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SUNDAY'S INTERESTING
CASES Oct 30, 2011 On Friday, Oct 28, 2011, I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1 consulted by the Group. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever would be ineffective as this dog had Babesia gibsoni. As imizole is "ineffective" against Babesia gibsoni, Vet 1 wanted to use the "3 effective" drugs atovaquone, clindamycine and azithromycin. However, it would cost the Rescue Group $1,000. Berenil was cheaper but might cause anaphylaxic shock and in any case there was no stock at that time. The Rescue Group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice and alternative options.
COMMENTS The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later. Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and Ehrlichia tick fever 10 days ago. A Cocker Spaniel has tick fever in 2011 is the case report.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related the story of the stray dog with tick fever to the cocker spaniel and she was worried that I had not given the correct treatment.
My thoughts on this fine Sunday morning were for that stray dog and the caregiver who was a student. The young Singaporeans prefer to text and on Saturday, Oct 29, 2011, 2.53 pm, I got the following:
As for the English Cocker Spaniel, as at Nov 3, 2011, the dog is normal. "Except that she tires easily," the owner said to me. She submitted a urine sample for testing. The values were normal. The urine SG was high, at 1.041 (range should be 1.005 -1.030), pH was 7.0 and struvite crystals were present. "Could it be the high liver I am feeding?" the lady asked me. "Should I stop feeding the liver?" She was also feeding iron supplements and all the good home-cooked food. "Since your dog tires easily, she has not fully recovered her normal red cell amount," I said. "The high urine SG is unusual. It shows that the kidneys can concentrate the urine well but what causes it is hard to say." I may need to have another urine test 2 weeks later. Nov 3, 2011, as I update this report, I had been thinking about the high urine SG. My hypothesis is that the destruction of so many red and white blood cells damaged by the Babesia and Ehrlichia organisms during the past 14 days would have contributed to a large amount of protein damage for the past few days. The kidneys are normal and have to work hard to excrete the urea. This resulted in a high urine SG. There may be a high blood urea but I did not take a blood sample when the urine sample was sent. Since the kidneys and bladder were normal, there was no proteinuria during urinalysis. Is this hypothesis sound? These are the types of questions the professor may ask in a case study during the final exam of the 5th year vet student. I remembered my "viva" or "oral exam" on a case study during my final year by my Professor of Vet Medicine and an external examiner and I presume Murdoch vet students still get this oral test. A reply or hypothesis may not be possible for a vet student so much burdened with 5 years of vet knowledge memorised to pass the Final examination in November 2011 if the Professor of Vet Medicine asked about the high SG during the oral test! Earlier report: A Cocker Spaniel has tick fever in 2011 or http://www.sinpets.com/dogs/20111039tick-fever-cocker-spaniel-singapore-toapayohvets.htm
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Wednesday, July 18, 2012
1082. Update: Imizole was effective against Babesia gibsoni in this stray dog
1081. Tick fever in a great dane, cocker spaniel and a samoyed video production
July 18, 2012 5.15 am
I am trying to get an educational video produced high-lighting the diagnosis and treatment on the 3 cases of tick fever in Singapore,
for the vet students studying hard in their little rooms. The cases are at:
http://www.asiahomes.com/army/2010067tick_control_bites_infestation-parasites-dogs-singapore-ToaPayohVets.htm
A lot of time is needed to summarise and compare the significant points of the 3 cases
Tuesday, July 17, 2012
1080. Veterinary leadership
Managing a practice seems easy to the outsider. I have 3 associate vets. I can sleep late and come to office whenever I wish. This is the wrong perception of outsiders. This is because employees start to slacken as the boss is seldom around. If the boss does not bother or become a womaniser as in some successful employment agencies I know, the whole business goes down the drain.
From Monday to Friday and some Saturdays, I leave home at 7.30 am, take a feeder bus to the subway, then another feeder bus or walk to Toa Payoh Vets. On weekends and public holidays, I drive and reach the surgery before 9 am.
GETTING FEEDBACK ON SERVICES
1. I man the phone calls in the morning and get complaints or feedback on services provided by associate vets. It is better to receive negative feedback so that we can improve. One of them is long waiting time, as long as two hours in one case. I had spoken to my associate that waiting time should be less than 15 minutes in general.
2. Coming back for stitch removal after spay or neuter. I told my associate vets that this need to return must be stopped as we use dissolvable stitches. I don't ask the patients to come back in 10-14 days after surgery but my associates do. So, there is an inconsistency in services from the same company.
3. No offer of chair for client during one-on-one consultation. I simply grab a chair for the client when I see my associate vet not doing this despite my advice. Mindsets of the young ones are hard to change as they are brought up in a different affluent culture. But excellent services retains customers and the associate vets should be aware of this. We get more new customers but where are the old ones?" I asked them
From Monday to Friday and some Saturdays, I leave home at 7.30 am, take a feeder bus to the subway, then another feeder bus or walk to Toa Payoh Vets. On weekends and public holidays, I drive and reach the surgery before 9 am.
GETTING FEEDBACK ON SERVICES
1. I man the phone calls in the morning and get complaints or feedback on services provided by associate vets. It is better to receive negative feedback so that we can improve. One of them is long waiting time, as long as two hours in one case. I had spoken to my associate that waiting time should be less than 15 minutes in general.
2. Coming back for stitch removal after spay or neuter. I told my associate vets that this need to return must be stopped as we use dissolvable stitches. I don't ask the patients to come back in 10-14 days after surgery but my associates do. So, there is an inconsistency in services from the same company.
3. No offer of chair for client during one-on-one consultation. I simply grab a chair for the client when I see my associate vet not doing this despite my advice. Mindsets of the young ones are hard to change as they are brought up in a different affluent culture. But excellent services retains customers and the associate vets should be aware of this. We get more new customers but where are the old ones?" I asked them
1079. Love what you do - Singapore vet graduates are fortunate to get employment easily
Yesterday Jul 16, 2012, I interviewed a Filipino vet who had 7 years of medical transcription experience and was looking for a vet technician job in Singapore. She sent 100 resumes and phone various practices and received negative replies. Now she has 8 days left to look for a job. She was referred to me by my friend, Khin Khin, a licensed employment agent dealing mainly with Myanmar applicants. Lately she got walk-in Filipino and Indian prospects too.
Now, it is extremely difficult to find an employer. The ratio of 4 Singaporean to 1 foreign worker has been increased to 5:1 and the salaries have been increased much more since July 1, 2012. So many organisations just can't employ foreigners as they don't have this ratio.
She came to Toa Payoh Vets at 9.15 am as Khin Khin had asked her to be punctual at 9.30 am. Punctuality is important for anybody and creates a good impression.
"Why did you leave out your personal particulars like citizenship, home address?" I asked. "By doing this, you make the interviewer do more work to ask you."
"My friend in the event management company in Singapore told me not to include these info," she said. "I will be discriminated if I do it."
"It is better that the employer knows what nationality you are and if there is no need for Filipinos, you will have been better off, saving time."
I reviewed her veterinary degree. The surname on the degree is different from the passport name. She had an affidavit to say that there was a mistake in the spelling. "This creates a bad impression that you don't bother to ensure accuracy," I explained to her. "MOM officers will check the surname and reject any application immediately."
She said she needed to spend time to get this rectified.
"Why didn't you work in a veterinary practice instead of medical transcription for a US hospital for 7 years?" I read her letter of appointment. "You just don't have the necessary small animal experience."
"Medical transcription pays me more," she mentioned this was S$1,000 per month with 12 hours of her efforts daily. Now she has shoulder ache and pain in her left thigh (sciatica?) and so was looking for a job that would not involve typing.
"My father was not happy when I told him I would be working as a waitress in Singapore," she knew that vet technician jobs are hard to find as she had spoken to her counterparts in vet practices and she was not in desperate need of money since her family was well to do.
"It is the timing and the referral from your friends in the vet practices rather than emailing," I said I do get several such emails.
It is so difficult for her to work in vet surgeries in the Philippines as the pay is low. New Singaporean vet graduates are so fortunate as all can get to work in veterinary practices or the government. Yet there are so many vet graduates in other countries who can't do what they love.
Now, it is extremely difficult to find an employer. The ratio of 4 Singaporean to 1 foreign worker has been increased to 5:1 and the salaries have been increased much more since July 1, 2012. So many organisations just can't employ foreigners as they don't have this ratio.
She came to Toa Payoh Vets at 9.15 am as Khin Khin had asked her to be punctual at 9.30 am. Punctuality is important for anybody and creates a good impression.
"Why did you leave out your personal particulars like citizenship, home address?" I asked. "By doing this, you make the interviewer do more work to ask you."
"My friend in the event management company in Singapore told me not to include these info," she said. "I will be discriminated if I do it."
"It is better that the employer knows what nationality you are and if there is no need for Filipinos, you will have been better off, saving time."
I reviewed her veterinary degree. The surname on the degree is different from the passport name. She had an affidavit to say that there was a mistake in the spelling. "This creates a bad impression that you don't bother to ensure accuracy," I explained to her. "MOM officers will check the surname and reject any application immediately."
She said she needed to spend time to get this rectified.
"Why didn't you work in a veterinary practice instead of medical transcription for a US hospital for 7 years?" I read her letter of appointment. "You just don't have the necessary small animal experience."
"Medical transcription pays me more," she mentioned this was S$1,000 per month with 12 hours of her efforts daily. Now she has shoulder ache and pain in her left thigh (sciatica?) and so was looking for a job that would not involve typing.
"My father was not happy when I told him I would be working as a waitress in Singapore," she knew that vet technician jobs are hard to find as she had spoken to her counterparts in vet practices and she was not in desperate need of money since her family was well to do.
"It is the timing and the referral from your friends in the vet practices rather than emailing," I said I do get several such emails.
It is so difficult for her to work in vet surgeries in the Philippines as the pay is low. New Singaporean vet graduates are so fortunate as all can get to work in veterinary practices or the government. Yet there are so many vet graduates in other countries who can't do what they love.
Monday, July 16, 2012
1078. Uplifting Service - 2012 Ron Kaufman
Saw the book at the library. Good tips to create value for customers through action.
Chapter 16. Pg 164. Building your service recovery system is useful - stories of recovery are collected and service providers rewarded.
How can this be applied to Toa Payoh Vets?
Skin disease cases - recurring or from another practice
If the vet in Toa Payoh Vets can successful resolve the dog's skin problems.
This means using evidence-based medicine (skin scrapings of 5 sites, not just one site, swabs, microscopic exam) and follow up 3 days later and 2 weeks later. Very few vets bother to do it. Very few owners bother to return for review 2 weeks later. A system to document skin disease treatment?
Recovering an existing customer is usually less expensive than acquiring a new one.
1. If the vet promses to phone back later, the vet must do it. This is one complaint I receive when I man the phone calls.
Other matters
1. Waiting more than 2 hours despite making appointments. A rare complaint but this should be attended to. There must be a monitoring system by me. Now, waiting times are limited to 15 minutes per person.
Chapter 16. Pg 164. Building your service recovery system is useful - stories of recovery are collected and service providers rewarded.
How can this be applied to Toa Payoh Vets?
Skin disease cases - recurring or from another practice
If the vet in Toa Payoh Vets can successful resolve the dog's skin problems.
This means using evidence-based medicine (skin scrapings of 5 sites, not just one site, swabs, microscopic exam) and follow up 3 days later and 2 weeks later. Very few vets bother to do it. Very few owners bother to return for review 2 weeks later. A system to document skin disease treatment?
Recovering an existing customer is usually less expensive than acquiring a new one.
1. If the vet promses to phone back later, the vet must do it. This is one complaint I receive when I man the phone calls.
Other matters
1. Waiting more than 2 hours despite making appointments. A rare complaint but this should be attended to. There must be a monitoring system by me. Now, waiting times are limited to 15 minutes per person.
Sunday, July 15, 2012
1077. Sunday Jul 15, 2012 interesting cases
Sunday Jul 15, 2012 interesting cases
Bright sunshine, blue skies
1. Case 1. New client. 3-year-old plump femal echihuahua suddenly lethargic and not eating. Black green diarrhoea.
"I saw whitish discharge yesterday," the 70-year-old man said.
"Is it from the anus or from the vagina?" I asked.
"Can't tell,"
"When was the dog's last heat?" I asked.
"Last 4 weeks, small amounts of blood unlike the first heat."
"It is not normal for a healthy to have small amounts of bleeding and for 4 weeks," I palpated a swollen anterior abdomen. The dog growled in response.
"Most likely a closed pyometra," I said. "An infection of the womb. Blood test and X-rays will be taken and an IV drip with antibiotics to be given today."
2. Case 2. 5-year-old male rabbit with rapid breathing and not eating.
"He had never fully recovered since 2 months ago," the young lady said.
"With this type of fast nose breathing, the rabbit is suffering from a serious lung infection usually," I said. "He is unlikely to live for a few days. Any change of hay and is it dusty?" I asked as the rabbit showed signs of pneumonia. The owner did not want any blood test or X-ray. So treatment would be symptomatic and the rabbit warded for one day. The rabbit passed away soon and the owner was informed promptly. No complaints as she was informed of the poor prognosis.
3. Review of Shih Tzu with vomiting and diarrhoea. Came in yesterday Saturday while Dr Daniel was on leave. He was neutered by Dr Daniel but his surgery area was not infected. For such serious vomiting cases, I warded the dog for 24 hours, gave the IV drip, antibiotics and anti-spasmogesic. Blood test. Vomited once but no diarrhoea due to treatment. Dr Daniel will call the owner as this is his case and responsibility to provide a good customer service. Very painful throat (forced feeding of medication) when I palpated it and bit me as the dog hated oral medication and bit the owner. Dog went home.
4. Review of poodle with intense facial itch. Dorsal elbows blackened skin. Had horizontal ear canal resection done by me some weeks ago and was OK. "Allergy?" It is hard to say. Warded and horizontal ear canal cleaned. No demodectic mange mites seen on microscopic exam of elbow skin but it does not mean there is none. Allergy to various things is a possibility, like dog treats.
5. A young French couple with a 3-year-old boy came to buy a kitten or dog like the tea-cup yorkshire. "We don't sell them as we are a vet surgery," I said. I checked my Samsung laptop for the phone number of a pet shop that sells kittens and puppies but stopped when a rabbit owner came in. I resumed later and asked them to phone the Holland branch of Pets Station. "Best not to buy a tea-cup yorkshire," I said. "It is hard to take care when you have a small boy."
This is "creating value" to a prospective client as it will be easier to tell him to go look for the phone number himself. The husband shook my hand.
Bright sunshine, blue skies
1. Case 1. New client. 3-year-old plump femal echihuahua suddenly lethargic and not eating. Black green diarrhoea.
"I saw whitish discharge yesterday," the 70-year-old man said.
"Is it from the anus or from the vagina?" I asked.
"Can't tell,"
"When was the dog's last heat?" I asked.
"Last 4 weeks, small amounts of blood unlike the first heat."
"It is not normal for a healthy to have small amounts of bleeding and for 4 weeks," I palpated a swollen anterior abdomen. The dog growled in response.
"Most likely a closed pyometra," I said. "An infection of the womb. Blood test and X-rays will be taken and an IV drip with antibiotics to be given today."
2. Case 2. 5-year-old male rabbit with rapid breathing and not eating.
"He had never fully recovered since 2 months ago," the young lady said.
"With this type of fast nose breathing, the rabbit is suffering from a serious lung infection usually," I said. "He is unlikely to live for a few days. Any change of hay and is it dusty?" I asked as the rabbit showed signs of pneumonia. The owner did not want any blood test or X-ray. So treatment would be symptomatic and the rabbit warded for one day. The rabbit passed away soon and the owner was informed promptly. No complaints as she was informed of the poor prognosis.
3. Review of Shih Tzu with vomiting and diarrhoea. Came in yesterday Saturday while Dr Daniel was on leave. He was neutered by Dr Daniel but his surgery area was not infected. For such serious vomiting cases, I warded the dog for 24 hours, gave the IV drip, antibiotics and anti-spasmogesic. Blood test. Vomited once but no diarrhoea due to treatment. Dr Daniel will call the owner as this is his case and responsibility to provide a good customer service. Very painful throat (forced feeding of medication) when I palpated it and bit me as the dog hated oral medication and bit the owner. Dog went home.
4. Review of poodle with intense facial itch. Dorsal elbows blackened skin. Had horizontal ear canal resection done by me some weeks ago and was OK. "Allergy?" It is hard to say. Warded and horizontal ear canal cleaned. No demodectic mange mites seen on microscopic exam of elbow skin but it does not mean there is none. Allergy to various things is a possibility, like dog treats.
5. A young French couple with a 3-year-old boy came to buy a kitten or dog like the tea-cup yorkshire. "We don't sell them as we are a vet surgery," I said. I checked my Samsung laptop for the phone number of a pet shop that sells kittens and puppies but stopped when a rabbit owner came in. I resumed later and asked them to phone the Holland branch of Pets Station. "Best not to buy a tea-cup yorkshire," I said. "It is hard to take care when you have a small boy."
This is "creating value" to a prospective client as it will be easier to tell him to go look for the phone number himself. The husband shook my hand.
Saturday, July 14, 2012
1076. Golden Retriever keeps panting every day
GR, Male, 7 years started panting. Treated by Vet 1, but panting came back again after 7 days of medication. Owner did not want blood test again.
I checked the Vet 1's report. Liver and spleen enlarged.
"Unable to do CBC as the machine cannot read the blood."
However, he did a blood smear (RBC NAD, large reactive lymphocytes 3+) and rectal palpation (enlarged prostate both sides). He did blood biochemistry - NAD
Recorded panting could be due to anaemia
Diagnosis: Acute lymphoblastic leukaemia? prostatitis/BPH
Treatment: Tardak inj. and usual medication.
MY BLOOD TEST done without charging the owner
Total WBC 91 (6-17)
Marked luekocytosis with many abnormal cells seen. No platelet clumps seen.
RBC and Hb low --- anaemia
PCV 0.28, MCF low, MCHC low. Platelets low 196 (200-500)
What's the cause of this high WBC? Due to economic problems, the owner did not want any testing.
Could this be a case of tick fever? So far, the dog is still panting but is at home as the ladies do not want euthanasia.
Glucose 3.4 (3.9-6)
Hb 10.5 (12-18)
RBC 5.0 (5.5-8.5)
Platelets 196 (200-500)
PCV 0.28 (0.37-0.55)
Total WCC 91 (6-17)
N= can't do
L=
M=
E=
B=
There is a marked leucocytosis with many abnormal cells seen. No platelet clumps.
Two blood tests showed similar leucocytosis. As to the cause, it is hard to say.
SGPT/ALT 122 (<59)
SGOT/AST 792 (<81)
Urea 7.6 (4.2 - 6.3)
Creatinine 132 (89-177)
Dog was euthanased on Jul 17, 2012 as he had deteriorated in health.
I checked the Vet 1's report. Liver and spleen enlarged.
"Unable to do CBC as the machine cannot read the blood."
However, he did a blood smear (RBC NAD, large reactive lymphocytes 3+) and rectal palpation (enlarged prostate both sides). He did blood biochemistry - NAD
Recorded panting could be due to anaemia
Diagnosis: Acute lymphoblastic leukaemia? prostatitis/BPH
Treatment: Tardak inj. and usual medication.
MY BLOOD TEST done without charging the owner
Total WBC 91 (6-17)
Marked luekocytosis with many abnormal cells seen. No platelet clumps seen.
RBC and Hb low --- anaemia
PCV 0.28, MCF low, MCHC low. Platelets low 196 (200-500)
What's the cause of this high WBC? Due to economic problems, the owner did not want any testing.
Could this be a case of tick fever? So far, the dog is still panting but is at home as the ladies do not want euthanasia.
Glucose 3.4 (3.9-6)
Hb 10.5 (12-18)
RBC 5.0 (5.5-8.5)
Platelets 196 (200-500)
PCV 0.28 (0.37-0.55)
Total WCC 91 (6-17)
N= can't do
L=
M=
E=
B=
There is a marked leucocytosis with many abnormal cells seen. No platelet clumps.
Two blood tests showed similar leucocytosis. As to the cause, it is hard to say.
SGPT/ALT 122 (<59)
SGOT/AST 792 (<81)
Urea 7.6 (4.2 - 6.3)
Creatinine 132 (89-177)
Dog was euthanased on Jul 17, 2012 as he had deteriorated in health.
1075. Tick fever in Singapore dogs from the drug supplier and in a Westie
Saturday 11.35 am
I spoke to the drug supplier of anti-tick fever medication. He said that the bottle costs around $200 and he does not stock it anymore. "Sudden demand for the drug," he said. "Then no demand. I have lost money." I asked him which months of the year were there more tick fever cases, but he could not say.
I ordered another bottle by indent and he said it would arrive in August.
Dr Jason Teo's dachshund had tick fever recently while he was in Australia, he told me today.
"In many cases, no fever," I said to him.
"Yes, my dog did not have fever. I did 4 blood tests."
"Usually, only anaemia will be the finding," I said.
"Yes,"
He could tick fever confirmed by the lab and so now I asked him to use the medicine at correct dose. "Not over the recommended dose," I said. "It can be lethal."
I will see how his dog responds.
A WESTIE WITH TICK FEVER
A few days ago, I met the "Huggies" girl whose Westie had tick fever and had recovered after treatment and blood transfusion. I remember Huggies. "How many diapers per day for the new born baby to one year old ," I asked. "You were not born when I became a father some 30 years ago."
"8 diapers/day for 6 months."
"How much it would total up?" I asked.
"0.30cents/diaper."
Her dog kept having small ticks every day and so she phoned me for the solution? I advised a tick dip, putting the Westie inside a bath tub. "Wear an e-collar for next few days. Vaccum the flooring or keep the dog in a confined room." Easier said than done. The dog had "hot spots" in the belly and around the neck. So I advised careful use of the tick wash and total clipping of the coat. Eye ointment to protect the eyes during tick dip and antibiotics for the hot spots.
"Baby ticks of small dots come from the floor cracks and surroundings and also from the coat," I said to her. They can't be seen till they reach a certain size. That is why I recommend total clipping of the entire body including the face."
I don't know whether she clipped her dog bald or not. So far, no news from her.
I spoke to the drug supplier of anti-tick fever medication. He said that the bottle costs around $200 and he does not stock it anymore. "Sudden demand for the drug," he said. "Then no demand. I have lost money." I asked him which months of the year were there more tick fever cases, but he could not say.
I ordered another bottle by indent and he said it would arrive in August.
Dr Jason Teo's dachshund had tick fever recently while he was in Australia, he told me today.
"In many cases, no fever," I said to him.
"Yes, my dog did not have fever. I did 4 blood tests."
"Usually, only anaemia will be the finding," I said.
"Yes,"
He could tick fever confirmed by the lab and so now I asked him to use the medicine at correct dose. "Not over the recommended dose," I said. "It can be lethal."
I will see how his dog responds.
A WESTIE WITH TICK FEVER
A few days ago, I met the "Huggies" girl whose Westie had tick fever and had recovered after treatment and blood transfusion. I remember Huggies. "How many diapers per day for the new born baby to one year old ," I asked. "You were not born when I became a father some 30 years ago."
"8 diapers/day for 6 months."
"How much it would total up?" I asked.
"0.30cents/diaper."
Her dog kept having small ticks every day and so she phoned me for the solution? I advised a tick dip, putting the Westie inside a bath tub. "Wear an e-collar for next few days. Vaccum the flooring or keep the dog in a confined room." Easier said than done. The dog had "hot spots" in the belly and around the neck. So I advised careful use of the tick wash and total clipping of the coat. Eye ointment to protect the eyes during tick dip and antibiotics for the hot spots.
"Baby ticks of small dots come from the floor cracks and surroundings and also from the coat," I said to her. They can't be seen till they reach a certain size. That is why I recommend total clipping of the entire body including the face."
I don't know whether she clipped her dog bald or not. So far, no news from her.
Wednesday, July 11, 2012
1074. SOP: Tick fever in a Samoyed
Tuesday July 10, 2012, I had a discussion with Video producer Nicole, Dr Daniel, Dr Vanessa and Intern Siti, a 4th year student from Serdang Vet about the diagnosis and treatment of tick fever in dogs, using a real case example referred to me recently but died within 4 hours of arrival. Siti is to present this case in her 5th year and so she was writing up the case. I gave her a day to write the case but she could not do it.
What is tick fever?
What body systems are affected?
When do clinical signs appear from the start of infection?
What should be done to diagnose tick fever is suspected?
The vet had 3 differential diagnosis - pyometra, tick fever and liver failure. His medication indicated that he was treating for liver failure and had given the owner a poor prognosis.
What is most important question to ask in the history if tick fever is to be diagnosed?
What laboratory tests must be done?
What signficant aspects of the tests must the vet look for?
What is the cause of death in this Samoyed?
An autopsy would be needed but the owner would not want it.
Possible causes:
1. Kidney failure according to one senior vet, based on the 2nd blood test.
AMA - Against medical advice. The vet did record in his case file that the owner did not want a tick-vector test to be done. The vet has given his advice but it is up to the owner to accept his advice as the owner pays for the test.
Follow-up. The vet recorded that he did phone the owner 3 days after treatment. That is good practice, but the owner denied having received any call.
Medical negligence - The burden of proof is on the owner. Was this vet negligent? My answer is no.
What is tick fever?
What body systems are affected?
When do clinical signs appear from the start of infection?
What should be done to diagnose tick fever is suspected?
The vet had 3 differential diagnosis - pyometra, tick fever and liver failure. His medication indicated that he was treating for liver failure and had given the owner a poor prognosis.
What is most important question to ask in the history if tick fever is to be diagnosed?
What laboratory tests must be done?
What signficant aspects of the tests must the vet look for?
What is the cause of death in this Samoyed?
An autopsy would be needed but the owner would not want it.
Possible causes:
1. Kidney failure according to one senior vet, based on the 2nd blood test.
AMA - Against medical advice. The vet did record in his case file that the owner did not want a tick-vector test to be done. The vet has given his advice but it is up to the owner to accept his advice as the owner pays for the test.
Follow-up. The vet recorded that he did phone the owner 3 days after treatment. That is good practice, but the owner denied having received any call.
Medical negligence - The burden of proof is on the owner. Was this vet negligent? My answer is no.
1073. FLUTD and constipation in a cat
Hi Dr Sing, My name is Gary from Vancouver Canada, I really appreciate your blog and it gives me a lot of in depth on animal's medical problems.
I am not sure if you would accept inquiry from general public on Internet, but I would like to give it a try and see if you can drop me a quick notes.
I have a 19 month British shorthair cat. He is male, neutered. As I have learned the hard way, male cats are prong to FLUTD.
Two months ago, he was completely blocked. I took him to local vet here. They unblocked him and put him on prescription diet Hill's S/D for about a month.
He was peeing fine, but the flow was never that strong after catheteration. The doctor prescribe him with some medicine which helps relieve of urethra and it helped him for about a week.
We took him back to the vet for the follow up. He did urine test and found no crystal or inflammation. But around that time, my cat started to dribble during peeing. Doctor did a physical test on his bladder and found it was not big. Therefore we went home and put him on Hill's C/D and monitoring his peeing status. (we gave him more water in the wet foods to increase his water intake)
A week has passed by, he still dribbles. He usually goes into bathroom two to three times and each time takes a long time, it sometimes takes up to 5 minutes, I see urine pass through constantly, but again, it dribbles, not a stream.
We decided to take him to another vet today. This new doctor said his bladder is big, and need to do x-ray and catherteration again. We went ahead with it.
As we discussed about the result of the x-ray, doctor mentioned that he also has constipation problem.
This leads to several of my questions.
1. Ever since my cat got blocked the first time, we fed him prescription diet dry and wet foods with additional water in the wet foods. Why would he get re-blocked and suffer from constipation? I would assume the water intake is enough and it should resolve urethral obstruction and constipation problem
2. what is your opinion on raw foods and all wet foods for cat? From what I read online, it could resolve FLUTD and constipation problem.
3. Would prescription diet such as Hill's c/d and s/d cause constipation? or if doctor prescribe diet to address constipation issue, will it cause future FLUTD again?
4. what is the best diet you would recommend for my cat who suffer from both constipation and FLUTD caused by urethral obstruction?
Thank you in advance for your help. I really hope I can hear back from you. I am just a desperate cat lover who is at loss and seeking help everywhere.
Thank you again and appreciate your time.
Gary
Reply Forward
Gary Chen
2:12 AM (4 hours ago)
to me
-------------------------------------------------
On Tue, Jul 10, 2012 at 10:05 AM, ..@gmail.com> wrote:
Thank you for your email. It is extremely difficult to know what causes FLUTD in a male neutered cat. Before answering your questions, I would like to know the following:
1. Results of urinary analysis and X-ray images taken by your two vets will be very useful.
1.1 Did the first vet's urine test show struvite crystals?
1.2 What does the second vet's urine results show? Do you have the results?
1.3 Any blood test results?
2. What type of cat litter you are using and how often you change the litter?
3. Any other cats in the house?
4. Any new events or pets like dogs introduced recently?
5. Constipation. You will know better whether your cat is constipated if you are the one cleaning up his litter. Is he constipated?
Can you provide the info?
---------------------------------------------------------------------------
Hi Dr. Sing
Thanks for your reply. I am so glad that I can hear from you for 2nd opinion.
I will try my best to answer 1st set of question at this moment, if it's not thorough enough, I will get info my my vet.
1. 1 First vet's first urine test at the time of obstruction, show struvite crystals, therefore he gave him Hill's S/D. After a month on S/D, we went back for 2nd urine test, and the result was negative. but my cat, Maoru, wasn't peeing smoothly
1.2 Maoru is still with the 2nd vet, we will know result of the urine test today or tomorrow
1.3 Blood test was done by first vet, but I could not remember the result. I will have to find out for you
2. Maoru uses human toilet bowl instead of litter box, and we flush right after he uses toilet almost every time.
3. We just lost the other cat last Thursday due to breath arrest.
4. During first obstruction, there was no environment change, but I suspect constipation was a long term issue. Second obstruction slowly getting developed two weeks ago, and we lost our other cat last Thursday
5. yes, He is constipated. he's very inconsistent and irregular. He sometimes goes daily, then we worry less, but he could go every two days or sometimes goes into the third day. His X-ray yesterday did show a lot of feces in his body.
I am not sure if you would accept inquiry from general public on Internet, but I would like to give it a try and see if you can drop me a quick notes.
I have a 19 month British shorthair cat. He is male, neutered. As I have learned the hard way, male cats are prong to FLUTD.
Two months ago, he was completely blocked. I took him to local vet here. They unblocked him and put him on prescription diet Hill's S/D for about a month.
He was peeing fine, but the flow was never that strong after catheteration. The doctor prescribe him with some medicine which helps relieve of urethra and it helped him for about a week.
We took him back to the vet for the follow up. He did urine test and found no crystal or inflammation. But around that time, my cat started to dribble during peeing. Doctor did a physical test on his bladder and found it was not big. Therefore we went home and put him on Hill's C/D and monitoring his peeing status. (we gave him more water in the wet foods to increase his water intake)
A week has passed by, he still dribbles. He usually goes into bathroom two to three times and each time takes a long time, it sometimes takes up to 5 minutes, I see urine pass through constantly, but again, it dribbles, not a stream.
We decided to take him to another vet today. This new doctor said his bladder is big, and need to do x-ray and catherteration again. We went ahead with it.
As we discussed about the result of the x-ray, doctor mentioned that he also has constipation problem.
This leads to several of my questions.
1. Ever since my cat got blocked the first time, we fed him prescription diet dry and wet foods with additional water in the wet foods. Why would he get re-blocked and suffer from constipation? I would assume the water intake is enough and it should resolve urethral obstruction and constipation problem
2. what is your opinion on raw foods and all wet foods for cat? From what I read online, it could resolve FLUTD and constipation problem.
3. Would prescription diet such as Hill's c/d and s/d cause constipation? or if doctor prescribe diet to address constipation issue, will it cause future FLUTD again?
4. what is the best diet you would recommend for my cat who suffer from both constipation and FLUTD caused by urethral obstruction?
Thank you in advance for your help. I really hope I can hear back from you. I am just a desperate cat lover who is at loss and seeking help everywhere.
Thank you again and appreciate your time.
Gary
Reply Forward
Gary Chen
2:12 AM (4 hours ago)
to me
-------------------------------------------------
On Tue, Jul 10, 2012 at 10:05 AM, ..@gmail.com> wrote:
Thank you for your email. It is extremely difficult to know what causes FLUTD in a male neutered cat. Before answering your questions, I would like to know the following:
1. Results of urinary analysis and X-ray images taken by your two vets will be very useful.
1.1 Did the first vet's urine test show struvite crystals?
1.2 What does the second vet's urine results show? Do you have the results?
1.3 Any blood test results?
2. What type of cat litter you are using and how often you change the litter?
3. Any other cats in the house?
4. Any new events or pets like dogs introduced recently?
5. Constipation. You will know better whether your cat is constipated if you are the one cleaning up his litter. Is he constipated?
Can you provide the info?
---------------------------------------------------------------------------
Hi Dr. Sing
Thanks for your reply. I am so glad that I can hear from you for 2nd opinion.
I will try my best to answer 1st set of question at this moment, if it's not thorough enough, I will get info my my vet.
1. 1 First vet's first urine test at the time of obstruction, show struvite crystals, therefore he gave him Hill's S/D. After a month on S/D, we went back for 2nd urine test, and the result was negative. but my cat, Maoru, wasn't peeing smoothly
1.2 Maoru is still with the 2nd vet, we will know result of the urine test today or tomorrow
1.3 Blood test was done by first vet, but I could not remember the result. I will have to find out for you
2. Maoru uses human toilet bowl instead of litter box, and we flush right after he uses toilet almost every time.
3. We just lost the other cat last Thursday due to breath arrest.
4. During first obstruction, there was no environment change, but I suspect constipation was a long term issue. Second obstruction slowly getting developed two weeks ago, and we lost our other cat last Thursday
5. yes, He is constipated. he's very inconsistent and irregular. He sometimes goes daily, then we worry less, but he could go every two days or sometimes goes into the third day. His X-ray yesterday did show a lot of feces in his body.
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