2967. INTERN. A cat has dysuria and pollakiuria after boarding

Aug 17, 2015

Aug 15, 2015. Cat. 4 years. Female. Boarded last week. Dysuria and pollakiuria for the past 5 days.

Black and white cat. (video).

AUGUST 15, 2015

On August 15, 2015, I saw this 3-year-old male, not neutered cat. He peed with difficulty (dysuria) and dribbled urine all over the apartment (pollakiuria) for the last 5 days.

AUGUST 5-10, 2015
He was in a boarding cattery in Pasir Ris ing for 5 days over the National Day holidays (Aug 5-10). The owners were worried about his illness.

"Are there other cats in the house?" I asked.
"No," the wife said.  So this cat would not be stressed out by sharing litter boxes or bullied by other cats. As for toilet, he goes to the squatting toilet bowl to do his business. 

AUGUST 15, 2015
I palpated the kidneys. The cat reacted in pain (Video clip). X-rays showed enlarged kidneys (image).

The blood was collected from the jugular vein (video clip). Blood results showed normal kidneys and liver. Only that the platelet count was low at 33 (300-800). The low platelet  count could mean that this cat had licked some poisons during boarding. The owners said that the cat's body had a strong stench of urine and smell on return from boarding. These body stains would be toxic and the cat would attempt to groom himself, licking off as much of the toxic contaminants on his body. The toxins entered his blood stream. They  caused pain in the bladder and urination.

Treatment was by haemodialysis with IV drip to flush out the toxins in the blood. Antibiotics and painkillers. The cat was boarded for one day and went home on August 16, 2015.


AUGUST 18, 2015 TEL TO OWNER.
As at Aug 18, 2015, the cat is active and has recovered fully his bladder control. 

ADVICES TO OWNER
1. Lifestyle of the cat is as follows:
1.1  Daytime - free to roam in the apartment. Toilet would be the squatting toilet bowl and toilet floor.
Night-time - confined to a small carrier (video). This is to prevent noise nuisance and urine marking. Sometimes he would soil his body with urine and stools overnight.
1.2  Next morning, the cat's body would be washed and cleaned before letting out. Most likely, the boarding cattery would not bother to adopt this lifestyle of cleaning the cat daily.

2. Neutering the male cat would have prevented the caterwauling noises and urine marking.  For religious reasons, the owners did not want to do it. So, night confinement to the carrier and daily body cleaning would be performed.


In Singapore, some male dogs are similarly confined to a cage at night to prevent urine marking. Some owners put on pads to cover the back of the dog to contain the urine or prevent urine marking when they are not at home. 

The best advice is to neuter the cat or dog at 6 months of age to prevent urine-marking and noise nuisance.

FOLLOW UP ON SEP 30, 2015
No complaints from the owner as the cat is normal now.

2966, A 10-year-old chihuhua has occasional pain in the back rib cage area - X rays

August 13, 2015

A 10-year-old female spayed chihuahua recently curled up to sleep on her right side. Sometimes she had her collar hairs standing erect. On July 21, 2015, I had performed dental scaling and extraction of loose teeth. A blood test showed higher number of red blood cells and haemoglobin.

"What's the problem with her appearing to have painful?" the couple asked me today. I palpated the back part of the rib cage with 2 hands inwards. The dog winced and attempted to bite me (video).
So, was there something wrong with the rib cage?

Video   Chihuahua

A cavalier king charles dislocates her left hip

August 11, 2015.

Unusual behaviour led to left hip dislocation.
For the past 7 years, this female CKC must jump up and hit the wall for a while before squatting  down to poo. She lives in an apartment and was not seen jumping up and down the sofa or had a fall from the table, according to the owner.

So, the hip dislocation was attributed to this behaviour.

The owner agreed to a closed reduction. In this procedure, Dr Daniel anaesthesized the dog, put back the femoral head into the hip and splinted up the dog's leg. The dog is at home now. If closed reduction does not work, then surgery is needed.

2964. Internship

August 7, 2015. Thursday.

Today is a public holiday given by the government for  "Singapore Jubliee celebration" and forthcoming National Day on August 9.  Many Singaporeans just took the long weekend and extra holidays to go overseas. I am still open today.

Yesterday, spoke to the two RI interns and my assistant Naing on work matters.
1. Doing what they like - an attitude of the younger generation. However, the work process is short-cutted or amended, leading to inefficiency and waste of time.

2. Texting and video watching while at work. A common bad attitude as work does not get completed.

3. Not giving priority to important tasks given by the boss. So, long delay in project.

2963. Bladder stones in a 4-year-old female Silkie X

A gentle young female Silkie X
X-rayed at 6.30 pm.
"No staff," the Filipino assistant said as she opened the evening clinic. "I will X-ray the dog myself and will call you for help if necessary."
She was good and helpful. The X-rays are excellent. No kidney stones but at least 16 bladder stones.

Dr Daniel discussed the case  with the owner who cycled back to Bishan with the dog on the basket. He will discuss with the family. Looks very much like struvite stones. The dog is said to be eating mostly home-cooked food. 

2962. Birthday celebration. 76 years old.

4048. A 1-year-old Border Collie dislocates her right hip

Aug 5, 2015
The Border Collie was limping on her right hind limb this morning. X-rays show the right femoral head has dislocated entirely out of the right hip joint. A Femoral Head Osteotomy surgery is advised.

"The chances of being back to normal without surgery are slim.," I said. "Without surgery, I can apply the Ehmer Sling. In this treatment, I use adhesive bandage to wrap around the affected leg and then sling it across the body. The dog may still be lame. The surgical option is likely to be lasting as most dogs do not limp after the surgery."

"I prefer surgery."  The femoral head was cut off under general gaseous anaesthesia. The femoral head was excised.

 Video 

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

March 5, 2017
The owner came as the dog had swallowed a rubber toy.
I asked about the time it takes the border collie to recover normal gait after femoral head excision.
"She took 3 months to recover and walk normally!"













   

2960. Client control

August 2, 2105

Client control refers to a client who dictates what is to be done in the diagnosis and treatment of the medical condtion.

I had a case where the client said that her Schnauzer suffers from allergies and therefore an anti-allergic injection is to be given. Yet this spayed Miniature Schnauzer had two flanks bitten bald, as in an endocrine alopecia case.

There was ringworm treatment given. UVL showed some fluroescence. The owner wanted control of the treatment and such owners are best avoided. She said the dog is allergic to chicken.

If the dog does not recover, more steroid injections are given on command. This may not be in the best interest of the dog.

There will be clients who want to control the treatment as they have surfed the internet and had some medical knowledge.

2959. Looking for a "good" vet. Retained ovarian tissues

August 2, 2015

Hi Dr Sing,

She has stop passing gas now but she's been drinking a lot of water since yesterday (estimate 400-500 ml today). Her temp went from her usual 37.7-38.2 to 38.2 - 38.9, albeit it's within the normal range I find it quite peculiar the vast changes. She had some slight lethargy, weak legs, slow motion, panting, hiding under the bed/table/couch, restlessness on Yesterday. 

This is just so strange she was so well playful, no swollen tummy, normal water consumption on Wednesday till Saturday. 

I've now removed the water in case there's a stump and it builds up into pus. 

Here's the latest pix of the swollen stomach. I've also discovered a blood spot, which doesn't seems recent. 

She's on juroclav since yesterday (Sunday), she had to stop her antibiotic on Wed-Sat because she had severe rashes from it. 

Question:

What's the cost of x-ray? Do u have the facilities in your clinic?

Im not too sure if she has an infection, how do we determine that? In her previous urine test it showed her WBC was in the normal range, would that confirm any infection.

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

This case shows the lack of confidence in all vets as the owner now does her own diagnosis. Vet 1 had spayed her dog (pyometra) saving the dog's life. However the dog showed signs of heat after the spay and passed some spots of vaginal discharge. Vet 2's ultrasound diagnosed ovarian remnant in the left kidney area and gastroenteritis.

The dog was not as active as before and seemed to be in pain. I advised her to get a review again with Vet 2. The owner decided on self-treatment with antibiotics and tramadol pain-killer. She looks for a "good" vet.
---------------------------------------------------------

In my reply, I wrote:

As each vet, like you, is an individual, you cannot expect perfections.

2958. Stray cat spay in 5 minutes

Aug 3, 2015

Youtube Video:
https://www.youtube.com/watch?v=ouUePbKDUdg

A stray cat is spayed in 5 minutes.

1. Short skin incision around 2.5 cm
2. Hook out uterine horn, exposing a longer length of ovary and ovarian ligament
3. Clamp on ovarian ligament twisted in a circle to include the tip of a part of the ligament when the ovarian tissues are cut. The tip of the clamp forceps then catch this tip and pull it inwards to "ligate" the ovarian blood vessels. No need to use stitches as in standard spay.  Repeat on the other ovary.
4. Uterine body is clamped and ligated as in standard spay.
5. Stainless steel suture is used to ligate uterine body, muscle layer (one cross stitch) and subcutaneous skin (horizontal mattress suture under the skin).  

Claimed that the cat can be released immediately. Any age from 6 weeks onwards. These are stray cats.  

Video time taken: Less than 5 minutes. Cat spayed was on heat and so the uterine horns are swollen and easily hooked.No need e-collars.

COMMENTS
For most vets, I will advise
1. A longer skin incision to ensure that the ovarian tissues are 100% taken out and seen. This is to prevent remnants of ovarian tissues remaining in the "spayed" cat.
2. Ligate  the ovarian ligament with absorbable sutures as in the standard spay.
3. Toa Payoh Vets use one separate suture packet per cat spayed, not from a reel of sutures as for stray cats.