Abscess in pets - Case Study: closed pyometra

Two interns from RI.  Abscess is their project.
Abscess can occur in any part of the body and system. Closed pyometra is an example of abscess in the reproductive system


They saw two cases

Open pyometra in a young female Boxer. Pus in vagina.
Closed pyometra in a 15-year-old. No pus in vagina.
   "I thought she was putting on weight," the elderly owner said.
   "The left abdomen has a large bulge, while the right is swollen but not bulging," I said to the interns. "Observation can tell a vet many things. This is not a case of ascites, a video done by the 2 interns recently.
  The dog has closed pyometra," I said. "When was her last heat?"
  "No more since last year," the woman said.
   "To save on medical costs, no blood test and X-rays."

I checked the history.

History
Maltese, Female, not spayed, Born July 1998

7 Sep 2005 I saw the dog in 2005.  Ear flap infections. "False pregnancy," I advised spay.
11 Sep 2006  Vaccination. Breast tumour MG5 left advised surgery.
11 Aug 2008. Vaccination. False pregnancy. Heat 2 months ago.
14 May  2009      Vacc
8 Oct 2010            Vacc
22 Sep 2011   Vacc & dental
20 Sep 2012   Vacc
11 Dec 2012  Vacc
17 Dec 2012  Tooth extraction
16 Jan 2013   False pregnancy Milk seen
18 Aug2013  Swollen abdomen, left side much bigger bulge. 15 years old.

BLOOD TEST
No abnormal total white cell count, but neutrophils high at 84.9% (60-70%)
Kidney's Creatinine 26 low (89-177)

X-RAYS
Radio dense womb seen

As dog is said to have swollen abdomen seen only in the past 2 days, it is possible that there is no increase in total WCC.

The dog came in on Aug 19, 2012 and the owner was worried about anaesthetic deaths. This was a 15-year-old Maltese. So, she had taken the dog back to think whether to do surgery or not. I gave the dog antibiotic injections and medication home. 

I spoke to the owner yesterday Tuesday, Aug 20, 21 as regards the X-rays showing swollen uterine bodies.
The left abdomen had such a large bulge as if there was a big hot dog bulging from the skin.

"I gave the dog the oral antibiotics. She vomited but now is eating and looks active."
"This is only temporary improvement in health," I said. "If you delay the surgery, the toxins will spread and it will be too late. It is urgent that you get the dog operated today before the uterine body rupture leaking pus into the inside and killing the dog, but there is the possibility of death on the operating table. You have to make the decision to operate."

"What is the chance of survival?" the slim elderly lady asked.

"Not good as the dog is very old and the kidney function is not normal."
"What are the chances of the dog dying during surgery?"
"Less than 50%," I said.
"How am I to decide?" she asked.
"The owner has to decide. Actually you have no choice," I said. "If you don't operate now, it will be too late as the dog gets sicker every day." 
The owner decided to get the dog operated today, Wednesday.



 

1091. Follow up on terrapin with right ear abscess

Aug 19, 2013

Abscessed right ear lanced. Terrapin went home on the same day, to live apart from the other 3 and to give medication.

I phoned today, 6 days post surgery.
"Swelling gone down a bit," the owner said. "He is eating a bit. I am usually out working and so I don't know."
"Is swelling down by 50%?" I asked.
"Yes."
"You must give the medication," I said.
"It is difficult to feed medicine," he said. "He won't open his mouth. Sometimes I managed to do it."
"How about closing his nostrils so that he will open his mouth?"
"I do it but he does not open his mouth."
There seems to be some return of appetite. The owner will come for medicine. Follow up is  important for the pet as most owners don't provide feedback.

Dysuria - X-rays taken. S/D trials not properly complied with

TOA PAYOH VETS toapayohvets.com Date:   20 August, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits   Proper use of the S/D diet to dissolve the crystals  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   20 August, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129   Wednesday, August 14, 2013 1078. The Ang Mo Kio Silkie Terrier ate lots of treats   I had known Celebrity since she was a puppy in 2005. After the puppy vaccination, no more visits. In Jul 3, 2013, blood appeared in the urine. I took a urine test. July 3.  Haematuria. Urine test. pH 9.0, SG 1.034, Protein +, Blood 3+, Crystals triple phosphate +, amorphous phosphate 3+ . No bladder stone palpated.  I advised X-ray and S/D for 3 months.  July 10. Cannot pee. Owner sent the dog for X-rays at another practice. No stones seen. Aug 13. The owner brought in the urine for test. pH 8, SG 1.020, Blood Trace, Bacteria +, amorphous phosphate 2+, Triple phosphate occasional After July 10, no problems of urination or visible blood in the urine and so the owners were satisfied. Surprisingly, the wife brought in the urine sample on Aug 13, for analysis as advised by me. Most Singaporean dog owners don't bother since the dog had no urination problems.  Dissolving of urinary crystals My advice on the first consultation. S/D 3 months to dissolve the crystals. Urine test monthly.  Then C/D dry. PROBLEM Dog will not eat the S/D and so the owner did not comply with my instructions.  I advised the owner to feed 10% S/D and then add to become 100%. However, the owner bought S/D x 7 cans on Jul 6, 12 cans on Jul 20 and now 12 cans on Aug 13. No dog treats given. Fed Pedigree Canned + rice in the past month. CONCLUSION The dog had no episodes of urination difficulty since Jul 10 to date. However, the mixture of S/D diet and other food did not dissolve the crystals as the owner needs to convert to 100% of S/D. I text the husband who says he will do it. Aug 15, 2013. The husband phoned to see me in 20 minutes. I advised medication and review of the X-rays taken by another vet again. Many cases need monitoring and review but vets will have no "work-life" balance if they really review ever case and write case report to understand the effects of home management on S/D diet. So, we can't do it for every case. In this case, S/D diet would have worked to eliminate the amorphous phosphate crystals in the urine if the owner had diligently converted the dog to 100% of S/D in July. Although the dog did not get 100%, she still benefited in that she no longer had urination problem. But the latest urine test in Aug showed that blood, bacteria and crystals are coming back in the alkaline urine again. Many owners don't understand the technical use of S/D diets in dissolving the crystals by acidification of the urine. So they don't comply since the dog will not eat it. The trick is to give 5% increasingly and consistently. Let's hope this dog will be OK with the new motivation and participation of the owners, a couple in their late 50S  ----------------------------------------------- Sunday, August 18, 2013 Dysuria - X-rays taken. S/D trials not properly complied with   The old female Shih Tzu peed blood in the urine 3 days ago in July 2013. The owner did not want an X-ray. "Practising heartlander medicine is not as easy as practising in a practice where clients do not worry about medical costs," I said to the two Raffles Institution interns from Secondary Four working on Aug 19, 2013.  "Some owners don't want x-rays. Some don't want blood test and so the vet has no complete evidence to support his diagnosis and treatment.  Then the dog could not pee normally 7 days later. The owners phoned me. They went to a clinic to get the X-rays done and consulted me with the X-rays. There were no radio-dense stones.   I had advised S/D diet to acidify the urine which had amorphous phosphate urinary crystals, bacteria, blood and alkaline pH 3 days ago during the first consult. I also advised S/D based on urine test and get another urine test 1 month later. "My dog will not eat the S/D" the couple said. "Mix with the original food and increase to 100% S/D," I advised. "Otherwise the stones may form." One month later, the wife brought in a bottle of dog's urine for testing. The amorphous phosphate crystals were lesser in amount but a bit of blood and bacteria were present. "You didn't feed 100% S/D for the last 4 weeks. Based on the latest test, the blood is coming back in the urine." This time the couple was serious. "How did you do it?" I asked. "Just starve the dog. He will eat 100% S/D". S/D is fed to dissolve the phosphate crystals for 1-3 months. Urine tests must be done monthly. Then the owner has to be careful in feeding commercial food. No more dog treats for sure. Updates will be on this webpage: www.sinpets.com/F6/20130820bladder _crystals_non_compliance.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: August 20, 2013 Toa Payoh Vets

 

Rabbit - parasites causing head tilt in rabbits - Encephalitozoon cuniculi

Head tilt is rabbits is a most common condition seen in practice. The causes may or may not be a intracellular protozoan parasite called Encephalitozoon cuniculi. It is passed in the urine. It is transmitted by ingestion of spores in food or water contaminated by urine.

Signs include head tilt, hind limb paraesis, urinary incontiennce, cataract, uveitis and death.

Diagnosis is difficult. Blood tests are required. 

Treatment
Clinical signs - Oral 20mg/kg fenbandazole for 28 days once a day (e.g Panacur)

Prevention - above for 9 days.
Separate food and water from urine

Deworming of intestinal worms 3-4 times per year is best. 

Zoonosis - Some infected rabbit owners complained of being unwell.


Some references
http://www.petrabbitworld.com/

1088. An old cat in Turkey has bladder stones

TOA PAYOH VETS toapayohvets.com Date:   20 August, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits   Blood in the urine of a Turkey's cat   Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   20 August, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129   EMAIL TO DR SING DATED AUG 18, 2013Hello i am a vet doctor from Turkey and i was searching some info about stones of cats also found you in internet.  I'll appreciate if you can help me about this x-ray. My patient has a blood urine and she has some stones in her bladder. She is 12 years old. I begin to give her hills c/d from today and pills as must be. But I don't know really whether she needs an operation or wait to see the results of c/d food for a while, or what i have to do more? What do you think about this fact and type of stones? (like struvite or?) Thank you. Best regards Dr H EMAIL REPLY FROM DR SING DATED AUG 19, 2013 Thank you for your X-rays. It is hard to know what type of stones are present in the bladder. The spikey ones look like calcium oxalate but you cannot base the composition of stones on X-rays. It must be done on stone analysis. Have you done a urinalysis for the urinary crystals? The only solution is to perform surgery to remove the stones as they are too large and many. In my opinion, the C/D  prescription food for cats is not meant to dissolve struvite urinary stones but to prevent stone formation. Anaesthesia is risky in very old cats and so you have to let the owner know.  ------------------------------------------------------------------------ EMAIL TO DR SING DATED AUG 20, 2013 i am sorry that i disturbed you and thanks a lot for your quick response.. yes spikes are look like calcium i have told the owner about complication with anesthesia and they don't want the operation..i didn't make a urinalysis for the crystals by the way so i will do tomorrow.. is there another choose except c/d? or what to do more if the owner doesn't want the operation? Need your advice thanks..   EMAIL REPLY FROM DR SING DATED AUG 20, 2013 If the owner does not want the surgery, this is the owner's choice. 1.  The vet must record his advice to perform surgery in writing to the owner to prevent misunderstanding from family members and friends who may not be aware of the owner's choice. 2.  Regular urine and bacterial cultures and antibiotic sensitivity tests when there is haematuria and infections 3. Blood test to screen the health esp. kidney function when there is vomiting. 4.  Prescription of antibiotics when there is haematuria may be the only treatment in this case.   5. Do you have a ventral-dorsal view of the bladder?   Updates will be on this webpage: www.sinpets.com/F6/20130819bladder_stones _cat_Turkey.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: August 20, 2013 Toa Payoh Vets

5 weeks after an ivomec injection - scabies

1086. Update & Review: Maine Coon slightly pinker gums - goes home today Saturday

Saturday Aug 17, 2013

An unusual challenging case
 
Maine Coon, MN, 5 years
On Aug 8, 2013, owner complained the cat was behaving strangely. Wanted to hide under the table but can walk. Limped on left hind limb. Had fallen from a height when held by a girl around 2 days ago.

Aug 8, 2013.  Examination
Lethargy. Thin at 8.1 kg but no fever.
Pallor (white gums)
Left nasal discharge
Swollen prepuce (can't see the penis)

Very painful area between and behind the shoulders and also above the kidney area and tail area. Advised strict confinement in a cage but no cage.

Aug 11, 2013
Very quiet but not as bad as on Aug 8. Ate less. Walked a lot in the kitchen area.

X RAYS

A history of puppy breeding and selling in Singapore

TOA PAYOH VETS toapayohvets.com Date:   17 August, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Blood in the cat's urine for the 8th time - FLUTD?   Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   17 August, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Saturday Aug 17, 2013 Recently, I have 2 clients who bought puppies from the internet. It is extremely difficult to sell puppies in Singapore nowadays. In the past, home-breeders and Seller sell using the Straits Times classified. Now I believe they use the internet.Using print advertisement is costly at least $33 for a daily 3-line advert while Facebook is free. There is the risk of the veterinary authorities imposing penalties for selling puppies without a pet shop licence. Pet shop operators must be approved to sell puppies, otherwise they can't open for business. Sometimes the authorities impose expensive infrastructural requirements for selling puppies. A few years ago, new pet shops selling puppies must have large extractor vents like chimneys to suck out the air inside the kennels. Something seen in restaurants. I don't see them nowadays. The number of puppies permitted to be sold are restricted according to the floor area of the kennel space. As for the 2 clients who brought puppies from the internet (Facebook), both of the puppies were poodles costing over $1,500. In the first case, the Buyer saw the puppy in the apartment. The Seller said he was selling for friends. The purchased puppy was coughing. "It is kennel cough," I declared while Dr Daniel was examining this puppy. I palpated the puppy's throat. The puppy gagged and coughed a few times. The Buyer said she was purchasing from a home and so I assumed it would be one of those home-breeders who loves dogs but need to earn some money to maintain his hobby. "Did you bring your puppy to the public places?" I asked the mother and child. "No," she said. Home breeders' puppies seldom have kennel cough because the puppies are reared in a healthier environment. "Were there other breeds in the apartment?" I asked. "Yes," the mother said. "Three or four other breeds like Chihuahua". This would account for the kennel cough micro-organisms being spread from other puppies consigned for sale by other breeders.  In the second case, the Seller would bring the puppy downstairs to show the prospective Buyer as he did not want the authorities to raid his premises. That was what the mother and teenaged daughter told me. This puppy did not have kennel cough. "How many puppies are present in the apartment?" I asked. The mother said: "Four puddings."  The little girl, slim and around 12 years old, laughed: "It is four poodles, mum."  Nowadays, children are too smart. "Why do you name your poodle 'Pudding?'" I asked the mum. "Puddings sound like poodles and now your little girl laughed aloud at your mistake." "My daughter gave this name," the mum confessed.       A few days ago, I met an experienced pet food supplier. He said to me: "Dr Sing, you are lucky that you no longer serve the dog breeders of Pasir Ris. Now there are at least seven vets soliciting for business. The vaccination price has dropped to $7.00/puppy vaccinated. They are mainly younger vets." "I gave up serving the breeders and pet shop operators as I don't have time for my private clients," I said. "In any case, the breeders want to press down the vaccination price of $10/puppy and one bigger pet shop operator even demanded $9.00. Caesarean sections were $250. The whole business model was losing money and time and so I was glad that there were other vets providing the service. "As for your statement that the vaccination is $7.00/puppy for the breeders, I remember a story told to me by one of those non-vet running a veterinary practice. He marketed cheap vaccinations to breeders for his practice. There were four vets including him doing the Pasir Ris breeders. He said to me he organised a meeting with the other 3 vets to set the price at $10.00. The next day, one of the vets under-priced by offering $7.00. So, your $7.00 vaccine cost to breeders is not a new issue!"  "Nowadays, few Singaporeans are buying puppies," he lamented. "The authorities ask them to adopt rescue puppies and not buy from puppy mills." "Are you sure?" I asked. "The government should be impartial as it is incorruptible." "You don't support the breeders as you sell your puppy food to them at high prices," I said. "You don't help them to promote the sale of puppies." "I sell the puppy food to them at very low prices," he replied. "Some of them sell to pet shops. When my people went to the pet shop, we saw our products which we did not sell to them. So, I had the bags tagged and identified the breeders involved." "Who are they?" I asked. "Sorry, I can't tell you." "Is the big breeder XXX involved?" I asked. "No," he said. Pet shop operators face cut-throat competition and so they sell the dog food are lower than the recommended retail prices or lose to others. There are an estimated 200 brands of pet food and the bigger pet shops seem to corner the market, as in most businesses in Singapore. There are now 55 veterinary practices with the latest two soon to open in the West Coast. I can understand the need of the newer vet practices to under price their services so that they can survive day to day. All new business do it. So, it is not a new issue for veterinary practices to do the same.   Updates will be on this webpage: www.sinpets.com/F6/20130817Singapore_ history_puppy_sale.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: August 17, 2013 Toa Payoh Vets

   

1084. e-book publishing. Designing book covers for e-book

Ref: Writing Magazine March 2013  Pg. 34
www,writers-online.co.uk

1. Show or tell?
The sole reason for an ebook is to grab the prospective reader's attention rather than to tell him the story.

2. Don't try to tell the whole stroy.
Choose 1 or 2 salient points from your story. Keep it simple. Create an emotion not tell wht the book is about. Very tiny icon on the website. Too much details confuse.
3. Show your genre/tone
Check out other books in the same genre to show the tone of the story.
4. Restrict your fonts
Three is maximum. No Papyrus or Comic Sans fonts. Too thin.

5. Colour scheme.
Few colours better. Create an emotion in the reader. Leave space. Simple. No white background as impact will be lost in a website (white). Use thin black borders to stand out from white screen.

6. Original photos/artwork. See best sellers in your genre in Amazon or Goodreads. Some ideas. Graphics expensive. Roytalty free not free. Cheap photos used by others. Pay for one at deviantART to avoid a popular image.

7. Mark the book as yours. Branding. Esp. in a series. Particular font, similar design, logo, fancy line underlining name of author or title.

8. Experiment.  Re-do.


www.fotolia.com
www.dreamstime.com
www.deviantart.com
http://chipkidd.com/journal (book designer)
www.the book designer.com

7.     

Update on Maine Coon

The Maine Coon, MN, 5 years was hospitalised from Aug 14 for the past 2 days as he was lethargic and not eating again. Blood test and X-rays were done.

Blood test showed lower RBC, Hb and platelets than previous test done around 7 days ago.
Reticuloytes were low too.

FIV/FeLeV tests. Positive for feline leukaemia. This could be a cause of the low platelet count and loss of weight. 

Check for haemobartonella?

This morning, the cat meowed whenever I approached him. He was alert and the gums were slightly pink. He did not want to walk much but could do so.