1. Dog with dead grey skin below throat of 20 cent area. Some pain. Could it be due to penetration by hard dog bone treats? Few days only. The owner was flying and would be back tomorrow. Large area of cellulitis. conservative treatment. IV drip first and blood test.
2. Owner phoned wanting to de-mat the cat under sedation. A man here told him that there are 2 types of sedation. One without recovery and one with recovery. The former type is safer. I was surprised. "Much depends on the cat's health like heart, liver and kidney problems," I said. If the cat is not healthy, both types may kill the cat.
3. Beagle, 13 years old follow up on high liver enzymes by Dr Vanessa. Had vomiting and diarrhoea last visit. I insisted on IV drip with medication and to bring the dog home with the drip as the young lady did not want hospitalisation. IV drip gives direct effect. The dog recovered the next 2 days. "Just giving an injection and some medication to give at home will not work," i said to the father. "The intestines are not well and so there wil be more bloody diarhoea overnight and unhappy owner having to clean up the mess." As to the request for liver supplementation, I educated the young lady to take another blood test to check the status of the liver health rather than getting supplements. "For all you know, the liver was damaged due to an infectious organism at that time and has now recovered. The monocytes were 36% last time while the normal should be around <5%. So there was a chronic infection somewhere. The blood test showed "degenerative changes in the blood cells" too indicating something toxic at that time. A blood test was agreed upon by her father.
4. "Thank you for your help," the woman with red eyes said to me after her 18-year-old shih tzu was euthanased as I had interrupted Dr Vanessa to treat her case first as an emergency of a suffering crying old dog. "I wonder whether I should have her anal tumour removed when it was very small." Earlier she had wanted a house-call to euthanase the dog but we could not spare a vet to do it on a busy Sunday.
"When was that?" I asked.
"2 years ago."
"Did you neuter the dog as the male hormones encourage the growth of this circum-anal tumour?" I asked.
"No," she said. "The tumour just exploded and grew large only in the last few weeks."
"The other vets would not advise operation as the dog was very old and high anaesthetic risk," I explained. "This dog has a long life."
"My female dog has been spayed and is 18 years old and alive. I didn't neuter the male."
I checked the recent blood test results:
Only significant changes were in the differential blood count with N=83% (60-70) and L = 8% (12-30) and M=1% (3-10). But total WBC was normal at 8.8 (6-17).
In conclusion, it is still best to neuter your dog and to get small anal tumours in male dogs removed by your vet when it is very small, even if the dog is "old".
Sunday, July 29, 2012
Jul 29, 2012 Sunday's interesting cases
July 29, 2012
Arrived at 8.30 am. Bright sunshine Sunday.
1. Poodle spay came in at 10 am. I told the owners that they could pick up the dog at 12 noon.
I prepared D+K, for this 3.5 kg dog.
D+K at 50% IV sufficient to intubate when done at the 4th minute after injection. Dr Daniel to spay.
2. Lady intern from stat board wanted to do internship as she wanted to become a vet. Had an Arts degree, AVA does not give vet scholarship to older graduates and the cost was prohibitive. "Be proactive and positive," I said. "Nobody can predict the future.
3. A Tampenis client of Dr Vanessa came to get some medicine and cream for his dog treated successfully for skin disease in Nov 2011. He wanted the tablets and the cream. When I advised that we don't sell tablets, he was furious as he could "buy from other vet clinics." So, he left in his taxi.
4. Dr Vanessa's 3 clients came in a bunch. So it is barking dogs. As it is a personalised service, her clients must wait. We have other vets but they want her.
5. You treated my Schnauzer with bloodied ears and pus flung onto Mr Saw last time," the lady selling rabbit health products said to me. "So I come back as the ears are giving me problems again." That was 3 days ago. I warded the 12-year old dog for ear irrigation and dental work. This morning I checked the oily ears. Much better. Took some pic. Will write up this case later.
Arrived at 8.30 am. Bright sunshine Sunday.
1. Poodle spay came in at 10 am. I told the owners that they could pick up the dog at 12 noon.
I prepared D+K, for this 3.5 kg dog.
D+K at 50% IV sufficient to intubate when done at the 4th minute after injection. Dr Daniel to spay.
2. Lady intern from stat board wanted to do internship as she wanted to become a vet. Had an Arts degree, AVA does not give vet scholarship to older graduates and the cost was prohibitive. "Be proactive and positive," I said. "Nobody can predict the future.
3. A Tampenis client of Dr Vanessa came to get some medicine and cream for his dog treated successfully for skin disease in Nov 2011. He wanted the tablets and the cream. When I advised that we don't sell tablets, he was furious as he could "buy from other vet clinics." So, he left in his taxi.
4. Dr Vanessa's 3 clients came in a bunch. So it is barking dogs. As it is a personalised service, her clients must wait. We have other vets but they want her.
5. You treated my Schnauzer with bloodied ears and pus flung onto Mr Saw last time," the lady selling rabbit health products said to me. "So I come back as the ears are giving me problems again." That was 3 days ago. I warded the 12-year old dog for ear irrigation and dental work. This morning I checked the oily ears. Much better. Took some pic. Will write up this case later.
Jul 29, 2012 Sunday's interesting cases
July 29, 2012
Arrived at 8.30 am. Bright sunshine Sunday.
1. Poodle spay came in at 10 am. I told the owners that they could pick up the dog at 12 noon.
I prepared D+K, for this 3.5 kg dog.
D+K at 50% IV sufficient to intubate when done at the 4th minute after injection. Dr Daniel to spay.
2. Lady intern from stat board wanted to do internship as she wanted to become a vet. Had an Arts degree, AVA does not give vet scholarship to older graduates and the cost was prohibitive. "Be proactive and positive," I said. "Nobody can predict the future.
3. A Tampenis client of Dr Vanessa came to get some medicine and cream for his dog treated successfully for skin disease in Nov 2011. He wanted the tablets and the cream. When I advised that we don't sell tablets, he was furious as he could "buy from other vet clinics." So, he left in his taxi.
4. Dr Vanessa's 3 clients came in a bunch. So it is barking dogs. As it is a personalised service, her clients must wait. We have other vets but they want her.
5. You treated my Schnauzer with bloodied ears and pus flung onto Mr Saw last time," the lady selling rabbit health products said to me. "So I come back as the ears are giving me problems again." That was 3 days ago. I warded the 12-year old dog for ear irrigation and dental work. This morning I checked the oily ears. Much better. Took some pic
Arrived at 8.30 am. Bright sunshine Sunday.
1. Poodle spay came in at 10 am. I told the owners that they could pick up the dog at 12 noon.
I prepared D+K, for this 3.5 kg dog.
D+K at 50% IV sufficient to intubate when done at the 4th minute after injection. Dr Daniel to spay.
2. Lady intern from stat board wanted to do internship as she wanted to become a vet. Had an Arts degree, AVA does not give vet scholarship to older graduates and the cost was prohibitive. "Be proactive and positive," I said. "Nobody can predict the future.
3. A Tampenis client of Dr Vanessa came to get some medicine and cream for his dog treated successfully for skin disease in Nov 2011. He wanted the tablets and the cream. When I advised that we don't sell tablets, he was furious as he could "buy from other vet clinics." So, he left in his taxi.
4. Dr Vanessa's 3 clients came in a bunch. So it is barking dogs. As it is a personalised service, her clients must wait. We have other vets but they want her.
5. You treated my Schnauzer with bloodied ears and pus flung onto Mr Saw last time," the lady selling rabbit health products said to me. "So I come back as the ears are giving me problems again." That was 3 days ago. I warded the 12-year old dog for ear irrigation and dental work. This morning I checked the oily ears. Much better. Took some pic
Friday, July 27, 2012
1813. Two vets not punctual.
The lab with epulis waited for Dr Daniel and another poodle owner waited for Dr Vanessa as they did not turn up early. That is not a good practice to come late.
1812. Epulis - Vet 1 advised no need surgery, not malignant
| Friday, July 27, 2012 Today, I left home at 7.19 am, missed the feeder bus and walked to the Yio Chu Kang subway as the next bus will be 9 min. A breezy bright morning with sunshine and blue skies. I reached Toa Payoh subway at 7.50 am and walked to Toa Payoh Vets reaching at 8.41 am. A slow walk for exercise. Quite breezy but still sweating at the end. A father and son came with a Labrador, Male, 12 years, bleeding from a large gum tumour. He had consulted "3 vets" but they did not advise surgical excision. According to Vet 1's medical report- biopsy of gingival mass which was a fibromatous epulis of periodontal origin. According to the owner, Vet 1 did not advise surgical excision as it was "generally benign". Neither did another 2 vets from the same practice. The lump grew and grew and started to bleed at times. He was bleeding spots of blood outside the surgery at 9.15 am when the owners came. I asked them to wait as Dr Daniel was not here yet. More bleeding. I decided to take over the surgical case as this is an old dog. Should be 14 years as he was stated 12 years in 2009 in Vet 1's record. Blood test by Dr Daniel showed normal results except slightly below the low range of RBC and PCV Domitor + Ketamine at 25% instead of 50% as the dog is really old. Electro-excision is OK at this dosage if not delayed. Needed some isoflurane gas. Also for dental scaling. Strong teeth. Implemented new anaesthetic recording system. Today I used my first Anaesthesia & surgery record No. 151. 27.7.12, Lab Retriever, Male, 12 years, 36.3 kg, 39.1C A *Inj Domitor (0.4 ml) +K (0.5ml) IV at 25% calculated dose 10.06 am B Isoflurane gas first given 10.18 am for dental scaling. Good teeth. C Isoflurane gas stopped 10.51 am. End of dental scaling D Electro-excision of epulis started 10.10 am E End of excision 10.18 am Antisedan IV to reverse domitor 11.02 am. Dog wakes up in 1 minute In 2009, Vet 1 said half the jaw had to be cut off, so the owner did not want surgery. Another of the 3 vets said that since the epulis was not cancerous as checked by biopsy, there was no need to remove it. But this epulis grew to twice the size and blood dripped from this tumour whenever it was injured, soiling the floor. He did some internet surfing and consulted Toa Payoh Vets' Dr Daniel as 2nd opinion. As the dog is old, I took over the case as I had more experience and could perform a shorter surgery, minimising risks of death on the op table. The likely reason that the other 3 vets didn't recommend surgery would be that the dog is old and they don't want to bear the high risk of anaesthetic death ruining their reputation. I took 8 minutes to excise the epulis 2x2x1.5 cm under Domitor and Ketamine at 25%. A vet must be quick and know what to do during surgery, as the analgesia would wear off 8 minutes after injection. The dog started to move around the 8th minute. The incisor tooth might be entombed but I did not think of slicing the epulis to check and gave it to the owner. The owner threw it away. Isoflurane and intubation were done for dental scaling. Solid teeth in general except for the tartar and plaque. The dog was given carrots and apples and had good food.
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Wednesday, July 25, 2012
1811. Blood test of closed pyometra CKC 4 years
The size of the womb is bigger than the German sausages sold in the gourmet supermarket as you can see from the images. Packed bursting with pus. I showed dog with PUO, JJ's owner, the difference in blood test of a bacterial infected dog.
"The blood test showed low RBC, HCT and Hb and normal MCHC.
Total WCC 127 (6-17). Neutrophils at 95% indicating a raging bacterial infection and a serious poor prognosis of death.
The platelets were low at 11 (normal 200-500) - likely to bleed internally to death.
The lab report said: "the blood cells show degenerative changes? age/transport. several abnormal seens seen. No platelet clumps."
On clinical grounds, this dog was having septicaemia and the owner must be informed early prior to surgery of the high probability of death on the op table. Failure to do so would be negligent of the vet. I phoned the owner to tell him. The dog was operated by dr Daniel and is OK now. She is young and so has a better chance of survival. No x-rays were wanted.
"The blood test showed low RBC, HCT and Hb and normal MCHC.
Total WCC 127 (6-17). Neutrophils at 95% indicating a raging bacterial infection and a serious poor prognosis of death.
The platelets were low at 11 (normal 200-500) - likely to bleed internally to death.
The lab report said: "the blood cells show degenerative changes? age/transport. several abnormal seens seen. No platelet clumps."
On clinical grounds, this dog was having septicaemia and the owner must be informed early prior to surgery of the high probability of death on the op table. Failure to do so would be negligent of the vet. I phoned the owner to tell him. The dog was operated by dr Daniel and is OK now. She is young and so has a better chance of survival. No x-rays were wanted.
1810. PUO - Pyrexia of Unknown Origin in a hiding Maltese
Today is Wednesday. On Sunday, the young couple from Bukit Panjang brought a 4-year-old male neutered Maltese to consult me. Late in the night, the dog suddenly went to a corner to hide. "He was restless and reluctant to walk," the young lady said. "He panted but could walk."
So the owner took him to an emergency clinic on that Saturday. Tramadol and meloxicam inj and SC drip were given.
Fever was present. She was told to monitor the breathing closely and keep JJ in a cool place and ensure access to water and to see her regular vet the next day. The owner was worried about tick fever as she had plucked out a fat mother tick 2 weeks ago from the dog. Also the dog is not on anti-tick spot on medication but never had tick problems.
The first blood test taken on Jul 21, 2012 at 8.54 pm showed high RBC, HCT and Hb and low MCHC. Other results were normal.
On Sunday morning, I saw the dog at 10 am. The dog still had fever at 40C. "The high RBC and Hb is a concern. I need another blood test to check," I asked for permission as the lady thought that the dog was dehydrated. Clients are much more sophisticated with the internet nowadays.
Other than fever, JJ had some pain on his back spinal area. He gave a soft "ha" when I pressed the spinal area between T7-13 and this effect could be reproduced as the owner could hear it too. "Did the vet check on this?" I asked. "Yes," she said. "She did it in a different way." No abdominal pain could be found but the dog was already given painkillers yesterday.
"There is some pain, now muffled by the use of Tramadol and meloxicalm painkiller injections given yesterday," I said. "Did the dog fall on his back?"
The dog could have tripped. For the pat 4 years, he hoped over the concrete bar to go inside the toilet for around 5x/day. Over 4 years, this would be over 6,000 hops and punishing to the spinal column. Pain --- panting --- leads to "fever".
2ND BLOOD TEST
July 22, 2012 10 am
The second blood test showed normal RBC, HCT and Hb and MCHC. "RBC, HCT and Hb" are on the higher side of the normal range," I explained. "MCHC was on the lower side of the normal range. " Other results were normal.
"The bad news is that the liver enzymes are high ALt 219( normal <59) and AST 196 (<81)," I said. "There could be hepatitis just starting and so the total WCC did not go up. However, the neutrophils are 77% as compared to 56% from the first vet. It is possible that there is a bacterial infection just starting. Since the first vet did not do this test, it would not be known if there was abnormal liver function."
So was this a case of heptititis causing fever? The owner consulted me on Tuesday as the dog was dragging his left hind feet but otherwise energetic and happy and eating. No fever but then he was on anti-fever medication. "The first vet used the hind legs to collect blood," I showed the lady the bruised black area around the hocks. Some vets like to collect blood from the back legs but usually no problem in walking."
Today, Wednesday, I phoned the owner at 5 pm. JJ was ok.
Advised toilet ramp and attention to paw licking. Wear booties? The owner didn't like the idea. I suggested a short-term use of anti-inflam and also trimming and washing the paws.
Conclusion. Cause of liver disorder and hepatitis? Hard to say. The dog was not vaccinated. He was walked daily outdoors by the mum and could have picked up an infection. He could have got infected in the liver from unhealthy dog treats. So, it is difficult to come to a conclusion. LD diet was given for 2 weeks for the liver and we have to wait and see.
So the owner took him to an emergency clinic on that Saturday. Tramadol and meloxicam inj and SC drip were given.
Fever was present. She was told to monitor the breathing closely and keep JJ in a cool place and ensure access to water and to see her regular vet the next day. The owner was worried about tick fever as she had plucked out a fat mother tick 2 weeks ago from the dog. Also the dog is not on anti-tick spot on medication but never had tick problems.
The first blood test taken on Jul 21, 2012 at 8.54 pm showed high RBC, HCT and Hb and low MCHC. Other results were normal.
On Sunday morning, I saw the dog at 10 am. The dog still had fever at 40C. "The high RBC and Hb is a concern. I need another blood test to check," I asked for permission as the lady thought that the dog was dehydrated. Clients are much more sophisticated with the internet nowadays.
Other than fever, JJ had some pain on his back spinal area. He gave a soft "ha" when I pressed the spinal area between T7-13 and this effect could be reproduced as the owner could hear it too. "Did the vet check on this?" I asked. "Yes," she said. "She did it in a different way." No abdominal pain could be found but the dog was already given painkillers yesterday.
"There is some pain, now muffled by the use of Tramadol and meloxicalm painkiller injections given yesterday," I said. "Did the dog fall on his back?"
The dog could have tripped. For the pat 4 years, he hoped over the concrete bar to go inside the toilet for around 5x/day. Over 4 years, this would be over 6,000 hops and punishing to the spinal column. Pain --- panting --- leads to "fever".
2ND BLOOD TEST
July 22, 2012 10 am
The second blood test showed normal RBC, HCT and Hb and MCHC. "RBC, HCT and Hb" are on the higher side of the normal range," I explained. "MCHC was on the lower side of the normal range. " Other results were normal.
"The bad news is that the liver enzymes are high ALt 219( normal <59) and AST 196 (<81)," I said. "There could be hepatitis just starting and so the total WCC did not go up. However, the neutrophils are 77% as compared to 56% from the first vet. It is possible that there is a bacterial infection just starting. Since the first vet did not do this test, it would not be known if there was abnormal liver function."
So was this a case of heptititis causing fever? The owner consulted me on Tuesday as the dog was dragging his left hind feet but otherwise energetic and happy and eating. No fever but then he was on anti-fever medication. "The first vet used the hind legs to collect blood," I showed the lady the bruised black area around the hocks. Some vets like to collect blood from the back legs but usually no problem in walking."
Today, Wednesday, I phoned the owner at 5 pm. JJ was ok.
Advised toilet ramp and attention to paw licking. Wear booties? The owner didn't like the idea. I suggested a short-term use of anti-inflam and also trimming and washing the paws.
Conclusion. Cause of liver disorder and hepatitis? Hard to say. The dog was not vaccinated. He was walked daily outdoors by the mum and could have picked up an infection. He could have got infected in the liver from unhealthy dog treats. So, it is difficult to come to a conclusion. LD diet was given for 2 weeks for the liver and we have to wait and see.
1809. Vets to write down follow-up tel calls to owners
Sometimes the husband gets the calls and don't communicate with the wife, as in the case of the CKC with closed pyometra. I phoned the husband a few times as his tel is on the case card. The dog was hospitalised 5 days. On the 4th day, the wife phoned the clinic and told me that nobody ever informed her about the health of her dog operated by Dr Daniel Sing. The dog was in good condition.. This was surprising as I had spoken to her husband who knew the seriousness of the case based on blood test with total WCC hitting the roof.
Another owner of a jack russell that vomited phoned and told me that Dr Vanessa had not informed him of the blood test result. But Dr Vanessa said she had. It was her word against the owners.
So, nowadays, all vets will write down date and time of informing the owner in the case file, to avoid misunderstanding. Such feedback is valuable to improve our services and that is why I do answer phone calls to know the ground level.
Complaints about long waiting time and not be seen at the appointed time are another issue that have to be resolved.
Another owner of a jack russell that vomited phoned and told me that Dr Vanessa had not informed him of the blood test result. But Dr Vanessa said she had. It was her word against the owners.
So, nowadays, all vets will write down date and time of informing the owner in the case file, to avoid misunderstanding. Such feedback is valuable to improve our services and that is why I do answer phone calls to know the ground level.
Complaints about long waiting time and not be seen at the appointed time are another issue that have to be resolved.
1809. Toa Payoh Vets Anaesthsia & Surgery Record
Today the printer came with the books. Each of the 4 vets here will be having his own book to record % of isoflurane gas used, time taken, sutures, tranquilisers used. This record will be used in cases of complaints/litigation and each vet will be accountable for his recording.
These records will serve as a check and audit for 'controlled drug' usage and shown to the authorities when needed. Such records are necessary to ensure good management in vet surgery and anaesthesia and it is the responsibility of the licensee vet. For the vets, it means meticulous recording is required and serves as a good defence in cases of litigation/investigation.
These records will serve as a check and audit for 'controlled drug' usage and shown to the authorities when needed. Such records are necessary to ensure good management in vet surgery and anaesthesia and it is the responsibility of the licensee vet. For the vets, it means meticulous recording is required and serves as a good defence in cases of litigation/investigation.
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