May 20, 2015
"What is the stage of kidney failure in my cat?" the young lady asked when I told her that her 12-year-old cat had high serum urea 36.1 (7.2-10.8) and creatinine 423 (71-160).
The cat also had low platelets 226 (300-800). but the red blood cells were normal. Neutrophils were 97% (60-70%) with absolute 13.7 (3-11.5), but the total white cell count was normal.
Vets seldom if ever stage the stage of kidney failure, unlike in human medicine. Her cat came in last week for not eating.
The cat was very thin or emaciated. He had poor appetite for the past one year. For the past 2 days, he stopped eating. There was a bad breath which could be due to teeth and gum infections. The rectal temperature was 37.2C, below normal.
"The kidneys are enlarged but there is little pain on palpation," I said. "A blood test is the minimum to check for kidney disease." I said to the parents who came in with the young girl. "I had a case where the owners did not want the blood test to check for kidney impairment and other diseases. The cat did not recover his appetite and he went to another vet."
I gave the parents some time to think about the blood test. Many Singapore cat owners just want some antibiotic injections but are not happy when the treatment does not work.
In this case, the cat had lost weight for the past year or more. He would be suffering from chronic kidney failure. What is the cause?
He could have hyperthyroidism but my hands are tied as the owners want the least medical costs.
I gave the cat 200 ml of Hartmann's Solution and dextrose saline with vitamin B, antibiotic and anti-inflammatory. In the afternoon, his rectal temperature had gone up to normal 38.3. He went home and it was 3 days later before he ate.
Fortunately, the parents consented to a blood test and we know that the cat has kidney failure and an impending bacterial infection (neutrophilia and low platelet count). But more tests like X-rays, more detailed blood tests and urine tests are needed in the ideal world, to check for urine proteins, blood potassium, calcium, proteins and reviews.
UPDATE ON MAY 21, 2015
The young lady made time to buy the Prescription Diet K/D for her cat. "Measure volume of water intake per 24 hours and record in the chart," I advised. "Hand-feed the K/D mixed with 90% of original canned food first until the cat eats 100%. If you just offer the K/D immediately, the cat will not eat it."
These are the tips of changing over to a new diet. The owner must make an effort to mix the new food at 10% and coax the cat to eat it till 100%. The cat is said to be eating and active. Chronic kidney failure cannot be cured as much depends on the cause which is unknown. It could be toxicity of the environment as the platelet count was low.
Will wait and see.
Wednesday, May 20, 2015
2159. Injectable anaesthestic in an animal shelter and Toa Payoh Vets
TOA PAYOH VETS
toapayohvets.com Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074 Tel: 6254-3326, 9668-6469, 9668-6468. judy@toapayohvets.com
20 May, 2015 Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits
Injectable Anaesthetic Procedures in
an animal shelter and in Toa Payoh Vets
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 8 May 2008
Updated: 20 May, 2015
PART I. Sharing Knowledge with Veterinarians
Anaesthetic Procedures in NANAS
Sunday, Apr 27, 2008
I visited NANAS (Noah's Ark and Natural Animal Sanctuary), an animal sanctuary in Johor on a fine cloudy humid Saturday afternoon of April 26, 2008 to know more about animal shelter medicine. I had the opportunity to study the effects of Zoletil combination being used.
To share knowledge with others working in dog and cat shelter medicine in other countries via the world wide vet, I have recorded below the following effective anaesthetic regime in NANAS. It is an alternative to gas anaesthesia and is less expensive. The dosage is as follows:
1. Zoletil 50 (Virbac) white powder is present in a bottle.
Tiletamine 125mg, Zolazepam 125 mg. I refer to this as the Zoletil bottle.
2. Xylazine 100mg/ml in a bottle. Put 2 ml of this into the Zoletil bottle.
3. Ketamine 100mg/ml in a bottle. Put 8 ml of this into the Zoletil bottle.
4. The bottle now contains a clear solution of 10 ml. This combination is used as shown below:
FOR CAT SPAYS
1-2 kg. 0.15 - 0.18 ml IM
Bigger cats 0.2 ml IM.
I noted that the duration of surgical anaesthesia was more than 30 minutes in cats 1-2 kg being spayed. The tongue is pulled out as a routine to prevent food being vomited during surgery. Such food gets into the lungs and cause death by inhalation pneumonia. Surgical incision is midway between umbilical scar and pelvic brim in the young cats being spayed.
FOR DOG SURGERYIn a dog of around 15kg , a 0.8 ml IM permitted surgical anaesthesia of around 30 minutes in one case of conjunctival growths being removed. As the dog showed signs of waking up (eye reflex and mouth clamping), a 0.6 ml IM was injected. The dog was under surgical anaesthesia within 1 minute. Topping up may be required at Animal Shelters.
POST-OPERATION
In NANAS, the following were given for cats and dogs.
1. Tolfedine 4% (tolfenamique 4g) at 0.5 ml IM or SC for cats after spay and neuter. A pain-killer.
2. Amoxicillin (Longamox) at 0.5 ml SC for cats after spay. An antibiotic.
PART IV. Sharing Knowledge with Veterinarians - a Singapore PDSA?
A stray male cat after neuter by Dr Sing in 2003 using xylazine 0.2 ml IM and gas anaesthesia at that time. Clipped left ear tip in stray cats indicate they have had been sterilised. But stray dogs do not get such treatment and it is difficult to know the status of whether the female stray has been spayed or not.
Despite a first-world country status, Singapore unfortunately does not have a charitable foundation like the People's Dispensary for Small Animals (PDSA) in the UK to cater to the treatment of sick street cats and dogs for owners who can't afford veterinary treatment.
I saw practice with a private vet in in England in the 1973 during my 4th year at Glasgow University. He spent 1 day a week at the PDSA to offer his veterinary services. What stuck in my mind was the arrival of a driver/owner of a Jaguar car. He brought in a dog for free treatment. One presumes that the Jaguar car owner does not need the help of the PDSA.
It is hoped that one day, one of our successful entrepreneurs will set up a Singapore PDSA to help owners who can't afford veterinary attention for their pets.
1962-67. Neutering a 2-month-old hamster at Toa Payoh Vets
FOR MORE CASES AT TOA PAYOH VETS, goto:
Cats or Dogs
toapayohvets.com Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074 Tel: 6254-3326, 9668-6469, 9668-6468. judy@toapayohvets.com
20 May, 2015 Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits
Injectable Anaesthetic Procedures in
an animal shelter and in Toa Payoh Vets
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 8 May 2008
Updated: 20 May, 2015
PART I. Sharing Knowledge with Veterinarians
Anaesthetic Procedures in NANAS
Sunday, Apr 27, 2008
I visited NANAS (Noah's Ark and Natural Animal Sanctuary), an animal sanctuary in Johor on a fine cloudy humid Saturday afternoon of April 26, 2008 to know more about animal shelter medicine. I had the opportunity to study the effects of Zoletil combination being used.
To share knowledge with others working in dog and cat shelter medicine in other countries via the world wide vet, I have recorded below the following effective anaesthetic regime in NANAS. It is an alternative to gas anaesthesia and is less expensive. The dosage is as follows:
1. Zoletil 50 (Virbac) white powder is present in a bottle.
Tiletamine 125mg, Zolazepam 125 mg. I refer to this as the Zoletil bottle.
2. Xylazine 100mg/ml in a bottle. Put 2 ml of this into the Zoletil bottle.
3. Ketamine 100mg/ml in a bottle. Put 8 ml of this into the Zoletil bottle.
4. The bottle now contains a clear solution of 10 ml. This combination is used as shown below:
FOR CAT SPAYS
1-2 kg. 0.15 - 0.18 ml IM
Bigger cats 0.2 ml IM.
I noted that the duration of surgical anaesthesia was more than 30 minutes in cats 1-2 kg being spayed. The tongue is pulled out as a routine to prevent food being vomited during surgery. Such food gets into the lungs and cause death by inhalation pneumonia. Surgical incision is midway between umbilical scar and pelvic brim in the young cats being spayed.
FOR DOG SURGERYIn a dog of around 15kg , a 0.8 ml IM permitted surgical anaesthesia of around 30 minutes in one case of conjunctival growths being removed. As the dog showed signs of waking up (eye reflex and mouth clamping), a 0.6 ml IM was injected. The dog was under surgical anaesthesia within 1 minute. Topping up may be required at Animal Shelters.
POST-OPERATION
In NANAS, the following were given for cats and dogs.
1. Tolfedine 4% (tolfenamique 4g) at 0.5 ml IM or SC for cats after spay and neuter. A pain-killer.
2. Amoxicillin (Longamox) at 0.5 ml SC for cats after spay. An antibiotic.
PART II. Sharing Knowledge with Veterinarians
Anaesthetic Procedures in TOA PAYOH VETS, SINGAPORE.
Recently, some owners asked me why there were no antibiotics given after sterilisation of their male cats. Generally, no pain-killers or antibiotics are given to your male and female cats post-operation from Toa Payoh Vets for cases operated by Dr Sing as experience indicates that they are not necessary. Many owners find it hard to give oral medication to cats.
In big dogs, non-steroidal anti-inflammatory pain-killer and antibiotics may be prescribed after spay. Typical anaesthetic regimes for cats living and born in Singapore are shared with fellow veterinarians by Dr Sing Kong Yuen. Some vets may seek such internet information. They are as follows as at Feb 1, 2009:
For Dr Sing's cases at Toa Payoh Vets, the anaesthetic regime is usually:
Xylazine & Ketamine injectable anaesthesia are used for cats. Dosage is xylazine 20 mg/100 ml at 0.2 ml mixed with ketamine 100 mg/ml 0.8 ml in 1 syringe, IM injection. This dosage is most effective for a cat around 2-4 kg. Onset of anaesthesia is 2 minutes after IM injection in most cases. Duration of surgical anaesthesia is at least 30 minutes.
For fat cats or young ones less than 2 kg, half the above dose is sufficient but surgical anaesthesia is less than 10 minutes compared to 30 minutes in above full dose. If necessary, isoflurane anaesthetic gas at 5% is given by mask for one minute to effect to complete the surgery.
Xylazine & isoflurane gas anaesthesia or gas anaesthesia alone are usually used for dogs by me as I find them to be most effective. I want the patient to wake up within 1 minute at the end of surgery. For injectable anaesthetics, the patient sleeps a long time and this has advantages and disadvantages. Many owners are happy that their pets are already awake after surgery.
Please note that the xylazine solution I used is 5X less potent than that used for the Zoletil combination at NANAS. It is 20 mg/100 ml xylazine, not 100 mg/ml which is the bottle usually used for horses
Toa Payoh Vets do use Domitor, Antisedan, Zoletil anaesthetic protocols as well. Experiences are recorded in other webpages.
UPDATE ON MAY 20, 2015. I found that the following formula is effective and safe:
For a healthy and young dog, 10 kg. Domitor 0.4 ml + Ketamine 0.5 ml IV in one syringe.
Duration of anaesthesia is around 20 -30 minutes
Onset is 5 minutes.
No need for isoflurane and O2 gas top up if the spay can be completed within 20 minutes
For old dogs, 50% of dosage with isoflurane gas top up if necessary
For a 16-year-od sick dog, 10% of dosage for short sedation is safe generally.
Anaesthetic Procedures in TOA PAYOH VETS, SINGAPORE.
Recently, some owners asked me why there were no antibiotics given after sterilisation of their male cats. Generally, no pain-killers or antibiotics are given to your male and female cats post-operation from Toa Payoh Vets for cases operated by Dr Sing as experience indicates that they are not necessary. Many owners find it hard to give oral medication to cats.
In big dogs, non-steroidal anti-inflammatory pain-killer and antibiotics may be prescribed after spay. Typical anaesthetic regimes for cats living and born in Singapore are shared with fellow veterinarians by Dr Sing Kong Yuen. Some vets may seek such internet information. They are as follows as at Feb 1, 2009:
For Dr Sing's cases at Toa Payoh Vets, the anaesthetic regime is usually:
Xylazine & Ketamine injectable anaesthesia are used for cats. Dosage is xylazine 20 mg/100 ml at 0.2 ml mixed with ketamine 100 mg/ml 0.8 ml in 1 syringe, IM injection. This dosage is most effective for a cat around 2-4 kg. Onset of anaesthesia is 2 minutes after IM injection in most cases. Duration of surgical anaesthesia is at least 30 minutes.
For fat cats or young ones less than 2 kg, half the above dose is sufficient but surgical anaesthesia is less than 10 minutes compared to 30 minutes in above full dose. If necessary, isoflurane anaesthetic gas at 5% is given by mask for one minute to effect to complete the surgery.
Xylazine & isoflurane gas anaesthesia or gas anaesthesia alone are usually used for dogs by me as I find them to be most effective. I want the patient to wake up within 1 minute at the end of surgery. For injectable anaesthetics, the patient sleeps a long time and this has advantages and disadvantages. Many owners are happy that their pets are already awake after surgery.
Please note that the xylazine solution I used is 5X less potent than that used for the Zoletil combination at NANAS. It is 20 mg/100 ml xylazine, not 100 mg/ml which is the bottle usually used for horses
Toa Payoh Vets do use Domitor, Antisedan, Zoletil anaesthetic protocols as well. Experiences are recorded in other webpages.
UPDATE ON MAY 20, 2015. I found that the following formula is effective and safe:
For a healthy and young dog, 10 kg. Domitor 0.4 ml + Ketamine 0.5 ml IV in one syringe.
Duration of anaesthesia is around 20 -30 minutes
Onset is 5 minutes.
No need for isoflurane and O2 gas top up if the spay can be completed within 20 minutes
For old dogs, 50% of dosage with isoflurane gas top up if necessary
For a 16-year-od sick dog, 10% of dosage for short sedation is safe generally.
INCISION SITE.
In NANAS, I observed that the incision begins at the middle 1/3 area between the umbilical scar and the pelvic brim. Cats I observed were around 6 months of age. The cat's tongue was pulled out to one side of the mouth to prevent vomitus from being swallowed. Bladder was expressed so that the bladder would not be nicked.
At Toa Payoh Vets, I incise at the cranial 1/3 area, at 1 cm from the umbilical scar in dogs and cats. This position enables me to easily access and ligate the swollen "on-heat" ovaries easily, especially in dogs. Palpate for the full bladder and express it free from urine before spaying. Be careful not to nick the full bladder. Seldom do I encounter a full bladder at this location but there needs to be care in incising the linear alba in case the bladder is just below. Palpate the abdomen first to check for the bladder and express the urine.
In NANAS, I observed that the incision begins at the middle 1/3 area between the umbilical scar and the pelvic brim. Cats I observed were around 6 months of age. The cat's tongue was pulled out to one side of the mouth to prevent vomitus from being swallowed. Bladder was expressed so that the bladder would not be nicked.
At Toa Payoh Vets, I incise at the cranial 1/3 area, at 1 cm from the umbilical scar in dogs and cats. This position enables me to easily access and ligate the swollen "on-heat" ovaries easily, especially in dogs. Palpate for the full bladder and express it free from urine before spaying. Be careful not to nick the full bladder. Seldom do I encounter a full bladder at this location but there needs to be care in incising the linear alba in case the bladder is just below. Palpate the abdomen first to check for the bladder and express the urine.
PART III. Sharing Knowledge with Veterinarians
Anaesthetic Procedures in one Singapore veterinary practice
Anaesthetic Procedures in one Singapore veterinary practice
I have insufficient experience with the following anaesthetic regimes but am recording the procedures based on information provided to me by one vet with considerable experience in the following anaesthetic protocol without the need to use gaseous anaesthesia as at Feb 2009.
1. Xylazine 20 & Ketamine 100.
1.1 For example in a Jack Russell, 5 kg dog. 1-5 years old.
Xylazine 20 at 0.4 ml IV, Ketamine 100 at 0.1 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.2 For example in a Jack Russell, 6 kg dog. 1-5 years old.Xylazine 20 at 0.4 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.3 For example in a Jack Russell, 10 kg dog. 1-5 years old.Xylazine 20 at 0.8 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.4 For example in a Jack Russell, 15 kg dog. 1-5 years old.Xylazine 20 at 1.3 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1. Xylazine 20 & Ketamine 100.
1.1 For example in a Jack Russell, 5 kg dog. 1-5 years old.
Xylazine 20 at 0.4 ml IV, Ketamine 100 at 0.1 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.2 For example in a Jack Russell, 6 kg dog. 1-5 years old.Xylazine 20 at 0.4 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.3 For example in a Jack Russell, 10 kg dog. 1-5 years old.Xylazine 20 at 0.8 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.4 For example in a Jack Russell, 15 kg dog. 1-5 years old.Xylazine 20 at 1.3 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.5 For example in a Jack Russell, 20 kg dog. 1-5 years old.Xylazine 20 at 1.6 ml IV, Ketamine 100 at 0.4 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.6 For example in a Jack Russell, 2.5 kg dog. 10 years old.
Xylazine 20 at 0.2 ml IV, Ketamine 100 at 0.05 ml IV.
Separate syringes. Then top up with Zoletil IM or IV injection if necessary
2. TOPPING UP WITH ZOLETIL when the animal shows signs of movement and recovering from surgical anaesthesia from the xylazine/ketamine combination.
Zoletil 100 powder. Add 10 ml diluent. The solution is equivalent to Zoletil 50 now.
Use 0.1ml Zoletil 50 IM for small breeds
Use 0.2 ml Zoletil 50 IM for big breeds (20 kg)
Topping up with Zoletil IM in the above protocols is effective. The above is useful for vet surgeries without gas anaesthesia or in field work. It is much more expensive to install gas anaesthesia in certain situations and I hope the above information will be of use for practitioners. Obviously, the older dogs and cats will need half the dose and there is a need to be very careful with injectable anaesthetics. It may be best to refer to other vets with gas anaesthesia facilities, in the best interest of the animal.
CASES IN MAY 2009 AT TOA PAYOH VETS
RABBIT INJECTABLE ANAESTHESIA
1.3 kg. Around 4-5 months old. Neuter.
0.1ml Zoletil 50 IM. Wait 5 minutes. Give 0.05ml Domitor IV ear vein, 27G needle. Effective general anaesthesia. Rabbit takes >1 hour to wake up. No problem. No need for Antisedan.
CATS INJECTABLE ANAESTHESIA2 kg. Around 8 months
0.1ml Ketamine 100 and 0.05ml Xylazine 20 IV in one syringe gave general anaesthesia >60 minutes for spay.
Separate syringes. Then top up with Zoletil IM injection if necessary
1.6 For example in a Jack Russell, 2.5 kg dog. 10 years old.
Xylazine 20 at 0.2 ml IV, Ketamine 100 at 0.05 ml IV.
Separate syringes. Then top up with Zoletil IM or IV injection if necessary
2. TOPPING UP WITH ZOLETIL when the animal shows signs of movement and recovering from surgical anaesthesia from the xylazine/ketamine combination.
Zoletil 100 powder. Add 10 ml diluent. The solution is equivalent to Zoletil 50 now.
Use 0.1ml Zoletil 50 IM for small breeds
Use 0.2 ml Zoletil 50 IM for big breeds (20 kg)
Topping up with Zoletil IM in the above protocols is effective. The above is useful for vet surgeries without gas anaesthesia or in field work. It is much more expensive to install gas anaesthesia in certain situations and I hope the above information will be of use for practitioners. Obviously, the older dogs and cats will need half the dose and there is a need to be very careful with injectable anaesthetics. It may be best to refer to other vets with gas anaesthesia facilities, in the best interest of the animal.
CASES IN MAY 2009 AT TOA PAYOH VETS
RABBIT INJECTABLE ANAESTHESIA
1.3 kg. Around 4-5 months old. Neuter.
0.1ml Zoletil 50 IM. Wait 5 minutes. Give 0.05ml Domitor IV ear vein, 27G needle. Effective general anaesthesia. Rabbit takes >1 hour to wake up. No problem. No need for Antisedan.
CATS INJECTABLE ANAESTHESIA2 kg. Around 8 months
0.1ml Ketamine 100 and 0.05ml Xylazine 20 IV in one syringe gave general anaesthesia >60 minutes for spay.
2.5 kg. Around 1 year
0.1ml Ketamine 100 and 0.1ml Xylazine 20 IV in one syringe gave general anaesthesia >60 minutes for spay. Femoral vein used.
0.1ml Ketamine 100 and 0.1ml Xylazine 20 IV in one syringe gave general anaesthesia >60 minutes for spay. Femoral vein used.
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| A beautifully designed cat house in NANAS. Waterfront views and wooden floor boards. |
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| An open area permitted cats to get out and enjoy the views and sun. |
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| I introduced a 2nd-year Murdoch University vet student who loves cats to visit NANAS with me so as to expose her to animal shelter medicine. Would she set up a cats only practice in Singapore? Would such a practice be feasible? |
A stray male cat after neuter by Dr Sing in 2003 using xylazine 0.2 ml IM and gas anaesthesia at that time. Clipped left ear tip in stray cats indicate they have had been sterilised. But stray dogs do not get such treatment and it is difficult to know the status of whether the female stray has been spayed or not.
Despite a first-world country status, Singapore unfortunately does not have a charitable foundation like the People's Dispensary for Small Animals (PDSA) in the UK to cater to the treatment of sick street cats and dogs for owners who can't afford veterinary treatment.
I saw practice with a private vet in in England in the 1973 during my 4th year at Glasgow University. He spent 1 day a week at the PDSA to offer his veterinary services. What stuck in my mind was the arrival of a driver/owner of a Jaguar car. He brought in a dog for free treatment. One presumes that the Jaguar car owner does not need the help of the PDSA.
It is hoped that one day, one of our successful entrepreneurs will set up a Singapore PDSA to help owners who can't afford veterinary attention for their pets.
| SOME CASES OF CAT SPAYS DONE BY DR SING KONG YUEN |
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| Xylazine: ketamine injectable combination for the 2 fat cats of around 5 kg neutered by Dr Sing. Dosage was halved for cats 2-3 kg. Surgical anaesthesia was around 5 minutes as the dosage should be higher. Neutered around 5 minutes after injection. No topping up was needed in this case. If necessary, I would use gas anaesthesia for 1 minute. That would be sufficient to provide surgical anaesthesia. |
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| For this pregnant 4-kg cat, the xylazine: ketamine at 0.2 ml:0.8 ml IM (usually given to cats 2-3 kg) permitted excellent surgical anaesthesia of around 30 minutes for spaying. |
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| Dr Sing's incision for spaying of cats is normally 1 cm caudal to the umbilical scar. The incision length is 1 cm if the cat is not pregnant. In this case, it is longer as the womb is much larger due to the presence of foetal lumps. Ligate the uterine body in this pregnant cat two areas although there should be no slippage of sutures with one ligation. |
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| A street cat weighing less than 2 kg. The xylazine: ketamine dosage was less than half of that used for cats 2-3 kg. The skin incision is around 1 cm. Two horizontal mattress sutures are usually given. |
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| How young should your cat be spayed? If it is a street cat, animal activists get them spayed as young as 4 months. For your pet cat in Singapore, I would advise 6 months so that her private parts can develop into adult size. If she caterwauls (meowing loudly non-stop), wait till she stops caterwauling to get her spayed as it will be bloody doing it during this stage. The above cat in Singapore was spayed around 5 months of age by Dr Sing Kong Yuen. |
1962-67. Neutering a 2-month-old hamster at Toa Payoh Vets
FOR MORE CASES AT TOA PAYOH VETS, goto:
Cats or Dogs
Tuesday, May 19, 2015
2158. How to prevent dry eyes in your old dog
A 13-year-old Silkie has sticky right eye discharge everyday for several months.
"Dr E prescribed eye drops and eye ointment and they were effective for some time," the wife took out the bottles from the plastic bag and put on my consultation table. "After a while, they don't work and I went to the pet shop to buy the eye drops. I don't want the same eye medication from you."
17. How to take care of your old dog's eye (Video)
Surprisingly, the left eye cornea was as clear as a crystal but the right eye cornea was scarred with brown dots of pigments covering 80% of the surface. The eye white was reddish as compared to the normal white of the left eye.
"Has the dog been rubbing his right eye with his right hind leg daily?" I asked.
"Yes, yes," the husband said.
I applied fluorescein eye drops onto the cornea (video) and there was no ulcerations as there was no green stain.
"The brown pigments on the right eye cornea are caused by long-time scratching and now is scarred," I said. "There is no chance of reverting to the clear cornea. Now, we need to prevent the 20% of the cornea from becoming covered up with brown pigmentation."
"The possible causes could be the right ear pain as the dog wanted to snap at me when I palpated the ear. Another cause could be tooth ache as the roots of the back upper teeth are exposed and the teeth are cemened with thick tartar," I explained to the owners.
Sedation 5 kg, 13-year-old Silkie: Domitor + Ketamine 0.05 + 0.05 ml IV
Ear irrigation
Eye irrigation with 3rd eyelid everted to flush out debri
Optomimmune and eye drops. E-collar.
Inj. antibiotic and anti-inflam.
E-collar for 2 months.
To review in 3 weeks and dental scaling.
CONCLUSION
Allergy to commercial ear drops, vigorous overcleaning of the right ear and periodontal diseases can cause ear scratching with collateral damage to the right eye in this case. Early dental scaling would have been preferred.
"Dr E prescribed eye drops and eye ointment and they were effective for some time," the wife took out the bottles from the plastic bag and put on my consultation table. "After a while, they don't work and I went to the pet shop to buy the eye drops. I don't want the same eye medication from you."
17. How to take care of your old dog's eye (Video)
Surprisingly, the left eye cornea was as clear as a crystal but the right eye cornea was scarred with brown dots of pigments covering 80% of the surface. The eye white was reddish as compared to the normal white of the left eye.
"Has the dog been rubbing his right eye with his right hind leg daily?" I asked.
"Yes, yes," the husband said.
I applied fluorescein eye drops onto the cornea (video) and there was no ulcerations as there was no green stain.
"The brown pigments on the right eye cornea are caused by long-time scratching and now is scarred," I said. "There is no chance of reverting to the clear cornea. Now, we need to prevent the 20% of the cornea from becoming covered up with brown pigmentation."
"The possible causes could be the right ear pain as the dog wanted to snap at me when I palpated the ear. Another cause could be tooth ache as the roots of the back upper teeth are exposed and the teeth are cemened with thick tartar," I explained to the owners.
Sedation 5 kg, 13-year-old Silkie: Domitor + Ketamine 0.05 + 0.05 ml IV
Ear irrigation
Eye irrigation with 3rd eyelid everted to flush out debri
Optomimmune and eye drops. E-collar.
Inj. antibiotic and anti-inflam.
E-collar for 2 months.
To review in 3 weeks and dental scaling.
CONCLUSION
Allergy to commercial ear drops, vigorous overcleaning of the right ear and periodontal diseases can cause ear scratching with collateral damage to the right eye in this case. Early dental scaling would have been preferred.
2157. The old German Shepherd is scratching furiously
Monday, March 18, 2015
After 2 days of scratching from nose to paws, the owner phoned me for help. The 2nd sister had given this dog a piece of chicken on Mother's Day and now the dog keeps scratching her body.
She was fed only meat and rice nowadays and was all right. If fed commercial dog food, she would have diarrhoea and itchy body.
This old German Shepherd has bad hips and could not stand up if the carprofen injection under the skin is not given every 2 weekly. She got this injection from another vet every 2 weeks, not wanting to bother me. Lately she had her cataract operation on one eye first. As the surgeon had been on medical leave, after operating on 150 cases in one day, she saw her relief surgeon. She was a popular in great demand surgeon and had to take leave. So she packed the previous day's cases to the next day, totalling 150 cataract operations.
The relief surgeon read her medical notes and said: "It is lucky that you had opted for the mono-foal lens instead of the multi-focal as you have scars in your retina."
However, the surgeon had actually recommended multi-focal lens and she had accepted this advice. In multi-focal lens, you don't need reading spectacles. However, 3 days before the surgery, we went to my family optician, an experienced man in his 50s. He said: "Some of the people having multi-focal lens suffered side effects of seeing flashing lights and get depressed. There is no cure for this. Taking out the multi-focal lens and replacing a mono-focal is not that easy as in the first implant. With mono-focal, you need to have prescription lenses to read but you don't have these flashing lights."
So, this owner was very unhappy with the surgeon.
After 2 days of scratching from nose to paws, the owner phoned me for help. The 2nd sister had given this dog a piece of chicken on Mother's Day and now the dog keeps scratching her body.
She was fed only meat and rice nowadays and was all right. If fed commercial dog food, she would have diarrhoea and itchy body.
This old German Shepherd has bad hips and could not stand up if the carprofen injection under the skin is not given every 2 weekly. She got this injection from another vet every 2 weeks, not wanting to bother me. Lately she had her cataract operation on one eye first. As the surgeon had been on medical leave, after operating on 150 cases in one day, she saw her relief surgeon. She was a popular in great demand surgeon and had to take leave. So she packed the previous day's cases to the next day, totalling 150 cataract operations.
The relief surgeon read her medical notes and said: "It is lucky that you had opted for the mono-foal lens instead of the multi-focal as you have scars in your retina."
However, the surgeon had actually recommended multi-focal lens and she had accepted this advice. In multi-focal lens, you don't need reading spectacles. However, 3 days before the surgery, we went to my family optician, an experienced man in his 50s. He said: "Some of the people having multi-focal lens suffered side effects of seeing flashing lights and get depressed. There is no cure for this. Taking out the multi-focal lens and replacing a mono-focal is not that easy as in the first implant. With mono-focal, you need to have prescription lenses to read but you don't have these flashing lights."
So, this owner was very unhappy with the surgeon.
Sunday, May 17, 2015
2156. Third opinion. The stench of covered armpit wounds in a 16-year-old dog
Sunday May 17, 2015
The 16-year-old Maltese was afraid of me examining the wound, despite being given Tramadol painkiller tablets by Vet 2, 4 days ago. I was unwrapping the elastoplast and yellow wrap around self-adhering bandages covering the long left armpit wound. As I unrolled the bandage, the smell of rotting flesh permeated the consultation room.
"Vet 2 had given an antibiotic injection guaranteed to last 2 weeks," the young lady owner said. "So, he only prescribed the Tramadol, 1/2 tablet 2 times a day."
"Was Tramadol effective?" I asked.
"Yes," she confirmed that the dog was walking around when given the medication.
The dark greenish stained gauze under the bandage gave off an offensive odour of dead meat. I tried to control my breath. It is an odour of decomposed egg few Singaporeans will ever smell. It glued onto my fingers and needed several hand shampoos to get rid of the smell.
Vet 1 had prescribed some antibiotics and cleanser but this did not work. The dog's armpit got infected. So Vet 2 bandaged the leg from the wrist upward and adduct the armpit closer to the body with Elastoplast. The owner must return every 3 days to get the bandage changed. The owner sought me as the 3rd opinion.
The dog was practically screaming when I slowly unwrapped the bandage. He had a high tolerance to pain and had taken half a tablet of a 50-mg Tramadol.
"There's no choice but to sedate him to clean up the bad smelly armpit wound," I told the owners. "When a wound is covered up, it becomes smelly as a different type of bacteria thrives and grow in the flesh. It is highly risky as he may die. I will give a very low dose."
I can understand that Vet 1 and Vet 2 do not want to take risk in anaesthesizing this old dog to stitch up the wound. It is a thankless option if the dog dies. Some owners just blame the vets when the dog dies, implying negligence and incompetence.
I gave Domitor and Ketamine at 10% of the normal dosage IV. The dog slept for less than 10 minutes and the armpit wound was flushed and irrigated. The dog was shampooed. I applied KMnO4 powder, injected antibiotics and inflammatory and the dog was sent home.
The 16-year-old Maltese was afraid of me examining the wound, despite being given Tramadol painkiller tablets by Vet 2, 4 days ago. I was unwrapping the elastoplast and yellow wrap around self-adhering bandages covering the long left armpit wound. As I unrolled the bandage, the smell of rotting flesh permeated the consultation room.
"Vet 2 had given an antibiotic injection guaranteed to last 2 weeks," the young lady owner said. "So, he only prescribed the Tramadol, 1/2 tablet 2 times a day."
"Was Tramadol effective?" I asked.
"Yes," she confirmed that the dog was walking around when given the medication.
The dark greenish stained gauze under the bandage gave off an offensive odour of dead meat. I tried to control my breath. It is an odour of decomposed egg few Singaporeans will ever smell. It glued onto my fingers and needed several hand shampoos to get rid of the smell.
Vet 1 had prescribed some antibiotics and cleanser but this did not work. The dog's armpit got infected. So Vet 2 bandaged the leg from the wrist upward and adduct the armpit closer to the body with Elastoplast. The owner must return every 3 days to get the bandage changed. The owner sought me as the 3rd opinion.
The dog was practically screaming when I slowly unwrapped the bandage. He had a high tolerance to pain and had taken half a tablet of a 50-mg Tramadol.
"There's no choice but to sedate him to clean up the bad smelly armpit wound," I told the owners. "When a wound is covered up, it becomes smelly as a different type of bacteria thrives and grow in the flesh. It is highly risky as he may die. I will give a very low dose."
I can understand that Vet 1 and Vet 2 do not want to take risk in anaesthesizing this old dog to stitch up the wound. It is a thankless option if the dog dies. Some owners just blame the vets when the dog dies, implying negligence and incompetence.
I gave Domitor and Ketamine at 10% of the normal dosage IV. The dog slept for less than 10 minutes and the armpit wound was flushed and irrigated. The dog was shampooed. I applied KMnO4 powder, injected antibiotics and inflammatory and the dog was sent home.
2155. Ozone-oil treatment for all types of illnesses?
Saturday May16, 2015
I had breakfast on this sunny blue-sky Saturday morning with a senior vet. There was a Caucasian vet who came to Singapore to buy veterinary practices and I advised him to sell his practice. "The general offer is 3 times the annual revenue, subject to negotiations," I had read about this in some financial books and this Caucasian vet had also mentioned this formula to me.
This senior vet has a new product - an ozone-oil said to be very good for coughs, diarrhoea, skin wounds and many illnesses. In one case, the puppies with diarrhoea recovered after being given this product. "However, the breeder did not get the same outcome when the puppies had diarrhoea again," he laughed. His hypothesis is that antibiotics are specific for some types of bacteria like gram +positive only. But his ozone-oil, like the freshness of the air around sea waves, kills all bacteria, yeasts, viruses and other pathogens.
I had no comments. "If your product can heal wounds within 2 days, you have a big market with the construction workers," I said. "They suffer from cuts at work and coughing from hard work. Your product will say like hot cakes."
I had breakfast on this sunny blue-sky Saturday morning with a senior vet. There was a Caucasian vet who came to Singapore to buy veterinary practices and I advised him to sell his practice. "The general offer is 3 times the annual revenue, subject to negotiations," I had read about this in some financial books and this Caucasian vet had also mentioned this formula to me.
This senior vet has a new product - an ozone-oil said to be very good for coughs, diarrhoea, skin wounds and many illnesses. In one case, the puppies with diarrhoea recovered after being given this product. "However, the breeder did not get the same outcome when the puppies had diarrhoea again," he laughed. His hypothesis is that antibiotics are specific for some types of bacteria like gram +positive only. But his ozone-oil, like the freshness of the air around sea waves, kills all bacteria, yeasts, viruses and other pathogens.
I had no comments. "If your product can heal wounds within 2 days, you have a big market with the construction workers," I said. "They suffer from cuts at work and coughing from hard work. Your product will say like hot cakes."
2154. The Schnauzer's groomer is more important than the vet
Saturday Mar 16, 2015
Today was a busy Saturday. Dr Daniel had gone to Bangkok for a seminar and I was the only vet seeing cases. I was surprised to see this 10-year-old Miniature Schnauzer as the owner had not bothered to bring him for an annual vaccination and check up. The dog goes to the groomer every 2 monthly or so.
The dog was itchy and kept scratching his ears and body. So, the mistress came to see me. "He bites and will not be muzzled," she said. "He was whining in the car as I drove nearer to your clinic. Whenever he bites he paws, I will say 'Dr Sing' and he would stop. However, he would still bite his paws when I am not around."
I had seen this dog as a puppy and had seen him for the first 6 years at least once. As the mistress got promoted, she had to travel a lot for meetings in Germany and so she did not spend any time to bring the dog in for his annual check up or vaccination. The groomer's appointments were kept. Many owners doctor hop and so it was most surprising when I saw her after 4 years.
Health screening or wellness care once a year including physical examination, blood and urine tests and dental check ups will detect any diseases early so that the dog can live longer.
Case 2.
A young lady who returned home from overseas phoned to say her Cocker Spaniel had fits suddenly. She booked dog transport and came to see me. "Rotten teeth and painful ear infections can cause fits," I said to her. The dog was 12 years old and the teeth were all black. In some cases, just removing the painful decaying teeth would have improved the health of the older dog. But many owners in Singapore just do not have time or inclination to send the dog for dental check up at the vet. Some dog groomers provide such a service and so, the groomer is more important than the vet. Till the dog has serious illness and in this case, the vet is needed!
Today was a busy Saturday. Dr Daniel had gone to Bangkok for a seminar and I was the only vet seeing cases. I was surprised to see this 10-year-old Miniature Schnauzer as the owner had not bothered to bring him for an annual vaccination and check up. The dog goes to the groomer every 2 monthly or so.
The dog was itchy and kept scratching his ears and body. So, the mistress came to see me. "He bites and will not be muzzled," she said. "He was whining in the car as I drove nearer to your clinic. Whenever he bites he paws, I will say 'Dr Sing' and he would stop. However, he would still bite his paws when I am not around."
I had seen this dog as a puppy and had seen him for the first 6 years at least once. As the mistress got promoted, she had to travel a lot for meetings in Germany and so she did not spend any time to bring the dog in for his annual check up or vaccination. The groomer's appointments were kept. Many owners doctor hop and so it was most surprising when I saw her after 4 years.
Health screening or wellness care once a year including physical examination, blood and urine tests and dental check ups will detect any diseases early so that the dog can live longer.
Case 2.
A young lady who returned home from overseas phoned to say her Cocker Spaniel had fits suddenly. She booked dog transport and came to see me. "Rotten teeth and painful ear infections can cause fits," I said to her. The dog was 12 years old and the teeth were all black. In some cases, just removing the painful decaying teeth would have improved the health of the older dog. But many owners in Singapore just do not have time or inclination to send the dog for dental check up at the vet. Some dog groomers provide such a service and so, the groomer is more important than the vet. Till the dog has serious illness and in this case, the vet is needed!
2153. How your dog can live longer - Recurring kidney stones in a 12-year-old poodle
Kidney stones do occur in dogs. In this 10-year-old poodle, they were small specks of kidney stones seen in the X-rays in 2013. I had removed the bladder stones and had advised that the minor struvite kidney stones could be dissolved with prescription S/D diet over 1-3 months. Regular urine tests, blood tests and X-rays needed to be done to ensure that the stones had been completely eliminated.
However, the owners did not return for follow ups over the next two years. Nor did they come for annual check ups. They fed brown rice and minced beef mainly.
In 2015, they came as the poodle was passing blood in the urine. She had extremely painful kidneys and the left kidney stones had become gigantic as can be seen in the 2015 X-rays.
Blood test indicated kidney failure. The dog could have lived longer if she had been fed the S/D diet till the stones dissolved from 1-3 months.
This poodle was euthanased. I hope thiscase study may save lives of dogs in a similar situation with small specks of struvite kidney stones. Struvites can be dissolved by dietary management. Regular monitoring over the year is necessary.
Friday, May 15, 2015
2152. A good mother brings a child's hamster for treatment. A good father could have bought a tankful of terrapins
May 15, 2015
The storm clouds were gathering. I was teaching my intern Sue how to take care of the vertical ear canal ablation Schnauzer in-patient for 3 days. Yesterday, I had sedated the dog and Naing had cleaned up the blood clots. There was some bleeding (see video) and I made a video on how to do the nursing part.
At around 10 am, a mother came in with a dwarf hamster. He has a left swollen eyelid just like the other hamster with ear warts. She had texted me and emailed me for an appointment. This is her child's beloved pet and she took the trouble to contact me and come early.
I was also treating a terrapin that had closed and swollen eyes for over 7 weeks. "With the money I spent on vet fees," the father said. "I could have bought a tank full of terrapins!"
He was a dynamic man in his 30s sending out strong vibes as I asked him about executive condos and HDB apartments for sale. He had brought the terrapin to see Dr Daniel 3 weeks ago but was unable to medicate the terrapin.
Well, at $5.00 per hatchling, he could have bought 50 terrapins and discard this sick emaciated one weighing 16 g now. Definitely a tankful. But I don't think his son has the same point of view as the father.
ISOFLURANE + O2 ANAESTHESIA
5% for around 45 seconds. Hamster had an upper eyelid abscess of the right eye and gigantic lower eyelid abscess of the left eye (video). Quick lancing, drainage with cotton bud tip and finger expression, lavage incised wound with water within 20 seconds as the hamster wakes up.
My intern decided to adjust the operation light at the ending of the operation which made me quite mad as the video could not be completed entirely. While her hands were adjusting the operating lights, she could not film and by the time she could film, I had completed my operation.
Many young people do not comply with instructions.
A good mother brings a child's hamster for treatment without bean-counting.
A good father could have bought a tankful of terrapins if not for his son's love for the sick terrapin.
The storm clouds were gathering. I was teaching my intern Sue how to take care of the vertical ear canal ablation Schnauzer in-patient for 3 days. Yesterday, I had sedated the dog and Naing had cleaned up the blood clots. There was some bleeding (see video) and I made a video on how to do the nursing part.
At around 10 am, a mother came in with a dwarf hamster. He has a left swollen eyelid just like the other hamster with ear warts. She had texted me and emailed me for an appointment. This is her child's beloved pet and she took the trouble to contact me and come early.
I was also treating a terrapin that had closed and swollen eyes for over 7 weeks. "With the money I spent on vet fees," the father said. "I could have bought a tank full of terrapins!"
He was a dynamic man in his 30s sending out strong vibes as I asked him about executive condos and HDB apartments for sale. He had brought the terrapin to see Dr Daniel 3 weeks ago but was unable to medicate the terrapin.
Well, at $5.00 per hatchling, he could have bought 50 terrapins and discard this sick emaciated one weighing 16 g now. Definitely a tankful. But I don't think his son has the same point of view as the father.
ISOFLURANE + O2 ANAESTHESIA
5% for around 45 seconds. Hamster had an upper eyelid abscess of the right eye and gigantic lower eyelid abscess of the left eye (video). Quick lancing, drainage with cotton bud tip and finger expression, lavage incised wound with water within 20 seconds as the hamster wakes up.
My intern decided to adjust the operation light at the ending of the operation which made me quite mad as the video could not be completed entirely. While her hands were adjusting the operating lights, she could not film and by the time she could film, I had completed my operation.
Many young people do not comply with instructions.
A good mother brings a child's hamster for treatment without bean-counting.
A good father could have bought a tankful of terrapins if not for his son's love for the sick terrapin.
Tuesday, May 12, 2015
An old cat has painful kidneys - illustration for children's story
May 12, 2015
PATIENT
Fatty, Female, Spayed cat, 10 years old
Adopted by a young lady in her 20s.
The young lady studies for an illustration diploma. I asked her to illustrate her old cat's veterinary journey. She came today to buy a carton of feline k/d after I told her not to feed the usual cat food first as the kidneys were very painful when I checked the cat on April 29, 2015.
At that time, the cat came in as she was not eating and drinking for 3 days. she had diarrhoea for 4 days and passed dark choocolate-coloured stools. He had fever of 40.5 degrees C and also enlarged submandibular lymph nodes.
When I palpated the kidneys, the cat growled.
"The kidneys are enlarged," I advised X-rays which showed the enlargement.
Blood tests to check the health of the kidneys were not done to lower medical costs. However, in Mar 7, 2015, the cat had been vomiting every "2nd day" for the last 7 days. The kidneys were painful. The cat had ductal carcinoma of the left breast MG1 and enlarged left axillary lymph node. The breast lump was excised by Dr Daniel on Feb 15, 2015 and histology confirmed the malignant ductal carcinoma.
In January 31, 2015, the cat had dental work done and ears cleaned. The left lower canine tooth was decayed and extracted. The large left breast tumour 3 cm x 3cm was seen and surgery scheduled in Feb 15, 2015.
The stray cat could be 10 years old and had probably been abandoned. She was adopted by the young lady and treated since Jan 31, 2015.
Blood tests done on Feb 2, 2015.
No kidney disorder. Low platelets of 60 (300-800)
Blood tests done on Mar 8, 2015
No kidney disorder
Total white cell count was 2.3 (5-5 - 19.5) with neutrophils 24% (60-70%) and absolute at 0.55 (3-11.5).
Platelets were low at 78 (300-800).
Tiger Balm medication could have been licked by the cat. There was kidney pain in Mar and April 2015.
Kidney X-rays were done in April 29, 2015.
After IV drips and antibiotics, the cat was sent home with special diet feline K/D.
"Add the K/D to existing canned food bit by bit," I said to the young lady. The cat will not eat K/D which is meant for kidney diseases immediately.
Within a week, the cat was eating 1/2 can of K/D. Yesterday, the owner wanted to switch her entirely to the original canned food. However I did not re-examine the cat or has her urine to analyse for protein, bacteria, white cells and other abnormalities. I advised a month of K/D first and so she came to buy 24 cartons of the food.
The young lady said the cat was OK and wanted to switch to normal canned food.
PATIENT
Fatty, Female, Spayed cat, 10 years old
Adopted by a young lady in her 20s.
The young lady studies for an illustration diploma. I asked her to illustrate her old cat's veterinary journey. She came today to buy a carton of feline k/d after I told her not to feed the usual cat food first as the kidneys were very painful when I checked the cat on April 29, 2015.
At that time, the cat came in as she was not eating and drinking for 3 days. she had diarrhoea for 4 days and passed dark choocolate-coloured stools. He had fever of 40.5 degrees C and also enlarged submandibular lymph nodes.
When I palpated the kidneys, the cat growled.
"The kidneys are enlarged," I advised X-rays which showed the enlargement.
Blood tests to check the health of the kidneys were not done to lower medical costs. However, in Mar 7, 2015, the cat had been vomiting every "2nd day" for the last 7 days. The kidneys were painful. The cat had ductal carcinoma of the left breast MG1 and enlarged left axillary lymph node. The breast lump was excised by Dr Daniel on Feb 15, 2015 and histology confirmed the malignant ductal carcinoma.
In January 31, 2015, the cat had dental work done and ears cleaned. The left lower canine tooth was decayed and extracted. The large left breast tumour 3 cm x 3cm was seen and surgery scheduled in Feb 15, 2015.
The stray cat could be 10 years old and had probably been abandoned. She was adopted by the young lady and treated since Jan 31, 2015.
Blood tests done on Feb 2, 2015.
No kidney disorder. Low platelets of 60 (300-800)
Blood tests done on Mar 8, 2015
No kidney disorder
Total white cell count was 2.3 (5-5 - 19.5) with neutrophils 24% (60-70%) and absolute at 0.55 (3-11.5).
Platelets were low at 78 (300-800).
Tiger Balm medication could have been licked by the cat. There was kidney pain in Mar and April 2015.
Kidney X-rays were done in April 29, 2015.
After IV drips and antibiotics, the cat was sent home with special diet feline K/D.
"Add the K/D to existing canned food bit by bit," I said to the young lady. The cat will not eat K/D which is meant for kidney diseases immediately.
Within a week, the cat was eating 1/2 can of K/D. Yesterday, the owner wanted to switch her entirely to the original canned food. However I did not re-examine the cat or has her urine to analyse for protein, bacteria, white cells and other abnormalities. I advised a month of K/D first and so she came to buy 24 cartons of the food.
The young lady said the cat was OK and wanted to switch to normal canned food.
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