Lately I seem to be getting 13-year-old dogs and the white cat.
This Silkie Terrier is much loved as family members take time off to send the dog to me when she is sick.
On Jul 1, 2013, the father consulted me. The spayed female dog was panting for the past week.
HISTORY. This dog had a benign breast tumour (adeonoma) removed in Mar 29, 2010. She has a large submandibular lymph node on the right side and another breast tumour in Sep 2012 and fits started. The fits were controlled by anti-fits medication. She had panting and fits in Oct 13, 2012. I detected let heart murmurs and the dog was OK after treatment.
The anti-medication drugs were given once daily after stabilisation on two times per day but on July 1, the dog had panting again. The right submandibular tumour had increased 4X, being much more distinct and most likely cancerous. Being such an old dog, I did not recommend surgical excision. A blood test was done in Sep 27 2012 and in July 1, 2013.
In July 1, 2013, the platelet count was 843 (200-500) as compared to Sep 2012 when it was also high at 550, but not alarmingly high. In July there was kidney disorder with urea 32.2 (4.2-6.3) and creatinine 195 (89-177). Other blood cell values were within the normal range.
So, what is the cause of this high platelet count and the panting?
The heart, loose stool gastroenteritis or insufficient fit medication? Financial restraints mean no further testing. I gave the heart medication, an IV drip and advised correct timing of the anti-fit medication.
On July 2, 2013, the next day I phoned the father at 6 pm. "Normal. Walking about," he said. "But not much appetite." This case is likely due to the spread of cancerous cells from the submandibular into the lungs and elsewhere but there is financial consideration so more tests cannot be done for heartlanders, a situation similar to the 13-year-old white cat with "obsessive grooming".
Blood test is the minimum procedure to screen the old pet's health. Practisc of evidence-based wedicine gives the owner confidence and knowledge of what's wrong with their old pet. In old cats, sedation may be needed.
Wednesday, July 3, 2013
1500. Dwarf hamster with corneal ulcer stained fluoresdein green
Left eye tearing. Has corneal ulcer as evident by the green fluroescein stain covering a vast area
Dwarf hamsters intensely dislike e-collars and will pull it off by hook or by crook!
Tuesday, July 2, 2013
1498. Myanmar stories: Advising a 37-year old father
Today I visited Khin Khin's office and met a 37-year-old Myanmar man who absented himself from work for 3 days at the vegetable wholesale market in Pasir Panjang. His agent was present. He had worked for around one month and wanted to go home. He had worked his first job at a car repossession shop taking images of re-possessed cars and being on overnight security duty but found the work too stressful as he dislike working with computers. So he quitted and got this job which required more manual work."
"I can't stand the boss," he said. "He shouts at me. I work from 6 pm to 3 pm the next day. I am very tired. I want to go home."
"The boss is an old man," the agent said. "Probably his children do not work with him and he is alone. He shouts as he may be busy and you would not hear him."
"Let him talk," I said to the agent as this man wanted to pour out his grievances. Life is not good for him.
"Do you have a wife and children in Yangon?" I asked.
"Yes," he said his wife worked as a phone operator and earned S$120 (6000 kyats) a month. He has a 9-year-old daughter.
"So, you prefer to go home and be jobless?" I know it is extremely difficult to find a job esp. for a 37-year old man. His fingers are rough from handling the boxes. He sends home S$700 a month.
"The most important thing is that the boss pays you at the end of the month. Did he do that?" I asked.
He nodded his head.
"Your daughter needs money to go to school. To buy pencils and books. Your $700 is a lot of help. So you want to go home and let your wife work?"
He seemed to reconsider. The boss had not sacked him because it is extremely hard to find replacement. Only the two Chinese Nationals seem to soldier on. "They need the money for their families at home," I said to this Myanmar man. "Otherwise, they would have left." The Chinese Nationals could communicate with the old man.
Before I left at 5.30 pm, I shook his hand and told him:
"Remember. You are a father first. A husband second. Don't think of yourself. There are dependents who need your money. When you stay on, you may find other better bosses and then you ask the agent to change jobs. Just like what my worker did. He worked for 2 years and when he got a better pay, he asked the agent quietly to apply for him the work pass! Be like him. Don't just quit when you are not happy. If you are back in Yangon, you can't go for interviews with better Singapore bosses and nobody will hire you."
Khin Khin's manager said: "Private companies don't like to hire ex-civil servants like him. They are hard to control."
He has decided to resume working.
"I can't stand the boss," he said. "He shouts at me. I work from 6 pm to 3 pm the next day. I am very tired. I want to go home."
"The boss is an old man," the agent said. "Probably his children do not work with him and he is alone. He shouts as he may be busy and you would not hear him."
"Let him talk," I said to the agent as this man wanted to pour out his grievances. Life is not good for him.
"Do you have a wife and children in Yangon?" I asked.
"Yes," he said his wife worked as a phone operator and earned S$120 (6000 kyats) a month. He has a 9-year-old daughter.
"So, you prefer to go home and be jobless?" I know it is extremely difficult to find a job esp. for a 37-year old man. His fingers are rough from handling the boxes. He sends home S$700 a month.
"The most important thing is that the boss pays you at the end of the month. Did he do that?" I asked.
He nodded his head.
"Your daughter needs money to go to school. To buy pencils and books. Your $700 is a lot of help. So you want to go home and let your wife work?"
He seemed to reconsider. The boss had not sacked him because it is extremely hard to find replacement. Only the two Chinese Nationals seem to soldier on. "They need the money for their families at home," I said to this Myanmar man. "Otherwise, they would have left." The Chinese Nationals could communicate with the old man.
Before I left at 5.30 pm, I shook his hand and told him:
"Remember. You are a father first. A husband second. Don't think of yourself. There are dependents who need your money. When you stay on, you may find other better bosses and then you ask the agent to change jobs. Just like what my worker did. He worked for 2 years and when he got a better pay, he asked the agent quietly to apply for him the work pass! Be like him. Don't just quit when you are not happy. If you are back in Yangon, you can't go for interviews with better Singapore bosses and nobody will hire you."
Khin Khin's manager said: "Private companies don't like to hire ex-civil servants like him. They are hard to control."
He has decided to resume working.
The old Jack Russell coughs "to get attention"
"Dogs seldom if ever coughs to get human attention," I said to the gentleman whose 9-year-old female Jack Russell has been coughing for the last 3-4 months.
"She coughs when awake but not when she's sleeping," he said.
"Could she be suffering from kennel cough?" he speculated.
"Unlikely as she had not been to boarding," I said. "Let me check the heart and lungs."
I used the stethoscope on the heart and lung areas. There were heart murmurs but the most notable sounds were wet swishing sounds called rales inside the lungs.
"Is she breathless after exercise?" I prescribed heart disease medications.
"Yes. How's the blood test results"
JUNE 30, 2013 BLOOD TEST RESULTS WERE "WHAT'S APP" TO HIM
SGOT/AST 96 (<81 p="">Urea 4.0 (4.2-6.3)
Creatinine 67 (89-177)
Platelets 91 (200-500)
"It is unusual to get platelets so low at 91," I said. Also, SGOT has increased to 96, indicating some liver inflammation or damage. "Did you feed Chinese drugs for the cough?"
"I fed the Chinese herbal cough medicine for one week," he said.
"Did it stop the coughing?"
"No," he said. I advised him to stop this Chinese medicine.
UPDATE ON JULY 2, 2013
I phoned at 7 pm to follow up.
"Is the dog still coughing?"
"Yes," he said. "But the cough is softer".
"Is she coughing a lot?"
"Once in a while."
The dog is much happier and so is the owner.
This case illustrates the danger of giving unknown Chinese herbal cough mixtures to dogs as the platelets have had dropped drastically due to toxaemia. Seldom do I get to see such low platelet count yet normal red and white blood cells in a coughing dog as most owners do not want blood test. But this dog was coughing 3-4 months and the blood test provides evidence of good health. Except for the low platelet count which would be lead to serious internal bleeding if the count drops much further as in people with dengue haemorrhagic shock syndrome which is fatal.
"She coughs when awake but not when she's sleeping," he said.
"Could she be suffering from kennel cough?" he speculated.
"Unlikely as she had not been to boarding," I said. "Let me check the heart and lungs."
I used the stethoscope on the heart and lung areas. There were heart murmurs but the most notable sounds were wet swishing sounds called rales inside the lungs.
"Is she breathless after exercise?" I prescribed heart disease medications.
"Yes. How's the blood test results"
JUNE 30, 2013 BLOOD TEST RESULTS WERE "WHAT'S APP" TO HIM
SGOT/AST 96 (<81 p="">Urea 4.0 (4.2-6.3)
Creatinine 67 (89-177)
Platelets 91 (200-500)
"It is unusual to get platelets so low at 91," I said. Also, SGOT has increased to 96, indicating some liver inflammation or damage. "Did you feed Chinese drugs for the cough?"
"I fed the Chinese herbal cough medicine for one week," he said.
"Did it stop the coughing?"
"No," he said. I advised him to stop this Chinese medicine.
UPDATE ON JULY 2, 2013
I phoned at 7 pm to follow up.
"Is the dog still coughing?"
"Yes," he said. "But the cough is softer".
"Is she coughing a lot?"
"Once in a while."
The dog is much happier and so is the owner.
This case illustrates the danger of giving unknown Chinese herbal cough mixtures to dogs as the platelets have had dropped drastically due to toxaemia. Seldom do I get to see such low platelet count yet normal red and white blood cells in a coughing dog as most owners do not want blood test. But this dog was coughing 3-4 months and the blood test provides evidence of good health. Except for the low platelet count which would be lead to serious internal bleeding if the count drops much further as in people with dengue haemorrhagic shock syndrome which is fatal.
1496. Update: Ventriculocordectomy - The barking Beagle
This morning, at 9 am, the lady owner phoned to enquire about the dog. "He ate his canned food and can go home," I said. "No running around for the next 10 days. Give medication."
1495. Adhesive peritonitis and closed pyometra - a rare case in a 13-year-old Pom
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1494. Case of the Dakota cat --- A 13-year-old cat's "excessive grooming"
"Excessive grooming," the young lady brought in a recumbent white cat, female, 13 years. "Not eating for the past 7 days."
The lower body of the cat was stained yellow with urine. This is not normal for any healthy cat. I felt an enlarged lump the size of a kidney or hairball in the anterior abdomen. She was very thin, severely dehydrated as her skin folds stood up but temperature was normal at 38.1C. I gave the cat an enema but no stools were passed. The cat got angry after that.
What was the problem?
"Kidney failure," Dr Daniel told me based on colourless watery urine passed out.
"The owner has agreed to a blood test," I said that the cat needed a drip. "But the cat is very angry and fierce."
"Give Zoletil 50I M," I said. "Take blood from the jugular vein and the drip."
This cat weighed only 2.5 kg. 0.2 ml Zoletil IM sedated the cat fully.
The blood test showed:
urea 46.8 (7.2-10.8), creatinine 532 (71-160), glucose 10.2 (3.9-6), total white cell count 23.8 (5.5 -19.5) but neutrophils was 78% and absolute was 18.56. Platelets were 149 (300-800).
Blood test is important in aiding the diagnosis of kidney failure and satisfying the owners. Practise evidence-based medicine whenever possible, even in ferocious cats where blood taking will never be tolerated. Use safe sedation.
In conclusion, the "excessive grooming" was due to the cat trying to clean her belly of urine. She could not stand and so stained her lower half. After treatment for one day, the cat was standing now and the two ladies were quite happy when they took her home in the evening on Day 2. However the cat needs to be on a special kidney diet.
The owner phoned me back. The cat would only eat dry food. She had pooped one hard stool. "Any hair inside the stool?" I asked.
"No," she said. So the hard abdominal lump could be this hard stool.
"Did you bathe the cat and wash away the urine stain in the lower body?" I asked.
She had bathed his lower part. The cat was eating and had been drinking a lot. Thirst confirmed kidney disease. I advised slowly changing to the dry feline k/d diet which is meant for bad kidneys. So far, there is no vomiting and we hope for the best.
The lower body of the cat was stained yellow with urine. This is not normal for any healthy cat. I felt an enlarged lump the size of a kidney or hairball in the anterior abdomen. She was very thin, severely dehydrated as her skin folds stood up but temperature was normal at 38.1C. I gave the cat an enema but no stools were passed. The cat got angry after that.
What was the problem?
"Kidney failure," Dr Daniel told me based on colourless watery urine passed out.
"The owner has agreed to a blood test," I said that the cat needed a drip. "But the cat is very angry and fierce."
"Give Zoletil 50I M," I said. "Take blood from the jugular vein and the drip."
This cat weighed only 2.5 kg. 0.2 ml Zoletil IM sedated the cat fully.
The blood test showed:
urea 46.8 (7.2-10.8), creatinine 532 (71-160), glucose 10.2 (3.9-6), total white cell count 23.8 (5.5 -19.5) but neutrophils was 78% and absolute was 18.56. Platelets were 149 (300-800).
Blood test is important in aiding the diagnosis of kidney failure and satisfying the owners. Practise evidence-based medicine whenever possible, even in ferocious cats where blood taking will never be tolerated. Use safe sedation.
In conclusion, the "excessive grooming" was due to the cat trying to clean her belly of urine. She could not stand and so stained her lower half. After treatment for one day, the cat was standing now and the two ladies were quite happy when they took her home in the evening on Day 2. However the cat needs to be on a special kidney diet.
The owner phoned me back. The cat would only eat dry food. She had pooped one hard stool. "Any hair inside the stool?" I asked.
"No," she said. So the hard abdominal lump could be this hard stool.
"Did you bathe the cat and wash away the urine stain in the lower body?" I asked.
She had bathed his lower part. The cat was eating and had been drinking a lot. Thirst confirmed kidney disease. I advised slowly changing to the dry feline k/d diet which is meant for bad kidneys. So far, there is no vomiting and we hope for the best.
Monday, July 1, 2013
Sunday's Interesting cases: Ventriculocordectomy (devocalisation) of a Beagle using the laryngotomy approach
Case 1. Devocalisation in a Beagle
"The Vet book makes it sound so easy," I said to Dr Daniel as I was preparing to operate on this rarely done surgery using the laryngotomy approach. "Pull out the vocal cords, cut it and suture the ends. There is a very small space to operate and after excising the vocal cords, the ends shrink and there is no possibility of suturing. I use electro-excision to control bleeding. But there is alway a lot of bleeding in this surgery."
Sometimes I wonder whether the author of the article in "Small Animal Surgery 4th Edition, Theresa Welch Fossum" has ever done this surgery in the dog and actually stitch up the ends of the excised vocal cords.
I have done this operation in racehorses with laryngeal paralysis at the Singapore Turf Club when I was an equine vet. It was also a bloody surgery.
For dogs, there is an oral approach which I don't do as there are complaints of ineffectiveness in many cases. For this Beagle, he was neutered but he still has a habit of barking the whole day long, disturbing the neighbours. It was either death by lethal injection or this surgery. I try to dissuade owners from doing it by training the dog but it is easier said than done. After some weeks, the owner brought this dog in for the surgery. In my 40 years in practice, I have had performed around 5 of such operations in the dog only in cases of desperation by the dog owner. It is not a surgery I will do as it is deemed cruelty.
The operation is recorded to share my experience with other vets researching the internet for such cases.
ANESTHESIA
Domitor + Ketamine at 80% of the calculated weight via the IV drip.*
Dom = 0.45 ml + Ket = 0.56 ml IV at 80%. 5 years old, 14 kg bodyweight.
Atropine 1 ml IM after that. Isoflurane gas + O2 via a smaller endotracheal tube (size 6) so that it can be pushed to one side to access one of the vocal cords for excision.
Maintenance dose as high as 3.5%.
*Dog went rigid and head extended after Dom + Ket were given via the IV drip. Duration of a few seconds. Atropine 1 ml IM given. No recurrences of excitement.
SURGERY
Electro surgery
Dog's head under a bottle, extended neck.
Electro-excise skin and midline of the sternohyoid muscles retracted
Midline of thyroid cartilage electro-incised
Endotracheal tube could be seen taking up 50% of larynx
Assistant retracts thryoid cartilage so that the vocal fold can be seen. As space is so small, it takes experience to see the depression in which the vocal folds reside. View cranially. In the depression, use forceps to pinch out one tip of the vocal fold. Another forceps clamp below. Pull out as much as possible. I used the electro-incision to cut off the fold above the forceps and below the forceps whenever possible.
No stitching of the mucosa of the cut off vocal folds as stated in the Vet book as there is not much space to manipulate. This was not done by me in all my cases.
Lots of bleeding from the surgical areas. Unable to stem the bleeding as it was not possible to locate the bleeders. The less vocal fold area has lesser bleeding. This profuse bleeding has been present in all the past cases including the horse.
Stitch up thryoid cartilage, sternohyoid muscles and skin. Antisedan to wake up dog.
UPDATE 12 HOURS POST OP
OK
"The Vet book makes it sound so easy," I said to Dr Daniel as I was preparing to operate on this rarely done surgery using the laryngotomy approach. "Pull out the vocal cords, cut it and suture the ends. There is a very small space to operate and after excising the vocal cords, the ends shrink and there is no possibility of suturing. I use electro-excision to control bleeding. But there is alway a lot of bleeding in this surgery."
Sometimes I wonder whether the author of the article in "Small Animal Surgery 4th Edition, Theresa Welch Fossum" has ever done this surgery in the dog and actually stitch up the ends of the excised vocal cords.
I have done this operation in racehorses with laryngeal paralysis at the Singapore Turf Club when I was an equine vet. It was also a bloody surgery.
For dogs, there is an oral approach which I don't do as there are complaints of ineffectiveness in many cases. For this Beagle, he was neutered but he still has a habit of barking the whole day long, disturbing the neighbours. It was either death by lethal injection or this surgery. I try to dissuade owners from doing it by training the dog but it is easier said than done. After some weeks, the owner brought this dog in for the surgery. In my 40 years in practice, I have had performed around 5 of such operations in the dog only in cases of desperation by the dog owner. It is not a surgery I will do as it is deemed cruelty.
The operation is recorded to share my experience with other vets researching the internet for such cases.
ANESTHESIA
Domitor + Ketamine at 80% of the calculated weight via the IV drip.*
Dom = 0.45 ml + Ket = 0.56 ml IV at 80%. 5 years old, 14 kg bodyweight.
Atropine 1 ml IM after that. Isoflurane gas + O2 via a smaller endotracheal tube (size 6) so that it can be pushed to one side to access one of the vocal cords for excision.
Maintenance dose as high as 3.5%.
*Dog went rigid and head extended after Dom + Ket were given via the IV drip. Duration of a few seconds. Atropine 1 ml IM given. No recurrences of excitement.
SURGERY
Electro surgery
Dog's head under a bottle, extended neck.
Electro-excise skin and midline of the sternohyoid muscles retracted
Midline of thyroid cartilage electro-incised
Endotracheal tube could be seen taking up 50% of larynx
Assistant retracts thryoid cartilage so that the vocal fold can be seen. As space is so small, it takes experience to see the depression in which the vocal folds reside. View cranially. In the depression, use forceps to pinch out one tip of the vocal fold. Another forceps clamp below. Pull out as much as possible. I used the electro-incision to cut off the fold above the forceps and below the forceps whenever possible.
No stitching of the mucosa of the cut off vocal folds as stated in the Vet book as there is not much space to manipulate. This was not done by me in all my cases.
Lots of bleeding from the surgical areas. Unable to stem the bleeding as it was not possible to locate the bleeders. The less vocal fold area has lesser bleeding. This profuse bleeding has been present in all the past cases including the horse.
Stitch up thryoid cartilage, sternohyoid muscles and skin. Antisedan to wake up dog.
UPDATE 12 HOURS POST OP
OK
Sunday, June 30, 2013
1490. $500 for an elective Caesarean Section in a poodle
Saturday Jun 29, 2013
"The vet at Serangoon charges only $500," the home-breeder came yesterday. He had already X-rayed and knew he had 3 puppies. Now he was looking for a lowest quotation for a C-Section.
In the first birth, the dam had difficulty giving birth and a puppy had died. He still needed a C-section for the other puppies.
I used to charge $300 for every Caesarean section for the Pasir Ris breeders around 2006, but there was a vet who charged only $250.
Low surgical costs attract more customers. The costings must be done carefully. Otherwise, the vet loses money for every Caesarean section done. In the end, there is no profits to buy new equipment or upgrade, leading to a poor impression of the Surgery. Young Singaporeans love the glitz and the decor and if the vet does loss-making surgeries, he or she will need the volume. But at the end of the financial year, the net profits may be a loss.
So I told Dr Daniel that it is best not to perform C-sections at $500 as the time taken and complexity of this surgery as compared to a spaying of a female dog is much longer. We let the home breeder go. The associate vets must be some economic sense in working in a private practice so as not to make loss-making operations.
"The vet at Serangoon charges only $500," the home-breeder came yesterday. He had already X-rayed and knew he had 3 puppies. Now he was looking for a lowest quotation for a C-Section.
In the first birth, the dam had difficulty giving birth and a puppy had died. He still needed a C-section for the other puppies.
I used to charge $300 for every Caesarean section for the Pasir Ris breeders around 2006, but there was a vet who charged only $250.
Low surgical costs attract more customers. The costings must be done carefully. Otherwise, the vet loses money for every Caesarean section done. In the end, there is no profits to buy new equipment or upgrade, leading to a poor impression of the Surgery. Young Singaporeans love the glitz and the decor and if the vet does loss-making surgeries, he or she will need the volume. But at the end of the financial year, the net profits may be a loss.
So I told Dr Daniel that it is best not to perform C-sections at $500 as the time taken and complexity of this surgery as compared to a spaying of a female dog is much longer. We let the home breeder go. The associate vets must be some economic sense in working in a private practice so as not to make loss-making operations.
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