Case of euthanasia or not? May 20, 2013. 8 pm duty. Dr Sing Kong Yuen
THE CASE FOR OR AGAINST EUTHANASIA -
THE DOG HAS LIVED PAST THE EXPIRY DATE
14-year-old.male Cocker Spaniel.
Profuse salivation and "bad breath" now.
"He keeps drooling and he has bad breath. Is it worth treating him?" the gentleman owner consulted me for the first time at 7.30 pm on Monday May 20, 2013, half hour before my closing time. ""I read from the internet that Cocker Spaniels live up to 12 years and he is already 14 years old."
"This Cocker Spaniel is active. Is he eating or not?" I wanted to confirm.
"He eats a lot," the man said.
"One of the main reasons Singaporean dog owners put an old sick dog to sleep is financial," I said.
"Oh, I can afford the fees. Is it value for money? Will there be more medical problems down the road if you treat this drooling?"
"The decision to euthanase has to be made by the owner," I replied. "If he is my dog, I will get him treated for drooling and bad breath." Actually, there was no loud stench. I reviewed the medical records as the dog had been treated by my associate vets in the past 2 years. In April 2012, my associate vet had operated on the right ear for aural haematoma, excised a big skin wart and did dental scaling under anaesthesia. The costs amounted to $751. In May 2012, the dog was hospitalised 7 days for a ruptured skin abscess, costing $315. So, in 2012, the owner had spent around $1000 whereas for the past 11 years of the dog's life, he did not have to pay for veterinary costs except for the $35 annual vaccination from 2009 - 2012. In April 2013, he paid around $744 for dental and removal of skin lumps. Now there is profuse salivation.
So, I can understand that he is worried that there will be more veterinary bills and since the Cocker Spaniel is expected to live for 12 years, his dog had exceeded the life expectancy. So, he asked me whether he ought to euthanase him. The cost of living had shot up incredibly high with car, rental and property prices too high as there seemed to be a group of rich consumers. Many heartlanders are affected and so are their pet's health care treatment being delayed.
It is like my 8-year-old car. It cost me a bomb to repair the leaked radiator and yet after spending $6,000 over a period of one year, the radiator system still leaked. I had to rent cars while it was in the workshop. Recently, I scrapped it as the leak continued.
But this dog was drooling for the first time. What was the cause?
"If the dog does not drool till Christmas, it will be great," the owner said.
"Why not give him 2 weeks' chance?" I asked. "I give the medication and you stop feeding dog treats. Just canned food - no dry food and water for two weeks."
"Are you sure you can stop the drooling permanently?" the man asked.
"I don't know. If the gum ulcers heal and you don't feed abrasive food or treats, there may be a chance."
This was the live or die situation for this friendly big-sized Cocker Spaniel with white beard. At 13 kg, he was thin and he had a rectal temperature of 39.5C which might be a sign of fever. Due to economic reasons, I did not ask for a blood test to screen his health. I gave two injections and medication. "Strictly just canned food and water for the next 2 weeks." I said. "This is his last chance to live."
The next sunny blue sky morning of Tuesday, May 21, 2013 at 10 am, I phoned the gentleman. His sleepy voice over the phone told me that the dog had considerably reduced his drooling. "Last night, he did not drool at all. Maybe a drop or two! Wait, I will check him now."
He examined the dog and replied: "The drooling absolutely stopped. Will this be permanent?"
"Much depends on the cause of the gum ulreration," I said. This viscous salivation reminds me of cats being given some drugs they dislike and so they produce viscous salivation and drooling.
"Did you use alcoholic wipes to clean your dog's mouth?" I asked by the way.
"Yes, I do," he had bought some commercial wipes. "But there is no alcohol."
"Are those the baby backside wipes?" I asked.
"Yes," he said.
So, this follow up is useful in that the cause of salivation could be his habit of wiping the dog's mouth twice a day to clean him. The chemicals inside the wipe cause gum ulcers and evoked viscous salivation. There would be a smell of "bad breath."
"Do you think the wipes cause this drooling?" the man asked me.
"It is possible. Stop all wipes. Use paper towel or tissue paper."
I have to wait and see for 2 weeks. If there is no more drooling, this dog has a reprieve and may live up to 20 years of age. Much past his expiry date of 12 years according to the internet.
Tuesday, May 21, 2013
Saturday, May 18, 2013
Update Yorkshire 16 hours after breast tumour surgery
Update & Review of breast tumours removed yesterday at 4 pm. Very weak not standing when the owner visited at 7 pm. On IV drip.
Saturday May 18, 2013 9.29 am. Alert, walking. Not eating. Some swelling at right MG 2.
CASE
Yorkshire Terrier, F, Not spayed. Mammary tumours x 4.
7 months ago, small nodules but not excised as owner was worried about anaesthesia.
Tumours in right & left MG5 are extensive.
To remove only the right chain, MG3,4,5 as there will be no skin to suture if the left MG5 is also removed with the right MG5. Ovariohysterectomy not done at same time as the dog is very old. Shorter the surgery, higher the chances of survival.
SURGERY. Dr Daniel Sing to operate and I to assist. Nai to do vet anaesthesia.
The surgery took around one hour at minimal anaesthesia isoflurane 0-3%. Dom + Ket at 50% of formula given IV. IV drip.
Blood test May 17, 2013
Only urea high at 10.7 (4.2-6.3) and creatinine low 39 (89-177), platelets very high 886 (200-500). umours have spread possibly via the blood stream --- high platelet counts?. No X-rays of lungs done owing to economic reasons.
Goes home today 10.15 am.
Saturday May 18, 2013 9.29 am. Alert, walking. Not eating. Some swelling at right MG 2.
CASE
Yorkshire Terrier, F, Not spayed. Mammary tumours x 4.
7 months ago, small nodules but not excised as owner was worried about anaesthesia.
Tumours in right & left MG5 are extensive.
To remove only the right chain, MG3,4,5 as there will be no skin to suture if the left MG5 is also removed with the right MG5. Ovariohysterectomy not done at same time as the dog is very old. Shorter the surgery, higher the chances of survival.
SURGERY. Dr Daniel Sing to operate and I to assist. Nai to do vet anaesthesia.
The surgery took around one hour at minimal anaesthesia isoflurane 0-3%. Dom + Ket at 50% of formula given IV. IV drip.
Blood test May 17, 2013
Only urea high at 10.7 (4.2-6.3) and creatinine low 39 (89-177), platelets very high 886 (200-500). umours have spread possibly via the blood stream --- high platelet counts?. No X-rays of lungs done owing to economic reasons.
Goes home today 10.15 am.
Friday, May 17, 2013
1423. Old female Maltese had bladder rupture and vomiting
The 13-year-old female Maltese had a much swollen abdomen. Tense. Bladder ruptured and contained green fluid. The wound was stitched up. Continued vomiting the next 2 days. Blood tests renal disorder and total WCC of 43 (7-17). The prognosis was poor. The family decided on euthanasia.
1422. The Yorkshire is too "light-weight" for surgery
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TOA PAYOH VETS
Thursday, May 16, 2013
1421. Intellectual property for a write/illustrator
Another client of mine had written 10 stories on core values for a pre-school operator. "He paid me very little as compared to another writer," she said to me. "My stories are better as I write, illustrate and translate to Chinese language."
"He asked you to sign and paid you," I said. "So he has the copyrights. But you can always write another version. After all, you can write about a cat with one black ear instead of two black ears." She had lost her motivation.
Core values are now in the school curriculum but she said there are many other authors. "Does it mean no new writers should write about the same topic just because there are thousands of writers of how to care for your cat?"
"He asked you to sign and paid you," I said. "So he has the copyrights. But you can always write another version. After all, you can write about a cat with one black ear instead of two black ears." She had lost her motivation.
Core values are now in the school curriculum but she said there are many other authors. "Does it mean no new writers should write about the same topic just because there are thousands of writers of how to care for your cat?"
1420. Divine intervention?
Yesterday I spoke to my client whose heart had stopped beating for over one hour in 2008 when he went in for a surgery of his middle ear. Emergency resuscitation by the medical team revived him but now he feels deep chest rib pains. His heart is OK.
"My ECG reading was flat as a straight line," he said. "I was dead."
"Did you see bright lights?" I asked.
"I saw bright lights, blue skies and hear hymns."
Was it divine intervention for an athesist? Was there medical negligence as his medical form and his hand bracelet stated he was allergic to augmentin. Yet he was given augmentin prior to surgery? I am glad he is alive. His dog which was diagnosed with paraplegia by Vet 1 was massaged and managed to prevent bed sores survived to 15 years of age. He started to walk "but hopped" after home nursing. Recently he had kidney failure and I had to euthanased him. The client came for a death certificate and I asked him about his health after being "dead" on the operating table. I was most happy he was alive.
Doctors are not Gods. They make mistakes and will continue to make mistakes. Some mistakes cause deaths of patients. It is important to adopt a systematic procedure to check for drug allergies before anaesthesia and surgery and to ensure drug dosage is not above requirements.
"My ECG reading was flat as a straight line," he said. "I was dead."
"Did you see bright lights?" I asked.
"I saw bright lights, blue skies and hear hymns."
Was it divine intervention for an athesist? Was there medical negligence as his medical form and his hand bracelet stated he was allergic to augmentin. Yet he was given augmentin prior to surgery? I am glad he is alive. His dog which was diagnosed with paraplegia by Vet 1 was massaged and managed to prevent bed sores survived to 15 years of age. He started to walk "but hopped" after home nursing. Recently he had kidney failure and I had to euthanased him. The client came for a death certificate and I asked him about his health after being "dead" on the operating table. I was most happy he was alive.
Doctors are not Gods. They make mistakes and will continue to make mistakes. Some mistakes cause deaths of patients. It is important to adopt a systematic procedure to check for drug allergies before anaesthesia and surgery and to ensure drug dosage is not above requirements.
1419. Update: Anal wound closed up by Dr Daniel
"The old dog's circum anal wound is very big," my intern Ms Toh said to me. "But I can't illustrate. It is just very big!". Sometimes I try to motivate my intern to be more interested in the various surgical conditions in dogs. After all, she will be studying vet medicine next year and internship gives her real life cases.
"Is it a 12 to 6'oclock tumour around the anus?" I persisted.
"I don't know," she said. From Dr Daniel, it was this massive size. The wound was large as a big piece of the skin with tumours was removed and stools just lodge inside this big wound.
"This wound will never close by granulation because stools keep contaminating it," I said to the owner and to Dr Daniel. "A skin flap has to be made to stitch the anal sphincter to the skin." The owner consented to the surgery and even phoned yesterday to ask whether it was done. "It is being done now," I said. The surgery was done by Dr Daniel. No more defect or gap. Wait and see.
"Is it a 12 to 6'oclock tumour around the anus?" I persisted.
"I don't know," she said. From Dr Daniel, it was this massive size. The wound was large as a big piece of the skin with tumours was removed and stools just lodge inside this big wound.
"This wound will never close by granulation because stools keep contaminating it," I said to the owner and to Dr Daniel. "A skin flap has to be made to stitch the anal sphincter to the skin." The owner consented to the surgery and even phoned yesterday to ask whether it was done. "It is being done now," I said. The surgery was done by Dr Daniel. No more defect or gap. Wait and see.
Wednesday, May 15, 2013
1418. Large wounds
In some cases, I had to intervene when surgical wounds do not close and the owner will not want to pay for wound stitching..
Case 1. The kitten had a big left neck abscess. The pus was cleared and the wound stitched by my associate vet. Yet the stitch broke down. The owner did not want to pay for further stitching. "The wound is 3 cm x 2 cm," I said. "A large wound exposing the neck muscles and the big neck veins. Yellow pus and scratching will persist. Smelly later due to bacteria and hair trapped inside. Very itchy for the kitten. Stitching must be done." I offered him a below cost rate to get the kitten wound stitched up. The kitten recovered well.
Case 2. The old cross-bred had a massive circum-anal tumour from 6 to 12 o'clock. My associate vet excised the whole tumour. Now a big hole. The anal skin was gone. The anal opening shrank inwards. So the dog pooped and the stools are entrapped in this hole. What to do?
The owners let the maid look after the dog and did not seek treatment. The lady friends of the owner came to visit the dog. The owner had denque fever and could not turn up.
"It is not as if this dog is cuddly," the lady friend explained why the circum-anal tumour was permitted to grow so big, such that there is a big hole now. "The maid did not inform us." What is the solution? Re-stitching is the answer but there is no skin.
Case 1. The kitten had a big left neck abscess. The pus was cleared and the wound stitched by my associate vet. Yet the stitch broke down. The owner did not want to pay for further stitching. "The wound is 3 cm x 2 cm," I said. "A large wound exposing the neck muscles and the big neck veins. Yellow pus and scratching will persist. Smelly later due to bacteria and hair trapped inside. Very itchy for the kitten. Stitching must be done." I offered him a below cost rate to get the kitten wound stitched up. The kitten recovered well.
Case 2. The old cross-bred had a massive circum-anal tumour from 6 to 12 o'clock. My associate vet excised the whole tumour. Now a big hole. The anal skin was gone. The anal opening shrank inwards. So the dog pooped and the stools are entrapped in this hole. What to do?
The owners let the maid look after the dog and did not seek treatment. The lady friends of the owner came to visit the dog. The owner had denque fever and could not turn up.
"It is not as if this dog is cuddly," the lady friend explained why the circum-anal tumour was permitted to grow so big, such that there is a big hole now. "The maid did not inform us." What is the solution? Re-stitching is the answer but there is no skin.
1417. Update: The Chow Chow's backside hair has grown
There was another Chow Chow who bit her right backside bare and started losing hair. I remember this owner as he keeps beautiful arowanas displayed in big tanks in his office and beautiful koi. He has two pretty Golden Retrievers. And a Chow Chow.
The carer had gone back to China for a holiday and the Singapore employee groomer had resigned. "How's the dog?" I asked the brother of the owner. I had the dog clipped bald too and gave the skin disease treatment.
"I don't know," he said as he brought his dog for skin disease treatment. Later he checked and told me the hairs had grown back.
The carer had gone back to China for a holiday and the Singapore employee groomer had resigned. "How's the dog?" I asked the brother of the owner. I had the dog clipped bald too and gave the skin disease treatment.
"I don't know," he said as he brought his dog for skin disease treatment. Later he checked and told me the hairs had grown back.
1416. Update: The Chow Chow is a Sharpei? Skin disease
May 15, 2013
This Chow Chow looked very much like a Sharpei when she was clipped bald. But she looked like a Chow Chow when her hair grows back. I saw the dog yesterday, around 2 months after treatment for skin diseases and passing blood in the urine. She had skin diseases for several months and was referred to me by my wife's ex-colleague Susan.
It is very difficult to get dog owners to return for a review of the skin diseases. After all, if the dog has recovered, why see the vet? It was pragmatism in Singaporeans.
Yet, the skin may not be fully recovered if the dog has some leftover skin diseases. In this case, the Chow Chow has no more "dandruff" and the hairs are sturdy and not falling off. Yet the dog had started scratching around the ears.
"The ears are full of wax," I showed the cotton bud tip sticky with yellow brown wax. The neck hair had bloomed. Wetness was due to the dripping of water when drinking from the water bowl. The owner brought a urine sample for testing as previously the dog's urine tested for struvite crystals, high pH of 9.0 and presence of blood and bacteria. I prescribed 12 S/D cans to dissolve the crystals but the owner did not return for more. "The dog vomits the S/D," the young adult daughter said. Yet on further questioning, the dog did eat at least 10 cans but started vomiting the 2 cans later. There were no phone calls to me for advice.
"Taking S/D to dissolve the struvite crystals prevent them becoming stones," I explained. "It must be taken for 1-3 months, not 10 days."
I did not want to do hard sell. I advised spaying and entropion surgery of the two eyes. The Chow Chow had been peering from 3/4-closed eyelids for the past 3 years and the entropion surgery would have resolved the problems.
"We don't want the dog to go under anaesthesia," the young adult daughter said. to me.
"With this continuous eyelid rolling inwards irritation, the cornea becomes infected and ulcerated. In later years, you have a blind dog as the cornea becomes black from pigmentation and the dog can't see. It is important that the Chow Chow has her eye surgery. As for the spay, if you don't want it, that is OK."
Ignorance of the safety of modern anaesthetics is a reason for no spay and no eye surgery. This can't be helped.
This Chow Chow looked very much like a Sharpei when she was clipped bald. But she looked like a Chow Chow when her hair grows back. I saw the dog yesterday, around 2 months after treatment for skin diseases and passing blood in the urine. She had skin diseases for several months and was referred to me by my wife's ex-colleague Susan.
It is very difficult to get dog owners to return for a review of the skin diseases. After all, if the dog has recovered, why see the vet? It was pragmatism in Singaporeans.
Yet, the skin may not be fully recovered if the dog has some leftover skin diseases. In this case, the Chow Chow has no more "dandruff" and the hairs are sturdy and not falling off. Yet the dog had started scratching around the ears.
"The ears are full of wax," I showed the cotton bud tip sticky with yellow brown wax. The neck hair had bloomed. Wetness was due to the dripping of water when drinking from the water bowl. The owner brought a urine sample for testing as previously the dog's urine tested for struvite crystals, high pH of 9.0 and presence of blood and bacteria. I prescribed 12 S/D cans to dissolve the crystals but the owner did not return for more. "The dog vomits the S/D," the young adult daughter said. Yet on further questioning, the dog did eat at least 10 cans but started vomiting the 2 cans later. There were no phone calls to me for advice.
"Taking S/D to dissolve the struvite crystals prevent them becoming stones," I explained. "It must be taken for 1-3 months, not 10 days."
I did not want to do hard sell. I advised spaying and entropion surgery of the two eyes. The Chow Chow had been peering from 3/4-closed eyelids for the past 3 years and the entropion surgery would have resolved the problems.
"We don't want the dog to go under anaesthesia," the young adult daughter said. to me.
"With this continuous eyelid rolling inwards irritation, the cornea becomes infected and ulcerated. In later years, you have a blind dog as the cornea becomes black from pigmentation and the dog can't see. It is important that the Chow Chow has her eye surgery. As for the spay, if you don't want it, that is OK."
Ignorance of the safety of modern anaesthetics is a reason for no spay and no eye surgery. This can't be helped.
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