In Singapore, this stray cat has no proper home but the cat feeders ensure that she has food and water. "For the past 3 days, she would eat but spit out the canned food," the retiree said to me.
"There could be a fish bone lodged inside the throat," I advised X-rays. Stray cats love fish and some people will feed them with left over fish with bones.
The cat pawed me when I tried to open his mouth. Foul breath. The lower sides of his gums appeared blood red with ulcers. Hence the bad breath.
X-rays showed ulcerated pharynx and proximal oesophagus with gas.
After an anti-inflammatory and antibiotic injection, the cat was active and ravenous and the caregiver is much happier.
Sunday April 25, 2015.
Recurrent eye abscess.
The owner wanted the hamster home on the same day as the treatment of the abscess some 5 weeks ago. She disputed that I had advised her how to do post-discharge care. I had told her verbally to use a cotton bud tip to rub above and below the skin wound to express out the pus, daily. In this way, any residual pus would be let out and the abscess would not recur. She only put eye drops.
This educational video teaches vets how to handle this problem and to prevent the abscess from recurring.
A small skin incision heals too fast if the owner does not express the pus on the second day. There will be pockets of pus still inside the skin. So the abscess recurs. This video shows how an abscess is treated by me at Toa Payoh Vets. Isoflurane + oxygen gas anaesthesia is used here. The whole process of lancing, curetting, irrigating and draining the abscess takes around 5 minutes.
The hamster is OK and will be in-patient for 2 days.
UPDATE
On Day 2, I reviewed this gentle chubby hamster. I expressed more yellow pus from the incision wound. By inching out the residual pus, the wound can heal without another abscess popping out in the next week.
The owner phoned and her male friend came to check the hamster. She asked whether the hamster could go home. I said no. Hamsters are family members and so the lady owner did not want her in-patient but would not want to pay for a recurrent abscess.
POST DISCHARGE NURSING ADVICE IN WRITING.
The vet must let the owners wanting to bring the hamster home on the same day, they will have to bear the responsibility of post-discharge nursing and to pay in full should the hamster recur. This should be in writing to prevent any misunderstanding of the responsibilities of post-discharge care and much unhappiness in having to pay again for treatment.
This hamster stayed 2 nights in-patient and was cleared of pus on Day 3. On Day 2, I could express pus from the closed wound. On Day 3, more pus was expressed although the wound had closed (video). After that, I phoned the owner to bring her home. She should not have any recurring abscess within the next 2 weeks.
Friday Mar 27, 2015
2nd in-patient period at Toa Payoh Vets
Male, not neutered cat, 1.5 years old
Owner wants him to stay another 2 days. He went home after 2 days in-patient during the first visit.
History
Bladder obstruction some 2 weeks ago. The first vet had unblocked the bladder and sent the cat home after 5 days in-patient.
Yet the cat was still passing blood in the urine and had inflamed prepuce. He was not eating and was dehydrated.
The owner consulted me as a 2nd opinion on Mar 17, 2015.
I had palpated much enlarged painful kidneys (X-rays in another video). Therefore, the urethral obstruction blocking the flow of urine, putting back pressure enlarging the kidneys 3-6X and also causing bacterial infection and kidney failure (blood test results of high blood urea nitrogen and creatinine, leucocytosis and neutrophilia from the first vet).
After the first vet sent the cat home, the cat would not eat and it was difficult to give medication orally. Anorexia, tongue and lip ulcers are signs of uraemia as the cat had acute kidney failure. The cat was dehydrated and hypothermia (below 38C). Lethargy. No hope of survival?
This was acute kidney failure due to bacterial infections of the kidneys.
The first vet's clavulox antibiotics and treatment did not eliminate the bacteria. I got a bacterial culture and antibiotic sensitivity test of the urine. The bacteria was resistant to clavulox.
The video shows the cat after 2 days of treatmet at the 2nd in-patient treatment at Toa Payoh Vets
After antibiotics of Baytril, SC fluids of 200 ml for the next 2 days, the kidneys reduced in size (by palpation).The cat was not happy when the kidneys were palpated as there was still nephritis (see video).
CONCLUSION
The enlarged kidneys would be due to the back pressure of the urine from the obstructed bladder. The owner did not know that the cat had difficulty in urination as he shares a common toilet floor with the other 3 cats. The first vet relieved the obstruction and had treated him as an in-patient for 5 days.
This was a gentle cat and so did not claw the vets during fluid therapy. As the family could not accept pork in the prescripition diet, the Royal Canin Renal diet was reported not to contain pork. This was fed to this cat since he went home after the 2nd in-patient treatment.
FOLLOW UP
April 23, 2015
SMS
The owner was contactable by SMS. The cat is back to normal, eating only the Royal Canin Renal food. Normal temperature. So, it is good outcome. This cat is a favourite of the father as this cat meows as if talking to a person whenever he is spoken to. Unlike the other 3 neutered cats in the apartment.
So, he is much loved by the father who told me that he did not want to neuter him as he would become dumb like the other 3 cats.
There is a learning lesson here. Many young Singaporeans do not greet or say good morning to the parents or superior officers. Be communicative and you will be most appreciated by the hand that feeds you or mentors you.
"Your cat has a very low platelet count and liver disorder," I showed the blood test report to the very busy bearded husband who shook my hand as he arrived at 7.25pm to take back his cat.
I know he is very busy. He works in the car parking software field which demands all his waking hours of his life as the various car parks seems to have much bugs, needing his help to resolve the problems. "Your cat has been toxic. He also has pale gums but is now pinker. Did he drink toilet water?"
I had given the cat at least 200 ml of electrolytes, amino acids and antibiotics and the cat meowed when he saw the owner.
"Some cats love to drink from the water splashed or drippinig onto the bathroom floor," I said. The man reflected and thought that this cat could have lapped toilet water.
"I have 6 cats," he said. "The other 5 have no problems."
"It all depends on how much poison the cat drinks and for how long. Why do you have 6 cats? I thought you have only one?"
"The female becomes pregnant and it is against my religion to get an abortion," the husband explained. Fortunately, my relatives have booked a kitten from my latest pregnant cat!"
"Why don't you give some of the 6 cats away?"
"No, no," he replied. "We love them."
I can't understand why he did not neuter or spay the 6 cats. Now one is pregnant again.
"I better have him checked as she had been having an arched back during the past 2 days," the fair tall lady in her 30s, wearing a contrasting dark blue dress showed me a video clip of her dog walking with a "camel's bump".
"He would go to the bathroom and lie down there," she noted this unusual behaviour.
"Did he have difficulty in peeing?" I asked as house-trained dogs go to the bathroom to avoid peeing onto the apartment.
"No problem."
I palpated the dog's abdomen twice. During the first time, he winced slightly when I palpated the kidneys but the spinal column palpation showed no pain. I got the dog onto the floor to walk. He was walking normally with no hunched back.
"My dog will recover whenever he is at the vet," the lady laughed. Yet there was something wrong with him.
On the second palpation after the walking, I had my assistant do a video. This time, the dog reacted when I pressed the thoracic-lumber spinal column. There was some degeneration or pain in the spinal disc and that was why the dog hunched his back the last 2 days.
"The problem is with his disc at this T/L junction," I said. "He feels the pain and so does not walk to walk much. He walked with a hunched back and went to the bathroom to lie down. In case he needed to pee, he did not need to walk far." This was my hypothesis.
VIDEO
In Singapore, many young pet owners are well educated and do research. They use the smart phone to video unusual behaviours or clinical problems. For this lady, she would not permit me to do dental scaling since I use anaesthesia. "My groomer will do the dental work," she was afraid that her dog could die from anaesthesia.
Some dog groomers now provide dental scaling without anaesthesia and this is what some owners are interested.
The young lady phoned me. She was worried that the nervous stray cat, now housed indoors would be thrown out and left to fend for herself. "My parents are separating next week," she said. "I would not want my cat to suffer from attacks, starvation and diseases but I can't catch the cat."
When parents separate, there is a lot of damage. I recommended her a cat trapper.
This Chihuahua passes pus in the vagina. Blood test showed neutrophils at 92.8% (normal 60-70%) and platelets very low indicating toxaemia. After treating for 2 days as an in-patient, the dog had to be spayed to remove the pus-filled womb.
The ruptured womb was seen only during the surgery. There was a large inflamed spot adhered to the intestines. This was separated. The dog passed away 5 hours after recovery from anaesthesia.
The dog was a high anaesthetic risk in view of the very low platelet count. She passed away 5 hours post-op and this was very sad.
"His left eye keeps discharging thick pus daily" the lady had consulted a vet 2 weeks ago. The vet prescribed eye gel and eye drops and advised normal saline eye wash daily. "She said the dog's eye would recover soon."
"Did the vet really guarantee that?" I asked. "If not," she replied. "I should go back to her again. But I am not doing that!" "When was the left eye injured?" "About 2 to 3 months ago." she was not sure of the exact date. She had been treating the eye injury with eye drops herself but the eye got worse. "Shih Tzus have protruding eye balls," I said. "The eyes get injured easily, becomes ulcerated and scarred. Eye injuries are emergencies. Treatment by the vet should be done within 24 hours to prevent scratching of the eyes. Did the vet advise an Elizabeth collar to wear?" "No," she said.
"The left eye cornea is dull compared to the right eye," the owner noted the scarring.
Dr Daniel sedated the dog, got the hairs around the face and ears clipped off so that the eyes do not get loose hair irritations. The eyes were irrigated with saline. The 3rd eyelid was elevated to flush out any hairs and debri. I gave a subconjuctival injection of antibiotic and anti-inflammatory. The dog went home with eye drops and a dry eye ointment as well as e-collar. He will have to stay away from the wind and sun and wear the E-collar 24 hours daily for 2 months. There was no deep corneal ulceration based on fluorescein stain test.
I cannot guarantee normal tear production as the owner had delayed seeking vet treatment for 2-3 months. It is hard to predict the outcome as to whether the eye will recover fully. To follow up in a month's time.
A Shih Tzu's eyes are most easily injured. Treatment within 24 hours by your vet is important to save the eyesight.
