2485. Email from the Netherlands about dental work without anaesthesia

I got an email from a Netherlands vet today.




 Dear Dr. Sing, 

I read your report on the extraction of teeth on an old Pomeranian without general anesthesia (http://www.asiahomes.com/book2/20100664dental_extraction_16-year-old-Pomeranian_dogs_singapore_ToaPayohVets.htm). I have a few questions about this case. Please keep in mind that, as a veterinarian, I am just very interested in this case – I am not trying to “catch you out” or criticize your treatment!

First question is: have you used any kind of analgesia? I can’t find it in your report. I would be very apprehensive to perform extractions of teeth without anesthesia, but even more so without any kind of analgesia.

Second question is: how did the dog react to the procedure? I can only imagine that it must have been stressful. Extractions hurt, regardless if you have to use luxators or if the teeth is so loose that it can be plucked.

Question three: Weren’t you afraid of getting bitten? I have had some nasty infected scratches from working with bad teeth, so I’m careful. I have at least 25 years to go in this profession, I have to look out for my fingers. Even under general anesthesia I see some pretty powerful jaw reflexes, although more in cats than in dogs.   

I have performed lots of dental work on patients of all ages. I always use general anesthetic and to no ill effects, on geriatric dogs and cats. I usually advise the owner that living with such bad teeth causes so much pain that it’s inhumane to not do the dental work. In my opinion, it’s the quality of life that counts, not the duration (within reasonable limits of course). Also, I hold the owner accountable for state of the teeth, after all, he/she should have taken care of their animal. So if they don’t want anesthesia, I ask them if they would be comfortable to have their teeth pulled without anything. That usually does the trick. :-)

Furthermore, I have had very reliable results in anesthesia of geriatric patients, many of whom have either mitral valve disease, kidney dysfunction, or both. I provide analgesia with pre-op buprenorphine, anesthetic induction with midazolam/ketamine and surgical plane anesthesia with isoflurane. I supply a drip with Ringer’s lactate, and a low dose of furosemide for heart patients (and catheterization so they don’t flood the operating table). Before starting the extractions, I provide regional nerve blocks to minimize post-op pain, and always provide four day take-home analgesia in either NSAID or Tramadol. I would be glad to supply you with dosages if you’d like. 

Thanks for te time you took to read this e-mail and I look forward to receiving your answers.

Kindest regards,

Drs. Peter de Frankrijker-Schiphorst DVM,

BeterBeest Dierenartsen

The Netherlands

www.beterbeest.nl

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REPLY DATED JUL 9, 2015

Thank you for your email and interest in this case study.

In reply to your questions:
1. No analgesia was used in this case.
2. The dog's teeth were very loose. There was some reactions when the loose teeth were extracted..
3. The Pomeranian was the gentle type and did not attempt to bite me.  

I give anaesthesia and analgesia in all my dental work except for this case.  This was the only case, since I graduated in 1974 that I did tooth extraction without anaethesia. The owner was much worried about that her 16-year-old dog would die on the operating table. I had promised her that I would extract the loose teeth without anaesthesia and she trusted me. 

I reject another case of a younger dog when the owner did not want anaesthesia for dental scaling being worried about death on the op table. Patient safety under anaesthesia is my top priority

I shall be grateful if you will provide the dosages of drugs you use for geriatic patients.  Best wishes.

Dr Sing Kong Yuen
Toa Payoh Vets
Singapore 

2484. FIC - Feline Interstitial Cystis - A mother phoned to say her cat is now normal

Jun 6, 2015

Some 4 weeks ago, this career woman was much depressed as her cat would sit on the litter box trying to pee, affecting her sleep. She wanted to put the cat to sleep if this continued as she needed to work.

I drove to Smith Street to give the ACP anti-spasmodic tablets 12.5 mg to be given 1/4 tablet 2 x /day and painkiller meloxicam orally at 0.03 ml for 4 days. Antibiotics would be given if the first two medication did not work.

The cat should be given her own space, litter box, water and feed bowl, separated away from the other female cat.

Follow up on Jun 6, 2015.
She was most happy that the cat is back to normal.
"How did you persuade your cat to eat the Feline C/D diet?" I asked her.
"I feed him the canned C/D when I am home from work and leave the dry C/D and not feed him other food.  So he eats when he is hungry."

Many cat owners do not know what to do to change the diet and so the disease FIC recurs. She told me she did not need to use the antibiotics.

The cat had been warded by the first vet for 5 days some 4 months ago for bladder obstruction but the dysuria recurred 2 months ago. I palpated that there was no painful or swollen kidneys and bladder and so diagnosed FIC. The dysuria and polliakiuria recurred some 7 days later and the mother had considered euthanasia.  I rushed to Smith Street to hand over the above-mentioned medication to her son who worked as a bar tender. So, the medication worked and there was no need to do X-rays, blood test or urine test in this case.

Angel - A male cat sits on the litter box

Jul 2, 2015

Cat, MN, 3 years

"Have you encountered such cases?" the lady with a baby asked me about her cat having great difficulty in peeing, sitting on the litter box and vomiting twice yesterday.

"It is quite a common problem in male neutered cats," I replied. This cat eats only dry food and lives with two other female cats.

I palpated no enlarged kidneys but a big swollen bladder as big as an orange. The cat dribbled blood-tinged urine on the consultation table.

Under gas anaesthesia, the urinary cathether was not easily passed into the bladder, despite syringing normal saline. Some urine did flow out and the bladder was emptied 50%. I got the x-rays done and there were stones inside the bend of the urethra.

At home, 2 other female cats had no problem. One litter box and water bowl. Dry food only.

The owner gave permission for surgery. Dr Daniel did it in the afternoon. Body weight  4.8kg, temp = 38.3C.   Sedation xylazine + ketamine 0.1 + 04 ml IM. Maintenance with isoflurane and oxygen gas.
Cystotomy. Syringed saline into the urethra to get the 2 urethral stones into the bladder.

Warded. E-collar and urinary cathether. Antibiotics and pain-killers

 

2481. Profuse bloody vaginal discharge - 10-year-old Cocker Spaniel

Jul 1, 2015

"She has a bad life," the lady owner visited the sleepy old cocker spaniel at 7 pm. "She had 3 surgeries - first for a durian seed in her stomach and twice for breast tumours!"

After swallowing the durian during the time the family was feasting on durians, the dog developed diarrhoea and vomiting. A vet operated to remove the seed.  Just around 2 years ago, the dog had a gigantic breast tumour, bigger than mangoes, excised by Dr Daniel and I.

This case was documented at:
http://www.asiahomes.com/book2/20150521mammary_adenomas_breast_tumours_dogs.htm

"Why didn't you spay the dog?" I asked.
"You did advise and remind me, but the dog is so old. She would be getting menopause and so no more breast tumours."
"Dogs do still pass blood during heat even at an old age of 15 years in some cases," I said.

Then around June 16, the dog had heat and passed blood for a few days. Nothing after that. Then, on Jun 29, blood kept gushing out, as if a dam had burst.

On Jun 30, 2015, the dog was rushed to Toa Payoh Vets. "She was soiling the apartment. She licked and vomited her discharge!"

2480. Professionalism in veterinary surgery - video - rat mastectomy

June 30, 2015

Today, I spent much time discussing "Professionalism in veterinary surgeon" with Intern Ms Poh, intern who is  in her first year of animal health studies in Melbourne University. The veterinary degree is a second degree in this University.

PROFESSIONALISM IN VETERINARY SURGERY.
To prepare a video. She had to do her research and produced a report. Finally, I gave her a flow chart with the main subheadings as follows:




1. Hook  - An old rat with large breast tumours. To operate or not?

2. Theme.  BKTP - Professionalism in Veterinary Surgery

3. Pre-op
Correct diagnosis
Client education - Financial costs of op
Health screening costs  (blood tests, x-rays, urine tests, ultrasound)
Informed consent form signed. Old rat - high risks



4. Op
Correct treatment - surgical excision rather than drugs and painkillers
Referral to other experienced vets
Aseptic surgery
Ligation of the caudal superficial epigastric artery and vein. Less than 3 mm across in the rat unlike in the dog. Bleeding continuously if cut off without ligation.

No major nerves resected in this location

SAC  
Speed  - Knowledge of vet anatomy, skills and experience. Focus - no cracking of jokes.
Accuracy - Ensure correct tissues removed, blood vessels ligated
Completeness - all the tumours excised. 1-inch margin around tumour ideal but no practical in the rat.

No distractions during anaesthesia and surgery by cracking jokes.


5. Post op.
Painkillers and antibiotics
Histology report advised
Post-op complications - bleeding, infection, stitch breakdown, pain


6. Impact - financial costs, social costs, worries about anaesthetic deaths

7. Conclusion - What happens to this rat?

Credits

Produced by:
Videography by:
Veterinary surgeon operating on the rat: Dr Daniel Sing
For more information:

For more videos:

2479. A new puppy has a swollen belly

Post-purchase vet examination. 
Swollen belly in this beagle just purhased. Worms? Over-eating?
X-rays show fluid in the abdomen. A diagnosis of ascites.

"Can it be cured?" the pre-teen daughter was reluctant to return the puppy to the seller.
"It depends on the cause," Dr Daniel said. "It could be a liver or heart problem."
"You are not fated to keep a puppy," the mother said to her as one of her previous 2 dogs died and the other had to be given away owing to excessive barking.
 

FIC in a female cat?

Jun 30, 2015

One month ago, this cat, FS, 7 years old vomited and was not eating. She  had dysuria and frequent urination.  two strips of hair loss along her flanks and several patches of hair loss around her anal area. This was caused by anal sac abscess. 

Today, she had the same problem of dysuria and frequently going to the litter box to urinate.
Abdominal palpation - no enlarged or painful kidneys. No full or painful bladder. Large cylindrical column of stools in the colon felt.


1. Since young, the cat would drink for 5 minutes when the owner came back from work and switched on the running tap water.  Water bowl water seldom drank. Buy water fountain.

2. Single house-hold cat. No stress from other cats.

3. Litter box changed every 3-4 days. I advised daily picking up of the stools.
4. Litter box fine sand to be changed to paper.

5. Will eat only dry food. Feed feline C/D and observe for 1-3 months. With water fountain, may encourage more water drinking.

6. Foams when given oral medication. Disliked antibiotics.

TREATMENT
1. No urine for urinalysis.
2. Baytril inj.
3. Depo-medro 0.3 ml IM  (50mg/ml)

Will observe for next 1 month.

VIDEO

2477. Travel pics. Milan Airport going home

Jun 27, 2015

Back to Singapore. Felt the humidity here. Jet lag. Went to the tour leader's office to give her a tip. She was not in. Her business depended on referrals not on NATAS expo and advert.


Some memorable incidents are captured in the images.

Getting cash tax refund at the Milan Airport  for buying a Burberry bag in Milan.

A group of Hokkien and Mandarin speaking tourists enjoy picture taking and selfies.

2476. Travel pics. Milan

Jul 25, 2015  
Hotel Piacenza Fiera, Italy, Rm 111
facing open patio
At 7 am, will leave for airport for Singapore


Much drama, joy and laughter in this trip


Hokkien and Mandarin speaking group
Vocal minority
Tour leader ticked off for not "waiting" for all
Pregnant local tour guide abandoned us
Italian coach driver fainted from altitude sickness for 5 minutes flat on the grounds of Mt Blanc
One member had nose bleeding and puffy eyes
One member felt nauseous up mountain drive
Sunblock every 2 hours keeps a fair lady fair

2475. Travel pics. Foxtown Mall. "WhatsApp stops working" solution

Jun 24, 2015
Arrived MH Hotel Piaxenza Fiera  Rm 111
Big patio outside window. Some worries about security.
Free Wireless needed 10-digit code whereas other hotels needed just email address.
Singles complained that the room was too small - one bed lined against the wall on one side.
"You are all right as the room is bigger for your size," the slim fair lady said to a bigger sized lady friend. Then she hugged her and apologised.

Yesterday, WhatsApp had a message saying "WhatsApp has stopped working" on my Samsung. Fortunately, I googled and there was a solution.

www.fixedbyvonnie.com

How to Fix that stupid “Unfortunately (your app) has stopped.” error on your Galaxy S4
Inside settings, touch the More tab and flip open the Application Manager

Tap it open and touch the Clear data and Clear cache buttons.  This essentially resets the app to its initial state and should resolve the problem for you.

Swipe three screens to the right to open the section that displays ALL apps.  Now scroll down the list until you find your unruly app.

The solution worked for me. I had to confirm from a phone call from Colorado giving me a code. 


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Best to take pic without "objects" growing out of the head or the right ear. 3rd image was photoshopped to remove the driver of the truck. A waste of time. Plan ahead.


 

Foxtown Mall has a big Burberry presence. Yesterday, we had a woman who wore a Burberry scarf at lunch time at the train station in Chamonix. PK warned her that she could be arrested or jailed for wearing fakes in Europe. PK looked at the scarf and I thought she could differentiate the real from the fake. The woman's 23-year-old daughter had presented her this scarf. Was it the original or not? She did not wear it today at Foxtown Mall.