1175. Hard swollen abdomen in an old Pom - Ascites

X-ray of a hard swollen abdomen present for the past 4 weeks.
Dog was spayed in July 2012 by Vet 1. Inguinal hernia repaired and mammary tumours were excised by him.
The old Pom still had a hard swollen abdomen.

Owner said the 9-year-old dog was coughing a lot after operation and passed a lot of urine but was otherwise normal. 
Aspirated >200 ml of blood-tinged yellow gelatinous fluid from abdomen.

Vet 1 gave a better medical history than the owner. Ascites was confirmed by aspiration. X-ray showed radio-dense lump like a big abdominal tumour. Aspiration is important. There may still be a big tumour. Liver tumour? But liver enzymes are normal. 

1174. 15-year-old cat not eating

This 15-year-old cat would greet the owner when he comes home. Meow. She used to grumble a lot on the way home, inside the car, when she was being taken home from the boarding cattery during her younger days in Australia.

For the past month, she just would not eat. Syringe feeding 3x/day on A/D. Seen Vet 1. Saw me. Still would not eat.

Insulinoma? Hypoglycaemia in a female Miniature Schnauzer

"The 5-year-old spayed Miniature Schnauzer has 3 problems," the lady owner told me as I noted the lumps and scabs crusting the upper surface of the spinal area. "Skin infections in this backbone area, ear infections and urinary tract infections."
The dog had been to Vet 1 who had diagnosed UTI and had found one calcium oxalate crystal. He advised ultrasound at another practice and the report dated Sep 3, 2012 stated that the liver was enlarged, gall bladder had sediments 20%, stomach distended, intestines thick-walled, bladder had echogenic materials, kidneys inflamed.

I palpated and got a slight pain from anterior abdomen which appeared swollen. Onset of recurring UTI started a few months ago, vulval licking around one year ago. Anal sac expressed - thick oil +++
No steroid inj as the owner was not in favour of it and Vet 1 had already injected on Jun 29, 2012 for the "hot spots on dorsal back region" which was what had happened again in this consultation.

URINE TEST
dipstick pH 6.0, SG 1.040, Pn 3+, no blood, no white cells.

Commercial Lab Test -   pH 7.0, SG 1.048, Pn +, no blood,  white cells present, bacteria +, nitrites +,
ketones trace, crystals nil

BLOOD TESTS RESULTS MORE INTERESTING
1. Total cholesterol 11.28, HDL 5.7, LDL not able to estimated due to interference from elevated triglycerides level of 14.30

2. Glucose 1.4  (3.9 - 6.0).   Hb 20.9 (12-18) but other values are normal. Kidney and liver are normal.

So, what is the main problem? UTI.
What's the solution?
Nov 7, 2012 7.30 pm I phoned the owner. On Nov 5, 2012, Dr Daniel had used his GPS and drove me to the Bishan apartment. I delivered the blood test and urine test results in her post-box as Dr Daniel was going to Bishan. Today, I asked her. She did not go to the letter box yet.

Q1. How's the right ear?
Scaly. No pus.

Q2. Urine.
A. No blood. No dribbling or incontinent.

Q3. Does the dog drink a lot?
A. Drinks little. This explains why the UTI recurs. There is insufficient urine production to flush off the bladder's sediments which I presumed included calcium oxalate from the dry dog food. This explained the high USG of over  1.040

Q4. Still feeding the dry dog food? The owner bought expensive organic dry dog food of different brands.
A. Yes.


VET 1'S  CASE REPORT
1. June 29, 2012   Hotspots on dorsal back region. Antibiotic and shincort injection.
2. Jul 30, 2012      Haematuria & dysuria. No stones palpated inbladder. Cystitis. Advised to review with urine analysis and ultrasound if recur

3. Aug 18, 2012   Vaccination
4. Aug 28, 2012  Haematuria. Appointment for ultrasound at another practice.
5. Sep 3, 2012     Owner showed ultrasound report indicating "cystitis" and renal inflammatory condition". No stones, mass, polyps in ultrasound. Urine analysis - leucocytosis, glucose -ve, blood -ve, one calcium oxalate crystal seen.
6. Sep 25, 2012. Otitis externa right ear. pus.

This case is a challenging case and the whole history and situation has to be reviewed regularly. The main problem is the recurring UTI. According to the owner, onset of dysuria, haematuria, polyuria started a few months ago. The vulval licking was around one year.

How to solve this problem economically?
I SPOKE TO THE OWNER AT 7.30 PM AND THE FOLLOWING PLAN OF ACTION
1. Increase water intake. The dog drinks little. Therefore canned food. No dry food. What brand?
2. As one calcium oxalate crystal was found by Vet 1 and the pH was NOT stated in his two urine test on Jul 30 and Sep 3, 2012, it is hard to know whether the urine was alkaline or acidic.
Based on my urine test on Nov 3, it was pH 7.0 (neutral) but bacteria was present. No urinary crystals. Why was there positive nitrite?
3. For the next 4 weeks, strictly on U/D diet and re-check the urine again for infection. If no recurring UTI, the dog should be on U/D diet for some months.



Low glucose. The dog did not faint or go into fits any time as the owner did not complain about this. So the low glucose on Nov 3, 2012 was a puzzle. The beginning of insulinoma since ketones (trace) was present in the urine? High lipid in the blood - gluconeogenesis, starting ketosis?

More reviews will be needed.

 
















 

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.