3341. Deepavali - A Javan Mynah chirps on a tree behind my exercise machine

Nov 6, 2018   Deepavali
After exercise and chanting, a Javan Mynah perched on the tree behind me and chirped for a few seconds. Then he hopped onto the higher branches, chirped. After around 10 minutes, he flew off.

3340. A 6-year-old female, not spayed, Miniature Schnauzer pees blood

Nov 7, 2018.  The Schnauzer vomited and peed blood in the urine today. So, the owner was referred to me. She has bad breath.  Milk were expressed in the swollen mammary glands indicating
false pregnancy.

No abdominal pain. A small swollen bladder possibly a stone.
Urine test was done. No X-ray or blood test for the time being.
The owner will return in 2 weeks' time after antibiotics, to get dental work done. Spay is advised.

3339. Keppra in treatment of Seizures in a 3-year-old adopted dog

Deepavali
Tue Nov 6, 2018

The young man adopted a 3-year-old shelter dog that must be on Keppra daily, as instructed by the Shelter vet. He was not to stop the drug as the dog was previously on Phenobarbitone which became ineffective.

He wanted to know whether he can stop the medication since the adopted dog no longer lives in a stressful shelter with so many dogs barking. Now the dog is housed in his quiet home and he wanted to wean the dog off the anti-convulsant.

The Shelter vet said no way. So he contacted me for a 2nd opinion. See video.





Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907711/


KEPPRA

Abstract

Status epilepticus (SE) is a major clinical emergency that is associated with high mortality and morbidity. SE causes significant neuronal injury and survivors are at a greater risk of developing acquired epilepsy and other neurological morbidities, including depression and cognitive deficits. Benzodiazepines and some anticonvulsant agents are drugs of choice for initial SE management. Despite their effectiveness, over 40% of SE cases are refractory to the initial treatment with two or more medications. Thus, there is an unmet need of developing newer anti-SE drugs. Levetiracetam (LEV) is a widely prescribed anti-epileptic drug that has been reported to be used in SE cases, especially in benzodiazepine-resistant SE or where phenytoin cannot be used due to allergic side-effects. Levetiracetam’s non-classical anti-epileptic mechanisms of action, favorable pharmacokinetic profile, general lack of central depressant effects, and lower incidence of drug interactions contribute to its use in SE management. This review will focus on LEV’s unique mechanism of action that makes it a viable candidate for SE treatment.

Keywords: levetiracetam, calcium homeostasis, status epilepticus, anti-epileptic, mechanisms

Go to:

Status Epilepticus: Definition, Causes and Consequences

Levetiracetam (Keppra) is a unique anticonvulsant agent that has multiple mechanism of action that differentiates it from conventional anticonvulsant drugs. This makes it an ideal agent to add to the treatments for SE.

Refractory SE is a major medical and neurological emergency associated with high morbidity and mortality. Levetiracetam offers a unique anticonvulsant treatment option to initiate for the treatment of refractory SE. Its low incidence of side-effects and sedative properties make it an ideal agent to consider in treating refractory SE. The availability of an intravenous preparation of LEV also facilitates its use in treating refractory SE. Further studies should confirm that LEV will also be a major first line drug for the treatment of SE, but at present it is not approved for this use. The unique anticonvulsant mechanisms of action of LEV make it an ideal agent to add to conventional anticonvulsant agents and to consider for the treatment of refractory SE and intractable seizure disorders.

3338. Extensive eye ulceration in an old Chihuahua

The lady with the blond hair had several adopted dogs including this Chihuahua. "With blond hair, I need not go for monthly hair dyeing as the grey hairs do not show so clearly," this Grab taxi driver told me. Her friend had a mixture of blond and gold brown hair.

The Chihuahua had such an itchy eyeball rubbing his left eye on the bedside, despite an e-collar. "I researched the internet that eyeball removal is the best solution," she had been consulting the eye specialist for the past 2 years but the dog's eye condition did not improve.  

3337. An old poodle has thick encrusted tartar and bad breath - oro-nasal fistula

Nov  4, 2018

3336. Clouds Images Singapore

Sunday

Nov 4, 2018

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

Nov 15, 2018  morning driving to work

 

3335. TRAVEL - South Korea - Oct 5 2018. A Korean gave me his umbrella

I asked a gentleman in a delivery man for directions to the subway. It was drizzling. A long walk.
I had no umbrella and carried a camera - hence a tourist. He gave me his umbrella insisting I took it. He left in a van driven by a lady. A last morning in South Korea Airbnb accommodation.

3334. Advices to Young People. Ageing Parents

Sunday Nov 4, 2018

Some young adults who travel tend to forget updating their parents of their whereabouts thinking that no misfortunes will hit them.

It does not cost a child much time to post travel photos to his aged parents. The photos are peace of mind and a sign of gratitude for parental sacrifices giving him the opportunities he now enjoys.

3333. Entrepreneurs Singapore - Women-led start-up. Straits Times Sep 15, 2018 B9

1. KinderPass - subscription based, offers on-demand service for parents looking for children's activities. Children up to age 6.



2. Eainchat - top prize - leading digital food media platform in Myanmar. Step-by-step video tutorials on cooking Myanmar and other countries' food. Hope to create a mobile app.


3.  Fast Track Trade, SG digital trade platform for SME

4. My Health Care - Myanmar start-up matches people with health concerns to healthcare service providers who answer their questions online.

3332. *****2018 Case Study. A 12-year-old male neutered Shih Tzu has bladder stones again - recurring bladder stones

Nov 1, 2018 review of case of dysuria again one year after bladder stone removal by Vet 2.



Oct 27, 2018. Recurrence. Consulted Toa Payoh Vets
The owner regretted that she did not accept the advice to feed struvite prevention therapeutic diet
as advised one year ago when Vet 1 operated and removed the big stone and small ones. Vet 1's report from the University of Minnestoa Urolith Centre's stone analysis indicate a Magnesium Ammonium Phosphate (struvite) with ammonium urate stone.



 
Oct 27, 2018 
Came to Toa Payoh Vets
Urine test
pH 7.0  (5-8)
SG 1.033  (1.005-1.030)

Protein 2% Ketones +, Blood 4+ , Bacteria +, Crystals are triple phosphate +, Amorphous phosphate 3+. 

Dr Daniel catheterised the urinary bladder. Irrigated and remove multiple small stones. No X-rays were done to save owner the medical cost.

 ------------------------------------------------
FLASH BACK - ABOUT ONE YEAR AGO

Sep 23, 2017
The dog had great difficulty peeing and dribble urine all over the apartment. The owner went to Vet 1 whose X-rays did not show urinary stones clearly. Vet 1 advised ultrasound to be done by Vet 2 but the owner declined the offer.

Sep 26, 2017. The crying dog had great difficulty in peeing and the abdomen was much swollen.
Rushed to Vet 2 who X-ray and saw a big stone.

Ultrasound guided cystocentesis drew out stinking urine. Quoted $4,000 for surgery. The owner went back to Vet 1 who charged around $1,600.