROM DR SING DATED JUNE 8, 2012
I am Dr Sing. Thank you for your email. Your rabbit suffers from hyphema (bleeding inside the eye). Pl continue to confine the rabbit in a SMALL cage for the next 14 days to prevent further bleeding inside the eye. The bleeding is due to a forceful injury to the eye and needs some 14-21 days to resolve.
Continue medication for another 10 days.
UPDATE AND MORE PIC AT:http://www.bekindtopets.com/animals/20120608hyphema-netherland-dwarfd-rabbit-2months-old-ToaPayohVets.htm
Hi,
I pondered upon your vet webpage and would like to make a appointment for consultation for my pet rabbit.
It is a Netherland dwarf, about 2 months old. Recently it has eye dirt found on its eyes and one of the eye is seemingly reddish around it and opening not as wide as the other eye. Is it sick or suffering from eye infection?
Warmest Regards,
Name of owner
5359 -5363. Blood inside the anterior chamber of the right eye
E-MAIL REPLY FROM DR SING DATED JUNE 8, 2012
I am Dr Sing. Thank you for your email. Your rabbit suffers from hyphema (bleeding inside the eye). Pl continue to confine the rabbit in a SMALL cage for the next 14 days to prevent further bleeding inside the eye. The bleeding is due to a forceful injury to the eye and needs some 14-21 days to resolve.
Continue medication for another 10 days.
UPDATE AND MORE PIC AT:http://www.bekindtopets.com/animals/20120608hyphema-netherland-dwarfd-rabbit-2months-old-ToaPayohVets.htm
Thursday, June 7, 2012
1016. Just-enough dosage of injectable anaesthesia for cat spay
What is the most effective optimal dosage of injectable anaesthesia for a cat spay without the use of isoflurane anaesthesia? This answer is obtained from observations and the review of record keeping if the vet is interested. If not, the vet just has to give the cat isoflurane gas by mask to continue the surgery if the cat moves.
Obviously, an employee or associate vet has no need to account for the bottom-line of the practice and is not interested in reducing costs. So there is no motivation to conserve resources and use just-sufficient anaesthestics as they don't bear the expenses and responsibility for the economic health of the practice. If the practice closes down, just go to another practice to work!
Just give the cat isoflurane gas by mask to continue the spay if the cat is not sufficiently anaesthesized by xylazine and ketamine. So, more isoflurane and oxygen needs to be ordered if the vet has no interest in practical research in wanting to know what is best for the cat and for the practice economics.
Yesterday, June 6, 2012, a shy 3kg black and white cat from Bedok came in. I used this case to share my experience and demonstrate to Dr Daniel how I would use an effective optimal dosage of injectable anaesthesia WITHOUT the need of isoflurane gas top up. Toa Payoh Vets has the isoflurane gas facility and so, there is no need to catherise the cat or dog to top up, if the dosage of injectable anaesthesia is insufficient. However, catherisation means a waste of resource, more time spent in catherisation of the cephalic vein and in topping up to get surgical anaesthesia. This can make a spay surgery twice as long.
I prefer surgery to be simple and fast by giving the effective optimal dosage of xylazine and ketamine for a cat spay. I can get the whole spay done from first incision to stitching in 10-15 minutes if there is no need to top up.
As a guideline, a cat at 3 kg needs 0.15 ml xylazine and 0.6 ml ketamine IM to be sufficiently anaesthesized without the need of isoflurane gas or top up. Dr Daniel did not think this was possible and so the isoflurane gas was switched on as standby.
However, this amount lasted more than 30 minutes and he could see that the formula was sufficient. After the IM injection of 0.15 ml xylazine and 0.6 ml ketamine, there was a wait of 10 minutes. During this time, the cat's belly was shaved.
Obviously, if the vet takes a bit longer, isoflurane gas will be needed.
TIPS
1. Don't snip off the SC fat if possible. Just undermine and see the linea alba.
2. The start of the incision is around 1.5 cm from the umbilical scar.
3. This cat had enlarged congested ovaries with follicles and uterus of over 8 mm in diameter although she was never "mated". So, it was difficult to hook out the womb. A longer incision was needed and more surgery time had to be spent. I could not believe when I saw the uterine horns being as large as 8 m min diameter and over 12 cm long. The ovarian blood vessels were enlarged and engorged. As if the cat was pregnant.
Could this be a case of cystic ovaries, pyometra or early pregnancy? However, the lady owner said: "My cat would never leave the HDB flat. Whenever she sees another cat, she would run away. It is not possible that she was mated."
"Is there a male cat in the apartment?" I asked.
"Yes, he was neutered some time ago at another vet practice."
"Did he try to mate with this caterwauling female 2 weeks ago? " I asked.
"Yes, the male cat was humping her."
So, this could be a case of false pregnancy with the signs of pregnancy in the uterus being developed. There was no foetal lumps. I did not cut into the uterine bodies to check for foetuses. The uterus was just swollen and thicker by 100x normal for a non-pregnant young cat of around one year old. It could be a case of early pyometra.
RESTRAINT OF THE SHY CAT
I put the cat carrier on the consultation table. A wire crate was ready. As soon as I opened the carrier door and tilted the carrier, the cat shot out like a rocket and jumped onto the floor to a corner of the back table. I expected the cat. Dr Daniel bent on his knees and talked to the cat. He got her back into the crate. Now, what to do?
"Put some telephone books inside the plastic crate to corner him and I will inject the anaesthestic," I said. But there were no phone books. So, he put a large dog carrier to corner the cat. "Ready for injection," he asked me. The cat had crawled to the top of the plastic crate and was moving.
"Can you inject him now?" Dr Daniel asked.
"Based on my experience, the cat will move when injected as she is not tightly cornered. Only half dose may be given."
"That should be OK," Dr Daniel replied.
"Sometimes the syringe needle may bend when the injection is given as the cat springs away," I said. In practice, it is so much different from in theory from the lectures.
"In any case, a full dose IM must be given to get the best optimal anaesthesia," I said.
As I tried to get the cat cornered, she climbed up the plastic crate top towards Dr Daniel and away from me.
"There is a gap in the side of wire crate which could not be closed properly after he had put in the plastic crate."
It was only a gap of 8 mm but the small cat's head went out. In an instant, she sprang out and jumped onto the floor back to the corner of the floor as before.
I was quite angry at this "waste of time". The side of the wire crate was not secured properly first after the plastic crate was put in. The cat was dropped into the wire crate from the top as there was a door. So, the cat escaped and I cursed. I hate wasting time which is much more precious to me at my age.
So, I left the consultation room for Dr Daniel to coax the cat back and put her into the plastic crate. Why not the wire crate? I was surprised but since now there was a new situation, I had to decide what to do, being the senior.
"If your hand is strong enough to grip the scruff of the cat and you do not mind being scratched," hold the cat up with your hand and I will inject the back muscle" I said.
Dr Daniel did that. He has a strong grip. The cat did not move at all when I inject. That is the norm as a strong grip on the scruff makes a cat not feeling any pain in injection, in my experience. A weak grip will result in the cat feeling the IM injection and clawing.
Then Dr Daniel put the cat inside the wire crate and from then on, he could see that a full dose IM according to my formula was really effective and no isoflurane gas was ever needed to spay this cat. The duration of analgesia was at least 30 minutes and that was more than enough time to spay a cat.
As mentor, many optimal and safe anaesthetic lessons are taught to the younger vets by "seeing is believing"
as each young vet has his or her own ideas of anaesthesia, basically from what the vet professors have had taught them and used in the Vet School. When they come out to work in the industry, they have to adapt to different anaesthetic and formulas which their professors had never used. This is because there is more than one combination to safely anaesthesized the cat and the vet practice has its own experienced method usually different from the Vet School which could teach and advise more injections (pre-med with ACP, sedate with another drug, atropine etc) as according to the theory.
Website with images and updates at:
http://www.bekindtopets.com/cats/20120607spay-optimal-safe-anaesthetic-injectable-singapore-ToaPayohVets.htm
Obviously, an employee or associate vet has no need to account for the bottom-line of the practice and is not interested in reducing costs. So there is no motivation to conserve resources and use just-sufficient anaesthestics as they don't bear the expenses and responsibility for the economic health of the practice. If the practice closes down, just go to another practice to work!
Just give the cat isoflurane gas by mask to continue the spay if the cat is not sufficiently anaesthesized by xylazine and ketamine. So, more isoflurane and oxygen needs to be ordered if the vet has no interest in practical research in wanting to know what is best for the cat and for the practice economics.
Yesterday, June 6, 2012, a shy 3kg black and white cat from Bedok came in. I used this case to share my experience and demonstrate to Dr Daniel how I would use an effective optimal dosage of injectable anaesthesia WITHOUT the need of isoflurane gas top up. Toa Payoh Vets has the isoflurane gas facility and so, there is no need to catherise the cat or dog to top up, if the dosage of injectable anaesthesia is insufficient. However, catherisation means a waste of resource, more time spent in catherisation of the cephalic vein and in topping up to get surgical anaesthesia. This can make a spay surgery twice as long.
I prefer surgery to be simple and fast by giving the effective optimal dosage of xylazine and ketamine for a cat spay. I can get the whole spay done from first incision to stitching in 10-15 minutes if there is no need to top up.
As a guideline, a cat at 3 kg needs 0.15 ml xylazine and 0.6 ml ketamine IM to be sufficiently anaesthesized without the need of isoflurane gas or top up. Dr Daniel did not think this was possible and so the isoflurane gas was switched on as standby.
However, this amount lasted more than 30 minutes and he could see that the formula was sufficient. After the IM injection of 0.15 ml xylazine and 0.6 ml ketamine, there was a wait of 10 minutes. During this time, the cat's belly was shaved.
Obviously, if the vet takes a bit longer, isoflurane gas will be needed.
TIPS
1. Don't snip off the SC fat if possible. Just undermine and see the linea alba.
2. The start of the incision is around 1.5 cm from the umbilical scar.
3. This cat had enlarged congested ovaries with follicles and uterus of over 8 mm in diameter although she was never "mated". So, it was difficult to hook out the womb. A longer incision was needed and more surgery time had to be spent. I could not believe when I saw the uterine horns being as large as 8 m min diameter and over 12 cm long. The ovarian blood vessels were enlarged and engorged. As if the cat was pregnant.
Could this be a case of cystic ovaries, pyometra or early pregnancy? However, the lady owner said: "My cat would never leave the HDB flat. Whenever she sees another cat, she would run away. It is not possible that she was mated."
"Is there a male cat in the apartment?" I asked.
"Yes, he was neutered some time ago at another vet practice."
"Did he try to mate with this caterwauling female 2 weeks ago? " I asked.
"Yes, the male cat was humping her."
So, this could be a case of false pregnancy with the signs of pregnancy in the uterus being developed. There was no foetal lumps. I did not cut into the uterine bodies to check for foetuses. The uterus was just swollen and thicker by 100x normal for a non-pregnant young cat of around one year old. It could be a case of early pyometra.
RESTRAINT OF THE SHY CAT
I put the cat carrier on the consultation table. A wire crate was ready. As soon as I opened the carrier door and tilted the carrier, the cat shot out like a rocket and jumped onto the floor to a corner of the back table. I expected the cat. Dr Daniel bent on his knees and talked to the cat. He got her back into the crate. Now, what to do?
"Put some telephone books inside the plastic crate to corner him and I will inject the anaesthestic," I said. But there were no phone books. So, he put a large dog carrier to corner the cat. "Ready for injection," he asked me. The cat had crawled to the top of the plastic crate and was moving.
"Can you inject him now?" Dr Daniel asked.
"Based on my experience, the cat will move when injected as she is not tightly cornered. Only half dose may be given."
"That should be OK," Dr Daniel replied.
"Sometimes the syringe needle may bend when the injection is given as the cat springs away," I said. In practice, it is so much different from in theory from the lectures.
"In any case, a full dose IM must be given to get the best optimal anaesthesia," I said.
As I tried to get the cat cornered, she climbed up the plastic crate top towards Dr Daniel and away from me.
"There is a gap in the side of wire crate which could not be closed properly after he had put in the plastic crate."
It was only a gap of 8 mm but the small cat's head went out. In an instant, she sprang out and jumped onto the floor back to the corner of the floor as before.
I was quite angry at this "waste of time". The side of the wire crate was not secured properly first after the plastic crate was put in. The cat was dropped into the wire crate from the top as there was a door. So, the cat escaped and I cursed. I hate wasting time which is much more precious to me at my age.
So, I left the consultation room for Dr Daniel to coax the cat back and put her into the plastic crate. Why not the wire crate? I was surprised but since now there was a new situation, I had to decide what to do, being the senior.
"If your hand is strong enough to grip the scruff of the cat and you do not mind being scratched," hold the cat up with your hand and I will inject the back muscle" I said.
Dr Daniel did that. He has a strong grip. The cat did not move at all when I inject. That is the norm as a strong grip on the scruff makes a cat not feeling any pain in injection, in my experience. A weak grip will result in the cat feeling the IM injection and clawing.
Then Dr Daniel put the cat inside the wire crate and from then on, he could see that a full dose IM according to my formula was really effective and no isoflurane gas was ever needed to spay this cat. The duration of analgesia was at least 30 minutes and that was more than enough time to spay a cat.
As mentor, many optimal and safe anaesthetic lessons are taught to the younger vets by "seeing is believing"
as each young vet has his or her own ideas of anaesthesia, basically from what the vet professors have had taught them and used in the Vet School. When they come out to work in the industry, they have to adapt to different anaesthetic and formulas which their professors had never used. This is because there is more than one combination to safely anaesthesized the cat and the vet practice has its own experienced method usually different from the Vet School which could teach and advise more injections (pre-med with ACP, sedate with another drug, atropine etc) as according to the theory.
Website with images and updates at:
http://www.bekindtopets.com/cats/20120607spay-optimal-safe-anaesthetic-injectable-singapore-ToaPayohVets.htm
Tuesday, June 5, 2012
1015. Distemper images
On Tue, Jun 5, 2012 at 3:26 AM, Criss, Katie L <CrissKL@alfredstate.edu> wrote:
Yes, it is oK to use the photos. Best wishes
I am Dr Sing from Toa Payoh Vets.Dear Toa Payo vets,
My name is Katie An I wanted to ask for your permission to use the photo "160. Feb 10, 2005. The invisible killers stalked the Miniature Schnauzers." For a collage project on canine distemper. The photo will only be seen by my professor an some classmates. The photo will not be published. If you could please get back to me I would greatly appreciate it.
Respectfully,
Katie.
Yes, it is oK to use the photos. Best wishes
Monday, June 4, 2012
1014. Sunday Jun 3, 2012's interesting cases
Sunday June 3, 2012
2.30 pm to 5pm
Yesterday, Saturday morning and today Sunday afternoon, I presented myself at Toa Payoh Vets to do my "trust and audit" veterinary work. This is an important part of management of a veterinary practice as veterinary performance counts in the sustainablility of the business. Referrals come from good performance and good clinical and surgical outcomes from all the 4 vets at Toa Payoh Vets. My duty is to ensure a consistent and high standard of performance and so I do my unannounced "trust and audit" checks and mentorship.
On this Sunday afternoon, I was surprised to see a familiar black and white Corgi with cataract eyes coming in for a check up and vaccination. Corgis are rather rare in my practice and a Black and White one is rarer compared to the brown ones. I can remember this case distinctly as its case file is quite thick due to much veterinary investigations that had to be done.
"You don't work on Sunday afternoons," the slim lady owner said to me.
"No," I said. "I came to do my checks on the staff and cases. How's the Corgi now? Any more smelly urine passed?"
A bit of history. This Corgi had been having urinary tract infections for the past year or more. After a course of antibiotics, the dog would recover. Then, the infection comes again. This interesting emotional case is reported at:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
http://www.sinpets.com/F6/20111210recurrent-urinary-tract-infection-old-female-spayed-corgi-singapore-toapayohvets.htm
So, on this fine Sunday afternoon, I happened to be at the Surgery and see this Corgi again. She had lost some weight, around 1 kg and looked quite neat and majestic. She had come in for a check up, vaccination and pro-heart vaccination and Dr Vanessa would be in charge.
"When did you stop the S/D diet?" the lady said that S/D was too expensive.
"Around 2 months ago," she replied.
"S/D diet is specially formulated for cases of urinary struvite-stones and so it is more expensive. How long was she eating the canned S/D diet?"
"3 months," she replied. "Now she is on a holistic dry food."
"What is the name of the dry food?" I asked.
She did not remember.
"What is the colour of her urine?" I asked. "You are supposed to get her urine checked every 2 to 3 monthly for urinary tract infection and stones." But most owners don't do that till the dog has a urinary problem.
"Is she still passing smelly urine?" I asked. "Like ammonia?"
"No," she said. "No other vet had asked me about the smell of urine, except you."
Smelly urine is one topic vets don't ask, I guess that the vet professors never emphasize on smell during the lectures.
"Any difficulty in passing urine?"
"No more," the lady said. "Well, occasionally. I am seldom at home when she pees. She pees twice a day and sometimes when she pees on the 3rd time, there is a smell. But no more problem. She drinks more now."
"That's good news," I said. "She drinks more because she does not have to worry about painful urination as in the past months for over one year. I guess dogs with urinary tract infection may figure out that the less they drink, the less they need to pee as urination is painful."
The dog was checked by Dr Vanessa. I examined the dog too. There was some redness in her vulval mucosa and inguinal area.
"Any vulval licking?" I asked.
"Sometimes but not often as before"
I palpated the dog's bladder since this was her original source of problem. An empty bladder. There was a small walnut-sized lump of the bladder. The Corgi suddenly yelped as if it was painful but did not bite me. She was 9 years old and would bite and so I had to be careful as I was just bitten on the right forefinger tip guinea pig with the punk hair between the ears when I examined his mouth.
The dog had a blood test and was vaccinated. I made sure that the owner had a urine-collection bottle to send in the urine for testing during the week. Most owners don't do it but it is good for the dog with a long history of 2 years of urinary tract infection. The dog is in excellent condition. A bit of left forepaw itchiness for which Dr Vanessa prescribed a cream.
This is the type of challenging cases that need a lot of investigation and time. If the dog is treated by several weeks as was done in the previous 2 years, it was difficult to come to a satisfactory resolution of the old dog's urinary tract infections which recur after antibiotics. Bladder tumours were once diagnosed but with a good ultrasound of the bladder, as seen by Dr Daniel when he had not yet graduated, this case was diagnosed as not having bladder tumour but just bladder "sand".
When the urine sample was analysed, there was no crystals, no bacteria, no white cells. Negative crystals do not mean there was no struvite crystals which had been diagnosed by one of the vets during the past 2 years. In this case, the effects of treatment with the S/D diet and the resolution of her urinary tract infections for the past 2 months confirmed that this beloved spayed female 9-year-old Corgi had a urinary tract infection due to struvites stones inside her bladder.
Ideally, she should have her urine tested every 2-3 months since she had 2 years of urinary tract infections, but no Singapore owner will do that. Till there is a problem! Singaporeans are time-pressed but dogs are families and so there is great emotions involved when the vet cannot resolve a chronic urinary tract infection as in this case.
2.30 pm to 5pm
Yesterday, Saturday morning and today Sunday afternoon, I presented myself at Toa Payoh Vets to do my "trust and audit" veterinary work. This is an important part of management of a veterinary practice as veterinary performance counts in the sustainablility of the business. Referrals come from good performance and good clinical and surgical outcomes from all the 4 vets at Toa Payoh Vets. My duty is to ensure a consistent and high standard of performance and so I do my unannounced "trust and audit" checks and mentorship.
On this Sunday afternoon, I was surprised to see a familiar black and white Corgi with cataract eyes coming in for a check up and vaccination. Corgis are rather rare in my practice and a Black and White one is rarer compared to the brown ones. I can remember this case distinctly as its case file is quite thick due to much veterinary investigations that had to be done.
"You don't work on Sunday afternoons," the slim lady owner said to me.
"No," I said. "I came to do my checks on the staff and cases. How's the Corgi now? Any more smelly urine passed?"
A bit of history. This Corgi had been having urinary tract infections for the past year or more. After a course of antibiotics, the dog would recover. Then, the infection comes again. This interesting emotional case is reported at:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
http://www.sinpets.com/F6/20111210recurrent-urinary-tract-infection-old-female-spayed-corgi-singapore-toapayohvets.htm
So, on this fine Sunday afternoon, I happened to be at the Surgery and see this Corgi again. She had lost some weight, around 1 kg and looked quite neat and majestic. She had come in for a check up, vaccination and pro-heart vaccination and Dr Vanessa would be in charge.
"When did you stop the S/D diet?" the lady said that S/D was too expensive.
"Around 2 months ago," she replied.
"S/D diet is specially formulated for cases of urinary struvite-stones and so it is more expensive. How long was she eating the canned S/D diet?"
"3 months," she replied. "Now she is on a holistic dry food."
"What is the name of the dry food?" I asked.
She did not remember.
"What is the colour of her urine?" I asked. "You are supposed to get her urine checked every 2 to 3 monthly for urinary tract infection and stones." But most owners don't do that till the dog has a urinary problem.
"Is she still passing smelly urine?" I asked. "Like ammonia?"
"No," she said. "No other vet had asked me about the smell of urine, except you."
Smelly urine is one topic vets don't ask, I guess that the vet professors never emphasize on smell during the lectures.
"Any difficulty in passing urine?"
"No more," the lady said. "Well, occasionally. I am seldom at home when she pees. She pees twice a day and sometimes when she pees on the 3rd time, there is a smell. But no more problem. She drinks more now."
"That's good news," I said. "She drinks more because she does not have to worry about painful urination as in the past months for over one year. I guess dogs with urinary tract infection may figure out that the less they drink, the less they need to pee as urination is painful."
The dog was checked by Dr Vanessa. I examined the dog too. There was some redness in her vulval mucosa and inguinal area.
"Any vulval licking?" I asked.
"Sometimes but not often as before"
I palpated the dog's bladder since this was her original source of problem. An empty bladder. There was a small walnut-sized lump of the bladder. The Corgi suddenly yelped as if it was painful but did not bite me. She was 9 years old and would bite and so I had to be careful as I was just bitten on the right forefinger tip guinea pig with the punk hair between the ears when I examined his mouth.
The dog had a blood test and was vaccinated. I made sure that the owner had a urine-collection bottle to send in the urine for testing during the week. Most owners don't do it but it is good for the dog with a long history of 2 years of urinary tract infection. The dog is in excellent condition. A bit of left forepaw itchiness for which Dr Vanessa prescribed a cream.
This is the type of challenging cases that need a lot of investigation and time. If the dog is treated by several weeks as was done in the previous 2 years, it was difficult to come to a satisfactory resolution of the old dog's urinary tract infections which recur after antibiotics. Bladder tumours were once diagnosed but with a good ultrasound of the bladder, as seen by Dr Daniel when he had not yet graduated, this case was diagnosed as not having bladder tumour but just bladder "sand".
When the urine sample was analysed, there was no crystals, no bacteria, no white cells. Negative crystals do not mean there was no struvite crystals which had been diagnosed by one of the vets during the past 2 years. In this case, the effects of treatment with the S/D diet and the resolution of her urinary tract infections for the past 2 months confirmed that this beloved spayed female 9-year-old Corgi had a urinary tract infection due to struvites stones inside her bladder.
Ideally, she should have her urine tested every 2-3 months since she had 2 years of urinary tract infections, but no Singapore owner will do that. Till there is a problem! Singaporeans are time-pressed but dogs are families and so there is great emotions involved when the vet cannot resolve a chronic urinary tract infection as in this case.
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