Wednesday, June 3, 2015

2179. Another 5-year-old male neutered black and white cat has dysuria

Jun 2, 2015

Within 7 days, another black and white cat came in with dysuria, haematuria and pollikiuria. He is 5 years old, neutered. This is the first occurrence of difficulty in peeing and peeing everywhere, away from the litter box.  The mother and two teenaged boy and girl came with the fat cat.


"Is there another cat in the apartment?" I asked.
"Yes," the mother said. "A female spayed cat. But they got along well together."
"Did she bully him?"
"Sometimes. She hisses at him.  We're are not at home the whole day and so would not know if there is any bullying"

"This can be quite stressful. This problem is most common in male neutered cats. It is called FLUTD (feline lower urinary tract disease). It looks like a case of FIC (feline interstitial cystitis), said to be due to non-infectious cause in 60-70% of the cases and said to recover on its own by one cat vet from Canada when she gave her lectures in Singapore.

IN THIS CAT
1. Urine collected by catherisation on Jun 2, 2015
Amber, clear
pH 7 (5-8),
USG 1.047 (1.005-1.030)
Protein +
Blood 2+
No bacteria
White blood cells 26. Red blood cells 56
Crystals  Triple phosphate occasional.



2. Blood test
Glucose high 6.9  (3.9-6)
Platelets low  238  (300-800)


Other values normal esp. no kidney disorder or leucocytosis, neutrophilia.


3. X-rays. No radio-dense stones in the bladder and kidneys.






This cat's bladder was irrigated with normal saline and sent home with meloxicam and so far so good. .Based on the tests of no bacterial infection in the urine, this cat is diagnosed as suffering from feline interstitial cystiis (FIC). Cause is probably struvite sand irritating the bladder and urethra as confirmed by urinalysis of triple phosphate crystals seen.

This cat lived with a male neutered cat with no problem.


For FIC, the literature says that 60-70% of cases are not due to bacteria and will recover on its own. But how does the owner or vet guarantee that the cat will recover on its own?  What if it progresses to kidney disease and prolonged pain and dysuria? Will the vet be sued or investigated for negligence?

THE OTHER CAT WITH RECURRENT FLUTD

The problem recurred for the 3rd time last week. The first onset was 2 months ago when another vet hospitalised the cat and did the blood and urine tests. The cat recovered and Royal Canin S/O was prescribed by the first vet. The cat did not eat it. Then 2 weeks ago, same problem. 

No abdominal X-rays for stones were done by me during the 2nd time when the cat could not peed 2 weeks ago. No urine, X-rays or blood test were performed to lower medical fees for the owner. There was no bladder and kidney pain nor inflamed genitals and so I did not advise such tests. I advised C/D canned food + dry. The owner was unsuccessful in converting the cat to eat 100% C/D canned food. 

However, in this 3rd recurrence after one week of consultation, I prescribed meloxicam and ACP 2.

5 mg bid by bringing the medication to the son on June 4, 2015 in Chinatown. The mother was unable to come with the cat and thought of euthanasia.  She remembered that there was a need to do the X-rays to eliminate bladder and kidney stones if there is a 3rd recurrence. But she needed to find time to come to the clinic.  It was extremely stressful to see her cat not being able to pee. This cat lived with a female spayed cat who hissed at him. 

Once FLUTD happens, there is a high chance of recurrence. 


2181. Rat anaesthesia & surgery: Mastectomy. Zoletil. A 385-gram pet rat had a 77-gram breast tumour

Female Fancy Rats do develop mammary tumours. What to do?
Veterinary Stories by Dr Sing Kong Yuen, BVMS (Glasgow),  

This video has 2 parts
Part 1 - Video with images and text. No narration.
More info at:

https://2010vets.blogspot.com/2015/06/2181-385-gram-pet-rat-had-77-gram.html

http://2010vets.blogspot.sg/2015/06/2458-rat-has-stitch-breakdown-on-day-5.html


Part 2 - Video of Day 6 after a major surgery. The Fancy Rat has recovered well from a major surgery. The owner did not return to Toa Payoh Vets as recovery was uneventful.   
https://www.youtube.com/watch?v=qJj9GBXynd4

---------------------------------------------------

ELINA, START FROM HERE


1. INTRODUCTION










1.   VIEWER DISCRETION IS ADVISED. This video shows some surgical procedures.


 

3.  SPONSOR - Be Kind To Pet Rats Image 

4.  SURGERY - MASTECTOMY


5. TIPS AND ADVICES


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Be Kind To Pet Rats Image










SURGERY - MASTECTOMY




Image from the video clip































PART 2.
VIDEO - 6 DAYS AFTER SURGERY.

https://www.youtube.com/watch?v=qJj9GBXynd4


1. 








2.    VIDEO FOOTAGE POST OP 6 DAYS LATER

https://www.youtube.com/watch?v=qJj9GBXynd4

3. CONCLUSION




















The rat survived the surgery and anaesthesia and lived to an old age. A happy ending in this case, but an excellent outcome is not guaranteed in gigantic tumour surgeries.    Post operation weight of tumour - 77 g. The rat weighed 385 g. Therefore, the tumour was around 20% of bodyweight 



"The caudal superficial epigastric blood vessels must be located and ligated to prevent death from bleeding," I explained to my vet assistant. "Blunt dissection will enable you to find the artery and vein supplying blood to the massive tumour. It is a 5mm-wide bundle. Clamp and ligate it before resection of the tumour. If you fail to do this, there will be massive haemorrhage.”













ELINA.   END OF VIDEO PRODUCTION
-------------------------------------------------------------------e





















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BE KIND TO PET RATS Veterinary Educational Video, sponsored by Toa Payoh VetsDr Sing Kong Yuen, BVMS (Glasgow). 

4 Apr 2022 report for Instagram story of Toa Payoh VetsPet rats are rare in Singapore and therefore many vets will never perform a mastectomy in a rat. Many owners in the pre-Covid-19 period would wait till the breast tumour is gigantic to seek treatment, as in this 2 Jun 2015 case study.


The young couple knew that surgery was the only treatment for breast tumour of their 2.5-year-old female pet rat. Like many of the young pet owners, they had done internet research. 



“Such a huge tumour would have commandeered a large volume of blood,” I explained the risks involved in surgery. “Removal of a gigantic breast tumour in an older rat means removal of probably 20% of the bodyweight.” “A loss of a large amount of body tissue might deprive the rat of a sufficient blood volume,” I elaborated the science of haemorrhage. “There would be no blood transfusion in rat surgery. Death would be due to hypovolaemic shock.”“Furthermore, a huge tumour means a lengthy surgery and longer anaesthetic time,” I wished the couple had not procrastinated as I prefer not to take on high risk cases which lead to unhappy endings. “This increases the risk of death on the operating table.” 


The rat was still eating but the growing tumour hindered her movement. It would become ulcerated, bloody and smelly due to infections in a few days. The couple had thought through - either surgery or euthanasia later. The rat survived the surgery and anaesthesia and lived to an old age. A happy ending in this case, but an excellent outcome is not guaranteed in gigantic tumour surgeries.    Post operation weight of tumour - 77 g. The rat weighed 385 g. Therefore, the tumour was around 20% of bodyweight and much blood had been drained after mastectomy.  


More info and videos at: 

https://2010vets.blogspot.com/2015/06/2181-385-gram-pet-rat-had-77-gram.html

http://2010vets.blogspot.sg/2015/06/2458-rat-has-stitch-breakdown-on-day-5.html



--------------------------------------
DRAFT TEXT

Tuesday, June 2, 2015.


Pet rats are rare in Singapore and therefore most vets will never encounter a case of mastectomy in a female rat. This report shares my knowledge of the anaesthetic protocol for a pet rat anaesthesia.  



The couple was prepared to take the anaesthetic risk to get the gigantic 77-gram breast tumour of the 2.5-year-old female pet rat excised. Such a huge tumour would have commandeered a large volume of blood. Removal of a gigantic 77-gram breast tumour in a 385-gram older rat meant removal of 20% of the bodyweight.  Such a loss of a large amount of body tissue could deprive the rat of a sufficient blood volume. Death could be due to hypovolaemic shock.


It was either this surgery or euthanasia. The rat was still eating but the tumour kept growing.


"After surgery, the tumour may recur," I explained this possibility of a breast cancer to the owner. However the couple decided on surgery. So I prescribed 3 days of antibiotics and pain-killer and had the rat operated today.



Date: Tuesday, June 2, 2015. Patient admitted at 10 am. No food and water for the past 12 hours. Surgery at 3 pm. 2.5-year-old female rat Bodyweight: 385 grams Active, eating, not obese Gigantic breast tumours left mammary glands, growing larger from 7 months ago Surgery: mastectomy



"The caudal superficial epigastric blood vessels must be located and ligated to prevent death from bleeding," I explained to my vet assistant. "Blunt dissection will enable you to find the artery and vein supplying blood to the massive tumour. It is a 5mm-wide bundle. Clamp and ligate it before resection of the tumour. If you fail to do this, there will be massive haemorrhage.”


https://2010vets.blogspot.com/2015/06/2181-385-gram-pet-rat-had-77-gram.html

http://2010vets.blogspot.sg/2015/06/2458-rat-has-stitch-breakdown-on-day-5.html





VIDEO

6 DAYS AFTER SURGERY. STITCH BREAKDOWN VIDEO:

https://www.youtube.com/watch?v=qJj9GBXynd4




--------------------------------

DRAFT

Tuesday, June 2, 2015.


Pet rats are rare in Singapore and therefore most vets will never encounter a case of mastectomy in a female rat. This report shares my knowledge of the anaesthetic protocol for a pet rat anaesthesia.  



The couple was prepared to take the anaesthetic risk to get the gigantic 77-gram breast tumour of the 2.5-year-old female pet rat excised. Such a huge tumour would have commandeered a large volume of blood. Removal of a gigantic 77-gram breast tumour in a 385-gram older rat meant removal of 20% of the bodyweight.  Such a loss of a large amount of body tissue could deprive the rat of a sufficient blood volume. Death could be due to hypovolaemic shock in addition to anaesthetic death due to a lengthy anaesthesia and surgery to remove a gigantic mammary tumouor.


It was either this surgery or euthanasia. The rat was still eating but the tumour kept growing.


"After surgery, the tumour may recur," I explained this possibility of a breast cancer to the owner. However the couple decided. So I prescribed 3 days of antibiotics and pain-killer and had the rat operated today.


"The caudal superficial epigastric blood vessels must be located and ligated to prevent death from bleeding," I explained to my veterinary staff. "There will be bleeding from the tissues, but this vessel must be located and ligated."


https://2010vets.blogspot.com/2015/06/2181-385-gram-pet-rat-had-77-gram.html


SUNDAY, JUNE 7, 2015

2458. The rat has stitch breakdown on Day 5

Jun 8, 2015
The young lady brought her rat for check up as she is worried about the big wound.

"It is very hard to put an e-collar on the rat as well as the hamster," I said. "They will try to pull it out and get stressed."

The rat weighed 306 grams on 6 days after mastectomy but weighed 385 grams with the tumour of 78 grams before mastectomy. Pre-op weight of 385 - 78 was 307 grams. So, it was good news as the rat was back to normal. Otherwise she would lose weight. 


The career lady showed me a video of a swelling where the stitches had been one day ago. It would be a haematoma. Some pink plasma seeped out. Now it is a gap as the two stitches had been bitten off.


Over 20 pieces of big round stools were in the carrier indicating that the rat was normal as she would not eat if she was infected. This was good news.

http://2010vets.blogspot.sg/2015/06/2458-rat-has-stitch-breakdown-on-day-5.html


REFERENCES:
Rat analgesics

http://campusvet.wsu.edu/infofac/ratanalgesicsuse.htm


---------------------------------------------------------------

Tuesday, June 2, 2015.

Pet rats are rare in Singapore and therefore most vets will never encounter a case of mastectomy in a female rat. This report shares my knowledge of the anaesthetic protocol for a pet rat anaesthesia.  


The couple was prepared to take the anaesthetic risk to get the gigantic 77-gram breast tumour of the 2.5-year-old female pet rat excised. Such a huge tumour would have commandeered a large volume of blood. Removal of a gigantic 77-gram breast tumour in a 385-gram older rat meant removal of 20% of the bodyweight.  Such a loss of a large amount of body tissue could deprive the rat of a sufficient blood volume. Death could be due to hypovolaemic shock. A large tumour means a lengthy surgery and longer anaesthetic time. This increases the risk of death on the operating table. 

It was either this surgery or euthanasia. 

The rat was still eating but the tumour kept growing. It would ruptured, become ulcerated, bleeding and smelly due to infections later. 

"After surgery, the tumour may recur," I explained this possibility of a breast cancer to the owner. However the couple decided to take the risk. So I prescribed 3 days of antibiotics and pain-killer and had the rat operated today.

"The caudal superficial epigastric blood vessels must be located and ligated to prevent death from bleeding," I explained to my vet nurse. "There will be bleeding from the tissues, but this vessel must be located and ligated."

The rat was sedated with 0.2 ml Zoletil 100 and given around 0.5% isoflurane gas maintenance. She went home 2 hours after surgery but had not wakened up yet. She was placed in a horizontal stretching position with her eyes open. She was breathing very slowly even at 2 hours after surgery although the duration of Zoletil is said to be 30 minutes to 2 hours. So, I thought this could be a "touch and go" case.
 The owner did not want histology of the 77-gram breast tumours.

Anaesthetic protocol used in this rat for mastectomy

Date: Tuesday, June 2, 2015.

Patient admitted at 10 am. No food and water for the past 12 hours. Surgery at 3 pm.

2.5-year-old female rat
Bodyweight: 385 grams
Active, eating, not obese
Gigantic breast tumours left mammary glands, growing larger from 7 months ago
Surgery: mastectomy



1. Pre-surgical analgesia and antibiotics
Three days of the NSAID meloxicam and antibiotic enrofloxacin (baytril) given orally at home. Meloxicam at 1 mg/kg PO or SQ 30 minutes before surgery and every 24 hours after surgery is advocated by some vets. Enrofloxacin is given at 5-20mg/kg SQ once daily or 50-200 mg/L in the drinking water is advised by some vets.

No food 12  hours before surgery in this rat. Some vets say that food with-holding is not necessary as the rat does not vomit and water is to be freely available before anaesthesia.  

2. No premedication with atropine at 0.05 mg/kg SQ was done in this case. Atropine before induction is said to decrease bronchial and salivary secretion and protect the heart from vagal inhibition.

2.1 Induction was with Zoletil 100 IM at 50-75 mg/kg for rats.   In this case, 50mg/kg was selected as the rat is considered old (life span said to be 3 years). The amout rate was given 0.2ml IM.
 
2.2 Zoletil is said to be safe, permits smooth recovery, does not cause cardio-vascular depression or affect kidney funcions. It is safe for use in pregnant dogs and cats. No cumulative toxicity or effects on the kidneys if given top-up by IM for maintenance. Zoletil does not provide good analgesia. Onset was 3-5 minutes.  Isoflurane gas was used in this rat via a face cone. 

3. Isoflurane + oxygen gas via face cone at 5% and then mainly 0.5% (1-3%) for maintenance and to effect. Intubation was not done.

3.1  A precision vaporiser which delivers controlled levels of isoflurane gas mixed with oxygen was used.

4. Post-surgical analgesic was NSAID meloxicam oral. No injection of Opioids with buprenorphine preferred. Zoletil has mild analgesic effect and adequate pain management is given using NSAID or Opioid. Indications of pain in the rat are decreased food and water intake and locomotor activity, horizontal stretching (rat horizontal on the ground), twitching and withering. Zoletil provides a smooth recovery. 

4.1 For post-surgical pain control, some vets advocate the use of opioid buprenorphine 0.05 mg/kg SQ or opiod + NSAID like carprofen.
4.2 No post-surgical injections of opioids or opioid + NSAID in this rat
4.3 NSAID meloxicam oral was continued with good outcome of the rat eating and active within 24 hours after surgery.

No post-surgical fluid therapy with lactated Ringers or during anaesthesia in this case. Some vets advise Ringer's lactate at 5ml/kg/hour

5. Indicators of pain in rats are:
5.1  Vocalisation - rarely reported unlike in dogs..
5.2  Horizontal stretching (rat horizontal on the ground).
5.3 decreased food and water intake or movement.
5.4 withering and twitching

This rat went home 2 hours after surgery. The rat was placed in the horizontal stretching position in a container to bring home. She was breathing very slowly.

Warm water in plastic bag heating of the body was advised. Quiet and dark room to recover


FOLLOW UP 24 HOURS POST-SURGERY. I RECEIVED THE FOLLOWING TEXT MESSAGE FROM OWNER - June 3, 2015

Jun 2, 2015 3 pm mastectomy. Rat goes home at 6 pm. Still in horizontal stretching position and breathing rate is around 20/min. Eyes open.

Jun 3, 2015  6.30 pm.  Dr Sing Kong Yuen: "Is yr pet rat ok after op?"

Jun 3, 2015  6.45pm    Owner: "Yes she is okay now. Started eating since this early morning (18 hours post surgery) and now running places"

Dr Sing Kong Yuen: "Thanks. Continue medication for the next 4 days only."

CHALLENGES on Jun 4, 2015
Bit of dressing covering stitches. Start to bite stitch. Advise e-collar or replace plaster every time it got taken out by the rat for nest 10 days.
No running around. Place in a tank.


CONCLUSION
For premedication, a "single shot" injection of Zoletil causes less stress to the rat than multiple injections to reduce the dosage of isoflurane gas.

Some vets advocate atropine SC in premedication to prevent bradycardia.

Some vets advocate the following for mice:
isoflurane 4-5% + 0.8 - l L/min for induction and 1-3% + 0.8 - 1 L/min for maintenance
palpebral reflex to assess the depth of anaesthesia


For post-operative pain prevention, pre-surgical injection of NSAID (e.g. meloxicam 1 mg/kg SC 30min pre-surgery and q 24hr. I gave oral meloxicam for 3 days before surgery.  Some vets give Opioid like bupreorphine 0.05-0.1mg/kg SC q 12 hours.

Antibioitics can be enrofloxacin  5-20mg/kg q 24hr  or 50-200mg/L drinking water
or trimethorprim sulpohonamides 15-30mg/kg PO, SC, IM q 12hr
or gentamicin  5-10mg/kg SC
local anaesthetic on surgical wound injection or gel

oxygen-enriched environment, quiet, dark room
infra-red lamps, heating pads after and during surgery
ocular ointment to prevent corneal drying and damage



-----------------------------------------------------------------
http://2010vets.blogspot.sg/2015/06/2458-rat-has-stitch-breakdown-on-day-5.html


Jun 8, 2015

The young lady brought her rat for check up as she is worried about the big wound.
"It is very hard to put an e-collar on the rat as well as the hamster," I said. "They will try to pull it out and get stressed."

The rat weighed 306 grams on 6 days after mastectomy but weighed 385 grams with the tumour of 78 grams before mastectomy. Pre-op weight of 385 - 78 was 307 grams. So, it was good news as the rat was back to normal. Otherwise she would lose weight. 

The career lady showed me a video of a swelling where the stitches had been one day ago. It would be a haematoma. Some pink plasma seeped out. Now it is a gap as the two stitches had been bitten off.

Over 20 pieces of big round stools were in the carrier indicating that the rat was normal as she would not eat if she was infected. This was good news.





What are my advices?

1. There was no need to re-stitch as the rat may bite the stitches off. The rat may die under anaesthesia as she is older being 2.5 years old. A rat is said to live around 3-5 years.

2. An Elizabeth collar is not acceptable to the rat. She will be stressed getting it off. In any case, the wound will heal by granulation.  
3. Get a bigger plaster dressing to cover the wound instead of two smaller ones.

4. Clean the wound twice a day with chlorhexidine but rinse off the wash with clean warm water and dry the wound.

5. Antibiotics oral -  baytril and painkiller meloxicam for 2 days. Wait 4 days and repeat if needed.


TIME LINE
Day 1  Jun 2, 2015     mastectomy


FOLLOW UP BY SMS
Jun 3, 2015  6.30 pm
Dr Sing: Is you pet rat ok after op?

                     6.34pm
Owner: Yes, she is okay now. Started eating since this early morning and now running places.
                     7.54pm
Dr Sing: Thanks.

Jun 4, 2015  7.44am
Dr Sing: Give medicine for the next 4 days
                     8.17am
Owner: Thanks Dr. Will continue to give her medicine for another 2 days. The wound is quite dry. But she does chew a bit of the stitches off
                     8.21am
Dr Sing: Need to make an elizabeth collar with thin cardboard paper to wear around the neck for 7 days at least. No running around.  E-collar similar to what dogs wear. Do it before you go to work.
                   

                    8.22am
Owner: Will keep her in the tank and won't let her out. 

                   
                   8.22am
Dr Sing: Or bring her to office.

                  8.22am
Owner: Oh yah I saw that in the internet. Will make her one.

                  8.22 am
Dr Sing: Or tape wound with human dressing for wound protection. Urgent to do it before you go out.

                 8.23am
That's what we did yesterday with a plaster but it came off this morning.

                 8.24 am
Dr Sing: Need to keep replacing it for 10 days.  Pl email video of stitched area.  99pups@gmail.com

                8.46am
Owner: Sure I will.

Sat Jun 6, 2015        5.22 pm
Dr Sing: How is the patient?

                                          
Sunday Jun 7, 2015  10.57 am
O:  Hi. Pixie has a lump just to the left of the incision. She eats and drinks okay and still very active. Am wondering if it's water retention or internal bleeding. Will send you the video of it via email now.
                                  11.38 am  
Dr Sing:   Some bleeding in the area.

                                   11.39am
O: There was some pink trace of blood but the wound looks dry and neat.

                                   12.17pm
Dr Sing: The rat should be Ok.
                                   11.09pm
O: Hi, she pulled off the stitches. There's an open wound now. But not bleeding though. Will bring her in the morning

------------------------------------

Monday Jun 8, 2015. Inspection of the rat at Toa Payoh Vets

The fancy rat had an open wound as two stitches were taken out by the rat. Not serious. Advised bigger plaster and cleaning wound daily.  No need to re-stitch.  The wound will heal by granulation.








UPDATE Sunday Jun 14, 2015  6.18 am 
As I write this report, no news from the owner is good news.

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2180. A young English Bulldog kept purging fresh blood

June 2, 2015

A pet shop operator brought in a 1-year-old dog that purged and purged fresh blood since yesterday, about 4-5 times. The dog's rectal temperature was 36 degrees C, below normal of 38.5, the blood pressure is low and he was still passing blood on the trolley.

Test for parvovirus, coronavirus and Giardia showed negative. So what was the cause of this haemorrhagic enteritis?

Oxygen therapy and IV drip. Blood test. The dog had been drinking at the pet shop and vomited dark red brown fluid. He passed away.

The owner entrusted the dog to his friend as he was overseas. The friend phoned the pet shop to board the dog urgently as he was unable to cope with the dog's behaviour. After one day of boarding, the dog passed blood in the stools so much that he died. The friend was not happy with the pet shop operator and the owner wanted to sue.

This was a messy situation for the pet shop operator. The dog was panting and took more than an hour to recover after arrival at the pet shop. Did the friend walk the dog to the pet shop which was distant from his apartment? The past few days had been very hot and humid. Some people in India had died from the heat wave.

A pet's death at the boarding place or vet clinic creates anger, blame and demands answers. In this case, the friend and owner blamed the pet shop operator now.

Never walk a bulldog or pug for long distances. They do develop heat stress.




BLOOD TEST

Glucose (below normal)     <20mg dl="" p="">
LIVER PROFILE
ALT  2117 (<59 br="">ST     4933  (<81 p="">
KIDNEY PROFILE
Urea  18 (4.2-6.3)
Creatinine 396 (89-177)

Hb 25.4 (12-18)
Neutrophils  95%   Abso  10.34

Red cell count 9,8  (5.5 - 8.5)
Haematocrit    0.71 (0.37- 0.55)
Platelets  67    (200-500)

Monday, June 1, 2015

2178. Clinical Research on methone. Day 3 - sharp bladder stone Shih Tzu goes home

June 1, 2015

Bright sunshine blue sky day. Vesak Day. The couple is free to bring their 3-year-old Shih Tzu home today as they are a working couple. Nobody at home.

Yesterday on Day 2, this dog had ripped out his urinary catheter. I checked that he had tried to bruise his surgical wound near the flank of the penis, with his e-collar. I gave him methone inj. 10mg/ml at 0.3 ml SC. He also had Rimadyl 25 mg tablet.  I checked his surgical area. There was little pain on palpation and less bruising. He ate the U/D can and was very active. I videoed him peeing normally without one leg up.

At 3 years old, he appeared "obese" but actually he was broad-chested. The first vet had provided a good detailed examination report. She had said he was obese with body score BCS 8/9.  She said he could have "urate" crystals and that X-rays of the bladder stones were too radio-dense to be urate stones.  Urate stones are said to be radio-opaque in some reports but it is not true.

Free catch urine dipstick. pH 8, Protein 3+, blood 4+, leucoyctyes negative, "rest wnl."

The dog was super-active today and went home with instructions (Video on urination)

1.  not to feed any more dry food as he may have a familiar tendency to develop bladder stones.
 2. pee more than 2 times per day. Not practical as the couple works and nobody is at home during weekdays. So the dog holds his urine from 8 am to 8 pm waiting to go downstairs.

3. to measure volume of water drank/24 hour and record. Drinks lots of water.
4. to use dipstick monthly to measure pH, blood, etc and let me know
5. to send urine for lab test 6-monthly and if there are small crystals, I can flush out the bladder.
6. stones sent for analysis
7. U/D diet can be expensive. Eat canned food exclusively. No dog treats, rice, bread.

I don't know how many of the abovementioned instructions the couple will comply with.

Sunday, May 31, 2015

2177. Gigantic breast tumours in a 2.5-year-old cat

SUNDAY'S UNUSUAL CASE

A 2.5-year-old female rat with massive breast tumours of around 4" X 3" came in.  She was eating well despite this gigantic tumour. I found it hard to believe but she was not emaciated and looked good.

The couple decided on surgery to remove the breast tumours despite the high anaesthetic risks. I prescribed antibiotics and pain-killers for 3 days before surgery. Surgery was done with Zoletil sedation and isoflurane gas maintenance. The rat was OK within 24 hours. Now the problem was the biting of stitches. She bit off two stitches. I advised daily cleaning and covering with a bigger plaster rather than several small strips. The wound should heal by granulation.

This is an unusual case of an older fancy rat surviving anaesthesia. Do not wait till the breast tumours become bigger or malignant before removal as anaesthetic risks are higher.  Early removal saves lives.  

2176. Clinical research injectable anaesthesia in a dog

Sunday May 31, 2015
My tried formula for a deep anaesthesia and good analgesia lasting 30 minutes, enough for a spay or neuter in a dog, is as follows:

Young dog (less than 2 years, healthy on physical examination)
10kg
Domitor 0.4 ml, Ketamine 0.5 ml IV.


Today, I have Max, 7-month-old Bull Terrier X, male to be neutered.
At 16 kg, this young dog was given below the formulation dosage
Domitor 0.4 ml, Ketamine 0.5 ml IV

The dog moved his head at around the ligation of the first testicle, around 10 minutes.
I gave 5% isoflurane + oxygen gas at 3 lit/min  for 2 minutes and that was sufficient anaesthesia to complete the neuter.

CONCLUSION
The under-dosage was given to reduce anaesthetic risk but this was insufficient dosage without the need to top up with isoflurane.

Surgery must be speedy, accurate and complete. Proper planning is needed to be efficient.                   
 
Two ligatures of the spermatic blood vessels were performed on each testicle. No bleeding.
Baytril and tolfedine 2ml each was given post-op.






Saturday, May 30, 2015

2175. A spayed cat still caterwauls. Why?

May 30, 2015
A mother and her young adult daughter brought in 2 two-month-old kittens for vet examination.
They were grey Maine Coon X bought from a home-breeder, a male and female. There were so much wax that I would advise ear irrigation rather than putting ear ointment and massaging. With ear irrigation, the large chunks of black wax get syringed out.

"I have another cat spayed by a vet," the mother said. "She keeps coming on heat, meowing loudly. The vet said it was natural and prescribed some tablets which stopped the caterwauling. Could she have not done a proper spay?"

"It is hard to say, but generally, any ovarian tissues or ovary left inside during spay will cause this caterwauling!".

"What is the solution?"

"To open up the abdomen and look for the ovary near the end of the kidneys," I said. "It will be a long incision."

The owners prefer no surgery and asked about the side effects of the pills given to prevent heat given by the vet for the last 2 years.

"After prolonged use, there may be breast enlargement or pus inside the stump of the uterus, called stump pyometra."

"Other solutions?"

"Injections of hormone every 3 months as in Myanmar cats will stop the caterwauling," I said. "The side effects are stump pyometra."

2173. VIDEO. A young Shih Tzu has a bladder full of stones and an abdominal testicle



POLLIKIURIA AND HAEMATURIA IN A SHIH TZU
 -----------------------------------------------------------------------

Case report
May 30, 2015

"The dog bites," the couple said as I palpated the kidneys and the bladder. The dog reacted to kidney palpation as if there is kidney pain. The bladder was empty of urine and was the size of two grapes packed with hard gritty stones.

Vet 1 had taken urine tests and X-rays.
Urine pH 8 and numerous crystals suspected to be urates??
X-rays of bladder stones were too radio-opaque to be urates.
Had advised removal of retained abdominal testicle in one surgery as bladder stone removal.

"A retained testicle can easily be seen around the neck of the bladder," I told Dr Daniel. "It can be excised promptly by ligation in less than 2 minutes."

As this dog is "obese" at 8.5 kg, any prolonged anaesthesia is risky but abdominal cryptorchidism needs to be done at the same time to save on having to open up the abdomen again. As for the descended testicle, this can be removed another day to reduce risks.













Operation will commence after lunch and the dog will go home in 3 days, providing all goes well with anaesthesia. Stones need to be analysed as the prevention depends on the composition of the stones.

In the meantime, no dry food and give the dog plenty of water to drink.


SURGERY ON MAY 30, 2015
Red swollen bleeding bladder showing inflammation and damage from sharp bladder stones stuck inside the mucosa.  Every fragment had to be flushed out after picking out as many as possible with forceps. The dog's urinary bladder was catheterised but he pulled out the Elastoplast-taped catheter overnight, despite wearing an Elizabeth collar.  

The stones are sharp and may be urates as suspected by Vet 1. They will be sent for analysis.

To reduce anaesthetic time, no neutering was done.







FOLLOW UP POST OP

Sunday, May 31, 2015

2178. Clinical Research on methone. Day 3 - sharp bladder stone Shih Tzu goes home

June 1, 2015

Bright sunshine blue sky day. Vesak Day. The couple is free to bring their 3-year-old Shih Tzu home today as they are a working couple. Nobody at home.

Yesterday on Day 2, this dog had ripped out his urinary catheter. I checked that he had tried to bruise his surgical wound near the flank of the penis, with his e-collar. I gave him methone inj. 10mg/ml at 0.3 ml SC. He also had Rimadyl 25 mg tablet.  I checked his surgical area. There was little pain on palpation and less bruising. He ate the U/D can and was very active. I videoed him peeing normally without one leg up.

At 3 years old, he appeared "obese" but actually he was broad-chested. The first vet had provided a good detailed examination report. She had said he was obese with body score BCS 8/9.  She said he could have "urate" crystals and that X-rays of the bladder stones were too radio-dense to be urate stones.  Urate stones are said to be radio-opaque in some reports but it is not true.

Free catch urine dipstick. pH 8, Protein 3+, blood 4+, leucoyctyes negative, "rest wnl."

The dog was super-active today and went home with instructions

1.  not to feed any more dry food as he may have a familiar tendency to develop bladder stones.
 2. pee more than 2 times per day. Not practical as the couple works and nobody is at home during weekdays. So the dog holds his urine from 8 am to 8 pm waiting to go downstairs.

3. to measure volume of water drank/24 hour and record. Drink lots of water.
4. to use dipstick monthly to measure pH, blood, etc and let me know
5. to send urine for lab test 6-monthly and if there are small crystals, I can flush out the bladder.
6. stones sent for analysis
7. U/D diet can be expensive. Eat canned food exclusively. No dog treats, rice, bread. Stone analysis to confirm urates will be available in one week's time.

I don't know how many of the above-mentioned instructions the couple will comply with.

Friday, May 29, 2015

2172. Ap Alert sensor

March 29, 2015 

The vet's wife wanted to buy an Ap Alert sensor as her husband considered it very useful. If the dog stops breathing, there is the warning and if it breathes regularly, there is the regular beeping sound. She contacted another vet whose receptionist told her that she must wait till the product comes in from Australia. It would cost $35.

The supplier I sourced for her quoted $250. Her husband said to buy two as his wife did not answer the phone or called me back. I confirmed two but the wife said one would do. The supplier was angry at this change of mind and despite my confirming two, he would not sell.

"Some years ago, she ordered some equipment with price agreed at $580. My girl delivered it to her office," he said." She wrote a cheque of $500. My girl accepted it as she would have wasted her taxi fare in bringing it back. "This $58 meant a lot to me as I had few customers."

In another instance, she asked him to keep the equipment for her but did not buy it. He said another vet asked him for quotations and even asked him to inform other suppliers about the new premises. In the end, this vet did not buy anything from him nor inform him of his failure to secure any business.
Some vets would ask for quotations and buy elsewhere or directly from Australia but would phone him for repairs. One even used another telephone as he did not respond to her call.

2171. The guinea pig's head tilts left - review after 1 week

May 29, 2015

I did not expect to see the busy father after the treatment of the inappetant guinea pig with the left head tilt 7 days ago. The 3-year-old guinea pig was eating 50% of the food and was very thin at 700grams bodyweight.

He turned up with his two daughters today on May 29, 2015 and I was surprised as most owners do not bother or care for a review when their rabbit or guinea pig has head tilt.

"There is much improvement as she tilts her head less," he was glad that the bodyweight is now 752 grams and the guinea pig was eating. He fed Vitamin C tablet crushed in powdery form and bought wood and mineral blocks, but the guinea pig ignored them.

"No more left nostril pus after your antibiotic treatment, but the left eye is still cloudy."  He cared for this guinea pig much despite his busy travelling. "After 3 days of ear drops, she would object strongly to any more ear cleaning."

"I need to irrigate the left ear under isoflurane gas anaesthesia," I advised this procedure as the guinea pig had had painful ears with black soot-like substances. "To flush out the black sticky dirt inside the ears as the guinea pig had no ear cleaning for the past 3 years. Did you give her more space to exercise?" 

"This time, I extended the living space by placing her bottle at a far end of the pen. In this she's got to walk a longer distance to drink."

Under anaesthesia, I checked the molars using my fore-finger to feel for molar spurs. No sharp cheek teeth. The front teeth was trimmed 2 mm shorter.

The guinea pig's left eye cornea was cloudy but much less. She would rub her eyes whenever eye drops were applied.

As there is less head tilt, we will wait another 7-14 days after the ear irrigation and another type of ear drop dripped into the left ear to check whether the head will no more tilt to the left.