Saturday, July 11, 2015.
As part of the adoption agreement, the family brought the neutered Beagle under the care of Voices For Dogs to Toa Payoh Vets for a check up. I showed Intern Gin the procedures involved as her 2nd semester in Melbourne Univ Animal Health course will have a module "Animal Welfare".
If she gets straight As in the 2nd semester as in the first, she should have no problem being admitted to the Vet course.
Sunday, July 12, 2015
2490. A kind cat owner with a caterwauling "spayed" cat.
Sunday Jul 7, 2015.
This lady was very kind as she did not sue the vet who spayed her cat. A few weeks after spaying, the cat caterwauled. The vet gave her a strip of Ovarid tablets to be given whenever the cat makes noises. This happened around 4 times per year and after 2 years of medication, the cat became fatter.
The lady was worried about prolonged use of hormones such as kidney failure.
"You have only one alternative to hormonal control of heat," I said. "Surgery to open and look for the ovary or ovarian tissues which are near the kidney or kidneys. When the cat is on heat, as she is now, it may be easier to spot the ovarian tissues and take them out."
"What if the cat still caterwauls?" the Sec 4 daughter asked.
"No more caterwauling, if the ovaries are removed entirely." .
The mother signed the Informed Consent form and op will be done tomorrow
Dr Daniel advised ultrasound to see whether the ovarian tissues can be found and near which kidney. Op is delayed till next heat.
HISTORY
1. Around Nov 2012, Vet 1 spayed this cat. In 2013, consulted Vet 1 as caterwauling started a few months after spay. She prescribed some Ovarid tablets, to give 1/4 tablet when caterwaul on Day 1 and Day 3.
2. Cat caterwauls 4x/year and next 2 years. Given tablet. Cat puts on weight. Sometimes clear vaginal discharge.
3. Last Ovarid given some months ago. Cat on heat now, Jul 12, 2015
This lady was very kind as she did not sue the vet who spayed her cat. A few weeks after spaying, the cat caterwauled. The vet gave her a strip of Ovarid tablets to be given whenever the cat makes noises. This happened around 4 times per year and after 2 years of medication, the cat became fatter.
The lady was worried about prolonged use of hormones such as kidney failure.
"You have only one alternative to hormonal control of heat," I said. "Surgery to open and look for the ovary or ovarian tissues which are near the kidney or kidneys. When the cat is on heat, as she is now, it may be easier to spot the ovarian tissues and take them out."
"What if the cat still caterwauls?" the Sec 4 daughter asked.
"No more caterwauling, if the ovaries are removed entirely." .
The mother signed the Informed Consent form and op will be done tomorrow
Dr Daniel advised ultrasound to see whether the ovarian tissues can be found and near which kidney. Op is delayed till next heat.
HISTORY
1. Around Nov 2012, Vet 1 spayed this cat. In 2013, consulted Vet 1 as caterwauling started a few months after spay. She prescribed some Ovarid tablets, to give 1/4 tablet when caterwaul on Day 1 and Day 3.
2. Cat caterwauls 4x/year and next 2 years. Given tablet. Cat puts on weight. Sometimes clear vaginal discharge.
3. Last Ovarid given some months ago. Cat on heat now, Jul 12, 2015
2489. A Rottweiler has a few thousand ticks - VIDEO FOR INTERNS
Sunday Jul 12, 2015
Unusual to see a young Rottweiler with a few thousand adult and nymph ticks attached to the face and body.
Sedation needed. 35 kg. 4-year-old dog.
Given 1/3 formula ie. Dom + Ket at 0.4 ml + 0.5 ml IV. Able to clip bald.
The owner had applied Frontline Plus spot on. The pest control man applied a white insecticide wash yesterday. So, all ticks were dead but the mouth parts clamp to the face and body skin. Took over 2 hours to clip and remove the dead ticks. Goes home on same day. This dog had a left dislocated hip repaired by another vet (closed reduction) when he fell into a drain. He is OK now but still, the vet must be careful in case the hip dislocates and the owner blames the vet.
DE-TICKING AT TOA PAYOH VETS.
Dog safety and staff safety.
This dog looked thin and was probably poisoned by both Frontline Plus and Pest control man's insecticide. The owner wanted the dog's ticks extracted from the face and body. Looked horrible. One groomer suggested that euthanasia.
SEDATION. Minimum yet sufficient. This is hard to assess in a weakened toxic dog.
Formula: I gave 30% of the calculated dosage for this 35kg Rott. 0.4 ml + 0.5 ml Dom + Ket IV.
No top up. Dog muzzle when ticks plucked from face as he tends to bite.
"Topping up may kill the dog," I explained to Naing who was not so happy with the dog trying to get up and bite him. "Just muzzle him."
FOLLOW UP ON JUL 13, 2015
The dog ate but was not as active.
QUARANTINE FROM ANOTHER DOG (X-bred F, 7 years rescued as a puppy from the Defu Industrial Park with cement-covered body).
The lady owner said the Rott had a few small ticks seen and was told to remove them manually. I did the clipping but no further tick wash as the dog had Frontline Plus 7 days ago and the pest control had applied insecticide on his body the day before.
The Rottweiler was enclosed in a playpen of 7 fences in a circle (diagram) on the car porch.
"He could just push away the fences, being such a strong dog," I said.
"No, he dared not go near the play pen," the lady replied. Probably he had a lasting imprint of fright as a puppy when the playpen fence collapsed on him. So he dared not go near. That was good for the owner to quarantine him.
The other dog was quarantine but had few dead ticks.
PEST CONTROL
Yesterday
1. Sprayed insecticide mist on grass, walls, floors of car porchs, play pens, perimeter of home, and not indoors as there was no ticks indoors. Lady said about 95% effective as she saw few ticks.
2. Advised to tell the mum not to eat the papayas and pandan leaves in the garden as they will be contaminated with spray and from soil.
EPIDEMIOLOGY
Both dogs have no ticks for past 7 years.
Rott does not go outdoors except to the vet when he had right hip dislocation and surgery. On the follow up visit, the owner saw a large adult female tick which was removed.
X-bred, never visit vet since puppyhood 7 years ago. She goes out 3X/day by herself for 10 minutes. But no ticks for past 7 days. No more use of Frontline since 4 years ago for this X-bred. Rott never had any Frontline Plus. Both roam around the garden but the X-bred seemed immune. Given Frontline Plus on Jul 5 to both dogs, when Rott discovered to have ticks from the Vet clinic. X-bred had dead ticks on inspection after Frontline Plus on
When Rott had ticks at 2nd follow up visit some 3 weeks ago, Frontline Plus given to both dogs. But Rott's face became infested with ticks. Whole body and neck area plugged with grey adult female ticks around 1 cm x 0.8 cm.
OWNER TREATMENT OF ROTT
1. Advantix 2 X at once a month after seeing ticks from Vet clinic.
2. Frontline Plus 1X
3. X-bred clear of ticks. Rott has some small ticks, now plucked off.
Unusual to see a young Rottweiler with a few thousand adult and nymph ticks attached to the face and body.
Sedation needed. 35 kg. 4-year-old dog.
Given 1/3 formula ie. Dom + Ket at 0.4 ml + 0.5 ml IV. Able to clip bald.
The owner had applied Frontline Plus spot on. The pest control man applied a white insecticide wash yesterday. So, all ticks were dead but the mouth parts clamp to the face and body skin. Took over 2 hours to clip and remove the dead ticks. Goes home on same day. This dog had a left dislocated hip repaired by another vet (closed reduction) when he fell into a drain. He is OK now but still, the vet must be careful in case the hip dislocates and the owner blames the vet.
DE-TICKING AT TOA PAYOH VETS.
Dog safety and staff safety.
This dog looked thin and was probably poisoned by both Frontline Plus and Pest control man's insecticide. The owner wanted the dog's ticks extracted from the face and body. Looked horrible. One groomer suggested that euthanasia.
SEDATION. Minimum yet sufficient. This is hard to assess in a weakened toxic dog.
Formula: I gave 30% of the calculated dosage for this 35kg Rott. 0.4 ml + 0.5 ml Dom + Ket IV.
No top up. Dog muzzle when ticks plucked from face as he tends to bite.
"Topping up may kill the dog," I explained to Naing who was not so happy with the dog trying to get up and bite him. "Just muzzle him."
FOLLOW UP ON JUL 13, 2015
The dog ate but was not as active.
QUARANTINE FROM ANOTHER DOG (X-bred F, 7 years rescued as a puppy from the Defu Industrial Park with cement-covered body).
The lady owner said the Rott had a few small ticks seen and was told to remove them manually. I did the clipping but no further tick wash as the dog had Frontline Plus 7 days ago and the pest control had applied insecticide on his body the day before.
The Rottweiler was enclosed in a playpen of 7 fences in a circle (diagram) on the car porch.
"He could just push away the fences, being such a strong dog," I said.
"No, he dared not go near the play pen," the lady replied. Probably he had a lasting imprint of fright as a puppy when the playpen fence collapsed on him. So he dared not go near. That was good for the owner to quarantine him.
The other dog was quarantine but had few dead ticks.
PEST CONTROL
Yesterday
1. Sprayed insecticide mist on grass, walls, floors of car porchs, play pens, perimeter of home, and not indoors as there was no ticks indoors. Lady said about 95% effective as she saw few ticks.
2. Advised to tell the mum not to eat the papayas and pandan leaves in the garden as they will be contaminated with spray and from soil.
EPIDEMIOLOGY
Both dogs have no ticks for past 7 years.
Rott does not go outdoors except to the vet when he had right hip dislocation and surgery. On the follow up visit, the owner saw a large adult female tick which was removed.
X-bred, never visit vet since puppyhood 7 years ago. She goes out 3X/day by herself for 10 minutes. But no ticks for past 7 days. No more use of Frontline since 4 years ago for this X-bred. Rott never had any Frontline Plus. Both roam around the garden but the X-bred seemed immune. Given Frontline Plus on Jul 5 to both dogs, when Rott discovered to have ticks from the Vet clinic. X-bred had dead ticks on inspection after Frontline Plus on
When Rott had ticks at 2nd follow up visit some 3 weeks ago, Frontline Plus given to both dogs. But Rott's face became infested with ticks. Whole body and neck area plugged with grey adult female ticks around 1 cm x 0.8 cm.
OWNER TREATMENT OF ROTT
1. Advantix 2 X at once a month after seeing ticks from Vet clinic.
2. Frontline Plus 1X
3. X-bred clear of ticks. Rott has some small ticks, now plucked off.
Saturday, July 11, 2015
2488. 13-year-old cat has a recurring below right eye abscess -microbiological exam
Jul 3, 2015
Culture
Moderate growth of Lancefiled Group G Streptococcus
Susceptibility Results
Resistant to tetracycline
Sensitive to amoxycillin+clavulanic acid, erythromycine, penicillin, clinadmyain, azithromcyin, ampicillin, ofloxacin,clarithromycin.
Culture
Moderate growth of Lancefiled Group G Streptococcus
Susceptibility Results
Resistant to tetracycline
Sensitive to amoxycillin+clavulanic acid, erythromycine, penicillin, clinadmyain, azithromcyin, ampicillin, ofloxacin,clarithromycin.
Friday, July 10, 2015
2487. An FIV cat meowed and passed away at 6.34pm
Jul 10, 2015
The cat was diagnosed FIV +ve on Jun 23, 2015. The owner visited every evening at around 5.30 pm.Today, she panted rapidly, meowed once to the owner and passed away at 6.23pm.The lady owner said that the cat waited for her before passing away. Private individual cremation was her request so that the ashes would be the cat's.
The cat was diagnosed FIV +ve on Jun 23, 2015. The owner visited every evening at around 5.30 pm.Today, she panted rapidly, meowed once to the owner and passed away at 6.23pm.The lady owner said that the cat waited for her before passing away. Private individual cremation was her request so that the ashes would be the cat's.
A 14-year-old Jack Russell has canine lymphoma
Jul 10, 2015
TP 16462
Female JR, 14 years
All lymph nodes enlarged (video) but active and eating.
Blood test
Hb 12.3 (12-18)
Red cell count 5.4 (5.5-8.5)
Haematocrit (PCV) 0.34 (0.37-0.55)
Platelets 217 (200-500)
Total WCC 11.5 (6-17)
N = 45.3 % (60-70%) Absol 5.21
L = 26.6% Absol 3.06
M =23.5% Absol 2.7
E = 2.5% Absol 0.29
B = 2.1% Absol 0.24
Hb & RBC - lower than normal --- anaemia coming
bone marrow biopsy
Tests: lymph node biopsy or excision biopsy, bone marow biopsy, x-rays chest and abdomen
Standard chemotherapy 3 drugs + pred, 25 weeks. IV. Weekly visit to vet. Costs more than $7,000 done by another vet practice. Advised not a cure. Remission.
Immuran + pred?
TP 16462
Female JR, 14 years
All lymph nodes enlarged (video) but active and eating.
Blood test
Hb 12.3 (12-18)
Red cell count 5.4 (5.5-8.5)
Haematocrit (PCV) 0.34 (0.37-0.55)
Platelets 217 (200-500)
Total WCC 11.5 (6-17)
N = 45.3 % (60-70%) Absol 5.21
L = 26.6% Absol 3.06
M =23.5% Absol 2.7
E = 2.5% Absol 0.29
B = 2.1% Absol 0.24
Hb & RBC - lower than normal --- anaemia coming
bone marrow biopsy
Tests: lymph node biopsy or excision biopsy, bone marow biopsy, x-rays chest and abdomen
Standard chemotherapy 3 drugs + pred, 25 weeks. IV. Weekly visit to vet. Costs more than $7,000 done by another vet practice. Advised not a cure. Remission.
Immuran + pred?
Thursday, July 9, 2015
2485. Email from the Netherlands about dental work without anaesthesia
I got an email from a Netherlands vet today.
Dear Dr. Sing,
Thanks for te time you took to read this e-mail and I look forward to receiving your answers.
-----------------------------------------------------------------------
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
Dear Dr. Sing,
I read your report on the extraction of teeth on an old Pomeranian without general anesthesia (http://www.asiahomes.com/
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,
-----------------------------------------------------------------------
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
Tuesday, July 7, 2015
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.
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.
Thursday, July 2, 2015
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
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.
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
Wednesday, July 1, 2015
2481. Profuse bloody vaginal discharge - 10-year-old Cocker Spaniel
"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!"
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