Nov 16, 2011
I was reviewing a skin disease case and phoned the retired pharmacist.
"My poodle is OK now. 95% cured. Nibbles at front paws and will stop when I scold him."
"You can't be monitoring him 24 hours," I said. "Did you eat the Z/D diet?"
"He didn't like it, so I mix it with the usual dry dog food,"
Some info
Poodle, M, 4 years, landed property
Fed various brands of dry dog food
May 5, 2012
Itchy face, neck, paws, elbows. Skin scraping - no mites. No ringworm. Ears normal.
Medication and an anti-mite insecticide wash.
No further complaint.
Oct 20, 2012
Went to emergency night clinic.
Uncontrollable scratching of lower night all night until it bleeds.
Blood test normal. Skin scraping fungus and bacteria, no mites.
Hyperpigmented skin on ventral neck and dorsal surface of front paws - suggestive of chronic skin disease. Advised skin allergery/atopy workup.
Oct 21, 2012
Treated for bacteria and fungus. Canine Z/D trial for 3 months accepted by owner.
But the dog did not like it. So he did not give 100% when I phoned him on Nov 16, 2012 (today). He said the dog is 95% Ok with hair growth back to the areas. Except for front paws licking occasionally.
This case illustrated the great difficulty of some owners to do the Z/D food allergy elimination trial. "The dog is OK in the past 4 weeks," I said. "This is due to the medication. The real test will be the next 4 months. If you don't try the ZD, the dry dog food allergy may return once the drugs wear off."
Skin diseases are costly to treat but many owners don't realise the importance of review 4 weekly or the use of Z/D or equivalent food trials. The vet may need to keep a record and call the owner but we seldom do as we don't even have time to sit down.
Oct 21, 2012
Case came to me.
Friday, November 16, 2012
1181. Urine collection from guinea pigs for the vet - blood in the urine
PROCEDURES FROM TOA PAYOH VETS
BLOOD IN THE URINE
URINE COLLECTION BY THE OWNER/VET
1. Put guinea pig in a clean plastic box without chemicals. Syringe him or her 10 ml of water slowly.
2. Tilt the box slightly so urine will flow away from the faecal pellets.
3. Use a sterile syringe to collect the urine and give it to the vet. At least 0.5 ml of the urine or up to 5 ml.
URINE ANALYSIS
Urine dipstick test for blood etc.
Urine analysis by the lab
Urine cultures
X-RAY
5. X-ray of the bladder by the vet advised
Urinary sediments - amorphous urates (acidic urine) or amorphous phosphates (alkaline urine). In this case, urine analysis detected amorphous phosphates ++, the pH was 9.0 and bacteria was present in the urine.
CLINICAL SIGNS TO CO-RELATE WITH LAB FINDINGS
Loss of appetite
Difficulty in urination
Blood in the urine - red urine due to plant pigments or blood due to infection/trauma or urinary tract
Drinks a lot or little
ADVICES
It is difficult to use diet to acidify the urine. I advised a course of antibitoics, cutting down on too much wheat grass and hay and more water to drink as well as pesticide-free vegetables.Will need to follow up on another urine analysis. As at Nov 19, 2012, no complaint of haematuria.
BLOOD IN THE URINE
URINE COLLECTION BY THE OWNER/VET
1. Put guinea pig in a clean plastic box without chemicals. Syringe him or her 10 ml of water slowly.
2. Tilt the box slightly so urine will flow away from the faecal pellets.
3. Use a sterile syringe to collect the urine and give it to the vet. At least 0.5 ml of the urine or up to 5 ml.
URINE ANALYSIS
Urine dipstick test for blood etc.
Urine analysis by the lab
Urine cultures
X-RAY
5. X-ray of the bladder by the vet advised
Urinary sediments - amorphous urates (acidic urine) or amorphous phosphates (alkaline urine). In this case, urine analysis detected amorphous phosphates ++, the pH was 9.0 and bacteria was present in the urine.
CLINICAL SIGNS TO CO-RELATE WITH LAB FINDINGS
Loss of appetite
Difficulty in urination
Blood in the urine - red urine due to plant pigments or blood due to infection/trauma or urinary tract
Drinks a lot or little
ADVICES
It is difficult to use diet to acidify the urine. I advised a course of antibitoics, cutting down on too much wheat grass and hay and more water to drink as well as pesticide-free vegetables.Will need to follow up on another urine analysis. As at Nov 19, 2012, no complaint of haematuria.
Wednesday, November 14, 2012
1180. Second operation of the hamster with the right fore paw tumour
This morning, the young man came at 9.44 am to get his hamster operated. I was surprised that the hamster's cheek pouches were bulging with food and he looked much more alive than yesterday (Tuesday Nov 13, 2012 - a public holiday, Deepavali)
The young man had brought the dehydrated and easily tired hamster for surgery. "I had told your mum to quickly bring the hamster to me when the lump regrows," I had sliced off the large tumour on Oct 3, 2012, sparing the hand. "The hamster can hold and grip food after the surgery," the young man said. "But only last week, this growth started and became very big." It was a reddish globe of 8 mm x 8 m. It made the hamster look as if he was wearing a boxing glove. He was much irritated by it as it was painful and inflamed.
I prescribed oral antibiotics and pred yesterday
The young man had brought the dehydrated and easily tired hamster for surgery. "I had told your mum to quickly bring the hamster to me when the lump regrows," I had sliced off the large tumour on Oct 3, 2012, sparing the hand. "The hamster can hold and grip food after the surgery," the young man said. "But only last week, this growth started and became very big." It was a reddish globe of 8 mm x 8 m. It made the hamster look as if he was wearing a boxing glove. He was much irritated by it as it was painful and inflamed.
I prescribed oral antibiotics and pred yesterday
Saturday, November 10, 2012
1181. Skin diseases in two adult Westies
Case 1.
"You are so rough," the lady admonished me as I flexed and extended, abducted and adducted the Westie's left shoulder and other joints of the left fore limb. She expected gentle manipulation.
"If the joints are normal, a vigorous manipulation would not cause any pain," I replied. "See, only the dog was crying when I extended the left fore paw, but had no reaction on the shoulder, elbow joints. Gentle manipulation may not show any problems in the joints."
Today is Saturday Nov 10, 2012. I was at the Surgery at 8.45 am. Phone calls came in at 9 am for appointments for Dr Vanessa and one for Dr Daniel but both were not working today. I caught up with my admin work, checking on associate vets' cases, data mining, reviewing past medical records and doing a thousand and one things.
Suddenly a lady brought in her 7-year-old male Westie saying the dog had been limping. The dog could put weight on the left fore limb but occasionally lifted it up quite high as I observed him in the waiting room. He wouldl not walk into the consultation room where the lady called. So I came out and opened the door. Slowly he went in.
"The dog's backside is itchy," the lady in her late 30s said. "I sent him to the groomer recently."
"The dog's anal area is black and brown," I expressed the anal sacs and blood with dark brown oil were seen on the tissue paper applied to
"Has your Westie any more infection of the ears and the skin?" I checked the medical records. The Westie was a referral from her friend who was 16 years old when I treated the case and was now 35 years old, according to this lady. So, 19 years had passed for this young girl whose identity I do not know.
Westies are famous for skin diseases and so I reviewed this case of success for my knowledge. The owner did follow up reviews and the disease was cured
10.33 am Another client with a Pom comes in.
Friday, November 9, 2012
1178. Gum ulcer in the 15-year-old cat
Taught the owner how to "inject" feed pellets into the old cat. She had a gum ulcer and so did not eat. The owner did not know how to use the syringe or pill popper and so the pellets fall out from the mouth.
Why did the old cat stop eating? Is it because she's 15 years old. At the end of the life span? Vet 1 had been consulted and gave some medication.
"My cat attempts to grip the food, but gave up."
So there would be some problems with the mouth. I opened the mouth. A big swollen lump appears at the gum/tooth junction of the left upper canine. This was extracted. The cat still would not eat. The owner had to syringe feed 3 to 4 times a day again.
I examined the case a few days later. There was an ulcer caused by the long sharp left lower canine, causing a red oval ulcer in the opposing upper area where the canine teeth had been extracted. The periodontal abscess of the left upper canine gum area had shrunk. This was good news.
left lower canine was extracted. A big tumour was seen growing on the spinal area. "This looked like a nasty fast-growing tumour. It is best to send to the lab for testing," I said. The big tumour was excised and the lab results showed a poor differentiated carcinoma.
Yet the cat would not eat and the owner had to go on a business trip. He said to me, "My cat does not have cancer as the test did not show cancer. Yet she is not eating. Do you have any medicine to make her eat?" I asked Dr Daniel if he had said that but he did not say that. A carcinoma of the skin is cancerous.
The cat still had that upper gum ulcer. But the main problem was that he did not use the syringe popper properly. He did not insert it far back to the back of the mouth. So the dry pellet just landed in front of the mouth and the cat just pushed it out. Dr Daniel and Min showed him how to do it. We put the cat on the table, one person opened the mouth and the other popped 5 dry food pellets into the mouth via the popper. The cat swallowed.
Nov 13, 2012 update. The owner said that the cat was eating a bit and was interested in food after Dr Daniel prescribed some tolfedine painkillers.
Later,
Why did the old cat stop eating? Is it because she's 15 years old. At the end of the life span? Vet 1 had been consulted and gave some medication.
"My cat attempts to grip the food, but gave up."
So there would be some problems with the mouth. I opened the mouth. A big swollen lump appears at the gum/tooth junction of the left upper canine. This was extracted. The cat still would not eat. The owner had to syringe feed 3 to 4 times a day again.
I examined the case a few days later. There was an ulcer caused by the long sharp left lower canine, causing a red oval ulcer in the opposing upper area where the canine teeth had been extracted. The periodontal abscess of the left upper canine gum area had shrunk. This was good news.
left lower canine was extracted. A big tumour was seen growing on the spinal area. "This looked like a nasty fast-growing tumour. It is best to send to the lab for testing," I said. The big tumour was excised and the lab results showed a poor differentiated carcinoma.
Yet the cat would not eat and the owner had to go on a business trip. He said to me, "My cat does not have cancer as the test did not show cancer. Yet she is not eating. Do you have any medicine to make her eat?" I asked Dr Daniel if he had said that but he did not say that. A carcinoma of the skin is cancerous.
The cat still had that upper gum ulcer. But the main problem was that he did not use the syringe popper properly. He did not insert it far back to the back of the mouth. So the dry pellet just landed in front of the mouth and the cat just pushed it out. Dr Daniel and Min showed him how to do it. We put the cat on the table, one person opened the mouth and the other popped 5 dry food pellets into the mouth via the popper. The cat swallowed.
Nov 13, 2012 update. The owner said that the cat was eating a bit and was interested in food after Dr Daniel prescribed some tolfedine painkillers.
Later,
1177. Follow up on Ascites in the Pom
Today Friday Nov 9, 2012.
I reviewed the case handled by Dr Vanessa. She had aspirated some at 1 bdominal fluid yesterday and again today and the abdomen was not so tense. The dog ate a little.
"There appeared to be a large abdominnal tumour," I believed it could be a malignant metastasis from the breast tumours excised by Vet 1 earlier. In any case, the dog had a very high total white cell count, indicating a blood spreading bacterial infection. The dog was sent home with medication and given a poor prognosis.
"The tumour may be inoperable," I advised no surgery as the dog was in very poor health and would likely die on the operating table. No dog owner would forget the death as it would be emotional and costly. Therefore, I asked for the dog to be sent home today for observation. The cause of the ascites could be the heart disease.
Further X-rays and tests are needed but this would be too costly. The vet must understand the cost and the chances of survival before undertaking surgery. Inoperable tumours and poor health and heart disease are best not operated.
In conclusion, I wonder whether it would have been kinder for the female dog if she had been spayed at a young age as breast tumours are less likely to develop during her senior years. Vet 1 did not send the tumours for histopathology based on economic reasons.
I reviewed the case handled by Dr Vanessa. She had aspirated some at 1 bdominal fluid yesterday and again today and the abdomen was not so tense. The dog ate a little.
"There appeared to be a large abdominnal tumour," I believed it could be a malignant metastasis from the breast tumours excised by Vet 1 earlier. In any case, the dog had a very high total white cell count, indicating a blood spreading bacterial infection. The dog was sent home with medication and given a poor prognosis.
"The tumour may be inoperable," I advised no surgery as the dog was in very poor health and would likely die on the operating table. No dog owner would forget the death as it would be emotional and costly. Therefore, I asked for the dog to be sent home today for observation. The cause of the ascites could be the heart disease.
Further X-rays and tests are needed but this would be too costly. The vet must understand the cost and the chances of survival before undertaking surgery. Inoperable tumours and poor health and heart disease are best not operated.
In conclusion, I wonder whether it would have been kinder for the female dog if she had been spayed at a young age as breast tumours are less likely to develop during her senior years. Vet 1 did not send the tumours for histopathology based on economic reasons.
1176. Three-year-old cat vomits and can't poop
X-rays show hair balls. Kitchen floor tile renovation recently. Cat grooms excessively and may have got hair ball obstruction. X-rays show the hair balls. Likes to play with ribbons too.
Laxative and enema 2 times - stools come out.
Thursday, November 8, 2012
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.
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.
Wednesday, November 7, 2012
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.
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.
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.
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