1347. Why bother to screen your older dog's health?

TOA PAYOH VETS toapayohvets.com       Date:   04 April, 2013   Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits. Health Screening For the Older Dogs Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 21 September, 2011 Date:  04 April, 2013 toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Most dog owners in Singapore live hectic lives. There are just too many distractions and too much work or enjoyment. After an intense period of love and care for their new puppies, the senior dogs are just left alone as there is no time for them after their puppy hood. It is usually too late for many old dogs when they are sent to the veterinarian for some chronic disease problems. Veterinary costs become high as the dog is in poor health and need more intensive care.   Senior dogs are: Small and Medium-sized breeds: Over 7 years Large and Giant-sized breeds: Over 5 years. For those who may want their senior dogs to live longer, here are the following health screening recommendations by Toa Payoh Vets: 1. Veterinary examination every 6-12 months including examination for tumours and growths, ear infections, eye diseases and skin diseases. Skin diseases are the top 3 cases in Toa Payoh Vets. An educational video is at: Video: Microscopic exam of ringworm  2. Blood tests to check for blood disorders, diabetes, liver and kidney diseases. Special veterinary diets can be given to prevent further health deterioration when such health screening show disorders of the liver and kidneys, prolonging the dog's life. 3. Urine tests to check on bladder and kidney infections and presence of urinary stones. Urine tests for bladder stones 3-months or periodically after operation as advised by your vet, but many Singaporean owners don't bother and bladder stones recur 3 times.  Some owners euthanase their dogs when stones recur but others incur high veterinary costs to get them operated. Monitoring of the urine and X-rays as advised by your vet after bladder stone removal would have prevented much medical costs.  5863. Five surgeries for bladder stone problem in a Shih Tzu 4. X-rays for arthritic hip joints (can't stand up easily), spinal column, heart and lungs. X-rays for bladder stones 3-months or periodically after operation as advised by your vet. 5. Ultra-scans of the abdomen for abnormal growths of the internal organs. 6. An MRI scan of the brain for brain tumours. 7. Dental check up and scaling every year. Prevention of oral tumours and oro-nasal fistulas (carnaissal tooth abscesses) in the old dog can be done if the owner checks his or her dog's teeth at the vet yearly. 5957. Oro-nasal fistula: Follow up 6 years later 6. Heart check for murmurs and heart diseases. 7. Stool test for blood, parasites. 8. Blood tests for allergens affecting your dog. 9. A report and discussion about the delay in senility, obesity, behavioural problems, skin problems and any questions related to each individual dog. 10. Excision of small skin, mammary, circum-anal and other tumours.  Tumours detected early can be excised saving the dog's life and reducing veterinary costs. Delaying treatment results in tumours growing and multiplying as in the circum-anal tumour. Many Singapore dog owners delay removal of their senior dog's tumours till they grown big, become smelly and bleeding, messing up the apartment. In such cases, the anaesthetic risks are very high and the dog may die on the operating table. An example of the investigation tests and surgeries done for one older dog with heart disease and another with gum tumour is shown below Case 1: Heart disease confirmed in an old companion Cardiac Tamponade in a Labrador Retriever - Pt 1 Cardiac Tamponade in a Labrador Retriever - Pt 2 Case 2:  Get tumours excised by your vet when they are smaller  Old dogs are very high anaesthetic risks as they are seldom in the best of health unlike younger ones. Everyone is happy when the old dog does not die on the operating table after surgery. But every vet will have cases of old dogs dying on the operating table as it is impossible to get good clinical outcomes when the vets undertake high-risk anaesthetics. This is one main reason why some vets discourage or reject old dog surgeries. "The old dog will pass away before the circum-anal tumours grow much bigger," one vet said to the owner. But the dog lived longer, splattering the apartment with blood from the bleeding tumour and requiring frequent cleaning up.   \ 5646 - 5648.  Mammary adenoma. A kind Buddhist teacher. No further news from the teacher as at April 4, 2013 When a dog dies on the operating table, it is just too emotional for everyone including the operating veterinary surgeon. Such  deaths may be bad-mouthed by the owner or the family members to friends and recorded on the internet forum. The bad news adversely affect a vet's reputation that takes so much time and effort to build. So it is understandable if a vet does not want to operate on high-risk cases. I do avoid such cases if possible as deaths on the operating table means a beloved family member that has been growing up with the family children who have become adults is lost forever. The average life-span of a big breed dog is 12 years. Oldest small breeds in Singapore can live up to 20 years. However, many die before they are 10 years of age due to bad health and other preventable causes such as bacterial infection of the heart valves due to severe gum diseases (preventable by regular 2-yearly dental scaling and checks), pyometra (preventable by early detection or spaying), kidney diseases, diabetes and  tumours like breast, gum and circum-anal tumours (much less occurrence in a male dog that has been neutered). Many diseases such as circum-anal tumours rarely occur in male dogs that have been neutered. If you don't wish to neuter your dog, please check his backside monthly as small circum-anal tumours are easily removed and cost you less too.   Tumours like breast tumours are best removed when they are small.   Case study. Breast tumours have spread to two breast. If excision is not done, all 10 breasts will be cancerous. The surgery was done at Toa Payoh Vets in 2008 and the owners had not returned as at April 4, 2013. Make an appointment with your pet shop groomer if you have a close working relationship with them and needs pet transport to the vet of your choice. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail judy@toapayohvets.com your requirements.  Updates will be on this webpage: www.toapayohvets.com/surgery/20080807Senior_Dogs_Health_Checks_ToaPayohVets.htm   Advert for Veterinary Technicians  or Nurses For Toa Payoh Vets BE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER.  More case studies, goto:  Cats  or  Dogs To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129

Toa Payoh Vets Clinical Research

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1344. A Good Friday's miracle (Mar 29, 2013)

I don't believe in miracles. This 5-year-old male neutered  Jack Russell was rushed in by the father on March 27, 2013 panting and unable to stand since 12 hours ago.

His neck was skywards. His four limbs were extended as straight as a ramrod. Panting and panting non-stop. His rectal temperature skyrocketed to 41 deg C. This scene reminded me of a dog under domitor IV anaesthesia. All muscles stiffened. Or a dog with tetanus with all 4 limbs straight but in this case, the jaws were not locked.

Was there any hope? The father gave permission for blood sample and I took a urine sample to test. Evidence-based medicine should be used as the family will want to know what is the cause of these symptoms and should the dog die, much allegations of incompetence will be insinuated if the vet does not practise evidence-based medicine.

Recently one retiree dog owner did not want the blood test or X-rays although his female dog had been lethargic for 2 days and her abdomen was bloated. His dog had fever. He came towards closing hours and the dog was given a drip and therefore needed to be warded overnight. His daughter objected to the dog being hospitalised as "none of the family's sick dogs had ever been hospitalised over the years even by the vets of a well-known big practice."  In other words, no dogs need to be hospitalised. Just give an injection and medication and the dogs go home. I discharged the dog home the next day. He phoned again to ask what was wrong with his dog and what caused the abdominal bloat as his dog was sleepy again. I asked him to seek a second opinion from another vet.

For this dog, the blood and urine test showed a bacterial infection. The bacteria would have invaded the brain and meninges causing the stiffness. It was not a stroke as the father postulated. There was an explanation for the cause of this stiffness of limbs and neck.

I gave this dog intensive treatment to prevent dehydration, reduce the stiffness and medication. On the 2nd day, he still could not stand. He started crying non-stop all the morning and afternoon. He would drink when a bowl was held to him. He would not eat. Bloody stools stained the thermometer when I took his rectal temperature. His moaning was loud and neighbours wondered why there was dog abuse. I injected sedatives but his loud crying would recur soon as the IV drip diluted the sedative effect.

So I phoned the owner's father to let him know of the poor prognosis and asked him to visit the dog. In one  experience, I had not phoned the owner to view the sick dog and it died leading to scoldings from the owner. I did not expect it to die, but some owners are quick to vent their anger. In this case, I expected the dog to die and therefore contacted the owner urgently.

A dog crying continuously, in my experience, is a sign of intense pain affecting the brain. I had seen such cases in puppies infected with distemper virus encephalitis. The crying just goes on and on.

"Nothing can be done till my son come back from overseas," the father said that euthanasia would require the son's permission. He had visited the dog and attributed the crying to his visit. But the dog had been crying for three hours before his visit. Sedatives seem to have no effect. A half-dose domitor and ketamine lasted less than an hour. The IV drip was still on. Oral sedatives. Rectal sedatives. No effect. Feeding of water temporarily stopped the crying. He did not want to eat.

Finally I decided to give another type of IV sedative to let him sleep through the night. At 8 am on Good Friday, Day 3 of the hospitalisation, there was no more crying. The dog could lift his head and stand when placed on the ground. He lapped water from the bowl. My new assistant placed a bowl of canned food in front of him. "Feed him using the spoon," I said to this young man who is under training by me in dog nursing. The dog swallowed the food. I got a video of the dog outside the clinic, standing and walking a few steps, of sitting upright on his chest. Then I placed him back to rest.

The son and his wife and father came. "What is the cause of his problem?" the father asked again although I had told him. "It is a bacterial infection of the blood and brain," I said. "What type of bacteria?" he asked.  I said I had not got the bacteria cultured. Economics played a big part in the heartlander's veterinary practice and more tests meant higher veterinary bills. If my practice was situated in a prime area where money was no problem, I would have done MRI costing a $1,000 and other tests. The overall bill would add up to at least $3,000 or more. This would not be much appreciated by the heartlander client. 

The daughter-in-law  took out her card to pay the bill. The dog was alive, eating and drinking. I advised the son that the dog would do better when nursed at home. It would also cost less. The medication and management, if complied with, would lead to his recovery. There was no blood test to show that he has recovered from the bacterial infection. This ought to be done as the father asked whether the dog had recovered. As this is heartlander practice, the minimal costs would be appreciated.

If the dog could eat and drink and was able to stand and walk for a few seconds, there was progress and recovery. MRI would be excellent in such cases to aid diagnosis. In economics, the important thing is to deliver. And this was the miracle on this Good Friday, March 29, 2013. There are miracles one can't help but believe in.


   

1343. How to produce an interesting C-section video?

			6054 - 6064. >Six hours' delay resulted in two distressed pups bare

1342. Seamstresses in Myanmar

TOA PAYOH VETS toapayohvets.com Date:   28 March, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Seamstresses from Myanmar Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   28 March, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Yesterday, March 27, 2013, I visited Khin Khin who operates a licensed employment agent as I have had known her and her husband for more than 20 years.  Times are very hard for employment agencies as the Singapore Government has sharply cut down the quota of foreign workers for all employers. Many employment agencies have closed down in her building and in other parts of Singapore. Many retail operations including restaurants and cafes that are more reliant on foreign workers have to close down or stop expanding. Even the Housing & Development Board's construction of new HDB apartments is delayed by several months.    Khin Khin said she would close shop at the expiry of the lease in December 2014 as she had fewer successful closing. "Can I close earlier?" she had asked me. "Yes, if you continue paying the office rental of $1,600 per month from March to December 2014." I said. "All businesses have ups and downs. It is up to the owner to persevere. If every start up business is successful, everybody will start their own business. Why be an employee? "In this difficult time when others are closing down, you should be around and be well organised. You need to know how to manage the employment agency business. You have a special advantage over Singaporeans as you can speak the Myanmar language and English. So, you have many Myanmar prospects as they prefer their own agent who can communicate with them. But you are unable to connect them to Singaporean employers." Employment agencies supply maids too and they are numerous in the past 3 years as Singapore was very welcoming of the foreign workers contributing to an economic boom. However, the locals become dissatisfied as they lose bargaining power in getting well paid and not working long hours as much as 10 hours a day. Not all foreign workers will tolerate the long hours too as I could see from the new prospective job applicants at Khin Khin Employment Agency. Some will change employers to get shorter hours and seek help from Khin Khin. One Filipino worker change employer for higher pay but soon find out that the hours are not short. So she resigned as she wanted Sundays off. Soon her one-month extension of stay after termination of her "S" Pass expired and she had to go back to the Philippines as she could not find an employer. Many employers with "S" Pass quotas get their applications rejected as the MOM deemed that the quality of the prospective hires is not up to standard or for some reason. Such rejections have become very common nowadays. In this way, the foreign worker population is reduced to resolve the problem of overcrowding in subway trains and public places upsetting the locals. The way I see it, such policies are good for the small companies with lower overheads, such as that of Khin Khin who focuses on Myanmar workers. "You can upgrade to a higher quality of workers desired by Singaporeans," I said. "You can expand to include workers other countries." It is easier said than done. For example, there is a demand for male "maids" to help the aging men with strokes. There is a demand for nurses but this is a world wide demand. Can she provide such workers? Many start ups don't last 5 years. Some don't even last 1 year but Khin Khin had gone past one year. It is best for her to be well organised and do marketing to survive. It will not be easy but it can be done as she has this special niche - a knowledge of the Myanmar language and English. She can be a bridge for Myanmar businesses which are now booming in Yangon and needs services in Singapore. So much to do if she knows how to do it.      There was a Myanmar maid who visited her office yesterday but she was not in as she was coughing. This maid had a job with an English family through Khin Khin employment agency. This was a personable girl who understands and speaks good English. "How come you know how to speak good English?" I asked her. She had worked for a Singaporean family earlier. The English employer likes her very much. Her Thai maid had walked into Khin Khin's office and asked for a maid subject to being paid a commission on success. So this was how the Myanmar girl in her mid 20s got a job. "Are there many seamstresses in your village in Myanmar?" I asked her and showed her one "Alteration Shop" near Khin Khin's office in the office building to ensure that she knew what I meant. "So many," she said. I was looking for a seamstress to make some uniforms and operating clothes.  "My mother makes the dresses for me," she said. I thought her mum is a seamstress but she is a secondary school teacher employed by the Myanmar government . "How much does a teacher earn per month?" I asked her. "One Lak," she said. "One Lak" is the figure of 10,000 kyats. Something similar to the Chinese of "One Mum" which is equivalent to $10,000. Dividing "One Lak" by 700, it is equivalent to S$420. "So you are earning more than her!" I said and she smiled. The English employer pays her at least $450 per month with 4 days off per month. The Singaporean employer in general prefers the maid not to take a day off per week and pays the $20/day compensation. Some Singaporean employers allow one day off per month. 4 days off are important for workers in my opinion. It is to refresh their minds and to meet their country folks. Unfortunately some become pregnant and that is where the employer thinks that he has to pay $5,000 penalty to the MOM. On the subject of seamstresses, a prospective candidate came looking for a better job than being a maid. She wanted to earn more than a maid and she has a degree from Myanmar University. "It is very difficult for a maid to get a 'S' Pass," Khin Khin said to me. I don't agree with her as such ex-maids will have a better knowledge of Singapore's culture and can understand English. It may be MOM's policy to reject maids applying  for 'S' Passes but I don't know what MOM officers think. This slim lady wore a peaked cap, dressed in black blouse with sequins and a white jacket. She took off her peak cap and Khin Khin asked me to contact a Singaporean lady who could be interested in employing her as a maid and to do some sewing. "You had your own sewing shop in Myanmar for 10 years," I confirmed with her. "Did you sew dresses for fashion departments in Yangon?" "No," she said. "They don't do such things in Yangon," Khin Khin who had arrived at 4.30 pm said. "The best way to test her skills in sewing is to ask her to make a dress for the prospective employer." I phoned the prospective employer and left a message for her to call me. Many people are such that they don't return calls unless they require something from you. So, I had not received any return calls. To test her skills, the seamstresses need a sewing machine and so Khin Khin went to the neighbour to ask how much they will charge for her to sew a dress. "$20 for renting her equipment for her to sew a dress" she told me. "Sewing machine and threads and scissors. The neighbour wants to rent half of my office as she intends to close her shop. No business at all. She wants to sell her sewing machine to me for $400. Actually I have a good Japanese sewing machine in Yangon. For rental, I can partition half of my office." I can understand that Khin Khin is also trying to cut costs as she would get $800/month. Office rentals are high in Singapore compared to other countries like Malaysia. "You don't rent to anybody esp. trading and sewing shops," I advised. "Your office is so small at around 300 sq ft. Prospects need to come in to discuss with you and you will not have space for them. It gives a poor impression too." So Khin Khin shelved the idea again. The solution is to get more cases closed, not to rent out half the small office! This solution applies to all businesses including veterinary practices.   Update will be on this webpage: http://www.sinpets.com/F6/20130328seamstresses_Myanmar_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: March 28, 2013 Toa Payoh Vets

   



      

 

1341. Follow up on the rat with a nose "tumour"

The owner went to a 2nd vet for a second opinion. The vet  had a smear of the cells of the nose tumour done. The tumour was growing bigger over time. I had proposed surgical excision earlier on. The owner wanted a second opinion and investigation of the cells by another vet.

Nose "tumours" that keep growing bigger, in my opinion, are based excised when they are smaller. No delays and waiting for biopsy and giving antibioitcs to see if they will reduce in size. Some of them may be abscesses and antibiotics may work.  

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

On Wed, Mar 27, 2013 at 5:45 PM, ,,,@gmail.com> wrote:

Dear Dr Sing,

The tumour ruptured and we had to put XXX to sleep today. The tests came back inconclusive.

From the smears examined there is a moderate accumulation of intact erythroytes and rare hyperplastic epithelial (round to ovoid) central nucleu with mild amphophilic cytoplasm) and small round cells with no discernible mitoses or evidence of inflammation; the findings are not specific for any particular etiology. If lesion persists then if clinically allowable a representative tissue biopsy should be evaluated via histopathology. Clinical surveillance is warranted.

Thank you for everything that you and your staff have done for Moo.

Regards,

Jasmine Lim

 EMAIL REPLY FROM DR SING DATED MAR 28, 2013
 Thank you for your feedback. Please accept my condolences. Best wishes

Ringworm in a Labrador's puppy forehead

Ringworm infestation a 3-month-old puppy or kitten can take a long time to heal despite medications and washes. There are many reasons. One is that the immune system in the puppy is not as developed. The other reason may be that the owners or their maids have not been able to clear the infections through non-compliance with drug dosage or times. There may be re-infection from the surrounding area.

I spotted this case of ringworm in the black Labrador puppy given anti-ringworm medication and sent home during the first consultation by my associate vet. He had lots of scales. All over his body especially his forehead and backbone area from the neck to the tail. As if the skin was sprouting dandruff on the 2nd day after bathing.

I retained the puppy for a more thorough treatment as I know the average Singaporean owner would not be able to treat it as it was full of dandruff. Scales big and small fall from the body. Not just fine scales as in some chronic dog diseases. The puppy's skin was not dry nor oily. Did the breeder or seller give some medication or apply some wash that cause such a condition? Nobody knows. The owner just brought the dog as it was. A lively puppy that would never stop jumping on anybody and straining on the leash like a racehorse in prime condition to win a race. 

I had the puppy clipped bald. Scrubbed the forehead with anti-fungal shampoo and sent the puppy home after 4 days. The owners wanted the dog hospitalised as Chinese New Year was round the corner. So the dog was boarded and treated for more than 10 days. The forehead recovered as new hair grew. The whole body has a new shiny coat about 8 cm long. The puppy went home a week or two after Chinese New Year.

The owners sent him back again as dandruff sprouted from the backbone area, the sides of the thigh and the belly. "It could be due to too much bathing and loss of oil," Dr Daniel gave his opinion. "The owners bathe the dog and scales appear two days later."

OK. Too much bathing? Loss of skin oil. So dandruff forms. If this is the case, don't bathe the puppy often. But the dandruff keeps forming more and more. What is the solution?  The vet is the expert.

Dandruff along the spinal area. It indicated that the puppy had been rubbing his backbone area or somebody had applied strong medication on this area. Some friction on the skin. No hair loss unlike the usual ringworm infestation. Just lots of skin flakes in snow white colour and of various sizes. As if the skin is peeling off.

I checked the anal sacs. Dark brown oil of over 5 ml were expressed. Surprisingly so much oil in a 4-month-old puppy. Then I gave a Vitamin ADE IM and anti-inflammatory injection as well as got the puppy in a bath tub and scrubbed by myself and my assistant. A strong bristle brush. Red papules were seen in the skin after bathing. I started the puppy on the Z/D anti-allergic dog food.

4 days later, I noted that the dandruff did not form on the backbone area from the neck to the pelvis. "Good news," I said to Dr Daniel. "The anal sacs were impacted fully and expressed. The Vitamin ADE seemed to do a good job. Was it the Z/D? Or was it the anti-inflammatory or the scrubbing?"

A few flakes appeared around the tail area. It would take time to recover. I sent the boisterous puppy home and told the owner that recovery of the skin was around 80-90%  and the puppy was to be put on Z/D, anti-fungal medication and multi-vitamins. 

From my experience, it is difficult for owners to treat generalised ringworm in the puppy or kitten. It takes more than a month to recover and require clipping of the coat to remove the contaminated hairs.

I may produce an educational video about this case. An image of the puppy with the forehead ringworm is shown:

TOA PAYOH VETS toapayohvets.com Date: 23 March, 2013 Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The old Sheltie has a cauliflower lump Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate: 23 March, 2013 toapayohvets.com Be Kind To Pets Veterinary Education Project 2010-0129 Sunday Mar 10, 2013 I was reviewing this Sheltie X's case, operated by Dr Daniel 3 days ago, using electro-surgery to excise the large gingival mass. In this surgery, intubation is compulsory as it takes a longer time to excise this lump. Electro-cautery to seal the bleeders. Monosyn 2/0 sutures were used to close the large wound after electro-excision. I asked Dr Daniel what was the post-op situation 3 days after op now? "Any stitch breakdown or complaint from the owner?" "No news," he said. He phoned the owner but the line was busy. "You can text to her," I advised. After 10 minutes, I phoned the owner. The mother said: "I have not checked the mouth, but the dog is OK." She asked the daughter to check the mouth but she would not want to do it. "I will check for you," she replied. "The stitches are still there." "Give soft food or dry food with water for the next 14 days," I advised. "My Sheltie is eating dry food with water all the time," she said. "How long was the gum tumour there?" "I don't know. Four months probably." "One month," the daughter said. "If the tumour grows so fast and so large within one month, it is likely to be cancerous and will recur," I advised. This is an cauliflower-type gingival lump. Could it be malignant? Since the owner did not want histology, there is no way to know its nature. It is good practice to build up client loyalty in this competitive world. Getting feedback from the owner after surgery is one excellent way to show you care. But many of us don't do it often esp. if the vet has 40 cases a day to handle and is mentally exhausted at the end of the day. Too many customers/vet does not mean it is a good thing as each case becomes a bottom-line figure rather than a personal involvement and continued education through follow up on the clinical or surgical outcomes. Follow ups make a vet hone his skill and become better at the next case as no vet knows everything and every case is so much different. . In Singapore, busy owners may need repeated dialing or to phone their residence number just to communicate with them. Some don't return calls and some don't have time to talk! Sometimes I just text the message to them and we never talked at all since text messages are so convenient. Update will be on this webpage: www.bekindtopets.com/stories/20130323gingival_tumour_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: March 23, 2013 Toa Payoh Vets