1482. Vasectomy in a male German Shepherd X

The owner asked a lot of questions testing the patience of the vet.

"Does it mean that your quotation for a neuter of a 5-15-kg male dog of $200-$250 is proportional to the weight of the dog? If my dog weighs 5 kg, does it mean I pay $200?" 

"No," I said. "The cost depends on the time taken and complications. The quotation is a guideline."
He asked other questions like whether the dog's behaviour will be quieter and lazier after neuter and whether it is possible to neuter without changing the dog's personality? This retiree must have done his research as there is the vasectomy which is equivalent to the traditional neuter in that the spermatic cords are cut off and the male dog is unable to make female dogs pregnant.

When he cancelled the appointment to neuter, I said it was OK. No questions asked. No hard pressure sales talk. Suddenly he appeared with the cross-bred inside a medium sized kennel. "I had to use a treat to coax him inside this kennel," the senior citizen said to me. I could see that the dog was nervous and so I did not take him out till later. The man drove a hard bargain including the e-collar.

I did the vasectomy with Dr Daniel on Jun 27, 2013. Vasectomy is rarely done in Singapore dogs and I had done only a handful of cases over the past 40 years of practice. So Dr Daniel was considered fortunate to get a case. "I had advised him to neuter by removal of the two testes," Dr Daniel had also spoken at length with this retiree the day before.

"Give what the client wants," I advised. "If he wants vasectomy, there must be reasons. It should be a quicker operation than the usual neuter.'

I was mistaken. For this big dog, I was the mentor and Dr Daniel was the operating surgeon. The location of the first spermatic cord was difficult to find. There was the artery next to it and this must not be cut. The large veins of 8 mm across were easy to see and must not be cut as the blood supply to the testes would be gone.

We got 1.5 cm of the spermatic cords ligated and cut off. The dog weighed 20 kg, not 5-15 kg but I did not hustle the retiree for an additional cost. The retiree had fixed the cost as $260 with the e-collar and medication and I let sleeping dogs lie.  It was a learning experience for me as regards costing and I am sure Dr Daniel had benefitted from this rare type of surgery operating together with me. Over the years, I hope he would have honed his skills and be a top a veterinary surgeon of diverse surgeries in pets. Unlike human medicine, the surgeon may just specialise in one system such as the heart surgery but in vets, they are supposed to be able to operate on many systems.          

1481. Thursday's 4 new clients - varied problems.

Thursday Jun 27, 2013. Today is surprising in that 5 new clients whom I had not seen before, came in a row in the morning.

Case 1. The owner of this Alsatian X phoned to cancel the neuter appointment at 10 am and so I was surprised to see him turning up. He made the appointment with Dr Daniel yesterday. I had talked to him as he had some queries. "Actually there are two types of neutering," I said to him. "One is vasectomy in which part of the spermatic cord is cut away so that the dog does not breed. The other is the usual removal of the testes. Most dog owners ask for the 2nd method as this make the male dog less aggressive and display less anti-social behaviour like urine marking.

The owner wanted vasectomy so that his dog will not change his character. So vasectomy would be the answer to his reason to save $70-$14=$56 for the annual dog licence of a neutered dog.The dog is only aggressive towards other dogs. He looks nervous inside the crate and so we have to be careful.

Case 2. The gentleman kept picking out ticks for the past 2 weeks. "I used the Frontline spot-on late," he said. Frontline should be used 3-4 weekly regularly. Ticks stuck under the lush thich coat. "Clipping bald is the solution," I said. The dog was also nervous, moving his head to and fro. I gave IV dom + ket at 50% for this 10 kg dog. Just sufficient to clip without him biting. I taught my assistant how to use the clipper size 10 rather than size 40 as there is no need to clip bald to the skin. He mumbled less now but the use of clippers is never taught in vet schools including his Myanmar Vet University.  

Case 3. The lady and her mum came in with a 8-year-old Terrier X and her fractured tooth. "Is it common to have older dogs dropping teeth?" she asked me over the phone yesterday and made an appointment. "It is common if the tooth is loose and decayed," I replied. When I examined the dog today, the tooth was fractured half way at the gum level. "Your dog bites metal or solid objects," I said. The lady confirmed. "That is why this left upper Incisor 3 is broken. I have to get the root extracted. Dark brown stains in the back teeth. Otherwise, the teeth are in good condition and white."

The sky is still hazy. The sun is obscured as I write this report at 11.37 am. Three new cases with 3 new challenges. Veterinary practice is never dull.

Case 4. Spaying a ferocious stray cat of around 6 months. The mother and adult daughter came at around 11.30 am with a crate covered with rags. This is part of stray cat rescue of the Yishun group, operating for last 3 years feeding of the stray cats which cost a lot of money. "There is credibility in your work as it exists for 3 years," I said. "But nobody knows it  Even if a kind person want to donate some cat food, they don't know where to locate you. Facebook is the best. Record your work, your history of the group and ask for cat food, rather than cash. Don't expect a donor to come to you.

"The Facebook with stray cats sterilised and those needing vet treatment will be put up and over the years, others will come to help you. Personal donations by you will not be possible as there are just too many stray cats to feed! Your daughter should be able to use handphone to take images and upload on Facebook."

"Some vets are charging too much for spay," the mother said.
"It is too much to the volunteer, but vets have very high operating costs and are not a charity funded by outsiders. So, not all vets can sustain such subsidized services out of their own account too."     

Case 5.
"My cat started to scratch my expensive furniture," the lady said to me. The cat was declawed by Vet 1 on April 4, 2013. "This cat was brought in by my son but now he is not responsible. LF and RF

 

1481. Cancerous ear tumour spreading to the face - facial nerve injury

In this surgery, the facial nerve may be cut as the tumour from the ear canal or a separate tumour had spread to the face, near the right eye (see lowermost arrow). The dog cannot close his right eye when he sleeps and the owner has to apply eye drops 3x/day to prevent eye drying. There is no way to avoid the facial nerve as the facial tumour is on top of this nerve.

No histopathology was done to lower medical costs but I believe the tumours to be cancerous as they exploded in size and grew very fast in the last 2 months.

IMAGE OF POST-OPERATION EAR



The facial tumour had been excised. Its size was more than a 50-cent coin, more than 4 cm x 6 cm. The skin had been closed over the big hole. The ear canal had been opened up on the side, showing the horizontal canal opening. The whole ear tumour could not be removed 100% but at least, there is ventilation for the horizontal canal which had trapped pus and blood for many months as the ear canal tumour expanded and hardened to obliterate the space and stop ventilation.

As at Jan 26, 2013, 3rd day after the surgery, the owner reported that the dog started eating on her own and the operation area was "smelly." and bleeding.  I advised her to use syringe + warm water + antiseptic to irrigate the ear wound rather than swabbing it.   

I hope this op gives the dog relief from intense pain.

1480. Update on 14-year-old Maltese X dog with ear tumours

TOA PAYOH VETS toapayohvets.com Date:   27 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Ear tumours spreading to the face    Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   27 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1480. Update on 14-year-old Maltese X dog with ear tumours   Jun 26, 2013  7.11 pm, I  phoned young lady owner to follow up on post-op care of her beloved dog. She took much trouble checking out the health care for the dog's right ear tumours which had become smelly.  1. Ear very "smelly". Has lots of pus and bleeding. She used cotton balls and antiseptic to wipe this large wound. I advised: "Use warm water & antiseptic and put into a scoop or syringe and irrigate area. Too large a wound to be cleaned by cotton balls. 2. Left eye can't close when the dog sleeps. "Most likely the tumour had involved the facial nerve which was damaged during the two massive ear tumour surgery," I said. "Use eye drops 3X/day and keep eye wet." 3. "Is the dog eating?" I asked on this 3rd day after surgery    "Yes, she eats by herself today."   4. "Is the dog in pain?"   "No," she said. "Only shakes her head." 5. History A year ago, large "stomach lump" with nipple cut off was located near the "uterus". I told her this would be the mammary tumour. The petite fair lady vet whom I know to be a recent graduate at that time did advise histopathology of the lump but was rejected. She had advised excision of the ear tumour which was small then, just like an extra piece of meat.  Then 2-3 months ago, this ear tumour in the vertical ear canal grew fast and large. It became smelly. So, the dog needed a 3rd operation done by me to remove the ear tumours. The first op was spaying and the second one was the mammary tumour which does occur even in spayed dogs, but very rarely as compared to a female dog not spayed.  6. The pre-op blood test was requested by the lady on Jun 20, 2013. LIVER. SGPT/ALT 94  (<59> KIDNEY  Urea 13.9 (4.2-6.3), creatinine 144 (89-177) HAEMATOLOGY- normal but the lady had asked Dr Daniel for antibiotics. In conclusion, this dog was fit for anaesthesia. But she had heart murmurs and no ECG was done to lower medical costs.  7. Surgery done by me on Jun 23, 2013. My first consultation for the rotten ear was on May 30, 2013 and I had said the only option was surgery as medication would not last long to stop the ear scratching and bad smell. However, the dog was too old to take the anaesthesia and so the lady had to decide on the risks. The right ear oozed out pus over many months and ulcerated due to continuous scratching. It was hardened rock-hard as it evolved into ear canal tumours. Hence a bony hard vertical canal and a large subcutaneous tumour outside the vertical canal were palpated. This means there were actually two ear tumours and this could be malignant cancers as they grow rapidly and increase in size over 2-3 months. This was a messy surgery taking 51 minutes of isoflurane + gas and involvement of the facial nerves which if cut off, would affect the eyelid closing. Surprisingly, the old dog survived such a long surgery. Not every aged dog survive such long anaesthesias and so it is best to get tumours excised when they are small and that includes breast tumours.   6230 - 6232. Speedy ear surgery in a very old dog Conclusion. Small tumours in old dogs are best removed when they are small. In 10 days' time, I will take out the stitches. This dog was a puppy when the lady was in Sec 2, she told me. So, 14 years had passed by so fast but the dog looked so young owing to excellent care. This case shows that the many of the younger Singaporeans in their late 20s are much more educated and sophisticated and will care sufficiently to ensure that their beloved companion get back to good health. This is unlike the older baby-boomer generation who would think that it is cheaper to buy a new puppy and let the sick old dog die.  TIPS I don't know how the above-mentioned dog develops ear tumours as I had not seen this dog in the past years. Ear inflammation in your dog, if left untreated for many years, may evolve into hard bony ear canal tumours in old age. There is the lateral ear resection surgery to resolve chronic ear infections in floppy-eared dogs, preventing later medical problems. Many dog owners are unaware of this surgery and many vets don't offer this surgery as many owners seldom want it, owing to the expenses involved. So, the chronic infection persists till the ear canal hardens and the tumours form and become ulcerated and infected.    Updates will be on this webpage: http://www.sinpets.com/F6/20130627 old_dog_ear_tumours.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: June 27, 2013 Toa Payoh Vets

    

1479. Update on Ascites dog - Abdominal exudate report from the lab

Jun 1, 2013

Jack Russell, M, 6 years
1. Abdominal distension 1-2 weeks. Active, no blood in urine, no dyspnoea, pulse weak. 38.5 C, cyanotic mucous membranes.  Losing weight in last 1-2 months.

Appearance: Red & turbid

White blood cells  0.16  10 power of 9/L(<0 .15="" br="">Red blood cells  present
Glucose 112   (glucose 10mg/dL lower then blood level
Protein 4.3     (g/dL (1-3)
Crystals Nil

Reference ranges applicable to synovial fluid only

------------------------------------------------------------------------
Microbiological exam  - No bacterial growth
Cytology  - Atypical epithelias cells

Few small round clusters of atypical epithelial cells. Hyperchromatic ovoid nuclei and abundant cytoplasm. Background has abundant blood, scattered lymphoplasmcytic infiltrate and reactive mesothelial cells. 

Features are worrisome for an adenocarcinoma. To correlate with clinical features.




2. Blood test

Total protein 62 (62-85)
SGPT/ALT  90 (<59 p="">SGOT/AST  71 (<81 br="">)

Kidney Profile
Sodium 140 (141-152)
Potassium 5.5 (4.4 - 5.7)
Urea  4.7  (4.2-6.3)
Creatinine 41 (89-177)

Haematology normal except
Platelets  605 (200-500)


URINE TEST
pH 6.5  SG 1.032  Protein +,  Blood 4+
White blood cells 25, Red blood cells 513, Epithelial cells 45,  Bacteria 2+. No crystals.

X ray and ultrasound not done at this time.


UPDATE on Jun 19, 2013
No abdominal distension.
Eating and drinking.  Bone protruding out, now skinny, can see ribs and backbones. But stomach not bloated. Running about. Superactive. Jumps onto owner when he is home.

Is this a case of abdominal neoplasia? For economic reasons, no further consultation or tests are done but the owner will give the following:
Azathioprine 50mgx 10 tab (1/4 sid) for 40 days and review
Pred 5 mg x 5 (1/4 sid)
h/d dry food.


Azathioprine impairs lymphocyte proliferation and rapidly dividing cells. As to the actual cause of ascites, it is hard to confirm without more tests.

1478. Judgment Day for a Jack Rusell X

TOA PAYOH VETS toapayohvets.com Date: 26 June, 2013 Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Judgment Day Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate: 26 June, 2013 toapayohvets.com Be Kind To Pets Veterinary Education Project 2010-0129 Monday, June 24, 2013 1474. Judgment Day - An unusual closed pyometra in a Jack Russell Monday June 24, 2013 6pm "It is up to the vet to decide when to operate," I had seen the X-rays of this small-built 7-year-old female Jack Russell X who could be a cross with a Chihuahua as this was a popular breed with local breeders. "I usually give the dog an IV drip plus antibiotics to stabilise the dog and operate 24 hours later. Waiting another day may lead to the dog being toxic as there is a lot of pus and bacteria inside the swollen uterus of pyometra." Dr Daniel had palpated the Jack Russell yesterday, Sunday. She had a painful abdomen and had been on heat 2-3 weeks ago. She could pee normally. Today, her rectal temperature was 37.6 deg C. "It is more important that she be operated to remove her swollen womb today," I advised. "If the womb ruptures overnight, she will be dead tomorrow. The X-rays showed the swollen uterine bodies. There is no need to wait for the complete blood test results." I put the dog on the table and palpated a large swollen mass in the mid-abdomen. The dog did not cry in pain but was uncomfortable. "It felt like a big swollen bladder or stomach," I said. "But it could be the swollen uterus." "The dog can pee with no problem," my assistant Nia said. "No blood in the urine." So, it would likely be closed pyometra rather than a gastric dilatation (stomach swollen with gas). Dr Daniel decided to operate. I could see a large distended uterus stretching from the lower chest to the pelvic area. This was unusually long and large in a small-bodied Jack Russell X. "Make a longer incision forward to the sternum," I could see that Dr Daniel could not fish it out. "It is a swollen stomach," Dr Daniel said after fishing out the hemispheric swollen organ. Certainly it has the structure of a stomach full of gas or fluid with a greater curvature seen initially. As Dr Daniel extricated more of the organ, there were the continuation to the left uterine body which had 10 times smaller lumps. So this was closed pyometra confirmed. This was an abnormal presentation as usually all uterine bodies would be filled with pus and be of similar sizes in many closed pyometra cases. Here, there were only two gigantic swellings of part of the left uterine body, as if both ends of the lobules were cut off, resulting in two portions grossly distended and about to rupture. "Use the triple forceps method," I advised Dr Daniel. Each vet has his or her own method. "No need to ligate the omental fat separated from the uterine side but just clamp and cut. Surgery has to be quick in case the dog dies. For the uterus, ligate two parts so that if one ligature slips, there is another one." The dog was recovering when the mother and her two adult children came to visit at 7 pm. She looked dazed. "Why is her tongue sticking out? Will it be permanent?" the daughter asked me as Dr Daniel was busy clipping the long claws of a recumbent 18-year-old cat brought in by an adult son and his mother. It was his mother's cat. "The tongue sticking out is due to anaesthesia," I said. "The tongue will be in when the dog is awake." The dog's eyes were open wider as the owners stayed for another 20 minutes. But she could not stand. An Antisedan injection would reverse the Domitor given earlier and waken up the dog. But as each vet has his or her own ideas, I did not insist. The dog would likely recover after the operation on Judgment Day. If there was a delay, she might be dead. Evidence-based medicine is important in the diagnosis of closed pyometra as owners want to know for sure. In the old days, I would have got a history of the dog being on heat, passing out "blood with mucus", palpated a painful abdomen and advised spaying. This would save the dog's life and the owners some medical expenses. But nowadays, evidence-based medicine is important as owners are most sophisticated and likely to sue. UPDATE ON JUN 25, 2013 7.30 PM The family of a mother and 4 adult children came to visit the 7-year-old Jack Russell X on Day 2 after surgery. The dog was wagging her tail and this indicated good post-operation recovery. "I didn't bring the carrier," the mother said. "Go home tomorrow." "I will give you a box," I usually don't keep the dog warded for more than one day unless necessary to reduce medical costs for the owner. "The dog is OK to go home." One young man cradled the dog in his hands and the whole family went home happily. This was a dog with low platelet counts as evidenced by the blood test. So, she could die on the operating table by bleeding to death. There was a delay in seeking veterinary treatment for around one week of seeing bloody clots passed out from the vagina. A happy ending is always good for all parties if the vet can deliver a dog alive at the end of surgery. "It will be much much cheaper to spay the female dog when she is younger," I said to the daughter. The costs of blood test, X-rays, longer anaesthesia and longer surgery totalled around $1,300 which is considered inexpensive for the time taken to perform the closed pyometra surgery. This was much more than a spay of a normal dog. Dogs are family members and since we don't sterilise people, why sterilise the family pet? I took a video and some images of the challenges diseases present to sharpen the diagnostic skills of the veterinary surgeon. Updates will be on this webpage: http://www.sinpets.com/F6/20130626closed_pyometra.htmMore 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: June 26, 2013 Toa Payoh Vets

1481. Haze in Singapore

The last week of June 2013 had serious air pollutant problems. A mad rush to buy masks resulted in out of stock pharmacies for some time 2 days ago. Now, there is plenty of N95 masks for sale.

In very rare occasions, a picture at a traffic light junction produce interesting images of the life-style of people. I happen to have a camera and the image appears to be interesting in contrasts, in my opinion. The "Lone Ranger" movie will be coming soon. But this is a masked young lady in Singapore

 

1480. De-ticking a dog at Toa Payoh Vets

De-ticking several thousands of ticks in a dog at Toa Payoh Vets takes a long time as it involves:
1. Clipping of the coat
2. Bathing the dog with an anti-tick bath
3. After the coat is dry, each tick is manually pulled out and this process takes over 2 hours or more in this Border Collie with several thousands of ticks embedded in his body.

Sedation was needed in this gentle Border Collie as we could not clip his face which was painful and flooded with ticks.

Total cost could range from $150 - $250 depending on severity of tick infestations.

It is best to advise that the dog should be checked for tick fever and other infections and that the home environment including towels, beds and rooms be rid of ticks. 


Dengue fever has caused 3 deaths in Singapore recently. The hazy days are due to the burning of forests in Riau, Sumatra. Yesterday, Jun 25, 2013, there were hailstones - a freak occurrence in the tropics. However, today Wednesday, 10 am, the skies are grey and hazy again. Yet very few Singaporeans bother to wear the N95 face masks recently since there was blue skies on last Saturday and Sunday.   

1479. Rental of Singapore apartments and number of dogs permitted

On Thu, Jun 20, 2013 at 9:26 AM, Brigit Polanec wrote:
> Hi Judy, I'm wondering if you can give me a little guidance. I am from Sydney and am looking for work in Singapore. I'd like to come over (as a single) and bring my two miniature dachshunds. Do you think this would be possible? If so, how much can I expect to pay for a rental with my dogs? I'm not in the luxury market.
>
> Regards
>
> Brigit P
> 0408 2XXXX
> ...@bigpond.com


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



If the Landlord permits, the Singapore government regulation is a maximum of 3 dogs/private condo or house and 1 dog/HDB apartment. Therefore rental payment is NOT an additional cost of rental provided the Landlord permits dogs. Pl let me know if you need the rental apartment and Realtor Elson of www.asiahomes.com  will show you the places to rent. 

1477. Update - Speedy ear surgery in a very old dog

TOA PAYOH VETS toapayohvets.com Date:   26 June, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Speed in a very old dog surgery    Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   26 June, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Monday, June 24, 2013 1475. Speedy ear tumour surgery in a 14-year-old Maltese X "There is plenty of time," my assistant Nia said to me as I put pressure on Dr Daniel to perform a speedy surgery on the dog with a large ear tumour outside the ear and inside the ear. "The dog is 4 years old." Young dogs can take a longer anaesthetic time but I would like this dog to be operated within 15 minutes since it is 14 years old. "He looks young," I told Nia. "Look at his thick white cataract eye. 4-year-old dogs seldom have such eye cataracts." Nia did not know that the young lady owner had taken great pains to groom the dog after an earlier consultation with me. She would be the type who surf the net for information. She had blood test done which showed the dog was healthy for surgery and also a course of antibiotics. However, this dog has heart murmurs and any lengthy surgery may lead to heart failure. So I was much worried with this case. The young lady had nursed the ear to a much less infected mass and declared that the only tumour was outside the ear after a course of treatment. So just remove this external ear tumour would do, she said to me. "It is far more serious than that," I advised. "The whole of the vertical canal is tumourous, feel the hard lump and compare to the normal ear."   The dog survived the anaesthesia although she has a weak heart. The owner wanted her home on the next day and would nurse her wounds. I gave an Antisedan injection IM to reverse the drowsiness of Domitor and the dog woke up within 2 minutes. Old dogs should get up fast as prolonged recumbency may lead to respiratory or cardiac failure. Antisedan is a good antidote. The lady owner was happy as her dog was alive. No histopathology was done to reduce medical costs. Speedy surgery is necessary in old dogs. However, this case still took around 50 minutes. I am grateful that she survived the operation as old dogs are extremely high risk anaesthetic patients. Domitor + Ketamine + isoflurane + oxygen were used.   Updates will be on this webpage: www.sinpets.com/F6/20130625ear_tumour_surgery.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: June 26, 2013 Toa Payoh Vets