Date: Aug 30, 2013
TP 43996
Miniature Schnauzer
Black, F, spayed, 9 years
A vomiting and diarrhoeic dog.
8.8 kg, 38.4C.
Recent History
2 weeks no appetite
2 days of vomiting and diarrhoea
No abdominal pain
A simple case of gastro-enteritis?
Some injection and medication.
Not so fast. Review the previous history.
"Bladder stones removed 3 times", the owner said. "The first two times were in October 2010 and October 2011."
"How do you remember the dates so well?" I asked this groomer.
"October is her birthday and she missed the celebrations. I was happy to celebrate her October 2012 birthday. But she had the 3rd bladder stone surgery in January 2013!"
"Miniature Schnauzers are a breed prone to bladder stone formation," I said. "Struvite stones were analysed in Oct 2010. Did you still continue feeding the dry dog food after surgery?"
"Yes, but now I feed home cooked food, vegetables, rice and sometimes canned food"
Almost all Singapore dog owners do not follow up after bladder stone surgery as regards urine testing, X-rays and special diet for prevention of the struvite stones. So, the stones return and in this case, the dog had 3 bladder stone surgeries!
Blood test, urine test and X-ray advised.
Blood test was done in Jan 2013 and Aug 2013
INTERN TO HAVE DISCUSSION WITH DR DANIEL SING ON KIDNEY DISEASE.
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Friday, August 30, 2013
Thursday, August 29, 2013
Wednesday, August 28, 2013
Video movie of uterine torsion & closed pyometra
The patient bites and so the interns were frightened. However, we need to wrap up the video making today as it is 7th day post-op. I got a lady who is not afraid of dogs to bathe, dry the dog and bring it into the consultation room for last video section.
So much time had been spent with the 2 interns to shoot this video and re-do. I hope it will turn up educational and fun.
So much time had been spent with the 2 interns to shoot this video and re-do. I hope it will turn up educational and fun.
Tuesday, August 27, 2013
1102. Follow up: The old Maltese with uterine torsion & closed pyometra still snapped at the vet
Aug 27, 2013.
The dog is alert and is hosptialised for 7 days after her surgery.
She ate all a/d. Still she would snap at my hand should I go near her. She never forgives or forget.
At 15 years of age, her blood test results were unremarkable. Except for a decrease in creatinine and an increase in neutrophils, she has normal values. No increase in total white cell count unlike other closed pyometra cases I encountered despite such a gigantic womb and being so old.
Around 90-100 years old in human age. Still strong and alert.
The dog is alert and is hosptialised for 7 days after her surgery.
She ate all a/d. Still she would snap at my hand should I go near her. She never forgives or forget.
At 15 years of age, her blood test results were unremarkable. Except for a decrease in creatinine and an increase in neutrophils, she has normal values. No increase in total white cell count unlike other closed pyometra cases I encountered despite such a gigantic womb and being so old.
Around 90-100 years old in human age. Still strong and alert.
1101. Stray cat activism. Soft masses inside abdomen in a stray cat
The kind teacher brought one of these stray cats that had lost weight and was not eating for the past 2 months to Dr Daniel on Aug 19, 2013.
Blood tests were unremarkable. X-rays show a circular mass in the abdomen. Exploratory laporatomy showed the lumps which are sent for histopathology.
"There seems to be a stalk," Dr Daniel said.
"They appear to be encapsulated abscesses, peritoneal tumours or some worm masses e.g. round worm larvae migrating from the mouth to the intestines causing such reactive masses."
Mine was all speculation. Histopathology may enlighten me. Stray cats eat hazardous materials as part of their life-style. Did this cat swallow fish bones and perforated her intestines. Then such masses form to wall off the holes in the intestines?
Blood tests were unremarkable. X-rays show a circular mass in the abdomen. Exploratory laporatomy showed the lumps which are sent for histopathology.
"There seems to be a stalk," Dr Daniel said.
"They appear to be encapsulated abscesses, peritoneal tumours or some worm masses e.g. round worm larvae migrating from the mouth to the intestines causing such reactive masses."
Mine was all speculation. Histopathology may enlighten me. Stray cats eat hazardous materials as part of their life-style. Did this cat swallow fish bones and perforated her intestines. Then such masses form to wall off the holes in the intestines?
1100. HOW YOU OLD DOG CAN LIVE LONGER? Bladder rupture
Case study
TP 44384. Maltese, Female, Not Spayed, 12 years. Vet: Dr Daniel
The old dog was still active but had lost appetite yesterday. No vomiting or diarrhoea. Rotten teeth. First consultation on May 7, 2013. Complaint of stranguria and haematuria. Given antibiotics. Advised urine test, dental, spay and X-rays but the owner did not accept these advices.
Then on May 14, 2013, dog came in and the following tests were done.
URINE TEST
Amber, turbid, pH 7.0, SG 1.026, Nitrite +ve, Protein 2+, Blood 4+, White blood cells >2250, RBC >2250. Bacteria 3+, Crystals Amorphous phosphate 2+
BLOOD TEST
Urea 62.6 (4.2-6.3)
Creatinine 882 (89-177)
Total white cell count 44.3 (6-17)
N=98.7%, Absolute = 43.7 --- very high
X-rays not done
52 minutes of isoflurane gas anesthesia after sedation
Ruptured bladder repaired.
Dog was vomiting post-op on 2nd day.
Owner decided on euthanasia
RETROSPECTIVE REVIEW
Relevant medical advices were given as regards urination problems.
HOW YOUR OLD DOG CAN LIVE LONGER?
1. Dogs over 7 years old - yearly health screening (blood & urine test) and dental work.
2. Urine test and blood tests & X-rays to be done when there is urination problem rather than wait and see.
TP 44384. Maltese, Female, Not Spayed, 12 years. Vet: Dr Daniel
The old dog was still active but had lost appetite yesterday. No vomiting or diarrhoea. Rotten teeth. First consultation on May 7, 2013. Complaint of stranguria and haematuria. Given antibiotics. Advised urine test, dental, spay and X-rays but the owner did not accept these advices.
Then on May 14, 2013, dog came in and the following tests were done.
URINE TEST
Amber, turbid, pH 7.0, SG 1.026, Nitrite +ve, Protein 2+, Blood 4+, White blood cells >2250, RBC >2250. Bacteria 3+, Crystals Amorphous phosphate 2+
BLOOD TEST
Urea 62.6 (4.2-6.3)
Creatinine 882 (89-177)
Total white cell count 44.3 (6-17)
N=98.7%, Absolute = 43.7 --- very high
X-rays not done
52 minutes of isoflurane gas anesthesia after sedation
Ruptured bladder repaired.
Dog was vomiting post-op on 2nd day.
Owner decided on euthanasia
RETROSPECTIVE REVIEW
Relevant medical advices were given as regards urination problems.
HOW YOUR OLD DOG CAN LIVE LONGER?
1. Dogs over 7 years old - yearly health screening (blood & urine test) and dental work.
2. Urine test and blood tests & X-rays to be done when there is urination problem rather than wait and see.
1099. To publish*****: Veterinary stories. The optometrist's 3rd daughter
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1099. Sunday's interesting case - The optometrist's 3rd daughter
"I work very hard to raise and educate 3 daughters," the 67-year-old optometrist used to work from 9 am to 9 pm said to me. "Now, two are married and I don't get a cent from them."
"Do you really expect the younger generation to give parents some money from their earnings every month?" I asked. "They have different values. If they don't need your money as adults, you should consider yourself fortunate!"
Nowadays he closes his shop whenever he likes because his rental in downtown Orchard Road is around $4,000 while the other shop rentals in other malls were charging $8,000 - $20,000 rental per month. "I do not charge clients who are poor," he declared to me. "There was one who asked me if he could pay by instalments. His family member has cancer and so I said that he could pay me when he was able to do so."
"Would you be giving free spectacles if your rental was $15,000/month?" I asked.
"Well, the clients who need free spectacles will not step into such posh shops."
His 3rd daughter in her late 20s had brought in a 13-year-old cat for me to remove an ingrown toe nail. She had phoned me at 10 am on Saturday as the cat's paw was bleeding and I suggested that she bandaged the foot and bring the cat in today, in order to save on after-hours costs which would come to over $300.
So, here she was, with her father. She would not bear to see her cat's ingrown toe nail being cut off.
"My cat claws me all the time at home," she warned me. So I expected a ferocious lion all ready to swing her claws at me. But she was very quiet and there was no need for a sedative. She just lied quietly and patiently and I got some images taken.
"Since you have worked for so many years, you must have lots of clients," I said to the father. "Is your children taking over your business?"
"No, my children are not interested," he had already given up on his 2 older daughters and this younger one was working happily in an events marketing company in publishing.
"I am interested," the 3rd daughter said she had spoken to him and would not mind attending the compulsory optometry course to be accredited. He had not groomed the 3rd daughter.
"Rentals will not stay at $4,000/month forever," he had no confidence in his children to compete and bring his goodwill and clientele business to a higher level.
"Have you got a website?" I scrutinised his name card as he said my spectacles were out-dated and old fashioned. I told him they were branded "Gap" and the thick black frames were admittedly, not modern looking.
His 3rd daughter laughed as she is from this internet generation who appreciates websites and know the levelling power of the social media. Maybe the father knows that one-man-operator optometrist practice is a dying business but I don't think so. Many such shops hire people who come and go and there is a niche for proprietors who provide personalised service and is available over the years as the family members grow up.
Of course, the internet generation may not be loyal clients and go for fanciful renovations and high prices. However I believe there is a place for a niche optometry personalised service with years of experience. It is very difficult to find such old veterans nowadays if you value experience over glamour.
"Do you really expect the younger generation to give parents some money from their earnings every month?" I asked. "They have different values. If they don't need your money as adults, you should consider yourself fortunate!"
Nowadays he closes his shop whenever he likes because his rental in downtown Orchard Road is around $4,000 while the other shop rentals in other malls were charging $8,000 - $20,000 rental per month. "I do not charge clients who are poor," he declared to me. "There was one who asked me if he could pay by instalments. His family member has cancer and so I said that he could pay me when he was able to do so."
"Would you be giving free spectacles if your rental was $15,000/month?" I asked.
"Well, the clients who need free spectacles will not step into such posh shops."
His 3rd daughter in her late 20s had brought in a 13-year-old cat for me to remove an ingrown toe nail. She had phoned me at 10 am on Saturday as the cat's paw was bleeding and I suggested that she bandaged the foot and bring the cat in today, in order to save on after-hours costs which would come to over $300.
So, here she was, with her father. She would not bear to see her cat's ingrown toe nail being cut off.
"My cat claws me all the time at home," she warned me. So I expected a ferocious lion all ready to swing her claws at me. But she was very quiet and there was no need for a sedative. She just lied quietly and patiently and I got some images taken.
"Since you have worked for so many years, you must have lots of clients," I said to the father. "Is your children taking over your business?"
"No, my children are not interested," he had already given up on his 2 older daughters and this younger one was working happily in an events marketing company in publishing.
"I am interested," the 3rd daughter said she had spoken to him and would not mind attending the compulsory optometry course to be accredited. He had not groomed the 3rd daughter.
"Rentals will not stay at $4,000/month forever," he had no confidence in his children to compete and bring his goodwill and clientele business to a higher level.
"Have you got a website?" I scrutinised his name card as he said my spectacles were out-dated and old fashioned. I told him they were branded "Gap" and the thick black frames were admittedly, not modern looking.
His 3rd daughter laughed as she is from this internet generation who appreciates websites and know the levelling power of the social media. Maybe the father knows that one-man-operator optometrist practice is a dying business but I don't think so. Many such shops hire people who come and go and there is a niche for proprietors who provide personalised service and is available over the years as the family members grow up.
Of course, the internet generation may not be loyal clients and go for fanciful renovations and high prices. However I believe there is a place for a niche optometry personalised service with years of experience. It is very difficult to find such old veterans nowadays if you value experience over glamour.
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