2 weeks after spay - the aggressive cat from Hougang

I have removed her e-collar on Monday. I noticed that she keeps trying to pull out the surgical sutures (which is still very intact) and I'm afraid that it might "tear" her skin or something. Hence, may I know if I need to come back to your clinic to remove the sutures? or will it fall off on its own one day? Should I let her continue to lick her incision site so that the sutures will fall off faster?

.Hope to hear from you soon!

p/s: Thank you for the follow-up call to check on my cat's well being after her enema treatment on the eve of Hari Raya Haji. Great service! =)


Regards,
Di
Mobile:
-------------------------------------------------------

EMAIL REPLY FROM DR SING DATED NOV 7, 2011
On Wed, Nov 7, 2012 at 6:31 PM, Kong Yuen Sing <99pups@gmail.com> wrote:

If you have time, best to come and get stitches removed. If no time, put back e-collar and stitches will dissolve in Day 21-30 after surgery or earlier. If you have courage, get a pair of small clean scissors and cut at the knot

PHONE CALL
Phoned owner Nov 7, 2012 6.31 pm
1. She can take out the stitch but will email image of wound area before doing anything.
2. Cat had constipation post op and difficulty taking medication.
3. Cat would eat on day of surgery

1170. Eosinophilia in a Chow Chow from tick bites?

Only the best for this client and his Chow Chow was his pride and joy. Last week, his man brought the dog to me. This Chow Chow had lost a lot of hair, around 80%, with some left in the head and tail. His bare skin was black. A bigger version of the hairless Chinese Crested dog. Lumps could be seen all over the bare skin. "Get your groomer to clip off all the hair," I advised. No news from him till 4 days later.

"The Chow Chow has lost appetite and is very itchy," the man in his 40s said. "He had lots of tck bites. We applied Revolution 2 weeks ago and Frontline 3 weeks ago."

The Chow Chow had two bleeding spots at the tips of both ears. I asked Dr Daniel to check for scabies mites by taking a skin scraping of the areas. "There is a tick seen under the microscope but no scabies," he aske me to view the slide. True enough. One newly hatched baby tick.

"It is best to do a complete blood test," I advised. "To check whether the liver and kidneys are affected as well as the overall blood cells."

"Let me phone Mr Tan first," he said. Permission was given.

CHOW CHOW, M, 3 years, 21.3kg, 39.3C

Blood test results
The following was low   Urea 4.0 (4.2-6.3); Creatinine 81 (89-177).

Total WCC was normal, but N 66%, L 12%, M 1.4%, Eosinophils 21%, B 0%
Absolute                                N 10.08, L  1.75,  M 0.21  Eosinophils 3.15    B 0.0
PCV and platelets normal

Could the tick infestations cause eosinophilia?
Yes. Parasites can cause eosinophilia. So can allergy and some infections.

This is one case where eosinophilia is caused by tick bite allergy.

On Nov 6, 2012, the next day after treatment of the dog, I phoned the man.
"The Chow Chow now eats his usual two meals a day," he said.
"Is he still scratching his body?" I asked. The anal sacs were also filled with thick greyish oil and could cause itchiness of the back and tail biting.
"A bit of itchiness, here and there," he was quite pleased with the response.

I was glad that this Chow Chow did not suffer from tick bite fever or anaemia. Surprisingly, the two Golden Retrievers living in the same area had not one tick. So, could the other dogs be immune to ticks or the Revolution and Frontline were working fine? It is a mystery.


PHONE CALL TO THE BUSY OWNER to understand what's going on.
Lately the entrepreneur is busy with interior designing business for new apartment owners.
"Did you propose a fish tank?" I asked.
"The units are so small nowadays," he said. "It is hard to place the usual cabinets, sofa sets and carpets."
He told me one expatriate sold off his 3-bedroom condo for S$2million and bought a villa with 6 bedrooms and a pool in Johor Bahru for S$1 million and has left over money.
  
Q1.  Was the Chow Chow's skin so black since young?
A.     No. Only since Mar 2012. The skin was pinkish.

Q2.  Your brother said that the two Golden Retrievers have no ticks at all.
A.   Not true. They have ticks and so have the other 7 dogs but this was not a big issue. The source was from the 19-year-old Cocker Spaniel who was allowed into the open field brought in the ticks. The other dogs were housed indoors as there is a big terrace for them.

Q3. Was there any ointment or medication applied to the Chow Chow's skin?
 A.  No. Coal tar shampoo was used for all dogs last year though.

Q4. When did the Chow Chow start losing hair?
A.   In March 2012. He started biting his tail and the hair loss from the tail spread to his back and then the body. His coat was so beautiful and he looked very big when he had a full coat.

Q5. Did you clear the ticks in the terrace?
A. A pest-control staff smoke-bombed the area once. It could be insufficient or the ticks hatched again. It ought to be done 2-3X e.g Monday, Tuesday and Friday like what is done for fish lice. Ont time is not enough. However, the Cocker Spaniel would bring in the ticks again.

Q6. Those skin lumps in the body. When did they occur?
A. These are due to tick bites. His skin would erupt in lumps whenever ticks bite him.

So, the clue was from Q6. This Chow Chow had urticarial lumps from tick bites. A tick bite allergy leading to an increase in the eosinophils since Mar 2012. It is always good to get the history direct from the owner if only the vet will take the trouble to phone this "busy" owner who loves dogs, kois and arrowanas. And rears only the best of them. Readers may chance upon one of my earlier articles and images of kois kept by him.

 

 

Event Details:

Date: 7 November 2012, Wednesday

Time: 9.00 am - 12.00 pm (Registration starts at 8.30 am. Light refreshments will be served.)

Venue: DBS Auditorium 1, Marina Bay Financial Centre Tower 3, Level 3

12 Marina Boulevard, Singapore 018982

 

 

I will be attending the seminar.
Enhancing your business strategy” seminar by DBS.

The first speaker was an excellent presenter and is an experienced economist. For 2013, he predicted that the Singapore economy will slow down, interest rates would still remain low. Private residential properties would be in a large supply but he did not expect prices to crash.

His reasons for the 2012 slow growth in the Asian economy was due to the slow down in China investments (China being responsible for 56% of Asia) and change of China's policy towards domestic consumerism, 50 rate hikes in 2010 butt 14 rate cuts in 2011.

He said the above were the main contributing causes rather than just the euro debt crisis and the slow economic recovery in the US affecting Asia exports, as predicted by the other economists. .

Asia's manufacturing ans services would be affected in 2013

As for Singapore, 2007-2008 had a net inflow of 300,000 foreign workers in 2 years. The hikes in foreign worker policies and other fees just pass the increase cost to the customer, thereby increasing the inflation in 2011.

For the property market in Singapore, mortgage rates is below 2%. The real mortgage rate is negative. The global interest rate is so low. Therefore property prices go up.

Singapore is losing out to competitors due to a strong S$ and higher inflation. In the 4 quadrants in his chart, Singapore is on the upper left. Philipines, China, Thailand and Myanmar is in the lower right. Hongkong and Thailand is on the lower left. 

GDP Singapore is largely due to external factors. The real median income growth should be the target. The focus should not be on productivity growth factors

In conclusion, 2013 - poor economic outlook for Singapore due to slower than normal growth (cutting down foreign worker employment after the general elections) and higher than normal inflation.  
   

1169. Internship at Toa Payoh Vets - Prospective Interns to note

To Whom It May Concern

Dear Sir/Madam

My name is V...  and I am a second year veterinary student from the University of Melbourne. As part of our progression into the 3rd year of clinical placements and surgery, we are required to intern at different clinics in two week blocks to prepare us for surgical subjects next year. I would be in Singapore from the 11th December 2012 to 24th January 2013 and I would like to take on a two week placement at your veterinary facility anytime between the dates aforementioned.

I am very interested in specialising in small animal surgery after I graduate. I believe that your clinic would help me greatly in preparation for next year and that I would learn many skills from you.

I am a fast and keen learner and will work well in a team and I would really appreciate an opportunity to work in your veterinary hospital.

Thank you for your time and I hope to hear from you soon!

Warmest Regards

V... 

------------

Hi
I am Dr Sing from Toa Payoh Vets which is not a veterinary hospital. If you can work the hours 9.30 am to 8 pm on weekdays and 9.30 am to 5 pm on weekends, I will be most happy to accept you for the 2-week intern. Email to me your resume and two character references.


-------------

Dear Dr Sing

Thank you for your prompt reply! I would be happy to work these hours at your clinic. I have attached my resume (my character references included) as well as details from the school to my supervising veterinarian. I would like to enquire when would it be a good time for me to commence my placement? Thank you for your time!

------------------

Start at 9am from 11 Dec for 2 weeks. Interns should dress appropriately and be punctual and keen in vet medicine.

1168. To publish***** Urinary stones in a Schnauzer

Please inform your editor/publisher the following:

1.  To make the article useful and educational to readers, you should include the following X-ray (attached file) associated with the case study image you have had inserted.

This is preferred to a pretty face (the puppy standing around at the bottom of the article). It does not contribute any knowledge to the reader.

2. If there is no space for the X-ray, use the space taken by my photo requested by you.  I don't see my photo as being useful and educational to educate many ignorant Singapore dog owners whose dogs suffer from kidney and bladder stones. The X-ray picture has more impact on owner education as a picture says a thousand words. 

2.1  The X-ray image of the case study of the Schnauzer image you had inserted is as at:
http://www.kongyuensing.com/cgi/20120620bladder_stones_female_Schnauzer_toapayohvets.jpg.

It is attached as in this email.

3. Readers may wish to know what actually happened in my case study and you could have educated them more by printing:

To learn more about this case, goto:
http://www.sinpets.com/dogs/20120617female_dog_catherisation_singapore-ToaPayohVets.htm

4. This will be what I will do as the editor. Not just printing a pretty face of puppy or dog to adorn the article. There are millions of pretty dog images in dog magazines. These are commonly seen by your readers in every dog magazine published all over the world.

But they rarely see X-rays of bladder stones in a dog and I can bet you that your publisher has NOT published one in any past issues of your magazine. There must be some new ideas in publishing educational article in your pet magazine, rather than the usual method of generating text with pretty canine faces to adorn a veterinary article. This method is commonly done in most dog magazines published by the US and by Singapore dog magazine publishers till they are too common and not interesting.

1167. Kidney stones in a Miniature Schnauzer

The vomiting Miniature Schnauzer has kidney stones Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS 05 November, 2012

TOA PAYOH VETS  Be Kind To Pets Veterinary Education Project 2010-0129

1167. Kidney stones in a Miniature Schnauzer Yesterday, Nov 4, 2012 I attended a SVA continuing education lecture "Urolithiasis" by Adjunct Associate Professor Philip A Moses, BVSc, MRCVS, Cert SAO, FANZCVS, CMAVA, Memb AO, Specialist Small Animal Surgeon, Veterinary Specialist Services, Underwood and Gold Coast, Australia Much can be learnt from experienced veterinary surgeons. These are his advices regarding kidney stones. 1. Around 4% of the urinary stone cases are kidney stones. Therefore, always X-ray the kidneys as well as the bladder. 2. All vets should get the urinary stone analysed. It is not enough to just remove the stones and not analyse it. He cited one case where a loyal client lost faith in the vet who removed the stones the 2nd time and stones recurred again the 3rd time. Some vets don't get the stones analysed if the client is on a tight budget but this against medical advice should be recorded. 3. He would removed the kidney stone in the renal pelvis if the renal incision needed is less than 20% of the length of the kidney. For example, 1 cm incision length for a 5-cm long kidney. If it is 50% and more, it is unlikely that the kidney will function normally post-op. 4. Struvite stones and other stones do recur and this must be told to the dog owner. 5. In the US, there seems to be a higher rate in the occurrence of calcium oxalate stones. 6. As long as the vet monitor regularly post-op, most struvite stones will dissolve if the Urinary Tract Infection (UTI) can be controlled. While stones are there, there will be bacteria inside the bladder. Hence there is a need to give antibiotics even if these must be given for a long period of time. Regular monitoring via urine analysis and ultrasound are recommended. 7. "Can large struvite stones really dissolve by the dog eating stone-dissolving diets?" I asked him. "Yes," he said. "There have been reports of such cases." "Have you or your colleagues achieve success in such cases?" I asked. "No," he said. "I just remove them surgically." Owners in Singapore seldom bother to do regular monitoring though. Below are X-rays of one of my cases of kidney stones seen in a Miniature Schnauzer in Oct 2012. I advise the busy owner to do regular monitoring but this needs time from him to bring in the dog for examination. He has many things to do and so I don't know whether his dog will get a 3rd occurrence. It is costly to operate and some owners just get the dog euthanased. Yet this struvite stone disease can be prevented if the owner spends time to get the tests done.   5742. Kidney stone Nov 11? Vet 1 did not extend the X-ray area to the kidneys in this first occurrence 5742. Kidney stone Aug 12. Vet 1 did X-ray the left kidney area and a stone can be seen 5743. Kidney stone Oct 12. My X-ray shows the kidney stone too 2 months after Vet 1's X-ray in Aug 2012. 5742. Kidney stone Nov 11? 5743. Kidney stone Aug 12 5745. Kidney stone Oct 12

Images & Update at:
http://www.sinpets.com/F6/20121105kidney_stones_Schnauzer_toapayohvets.htm

1166. Follow up on heart attack obese Tibetan Spaniel

Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.

She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it. "

"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."

"I gave him the dog treats which I had bought a lot," she did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.

If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that wel educated on this aspect.   

Struvite stone Schnauzer eats today

Oct 25, 2012

At 6.30 pm, I saw the Schnauzer licking vigorously the operation area till serum oozed out. I changed to a bigger e-collar.


Oct 30, 2012
In hindsight, the dog could have felt itchy in her op area as she was walked for more than 5 minutes every morning at around 9 am by my assistant Min. Movement affected healing and stretched the long skin incision. As at Oct 30, 2012, the dog was at home for the past 3 days and no problem is encountered. The vomiting had disappeared. Owner must follow up on urine analysis for the next 3 months, but most owners are time-pressed and fail to do so.  

1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel

Tuesday, October 30, 2012


1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel



REVIEW OF AN UNUSUAL CASE



"I paid over $700 and the vet does not know what's wrong with my dog!" the owner had to paid for the emergency treatment for continuous panting which started on Friday at around 6 pm. She brought him to the emergency practice at 10.15 pm and the next morning, the dog was still furiously panting.



"It is not easy to diagnose what's wrong in some cases of uncontrollable continuous panting," I told the owner. I auscultated the lungs and heart on this fine sunny Saturday morning of Oct 26, 2012 at 10 am. The lung sounds were harsh and loud - the rhonchi and the rales of bovine pneumonia as that was what was taught in my Glasgow vet school in my final year in 1974.



Basically these were descriptions of the crackling noises in the lungs obscuring the heart sounds. Dr Jason Teo closed the muzzle while I placed the stethoscope inch by inch on the cardiac area of the left chest. I heard a "machinery murmur" in the midst of rapidly beating heart. It was just impossible to hear anything.



The dog had been panting non-controllably since 12 hours ago.



HISTORY

Thursday, Oct 25, 2012 - Nothing wrong. As usual playing on his own. Excellent appetite as usual.

Friday, Oct 26, 2012 - Did not poop since Oct 24. Brought him downstairs to walk and poop in the morning at 10am. Walked for only 10 minutes in the car park, not hot. Dog wanted to go home. Ate t home.

Then at 6 pm, dog started to pant heavily and continuously and at 10.15 pm, owner brought him to the emergency centre.



EMERGENCY CENTRE BLOOD TEST ON OCT 26, 2012 AROUND 10 PM

Tibetan Spaniel, MN, 28.4 lbs, 3 years, 39.8C

RBC low 1.95 (5.5 - 8.5)

HCT low 13.2% (37-55)

Hb is normal



WBC high 20 (5.5-17)

N 50%, L 37%, M 10%, E 3.4%, B 0.5% all normal

But L is high 7.15 (0.5-4.9), Platelet is low 62 (175-500)



High values for glucose 154 (74 - 143), TP 8.5 (5.2 - 8.2), GLOB 5 (2.5-4.5), TBIL 2.8 (0-0.9)



CHOL 159 (110-320) is normal





TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM on admission to Toa Payoh Vets. The dog had been treated by Vet 1 on Friday evening and overnight and had done a great job. But the owner was not impressed as the dog was still panting continuously.

13 kg 39.3 C. The significant findings are shown below:



TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM

Tibetan Spaniel, MN, 13kg, 3 years, 39.3C



Lipid profile

High total cholesterol 6.27, HDL chol 4.26, LDL < cannot be estimated due to interference from elevated triglyceride level, triglyceride 8.68



Liver profile

ALT 236 (<59 3151="3151" ast="ast">


Total WCC 26 (6-17)

N 95%, L 4.7%, M 0.3%, E 0%, B 0%. PCV and platelets normal. The neutrophil count at 95% is very high, indicating that the body produced lots of neutrophils to fight the bacteria in the blood and body.



The relevant finding for Vet 1 and me is that the total white cell is very high. This indicated a bacterial infection of the blood. This bacteria was of the type that the antibiotics took more than one day to control it.



My hypothesis: The heart, lungs and liver were infected and the dog was in great pain and therefore panted continuously as part of the whole process of infection.





The problem for me on this Saturday morning and afternoon was that the dog kept panting after the sedation of dom + ket given at 50% IV wore off. Continuous panting started after 2 hours. Gave IV diazepam, lasix and usual IV drips. At times, the tongue turned cyanotic. The panting was still continuous throughout the night but at 50% lesser pace. Nothing seemed to control it.



SUNDAY

Panting still persisted esp. after the owner visited with her 85-year-old mum who was most worried. The dog tried to stand up despite sedation. The owner changed the water bowl and wiped the dog. I told her not to stay more than one minute as the dog got excited and panted again. But she would not listen. The dog had "recovered" but that was due to medication. Soon the dog started to pant continuously again. "The dog is very sick and should not be visited," I said to her. One of my other clients said to me: "You are harsh to her." I told him that I had spent my Saturday afternoon ensuring that this dog's health was deteriorating and it should not be excited by getting up to greet the owner. I understand that the owner was anxious and worried to see her dog but visits ought to be very short in the interest of the canine patient.



"Do you visit a person in intensive care and change the bandages?" I asked her. "Let the dog rest and recover. If you insist on visiting the sick dog, please consider another clinic." It was a busy Saturday afternoon for me, trying to stabilise this dog as his panting would return once the sedation wore off. This was an unusual case but not uncommon.



If this dog kept panting for many hours and days, his heart would fail and he would die. The owner must understand the situation and not insist on patting the sick dog for the first day at least.



MONDAY

Got owner's permission to do X-rays of chest and abdomen again, ultrasound of abdomen (no gall bladder obstruction or pancreatitis, liver enlarged, urinary stones x2) and ultrasound of the heart (one coronary artery blocked 30%, dilated cardiac myopathy right heart). Panted again when brought to X-ray but much less.



TUESDAY

On heart medication. Dog no longer panted and the owner came to bring him home. Panted when brought out of the cage.



ADVICES

Some bacterial attack in the blood causing such sudden onset continuous panting. This would be my tentative diagnosis. Ultrasound did show 30% blockage in one coronary artery and Vet 3 diagnosed dilated cardiac myopathy of the right heart. Acute bacterial pericarditis?



The dog is obese and so high cholesterol and triglycerides were found. The dog should stay at home. Not going out for one month. No greeting neighbour's dog. Heart medication and H/D diet. This is an unusual case as continuous panting had persisted for over 48 hours despite medication. I agreed with a poor prognosis from Vet 1 but veterinary medicine is full of surprises. The dog survives after intensive treatment.



My associate vet said to me: "Better not to handle this case." I understood his concern he did not want any litigation and complaints if the critically ill dog with no hope should die at Toa Payoh Vets. Dogs do die and many owners don't forgive the vet. So I understand his advice. Yet, for this owner, it is hard for her if she had to go to the 3rd vet as time was of the essence in treating a continuous panting dog.



Day 1 of panting Day 3 of panting Day 3 of panting

Dog was not furiously panting on Day 3, so the X-rays are clearer. Ultrasound of the heart & abdomen were done



Bacteraemia was present on Day 1 & 2. The dog was stabilised on heart medication on Day 4 and is OK so far

Wednesday, October 31, 2012

1166. Follow up on heart attack obese Tibetan Spaniel



Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.



She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it."



"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."



"I gave him the dog treats which I had bought a lot," the owner did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.



If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that well educated on this aspect.



In conclusion, the dog had short episodes of panting during walks and had recovered but this time, he just had uncontrolled continuous panting. A bacterial infection of the blood was present. As to the source of the bacteria, it could be from the dog treats or the soil during exercise.

    Update at:
http://www.sinpets.com/dogs/20121101Tibetan_Spaniel_continuous_panting_toapayohvets.htm

1162. A 15-year-old Persian cat

"I went to Vet 1 twice and blood tests were done twice," the man in his late 60s said. "Nothing wrong. I was asked to give A/D by mouth daily and I have been doing it for 2 weeks. My cat is losing weight and not eating. She used to eat well till two weeks ago."

I did an abdominal palpation. The thin kidney meowed when I palpated the left kidney. I advised a blood test. The clues from the owner are important. He said: "My cat would look forward to the dry cat food but after one bite, would not eat."

"Is there mouth ulcers?" I asked. The cat clawed me and objected strenuously to her mouth being opened. I could see one left upper canine tooth gum was much bigger at around 5X the other. Was there a gum tumour causing pain? Was this swelling present at young?

What is the solution? I advised another blood test. But what is the diagnosis and the solution?
This is a difficult case. Dr Daniel said there was a big firm lump in mid-abdomen. Yes, there was one but it could be the kidney or bladder. He was sure they could be intestinal or abdominal tumours.  "An X-ray may show," I said.

I gave the cat an IV drip and medication. Will need to wait and see after the blood test results come in.